Pedriatic Orthopedics at OrthoCenter in Munich
Paediatric orthopaedics, a specialist area of orthopaedics, deals with the musculoskeletal system and its functioning interaction on the growing organism. A differentiation is made between congenital and acquired diseases. Paediatric orthopaedics covers the entire period from birth to 18 years of age. The major difference to adult orthopaedics is that the growth of a child has to be consistently planned for in the strategy for treatment. That means that we plan the right therapy at the right point in time individually for each patient, and must explain the reasons for the respective procedure in detail to the parents and involve them in the process.
Professor Dr med. Utzschneider would be happy to conduct a comprehensive examination of your child to eliminate any paediatric orthopaedic diseases as quickly as possible. Make an appointment online with us at the OrthoCenter Professor Lill.
The causes of paediatric orthopaedic diseases are extremely diverse. They are often congenital or hereditary. Some diseases, for example deformities of the arms or legs, can sometimes be traced back to infectious, hypoxic, toxic, medicinal or hormonal factors, which have an effect on the embryo or the foetus in the womb.
The exact anamnesis and family history is the first building block on the path to diagnosis. This is because some diagnoses can more or less be made based on this information, for example a dislocated kneecap or acute slipped capital femoral epiphysis (a fracture through the growth plate). There is also a series of paediatric orthopaedic diseases that can run in families (e.g. club foot, hip dysplasia, hereditary sensorimotor neuropathy).
The next step is an in-depth physical examination, as system diseases often affect several joints or the entire musculoskeletal (e.g. muscular dystrophy, skeletal dysplasia, arthrogryposis multiplex congenita). Because the legs or feet are affected in the majority of paediatric orthopaedic diseases, clinical gait analysis plays a prominent role. Certain diagnoses can be differentiated using the gait pattern (infantile cerebral palsy, hip disease vs. knee disease during growth).
A high percentage of the orthopaedic diseases of the growing skeleton can be reliably determined by an experienced paediatric orthopaedist during a clinical examination (congenital or acquired foot deformities, congenital or acquired torticollis). In this instance, it is important that an indicative neurological examination is performed on the patient to be able to differentiate neurological causes from orthopaedic problems (neuromuscular diseases, spina bifida), for example with a dropped arch, clubfoot or high arch.
Ultrasound plays an important role in the examination of infant’s hips (infant sonography) for diagnosing hip dysplasia and dislocation of the hip. However, ultrasound is also used to diagnose joint effusion in the case of acquired hip diseases (e.g. transient synovitis, Legg-Calve-Perthes disease, slipped capital femoral epiphysis) or acquired knee diseases (e.g. patella luxation, osteochondritis dissecans).
As well as this, the conventional X-ray is important for diagnosis (e.g. coxa valga vs. hip dysplasia), but also for mapping the progression of the disease (e.g. in the case of hip and spine diseases during growth such as coxa vara, scoliosis or Scheuermann’s disease). In some cases, special images are necessary, such as axial leg images in the case of axial deviations (genu varum or genu valgum) and differences in leg length.
While computed tomography (CT) is only seldom used in paediatric orthopaedics, magnetic resonance imaging (MRI) completes the imaging diagnostics in a useful way, and is ideally suited for identifying, for example, spondylolysis on the lumbar spine, dysplasia of the knee or damaged cartilage in the knee.
Based on a detailed diagnosis, we can differentiate between harmless form changes and serious diseases of the musculoskeletal system during growth and develop an individual treatment approach for the little patients.
Pediatric Orthopedics: Treatment – conservative
As the majority of paediatric orthopaedic diseases can be treated without operation, our individual therapy concept focuses initially on conservative therapy procedures.
The basis for this in many cases is an individually coordinated physiotherapy programme, which is supplemented in certain diagnoses with a trunk orthosis (e.g. in the case of spondylolysis) or a corset (e.g. in the case of scoliosis). Depending on the disease, therapy may include a reduction in school and recreational sport right through to no sporting activities at all (e.g. in the case of Perthes disease). Consistent exercises and muscle build-up (e.g. to remedy weak posture) act in many cases as a reasonable preventative measure against serious orthopaedic diseases in childhood and adolescence.
In a number of congenital or acquired foot deformities such as acquired flat feet or bunions in the growing years, inlays are needed, which are always customised individually to the problems in the growing foot. In the case of more complex diseases such as congenital clubfoot or neuromuscular diseases, night splints and/or an orthosis are often required during the day .
A hip spica cast is a special form of orthosis for the treatment of hip dysplasia in infants as well as hip luxation; the majority of infants’ hips mature completely physiologically within a few weeks and are healed.
Pediatric Orthopedics: Treatment – operative
Unfortunately, not all paediatric orthopaedic diseases can be successfully treated without an operation, with the result that an operation – generally minor – is unavoidable as early as in infancy for some congenital diseases.
In the case of severe hip diseases during growth, such as (remaining) hip dysplasia, coxa vara or Perthes disease, so-called corrective operations are often necessary in the area of the femoral bone or the pelvis. In the case of slipped capital femoral epiphysis, an urgent operation (emergency) has to be performed, as otherwise the hip joint can be severely damaged in the long term.
Some knee diseases during growth, such as cartilage damage or patella luxation require an arthroscopy of the joint with subsequent arthroscopic or minimal invasive therapy.
Foot deformities such as the painful acquired flat feet or tarsal coalition are corrected operatively, as a conservative therapy procedure is not expedient. A number of operations can be conducted as minimally invasive procedures. These include delaying growth in the case of axial deviations and differences in leg lengths. This is easy to regulate and well tolerated by our little patients. We always adapt every procedure individually to the patient, their age and their disease and plan each operation carefully at the most suitable time.