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Disorders of the Foot

The author wishes to acknowledge the contribution of John A. Herring and B. Stephen Richards for their work in the previous edition version of this chapter. Introduction The human foot is a complex structure capable of supporting body weight, accelerating the body in running, changing position for uneven terrain, and even assuming prehensile function in a person missing upper extremities. , , , The major articulation…

Disorders of the Leg

The author wishes to acknowledge the contributions of Charles E. Johnston and Megan Young for their work in the previous edition version of this chapter. Disorders of the Knee Presenting in Infancy Disorders of the knee presenting in infancy include hyperextension and flexion deformities. With the exception of patellar dislocation, which may not be apparent at birth, these deformities are usually obvious in the newborn infant.…

Disorders of the Femur

Femoral Anteversion The clinical significance of femoral anteversion is controversial. The contribution of excessive anteversion to childhood intoeing is accepted, whereas the relationship, if any, between anteversion and osteoarthritis of the hip and knee in adulthood remains uncertain. Definition Femoral anteversion is defined by the angle of the femoral neck in relation to the femoral shaft in the coronal plane ( Fig. 17.1 ). The degree…

Congenital Coxa Vara

Congenital coxa vara is a developmental abnormality characterized by a primary cartilaginous defect in the femoral neck with an abnormal decrease in the femoral neck-shaft angle, shortening of the femoral neck, relative overgrowth of the greater trochanter, and shortening of the affected lower limb. Typically, the deformity either is not present at birth or is sufficiently subtle not to be recognized at that time. , Affected…

Slipped Capital Femoral Epiphysis

The author wishes to acknowledge the contribution of John A. Herring for his work in the previous edition version of this chapter. During a period of rapid growth in adolescence, weakening of the upper femoral physis and shearing stress from excessive body weight may cause the femoral capital epiphysis to displace from its normal position relative to the femoral neck. Although this disorder is termed slipped…

Developmental Dysplasia of the Hip

Definition Developmental dysplasia of the hip (DDH) is a spectrum of disorders of development of the hip that present in different forms at different ages. The common etiology is excessive laxity of the hip capsule with a failure to maintain the femoral head within the acetabulum. The syndrome in the newborn consists of instability of the hip such that the femoral head can be displaced partially…

Disorders of the Upper Extremity

The authors would like to acknowledge the contributions of Drs. Marybeth Ezaki and Peter Carter. Introduction Very few congenital anomalies of the upper limb can be restored to normal function and appearance. The goals of treatment are therefore to maximize functional potential, preserve sensation, and minimize scarring. The surgeon should offer support, first to the family and later to the child, to help them cope with…

Other Anatomic Disorders of the Spine

The authors wish to acknowledge the contribution of Charles E. Johnston and Brandon A. Ramo for their work in the previous edition version of this chapter. Spondylolisthesis Spondylolisthesis is defined as the forward slippage of one vertebra on its adjacent caudal segment and has been recognized since the late 18th century, when it was first described by obstetricians as a barrier to passage of the fetus…

Kyphosis

Posture Posture is the relationship of parts of the body to a vertical line passing through the center of gravity. In practice, the term posture is almost always used to describe spinal relationships usually in the sagittal plane, although certain nonpathologic conditions unrelated to the spine (e.g., flatfeet, tibial torsion) could be considered postural variations. Posture in the upright or erect position develops from the action…

Scoliosis

Definition The term scoliosis , first used by Galen (131–201 AD), is derived from the Greek word meaning “crooked.” In 1741, André devised the crooked spine as his symbol for orthopaedics. Today, scoliosis is defined as lateral deviation of the normal vertical line of the spine, which when measured on a radiograph, is greater than 10 degrees ( Fig. 9.1 ). Because the lateral curvature of…

Disorders of the Neck

The author wishes to acknowledge the contribution of Lawsen A.B. Copley for his work in the previous edition version of this chapter. Overview The pediatric cervical spine is subject to a broad variety of disorders that may produce deformity and affect function necessitating treatment. An understanding of the developmental anatomy, normal cervical and craniocervical relationships, and common manifestations of pathologic processes is essential to evaluate and…

Back Pain

The author wishes to acknowledge the contribution of Karl E. Rathjen for his work in the previous edition version of this chapter. Back pain in children and adolescents is not as common as in adults; however, the incidence continues to increase. More than 50% of children experience some back pain by 15 years of age, and up to 36% of school-age children experience episodes of low…

The Limping Child

The author wishes to acknowledge the contribution of John A. Herring and John G. Birch for their work in the previous edition version of this chapter. Limping is common in children and can represent a diagnostic challenge for the orthopaedist. , , , , A painful or painless limp may be caused by multiple conditions: from the benign (e.g., an unrecognized splinter in the foot) to…

Gait Analysis

Observing a child’s gait, whether in a sophisticated computerized laboratory or simply in the hallway of a clinic, is an integral part of the orthopaedic examination. A systematic approach to gait analysis—that is, looking at the trunk and each joint moving in all three planes (sagittal, coronal, and transverse)—can yield valuable information about the patient’s condition and help in establishing a treatment plan. For a child’s…

The Orthopaedic Examination: Clinical Application

The author wishes to acknowledge the contribution of John G. Birch for his work in the previous edition version of this chapter. It is important for orthopaedic surgeons to be familiar with the numerous musculoskeletal and neuromuscular examinations detailed in Chapter 3 . Over time the orthopaedist will most likely perform many of these examinations on different patients presenting with a variety of complaints. If the…

The Orthopaedic Examination: A Comprehensive Overview

The author wishes to acknowledge the contribution of John G. Birch for his work in the previous edition version of this chapter. This chapter covers many aspects of the general musculoskeletal and neuromuscular examination of the neonate, infant, child, and adolescent. Because proper function of the musculoskeletal system depends on proper functioning of the neurologic system, the boundary between orthopaedics and neurology is often blurred at…

The Orthopaedic History

The author wishes to acknowledge the contribution of John G. Birch for his work in the previous edition version of this chapter. The comprehensive pediatric orthopaedic history includes questions that are not normally asked as part of routine history taking in adult patients. A history of the mother’s pregnancy, the neonatal period, the child’s neurologic development, and the family history often have a much greater impact…

Long-Term Results of Total Hip Arthroplasty

Introduction Total hip arthroplasty (THA) is a proven successful operative procedure that has demonstrated relief of pain and enhanced function for over 4 decades. Long-term results vary based on method of fixation, quality of prosthetic materials, presence of modularity, and precision of the surgical technique. This chapter reviews the long-term results of THA and factors associated with success versus failure. The Acetabular Component A variety of…