The Childrens Orthopaedic Center

The Childrens Orthopaedic Center is one of the nation's most comprehensive orthopaedic programs dedicated to the care of children and adolescents. UCMG orthopaedic surgeons together with nurse specialists, orthopaedic oncologists, rehabilitation specialists, prosthetists, physical therapists and biomechanical engineers evaluate and treat all childhood problems affecting bones, muscles and joints including congenital and developmental abnormalities of the arms, legs and spine. UCMG orthopaedic surgeons diagnose and treat traumatic inuries to these areas as well. Each year, Center physicians perform greater than 1200 operative procedures and see about 14,500 outpatients (including over 1000 fracture reductions). Because these are exclusively pediatric patients, Center specialists have achieved national prominence due to their experience and ability to handle simple to complex problems of young patients.

Center capabilities include complete laboratory, imaging, rehabilitation, physical therapy, surgery and computerized motion analysis. In addition to treating one of the largest number of pediatric spinal deformity cases in the United States, UCMG's orthopaedic surgeons diagnose and treat the region's highest numbers of pediatric bone tumor and congenital hand deformity patients. The Center has the most technically advanced motion analysis laboratory in the state. It has been a national pilot site for outcomes assessment for pediatric orthopaedic procedures.

UCMG physicians in the Center provide diagnosis and treatment for:
  • Spinal disorders, including scoliosis and kyphosis;
  • Hip disorders including those resulting from trauma, congenital or developmental dysplasia, Legg-Perthes disease, arthritis, steroid treatments, sickle cell disease and renal transplant;
  • Foot abnormalities;
  • Hand function abnormalities (congenital defects, accidents, sports injuries, microsurgery, transplantation).
  • Neuromuscluar diseases such as cerebral palsy, spina bifida and muscular dystrophy;
  • Bone and extremity tumors, both malignant and benign;
  • Leg length discrepancies;
  • Fractures;
  • Congenital extremity abnormalities, including amputations;
  • Genetic skeletal disorders such as short stature syndromes, bowed legs, Marfan syndrome and brittle bone disease;
  • Growth disturbance after trauma;

Special services include:
  • Pediatric Spine Program;
  • Sports medicine for the growing child;
  • Motion analysis laboratory.
UCMG physicians in the Childrens Orthopaedic Center also see patients at County of Los Angeles Medical Treatment Units and in offices in Encino, Los Angeles and San Luis Obispo.

Description of Programs and Services

  • Scoliosis and Spinal Disorders Program

    Created more than twenty years ago, the Scoliosis and Spinal Disorders Program at CHLA represents the only program of its kind in Los Angeles County devoted exclusively to children. Disorders treated include scoliosis (lateral curvature of the spine), kyphosis (rounding of the back), lordosis (swayback deformity), spondylolisthesis (slippage of a vertebra) and childhood back pain.

    Scoliosis can occur in young children, but most often is detected in children ages ten to fourteen. One of the most common spine abnormalities in adolescents, scoliosis may progress slowly, rapidly or not at all. If scoliosis is not detected and treated, problems with the heart and lungs may result; in later years, severe back pain or arthritis often occur.

    UCMG physicians within the Scoliosis and Spinal Disorders Program are all experts in the field and include members of the prestigious Scoliosis Research Society - an international group devoted to clinical and basic research of spinal deformities. The program's comprehensive team - scoliosis surgeons, a pediatric orthotist for braces and specially trained pediatric nurses and physical therapists - takes a sophisticated, compassionate approach to care.

    The key to treating scoliosis is early detection. In an effort to encourage families to obtain professional evaluation, the program offers a discounted first-time scoliosis evaluation to those patients referred through the school screening process. This visit includes an x-ray and clinical examination by a pediatric orthopaedic surgeon specializing in scoliosis. The surgeon sends diagnosis and treatment recommendations to the family and referring physician and school. Parents may bring their child back for follow-up evaluation and/or treatment as necessary.

    Treatment alternatives vary with the severity of the problem. Approximately 70% of patients with mild curvature of the spine require only simple observation. The scoliosis team will evaluate the curve's progress regularly until the child or adolescent has completed growth.

    Bracing may be necessary for some curvatures. If so, a custom-made brace is worn, usually for one or two years, and is designed to prevent the curve from worsening during the child's final growth spurt.

    The most serious cases of scoliosis require surgery. UCMG surgeons perform state-of-the-art surgical procedures in a specifically equipped operating room that includes spinal cord monitoring. The Center's team provides comprehensive pre-operative teaching and counseling to patients requiring surgery and their families.

    The Scoliosis and Spinal Disorders Program co-sponsors a bimonthly parent support group led by parents whose children have scoliosis. Parents have the opportunity to share experiences and concerns. Children meet with a specially trained psychologist in a support group of their own. Each child receiving braces is paired with a child who has already experienced the bracing process. In addition, adolescents contemplating spinal surgery are able to talk to others who have completed their surgical treatment.

  • Motion Analysis Laboratory

    The Motion Analysis Laboratory is one of the most sophisticated programs of its kind in the United States. Children with neuromuscular diseases such as cerebral palsy, spina bifida, head injuries and juvenile rheumatoid arthritis often have difficulty walking. Motion Laboratory personnel utilize advanced technology and specialized skills to analyze muscle activity and joint movements as these children walk, which provides orthopaedic surgeons with more information to help improve the child's walking ability. A comprehensive study consists of a complete clinical evaluation by a physical therapist and analyses of movement, muscle activity and forces at the joints during walking.

    The Motion Analysis Laboratory utilizes state-of-the-art technology to assess different joint movements and muscle activities occurring at various points of the walking cycle. In order to perform the study the patient must be able to walk down a specialized walkway, with or without crutches or a walker. Motion Lab personnel utilize four major analysis methods:
    - Video documentation;
    - Three-dimensional documentation of joint movement using a 7 camera VICON motion analysis system;
    - Electromyography to study muscle activity during walking;
    - Force plate measurements of the amount and direction of force occurring at each joint as each step is taken.

    Motion Analysis provides precise information on muscle activity, joint motion and the forces acting at the joints at different points of the child's gait, allowing the physician to analyze what is happening at each phase of the complex walking cycle. As a result, it is possible to more accurately determine abnormalities that require correction with surgery, bracing or other treatment methods. Before comprehensive Gait Analysis was available, physicians recommended treatment based subjectively on prior experience and clinical observation. Motion Analysis provides the physician with more objective information to help diagnose and treat walking problems, which enables the surgeon to address the full scope of the problem at one time. In many cases the child is able to walk better and spends less time recovering from surgical procedures. Motion Analysis also is helpful in customizing braces and artificial limbs to improve a child's walking ability.

    The multi-camera and electromyography systems of the Motion Analysis Laboratory provide precise information to evaluate a wide variety of complex movements. For example, muscle and ligament actions during athletic activities such as tennis, golf, baseball and gymnastics can be measured. The information obtained through Motion Analysis can allow better evaluation of sports injuries and act as a guide to treatment.

  • Orthopaedic Hand Program

    UCMG physicians within the Orthopaedic Hand Program are dedicated to helping restore hand function in children. As the only program of its kind in Southern California, the program takes a comprehensive approach to hand surgery, offering state-of-the-art care in one convenient location.

    The program's world-renowned hand specialists use the latest surgical techniques to treat a wide range of problems from birth defects and trauma to sports injuries. The extensive support staff includes specially trained pediatric nurses, pediatric occupational and physical therapists and orthotists who work closely to help young patients with hand problems achieve maximum functional capacity.

    Many congenital hand defects are detected at birth and can be surgically corrected between the ages of six and nine months. The Hand Program surgeons treat all types of congenital conditions including trigger fingers, syndactyly or webbed fingers, extra fingers and "lobster claw" deformity. In each case, advanced surgical procedures can help restore hand function and improve the hand's appearance.

    Major functional damage to the hand in children also is caused by athletic, motor vehicle and household accidents. Fingers may be fractured, crushed or severed completely and palms also may be injured. The Program's on-call orthopaedic surgeon works closely with the UCMG Emergency Medicine Division physicians to provide immediate care to accident and trauma victims.

    Pediatric hand trauma often results in more complicated injury than adult trauma because growth plates are present in each bone of the hand. Broken fingers or hands in children may result in joint injuries which can severely impair finger movement. Program surgeons are specially trained to detect and treat injuries of the joints and growth plates.

    The Orthopaedic Hand Program team works closely with UCMG plastic surgeons. Procedures may involve microsurgical re-implantation, where surgeons reattach fingers and restore motor function and transplantation where, for example, the big toe can be transplanted to substitute for an absent thumb.

    For hand operations that require an inpatient stay, a registered nurse who works exclusively with the Orthopaedic Hand Program coordinates the entire surgical process, from pre-operative tours and psychological counseling to post-operative therapy with on-site physical and occupational therapists.

  • Hip Disorders Program

    The Hip Disorders Program surgeons specialize in diagnosing and treating congenital hip disorders, developmental hip disorders, post-traumatic hip abnormalities and adolescent hip pain. Specially trained pediatric orthopaedic surgeons use the latest diagnostic techniques, including ultrasound, arthrography, bone scans Complete Tomography (CT) and Magnetic Resonance Imaging (MRI), in their evaluation. CT and MRI evaluation in 3-D assists the orthopaedic surgeon in optimal surgical planning. The treatment team includes pediatric orthopaedic surgeons, pediatric nurses, physical therapists and orthotists.

    - Developmental or Congenital Dysplasia of the Hip.
    UCMG orthopaedists in the Hip Disorders Program diagnose and treat dysplasia including abnormal hip development in infants and toddlers. Treatment alternatives vary with the severity of the problem. Some children under six months of age with hip dislocations may only need to wear a brace while others require surgery. As a child becomes older, surgical procedures are more frequently needed. This reconstructive bone surgery may be necessary to correct anatomic abnormalities and to prevent arthritis of the hip.

    - Legg-Perthes Disease
    Legg-Perthes Disease results from a loss of blood supply to the hip, usually affecting active boys aged four to ten. The Hip Disorder specialists are experienced in early detection of this condition and in determining the most appropriate type of treatment. Treatment for Legg-Perthes disease begins with regaining good hip movement through physical therapy, excercises or traction. After hip movement has improved, x-rays or MRI may be used to determine treatment alternatives, which range from bracing to reconstructive surgery.

    - Slipped Capital Femoral Epiphysis
    Slipped capital femoral epiphysis is a condition usually affecting growing adolescents aged ten to fifteen in which the ball of the hip begins to slip at the growth plate. Symptoms include a limp and gradual onset of hip or knee pain for several weeks or months. This condition is best treated by early diagnosis and surgery to stabilize the slippage. Specialists utilize the latest surgical techniques to avoid disabling complications.

    UCMG physicians within the Center also care for children and adolescents who have hip pain resulting from trauma, sickle cell disease, steroid treatments or renal transplants. In addition, treatment is available for patients with hip pain from all forms of arthritis, including juvenile rheumatoid arthritis, septic arthritis or other inflammatory hip conditions.

  • Bone and Extremity Tumor Program

    The Bone and Extremity Tumor Program (BETP) physicians diagnose and treat children with both malignant and benign tumors. The multidisciplinary program is an integral component of the Childrens Center for Cancer & Blood Diseases, the pediatric cancer program at CHLA which cares for more children with cancer than any other childrens hospital west of the Mississippi River. In the BETP, pediatric orthopaedic surgeons work closely with pediatric oncologists, pediatric general surgeons, pediatric plastic surgeons, pediatric radiologists, pediatric radiation oncologists, physical therapists, orthotists, nurses and social workers to provide comprehensive care to children with bone and extremity tumors.

    - Malignant Tumors
    Orthopaedic surgeons with the BETP team care for children with bone cancer before and after a diagnosis has been made. Because the location of the biopsy site often affects the ability to optimally treat a cancerous limb, referring physicians are urged to consult with UCMG's orthopaedic surgeons before conducting an independent work-up and biopsy.

    Comprehensive treatment at the BETP includes chemotherapy and surgery, as well as extensive family and child support from social workers, therapists, and child life specialists. The primary surgical goals in treating malignant tumors are to remove the tumor and, if possible, save the normal parts of the arm or leg. UCMG orthopaedic surgeons use the latest limb-sparing techniques, excising the tumor and replacing the affected bone with other bone or an artificial joint replacement. Following surgery, patients undergo an extensive inpatient rehabilitation program to regain use of their arm or leg.

    - Benign Tumors
    Benign bone tumors often require surgery. Upon discovery of a bone abnormality, the Bone and Extremity Tumor Program team will perform an evaluation and work-up, determine if the tumor is malignant or benign and decide the type of medical or surgical treatment best suited for that particular lesion. Treatment options vary depending upon the size, type and location of benign bone tumors, but generally, surgery effectively treats these abnormalities.

    - Family Support
    A Ronald McDonald House is located adjacent to CHLA. This facility provides low-cost apartments for families of patients, if needed, during treatment of their child for bone cancer. Other family support is provided by dedicated social workers and nurses.

  • Genetic Skeletal Disorders

    Genetic disorders are often called "syndromes," a term which includes all the features that are characteristic of a specific inherited condition. Orthopaedic treatment deals with the bone and joint manifestations of the syndrome rather than with the underlying genetic disorder. Genetic Skeletal Disorders team members are nationally recognized experts in treating orthopaedic problems related to genetic diseases.

    - Achondroplasia and Other Skeletal Dysplasias
    These short stature syndromes, termed skeletal dysplasias, result from abnormal bone development and growth and may lead to several orthopaedic problems. Orthopaedic disorders include spinal abnormalities such as scoliosis, kyphosis and spinal stenosis (a narrowing of the lumbar spine that produces spinal cord compression), hip abnormalities and bowed legs. Achondroplasia, a condition in which the child has arms and legs that are short in proportion to the rest of the body, is the most common short stature syndrome.

    Because these conditions occur infrequently, the Division's experience available through the Genetic Skeletal Disorders program, allows for thorough evaluation and appropriate treatment recommendations. In many instances it is possible to perform complex operative procedures that improve several functions in a child's daily life.

    - Marfan Syndrome
    In contrast to the short stature syndrome, children with Marfan Syndrome are extremely tall for their age and may have problems that affect the heart and eyes. Their musculoskeletal problems include scoliosis, hip pain and stiffness and knee and ankle pain. They also may have joint instability due to the abnormality of their ligaments and tendons. The Genetic Skeletal Disorders team provides a multidisciplinary approach to treat children and adolescents with Marfan Syndrome who often have cardiac and eye problems, as well. After thorough evaluation of the child's bones and joints, orthopaedic surgeons may perform operative procedures to correct specific spine, hip and foot problems. In some cases, medical treatment is used to limit the development of excessive height in children with Marfan Syndrome.

    - Osteogenesis Imperfecta
    Osteogenesis Imperfecta is a genetic disorder often referred to as brittle bone disease. Some infants are born with multiple fractures, while others develop their fractures during the first few years of life, especially when they start walking. Treatment options for less severe cases include bracing or casting. Although fractures heal in the same time as normal bones, repeated fractures may lead to bowing of the bones that will benefit from surgical realignment to decrease the rate of fracture and in many, preserve walking ability.

    The Genetic Skeletal Disorders Program physicians also treat other inherited conditions including multiple hereditary exoctoses, neurofibromatosis, Ehlers-Danlos Syndrome and a number of rare skeletal disorders.

  • Sports Medicine Program for the Growing Child

    Athetically active children from elementary school age through high school are the focus of the Sports Medicine Program for the Growing Child. Various types of injuries occur at different stages of growth. Children and teenagers often respond quite differently to exercise and athletic activity than do adults. For example, since the child's tendons and ligaments attach to growing bones, some athletic activities may result in overuse injuries to the growth areas of these bones. The Sports Medicine Program for the Growing Child is focused on the treatment of the unique combination of physiology and biomechanics seen in the growing athlete.

    - Diagnosis and Treatment
    The Sports Medicine Program physicians take a multidisciplinary approach to care of the young athlete. UCMG pediatric orthopaedists are expert in evaluating sports-related childhood musculoskeletal problems which often are different from those that occur in adults. The team is dedicated to the care of children and teenagers involved in both organized and recreational athletics. Expert orthopaedic care, both operative and nonoperative, is available for patients with all types of pediatric sports injuries. Patients with both acute injuries and overuse injuries are frequently evaluated and treated. Common acute injuries include knee ligament and meniscal tears, in addition to fractures and sprains of both upper and lower extremities. Overuse injuries are frequently treated as well, ranging from soft tissue injuries such as "little league" shoulder to stress fractures of the back and extremities. If surgery is required, the Program surgeons are skilled in the latest techniques including arthroscopic surgery.

    While Program physicians focus on musculoskeletal problems, other specialists are available to take care of specific health problems that may interfere with normal sports activities.

    - Motion Analysis and Childhood Sports
    Computerized motion analysis facilities enable Sports Medicine Program sugeons to evaluate complex muscle and joint movements during athletic activities. With this analysis, the team can evaluate a young athlete's running or throwing motion and recognize abnormalaties which may predispose the child to injury. The child's activity can then be appropriately modified to reduce risk of re-injury. Evaluation of a child's sports function after injury can also be objectively assessed as rehabilitation proceeds.

    - Evaluative and Educational Service
    The Center's educational program is designed to assist parents, children and coaches in understanding the differences between athletics in the growing child or teenager and in the adult. This includes providing tips on preventing sports injuries from occurring as well as offering insights into the beneficial or detrimental effects of certain athletic activities.

  • Leg Length Discrepancies Program

    Leg length differences may be due to a number of causes including congenital disorders, neurologic disorders or injuries to the growth plate from trauma or infection. Because a leg length difference may cause problems for children later in life, early detection is important. The UCMG orthopaedic surgeons are expert in diagnosing this condition as well as in determining its underlying cause. In addition, Program surgeons utilize the most advanced techniques available to correct these leg length discrepancies.

    - Treatment
    After diagnosing a difference in leg length, program specialists use imaging studies to periodically chart the child's progress. From this information, one can project what the limb-length difference will be at the end of growth and make recommendations for appropriate timing of treatment. In some instances, the growth in the long leg will be slowed so the legs will be equal in length when the child reaches the completion of growth. Other cases may require a limb-lengthening procedure in which surgeons use various devices to slowly lengthen the bones in the leg.

    - Congenital Limb Deficiencies
    Children with marked congenital limb shortening are evaluated by the Program's team to determine if they would best benefit from a limb lengthening procedure or prosthetic fitting. Specially trained personnel are available to counsel parents and children and to provide physical therapy as they undergo treatment.

    -Post-Traumatic Growth Disturbance
    When growth disturbance occurs following trauma, an injury has led to damage of either all or part of a growth plate in the leg. If a portion of the growth plate has been injuried so that the bone grows at an angle, surgeons can often remove the bony bridges that are blocking normal growth and replace them with material that allows growth to be re-established. If the majority of the growth plate has been damaged, a limb lengthening procedure on the shorter leg may be needed later.

    -Neurologic Disorders
    Some neurologic disorders, including polio, head injury or cerebral palsy also may be the cause of a limb length discrepancy. In these cases, UCMG specialists take a multidisciplinary approach, simultaneously addressing the neurologic problem and determining the appropriate treatment option for the limb length difference.

  • Clubfoot and Foot Disorders

    Clubfoot and Foot Disorders Program physicians specialize in diagnosis and treatment of children who have a foot abnormality. The Foot Disorders team is composed of specially trained orthopaedic surgeons, pediatric nurses, orthotists for shoe inserts and special shoes and pediatric physical therapists.

    In addition to clubfoot, other foot disorders treated include metatarsus adductus, congenital vertical talus ("rocker bottom" foot), painful flat foot and those disorders associated with neurological diseases.

    - Obtaining an Accurate Evaluation
    Some children are born with a "true" clubfoot, where the hindfoot and forefoot are turned in, making it impossible for the child to place his or her foot flat on the ground. Others have a condition called metatarsus adductus where only the forefoot is turned inward. Parents should know that with proper treatment, children with clubfoot can look forward to living normal, active lives and participating in athletic activities.

    It is necessary to obtain an accurate diagnosis to correctly treat foot disorders. UCMG orthopaedic surgeons are experts in distinguishing between those foot disorders requiring aggressive orthopaedic treatment and those that will improve by themselves.

    In children with clubfoot, spine and hip abnormalities also may be present. Division specialists thoroughly examine children with clubfoot for other undetected orthopaedic problems.

    - Treatment
    Because clubfoot is apparent at birth, treatment should begin immediately. This involves casting the foot each week for six weeks or more, at which time the surgeon will determine if surgery will be necessary. In over half of the cases, surgery is required.

    The casting process loosens ligaments, muscles and tendons to correct minor foot disorders and making surgery, when necessary, less complex. During the operation, pediatric orthopaedic specialists will surgically correct the foot, placing the bones and tendons in proper position.

    Once treatment is finished, children return for periodic evaluations until growth is completed.

    - Family Involvement and Interaction
    The success of the Clubfoot and Foot Disorders Program relies in large part on family involvement. Family members learn how to easily unwrap the cast material the night before a follow-up visit so infants can avoid the noise made by the cast saw. This allows the family to participate in the treatment and gives them an opportunity to bathe the baby and have "cast-free" contact.

    The treatment period can be a difficult time for parents. Many find comfort in speaking with other families who are experiencing the same fears and anxieties. Parents involved in the Program support each other through each phase of treatment, from casting to surgery preparation to post-operative care. Nurses and orthopaedists are available to answer any questions parents may have during treatment.

PHYSICIANS


HOW TO CONTACT US

The Childrens Orthopaedic Center welcomes your inquiries. To contact us you can:

Call the Center directly at (323) 669-4658

Write to us at
The Childrens Orthopaedic Center
Childrens Hospital Los Angeles
4650 Sunset Blvd., #69
Los Angeles, CA 90027-6062

Physicians who wish to contact a faculty member, consult about a patient or refer a patient can also call 1-800-ASK-PACE (1-800-275-7223). Please note, this service is for physicians ONLY.



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