Pediatric orthopedics; It is a sub-branch of the Orthopedics and Traumatology Department that deals with the diagnosis and treatment of all skeletal muscle system diseases in infants, children and adolescents and the problems of these diseases that can be carried to advanced ages. Since the body development process continues significantly from birth to adolescence in terms of the skeletal muscle system, orthopedic problems encountered in these periods require different diagnosis and treatment methods compared to adults.

COMMON DISEASES IN PEDIATRIC ORTHOPEDICS

* Hip dislocation (Developmental hip dysplasia)

* Cerebral palsy

* Meningomyelocele (Spina bifida)

* Congenital clubfoot (Pes equinovarus)

* Short stature

* Congenital musculoskeletal deformities

* Spinal curvatures (scoliosis, kyphosis, etc.)

* Skeletal musculoskeletal tumors

* Walking problems

* Flat feet (Pes planovalgus)

* Childhood fracture dislocations and soft tissue traumas

* Congenital arm paralysis.

DEVELOPMENTAL HIP DISPLACEMENT

If the baby’s neck is bent to one side when born, this condition is called congenital bent neck (torticollis). If torticollis is present, the neck is bent and the head is turned to one side The child’s ear is closer to the collarbone, the face is facing the opposite side. The reason for this situation is that the muscle in that area is tense. There is no pain in congenital neck curvature.

Symptoms

• Head tilted to either side, face turned the other way.
• A hard mass is observed in the muscle. This mass gradually gets smaller and disappears.
• The movement of the neck is restricted.
• One side of the face seems to be flattened and the other side is elongated.
• Since it can be similar to different problems, the diagnosis should be made by a specialist physician.

Treatment

Since congenital hip dislocation is seen in one out of every 5 children with a curved neck, the physician examines the baby’s hips before the diagnosis and treatment procedures to determine whether there is a dislocation. Initial treatment is exercises to be done several times a day. The head is turned to the opposite side and the neck is tilted to the opposite side. In this way, it is tried to lengthen the muscle. Toys or items that will attract the child’s attention can be placed in this direction so that the child can turn his head to the desired side while lying down. Generally, curved neck cases improve within a year. If it does not improve, the tense muscle is intervened with surgical method.

FLEXIBLE FLAT FOOTWEAR FOR CHILDREN

When children are born, they have flexible flat feet on their feet. When the child stands up and touches the ground, the arc of the foot disappears. The child’s mother, father and other relatives are worried if the child has a permanent disability. Many children continue to grow this way without any problems.

The following can be said for flexible flat feet:

• It is painless.
• Does not affect walking and doing sports.
• It resolves spontaneously without any treatment or surgery.
• In flexible flat feet, muscle functions and joint movements are normal, so the feet are also considered normal.
• The shape of the bones and solid ligaments prevent the flattening of the arch of the foot between the heel and toes.
• As the child grows and walks on his feet, the soft tissues tighten and harden, the arch of the foot appears.
• Usually after the age of 5, the foot takes its normal shape. If the child has reached puberty and still has flat feet, it may be the cause of pain. Painful cases require a doctor’s examination.

Treatment

If the child feels pain in the feet and legs when walking, exercises that stretch the Achilles tendon are recommended, insoles are recommended. If the Achilles tendon is too tight, lengthening can be done with a cast. Surgery may be required if you have painful flat feet during puberty. Rarely, some flexible flat feet become stiff as the child grows and may require additional medical attention.

SLIP OF THE FEMUR HEAD

It is the most common hip disorder in adolescence. The duration of diagnosis will determine the quality of the outcome of the treatments. The cartilage plate that enables the growth of the femur bone is between the head and neck. In growing children, the head displaces from this cartilage. Thus, a deformity occurs in the hip joint. The child is unable to turn the hip inward, stands with the foot turned outward, the leg is shortened, and it is painful to stand. This condition is more common in children aged 10-18, especially in obese or athletic children. With surgery, the femoral head is attached with nails and further slippage is prevented. Nails allow the head to attach to the bone. Treatment is even more difficult if arthritis has developed. Other surgeries may also be required.

KNOWLEDGE (Clubfoot)

It is the condition of the toes and heel pointing inward, and even if you try to fix it manually, it will not help. In addition, the legs are thin and short than they should be. About one in 1,000 newborn babies has this foot deformity. Since much simpler deformities can be mistaken for clubfoot, it is necessary to be careful when diagnosing them.

Before the child starts walking, his feet must be made functional and smooth. The first treatment to be followed is stretching and casting. For the correction of the foot, the stretching movements are tried to normalize the foot with the serial plastering technique. Casting continues for 6-12 weeks. During this period, changes in color and temperature of the feet should be monitored regularly and the treating physician should be informed immediately when these conditions occur. Special shoes and tools continue to be used to prevent the foot from regaining its former state after the treatment. Doctor follow-up is important during this period, as the risk will continue for up to seven years.

If it is understood that this treatment will not produce results, surgical methods are applied when the child is 6-12 months old. All deformities of the foot are corrected in a single operation. Rarely, another operation may be needed after the child has completed the growing period. After the clubfoot is corrected with surgery, the deformity may recur with the pulling of the muscles. For this reason, the feet are supported with special shoes for a minimum of one year.

If the treatment is successful, the child will have normal or very close to normal feet. When he grows up, he wears the shoes that everyone else wears, runs and plays with his friends as he pleases. However, the foot may remain small and the leg may remain thin. However, it should be remembered that if left untreated, lifelong disability is inevitable.

DEVELOPMENTAL HIP DISPLACEMENT

In developmental hip dislocation, the head of the thigh bone (femoral head) cannot remain stable in its socket. Joint ligaments are also loose or tight. When the child grows up, the hip joint is fully removed. The nest is shallow, the head remains small. This is why the child walks late. f left untreated, it causes calcification of the joint and the hip becomes painful. There is shortness on the protruding side.

arly diagnosis and treatment is very important in developmental hip dislocation. When the baby is born, the hips should definitely be examined. Ultrasound examination is required in suspicious cases and infants at risk. Treatment is difficult and more complex if diagnosed after the child has started walking. Sometimes it is impossible.

Symptoms

Symptoms Developmental dislocation of the hip sometimes may not cause any symptoms, but in the presence of the following conditions, it is necessary to consult a doctor.

• Length difference between legs
• Asymmetry in skin pleats
• Restriction in hip movements
• limping * Toe walking
• Taking wide steps to the right and left without breaking the knee

Treatment

The treatment process varies according to age. Early diagnosis makes it easier to reach the result and the treatment process.

In newborns

It is treated with scarves called Pavlik that hold the hip in place. With this scarf, the hip is kept in the desired position for 1-2 months. During this period, the joint ligaments will tighten, the socket will develop and the hip will not be able to come out.

1-6 Aylıklarda 1-6 Months Pavlik scarf can also give positive results in these months. If it doesn’t work, the hip is put in place under anesthesia and the child is put in a cast. The plaster period may take 3-4 months.

6-18 Aylıklarda The hip is placed under anesthesia and a plaster cast is made. If the procedure cannot be completed with closed methods, surgery is performed, the hip joint is opened and reduction is achieved in this way. In both methods, the plaster period is approximately 4 months and is mandatory.

Over 18 months In this period, the situation has reached much more serious dimensions. A larger surgical operation may be required. With this operation, it is tried to give depth to the shallow slot. In older children, the femur is also intervened. Casting is done after surgery; plaster time is 6-8 weeks. A larger surgical operation may be required. With this operation, it is tried to give depth to the shallow slot. In older children, the femur is also intervened. Casting is done after surgery; plaster time is 6-8 weeks.

INDOOR PRESSURE

Introversion is the inward pointing of the toes while walking or running, instead of facing forward. If your child is walking with an inward stride, it will most likely return to normal as he gets older. It does not require special shoes, exercises or any treatment. Children walking by stepping in may trip and stumble. It should also be known if:

• Usually does not cause pain.
• Does not pose a question in learning to walk.
• It does not cause calcification in adult life.

Causes of Push In

• Rotation in the tibia bone
• Rotation in the femur (thigh) bone
• Knee-bent leg
• Introversion in the comb bones