German Centre for Orthopaedics
Many children also suffer from orthopaedic diseases. These are mostly congenital deformities and developmental malformations. In the case of our little patients, it is mainly a question of hip, foot and spine disorders.
Here, we initially provide help in the form of targeted physiotherapy and the use of orthopaedic aids such as corsets or splints. In addition, we often treat our children with complex and individually prepared aids from our orthopaedic technology department.
With us, your children are in the best hands: Our specialists in paediatric orthopaedics have proven expertise and many years’ experience in this field.
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Dr. André Sachse
Head of the Paediatric Department
Specialist for orthopaedics & trauma surgery; paediatric orthopaedics, special orthopaedic surgery, chirotherapy, acupuncture
Specialist for orthopaedics & trauma surgery
Legg–Calvé–Perthes disease is an orthopaedic paediatric disease in which the blood supply to the head of the femur is temporarily interrupted or just partially disrupted.
This can cause the femoral head to die off – the bone becomes deformed, is generally pushed outwards, away from the protection of the hip socket, and ossifies in this position. As a result of the asymmetry in the hip joint, the children develop a protective limp and usually suffer from knee pain and impaired mobility.
Conservative treatment is not usually successful. Therefore, our orthopaedic specialists recommend a corrective operation on the hip, which locates the femoral head deeper in the socket (containment therapy).
The operation lasts about 40 minutes, and the children learn how to walk on forearm crutches after around four to five days. Partial weight-bearing to protect the leg is gradually increased in stages up to full weight-bearing after eight to ten weeks (depending on the age of the child).
Thereafter, the children can carry out all everyday activities again, even if Legg–Calvé–Perthes disease requires a longer period before it is completely cured. General school or even high-performance sports can only be taken part in to the full after two to four years.
On the basis of our experience on over 450 children who underwent surgery in the past 15 years and comprehensive follow-up examinations as part of a doctoral thesis, we can recommend containment therapy to treat Legg–Calvé–Perthes disease and avert the risk of permanent deformation of the hip joint with early wear.
The term scoliosis refers to a malalignment of the spine. In this condition, the spine is bent sideways and the individual vertebrae are twisted.
This deformation develops above all in adolescents: girls are affected four times more often than boys. Depending on the time of occurrence, doctors refer to an infantile (first to third year of life), juvenile (fourth to ninth year of life) and adolescent (tenth to 15th year of life) scoliosis.
At the beginning, scoliosis causes little or no pain. Later, the permanent malalignment causes wear on the bones of the spine, which can lead to considerable pain in adulthood. In addition, internal organs such as the heart, lungs or kidneys may be damaged as a result of the restricted space.
Depending on the extent of the scoliosis, physiotherapeutic measures and/or a corset therapy are applied. The chances of success are very good if optimal treatment with targeted physiotherapeutic measures is given at an early stage, which means that an operation can usually be avoided.
Severe deformities can often only be cured surgically by means of corrective spondylodesis, i.e. a fusion of the vertebrae, in which the spine is stabilised and a complete correction is achieved.
Clubfoot is a deformity of the feet that is usually congenital: here, the soles of the feet are turned inwards.
If left untreated, children then start to walk on the outer edges of their feet and, in the case of very extreme disease, even on the back of their feet. This deformity leads to impairment of early childhood motor development and restricts the growth of the leg muscles.
Orthopaedic specialists achieve excellent results in the treatment of clubfoot. The prerequisite for this is that it is diagnosed at an early stage and that therapy is started in good time.
It is usually sufficient to apply a plaster cast to the infant within the first few days after birth, in order to correct the deformity. After a treatment of six to twelve weeks, an elongation of the Achilles tendon may be necessary.
Only in rare cases is a complex surgical intervention required. However, treatment with splints has to be continued for a number of years, in order to counteract a potential deterioration.
While skewed flat foot can arise during childhood development and usually disappears again later, decompensation occurs in a small number of children:
The degree of kinking, especially of the heel, increases strongly. The foot cannot be straightened completely when standing on the toes or only at the end of the range – pain is experienced after prolonged standing, walking or running.
As a general rule, conservative measures are not successful: Unfortunately, children and adolescents often do not carry out foot exercises sufficiently. Apart from this, physiotherapists are only able to fully correct the deformity to a limited degree.
Therefore, particularly in the case of very painful skewed flat feet, we recommend extraarticular arthroereisis:
In this minimally invasive intervention, a titanium screw is inserted from the outside of the foot into the space between the heel bone and the talus bone. This prevents a further kinking of the heel bone outwards.
If indicated by the clinical findings, we conduct the operation between the eighth and 13th year of life.
After the operation and a brief period of immobilisation, full weight can be placed on the foot again. As a result of the correction, it is expected that the malaligned articular surfaces will return to their normal position over the further course of growth and that the foot will thus remain stable.
In the young people who have undergone the operation to date, a correction of the deformity, full weight-bearing and a good function of the foot have been achieved.
Cerebral palsy is an orthopaedic disease that is caused by early childhood damage to the brain.
The child usually suffers from movement disorders and later from deformities of the bones and joints. Therefore, without sufficient therapy, these children do not achieve or are late in achieving the motor milestones appropriate to their stage of development.
We help these children in our paediatric orthopaedic clinic: Comprehensive diagnostic procedures are carried out to determine the movement disorders. We then draw up a therapy plan together with the parents.
In the treatment of cerebral palsy patients, we are committed to taking an interdisciplinary approach: beside paediatric orthopaedic specialists and neurologists, this concept involvesphysiotherapists, speech therapists and social pedagogues.
The term wryneck describes the combination of findings determined by inspection of a head position and rotation deviating from the normal. Differential diagnosis decides on whether a true disease is present, as changes in the region of the cervical spine in childhood may be caused by different primary diseases.
Here, we conduct biterminal selective tenotomies. In other words, we look for strands of connective tissue fibre in the muscle and sever them, in order to correct the malposition and malrotation.
Thereafter, a cervical collar is sufficient, while a wryneck orthosis is applied in rare cases and very rarely a Minerva plaster cast. In addition, physiotherapy is carried out from the first day onwards.
Having fun while getting better
Especially for children and adolescents, impairment to health can become a burden. For this reason, we do all we can to distract them from their problems in a playful and child-oriented way.
The children should be given a chance to forget that they are being treated for a disease. After all, beside medical treatment, fun and enjoyment are an important factor in the healing process.
For this reason, our paediatric orthopaedic ward also offers various different child-oriented therapeutic options, which provide variety in everyday clinical routine and at the same time promote mobility and activity. Beside a playroom with a large selection of (donated) games, garden therapy is regularly offered here and occasionally also music therapy.
In the treatment of scoliosis, we put great store in a therapeutic option that the children particularly enjoy: hippotherapy.
Here, they sit on a horse without a saddle. The warmth and the movement of the animal are directly transferred to the child’s pelvis. The movements also act on the spine.
The Waldkliniken Eisenberg have for a long time been working closely with a local riding school, which provides us with specially trained horses and handlers.
The children even sometimes forget that they are here because they are ill. The horses have a calming influence and the children love the animals. Hippotherapy is something very special for many children.