An Overview of Pediatric Orthopedics

Kids are different from adults, and this is apparent even in the ways their bodies work. Their bodies are continuously growing and developing and so is their bone structure. The bones are so elastic that they can bend at odd angles without even breaking. Most of their issues can be well sorted but by a general orthopedic but in severe cases, it is important to get the child checked by a pediatric orthopedic who has over a decade of training and experience dealing with kids and their complex bone structures. He should understand the intricacies of their growing bones and give them the best possible treatment.

Problems The Pediatric Orthopedics Treat

While not every problem requires a visit to the pediatric orthopedic but some conditions do require an expert opinion such as

  • Birth deformities
  • Limping
  • Broken bones
  • Infections in bones and joints
  • Spinal deformities

Apart from these, the pediatric orthopedic should know how to provide emotional support and care to the child.

Pediatric Orthopedic Implants

Kids are different from adults

When dealing with kids, it is important to understand that kids are nothing like adults. The way their bodies work is different as well. When dealing with bones related issues, some of the most common things one needs to understand are:

  • Not every child is capable of telling where it hurts. It is then the job of the doctor to tactfully extract the relevant information from the child or diagnose it after examination.
  • The bones of the kids are continuously growing. The part of the bone which is undergoing rapid growth is most vulnerable to injury. While treating the child, it is important to make sure that the growth plate was not affected in any way since it can lead to deformities and abnormal growth of bones in the future.

Qualities To Look For In A Pediatric Orthopedic

Most of the kids who come to the doctors undergo a lot of stress, anxiety and depression issues due to their conditions. The doctors should guide the parents on how the child can be taken care of in a way that would keep him happy too. A pediatric orthopedic should be

  • Experienced with over ten years of training, treating and assisting children with bone problems.
  • Friendly so that the child feels comfortable talking to him about his problem. This way there would be no communication gap in the treatment. They usually have a proper environment created with toys, games and other activities that can help the child relax
  • Co-operative enough to guide the parents and help them understand the problem at hand
  • Professional with knowledge of how to treat the different problems while keeping in mind the intricacies of the children’s bone structures

When it is an issue related to the health of your child, it is very important to go to a doctor who is skilled and qualified enough to not only provide your child with the best medical attention but proper child care as well.

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Orthopedic Trauma Implants

Trauma is a physical injury derived from the Greek word meaning “a wound”. It involves transfer of kinetic energy. Orthopedic trauma involves fractures, subluxation or dislocation of bones and joints. Trauma can be of varying degrees and efficient evaluation of the severity of trauma by using ATLS system helps plan an effective management.

Orthopedic Trauma Implants

Implants in Orthopedic Trauma:

Out of various other options for the surgical management of orthopaedic trauma, one involves application of an implant or a device for permanently or temporarily restoring the physiology or anatomy of joint or other skeletal structures. An orthopedic implant is a medical device build to replace or support a lost joint or a damaged bone. Surgeon picks the implant by assessing the weight, size and type most appropriate to the individual. The strength of the implant is provided by stainless steel and titanium alloys used in its production and topped with a plastic coating to act as an artificial cartilage. The operation in orthopedic surgery that involves the implementation of such implants for the purpose of repairing a damaged or lost bone is called internal fixation. Pins, rods, screws and plates are among the few types of medical implants that are used to fixate the fractured bones while allowing them to heal.

Prevention of Infections in Implants:

Major concerns faced with implants are prevention of infection and amalgamation of the implant with the host-tissue. Infection has long been a serious issue leading to limb amputations and even death due to septicemia. Properties of the prosthesis used, such as its chemical composition, hydrophobicity, roughness of the surface are all important factors in the incidence of infection after an orthopedic implantation.

Advent of Antibiotics:

S.aureus and S.epidermitis are the main causative agents of implant-related infections in orthopedic surgery. Thanks to the discovery of antibiotics, the incidence of infections has been reduced and so has the mortality and morbidity associated with it. But the extensive use of antibiotics has produced a number of evolving resistant bacterial strains.

Coating methods:

A new method termed as coating is applied on the surface to further reduce the chances of bacterial invasion of the prosthetic and avoid loosening of the implant. These coatings are of different types such as antibiotic releasing and non-releasing coatings using different techniques such as active or passive methods. Hydroxyapatite is one of the non releasing coatings that require thermal method for application while dip or spray method is used to apply releasing coatings (antibiotic containing coatings) because of reduced thermal stability.

Implant Removal:

Implant removal is a common elective orthopedic operation that contributes 30% of planned surgical operations. In clinical practice the most common indications for implant removal include pain, irritation of soft tissue, and recommencement of strenuous activities after fracture healing or the patient’s demand. For children, it is important to remove implant early to avoid disturbances of the growing bone structure. Implant removal requires a second look operation as it may lead to scar tissue as well as increases chances of nerve damage.

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Orthopedic Nails, Wires, Pins & Staples used in Bone Fracture

Bones are made up of different connective tissues, which have the ability to heal themselves during a fracture. In the case of children and young adults or mild cases fracture, splints and casts are used for the treatment.

However, in all other cases, open reduction and internal fixation are required for which orthopedic nails, wires, pins, and staples are used to give the bone anchorage points so that it can heal properly. The internal fixation depends on the type of the fracture and which bone and parts of the bone are fractured.

Orthopedic Nails:

Nails are usually used for the fracture of long bones like the femur, humerus, tibia etc. The purpose of nails is to immobilize the bone in the correct alignment so that the bone ends do not overlap. There is no fascia or muscle interspersed between the fractured bone ends and both ends meet each other accurately to promote the callus formation. These are metal rods which are fixed in the medullary canal of the long bones to hold the fractured ends together. These are of different varieties and sizes according to the size of the bone and type of bone. Their varieties include:

Orthopedic Nails

Orthopedic Nails

Enders nail: They may be used for distal femoral, proximal humeral, subtrochanteric region of the femur and tibial shaft fractures as it provides three point fixation.

TENS nail: These are used for diaphyseal fractures of long bones, metacarpal, metatarsal fractures and complex fractures of the clavicle.

Other nail types include kuntscher nail, square nail, and rush nail.

Orthopedic Wires:

Wires are famous among children, for example, k-wires are used in sub-trochanteric fracture of humerus common in children. The wires are flexible and easy to bend and are usually used in the fractures of those bones where weight loading is minimal.

Internal fixation using wires is mostly done for the fractures of the small bones like phalanges, metacarpals, and metatarsal. It is also used for fracture of subparts like condyles of the proximal and distal humerus.

Orthopedic Wires

Orthopedic Wires

Its types include:

Suture wire: It is used for internal fixation and tendon repair.

K- wire: It is used for both temporary, permanent fixation, and skeletal traction.

Orthopedic Pins:

Pins are used to correct soft tissue damage and minimal bone fractures. The purpose of pins is that it provides provisional internal fixation so that it can be manipulated by further hardware use and inaccurate permanent fixation is avoided. It comes in different diameters and according to that, it can aid in screw fixation.

Orthopedic Pins

Orthopedic Pins

Various varieties include:

  1. Steinmann pin
  2. Austin Moore pin
  3. Knowles pin

Staples:

When there is vast damage and bone is broken into fragments then staples can be used between these fragments for internal fixation and bone reconstruction. They are more useful than inter-fragmental screws in these types of cases. Staples are usually used around the joints as in ankle and foot surgeries. These staples are also used in cases of soft tissue damage.

Orthopedic Staples

Orthopedic Staples

U-type stainless steel: These are used for internal fixation and bone reconstruction.

Coventry: It is also used for bone reconstruction and also for repair of soft tissue damage.

What is a Bone Implant?

Orthopaedic ImplantsA bone implant or graft is a surgical procedure which is used to fix problems related to bones or joints in order to repair bone fractures that are extremely complicated, pose a significant health risk to the patient or sometimes it fails to heal properly. Bone implantation can be done for many reasons that include injury, disease or infection. But the four main reasons are fractures, regeneration, fusion and implanted devices; due to which bone grafting is performed. The procedure of bone implantation should be done under the supervision of an orthopaedic surgeon who with the help of X ray, MRI or ultrasound devices decide which type of implantation is beneficial for the patient.

Types of Bone Implant:

  1. AUTOGRAFT:
    Autograft is a Procedure in which the transplantation of organs, tissues, or even particular proteins from one part of the body to another of the same person. In the word autograft auto means “self” and graft means “implantation”. Bone can be harvested from hips or ribs but it creates a second surgical site from which the patient must recover. The second surgery or site could be uncomfortable years after the surgery and the recovery time can extend the patients stay to the hospital. In a block grafting an autogenous bone is most preferred because there is less risk of graft rejection as it is originated from patients own body.
  2. ALLOGRAFT:
    Allografts are beneficial for complex cases such as who undergo multiple ligament injuries and revisions. Allograft is different from autograft as it is a process in which autogeneous bone is derived from humans; the difference is that in allograft it is harvested from another person other than one receiving the transplantation. Patients need not to go through second surgery by using allografting.
  3. DENTIN GRAFT:
    For dentin graft, dentin bone is made up of extracted tooth which comprises more than 85% of tooth structure. Dentin, like bone may release growth and differentiating factor when it is being resorbed by osteoclasts. Sorting, grinding and cleaning of teeth are done for making dentin graft more usable and bacteria-free.
  4. SYNTHETIC VARIANTS:
    Science and technology in the developing medical world have increased the number of synthetic graft options with the help of which a patient easily eliminate the problem of harvesting bone from a donor site. This provides them various options which is easily available and help them to recover easily from their injury.
  5. XENOGRAFTS:
    This bone substitute has its origin from a species other than human such as cow known as bovine bone and they are distributed normally only as a calcified matrix. Coral xenograft are mainly calcium carbonate which is saturated with growth enhancing gels and solutions.
  6. ALLOPLASTIC GRAFTS:
    Alloplastic grafts may be made of hydroxylapatite also called hydroxyapatite (HA), is a naturally occurring mineral form of calcium apatite which is the hydroxyl endmember of the complex apatite group. They may be made from bioactive glass and it is a synthetic bone  graft which is the most used now among other synthetic  because of its osteoconduction hardness and acceptability by bone.

The Risks of a Bone Implant:

  • During bone implant surgical procedure anesthesia is given to the patient which has the risk of reactions to medication and breathing problems.
  • Bleeding and infection.
  • Pain.
  • Rejection of the bone implant.
  • Additional surgery in the autograft added costs and patient takes time in recovery and increases patients stay to the hospital.
  • Nerve injury and inflammation creates problem to the patient.
  • In allograft grafted bone may take longer time to incorporate with the host bone.

It is good for you to ask your doctor about your risks and what you can do to control or minimize them to better understand them.

Othopedic Implants India

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