Melanie Cole (Host): When could your child benefit from a pediatric orthopedist. My guest is Dr. Mark Abel, he is a board certified orthopedic surgeon who specializes in caring for children at UVA Children’s Hospital. Welcome to the show Dr. Abel, tell us exactly what is a pediatric orthopedist?

Dr. Mark Abel (Guest): Thank you very much Melanie. Well, a pediatric orthopedist is someone who specializes in muscles, bones, and joint problems in children. It used to be that pediatric orthopedist were board certified surgeons like myself, but I would say that only 10 to 20% of the conditions we see in children require surgery, so I have a board certified pediatrician as well as a physician’s assistant that works with me and my surgical partner, Mark Romness.

Melanie: What types of patients do you typically see?

Dr. Abel: Well as you might imagine, children injure themselves, so especially when the warm weather comes, we always keep clinic spots open for fractures in bones and joint injuries in children and they get back to play and it’s a very gratifying practice that we have, but in addition to the fractures and sport injuries, we also see children whose limbs may grow in a bowing or knock kneed fashion, my practice entails a lot of management of spinal deformities in children which is rare fortunately, but we still see a number of these kids and then we take care of a number of kids who aren’t healthy, who have conditions like cerebral palsy and muscular dystrophies and as a result of those conditions develop growth abnormalities of their bones. I would say that unlike other specialities, children’s orthopedic specialist manage children’s conditions across the body, the one common denominator is that these are growing children and our practice specializes in getting them back to activities as quickly as possible and understanding how open growth plates in growth influence treatment.

Melanie: Dr. Abel, you know so many children are playing sports today and we are seeing more sports injuries from chronic repetitive play, you know, sports specific training children are doing these days, ACL injuries in girls, soccer players, when should parents know to bring their child to a pediatric orthopedic, what would be the pre-disposer symptoms that would say, you know, get yourself to this doctor.

Dr. Able: Well, most of the time, parents take their children to their primary care doctor, but more and more commonly, pediatric orthopedist become the primary care specialist for any child with a musculoskeletal complaint that doesn’t go away. The tip-off that I give to the parents is if you actually see swelling of the joint or the extremity or the child really isn’t able to function then you should seek medical attention and we see many-many kids as the first entry into the medical system, so we are prepared to be the primary care physicians for musculoskeletal complaints.

Melanie: And what are some of the common treatments that you provide?

Dr. Abel: Well, you are right Melanie about the emphasis on sports, so we try to be cognizant of the fact that these kids need to be active, it is healthy for them to be active. They need to get back, so we try to provide a graduated rehabilitation from injury beginning with typically some form of immobilization if it in the early phase with elevation, ice, and then a therapy program to reeducate the muscles, the injured muscles and joints, strengthening and watch them to see that they are really back to full capacity before we put them out on the field, so we use our physical therapist as well.

Melanie: So, you know, a child goes through physical therapy, they return to play, do you then advise them afterward about cross training and may be working with their physical therapist to make sure that this isn’t a recurring thing or something that becomes a chronic condition.

Dr. Abel: Very good question and I am a strong proponent of cross training, Melanie. The cross training is not only and for those who don’t understand cross training is where you use multiple exercise techniques, light repetitive weights as well as nonimpact aerobic conditioning and stretching, swimming, and cycling where you use a variety of exercises to cover all muscle groups and this is not only important in the maintenance of high level playing condition, but I also use cross training a lot to bring a child back from injury, so that the rest of the body doesn’t become deconditioned, so just because a child has an ankle injury does not mean that they have to be sedentary and I think that’s extremely important to avoid reinjury as they reenter the competitive field again.

Melanie: What would you like parents to know about treating their children if they do have something and you mentioned elevation and compression, is there, you know, are we still using RICE, are we moving after injury or we are staying still, what do parents need to know if their child sustains an injury out on the field or even at home walking around or playing in their backyard, what do you want parents to do right after that?

Dr. Abel: Well, I tell parents that when your child has an injury and of course when we talk about injury, we have everything from muscle bruises, sprains to fractures and so, you know, the first thing you need to do is assess your child and make sure that the extremity if you see swelling right away or if you see obvious deformity in the extremity then you really need to seek urgent care in emergency room. Our office at UVA, we have a provider everyday and we will often let them walk in and make a determination, that’s the first thing, if it is more minor than that, a child doesn’t want to play, they could be clearly hurt, then yes I bring him in off the field, ice it down, give them time to calm down and then reassess. If they are still having pain the next day then I would get an opinion and seek a medical opinion about that injury. In general, if you can mobilize the extremity, you should and the more severe sprains and fractures obviously for the first couple of weeks, we can do splint or brace to prevent motion to allow the tissues to heal and the swelling to go down. Ice is very important, so are the nonsteroidal antiinflammatory agents, that’s group of drugs like ibuprofen and Naprosyn are very-very helpful for musculoskeletal injury.

Melanie: Dr. Abel, why should families choose UVA Children’s Hospital for their orthopedic care?

Dr. Abel: Well, I am proud to say that the four pediatric orthopedists that work with me are a unique group. There are no fellowship trained specialists and pediatric orthopedists on this side, the west side of Richmond and our understanding of growth dynamics and how to bring child back as quickly as possible on the priorities of a child give us, I think, the upper hand in the management of these children.

Melanie: Thank you so much Dr. Mark Abel, board certified orthopedic surgeon specializing in caring for children at UVA Children’s Hospital. You are listening to UVA Health Systems Radio and for more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.