Pediatric Orthopedics

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 Conditions

Pediatric Scoliosis

Scoliosis is a condition characterized by an abnormal curvature of the spine in the appearance of an “S” or “C”. It can occur at any age and is seen more frequently in girls than boys. Some of the types of scoliosis include:

  • Idiopathic scoliosis: Most common type that develops between 10 to 15 years of age, where the cause is uncertain
  • Congenital scoliosis: Rare form present at birth as a result of developmental problems
  • Neuromuscular scoliosis: Associated with muscular and nervous abnormalities such as spina bifida, muscular dystrophy or cerebral palsy

Scoliosis does not cause any pain, but affects your child’s overall appearance. The main symptoms of scoliosis include uneven shoulders and waist, leg length discrepancy, constant leaning to one side, prominent shoulder blades and elevated hips.

To diagnose scoliosis, the doctor reviews your child’s medical history and performs a thorough physical examination, which includes the Adam’s forward bend test to check for deformity. The diagnosis is then confirmed by measuring the curve with the help of an X-ray of the spine.

The treatment of scoliosis is important because if left untreated, the curves may cause long term problems such as decrease in lung capacity, leading to restrictive lung disease. The kind of treatment needed depends on the degree of the scoliotic curve, your child’s age and the time remaining for your child to reach skeletal maturity. Treatment may include:

  • Nonsurgical treatment
    • Observation: If there is only a mild curve or if your child is nearing skeletal maturity, regular check-ups every 3-6 months are recommended.
    • Bracing: Bracing is done to prevent the progression of scoliotic curves. It is effective in growing children with a spinal curvature between 25° and 45°.
  • Surgical Treatment
    • Surgical treatment is recommended in case of curves greater than 45° and in those who have reached skeletal maturity with curves that exceed 50° to 55°.

Pediatric Sports-Related injuries

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. The risk of having an injury increases by a lack of protective gear especially during sports activities such as boxing, wrestling and hockey.

Childhood sports injuries are injuries may either be accidental injuries or develop as a result of inadequate training or practice. The most common sports injuries in children are soft-tissue injuries and head injury.

Some of the common sports injuries in children include:

  • Sprains and Strains: A strain refers to the stretching or tear of a muscle or tendon (tissue that connects muscles to bone) while a sprain refers to the stretching or tear of a ligament (tissue that connect adjacent bones).
  • Growth plate injuries: Growth plate injuries result from a damage to the area at the end of the long bones (growth plate), of a growing child.
  • Repetitive Motion Injuries: Repetitive motion injuries are caused by overuse of the tendons and muscles. It includes stress fractures and tendinitis (inflammation of the tendon). These injuries cause severe pain and discomfort.
  • Heat-Related Illnesses: Heat-related illnesses include dehydration (loss of body fluids), heat exhaustion and heat stroke (characterized by hot dry skin, headache, and dizziness leading to vascular collapse, coma, and death).

Causes of sports injuries

The causes of sports injuries in children include:

  • Slow reaction time: The slower reaction time in growing children makes them susceptible to sports related injuries
  • Poor training or practice
  • Lack of adequate protection gear such as mouth guards, headgears for respective sports
  • Insufficient stretching or warm-up exercises before playing

Types

The sports injuries in children can be acute injuries or overuse injuries.

Acute injuries: Young children may develop minor bruises, sprains and strains. Teenagers are likely to sustain more severe injuries such as broken bones and ligament tear. Acute injuries most commonly occur due to a lack of proper protective equipment during sports activities.

Overuse injuries: These injuries occur because of continuous stress on the bones and muscles from repetitive movements of a particular joint. The most common types of overuse injuries are:

  • Anterior knee pain: It refers to pain in the front of the knee, below the kneecap associated with swelling because of inflammation of the tendon or cartilage.
  • Little League elbow: It causes pain in the elbow because of repeated throwing action and may be associated with a difficulty in extending the arm.
  • Swimmer’s shoulder: It causes pain and swelling of the shoulder because of stress from repetitive movements of the shoulder during activities such as swimming or throw ball.
  • Shin splints: It leads to pain and discomfort in the front of the legs due to continuous running or overtraining.
  • Spondylolysis: This condition is characterized by chronic low back pain due to repeated stretching of the back muscles and is common in children who engage in sports such as football, weightlifting, gymnastics and wrestling.

Risk factors

The factors associated with an increased risk of sustaining a sports injury, in children, include:

  • Growth spurt phase (period of rapid growth during adolescence): During this period, the elasticity of the bone is reduced due to rapid bone growth, which predisposes the bone to injury
  • Improper use or lack of protective equipment’s and unfavorable environmental conditions increase the risk of injury
  • Poor nutrition: Lack of a healthy diet predisposes a child to injury

Treatment

Treatment for sports injuries depends on the nature of injury. The most common treatment recommended for sports-related injury is rest, ice, compression and elevation (RICE). H

  • Rest: Avoid activities that may cause injury.
  • Ice: Ice packs can be applied to the injured area which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Compression: Compression of the injured area helps to reduce swelling. Elastic wraps, air casts, and splints can accomplish this.
  • Elevation: Elevate the injured part above heart level to reduce swelling and pain.

Prevention

Some of the measures that are to be followed to prevent sports related injuries include:

  • Follow an exercise program to strengthen the muscles
  • Gradually increase your exercise level and avoid overdoing the exercise
  • Ensure that you wear properly-fitted protective gear such as elbow guards, eye gear, facemasks, mouth guards, and pads, comfortable clothes, and athletic shoes before playing any sports activity which will help to reduce the chances of injury
  • Make sure that you follow warm up and cool down exercises before and after sports activity. Exercises will help to stretch the muscles, increase flexibility, and reduce soft tissue injuries
  • Avoid exercising immediately after eating a large meal
  • Maintain a healthy diet which will nourish the muscles
  • Avoid playing when you are injured or tired. Take a break for some time after playing.
  • Learn all the rules of the game you are participating in
  • Ensure that you are physically fit to play the sport

Pediatric Orthopedics Treatment Options

Fracture Treatment

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:

  • Swelling
  • Tenderness
  • 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.

Pediatric Orthopedics Videos

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
  • Fractures
  • 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.