Crawling, Walking and Hip Disorders

crawlingwalkinghipdisorderHIP DYSPLASIA IN BABIES
“Hip dysplasia occurs when the ligaments that normally hold the ball of the hip into the cup are abnormally loose or relaxed so the hip slips out of place. It’s harder to diagnose in babies because it causes no discomfort and there aren’t any outward signs,” says Dr. Carl Weinert. “Treatment includes applying a harness that holds the hip into position. The baby wears it for two months full time and two months part time. The ligaments get tighter and the hip stays in place. If we treat this in a newborn, the harness treatment works most of the time.”

A pediatrician often may diagnose hip dysplasia in an infant and refer the baby for orthopaedic treatment, says Dr. Weinert. If it’s not found in infancy, older babies may require surgery and a body cast for four months, he says. “An untreated child with hip dysplasia,” says Dr. Weinert, “will walk independently, usually by 14 months. So, delayed walking won’t necessarily be the clue that the child has this.”

“With clubfoot, the foot is turned downward and inward. It’s obviously visible when the baby is born so diagnosis is easy. The earlier the treatment is started, the more successful it is and the easier it is,” Dr. Weinert says. “We prefer to see newborns within a week. The typical treatment is the baby gets a cast on his leg from his toes to above the knee. Each time the cast is changed-about once per week for six to eight weeks-the foot is manipulated slightly each time. Eventually, the foot’s final position is as upward and outward as a normal foot will go. Sometimes a minor surgery to lengthen a tendon is done during the casting procedure. After the last cast is removed, the child wears special shoes attached to a bar. The success rate of that treatment is about 90 percent.”

Orthopaedics is the field of medicine that diagnoses and treats conditions of the musculoskeletal system, including bones, joints, muscles, tendons and ligaments. In babies and children, orthopaedic specialists commonly treat bone fractures, birth defects that affect the development of bones and joints, and spinal deformities like scoliosis. Often, neurological diseases such as cerebral palsy cause bone or joint deformities that require orthopaedic treatment.

View the full feature on Crawling, Walking and Hip Disorders

Dr. Carl R. Weinert
Dr. Carl R. Weinert
CHOC Orthopaedic Surgeon


Dr. Weinert is the Director of the clubfoot and musculoskeletal tumor programs in the Orthopaedic Institute at CHOC Children’s. As a clinical professor of orthopaedic surgery at UC Irvine, Dr. Weinert has trained hundreds of orthopaedic and pediatric residents, medical students, nurses, physical therapists and pre-med college students. He completed his internship at Mercy Hospital in Pittsburgh and a fellowship in orthopaedic research at the University of Pittsburgh. His clinical and research interests include bone cysts and benign tumors, clubfoot and hip reconstruction.

Dr. Weinert’s philosophy of care: “When a child develops an orthopaedic problem, it can be just as scary for the parents as it is for the child. I treat the entire family with the greatest compassion and understanding.”

University of Pittsburgh School of Medicine, Pennsylvania

Orthopaedic Surgery

More about Dr. Weinert | More about Orthopaedic Institute at CHOC Children’s

This article was featured in the Orange County Register on February 4, 2014 and was written by Amy Bentley.

How to Prevent Common Play Injuries in Children

Childhood cplayground injuriesan be a wonderful time, but it can also be a dangerous period when children can get hurt from the normal activities associated with playing and just growing up.

Dr. Carl Weinert, a CHOC orthopaedic surgeon, treats many children who are hurt from falls off playground equipment. The most common playground and fall injuries are fractures to wrists and elbows, he says. In addition, falls from scooters, bikes and backyard trampolines are a big cause of injuries in children. Children also get injured in bounce houses, he noted.

Trampoline injuries are much more common when there are multiple children using the trampoline at once, Dr. Weinert says. As more kids climb on the trampoline,  the risk of injury increases.

“Trampolines are far more dangerous if there is more than one child on it at a time because the recoil of the trampoline from one of the kids landing can launch another child off of it,” says Dr. Weinert.

Injuries incurred in bounce houses are frequently found in the elbow, Dr. Weinert says.

If you fall and try to force the elbow to bend backward instead of forward, it breaks, no matter how soft the surface is,” he says. “The most common injuries we see that need surgery are fractured elbows.”

Ailments that are more preventable are wrist and forearm injuries from skateboards and skates, Dr. Weinert says.

“Children should wear wrist guards,” he advises. “They are readily available and relatively inexpensive. Knee guards and elbow guards really only protect against scrapes.”

Signs of a serious injury from a fall can include lacerations, lots of swelling, an obvious broken bone or a bone protruding through the skin. If a parent notices any of these signs or if the child can’t walk, it’s time to see the doctor or emergency department quickly,  says Dr. Weinert.

“These injuries can be emergencies and they need help as soon as possible to avoid infection and to get the best outcome,” he says. “The fracture starts to heal when the child hits the ground. The longer treatment is delayed, the harder treatment is and the more compromised the result.”

Orthopaedic specialists at CHOC can help. The CHOC Orthopaedic Institute specializes in the diagnosis and treatment of complex orthopaedic injuries, illnesses and disorders in children and adolescents.  To make an appointment, call 888-770-2462.

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Kids and Spine Issues

Girl_at_the_beachDEFINING THE CURVE

“If you look at the spine from the front and the back, it should be straight. When scoliosis is present, there is always a sideways [“S” or “C”-shaped curvature] shifting of the spine from the right or left,” says Dr. Aminian. The cause of scoliosis is unknown, but scientists have recently identified genetic markers that are contributing to individuals with it. The condition is more prevalent in girls during their growth spurt years. “Usually, the majority of cases don’t become progressive, but a small subset do and might require surgery in the future,” says Dr. Aminian.


“California is one of a number of states that requires screening students for scoliosis in schools. It’s important that children get screened with their school nurse or their pediatrician,” says Dr. Aminian. The Adam’s Forward Bend Test checks for scoliosis by having the child lean forward and looking at rib asymmetry. Others signs can be shoulder height (when one shoulder is higher than the other), uneven hips and waistline asymmetry.


“If we catch the scoliosis at younger ages and smaller curves, we’re able to control it with a bracing program,” says Dr. Aminian. The more often the customized brace is worn, the better. Some kids may feel self-conscious wearing it at first, but CHOC’s counseling program helps them cope. “We work with them to increase the number of hours they wear it at school. We stress they wear it at night,” says Dr. Aminian. And they can even sleep in it.


“Surgery is reserved for curves that are major that we think will cause problems in the future, including breathing, balance and pain,” says Dr. Aminian. “Luckily, it’s a standardized surgery. It’s very safe and effective.”


  • Grades when girls should be evaluated for scoliosis: 5th and 6th Grade
  • Grades when boys should be evaluated for scoliosis: 7th and 8th Grade
  • Percentage of the population that have a small (insignificant) curve in their spine: 10 %

View the full feature on Kids and Spine Issues

Dr. Aminian
Dr. Afshin Aminian
CHOC Children’s Orthopaedic Institute


Dr. Aminian is the director of the CHOC Children’s Orthopaedic Institute. He completed his general surgery internship  and orthopaedic surgery residency at Northwestern Memorial Hospital and is affiliated with the Pediatric Orthopaedic Society of North America, the American Academy of Orthopaedic Surgery and the Scoliosis Research Society.

Dr. Aminian’s philosophy of care: “I try to put myself in the parents’ shoes and explain to them in the most common terms what we’re doing and why we’re doing it, reminding them of the hospital’s capabilities.”

Washington University School of Medicine

Orthopaedic Surgery

More about Dr. Aminian | More about the CHOC Children’s Orthopaedic Institute

This article was featured in the Orange County Register on December 23 , 2013 and was written by Shaleek Wilson.

Taking Care of Your Child’s Cast

Broken bones, or fractures, are a common childhood hazard, particularly for kids in sports.  While it can happen in a split second, a broken bone takes time to heal and may often require a cast.  The experts at the CHOC Children’s Orthopaedic Institute understand that kids with casts – and their parents – have lots of questions.  Dr. John Schlechter, CHOC orthopeadic surgeon, recently sat down to provide answers to some of the most frequently asked questions he and his colleagues receive.

Q: What material is a cast made of, and what does the cast do?
A: There are two types of cast – one made of hard plaster and the other a fiberglass shell.  Both work to prevent movement of the broken or fractured bone, and allow proper healing to occur.  The amount of time a cast has to remain on a child depends on the type of injury.

Q: Can my child take a bath or shower with her cast on?
A: Unless a child is wearing a special waterproof cast, she should not get her cast wet. This is best avoided by taking a sponge bath, while still covering the cast with several layers of a towel or plastic bags. In the event a cast gets wet, dry it with a hair dryer on the cool setting.

Q:  How do I can get my child a waterproof cast?
A: Not all fractures are suitable for a waterproof cast. If a child can have a waterproof cast, his parent must request it.  These special casts, which can be completely submerged in fresh water, are available at additional costs and not typically covered by insurance.

Q: Do I need to elevate my child’s arm?
A: Elevating the affected limb for the first 24 hours significantly reduces the natural swelling that occurs after an injury.  Place the injured limb above the level of the child’s heart (the “high five” position for arm injuries), using pillows as support.  Moving fingers or toes on the affected limb may also assist in swelling.

Q: What can be done to alleviate itching under the cast?
A:  Tapping on the cast or blowing cool air inside the cast with a hair dryer can help alleviate itching.  Under no circumstances should an object be placed under the cast to scratch.  This may cause injury or infection.  If the itching becomes severe or persistent, speak to the child’s physician.

Q: How do I know if my child’s cast is too tight or too loose?
A: The most common symptoms of a cast that is too tight are:
• Numbness, tingling
• Increased pain
• Change in skin color compared to the unaffected limb (pale or blue, by comparison)
• New swelling of the fingers or toes

Keep in mind that swelling is expected in the first 24-72 hours, which may make the cast feel tight.  Elevating the injured limb should help reduce the swelling.  Once the swelling subsides, the case may then feel loose.  As long as the child cannot move the limb under the cast or take the cast off, he is fine.

Q: Is it normal for my child’s cast to smell?
A: Unfortunately, cast odor is normal since the affected limb cannot be bathed.  Never apply powder or perfume on or inside the cast.

Q. Can my child resume normal activities?
A: Children should enjoy being kids, and there should be no restrictions to activities of daily living.  However, they should avoid activities that can damage the cast, including getting it wet, or re-injure the limb.  This may include swimming, bicycle riding, skate boarding, contact sports, etc.

Visit to learn more about the CHOC Children’s Orthopaedic Institute.

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Kids and Broken Bones

Girl on SkateboardTHE LONG AND SHORT OF IT

When a child takes a fall, they may impact their growth plate. What is it? “It’s a [developing] area of the long bone, like the femur or tibia  that contributes to the length of your body,” says Dr. Lalonde. Located close to a joint, including the hip, knee or ankle, the growth plate  remains open until age 15 for girls and age 17 for boys.


“Wrists splints in skateboarding and certain roller skating activities would prevent a lot of fractures, especially growth plate fractures,”  says Dr. Lalonde. “It only takes a few minutes to put on, doesn’t limit the enjoyment of the activity and can go a long way in preventing a fracture. And when trotting on the trampoline, to avoid crashes, there should only be one child on at a time.”

If it looks crooked or there’s a significant amount of swelling, you may be dealing with a broken bone, says Dr. Lalonde. “In general, if you touch the bone and your child jumps from the pain, you should get an X-ray,” he says, adding that some fracture patterns are pretty subtle and go unnoticed for several days.

If it seems like a mild injury, parents can:

  • Apply ice
  • Provide a temporary splint
  • Check-in with primary doctor the next day


  • The length of time that it takes for a growth plate fracture to heal: 3 to 6 weeks
  • The percentage of childhood injuries that affect the growth plate: 15-30%
  • The number of children 14 and under treated in the ER for trampoline related injuries: 80,000

View the full feature on Kids and Broken Bones

Dr. Francois Lalonde
Dr. Francois Lalonde
CHOC Orthopaedic Institute


Dr. Lalonde is the director of the hip program at CHOC Children’s. In addition to his medical degree, Dr. Lalonde has a master’s in medical education. He is one of 10 orthopedic surgeons in the U.S. selected to participate in the American Orthopedic Surgeons Leadership Fellow Program and he is on the board of the California Orthopedic Association.

Dr. Lalonde’s philosophy of care: “Family and patient engagement. I want them to understand they have options and engage them in their treatment plan so they can recover as quickly as possible.


University of Toronto School of Medicine


Orthopedic Surgery

More about Dr. Lalonde | More about the CHOC Orthopaedic Institute

This article was featured in the Orange County Register on October 14, 2013 and was written by Shaleek Wilson.

CHOC Sports Medicine Program Opens Irvine Office

With year-round sports participation and an intense competitive environment, Orange County’s young athletes are at greater risk for injury, particularly overuse syndrome.

Comprehensive sports physical therapy services are now available much closer to home for South Orange County athletes. The CHOC Children’s Sports Medicine Program has opened a new office in Irvine to provide sports medicine physical therapy for school-age children and precollegiate teens.

“We are addressing the many issues associated with competitive youth sports, including preseason screening for injury prevention, nutrition, sports psychology and physical rehabilitation,” says CHOC Children’s pediatric orthopaedic surgeon John Schlechter, D.O. “Our goal is to work in conjunction with primary care physicians in order to provide the best care for athletes.”

The CHOC Children’s Sports Medicine Program, the only one of its kind in Orange County, is supported by CHOC cardiologists, pulmonologists, allergists, neurologists and neurosurgeons.

To learn more about the services available through the CHOC Children’s Sports Medicine Program in Orange and Irvine, please call 714-289-4054 or click here:

The CHOC Children’s Sports Medicine Program Irvine office is located at 980 Roosevelt, Suite 100.