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Does my child need surgery to fix a clavicle fracture?

Does my child need surgery to fix a clavicle fracture?

by | Sep 28, 2022 | Sports Medicine

Pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., along with colleagues from the multicenter study group Factors Associated with Clavicle Treatment Study (FACTS) have published another set of findings in the American Journal of Sports Medicine. This group, like many others in pediatric orthopedics and sports medicine, merges the experiences and data from across institutions to provide the best evidence for care in the pediatric population. This group focuses their efforts on collarbone (clavicle) fractures and injuries in children and adolescents.

Here are some highlights from the publication. You can also visit the journal’s website to read the full article.

  • Midshaft clavicle fractures most often occur in adolescents, yet, most medical evidence is in adults until now.
  • More than 400 patients (10 to 18 years) with 100% displaced clavicle fractures were included in the study.
  • After two years, there was no difference in outcomes between those that had surgery and those that did not.
  • Those who underwent surgery had more nerve damage (loss of sensation on their chest wall) and more second surgery to remove plates and screws.
  • The study conclusion states, “Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function or prevention of complications after completely displaced clavicle shaft fractures in adolescents at two years after injury.”

So, the answer to the question, “Does my child need surgery to fix a clavicle fracture?” is not yes. But, that also does not mean it is no. The study describes the general experience of a large group patients who have and have not had surgery for this condition. The individualized assessment of the patient is still important and necessary, but the study does show that there is not an obvious answer that applies to all patients. “This work is new and very important for the growing body of evidence in caring for this population,” Ellis says. “We can confidently tell families that one path is not yet obviously better than another.” In our individualized patient care, it is important for us to provide evidence-based recommendations, and in our research, we aim to define the recommendations.

This study, Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group, was published in the American Journal of Sports Medicine in September 2022.

NBC DFW: Scottish Rite, UTSW Awarded $6.6 Million for Scoliosis Research

NBC DFW: Scottish Rite, UTSW Awarded $6.6 Million for Scoliosis Research

by | Jul 18, 2022 | Press Coverage, Research & Innovation

Researchers at Scottish Rite for Children and UT Southwestern were awarded $6.6 million over five years by the National Institutes of Health (NIH) to continue research into the underlying causes of idiopathic scoliosis.

The grant which was announced by Scottish Rite Tuesday will fund a multisite program titled “Developmental Mechanisms of Idiopathic Scoliosis.” The goal of the program is to understand the biological causes of idiopathic scoliosis to develop future treatments.

Read the entire article.

Overuse Injuries in Pediatric Female Gymnasts

Overuse Injuries in Pediatric Female Gymnasts

by | Feb 9, 2022 | Sports Medicine

Overuse injuries can come in many forms and remain a concern for athletes of various sports.

Many recognize the risk of overuse injuries in the elbow in baseball players, but did you know gymnasts are at risk for elbow injuries as well? In our pediatric sports medicine practice, we see two unique conditions of overuse in gymnasts’ elbows. These conditions are triggered differently than in a throwing athlete. For gymnasts, these injuries are caused by compression when the arms are repeatedly in a weight-bearing position.

Recently published in The Journal of Bone and Joint Surgery, this study from our team described the different aspects between the following elbow conditions induced by repeated activity in a group of 58 competitive gymnasts seen in our practice.

What is capitellar osteochondritis dissecans (OCD)?
A rare, painful developmental bone and cartilage injury to the capitellum on the elbow end of the humerus, the upper arm bone.

What is a radial head stress fracture?
An even less common bone injury to the radial head, the elbow end of a forearm bone, caused by repeated compressive forces in the elbow.

“Even though these are rare conditions, we see them enough that we were able to look at a large group seen over five years in our practice,” study author Chuck W. Wyatt, M.S., CPNP, says,  Comparing multiple details of the images and characteristics of the gymnasts, including activity levels, the study found several key findings.

  • Both injuries present at a young age, 11.6 years on average in this group.
  • Radial head stress fracture may be more likely in a more acute (sudden) manner.
  • Likelihood of returning to competition seemed likelier with higher level of training and competition at the time of diagnosis.
  • Having capitellar OCD on both elbows was associated with the lowest rate of return. One in three returned to same or similar level of competition.

In our sports medicine practice, we will use this information to counsel gymnasts who present with these conditions and more importantly, continue to study and educate the gymnastics community about early recognition, treatment and prevention. “This population has so many unique characteristics to consider when it comes to injuries,” assistant chief of staff and lead author Philip L. Wilson, M.D., says. “We look forward to continuing to study to understand how growing and intense training affect their bones and long-term health, particularly in the elbow.”

This study, “Elbow Overuse Injuries in Pediatric Female Gymnastic Athletes” was published in a highly rated, peer-reviewed journal, The Journal of Bone and Joint Surgery. Authors include Scottish Rite for Children Sports Medicine medical staff and former research coordinators who have gone on to pursue post-graduate degrees in the field.

Read the full article here.

Learn more about Osteochondritis Dissecans (OCD) in the Elbow.

SAFE Program

SAFE Program

by | Sep 9, 2020 | Sports Medicine

As experts in caring for young athletes, our Sports Medicine team at Scottish Rite for Children is focused on providing tips and tools for kids to stay healthy – before they might need us. Sometimes the best way to learn how injuries occur is to evaluate children and young athletes who are not injured. Towards this effort, the Movement Science Lab in Frisco is leading a research initiative called the SAFE Program. The Specialized Athlete Functional Evaluation is a project which invites sports teams of all skill levels and ages to perform a variety of sports-related and other tasks to assess balance, mobility, agility and strength.

The Purpose
Sports specialization occurs when an athlete focuses on only one sport, year-round. More than ever, young athletes are concentrating on a single sport, which has resulted in an increase of overuse injuries due to a lack of variation in their training and no real off-season. Data collected from the SAFE Program will be a great resource to help our team identify who might be at the greatest risk of injury. 

The Process
Through the SAFE Program, healthy athletes go through a series of performance tests that evaluate their strength, speed, agility and flexibility. In addition, the Movement Science team uses high-speed motion capture to analyze each athlete’s motion during dynamic movements, such as running and jumping, and sport-specific tasks based on their primary sport, like penalty kicks, layups or back handsprings. Small reflective markers are placed on the athlete’s body during this motion analysis testing help our team accurately measure how each joint moves in 3D. 

One of the most important aspects of the SAFE program is injury surveillance. Each athlete receives a monthly survey asking if they have sustained an injury in the previous month. If so, they are asked follow-up questions regarding details about where and how the injury occurred. Athletes who are interested may come back for a second round of testing after six months or a year. This will provide our team the opportunity to analyze changes in performance due to growth, improvement or an injury.

The Goal
The SAFE program will allow the Movement Science team to create a database of assessments in hundreds of athletes across all ages, sports and skill level. Then, injury surveillance after SAFE testing will provide our experts with additional information to see if any of the movement or performance measures could potentially point to a future injury. Ultimately, the goal is to create an injury prevention program, using these same SAFE tests, that can provide athletes with an individualized, comprehensive performance report which includes an injury risk assessment.  

Leader of the project and assistant director of the Movement Science Lab in Frisco, Sophia Ulman, Ph.D., is excited to see this initiative come to life. “I have a passion for sports and the SAFE Program is a project that can really make an impact in the lives of young athletes,” says Ulman. “Although we are still in the data collection phase, once we have enough information, we hope to be a resource for our highly athletic community. We want to be a go-to center for young athletes – before, during and after an injury. This program will eventually allow us to provide injury prevention assessments, help determine injury risk and interpret prevention strategies – helping athletes stay safe and in the game.”

To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org.

A New Approach in ACL Reconstruction Helps to Reduce Re-injury in High Risk Population

A New Approach in ACL Reconstruction Helps to Reduce Re-injury in High Risk Population

by | Nov 27, 2019 | Sports Medicine

Recently, Assistant Chief of Staff Philip L. Wilson, M.D., and pediatric orthopedic surgeon Henry B. Ellis, M.D., published a novel technique for treating an anterior cruciate ligament (ACL) injury. 

Too many young and growing athletes who have an ACL injury and reconstruction reinjure the same leg or have a new injury in the opposite leg within two years of the initial reconstruction. In fact, the rate of re-injury can be as high as one out of every four (25%). “Young children and adolescents are the most challenging to treat after an ACL injury because their growth plates are still open,” says Wilson. “Because of this and their commitment to returning to a high level of activity, they require special techniques to both allow continued growth and give them the best chance of not re-tearing.” 

Since 2012, our team has been studying the results of a unique approach for this surgery. Our experts have combined a surgery intended for younger children (less than 12 years old) with a commonly used procedure for an older child. This approach has resulted in a reduced rate of re-injury to approximately 5% compared to 25%.

While allowing for uninterrupted function of the growth plates, the technique provides additional support when compared to other treatments for this rapidly growing population. The technique adds both additional lateral knee support as well as added ACL graft size, both of which have been demonstrated to reduce the risk of ACL reinjury. The reduced rate of secondary ACL injury in the study are less than half of any other reported results in a similar group. In many cases, ACL injuries take very young athletes out of play for a year. This important step in reducing the risk of secondary injury helps to ensure that athletes can stay active once they are cleared to return. 

“This surgical technique is very promising,” says Ellis. “As an institution committed to innovation, we are proud of the work that has gone into this project. It is rewarding to help athletes get them back to doing what they love and know that they have a much lower risk of re-injury.”

This research study was presented at the 2019 annual meetings of two prestigious organizations: Pediatric Orthopedic Society of North America and the American Orthopedic Society of Sports Medicine. The manuscript has also published in a highly rated, peer-reviewed journal American Journal of Sports Medicine. The data include outcomes from this procedure in almost 60 athletes (age 11-16 years) collected over a five-year period. The combined TPH/ITB technique has a low re-injury rate (5.3%) and high return to sport rate (91%) and a low risk of minor growth-related changes (5.5%).

Learn more about the ongoing research in the Center for Excellence in Sports Medicine.