MDNews - Long Island

treatment. Co-management guarantees continuous expert medical management even if Dr. Gaffney or his pediatric ortho- pedic colleagues are treating other patients. "Pediatric attendings, residents and nurses are all trained to provide care, so we maintain constant contact with patients no matter which stage of treatment they're in," Dr. Gaffney says. "In case of emergencies, these providers always have access to an orthopedic specialist, but this relationship is important because it allows constant medical supervision. Following surgery, care management on the floor is a critical component to optimizing outcomes." New Generations of Treatment Pediatric orthopedic surgeons at Winthrop-University Hospital treat the full spectrum of trauma-related, congenital and developmental musculoskeletal disorders using surgical and non-surgical techniques. Many children present to the Pediatric Emergency Unit with trauma-related inju- ries, which require personalized treatment. Traditional methods of stabilization, such as intramedullary rods with flexible nails, still are used often, but some fractures are not effectively stabilized by this method. For example, femur fractures are more conducive to submuscular plating because of the forces necessary to achieve stabilization and proper healing. "Treatments such as external fixation of fractures that were common in the 1980s and 1990s have fallen out of favor because complications began to arise," Dr. Gaffney says. "Flexible nails alleviate some of these complications, but since no one treatment is excellent for all fractures, the evolution continues. Right now, submuscular plating gives options in addition to flexible nails and rigid intramedullary rods." Submuscular plating is a leading-edge technique for fracture fixation that reduces complications associated with some tradi- tional techniques. "Submuscular plating involves placing a plate under the muscle — along the length of bone — where it reaches above and below the length of the fracture, leaving the periosteum intact and as much soft tissue attached to the fracture site as possible," Dr. Gaffney says. "We obtain alignment of the fracture and, through small incisions, place small screws to fix the plate to the bone. This allows us to leave the soft tissue envelope in place as much as possible." Humerus fractures require careful pin placement to avoid neurologic injury to the ulnar nerve. Treating Everyday Athletes Overuse injuries are an increasing trend in children, as delineations between athletic seasons become less defined. "These injuries are much more common in children today than in past generations because of the amount of athletic activ- ity children participate in," Dr. Gaffney explains. "Now, it's much more common to be involved in multiple sports within the same season. It's also common for children to play one sport throughout the year, which leads to some parts of the body being injured from repetitive force." Commonly, overuse injuries involve the knee, elbow or shoulder, and occur in children who participate year-round in a sport such as baseball, gymnastics or others that require repetitive motions that place stress on a specific part of the body. The unnatural pitching motion in baseball generates significant strain in TREATING THE MECHANISM FOR GROWTH WHEN GROWTH PLATES are damaged, several complications can arise. If an injury is severe and results in permanent damage, the growth plates prematurely transform into bone. If growth plate cells are damaged and cannot grow, the bones will stop growing altogether, which can lead to asymmetric growth and angular deformity. Growth plate injuries are graded on a scale from one to five, where five is complex and not amenable to treatment, other than anatomically reducing the associated fracture. For less severe injuries, treatment is patient-specific. When angular deformities or premature closings occur, pediatric orthope- dic surgeons focus on correcting the deformities. Growth plate injuries exemplify the error in the frequently held misconception that, physiologically, children are merely smaller adults. Children who experience trauma- related orthopedic injuries benefit from evaluation and treatment by a pediatric orthopedic specialist. "Whenever injuries do not resolve as expected, look to your colleagues in pediatric orthopedic surgery," says John T. Gaffney, DO, FAAOS, Chief of Pediatric Orthopedic Surgery and Vice Chair of the Department of Orthopedic Surgery at Winthrop-University Hospital. "Caring for pediatric injuries can be complicated, as growth can dictate treat- ment plans. We specialize in such complex medical management." Dr. Gould reviews an imaging study of a patient. SPECIAL CLINICAL SECTION: ORTHOPEDICS 1 8 | Long Island MD NEWS n M D N E W S . CO M

• Cover