Chapter 42: Alterations of Musculoskeletal Function in Children

Congenital defects such as clubfoot involve abnormal foot positioning requiring serial casting or surgical intervention, while developmental dysplasia of the hip ranges from acetabular underdevelopment to complete dislocation, diagnosed through specific clinical maneuvers and managed with protective devices or corrective surgery. Osteogenesis imperfecta, a genetic disorder affecting collagen synthesis, produces skeletal fragility, deformity, distinctive ocular findings, and hearing complications, managed through pharmacological treatment and orthopedic stabilization. Infectious processes including osteomyelitis and septic arthritis represent serious conditions causing bone and joint destruction, typically requiring aggressive antimicrobial therapy and surgical intervention. Juvenile idiopathic arthritis, the primary autoimmune arthritis in children, manifests in distinct phenotypes with variable severity and systemic involvement, treated through nonsteroidal anti-inflammatory agents and disease-modifying therapies. Osteochondroses represent avascular complications of growth plate regions, presenting with pain and functional limitation managed conservatively or surgically depending on severity. Structural spinal abnormalities such as scoliosis require monitoring during periods of rapid growth with intervention when progression threatens pulmonary or cardiac function. Neuromuscular disorders including Duchenne muscular dystrophy, spinal muscular atrophy, facioscapulohumeral dystrophy, and myotonic dystrophy each present progressive weakness through distinct pathophysiological mechanisms, requiring comprehensive multidisciplinary management addressing motor, cardiac, and respiratory complications. Primary bone malignancies including osteosarcoma and Ewing sarcoma demand urgent diagnosis and aggressive multimodal therapy combining chemotherapy, surgical resection, and radiation. The chapter emphasizes that nonaccidental trauma represents a critical diagnostic consideration in pediatric fracture presentations, requiring careful radiographic assessment and protective intervention when abuse is suspected.