CHILDREN'S PERSPECTIVE

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1 CHILDREN'S PERSPECTIVE ISSUE Lat dorsi and teres major are the muscles transferred to provide active shoulder abduction. Muscle transfers of triceps to biceps, Rerouting of pronator teres, finger flexors to intrinsics are also useful procedures. 01 April 2010 Paediatric Orthopaedic Update rom Ortho One or Paediatricians, Orthopaedic Surgeons, Parents And riends. Common myths The plexus injury cannot be prevented, vigorous exercises should be started immediately, the palsy is What's Inside? transient and the child will always recover from it. These are wrong beliefs. How to prevent OBPP? Spot Light : Recognition of breech delivery and other malpositions earlier and induction of early labor when large baby is anticipated are certain measures to prevent OBPP. School Backpacks and What should we do once we have a child with OBPP? Back Pain. Documentation of injury has to be done, indicate which arm is involved. Document what obstetrical maneuvers were employed throughout labor. The family has to be counseled properly. Optimizing Ø Arthrodiastasis - shoulder dystocia management, invariably associated with brachial plexus palsy is also a vital part of Way out for problem future OBPP prophylaxis. stiff hips in children. Ø Growth modulation - A simple method of correcting limb PRE OP OBPP SURGERY deformities. POST OP OBPP SURGERY Ø Obstetric brachial TEAM Edited by : Dr. K. Vinodh, M.Ch., Ortho (UK), D. Ortho., plexus palsy in the new born. Dr.S.G. Krishnan (Hon) Dr. David V.Rajan Dr. K.Vinodh lymphoblastic Dr. J.Clement Joseph leukemia can Dr. Siva Kumar (Chennai) masquerade as hip Dr. Easwar.T.R SCHOOL BAGS & BACK PAIN We are increasingly seeing school children presenting with back pain. Parents often wonder if the heavy school bags that these children have to carry are the culprits. Is there a direct relationship between the weight of the school bag and back pain? It is a well accepted fact now that heavy backpacks can cause back pain and long term damage to the spine. Several studies have proved this fact. The general guideline is, the weight of the bag should not exceed 10% of the body weight of the child. It is well known that this is not the case in many instances. MRI studies by gradually loading the bags more than 10% of the body weight have shown decrease in disc heights and malalignment of the spine. The children also started complaining of pain. The inside of the bag close to the spine should also be well padded. The way children carry the bags also matters. The bag should be carried over the back on both shoulders. The lower end of the bag should be above the level of pelvis. Children should be taught to arrange their bags. The bag should be arranged in such a way that the heavy books are close to the back. They should be advised to carry only the necessary books for that day. By spending some time with our children and paying attention to selection of bags back pain due to school bags can be prevented. Ø How acute pathology. 657, Trichy Road, Singanallur Coimbatore , Tamilnadu, India Contact No. : / 9; Emergency No. : / 9 (9.00 am pm) (24 Hours) E- mail : ortho.one@gmail.com, ortho.one@ortho.one.in Website :

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4 On removal of the fixator intensive physio is carried out to gain active movements.arthrodiastasis is a How is it done? useful tool as a salvage procedure for the problem stiff hips with the view to unload the collapsing hip, We use a small metal clip called staple or a small plate and two screws which are placed across and thereby allow some amount of cartilage regeneration. The early results of arthrodiastasis for painful, stiff hip in children are promising. Articulated fixators are ideal for this purpose. Patient selection is very important and this procedure should not to be done the growth plate. This plate known as 8 plate is becoming very popular and is very effective in controlling growth to effect deformity correction. Growth modulation is usually done towards the end of growth, which is between yrs in girls and yrs in boys. The growth plate is indiscriminately. not permanently damaged during this procedure and hence when the desired correction is CHONDROLYSIS POST SEPTIC DISTRACTION achieved, the plate can be removed and the bone allowed to grow normally. This procedure is relatively a minor procedure and after a few days rest the child can attend school without any walking aids. What are the advantages? Traditional procedures to correct bony deformity involve major open surgeries, followed by a period of some form of protective weight bearing and these children will miss school for some DO YOU KNOW ABOUT GROWTH MODULATION? time. Other method of deformity correction is with the use of external fixators like the Ilizarov's rings which is a slow process, and during this period these children will have to walk around Growth modulation is a term used for procedures used to correct deformities and limb length with these rings attached to their legs. However growth modulation is not a substitute for these discrepancies in growing children. These procedures are very effective in correcting limb deformities in procedures in every patient. The indications are very specific, and in carefully selected patients children towards the end of their growth period. Children present with deformities of the limbs due to the results are gratifying nutritional deficiencies like rickets, sequelae of infection and trauma, especially growth plate injuries, skeletal dysplasias and rare conditions like Blount's disease. It is a challenge to the treating orthopaedic surgeon to plan the management of correction, as the bones are growing and there is a high possibility of recurrence of the deformity. There are methods by which we can predict the extent of leg length discrepancy or deformity and plan at what time we should intervene. What is growth modulation? Bone grows longitudinally from both its ends through an area known as growth plate or physis. By slowing down growth in one half of the growth plate we can gradually correct a deformity in a bone or around a joint. This is a gradual process which takes months to years depending on the extent of deformity. This process can be reversed and the bone made to grow normally. This is known as growth modulation. 8 PLATE

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