The Carrell Clinic prides itself on having one of the best pediatric orthopedic physicians in the country. Dr. Sackett and his team are focused on the care of musculoskeletal problems with children and adolescents. Dr. Sackett is committed to providing the special needs of children and adolescents.
Pediatric orthopedics is a specialty that deals with the evaluation and management of musculoskeletal problems including the growing bones, joints, or muscles in children (newborns to teenagers). Pediatric orthopedic doctors focus their medical practice on the care of children and are trained in special skills in pediatric orthopedics as an additional subspecialty.
Musculoskeletal problems and their evaluation/treatment in children differ from those of an adult. In children, musculoskeletal problems arise due to growth which does not occur in adults. The complex musculoskeletal disorders in children are best treated by a medical-surgical approach by a pediatric orthopedic doctor.
Some of the common conditions treated by pediatric orthopedic doctors include,
- Deformities of the limb and spine, present at birth or later, such as limb length discrepancy, scoliosis, and club foot
- Abnormalities in gait/limping
- Infections or tumors in the bone or joint
Depending on your child’s condition, Pediatric orthopedists provide appropriate non-surgical or surgical treatments to address the problems. They are specialists trained in managing your child’s anxiety and discomfort.
The number of children participating in sports activities has been increasing over the recent years resulting in a substantial rise in the incidences of sports injuries. Even though there are several benefits of active participation in sports, including building up of self-confidence, physical fitness, and learning to work in a team, there is also a risk of sports-related injuries.
Treatment of Pediatric Forearm Fractures
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.
The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.
Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin, or “closed” where the broken bone does not pierce the skin.
The common types of fractures in children include:
- A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
- One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
- Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
- Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
- Fractured ulna and dislocated head of the radius (Monteggia fracture)
- Fracture occurring at or across the growth plate (Growth plate fracture)
Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).
A fractured forearm causes severe pain and numbness. Other signs and symptoms include:
- Inability to turn or rotate the forearm
- Deformed forearm, wrist or elbow
- Bruising or discoloration of the skin
- Popping or snapping sound during the injury
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.
Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.
Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or a metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.
In the long run, the forearm of your child may have a slightly different or crooked look than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten while the bones undergo the process of remodeling (reshaping). For growth plate fractures, your child’s doctor will carefully monitor the hand for many years to ensure that growth occurs normally.
Treatment of Pediatric Thighbone (Femur) Fracture
The femur or thighbone is the largest and strongest bone in the human body. Pediatric thighbone fractures can occur from hard falls on the ground, during sports, automobile accidents, or from child abuse. In a thighbone fracture, the broken bones may be aligned or displaced. The fracture can either be closed (with skin intact) or open (with the bone piercing out through the skin). Your child may experience severe pain, swelling, inability to stand and walk, and limited range of motion of hip or knee.
Your child’s doctor will conduct a physical examination. An X-ray or CT-scan may be recommended to locate the position and number of fractures, and determine if the growth plate is damaged. Femur fractures may be treated with non-surgical or surgical methods.
Non-surgical treatment involves stabilizing the bones so they can heal and fuse together. Braces, spica casting (cast applied from the chest, down the fractured leg) or traction (placing the leg in a weight system) may be used to ensure that the bones are properly set in their normal position.
Surgery is recommended for complicated injuries. Your child’s surgeon aligns the broken bones and uses metal plates and screws to hold the fractured bones together in proper alignment. Your child may have to wear a cast for a few weeks until complete healing. An external fixator may be used in case of open injury to the skin and muscles.
Treatment of Growth Plate Fracture
Growth plates are areas of soft, cartilaginous tissues present at the end of long bones in growing children. These cartilage tissues or soft bones later harden to become solid bones in adulthood once growing has completed. A fracture of these bones is termed a growth plate fracture. This type of fracture is most often caused from a fall or severe blow to the limb during sports activities such as football, basketball and gymnastics or from vehicular accidents.
Growth plate fractures may show symptoms such as:
- Difficulty in moving your limb in the affected area
- Pain and tenderness of the affected bone
- Difficulty in carrying heavy weight or putting pressure on the affected limb
- Swelling and warmth near the joint
Your doctor can diagnose growth plate fractures with the help of imaging tests such as X-rays, CT scan and MRI. They may order images of both the limbs for comparison between the normal and injured limb.
Treatment for growth plate fractures depends on the severity of the fracture. Mild fractures can be treated with the help of immobilization with a cast. If the fracture is severe and has affected the underlying bone, surgery may be required to realign the bone.
Treatment of Elbow Fractures in Children
The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone). An elbow fracture most commonly occurs when your child falls on an outstretched arm. It can lead to severe pain in the elbow and numbness in the hand. Fractures are more common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows.
Your child’s doctor first evaluates your child’s arm for signs of damage to blood vessels and nerves. An X-ray examination is then ordered to confirm and determine the severity of the fracture. Treatment of elbow fractures depends on the degree of displacement and type of fracture:
- Nonsurgical treatment: If there is little or no displacement from the normal position, nonsurgical treatment is recommended. Your child’s doctor may immobilize the arm using a cast for 3 to 5 weeks. Regular X-rays are ordered to check if the bones are properly aligned.
- Surgical treatment: Surgery may be recommended if the fracture has caused the bones to move out of alignment. Your child’s doctor brings the bones in correct alignment and may use metal pins, screws and wires to hold the bones in place. Your child will have to wear a cast for a few weeks. Exercises to improve the range of motion will be instructed after a month of healing.