PATHOLOGIC VERSUS HEALTHY PAEDIATRIC POPULATIONS: CHALLENGES IN MODELLING AND TREATMENT OF ORTHOPAEDIC DISORDERS

Paediatric orthopedic disorders widely range from congenital malformations and growth plate injuries to acquired disorders such as scoliosis or juvenile arthritis. These disorders can involve bones, joints, muscles, and ligaments and may arise from a combination of genetic, developmental, and environmental factors. Unlike adults, children's musculoskeletal system is still growing and developing with different biomechanical properties and responses to injury and disease compared to adults. In healthy children, epiphyseal plates are the most significant areas for bone growth and, thus, susceptible to injury, which can lead to long-term consequences if not properly managed. Paediatric orthopedic disorders often involve disruptions to this growth process, which can result in deformities, impaired mobility, and long-term functional disability if not addressed early. Computationally modeling paediatric orthopedic conditions has great potential in providing personalized, optimized, and sustainable treatment strategies. Paediatric models must account for developmental changes that impact bone strength, joint stability, and ligament flexibility, as well as the differential growth patterns that occur at various stages of childhood. Conditions such as clubfoot, hip dysplasia, or congenital limb deformities are typically present at birth and may require immediate treatment to prevent long-term disability. However, these disorders can vary widely in severity and response to treatment, making it difficult to simulate long-term outcomes or optimal therapies for each individual child. Similarly, disorders like juvenile idiopathic arthritis or osteogenesis imperfecta present with varied manifestations that require personalized approaches. Here, we present two of our projects focused on paediatric modeling towards personalized medicine. The variability within pathological paediatric populations also presents challenges in designing clinical trials. The paediatric population is not homogenous, and orthopedic disorders in children may manifest differently depending on the child's age, sex, genetic background, and comorbidities. Another significant challenge in paediatric orthopedic research is translating findings from adult models. Instead, treatments must be tailored to the unique needs of growing bones and joints. In addition, the long-term side effects of orthopedic surgeries, such as bone growth abnormalities, may be more pronounced in children, raising concerns about the balance between immediate therapeutic benefits and future functional outcomes. A lack of paediatric-specific evidence can lead to suboptimal treatment choices, prolongation of symptoms, and an increased likelihood of long-term complications. Even with the best surgical techniques, children may experience complications, such as limb length discrepancies or joint deformities, which can require additional surgeries in the future. This long-term care aspect is another unique challenge in paediatric orthopaedics.