INTRODUCTION
About 5% of the total population of India suffers from physical disability which may be congenital or acquired in due course. Persons with disabilities could not live normal life as they do not perform normal activities. This becomes burden to the family, to the society and so to the state.
Pediatric Orthopedics as a super specialty in the field of Orthopedics,
Because of continuous advancement in the different fields of Orthopedics, it becomes extremely difficult to be aware of & be updated by the newer concepts in the specialty fields. The principles of Pediatric Orthopedics are changing and research work has been tremendously accelerated in the last few years. It is the time to develop a new approach towards this field of orthopedics.
Pediatric bones are unique in their anatomy & differ from the adults by the presence of “growth plate”. It is vital & a demanding skill is required to preserve the growth plate while treating bony anomalies to avoid future growth disturbances. Pediatric bones also behave differently depending on their remodeling attitude.
Many developmental conditions require a thorough knowledge of the complete natural history of the abnormality to predict the most possible future outcome. This information helps to visualize the future productivity of the child & its independent functioning.
It warrants detailed clinical examination to diagnose the exact problem, as unlike adult patients, we do not have access to the verbal clinical history. It requires tremendous experience to bring out correct clinical findings from tiny bones of pediatric patients. A small error can magnify the problem in adulthood.
Pharmacotherapy of these patients is not generalized but weight related, so it is important to have access to the correct dosage & formulations of various drugs. Pediatric anaesthesia, Pediatric pain management &Neuro-developmental therapy are also critical part to effect the successful outcome. Most of the times, it is a comprehensive approach to a single problem, requiring a team work to lead the child to a self-dependent and productive life.
Finally, the growth of these children has to be continuously monitored and timely interventions have to be done to prevent irreversible problems.
As per the latest census, 2.41% of the total population of India is handicapped. But this does not give the actual picture, since it is believed by specialists that the actual figure may be much higher, given the facts that various families do not give the correct information leading to an incorrect calculation. Hence the actual figure can be pegged at a much higher 5%. of the total handicapped population of India, 50% of the reasons are congenital (birth defect) and the major chunk of the congenital defects is Cerebral Palsy. It is believed that for every 250 births, one child suffers from cerebral palsy.
The deformities, which will be treated falls into following categories.
(1) Congenial anomalies: Affect both joints & bones
(2) Post polio deformities: Polio leads to paralytic deformity
(3) Cerebral palsy: Causes Spastic paralysis involving both the limbs
(4) Post traumatic deformities: Due to birth trauma or accidents.
Management of Deformities
A. Preventive measures
1. Polio vaccination
2. Ante-natal medical check-up
3. Medical counseling of parents
B. Examination & investigation
1. Clinical examination by pediatric orthopedic surgeons
2. Path-lab. Investigation
3. CT-Scan
C. Medical measures
1. Symptomatic treatment by drugs
2. Physiotherapy, occupational therapy Speech therapy
3. Medical counseling of parents
D. Surgical measures
This measure involves various deformities which are subjected to the state of art corrective surgery as mentioned below,
Grade One
1. Plantar Release
2. Tendoachillies lengthening
3. Vulpius release
4. Hamstring release
5. Knee release
6. Adductor tenotomy
Grade Two
1. Hip release
2. Wilson release
3. Supracondylar osteotomy
4. Triple fusion
5. Ankle fusion
6. Flexor release (upper limb)
Grade Three
1. Shoulder fusion
2. Shoulder osteotomy
3. Tendon transfer
4. Hip osteotomy
5. CTEV PMR
6. Telectomy
Grade Four
1. Spine surgery
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