Paediatric Orthopaedics: Bone & Joint Treatment In Children

A child's musculoskeletal system is fundamentally different from an adult's, not just in size, but in how it responds to injury, how it grows and how it repairs itself. The growth plates sitting at the ends of long bones are not simply cartilage that will eventually harden. They are the engines of longitudinal growth, and damage to them has consequences that extend far beyond the injury itself. This is why paediatric orthopaedic care is a separate discipline, not simply adult orthopaedics applied to smaller patients.

At CARE Hospitals, our paediatric orthopaedic specialists assess and treat the full range of bone and joint conditions in children from the fractures that follow a fall in the playground to the congenital conditions identified at birth, and everything that develops in between.

Common Bone & Joint Problems in Children

The conditions that bring children to a paediatric orthopaedic clinic span a wide range. Some are present from birth. Others emerge as the child grows. Some follow injury; others develop insidiously without a clear cause. These are:

• Fractures: Children break bones frequently. Forearm fractures, clavicle fractures and supracondylar fractures of the elbow are among the most common. What distinguishes a child's fracture from an adult's is the involvement of the growth plate (physeal fracture) and the degree of remodelling the bone can undergo during subsequent growth. A fracture that would need surgical fixation in an adult may heal acceptably with casting in a child, provided the alignment is within the limits the growing bone can correct.
• Developmental dysplasia of the hip (DDH): The hip socket fails to develop normally around the femoral head, leaving the joint unstable or frankly dislocated. Caught in the neonatal period with a harness, outcomes are excellent. Left undetected until a child starts walking with a limp, surgical correction becomes necessary and the outcomes are less predictable.
• Clubfoot (congenital talipes equinovarus): The foot is turned inward and downward at birth. With the Ponseti method (serial casting started in the first weeks of life) this deformity is correctable without major surgery in the vast majority of cases.
• Scoliosis: Lateral curvature of the spine that develops during the growth years, most commonly in adolescent girls. Mild curves are monitored. Moderate curves are braced. Curves above 45 to 50 degrees in a growing spine require surgical correction before skeletal maturity locks the deformity in place.
• Perthes disease: Avascular necrosis of the femoral head in children, most common between ages four and ten. The blood supply to the femoral head is disrupted, the bone dies and then regenerates, a process that takes two to four years. If poorly managed, it results in a deformed femoral head and early hip arthritis.
• Osgood-Schlatter disease: Pain and swelling at the tibial tuberosity (just below the kneecap) in adolescents who are active in running and jumping sports. The growth plate at this site is stressed by the quadriceps pulling through the patellar tendon during rapid growth. Painful but self-limiting. Activity modification and physiotherapy manage most cases without intervention.
• Limb length discrepancy and angular deformities: Legs of noticeably different lengths, knees that bow inward (genu valgum) or outward (genu varum) beyond what is normal for the child’s age. Some resolve spontaneously with growth; others require guided growth techniques or osteotomy to correct.
• Infections (osteomyelitis and septic arthritis): Bacterial infections of bone or joints are orthopaedic emergencies in children. A hot, swollen, painful joint with fever in a child who refuses to move the limb or bear weight needs same-day evaluation. Delayed treatment risks joint destruction and growth disturbance.

Treatment for Bone & Joint Problems in Children

The treatment approach is determined by the diagnosis, the child's age and the stage of skeletal development. Surgery is not the default. The developing skeleton has a capacity for remodelling and self-correction that adult bone does not and paediatric orthopaedic management is built around using that capacity wherever possible. Treatment options are:

• Casting and splinting: The backbone of paediatric fracture management and the primary treatment for clubfoot. Serial plaster casting in the Ponseti technique corrects clubfoot deformity through a specific sequence of manipulations over six to eight weeks. For fractures, casting maintains alignment while the bone heals, often without the need for any surgical fixation.
• Bracing and orthoses: Scoliosis curves in the 25 to 45 degree range in a growing child are managed with a brace worn 16 to 20 hours per day. The Pavlik harness holds the hip in a position that promotes socket development in infants with DDH. Foot orthoses manage symptomatic flatfoot. The common thread is that bracing works best when the skeleton is still growing and the brace can guide development rather than simply support a fixed structure.
• Guided growth: For angular deformities and leg length discrepancy, a small implant placed across the growth plate on one side of the bone slows growth on that side, allowing the other side to catch up. It is reversible, requires a small procedure and uses the child’s own growth as the corrective mechanism. Elegant when the timing is right.
• Surgery: The decision to operate is made when conservative management has reached its limit or when early surgical correction produces a substantially better long-term outcome than waiting. Surgical measures are:
  • Open or closed reduction for DDH that has not responded to harness treatment. 
  • Posterior spinal fusion for scoliosis curves above the bracing threshold. 
  • Intramedullary flexible nailing for displaced fractures. 
  • Surgical washout for septic arthritis. 
  • Soft tissue releases for cerebral palsy spasticity. 

When to See a Paediatric Orthopaedic Doctor

Some presentations need same-day emergency assessment. Others can wait for an outpatient appointment. Knowing which is which matters. Go immediately if a child has:

• A hot, swollen joint with fever 
• Refuses to move it or bear weight
• Any significant deformity after trauma
• An open fracture
• Neurological symptoms like weakness, numbness, loss of bladder or bowel control alongside spine or neck pain.

Book an early appointment if the child limps persistently without an obvious cause, complains of joint or bone pain that does not settle within a few days, has visibly unequal leg lengths, toe-walks beyond age three or has a spine that appears curved. Newborns with clubfoot or a hip that clicks on examination should be referred without delay.

What to Expect During a Paediatric Orthopaedic Visit?

The first consultation begins with a detailed history of when symptoms started, how they have changed, whether there was an injury, what the birth history was for congenital concerns and what the child's general development has been like. Parents are the most important source of this information; children, depending on age, contribute their own account of pain and functional limitation.

Physical examination assesses gait, joint range of motion, limb alignment, muscle tone and neurological function in the limbs. For spinal concerns, the Adams forward bend test is used to detect rotational deformity that is the hallmark of scoliosis. Hips are assessed for range of motion and provocative signs of dysplasia or Perthes.

Imaging is ordered based on what the examination suggests, not routinely. An X-ray is usually the first step. MRI is used for soft tissue, growth plate and spinal cord assessment. The radiation protocols for children are adapted to minimise exposure while maintaining diagnostic quality.

At the end of the visit, the family receives a clear explanation of the diagnosis, what the management plan involves and what the realistic expectations are. For conditions requiring monitoring, like scoliosis, Perthes, and DDH follow-up, the review schedule is established and the family understands what changes would prompt an earlier return.

FAQs

1. What are common bone problems in children?

Fractures are the most frequent, particularly of the forearm, clavicle and elbow. Beyond trauma: clubfoot and DDH in infants, scoliosis in adolescents, Perthes disease and Osgood-Schlatter in school-age children, and infections of bone or joint at any age. Leg length discrepancy and angular deformities such as bow legs and knock knees are common reasons for referral in younger children.

2. When should I consult a doctor?

A persistent limp, joint pain lasting more than a few days, visible deformity, or a child who stops bearing weight without a clear explanation all warrant an assessment. Fever with a swollen joint is an emergency do not wait. Newborns with foot deformity or asymmetric hip creases should be seen within the first few weeks of life, where a short window of opportunity for non-surgical treatment exists.

3. How are fractures treated in kids?

Most children's fractures are treated with casting, taking advantage of the bone's remodelling capacity to correct residual angulation during subsequent growth. Significantly displaced fractures, those involving the growth plate with a step-off, or unstable fractures may need surgical fixation, typically with flexible intramedullary nails or small screws that preserve the growth plate. The growth plate is treated with particular care; crossing it with a large implant can tether growth on one side and produce a deformity.

4. Is surgery required in all paediatric bone issues?

No and in paediatric orthopaedics, avoiding unnecessary surgery is as important as performing necessary surgery well. Many conditions that require surgical correction in adults resolve with casting, bracing or guided growth in children. Clubfoot corrects with serial casting in most cases. Scoliosis below 45 degrees in a growing child is braced, not fused. DDH in infants responds to a harness. The growing skeleton provides treatment options that simply do not exist once growth is complete.