Paediatric Orthopaedics

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Christopher W. Reilly

Christine M. Alvarez
Tom Austin
Richard Beauchamp (Emeritus)
Anthony Cooper
Ravi Ghag

Lise Leveille
Firoz Miyanji
Kishore U.K. Mulpuri
Shafique P. Pirani
Stephen Tredwell (Emeritus)

Treatment of children with musculoskeletal problems is actually the root of orthopaedics as a specialty. The very first specialists in this area devoted their efforts to the management of children with deformity. Most notably, these were children who either had overwhelming infection or polio. From this beginning orthopaedics rapidly developed into a specialty devoted to the musculoskeletal system for all ages and all causes and disabilities.

Paediatric orthopaedics has remained as an integral component of the specialty, and those surgeons who devote their practice to it address all forms of musculoskeletal problems that relate to the growing child. A practicing community orthopedist will have approximately 10-15% of his practice devoted to problems in children.

The difference between the problems presented by the paediatric and adult population is the superimposition of growth on the presenting problem, and one of the challenges facing those who do a paediatric practice is predicting how today’s treatment will affect the child’s future. Because of the complex nature of musculoskeletal development, the surgeon must carefully consider the impact of treatment, be it non-operative (brace) or operative.

At the University of British Columbia the Division of Paediatric Orthopaedics is based at the British Columbia’s Children’s Hospital. Here there are six active surgeons who restrict their practice to the problems of children. Also present on the children’s site is a full-time PhD biomechanist who restricts her research to problems of the developing child. At the New Westminster campus, Dr. Shafique Pirani has a major paediatric focus, as does Dr. Norgrove Penny at the Victoria campus site. Both of these gentlemen hold cross appointments at BC’s Children’s Hospital in a consulting capacity.

The spectrum of clinical conditions seen include: paediatric trauma, developmental and early degenerative problems that affect the spine, hip, foot and ankle as well as the upper extremity. The individual diagnostic list is exceedingly long, including but not restricted to, congenital dislocation of the hip, clubfoot, brachial plexus, palsy, cerebral palsy, spinal muscular atrophy, vascular anomalies, myelomeningocele, neurofibromatosis and orthopaedic oncology.

The Division supervises an active clinical gait analysis laboratory at the Sunny Hill Hospital Site, and here complex force and pattern analysis of abnormal walking patterns provides guidance in the choice of surgical treatment for children with cerebral palsy and other motor function disorders.

The research endeavors of the Division focus on two major areas, the first of which is on the outcome of treatment of children with paediatric problems. Formal programs address the clubfoot population, children with hip disorders, the outcomes of trauma and musculoskeletal oncology. Our second area of research is on the molecular biology of multiple hereditary exostosis.

An active multidisciplinary program addressing the molecular biology and genetic expression of multiple hereditary exostosis is coordinated through Dr. Christine Alvarez’s office on the BCCH site.