Ezra Berkowitz

Ezra Berkowitz, M.D

Pediatric Orthopedic Surgery

Theresa E. Rattey

Theresa Rattey, M.D. Emeritus

Pediatric Orthopedic Surgery

Pediatric Orthopedic Surgery

pic-occupational-therapy2Orthopedic Center of Palm Beach County provides comprehensive care for musculoskeletal (bone) problems and conditions inchildren. Caring for kids is very different from the care of adults. Our Pediatric Orthopedic Surgeons face specific issues in the treatment of Children. They offer a full complement of surgical and non-surgical services.

Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination. Our Physicians know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, they often uses equipment specially designed for children.

If your pediatrician suggests that your child see a pediatric orthopedic surgeon, you can be assured that our team has the widest range of treatment options, the most extensive and comprehensive training, and the greatest expertise in dealing with children and in treating children’s orthopedic disorders.

What kind of training do pediatric Orthopedic surgeons have?

pic-services-pediatrics4Pediatric orthopedic surgeons are medical doctors who have:

  • Graduated from an approved medical school
  • Graduated from an approved Orthopedic surgery residency program
  • Completed additional subspecialty training (Fellowship) in pediatric orthopedics. Pediatric Orthopedic surgeons treat children from the newborn stage through the teenage years. They choose to make pediatric care the core of their medical practice, and the unique nature of medical and surgical care of children is learned from advanced training and experience in practice.

Our Physicians provide comprehensive care in diagnosis, treatment and management of children’s musculoskeletal problems including the following Pediatric Orthopedic Conditions:

  • Breech births/Hip dysplasia/Hip clicks
  • Arm, leg, neck or back pain in the pediatric patient
  • Benign soft tissue and Bone tumors
  • Fracture care (broken bones)
  • Overuse injuries in the athlete of the arms and legs
  • Bow legs/Knock knee deformity
  • Leg length discrepancy
  • Foot problems
  • Injury prevention
  • Conservative treatment of Torticollis and Scoliosis
  • Cerebral Palsy
  • Congenital upper and lower extremity problems
  • In toeing/out toeing
  • And many other orthopedic problems.

Frequently Asked Questions – Pediatric Orthopedic Surgery

When to see a Pediatric Orthopedic Surgeon after your child has an injury?
If your child has significant pain, swelling or deformity, the inability to use that arm or leg, a limp, or pain that persists for more than a couple days, or decreased movement of a joint.

What is a growth plate and why is it important with respect to injuries?
A growth plate is a layer of cartilage cells at the ends of long bones that “grow” and make the bone longer. Once the child is finished puberty, the cartilage cells turn into bone and the growth stops. The growth plates stop growing at different times in children. The growth plate is weaker than bone and is therefore it is more likely to fracture at the growth plate than to sprain the joint. Even if the x-ray is negative or normal, there may be a fracture though the growth plate.

Why is fracture treatment different in children compared to adults?
Children are not just little adults. Fractures may occur in the growth plate and need different treatment to allow the fracture to heal yet not disturb the growth of the bone. More fractures in children can be treated with casts compared to adults. The time to healing is different for children of different ages. Different surgical equipment is needed because of the growth plates and the size of the bones.

What is an “overuse injury” and how is it treated?

pic-services-pediatrics2An overuse injury is an injury related to over using the arm or leg. Different areas are involved related to the type of sport. Pitchers can get “Little League Elbow” or “throwers shoulder”. Basketball players can get “Jumpers Knee”. Sever’s is related to too much running on hard surfaces. The body of a child can not take too much stress or use if they are growing. The body chooses to grow instead of fixing minor aches and pains. The principle of treatment involves rest, ice, cross training and different types of immobilization. Failing to treat overuse injuries can lead to permanent disabilities. The child should not be advised to put up with the pain and continue playing.

 What things can I do to prevent injuries?

Some examples include:

  • Never let your child get on a trampoline with anyone else. More than one person on a trampoline causes the smaller children to get bounced too high and land hard or off balance. Someone else could also land on the child’s arm or leg causing a fracture. Even the safety nets do not prevent all injuries.
  • Wrist fractures are 90% of the injuries related to roller skating, heelie’s, rip sticks or inline skating. The wrist or arm fracture rate can be 99.5% decreased with the use of wrist guards.
  • Are slides dangerous? Holding a child/infant between your legs and going down the slide can lead to tibial fractures in the child who is wearing shoes or sneakers. I have seen this recently with the new slides being made of plastic and having a U shape. The shoe gets caught on the side of the slide and the leg gets twisted as they go down.
  • What is a “pulled elbow” or “nursemaids elbow”? If you are holding a child (< 5 years old) by their hand and then suddenly pull on the arm, a ligament around the radial head gets pulled out of place and then the child has elbow pain, holds their arm by the side and won’t turn the forearm. This has to be reduced right away to relieve the pain. Some times the ligament will reduce itself while getting an x-ray. Once it is reduced, the pain goes away within 15-20 minutes. The pediatrician, Emergency doctor, Pediatric Orthopedic surgeon can reduce this usually quite easily and the parent can be taught how to do it. If the pain does not go away, there may be something else wrong.

What is scoliosis?
Scoliosis is a condition where there is a curvature of the spine. It runs in families or may start in a child. It usually shows up in adolescents but may show up earlier. It is more frequent in girls than boys. The child should be seen by a Pediatric Orthopedic Surgeon as soon as it is suspected or diagnosed for a baseline x-ray. Some curves are bigger than they look. If left untreated, the curve may progress to the point of needing surgery. Bracing is sometimes necessary. Scoliosis is NOT caused or made worse by back packs.

pic-services-pediatrics3Should I be concerned about Intoeing?
Intoeing may be caused by problems in the foot, lower leg or thigh area. It usually gets better by itself without treatment at different times depending on where the problem lies. An assessment should be done early to find the location of the intoeing and decide on treatment if necessary.

When should I be concerned about leg deformity?
Leg deformity may be related to birth, developmental, or related to trauma, infection or bone tumors. Sometimes it gets better by itself without special shoes or braces. It needs to be assessed to find the cause to see if treatment is necessary.
Should I be concerned about my newborn baby’s hip?
Some problems with your baby’s hips can be related to the soft tissues, muscles or bones. A clinical exam is the first step to assessment. An ultrasound is the next best test for the baby up to age of 4 or 5 months old. After that an x-ray is the best test to see how well the hip joint itself is developing. Some times the hips will get better with growth. Sometimes the hips don’t develop normally overtime. Therefore follow-up is essential.

When is a leg length difference important?
Leg length differences can be mild or severe. Many people have a small difference is their leg lengths without any problems. The difference may be stable or progressive. The child may need treatment or observation based on the history and examination. The treatment can be conservative or surgical depending on the amount of the difference.