Boy sitting on an exam table during visit at orthopedic office

Dr. Barkha Gurbani Analyzes the Dramatic Changes in Modern Pediatric Orthopedic Surgery

The field of pediatric orthopedics is at the forefront of new surgical technologies. Pediatric specialists use all the best techniques and technology available to them to enhance children’s lives, allowing them to recover from injuries or overcome irregularities and deformities in their development.

A child’s body is different from an adult’s since the bone has not fully formed and ligaments and nerves respond differently. Having a better perspective on children’s treatment can help a pediatric orthopedic surgeon enhance a child’s life.

In the 1990s, pediatric orthopedics became a popular specialty. Prior to this development, only a handful of orthopedists in the United States worked exclusively with children. Today, there are hundreds of specialists in this field. Pediatric Orthopedic specialists complete a year of dedicated fellowship training, in addition to the five years of general Orthopedic surgery training.

Children with major orthopedic issues can now find a greater level of treatment than they could in the past. Conditions that would have caused a child to be relegated to a wheelchair are now treatable to the point where these children can walk normally. These exciting developments are happening every year, and many believe even the most impaired children will soon have a chance at a normal life.

Dr. Barkha Gurbani, an experienced pediatric orthopedic surgeon, describes the most important changes that have occurred in the field over the past 25 years, explaining how each one can help children live healthier lives.

A Higher Degree of Specialization
Like orthopedic surgeons who work on adults, pediatric orthopedic practitioners can now sub-specialize. There are congenital hand specialists, hip preservation specialists, and spinal specialists, to name a few. Pediatric Orthopedic practitioners are even focused on sports conditions or limb deformities for children. 

Previous Barriers to Children’s Treatment
Most medical device manufacturers did not produce child-sized replacement joints or other surgical implants. When these parts were needed, they used to be produced one at a time. This used to slow down the surgical process for these children and cause them more expense over time. Medical device manufacturers saw a growth market in treating children, and now produce child size plates, screws, and nails which help to treat children’s fractures with rigid or flexible fixation.

Even in regards to join replacements, this problem is improving, especially with the use of 3-D printing. Individual implant parts are able to be modeled and printed using this technology.

Surgical Advances in Pediatric Orthopedics
One of the most transformative advances in pediatric orthopedics is the advent of extendable spinal rods for scoliosis. Children with Infantile or Juvenile Scoliosis used to have to undergo yearly “birthday surgery.”

Using the new system where the rods can be lengthened with an electromagnet in the doctor’s office, the number of surgeries that a child must undergo is greatly decreased. This reduces a child’s pain and suffering and lessens the chance for infections or other serious side effects.

The treatment of pediatric spinal problems has also undergone many amazing developments. Scoliosis can be a challenging diagnosis for young children. The process of correcting scoliosis has advanced with the use of EDF (elongation, derotation, flexion) casting. This form of casting acts simultaneously on the coronal, sagittal, and frontal planes. EDF casting has improved the outlook for these children and can provide a return to normal mobility without the daily use of a brace.

Research has also helped doctors determine which children will outgrow their scoliosis and which will need ongoing orthopedic treatment. These advances has helped to answer some of the questions on which children with Idiopathic Scoliosis do better with surgery, bracing or observation.

EOS Imaging Technologies
EOS is a low-radiation imaging system now offered at some of the Children’s Hospitals. A 2015 study found that skeletally immature patients given EOS treatments received 4 times less radiation to their thyroid and breasts. This can help to lessen the chances of developing cancer later in life, considering how many times a child with a skeletal irregularity undergoes imaging scans. EOS provides a win-win situation for patients and their physicians.

Intraoperative Imaging
CT-guided navigation has made huge strides over the past 25 years. Using a live CT scan image, a physician is able to see exactly which part of the spine they are targeting for screw placement in an operation. This technology provides a 3-D view of a child’s spine, ensuring that the surgery is focused in the correct area.

The Mayo Clinic found that using intra-operative CT scans increased the likelihood of placing screws correctly by up to 97 percent. In previous studies, it was found that up to 15 percent of screws placed freehand were not properly positioned.

3-D Modeling
Doctors are better able to visualize how their patients’ unique anatomy when they are provided with a 3-D model. CT scanning and 3-D printing can help doctors and families understand the underlying issues and provide the best path forward for treating the child’s problems.

Doctors are able to print out 3-D models of their patient’s spine or other affected body part, for example large tumors, allowing them to precisely plan the surgery. They can also help to educate patients and parents about the surgery.
Treating Children to Improve Lives
The pediatric orthopedist is a vital part of children’s medical treatment. Children are often injured when they are playing, and others are born with irregularities that must be treated. The science of pediatric orthopedic surgery has made many strides forward over the past 25 years, including imaging, device production, and improvements in assistive technologies.

Dr. Barkha Gurbani understands that parents of children with orthopedic problems will worry about their child’s quality of life. The constantly developing science of pediatric orthopedic surgery means that more children will be able to play, walk, and do their daily activities with less pain and impairment.