Pediatric orthopedics

Pediatric orthopedic surgeons are specially trained to diagnose and treat the unique nature of orthopedic injuries in children. Your orthopedic team will consider several factors when developing a treatment plan for your child, including:

• Possible injury to growth plates
• Potential for growth and its effects on correcting or worsening a deformity
• How an injury or condition may affect a child later in life

Falls are the most common cause of non-fatal injuries in children. Every day, about 8,000 children need emergency care due to falls. Common injuries that result from falls, sports and other physical activities include:

• Broken bones
• Joint dislocations
• Sprains, strains and tears of muscles, tendons and ligaments
• Overuse injuries, such as shin splints and tennis elbow

Did you know the terms "fracture" and "break" mean the same thing? A fracture is a broken bone, but there are many different types of fractures. When a twisting injury happens, for example, it causes the bone to break like a spiral. This is called a spiral fracture.

Children can break bones doing almost anything. However, some activities are riskier than others.

Types of pediatric fractures include:

• Greenstick fractures, which occur when a bone bends and cracks but doesn't completely break
• Torus fractures (buckle fractures), which occur when the bone compresses and bulges but doesn’t completely break
• Closed fractures, which are fractures that don’t penetrate the skin
• Open fractures (compound fractures), which occur when bone fragments break through the skin
• Non-displaced fractures, which occur when the bone cracks completely and the pieces line up
• Displaced fractures, which occur when the bone cracks completely in two or more pieces and the pieces move out of alignment

Common ways children break bones

Orthopedic specialists and ER doctors regularly see patients with broken bones from activities like playing on monkey bars. There's also a high risk of injuries while playing on trampolines. Use caution when letting kids participate in these activities and others, such as:

• Contact sports
• Sports that involve tumbling or twisting, such as cheerleading
• Riding ATVs or dirt bikes
• Jumping in bounce houses
• Riding down slides in a parent's lap

How to identify a broken bone

Children who exhibit any of the following symptoms should see a doctor right away:

• Intense pain
• Pain that lasts longer than a few days after a fall or injury
• Swelling, bruising or bleeding
• Numbness and tingling
• Favoring or not using an arm or leg
• Being unable to walk or walking crooked

If your child can't talk yet, they may point to a body part with a fracture or cry when the broken bone is moved or touched.

For an accurate diagnosis, your child will need an X-ray and medical exam. If your doctor recommends casting, ask for a waterproof cast so your child can shower, bathe and swim comfortably.

How to help your children avoid fractures

Here are some ways to help lower kids' risk for broken bones and other injuries while still encouraging them to be active:

Make sure your child:

• Is well rested, eats a balanced diet and stays hydrated
• Wears protective gear appropriate for their sport or activity
• Warms up and gently stretches muscles and joints before activities
• Plays in areas that are safe and free of holes, ruts and debris

A dislocation occurs when extreme force is put on a ligament (flexible bands of fibrous tissue), separating the ends of two connected bones. Severe trauma can even dislocate a joint.

Symptoms of dislocation

Every child may experience dislocation symptoms differently. However, these are the most common signs of this injury:

• Severe pain in the injured area
• Swelling in the injured area
• Difficulty using or moving the injured area in a normal manner
• Deformity of the dislocated area

Diagnosing a dislocation

An orthopedic specialist can diagnosis a dislocation with a physical examination. A diagnostic procedure, such as an X-ray or magnetic resonance imaging (MRI) scan, give a more complete picture of the injury and further guide your child's treatment options.

Dislocation treatment

Initial treatment of a dislocation includes rest, ice and elevation. For dislocations that do not go back into place on their own, your child’s physician will need to place the joint back into its proper position.

Your child’s physician may recommend any of the following to help reduce the dislocation or promote healing after initial treatment:

• A splint/cast to immobilize the dislocated area
• Medication for pain
• Traction (pulleys, strings, weights and a metal frame attached over or on the bed) to stretch the muscles and tendons around the bone ends
• Surgery, which may be recommended for recurrent dislocations or if a muscle, tendon or ligament is badly torn
• Activity restrictions while the dislocation heals
• Crutches or a wheelchair so your child can move around during healing
• Physical therapy

Sports injuries are among the most common pediatric orthopedic injuries. But how do those accidents happen? The most common causes are:

• Collisions
• Pileups
• Twisting
• Falling

Protect your little athletes by making sure they know how to play the game, are properly supervised by qualified adults who know CPR and are outfitted with the proper equipment and safety gear.

Developmental dysplasia of the hip (DDH), commonly called hip dysplasia, is a condition related to how the thigh bone and pelvis fit together. The thigh bone has a ball-shaped top which is supposed to fit into a cup-shaped area on the pelvis. DDH may occur when:

• The ball of the thigh is loose inside the pelvis cup, making the hip unstable
• The ball moves easily out of the cup, dislocating the hip
• The ball and cup don't meet at all
• The cup is improperly shaped

Risk factors for developing hip dysplasia

Some children (girls in particular) are more likely to develop DDH than others. Risk factors for hip dysplasia include:

• Breech birth (when the baby is born feet or bottom first)
• Firstborn child
• A family history of DDH
• Low levels of amniotic fluid during pregnancy
• Late delivery (birth after 42 weeks of pregnancy)
• Birth weight greater than 8 pounds and 13 ounces
• Swaddling legs too tightly

Even if a child has all of these risk factors, they're still unlikely to develop hip dysplasia. However, your pediatrician will want to keep an eye on your child and treat any issues sooner rather than later.

Treating hip dysplasia

Hip dysplasia can be helped with treatment, which can include:

• Wearing a cloth harness for six weeks (for infants with mild hip dysplasia caught early)
• Surgery to position the bone in the socket (for infants and toddlers with more advanced DDH)
• Surgery to correct hips that are too shallow or at risk of dislocating (for older children)

Doctors call the areas where bones grow "growth plates." These are cartilaginous areas or places of cartilage, typically at the ends of long bones. A child's growth happens in two places. Length comes from the growth plate, and girth comes from the tissues that line the bones.

Treating growth plate injuries

Determining how to treat a growth plate injury depends on several things, including:

• The child's age
• The location of the fracture
• The amount of displacement of the fracture

A younger child with a largely displaced fracture in a rapidly growing part of the body would be more aggressively treated than an older child with a minimally displaced fracture.

There's some urgency in treating a growth plate injury, particularly if it’s displaced. This is because growth plates tend to start healing more quickly than regular bone.

When a growth plate is fractured or injured, it needs to be set within the first five to seven days. There's risk to the growth plate if attempts are made to set it after that. The danger of injury to a growth plate lies in its implications for further growth of that bone, which may result in length deformity or an angular deformity.

How to prevent tendinitis and growth plate inflammation

Tendinitis (severe swelling of a tendon, which is a flexible band of tissue connecting muscles to bones) and inflamed growth plates (the growing tissue near the ends of the long bones in children and adolescents) usually occur from overuse or repeated injury to one area. Stretching is the best way to prevent these types of injuries.

Preteens and teens tend to develop overuse injuries because their muscles are very tight—particularly their hamstrings and calf muscles. Following a full stretching program can decrease the risk of developing these injuries as well as sprains and strains.

Leg length discrepancy means a child's legs are of different lengths. This may be a congenital condition, where the child is born with the discrepancy, or it could develop over time due to injury or illness.

A significant discrepancy between leg lengths can make it difficult for a child to run and play. This can also result in asymmetry of the spine. Treatment is based on the severity of the condition and can range from wearing a shoe lift to surgery in more severe cases.

Clubfoot is a medical condition that children are born with. Left untreated, it will be difficult if not impossible for a child to walk. The earlier treatment begins, the better.

There are two treatment options for children with clubfoot. Your doctor may recommend the Ponseti method, which involves a series of casts designed to manipulate and correct the growth of the foot. This treatment may eliminate the need for surgery or make surgery less invasive. Your orthopedic doctor may also recommend surgery either on its own or in conjunction with the Ponseti method.