Anaesthesia for paediatric orthopaedic surgery

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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