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Bone Fractures in Children Honest Expert Advice
Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis, answers some common questions about bone fractures. Is there a difference between broken bones and fractures? No, these are two different names for the same injury. Of course the common term is a broken bone. Using either name will describe your concerns. Medical personnel typically describe a broken bone as a fracture to a specific bone. For example, a broken wrist is also a fractured distal radius. To clarify, this describes the injured bone and the precise location. How do I know if my child has broken their bone? Many times children will fall and complain of their arm or leg hurting. In most cases the pain goes away and the child will return to their activities. When there is a deformity to the limb (curve in arm) and the child is complaining of pain, it is probably a fracture. If the arm or leg looks straight, look to see if there is any swelling or bruising. Both are signs of a possible fracture. Finally, if the limb looks normal but the child continues to complain, gently push on the bone. Likewise if it causes the same pain, then they likely have a fracture and should have an x-ray. My child fractured their growth plate, what does this mean? Growth comes from this area of the bone. In detail, these are located all over the body but typically at the end of the bones. With this in mind, fractures to these areas can result in the bone growing abnormally. Because of potential shortening of the arm or leg, or bones growing crooked, it is important to follow fractures closely (up to 1-2 years or longer). It is better to identify a problem early. Small problems can be treated with small surgeries. What if the bones of the x-ray do not line up? Because children are growing, unlike adults, their bones will remodel and straighten with growth. The amount of remodeling occurring depends on a child’s age, the bone fractured and the location. In many cases an angled bone will grow straight over the course of a year. For this reason, someone with experience in caring for children needs to follow bone growth. How long does it take fractures to heal? Factors deciding when a cast can come off include: Child’s age. Bone fractured. Fracture location. Young children heal faster than teens, teens heal faster than young adults, who heal faster than older adults. In young children most fractures heal in 4-6 weeks. However, teens generally take 6 weeks to heal, and adults can take much longer. Although your child is out of their cast, it may not be healed completely to return to all activities. Placing a splint is during this time is common. This typically gives them added protection for several weeks after their cast is removed - in case they forget their limitations. What if my child is still limping? Whether a child is in a walking or non-weight bearing cast, removing it often leaves them stiff and sore. Therefore many children will walk as though they still have a cast in place. In most cases this resolves in about three weeks. Regardless, if your child is still limping or walking abnormally after three weeks, contact the treating doctor. They may benefit from physical therapy or a repeat evaluation. (This article was original published in the July 2019 issue of South Reno Kids & Sports.)
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Tummy Trouble? Renown Children’s Hospital Adds Another New Specialty, Pediatric Gastroenterology
Two pediatric gastroenterologists bring life-saving care to kids and make Renown their new home The Renown Children’s Hospital team and our community is celebrating the addition of a new life-saving pediatric specialty to its practice serving children and families in northern Nevada. Parents and guardians will now be able to seek professional pediatric gastroenterologist care with the addition of Drs. Juan Gregory and Kathleen Holland to Renown Medical Group. “Recognizing the importance of diagnosing and caring for children who have conditions that affect the organs in the digestive system, including the stomach, liver and bowel, while also helping children who have issues feeding and eating, is critically important to us at Renown,” said Kristina Deeter, MD, MBA, FAAP, Chair of Pediatrics, University of Nevada Reno School of Medicine (UNR Med) and Physician-in-Chief, Renown Children’s Hospital. “Both Drs. Gregory and Holland are superb clinicians, we are excited to have them join Renown Children’s Hospital to offer pediatric gastroenterology services, including a wide range of complex and vital procedures and screenings, endoscopies and colonoscopies.” Juan Carlos Gregory, MD, has 18 years of experience caring for children in northern Nevada. He is a clinical associate professor of pediatrics at UNR Med with a special interest in celiac disease, abdominal pain, and gastroesophageal reflux in children. Gregory earned his undergraduate degree at Texas Christian University in Fort Worth, TX before completing his medical training, including a residency in pediatrics at the University of San Diego in Pediatrics and fellowships in Pediatric Gastroenterology and Nutrition at both Children’s National Medical Center in Washington, DC, and at the National Institutes of Health, Digestive Disease Section in Bethesda, MD. He is board-certified in Pediatric Gastroenterology and speaks Spanish. Kathleen Holland, MD, MPH brings a global health perspective to her work caring for children. A graduate of the University of Nevada Reno School of Medicine (UNR Med) with her medical doctorate and her master’s in public health with a social and behavioral health emphasis, she has donated her skills to providing international medical relief for children in Uganda and Nicaragua. Holland earned her undergraduate degree at University of Nevada Reno in Biology, Health Ecology and Healthcare Ethics before completing her medical training and residency in Pediatrics and a fellowship in Pediatric Gastroenterology at Indiana University School of Medicine in Indianapolis, IN. Her research and scientific interests include vaccination rates and family barriers among children with inflammatory bowel disease, Crohn’s and colitis, pediatric autoimmune pancreatitis, and cystic fibrosis. How Pediatric Gastroenterologists Help Children and Families The Pediatric Gastroenterology Program at Renown Children’s cares for children experiencing common GI-related problems of childhood; nausea, vomiting, abdominal pain, diarrhea, constipation, reflux, colic, milk protein allergy, poor growth and feeding difficulties, and sees patients from infancy to 18 years old. “As specialists in the care of children with gastrointestinal and liver problems, we focus on the diagnosis and treatment of these issues,” said Larry Duncan, MD, Vice President of Pediatrics and Surgery & Administrator of Renown Children’s & Women’s Services. “Our physicians play an active role in teaching and research. We have several areas of expertise including prevention, diagnosis and treating disease of the digestive tract including the esophagus, gallbladder, stomach, pancreas, colon, small intestine and liver disease.” Special expertise includes: Pediatric feeding and growing disorders Aerodigestive disorders Food and hypersensitivity disorders Inflammatory bowel disease Celiac disease Liver diseases Children requiring parenteral and enteral nutrition Renown Children’s Hospital is the only dedicated children’s hospital in northern Nevada, offering programs and services for families from a 100,000 square mile area, from Sacramento, CA to Salt Lake City, Utah. Renown Children’s provides the area’s only Children’s Emergency Room, Pediatric ICU (PICU), children’s imaging center and the largest neonatal ICU (NICU), a level III intensive care unit. Specialty Children’s Care at Renown Today, over 90% of families in northern Nevada seek care from the experts at Renown Children’s Hospital. “We are so grateful to the William N. Pennington Foundation for its support in establishing the William N. Pennington Fund for Advance Pediatric Care in 2016, which allowed us to hire our first 15 pediatric specialists,” said Dr. Deeter. “Today we have over 40 pediatric physician specialists at Renown Children’s Hospital who provide care in adolescent medicine, pediatric endocrinology, pediatric hematology/oncology, pediatric pulmonology, pediatric neurology, pediatric nephrology, pediatric infectious diseases, pediatric ophthalmology, pediatric orthopedic surgery, pediatric cleft and craniofacial surgery, pediatric urology, pediatric dentistry, pediatric emergency medicine, and now, pediatric gastroenterology. Our clinicians provide 30,000 patient visits annually, offering an exceptional level of care. The Pennington gift is truly a gift that keeps giving to the families in our area.” Now Being Constructed: Expanded Inpatient Care at Renown Children’s Hospital New construction of an expanded Neonatal Intensive Care Unit (NICU) with increased capacity to 49 bassinets, an expanded Pediatric Intensive Care Unit (PICU) with increased capacity to 16 private patient and family rooms, and a new Renown Children's Hospital inpatient floor with increased capacity for 38 private patient and family rooms for a total capacity of 58 pediatric beds are currently being constructed on Tahoe Tower, Level 5 of Renown Regional Medical Center. It is expected that the new units will open to patients and families in April 2023. In the most recent US News & World Report Best Hospital rankings, Renown Regional Medical Center was named as the number one hospital in Nevada. Ningún otro hospital del estado cumplió con sus estrictos estándares para el ranking de 2021. Renown Health is High Performing, its highest rating possible, in eight procedures and conditions including Heart Failure, Colon Cancer Surgery and Chronic Obstructive Pulmonary Disease, Hip Replacement and Knee Replacement. A hospital's score is based on multiple data categories, including patient outcomes, safety, and volumes. Los hospitales calificados como sobresalientes eran significativamente mejores que el promedio nacional. Renown Medical Group is an in-network provider for Hometown Health and other health plans. Drs. Gregory and Holland are pleased to see new patients at their location at the Renown Children’s Subspecialty Clinic inside Renown Regional Medical Center at 75 Pringle Way, Suite 505, Reno, Nev. Ask your pediatrician for a referral to a medical specialist when further evaluation of a particular issue is necessary. About Renown Health Renown Health is Nevada’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in a community-based genetic population health study, the Healthy Nevada Project®. About UNR Med The University of Nevada, Reno School of Medicine (UNR Med), Nevada’s first public medical school, is a community-based, research-intensive medical school with a statewide vision for a healthy Nevada. Since 1969, UNR Med has trained more than 3,900 students, residents, and fellows. UNR Med continues to improve the health and well-being of all Nevadans and their communities through excellence in student education, postgraduate training and clinical care, research with local, national and global impact and a culture of diversity and inclusion. For more information, visit med.unr.edu.