The HKCH orthopaedic team specializes in complex and rare orthopaedic diseases in children, including hip problems, limb deformities, neuromuscular diseases, skeletal dysplasias, metabolic bone diseases, and complex scoliosis. Trauma cases and general developmental problems are handled by regional hospitals.

The beauty of multidisciplinary management

Dr Chow Wang, the consultant-in-charge of the Department of Orthopaedics & Traumatology, emphasizes that children with complex orthopaedic diseases often experience issues in other body systems, "HKCH brings together expertise from various specialties, creating a powerful synergy in clinical management and research, and enabling the team to provide clear explanations to parents regarding their child's condition and future outlook to ensure comprehensive care and informed decision-making."

Dr Chow recalls his team once performed a lower limb surgery for a patient with metabolic disorder. "Various teams coordinated their efforts, so orthopaedic and ENT procedures, eye examinations, and nerve conduction tests could be done during the same session, minimizing the need for multiple anaesthesia and reducing the anxiety not only for the patient but also the family."

Enhancing care with rehab and technologies

He highlights the role of allied health professionals in providing comprehensive care, as surgery alone is only one aspect of the overall treatment, while rehabilitation is the other crucial half. For example, in the seating clinic, the orthopaedic surgeon would address patients' spine and limb deformities to enhance posture. Simultaneously, therapists would assess patients with limited mobility and prescribe suitable wheelchairs to cater to their body support and daily needs. This personalized approach is vital in enhancing patients' quality of life.

Advanced technologies are adopted to facilitate targeted treatment and enhance clinical outcomes, they include the motion analysis lab which captures complex deformities and gait problems; and the EOS system which provides precise and low-dose imaging for musculoskeletal and orthopaedic problems.

▲Patients with neuromuscular disorders may have gait deviation. In the new motion analysis laboratory at the Integrated Rehabilitation Centre, reflective markers and wireless electromyography sensors are placed on the patient's lower limbs. The patient then walks back and forth on a force platform while 12 high-speed cameras capture their movements. This comprehensive setup enables accurate identification of joint and muscle problems, facilitating precise analysis and targeted treatment.

Medical advancements bring new challenges

Dr Chow acknowledges that medical advancements have led to remarkable progress in controlling or treating some previously incurable diseases. However, they also present some new challenges. He quoted children with spinal muscular atrophy, who were previously confined to the wheelchair for life, as an example. With the availability of new medications and therapies, these patients can now regain mobility and walk. However, as they continue to grow, orthopaedic issues such as lower limb deformities and hip joint dislocation may arise, and there are currently no established treatment protocols worldwide to address these specific challenges.

"I see these emerging challenges as an exciting opportunity for the field of paediatric orthopaedics as they present room for innovation and development. By sharing successful cases internationally and taking a leading role, I believe there will be significant strides in finding effective solutions for these orthopaedic issues."

Dr Chow holds a vision for the orthopaedic department to develop as a leading centre for paediatric orthopaedics, with the ultimate goal of improving outcomes and enhancing the quality of life for children with complex orthopaedic conditions.

▲To reduce radiation exposure and improve imaging accuracy, the Department of Radiology recently introduced the next-generation low radiation X-ray system, EOS. It is particularly beneficial for children who require repeated X-ray exams and have conditions such as scoliosis, kyphosis, limb length discrepancy, hip dysplasia, bowlegs and knock knees. It is capable of capturing both frontal and lateral views of the patient simultaneously in less than eight seconds, enabling the production of a 1:1 full-body image in a single scan, which eliminates blurry images caused by patient movement and errors in stitching images together. It can also modulate radiation dose, thereby reducing radiation dose by up to 80%.