Pediatric Orthopedics Q&A with Dr. Naum Simanovsky

Pediatric orthopedics involves medical intervention to correct congenital abnormalities and acquired disorders of the musculoskeletal system of children, including post-injuries and previous surgeries that were unsuccessful.

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.

Dr. Naum Simanovsky

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.

My baby was born with spina bifida occulta. Our pediatricians say that this is a mild form of the disease, but complications might still occur. What should we expect? Is there a lifelong treatment? Thank you.

Spina bifida occulta is not a disease; it is a variant of normal anatomy. No complications expected - sometimes questions may exist.

Our 4 y/o girl has cerebral palsy. We’ve heard that children with CP are more prone to osteoarthritis and degenerative arthritis in adulthood. Is there anything we can do now to make it easier for her when she's fully grown?

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.

My daughter aged 1.5 has congenital kyphosis. We are monitoring her condition and so far there have been no complications. Doctors say that if she’s walking, there's no need for surgical intervention. Is that true? In what case might surgery be necessary?

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.

My baby boy was born without his 4th and 5th fingers on his right hand. He is 3 months old. Is there anything we can do for him at this age? I heard that a transplantation from the feet is a possibility. Thank you.

At this age, we do not interfere surgically. Usually 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.

My 9-year-old son was diagnosed with flatfoot after complaining about pain and discomfort. We’ve bought him special shoes and he is receiving physiotherapy, but he said he doesn’t feel any better. What other options are there to lessen his pain and discomfort?

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.

My son of 3.5 years old dislocated his hip and was in a cast for some time. We've since taken the cast off, he is not really active as of yet and our treating physician says physical therapy is not necessary. Why do children not need physical therapy and how long will it take until my boy is active and walking again? Thank you.

It is unclear of the time from the cast being removed, timing is important. Usually kids at this age do not need physiotherapy - normal physiotherapy such as games on the playground are fine. However, extreme sports should be avoided, such as gymnastics and contact sport. Swimming and bicycling is fine.

Hello, doctor! Our 7-year-old son after multiple consultations with doctors was finally diagnosed with Perthes disease stages 2-3. He was prescribed bed rest for an indefinite period. What are less restrictive methods of treatment that exists for this disease?

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.

My girl (born 5 weeks ago) was diagnosed with clubfoot, doctors want to cast the feet and then follow this by the Ponseti method. Please tell me whether this method is effective? Maybe in Israel there are more effective approaches to the treatment of clubfoot? Why is surgery not recommended?

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.

Dear Dr. Simanovsky, our daughter is 3 years old. She later began to walk at the age of 1.5 years; we took her to an orthopedist, as we noticed that her walk was not balanced. It turned out that she had a congenital hip dislocation. We are anxious; we feel that we should have addressed this issue from her birth. What is the consequence of the disease? What should be done so that she develops normally in the future?

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.

Good afternoon! I am writing about my daughter was born a few months ago with syndactyly of the legs, on the 2nd and 3rd toes fused. My husband is the same. Tell me, what can I do? What are the surgical options? At what age is it best to operate?

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.

Our son has a congenital anomaly of the lower limb, in connection with which the right leg is shorter than the left. He is 6 years old; doctors were unable to establish the exact cause of the defect. What can be done for him in order that he leads a normal life? Genetic tests? Gymnastics? Operation? We will be glad to have any advice. Thanks!

Usually such pathologies are not be 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) is enough.

Dr. Simanovsky, hello. Our girl of 7 years has cerebral palsy. A couple of months ago, she underwent surgery of the Achilles tendon, but there was no improvement in her condition. Is it possible to carry out a second surgery even though the first failed, is there no further options for treatment?

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 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.

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