Orthopaedics plays a critical role in ensuring healthy growth and mobility in children. Many orthopaedic conditions are congenital (present at birth) or develop in early childhood, affecting limbs, joints, bones, or the spine. This article breaks down the causes, clinical features, diagnosis, and management of common congenital and childhood orthopaedic disorders in a clear, structured format.
What Are Congenital Orthopaedic Disorders?
These are structural or functional abnormalities of the musculoskeletal system that are present at birth or manifest during early childhood. They range from mild foot deformities to complex joint dislocations or spinal defects. Timely diagnosis and multidisciplinary intervention are essential to avoid long-term disability.
Causes of Congenital Disorders
Congenital orthopaedic diseases arise due to genetic, environmental, or intrauterine factors.
Major Causes:
- Genetic defects
- Intrauterine infections (rubella, CMV)
- Drugs, chemicals, irradiation
- Intrauterine vascular events
- Positional deformities (e.g., oligohydramnios)
- Metabolic disorders (e.g., rickets)
- Muscle diseases (e.g., Duchenne muscular dystrophy)
Classification of Childhood Orthopaedic Disorders
1. General Abnormalities
Cerebral Palsy (CP)
- Leading cause of childhood disability (~40%)
- Causes: brain damage during birth → spasticity, contractures, weakness
- Requires multidisciplinary care: physiotherapy, botulinum injections, orthopaedic surgery
Achondroplasia
- Short-limbed dwarfism due to growth plate mutation
- Trunk is normal, limbs are short
Osteogenesis Imperfecta
- "Brittle bone disease" due to collagen deficiency
- Features: multiple fractures, blue sclera, hearing loss
Enchondromatosis (Ollier disease)
- Cartilage tumors in long bones → deformity, shortening
Osteochondroma
- Bony outgrowths (exostoses) on long bones
- Often asymptomatic
2. Specific Disorders
A. Hip Disorders
Developmental Dysplasia of the Hip (DDH)
- Also called Congenital Dislocation of the Hip (CDH)
- Seen in 1.5 per 1000 births; more common in females
Pathogenesis
- Flat acetabulum
- Lax capsule
- Retroverted femoral neck
- Posterolateral dislocation
Clinical Signs
- Asymmetrical thigh folds
- Short limb
- Limited abduction
- Positive Barlow and Ortolani tests
Diagnosis
- Ultrasound in <6 months
- X-ray in >6 months
Treatment
- Early: Harness (Pavlik)
- Late: Surgery (osteotomy)
- Risk of OA if untreated
B. Foot Disorders
Talipes Equinovarus (Clubfoot/CTEV)
- Foot is adducted, supinated, with short midfoot
- High heel, tendon shortening
- Underdeveloped limb
Treatment:
- Ponseti method (casting)
- Surgery if resistant
Other Foot Disorders:
- Talipes Calcaneovalgus – reverse of clubfoot
- Metatarsus Adductus – forefoot deviates medially; 90% resolve spontaneously
- Pes Cavus – high arch foot (often neurological)
- Flat foot – often benign; due to ligament laxity
C. Knee Disorders
- Genu Varum – bowed legs
- Genu Valgum – knock knees
- Usually self-limiting unless severe or asymmetrical
- Osgood-Schlatter disease – bony prominence at tibial tuberosity due to traction
D. Spine Disorders
Spina Bifida & Meningomyelocele
- Neural tube defect: spinal cord and meninges protrude
- Associated with hydrocephalus (Arnold-Chiari malformation)
- Leads to lower limb weakness, bladder/bowel dysfunction
Scoliosis
- Lateral curvature of the spine
- Idiopathic most common
- Treated with bracing or surgery in severe cases
E. Neck
Torticollis
- Sternocleidomastoid muscle contracture → tilted head
- Can be due to birth trauma
- Treatment: physiotherapy, surgical release if severe
F. Legg-Calvé-Perthes Disease
- Avascular necrosis of the femoral head
- Affects boys (4–10 years)
- Symptoms: hip pain, limping
- Radiograph: sclerosis and fragmentation of femoral head
- Management: activity restriction, surgical containment if severe
G. Slipped Capital Femoral Epiphysis (SCFE)
- Femoral head slips from the neck at the growth plate
- Adolescents (esp. obese males, age 10–16)
- Symptoms: hip/knee pain, limp, limited internal rotation
- Risk of avascular necrosis
- Needs urgent surgical fixation
Management Principles
General Approach
- Multidisciplinary team: paediatrician, orthopaedic surgeon, physiotherapist, occupational therapist
- Early detection and intervention
- Regular developmental monitoring
- Imaging: X-ray, ultrasound, CT/MRI when needed
Key Interventions
| Condition | Treatment |
|---|---|
| DDH | Pavlik harness / open surgery |
| Clubfoot (CTEV) | Ponseti method / soft tissue surgery |
| Cerebral palsy | Botox, tendon release, splints |
| Spina bifida | Neurosurgical correction |
| Scoliosis | Bracing / spinal fusion surgery |
| SCFE | Urgent pinning surgery |
| Torticollis | Stretching, surgical release |
Key Points to Remember
- DDH must be screened in all newborns (Barlow & Ortolani tests)
- Cerebral palsy is the most common cause of disability in childhood
- Clubfoot requires early intervention for best outcomes
- SCFE is an emergency—can lead to hip joint collapse if untreated
- Children with neuromuscular disorders often need long-term orthopaedic follow-up
Frequently Asked Questions (FAQs)
1. Is DDH genetic?
Yes. Family history and female sex are major risk factors.
2. Can children outgrow flat feet?
Yes, most cases resolve naturally by age 6–7.
3. What is the difference between valgus and varus?
Valgus: knees knock in (genu valgum); Varus: legs bow outward (genu varum).
4. Is scoliosis painful?
Not always. Mild scoliosis may be painless. Severe curves may cause back pain or breathing issues.
5. Can cerebral palsy be cured?
No cure, but early intervention improves quality of life significantly.
Conclusion
Congenital and childhood orthopaedic disorders may begin silently but can affect lifelong mobility, posture, and function. With increased awareness, early screening, and a multidisciplinary approach, most of these conditions can be effectively managed—restoring not just limbs, but lives.
