Herzliya Medical Center
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HMC hosted its monthly Facebook Q&A session, where our members had the opportunity to have their questions answered by an expert specialist regarding a particular field of medicine. This month we featured questions relating to fractures, congenital anomalies, infantile cerebral palsy and hip dysplasia (to name a few), in the field of Pediatric Orthopedics.
Doctor Naum Simanovsky answered your questions; he has over 15 years of clinical experience in pediatric orthopedics, two of which he has spent in Boston Children’s Hospital on a fellowship. He is currently deputy chief of the pediatric orthopedics department at Hadassa Hospital in Jerusalem and has a private practice at Herzliya Medical Center.
A: Spina bifida occulta is not a disease; it is a variant of normal anatomy. No complications expected – sometimes questions may exist.
A: Pediatric consultation is justified; we look at hip joints, as it is relatively rare to see it within other joints. Periodical hip x-rays are done. It also depends on the severity of their CP. Prevention of joint contractures and improvement of major joint movements will prevent degenerative changes.
A: Congenital kyphosis depends on the severity. It is a structural anomaly – it depends on the severity and progression rate. If there is a rapid progression, surgical treatment is required. The condition should be monitored at least every 5-6 months.
A: At this age, we do not interfere surgically. Usually, the absence of these fingers is a form of forearm dysplasia – it starts around the age of 3. Transplantation of the toe to the hand is not indicated, functionally it is not justified.
A: Flatfoot is a normal situation within the population. It is asymptomatic usually; pain is an indication of a pathological condition and must, therefore, be evaluated. Treatment depends on the exact cause of this particular case. Radiology is also required like CT and x-ray scans for further investigation.
A: It is unclear if the time from the cast is removed, timing is important. Usually, kids at this age do not need physiotherapy – normal physiotherapy such as games on the playground is fine. However, extreme sports should be avoided, such as gymnastics and contact sport. Swimming and bicycling are fine.
A: Bed rest in Perthes’ disease is not indicated! The main task at the moment is to reduce the axial load on the joint, that is, jumping, running, long walking/ standing. Thus, it is necessary to keep the amount of motion of the joint – gymnastics, swimming, bicycling. In periods of acute illness, you can use crutches, so as not to step on the foot. Usually, these periods are short. Sometimes surgery is justified, but this decision can only be made based on X-ray and clinical examination.
A: Ponseti method is recognized in Israel, as well as throughout the world as the most effective to date. Your little girl will have a long way ahead of her – a cast then medical devices, special shoes and more. However, overall, the outlook is rather favorable.
A: Considering the severity, as well as the late diagnosis of this pathology, she needs aggressive treatment, the sooner – the better. It is important to carry out a clinical examination and take pictures. Typically, X-rays are enough, but sometimes it is necessary to do contrast arthrography. Most likely, the girl needed surgery – again, the sooner – the better. Provided that we are not talking about serious complications, your little girl has all the chances to restore joint function.
A: I recommend not operating. The child is not expected to have any functional problems. Operation – is an option, but it is fraught with serious complications and scarring. If your daughter decides to do the surgery later on in life, she will not be refused.
A: Usually such pathologies are not genetic. Most likely, you can help the boy surgically. It is important to understand that we are talking about multiple operations every few years. Before making a decision, it is necessary to clarify the nature of the defect and eliminate the associated structural violations. Clinical examination and a simple method of imaging (x-ray) are enough.
A: To provide the most accurate answer to your question is to know what the form of cerebral palsy is in question, and what is the level of spasticity and functioning of the child. We need to understand whether or not the operation that was carried out was in fact indicated, and was performed successfully. I cannot give further details without a full examination.
HMC will continue hosting live Q&A sessions with leading physicians every month, to better serve our patients and the public. If you have any other question regarding disorders of the musculoskeletal system or treatment of post-injuries, or you wish to receive a medical quote, please do not hesitate to contact us.