Buckle Fracture – Important Things Parents Should Know

Buckle Fracture – Important Things Parents Should Know

by | Oct 15, 2020 | Fractures

In our Fracture Clinic at the Frisco campus, our team cares for various types of fractures – from simple to complex. It is important to be seen by a pediatric specialist when your child gets injured because treating growing bones is different than treating adult bones.

The distal radius buckle fracture is one of the most commonly seen fractures in our patient population. These fractures heal well with splint immobilization for four weeks. In general, the patient seen in our clinic do well with this type of fracture and are able to return to full activity quickly after splint removal. 

What is a buckle fracture?
A buckle fracture or torus fracture is a break in the bone. One side of the bone may buckle or bend upon itself without breaking the other side of the bone. Pediatric bones are softer and more flexible than adult bones, therefore this is a very common injury for children. It can also be called an incomplete fracture.

Generally, buckle fractures occur in the distal radius portion of the wrist and occurs when falling on the hand. Often this injury occurs from a fall on outstretched hand, or “FOOSH.”

What are the symptoms?

  • Wrist pain following a fall.
  • Mild to moderate wrist swelling.
  • Limited range of motion in the wrist or forearm following the injury.

How is a buckle fracture diagnosed?
A detailed history and physical exam will be performed. In many cases, X-rays will be used to see if the arm is fractured/broken.

What is the treatment?
A removable wrist splint is worn for four weeks. The splint helps protect the bone and keep it still to allow for adequate healing. It is important to wear the splint for the full time, even after the pain is gone. The splint should only be taken off with parent’s help during showering/bathing and for a daily skin check. 

What to expect following treatment:

  • Buckle fractures typically heal within four weeks from the injury.
  • No follow-up appointment is needed in most cases.
    • Tenderness, weakness and stiffness may last for one to two weeks following the splint removal.
  • It is important to have full strength and full range of motion, without pain, before returning to activities.
  • There is no evidence of issues with growth, function, ability or stability after these injuries.

Learn more about the Fracture Clinic.

Toddler’s Fracture: Important Things Parents Should Know

Toddler’s Fracture: Important Things Parents Should Know

by | Oct 8, 2020 | Fractures

Our team of pediatric orthopedic specialists in the Fracture Clinic understand that accidents happen. When your child gets injured, it can be scary, especially if the child is very young. It is important to understand common fractures, what to do and where to go if it happens to your child.

A fracture is a break in a bone. A toddler’s fracture is the name for a broken bone in the leg that typically occurs in children less than 3 years of age. A toddler’s fracture is a spiral fracture (break) in the tibia (the shin bone). It is considered a low energy break, and usually presents as a hairline (small) crack without significant damage to the bone or surrounding tissue.

As a nurse coordinator in the Scottish Rite for Children Fracture Clinic, Bonnie Ste. Marie, R.N., works closely with families when they come into the clinic. “We see this type of fracture often,” says Ste. Marie. “As a mom myself, I understand the concern of parents when this happens to their young child. It is important to me and the team to provide information every step of the way. This helps the child and parent feel comfortable and assured we provide the best care for each patient.”

How does a toddler’s fracture occur?
This type of fracture is the result of a twisting leg injury and typically occurs during a fall or going down a playground slide.

What are the signs and symptoms of a spiral tibia fracture?

  • One of the first symptoms is that your child will refuse to put weight on the injured leg and will withdraw the foot by bending at the knee with attempts to stand or weight bear.
  • Due to your child’s young age, it is difficult for them to communicate where the pain is coming from and they will often complain of pain in the entire lower leg or specifically point to the foot.
  • Mild swelling to the lower leg or foot is possible but rare in most cases.

 How is a toddler’s fracture diagnosed?

  • History – You will give a detailed description of the activity that caused the injury.
  • Physical Exam – A physical exam is performed, from the hips down to the feet. Typically, there is tenderness to touch in the tibia or shin bone area and pain with rotation of the lower leg. The hips and knees should be pain free and have full range of motion.
  • Imaging – X-rays may be taken of the lower leg.
    • In most cases, the fracture is very small, and the X-rays will show that the bone is still in place, or in normal alignment.
    • In some cases, X-rays will not show any obvious fracture. This is called an occult fracture and is diagnosed during a physical exam.

What is the treatment for a toddler’s fracture?
The majority of these fractures are stable injuries and treatment is aimed at providing comfort and modifying activities. A hard cast is rarely necessary. Evidence shows that a walking boot and allowing the child to continue to walk as tolerated produces similar results to wearing a cast or splint but with fewer risks of complications. Children will generally wear the walking boot for around four weeks.

The Fracture Clinic in Frisco is open Monday – Friday from 7:30 a.m. to 4:30 p.m. 

Learn more about the Fracture Clinic.

Sports Medicine and Psychology Experts Work Together – Caring for the Whole Child

Sports Medicine and Psychology Experts Work Together – Caring for the Whole Child

by | Oct 6, 2020 | Research & Innovation

Our Sports Medicine team noticed that a commonly used outpatient depression screening questionnaire was identifying more patients than were actually at risk for concerns for suicide. This created an excessive number of alerts to the clinical team to assess patients that were not at risk, which is called a high false positive rate. The team implemented changes to reduce that rate without missing those patients that were truly at risk and needed further evaluation.

Jane S. Chung, M.D., sports medicine physician, says, “Suicide is now the second leading cause of death among young people 10-24 years of age, and is a serious public health problem in our youth. Often, in the sports medicine setting, these kids who are hurting and struggling internally are the ones coming in to see you for sports-related injuries and other musculoskeletal ailments,” says Chung. “Our team felt it was important to look into this trend in our own outpatient clinics to come up with a strategy to best identify those patients at risk so we can provide early intervention, as early identification and intervention is key in helping these youth at risk.” Success with the effort would allow resources to be properly allocated to the right patients.

Partnering with the Psychology and Research teams, the group developed a new strategy to decrease the high false positive rate in screening questionnaires utilizing a staged process in the electronic medical record. Additionally, patients were given the opportunity to review their responses before submitting, as often young patients can misread or answer a question too quickly on the iPad questionnaires. The clinical staff was then notified of those patients who provided responses that were concerning for suicide risk.

Recently, in March 2020, the team implemented a more pointed suicide screening questionnaire with hopes that future analysis will show continued improvement in identifying those youth at risk. The staged approach effectively identified patients in need of intervention and the false positive rate drastically improved. Researcher, Connor Carpenter says, “Quality improvement projects like this one have a real impact on our patients and our system. When patients get treatment they need and not the treatment they do not, everyone wins.”

This study, “Effective Administration of Mental Health Screening Tools Affects Appropriate Allocation of Resources and Improves Clinician Ability to Identify Those at Risk for Suicide,” was shared as a medical poster at the 2020 virtual annual meeting of the American Academy of Pediatrics.

Learn more about mental health in young athletes in a previous article.

Get to Know our Staff: Karina Zapata, Therapy Services

Get to Know our Staff: Karina Zapata, Therapy Services

by | Oct 5, 2020 | Therapy Services

What is your role at Scottish Rite for Children?
I am a physical therapist/research therapist in the Therapy Services department. I spend half of my time seeing patients as a physical therapist and the other half working on research or quality improvement projects. I enjoy being able to support effective implementation of evidence-based practice.
 
What do you enjoy most about Scottish Rite?
I love the mission – that we can do what is best for the child, regardless of families’ ability to pay.
I love being able to collaborate with so many disciplines to provide holistic care.
I love that we have a strong research team to have an impact on a wider scale. I initially thought that I was going to move back to sub-Saharan Africa to “make a difference,” but I realized that I can also make a difference right here at Scottish Rite. The unique opportunities that this organization provides, allows me to utilize my skills and talents on a daily basis.
What path did you take to get here? How long have you worked here?
I grew up in Kenya and Papua New Guinea. I initially thought that I wanted to use my privilege of studying in the US to return overseas, but once I learned about Scottish Rite for Children, my plans changed. My physical therapy professor in Los Angeles told me about Scottish Rite. She knew that Scottish Rite had a physical therapy method for treating clubfoot, which is a hot topic overseas. After graduating from PT school 13 years ago, I started working here.

What’s the coolest or most interesting thing you’re working on right now?
When I began working here, I noticed that we saw a lot of kids with scoliosis, but physical therapy did not play a large role in their treatment. In Germany, my other nationality, scoliosis-specific exercises are commonly performed. I ended up getting my Ph.D. while working here to evaluate whether scoliosis-specific exercises prevent curve progression and determining if it should be part of our standard of care.
 
What are you currently watching on Netflix/Hulu/TV/etc.?
Between work and staying active with my three kids, I fall asleep before I’m able to watch anything.
 
What would be the most amazing adventure to go on?
Traveling around the world for a year with my family.
 
What is special about the place you grew up?
Papua New Guinea has the most linguistic diversity in the world, with over 800 languages.
 
What is your favorite thing to do when you’re not working? 
Without kids, kitesurfing. My department director actually got me hooked. With kids, exploring a nearby state park.