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Why PediOrtoS?

PediOrtoS (Pediatric Orthopedic Surgery) is a website designed for everyone in need of a pediatric orthopedic surgeon. In today’s age, where information is more accessible than ever, and a simple click can lead to numerous answers, PediOrtoS offers expert opinion, authentic and verified information. The content is envisioned as a supplement to a doctor’s visit, not a replacement.

It is known that knowledge is all around us, easily accessible. However, more awareness and knowledge lead to new questions. The same goes for health, especially children’s health. All parents, regardless of their professions, want to have more information to do everything in their power to improve their child’s well-being.

PediOrtoS is a website that will try to provide at least a part of the answers or stimulate reflections, and in the best case, completely clarify doubts in the field of pediatric orthopedics. Often, during a doctor’s visit, parents or caregivers may not have time to ask everything they want, or questions may arise later when the impressions from the examination settle. PediOrtoS serves to make your child’s next examination as pleasant as possible.

What is orthopedics?

Orthopedics (from the Greek words “orthos” – straight or upright, and “paidion” – child) is a branch of medicine that deals with the study, prevention, and treatment of diseases and injuries of the musculoskeletal system. It was first mentioned in 1741 when the French physician Nicolas Andry associated orthopedics with the art of preventing and correcting body deformities in children. Therefore, orthopedics, in addition to having “child” in its name, began its development as a discipline specifically focusing on pediatric orthopedics. Moreover, the symbol of orthopedics introduced at that time, a young tree that straightens as it grows by being tied to a straight pole, has persisted to the present day. However, orthopedics today is primarily a surgical discipline, yet the importance of preventive and non-operative treatment is reflected through pediatric orthopedics.

Tree of Andry, bent tree braced to a stake to make it grow upward and straight, has become the traditional symbol of orthopedics for hundreds of years.

Picture. The first illustration of the symbol of orthopedics, a young curved growing tree tied to a straight pole. Original image from the book: Nicolas Andry, “L’Orthopédie ou L’art de Prévenir et de Corriger dans les Enfants, les Difforités du Corps, 1741.

What do pediatric orthopedists do?

Pediatric orthopedics is a subspecialty of orthopedics that focuses on the musculoskeletal system (bones, joints, and muscles) of growing children, from infancy to adolescence and adulthood. Pediatric orthopedists often work in teams with other specialists, closely collaborating with pediatricians, school physicians, physiatrists, and rheumatologists. As children are constantly growing, their musculoskeletal problems differ from those of adults. It’s important to note that children are not just small adults; their bodies respond differently to deformities, injuries, or infections. Additionally, children are psychologically, mentally, and emotionally different from adults. They may not always express their discomfort, answer questions, or be patient and cooperative during examinations. Therefore, examinations need to be adapted to make them as comfortable as possible for the child.

Pediatric orthopedists prevent, recognize, and treat a wide range of musculoskeletal problems in children, including:

  • Limb and spine deformities observed at birth or later in life (clubfoot, flatfoot, scoliosis, torticollis, congenital hip dysplasia, limb length inequality).
  • Gait abnormalities (limping).
  • Tendon insertion pain (tendinitis).
  • Major joint injuries (meniscus tears, ankle sprains).
  • Ligament tears (anterior cruciate ligament, ankle ligaments).
  • Bone fractures or consequences of poorly healed fractures.
  • Joint instability (shoulder dislocation, patellar dislocation).
  • Bone, muscle, and joint infections (osteomyelitis, septic arthritis).
  • Other joint inflammations (transient synovitis, juvenile arthritis).
  • Tumors of the musculoskeletal system.
  • Cerebral palsy.
  • Bone dysplasias (rickets, achondroplasia, osteogenesis imperfecta).
  • Syndromic diseases (Down syndrome, Marfan syndrome).
  • Muscular dystrophies.
  • Spina bifida.

What is a pediatric orthopedic examination like?

Working in a comfortable, child-friendly environment with colorful decorations or items of interest to children, possibly including a few toys, is always an advantage. Pediatric orthopedists are trained to examine children in a way that helps them relax, turning the examination into something resembling play. However, it’s crucial to know how to handle the concerns and stress that may arise in families when a child has a health problem. Often, what is considered a problem in a child may just be a variation in growth that will resolve on its own over time. For these reasons, pediatric physicians, in addition to possessing medical knowledge and skills, must be excellent communicators to effectively convey information to worried parents.

A pediatric orthopedic examination always begins with a discussion about the reason for the visit, the child’s symptoms, the duration of the complaints, and any previous injuries. Questions should be directed toward the child as much as possible given their age and health status, with parents being involved in the responses. After the discussion, the clinical examination needs to be adapted to the child’s symptoms and age, sometimes requiring the physician to be creative to encourage the child to perform the required movements. For a more comfortable experience, it’s sometimes good to let the child sit on a parent’s lap during the examination. During the examination, pediatric orthopedists often utilize imaging methods such as ultrasound (US), X-rays (radiography), computed tomography (CT), or magnetic resonance imaging (MRI). Therefore, it’s necessary to bring any previous images that may exist. The pediatric orthopedic examination is like assembling a puzzle. Conversation, clinical examination, and imaging methods are pieces of a puzzle that need to be put together in a logical way, making each part meaningful.

What happens after a pediatric orthopedic examination?

Fortunately, about 70% of pediatric orthopedic examinations end with a discussion about how the child’s condition is not a disease but rather a variation in growth, it is harmless, and it will not affect their future life. Around 20% of children after the examination may require conservative treatment (physical therapy, casting, or wearing orthoses). In these cases, parents and older children need to be informed about the condition, the nature of the disease, and what the aim of conservative treatment is. In the smallest number of cases, about 10% of children after a pediatric orthopedic examination may require surgical treatment. In these cases, it is crucial to thoroughly explain everything to the parents, and sometimes it’s helpful to sketch the surgery on paper so that they fully understand what their child will go through in the coming period. Although it’s never pleasant to hear that a child needs surgery, it’s important to keep in mind that it can make a lifelong difference for the child.

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