Chapter 40: Pediatric Musculoskeletal Problems

Developmental dysplasia of the hip involves abnormal femoral positioning within the acetabulum and is identified through clinical tests such as Ortolani's and Barlow's maneuvers, with early intervention using devices like the Pavlik harness preventing need for surgical correction. Congenital clubfoot presents as a complex deformity involving inversion, eversion, and plantar positioning variations, requiring serial casting protocols initiated immediately after birth to achieve proper alignment. Idiopathic scoliosis emerges during growth spurts as a three-dimensional spinal deformity combining lateral curvature, vertebral rotation, and rib asymmetry, managed through diagnostic imaging and physical examination techniques before progressing to bracing or surgical fusion when indicated. Juvenile idiopathic arthritis represents an autoimmune inflammatory process targeting articulations and surrounding tissues, necessitating disease-modifying medications and strategic positioning to preserve functional capacity while managing complications such as uveitis. Marfan syndrome, a fibrillin-1 gene defect affecting connective tissue, requires comprehensive monitoring of skeletal, cardiovascular, and ocular systems with activity restrictions and preventive antimicrobial protocols. Legg-Calvé-Perthes disease involves temporary disruption of femoral head blood supply, managed through load reduction and supportive therapies. The chapter also covers fracture management across the spectrum from assessment and reduction techniques through immobilization strategies including traction modalities and casting, emphasizing neurovascular monitoring and complication surveillance. Osteomyelitis, an infectious bone process typically caused by Staphylococcus aureus, demands prolonged intravenous antimicrobial therapy with possible surgical intervention for resistant infections.