Pediatric orthopedics
The Pediatric Orthopedics is a specialty of orthopedics that deals with congenital and acquired deformities and diseases of the musculoskeletal system employed in children and adolescents. This includes the treatment of fractures and dislocations in childhood, as well as the treatment of any subsequent conditions.
Historical
Nicolas Andry
The term “orthopedics” goes back to Nicolas Andry. His work " Orthopedics, or the art of preventing and improving the deformity of the body in children " , published in German in 1744 , gave the field its name. Pediatric orthopedic therapies were proposed in ancient times, some of which can be found today. The clubfoot redression goes back to Hippocrates, back then with papyrus strips. Up until the middle of the 20th century, orthopedic hospitals mainly treated children and adolescents with congenital or acquired malpositions for weeks, sometimes for months and even years. The focus was on the treatment of sequelae from poliomyelitis and bone tuberculosis. Children with scolioses, hip dislocations, Perthes disease and adolescent femoral head dislocation were also treated as inpatients for long periods. The development of arthroscopy, the advent of endoprosthetics for arthritic joints, expanding shoulder and foot surgery, advances in the treatment of herniated discs and spinal canal stenosis have shifted the spectrum of orthopedic clinics and practices significantly towards adult orthopedics. As a result, specialization in pediatric orthopedics prevailed. Currently 3.4 percent of US orthopedic surgeons state that they mainly work in pediatric orthopedics.
Pediatric Orthopedic Society of North America (POSNA)
The first specialist society was the American POSNA (Pediatric Orthopedic Society of North America), whose predecessor society (POS) was founded in early 1970 on the initiative of M. Tachidijan from Chicago and other leading American pediatric orthopedists.
European Pediatric Orthopedic Society (EPOS)
In Europe, the EPOS (European Pediatric Orthopedic Society) was founded as an amalgamation of national child orthopedic associations and interested individual child orthopedists. The first meeting with 15 participants from 12 countries took place in Paris in 1983. Since then, annual specialist congresses have been held and international training courses have been organized together with POSNA.
Association for Pediatric Orthopedics (VKO)
It was not until 1987 that the German-speaking “Friends of Pediatric Orthopedics” joined forces to form the Association for Pediatric Orthopedics (VKO) on the initiative of Thomas Brinkmann from Hamburg and Klaus Parsch from Stuttgart . Since the first conference in Stuttgart, annual congresses have been held in Germany, Austria and Switzerland. The VKO has been a section of the German Society for Orthopedics and Orthopedic Surgery (DGOOC) since 1995 and a section of the German Society for Orthopedics and Trauma Surgery (DGOU) since the merger of orthopedic surgeons and trauma surgeons . Since 2007, the Association for Pediatric Orthopedics has organized four-day compact courses for specialists and assistants in continuing education every November .
Trade journals
The Journal of Pediatric Orthopedics (JPO), edited by Lynn Staheli and Bob Hensinger, has been a pediatric orthopedic and child trauma specialist journal since 1980 . In 1992, Henri Bensahel from Paris started the European supplement, the Journal of Pediatric Orthopedics part B (JPO-B). In 2007 Shlomo Wientroub from Tel Aviv founded the Journal of Children's Orthopedics (JCO) as the official organ of the European Society for Children's Orthopedics .
Additional qualification in children's orthopedics in Germany
Since 2005, almost all of Germany's state medical associations have introduced the additional designation of pediatric orthopedics , which can be obtained by specialists in orthopedics and trauma surgery and specialists in pediatric surgery. In the eighteen months of further training in an authorized department, the required training content must have been fulfilled and appropriate child orthopedic interventions carried out. After a successful oral examination, the additional title of pediatric orthopedics is awarded.
Pediatric orthopedic departments
There are child orthopedic departments . a. at several university clinics. The first chair for pediatric orthopedics in German-speaking countries was established in Basel at the University Children's Hospital in Basel . The current successor to Fritz Hefti in the chair is Carol Hasler. As in the USA, pediatric orthopedic departments can also be found at large children's clinics (pediatric centers), such as at the Olgahospital Stuttgart, in Sankt Augustin near Bonn, in the Altona children's hospital in Hamburg or at the children's hospital in St. Gallen in Eastern Switzerland or in the Dortmund clinic area . There are also independent pediatric orthopedic clinics, for example in Aschau im Chiemgau, or affiliated to specialist orthopedic clinics such as the Orthopedic Hospital in Vienna-Speising. Some departments have also become sub-specialized, for example for neuro-orthopedics in Aschau im Chiemgau , in Basel, Düsseldorf, Rummelsberg , Munich-Harlaching and Stuttgart, for children's spine surgery in Bad Wildungen , Hamburg-Altona , Sankt Augustin or in Stuttgart and for hand surgery at Wilhelmstift Hamburg.
spectrum
General pediatric orthopedics deals with the entire spectrum of diseases of the musculoskeletal system in children and adolescents. Some organ-related and non-organ-related diseases are listed in the overview.
Organ-related diseases
Spine
- Scoliosis , - congenital scoliosis. EOS (early onset scoliosis), idiopathic scoliosis
- Kyphosis , Scheuermann's disease , - Pott's disease
- muscular torticollis ( torticollis )
- Spondylolysis - Spondylolisthesis
hip joint
- Hip dysplasia - hip dislocation ,
- Coxa vara congenita, - Proximal Femoral Defect (PFFD)
- Perthes disease - Meyer's dysplasia
- Epiphyseolysis capitis femoris (femoral head cap solution)
- Femuro-acetabular impingement (FAI) (femoral head and socket wear due to constriction)
Knee joint
- Congenital knee dislocation - congenital patellar dislocation
- Patellar dysplasia - patello-femural instability
- Disc meniscus , - meniscus lesion, - cruciate ligament lesion bony and intraligamentary
- Osteochondrosis dissecans
Lower leg
- tibial hemimelia and fibular hemimelia
- Limb shortening with and without axis deviation
- Axial deviation genu valgum , genu varum , genu recurvatum
- post-traumatic axis deviation
foot
- Polydactyly , macrodactyly , cleft foot
- Clubfoot , rocking foot ( talus verticalis ),
- Sickle foot , heel foot , flat arched foot ,
- Coalitio calcaneo-naviculare
shoulder
elbow
- Radioulnar synostosis
- Radio-ulnar dysplasia with / without dislocation of the radial head
- Ulna hypoplasia
Wrist / hand
- Madelung deformity
- Polydactyly , syndactyly , thumb hypoplasia
- Macrodactyly
- Snap thumb - snap finger
Non-organ related diseases
Neuro-orthopedic diseases
- Infantile cerebral palsy
- Hereditary neuropathies
- Spina bifida cystica, myelomeningocele
- Arthrogryposis multiplex congenita
- Duchenne's disease ,
- Other congenital muscle diseases
Hereditary malformations
- Glass bone disease ( osteogenesis imperfecta ),
- Marble bone disease ( osteopetrosis ),
- bony and cartilaginous dysplasias (e.g. achondroplasia )
- Vertebral malformations
- Misalignments of the extremities as well as complex malformation syndromes
Inflammatory bone and joint diseases
- Septic arthritis,
- Osteomyelitis ,
- Spondylitis , spondylodiscitis
Rheumatoid joint diseases
Bone and soft tissue tumors
Benign
- Osteochondroma
- Non-ossifying fibroma (fibrous cortical defect)
- Juvenile bone cyst
- Aneurysmal bone cyst
- Osteoid osteoma
- Eosinophilic granuloma (Langerhans cell histiocytosis )
- Chondroblastoma
Vicious
Fractures and dislocations
- Shaft fractures diaphyseal, metaphyseal,
- Fractures of the growth plate
- Intra-articular injuries
- Fractures of the spine, clavicle and pelvis
- Upper limb fractures
- Lower limb fractures
- Post-traumatic misalignments
therapy
According to an estimate by Fritz Hefti, 70% of all child orthopedic consultations only require advice “that the child is just enough” . Conservative treatment is necessary in around 20%, for example with insoles, orthoses , corsets , physiotherapy or plaster treatment. Recently, botulinum toxin has also been used to treat overactive muscles such. B. to paralyze temporarily with a spasticity . Surgical-operative therapy is only necessary in about 10%. Typical pediatric orthopedic interventions are osteotomy osteotomies , e.g. B., on the hip with hip dysplasia or Perthes disease , or on the knee with knock knees or bow legs. Lengthening or cutting of the tendons (tenotomies) are also common. B. in spastic equinus or contractures . Further interventions are e.g. B. the spinal column graduation and stiffening ( spondylodesis ) in scoliosis , the blocking of the growth plates ( epiphysis ) in malpositions or the lengthening of the extremities by means of an external fixator , z. B. Ilisarov distraction or with the Taylor Spatial Frame.
According to an American study, around 50% of all children and adolescents have at least one broken bone and around 40% have an orthopedic problem at least once. The malpositions that are conservative or do not require treatment predominate. So 20% of all children and adolescents have Knicksenkfüße or flexible flat feet, 15% an increased hip anteversion ( coxa antetorta ), another 15% have a benign bone tumor or tumor-like bone change. this is followed by spondylolysis with 5%, sickle foot with 3% and scoliosis with 3% in girls. hip dysplasia is found in 2%. Everything else is less than 1: 100.
Individual evidence
- ^ DR Wenger, M. Rang: The art and practice of children's orthopedics. Raven Press, New York 1993.
literature
- M. Benson, J. Fixsen, M. MacNicol, K. Parsch: Children's Orthopedics & Fractures. 3. Edition. Springer, London 2009, ISBN 978-1-84882-610-6 .
- K. Buckup: Pediatric Orthopedics. 2nd Edition. Thieme Verlag, Stuttgart 2001, ISBN 3-13-697602-9 .
- Reinhard Graf: Sonography of the infant hip and therapeutic consequences. 6th edition. Thieme Verlag, Stuttgart 2009, ISBN 978-3-13-117525-0 .
- Fritz Hefti: Pediatric Orthopedics in Practice . Springer-Verlag, Berlin 1997, ISBN 3-540-61480-X .
- FU Niethard: Pediatric orthopedics. 2nd Edition. Thieme Verlag, Stuttgart 2009, ISBN 978-3-13-106592-6 .
- KP Schulitz, HO Dustmann: Perthes disease. 2nd Edition. Springer Verlag, Berlin / Heidelberg 1998, ISBN 3-642-63772-8 .
- LT Staheli, KM Song: Pediatric Orthopedic Secrets. 3. Edition. Mosby, Elseviers, 2007, ISBN 978-1-4160-2957-1 .
- D. Tönnis: Congenital hip dysplasia and hip dislocation in childhood and adulthood . Springer, Heidelberg 1984, ISBN 3-540-13015-2 .
- L. v. Laer, R. Kraus, WE Linhart: Fractures and dislocations in growing age. 6th edition. Thieme Verlag, Stuttgart 2013, ISBN 978-3-13-674305-8 .
- DR Wenger, M. Rang: Art and practice of children's orthopedics. Raven Press, New York 1993, ISBN 0-88167-867-8 .
- N. De Sanctis, H. Bensahel, J. de Mesquita Montes, K. Parsch: EPOS History, 25 Years of European Pediatric Orthopedic Society. Sorrento 2007. http://www.epos.org/
- K. Parsch, S. Stotz: 25 years of the Association for Pediatric Orthopedics 1987–2012.