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Paediatric Trauma and Orthopaedic Surgery

Description of service

We offer a comprehensive specialist outpatients service for the management of all secondary and tertiary paediatric orthopaedic conditions.

Our expertise

  • general paediatric orthopaedic conditions
  • acute fracture management
  • Cerebral Palsy (CP)
  • Congenital Talipes Equinovarus (CTEV/Clubfoot)
  • correction of limb deformities
  • skeletal dysplasias
  • Developmental Dysplasia of the Hip (DDH)
  • gait analysis
  • Ilizarov technique of deformity correction

Contact us

Mr Guy Atherton: 0117 342 8832
Mr Martin Gargan: 0117 342 8842
Mr Fergal Monsell: 0117 342 8892
Mr Simon Thomas 0117 342 8755

Further information

Combined Cerebral Palsy Clinics are run by the consultant orthopaedic surgeon and senior physiotherapist with an interest in cerebral palsy. They assess the ongoing and future management of patients with CP, from surgery to community support.

Young Adult Clinic
This clinic, run by a consultant orthopaedic surgeon is for patients who are too old for the children's hospital, but too young for the BRI. We manage a wide variety of conditions from CP to Acetabuloplasty.

Skeletal Dysplasia Clinic
This clinic is run by two consultant orthopaedic surgeons, a consultant geneticist, consultant endocrinologist and a senior physiotherapist. It runs four times a year and is for the management of all the various types of skeletal dysplasia. We see both new and follow-up patients.

DDH Clinic
This clinic is run by a consultant orthopaedic surgeon, consultant radiologist and senior physiotherapist. It is for patients under six months old with suspected DDH. Patients will have an examination and ultrasound of their hips. Pavlik harness treatment can be instigated and supervised if required. We see new and follow-up patients at this clinic.

CTEV Clinic
This clinic is run by a consultant orthopaedic surgeon and senior physiotherapist. The clinic is for the assessment and treatment of congenital foot deformities. The Ponseti method will be used if appropriate.

Upper Limb Clinic
This clinic is run by a consultant orthopaedic surgeon, occupational therapist, physiotherapist and consultant hand surgeon. This clinic is for patients with musculoskeletal disorders affecting the upper limb (ie Hemiplegic CP).

Gait Clinic
We carry out gait analysis at the University West of England Campus, where there are consultant orthopaedic surgeons, physiotherapists, orthotist, gait lab staff. We use static video and 3-D instruments to analyse a child's gait. This is used for diagnosis, planning future management and response to treatment.

Frame Clinic
This clinic is run by consultant orthopaedic surgeons, physiotherapists and occupational therapists. It is held in the Bristol Royal Infirmary and is for patients undergoing correction of a deformity using the Ilizarov technique. We ask patients to attend the clinic so that we can monitor the progress of correction and alter/update frame prescription.

Conditions we treat

We treat all general paediatric conditions, for example:

  • factures
  • bone/joint infections
  • genu varum (bow-legs)
  • genu valgum (knock-knees)
  • idiopathic toe walking
  • pes planus (flatfeet)
  • pes cavus
  • curly toes
  • accessory navicular
  • assessment of musculoskeletal pain
  • knee disorders
  • in-toeing/out-toeing
  • Idiopathic Scoliosis, and other spinal deformities
  • bone tumours
  • trigger thumb/digit
  • sporting injuries of childhood
  • upper limb deformities
  • assessment of gait
  • orthopaedic manifestations of common syndromes, ie neurofibromatosis, arthrogryphosis, Down's, mucopolysaccharidosis
  • limb deformities
  • congenital limb shortening
  • leg length discrepancies
  • epiphysial arrest (growth plate arrest)
  • tortional deformities (twisting of the limbs)

Cerebral palsy
Cerebral palsy is a condition that affects posture, movement and coordination. It is caused by damage to the brain before, during or after birth. Cerebral palsy is not a progressive disease; however, the effects have been known to change over time.

Children with cerebral palsy often have an irregular posture; their bodies may be either very floppy or very stiff, and this may lead to deformities of the spine or lower limbs over time.

Gait abnormalities
Gait abnormailities typically result from affections of nervous and musculoskeletal systems. Abnormal gait may be caused by a variety of conditions, the commonest of which is CP, but may also include hip dysplasia, arthritis, anatomical abnormalities, pain and neurological conditions.

Developmental dysplasia of the hip
Developmental dysplasia of the hip (DDH) describes a variety of conditions in which the ball and socket of the hip do not develop properly. In the mildest forms, the socket may fail to grow deep enough. In the more severe forms, the femoral head or ball may be displaced completely out of the socket and be dislocated. In the past this was known as a congenital dislocated hip (CDH). Some babies may grow out of a mild instability without treatment, but at the moment there is no way to tell which hips will come right on their own. So all babies who have been diagnosed as having a hip problem will be closely monitored.

Treatment ranges from using a Pavlik Harness (if diagnosed early), to an examination under anaesthetic (with application of a hip spica plaster cast) or a more extensive operation to put the ball and socket in place.

Legg-Calve-Perthes disease is an age dependent condition of the hip joint, where a loss of bone mass leads to some degree of collapse of the hip joint, which may cause a deformity of the ball of the femur and the surface of the hip socket. It is caused by an interruption to the blood supply of the head of the femur close to the hip joint. It is equivalent to adult avascular necrosis. The goal of treatment is to avoid degenerative arthritis.

SUFE (Slipped Upper Femoral Epiphysis) Is a condition involving the upper end of the femur (thigh bone), where the epiphyseal plate (growth plate) is weakened and the head of the femur (ball) is slipped downward and backward. As the hip joint functions as a ball and socket, movement of the hip may be affected. The exact cause of this condition is not known, although there may be a link between increased weight and the hormones associated with puberty.  Early diagnosis is important to prevent delay in treatment and worsening of the slip.

Skeletal dysplasias is a general term that refers to abnormal bone and cartilage development. There are over 200 different kinds of skeletal dysplasias, with a wide range of symptoms. The four most common skeletal dysplasias are achondrogenesis, achondroplasia (aka dwarfism - one of the most common forms of non-lethal skeletal dysplasia), osteogenesis imperfecta, and thanatophoric dysplasia.

Metatarsus adductus is a common foot deformity that causes the front half of the foot, or forefoot, to turn inward. May also be referred to as "flexible" (the foot can be straightened to a degree by hand) or 'non-flexible' (the foot cannot be straightened by hand). The goal of treatment is to straighten the position of the forefoot and heel. Treatment options vary for infants, and may include observation, stretching/manipulation of the foot, casts and surgery.

Juvenile Hallux Valgus
Hallux valgus is an abnormally positioned big toe, in which the joint at the base of the toe bulges outward from the inner side of the foot and the big toe points inward (toward the smaller toes). People commonly come to hospital because of pain, or because they are unhappy with the way their foot/feet looks. Surgery is the mainstay of treatment for this condition, but it is often delayed until skeletal maturity if possible, as this decreases the chance of the deformity recurring post operatively.

Radio-Ulnar Synostosis is a term used to describe a bony or soft tissue connection between the radius and ulna, the two bones of the forearm. This abnormal connection may be congenital or may occur following fracture or other trauma to the forearm. The diagnosis is often made late in childhood or adolescence, as pain is rarely a complaint and much of elbow flexion/extension is preserved. Treatment recommendations are made based upon the degree of functional loss associated with loss of forearm rotation. Treatment ranges from surveillance of the condition to surgery.

Tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection-which can be composed of bone, cartilage, or fibrous tissue-may lead to limited motion and pain in one or both feet. Symptoms generally do not appear until the bones begin to mature-usually around ages 9-16, but can range from pain to stiffness in the foot/feet. A tarsal coalition is difficult to identify until a child's bones begin to mature, additional diagnostic imaging tests (such as a CT scan or MRI) may also be needed. Treatment varies from analgesia, physiotherapy, steroid injections to surgery.

Patient information leaflets

There are a wide range of high quality patient information leaflets available. Please visit and select 'Patient Information' then 'UH Bristol, all the leaflets are then organised by Division and service. Please identify the appropriate leaflets for your service and enter their names into the box below, along with the DMS link to the leaflet.

Information for GPs

Mr Guy Atherton: 0117 342 8832
Specialist areas: paediatric orthopaedic surgery

Mr Martin Gargan: 0117 3428842
Specialist areas: paediatric orthopaedic surgery

Mr Fergal Monsell: 0117 3428892
Specialist areas: paediatric orthopaedic surgery

Mr Simon Thomas: 0117 3428755
Specialist areas: paediatric orthopaedic surgery