Fortunately most of these problems are rare with an incidence of less than 1 in 2000
Dislocated Hip (DDH)
This condition varies in severity; most cases are detected shortly after birth by routine examination. The risk is increased with a family history, breech presentation, female sex and first born. An ultrasound scan will detect the problem. In older infants there may be limitation of sideways movement of the leg or a painless limp after walking. If detected early it can be treated by a splint or harness, in the older infant surgery may be needed but it may be difficult to make the hip completely normal.
Club Foot (talipes equino varus)
This can be detected on antenatal ultrasound scanning but it is difficult to assess the severity. Most cases are an isolated problem (idiopathic) but sometimes it occurs in association with other abnormalities. Almost all patients these days are treated by the Ponseti regime of plastering and special boots which gives good results and surgery is quite uncommon except for difficult cases.
Osteomyelitis and septic arthritis
These are serious infections that require prompt treatment. There may be redness and swelling and the child is unwell with a fever and unwilling to take weight or move a limb.
Sports Injuries & Fractures
Whilst children can suffer the same sorts of injuries as adults, ligament injuries are less common and a child is more likely to sustain a fracture (see below). Very sporty children can sometimes develop overuse injuries where the muscle tendons attach to bone that is still a little immature. These conditions may be more frequent if the muscles are tight. The muscles and the bones may not grow at the same rate so these problems are more common during growth spurts. Patients usually complain of aching pain after or during exercise limiting activity. Common sites are around the knee cap or upper shin bone where a lump may develop (e.g. Osgood Schlatters disease), the heel and sometimes the hip. Treatment is usually by stretching out tight muscles (don’t forget warm ups before sport!), activity restriction and a short course of painkillers.
Read more about Sports Injuries
Fractures in children are different from adults. The bones heal quicker and some deformities will correct with growth unlike the adult. Some fractures involve the growing part of the bone, (growth plate), these can cause serious problems with growth leading to shortening and deformity; the fracture should be lined up as accurately as possible to minimise this risk and surgery may be required. As in adults a fracture that goes into a joint is a serious problem. There is a different pattern of fractures in children compared to adults which is age related.
Some children’s fractures are known to be difficult to be troublesome for example the supracondylar fracture of the elbow and hip fractures. It is worth asking for a paediatric orthopaedic opinion for any growth plate injury and any complex elbow injury.
Read more about Fractures