https://www.gosh.nhs.uk/health-professionals/orthopaedics/

Orthopaedics

Targeted review into care of orthopaedics patients

We are carrying out a review into the care of some of our patients and have contacted them directly.

We asked the Royal College of Surgeons to review our paediatric orthopaedic service, after concerns were raised by a number of our patient families and staff.

We take all concerns incredibly seriously and have written directly to all those patients and their families who may be affected. We know that for them this could be a worrying time and we are sorry for the concern these letters may have caused.

We are committed to learning from every single patient that we treat, and to being open and transparent with our families when care falls below the high standards we strive for.

If you have any questions about the review, please contact our Patient Advice Liaison Service (PALs) on 0207 829 7862 or by email PALS@gosh.nhs.uk .

There has been recent media coverage concerning the review into our paediatric orthopaedic service. Please see here for our latest statement.

Orthopaedics is the specialty that treats diseases or injuries of your body's musculoskeletal system. This system includes your bones, joints, ligaments, tendons, muscles, and nerves and allows you to move, walk and be active.  At Great Ormond Street Hospital (GOSH) we specialise in treating babies and children with often rare and complex congenital (born with) and developmental orthopaedic conditions.

Orthopaedic physiotherapy services at GOSH

We primarily offer physiotherapy treatment as an inpatient service. We also provide the following services:

  • physiotherapy-led Ponseti clinic in outpatients
  • harness treatment for developmental dysplasia of the hip in outpatients
  • serial casting (plastering)
  • hydrotherapy (exercises in water)

What conditions are commonly seen by the team?

We see children who require physiotherapy with the following conditions:

  • Scoliosis – we offer specialist assessment and advice in clinic and see children who are undergoing surgery including both idiopathic scoliosis and neuromuscular scoliosis with complex needs.
  • Limb lengthening – we offer a highly experienced physiotherapy service for children undergoing limb lengthening or deformity correction with external fixators. This may include inpatient admissions for rehabilitation.
  • Club foot (congenital talipes equinovarus) – we offer a physiotherapy-led Ponseti service which is available upon referral by one of our orthopaedic consultants.
  • Cerebral palsy – we offer specialist assessment of children with complex movement disorders, to help determine if surgery or other interventions may improve a child’s ability to perform functional skills or sit more comfortably in their wheelchair. This may involve surgery to the bones or muscles, recommendations for orthotics or botulinum toxin injections to relax muscles.
  • Developmental dysplasia of the hip – we offer treatment for babies in harnesses to treat clicky hips.
  • Osteogenesis imperfecta – we are experienced in providing physiotherapy for children undergoing treatment for associated fractures.
  • Arthrogryposis – we offer assessment and advice for children with this condition. 

What does the physiotherapist do and how will it help?

An experienced physiotherapist will complete an assessment of all children who are going to have orthopaedic surgery. This assessment records joint ranges, muscle length, muscle tone, and age-appropriate functional skills such as crawling, standing, balance, walking and running.

The physiotherapy assessment is essential in aiding decision-making regarding surgery or other recommendations, for example botulinum toxin, orthotics, specialist equipment and physiotherapy programmes. It also allows us to prepare you and your child for surgery, answer questions, and plan what help and further physiotherapy might be needed after you are discharged home.

Our specialist orthopaedic physiotherapy team are also present in clinics to assess children alongside the doctor. We also ensure effective communication with community physiotherapists.

What sort of things might physiotherapy involve?

The physiotherapist plays an essential role within the multidisciplinary team of doctors, nurses, occupational therapists and play therapists. After surgery they will help the child start moving and reach a level where they are safe to go home.

This can include exercises based on Sky Ward in bed, in the play room, multisensory room or in our physiotherapy gym. Other treatments might involve plastering or providing splints.

The aim of physiotherapy is to get joints and muscles moving and to gain functional skills, such as learning to walk with crutches or a frame. We are a team of specialised paediatric physiotherapists who aim to make physiotherapy child friendly and fun.

To ensure each child reaches their best physical outcome, we will offer advice and exercises to do at home and ensure prompt communication with local therapy teams as required.