Transcription:
Bone Fractures in Children

Melanie Cole (Host):  When children are active, injuries are always almost possible, including bone fractures. What are some of the most common fractures and what steps can parents and kids take to reduce this risk? My guest today is Dr. Leigh Ann Lather. She's board certified in pediatrics and specializes in pediatric orthopedics, including bone fractures. Welcome to the show, Dr. Lather. Tell us a little bit about the most common bone fracture that you see in kids.

Dr. Leigh Ann Lather (Host):  Yes. Thank you. If you don't mind, first, if I can clarify that bone fractures are broken bones. It's amazing how many times we tell folks they have a fracture and they ask, "So, is it broken?" Yes, it's broken.

Melanie:  Good point.

Dr. Lather:   You can have small breaks or pretty bad breaks that might need surgery. They all hurt but the most common ones that we see in kids are usually involving the arms and the legs. So, with arms, we see a lot of elbow fractures, forearms, wrists and fingers, and then, the legs, knee, ankles and the shin bone and some femurs--the thigh bone.

Melanie:   So then, tell us a little bit about what causes these injuries. If we’re talking, forearm and thigh area, what will generally predispose a child to having these kinds of injuries?

Dr. Lather:  Well, I think there are a lot of things that parents can do to reduce their children’s’ risk of fractures. I like to think of it as a three-pronged attack:  good nutrition, plenty of exercise and god safety--avoiding unnecessary risks. So, as far nutrition goes kid s are growing fast and you want them to grow long strong that are more resistant to injury, then you need to make sure they are getting plenty of calcium and vitamin D every single day. Then, with exercise, kids should get at least 30 or 60 minutes of exercise a day Exercise build stronger bones. Our muscles are attached to our bones and as the muscles pull on the bone, the bone reacts by building more, stronger bone. So, exercise is also very important. Then, for the safety piece and avoiding unnecessary risks, kids are going to play and they are going to fall down. They are going to get injured. There are some things that we know are high risk. As far as different age groups go, toddlers tend to fall and one injury we see commonly that people are unaware of is foot entrapment on a slide. So, if you’re riding down a slide with your small child on your lap, please make sure to keep those feet tucked in. Elementary-aged kids turn to get hurt on the play ground. Playgrounds are great but the monkey bars are what cause most our arm injuries, especially about the elbow. So, if you’re at a playground with your kid and you’re on the monkey bars, consider just standing underneath them in case they fall .It's a long fall and they tend to land on the arm. Then, with older kids, we see mostly sports injuries--sports related injuries. So, I think it's important to avoid early specialization in one sport where we turn to see overuse injuries and avoid playing in multiple teams in one season and continue to cross-train around all different kinds of sports and activities. Then, the last high risk thing I should probably mention is trampolines and trampoline parks. Trampolines are great. They are great fun and exercise but we see most of the injuries in situations where there's more than one bouncer at a time on the trampoline. Usually, it's the smaller kids that get hurt.

Melanie:  I'm sure that usually is. That's such good advice about risk assessment and where those injuries happen. Now, let's start with some sports injuries because parents tend to think, “Well, these kids are wearing pads. They’ve got helmets on. The coach knows what they are doing. Especially in contact sports, or even in lateral movement sports, where, you know, just one little movement. So, you spoke about  sports specific training, overuse injuries, overtraining, but were broken bones are concerned, does that equipment that they are using protect them or is that pretty much a myth for parents?

Dr. Lather:  I think there is some equipment that is protective. Certainly, the helmet is important for football and then, for skiing and sports were you’re riding a motorized vehicle, it's very important to wear the protective equipment but it doesn't prevent all bone fractures. If you get hit hard, you’re going to get hurt. So, sometimes it will tend to give kids an inflated sense of protection and they are likely to hit each other harder on the football field because they think they are protected. They tend to have that Superman complex anyway, where they feel like they will never get hurt.

Melanie:  Yes, they do. They certainly do. Now, when we are talking abbot bone fractures and broken bones, if a parent has a child with a broken bone, you call 911 right away. We've heard stories of bones sticking out and all of these things with kids. What do you do for them? What's the first line of defense when you know there is a broken bone and then, what are the risks that a child is going to have some sort of aftereffects from it?

Dr. Lather:   Right. Well, I think the first thing to do when your child gets hurt is to take a deep breath. Yes, sometimes there are bad broken bones, where it's obviously an emergency but most injuries not that bad, fortunately. So, the best thing to do immediately is to have the child rest that body part. Don't use it; don't walk on it. You can apply ice. You can wrap it for compression to decrease swelling and you can elevate that body part higher than heart. The sooner you do these things, the better off they are going to be. It makes a huge difference in healing if you immediately respond that way.

 Melanie:  So then, what do you do? You set that bone back. You get it ready because kids’ bones are in ossification and they’re growing. Is this something that can just takes time and it will heal once you've set it?

Dr. Lather:   Yes. I think it's really important when your kid gets hurt to look at the injury. If there is any deformity; if there are cuts in the skin; if there's exposed bones; if the hand or foot feel cold distal to the injury, that child needs to go to an emergency department. That's truly an urgent or emergent situation. But, if none of those things are the case, make a child comfortable, use the ice, give them ibuprofen, wrap it, elevate it and you really don't need to pay for urgent or emergent care. If you think they need pre-medication above and beyond Ibuprofen or Tylenol, then you may need to seek care more urgently so that you can get good pain medicine. If that’s not the case, you really can keep your child comfortable and call your regular doctor’s office during office hours, tell them exactly what happened. Tell them you suspect a broken bone, even if it's not badly broken and they may send you directly to an imaging center or you can ask for a referral to an orthopedics office where you are likely to get the most efficient care.

Melanie:  One thing I want to make sure to mention, Dr. Lather, is so many of these kids are using skateboards and scooters and things and they fall, and, as you mentioned, forearms and wrists, what can we do in those situations as parents, to say, “Let’s reduce that risk,” because they flip over these things all the time.

Dr. Lather:  I know and I think that's just going to happen and a certain number of injuries are just going to happen when you let tour kids be active. It's important to let them be kids. They can wear elbow guards and wrist guards but sometimes they are going to get injured anyway and, you know, we are fortunate here at UVA that we have pediatrics orthopedic specialists and sports specialists. Kids have unique types of injuries. They may involve the growth plates and so, I think it is lucky that we can take our kids to place with knowledgeable, specialized care. Kids often need half the time in a cast than an adult would need and they are much less likely to need surgery. So, if you go to a pediatric orthopedist, I think you are going to get the most appropriate advice as far as treatment needed, whether it’s a splint, brace, cast or even surgery. You’re going to get the best advice about return to play for sports. Sometimes, if you go to a doctor who doesn't see a lot of trauma, you may be held out too long or sent back into you sport too soon before you’re really healed.

 Melanie:  In just the last minute or so, why should families come to UVA orthopedics to get treatment for children sports injuries?

Dr. Lather:  I think for all the reasons that I just mentioned, it's good to go to a place where you’re going to get specialized care. We have people in the office all day, every day. We can fit people in on an urgent basis if they have injuries and we've got a specialized team of staff and nurses that treat kids all the time. So, it's like going to your pediatrician’s office where they know how to deal with children of all ages and talk to kids of all ages. It's just that we happen to do all orthopedics but it is a pediatric office. It's set up to make it easier for kids with televisions to distract them while they are getting their casts and colorful casts and waterproof casts. Then, we have physicians in the office who are there all the time. We also have two surgeons who can respond if an injury needs that kind of care.

Melanie:  Thank you so much. It's great information. You’re listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.