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When a Child Should See a Pediatric Orthopedic Surgeon
Dr. Richard Reynolds discusses why your child might need to see a pediatric orthopedic doctor and the conditions they treat.
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Richard Reynolds, MD
Richard Reynolds, MD is a Pediatric Orthopedic Surgeon.Learn more about Richard Reynolds, MD
Transcription:
Prakash Chandran (Host): When it comes to your child or teen, specialized orthopedic treatment really matters because not every doctor knows how to treat growing bones. But what exactly do you need to know about orthopedic treatment for children? Let’s talk about it with Dr. Richard Reynolds, Chairman of Surgery and Chief of Orthopedics at Nemours Children’s Health System working at West Florida Hospital.
This is Helmet of Health, the podcast from West Florida Hospital. I’m Prakash Chandran. So, Dr. Reynolds, let’s start with the basics. Tell us how orthopedic treatment for children differs from orthopedic treatment for adults.
Richard Reynolds, MD (Guest): So, I think you can divide it into two sections; trauma or fractures. More than 50% of what we do is the treatment of fractures. And so the big difference between adults and children is that we have to deal with growth plates. And then the other stuff is related to congenital anomalies; so these are things that you are born with. So, we have to deal with those things that adults don’t have to deal with.
Host: Okay, that makes a lot of sense but I’m curious about how that usually manifests itself.
Dr. Reynolds: Usually it’s falling off of monkey bars, or other kinds of apparatuses that come in with pain, swelling, deformity and inability to use their arm or extremity. And so, then we need to be very careful as to how long it’s been fractured because a lot of these fractures need to be treated immediately so that they don’t get growth problems.
Host: Yeah, you mentioned the growth plates and I’m really curious as to why injuries can affect limb growth. Talk to us a little bit about the long term affects of that.
Dr. Reynolds: So, growth can be affected in multiple different ways. If you have a fracture close to a growth plate, but not in the growth plate itself; it can actually stimulate the growth so the leg can be longer, or the arm can be longer than the other side because it’s like sprinkling fertilizer on your garden. More blood goes to the extremity and so then it grows faster.
The other is that if the fracture goes through the growth plate in certain ways; it can cause either a complete growth arrest where the entire growth plate doesn’t grow normally, or it can create a partial growth arrest where it then grows crooked.
Host: I see so, in addition to some of the growth affects that you are talking about, tell us a little bit more about why it’s important that children receive specialized treatment.
Dr. Reynolds: The reason is, is the judgement to when to do an operation versus no operation. So, is it safe to use a cast or a splint or do you need an operation where the growth plate is put back anatomically. And usually, we only have three to five days in which to make that decision. After that, then we have to wait until the fracture is healed and then deal with any long term deformity later so as not to cause significant growth plate problems.
Host: So, I’m a relatively new parent and I’m already thinking about this. What should a parent do if their child breaks a bone? And when should they seek out someone like a pediatric orthopedic specialist after the initial treatment?
Dr. Reynolds: So, usually what happens is you have the injury, it’s pretty clear that there’s been a significant injury to the arm or leg and therefore you want to take your child to an emergency department or urgent care. They’ll assess you to make sure that there’s no other serious injuries. The extremity is then stabilized by putting a splint on and then from that point forward, it’s important that you see a pediatric orthopedic surgeon so that you can have that judgement as to what the next step in treatment is.
Host: Kind of related to that, I’d love to hear a little bit about something that you wish more parents knew before they came to see you with their child.
Dr. Reynolds: Well I think with certainly the trauma component, just timeliness of getting in to see us. We sometimes see parents who have been seen in an urgent care six weeks ago. And I just had a child come in yesterday and they had an injury that was put in a splint six weeks ago and now the fracture, through the growth plate has healed in a very abnormal position and now we have to wait three to six months longer for the growth plate to see if it recovers and if it does; then we can do an operation to straighten it out down the road.
Host: It really does seem like time is of the essence. I think if a parent waits like you mentioned, that at six weeks it can actually cause more problems down the road and more surgery. Is that correct?
Dr. Reynolds: That is definitely correct. The major thing is, is that when you identify that there’s a fracture; that you get into see a peds ortho person as soon as you can so that those decisions that are timely can be made in an appropriate way so that we don’t have to deal with long-term deformities.
Host: Yeah, speaking of these long-term deformities; how common is it where parents will wait a little bit too long and you have to do treatment down the road? Like how often are you seeing these cases?
Dr. Reynolds: I’d say we see at least a kid a week where the fracture is more than a week old and now the risk of manipulating the growth plate to cause a growth arrest outweighs the risk of waiting to see if it grows out.
Host: All right, so, what I’m hearing from you is that basically as soon as you get it addressed either urgent care or the emergency room; you should really be making that appointment within a week to see a specialist so they can monitor it and tell you about the best course of action.
Dr. Reynolds: Correct.
Host: All right Dr. Reynolds, I really appreciate that. That’s Dr. Richard Reynolds, Chairman of Surgery and Chief of Orthopedics at Nemours Children’s Health System working at West Florida Hospital. Thanks for checking out this episode of Helmet of Health. For more information about the services at West Florida Healthcare, you may call 850-494-3212 or visit the website at www.westfloridahospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): When it comes to your child or teen, specialized orthopedic treatment really matters because not every doctor knows how to treat growing bones. But what exactly do you need to know about orthopedic treatment for children? Let’s talk about it with Dr. Richard Reynolds, Chairman of Surgery and Chief of Orthopedics at Nemours Children’s Health System working at West Florida Hospital.
This is Helmet of Health, the podcast from West Florida Hospital. I’m Prakash Chandran. So, Dr. Reynolds, let’s start with the basics. Tell us how orthopedic treatment for children differs from orthopedic treatment for adults.
Richard Reynolds, MD (Guest): So, I think you can divide it into two sections; trauma or fractures. More than 50% of what we do is the treatment of fractures. And so the big difference between adults and children is that we have to deal with growth plates. And then the other stuff is related to congenital anomalies; so these are things that you are born with. So, we have to deal with those things that adults don’t have to deal with.
Host: Okay, that makes a lot of sense but I’m curious about how that usually manifests itself.
Dr. Reynolds: Usually it’s falling off of monkey bars, or other kinds of apparatuses that come in with pain, swelling, deformity and inability to use their arm or extremity. And so, then we need to be very careful as to how long it’s been fractured because a lot of these fractures need to be treated immediately so that they don’t get growth problems.
Host: Yeah, you mentioned the growth plates and I’m really curious as to why injuries can affect limb growth. Talk to us a little bit about the long term affects of that.
Dr. Reynolds: So, growth can be affected in multiple different ways. If you have a fracture close to a growth plate, but not in the growth plate itself; it can actually stimulate the growth so the leg can be longer, or the arm can be longer than the other side because it’s like sprinkling fertilizer on your garden. More blood goes to the extremity and so then it grows faster.
The other is that if the fracture goes through the growth plate in certain ways; it can cause either a complete growth arrest where the entire growth plate doesn’t grow normally, or it can create a partial growth arrest where it then grows crooked.
Host: I see so, in addition to some of the growth affects that you are talking about, tell us a little bit more about why it’s important that children receive specialized treatment.
Dr. Reynolds: The reason is, is the judgement to when to do an operation versus no operation. So, is it safe to use a cast or a splint or do you need an operation where the growth plate is put back anatomically. And usually, we only have three to five days in which to make that decision. After that, then we have to wait until the fracture is healed and then deal with any long term deformity later so as not to cause significant growth plate problems.
Host: So, I’m a relatively new parent and I’m already thinking about this. What should a parent do if their child breaks a bone? And when should they seek out someone like a pediatric orthopedic specialist after the initial treatment?
Dr. Reynolds: So, usually what happens is you have the injury, it’s pretty clear that there’s been a significant injury to the arm or leg and therefore you want to take your child to an emergency department or urgent care. They’ll assess you to make sure that there’s no other serious injuries. The extremity is then stabilized by putting a splint on and then from that point forward, it’s important that you see a pediatric orthopedic surgeon so that you can have that judgement as to what the next step in treatment is.
Host: Kind of related to that, I’d love to hear a little bit about something that you wish more parents knew before they came to see you with their child.
Dr. Reynolds: Well I think with certainly the trauma component, just timeliness of getting in to see us. We sometimes see parents who have been seen in an urgent care six weeks ago. And I just had a child come in yesterday and they had an injury that was put in a splint six weeks ago and now the fracture, through the growth plate has healed in a very abnormal position and now we have to wait three to six months longer for the growth plate to see if it recovers and if it does; then we can do an operation to straighten it out down the road.
Host: It really does seem like time is of the essence. I think if a parent waits like you mentioned, that at six weeks it can actually cause more problems down the road and more surgery. Is that correct?
Dr. Reynolds: That is definitely correct. The major thing is, is that when you identify that there’s a fracture; that you get into see a peds ortho person as soon as you can so that those decisions that are timely can be made in an appropriate way so that we don’t have to deal with long-term deformities.
Host: Yeah, speaking of these long-term deformities; how common is it where parents will wait a little bit too long and you have to do treatment down the road? Like how often are you seeing these cases?
Dr. Reynolds: I’d say we see at least a kid a week where the fracture is more than a week old and now the risk of manipulating the growth plate to cause a growth arrest outweighs the risk of waiting to see if it grows out.
Host: All right, so, what I’m hearing from you is that basically as soon as you get it addressed either urgent care or the emergency room; you should really be making that appointment within a week to see a specialist so they can monitor it and tell you about the best course of action.
Dr. Reynolds: Correct.
Host: All right Dr. Reynolds, I really appreciate that. That’s Dr. Richard Reynolds, Chairman of Surgery and Chief of Orthopedics at Nemours Children’s Health System working at West Florida Hospital. Thanks for checking out this episode of Helmet of Health. For more information about the services at West Florida Healthcare, you may call 850-494-3212 or visit the website at www.westfloridahospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.