Dr. Mackie performs more complicated children’s operations at the Royal Hobart Hospital. Dr. Mackie performs some of the following operations within the 2 private hospitals in Hobart (Hobart Private Hospital and Calvary Hospital).
Upper and Lower Limb trauma
Children’s fractures are most commonly managed with plaster application. A small number may require a temporary pin insertion into bone, with the pin being removed between 6 and 8 weeks later. An even smaller number of children’s fractures will require more extensive internal fixation with plates, screws or metal rods.
Upper limb corrective operations
These may include the correction of deformities related to past fractures or due to abnormalities during growth. Most corrective operations will require a period of plaster immobilisation as well.
Discoid lateral meniscus resection
Discoid lateral meniscus is an abnormality of the shock absorbing cartilage on the outer side of the knee that sometimes interferes with normal knee movement. Children with this condition may present with pain and an inability to straighten the knee. Arthroscopy (keyhole) surgery can be performed to reshape the meniscus and repair any tears within the meniscus.
Osteochondritis dissecans (OCD) of the knee results from an abnormality in the blood supply to the articular (hard) cartilage of the knee and the underlying bone. A small area may loosen or collapse, causing pain, catching or giving way sensations in the knee. Often a period of ~ 1 year away from sporting activity is required to allow the area to heal. A small number of children may require arthroscopy surgery to pin or stabilise a loose fragment of bone. Small drill holes in the bone can also be used to improve the blood supply to the area to speed up healing.
Anterior cruciate ligament rupture
Anterior cruciate ligament (ACL) injuries are becoming more frequent in children and are usually related to high-energy sports injuries. Knee reconstruction (replacing the damaged ACL with a graft taken from part of the hamstring tendons) may be required to reduce the chance of secondary injuries in the knee. Slightly different techniques are utilised in children compared to adults in order to reduce the chance of damaging the growing ends of the bones of the leg.
Minor angular deformities
Minor angular deformities in the knees of children, such as bow-leg or knock-knee do not require surgery. More severe angular deformities can be treated via growth modulation surgery. This involves minor surgery to anchor part of the growing bone on one or both sides of the knee with a small metal plate and screws. Ongoing growth in the rest of the bone can slowly correct a deformity and the plate and screws may be removed as a day-case operation when the leg is straighter.
Patella (kneecap) dislocations are common in active children. Teenage girls with minor rotational differences in their legs may be more prone to having the patella dislocate or track abnormally to cause pain. In a small number of teenagers an operation may be performed to stabilise the kneecap, sometimes using one of the hamstring tendons to reconstruct a weakened ligament on the inside of the knee.
Foot and Ankle Surgery
An accessory navicular bone is a relatively common condition in which one of the bones on the inner side of the midfoot is partially duplicated. A strong tendon inserting into this bone may cause pain with activities due to partial movement of the accessory bone against the normal bone. Most will settle if rested for several months from sporting activities or if placed in a walking plaster or boot. A small number of children may benefit from removal of the accessory bone and advancement of the tendon onto the main bone. A flatfoot appearance is associated with this condition and may not significantly change after surgery (which is only performed for pain and not for cosmetic reasons).
Residual clubfoot deformities may occasionally be operated upon in the private hospitals. Extensive clubfoot management is performed via the Royal Hobart Hospital. Occasionally a tendon transfer in the foot or osteotomy (bony cut and correction) can be performed to fine-tune the shape of the foot in older children.
More information on clubfeet can be found in the common paediatric conditions section.
Tarsal coalition refers to a group of conditions in which there is an abnormal joining (coalition) of one or more bones in the foot (tarsal bones). Pain may be present at variable times between ~ 8 years and ~ 12 years age, during the time that the coalition forms. A period of rest from sports or in a walking splint may reduce pain. A subtle reduction in hindfoot movements may persist into adulthood. If pain does not settle with rest then an operation may be attempted to remove the abnormal coalition and to free up movements in the joints.
Juvenile bunions are the children’s variant of bunion deformities commonly seen in the much older population. Corrective surgery in adults will usually be very successful in dealing with the deformity. In children there is a very high chance of recurrent deformity of the great toe and reappearance of a bunion lump on the side of the toe. Surgery is sometimes used because of the extent of the deformity, acknowledging a likely need for further surgery in adulthood.
Curly toe deformity is very common in children. A sideways bend is evident in the lesser toes (most commonly the middle toes) and usually straightens during growth. If curly toes have not spontaneously improved by ~ 5 years of age a very small operation as a day case can be performed to release tight tendons. Normal growth from that time allows the toe to straighten slowly.