UBMD pediatric orthopedist discusses common problems affecting young kids and lists the most accident-prone sports (yes, football tops the list)
By Chris Motola
Q: Pediatric orthopedics isn’t necessarily a specialty a lot of people come into contact with. What kinds of issues do you treat?
A: Pediatric orthopedics is a very broad spectrum specialty even as it’s a fairly unique one. I see patients from day zero of life up through 21 years old. We treat everything from congenital hip dysplasia or hip dislocation to sports injuries in a 17-year-old athlete. So it’s a wide range of things. And we treat traumas in all these individuals. A broken arm in a baby is different than in a skeletally mature teenager.
Q: And that’s because the bones aren’t fully formed?
A: Correct. A child has growth plates in multiple areas of their bones. The growth can be altered by the injury. But the other side of that is their remodeling potential in children. If their growth plates aren’t damaged, they can remodel a lot of different fractures and injuries that adults can’t. But if their growth plate is damaged in the initial trauma, there may be a growth disturbance as they develop. And sometimes that needs to be addressed. With a skeletally mature teenager, we’re going to treat that fracture more or less the same way we would an adult’s. It’s all related to growth.
Q: At that age are we mostly talking traumas?
A: The biggest thing that I see, especially in the summer, is fractures. Children tend to be rambunctious and, in the summer, you have all the sports and trampolines and monkey bars. So the most common thing is upper extremity fractures. Some of the other common things we see are hip dysplasia and clubbed feet.
Q: How do you treat deformities?
A: For hip dysplasia, the treatment varies depending on the severity and the age of the patient. For instance, if the child is born breech, they’ll get an ultrasound screening from their primary care physician. A lot of times it’ll show mild dysplasia. If that’s the case, we treat them with a harness that they’ll wear full time for about three months, which usually takes care of it. Now if a child is born with a dislocated hip, that can be more problematic. The child may have to go the operating room for a closed or open reduction and then put in a full-body cast. Once in a while, we get a child whose parents never sought care and is now 5 or 6. For those children their pelvic bones need to be cut and reshaped. So the treatment does vary quite a bit depending on the age and the severity.
Q: Do you perform those types of surgeries?
A: Yes, I do. I do everything from non-operative treatment to treatments of every part of the muscular skeletal system, including surgeries.
Q: I remember as a child having to go down to the gym for scoliosis screenings every year. What’s the deal with scoliosis?
A: I just did a scoliosis surgery yesterday! Scoliosis is another thing we do see a lot of. The treatment of that does vary a lot depending on the severity. The vast majority of kids with scoliosis just need to be watched. If the curve reaches 25 degrees and they’re still skeletally immature, then we’ll brace them. If it goes beyond 50 degrees then we’ll do surgery. Otherwise we just observe.
Q: Is it not worth intervening at less than 25?
A: Scoliosis is mostly a cosmetic thing. Studies show that it won’t continue into adulthood if it’s less than 50 degrees. If it’s above that, it’ll progress about 1 to 2 degrees per year, which can lead to deformity and even pulmonary issues. Less than that we haven’t found it to cause any functional difficulties whatsoever.
Q: Do parents have a good sense of what their kids can and can’t take? Are they overcautious? Reckless?
A: There’s a wide variety of parents. We’ll see anxious parents bring in their perfectly normal child for a gait disturbance. Or they’ll bring in their toddlers for in-toeing, which is a normal growth pattern for their gait. And then you have parents who will only bring their kids in when they can barely walk. So the spectrum is very wide, and a big part of my practice is managing families. I’m a mom myself, so that helps me relate to them, even the over-anxious parents. I try to put myself in their shoes and try to reach them that way. But, yeah, there’s a huge spectrum of personalities and parenting styles. I think the important thing for parents to understand is that children’s bones are not the same as adults, and there are some unique problems that can occur. I think parents should trust their guts. If they think something is wrong, they shouldn’t ignore it.
Q: Have cultural and technological changes affected the types of injuries and issues you see? I have a standing desk now to help deal with some posture-related issues. I’m wondering if those issues are showing up in younger people now.
A: Yeah, in young patients, the biggest newer development is stress-related injuries related to overuse. One of the causes is that a lot of children are doing a single sport year-round now. There are a lot of repetitive injuries that can occur to their growth plates. For example, throwing athletes can damage the growth plate in their humerus [a long bone in the arm or forelimb that runs from the shoulder to the elbow]. Back in the day, kids didn’t play year-round or quite so competitively. In gymnasts we see back issues, wrist issues. And many of these are unique to children because they involve injury to growth plates.
Q: I take it the sports medicine side of your practice usually involves teens?
A: For the most part. Once in a while we’ll get a 10-year-old boy with a growth plate injury because his parents make him pitch 200 throws a day. But for the most part it is teenagers.
Q: Which sports are the biggest culprits?
A: Football is huge is the fall. Lots of football injuries. Soccer is also pretty big. For girls cheerleading is pretty big, believe it or not. Gymnastics is a pretty big one. Football is probably the biggest, though. From football, we get a lot of forearm fractures, even femur fractures, hip dislocations. So they can be pretty bad, but usually it’s an arm fracture.
Name: Allison S. Binkley, M.D.
Position: Pediatric orthopedist with UBMD Orthopaedics & Sports Medicine; clinical assistant professor at University at Buffalo; specialist in pediatric orthopedics, scoliosis and sports medicine
Education: University at Buffalo
Affiliations: Oishei Children’s Hospital
Organizations: American Academy of Orthopedic Surgeons; American Medical Association
Family: Husband Matthew, also an orthopedic surgeon with UBMD Orthopaedics & Sports Medicine; a daughter, Ava; and another child on the way
Hobbies: Working out, running, baking