Anaesthesia for paediatric orthopaedic surgery - Revision history

WikiSysop at 18:02, 26 December 2025

2025-12-26T18:02:15Z

WikiSysop at 02:41, 24 December 2025

2025-12-24T02:41:58Z

← Older revision		Revision as of 02:41, 24 December 2025
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	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''

			https://resources.wfsahq.org/wp-content/uploads/uia30-Anaesthesia-for-paediatric-orthopaedic-surgery.pdf

	SUmmary Paediatric orthopaedic procedures range from fixing simple fractures in otherwise healthy children to more complex procedures in patients with major co-morbidities. Anaesthetic management is generally dependent on the complexity of the procedure as well as the child’s general health. Pain relief is a particular challenge. Regional anaesthesia plays a very important role in managing intra- and postoperative pain. Availability of resources, training and safety are a major determinant of anaesthesia technique in LMICs. Tsitsi Madamombe Consultant paediatric anaesthetist, University Hospital, Southampton Ollie Ross Consultant paediatric anaesthetist, University Hospital, Southampton Jim Turner Orthopaedic surgeon, Beit Cure International Hospital, Blantyre Malawi		SUmmary Paediatric orthopaedic procedures range from fixing simple fractures in otherwise healthy children to more complex procedures in patients with major co-morbidities. Anaesthetic management is generally dependent on the complexity of the procedure as well as the child’s general health. Pain relief is a particular challenge. Regional anaesthesia plays a very important role in managing intra- and postoperative pain. Availability of resources, training and safety are a major determinant of anaesthesia technique in LMICs. Tsitsi Madamombe Consultant paediatric anaesthetist, University Hospital, Southampton Ollie Ross Consultant paediatric anaesthetist, University Hospital, Southampton Jim Turner Orthopaedic surgeon, Beit Cure International Hospital, Blantyre Malawi

WikiSysop at 18:35, 13 November 2025

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WikiSysop at 23:20, 10 October 2025

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WikiSysop at 23:19, 10 October 2025

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WikiSysop at 23:12, 10 October 2025

2025-10-10T23:12:20Z

← Older revision		Revision as of 23:12, 10 October 2025
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	Tsitsi Madamombe, Jim Turner and Ollie Ross*		Tsitsi Madamombe, Jim Turner and Ollie Ross*
	*Correspondence Email: oliver.ross@uhs.nhs.uk		*Correspondence Email: oliver.ross@uhs.nhs.uk

			introdUction
			Paediatric orthopaedics in low or middle income
			countries (LMIC) ranges from simple fractures
			(but often complicated by delayed presentation,
			anaemia or nutritional deficiency), to chronic
			osteomyelitis and fracture non-union, to
			complex elective procedures in children with
			cerebral palsy. This article will consider the
			spectrum of disorders encountered in paediatric
			orthopaedic surgery in LMICs, the orthopaedic
			manifestations of specific conditions in
			childhood, specific orthopaedic procedures and
			anaesthetic management of these conditions.
			Practical aspects of regional anaesthesia are
			covered elsewhere in this issue of Update (page
			99).
			the SpectrUM OF diSorderS Seen in
			paediatric orthopaedic SURGery
			Conditions can be considered under the
			following broad headings:
			• Trauma: Simple and complex fractures
			(acute or delayed), burns, polytrauma,
			traumatic paraplegia, conflict related
			• Common congenital conditions: Talipes
			equinovarus (club foot), scoliosis and other
			congenital limb deformities, achondroplasia,
			bone cysts
			• Infections: Osteomyelitis (acute, untreated,
			chronic), TB, poliomyelitis
			• Developmental abnormalities:
			Developmental dysplasias of the hip
			(congenital dislocation of the hip (CDH)),
			Perthes disease, slipped upper femoral
			epiphysis (SUFE), idiopathic scoliosis
			• Neuromuscular conditions: Muscular
			dystrophies, progressive muscular atrophy,
			poliomyelitis, scoliosis
			• Neurological conditions: Cerebral palsy,
			spina bifida
			• Auto-immune conditions: Juvenile
			idiopathic arthritis (JIA)
			• Tumours: Sarcomas, osteochondromas
			• Rare congenital conditions:
			Osteogenesis imperfecta, neurofibromatosis,
			mucopolysaccharidosis (Hunter’s, Hurler’s),
			arthrogryposis multiplex.
			common orthopaedic conditionS in
			lmic
			Trauma
			Acute fractures and burns are common in
			children in LMIC and can be associated with
			high morbidity. A high proportion of fractures
			are treated non-surgically with traction or simple
			casting, with fracture manipulation under
			anaesthesia one of the most common paediatric
			orthopaedic procedures undertaken. Paediatric
			musculoskeletal impairment (MSI) has a
			prevalence of 2.6-4.8% in children under 12
			years; angular limb deformity and fracture non/
			mal-union are seen in a significant proportion
			of children presenting for elective surgery.1,2
			Polytrauma and burns (acute and reconstructive
			procedures) are challenging problems associated
			with high mortality, which are considered
			elsewhere in this edition of Update [page 199
			and 204].
			Congenital talipes equinovarus (clubfoot)
			Congenital talipes equinovarus (clubfoot)
			seems to have a higher prevalence in developing
			countries compared to elsewhere - for example,
			the incidence of clubfoot in Malawi is 2 per
			1000 children, twice that of North America
			and Europe.3,4 Although clubfoot programmes

WikiSysop at 22:21, 11 September 2025

2025-09-11T22:21:50Z

← Older revision		Revision as of 22:21, 11 September 2025
Line 6:		Line 6:
	Tsitsi Madamombe, Jim Turner and Ollie Ross*		Tsitsi Madamombe, Jim Turner and Ollie Ross*
	*Correspondence Email: oliver.ross@uhs.nhs.uk		*Correspondence Email: oliver.ross@uhs.nhs.uk
	~~introdUction~~
	~~Paediatric orthopaedics in low or middle income~~
	~~countries (LMIC) ranges from simple fractures~~
	~~(but often complicated by delayed presentation,~~
	~~anaemia or nutritional deficiency), to chronic~~
	~~osteomyelitis and fracture non-union, to~~
	~~complex elective procedures in children with~~
	~~cerebral palsy. This article will consider the~~
	~~spectrum of disorders encountered in paediatric~~
	~~orthopaedic surgery in LMICs, the orthopaedic~~
	~~manifestations of specific conditions in~~
	~~childhood, specific orthopaedic procedures and~~
	~~anaesthetic management of these conditions.~~
	~~Practical aspects of regional anaesthesia are~~
	~~covered elsewhere in this issue of Update (page~~
	~~99).~~
	~~the SpectrUM OF diSorderS Seen in~~
	~~paediatric orthopaedic SURGery~~
	~~Conditions can be considered under the~~
	~~following broad headings:~~
	~~• Trauma: Simple and complex fractures~~
	~~(acute or delayed), burns, polytrauma,~~
	~~traumatic paraplegia, conflict related~~
	~~• Common congenital conditions: Talipes~~
	~~equinovarus (club foot), scoliosis and other~~
	~~congenital limb deformities, achondroplasia,~~
	~~bone cysts~~
	~~• Infections: Osteomyelitis (acute, untreated,~~
	~~chronic), TB, poliomyelitis~~
	~~• Developmental abnormalities:~~
	~~Developmental dysplasias of the hip~~
	~~(congenital dislocation of the hip (CDH)),~~
	~~Perthes disease, slipped upper femoral~~
	~~epiphysis (SUFE), idiopathic scoliosis~~
	~~• Neuromuscular conditions: Muscular~~
	~~dystrophies, progressive muscular atrophy,~~
	~~poliomyelitis, scoliosis~~
	~~• Neurological conditions: Cerebral palsy,~~
	~~spina bifida~~
	~~• Auto-immune conditions: Juvenile~~
	~~idiopathic arthritis (JIA)~~
	~~• Tumours: Sarcomas, osteochondromas~~
	~~• Rare congenital conditions:~~
	~~Osteogenesis imperfecta, neurofibromatosis,~~
	~~mucopolysaccharidosis (Hunter’s, Hurler’s),~~
	~~arthrogryposis multiplex.~~
	~~common orthopaedic conditionS in~~
	~~lmic~~
	~~Trauma~~
	~~Acute fractures and burns are common in~~
	~~children in LMIC and can be associated with~~
	~~high morbidity. A high proportion of fractures~~
	~~are treated non-surgically with traction or simple~~
	~~casting, with fracture manipulation under~~
	~~anaesthesia one of the most common paediatric~~
	~~orthopaedic procedures undertaken. Paediatric~~
	~~musculoskeletal impairment (MSI) has a~~
	~~prevalence of 2.6-4.8% in children under 12~~
	~~years; angular limb deformity and fracture non/~~
	~~mal-union are seen in a significant proportion~~
	~~of children presenting for elective surgery.1,2~~
	~~Polytrauma and burns (acute and reconstructive~~
	~~procedures) are challenging problems associated~~
	~~with high mortality, which are considered~~
	~~elsewhere in this edition of Update [page 199~~
	~~and 204].~~
	~~Congenital talipes equinovarus (clubfoot)~~
	~~Congenital talipes equinovarus (clubfoot)~~
	~~seems to have a higher prevalence in developing~~
	~~countries compared to elsewhere - for example,~~
	~~the incidence of clubfoot in Malawi is 2 per~~
	~~1000 children, twice that of North America~~
	~~and Europe.3,4 Although clubfoot programmes~~

WikiSysop at 18:45, 3 February 2025

2025-02-03T18:45:46Z

← Older revision		Revision as of 18:45, 3 February 2025
Line 3:		Line 3:

	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''

			Tsitsi Madamombe, Jim Turner and Ollie Ross*
			*Correspondence Email: oliver.ross@uhs.nhs.uk
			introdUction
			Paediatric orthopaedics in low or middle income
			countries (LMIC) ranges from simple fractures
			(but often complicated by delayed presentation,
			anaemia or nutritional deficiency), to chronic
			osteomyelitis and fracture non-union, to
			complex elective procedures in children with
			cerebral palsy. This article will consider the
			spectrum of disorders encountered in paediatric
			orthopaedic surgery in LMICs, the orthopaedic
			manifestations of specific conditions in
			childhood, specific orthopaedic procedures and
			anaesthetic management of these conditions.
			Practical aspects of regional anaesthesia are
			covered elsewhere in this issue of Update (page
			99).
			the SpectrUM OF diSorderS Seen in
			paediatric orthopaedic SURGery
			Conditions can be considered under the
			following broad headings:
			• Trauma: Simple and complex fractures
			(acute or delayed), burns, polytrauma,
			traumatic paraplegia, conflict related
			• Common congenital conditions: Talipes
			equinovarus (club foot), scoliosis and other
			congenital limb deformities, achondroplasia,
			bone cysts
			• Infections: Osteomyelitis (acute, untreated,
			chronic), TB, poliomyelitis
			• Developmental abnormalities:
			Developmental dysplasias of the hip
			(congenital dislocation of the hip (CDH)),
			Perthes disease, slipped upper femoral
			epiphysis (SUFE), idiopathic scoliosis
			• Neuromuscular conditions: Muscular
			dystrophies, progressive muscular atrophy,
			poliomyelitis, scoliosis
			• Neurological conditions: Cerebral palsy,
			spina bifida
			• Auto-immune conditions: Juvenile
			idiopathic arthritis (JIA)
			• Tumours: Sarcomas, osteochondromas
			• Rare congenital conditions:
			Osteogenesis imperfecta, neurofibromatosis,
			mucopolysaccharidosis (Hunter’s, Hurler’s),
			arthrogryposis multiplex.
			common orthopaedic conditionS in
			lmic
			Trauma
			Acute fractures and burns are common in
			children in LMIC and can be associated with
			high morbidity. A high proportion of fractures
			are treated non-surgically with traction or simple
			casting, with fracture manipulation under
			anaesthesia one of the most common paediatric
			orthopaedic procedures undertaken. Paediatric
			musculoskeletal impairment (MSI) has a
			prevalence of 2.6-4.8% in children under 12
			years; angular limb deformity and fracture non/
			mal-union are seen in a significant proportion
			of children presenting for elective surgery.1,2
			Polytrauma and burns (acute and reconstructive
			procedures) are challenging problems associated
			with high mortality, which are considered
			elsewhere in this edition of Update [page 199
			and 204].
			Congenital talipes equinovarus (clubfoot)
			Congenital talipes equinovarus (clubfoot)
			seems to have a higher prevalence in developing
			countries compared to elsewhere - for example,
			the incidence of clubfoot in Malawi is 2 per
			1000 children, twice that of North America
			and Europe.3,4 Although clubfoot programmes

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''Originally from Update in Anaesthesia | www.wfsahq.org/resources/update-in-anaesthesia''