Treatment Approach

Pediatric OrthopedicsWashington University Orthopedics provides the highest level of specialty care for pediatric orthopedic patients. Our multi-disciplinary team includes board-certified and fellowship-trained physicians and surgeons, pediatric orthopedic nurse practitioners, registered nurses and medical assistants, physical therapists, physiatrists, and rehabilitation medicine specialists. The team works closely with pediatric radiologists and radiology technicians at St. Louis Children’s Hospital to optimize assessment and treatment.

Highly defined specialization is the hallmark of our pediatric and adolescent services. We offer numerous specialized services and treatment for child and adolescent patients, including:

Foot Deformities

For the treatment of congenital pediatric foot deformities such as clubfoot, vertical talus, flatfoot, polydactyly, or metatarsus adductus, Washington University Orthopedics leads The Clubfoot Center at St. Louis Children’s Hospital. The Center receives international referrals and is one of the largest programs for the non-surgical correction of clubfoot through the use of the Ponseti method. The procedure, begun as soon as possible after birth, offers excellent results to correct clubfoot by weekly bracing and casting instead of surgery. Currently, pediatric orthopedists are achieving remarkable compliance and correction results after creating a new brace used in the Ponseti method. Another innovative cast-correction method also has been developed for the treatment of congenital vertical talus.

Spinal Deformities

The Washington University Orthopedics Pediatric Spine Surgery Program at St. Louis Children’s Hospital is one of the leading programs in the world for the treatment of spinal deformities and problems with the immature growing spine. Our surgeons are at the forefront in treating early onset scoliosis and severe cases of scoliosis, kyphosis, and spondylolisthesis. This includes neuromuscular scoliosis related to Duchenne’s muscular dystrophy, spinal muscular atrophy, cerebral palsy, and myelomeningocele; and spinal deformities related to connective tissue disorders, including Marfan syndrome and neurofibromatosis. Because of its innovative research and expertise, many of the operative and conservative treatments now offered globally have been popularized by research by the spine specialists with Washington University Orthopedics.

Hip Deformities

Among the newest and rapidly evolving specialties within pediatric orthopedics is the treatment of adolescent hip deformities. Washington University Orthopedics is one of only a handful of orthopedic practices in the country with expertise in adolescent hip arthroscopy. A multidisciplinary approach focuses on relieving pain, improving function and preserving the hip joint in patients diagnosed with complex conditions such as developmental hip dysplasia, impingement disorders or deficient hip sockets.

Hand & Wrist Problems

Washington University Orthopedics is nationally recognized for using microsurgical reconstruction techniques to treat congenital and developmental hand deformities in children, including radial club hand, thumb deficiencies, syndactylyl (webbed fingers), polydactyly (extra fingers), cleft hands, Madelung’s and other wrist deformities. Trauma and sports-related injuries to the hand, wrist, and forearm also are treated, as is adolescent carpal tunnel syndrome. Arthroscopy of the elbow, wrist, and hand may be used to evaluate and treat traumatic injuries. The team specializes in microsurgery and reconstructive surgery and performs reconstructions of congenital hand deformities and peripheral nerve repair.

Lower Extremity Deformities and Limb-Lengthening

Washington University Orthopedics is adept at the treatment of lower extremity deformities, including the correction of Blount’s Disease commonly caused by Genu varum (bowed legs), and the treatment of uneven limb length in young children. A computer-driven system, the Taylor Spatial Frame External Fixator, enables orthopedists to provide daily correction prescriptions to patients recovering from traumatic injuries or to help correct limb deformities or poor bone alignment.

Sports Medicine

With fractures and trauma to the leg, knee, or elbow among the most common conditions treated by pediatric orthopedic specialists, Washington University Orthopedics is widely regarded for its ability to return a child to as much function and mobility as possible after orthopedic treatment.

In addition to treatment of traumatic injuries, Washington University Orthopedics offers a specialized team to treat sports-related injuries. At the Washington University and St. Louis Children’s Young Athlete Center, physicians and surgeons work closely with physical therapists, physiatrists, athletic trainers, and rehabilitation medicine specialists to ensure optimal recovery for orthopedic injuries. Areas of expertise include the treatment of osteochondritis dessicans (OCD), discoid meniscus condition, patellar dislocations and anterior knee pain, as well as meniscal repair and ligament reconstructions. Acute and overuse injuries of the shoulder, elbow, ankle, back, wrist, hands, and feet also are treated.

For young patients with an anterior cruciate ligament (ACL) injury, Washington University Orthopedics offers an ACL injury prevention program, a young runner’s treatment clinic, custom orthotic services, and compartment testing.

Our team also provides comprehensive evaluations following sports-related concussions, including return-to-play decisions, management of post-concussion syndrome and neuropsychological testing. Pre-participation sports physicals for grade school and college athletes also are available.

Adolescent medicine, pain management, sports psychology, rheumatology, cardiology and nutrition specialists are also a unique part of the Young Athlete Center. This multispecialty format allows for comprehensive care within a sports-minded environment. To learn more about the Young Athlete Center, click here.

Musculoskeletal Oncology

A multidisciplinary approach is used to diagnose and treat children with benign and malignant tumors of the musculoskeletal system. This includes both bone and soft tissue tumors such as osteochondroma and bone cysts as well as malignant bone tumors, most commonly osteosarcoma and Ewing’s sarcoma. A specially trained orthopedic oncologist works closely with radiologists, pathologists, and pediatric oncologists to create an individualized treatment plan that aggressively treats the cancer while ensuring the highest quality of life for the patient. The goal of surgery is to completely remove the tumor, while preserving and maximizing extremity mobility and function. In more than 90% of the cases we see, we are able to avoid amputation because of our extensive experience in limb salvage techniques. Specific techniques used in reconstructing a limb after tumor removal include: metallic and endoprosthetic bone reconstruction, large fragment allograft reconstruction, and vascularized fibular graft reconstruction. Special considerations in the pediatric age group includes the necessity of using smaller size implants and/or special techniques to address the growing child, such as expandable endoprosthetic implants. For most of our oncology patients, rehabilitation starts soon after surgery, once they are surgically and medically stable. Careful coordination of other services results in optimal recovery, both from a functional standpoint as well as with disease control.

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