Bristol Children's Orthopaedic Group cover all of children's orthopaedics up to the age of 16 years. Although we do not operate for children's spines we can see and advise for adolescent scoliosis and back pain.
Particular specialist areas are listed below with a little more detail. Any queries will be answered promptly through the contact options above.
Foot and ankle conditions
We tend to think of foot deformities in newborn children as either "packaging" or "manufacturing" problems.
The former relate to a tight intra-uterine environment, common in first pregnancies or those where there was less fluid around the foetus. Examples include a foot that hooks across looking "pigeon-toed" or one that sits up against the shin bone. Packaging defects almost always resolve without treatment but need careful evaluation plus examination of the hip joints for instability.
Manufacturing problems are true congenital deformities such as a club foot or a rocker bottom sole. These will require intervention, although fortunately we are increasingly able to offer less invasive surgery for many of these conditions.
Adolescents sometimes develop stiff flat feet because of abnormal coalitions between some of the foot bones. These will usually require a scan for diagnosis.
The foot and ankle can also be affected by sports injuries, including growth plate sprains and damage to joint cartilage.
Back pain and deformity
Back pain is fairly common in adolescents. Fortunately a serious cause is rarely found but we often perform an MRI scan to be certain. This excludes significant pathology in the majority without using any irradiation and is generally reassuring all round.
A relatively common neonatal foot deformity managed almost universally now with the Ponseti technique of serial manipulation and casting- the Bristol Ponseti clinic is run by BCOG surgeons. Some children will require a small procedure to release the heelcord at the end of the casting phase of the treatment. Others may suffer a later relapse and require a slightly more invasive procedure to transfer a muscle across the foot.
A problem of impaired balance and co-ordination caused by an abnormality of the immature brain. Muscle contractures cause bone and joint deformities that progress with growth in all but the most mildly affected cases. Orthopaedic input is important to assist with management of muscle spasticity and correction of deformity.
Cerebral palsy is a particular interest in Bristol where we see many children with this condition.
A serious condition of the hip caused by transient compromise of the blood supply to the joint. Typically affects boys aged 4-8 years and can cause pain and restricted mobility throughout childhood.
Some children may benefit from surgery but decision-making is complex and indications vary between surgeons.
In Bristol we are represented on an important group of international surgeons aiming to improve our understanding and treatment of the condition.
Abnormal hip development in the womb leads to a joint that is unstable or frankly dislocated at birth. This can be missed, especially if both sides are affected. Earlier treatment is less invasive and more effective.
Mr Atherton and Mr Thomas both have extensive experience with this condition and have published important research in this area.
Adolescent hip conditions
Older children can have a variety of hip complaints. Important not to miss is a slipped capital femoral epiphysis (SCFE) when the "ball" of the "ball and socket" joint starts to slip through a nearby growth plate. Early diagnosis is difficult, as many adolescents complain of knee rather than hip pain, but critical as a severe slip is difficult to treat and can have serious complications.
Teenagers active in sport can pull off muscle origins around the pelvis or sprain these same areas, which are usually a centre for growth and are inherently weak until skeletal maturity.
Occasionally adolescents will present with symptoms caused by "silent" hip dysplasia.
Adolescent knees can develop a condition in which an area of cartilage starts to detach with a sliver of underlying bone. This is common in very active children and known as osteochondritis dissecans. The outlook is pretty good if the skeleton is still growing, but large or unstable lesions may require enforced rest or even surgery. An MRI scan will usually be required to characterise these defects.
Injuries to the meniscal cartilages, common in adult footballers, are increasingly seen in children because of increased intensity of sports participation. Most can be repaired as the immature knee has better healing potential than in adults. Immediate and marked swelling of the knee after injury may indicate a torn cartilage or ligament and should be investigated promptly.
Injuries to the anterior cruciate ligament are also being seen in increasingly younger children, although those under the age of 12 remain more likely to pull out the bone insertion rather than rupturing the ligament itself. Fixation or reconstruction require careful consideration of the nearby growth plates which contribute the majority of leg growth.
Other sports injuries
All the major joints in children have adjacent plates of growth cartilage which are liable to strain from overuse, particularly where muscles insert into them. Typically affected areas include the heel (heelcord insertional apophysitis), knee (Osgood Schlatter's disease and Jumper's knee), hip, wrist and elbow.
Treatment usually involves rest and physiotherapy with surgery rarely indicated and only then as a last resort. Occasionally an underlying bone cyst or occult infection may masquerade as one of these conditions. Investigation with simple x rays will usually suffice.