Pediatric orthopedic conditions: Clinical

Pediatric bone pathologies typically cause pain, and it can vary in terms of intensity and radiation.

Pain usually involves the hip, knee, and back, and it usually worsens over time. If it involves one leg, the pain can lead to limping, and in some cases, individuals might not be able to bear weight.

The symptoms might be unilateral or bilateral, and they might worsen after physical effort and improve with rest. Arm pain is usually related to fractures or arm injuries secondary to trauma and an x-ray or CT of the arm is enough for diagnosis.

The conditions can be divided into those lead to hip pain which include developmental dysplasia of the hip, Legg-Calve-Perthes, slipped capital femoral epiphysis, and transient synovitis; those that cause knee pain, mostly represented by Osgood-Schlatter disease; and conditions that lead to back pain, usually congenital scoliosis.

First, developmental dysplasia of the hip or DDH is mostly associated with newborns, and it’s a spectrum of conditions that includes abnormal development of the acetabulum and proximal femur, and mechanical instability of the hip joint.

DDH results from laxity of the ligaments around the joint or from in utero positioning.

First, history might reveal associated risk factors like a positive family history of DDH, female gender, breech presentation at more than at 34 weeks of gestation, and tight lower extremity swaddling.

Physical examination might detect limited range of motion of the hips and legs, asymmetry of the limbs if only one side is affected, or asymmetric skin creases in the thigh and groin.

In those up to 6 months of age, DDH can be detected by the Barlow and Ortolani tests, which are also widely used as screening tests. The tests begin with the individual laying on their back on a stable surface with the hip flexed to 90° and in neutral rotation, which is when the limb is turned neither toward nor away from the body's midline.

During the Barlow test, the hip is then slightly adducted, which is when the thigh is brought towards the midline, while the examiner's hand is placed on the knee, directing the pressure posteriorly. The test is positive when a clunk indicates that the head of the femur is moving out of the acetabulum.