Tag Archives: Children’s Orthopedics

Spina Bifida and Hydrocephalus Conference 2018 NewDelhi


#IFSBHCON2018
#SPINABIFIDA
#hydrocephalus
#spinabifidafoundation
Lovely conference and lovely to see the so many families and patients viewing life with such a positive attitude https://t.co/eXqZWmuhoa

Dr. Santhosh Karmakar and Spina Bifida Foundation deserve credit for bringing together different professionals -doctors, physiotherapists and families, together for this event

#CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad


Had a wonderful #CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad #Kerala organised by wonderful people at #SevaBharathi . It was well attended with parents and children braving the heavy rain.
@sevakeralam
@sevabharathitn https://t.co/Z3FT9C6RVO

Free Medical Camp for Children’s Orthopedic Disorders and Cerebral Palsy


I’m conducting a free medical camp for #Childrens #Orthopedic #Disorders and #BoneDiseases , #LimbDeformities and #CerebralPalsy at #Palakkad ,#Kerala . Event is organised by #SevaBharathi .

The event will be held in the premises of Life Care Cerebral Palsy Clinic which is in centre of Palakkad town enabling easy transport to the venue.

Patients and relatives are advised to bring all old records while seeking opinion. All old x-ray, other scans and will also be needed for evaluation.

Phone number for Booking :+91-80759-21075

Contact the phone on last line of notice for appointment.
(Notice is in #Malayalam, local language of Kerala )

https://t.co/smNqhcYRRS

Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis

Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis

Developmental Dysplasia of Hip - Left hip is dislocated

DDH – Its June !! It’s Dysplasia Awareness Month


DDH otherwise called Developmental Dysplasia of Hip is a condition where the ‘ball-and-socket-joint’ of the hip is not formed well at birth. It used to be called Congenital Dislocation of Hip.

The child is born with a slightly misfitting hip joint where the ball is slightly shifted out of cup or a hip joint where the ball is completely outside the cup and cup is also very shallow. This can occur on one side or both sides.

Developmental Dysplasia of Hip - Left hip is dislocated

Developmental Dysplasia of Hip – Left hip is dislocated

Why does it happen ?

Most times its ‘Idiopathic’ , a medical term which means – cause is not known. In many other patients, the child will be having one of the syndromes (a group of clinical features and disorders in other organs systems and external appearance) or neurological issues in the spine (like meningomyelocele) that also causes this. This second group is sometimes medically referred to as Teratogenic DDH and is much more difficult to treat.

We will discuss below the aspects as related to Idiopathic DDH. They don’t apply to Teratogenic or Neurological DDH.

How do we know the child has DDH ?

Most newborn screening procedures at the hospitals have doctors checking to see if the new born child has clinical signs of DDH. It is easiest to detect and treat it at that early stage.

Once a clinical suspicion of DDH is there the Neonatologist usually refers the child to a Pediatric Orthopedic Surgeon. In addition to establishing the clinical diagnosis by physical examination, the doctor will order an x-ray and an Ultrasound Scan of the Hips to check the dislocated hips. Several measurements need to be taken and ease of dislocation need to be established under Ultrasound scan by a procedure called Dynamic -Ultrasound. The treatment starts after these are done.

In many children, the initial diagnosis may not be made in the immediate post-delivery period. Children may be brought to the OPD by parents with complaints that the thigh skin fold dont look symmetrical and the hips don’t open out fully for parents to change diapers.

In older children parents may notice a limp when the child walks or a limb length difference may also be noted with the dislocated side being shorter.

Limb Length Difference in DDH

Limb Lengths may be noted to be different in DDH when child is older and walking. The limb with the dislocated hip will appear shorter.

How soon should the treatment start ?

As described in previous section, treatment should ideally start in neonatal period once the problem has been detected. After clinical examination and Ultrasound examination, your doctor will suggest usually a belt type device called Pavlik Harness to be applied on the child to keep the hip reduced inside the cup. This harness is to be worn full time. Parents are counselled on how this is applied and how the straps are tightened.

Ultrasound exam for a child with Hip and Knee dislocation

Ultrasound exam for a child with Hip and Knee dislocation

Once this harness has been applied, the hips are scanned with Ultrasound every 2 weeks to check for improvements. Ideally this has to be kept for about 3 months and taken off after the hip stabilizes inside the socket. A slow weaning period is there before the child can be fully taken off the Pavlik Harness. This is to ensure that the Ball ( head of femur ) stabilizes inside the socket (Acetabulum of Pelvis) and the hip is stable. The tissues around the hip also has to shrink and adapt to the new location of Head of Femur. Otherwise re-dislocation or partial slip (medically called subluxation) is a possibility.

In many cases the parents may not be willing for a device to be applied on the child full time post-delivery or the DDH itself may go undetected. This child eventually may be brought later in life by the parents with complaints necessitating surgical procedures.

What is the treatment options for DDH?

As previously described if the newborn is detected to have DDH the treatment is to apply Pavlik harness on the child after Ultrasound exam proves hip is reducible and stable in what is called a safe zone. Safe Zone is a zone where the position in which the harness has to be applied to the child does not compromise the blood supply the head of femur. This is very important decision to make.

Pavlik Harness for DDH hip needs to be fitted properly

Pavlik Harness for DDH hip needs to be fitted properly

Hip Spica Plaster in child with DDH

Hip Spica Plaster in child with DDH

Application of Hip Spica under anesthesia in DDH

Application of Hip Spica under anesthesia in DDH

If the child is brought later in life, before 1 year, the hip has to be checked for reducibility as the tissues around the hip would have become contracted and sometimes it is difficult to reduce the hip back into the socket. Usually anaesthesia would be required and the hip once reduced back into the socket is held there by application of the plaster of paris or POP called Hip Spica. This is kept for approximately 3 months until the hip has stabilised inside. A CT scan to verify whether the hip is reduced should be done while child is in POP as slippage of the hip socket is also seen when POP cast becomes loose with time.

Surgery is the only option in older children with DDH. These range from relatively simple procedures to complex hip reconstruction procedures depending on age of the child, slope of cup, angle of rotation of the neck of the thigh bone and shape of the head. These are best evaluated as per the needs of the child.

Arthrogram for DDH

Arthrogram for DDH

Generally these surgical procedures can be grouped into a few types :

  • Open Reduction of Hip and Capsulorraphy (medical term meaning stitching up of capsule or the covering around the joint)
    • This is basic necessity. Here the hip is reduced back into the socket and the covering, the capsule, which is loose is tightened with several sutures
  • Femur Derotation Osteotomy with shortening
    • This would involve a slight shortening of the hip bone and turning it around. The bone would then be stabilied with a metal plate and screws
    • The need for your child to have this done depends on the age of the child and the angle of the ‘neck of the femur’, something medically known as Anteversion. This procedure essentially de-rotates the femur neck and allows the head of femur (the Ball) to deeply sit inside the Acetabulum (the socket). A slight shortening of the thigh bone may be needed as the child , if old enough, would have developed tightness of the tissues and hip should be sitting inside the socket slightly loose than in tension.
  • Acetabular Osteotomy
    • In many children, when they present to the clinic their Acetabulum would be shallow and not deep enough to receive the Head of Femur. In such children deepening of the Acetabulum by a surgical procedure called Osteotomy (a type called Salter Osteotomy being the most popular) may be done.

The above procedures may be combined along with Open Reduction as the surgeon sees fit after evaulating the child. These options and its pros-and-cons would be discussed with the parents before the surgery.

What happens if we don’t treat DDH promptly ?

Best time to treat the child is in the newborn period. With time the tissues around the hip gets tighter and the bone structure of thigh bone and pelvis alters since the normal growth with moulding of the ball being inside the cup doesn’t happen.

This lack of moulding results in a shallow cup. Additionally the thigh bone’s upper end would be twisted out of shape and the ball also would be misshapen since it has not been moulded by the acetabulum.

All these result in a much more complex procedure to try and restore the hip.

Left untreated DDH causes osteoarthritis or the Hip joint and Hip pain in early adulthood often requiring complex reconstructive procedures.

It is best if the treatment is not postponed and done at the earliest.

Hip Dysplasia Awareness Month – June !!

The Hip Dysplasia Awareness Month of June is to educate parents on Hip Dysplasia and its treatment methods. We hope that parents would bring children to care centers at the earliest if suspicion of hip dysplasia is there.

For more information please visit : http://livingwithhipdysplasia.com/june/ or consult your Pediatric Orthopedic Surgeon.

Free Medical Camp for World Clubfoot Day 2018


World Clubfoot Day free medical camp concluded well and many patients had the opportunity to consult free and take advise for their child.

Attaching below is the collage .

We have a lovely Clubfoot Care team that made this event and caring for these children over team so much easier.

World Clubfoot Day

World Clubfoot Day with Children, Parents and Clubfoot Care Team

World #Clubfoot Day is afoot ! – Free medical camp for children with Clubfoot


I’m organising a free medical camp on June 4th at Palakkad Cooperative Hospital, Palakkad, Kerala on World Clubfoot Day.

Please do spread the news so that anybody interested can seek care.

Attaching below is a poster in local language Malayalam.

Interested patients may contact hospital Reception on following phone numbers for registration :

+91 491 252 0391

+91 491 252 2805

+91 491 253 6293

Clubfoot medical camp

World clubfoot day free medical camp

Bracing and Orthotics for Clubfoot (CTEV)


Once clubfoot is corrected with Ponseti plaster application and tendoachilles tenotomy, it’s time to maintain the correction of foot till child is grown more and started walking well. There is risk of clubfoot recurring without proper bracing.

Recurrent clubfoot

Recurrent clubfoot without bracing

Types of braces

Steinbeck device, Iowa Brace and Dobbs Brace are commonly used clubfoot Foot Abduction Orthosis.

Dobbs brace in particular has the added advantage of providing extra mobility to the child potentially improving compliance. Comparatively it’s more expensive.

Compliance

In rural India it’s especially difficult to ensure compliance to orthosis for parents as many feel clubfoot treatment finishes with Ponseti casting. Social issues and sensitivity of going out of home with brace fitted is one of the issues that makes parent fall out. Some of them don’t spend enough time learning to put it on and take it off and give up once child starts crying. It’s an easy procedure that we teach aling with nurses and orthotists to help parents during initial days.

Steinbeck braces

Steinbeck bracing

Clubfoot Steinbeck braces

Fitting Steinbeck clubfoot brace

Foot inside Steinbeck clubfoot brace

Dobbs Bracing

Dobbs brace for Clubfoot

Dobbs brace allowing movement

Osteogenesis Imperfecta


Osteogenesis Imperfecta is a congenital disorder of bones that has varied types and presentations. Severity varies based on the type of the genetic mutation that causes this disorder.

Regardless of the type the genetic modification cause malformed and weak bones and in some cases malformed teeth. Bone bend and deform or break easily and heals in deformed position. This results in cosmetic deformity along with issues with walking , standing for the child.

The bend of the bone if significant can cause repeated fractures either due to poor handling by caretakers or when child tries to bear weight and stand up.

Fortunately for the milder variants there’s are medications to make bones stronger and surgery to straighten bent bones. This allows child with help of walking aids and/or splints to ambulate.

For the very severe variants unfortunately clinical breakthrough is still awaited.

Paramedical Awareness of Cerebral Palsy Care


Cerebral palsy awareness lecture for paramedical personnel at ICCONS

Cerebral palsy awareness lecture for paramedical personnel at ICCONS


At ICCONS, where we have been successfully treating cerebral palsy children for over 10 years, rehabilitating them to achieve goals. It is so important to maintain the momentum of care across all departments.

Paramedical training ( physiotherapists, occupational therapists, orthotists, speech therapists, behavioral therapists, clinical psychologists, nursing team, social workers ) in cerebral palsy care, handling, treatment options and outcomes gives all those who are involved in the care of these children hope for the future. It also helps them prime parents towards realistic goals; both long and short term. The end result is a comprehensive care for these children with cerebral palsy. 

Frequent lectures are so important to keep up the spirit among team members and orienting new employees. 

A recent talk i gave at Pediatric Orthopedic & Cerebral Palsy Clinic, ICCONS, Kerala preceding the World Health Day , 2017

Cerebral palsy awareness lecture for paramedical personnel at ICCONS

Cerebral palsy awareness lecture for paramedical personnel at ICCONS

Take a look at @dreaswar‘s Tweet: https://twitter.com/dreaswar/status/850260886535020544?s=09