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Spine, hip, cerebral palsy and limb deficiency among 'most often treated'

Spine, hip, cerebral palsy and limb deficiency among 'most often treated'

Shriners Hospitals for Children — Greenville, the trusted leader in orthopaedic care for kids, specializes in the diagnosis and treatment of a wide range of bone, joint and muscle conditions. All patients have prompt access to decades of experience from a multi-disciplinary team using evidence-based treatments, the most current procedures and state-of-the-art technology to achieve the best results.

Though the largest team of pediatric orthopaedic surgeons in the Carolinas nets over 150 years in caring for over 85 conditions, four conditions are among the most frequently treated: spine, cerebral palsy, limb deficiency and hip disorders.

Spine

Specializing in the management of pediatric and adolescent spine disorders

Shriners Hospitals for Children — Greenville performs more than 100 spine surgeries and approximately 200 Mehta casts each year. A majority of these surgeries involves scoliosis. As with other complex procedures, hospitals performing these types of surgeries with this frequency have a quality and safety advantage.

We specialize in the care of infantile, juvenile and adolescent scoliosis. Our goal is to manage the curvature while allowing for optimum growth of the chest and spine. This allows for the best development of pulmonary function, necessary for a healthy adulthood.

Management options:

  1. Observation
  2. Bracing/casting
  3. Physical therapy
  4. Halo traction
  5. Surgery

If the curve continues to progress while administering all conservative approaches, surgery may be required. If the surgeon recommends surgery, there are a few options to consider.

Posterior spinal fusion

  • For patients approaching, or who have reached skeletal maturity, a spinal fusion may be considered.
  • The vertebrae in the back are joined, or “fused” together with a bone graft.
  • Fixation to the spine is achieved and rods are placed to hold the alignment while the bones heal in a better position.

Growth-friendly techniques

  • As we put more emphasis on pulmonary function, “growth-friendly” techniques allow the physician to maximize growth of the chest and lungs.
  • For children who are not close to skeletal maturity, growing rods, staples or tethers may be recommended.
  • In some cases, the surgeon may recommend MAGnetic expansion control (MAGEC) spinal bracing and distraction system. Once the rods are fused to the spine, this technology allows our physicians to lengthen the spine using two magnetic, telescoping rods. MAGEC rods may minimize the number of operations over the course of treatment.

Cerebral palsy

Cerebral palsy program meets needs of largest percentage of hospital’s patient population

Between 5 and 7 years of age, it becomes clear which children will be able to walk, and which will require a wheelchair for mobility.

For patients who can walk:

  • Their gait pattern is frequently disrupted by muscle spasticity and contracture, skeletal malalignment, and deficits of balance and motor control.
  • Clinical decision making is based upon our use of quantitative gait analysis, which is performed at our motion analysis center.

For patients who don’t walk:

  • We have a seating team that develops an individualized plan for a seating system.
  • This seating team will also evaluate existing seating systems and make recommendations for modifications to accommodate the growing child.

For patients who can ambulate, surgery is primarily focused on the upper and lower extremities.

Surgeries may be performed:

  • About the hips, knees and ankles to improve range of motion and positioning of these joints.
  • To correct foot and ankle alignment to facilitate orthotic and shoe wear.
  • On the lower extremities to correct common gait problems, such as in-toeing or out-toeing.
  • On the upper extremities to promote hygiene and improve function.

For non-ambulatory patients, surgery is focused upon the hips, the upper and lower extremities, and the spine.

Surgeries may be performed:

  • About the hips to prevent the development of painful dislocation.
  • To correct foot and ankle alignment to facilitate orthotic and shoe wear.
  • To correct scoliosis to improve sitting balance or heart and lung function.
  • On the upper extremities to promote hygiene and improve function.

Limb deficiency

Fifty years of experience fuels multi-disciplinary limb deficiency clinic

Pediatric orthopaedic surgeon
Physician assistant
Prosthetist
Prosthetic technician
Care coordinator
Occupational therapist
Physical therapist
Geneticist

  • The innovative surgical and prosthetic treatment protocols developed at the Greenville Shriners Hospital have resulted in numerous publications in scientific literature.
  • The patient population of the hospital provides the opportunity for children and their families to meet and interact with others who have similar challenges.
  • A growing child will require fabrication of a new prosthesis every 12 to 18 months, and our in-house prosthetics and orthotics department is staffed by certified prosthetists who work exclusively with children.
  • Our care addresses the physical and psychological needs of children with both congenital and acquired limb deficiencies.

Hip preservation

Hip preservation program specializes in congenital, developmental, sports injuries and post-traumatic conditions

Some conditions include:

  • Developmental dysplasia of the hip (DDH)
  • Cerebral palsy hip disorders
  • Legg-Calvé-Perthes disease
  • Snapping hip
  • Adolescent hip dysplasia
  • Femoroacetabular impingement (FAI) and labral tears
  • Slipped capital femoral epiphysis (SCFE)
  • Sports related hip injuries

After exhausting all conservative approaches to treatment, surgery may be recommended. Below is a brief overview of our surgical interventions.

Developmental dysplasia of the hip (DDH)

  • Between 6 months and 9 years.
    • If a closed reduction is unsuccessful, an open reduction will be required to remove the soft tissue that is preventing the femoral head from staying in the acetabulum.
    • After 2 years of age, an open reduction is commonly required.
  • DDH in the adolescent.
    • If surgery is recommended, a Ganz periacetabular osteotomy is frequently recommended to improve and preserve the hip joint.

Slipped capital femoral epiphysis (SCFE)

  • In situ fixation is the most common procedure for patients with stable or mild SCFE.
  • An open reduction will be required for patients with unstable SCFE.

Femoroacetabular impingement (FAI) and labral tears

  • Arthroscopic surgery is preferred to repair any damage to the cartilage and make adjustments to the acetabulum and femoral head.
  • Some severe cases may require an open operation.

Legg-Calvé-Perthes disease

  • An osteotomy may be recommended to re-establish proper alignment of the hip bones and to keep the femoral head within the acetabulum.