Musculoskeletal and Orthopedic Rehabilitation
Common congenital and developmental conditions
Developmental dysplasia of the hip is screened with Ortolani and Barlow maneuvers in the first 2 to 3 months, with ultrasound reserved for risk factors or equivocal exams - routine ultrasound at birth overdiagnoses because of physiologic immaturity. Treatment is a Pavlik harness in infants and reduction with casting or surgery in older children. Clubfoot is managed with the Ponseti serial casting method plus Achilles tenotomy and bracing. In-toeing is usually benign and resolves: femoral anteversion (ages 3 to 6, "W" sitting), internal tibial torsion (toddler), and metatarsus adductus (infant).
Acquired conditions
Legg-Calve-Perthes affects boys aged 4 to 8 with an antalgic gait and limited abduction and internal rotation. Slipped capital femoral epiphysis occurs in obese adolescents and may present with knee or thigh pain, obligate external rotation with hip flexion, and needs urgent pinning. Osgood-Schlatter is a traction apophysitis and is self-limited. Overuse injuries follow growth: Little League shoulder involves the proximal humeral physis, and spondylolysis in gymnasts produces extension-based back pain.
Traps
A child who refuses to bear weight with fever needs septic arthritis and osteomyelitis excluded urgently (Kocher criteria). Night pain, weight loss, and a mass are red flags for malignancy. Always consider physeal (Salter-Harris) injury after trauma in a child, and remember that neuromuscular scoliosis behaves differently from adolescent idiopathic scoliosis.
Worked rule of thumb
Limp with fever equals infection until proven otherwise; limp without fever in a 4- to 8-year-old boy equals Perthes until shown otherwise.