FAQ Category: Child

Complex fractures with multiple fragments often require external fixation. You didn’t mention whether it was the femur (thigh bone) or tibia (lower leg bone).

Either one can have a long, spiral fracture of the diaphysis (shaft). This can require pins to hold it in place while healing takes place. External fixation also allows for earlier weight bearing. And there are fewer problems with the bone fragments moving or dislocating. A short fracture line might not need plates, pins, or screws to hold it in place. Intramedullary nailing is another name for this type of treatment.

When fractures can be realigned without an incision, the procedure is called a closed reduction. When the leg must be opened to give the surgeon a direct view of what’s going on, then it’s called an open reduction. Sometimes fractures of the long bones can be treated with a tiny incision. The procedure is referred to as minimally invasive.

It’s not too late to request more information about your daughter’s fracture. If she is still in the hospital, ask the nurse in charge to explain what was done and why. Or request this information at your next follow-up visit with the surgeon.

Fluoroscopy is a fairly new imaging technique. It is used by physicians to get real-time images of the internal structures of a patient.

The fluoroscope used has an x-ray source and fluorescent screen. The patient is placed between these two parts of the device. Images are sent via a video camera to a monitor where the surgeon can see them in full view.

Fluoroscopy is a form of x-rays, which involve ionizing radiation. It’s this ionizing radiation that has potential risks. Knowing this, the surgeon only uses this device when the benefits of the procedure outweigh the possible negative effects.

Physicians and surgeons who use fluoroscopy always try to use the lowest dose rates possible. Besides exposure to the patient, there is also exposure to the surgeon and staff. And they are exposed for each patient treated.

Improved technology has made it possible to digitize images and reduce the radiation dose even more. For procedures to repair lower leg bone fractures, the average length of time children are exposed to radiation is between 42 and 70 seconds. In some cases, the total time may be as much as two minutes.

Cerebral palsy is a neurologic disorder that can be present at birth or develop as a result of a birth injury. Hemiplegia refers to the fact that only one side of the body is affected.

The foot position you describe may be referred to as a clubfoot. Clubfoot describes a curved position of the foot with toes pointed down. At the same time, there is a second condition called pes cavus. Pes refers to the foot and cavus describes a very high arch.

Surgery to correct these types of problems may be needed when pain, pressure ulcers, and loss of foot contact with the floor occur. A good result after surgery and recovery would be at least 75 per cent of the bottom of the foot making contact with the floor when in the standing position. There should be no pain and no abnormal areas of pressure.

After the operation, your son may need a special (adapted) or customized shoe. The goal is to provide pain free motion needed to walk and play. Additional surgery may be needed later if structural changes occur as a result of growth.

Spondylolysis is an undisplaced fracture of the pars interarticularis. The pars is a part of the back half of the vertebra. It provides structural support for the vertebral arch. The arch forms around the spinal canal to protect the spinal cord.

Some children are predisposed to spondylolysis. This means there is a structural anomaly or deformity already present at birth that can lead to spondylolysis. Under the right conditions, the inherited defect of the pars is at increased risk for fracture.

Repetitive trauma or hyperextension of the spine puts children at risk for this type of damage. Football, wrestling, gymnastics, and tennis athletes are at the greatest risk for spondylolysis.

Too much training for too long and poor technique combined together stretch young children beyond their strength and physical capacity. Jump landings, spinal twisting, and heavy lifting place large amounts of pressure and stress on the bone. The end result is a fracture of this type.

Spondylolysis is a stress fracture of the spine. In particular, the pars interarticularis has a fracture line. The pars is located on the posterior portion of the vertebral bone.

With spondylolysis, the fracture is undisplaced. In other words, the bone still lines up on either side of the fracture. The lumbar spine is affected most often, especially at the L4 or L5 level.

Treatment is conservative at first. Rest and reduction of activity levels are advised until the pain goes away. This time period varies from patient to patient. It depends (in part) on how well the child follows the doctor’s recommendations.

If the symptoms are not improved, then a back brace may be ordered. The brace helps decrease muscle spasms and stabilizes the spine. It usually takes six to eight weeks for bone to heal in this age group. Once the symptoms have resolved, then a physical therapy program is often started.

Strengthening of the abdominal, trunk, and back muscles is needed to prevent this problem from recurring. From start to finish, expect at least 10 to 12 weeks from the time of diagnosis until normal resumption of activities. If a back brace is prescribed, it must be worn a minimum of three months before rehab begins. It may take another six months to gradually wean from wearing the brace. In a small number of cases, surgery may be needed.

Although treatment for knee injuries is greatly dependent on each individual case, many knee injuries are treated conservatively, without surgery. If the knee would not be made worse by physical therapy and exercise, it is likely the doctor will recommend that first before considering surgery.

By strengthening the quadriceps and calf muscles, the muscles above and below the knee, it is possible to keep the legs strong enough to allow the knee to heal, or to reduce the strain on the knee.

Clubfoot is a deformity that is usually corrected with casting and bracing, although surgery may be needed to release the Achilles tendon. Usually, doctors assess how the foot is progressing by how it looks and how well the foot moves and the angles it can and cannot make.

Currently, there is a movement to use ultrasound to monitor the progress of clubfoot during treatment. This would allow doctors to see the bones and their progress, detecting any problems before they have gone on too long.

Depending on the severity of the clubfoot, if you don’t correct it, this could affect a person’s mobility and safety. If the foot is significantly turned inwards, the child will not be able to bear weight on the foot properly, affecting walking. If the curve isn’t too bad and the child does manage to learn how to walk, he or she is at risk of fracturing (breaking) the leg because the side of the foot was not meant to bear the full weight of the body.

This type of question is best answered by your son’s surgeon because it addresses his type of fracture, his bone health, the type of plate used, and any complications that may occur.

In general, however, plates that are inserted to help a bone knit together, to heal, do not need to be removed, although some surgeons do choose to do so.

Finger injuries are very common in children, particularly the finger tips. Many times, as with your nephew, if the injury doesn’t appear to be severe, it isn’t treated but it can develop into an issue that needs to be addressed later on.

At this point, your nephew, if he has not already done so, should see a doctor to have his finger evaluated. Depending on what the injury may be, your nephew’s finger might be corrected through splinting or surgery.

It is important, as you know, that the splint stay on for as long as it is supposed to in order for the finger to heal. First, if you haven’t already, have the splint evaluated by the doctor or the healthcare professional who applied it to be sure it is the correct fitting.

If the splint is correct, try speaking with the doctors or nurses to see what tricks they may know for keeping the splint on.

If the splint doesn’t stay on, your daughter may have to have surgery eventually to fix any remaining deformity.

A Chiari malformation is an abnormality in the brain, in the area of the cerebellum. This is the part of the brain that controls balance. There can be a build up of fluid as the pressure blocks the flow of cerebrospinal fluid. This can cause problems with balance, headaches, vision problems, and other neurological problems.

If your daughter’s doctor had to look for the abnormality, chances are it is what is called Chiari 1 malformation; there are three types, with 1 being the mildest and 3 the most severe.

Deciding whether to allow your daughter to have surgery on her spine can be a difficult one. It is a decision that you can only make with your family and your daughter’s doctor, however.

In order to make things clearer in your mind regarding the necessity of the surgery, you can ask the surgeon several questions. They include:

The type of cast you are referring to is called a hip spica cast. It does indeed keep the child from bending at the waist or hip. The involved leg will have a cast down to the toes as well. The other hip will be casted but the knee on that side will be left free to bend.

A special opening or window is left in the spica cast to allow for bowel and bladder functions. An absorbent pad is placed under the edges of the cast for toileting. Many parents use disposable diapers for this task. For larger children, adult Depends can be adapted or cut down to size.

It is important to keep the cast from getting wet with urine or soiled with feces. The pads must be checked and changed often. If your child has full bowel and bladder control, then a bedpan and urinal can be used at the appropriate time.

Many parents adapt a child’s wagon to use for TV watching, transportation, and eating. Although there’s no bend at the waist, the child can be propped up with pillows well enough to eat and drink.

The nursing staff will give you precautions and tips for keeping your son’s skin safe. There are some problems that can be caused by the cast if it is too tight or ill fitting. Any complaints or signs of irritability must be checked carefully to avoid complications.

Increased weight-bearing and repetitive joint loading in active teens is a good thing. Research shows that the volume and thickness of joint cartilage actually increases in athletes and adolescents with activity.

There are three main types of cartilage: elastic, articular or hyaline, and fibrocartilage. Articular cartilage is the smooth cartilage that lines the joints. It makes smooth, coordinated joint motion possible.

The more repetitive loading the athlete experiences, the healthier the function of the articular cartilage. However, it is true that too much of a good thing can lead to problems. There is a threshold of activity beyond which damage to the articular cartilage can occur.

Chronic microtrauma and/or acute injury in the high-impact athlete can damage the articular cartilage. Symptoms of articular cartilage can be fairly vague. Activity-related pain or swelling around the joint should be examined sooner than later. The same is true for any reports of joint clicking, catching, or locking.

Given that the pain has persisted, and extension is painful, your son could have spondylolysis. It can be evaluated by having a physical exam, and likely plain Xrays. Keep in mind that often plain films are falsely negative and your child may need to have further imaging studies done to determine if he has spondylolysis.

Spinal surgery for scoliosis (curvature of the spine) can be very complex. This is especially true for the growing child. Much study, thought, and planning goes into surgery for this type of deformity.

X-rays, CT scans, and other imaging studies are often required. Using these two-dimensional pictures together gives the surgeon the best chance of seeing the spine as it really is in three dimensions.

Advances are being made in this area through research. Mechanical and biomedical engineers are developing rapid prototype models of patients for use in surgery. These 3-D models are made from CT scans that are translated into virtual models on a computer.

The surgeon reviews the virtual model and if acceptable, a 3-D plastic model is then created. The model accurately reflects the anatomy and deformity of each individual patient.

The surgeon can use this type of model to determine what type and size of screws, plates, and rods to use. He or she can even use the model to rehearse various aspects of the surgery ahead of time. This can help reduce errors and the actual time it takes to do the procedure.

The RP models aren’t commercially available yet but it may be only a matter of time before they are routinely used for spinal surgery.

Triplanar fractures of the ankle represent three separate breaks in the bones. The breaks occur in three different planes or directions. There’s a fracture from front-to-back, side-to-side, and top-to-bottom.

These kinds of fractures occur in older children and young teens whose growth plates have not closed yet. The growth plates do not all close at the same time. This means the overall prognosis depends on the status of each individual fracture.

Premature closure of the growth centers is a major concern with this type of fracture. If the child is years away from skeletal maturity, deformity and uneven leg length can develop.

One other important factor in the prognosis is how well the fracture is reduced. With proper reduction, the bones are brought back into place. The joint surfaces match up and there are no gaps in the involved bones.

In some cases, even good fracture reduction isn’t enough to guarantee an excellent result. Sometimes the bone fragments start to drift apart after reduction. And sometimes there’s more damage to the surface of the joint than can be seen on X-ray or CT scans. When this is the case, patients may only obtain a poor to fair result.

With a proper diagnosis and the correct treatment, many youngsters do have an excellent outcome. You can certainly ask your surgeon what to expect based on all the current factors.

We are very sorry for your loss and appreciate your comments. All-terrain vehicles (ATVs) were first brought onto the consumer market in the 1970s. There are more than seven million of these units currently in use today in the United States.

The more up-to-date models can go up to 75 miles per hour. Each unit can weigh up to 600 pounds. Many accidents involve high speeds and the ATV tipping backward landing on top of the driver. Even with safety helmet, goggles, and other protective gear, severe injury can occur.

In the last 30 years, there have been more than 6,500 deaths linked with ATV use in the United States. Another 136,000 people have been injured by ATV accident-related injuries. Some of these injuries have been serious enough to cause permanent head injury or spinal cord paralysis.

One-third of all ATV accidents involve children under the age of 16. There are reports of children of all ages from infant to 16 and older injured by ATV-use. The greatest number of injuries occurs among boys between the ages of 11 and 15 years.

Helmet use does not prevent face or skull fractures or traumatic brain injuries (TBIs). But helmets can reduce the severity of these injuries. More studies are needed to find the best helmet design.

Whether the use of goggles, visor, or face shield make a difference should also be determined. Likewise the benefit of protective clothing, chest protectors, boots, kidney belts, and elbow pads or forearm-wrist guards must be investigated.

Adult supervision, following safety guidelines, and using proper protective equipment is essential for safe and fun ATV use. Many concerned citizens and health care professionals advocate stricter laws prohibiting underage use of ATVs. It has been suggested that helmet use should be required.

Some experts advise that passengers should not be allowed to ride with the driver. The idea of a written and practical driver’s exam has also been put forth. Currently, there are no federal laws legislating the safe use of ATVs.

There remains much debate over the issue of ATV use as well as protective gear required or recommended. Prior to 1998, there was an agreement in place between ATV manufacturers and the Consumer Product Safety Commission. This safety agreement was called the 1988 Consent Decree. It was an effort to decrease injury and death among ATV users.

Between 1988 and 1998, ATV use was restricted to operators older than 16 years of age. Three-wheeled vehicles could not be sold to or used by anyone younger than 16 years. Safety warnings were required. Education and safety training were also provided.

Since the Consent Decree expired and was not renewed, injuries and deaths linked to ATVs in children have quadrupled. Most of the children involved in these accidents were not wearing a helmet.

Safety experts suggest everyone should wear a helmet at all times when on an ATV. Even if the ATV is not moving, if it is on a trail or near other ATVs, the riders can be hit by someone else.

Long-sleeved shirts, gloves, protective long pants, coveralls, and/or boots are worn by some individuals. Other more specific protective gear include a chest protector, kidney belt, elbow pads, and forearm-wrist guards.

Since none of these devices are required, each individual must decide for him or herself the level of protection to use. Type of terrain, weather, single or group activities may make a difference.