What is new regarding pediatric orthopedic surgery?

Transcript (edited for clarity):

Contemporary Pediatrics®:

Hi, and thank you so much for joining us. I'm Joshua Fitch, editor of Contemporary Pediatrics®.

Jeanne Franzone, MD:

Thanks so much, Joshua. I'm Jeanne Franzone, a pediatric orthopedic surgeon at Nemours Children's Health in the Delaware Valley.

Contemporary Pediatrics:

Dr. Franzone, thank you so much for joining us. For our audience, what is kind of "new" when it comes to pediatric orthopedic care and surgery? Is there kind of one type of surgery more prevalent than others recently and are maybe more happening now compared to a year or two ago? Can you give us an update of what you've been seeing recently?

Franzone:

Yeah, that's a great question. Pediatric orthopedic surgery is a very broad field. We take care of children with musculoskeletal injuries, as well as other conditions, some of which children are born with. We also at Nemours, Children's Health, here in the Delaware Valley, have a number of multidisciplinary specialty programs, which I think also sets us apart in addition to the care of otherwise healthy children who come in with injuries. We do, now being summertime here in the northeast, we do see a rise in fractures during the summer. So our trauma programs are quite busy managing a number of injuries, we're a level-1 trauma center. So some kids will come in with injuries to our fracture clinic and others you know, will need to be flown in to the to the emergency room. As sports pick up in the fall, we do tend to see a little bit of a rise in in sports injuries as well.

Contemporary Pediatrics:

Thank you Dr. Franzone. W hat should general pediatricians, pediatric health care providers know when following up with a patient that maybe has gone through a surgery? Any signs they can watch for depending on a specific surgery or in general?

Franzone:

Yeah, that's a great question, Joshua. When I think about us, as orthopedic surgeons, partnering with pediatricians, I really think of us as partners in the in the overall care of children. As far as routine care for children coming in for perhaps elective orthopedic surgeries, or even when a fracture does happen, again, I think of us as partners, keeping children as healthy as possible. So, the united front in terms of encouraging kids to have a healthy amount of activity, keeping weight healthy can really help minimize risks coming into surgery, making sure kids are getting enough vitamin D, in their diets, or taking appropriate supplements to keep their bones healthy, can be very helpful. All of those can help optimize the recovery. Then, I really like to have open lines of communication with our patients' pediatricians. If there is a concern that is raised we certainly like to know about it. We [encourage the pediatrician] to reach out to us with any questions about post-operative activities, managing incisions. And again, really keeping nutrition healthy to minimize complications.

Contemporary Pediatrics:

Can you speak to how the age of the child can potentially change one of these fractures? Same fracture in an 8-year-old versus a 16-year-old per se? What are some of the changes there as the children progress and see some of these same injuries?

Franzone:

Yeah, age does make a big difference in terms of the types of fractures that we see and I think this really hones in on the point that children are not small adults. There are very specific concerns related to many pediatric fractures. For example, fractures that happen, either very close to or through a growth plate, require very special considerations in terms of how we manage them. Then ongoing follow up as well because children can develop a growth disturbance for a period of time following that type of fracture, so even once kids with a growth plate fracture are healthy and back doing all of their activities, it is important for them to come for those routine growth checks. That's an important consideration. Then the other unique thing about pediatric fractures, and particularly the younger the child, the more potential they have to do something called remodeling. So, a child can have a fracture with a certain amount of angulation to it and depending on where that fracture is, what part of the bone it's in and how close it is to a growth plate, over time, they have the ability to grow that bone straight. That's where we come in as pediatric specialists, helping guide families through that, doing surgeries when we need to for fractures, but also avoiding surgery when we can.

Contemporary Pediatrics:

Let's talk about prosthetics a little bit. Just generally first, what kind of new technologies, if any, are there when it comes to prosthetics? Can you kind of speak to how the children are affected when use of a prosthetic is needed, regardless of age or how age makes a difference once again?

Franzone:

Yeah, thanks for that really interesting question. We're fortunate at our hospital to have a multidisciplinary clinic for children with lower extremity amputations, who use prostheses and it's a patient population we really enjoy working with very much. There's many reasons that for which a child may need an amputation of a lower extremity and to use a prosthesis, some because of traumatic events, some because of cancer, or a tumor, some because of a congenital birth difference and the list really goes on. There's many different conditions and we use our multidisciplinary team to really guide families oftentimes, if it's an elective surgery, through the surgical decision making, through the recovery, the wound healing, and then optimizing function and recovery afterwards. So I work really closely with rehabilitation medicine specialist, with our physical therapy colleagues, with our prosthetists. We also have tremendous psychosocial support for both the children, their siblings, and their families going through an event and helping them adjust and cope is they reenter activities and the school environment. In terms of new developments, one of the really exciting things is, you know, prosthesis components are advancing quite rapidly. We have options now, for various types of running blades that can really maximize a child's ability to participate in various sports and athletics, we have other specialty types of prostheses. When we think about a knee joint for example, in a prosthesis, there's been a lot of advances in terms of computerized programming, and really trying to help that prosthesis function as naturally as possible and adjust to different types of ground surfaces and terrain. The other advances children are very rough on their components, and we love that. Running, playing, and being as active as possible. So they do need to be very durable, and some of the newer materials coming down the pipeline have really helped in that regard.