Pediatric Orthopedics

We help children suffering from bone, joint, and muscle conditions. When children’s activities from trampolines to monkey bars end up causing musculoskeletal injuries, our pediatric orthopedics care at American Hospital Dubai helps them heal and get them back to the sport and play quickly.

American Hospital Dubai is fully committed to delivering world-class treatment for pediatric orthopedic conditions, including chronic and congenital conditions that affect the bones and muscles, by a highly specialized team of expert Pediatric Orthopedic Doctors and Pediatric Physiotherapists alongside other healthcare professionals. We are also experts in Pediatric Rehabilitation Medicine and Pediatric Orthotic Services in parallel with our Pediatric Orthopedic expertise. Our multi-disciplinary approach ensures that your child receives the best possible care throughout the treatment of their condition here at the American Hospital Dubai.

Please continue reading to learn more about Pediatric Orthopedics, the patient’s journey towards healing, and the range of services we offer at the American Hospital Dubai.

About Pediatric Orthopedics:

Pediatric Orthopedics is the science and practice of treating children with deformities of the bone, joints, and muscles. It is a broad specialty encompassing congenital conditions a child may be born with or conditions arising in childhood from disease or injury. Children with pediatric orthopedic conditions usually present to the doctor with pain or deformity in their limbs affecting their function and well-being.

Why You Should See a Pediatric Specialist in Orthopedics:

Pediatric Orthopedics is quite distinct from adult orthopedics with very little overlap between conditions. In essence, problems affecting the bones, muscles, and joints in adults are very different to conditions affecting children. Degenerative change causing joint damage from arthritis or tendon injury/tears are not usually seen in children. Similarly, pediatric conditions such as slipped upper femoral epiphysis and Perthes disease do not arise in adulthood. It is always best to see a doctor with specific experience in managing pediatric orthopedic conditions in the first instance so that a diagnosis can be reached quickly and treatment commenced.

Investigations and treatments can be very different when comparing pediatric and adult orthopedics. Adult orthopedics mainly focuses on dealing with damaged joints and tendons with joint replacement technologies or tendon repair. In children, the emphasis is on the assessment of deformity and muscle imbalance. The Pediatric Orthopedic doctor focuses the clinical examination on whether there is an asymmetry in leg length, alignment, or muscle imbalance causing the child’s symptoms. The aims of treatment are to address the deformity and muscle imbalance through patient-specific treatment programs including physiotherapy, orthotics, and surgery to improve the comfort and function of your child.

In adults, bones, joints, and muscles may not change much over time. However, children are constantly growing producing an ever-changing landscape. Pediatric orthopedic doctors are experts in the development of children’s bones and joints and can provide the best advice on how your child’s condition will change as they grow. Many pediatric orthopedic conditions will improve over time, and the doctor can advise you on the timescale for improvement and whether treatment may be required. Some conditions may require early treatment before symptoms arise, whereas in other conditions, it will be best to treat only after symptoms arise.

Complex conditions require a lifetime treatment plan to address how the child’s condition will change over time and at what stages treatment will be required. The aim of every lifetime treatment plan is to ensure that comfort and function are optimized by the time the child reaches adulthood.

Pediatric Orthopedic Conditions We Treat:

Our portfolio of successfully treating pediatric orthopedic disorders covers all pediatric orthopedic conditions including:


• Congenital hip dislocation/developmental hip dysplasia – American Hospital has focused expertise in diagnosing and treating developmental hip dysplasia using a step-wise management program beginning with the most non-invasive treatments possible to achieve the best outcome. American Hospital has an ultrasound screening program for all babies deemed to have elevated risk of hip dysplasia to diagnose the problem early when non-invasive treatments will be most successful. Our treatments include hip bracing using the Pavlik harness, arthrogram assessment, closed reduction, and surgery. American Hospital is proud to offer the most comprehensive surgical treatment for congenital hip dislocation. Single-stage hip reconstruction combines open reduction, soft tissue surgery with femoral and pelvic osteotomies to restore the natural anatomy of the hip and minimize the time your child has to spend in a plaster cast following surgery. Following surgery, most patients will not require a plaster cast for longer than 6 weeks. The risk of repeat dislocation following surgery is comparable with the best Pediatric Orthopedic Centers in the world.

• Perthes disease – The American Hospital is at the forefront of early treatment of this condition to achieve the best possible outcome. We aim for early diagnosis and tailor treatment to the specific patient by evaluating the hip with an arthrogram to determine the optimal treatment strategy. Containment surgery is offered in selected cases to minimize the risk of future hip deformity giving rise to pain and stiffness requiring hip replacement surgery. In cases that present late where head deformity has occurred, we will discuss the various treatment options available to improve the clinical outcome including physiotherapy, hip distraction/arthrodiastasis, corrective osteotomy, and acetabular shelf augmentation.

• Slipped upper femoral epiphysis – Our doctors will carefully assess your child to determine a patient-specific treatment plan based on how long the problem has been going on, how severe the slip is, and the risk of complications with or without treatment. Treatments include pinning in situ for milder slips, open surgery with osteotomies to treat severe slips, and corrective osteotomies for healed deformities.

• Clubfoot – Ponseti treatment is undertaken by our dedicated clubfoot multidisciplinary team including pediatric orthopedics, physiotherapy, and orthotics. Serial casting is undertaken to slowly correct the deformity with Achilles tendon tenotomy as a final step. Our expert Orthotic service will ensure that your child has comfortable well sized boots and bar to maintain the correction throughout infancy with input from expert physiotherapists to keep your child’s feet strong and stretchy.

• Flatfeet – Severe flatfeet can become painful in teenagers particularly if they have tight calf muscles. Non-operative treatment is always the first line with specialist physiotherapy and orthotic insoles. Surgery is reserved for teenagers with significant flatfeet that still cause discomfort when walking long distances despite physiotherapy and orthotic insoles. At American Hospital, our Pediatric orthopedic Doctors undertake biological reconstruction with osteotomies and tendon procedures to change the shape of your child’s foot to improve their comfort levels without fusing joints or using artificial implants.

• High arched (cavus) feet – these can cause problems with children walking on the outside of their feet leading to discomfort when walking long distances, ankle instability and muscle tears due to repeated ankle sprains. Our Pediatric orthopedic doctors will assess the deformity clinically and with radiographs. If there is a significant deformity causing symptoms, surgery to correct the deformity may be the best choice. We offer patient specific minimal surgery with osteotomy and tendon transfer to correct the deformity while preserving strength and flexibility.

• Equinus deformity – although many children tiptoe due to calf muscle tightness, this does not always cause symptoms. However, tiptoe walkers may progress into teenage years with tight calf muscles and discomfort with sporting activity. Physiotherapy is the best first-line treatment at the American Hospital. If there is significant deformity, lengthening of the calf muscle complex is a fairly straightforward procedure to improve ankle range of motion and discomfort from calf tightness.

• Cerebral palsy – children with cerebral palsy who are wheelchair users are at risk of progressive hip dislocation during the first decade of life which manifests slowly with slumped seating posture, difficulty washing, and dressing, future scoliosis, and eventual hip pain and stiffness. Our multi-disciplinary team at American Hospital are focused on the care of children with neurodevelopmental conditions such as cerebral palsy. Physiotherapy, rehabilitation medicine, and pediatric orthopedic doctors work together to optimize the comfort and function of children. Postural management and physiotherapy are initiated as a first-line for hip displacement with surgery reserved for progressive dislocation. Our doctors are skilled in undertaking single-stage hip reconstruction which is the gold standard treatment for hip displacement in cerebral palsy.

• Children with cerebral palsy who are able to walk using mobility aids are at risk of losing walking ability and having reduced independence as they progress into adult life. Our multi-disciplinary team focuses treatment on ensuring that walking is optimized in these children through input from physiotherapy, rehabilitation medicine, orthotics and pediatric orthopedics. American Hospital has expertise in gait analysis to generate a comprehensive treatment plan to optimize your child’s walking ability as they grow older. Surgery is focused on preserving muscle strength by correcting bony deformities and restoring soft tissue balance without cutting tendons in walking children. American Hospital offers single event multi-level surgery (SEMLS) for comprehensive deformity correction and gait optimization in walking children and teenagers affected by neuromuscular conditions such as cerebral palsy.

• Guided growth – Knee alignment in children usually changes up to the age of 8 years after which knock knees or bow legs can persist into adult life. Our pediatric doctors undertake comprehensive deformity analysis on standing x-rays to accurately quantify any deformity and advise you on whether treatment will improve your child’s comfort and function. Guided growth (temporary hemi-epiphysiodesis) is a modern technique for utilizing children’s innate growth potential to correct their knee alignment without the need for major surgery.

• Leg length equalization – Significant leg length differences due to congenital causes or previous injury may progressively affect children as they grow older. Our pediatric doctors are experts at undertaking comprehensive deformity analysis to determine the extent of shortening and/or limb angulation and generate predictions for the magnitude of any leg length or alignment asymmetry when your child is an adult. We offer a comprehensive range of treatment options including orthotics for mild leg length differences and surgery for major predicted leg length differences. Surgical options include leg length equalization with epiphysiodesis (slowing down the longer leg) and leg lengthening and deformity correction using a circular frame construct. Our dedicated multi-disciplinary team ensures that your child will have all the support they require through their leg-lengthening treatment program with dedicated input from physiotherapy, rehabilitation medicine, orthotics and clinical psychology. Our pediatric orthopedic doctors design treatment programs so that your child spends the minimum amount of time in a circular frame and can return to school and play free of this device as soon as possible.

What to Expect from Your Visit:

The evaluation of your child’s pediatric orthopedic problem begins with a thorough history including antenatal history, findings at the time of birth and in early life, developmental milestones such as when your child started sitting up independently or walking, and any history of similar conditions in other family members. The symptoms and functional impact on the child’s schooling, physical activity, and well-being are explored in detail.

Your child will be made to feel comfortable throughout a physical examination by preserving their modesty and having a chaperone in attendance. A detailed physical examination is performed even if the problem may just be in the feet. Often the alignment of the leg as a whole may be contributory to the problem which is why a thorough assessment is required. Often, the history and examination are enough to furnish the doctor with sufficient information that can help define the most probable diagnosis or a list of possible diagnoses which need to be excluded.

Investigations/Diagnostic Testing in Pediatric Orthopedics:

The pediatric orthopedic service at American Hospital Dubai utilizes a comprehensive portfolio of diagnostic investigations to accurately characterize any deformity which may be causing symptoms in your child. Pediatric-specific diagnostic imaging protocols may include X-ray, Ultrasound, and MRI to measure the anatomical location and severity of the deformity. The X-ray images can also be manipulated through deformity analysis software that can help plan deformity correction surgery. X-rays are often not required at each visit, however, they may be undertaken to make a diagnosis, measure a deformity and assess improvement following surgery.

Not every bone, joint or muscle disorder in children requires early treatment. However, in some conditions “early detection”  may enable timely treatment with improved chances of a successful outcome and a lower risk of complications. In cases of congenital hip dislocation, early detection and treatment may lead to successful outcomes from non-operative treatment with a lower risk of complications. On the other hand flexible flat feet are very common in children and often cause no problems until the teenage years. In this condition, treatment should only be commenced when problems arise rather than needlessly treating all children who have flat feet with insoles which may have a bearing on their psychological well being.

During your consultation at American Hospital, the Pediatric Orthopedic doctor will take time to explain to you when it is it best to consider treatment for your child, and the scientific rationale behind this.

Depending upon the diagnosis of your child’s condition, the doctor will discuss what the outcome is likely to be if your child’s condition is left untreated. Some conditions may require treatment to help with symptoms but will improve over time even if they are untreated. For example, Sever’s disease (Heel pain in growing children) usually gets better over time even if left untreated. However, on the hand, some children will gain benefit from physiotherapy and gel heel pads while they have symptoms.

 

Although many pediatric orthopedic conditions naturally improve over time, some conditions like congenital hip dislocation in children give rise to progressive problems. When the child is young they may have no pain and only walk with a slight limp but if the condition is left untreated, it will lead to pain and stiffness requiring complex treatment in adult life.

Not every deformity in a child requires surgery. Surgical treatments are considered only after analyzing the impact of a deformity on the comfort and function of a child while taking into account the possibility of the condition worsening and causing more problems over time. For example, mild foot deformities that are not causing pain can be managed non-operatively and do not require surgery.

Surgery is usually recommended for severe or progressive deformities that cause problems despite the best non-operative treatment. Examples of such deformities include clubfoot deformity recurrence and moderate to severe congenital limb shortening.

Your child’s journey from clinic attendance to pre-assessment, the day of surgery, inpatient stay and to rehabilitation will be discussed in detail during your consultation with a Pediatric Orthopedic Specialist. We will explain what improvements can be expected following treatment by sharing treated case examples to better understand the timeframe for clinical and functional improvement.

Surgical treatment will be offered if there is a realistic expectation that the condition cannot be treated non-operatively, or that the condition has not satisfactorily improved with non-operative treatment.

Musculoskeletal discomfort can frequently arise during childhood, especially during periods of rapid growth and when children’s physical activity levels are high. Growing pains frequently arise in teenagers as they progress through the adolescent growth spurt where growth velocity peaks and the muscles in the soft tissue envelope can become tight. Symptoms usually improve as growth slows down and can be aided by physiotherapy to stretch the tight muscles. In young children, benign type leg pains can arise due to the excessive physical demands children place on their legs due to high activity levels at this age. Although most lower limb discomfort in children may be benign in origin, it is important that you are reviewed by a specialized Pediatric Orthopedic doctor who can ensure that there is no alignment problem or other pathology giving rise to these symptoms.

Some conditions like bow legs in infants usually improve by 2 years of age and do not require treatment. Similarly, flat feet may also cause no problems until teenage years when the child gets heavier and the joints get stiffer. During the patient’s consultation with the Pediatric Orthopedic doctor, the patient and family will be presented with evidence based illustrations and graphs to understand how their child’s condition will improve over time, and when they might require medical intervention.

There are many factors to take into account when deciding the best treatment plan for a specific child - the diagnosis and severity of the condition, the natural history if left untreated, the impact on the child’s comfort and function and the patient and family’s treatment choice must all be taken into account. The doctor will recommend a specific treatment plan taking all of these factors into consideration having carried out a thorough patient evaluation and reviewing the findings from investigations. Treatment programs in pediatric orthopedics include physiotherapy, orthotics, surgery or a combination of these treatments. The doctor will discuss if there are alternative treatment options to surgery and the outcomes from operative and non-operative treatment.

Often children and their families get confused by different medical opinions from different professionals. This is especially the case when a recommendation of surgical treatment has been made. At American Hospital Dubai, we approach each child with a clean mindset to assess and diagnose the problem. We hope to deliver a comprehensive consultation in terms of assessment and treatment planning so that the child and their family feel fully informed to make the best treatment choice for their child.

 

The American Hospital strives to deliver the best ethical treatment for each and every child based on the world class clinical expertise of the doctors practicing here. Following the consultation, you will receive a detailed report outlining the clinical presentation, examination findings, plan of investigation, and discussion on treatment options and likelihood of expected outcomes. The American Hospital supports patients in seeking additional opinions from doctors working in other institutions before choosing the American Hospital for their child’s treatment. American Hospital prides itself on unparalleled expertise in children’s orthopedics so that you can feel confident that you have made the best choice for your child.

Ultimately, your child is unique and the most precious thing in the world to you. We work hard to ensure that as a parent, you can completely place your trust in us delivering the best possible care for your child.

Often, the child’s history, examination, and basic X-rays provide sufficient information to make a diagnosis and devise a treatment plan. In some cases, an exact diagnosis requires further investigations. The Pediatric Orthopedic doctor will guide you on the course of investigation to help make a diagnosis which may include Ultrasound, MRI, or CT.

Doctors Panel of Pediatric Orthopedics

Assad Qureshi

Consultant Pediatric Orthopedic Surgeon

English, Urdu

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