Development of important innovations in paediatric orthopaedics.
| SR. NO. | Innovation | Year (inventor/country) | Uses | Modification (if any) over time | Status | Future perspective |
|---|---|---|---|---|---|---|
| 1 | Advanced paediatric musculoskeletal imaging [1–17] | 1980s (various contributors across the globe) | To make accurate and reliable diagnoses in all phases of patient care | Several modifications for making them safer, affordable, and accurate in making diagnosis | A pivotal role in impeccable clinical practice | Deep learning reconstructionUse of AI toolsImage-guided interventions in a 3D virtual reality environment |
| 2 | 3D printing [18–30] | 1983 (Charles Hull/USA) | Preoperative planning, getting patient-specific implants, instrumentation, and prosthesis | Modification focused on improving speed, material versatility, and precision | Though a promising tool in patient care, it has many challenges for use on a larger scale | Need for a modified technique that is cost-effective, readily available, and can deliver the product much faster |
| 3 | Ponseti technique [31–38] | 1952 (Ignacio Ponseti/USA) | Early treatment of clubfoot deformity | Accelerated Ponseti techniqueModified Ponseti technique for atypical clubfoot | Today, it is the standard method for treating early clubfoot deformity | Need to further reduce the duration of casting and improve the complianceOne-week accelerated Ponseti technique could be the next standard practice |
| 4 | Safe surgical dislocation of the hip [39–53] | 2001 (Reinhold Ganz/Switzerland) | Treatment of traumatic and non-traumatic paediatric hip conditions like DDH, SCFE, Perthes disease, and femoro-acetabular impingement | Smith’s modification for younger children. Instead of doing TFO, elevation of the cartilaginous sleeve from GT is preferred | Favored approach for hip preservation surgery | To see its continued evolution as a crucial joint preservation technique, augmented by advanced technologies like computer navigation and robotics |
| 5 | Use of botulinum toxin in cerebral palsy [54–67] | 1993 (A.L. Koman/USA) | Treatment of spasticity and early contractures in cerebral palsy | Increased precision with USG guided injections, attempts to lower the dosage, and combining injections with a comprehensive treatment plan | Standard treatment for dynamic contractures in cerebral palsy | Developing newer variantsExploring new indicationsTo increase the safetyTo reduce the long-term effects on the injected muscle |
| 6 | Three-dimensional instrumented gait analysis (3D-IGA) [68–81] | 1890 (Christian Braune & Otto Fischer/Germany) | Assessment of gait abnormalities | Integration of wearable sensors like inertial measurement units (IMUs) and electromyography (EMG) | It has evolved as an important tool in the assessment of ambulant children with cerebral palsy | Development of markerless systemsWearable sensorsUse of AI and smartphone apps for data analysis |
| 7 | Growth modulation with tension band plates [82–97] | 2007 (Peter Stevens/USA) | Correction of limb deformities before skeletal maturity | More minimally invasive techniques (plate is positioned over skin before inserting the guidewires, central wire is avoided), sleeper plate technique | Preferred choice for growth modulation | More minimally invasive techniques, better understanding of its use in complex deformities and younger children, and development of novel implants based on the “constant force” concept for better control of growth modulation |
| 8 | Ilizarov principles and distraction osteogenesis [98–103] | 1950 (Gavril Abramovich Ilizarov/USSR) | Correction of bone defect, complex limb deformity, and limb length discrepancy | Unilateral external fixators, hybrid techniques for bone transport, internal limb lengthening device, software-driven six-axis external fixation device, use of carbon fiber providing lighter weight and lower profile, improvement in pin and clamp design for better stability | Preferred choice for management of difficult nonunion, bone defect, limb deformity, and limb length discrepancy | Further improvements in the design of hardware and software, leading to more precision, fewer complications, and which will be more user-friendly. Its amalgamation with technology like robotics and augmented reality may help in expanding the indications to other areas beyond deformity correction. The construction of patient-specific frames through 3D printing may further improve the treatment outcome |
| 9 | Motorized internal limb lengthening [104–126] | 1992 (Rainer Baumgart & Alex Betz/Germany) | Limb lengthening for correction of limb length discrepancy | Initial nails required mechanical activation, whereas the currently available nails are motorized and remote-controlled | Motorized intramedullary lengthening nails have become the implant of choice for limb lengthening in many countries | Innovations in metallurgy and implant design for higher mechanical strength & biocompatibilitySmart nails with built-in sensorsPlate-based & extramedullary devices |
| 10 | Magnetically controlled growing rods for early onset scoliosis (EOS) [127–142] | 2004 (Arnaud Souberian/France) | Correction of EOS in children | The Phenix rod was the original invention. The current version available is the MAGEC rod, which is built upon the original concept, but is a different implant | MCGR is an important innovation in the management of EOS as it offers gradual, non-invasive, outpatient correction of spine deformity | Focus on enhanced longevity, improved biomechanics, and long-term safety |
SR. NO.: serial number; AI: artificial intelligence; DDH: developmental dysplasia of the hip; SCFE: slipped capital femoral epiphysis; TFO: trochanteric flip osteotomy; GT: greater trochanter; USG: ultrasonography; MAGEC: Magnetic Expansion Control; MCGR: magnetically controlled growth rods.