Transcription:
No Bones About It: Common Childhood Orthopedic Conditions

Prakash Chandran: As parents, we always want our children to have the best quality of life. Sometimes we fear that traumatic injuries like fractures or even more common conditions like bow leg, can affect that. Luckily, there are specialists who can help our children heal and manage regardless of the orthopedic condition they're faced with.

Here to tell us more is Dr. Amr Abdelgawad, an orthopedic surgeon, pediatric orthopedic surgeon, and limb lengthening and reconstruction surgeon at Maimonides Medical Center. This is Mai Mo Med Talk. I'm your host Prakash Chandran. So Dr. Abdelgawad, thank you so much for joining us today. I truly appreciate your time. Now, you are among many things a pediatric orthopedic surgeon. For those of us not in the know, what exactly does that mean?

Dr. Amr Abdelgawad: Thanks for having me. So pediatric orthopedic surgeon means, orthopedic surgeons specialized in dealing with musculo injuries of the kids, meaning the if the kids have, Injury to the arms or to the legs. They are the orthopedic surgeon that are specialized in this, but not only injuries, it also, includes working with diseases of the musculoskeletal in system in kids.

So if Pathology, like deformity bowl, leg, or something in the foot, a flat foot or high arch, or some disease that affects the hips or some diseases that affects the elbow. all these, diseases that affect the bone and the joints, of the kids, whether it's injury or disease. The pediatric orthopedic surgeon are the one who's specialized in these things.

Prakash Chandran: Got it. Understood. And just outta curiosity, what compelled you to seek this line of workout?

Dr. Amr Abdelgawad: I always like to work with kids. When I was in the medical school, I was thinking of becoming a pediatrician, but then I found that I like surgery more. So after specializing in orthopedic surgery I decided to continue my passionate toward treating kids. And that's why I became a pediatric orthopedic.

Prakash Chandran: So you touched upon this, but can you talk about the most common things that you see children come in for? Both on, I guess, the traumatic injury fracture side as well as kind of the common orthopedic conditions as well?

Dr. Amr Abdelgawad: So the most common thing for injuries, for fractures, it is wrist injuries and elbow injuries. So kids, when they fold, they try to protect theirself. This is like a reflex. They do this to protect their body, so they put their hand so they fill on their hand. When you fill on your hand. The two most common thing you will break is either your wrist or your elbow.

So these are the two most common injuries that we get. Most of these, if they are minimal which this is the case. Most of these cases are just like a small, teeny, tiny break we call sometimes hairline break, or, the scientific name is called like a buckle. Because the bone like buckles, it does not like completely shattered. We manage them with a cast or a splint if it's a little bit displaced, or if there is like a more of an angulation to the fracture.

It's either going to be closed reduction means that we put the fracture back in position and then put a cast. Or if the displacement is more, sometimes we have to do more invasive treatment in which we put the pieces of the bone back together and fix them with like a metal wire.

Prakash Chandran: Okay. Understood. And then there's also, some more common conditions that I know that you deal with. You mentioned bow leg, flatfoot. Can you talk at a high level about what those are and how common they are?

Dr. Amr Abdelgawad: Actually bow legged is extremely common because, it's part of the physiologic development. So most kids will have some elements of bow legged when they're born, till the age of about two to three in which they start, the normal alignment, first they go into a little bit of the other direction, which is called knock knee.

And then by the age of seven to eight years old, they will have the normal alignment. However, sometimes that bow legged is not the normal Bow legged or what we call the physiologic bow legged. So some, sometimes the Bo leg is not physiologic, it's due to a disease of the growth. The growth plate is the area that boy or the girl grow from.

Sometimes this growth plate is not growing, in the normal way, and it's growing in an area faster than the other. So it'll push the leg either inward or outward. So this is one of the causes of the bow leg that we sometimes see. Sometimes also the bow leg is coming from decrease in the vitamin in the bone, especially vitamin D.

We see this less common because most of the food now are fortified, which means they actually add vitamin D to the kids' food. But you still sometimes, see this condition if the kid nutrition is affected that he will some sort of a bow leg or the other deformity, which is the [?].

Prakash Chandran: Okay, so one of the things that I think is pretty natural for a parent to do is to worry about their children's quality of life over time, right? If they have one of these conditions, they're worried that they're gonna be suffering with them forever. So can you talk to us about how these conditions change over time?

Dr. Amr Abdelgawad: As we said, most of these conditions will actually improve with the patient, growth. so, most of it, the Bow leg is in the age of two to three years old. So when we see the patient, we in most cases get x-ray the radiographs, the plane one, and it'll tell us a lot. It'll give us lots of information if the condition looks benign, if the bone quality is fine and just there is some bow leg.

We will, do what we called observation or we just wait a little bit. Give the child one or two years for growth and see how is he doing, is he or she getting better or not. And as we said, most of the time, they will get better. If there is, like, more advanced condition, if it's not physiologic, if there is actually a disease it is not that hard to treat.

if the kids are small, we sometimes put them in a brace that gets them out of the deformity or if it's, not responding sometimes we do a small surgeries we call it growth modulation in which we control the growth in the way to help us. So, if the patient is bull leg, we try to apply the growth in a way to push the leg out of that, position.

Or if the reverse, if he or she's knock knee, we put the, growth modulation on a different part of the growth plate, and that will allow the child to grow gradually into the normal position.

Prakash Chandran: Okay. So it seems like there are two categories of things that you deal with. There's kind of the traumatic break or fracture, and then there's also the more common orthopedic conditions. So in the case of the first one, the break or fracture, in terms of advice that you might give to parents, the best thing to do is to go immediately and get it treated. Especially because I imagine that the bones, or the skeletal system, heal differently over time. So you wanna make sure to guide that healing process. Is that more or less correct?

Dr. Amr Abdelgawad: Correct. Yeah, definitely correct. So kids, the skeleton is different than the adult skeleton. The kids, the skeleton, as I said, has something called growth plate. The growth plate is the area of the bone, which allows the bone of the kit to grow. So when are we born our bones are much smaller than our bones when we reach this greater maturity, that's happened through the growth that happens through the growth plate.

So when we get a fracture, we always assist the remaining growth that this child, has an effect on that or not. Like if the child is still like five year old and expected to go maybe for 10 more years or at 11 more years. So we sometimes accept like 10 degree angulation. Why? Because he's still growing and we are expecting that during that growth and that increase in length, that 10 degree angulation will get corrected with time.

If he or she is like, have only like five more month of growth or one year more growth, maybe the 10 degree that we accepted when the child was five year old will not accept it now because we know that it's, the child does not have enough growth potential to correct that angulation that he's presenting with. In this case, we have to get it correct and apply a splint or such.

Prakash Chandran: Okay, that makes sense. And so for example, if a parent like myself, whose child has just experienced an injury, best thing to do is to what? Go into, or to give you a call to see you? What? What should a parent do immediately?

Dr. Amr Abdelgawad: So that's an excellent question. It depends on the timing. If it happens during the weekend, what happens is most of the parents can go to the urgent care, get an x-ray and put the splint till they see the orthopedic surgeon, the specialized pediatric orthopedic surgeon. If it's in the middle of the week and you can get an appointment, immediately or the next day definitely that, will save the family a trip to the urgent care or to the ER.

Prakash Chandran: Okay. And then for the second category of conditions, the ones that are more common, like the bow leg and flat foot, for the most part, it sounds like it. usually works itself out. So what should a parent do by way of, you know, coming in to see someone like yourself versus just staying at home and just letting things heal on their own?

Dr. Amr Abdelgawad: This is very good. So, most of the, as you said, I would say more than 95% of these conditions will get better by themselves. My advice is always listen to the pediatrician, because you'll see the pediatrician anyway, maybe once or twice a year. If you have any concern, you think that there's a flat foot, there is bow leg.

There is some decreased range of motion of any joint. Just show it to the pediatrician. And, if, he or she, the pediatrician think that, it's part of the normal development they will tell you that. If they think that this does not really fall into that, or it's not getting better as they expected, they will take the decision for the referral.

Prakash Chandran: Okay. And finally, one question I always like to ask is, you've probably treated, many, many children and in all of your work experience, what's one thing that you know to be true that you wished more parents knew before they came to see you?

Dr. Amr Abdelgawad: Oh, there's lots of them. First of all, you cannot have an arch in the foot before the age of four year old, so I get lots of families that tell you, oh, the kid is flatfoot and he's three years old. Yes, because there is no kid that can develop an harsh before the age of four. So this is very important.

Also, falling, falling is extremely common in kids because the gate pattern, the normal gate pattern that we have is not reached before the age of four. So, kids who are two and three years old are expected to fall. There is no way not to prevent them from, ing. Another one very important is, You are not considered delayed in walking till the age of 18 months because I get lots of, families that are very, very concerned that the child is like 15 month and he or she did not start walking.

That's still considered with a normal because it's up to 18 months. So these are the three things that wish most parents would know.

Prakash Chandran: Well, Dr. Abdelgawad, thank you so much. I think that's the perfect place to end. Really appreciate your time today.

Dr. Amr Abdelgawad: Thank you. Thank you very much and thanks for having me.

Prakash Chandran: That was Dr. Amr Abdelgawad, an orthopedic surgeon, pediatric orthopedic surgeon, and limb lengthening and reconstruction surgeon at Maimonides Medical Center To make an appointment, you can call 718-283-7400 or you can visit maimo.org. You can hear more topics that might interest you on our podcastPage@maimo.org/medtalk. This has been Mai Mo Med Talk. I'm your Host Prakash Chandran. Thank you so much and be well.