Pediatric Orthopaedics in Northern Virginia
Specialized orthopedic care for infants, children, and adolescents with fractures, growth plate injuries, sports injuries, gait concerns, developmental conditions, and other musculoskeletal problems with Candice P. Holden, MD.
Pediatric Orthopaedic Care at a Glance
Patients: Infants, children, adolescents, and teenagers
Common Concerns: Fractures, growth plate injuries, sports injuries, sprains and strains, gait abnormalities, developmental conditions, scoliosis, and other bone and joint problems
Treatment: Nonsurgical care whenever appropriate, including casting, splinting, bracing, activity modification, observation, and physical therapy
Surgery: Available when the specific injury or condition requires surgical treatment
Pediatric Orthopedic Surgeon: Candice P. Holden, MD
Locations: Sterling and South Riding, Virginia
Goal: Protect healthy growth and development while helping children safely return to everyday activities, school, play, and sports
What Is Pediatric Orthopaedics?
Pediatric orthopaedics focuses on conditions and injuries affecting the bones, joints, muscles, ligaments, tendons, and other parts of the musculoskeletal system in growing children and adolescents.
Children are not simply smaller versions of adults.
Their bones are still growing, growth plates remain open, and certain injuries and developmental conditions occur only—or behave differently—during childhood and adolescence.
The child's age, stage of development, remaining growth, and activity level can therefore influence both diagnosis and treatment.
At Arthritis & Sports Orthopaedics, Candice P. Holden, MD, provides both nonsurgical and surgical pediatric orthopedic care at our Sterling and South Riding locations.
Why Is Orthopedic Care Different for Children?
Growing bones respond differently to injury than mature adult bones.
Children also have growth plates, which are areas of developing tissue near the ends of many bones that contribute to future bone growth.
Because growth plates can be more vulnerable to injury, an injury that might cause a ligament sprain in an adult can sometimes involve a growth plate in a child.
Children also have a remarkable ability to heal and remodel certain bone injuries as they grow, which can affect whether a fracture needs surgery or can be treated with a cast or other nonsurgical approach.
Pediatric orthopedic treatment therefore considers both the problem your child has today and how treatment may affect continued growth and development.
What Conditions Does a Pediatric Orthopedic Surgeon Treat?
Dr. Holden evaluates a broad range of musculoskeletal injuries and conditions affecting children and teenagers.
Pediatric Fractures
Broken bones are common during childhood and can occur after falls, sports injuries, playground accidents, or other trauma.
Treatment depends on the child's age, the bone involved, fracture pattern, alignment, whether the growth plate is affected, and how much growth remains.
Many pediatric fractures can be treated without surgery using a splint or cast.
Other fractures require the bones to be realigned, and certain unstable or complex fractures may require surgery.
Follow-up can also be important for selected fractures involving a growth plate because the child's future growth may need to be monitored.
Growth Plate Injuries
Growth plates are areas near the ends of developing bones that help determine the bone's eventual length and shape.
Because these areas are still developing, they can be injured during falls, twisting injuries, collisions, repetitive activity, and sports.
Growth plate injuries can sometimes resemble a sprain or strain.
Pain directly over a bone, persistent swelling, limping, difficulty bearing weight, or continued pain after an injury may warrant orthopedic evaluation.
Most growth plate injuries heal successfully with appropriate care, but certain injuries may require continued follow-up to make sure growth remains normal.
Pediatric Sports Injuries
Children and teenagers can experience many of the same sports injuries as adults, including sprains, strains, fractures, ligament injuries, tendon problems, and joint injuries.
However, growing athletes are also vulnerable to injuries involving growth plates and developing areas where tendons attach to bone.
Dr. Holden evaluates acute sports injuries as well as problems that develop gradually through repetitive training.
Read our guide to pediatric orthopedics and youth sports injuries.
Overuse & Growth-Related Sports Injuries
Not every sports injury happens during one collision or fall.
Repeated running, jumping, throwing, gymnastics, or other activity can place stress on growing bones and their attachment sites.
Examples of growth-related overuse conditions include Osgood-Schlatter disease at the knee, Sever's disease near the heel, Little League elbow, and certain stress injuries.
Treatment may involve temporary activity modification, rehabilitation, flexibility and strengthening work, and gradual return to sport.
The appropriate plan depends on the diagnosis and the child's stage of growth.
Sprains, Strains & Joint Injuries
Children can injure ligaments, muscles, tendons, and joints during sports, play, and everyday activities.
Symptoms may include pain, swelling, bruising, reduced motion, limping, or difficulty using an arm or leg normally.
Because growth plate injuries can sometimes resemble sprains, persistent pain after a childhood injury should not automatically be assumed to be a simple soft-tissue injury.
Knee Problems in Children & Teenagers
Knee pain is common in active children and adolescents.
Potential causes include overuse conditions, patellar instability, growth-related irritation, meniscus injuries, ligament injuries, fractures, and other problems.
The location of pain, how symptoms began, the child's age, and the activities that trigger symptoms can help determine the cause.
Hip Problems in Growing Children
Hip pain, limping, limited motion, or changes in walking can sometimes be associated with pediatric hip conditions.
In younger patients especially, hip problems may occasionally cause pain that is felt in the thigh or knee rather than directly at the hip.
Persistent limping or unexplained hip, thigh, or knee pain deserves evaluation.
Foot, Ankle & Leg Concerns
Children may be evaluated for fractures, ankle injuries, foot pain, alignment concerns, flat feet, intoeing, out-toeing, limb-length differences, and other problems involving the lower extremities.
Not every difference in foot shape or walking pattern requires treatment.
A pediatric orthopedic evaluation can help determine whether the finding represents a normal variation of growth, needs observation, or requires additional treatment.
Gait & Walking Concerns
Parents often notice changes in the way a child walks before the child reports pain.
Examples can include limping, intoeing, out-toeing, toe walking, uneven walking, or apparent differences between the legs.
Some walking patterns improve naturally with growth, while others may be associated with a structural, developmental, neurologic, or musculoskeletal condition.
Evaluation can help determine whether treatment or continued observation is appropriate.
Scoliosis & Spinal Alignment
Scoliosis is an abnormal sideways curvature of the spine that can develop during childhood or adolescence.
Small curves may simply require observation, while larger or progressive curves may require additional treatment.
Evaluation considers the size of the curve, the child's age, skeletal maturity, symptoms, and how much growth remains.
Treatment decisions are individualized rather than based on the presence of a curve alone.
Congenital & Developmental Orthopedic Conditions
Some orthopedic conditions are present at birth or become apparent as a child grows.
These may involve the hips, feet, legs, spine, limbs, or other parts of the musculoskeletal system.
Dr. Holden evaluates pediatric developmental and congenital orthopedic concerns and can determine whether the condition requires observation, nonsurgical treatment, additional testing, or surgical care.
When Should My Child See a Pediatric Orthopedic Specialist?
Not every bump, bruise, or temporary ache requires specialist care.
A pediatric orthopedic evaluation may be appropriate when your child has:
a suspected or confirmed fracture;
pain directly over a bone after an injury;
persistent joint or limb pain;
a growth plate injury;
ongoing swelling;
difficulty moving a joint;
trouble bearing weight;
a persistent limp;
repeated sports injuries;
unexplained changes in walking;
a visible orthopedic deformity;
or difficulty returning to normal activities after an injury.
Parents do not need to determine the diagnosis before scheduling an appointment.
If the problem involves your child's bones, joints, growth, movement, or musculoskeletal function, a pediatric orthopedic evaluation can help determine the appropriate next step.
When Does a Pediatric Injury Need Urgent Care?
Some injuries should be evaluated promptly rather than waiting for a routine appointment.
Seek urgent or emergency medical attention when there is:
an obvious bone or joint deformity;
an open wound associated with a suspected fracture;
loss of circulation or significant color change below an injury;
new numbness or significant weakness;
severe uncontrolled pain;
inability to bear weight after a significant injury;
or another serious injury requiring immediate medical attention.
Suspected concussion or significant head, neck, or spine injuries also require appropriate medical evaluation.
How Are Pediatric Orthopedic Problems Diagnosed?
Diagnosis begins with understanding what happened, how symptoms have changed, and how the problem is affecting your child's movement and activities.
Your child's age and stage of development are also important.
Physical Examination
Dr. Holden may evaluate the injured or affected area for tenderness, swelling, alignment, range of motion, strength, stability, and function.
Depending on the concern, she may also evaluate how your child walks, runs, stands, or moves a particular joint.
Comparing both sides of the body can provide useful information in growing children.
X-Rays
X-rays are commonly used when a fracture, growth plate injury, alignment problem, or other bone condition is suspected.
For some pediatric conditions, X-rays may need to be interpreted differently than adult images because children's bones are still developing.
Follow-up X-rays may also be recommended for selected fractures or growth-related conditions.
MRI & Other Imaging When Needed
MRI, ultrasound, CT, or other imaging may be used when additional information about ligaments, cartilage, tendons, growth plates, bone, or other structures is needed.
Advanced imaging is not necessary for every pediatric orthopedic problem.
The appropriate study depends on the suspected diagnosis and examination.
How Are Pediatric Orthopedic Conditions Treated?
Many pediatric orthopedic conditions can be treated without surgery.
Treatment is individualized based on the diagnosis, child's age, remaining growth, severity of the problem, and activity needs.
Observation & Activity Modification
Some developmental orthopedic findings improve naturally as a child grows and may only require monitoring.
Sports and overuse injuries may require temporary changes in training or activity while the affected tissue recovers.
The goal is to protect healing without unnecessarily restricting normal childhood activity.
Casting, Splinting & Bracing
Casts, splints, and braces can protect injured bones and joints while they heal.
The type of immobilization depends on the injury, location, stability, age of the child, and stage of recovery.
Follow-up is important because swelling changes and children continue to grow during treatment.
Physical Therapy & Rehabilitation
Physical therapy may be recommended to restore motion, strength, balance, coordination, and confidence after an injury or surgery.
For athletes, rehabilitation may also address sport-specific movement and a gradual return to activity.
Arthritis & Sports provides physical therapy at both our Sterling and South Riding locations, allowing orthopedic and rehabilitation care to be coordinated when therapy is appropriate.
Learn more about physical therapy at Arthritis & Sports.
When Is Surgery Needed?
Seeing a pediatric orthopedic surgeon does not mean your child will need surgery.
Many fractures, growth-related conditions, sports injuries, and developmental concerns can be managed nonsurgically.
Surgery may be recommended when an injury cannot heal in an acceptable position without stabilization, when a joint or ligament is significantly unstable, when a deformity requires correction, or when another pediatric orthopedic condition is unlikely to respond adequately to nonsurgical care.
The decision considers both the immediate problem and the child's future growth.
Pediatric Orthopedic Surgery
When surgery is needed, the procedure is selected specifically for the child's diagnosis, age, anatomy, and stage of skeletal development.
Depending on the condition, treatment may involve fracture fixation, correction of a structural problem, arthroscopic treatment, ligament or joint surgery, or another pediatric orthopedic procedure.
The goal is to address the condition while protecting healthy tissue and future growth whenever possible.
When Can My Child Return to Sports?
Return to play should be based on recovery rather than simply the number of days or weeks since an injury.
Before returning to unrestricted sports, a young athlete may need adequate healing, comfortable range of motion, strength, balance, and the ability to perform sport-specific movements without significant symptoms.
The requirements differ depending on whether the injury involved a fracture, growth plate, ligament, tendon, joint, or another structure.
Returning too early can place a healing area at risk.
Dr. Holden and the rehabilitation team can help determine when your child can safely progress from rest to practice and eventually back to competition.
Read more about caring for young athletes and returning to sports safely.
Meet Our Pediatric Orthopedic Surgeon
Candice P. Holden, MD
Candice P. Holden, MD, is a board-certified orthopaedic surgeon with fellowship training in pediatric orthopaedic surgery.
Dr. Holden has more than 20 years of experience providing nonsurgical and surgical care for infants, children, and adolescents with orthopedic injuries and conditions.
Her clinical experience includes pediatric fractures, sports injuries, growth plate problems, gait abnormalities, developmental and congenital orthopedic conditions, scoliosis, and other musculoskeletal concerns affecting growing patients.
Dr. Holden sees pediatric orthopedic patients at both our Sterling and South Riding, Virginia offices.
Pediatric Orthopaedics in Sterling & South Riding, Virginia
Arthritis & Sports provides pediatric orthopedic evaluation and treatment at our Sterling and South Riding locations.
Our practice serves families throughout Loudoun County and Northern Virginia, including Sterling, Ashburn, Leesburg, Reston, Herndon, Chantilly, South Riding, Aldie, and surrounding communities.
Sterling
Dr. Holden sees pediatric orthopedic patients at:
Arthritis & Sports Orthopaedics
21475 Ridgetop Circle
Suite 150
Sterling, VA 20166
South Riding
Dr. Holden also sees pediatric orthopedic patients at:
Arthritis & Sports Orthopaedics
25055 Riding Plaza
Suite 260
South Riding, VA 20152
Visit our South Riding location.
Frequently Asked Questions About Pediatric Orthopaedics
What ages does a pediatric orthopedic surgeon treat?
Pediatric orthopedic care is designed for growing patients, including infants, children, adolescents, and teenagers. The specific age at which a patient transitions to adult orthopedic care may depend on the condition and whether skeletal growth is complete.
Does seeing a pediatric orthopedic surgeon mean my child needs surgery?
No. Pediatric orthopedic surgeons provide both nonsurgical and surgical treatment. Many childhood fractures, sports injuries, growth-related problems, and developmental conditions are treated with observation, activity modification, casting, splinting, bracing, or physical therapy.
What is a growth plate injury?
A growth plate injury affects an area of developing tissue near the end of a child's bone. Because growth plates contribute to bone growth, certain injuries require careful diagnosis and follow-up. Most heal successfully with appropriate treatment.
Can a child's sprain actually be a growth plate injury?
Yes. Because growth plates are still developing, some injuries that might affect a ligament in an adult can involve a growth plate in a child. Persistent pain over a bone, swelling, difficulty bearing weight, or symptoms that are not improving may warrant further evaluation.
When should I worry about my child's limp?
A temporary limp may occur after a minor injury, but persistent limping, unexplained limping, inability to bear weight, significant pain, fever, or worsening symptoms should be evaluated. A limp can originate from the foot, ankle, knee, hip, or another condition and does not always indicate where the underlying problem is located.
Should my child play through sports pain?
Children should not be encouraged to simply play through persistent or worsening pain. Temporary muscle soreness can occur after activity, but pain that alters movement, causes limping, persists during or after activity, or repeatedly returns deserves evaluation.
How do I know when my child can return to sports?
Return to sports depends on the diagnosis and recovery. A young athlete should generally demonstrate adequate healing, motion, strength, function, and sport-specific ability rather than returning solely because a predetermined amount of time has passed.
Schedule a Pediatric Orthopedic Appointment
If your child has a fracture, sports injury, persistent joint pain, growth-related concern, limp, or another orthopedic problem, an evaluation can help determine what is happening and whether treatment is necessary.
Dr. Candice Holden provides specialized pediatric orthopedic care for infants, children, and adolescents at our Sterling and South Riding locations.
