Correcting children's limb deformities: Personalised paediatric surgery
Personalised care is increasingly becoming the gold standard in many areas of medical practice. The ‘precision’ approach, where treatments and surgical procedures are highly targeted for each individual, is increasingly considered best practice. "Nowhere is this more important and impactful than in paediatric care," says Mr Jonathan Wright, Paediatric Orthopaedic and Limb Reconstruction Surgeon at HCA UK’s The Portland Hospital.
Specialising in congenital and acquired limb deformities, Mr Wright offers a range of highly specialist, age-sensitive procedures and technologies, including both external fixators (such as the Taylor spatial frame) and internal lengthening nails (including Fitbone), to meet the diverse physical, medical, psychological and lifestyle needs of children and adolescents.
"With young people we need to be particularly patient-led – I would say even more so than with other patient groups," he says. "It’s essential that we’re sensitive to the development needs of the child and engage them at every step. Especially with limb length discrepancies and multiplanar deformities, we want to make sure the patient is fully on board with what can be a complex reconstructive process."
Even small length differences between the legs can cause significant challenges such as back and joint pain, so being able to correct deformities and straighten and balance the limbs can be hugely transformative for the patient.
"For some patients, conservative treatments are effective, or minor surgical adjustments can slow down the growth plate of one leg, and allow the other leg to catch up," he explains. "But for more complex deformities, where you need to correct three planes at once, you need a high degree of accuracy. That’s where the Taylor spatial frame can be helpful for some patients."
One of a handful of surgeons in the UK who are trained to use the Taylor spatial frame, Mr Wright works within a rare paediatric multidisciplinary team located at The Portland Hospital, consisting of consultant orthopaedic surgeons, paediatric physiotherapists and a dedicated clinical nurse specialist. Together the team bring all the expertise and experience needed to offer a broad range of sub-specialist treatments for children with complex congenital and acquired deformities.
Mr Wright also works closely with neurologists, rheumatologists, endocrinologists, orthotists and other clinicians to offer a full wrap-around service for his young patients. While the corrective treatment can include managing pain and motor difficulties, adjusting walking gait, fitting custom-made orthotics and post-surgery rehabilitation, the complexity of these conditions means he never works in isolation.
"Because many paediatric limb reconstruction treatment programmes take several months," he explains, "they require an understanding of the developmental needs of the child, taking into account their physical growth, cognitive ability, medical condition and emotional needs at each stage of their treatment." But, he says, it’s precisely these challenges that he loves most.
"It’s a fascinating area!" he says. "You're always adapting to the growth of the child. Every child is individual. There are no 'simple’ conditions and there is never one set answer. Plus, there are lifestyle choices to consider. You can offer a child a well thought out treatment plan and they’ll say ‘no chance, what else have you got?'
"As you can imagine, these corrective processes are huge for a child. You need to work with the whole family to understand their specific challenges – from neuromuscular issues and joint implications to emotional and psychological needs – all while managing any risk of complications from stretching nerves, muscles and tendons.
"You then come up with the best treatment options, whether that’s an external frame, intramedullary lengthening or an alternative method. Luckily, we can offer all the options here – which is unusual for such rare conditions.
"All in all, it’s a hugely challenging and constantly changing area. Nothing about it is standardised. You have to bring all your skills and experience to work out the best way for each child – and get them the best outcome. That’s always the goal."