Pediatric Orthopedics

Sudden or unexpected injuries and trauma — like falls, sports injuries, or accidents — that need timely or emergency care to support proper healing. Examples include:

Bone fractures/breaks

An out-of-place bone that can be closed (skin intact) and nondisplaced (cracked) or open (broken skin) and displaced (shattered). Often caused by falls, sudden trauma, or repetitive stress.

Cartilage injuries

Tears and other injuries to cartilage, a smooth and flexible connective tissue that supports and cushions the bones in a joint. Cartilage injuries are especially common in the knee, but can occur in other joints as well.

Ligament injuries (sprains and tears)

These injuries involve stretching or tearing of ligaments, which are bands of tissue that connect bones to other bones. Common examples include ankle sprains and injuries to the anterior, medial, lateral, or posterior cruciate ligaments (ACL, MCL, LCL, or PCL) of the knee.

Meniscus injuries

Tearing or other damage to the knee’s meniscus, which is a flat piece of cartilage that cushions the space between the thigh bone and shin bone. Symptoms of a torn meniscus include pain, swelling, and stiffness in the knee.

Patella (kneecap) dislocation

The kneecap pops out of the groove formed by the ends of the thigh bone and shin bone, where it is normally held in place by tendons and ligaments. This often causes immediate, intense pain and deformity.

Rapid or abnormal growth of bone tissues can result in cysts or tumors that may need attention. Most are non-cancerous, but they can still be painful or restrict motion. Examples include:

Aneurysmal bone cyst (ABC)

Blood-filled tumor in the long bones of the arms, legs, or spine. It typically occurs in children and young adults.

Chondroblastoma

Tumor made of cartilage that forms at the end of a long bone in a child who is still growing. Common locations include the humerus (upper arm bone) at the shoulder, the femur (thigh bone) at the hip or knee, and the tibia (shin bone) at the knee.

Enchondroma

A noncancerous (benign) bone tumor that forms in the cartilage inside a bone, most often in the hands and feet.

Osteoblastoma

Tumor that destroys healthy bone and creates a mass of osteoid tissue, which is weaker than mature bone. This can greatly increase the risk of fractures. It can occur in any bone, but is most commonly found in the spine.

Osteochondroma

Tumor made from bone and cartilage that appears on the surface of a bone, usually at the end of a long bone in a child or teen who is still growing.

Osteoid osteoma

A small tumor, usually less than one inch in diameter, made from soft bone tissue (osteoid). Unlike osteoblastoma (which is also formed from osteoid tissue), osteoid osteomas tend to be located in long bones and do not grow as large.

Osteomyelitis (bone infection)

An infection in one or more bones, often caused by bacteria, that can start in the bone or spread to a bone from the bloodstream.

Unicameral bone cyst (simple bone cyst)

Tumors that create fluid-filled pockets of space inside of a bone.

These include structural or functional problems with bones, muscles, or movement that are present at birth or apparent in early childhood, such as:

Brachial plexus injuries

Injuries to the bundle of nerves located where the shoulder and neck join together. Because these nerves are responsible for movement and sensation in the shoulder, arm, and hand, injuries can result in pain, tingling, numbness, and muscle weakness — up to paralysis in serious cases.

Clubfoot

One or both feet are turned excessively inward. This is not painful for your newborn, but early treatment is needed to correct the deformity before they begin standing and walking.

Congenital and developmental limb deformity

Conditions that affect how the legs or arms develop before birth or as a child grows. Examples include hemimelia, congenital pseudarthrosis, genu varum (bow legs, including Blount's disease), genu valgum (knock knee), and hemihypertrophy.

Flat foot and other foot deformities

These conditions involve the shape or structure of a child’s foot that can cause pain and discomfort and make it harder to stand, walk, or run. Some are present from birth, while others develop as a child grows.

Gait abnormalities

Abnormal walking patterns, such as limping, walking on tiptoes, or intoeing (walking with feet turned inward, commonly called “pigeon toes”). We also evaluate children with significant walking delays (such as no independent walking by 18 months of age).

Leg length differences

When one leg is noticeably longer than the other, it may lead to difficulty walking and playing. It can also make a child more susceptible to injuries and lower back pain throughout life.

Osteogenesis imperfecta (brittle bone disease)

Children with this condition have soft bones that are more prone to fracturing. They may experience other symptoms as well, including bone deformities and muscle weakness.

These conditions affect the appearance, positioning, structure, or function of a child’s hands and wrists. Many are already present at birth (congenital), but some can develop later in life. They include:

Polydactyly

Extra fingers or toes.

Syndactyly (webbed hands or feet)

Two or more fingers or toes are fused together.

Trigger finger and trigger thumb

A finger or thumb that tends to get stuck or locked into a bent position, usually due to a tight or swollen tendon. It may suddenly pop back into place when your child attempts to straighten it. Any finger can be affected, though the thumb (trigger thumb) is the most likely for children.

Wrist, finger, and other joint contractures

When one or more joints, including those in the wrist, fingers, knees, elbows, ankles, or other areas, become fixed in a bent position and are difficult or painful to straighten.

Structural or functional problems with the hip, which is a “ball and socket” joint where the head of the thighbone (ball) inserts into the socket of the hip bone. Examples include hip dysplasia, a condition where the ball isn’t fully covered by the socket and prone to dislocation, and femoroacetabular impingement, a condition where excess bone growth in either the ball or socket causes pain and stiffness in the joint. Other conditions include slipped capital femoral epiphysis (SCFE) and coxa vara.

These conditions impair voluntary muscle movement due to problems with muscle fibers or the nerves that control them, or the interaction between the two. This can cause progressive muscle weakness, muscle spasms, pain, tingling, numbness, or other symptoms in the affected areas. Many of these diseases cause orthopedic problems requiring braces or surgery. Examples include muscular dystrophy, spinal muscular dystrophy, cerebral palsy, and spina bifida.

These injuries develop gradually over time, when kids put repeated strain on muscles, bones, tendons, and other tissues. They are especially common in children and teens who play sports or are highly active. Examples include:

Osgood-Schlatter disease

Knee pain felt at the top of the shin bone, where it connects to the patellar tendon. It is caused by repetitive strain on the growth plate, an area of soft bone tissue responsible for growing new bone. Osgood-Schlatter disease is very common in active kids going through growth spurts in their early teens.

Patellar tendinitis (jumper’s knee)

Knee pain and tenderness caused by swelling in the patellar tendon, which connects the kneecap to the shin bone.

Plantar fasciitis

Pain at the bottom of the foot, where a band of tissue called the plantar fascia inserts into the heel bone. Symptoms are often worst when putting weight on the foot for the first time after sleeping or a long rest.

Sever’s disease (calcaneal apophysitis)

Pain at the back of the heel caused by strain on the growth plate from tight heel cords (Achilles tendons), which happens while kids are growing.

Stress fractures

Tiny, hairline cracks that form in bones, especially the weight-bearing bones of the legs and feet.

Tendonitis

Chronic inflammation and pain in a tendon, which is a band of tissue that connects muscles to bones.

Throwing injuries

Kids who play sports that require a lot of throwing can place excessive strain on their shoulders and elbows. Over time, chronic pain and tenderness can develop in and around those joints.

Abnormal shape, curve, or alignment in the spine. Specific conditions include all types of scoliosis (side-to-side curve), kyphosis (forward rounding of the upper back, including Scheuermann’s kyphosis), spondylolysis (stress fractures in the back), and spondylolisthesis (shifting of the vertebra on another). These conditions may cause visible changes in posture, uneven shoulders or hips, back pain, or difficulty with movement and balance.

Our team uses a variety of different techniques to treat broken bones. Procedures will be selected based on your child’s condition and needs.

Non-surgical treatments

Many pediatric fractures can be treated non-surgically by immobilizing the bone with a splint, brace, or cast. This is often the case when the pieces of broken bone have not become displaced (moved out of alignment). If the bone ends are displaced, it may still be possible for doctors to move them back into position without surgery (closed reduction).

Surgical treatment

Some broken bones require surgery in order to heal properly. This is more likely to be the case when fractures are displaced or bones have broken into more than two pieces. All fractures that break the skin (open fractures) will require surgery.

These treatments focus on supporting, stabilizing, or repairing joints (such as the knees, hips, and shoulders) to correct deformities, reduce pain, or help them heal from injury. They include:

Arthroscopic surgery and ligament reconstruction

Minimally invasive surgery on a joint, using only a small incision for tools and a small camera on a thin, flexible tube (arthroscope). It may be used for a variety of procedures, including repairing meniscus and ACL tears, relieving pressure on nerves, removing scar tissue or bone fragments from a joint, and more.

Hip reconstruction

Surgery to reposition, realign, and repair a hip joint with an inherited deformity, traumatic injury, or any other reason.

Joint injections and aspirations

Use of a needle to either inject medication or remove existing fluid (aspiration) from an injured joint.

Tendon and muscle surgery

Contracted or injured muscles may need surgery to restore their function. This can include the repairing, lengthening, or transferring of muscles and tendons.

These treatments correct misaligned bones and structural deformities predominantly in the lower limbs. They typically require one or more surgeries to cut or realign bone. However, in some cases (such as clubfoot correction in newborns), doctors may be able to gradually realign growing bones through stretching and casting. Procedures include:

Bone lengthening

Surgical treatments to lengthen bones, often to correct leg length discrepancies.

Clubfoot casting

Complete care for children with club foot, including the Ponseti method, a gentle casting treatment that gradually moves the foot into the correct position.

Foot deformity reconstruction

Correction for foot deformities such as clubfoot, flat feet, cavus foot (high arch), webbed toes, or extra toes.

Hand surgery and reconstruction

Advanced surgical options to treat hand, wrist and arm deformities or injuries.

Limb deformity correction

Strengthening or untwisting of bones in the arms or legs to allow them to function normally.

Single event multilevel surgery (SEMLS)

This surgical treatment for children with cerebral palsy helps correct several bone and muscle problems — such as with the hip, knee, and foot — at the same time.

These procedures can help children with a curved spine condition (such as scoliosis) or spine injuries. They include:

Bracing and casting

These therapies may help children stop scoliosis from getting worse, delaying or preventing the need for a future surgery. Bracing requires your child to wear a firm, vest-like plastic brace during periods of growth. Serial casting (using a series of casts, reapplied at regular intervals) instead of a brace may be recommended for younger children.

Growing rods

Surgical implants used to treat severe, early-onset scoliosis in children, correcting spinal curves while allowing the spine to continue growing.

Spinal fusion

Surgeons permanently connect two or more spinal vertebrae together. This may be performed for many reasons, including limiting abnormal or unstable motion or correcting deformities.

Spinal traction

This hospital-based therapy may be recommended before surgery for children with severe spinal deformities. A surgeon attaches a lightweight metal ring to your child’s head and connects it to a rope and pulley system that uses weight and gravity to gently stretch and straighten their spine. This may take a few weeks to a few months, until surgery can be performed.

Vertebral body tethering

This minimally invasive surgical technique may be used to correct scoliosis in children who are still growing. Using only small incisions, surgeons attach a flexible cord to one side of the spine using metal anchors. This restricts growth on that side of the spine, allowing it to gradually straighten out as your child grows.