WINIFRED OGBEBO writes on how research and vigilance can help in the diagnosis and treatment of birth defects and abnormalities.
One day, a parent took their five-year old daughter for consultation. Upon investigation, it was found that she had dislocation of both hips. On further questioning, the doctor got to know that they were advised not to treat the child till she becomes 12 years old.
The doctor had to do a lot of explanation to convince them that reducing both hips early will give better quality of life.
According to a paediatric orthopaedic and spine surgeon of the Department of Pediatric Orthopaedic Surgery, Apollo Hospital, India, Dr R. Sankar, and this misguided advice happens because of consulting orthopaedic surgeons with no formal training in children’s orthopaedic problems.
He explained, “Since birth defects were my area of special interest, I was able to plan and perform this complex surgery on both hips of this child during their visit to India. This was done in two stages, – one hip at a time. It involved preparing the socket of the hip, open reduction and shortening of femur bone with plating to keep the hip in the socket. It nearly took three weeks for the child to get up and stand and two months to walk. The parents were thrilled to see their child walking and running like any other children. Now and then, they send me video of her playing around. “ Sankar, who was instrumental in setting up the paediatric orthopaedic department in the children’s hospital, Apollo Hospital, said reason for such complex surgery is because of late presentation.
“If hip dislocation is diagnosed at birth, it can be treated with Harness. Till the child is one year old, this can be managed with plaster cast. Any later diagnosis will end up with major surgery. In our institution, we always examine all new born present with risk factors for hip dislocation. Sometimes clinical examination is supported by ultrasound examination.”
The dream of every parent is to have a child born with no birth defects. Nowadays, medicine has advanced so much that lot of congenital abnormalities can be diagnosed very early as early management will lead the child to have a near normal life.
Sankar said common birth defects like clubfeet will show up as soon as the child is born but problems like hip dislocation can be missed till the child starts walking if parents are not vigilant.
“If conditions like these are diagnosed and treated early, they will have good quality of life. Literature suggests that late diagnosis will result in problem in later life.”
He said children should not be treated as little adults as their anatomic and physiological development is different from that of adults and so their response to disease, injury and surgery is also different from adults.
“Orthopaedic conditions, including birth and congenital defects (such as club foot or dislocated hip), require ongoing treatment and care from birth into adulthood. Management of children’s fractures differs significantly from adult fractures because of children’s growing bones and the presence of growth plates. Consequently, orthopaedic services should be tailored to meet the needs of paediatric patients.”
Paediatric orthopaedic surgeons can diagnose and manage children’s musculoskeletal problems, such as:
• Limb and spine deformities noted at birth or later in life (clubfoot, hip dislocation, radial and ulnar club hand, scoliosis, limb length differences)
• Gait abnormalities (limping)
• Neuromuscular Disorders
• Broken bones
• Bone or joint infections and tumours
By: Winifred Ogbebo
Leadership News
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