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Complications in Surgical Management of Adolescent Blount Disease

Introduction Adolescent Blount disease is a developmental disorder of the posteromedial proximal tibial physis. Asymmetric growth results in a classic deformity characterized by tibia vara, internal tibial torsion, and procurvatum. The severity of alignment falls along a spectrum, and appropriate treatment is based on the characteristics of a patient’s particular deformity. Careful analysis of all three dimensions is key to deciding which treatment to prescribe. Achieving…

Complications in Treatment of Slipped Capital Femoral Epiphysis

Introduction Slipped capital femoral epiphysis (SCFE) is the most prevalent hip disorder presenting during adolescence, occurring at a rate of 10 per 100,000 children. It is characterized by anterior translation and external rotation of the proximal femoral metaphysis relative to the epiphysis, resulting in an anterior metaphyseal prominence and obligate external rotation of the hip with flexion ( Fig. 31.1 ). SCFE typically occurs during rapid…

Complications of Surgical Treatment of Perthes Disease

Introduction Legg-Calve-Perthes disease (LCPD) is a self-limited childhood hip condition that can produce permanent deformity of the femoral head. Its treatment remains a challenge, given the wide variation in stage and disease severity. Early containment surgery has become increasingly popular in LCPD, especially for children who present at a later age. Surgical techniques utilized range from minimally invasive, including tenotomies and casting, to more extensive, including…

Proximal Femoral Osteotomies

Introduction The proximal femoral osteotomy (PFO) has been a part of pediatric orthopedic surgical techniques since at least the 1960s, when Dr. Southwick described a peritrochanteric osteotomy in 1963. Numerous variations of the PFO have been described since that time, all with the intent to optimize coxofemoral hip anatomy, maximize patient function, and delay long-term degenerative arthrosis. Great diversity exists when it comes to patient pathology,…

Complications of the Periacetabular Osteotomy for Treatment of Adolescent Hip Dysplasia

Introduction Acetabular dysplasia is a condition defined by insufficient acetabular coverage of the femoral head. In addition to pain and variable hip instability, the dysplastic morphology is associated with increased loading of the anterolateral acetabular rim, chondrolabral injury, and early onset and accelerated progression of secondary osteoarthritis – often resulting in the need for total hip arthroplasty by an early age. In skeletally mature adolescents and…

Complications in Open Treatment of Developmental Dysplasia of the Hip

Introduction Developmental dysplasia of the hip (DDH) is a common pediatric condition that encompasses a spectrum of hip pathology ranging from increased hip laxity to hip dislocation. If diagnosed early, most of these infants can be successfully managed with brace treatment. However, if brace treatment is unsuccessful or the child is not diagnosed by the time that they are ambulatory, children will often require open surgical…

Complications of Closed Reduction of Developmental Dysplasia of the Hip

Preoperative Workup History (Brace Management/Preoperative Complications) When evaluating a patient with developmental dysplasia of the hip (DDH), there is a standardized treatment protocol that is followed prior to pursuing closed reduction of the hip. It is important to take a detailed history, as not all patients should undergo bracing or closed reduction. This is particularly true for those with stiff, teratologic dislocations such as in arthrogryposis…

Complications Associated With Management of Septic Arthritis of the Hip in Pediatric Patients

Background Septic arthritis of the hip can be a devastating process to the pediatric patient, and failure to effectively treat may result in severe patient morbidity and create late sequelae to hip function. Septic arthritis of the hip most commonly affects younger children between 2 and 6 years of age, though it may affect neonates and young adults alike. The incidence in the United States is…

Pediatric Complications: Growing Rod Treatment

Introduction Early-onset scoliosis (EOS) is defined as scoliosis with onset earlier than age 10 years and is classified based on age, etiology, major curve, degree of kyphosis, and curve progression. The characteristics of the deformity guide treatment options available. Stabilizing the spine and minimizing progression of spine and chest deformity must be balanced with the requirement of continued thoracic growth needed for pulmonary development. There are…

Complications in Kyphosis in Children

Introduction Kyphosis is defined as an abnormal forward spinal curvature in children when looking at the sagittal plane. It can be separated into multiple different types, including postural, Scheuermann, congenital, infectious, traumatic, neuromuscular, degenerative, and postoperative kyphosis after laminectomy or spinal fusion, such as proximal junctional kyphosis (PJK) and distal junctional kyphosis (DJK). Each type requires specific management and special concerns when treating, as rates of…

Congenital Spine Deformities

Introduction Treating congenital spine deformities is notoriously challenging, largely because the range of anomalies is so broad and heterogeneous that there is no accepted algorithm for treatment; each patient’s care must be planned case-by-case. Additionally, the timeline of treatment frequently ranges from infancy to skeletal maturity, often with numerous surgeries along the way. Spinal deformities include several categories of disease, such as congenital scoliosis, congenital kyphosis,…

Complications in the Treatment of Neuromuscular Spine

Introduction The treatment of pediatric patients with neuromuscular scoliosis is challenging and requires constant vigilance. These patients are more medically complex and have higher complication rates than their idiopathic counterparts. This chapter will focus on preoperative, intraoperative, and postoperative complications, as well as strategies for the prevention and treatment of these complications. Surgical site infection (SSI) is one of the most significant concerns in this population…

Complications in the Treatment of Adolescent Idiopathic Scoliosis

Introduction Adolescent idiopathic scoliosis (AIS) is defined as a three-dimensional spinal deviation greater than 10 degrees occurring after the age of 10 years and before the musculoskeletal system has fully matured, with larger curves usually affecting girls over boys in a 10:1 ratio. The reported prevalence of AIS varies widely, but it averages between 2% and 3% in children under the age of 16 years, and…

Cubitus Varus/Valgus Correction

Introduction Distal humeral osteotomies are performed to correct cubitus varus or valgus malalignment. Cubitus varus typically results from a malunion of a supracondylar fracture, and cubitus valgus typically results from a nonunion of a lateral condyle fracture. Cubitus varus malunion occurs following treatment of a displaced supracondylar fractures historically in about 4% to 57% of cases depending on the treatment method utilized. The varus is caused…

Complications in Surgery of the Thumb

Introduction The thumb is essential to the function of the human hand, particularly for large object grasp and fine pinch There is a wide spectrum of congenital and acquired anomalies that may affect thumb development. The goal of pediatric thumb surgery is to restore or recreate the function of the thumb. Common pediatric thumb surgical procedures include pediatric trigger thumb release, hypoplastic thumb reconstruction, pollicization, and…

Syndactyly

Introduction Syndactyly is defined as a narrowed or nondifferentiated web space between adjacent fingers. This diagnosis is the most common abnormality of the newborn hand and is typically classified into complete (to fingertip) or incomplete; and simple (isolated soft tissue involvement), complex (with bone or fingernail union), or complicated (more than distal bony fusion) ( Fig. 17.1 ). Syndactyly is often addressed surgically, with the primary…

Brachial Plexus Reconstruction

Introduction Brachial plexus birth injuries (BPBIs) occur in approximately 0.4 to 4.6 per 1000 live births. Approximately one-third of these cases have lifelong impairments. Brachial plexus reconstruction is indicated when inadequate spontaneous nerve recovery occurs. The timing of surgery depends on the severity of the injury. For isolated upper trunk injuries, surgery is typically recommended between 6 and 9 months of age. However, for global plexus…

Foot Fractures

Introduction Although foot fractures account for approximately 5% to 8% of fractures in children, there is a scarcity of literature discussing complications of these injuries and complications arising from foot fracture treatment. Surgeons who treat foot injuries in children should be aware of certain injuries that are more inherently prone to complications, such as certain intraarticular hallux phalangeal fractures, distal phalangeal physeal fractures that extend through…

Ankle Fractures

Introduction Pediatric ankle fractures are very common injuries, accounting for approximately 5% of all pediatric fractures and up to 15% of physeal injuries. The distal tibial physis is among the most commonly injured growth plate, accounting for 10% to 20% of all physeal injuries. Although the majority heal without difficulty, complications may occur and can have devastating consequences. These complications include many of the same as…

Complications in Tibial Shaft Fractures

Introduction Accounting for 15% of long-bone fractures in the pediatric population, tibial shaft fractures are one of the most common injuries treated by orthopedic surgeons. The treatment of such a common fracture can vary from nonoperative to surgical management depending upon several factors: fracture pattern, alignment, mechanism, associated injuries, and skeletal maturity of the patient. In terms of nonoperative management, the most common treatment involves long…