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  • Print publication year: 2014
  • Online publication date: June 2014

12 - Orthopaedic examination techniques in children


Paediatric orthopaedic examination is an art, and the success of the consultation relies on the surgeon’s ability to communicate with the parents and the child. Most children who are referred do not require surgery, and time is spent on reassuring the anxious parents or guardian of the normal variations in the development of the child. Quite often, observing the child during the consultation with the parents and a thorough general examination give the clues in making a clinical diagnosis.

The paediatric consulting area should be child-friendly, with toys and ample space for the child to play and for the surgeon to observe. Gaining the confidence of the child is crucial, as well as being warm and patient with the parents who are anxious and concerned. The initial interview should include introductions, as it is important to know the accompanying adults apart from the parents. They could be carers, guardians, grandparents or physiotherapists, and valuable information could be gained. History should be gained from the parents as well as the child, for, not infrequently, it could be conflicting. Clinical history skilfully obtained is the key to diagnosis, and a methodical examination of the child depending on the symptoms and age confirms your initial impression.

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Further reading
Apley, AG, Solomon, L. Apley’s System of Orthopaedics and Fractures, 7th edition. Oxford: Butterworth–Heinemann, 1993.
Benson, MKD, Fixsen, JA, Macnicol, MF. Children’s Orthopaedics and Fractures. London: Churchill Livingstone, 1994.
Bleck, EE. Orthopaedic Management in Cerebral Palsy, Clinics in Developmental Medicine no. 99/100. Philadelphia: MacKeith Press, 1987.
Broughton, NS. Paediatric Orthopaedics. Philadelphia: WB Saunders, 1996.
Gage, JR. Gait Analysis in Cerebral Palsy, Clinics in Developmental Medicine no. 121. Oxford: MacKeith Press, 1991.
Herring, JA. Tachdjian’s Pediatric Orthopaedics, 4th edition. Philadelphia: WB Saunders, 2008.
Sivananthan, S, Sherry, E, Warnke, P, Miller, MD. Mercer’s Textbook of Orthopaedics and Trauma, 10th edition. London: Hodder Arnold, 2012.
Tachdjian, MO. Pediatric Orthopedics. Philadelphia: WB Saunders, 1990.