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