Paediatric Orthopaedic Surgery

 

Paediatric orthopaedic surgery treats conditions and injuries of the musculoskeletal system in children. Common problems associated with the musculoskeletal system in children include hip dysplasia and foot deformities. Hip dysplasia is often hereditary, and other metabolic and neuromuscular disorders can also affect the body's musculoskeletal system. Listed below are some common procedures performed during paediatric orthopaedic Brisbane.

Prehabilitation interventions

Early and well-timed prehabilitation can significantly reduce the postoperative length of stay. A recent systematic review found that prehabilitation interventions led to a reduction of hospital LoS and extra bed days by 8%, which is equivalent to saving the lives of forty extra children. In paediatric orthopaedic lower limb surgery, prehabilitation interventions are as simple as goal setting and patient education.

In the current study, patients who have undergone prehabilitation interventions are more likely to recover from surgery with a minimal level of functional independence than patients who did not receive prehabiliation. The intensity, duration, and frequency of prehabilitation interventions were correlated with improved perioperative outcome. Prehabilitation interventions were first described in 1946 and have gained increasing acceptance since then. While the cost of prehabilitation interventions has not been formally evaluated, it is suspected that a physiotherapy-guided strength training programme prior to surgery could enhance postoperative recovery.

Supraglottic devices

Various supraglottic devices have been used in paediatric orthopedic surgery to secure a patent airway. The most common of these devices is the laryngeal mask airway (LMA), which has undergone various modifications both in clinical practice and in the literature. One relatively new device is the i-gel airway. This device has a gel-like thermoplastic elastomer cuff that is inflated. The device is comparable to the LMA in many aspects.

Another common use of these devices in paediatric orthopaedic surgery is for airway management. These devices can be used as primary devices, as well as back-ups in difficult airway management. Unfortunately, most of these devices have not been evaluated clinically before release to the market. Therefore, we conducted this study to evaluate these devices. We compared the effectiveness of three different supraglottic airways for paediatric surgery.

Anaesthetic techniques

There are several different types of anaesthetic techniques available for paediatric orthopaedic surgeries. The most popular is spinal anaesthesia, which is only suitable for certain procedures and is associated with a lower risk of postoperative apnoea. This technique is also less likely to cause vomiting and nausea, and it is also suitable for high-risk infants.

The main differences between general anaesthesia for adults and the anaesthetic technique used during paediatric surgery include the different methods of pre-anaesthesia preparation, induction, and maintenance of anaesthesia in children. During paediatric orthopaedic surgery, a thorough pre-anaesthetic evaluation should take place, which should include a review of the child's systems, an anaesthetic-directed physical examination, and modifications appropriate to the child's age and developmental stage. The physiology of children undergoes changes to accommodate for the child's development and a family history.

Children's anatomy

As the name suggests, paediatric orthopaedic surgery deals with conditions affecting children's musculoskeletal and locomotor systems. As children's bodies are different from those of adults, the approach used by paediatric orthopaedic surgeons must reflect that difference. Furthermore, paediatric orthopaedic surgeons treat symptoms as well as prevent late complications in adulthood.

Pediatric fractures tend to occur at a lower energy level than those of adults, resulting in torsion, compression, and bending moments. Compression fractures, which occur at the metaphyseal-diaphyseal junction, may result in an acute angular deformity. Torsion injuries, on the other hand, may result in two distinct patterns depending on the degree of physeal maturity.

Treatment of fractures

Early stabilisation of a fracture in a multitrauma child is important for a number of reasons. This is because early stabilisation reduces pain and the complication of immobilisation, enables easier transfers and mobilization, and reduces the inpatient stay. In addition, definitive fixation of a fracture in an early stage of multiorgan failure is less invasive and safer than delaying treatment until the fracture has fully healed.

Firstly, the fracture must be identified and treated early. The aim is to minimise pain, prevent infection, and promote bone healing. The treatment process can take several different forms, ranging from skeletal traction and casting to surgical alignment. Non-union of a fracture occurs when the broken bone does not receive adequate nutrition, blood supply, and stability. It is also associated with deformity and difficulty bearing weight.

Treatment of CTEV deformities

Treating CTEV deformities is a common paediatric orthopedic issue. Treatment focuses on achieving a pain-free, plantigrade foot. While surgical correction has shown some success in some patients, it is not a cure for CTEV. The most successful treatment is often a combination of minimal surgery and other treatments. This approach should be explored further.

Both surgical and non-surgical approaches to correct CTEV deformities are described in the literature. In one study, 14 feet of 14 patients underwent posteromedial soft tissue release at the Department of Orthopaedics, S. V., over a one-and-a-half year period. Results were graded according to Denis-Brown severity. The sex ratio was 2.5:1. Of the 14 patients, a total of eight patients developed postoperative complications: nine developed a superficial infection and ten required a CTEV boot. Although this was an improvement over non-surgical treatment, the results were not as satisfactory as those of surgical techniques. The mean follow-up of the C-group was ten months, while those of the E-group were eleven months.