Pediatric Musculoskeletal Overview
A growing skeleton brings unique conditions.
Children's bones are still growing — they have growth plates and are more flexible than adult bone — which creates a unique set of orthopedic conditions, from congenital problems present at birth (hip dysplasia, clubfoot) to issues that appear during growth spurts (scoliosis, slipped epiphysis). Early detection often makes treatment far easier.
A recurring theme in pediatric orthopedics is that early detection improves outcomes — newborn hip checks for DDH, early casting for clubfoot, and school screening for scoliosis all aim to treat problems while the skeleton is still easy to reshape.
Every key point in this guide fits on one free printable page. Jump to the free cheatsheet PDF →
Developmental Dysplasia of the Hip (DDH)
An improperly developed hip joint, found in infancy.
Signs
- Asymmetric thigh and gluteal skin folds
- Limited abduction of the affected hip
- Apparent leg-length difference (uneven knee height — positive Galeazzi sign)
- A "clunk" with the Ortolani (reduces the hip) and Barlow (dislocates it) maneuvers
Treatment (infants): a Pavlik harness that holds the hips flexed and abducted so the joint develops in the socket; worn continuously, with parent teaching on skin and harness care.
The Pavlik harness keeps the hips flexed and abducted (the position that seats the femoral head in the socket). Teach parents not to adjust the straps themselves, to check skin under the straps, and to dress the baby in a light shirt under the harness to protect the skin.
Clubfoot (Talipes Equinovarus)
A foot turned inward and downward at birth.
- A congenital deformity where the foot points down and inward.
- Treatment — the Ponseti method: weekly serial casting started early to gradually reposition the foot, followed by a foot-abduction brace to maintain the correction.
Clubfoot is treated best when started in the first weeks of life, while the bones and ligaments are most flexible. After serial casting corrects the position, faithful brace wear prevents relapse — adherence is the key teaching point for families.
Scoliosis
A sideways curvature of the spine.
Scoliosis is a lateral curvature of the spine, most often appearing during the adolescent growth spurt (more commonly in girls).
- Screening — the Adam's forward-bend test: as the child bends forward, look for a rib hump, uneven shoulders, uneven scapulae, or uneven hips.
- Treatment: mild curves are observed; moderate curves use a brace (worn most of the day) to halt progression; severe curves may need spinal fusion surgery.
An important teaching point: the scoliosis brace is worn to prevent the curve from worsening while the child is growing — it does not straighten an existing curve. Wear it over a thin t-shirt to protect the skin, and support the adolescent emotionally, since adherence and body image are real challenges.
Pediatric Fractures
Flexible bones and growth plates change the picture.
- Greenstick fracture — an incomplete break: one side breaks while the other bends, because children's bones are flexible (like a green tree branch).
- Growth plate (epiphyseal/Salter-Harris) fractures — fractures through the growth plate can affect future bone growth, so they are watched closely.
- Children's fractures generally heal faster than adults'.
Certain fracture patterns are red flags: a history that doesn't match the injury, spiral fractures (from twisting), fractures in a non-mobile infant, or multiple fractures in different stages of healing. Nurses are mandatory reporters — these findings must be assessed and reported.
Legg-Calvé-Perthes Disease & SCFE
Two hip problems at different ages.
- WhatLegg-Calvé-Perthes
- Avascular necrosis of the femoral head (blood supply disrupted)
- WhatSCFE
- The femoral head slips off at the growth plate
- Typical ageLegg-Calvé-Perthes
- Younger child (~4–8 years)
- Typical ageSCFE
- Adolescent, often overweight
- SignsLegg-Calvé-Perthes
- Painless limp or hip/knee pain
- SignsSCFE
- Hip, groin, or knee pain; limp; out-toeing
- CareLegg-Calvé-Perthes
- Limit weight-bearing; containment
- CareSCFE
- Surgical pinning; non-weight-bearing
In both conditions, a child may complain of knee pain even though the problem is in the hip (referred pain). Don't dismiss a limping child with knee pain — the hip needs to be examined.
Muscular Dystrophy (Duchenne)
Progressive muscle weakness in boys.
- Duchenne muscular dystrophy is an X-linked disorder, so it primarily affects boys; it causes progressive muscle weakness.
- Gowers' sign — because of proximal (hip/thigh) weakness, the child "walks" the hands up the thighs to stand up from the floor.
- Other findings: a waddling gait, frequent falls, and enlarged-looking calves (pseudohypertrophy from fat/scar tissue).
If a question describes a young boy who pushes his hands against his legs to rise from the floor, think Gowers' sign and Duchenne muscular dystrophy. Care is supportive — maintaining mobility and function as long as possible and supporting the family.
Cast Care & Nursing
Protect circulation, skin, and the correction.
- Neurovascular checks (priority) — color, warmth, movement, sensation, pulses, and capillary refill distal to the cast; watch for compartment syndrome (increasing pain, pallor, paresthesia, pulselessness).
- Elevate the casted limb to reduce swelling, especially in the first 24–48 hours.
- Keep the cast clean and dry; do not insert objects inside to scratch; "petal" rough edges to protect skin.
- Report a foul odor, "hot spots," drainage, or increasing pain (possible infection or pressure).
- Family teaching — harness/brace adherence, skin checks, mobility, and emotional support.
Match the clue: asymmetric folds + limited abduction = DDH (Pavlik harness); rib hump on forward bend = scoliosis (brace halts progression); incomplete break = greenstick; "walks up the legs" = Gowers'/muscular dystrophy. And for any cast, neurovascular checks come first.
? A child in a leg cast reports increasing pain unrelieved by medication, and the toes are pale and cool. What is the concern and priority action?
Frequently Asked Questions
Common student questions on this topic.
What are the signs and treatment of developmental dysplasia of the hip (DDH)?
How is clubfoot treated?
How is scoliosis screened for and treated?
What is a greenstick fracture and why are pediatric fractures different?
What is Gowers' sign?
What are the priorities of pediatric cast care?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Pediatric Musculoskeletal Cheatsheet
Free, printable PDF · no spam · returning visitors skip the email step.