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Why Your Child Needs an Orthopedist Who Specializes in Pediatrics

March 23, 2021

A conversation with Lurie Children’s specialists in bone fractures and sports injury care

Dr. Craig Finlayson signs patient Rayhan's cast

Lurie Children’s nationally ranked Division of Orthopaedic Surgery and Sports Medicine specialists regularly treat bone fractures and sports injuries in children and teens throughout Chicago, the suburbs and regionally.

Read more below to hear from three orthopedic physician-surgeons about why care for your child from an orthopedic doctor who specializes in pediatrics is so important.

Learn more about Lurie Children’s orthopedic specialists’ locations and how to make an appointment here.

How common are bone fractures in children and teens? What are the typical causes? 

Dr. Craig Finlayson, Attending Physician, Division of Orthopaedic Surgery and Sports Medicine; Surgical Director and Co-Medical Director, Lurie Children’s Surgery Center in Northbrook: Fractures are quite common in children and teens. Around a third of young people suffer a fracture before age 17. Playground injuries are common in our grade-school patients and younger patients while sports-related injuries become more common in adolescents. 

Dr. Sagan

Dr. Michelle Sagan, Attending Physician and Surgeon, Division of Orthopaedic Surgery and Sports Medicine: There are also seasonal differences in injuries. Winters like this one with a large amount of snow and frigid temperatures lead to many injuries from sledding, skiing/snowboarding and falls on the ice.

 

Why does it matter that an orthopedic specialist has training in pediatrics and experience with children and adolescents?

Dr. Sagan: Specialized training in pediatric orthopedics gives us the specific knowledge and experience to avoid the complications and pitfalls that can happen when caring for patients with open growth plates (areas of new bone growth) and still-developing bodies. As pediatric orthopedists, we have the unique understanding of how the specific age and development stage of the child will affect their orthopedic care from birth until they are mature. This allows us to cater care to the child’s individual needs based on not only the development of their musculoskeletal system, but also their maturity level.

Dr. Patel

Dr. Neeraj Patel, Attending Physician and Surgeon, Division of Orthopaedic Surgery and Sports Medicine: It is important to have a surgeon who is experienced working with the child and the family for several reasons. A big one is that post-surgical care for children and teens who undergo a procedure will be different from post-surgical care for an adult to ensure a good outcome. This care involves discussing expectations, motivating the patient through rehabilitation and ensuring the child understands the injury/treatment/plan.

Furthermore, there are some operations, like ACL reconstructions, where even if the surgery itself is technically similar in a 15-year-old and a 30-year-old, the post-operative risks are much different for the young patient. These children and adolescents deserve a surgeon that understands these differences and tailors their care accordingly.

 

How are bone fractures and related injuries different in children than they are in adults? 

Dr. Finlayson: Children are definitely not just small adults when it comes to fracture care. In some cases, children’s fractures require more prompt or aggressive intervention to avoid long-term complications. In contrast, some fractures that are routinely treated with surgery in adults may be managed with casting or less-invasive forms of fixation in children.  Growing bones also have the potential to remodel as they continue to grow.  Because of this amazing property, some fractures do not need to be perfectly aligned during healing to ensure a good outcome.

Pediatric specialists understand all these factors and can help families determine when surgical or non-surgical treatment is most appropriate. 

Dr. Sagan: Children are at risk for some types of injuries rarely seen in adults. An example would be fractures of the ankle as they typically occur when children are starting to have fusion (or normal closure) of the growth plate.  The entire growth plate does not close all at once. The specific pattern of growth plate closure leads to classic fracture patterns that are unique to children and teens.  These fractures require the surgeon to understand the ramifications of their fracture management on the patient’s further growth and long-term ankle function. 

Dr. Patel: There are a number of injuries that are relatively rare, but unique, to young children. These are easy to miss and can result in significant functional problems later in life. One example is fractures of the tibial spine (the ridge of the bone on top of the shinbone), which is when the bony attachment of the ACL fractures from the tibia, or the shinbone. Another injury is known as the Monteggia fracture-dislocation, in which the ulna, a bone in the forearm, is fractured and the radius dislocates at the elbow. Such injuries may be subtle, but they require prompt, appropriate care.

 

What are some potential long-term effects of bone fractures on children? 

Dr. Finlayson with patient Eloise

Dr. Finlayson: Fractures in young patients have the potential to cause problems with the future growth of the bone. The most vulnerable part of the bone is the growth plate, which is a layer of cartilage where bone growth occurs. Fractures that involve the growth plate may cause damage that limits the future growth of the bone, resulting in shortening or angular deformity of the bone.  

Even fractures that do not involve the growth plates can cause issues with growth. For example, a fracture of the femur (thigh bone) may cause the bone to grow more rapidly than normal, while certain fractures of the tibia (shinbone) may result in asymmetric growth that causes an angular deformity. Pediatric specialists are aware of these potential complications and have training to help prevent, monitor and treat them. 

Dr. Patel: Children are vulnerable to fractures that are either very subtle or uncommon in adults. These are easy to miss and can result in significant functional problems and deformity later in life. For this reason, it is important to ensure that the child is seen by someone that is experienced in caring for young patients so that appropriate and timely treatment can be provided.

 

What special training or experience do Lurie Children’s orthopedic and sports medicine specialists have to help young people dealing with bone fractures and/or sports injuries? 

Dr. Finlayson: All of our providers have completed additional fellowship training specific to Pediatric Orthopedics and practice exclusively at Lurie Children’s, so we have a vast amount of experience in dealing with these unique injury patterns and patients.

Dr. Sagan: Beyond our specialized pediatric orthopedic fellowship training, we all maintain membership in the Pediatric Orthopedic Society of North America and other specialty organizations to ensure that we stay up to date in cutting edge research and pediatric orthopedic surgical procedures/techniques.

 

Is surgery always necessary when a bone is fractured? When might it not be, and how are those patients treated?

Dr. Finlayson: Surgery is not always necessary for a broken bone.  In fact, many fractures that are treated with surgery in adults will heal well for children with simple immobilization in an appropriate cast. Depending on the type of fracture, the bone may need to be realigned prior to casting, however. Even though realignment is not technically a surgical procedure, sedative medications or general anesthesia is often utilized to maximize patient comfort and facilitate realignment of the bone during cast application. Treatment with casting avoids scarring and the potential for complications related to surgery and surgical implants. 

Dr. Sagan:  Casting itself is an art. The right casting technique may be able to maintain a fracture in the proper position.  Too much or too little padding, where pressure is applied, how much cast material is used and understanding of which cast may need to be adjusted over time can all have huge impact on the success of cast treatment.

 

Beyond specialty training in pediatrics and having a nationally ranked orthopedic program, what else makes Lurie Children’s a top choice for patient families dealing with fractures or sports medicine injuries?

Dr. Sagan: At Lurie Children’s, we have all of bases covered.  No matter what your fracture or sports injury may be, our team will be able to care for your problem no matter how big or small.  At several clinic locations and at all our operating room locations, including Northbrook and Westchester, we also have child life specialists who function to make stressful visits less so through age appropriate distraction tools and education. This is just another example of what sets our pediatric orthopedic experience at Lurie apart from the rest. There are also providers available five days a week at some locations, and several locations have family-friendly early morning and evening hours.

​Dr. Patel: We cover just about every clinical subspecialty in pediatric orthopedics and are available within Chicago but also in almost every direction outside of the city. With the development of telemedicine, our reach expands even further. Many of our surgeons are nationally recognized experts in their field or active leaders in research, so children in the Chicago area truly have access to some of the most cutting edge and well-researched care. Finally, beyond just the pediatric orthopedists at Lurie, our patients are treated by a large team of nurses, advanced practice providers, radiologists, anesthesiologists, physical therapists, and many others that are experienced and dedicated to specifically caring for children and teens.