Orthopaedics

An orthopaedic specialist is a doctor who is an expert on bones, joints and muscles. They will perform an assessment and give you and your child advice about how to manage bone, muscle and joint problems and, in some cases, they may recommended surgery to improve your child’s comfort, physical ability or well-being.

An orthopaedic specialist may become an important part of your child’s medical team if problems are identified with:

• Muscle or joint stiffness
• Curvature of the spine
• Fracture/s (broken bone/s)
• Concerns about shape or structure (deformity) of limbs

Muscle or joint stiffness

Muscle or joint stiffness, in SMA is managed with a daily stretching and/or splinting program, developed by your child’s therapy team. However, if stiffness is difficult to manage, a review by an orthopaedic specialist may be required.

Monitoring the spine for curvature

Children with SMA are at risk of developing a curvature of their spine as they grow older. The health team will monitor for changes in the spine when your child come for clinic reviews.

If it is suspected that a curve is developing, they will refer for a spine x-ray and will request a review with the orthopaedic specialist.

Fractures (broken bones)

A broken bone, or fracture, may occur from a fall, traumatic event or as a side-effect of having weaker bones. If you or your child have a fracture an orthopaedic specialist is required to build a management plan and to monitor recovery.

Shape or structure of limbs

Children with SMA, especially those who have limited ability to stand, may have problems with the shape of their hip joints. This can sometimes lead to pain and cause movement problems. An orthopaedic specialist may be able to help if your child has hip joint problems.

Your child will need to be referred to an orthopaedic specialist by a member of your medical team.

It is often very helpful (but not essential) if a physical assessment is completed by your therapist/s and this information provided to the orthopaedic specialist before the appointment.

No, not necessarily, initially a referral may be made to an orthopaedic specialist to get their opinion and to discuss a plan around non-surgical management (such as splinting, orthotics and stretching programs).

If surgery is recommended, the orthopaedic specialist will discuss a surgical plan for your child, taking into consideration you and your family’s priorities, concerns and goals.

It is common for the orthopaedic specialist to ask your child to have an x-ray before the appointment. An x-ray provides extra information that cannot be gained from a physical assessment alone. This means the orthopaedic specialist has the information they need to provide the best advice at your appointment.

If you have concerns about the x-ray risks or how your child will cope with it, you may like to get in touch with your local therapy or neuromuscular team, so they can help you or your child prepare.

Orthopaedic clinics can be very busy and appointments can run quite quickly. You may like to think about and/or write a list of any concerns or questions you or your child may have for the specialist before you arrive.

If requested, make sure to have an x-ray before your orthopaedic appointment. If an x-ray was done at a different center, bring the x-ray film (it might be an actual x-ray, or the information may be stored on a USB or CD) to the appointment.

Bring any splints or braces your child has been using even if they have grown out of them recently.

This may vary depending on the health service, but if surgery is recommended for your child the following stages will likely occur:

• Planning: To build a plan and identify priorities and goals for orthopaedic management the family, the medical team and the orthopaedic specialist will have a discussion.
• Waitlist: If the decision is made to go ahead with surgery, your child will be placed on a waitlist. The length of this list will vary and can be discussed with the specialist medical team at your health service.
• Pre-operative review: Before surgery, the anaesthetic and orthopaedic team will meet with you and your child to provide more information about the surgery, hospital stay and recovery period.

How often you or your child will need to see the orthopaedic specialist will depend on:

• why an appointment has been requested
• whether surgery is planned or has already been completed
• the ongoing management plan
• whether the problem is getting worse or staying the same

The orthopaedic specialist may request:

• occasional review appointments once or twice a year to keep an eye on how things are going over time.
• more regular appointments to allow for close monitoring, if things are changing quickly, or if planning for- or follow-up after- surgery.

If in doubt, this is a good question to ask the orthopaedic specialist during the appointment, or to ask the clinic’s nurse co-ordinator, or another member of the health care team, after the appointment.