Pediatric Orthopedics

Pediatric orthopedics is a medical specialty dedicated to diagnosing and treating muscle, bone, and joint conditions and injuries in children. Pediatric orthopedic specialists at Corewell Health Children’s treat many disorders of the musculoskeletal system.

Orthopedic specialists offer a variety of treatments, ranging from physical therapy and medication to pediatric orthopedic surgery.

Some of the more common orthopedic conditions they treat are:

Overuse injuries in children occur when children engage in repetitive motion, often during sports activities, and don’t have enough time to heal between activities. Because children’s bodies are growing and changing, they are more susceptible to the effects of overdoing it. Overuse injuries can get in the way of normal growth and can have long-term health consequences. If your child regularly complains of pain after sports activities, make sure he or she rests between days of sports, and bring your child to the doctor if pain persists.

Pain is the most common symptom of overuse injuries. Other symptoms include:

• Discomfort
• Swelling
• Differences in how your child plays (alters form or technique during play)
• Decreased desire to practice

Some common overuse injuries are:

• Tendonitis
• Plantar fasciitis
• Osgood-Schlatter disease
• Sever’s disease
• Jumper’s knee
• Throwing injuries to the shoulder or elbow
• Stress fractures

Orthopedic congenital defects and deformities include several types of conditions that develop during gestation. These conditions can affect a child’s bones, muscles, tendons, or ligaments. Some of the congenital conditions Corewell Health Children’s diagnoses and treats are:

• Clubfoot
• Developmental dysplasia of the hip (DDH)
• Spine deformities, including scoliosis and kyphosis
• Muscular dystrophy
• Defects of the arms or legs
• Bone infections
• Osteogenesis imperfecta (also known as brittle bone disease)
• Leg-length issues

Signs and symptoms of orthopedic congenital defects include:

• Twisting, bowing, or curvature of the spine
• Visible problems with the limbs
• Fragile bones that break easily
• Muscle weakness
• Difficulty walking
• Limited movement or difficult movement

Treatment for congenital defects might include:

• Braces, casts, or splints to help align bones or joints
• Surgery to correct abnormalities
• Physical therapy to increase range of motion and improve strength
• Occupational therapy to help with mechanical life skills, like eating, dressing, or walking

Bacteria and fungi can infect bones and joints in children, which can cause inflammation and pain. These infections, which include osteomyelitis and septic arthritis, are considered deep infections because they occur deep within the body, usually in bones and joints. Infections of the muscles can also occur.

Antibiotics are usually effective at clearing these infections if they are caught early enough. However, some children need surgery to clean out the infection. In children, bone and joint infections tend to occur in the arms and legs.

Symptoms of these infections may include:

• Fever
• Pain
• Swelling, warmth, or redness near the infection site
• Limited movement of the affected limb

Infants who have bone or joint infections may be lethargic or irritable. They may also have decreased appetite, refuse to eat, or vomit if they do eat.

These infections may occur after an injury, so the symptoms might be written off as part of the healing process. If your child has any of the above symptoms, bring him or her to the doctor right away. If any symptoms don’t improve quickly at home, call the doctor. The longer you wait to get treatment, the more difficult the infection can be to treat, and the infection can lead to long-term problems.

Your child’s doctor will look for signs of infection by doing a physical examination and asking questions about signs and symptoms. An official diagnosis may require tests, including bone scans, needle aspiration, blood tests, tissue cultures, x-ray, MRI, or ultrasound.

Gait is a medical term to describe the way someone walks. Many children have an abnormal gait for the first few years, and some children have a walking delay. For many children, this will improve on its own without any intervention. However, some children need treatment to correct an abnormal gait or walking delay.

There are several types of gait abnormalities, including intoeing (feet pointing inward), outtoeing (feet pointing outward), toe walking, and limping.

In-toeing and out-toeing are the most common gait abnormalities. There are several causes, including:

• Tibial torsion (turning of the lower leg bone either inward or outward), which normally improves by age 4. Sometimes doctors may recommend a brace at night for children between 18 and 30 months, but surgery is usually not done until a child is at least 8 years old and still experiencing the gait abnormality.
• Femoral torsion (turning of the upper leg bone either inward or outward), which tends to be most obvious between 5 and 6 years of age, can improve without treatment. Most doctors recommend delaying surgery until a child is at least 9 and has a severe gait abnormality that causes significant tripping or an obvious gait problem.
• Bowlegs or knock-knees are common, but they usually straighten out as children grow.
• Flat feet are normal in children under age 5 because foot arches don’t develop until after that age. Flat feet can cause gait abnormalities, but this condition won’t be treated in children under 5.
• Metatarsus adductus is a birth defect that is characterized by feet that are bent inward from the middle of the foot to the toes. This condition tends to improve on its own, so babies aren’t treated until they are at least several months old. Treatment includes exercises and casts or corrective shoes. Pediatric orthopedic doctors usually have success treating babies between the ages of 6 and 9 months.

Bone tumors can be cancerous or non-cancerous. At Corewell Health Children’s, we diagnose and treat all types of bone tumors and bone cysts. Some of the types of tumors we treat are:

• Osteoid osteoma
• Osteoblastoma
• Osteochondroma
• Chondroblastoma
• Simple bone cysts (unicameral)
• Aneurysmal bone cyst (ABC)
• Osteosarcoma
• Ewing’s sarcoma

Non-cancerous bone tumors are much more common than cancerous bone tumors, and their treatments vary widely depending on the type of tumor, whether it has spread beyond the primary site. Cancer treatments usually include some combination of chemotherapy, radiation therapy, and surgery. Non-cancerous bone tumor treatment ranges from watchful waiting and observing the tumor for changes to surgery to remove the tumor.

Orthopedics is the branch of medicine dedicated to diagnosing and treating conditions of the musculoskeletal system – the muscles, bones, joints, and connective tissue throughout the body. A pediatric orthopedic surgeon is a doctor specially trained to treat orthopedic conditions in children who are still developing. Pediatric orthopedic surgeons treat children from infancy through the teen years.

Children who have complex problems are often treated by multidisciplinary pediatric teams at children’s hospitals, such as Corewell Health Children’s.

Because children are growing and their bodies are developing and changing, they have different needs than adults when it comes to orthopedic surgery. Most adults who have surgery are treating injuries or degenerative joint conditions. Children also have orthopedic surgery to treat injuries, like broken bones or ruptured tendons, but many children who see orthopedic surgeons have congenital deformities that require specialized attention. With adults, most orthopedic surgeries are straightforward, while childhood orthopedic surgeries are often more complex.

Pediatric orthopedic surgeons must consider every child’s unique situation and how much growing that child has left to do before deciding upon the right treatment.

The pediatric orthopedic specialists at Corewell Health can help your child with a wide variety of musculoskeletal conditions – from sports-related injuries to complex congenital conditions. We treat the muscles, bones, and joints all over the body, including hips, knees, legs, feet, back, spine, neck, wrists, hands, fingers, and more.

Whether your child has a broken arm or a severe congenital defect, or developmental delay, we can help. Our multidisciplinary team works together to offer both medical treatment and pediatric orthopedic surgery for orthopedic conditions.