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Other orthopaedic conditions and treatments

Other orthopaedic conditions and treatments

Other orthopaedic conditions and treatments

Amputations

Amputation is the removal of an injured, diseased or malformed body part. An amputation may be the result of a traumatic injury or it may be a planned operation to prevent the spread of the disease in an infected finger or hand.

When a broken bone has become severely infected, amputation may be required to protect the rest of the limb and the body from further infection. At Shriners Hospitals for Children, amputations are done with the goal of minimizing the amount of the limb that is lost and creating a structure that can successfully support a prosthetic device when appropriate.

Arthrogryposis

Arthrogryposis is a number of rare, nonprogressive muscle disorders causing stiff joints and abnormal development of muscles. From the Greek word meaning “curved joint,” children with arthrogryposis are born with a limited range of joint motion.

Treatment options

  • Therapy: For most types of arthrogryposis, a rigorous treatment of physical and occupational therapy can be successful in the improvement of the range of motion of the affected joints.
  • Splints/casts: Splints are made to increase the stretching exercises and increase the range of motion. Casting is frequently done to improve foot position. Removable splints can be used on knees and feet to allow exercises, but some patients experience significant results by wearing splints at night.
  • Surgery: Some children may require surgery to address any deformities that the child may have been born with and can include elbows, feet, hips, knees and wrists. Surgery is generally recommended if more range of motion is needed after therapy has achieved maximum results.

Benign bone lesions

Fortunately, the majority of tumors that originate in the bones are benign, meaning that the tumor is very unlikely to spread from its original site to a new location.

Treatment options

  • Nonsurgical or Self eliminating: Treatment for benign bone tumors depends on the specific type of tumor, its size, its location and age. Surgery is not always necessary. The child may only need to be checked once a year to ensure that the tumor is not growing or showing signs of being aggressive. Some tumors clear up on their own.
  • Surgery: Treatment includes the removing of the tumor and the regeneration of new, healthy bone at the site of the tumor. Our surgeons have knowledge and experience with specialized techniques for removing these tumors.

Cerebral palsy

Cerebral palsy (CP) is a group of disorders affecting the muscle tone, movement and motor skills – ability to move in a coordinated and purposeful manner. CP is the most common physical disability in childhood and is the result of a combination of events before, during or after birth that can lead to an injury in a baby’s developing brain.

Treatment options

  •  Assistive devices: These devices can help offer the child physical support. Shriners Hospitals for Children — Spokane's medical staff may recommend one of the following:
    • Braces
    • Canes
    • Walkers
    • Wheelchairs
  • Motion analysis is an important part of understanding how the child walks. Because children with CP often have difficulty walking normally, motion analysis is used to fully understand how the muscles and bones function and how they can be helped to function more smoothly or effectively. We have a state-of-the-art motion analysis center at Shriners Hospitals for Children — Spokane.
  • Medications: Certain drugs to control or prevent seizures associated with cerebral palsy may be needed. Since there are various types of seizures, combinations of drugs may be prescribed that are best suited to the child’s specific condition. Drugs can also be used to reduce spasticity, or stiff or rigid muscles that can affect movement, general movements, talking and walking.
  • Occupational therapy: The patient may work with an occupational therapist who helps them to improve the development of the small muscles of the body, such as their face, feet, fingers, hands and toes. The therapist may also teach the child how to perform daily activities, such as eating and dressing along with showing them easier ways to brush their teeth, draw, use scissors and more.
  • Physical therapy: A physical therapist specializes in helping with the development of the large body muscles, such as those found in the abdomen, arms and legs. The child may work with a physical therapist to learn easier ways to balance and move. They can help the child learn to walk, stand by themselves, safely go up and down stairs, or use a wheelchair. Physical therapy is usually prescribed soon after the child has been diagnosed with cerebral palsy to prevent any further deterioration or weakening of muscles that can result from not moving.
  • Surgery: While surgery is not always needed, it can sometimes improve muscle development, correct contractures and reduce spasticity in the legs. Surgery may be needed for tendon lengthening, which can help children with their ability to walk and improve their balance.

Dwarfism

Dwarfism is a condition where children are of short stature, ranging to an adult height of between 2 feet 8 inches to 4 feet ten inches. Also known as skeletal dysplasia, it can be caused by over 150 disorders where a child’s bones do not grow in the usual way.

Dwarfism is caused by a genetic mutation – a change in the egg or sperm cells prior to conception. It affects the ability of a child’s bones to grow to an average length and the bones are frequently short and crooked, especially in the arms, legs or trunk, which may be shorter than the rest of the body.

Treatment options

Most treatments for dwarfism do not increase stature, but can possibly reduce problems or complications that the child may have or experience as they become an adult.

  • Surgery: Various surgeries may be necessary to correct bone direction and involve inserting metal staples into the ends of long bones, dividing limb bones, inserting rods or staples to help correct the shape of the spine, or increasing the size of the bone openings in the spine to eliminate pressure on the spinal cord.
  • Limb lengthening: We can treat dwarfism through limb lengthening surgery where a long bone is divided into two or more sections by the surgeon. These sections are slightly separated and the bone and limb, arm or leg is braced with a metal frame. Pins and screws on the frame are adjusted to maintain tension between the sections which allows the bone to grow back together slowly into a complete, but longer bone.

Metabolic bone disease

Normal bone growth and mineralization requires adequate calcium and phosphate. Metabolic bone diseases encompass a large spectrum of disorders that are commonly caused by abnormalities of minerals, such as calcium, phosphorus, magnesium or vitamin D. Some will stabilize once the bones stop growing, while still others will require lifetime management and treatment.

Muscular dystrophy

Muscular dystrophy (MD) is a genetic or hereditary disorder that gradually weakens the body’s muscles. When the muscles are weakening, or breaking down, they are replaced by fatty deposits that collect over time. The most common forms of muscular dystrophy are caused by a deficiency of the muscle protein dystrophin.

Although there is no cure for MD, there are treatments and medications that can slow the progression of the disease. Shriners Hospitals for Children offers various treatments for MD. The exact treatment will be determined by the severity of the diagnosis, as well as other factors that their doctors feel are relevant to treatment planning.

Treatment options

  • Assistive devices: These devices can help offer support for weakened hands and lower leg muscles. Shriners Hospitals for Children — Spokane medical staff may recommend one of the following:
    • Braces
    • Canes
    • Walkers
    • Wheelchairs
  • Physical therapy: Because MD causes muscle weakness, there are many other issues that occur, such as shortening of tendons, contractures in joints and the limitation of joint flexibility and mobility. Physical therapy can help with range of motion, keeping joints as flexible as possible and possibly delaying further muscle weakness. Part of the physical therapy treatment at Shriners Hospitals for Children includes sessions in our hydrotherapy pools.
  • Medications: In some cases, the child’s doctor may prescribe certain medications that will slow the progression of MD and/or manage their symptoms. Different medications may be needed for the following types:
    • Muscle spasms, stiffness and weakness
    • Muscle deterioration
  • Surgery: Some children may have contractures that are painful. The child’s doctor can perform tendon release surgery on their hips, knees and on the Achilles tendon at the back of the foot.

Neurofibromatosis (NF1)

Neurofibromatosis causes tumors to grow on a child’s nerve tissue, producing skin and bone abnormalities. Neurofibromatosis is usually diagnosed in children ages of 3–16, and severe cases are found in infants. The severity of the disease varies and some children have mild symptoms while others may be severely involved.

Treatment options

  • Bracing: Since some children diagnosed with NF1 may also have scoliosis, a back brace may be recommended.
  • Regular monitoring: Because the age range is so varied for NF1, the child’s doctor may monitor their overall medical health and look for any medical or developmental problems.
  • Surgery: In many cases, surgery is a treatment option to remove all or sections of tumors that may be pressing on tissues or organs. The removal of these tumors often provides relief of some systems.Other surgical procedures may be required and, depending upon the type of neurofibromatosis and the severity of symptoms, further treatment options can be explored with the doctor.

Osteogenesis imperfecta (brittle bone disease)

Osteogenesis imperfecta (OI), also known as brittle bone disease, is a genetic disorder that affects the bones and bone formation. The cause of OI is a gene defect that affects how the body makes collagen, a protein needed to make bones strong. Either the Type 1 collagen gene is not producing enough collagen or the collagen produced does not work properly.

Children born with OI have bones that are less dense and break easily for no known reason. OI can also cause weak muscles, brittle teeth, a curved spine and hearing loss.

Treatment options

The goal of treatment is to manage the symptoms, prevent deformities and fractures, and allow the child to function as independently as possible.

Treatments may include the following:

  • Fracture care: Casting, splinting and bracing broken bones can help them heal properly.
  • Medications: Medications may be prescribed to increase bone density.
    • At Shriners Hospitals for Children, we are leaders in OI treatment with the use of infusions. The medication is given via an intravenous (IV) infusion that lasts about three hours. To keep kids mobile and distract them from the infusion therapy, OI patients at Shriners Hospitals for Children have the IV bag placed into a backpack that can be worn on the back or hung on a wheelchair. This allows the child to play a video game, read a book or work on homework while the drug is being administered.
  • Mobility equipment: Assistive devices, such as wheelchairs, braces or other equipment may be recommended by the medical staff.
  • Physical therapy: Goals for physical therapy include improving and maintaining function and promoting independence.
  • Surgery: Surgery may be needed to repair a broken bone or correct bone deformities. Some children with OI may undergo a surgical procedure known as rodding, in which metal rods are inserted into the long bones to control fractures and improve deformities that interfere with function.

Osteomyelitis (bone Infection)

Osteomyelitis is an infection in the bone, most often caused by bacteria. In children, the long bones of the arms or legs are most often involved.

Treatment options

Treatment of osteomyelitis depends on the severity of the infection and whether it is a recent infection or has been present for an extended period of time. The goal of the treatment is to eliminate the infection and reduce damage to the bone and surrounding tissues.

  • Intravenous (IV) and/or oral antibiotics: These medications can be given to fight the infection.
  • Surgery: Surgery may be necessary if the child has an infection that does not go away.

Pectus carinatums

Pectus carinatum is a condition in which the breast bone (sternum) protrudes outward from the chest and can be associated with pain at certain times, such as when a child exercises or is breathing hard. Pectus carinatum occurs more frequently in boys than girls.

Treatment options

  • Bracing: Most children diagnosed with pectus carinatum will be treated by a brace that is custom-fit to their chest wall. The brace has front and back compression plates that are affixed to aluminum bars that are bound together by an adjustable leather strap in both the front and back. The pressure of the brace to the chest usually corrects the deformity. Each case varies and the doctor will prescribe the amount of time the brace should be worn.

Pectus excavatums

Pectus excavatum is a condition that causes a child’s breastbone to sink into their chest. Pectus excavatum is also known as funnel chest or sunken chest. Because pectus excavatum causes a deep depression, usually on both sides of the chest, a child’s abdomen protrudes, giving the appearance of a “pot belly.” This disorder is more common in boys than girls.

In severe cases of pectus excavatum, the function of a child’s heart and lungs can be affected.

Treatment options

Shriners Hospitals for Children offers various treatment plans for children diagnosed with pectus excavatum. Generally, mild cases of pectus excavatum correct themselves in early childhood. Children with more severe abnormalities may require surgery.

The child’s doctor will recommend the specific type of surgery based on their individual condition. The goal of the surgery is to correct any cosmetic issues and the outcomes are usually very good.

Rickets

Rickets is a bone disease in children that causes bowed legs and other bone deformities. Children with rickets do not get enough calcium, phosphorus or Vitamin D, all of which are important for healthy growing bones.

Rickets can also be caused by a genetic abnormality that does not allow Vitamin D to be absorbed correctly. This form of rickets may be inherited.

Treatment options

Treatment depends on the type of rickets the child has. The doctor will determine why the child has rickets and treat the cause. In most cases, rickets can be treated by replacing the missing vitamin or mineral in the body, such as vitamin D and calcium.

Orthopaedic manifestations of neuromuscular disorders

  • Charcot Marie Tooth
  • Friedreich’s Ataxia
  • Multiple sclerosis

Orthotics and prosthetics

Orthotics and prosthetics can help a child with an orthopaedic disorder or deformity, or a missing limb, return to optimal function and form. At Shriners Hospitals for Children — Spokane, we fabricate thousands of orthotics and prosthetics each year.

Plastic surgery for burn scars affecting range of motion

Traumatic injuries result in damage to the skin, soft tissue, muscle and sometimes the bones. The type and extent of treatment depends on the nature and location of the injury. A consistent, planned approach that addresses functional needs, as well as the residual deformities is necessary.

The goal of treatment is to maximize function and help children lead as normal a life as possible. Treatment will depend on the type and severity of the injury/defect. Depending on the type of injury, the duration of treatment may also include physical and occupational therapy to return the child to optimum functioning. Every child’s condition is evaluated on a case-by-case basis, and a plan of treatment is identified.

   
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