FAQ Category: Child

Any type of surgery can have complications. Some complications are common to all surgeries that involve general anesthetics, such as respiratory (breathing) problems and infections. When a patient undergoes surgery for scoliosis, there are a few other complications that can occur.

If the surgery includes fusing the vertebrae (bones in the spine) and grafting, there is always a risk that the fusion or the graft don’t take as they should.

It’s best to speak with the surgeon about the different types of complications that may occur.

Perthes disease is also known as Legg-Calvé-Perthes disease. It is an idiopathic avascular necrosis of the proximal femoral epiphysis. Idiopathic means we don’t know yet what causes it. Certain ethnic groups seem to be at higher risk. There may be a link between delay in bone growth and this condition.

Avascular refers to a loss of blood supply to the head of the femur (thigh bone). This leads to necrosis or death of bone tissue. The epiphysis or growth plate is directly affected.

The disease can range from mild to severe. The round shape of the femoral head becomes flattened and misshapen. Pain and loss of motion can affect how the child walks and runs. In severe cases, the femoral head can collapse.

Osteoarthritis can develop early in the adult years for those children who had moderate to severe Perthes disease. Treatment is aimed at preventing all of these complications.

Younger children have the best chance of good results by avoiding deformity. Older children (more than 10 years old) seem to be at greatest risk for a poor outcome.

Hip arthritis seems to be a natural result in adults who had Legg-Calvé-Perthes disease as a child. The more severe the condition and the later it was diagnosed, the more likely the individual will develop arthritis. Many adults have a hip replacement by the time they are in their mid-50s.

Scheuermann’s kyphosis is a forward curvature of the spine. Although any part of the thoracic (middle) and/or lumbar (lower) spine can be affected, the thoracic area is involved most often.

If the curve progresses without treatment, a severe humpback deformity can occur. With proper treatment, this type of cosmetic appearance can be prevented.

The cause of Scheuermann’s is still unknown. Many theories have been put forth and studied but without enough proof to support them. Weakness of the cartilage that makes up the vertebral endplate has been suggested as one possible cause. Infection, osteoporosis, and hormone or endocrine disorders have also been proposed.

It’s difficult to tell if the bony changes that occur are the cause or the result of this condition. Even with improved technology, insight into the cause of this condition is limited. The changes observed on X-rays and MRIs vary so much from patient to patient.

We do know that the condition develops during a growth spurt. Most often a period of fast growth just before puberty is identified as the onset of Scheuermann’s.

Children between the ages of 10 and 14 are affected most often. Boys may have this condition more often than girls but some reports suggest an equal number of boys and girls are affected.

Child abuse is a very serious problem in this country. Injuries from nonaccidental trauma (NAT) are probably under reported. NAT include soft tissue injuries, fractures, and internal damage. Many children never see a doctor and go undiagnosed and unrecognized.

The majority of deaths from child abuse occur in children under the age of three. The abuser is usually one or both parents or one parent acting with another person. Death from child abuse is four times more likely in children with NATs compared with victims of accidental trauma.

Any socio-economic group can be affected. Risk factors include blended families (step children), a child with a mental or physical handicap, drugs used in the home, and parents who were victims of child abuse themselves. Death is more likely among African-American children who are abused.

There are several medical conditions that can cause bruising and/or fractures that mimic child abuse. These include leukemia, osteogenesis imperfecta (OI), hemophilia, rickets, and syphilis passed from the mother to the child at birth. Some kidney disorders and reactions to drugs can cause changes in the bones that look like child abuse.

Your neighbor’s child may have OI, sometimes known as brittle bone disease. This is a genetic bone disorder caused by a lack of Type I collagen. Collagen is a protein needed to make strong bones. Without it, the child with OI has weak or fragile bones that fracture easily.

Medical doctors, nurses, and other health care professionals are trained to recognize true signs of abuse. There are many ways to recognize abuse from other conditions. It might help you to find out the name of the condition your neighbor’s child has. Knowing more about the disease process may help you understand your neighbor’s situation.

Dr. Alan Stotts from the University of Utah has written a fairly comprehensive review of this topic. He reviewed the recent literature for orthopedists. He reported on the diagnosis and treatment of children and teens with injuries caused by child abuse.

Soft tissue injuries and fractures are the most common conditions seen by the orthopedic surgeon. The surgeon must also be on the alert for any internal injuries and unseen trauma that may be present. X-rays and CT scans may be needed in suspicious cases.

There are many red flags to alert the health care professional of possible child abuse. Certain patterns of injury may be recognized. For example, watch for finger marks or any bruising that goes all the way around an arm or leg. Burns and bite marks must be reviewed carefully.

Fractures and multiple injuries are rare from simple falls in young children. Fractures are very suspicious in children who aren’t walking yet or who are just starting to walk. Injuries at different stages of healing is a major red flag.

There are some specific types of bone fractures that raise the suspicion of child abuse. These include the corner fracture or bucket handle fracture of the long bones. A section of the growing bone at the ends of long bones is pulled away along with a piece of the bone. Such injuries are not likely with simple falls.

Posterior rib fractures are also red flag injuries. These fractures are distinctly different from common fractures seen in children from accidents or falls.

A careful survey of any child, espcially under the age of two is warranted when there are any red flags or suspicious signs of abuse. Oblique X-ray views of the ribs may be warranted in such circumstances.

Developmental dysplasia of the hip (DDH) is a fairly common problem. Many studies have been done to find the best way to identify and treat it. There’s some debate about routine screening.

Should every child be checked for this problem? When is it necessary to order special imaging tests such as X-rays or ultrasound? How soon should treatment begin? And how long can surgery be delayed?

There isn’t clear evidence to support a definite answer for all of these questions. We do know there are some children at greater risk for DDH. Any child who is born breech should be screened. Likewise, screening is advised when there’s a family history of DDH.

When DDH is suspected or diagnosed in the young child (birth to six months), conservative care can be tried. Proper positioning of the hip is important. This can be accomplished by using double or in some cases, even triple layers of diapering.

Holding the hip in a flexed and abducted position (away from the body) helps hold the hip in the socket during growth and development. If the condition is severe enough, a special device called a Pavlik harness can be used. This is strapped on over the child’s clothing. It also holds the hip in the best position to train the hip and prevent dislocation.

Regular follow-up exams are needed to make sure the treatment is working. Surgery may be needed if conservative care isn’t effective. The average age at the time of this operation is around six years old. Although the procedure has been done in children as old as 11, it is usually done by the time the child is nine or 10 years old.

Your pediatrician and orthopedic surgeon will work together with you to determine the best time for surgery should your child need it. Take all of the preventive steps suggested and make sure you continue with regular follow-up appointments. This will ensure the best results for your child.

Screening of newborns for possible hip deformities can help prevent long-term problems. But when test results are positive or mixed, it can cause great concern on the part of the parents and other family members.

The main condition doctors are looking for is called developmental dysplasia of the hip (DDH). A shallow depression called dysplasia in the acetabulum (hip socket) can lead to hip dislocation. In many cases, identifying this problem early can prevent serious problems later.

There are several tests the doctor can perform to find DDH. None of these tests are foolproof. Sometimes there are false-positive results. A false positive means that a test claims something is positive when that’s not the case. In fact, when using the most reliable test for DDH (Ortolani’s maneuver) there are false-positive findings about 25 per cent of the time.

That’s why a second opinion and further testing is a good idea. When results are in question, parents are instructed in proper ways to manage the problem. The testing is repeated at regular intervals. Imaging studies such as ultrasound to see the shape and position of the hip can also aid in the diagnosis.

For children less than six months old, double diapering and carrying the child with his or her legs around the parents’ waist may be advised. In some cases, a special device called the Pavlik harness is used to hold the hips in proper alignment.

If your physician has not talked to you about these preventive steps, don’t hesitate to make a follow-up appointment to discuss options. With the proper screening and prevention techniques, most children develop normal hips and do not need further treatment.

Spinal fusion for pediatric scoliosis can be done using one of three approaches. The anterior spinal fusion (ASF) is done from the front of the spine. The posterior spinal fusion (PSF) is performed from the back of the spine. The third option is a combined anterior and posterior fusion.

With any of these methods, curve correction is done with a series of surgical steps. Discs in between the vertebrae to be fused are removed. Sections of the ribs that have rotated and formed a rib hump may be removed. The surgeon crushes the bone and uses it as graft material for the fusion.

The surgeon uses a variety of derotation and compression-distraction techniques to straighten the spine. In some cases, the rods used along side the spine may hve to be curved or bent if the spine can’t be straightened all the way.

A special brace is worn to maintain the corrected position while the bone graft takes effect and fusion occurs.

Not necessarily. Spinal fusion for scoliosis is a lengthy procedure with many steps. The goal of surgery is to balance the spine in a more neutral position and get a solid fusion.

Time in the operating room can depend on the age of the patient, general health, and type of scoliosis. Patients with neuromuscular causes of scoliosis may have other complications linked with the condition before they ever go into the surgery.

For example, children with scoliosis from cerebral palsy may also suffer from a seizure disorder or chronic pneumonia. Such problems can put them at increased risk for problems during or after surgery.

Studies show that patients with idiopathic scoliosis (of unknown cause) have a lower rate of post-operative complications. But for either type of scoliosis, the length of surgery is not usually a sign of problems with the surgical procedure itself. It is more likely to occur in multicomplicated patients who require extra care and attention.

Only your doctor can tell you what type of surgery is being considered for your daughter, however, there are a few different types of treatments that are done through surgery.

Traditionally, most doctors who operate on this problem do what is called a debriding, or removing dead tissue. This clears the area and removes any loose bits that may be present. Another procedure is called a microfracture. To do this procedure, the doctor makes a small incision and uses a tiny drill to make several very small holes in the bone right next to the problem area. When the holes are drilled, the bone marrow seeps out and makes new tissue, healing the lesion.

Finally, another procedure, called osteochondral transplantation, involves removing a bit of tissue from the patient’s knee and implanting it into the elbow to heal the lesion. This particular procedure is looking very promising and seems to have a good long-term outcome.

A spiral fracture is different from a “regular” fracture that many people can sustain from a fall or trauma. Also called a torsion fracture, a spiral fracture can only be caused if a limb (arm or leg) is twisted in such a way that causes the bone to break.

There are certain types of accidents that can cause a spiral fracture, however, they can also be caused by abuse, if an arm or leg is twisted by the abuser.

The long bones in our body, the femur, or thigh bone, for example, have a growth plate on each end, where the bone growth actually occurs. When a child stops growing, the growth plate hardens and becomes solid.

This part of the bone is also the weakest part of the bone and can be broken when children fall or sustain some sort of trauma. Although most of these fractures heal well, if a growth plate fracture does not heal well, it can affect the child’s growth.

Osgood-Schlatter disease is a problem that affects some children and adolescents, usually the more active or athletic children. The term “disease” is a bit misleading because it is not a disease but an injury caused by over use. Doctors aren’t entirely sure what causes it but the general consensus is that the powerful muscles around the knee begin to pull and pull the tendons away from the tibia, or shin bone.

OSD can be quite painful, but the good news is that it almost always heals with conservative treatment. That means that surgery is rarely needed. Children with OSD are advised to limit their activity to give their knee a chance to heal. Surgery is usually only considered if the knee does not appear to be healing.

Osgood-Schlatter disease, an injury that affects the knees of children and adolescents, If a child complies and uses crutches regularly, reducing the amount of stress on the knee, the knee may heal within 4 to 6 weeks. If the knee hasn’t healed in that time, the doctor may want to investigate further and surgery may be needed.

If a scoliosis curve is not corrected by conservative, non-surgical, treatment, surgery may be needed, particularly if the curve is more than 45 degrees. The goal of surgery is to correct the curve and to keep it from curving more.

To do this, a surgeon will do a spinal fusion, which involves placing a rod next to the spine for support and fusing bone to the spine to strengthen it. The rod helps the back stay straight while the bones fuse properly and heal.

The surgery can be done from the back, the posterior approach, or from the front, the anterior approach. To do surgery from the front,the surgeon deflates a lung and removes a rib to be able to reach the spine.

If a child is diagnosed with scoliosis, he will be followed to see how the curve or curves progress. Usually, an orthopedist is in charge of patients with scoliosis. By taking x-rays on a regular basis, the doctor can see if the curves are getting worse or staying stable.

If the curves are worsening, treatment with braces may be needed. If the curves continue to worsen and don’t seem to be responding to the bracing, the orthopedist may suggest that surgery is needed. In this case, a metal rod is placed next to the spine to stabilize it. The surgeon then grafts bone to the spine, which will then fuse and strengthen it, keeping it from curving any further.

The decision as to how long a cast should be put on a broken arm depends on how the x-ray looks after a set period of time, usually 4 weeks. If your son’s doctor felt that the arm had healed sufficiently and it was safe to take off the cast, this would have been based on what the x-ray showed.

Keeping a cast on for longer won’t necessarily benefit the fracture, however. Even after 6 weeks, the bone can be fragile and you would still have to be careful. It takes a while for the bone to heal completely and regain its full pre-break strength.

Bone refracturing in the forearm is not uncommon in children. Because of their activities and the way they play, the fractures can happen easily. In a recent study, researchers found that children with breaks closest to their wrist had a higher risk of breaking their arm again than did children with their break closer to their elbow.

To reduce the chances of a bone breaking again in the same place, some children wear splints for several weeks after the cast is removed. They may also be advised against participating in certain types of activities for a while after the splint has been removed.

It is a reality that emergency room personnel must be on the look out for child abuse. As you say, one of these signs could be frequent visits because of injuries.

Unfortunately, it does happen from time to time that a red flag is raised and parents are put under suspicion when they may be innocent. However, for the most part, the doctors and nurses are able to look at the situation and draw conclusions from the actual injury. Certain types of fractures in certain age children, for example, are a strong indicator for abuse because of the way the bones are broken.

If you and your child are open with the staff and are able to explain the injuries, it isn’t likely that they will think you are hurting him.

Doctors have to be on the look out for child abuse, particularly in emergency departments where children come with broken bones and other injuries.

From experience, the medical community has learned that certain types of breaks don’t often happen in certain age children, although accidents do happen. For example, a complete fracture of the thigh bone is not a common injury among children who can’t walk yet. In a recent study, researchers examined the records of 20 children under the age of 1 year who had these fractures. They found that 10 were victims of abuse and 5 were highly suspicious.