Dr Karthik Gudaru - Specialist Paediatric Orthopaedic Doctors in Hyderabad

Clinical Insight from Dr Karthik Gudaru

What is Paediatric Orthopaedic Surgery?

Paediatric Orthopaedic Surgery is a subspecialized branch of medicine dedicated to diagnosing, managing, and surgically correcting musculoskeletal deformities, neuromuscular conditions, and congenital bone and joint disorders in growing children (from newborns to adolescents). Key clinical management pillars include:

• Conservative Biological Correction: Utilizing the Ponseti technique of gentle serial plaster casting for infant clubfoot (CTEV) and dynamic bracing to avoid premature surgery.
• Guided Growth Modulation (Hemiepiphysiodesis): Using miniature tension-band plates (8-plates) to gently steer natural bone growth, straightening knock-knees, bowlegs, or leg discrepancies without cutting bone.
• Neuromuscular Realignment (Cerebral Palsy & Polio): Single-Event Multilevel Surgery (SEMLS), soft-tissue tendon lengthening, and bony osteotomies to achieve balanced foot-ground contact and independent walking.
• Congenital Reconstruction: Surgical separation of fused digits (syndactyly), excision of abnormal bone bridges (synostosis), and gradual limb lengthening via Ilizarov or internal lengthening techniques.

In-Depth Clinical Breakdown: Conditions & Surgical Management

1. Cerebral Palsy (Neuromuscular & Spasticity Management)

Cerebral Palsy (CP) leads to abnormal muscle tone, spastic contractures, and skeletal malalignment that compromise gait. Dr Karthik Gudaru specializes in comprehensive neuromuscular functional mobility management:

• Gait Analysis & Assessment: Classifying gait patterns (crouch gait, scissoring gait, stiff-knee gait, and equinus foot).
• Single-Event Multilevel Surgery (SEMLS): Rather than subjecting a child to repetitive operations year after year, SEMLS addresses muscle contractures, tendon tightness, and bony torsional deformities across the hips, knees, and ankles in a single, coordinated surgical sitting.
• Tendon Transfers & Muscle Balancing: Soft-tissue rebalancing procedures (such as fractional lengthening of hamstrings, psoas release, and peroneus longus tendon transfers) to restore neutral foot positioning and stability.
• Bony Stabilizing Osteotomies: Varus derotation osteotomies (VDRO) and pelvic osteotomies to prevent neuromuscular hip subluxation and dislocation.

2. Congenital Anomalies (Structural Birth Conditions)

Congenital anomalies are structural musculoskeletal differences present at birth requiring expert paediatric subspecialty assessment. CTEV causes the infant’s foot to be turned inward and downward at the ankle.

• The Ponseti Method (Gold Standard): Dr Gudaru strictly adheres to the conservative Ponseti protocol—initiating gentle serial manipulative plaster casts within the first weeks of life.
• Percutaneous Achilles Tenotomy: A quick, minor keyhole procedure performed under local numbing to release the tight heel cord, followed by final casting.
• Steenbeek / Mitchell Bracing: A disciplined dynamic bracing schedule prevents relapse while the child learns to walk naturally.
• Complex / Neglected CTEV: For older children or neglected cases, specialized soft-tissue releases, calcaneal osteotomies, or external fixators achieve a plantigrade, pain-free foot.

Syndactyly is the congenital failure of adjacent digits to separate during embryonic development, affecting either soft tissue alone (simple) or fused bony structures (complex).

• Surgical Separation & Zig-Zag Plasty: Dr Gudaru performs meticulous micro-surgical separation using precise interdigital zig-zag incisions.
• Full-Thickness Skin Grafting (FTSG): Preserves neurovascular bundles while harvesting small aesthetic skin grafts from the groin or lower abdomen to line digit valleys without contractures.
• Functional Alignment: Timing is optimized between 12 and 18 months of age, allowing normal grasp, pinch, and hand function before school age.

Synostosis occurs when two bones abnormally bridge or fuse together during fetal development, severely restricting rotational motion:

• Congenital Radioulnar Synostosis: Fusion between the radius and ulna in the forearm, locking the hand in extreme pronation (palm facing down) and hindering basic activities like eating or receiving objects.
• Surgical Mobilization & Derotation: Depending on the angle, Dr Gudaru performs rotational osteotomy to place the forearm into a functional position (20°–30° pronation) or interposition arthroplasty to enhance functional independence.
• Tarsal Coalition (Foot Synostosis): Abnormal fusion between tarsal bones causing rigid, painful flatfoot in older children; managed with surgical coalition resection and interposition of muscle or fat pads.

A noticeable difference in the length of the legs can stem from congenital hemiatrophy, fibular hemimelia, vascular malformations, or past growth plate infections:

• Guided Growth / Epiphysiodesis (For Differences < 5 cm): In growing children, a small titanium plate is placed across the growth plate of the longer leg, temporarily pausing its growth until the shorter leg catches up naturally.
• Distraction Osteogenesis (Ilizarov & Rail Fixators for Differences > 5 cm): Controlled, biological bone lengthening where a small bone cut is made and gradually lengthened at a rate of 1 mm per day, stimulating new natural bone formation (callotasis).

3. Poliomyelitis (Residual Paralytic Deformities)

Although acute polio has been eradicated in many regions, post-polio paralysis and neglected sequelae continue to affect thousands of children and adults.

• Clinical Presentation: Flaccid paralysis, asymmetric muscle weakness, knee recurvatum (hyperextension), dynamic foot drop, and quadriceps paralysis..


• Surgical Stabilization: Dr Gudaru applies decades of institutional experience from BIRRD Hospital:
• Tendon Transfers: Transferring active, healthy muscles to take over the function of paralyzed muscle groups.
• Corrective Osteotomies: Realignment of structural bone deformities to restore a balanced weight-bearing axis.
• Triple Arthrodesis: Joint fusion of the hindfoot for older adolescents to eliminate floppiness, stabilize the ankle, and eliminate the need for heavy, cumbersome calipers.

4. Metabolic Bone Diseases

Metabolic bone disorders disrupt mineralization, causing soft, weak, or brittle bones prone to severe deformities requiring targeted medical and surgical intervention.

Nutritional & Refractory Rickets

Vitamin D deficiency, renal tubular acidosis, or hypophosphatemic rickets causing classic "bowlegs" (genu varum) or "knock-knees" (genu valgum).

• Medical Stabilization: Optimization of vitamin D, calcium, and phosphate levels in close coordination with paediatric endocrinologists.
• Guided Growth (8-Plate Realignment): Minimally invasive tension-band plating gently straightens bowing as the child grows without cutting bone.

Comparative Analysis: Paediatric Orthopaedic Care at a Glance

Note - Medically Reviewed by Dr. Karthik Gudaru | Senior Orthopaedic Surgeon, HOD (Orthopaedics) GreenMed Hospital | Updated March 2026.