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Melanie Cole (Host): As participation of children and adolescents in organized sports continues to rise, so do concerns about the risk and severity of injury to a child's growing body. My guest today is Dr. Jeremy Bauer. He's a pediatric orthopedic surgeon with Shriners Hospitals for Children in Portland. Dr. Bauer, what types of sports injuries or contact or movements cause bones to fracture, and in which sports do you see this most?

Dr. Jeremy Bauer, MD (Guest): We tend to see two sorts of things. We see fracture or broken bones, mostly that's happening with playgrounds. So the majority are happening to young kids that have been playing on the playground, playing on the trampoline, or just being kids running around and playing tag with their friends. Now sports injuries, those tend to occur both from contact and non-contact injuries. So contact, we would think about football, they're running down the field and they get tackled, that causes an ACL tear. And sometimes it's non-contact. So a basketball player could be coming down from a layup and land awkwardly on their knee, and that causes also an ACL tear. So we see lots of kids with ACL tears, kneecaps that are popping in and out of place, ankle sprain injuries, and those sorts of sports contact and non-contact injuries.

Host: Doctor, children are not really small adults, and their bones are growing in ossification, they're busy growing. Do their bones heal faster than adults? And if they tear a ligament, or a tendon, or fracture a bone, what is healing like for a child versus an adult?

Dr. Bauer: You know, it's a great question. So fractures in general for kids do heal up pretty quick. So a short time in a cast, or sometimes a boot to help them get back into the game or back to playing is all they need. So they'll heal their fracture really well. What they don't heal though is overuse injuries. So kids that are playing lots of sports, playing year-round sports, playing sports in the morning, or sports in the night, weekends; they can sometimes get small injuries that are happening quicker than their body is able for them to heal. And then particular with kids, we have to watch out for their areas of growth. So sometimes fractures happen right where they're growing, and if we ignore those and just treated it like an adult, they would grow crooked or cause problems down the road. So we want to treat them right the first time and make sure that they're set for life.

Host: This is strictly opinion, Dr. Bauer, but do you feel that the societal pressures- you mentioned chronic overuse injuries of sport-specific training that's going on today. Do you think that the physiologic stresses that we're putting on our children - whether or not they're putting it on themselves as well because children are very dedicated athletes if they really love a sport - do you think that this is causing a rise in this type of youth athlete, and causing more injuries by this sport-specific training and chronic overuse?

Dr. Bauer: You know, we certainly do see it in increasing incidents, and it's from all those types that you talked about. Not doing multiple training, spending lots of extra time on it, and it's really hard to determine where is the pressure coming from? Is it coming from the parents? Is it coming from the coach? Is it coming from the child? And so we really have to do a good job to kind of come along them and try to sort out what is needed for them. The big problem with overuse injuries is that we're keeping them out of the game and keeping them from doing what they want to do. Now you have to balance all of this with the obesity epidemic that we have. So we really want kids to be active, we want them playing sports, we want them having fun, but you have to balance that with overuse. So hopefully we can strike a happy medium.

Host: Tell us about growth plate fractures that you mentioned. How are they treated? And what do you do for a child that comes to you at Shriners if they do have a growth plate fracture?

Dr. Bauer: Yeah, so where the growth is occurring is the tops and bottoms of the bones, and if a fracture goes through that, we do a really careful job to make sure that it's put back or reduced in a perfect position depending on the kid's age. And then we have to follow them. So where some fractures, they might have a small little fracture, it's away from the growth plate, they are in a cast or a splint for a few weeks and they're done. And those other kids, we have to keep an eye on them for a couple years to make sure that they continue to grow straight, because sometimes they do need other surgeries or other treatments to help keep them growing the best they can.

Host: Can these injuries be prevented?

Dr. Bauer: Well, certain ones certainly can. And so a big focus for pediatric orthopedic surgeons who do sports is looking at prevention. So particularly we see with adolescent girls, high incidents of ACL and knee injuries, so we try to do a big push with the coaches and even FIFA gets involved to help train the young women and men to jump well, and land well, and have good body mechanics to help reduce it.

Host: Dr. Bauer, what are some things that parents and coaches can do to help prevent sports injuries, and what about vitamin D? Does that help?

Dr. Bauer: Yeah, so particularly for anyone living in the northwest, vitamin D deficiency is a big deal. And so I encourage all of my patients to be on vitamin D. There's reasonably good evidence for it, it's a safe vitamin, it has probably better evidence than most any other vitamin for its use for both helping to build the bones strong. When it comes to calcium, it's a bit more controversial. My opinion is as long as the child can eat a really well-balanced diet, then they don't need to supplement calcium, but others should supplement with calcium to help build up their bones strong.

Host: Dr. Bauer, give us your best advice for preventing sports injuries in our youth athletes. Tell us a little bit about your multi-disciplinary team at Shriners Hospitals for Children in Portland.

Dr. Bauer: Yeah, so for preventing overuse injuries, there's pretty good recommendations from the American Academy of Pediatrics that says that you need to have some rest every year. So you need to have some time off during the year where you're not playing any sports. You need to have a day off of rest as well to allow your body to heal up. So a day off every week. What we do for our kids here is we have a great physical therapy and occupational therapy program that helps come along these kids as they're healing up and getting back into sports, making sure that they're ready from the physical side of things, and then one of the great things we have- the whole process can be scary, from going through surgery, we have a great child life specialist that will help them navigate this kind of scary time. It's all unknown, it's all new, and it's common for us but we try to make it feel less scary for them.

Host: That's great information. So important for parents and coaches and youth athletes to hear about the ways to prevent some of these sports injuries and fractures from happening in the first place. Thank you so much, Dr. Bauer, for joining us today. For more information on services offered at Shriners Hospitals for Children in Portland, please visit www.PortlandShrinersHospital.org. That's www.PortlandShrinersHospital.org. This is Melanie Cole, thanks so much for tuning in.