Pediatric Injury in the Spring and Summer- A note from Dr. Laura Copaken

Injuries in children are greatly influenced by weather and season. One study of over 15,000 children demonstrated that emergency rooms visits for trauma in children peak in the month of June. While each season has it’s most common culprits—football injuries in the fall, sledding and snowboarding injuries in the winter, playground, trampoline, and lawn mower injuries in the spring and summer—as a pediatric orthopedic surgeon, I see far more fractures that require surgery in the spring and summer. As these months are upon us, parents should be aware of the most common injuries, ways to minimize the risks, and what can be expected if your child has the unfortunate experience of sustaining one of these injuries.

When I was a resident, when sleep was at a premium, I used to joke that if we could just get rid of backyard trampolines, scooters, motorized vehicles for children and monkey bars, I would be far more rested. The fact is, though, that our children are going to participate in all of these activities, and we can not always protect them. I, myself, was the proverbial “wild child.” As an ex-gymnast and thrill seeker, I have had more than my share of fractures. People used to differentiate between my twin sister and me by who had the cast on at that time. I am convinced that my family helped finance my orthopedic surgeon’s back yard pool and that my parents were fearful that social services were going to knock on their door at any moment. Accidents happen and are terrifying for both the child and parent, but knowing how to recognize a more serious injury and what to expect can alleviate some of that fear.

Lawn Mower Injuries
Spring comes, grass grows and the lawnmowers come out. Lawn mowers are a highly unrecognized source of significant injury to our children. Between 1990 and 2004 there were 140,700 lawn mower related injuries in children with a mean age of 10. These injuries included lacerations, soft tissue injuries, burns and fractures. Many of these injuries required surgical intervention ranging from repair to amputation. These injuries can be devastating with a high risk of infection, soft tissue and bone loss or growth arrest of the susceptible growth plates in small children. When it comes to injuries from lawn mowers, prevention is the key. Many standards of safer product design have already been instituted including ways to prevent feet and toes from coming into contact with the blades, shielding of hot mower parts and a default setting which prevents mowing in reverse. This last feature can be overridden, but should require the operator to turn around to do so and therefore view any potential little feet behind the mower before operating it in reverse. Product safety is one thing, but what can a parent do to prevent this injury? First, children should not be playing outdoors while the lawn is being mowed. Be obsessively aware of where your children are while you are operating this dangerous equipment. Children tend to dart around quickly and enquiring little hands and feet like to check out moving parts. Next, ride along mowers may seem like a fun ride for you and your kids, but usually there are no safety belts and even with the best intentions, a child can fall under your direct supervision and come in contact with a moving blade or metal part which is hot enough to burn them.

Trampoline Injuries
I googled “trampoline injuries” to see what I would find. The answer: over 550,000 references. In 2004, the Consumer Product Safety Commission found that more than 89,000 people were sent to emergency rooms with trampoline-related injuries. A study by the Hasbro Children's Hospital in Rhode Island, found that spring and summer are the time when trampoline injuries hit their peak, and 91% of them happen at home. Some of the more common injuries include fractures of the ankles, wrists, and elbows, concussions, spinal injuries and there have even been six reported deaths since 1990. Contrary to common belief, nearly three quarters of these injuries occur while the child is on the trampoline mat itself and less than 25% are from falls off the trampoline. Mechanisms of injury include falling on the mat, falling onto the springs or metal
supports, colliding with other jumpers, and falls off the trampoline. The majority of these injuries (83% by one University of Utah study) occur when there is more than one jumper at a time on the trampoline. This same study found that 37% of the injuries are in children under the age of six. The American Academy of Pediatrics advocates against the use of home trampolines, but if your children have access to one and are going to use it, there are ways to promote a safer environment. First, parental supervision, alone, will not prevent injury, but it may prevent some of the more common misuses of the device. The most common misuse and the most common cause of injury is having more than one jumper at a time on the trampoline. The lighter weight child is more than five times as likely to be injured in this scenario. Some believe that if we could enforce the following of this one rule, we could dramatically decrease the number of trampoline injuries. Next, spotters who are big enough to catch or slow the fall of a child are recommended on all sides of the trampoline. To this same end, a surrounding net may decreased the injury rate, but this has not been extensively proven. Next, if possible, place the trampoline jumping surface at ground level over a pit. Finally, all supporting bars and springs should be well padded.

Playground Injuries
The National Center for Injury Prevention and Control states that each year in the United States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries with children ages 5 to 9 being at the highest risk. This being said, play is an essential component of healthy development in children. Playgrounds provide an opportunity for children to develop motor, cognitive, perceptual and social skills. So, what can you do as a parent? First, supervise children at all times and intervene when there is pushing, shoving, and crowding around equipment. Next, make sure playground equipment is age appropriate. Maximum fall height should be five feet for preschool-aged children and seven feet for school aged children. Finally, avoid playgrounds with asphalt, concrete, grass, and solid surfaces under the equipment. Look for surfaces of hardwood fiber, mulch chips, pea gravel, fine sand or rubber to a depth of at least nine inches. Despite my best efforts, my child has an injury. No matter how careful we are and how safety conscious we are, accidents do happen. Most children under five don’t understand “faking it.” If they are limping, or do not want to use their arm, something is probably wrong. Rest, ice, compression (or immobilization), and elevation are useful, but if the child has persistent complaints, take them to be evaluated either at the ER or urgent care center or pediatrician or orthopedic surgeon. If there is bruising or swelling, there is likely a real injury. Children are much more likely to crack through the weaker growth plates or bones then to tear ligaments or tendons typical of an adult sprain. In fact, any child with open growth plates who is tender directly over that growth plate should be treated as a fracture even in the presence of negative x-rays. Growth plates look like a black line on an x-ray as does a fracture, and sometimes we treat based on our clinical exam alone. Generally these types of injuries can be treated with a cast alone. Some injuries are more obvious. If there is obvious deformity or any bleeding in the area of a deformity, go immediately to the ER and do not stop for snacks on the way. If your child will need surgery or sedation, it is much safer on an empty stomach. When and if possible, stabilize the arm or leg or wrist on a board or by just wrapping a heavy blanket around it. The less it moves, the less pain your child will have. In children, deformities from fractures can often be treated under sedation in the emergency department and then casted. The most common of these would be fractures of the wrists and forearms and those of the shin bones and ankles. The wonderful thing about growing bones is that they remodel. As long as the bones are aligned within certain acceptable ranges, the bones will remodel as they grow and straighten out over time. Exceptions to this are fractures around the elbow and fractures that include joint surfaces. Many of these fractures may need surgical repair and stabilization. Finally, any fracture that has a laceration in the skin over it, must be considered an “open” fracture. This means there is contact between the outside environment and the bone. These fractures are at high risk for infection will almost always require IV antibiotics and debriding or cleaning in the operating room. These are considered surgical emergencies and should be transported directly to the hospital emergency room. Spring and summer are a wonderful time of outdoor activities, but every parent should be aware of the risks, talk to their children about safety, and have a plan should injury ensue.

2010 SECAC Resource Fair

The Mid Maryland Musculoskeletal Institute will be attending the 2010 SECAC Resource Fair on Saturday March 20, 2010. The Resource fair is from 10 am until 2 pm at Rock Creek Elementary. It will be a great resource for families with children with special needs. Below is more information about the SECAC fair. We hope to see you there!!


The Frederick County Special Education Citizens Advisory Committee (SECAC) is hosting its annual Resource Fair on March 20, 2010 at Rock Creek School from 10:00 a.m. – 2:00 p.m. The school is located at 191 Waverley Drive in Frederick, MD. SECAC’s main purpose is to advise the Board of Education and the Director of Special Education and Psychological Services on issues relevant to special education in Frederick County Public Schools. In addition, it hosts an annual Resource Fair that provides information and opportunities for parents and community members to attend workshops relative to services available to families of children with special needs. The Parents’ Place of Maryland will present two workshops: “Making Your Health Plan Work for You” and “Managing the Maze: Record Keeping,” while The Arc of Frederick will be presenting “Educational Advocacy, Information, and Referral.” Dr. Scott Winget is also presenting a workshop on “Understanding Temperament Differences,” in which he explains ways to match strategies to an individual’s behavioral style. In addition, vendors will be present and available to answer questions and provide additional information on services available to these families, including, but not limited to, camps, equipment and therapeutic services.

The ARC of Frederick County will provide a sibshop for brothers and sisters of children with special needs to celebrate the many contributions made by siblings. Siblings ages 6 – 11 may participate in this program from 10:00 a.m. – 1:00 p.m. during the Resource Fair. In addition, the YMCA of Frederick County will provide an Activity Center at the fair for children in attendance to participate in arts and crafts activities.

Walkersville High School Band Boosters will be selling food at the fair and the Rock Creek Graduation Committee will be hosting a bake sale.

For more information or to register for a workshop, contact Susan Donoghue-Rick at 240-236-8744 or email susan.donoghue-rick@fcps.org.

Information from Frederick County Public Schools at http://bhs.sites.fcps.org/node/306

Pediatric Occupational Therapy

The pediatric team at Mid Maryland Musculoskeletal Institute (MMI) would to like announce the addition of Jennilee Ambush, MS, OTR/L. Jennilee is a pediatric occupational therapist who has been working with children in a clinical setting for 3 years. Jennilee received her undergraduate degree from the University of Maryland and her Masters of Science in Occupational Therapy from Shenandoah University. During her studies, Jennilee participated in a day rehab program at Children’s Health Care of Atlanta for pediatric brain injuries. Jennilee was part of a team that provided children with intensive therapy in one on one and group settings.

Jennilee will be able to develop customized therapeutic plans for children whether their needs range from minimal to maximal support. Jennilee specializes in sensory integration, fine motor coordination, self care difficulties, and visual/ perceptual skills. She has experience in sensory processing disorder, hand writing, ADHD or ADD, stroke, and rehabilitation after a traumatic event. Jennilee is excited to be working with area children and helping them reach and surpass their goals.

To schedule an appointment with Jennilee or if you have any questions please contact the pediatric therapy department at 301-694-8311 ext 145.

Jennilee will also be at the Parent Support Group meeting which is Monday March 8th from 6pm-7pm at 184 Thomas Johnson Drive, Suite 104!!

Take Care and have an injury free weekend :)

Upcoming Events- MMI's Pediatric Neurologic and Orthopaedic Support Group

March Support Group Meeting

When: Monday March 8th from 6pm-7pm
Where: Suite 184 Thomas Johnson Drive, Suite 104
Topic: What Is On Your Mind??

Mid-Maryland Musculoskeletal Institute has created a Pediatric Neurological and Orthopaedic Support Group. The Pediatric Team at MMI has developed the support group to provide information, educate, and offer a forum for local families of children with congenital or developmental orthopaedic or neurological problems. Monica Johnson, DPT, MMI’s pediatric physical therapist, and Jennilee Ambush, MS, OTR/L, MMI’s pediatric occupational therapist, will be integral parts of the support group. Dr. Johnson explains, “we hope this program will allow families from the Frederick area to meet other families that have similar concerns, as well as be a source of education and support.”

The support group will meet once a month, on the second Monday of the month at MMI’s Pediatric Physical & Occupational Therapy office located at 184 Thomas Johnson Drive, Suite 104.; The meetings will grow and develop based on the group’s interests. The meetings will include guest speakers, facilitated discussions, and question and answer periods. Recognizing that some parents may need to bring their children, crafts and activities will be provided to entertain the children who may attend.

When asked about why MMI decided to start this new initiative Dr. Johnson explained that the idea came from interacting with many of her patient’s family members. “Many parents would see other families coming in and out of the building and they would ask questions and want to know where the other parents were getting the equipment for their children. I also had families giving me information about local resources and we began to develop the idea of bringing these groups of people together.” Dr. Johnson explained the group is open to families who have both orthopaedic and neurological concerns. “These concerns can include anything from intoeing and outtoeing, sports and overuse injuries, abnormalities of legs and feet, to developmental delay, Cerebral Palsy, Down’s Syndrome, etc”... she explained. MMI hopes that the group will help bring local parents and families together in a supportive and educational environment. “We hope that this new program will be a valuable asset to families, give them a renewed energy, and really allow them to build friendships and relationships that will assist them in caring for their children.”

The meetings are open to families of MMI patients and community members who may have an interest in the neurological and orthpaedic care of their children. Interested individuals can register by email or telephone. Please contact MMI at 301-694-8311 ext 178 or email at mmipediatricsupportgroup@gmail.com.

Just in time for the Snow!!

The good news is that fifteen minutes of snow shoveling counts as moderate physical activity. The bad news is that researchers have reported an increase in the number of fatal heart attacks among snow shovelers after heavy snowfalls. This rise may be due to the sudden demand that shoveling places on one's heart. One study determined that after only two minutes of shoveling, a sedentary man's heart rates rose to levels higher than those normally recommended during aerobic exercise. Shoveling can be made more difficult by the weather; Cold air makes it harder to work and breathe, which adds some extra strain on the body.

With the most recent snow, and now upcoming snow, we thought you might find these tips helpful. To get a good handle on snow shoveling follow the safety tips below!!

1. Individuals over the age of 40 or those who are relatively inactive should be especially careful

2. If you have a history of heart trouble, do not shovel without a doctor's permission.

3. Do not shovel after eating or while smoking

4. Take it SLOW!! Shoveling (like lifting weights) can raise your heart rate and blood pressure dramatically; so pace yourself. Be sure to stretch out and warm up before taking on the task.

5. Shovel fresh snow! Freshly fallen, powdery snow is easier to shovel than the wet, packed-down variety.

6. Push the snow as you shovel. It's easier on your back than lifting the snow out of the way.

7. Don't pick up too much at once. Use a small shovel or fill only one-forth or one-half of a large one.

8. Lift with your legs bent, not your back. Keep your back straight. By bending and sitting into the movement you'll keep your spine upright and less stressed. Your shoulders, torso, and thighs can do the work for you.

9. Do not work to the point of exhaustion. If you run out of breath take a break. If you feel tightness in your chest, stop immediately.

10. Dress warmly. Remember that extremities such as the nose, ears, hands, and feet need extra attention during winter's cold. Wear a turtleneck sweater, cap, scarf, face protection, mittens, warm socks, and waterproof boots.

12. If one needs to pick up the snow rather then push it then breathe out as you are picking it up. This puts a whole lot less stress on the heart.

We hope this makes your snow shoveling a little easier.

Enjoy the Snow :)

Take Care,

Michelle

**Disclaimer- The above information is not a substitute for medical advice or an evaluation. If you have an injury, chronic ache, question, etc please contact your doctor.**

***Information provided by Beverly Kornides, PT, and MMI's Director of Rehab

The Beginning!

Hello Everyone!

Welcome to the NEW Mid Maryland Musculoskeletal Institute Blog. We are very excited to be starting this blog and hope you will find it informative. We hope to be able to give you inside information on various orthopedic topics as well as give you an inside peek into the MMI perspective. Here is some background information about the Mid Maryland Musculoskeletal Institute (MMI).

MMI is your single source for musculoskeletal care located at 86 Thomas Johnson Court, Frederick, MD. If you are from Frederick, you are probably familiar with Thomas Johnson Drive since there are many medical practices located on the street. MMI has 11 doctors and many rehabilitation specialists that are able to offer patients specialized treatment for a wide variety of musculoskeletal conditions. Our providers specialize in the following areas:

• Spine Care
• Sports Medicine
• Hand Surgery
• Foot and Ankle Care
• Pediatric Orthopedics
• Rheumatology
• Physical Medicine and Rehabilitation
• Total Joint Replacements
• General Orthopedics
• Occupational Medicine
• Physical Therapy
• Pediatric Physical and Occupational Therapy
• The Therasuit: Intensive Physical Therapy for Children
• Infusion Treatment and more

We are just beginning our venture into blogs, twitter, and facebook but we hope to reach out to the Frederick community and surrounding areas.

For more information about MMI check out our website at www.mmidocs.com

Follow us on Twitter at www.twitter.com/MMIDOCS

or call us at 301-694-8311 or toll free 1-800-349-9386

Wishing you the best,

Michelle