Pediatric Orthopaedic Surgery: When It Really Makes Sense to Operate
Pediatric orthopaedic surgery in Milan: the clinical questions behind every surgical indication, what changes for the child and family, when watchful waiting is right and when it isn't. Dr. Daniele Priano, ASST Gaetano Pini-CTO.
In pediatric orthopaedics, an operation only makes sense when the expected benefit clearly outweighs the cost of surgery for the child and for the family. Many conditions improve with growth, with observation or with conservative treatment. Surgery is one tool among several, not a default answer.
Note on spinal conditions: for scoliosis and other spinal pathologies I follow only the conservative pathway (observation, bracing, physical therapy). When surgery becomes necessary, I refer the patient to spine surgeons I trust.
The questions I ask before proposing surgery
Before recommending an operation, the indication has to pass through some honest questions.
- Can the problem improve as the child grows?
- Is the pain or functional limitation real, daily, and meaningful?
- Is the deformity stable or is it progressing?
- Are there reasonable conservative alternatives that haven't been fully tried?
- Is this the right moment, or does it make more sense to wait?
- What is the most likely scenario if we do not operate?
What I always explain to parents
When the indication is clear, I prefer the family to know what to expect in concrete terms.
- Why surgery is being proposed in this specific case
- What happens on the day of surgery
- What to expect in the first days and weeks after
- Which follow-up visits and imaging are planned
- What realistic timelines look like for school, daily life and sport
- Which warning signs should be reported promptly
Practical indicators in everyday clinical practice
These are not rigid rules but recurring patterns that help families understand when a calm follow-up is enough and when it makes sense to get in touch sooner.
Situations where waiting is reasonable
- Mild deformity, stable over time, with no impact on daily life
- Pain that resolves with rest and a temporary adjustment of sport
- Common growth variants in young children, without asymmetry
- Physiological flexible flatfoot, painless, in a child who lives a normal life
- Post-traumatic course in line with planned follow-up
Situations where it's better to get in touch early
- Limp lasting more than a few days, especially with fever or hip/groin pain
- Adolescent with knee or groin pain and limp without a clear cause
- Pain that wakes the child at night or worsens despite rest
- Deformity that is visibly progressing in a short time
- Loss of joint motion or strength after a trauma
- Plaster cast or brace causing pain, numbness, colour change in the fingers/toes
These indicators do not replace a clinical evaluation and are not an emergency channel. In case of severe trauma, evident deformity, uncontrolled pain or neurovascular signs (cold, pale or numb fingers/toes), go directly to the Emergency Room.
Conditions I treat surgically
These are examples of conditions for which surgery may be indicated. The choice of technique and timing is always specific to the individual case.
Click on a condition to read about indications, surgical techniques and postoperative course.
Foot and ankle
Hip
Knee and lower limbs
Trauma and growth plate
Benign bone lesions
Pediatric fractures by site
Typical surgical procedures (K-wires, ESIN, plating, spica cast) site by site, with conservative alternatives and follow-up considerations.
Disclaimer: this page is for general information only. It does not replace a medical evaluation. Indications, techniques and timelines are decided case by case during the clinical visit.
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