The new Musculoskeletal Centre (MSC) at KK Women's and Children's Hospital (KKH) brings together multidisciplinary specialists, services and facilities on one campus, to provide care for children with orthopaedic and spine conditions. This includes diagnostic and interventional imaging, paediatric sport and exercise medicine, orthopaedics, and prosthetics and orthotics.
KKH sees about 34,000 visits each year from children and adolescents with orthopaedic and spine conditions. The MSC facilitates the seamless continuum of end-to-end support that these children need to lead a fulfilling life and improve their quality of life in the long term.
1. Paediatric musculoskeletal tumours
At KKH, tumour management is provided by a dedicated multidisciplinary care team. The privilege of treating children with tumours requires the consideration of multiple factors. These include psychosocial management, and perioperative and operative considerations toward an optimal outcome for the child in the long term.
Tumours in the paediatric musculoskeletal system present at differing ages, sizes and locations. As such, the management approach is complex and has to be specific. The priority is to eradicate the disease where possible, coupled with the aim of optimising long-term growth and function for the child.
2. Paediatric sport and exercise medicine
The increased participation in sports amongst children and adolescents has led to an escalating incidence of sports injuries. It is prudent to treat sports injuries in an appropriate and timely manner to facilitate optimal recovery, quality of life and injury prevention.
The Sport and Exercise Medicine (SEM) service provides one-stop access to the sports physician, surgeon and sports allied health team (consisting of exercise physiologists, dietitians, physiotherapists and psychologists).
While most sports injuries can be managed non-operatively, some do require surgery. The SEM service team uses advanced techniques to establish good management outcomes.
Surgeries are performed via keyhole (arthroscopic) or minimally invasive methods for improved patient comfort, decreased recovery time and shorter hospital stays.
3. Paediatric foot and ankle conditions
At the MSC, the Foot and Ankle Clinic care team provides intervention and management for a range of conditions at various stages of a child's growth, including:
With advancements in treatment modalities, children with foot and ankle conditions can experience pain relief and improvement in their conditions. At the MSC, patients can benefit from one-stop management by physicians, physiotherapists and occupational therapists within the same centre. Customised insoles and orthotics can be fabricated by in-house orthotists.
Non-surgical management will first be provided and, should this be insufficient, keyhole surgical alternatives are explored.
4. Paediatric orthotic services
The KKH Paediatric Orthotic Centre provides a full range of orthotic services for infants and children with lower limb and spine conditions requiring assistive devices, and houses a fully-equipped workshop for the fabrication of custom orthoses.
The one-stop paediatric orthotic facility is run by prosthetists, orthotists and technicians. Patients can have their consultation, fitting and adjustments done in one location.
5. Limb lengthening and deformities
The Limb Lengthening and Deformity (LLD) Clinic provides limb lengthening and complex deformity correction in paediatric orthopaedic patients.
Treatment options include advanced surgical techniques with the use of hexapod and Ilizarov frames. 3D printing is incorporated into deformity assessment and pre-surgical simulation, enhancing safety and efficiency in treatment.
A multidisciplinary team approach to patient care includes specialty nurses, physiotherapists, occupational therapists, home modifications, psychologists as well as surgeons. The LLD Clinic care team continues to work with the Singapore University of Technology and Design on innovative solutions for these complex conditions.
6. Cerebral palsy-orthopaedic care
The only clinic of this nature in Singapore, the Cerebral Palsy-Orthopaedic Care (CPORHTO) Clinic provides management for patients with complex and multiple secondary orthopaedic problems arising from cerebral palsy, a condition that affects brain function in children less than three years old.
Orthotic or physiotherapy interventions can be carried out at the clinic, negating the need for multiple visits to different locations and on separate occasions for management by the various care teams. This achieves the goal of maximising the functional potential of these patients in the most efficient and patient-friendly manner.
Multidisciplinary sessions are conducted with neurorehabilitation doctors, orthotists and physiotherapists, to provide input towards a customised approach to manage the patient's orthopaedic concerns. Patients and caregivers are also involved in this face-to-face discussion, to provide clarity in the management approach.
7. New EOS system for a child-friendly imaging experience
The EOS Connect Imaging System enables safe and high-quality interventional and diagnostic imaging for children with musculoskeletal conditions. Approximately 2,000 paediatric examinations are conducted each year using the EOS system.
The technology used produces a high-quality image with 50 per cent less radiation dosage, compared to digital radiography using a conventional X-ray system. The duration of time for the imaging of an entire spine is reduced by half, compared to conventional imaging systems.
8. Holistic spine care for children and adolescents
The Spine Service at MSC facilitates access to comprehensive care by paediatric orthopaedic surgeons, allied health professionals, prosthetists and orthotists for spinal conditions in children and adolescents. These conditions include scoliosis, kyphosis (hunch-back) and acute or persistent back pain that may arise from conditions such as spondylolisthesis (when a vertebrae slips forwards on the one below).
The MSC has a low-dose x-ray machine (the 'EOS') which makes it safer for children with scoliosis who require multiple x-rays in the course of their treatment. The service has also pioneered the use of radiation-free surgical navigation, guided by artificial intelligence, for safer scoliosis and spinal surgery. Blood loss and operative surgery time is also minimised for patients, translating to reduced surgical risks such as lower complication rates and faster post-surgery recovery.
For GP referrals, please contact the MSC at:KKH GP Hotline: 6692 2984MSC Hotline: 6394 7227
Clin Assoc Prof Arjandas MahadevHead & Senior Consultant,Dept of Orthopaedic SurgerySpecial interest: Cerebral palsy
Dr Lam Kai YetDeputy Head & Senior Consultant,Dept of Orthopaedic SurgerySpecial interest: Lower limb deformities
Clin Assoc Prof Kevin LimChairman, Division of Surgery;Senior Consultant,Dept of Orthopaedic SurgerySpecial interest: Paediatric spine and scoliosis
Dr Mohammad Ashik Bin ZainuddinSenior Consultant,Dept of Orthopaedic Surgery;Head, Sports Medicine ServiceSpecial interest: Paediatric sports and exercise medicine
Dr Zackary ChuaConsultant,Dept of Orthopaedic SurgerySpecial interest: Paediatric foot and ankle
Dr Kenneth WongConsultant,Dept of Orthopaedic SurgerySpecial interest: Paediatric musculoskeletal tumours and hand surgery
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