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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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American College of Surgeons Awards Level II Pediatric Trauma Designation to Renown Children's Hospital
(Pictured Above: Dr. Frieda Hulka, Pediatric Trauma Program Medical Director at Renown Children’s Hospital, helps announce pediatric trauma verification on Wednesday, Feb. 7, 2024) Renown Health, a locally governed, not-for-profit academic healthcare network serving northern Nevada, Lake Tahoe and northeast California and the teaching hospital for the University of Nevada, Reno School of Medicine, has been verified as the first level-2 pediatric trauma center in northern Nevada by the American College of Surgeons (ACS). This recognition is a historic first for children’s healthcare in northern Nevada. Renown Regional Medical Center is the region’s only Level II Trauma Center (adult) and one of the largest hospitals in the United States, with 826 licensed beds, providing care to approximately one million patients across 17 counties, across 100,000 square miles between Sacramento and Salt Lake City. Serving urban, suburban, and rural communities, Renown Health is one of the region’s only providers of neonatal care with both a pediatric intensive care unit (PICU) and the largest newborn intensive care unit (NICU) in the area. RENOWN ONLY ONE OF TWO IN NV; ONE OF 153 IN THE US The pediatric trauma verification by the ACS recognizes that the Renown team offers immediate, around-the-clock, emergency treatment for pediatric trauma patients. Renown is one of only two health systems to receive the designation of a Level II Pediatric Trauma Center in Nevada by the ACS; and the first in northern Nevada to earn this national distinction. To achieve verification, the hospital must meet rigorous standards for comprehensive care, staffing, facilities, research, and educational contributions. Nationwide, only 153 hospitals are pediatric trauma centers. The new status considers trauma treatment capabilities of Renown’s pediatric emergency department as well as the ability of Renown Children's Hospital to offer such services as pediatric surgery, pediatric intensive care unit stays and pediatric physical and occupational therapy to children recovering from traumatic injuries. EXTENSIVE ON-SITE REVIEW “This new achievement was granted after an extensive on-site review conducted by an expert team from the American College of Surgeons; a group dedicated to improving the care of surgical patients and safeguarding standards of care in a safe, optimal and ethical practice environment,” said Brian Erling, MD, MBA, President & CEO of Renown Health. “We are proud that Renown Regional Medical Center has earned the designation of being the only ACS verified Level 2 Trauma Center for adults in the region since 1984. This verification process, renewed every three years, was completed in late December 2023 alongside the new verification for Renown Children’s Hospital. Now with UNR Med, we celebrate serving our community with a robust Level 2 Pediatric Trauma Center; and have grown to become a nationally recognized children’s hospital with a robust academic department of pediatrics.” “The team at Renown Children’s Hospital consistently provides outstanding pediatric trauma care, and we are thrilled that the American College of Surgeons has awarded us with this official distinction,” said Dr. Frieda Hulka, Pediatric Trauma Program Medical Director at Renown Children’s Hospital. “This is particularly significant for families in northern Nevada, where trauma remains the leading cause of death in infants and children. Some nationwide studies show that children treated at pediatric trauma centers have a lower mortality risk compared to children treated at other facilities.” This year marked the first time the emergency department's pediatric capabilities were evaluated separately. To be a designated Level II Trauma Center, a hospital must have 24-hour immediate coverage by general surgeons and multiple specialties, such as orthopedic surgery, neurosurgery, and emergency medicine. In addition, the hospital must provide trauma prevention and ongoing education for its teams and incorporate a comprehensive quality assessment program. The emergency department did not meet the minimum volume of 200 pediatric trauma patients per year to qualify for the level-1 pediatric designation, but the Renown team anticipates with growing community support, combined with UNR Med’s research and residency programs, that they will pass this threshold in the future. “More than 100,000 children between the ages of zero and 17 live in Washoe County, and that number continues to grow,” said Nicholas Mannering, Trauma Program Manager at Renown Health. “Caring for our community’s children is a responsibility we take extremely seriously, and we are so grateful to our patients and the families for trusting us with their care.” “Both the pediatric and adult trauma verification honor the many pioneering trauma physicians, surgeons and clinical and support teams who have built a stellar reputation over the last 160 years for Renown; and align with our strategic vision for providing comprehensive and best-in-class healthcare for the people of northern Nevada for the next 160 years,” said Chris Nicholas, CEO of Renown Regional Medical Center. “These designations celebrate our team’s commitment to maintaining and exceeding the highest standards of care for our patients.” GRATEFUL DONORS INVEST IN NORTHERN NEVADA’S CHILDREN In 2016, The William N. Pennington Foundation recognized the need for enhanced care and expertise for pediatrics and donated $7.5 million to Renown Children’s Hospital to establish the William N. Pennington Fund for Advanced Pediatric Care. “Through these gifts,” adds Kristina Deeter, MD, MBA, FAAP, Chair of Pediatrics (UNR Med) and Physician-in-Chief, Renown Children’s Hospital, “100,000 area children now have access to more than 30 pediatricians, including general pediatricians and specializing specialists in oncology, orthopedics, pulmonology, emergency medicine, urology and many other subspecialties previously lacking in the community, as well as a pediatric emergency room, pediatric ICU and a dedicated pediatric floor at Renown Children’s Hospital. Prior to 2016, a significant percentage of pediatric patients requiring critical and specialty care had to be transferred outside of our region to receive the specialty care they needed. Now, thanks to donor support, Renown estimates that 97% of all pediatric patients and their families can receive both general and specialty pediatric care locally. The next nearest children’s hospital in the state is 7 hours or 438 miles away in Las Vegas.” In 2022, the hospital treated 82,544 patients, performed 26,388 inpatient and same-day surgeries, gave care to 37,380 children through its pediatric providers, and delivered 3,792 babies. In June 2023, Renown Regional Medical Center expanded its pediatric critical care services to the region with a New Neonatal Intensive Care Unit with advanced technology and trained healthcare professionals to give special care for women and babies. Renown also has a Neonatal Transport Team which brings infants with serious illnesses, injuries, or complications from outlying communities to the comfort of Renown's NICU. In July 2023, The University of Nevada, Reno School of Medicine (UNR Med) and Renown Health welcomed members of the first resident class of the new UNR Med Pediatric Residency Program. Renown Health is a 501 c3 not for profit organization. Donations to the Children’s Hospital are needed and accepted here. About Renown Health Renown Health is the region’s largest, locally governed, not-for-profit academic healthcare network serving Nevada, Lake Tahoe, and northeast California. Renown Regional Medical Center is the teaching hospital for the University of Nevada, Reno School of Medicine. 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 for both adults and children, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health.
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Renown Regional Medical Center reconocido como mejor hospital en Nevada por US News & World Report
Best hospital for patients with complex, life-threatening or rare conditions; rated highest in NV in eight specialty areas. US News & World Report publicó recientemente sus rankings de Mejores Hospitales 2021, donde ubicó al Renown Regional Medical Center en el primer puesto para el estado de Nevada. Ningún otro hospital del estado cumplió con sus estrictos estándares para el ranking de 2021. Las instituciones que componen los rankings de Mejores Hospitales de 2021-22 se seleccionan de entre un conjunto de 4,523 instalaciones, que representan a casi todos los hospitales estadounidenses que brindan atención para pacientes hospitalizados. Los hospitales se evalúan según una amplia gama de condiciones y procedimientos, incluidas 16 áreas de especialidad médica. US News & World Report evaluó 58 hospitales en Nevada. Only one, Renown Regional Medical Center in Reno, NV, met the high U.S. News standards to rank the #1 hospital in the state. We constantly strive to be among the best in the nation for quality, safety and patient experience," said Tony Slonim, MD, DrPH, FACHE, President and CEO of Renown. "This ranking confirms what the Renown Health team has always been dedicated to - providing the best patient care possible. Quality and safety are the responsibility of every employee and physician at Renown, and we are proud that Renown Regional Medical Center has been chosen as the best in the state and among the best in the nation." "We thank the incredible physicians, nurses, employees and volunteers across our organization for their dedication to excellent patient care. We know that our patients and our community who benefit from our care are the true award winners," said Erik Olsen, FACHE, MHA, CEO of Renown Regional Medical Center. "We applaud the Renown team and our Medical Staff as being not only the best in the state, but among the best in the nation." Además, el Renown Regional Medical Center tiene una calificación “sobresaliente”, la más alta posible, en ocho procedimientos y afecciones, lo cual lo coloca entre el mejor 10 % a nivel nacional y el de mayor reconocimiento en Nevada para las siguientes áreas de especialidad: Cancer, including Colon Cancer Surgery and Lung Cancer Surgery; Cardiology & Heart Surgery, including Heart Failure; Abdominal Aortic Aneurysm Repair; Aortic Valve; Heart Bypass Surgery; Transcatheter Aortic Valve Replacement (TAVR); Heart Attack; Diabetes & Endocrinology, Diabetes; Gastroenterology & GI Surgery, including Colon Cancer Surgery Nephrology, including Kidney Failure; Neurology & Neurosurgery, including Back Surgery (Spinal Fusion), Stroke; Orthopedics, including Back Surgery (Spinal Fusion), Knee Replacement, Hip Replacement, Hip Fracture; Pulmonology & Lung Surgery, including Lung Cancer Surgery, Chronic Obstructive Pulmonary Disease (COPD) and Pneumonia. "The ability to have a positive impact on people's lives through the care we provide, investing in improving the health of our community and working in service to others, is a tremendous gift," said Sy Johnson, MBA, Chief of Staff for Renown. "To be nationally recognized as being a leader in caring for other is a tremendous honor to our entire team." In an innovative, public-private partnership, Renown Health and the University of Nevada, Reno School of Medicine recently established Nevada's first integrated health system to advance health and health care through world-class medical education, clinical research and patient care. "We are humbled by this national recognition," says Thomas Graf, MD, Chief Clinical and Quality Officer for Renown. "Our goal is to produce the greatest value by working with physician partners to deliver care of highest clinical quality. Renown has a national reputation for delivering excellent care using approaches that are creative, innovative and maximize technology, and it is exciting to see the team recognized for their extraordinary contributions across the medical center and in eight specialty areas including cancer care, cardiac care, surgery and neurosciences." El puntaje de un hospital se basa en múltiples categorías de datos, que incluyen Resultados y experiencia de los pacientes (48.2 %), Reconocimiento profesional (36.1 % del puntaje), que incluye avales de organizaciones nacionales respetadas que demuestran estándares altos, y Programas, servicios y personal clave (15.7 % del puntaje), en la atención de pacientes difíciles que exigen atención práctica y experiencia altamente especializada. Higher numbers suggest better survival odds, fewer complications and more patients treated. Los hospitales calificados como sobresalientes eran significativamente mejores que el promedio nacional. Hospital rankings are determined by an extensive data-driven analysis combining performance measures in three primary dimensions of healthcare: structure, process and outcomes. The data source for most structural measures is the American Hospital Association (AHA) Annual Survey. US News & World Report seleccionó al Renown South Meadows Medical Center como hospital n.º 1 en 2020. Renown Health has been recognized by several national organizations for excellence and quality. Awarded by the American College of Surgeons for the 30th year, Renown Regional Medical Center is northern Nevada's only designated Level II trauma center. Renown Regional ganó el premio America's 250 Best Hospitals Award™ (2021) por estar entre el mejor 5 % del país en brindar calidad clínica de forma constante. Other national recognition and accomplishments are listed below. About Renown Health Renown Health is the region's largest not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. 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 region's largest, locally owned, not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in the world's largest community-based genetic population health study, the Healthy Nevada Project®. Visite renown.org para obtener más información. About US News & World Report US News & World Report is the global leader in quality rankings that empower people to make better, more informed decisions about important issues affecting their lives. A digital news and information company focused on Education, Health, Money, Travel, Cars and News, USNews.com provides consumer advice, rankings and analysis to serve people making complex decisions throughout all stages of life. Más de 40 millones de personas visitan USNews.com cada mes para hacer averiguaciones y obtener orientación. Fundada en 1933, US News tiene su sede central en Washington, D.C.
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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.