Pediatric Orthopedics in Practice

912 Pages·2015·59.82 MB·English

by  Prof. Dr. med. Fritz Hefti (auth.)

Pediatric Orthopedics in Practice
Fritz Hefti
Pediatric
Orthopedics in
Practice
Second Edition
Foreword Second Edition from S. Wientroub and D. R. Wenger
Foreword First Edition from J. R. Kasser and G. D. MacEwen
In collaboration with:
R. Brunner, F. Freuler, C. Hasler, G. Jundt and A. Krieg
Translated by R. Hinchliffe
Freehand Drawings by F. Freuler
Schematic Drawings by F. Hefti
With 1623 Figures
123
Prof. Dr. med. Fritz Hefti
Universitätskinderspital beider Basel (UKBB)
Spitalstrasse 33, 4056 Basel, Schweiz
Email: [email protected]
[email protected]
In collaboration with:
Prof. Dr. med. Reinald Brunner Prof. Dr. med. Gernot Jundt
Universitätskinderspital beider Basel (UKBB) Institut für Pathologie der Universität Basel
Spitalstrasse 33, 4056 Basel, Schweiz Schönbeinstrasse 40, 4056 Basel, Schweiz
Email: [email protected] Email: [email protected]
Dr. med. Franz Freuler PD Dr. med. Andreas Krieg
Arabienstr. 26, 4059 Basel, Schweiz Universitätskinderspital beider Basel
Email: [email protected] Spitalstrasse 33, 4056 Basel, Schweiz
Email: [email protected]
Prof. Dr. med. Carol Hasler
Universitätskinderspital beider Basel (UKBB)
Spitalstrasse 33, 4056 Basel, Schweiz
Email: [email protected]
ISBN 978-3-662-46809-8 ISBN 978-3-662-46810-4 (eBook)
DOI 10.1007/978-3-662-46810-4
Library of Congress Control Number: 2015939437
© Springer-Verlag Berlin Heidelberg 2007, 2015
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For Christiane and for my three sons André, Philippe and Stephan,
who have repeatedly taught me how children and adolescents feel
and what their needs are.
Foreword I to the second edition
» Knowledge is of no value unless you put it Prof. Fritz Hefti whom I know for many years
into practice. and that together we are the Editors-In-Chief of the
Anton Chekhov Journal of Children’s Orthopaedics, has a broad
clinical experience in an academic setting with
Modern medicine today is in a state of ever-ex- excellent clinical skills and wisdom as an outstand-
panding knowledge. More medical knowledge has ing Pediatric Orthopaedic surgeon, researcher and
been created or discovered in the last century than innovator with a unique international profile.
in the previous 5,000 years. More scientific and
medical papers are being published now than ever In addition to being a successful chairman, prolific
before. The half-life of medical knowledge is ex- writer, and world renowned speaker he was a
tremely short and what seemed new and up-to-date t eacher and a mentor to many Pediatric Orthopae-
yesterday is redundant today. Moreover, techniques dics surgeons around the world.
change because of technologic advances and hu-
man creativity. Medical practice must try to keep When these features are combined – talent for
pace with this new medical information. Patients teaching, a brilliant mind, creativity and years of
should receive appropriate, updated, evidence- experience, this book is the outcome.
based care when they need it.
The co-authors are Reinald Brunner (neuro-ortho-
Since the last edition of Pediatric Orthopedics in pedics), Carol Hasler (spine and trauma), Gernot
Practice, the field of Pediatric Orthopaedics has Jundt (pathologist and tumors) and Andreas Krieg
moved forward at a rapid pace and grown substan- (axes and lengths). Their specific expertises make
tially. Changes in evidence-based information their contribution very valuable. They were taught
effected standard of care in many orthopedic con- by Prof. Hefti and now are regarded as the new
ditions. Therefore this revised, updated and ex- young leadership in the world of Pediatric Ortho-
panded edition which covers the spectrum of paedics carrying his torch for generations to come.  
Pediatric Orthopaedics creates a comprehensive
updated source for those who care for children and Professor Shlomo Wientroub
adolescents with musculoskeletal problems. All Tel Aviv
important aspects of Pediatric Orthopaedics con-
ditions are covered in this new edition. Recom-
mended treatment is outlined with discussion of
the tremendous diversity of expertise from around
the world with a special Swiss and European flavor
and all is accompanied by the beautiful drawings of
Franz Freuler.
This book is not intended to be encyclopedic but
practical and immediately applicable. It provides
a guide to the diagnosis and management of a wide
spectrum of orthopaedic conditions that most
surgeons in a Paediatric Orthopaedic practice are
likely to encounter and is a valuable guide for
inexperienced and experienced surgeons alike in a
readable, clear and instructive manner.
VII
Foreword II to the second edition
This English language Second Edition of a well- The editor notes that the half-life of medical knowl-
known European children’s orthopedics text, edit- edge is short, and, thus, the new edition contains
ed by Fritz Hefti, M.D., Professor of Orthopedic many new references, but also deletes some of the
Surgery at the University of Basel, provides an ex- old to avoid making the text overly long. Our spe-
panded, comprehensive and often entertaining cialty has grown exponentially over the last decade
overview to the subject of children’s orthopedics. with intellectual leadership provided by the Pediat-
ric Orthopedic Society of North America (POSNA)
As in the First Edition, Hefti and colleagues present and the European Pediatric Orthopedic Society
a comprehensive review of our specialty, describing (EPOS).
all areas of children’s orthopedic surgery. The book
continues to feature multiple cartoon-like drawings Professor Hefti and his colleagues in Basel have
that provide both information and entertainment maintained a close focus on both the development
describing common problems in children’s ortho- of children’s orthopedics as a specialty, but also on
pedics. the many advances in knowledge that have oc-
curred over the last ten years. Europe is fortunate to
This updated edition also focuses on innovation have an energetic, clear thinker to update what was
in our specialty. The conservative, non-operative already an important text into a modern classic.
Ponseti method for correction of clubfoot is now
widely accepted and clearly described. The ortho- North America has Lovell and Winter, and Europe
pedic management of scoliosis is well covered, has Hefti as critical children’s orthopedic referenc-
i ncluding new dynamic corrective methods that es. The well-read orthopedist will regularly refer to
do not require fusion (anterior, tether, staples) etc. both.
They also describe in some detail the use of mag-
netically driven implanted rod-screw systems Dennis R. Wenger, M.D.
which allow correction of scoliosis without stiffen- San Diego
ing or fusion.
This edition includes a focus on much that has
been learned over the last ten years in many areas
of children’s orthopedics, including a better under-
standing of the treatment of bone and soft tissue
tumors in childhood, a clear depiction of the
current discipline of femoral acetabular impinge-
ment, and the benefits of new technology such as
the »FitBone«(cid:112) implant to lengthen limbs with a
digital external guidance.
There are many areas of special value in this text,
including a comprehensive update in the chapter
on skeletal dysplasia to allow better understanding
of genetics in these disorders. The international
classification of these conditions has been updated
accordingly.
Forewords to the first edition
The specialty of pediatric orthopaedics involves I have just finished reading this enjoyable book.
a vast array of primary and secondary musculo- I started out only to scan it but found it to be most
skeletal conditions influenced by growth and de- enjoyable and educational and I learned a great
velopment. Writing a comprehensive textbook is a deal.
somewhat herculean task which Fritz Hefti and his
group have done with wit and style, making this Fritz Hefti has been the first who was appointed as
book both instructive and readable. The sometimes a full Professor of Pediatric Orthopedics in Switzer-
humorous, cartoon-like illustrations are reminis- land and has had a very large clinical experience
cent of those drawn by Mercer Rang. These draw- at the University of Basel. He is, therefore, very
ings emphasize important facts, as does the bold qualified to include his personal indications for
colored print throughout the textbook. chosen treatment programs. His book covers all
areas of pediatric orthopedics including fractures.
As near as I can tell, all important aspects of pedi-
atric orthopaedic conditions are covered in this It is a detailed work that is educational as well as
textbook. Each new disease or section begins with humorous. The line drawings make the points in an
a discussion of etiology, complemented by a full unforgettable way.
description of diagnostic, historical and physical
findings. Diag-nostic studies are recommended The references are up to date. Since the work was
with an eye towards the efficient use of resources in done in Europe it includes many important refer-
»working up« a patient. Recommended treatment ences from journals not in-cluded in the English
is outlined with frequent discussion of personal, works.
Basel, Swiss, or European experience. Reference to
the Basel Tumor Database and other datasets is Fritz Hefti worked with me at the beginning of his
helpful to the reader. career. He was an excellent clinical and research
fellow and since then I appre-ciate him very much.
Whether you are searching for information on He is very proficient in English and the book is
tumors, regional pediatric orthopaedic conditions easily read.
or genetic diseases, you will find it in this textbook.
In addition to being a reference source for answer- I know that you will enjoy it as much as I have.
ing a question about a specific disease, one can read
the text in a journey through pediatric orthopae- G. Dean MacEwen, M.D.,
dics as it is written in a stimulating and entertaining Newark, Delaware
style rather than simply a listing of facts.
I’ve known Fritz Hefti for 25 years and have
a dmired his thoughtful approach to pediatric
o rthopaedics. Through this textbook, others will
have an opportunity to be exposed to the wit and
wisdom of an outstanding Swiss pediatric ortho-
paedic surgeon.
James R. Kasser, M.D.,
Chief of Orthopaedics at the Children’s Hospital
Boston
John E. Hall Professor of Orthopaedic Surgery
at Harvard Medical School
IX
Preface to the second edition
» The electric light was not discovered
as a result of the development of candles
(author unknown).
Correction and growth control have been key therapeutic Genuine innovations require novel approaches…
principles in orthopaedics ever since Nicolas Andry coined
the term in 1646.
Real progress in medicine arises from novel be achieved with a corrective technique, without
approaches, rarely from the perfection of what the need for extensive surgery.
already exists. Naturally, what is already known
and in existence still forms the basis for new devel- The surgical treatment of scoliosis is now over
opments. Both the candle and the filament in a light 100 years old. In 1910, Russell A. Hibbs first se-
bulb obtain the energy for emitting light from the cured crooked spinal columns in a corrected
thermal motion of their particles. There have been position, after posterior fusion, with a corrective
countless examples of new approaches in the past cast. The instrumented management of scoliosis
that profoundly changed the therapeutic possibili- is already over 50 years old. In 1961, Harrington
ties, for example the introduction of the elastic published his technique for straightening and
i ntramedullary nails for the management of frac- f ixing the spine from the posterior side with rods.
tures in children and adolescents, circular fixators While nothing has changed in respect of the prin-
for leg lengthening and correction of deformities or ciple of stiffening, novel approaches are still needed
the containment operations in Legg-Calvé-Perthes here. Fortunately, such approaches have emerged
disease. Moreover, certain long-established ideas at various levels in recent years. The correction
whose value is not recognized for years often of the spine in children is now possible without
achieve the breakthrough only at a much later s tiffening, while the growth potential is preserved,
stage. In the treatment of clubfoot for example, the or even promoted by active distraction. New oper-
conservative Ponseti method has now largely re- ations at intermittent intervals are no longer con-
placed extensive operations, but only some 40 years stantly required for lengthening, as this can now be
after it was first described. What works for clubfoot controlled remotely with a magnetic drive. While
has also proved successful, in modified form, for substantial improvements in the treatment options
congenital flat foot. Here too, very good results can are expected in these therapeutic techniques over
X Preface to the second edition
Major changes have also been made to the chapter
on skeletal dysplasias. As a result of the constantly
changing developments in genetics, the Interna-
tional Classification has also been updated since
the 1st edition. This chapter is structured as in the
previous edition, but is now subdivided very differ-
ently. The third digit of the section number corre-
sponds to the respective group number of the Inter-
national Classification.
Time-consuming treatment is not always necessary. Some- » How should we fertilize the fields of prog-
times regular watering of the sapling is all that‹s required… ress if we stopped making enough manure?
(Peter Schumacher).
the coming years, they are also associated with New findings have been incorporated to a greater
s tiffening. If freedom of movement of the spine is or lesser extent in all the chapters: Important new
hampered by an implant for longer than a few treatments have been developed for the manage-
months, stiffening will inevitably occur. The same ment of juvenile rheumatoid arthritis, while new
would apply to a knee that was immobilized in entities and concepts have been adopted in tumor
a cast for a year. Nevertheless, some hopeful ap- diagnosis, both of which were not yet relevant at
proaches are on the horizon, and the concept of the time of the last edition or have replaced other
»non-fusion« may become a reality in the not too pathologies (for example vascular malformations,
distant future. pleomorphic soft tissue sarcomas). New therapeu-
tic approaches are also described for tumor treat-
The half-life of medical knowledge is extremely ment, femoroacetabular impingement is reported
short, so it is not surprising that this new edition more precisely and in greater detail, the Dobbs
contains substantial new material, while old infor- method for treating flat foot is described, a table on
mation has also had to be deleted. The literature the differential diagnosis of foot pain has been
references have been comprehensively updated, newly added, more space has been allocated to the
with two-thirds being deleted and replaced by new description of the correction of deformities with
ones. This has also resulted in major substantive the Fitbone(cid:147) implant, various new classifications
changes to the text. have also been added, as well as new concepts in
neuro-orthopaedics, to mention just a few of the
The structure of the book has also been modified: many new entries.
It is now divided into three sections and the
chapters are numbered consecutively, simplifying Once again I have received many ideas from
the figures stated for the cross-references. The readers and colleagues. I have handed over the
chapters are structured in such a way that the leadership of the Pediatric Orthopaedic Depart-
individual pathologies are generally assigned their ment in Basel to my former colleague Carol Hasler,
own section number, while the subheadings within who has already achieved an outstanding interna-
the pathologies are not numbered. tional profile particularly in the field of surgery
for spinal deformities. He has given me the oppor-
Franz Freuler has drawn many new cartoons, and tunity to continue working as a medical consultant,
numerous illustrations with clinical images, radio- which enables me to keep in touch with everyday
graphs and schematic drawings have been added, clinical practice and experience new developments
resulting in a total of more than 150 new illustra- at first hand. This book has doubtless benefited
tions. In addition to his chapters on fracture man- as a result. As ever, my family has also supported
agement and the correction of deformities, Carol me with great patience.
Hasler is now cited as co-author in the chapter on
the spine, which incorporates many of his innova- F. Hefti
tive contributions. In the general section I have Basel, January 2015
added a separate chapter on biomechanics.