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Special orthopaedic conditions and diseases

Special orthopaedic conditions and diseases

From sports injuries to rare bones diseases, to complex conditions such as arthrogryposis, the medical team at Shriners Hospitals for Children — St. Louis includes the specialists to help your child reach his or her full potential physically, as well as socially and emotionally. Our multidisciplinary team of therapists, prothetists, orthotists and nurses have experience with the rarest of rare conditions and can help pave the way for you and your child as he or she grows.

More about the special orthopaedic conditions we treat:


Bone lesions (non-cancerous) are abnormal growths or tumors found in the bone. Surgery may be a necessary form of treatment if the tumor enlarges or affects function.

Metabolic bone diseases are diseases that cause bones to become soft, brittle or too dense due to a genetic cause. Our Center for Metabolic Bone Disease and Molecular Research diagnoses, treats and investigates more than 100 of these rare conditions. Two examples are below. See a full list on our research page.

Osteogenesis imperfecta is a genetic defect that impairs the body’s ability to make strong bones. Treatment may include medication, casting or bracing. Surgery may be necessary for fractures that do not heal, recurrent fractures of the same bone, or for scoliosis.

Rickets is a metabolic bone disease that causes weak bones, bowed legs and other bone deformities. Treatment for rickets may include vitamin D and calcium supplements or bracing. Surgery may be required for severe cases only.


Pectus carinatum occurs when excessive growth occurs in the connective tissues of the ribs and breastbone causing the sternum to protrude. It often is first noticed midway through childhood. Other than their physical appearance, most children do not have symptoms. However, some children may experience difficulty playing and exercising, tenderness and intermittent pain near the overgrown cartilage, and older children may develop issues involving self-image or self-confidence. Depending on the severity of the condition and the decision of the child and family, treatment varies from external bracing, surgery or no treatment at all.

Pectus excavatum is caused by the abnormal growth in the chest of the connective tissues that attach the breastbone to the ribs. This causes a depression in the chest that can range from mild to severe. Both or just one side of the breastbone may be affected. While most patients do not have symptoms, those with severe forms of the abnormality may experience fatigue, shortness of breath and chest pain. Older children may develop issues involving self-image or self-confidence. While most diagnoses are made when the child is an infant, for those without symptoms and not in need of immediate intervention, surgery is often postponed until puberty. Some patients, with the consultation of their physicians and family, forego the surgery altogether.


Achondroplasia (dwarfism) is a bone growth disorder resulting in short stature. Options for treatment may be hormone therapy or surgery.

Skeletal dysplasia is a broad term used for genetic bone conditions that cause short stature in children, such as achrondoplasia and osteogenesis imperfecta.

Fracture care

Fracture (complete or partial) is a broken bone. Treatment may include casting or surgery. Physical or occupational therapy may be necessary following the cast removal or surgery.

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (includes juvenile rheumatoid arthritis) is an autoimmune disease that causes inflammation of the joints. Treatment may include medication such as NSAID (non-steroidal anti-inflammatory drugs), steroids and biologics, and physical and occupational therapy. Surgery may be necessary for very severe cases only.

Limb deficiency

Limb deficiency is a condition where a child is missing all or part of a limb. Limb deficiencies may be congenital or acquired and may take place in lower or upper limbs.

  • Congenital limb deficiency is when a portion or the entire upper or lower limb does not form or does not form properly during pregnancy.
  • Acquired limb deficiency is a traumatic loss of a limb due to an accident or illness.

A multidisciplinary team of surgeons, nurses, prosthetists and therapists evaluate and work with each child to create a solution that maximizes their individual function. Treatment for both congenital and acquired limb deficiency may include custom prosthesis (artificial limb), splints or braces. Physical or occupational therapy may be needed. Surgery may be necessary to improve function and appearance of the residual limb.

Orthopaedic oncology

Benign bone tumors, malignant bone tumors (osteogenic sarcoma, Ewing's sarcoma, chondrosarcoma), benign and malignant soft tissue tumors and metastatic lesions to the bone (cancer that spreads to the bone from other parts of the body)

Sports medicine

Meniscus injury, or meniscus tears, occur when the knee is twisted during sports or other activities and becomes torn away from its attachments. First choice of treatment is to repair the meniscus surgically through an arthroscope, but if it is too damaged, surgeons will remove it, saving as much as possible.

Sports injuries include strains, sprains or overuse injuries to the bones or ligaments, tendons or muscles, from athletic activity. Recommended treatment for sports injuries includes RICE: rest, ice, compression, elevation; medication; bracing, casts or splinting; and physical or occupational therapy.

Stiff joints

Arthrogryposis is a rare congenital disorder characterized by multiple joint contractures (stiff joints) which can include weakness and fibrosis. Treatment may include physical and occupational therapy, splints or casts. Surgery may be necessary to improve joint function.