FAQ Category: Child

Orthopedic surgeons are specialists in repairing bones, as you already know. However, depending on the types of patients they see, their expertise within orthopedics varies. The problems that children may encounter are different than that of adults. For example, children still have growing bones, so this must be taken into account when a doctor is operating on the bone.

For younger children, the equipment a surgeon may use may be a different size and approaches to the surgical area may be different. By staying within their realm of expertise, the surgeons give their patients a better chance at a successful surgical outcome.

Hair is amazingly strong – try taking a strand of your hair and snapping it in half. Unless you have very brittle or fragile hair, you’ll likely find this a difficult thing to do.

When babies are young, they have a surprising high exposure to loose hair. It’s not unusual for a new mom to lose significant amounts of hair during the post-partum period and the longer the hair, the higher the risk of getting wrapped around a baby’s delicate toe. And, perhaps surprisingly, sometimes the hair that wraps around is from the baby itself, not a parent or someone else.

First, your grandson’s doctor is correct when he says that a broken collarbone, or clavicle, is fairly common among children. The bone hasn’t firmed up completely yet and doesn’t usually until children are in their late teens.

Regarding the bump, while it can’t be said for certainty because your grandson’s bump can’t be seen, the doctor – again – is likely correct. Very often, while the fractured bone is healing, there is a bump. This bump may hang in for quite a while after the fracture has officially healed. If this is what the bump is, there isn’t a cause for alarm.

Collarbones important bones that help support the arms. They can be broken either by a direct hit to the bone or through an indirect one. In your daughter’s case, it sounds like an indirect break. When she put out her hand to stop the fall, the force of the contact between her hand and the ground had an impact on the bones in her arm and went up towards the collarbone.

The collarbone, the clavicle, is one of the easiest bones to break because of its role and its location. While it is possible to break it by a direct hit, it also can be broken by a transfer of shock. This means, if you fall hard on your shoulder or on an outstretched hand, the shock of the impact could travel along to the collarbone, breaking it.

To be blunt, you are right. Three-point restraint seat belts, with the chest straps are made that way for a reason and if you remove the chest strap, you don’t get the protection they provide.

Lap belts were good protection when they were all we had, but research has evolved and it’s been found that although lap belts do save lives they may also cause serious injury to the spine and internal organs in high speed accidents. If your car is in a collision and only your lap belt is on, your body will fold itself in half at a great force. You could end up with a Chance fracture of the spine, facial injuries from striking whatever is in front, and serious damage to the organs in your abdomen. In essence, when you remove the chest strap, you are turning your seatbelt into a lap belt.

For children, wearing seat belts – properly – should be a non-negotiable family rule.

As much as we try to protect our babies, sometimes trouble finds them, even in their bed. It is true that strong, unbreakable threads should not be used in children’s blankets and quilts, precisely because they could come unravelled and then get wrapped around a baby’s tiny finger or toe.

If the thread tightens, it can begin to cut of circulation to the toe, causing pain, redness and swelling. While there are some cases of damage being so severe that a digit may need to be amputated, as a rule this is avoided by quick action. By bringing the baby to an emergency room or urgent care clinic, the doctors or nurses have various tools at their disposal that can help them get underneath the thread to cut it off. In extreme cases where they can’t do so, the child could have minor surgery, allowing the doctor to make an incision into the toe to get at the thread

The patellar bone doesn’t come fully developed at birth — it is either two or three peices that eventually ossify (harden into bone). By age six, most children have the pieces necessary to form a single, hard patellar bone. Between ages six and 12, all the pieces join together and fuse into one bone that forms the adult patella.

But in about two to six per cent of children (boys more often than girls), fusion doesn’t take place. The patella may remain in two pieces called bipartite patella or three pieces called tripartite patella. The patella remains that way into adulthood. Most of the time, the person isn’t even aware that there’s a problem.

It’s only if the knee is injured and an X-ray is taken or (more rarely) the knee becomes painful slowly over time that the diagnosis is made. It sounds like the skiing injury brought this to your attention. There’s still some debate whether the bipartite condition is really just a failure of the growing bone fragments to form solid bone or if injury somewhere along the line caused a fracture that hasn’t healed.

Either way, the question of what can be done is important. Current guidelines for the management of this problem begin with a recommendation for conservative care first (for at least six months). Treatment begins with rest, the use of nonsteroidal antiinflammatory drugs (NSAIDs), and physical therapy. The therapist prescribes stretching exercises, a dynamic patellar brace, and possibly low-intensity pulsed ultrasound to stimulate a healing response. Steroid injections administered by the physician may also be helpful.

If there’s no response to treatment or an inadequate response (i.e., patient still can’t participate in sports or tolerate daily activities), then surgery is the next step. There is a wide range of surgical options to choose from.

If the surface of the patella is scarred and irregular and the bone is in pieces that move, the surgeon removes the moveable fragments. This can be done with arthroscopic surgery but in some cases, an open-incision procedure may be needed.

Anyone with this condition who has a healthy surface and the patellar pieces are stable (not moving) may be treated differently. Small fragments can be removed. Or instead of taking the extra bone out, the soft tissues still attached to the fragment can be cut to release the pull on the patellar piece. There are different ways to do this — each one has some disadvantages (e.g., muscle weakness, muscle imbalance, abnormal patellar tracking up and down).

Larger pieces can be wired back in place but there’s always the risk of stiffness from the long period of immobilization needed to foster healing. Fortunately, not very many people end up needing surgery for this problem. When they do, the results are usually pretty good.

The key to a successful outcome is to choose the right treatment for each patient individually. The goal of treatment is to provide pain relief, return to full activity (including sports participation for athletes), and protection of the remaining knee cap.

Knee injuries involving the meniscus (cartilage) are well-known in adults, especially athletes. But meniscal tears in children are becoming almost as common. Increased sports participation among young children and young adolescents is the main reason for the increased prevalence of this problem. Treatment in children parallels treatment for adults but with a few differences.

For one thing, growing children who have not reached skeletal maturity have a greater blood supply to the knee and its cartilage compared with adults. And the soft tissues in question (menisci) are young, not yet showing degenerative changes as seen in older adults. So the chances of self-healing and recovery are much greater in children and teens. In fact, sometimes treatment is just a hands-off policy of rest and activity modification.

But if symptoms have persisted this long (two years), it’s likely that some other approach is needed. Imaging studies such as X-rays and MRI scans are useful to look for fractures, dislocation, loose fragments of bone or cartilage, and bleeding into the joint. MRIs are less reliable in children under the age of 12 because of the immature bone and soft tissues. What looks like a meniscal tear may just be the extra blood supply to the area normally present in a growing child.

When necessary, the meniscus is sewn back in place. Surgical removal of the meniscus called a meniscectomy may be needed if the meniscus just can’t be saved. Surgeons avoid removing any part of the meniscus as much as possible because studies show that the loss of the meniscus results in continued pain and early arthritic changes even in children. Exactly what is done in surgery will depend on the location, size, and type of injury. The surgeon will look for any other areas of damage, especially among the knee ligaments and repair or reconstruct them at the same time. Recovery and a successful result depend on this.

In some children, there is a change in the normal shape of the meniscus, which may require a slightly different surgical approach. Instead of a C- or crescent-shaped piece of cartilage, the meniscus is more block-shaped and thicker with a disorganized array of fibers. This abnormality is called a discoid meniscus. In fact, the presence of a discoid meniscus is a second reason (besides increased sports participation) why meniscal injuries are on the rise in active children. When surgery is needed, the meniscus is reshaped and smoothed down, a procedure called saucerization. The goal is to create a stable, yet functional, meniscus.

Your daughter’s surgeon will be able to advise you on the best management for her particular anatomy, injury, and activity level. The presence of a discoid meniscus is just one of many additional factors that must be taken into consideration. If surgery is required, expect a six to eight week recovery period with physical therapy and rehab. Full return-to-sports may take an extra couple of months in order to ensure strength and stability needed for twists, turns, and quick changes in direction required by many sports activities.

The type of leg fracture you are describing is called a pediatric dipahyseal femur fractures. Pediatric, of course, refers to children who are still growing. Diaphyseal tells us it’s the shaft of a long bone and femur is the anatomical term for thigh bone.

Even in the United States, children who suffer this type of fracture don’t always have a specialized children’s hospital to go to for the latest in care. Orthopedic surgeons around the country treating pediatric diaphyseal femur fractures aren’t always pediatric specialists or if they are, they don’t see 100s of these cases each year. So, even here, there can be wide ranges in the treatment approach for the same problem depending on where the treatment is administered and by whom.

In order to help all orthopedic surgeons follow the best evidence in treating these traumatic injuries, the American Academy of Orthopaedic Surgeons (AAOS) has published this list of 14 clinical practice guidelines. They are specific to children from infancy to skeletal maturity who have broken the shaft of the femur.

A group of 16 pediatric experts from around the country worked together to review all published studies from 1996 through 2008 just dealing with the treatment of diaphyseal femur fractures in children. In the course of reviewing treatment results and recommendations, they noticed a trend over the past 10 years. Treatment seems to have shifted away from conservative (nonoperative) care more toward surgical intervention to stabilize the leg.

Nonsurgical options include Pavlik harness for infants, and traction or casting in a waist-high cast called a hip spica cast for all other ages. Surgery can include placing a nail (long metal rod) down through the bone, and/or special submuscular plating. Different types of nails can be used. Some are rigid, others are more flexible. Pain management may be required no matter what type of treatment is used.

The specific treatment plan selected depends on many factors such as the child’s age, type of fracture (severity, location, displaced versus nondisplaced), and the family’s social and economic situation. One other thing to consider in your situation is the need for follow-up during the months of healing and recovery. Repeated X-rays will be needed to check the progress of the fracture. It’s important to watch for any shifts in the fracture site that could result in a shortening or lengthening of the bone and eventual leg length difference.

Once you visit with the local hospital staff and see the X-rays, the decision about specific treatment and location of treatment may become much clearer. If your child needs extended hospitalization for traction or a spica cast, it might change how you decide what’s best. Caring for a nine-year-old in a spica cast has some additional challenges you’ll want to consider.

Treating diaphyseal femur fractures with a special harness called a Pavlik harness is an option for infants up to age six months. Diaphyseal femur fracture refers to a break in the long shaft of the thigh bone. The harness holds the hips and knees in a bent and separated position until healing takes place. This can take five to six weeks.

Studies are limited in comparing treatment for this problem but it does appear that results are better the younger the child is (up to three and a half months old). The use of a waist-high spica cast is the other option. There can be some problems from the cast rubbing on the leg but it does hold the very active child still. Comparing outcomes between the Pavlik harness and the spica cast shows similar results.

So you may really be looking at what would work best for your child’s size, severity of fracture, your living situation, and your stress level. Each treatment option comes with pros and cons. Since your pediatrician knows your child well, you may want to go over the various issues, factors, and potential complications of the various treatment options before making the final decision. Whichever route you choose, follow-up X-rays will be taken. Should there be any change in the status of the fracture site, treatment can be changed.

Without looking at the boy’s medical records and history, it would be dangerous to guess as to what is happening, but from what you write, it is possible that the boy has an infection called community-acquired Methicillin-resistant Staphylococcus aureus, or CA-MRSA. MRSA has been around for a while but used to be only in hospital settings, but now it can be found in the community. Doctors differentiate the two by saying they are community-acquired or hospital-aquired. The infections caused by MRSA are very serious.

Children with CA-MRSA infections can get them through a relatively small cut or scrape, frequently during a sports event. The problem with an infection like this is that usually, we take care of minor cuts and scrapes by cleaning and dressing. Watching for infection (redness, swelling, and warmth) is important but even if infections set it, we’re used to them being dealt with fairly quickly. Unfortunately though, if MRSA sets in, parents have no way of knowing right away if the infection is severe or not and the child may not get medical help quickly enough. The infection may also be missed by the doctors, who aren’t expecting to find it. As a result, the infection could spread quickly and result in damage to the bone or muscles.

Broken collarbones, or clavicles may be treated with or without surgery, depending on the type of break, the severity and where the break is. Sometimes the child’s age is also a deciding factor.

Research has shown that as children get older, pre-teens and teens, their collarbones are no longer growing as rapidly as they did when they were younger. Therefore, more studies are showing that surgery may be the best option in their case. However, this depends, not only on the fracture itself as mentioned previously, but on the patient and the parents’ wishes.

There have been study findings that have shown that surgery may be better for repairing certain types of broken collarbones, increasing the likelihood of the bone ends joining properly and the patient regaining full use of the arm.

Broken arms are quite common among children. Statistics show that between 10 to 25 percent of children break at least one bone and, most often, it’s in the upper extremity, meaning the arm, the hand, and so on.

Whether surgery is done depends on many factors, including the severity of the break, where the break is, the history of success that the break has with healing on its own, any other damage in the arm to the surrounding tissue, and the doctor’s experience and preference.

While it may seem that two people have the same type of arm fracture, inside, there could be a significant difference. This difference would require a different approach.

Surgery has risks and is generally avoided as much as possible. If a treatment can be done without surgery, it really is. Some risks associated with surgery for a broken bone include damage to the tissue around the broken bone, blood loss, and infection. In your grand-daughter’s case, her doctor likely felt that she had a good chance of healing properly without surgery, so he or she took that approach. The fact that she had to have a re-adjustment to the break may not have had anything to do with the original treatment. In fact, studies seem to show that there isn’t a big difference between people who had to have a second procedure and whether they had surgery initially or not.

It used to be thought that children couldn’t have lower back pain without there being a serious problem causing it. Adults, on the other hand, often know what it’s like to have a sore back and not know what exactly they did to make it hurt.

Over the years, we have learned that children can have non-specific lower back pain – pain that isn’t caused by a specific problem. The diagnosis of non-specific lower back pain is considered a diagnosis of exclusion, one that the doctor comes to when the testing doesn’t turn up something specific. One thing to remember is just because the doctor can’t find a specific cause, doesn’t mean that your son isn’t having back pain.

Some things to watch out for are your son’s activity level, what does he do and what is his posture like when he does it? Is your son a good weight? Is he depressed or anxious? Is he having any other problems besides back pain? Researches have found that children who are having problems, such as depression, do tend to have more back pain than other children.

Back pain is very common among adults. Many of them go to the doctor and the doctor can’t find anything specific – no slipped disc, no breaks, nothing obvious. But, the back still hurts and it still interferes with every day life. While back pain is not as common among children as in adults, it can have the same properties – the doctor may not be able to find out what is causing it. This is called non-specific back pain. This doesn’t mean that your grandson doesn’t have back pain. It just means that the doctor can’t find a cause for it.

Although rickets, which is what it sounds like your brother had, and Blount’s disease both cause bowed legs, they are caused by two different things. Rickets is caused by a vitamin deficiency, which results in softening of the bones. With a proper diet, it’s possible to strengthen the bones and prevent further bowing.

With Blount’s disease, the bowing is caused by something different. The shin bone, directly below the knee cap, doesn’t develop properly, so the knee cap can’t work properly. As a result, the child’s legs begin to bow. The only way to reverse this is with bracing, if it’s not too far along, the wires that you mention, and sometimes surgery on the bone itself.

Blount’s disease, a bone disorder that causes bowing of the legs, is not a common disease. There are some risk factors that have been identified and if you take them all into account, it is possible for more than one child in a family develop Blount’s disease. In fact, family history is a risk factor in itself. The risk factors include:

Being a girl
Being African American
Being oveweight for the child’s age
Walking earlier than expected
Family history

It is not unusual for parents of children with either chronic diseases or chronic pain to have difficulties themselves. As parents, we want to protect our children and we feel that we should. When our children hurt, we hurt, and sometimes our reactions may not seem logical.

Although not a lot of studies have been done, it has been found that children who have chronic pain or illness may have more difficulty down the road if their parents are having difficulties of their own. So, it could be in your best interest as a family, to find a way to cope. This could be by talking to your daughter’s health care team or even seeing a counselor or family therapist to try to organize your thoughts and feelings.

It’s not unusual to feel out of sorts, but it helps if you try to get it all settled as much as possible.