Interview with Dr. Stefan Wilke

The lack of physical exercise is probably the biggest problem

Stefan Wilke talking about paediatric orthopaedics -

What are the special aspects of paediatric orthopaedics?

What do you have to watch out for and what role do medical retailers play in caring for children? Dr Stefan Wilke (Specialist for orthopaedics, accident surgery and paediatric orthopaedics), paediatric orthopaedic specialist in Berlin, answers our questions.

What are the most common orthopaedic injuries in children?

A number of different studies have reached the conclusion that around 50% of all children and teenagers suffer at least one broken bone. These injuries affect the upper limb more often than the lower limb, mostly the forearms, followed by the upper arm and collarbone. The nature of the fracture is predominantly determined by the maturity of the growth plate. But ligamentous injuries of the ankle joint and the knee joint, above all the anterior cruciate ligament in the knee, are not rare either.

What is the difference between paediatric orthopaedics and adult orthopaedics?

Children are not little adults. Paediatric orthopaedics is a separate speciality and is concerned with diagnosing, preventing and treating hereditary and acquired disorders of the musculoskeletal and locomotor apparatus during growth. The conditions differ very strongly from those seen in adulthood. It is vital to know about the normal ("physiological") development of children's musculoskeletal and locomotor apparatus. Only then can we diagnose and weigh up any abnormal findings and their consequences. The treatment objective is to eradicate the current symptoms and, above all, to avoid late complications in adulthood.

Have you observed any particular trend with regard to conditions in children?

The lack of physical exercise is probably the biggest problem. If we are to believe a number of different studies, only 16% of schoolchildren tested in 1985 still had special needs for physical education, in 1995 this figure amounted to 47%. This may possibly be interpreted as the result of increasing physical inactivity (Rusch and Irrgang 1999). In orthopaedic practice, this has led to an increase in the numbers of clinical pictures that we would actually expect to see in the field of adult orthopaedics. For instance, the number of children with back pain has increased considerably.

What is the situation regarding early care for children?

Early care depends primarily on early diagnosis and starting correct treatment. This depends on the diagnosis and when treatment is started.

What can orthopaedic medical devices achieve in paediatric orthopaedics?

According to an estimate published by Professor Fritz Hefti MD, 70% of all paediatric orthopaedic consultations merely require advice, i.e. "that the child is straight enough". Around 30% need conservative treatment, for example, with insoles, braces, corsets, physiotherapy or plaster casts. When put to use specifically for the right indication, the symbiosis of physiotherapy and orthopaedic medical devices can lay the foundation stone for successful conservative therapy.

How do you see the role of specialist medical retailers in the field of paediatric orthopaedics?

They are the key link in the supply chain. On the one hand, their know-how regarding the medical devices available in the field of paediatric orthopaedics, such as supports, braces and insoles makes them valuable as advisers and, on the other hand, a medical device is only as good as how well it is fitted. For this, the choice of the right size and the right model is decisive, which requires a high degree of professional knowledge and skills.

How can parents recognise that their children have postural problems or symptoms, and what would you advise them to do?

It is important to keep an eye on the development of the axes of the feet and of the legs and the back. Not every deformity requires treatment. At least 20% of all children and teenagers have valgus foot or flexible flat feet. Knock knees and bowlegs are part of our physiological development. Parents should be alerted by asymmetries, for example one-sided knock knee or bowleg, or if their child is in pain. The same applies to the spine. If in doubt, I recommend they consult a paediatric orthopaedic specialist.

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