Common bone disorders in children and care guidelines

I believe some parents may have children with a congenital disorder or deformed limbs and spine. They may have extra or webbed fingers and toes or some may be missing. Their hands, feet, or spine may be deformed.  They wouldn’t walk even when reaching the age they should be able to. Or they may have stiff limbs and walk on their toes.  As they’re growing up, parents are not sure if their children’s limbs are bent or if they have a curved torso. The way they walk or move seems unusual, leading to comments on their twisted gait, in-toeing, flatfoot, and uneven length of legs. Some children may suddenly refuse to move their limbs or to walk. Or they may limp and complain about joint and limb pain. There may be emergency cases of serious injuries while at play, with bent, dislocated, or broken limbs. These problems may require special care by a pediatric orthopedic specialist as children’s bones and joints have different characteristics from those of adults.

Compared to adults, children's bones differ in shape and features as they keep developing and growing all the time, starting with bone tissues forming in the womb.  Once born, they keep changing, developing with age.  Any disruption during this period of growth could derail the normal development process of the bones and joints. In serious cases, stunted growth may result in bowed arms and legs, with uneven length, and unusual movement. 

Treatment of bone disorders in children should be provided as soon as the problem is identified. Treatment at a younger age is often more effective than at an older age. In small children, this could simply involve wearing a brace.  If treated at an older age, surgery may be needed.  If required, a minimally invasive technique may be used in small children while a full open surgery, requiring longer  recovery time, may be needed for older children.  Meanwhile, for disorders detected while the baby is still in the womb, advice is given and treatment plans can start as soon as the child is born.

Generally, in treating children, while the problem encountered at the time is corrected, it is important that possible subsequent future effects be considered. 

Certain treatments used in adults may not be used in children as they can affect tissue growth and cause bone deformities or stunted growth.  In addition to providing treatment, in order to prevent these effects, close monitoring of the children is necessary so that treatment can be adjusted immediately should any problem present itself.

Treatment with some specialized devices can be very costly and this becomes a constraint in many hospitals. On the other hand, such devices can be effectively used to lengthen the bones or straighten them.  This kind of treatment is a complex process but can be provided by an experienced pediatric orthopedist specialist.  

Written by Dr. Pariyut Chiarapattanakom, 
Orthopaedic Surgery and 
Pediatric Orthopaedic Surgery specialist

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