Most playground injuries require specialist, not hours in ER
costly – and, in the end, not be the most ideal care solution for the child, advises orthopedic surgeon Alejandro Badia M.D.
“If parents suspect their child has a joint sprain or broken bone, best option is go to an orthopedic urgent care center where specialists can properly evaluate and treat the injury,” says Dr. Badia, founder and chief medical officer of OrthoNOW®. He is also a hand and upper limb surgeon at the Badia Hand to Shoulder Center.
His comments echo those of the American Society of Surgery for the Hand (ASSH), which emphasizes children are not mini-adults. “Because they are still growing, their injuries require different evaluation and sometimes different treatment,” the ASSH says.
“An emergency room physician is not specifically trained in musculoskeletal issues, especially those affecting children,” says Dr. Badia. “That’s why it’s usually wiser for parents to seek care at an orthopedic urgent care center or at a walk-in orthopedic practice where specialists are on staff, wait times shorter and costs lower.”
OrthoNow®, an expanding national network of clinics offering a full range of orthopedic services for children and adults, is an example of the new type of care delivery system transforming the treatment of musculoskeletal problems throughout the United States. But, even in areas where no such centers yet exist, large orthopedic practices are proving increasingly willing to accept patients on an urgent-need basis, Dr. Badia says.
As many as 250,000 children 15 years of age and younger are hurt each year as a result of playground mishaps, according to the National Electronic Injury Surveillance System. Bone fractures, sprains and joint dislocations in the upper limbs, namely hand and fingers, wrist, upper and lower arm, elbow and shoulder, are among the most common of these injuries, say authors of a study by the Center for Injury Research and Policy at Nationwide Children’s Hospital.
“Most sprains and childhood fractures heal quickly – oftentimes within a month or less,” Dr. Badia says. “However, the optional treatment approach depends on type of injury, its severity and the child’s age.”
Forearm shaft fractures, for example, are common in children. But, should the fracture involve both forearm bones – ulnar and radius, treatment to restore anatomic realignment of the bones and full range of motion of the arm can prove challenging and require the expertise of an orthopedic surgeon – rather than quick assessment and substandard splinting in the ER, explains Dr. Badia.
He refers specifically to a study presented at an American Academy of Pediatrics national conference in 2014. In that study, researchers determined that “more than 90 percent of potential pediatric fractures are splinted improperly in [hospital] emergency rooms and [non-orthopedic] urgent care centers, which can lead to swelling and skin injuries amongst other complications.”
Also occurring frequently are pediatric elbow fractures, which can be especially complex and require the expertise of an upper-limb orthopedic subspecialist or pediatric orthopedist for proper treatment, he says.
Similarly, a fracture may seem relatively minor, but if it involves the growth plate, namely soft cartilage at the end of a young bone allowing the bone to continue growing, “the bone may have to be realigned and reset before the fracture begins healing – another reason why correct diagnosis and care by the appropriate orthopedic specialist is so important,” Dr. Badia adds.
Authors of a military medicine study quoted in a 2017 issue of AAOS Now, a publication of the American Academy of Orthopedic Surgeons, reported that musculoskeletal injuries were the “most commonly missed injuries” in an emergency department and that emergency department consultations concerning such injuries were inaccurate nearly 40 percent of the time.
“Finding the right specialist to ensure proper evaluation of a child’s injury is necessary to prevent future complications and assess whether the child may have other musculoskeletal health issues,” Dr. Badia says.
He offers parents these tips:
• Most childhood sprains and fractures do not require emergency treatment. Control the child’s pain by propping up the injured area and icing it to minimize swelling until help can be obtained from a specialist.
• Go to the ER if the child has suffered a head injury, is bleeding profusely from a severe cut, or has a significant fracture in which the bone is visibly pushing against or breaking the skin (open or compound fracture).
• Encourage children to be active and eat healthy diets. Obesity and inactivity are fracture risks.