August 26, 2022
Summer is widely known as “trauma season” for children and teenagers. The combination of more activity, more opportunities for accidents and less parental oversight can result in more traumatic injury for kids. On this podcast, we interview Kid Expert Dr. Eric Lund, orthopedic trauma surgeon, and a key player in our adolescent and young adult trauma program, about how to keep kids safe(r) and avoid traumatic injury and what to do in the primary care office when injuries present to ensure the best outcomes when they get to the specialist’s office.
Transcript
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to The Kid Experts, where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric healthcare information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge and perhaps change how you care for kids.
Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. Summer is here and it comes with plenty of time for fun in the sun, and plenty of opportunities for broken bones. Between playgrounds, trampolines, summer sports and tree climbing, the chances for childhood injury definitely increase in the summer. Here to talk to us today about pediatric trauma and orthopedic injuries is one of our Kid Experts, Dr. Eric Lund, Orthopedic Trauma Surgeon here at Children’s Minnesota. Eric, thanks for joining me today.
Dr. Eric Lund: Thanks for having me.
Dr. Angela Kade Goepferd: So first I’d like to learn a little bit more about your specialized role here at Children’s. We were talking before the podcast about sort of a new gap in adolescent care that you’re providing. Can you talk to us a little bit more about your role here at Children’s?
Dr. Eric Lund: Yeah. Thank you for the introduction. And thanks for having me. The Gillette Orthopedic Group has covered here for many years and as part of their niche, they usually treat the skeletally immature pediatric musculoskeletal injuries. And now we have full coverage up to 18 and older with the adolescent population, with our group of orthopedic traumatologists.
Dr. Angela Kade Goepferd: So specializing in that adolescent age range, you were saying kind of 15 and older, up to even 18, 19, kind of young adult range.
Dr. Eric Lund: Yep. And we will go younger too, depending on the severity of the injury as well. So we’re excited to take this new program and grow within the Children’s system.
Dr. Angela Kade Goepferd: Yeah, that’s great. You were telling me earlier about a story that I thought would be interesting to share with our audience about a kid that you happen to care for here at Children’s, a teenage patient who, because you were right here and able to get in and do her surgery sooner, rather than later, it had a pretty positive outcome. Do you mind sharing that?
Dr. Eric Lund: This patient was a 16-year-old girl. She had a high energy fall and fractured dislocation of her elbow, and we were able to triage her the next day into the operating room when otherwise would’ve transferred out of the Children’s system or been delayed by days or more hours. And because of that, she was able to go just a couple days later to a presentation, which was the culmination of many weeks of research. And she won her podium presentation at the national level and just went to the international competition and took a second prize there. She would’ve otherwise missed it.
Dr. Angela Kade Goepferd: I think it just speaks to how busy kids’ lives can be and when they can get immediate care for their injuries, where they need it and when they need it, it can have really cool outcomes like that. This is our first time meeting. So I was reading about you before the podcast and found out that you’re a big hockey fan. So science and hockey fan, I should say. And I have a six year old in my family who is also a big science and hockey fan. And so I was hoping that maybe as an orthopedic surgeon, you could convince me, as a parent, who’s a pediatrician that it’s safe for my son to play hockey.
Dr. Eric Lund: Well, at the six-year-old age, they’re basically Gumbies. So they can bounce off the boards or the ice and not miss a beat. But also, with the newer equipment, better helmets and coaching, including safety for falls and body contact earlier, there’s fewer injuries, lesser degree of time away from sport, fewer concussions. I would strongly encourage you and many other people to put their kids into hockey, especially in Minnesota.
Dr. Angela Kade Goepferd: All right. Maybe I’m mildly convinced. In pediatrics, we often talk about summer is trauma season. Kids get a lot of injuries this time of year. What types of injuries do you tend to see more in the summertime when it comes to kids and teenagers?
Dr. Eric Lund: A lot of monkey bar injuries are the classic pediatric elbow mechanism of injury. We’ll see a lot of knee and ankle injuries with soccer, not on the grassy fields. In the winter, in ice time, it’s slip and fall season for the young and the old, when you get a lot of wrists and ankles. So there’s always a different mechanism of injury. The lulls are between the summer and the ice.
Dr. Angela Kade Goepferd: Yeah. Particularly with your sort of niche in the adolescent orthopedic trauma. I am terrified for my children to become teenagers and get that risky streak and want to do more aggressive things that are high up in the air or skateboarding or things like that. Do you tend to see more extreme sport injuries this time of year? And what would those look like?
Dr. Eric Lund: For sure. And we’ve had them already this summer. BMX biking, a jump goes wrong, and they really impart a high degree of force on some joint in an awkward way. It wasn’t meant to bend or twist. Rollerblading, for sure. And some of the ways to prevent that kind of injury would be proper equipment and padding the obvious. Youthful minds will seek adventure and sometimes you can’t avoid it, but knowing where to go and when to go to an urgent care or an ER, is something you might want to talk to the families about in pediatric clinics.
Dr. Angela Kade Goepferd: So speaking of prevention, I know that there are lots of traumas that are just accidents. One of my sons tripped on the second step, climbing up a playground and fell and broke his wrists. So I know sometimes you just can’t avoid it, but some things are prevented. So let’s talk about some examples of common injuries that could be prevented. So you talked about proper padding and equipment. And I often wonder with my own kids, when they’re going out on their scooters or their roller blades, they always have a helmet. Does it really matter if they have the elbow guards and the wrist guards? So talk to me a little bit about prevention and what’s important.
Dr. Eric Lund: When I was 12, I turned my hockey net on its side and tried to grind the crossbar like a pipe in line skating. And I was not wearing my wrist guards. And I broke my wrist right before tryouts. So risk guards do make a difference, even for hockey skaters who are used to roller blades or anybody. And there’s little pebbles or cracks, and the first thing you fall on is you’re outstretched hands. So risk guards, as much as they might make you look overprotected will prevent a distal radius fracture.
Dr. Angela Kade Goepferd: Other types of protective sort of equipment or prevention techniques you’d recommend for summer sports.
Dr. Eric Lund: I think a helmet for anything where you’re moving on wheels: bike, roller blades, scooter. Even wearing sunglasses or eyewear for bugs and dust and debris, so you can always see. Gloves, skidding across, so you don’t get raspberries on the palms of your hands. I’m kind of thoughtful of that given my profession. Knee pads. You can never go wrong with knee pads, because that’s where you get a lot of rug burns and road burns, I should say, road rash.
Dr. Angela Kade Goepferd: Yeah. And let’s talk a little bit about trampolines or as I sometimes refer to them, to my parenting friends, broken bone machines. So let’s talk about trampolines. What types of tips should we be giving around trampoline safety?
Dr. Eric Lund: At least the modern ones have really almost universally included the 360 fence, which has helped. And then there’s the springless tramps that are a little bit newer. So you can’t get your feet or toes caught in them. We live near a sky zone, my wife and I and our kids. We don’t go. I’ll be honest. Avoidance of trampolines is probably number one, but I grew up with a trampoline and I would launch off of it onto the ground for fun. And just think how I luckily avoided injuries. But some of those things, fences, springless ones, parent rules and setting expectations. One or two people on, not three or four can then go a long way to avoid an injury.
Dr. Angela Kade Goepferd: Yeah. People are heading to cabins and things like that. And we always are talking to families about boating safety and avoiding drownings. Anything from an orthopedic surgeon perspective that you would want us advising parents and families on when they’re heading up to the cabin to avoid injury from your perspective?
Dr. Eric Lund: Yeah. That is probably the biggest fear for parents with young children, ours included. It’s just strict rules before going to any location like that, that you have to have your swim arms and an adult before you go down there. We have a pediatric trauma review you might be familiar with here at Children’s. And I look at the list of the M&Ms, morbidity and mortality, and it includes a lot of these sad cases of drowning. So setting firm rules, repeating them before you go. Our children just know that that’s the rule. You can’t go down there without the mom or dad or adult, and you have to have your swim arms on.
Dr. Angela Kade Goepferd: I always think of kids getting pulled behind boats at high speeds. Any other types of injuries that you tend to see relative to water sports, that we should be advising parents to be careful about?
Dr. Eric Lund: A moving propeller. I’ve seen some really bad foot and ankle injuries from boating and lawn mowing. So another summer seasonal injury with young kids is you just cannot put them at that risk. Grandma or grandpa often is the classic story on the lawnmower, riding lawnmower with the four or five year old. So there’s rules. Don’t go near the boat engine, have it off and out of gear when you’re tubing. We do that with some of our cousins and stuff and our family. And you just have to have it off and in a neutral or off completely. And then the same with the lawn mowing. We have a riding lawnmower where my grandparents bought it and we do not let our kids ride on there. As much as it would be fun to go down the trail through the woods, can’t do it.
Dr. Angela Kade Goepferd: Speaking of riding on things, ATVs are one of the things I worry about with kids this time of year riding on ATVs and those types of injuries. What can you tell us about safety related to that and injury from those?
Dr. Eric Lund: They are a lot of fun, but they’re also very dangerous. So, for sure, three-wheelers are a no go and that’s been faded out by the industry itself. Full helmet, like dirt bike helmet, and long clothing, and then safe speeds. The newer ones won’t let you go over a certain speed limit, the side-by-sides, without the seatbelt clicked. I think that’s a great feature. You can add car seats to a lot of the side-by-sides that are popular. Same as biking or roller blading, if you have that helmet and appropriate supervision.
Dr. Angela Kade Goepferd: I will try to keep my own children off of ATVs for as long as possible.
Dr. Eric Lund: That’s probably the best answer. And dirt bikes. Those are fun but dangerous.
Dr. Angela Kade Goepferd: I agree. As a child who experimented with dirt bikes myself, I think there were a lot of unsafe maneuvers that happened out on the self-made dirt bike hills.
Dr. Eric Lund: I did too. And now that I do this, I don’t ride them as much as I want to still.
Dr. Angela Kade Goepferd: I was wondering also, if you could update us a little bit, I was mentioning to you before we started the podcast that I’ve been in practice for 17 years now. And when I did my orthopedic rotation, it was a long time ago, 20 years ago in medical school. And certainly when I broke bones as a kid, that was even longer ago. I won’t tell you how long ago that was. What’s changed? So for example, my son had a broken arm a few years ago and he came home with a waterproof cast. So he could still swim in a pool, which I wasn’t aware that we had waterproof casts. So that was sort of a small but meaningful innovation for a child. What else has changed in the last five to 10 years that folks who’ve been in practice for a while might not be aware of when it comes to orthopedics for kids?
Dr. Eric Lund: We’ve had the tincture of time to follow a lot of injuries, especially in the pediatric population. So we used to think some really crooked bones would require surgery and it’s not totally a new idea, but there have been extreme examples where the capacity for remodeling an angulated form or wrist fracture really heal well. The non-operative casting is really successful in the very young. And then in the older kids that don’t have that remodeling capacity, we treat them almost more like adults. There have been a great percutaneous, minimally invasive implants that have come to market where you have some nasty femur fracture, thighs crooked, maybe it’s coming through the skin, and we can really triage those and understand that we can fix them that day or the next day, reduce their complication risk, reduce their need for reoperation and make their incision smaller. So they’re healing up. They didn’t realize they have a 40-centimeter rod in their femur, like a kid I saw today. And it’s just two small stab incisions.
Dr. Angela Kade Goepferd: Wow.
Dr. Eric Lund: So, that’s kind of cool. We can cannulate in through percutaneous means and get them walking, putting full weight on it before the bone’s even healed.
Dr. Angela Kade Goepferd: Yeah, that’s great. That sounds even more amazing than a waterproof cast. So you mentioned triaging injuries. A lot of times parents will head to their primary care office for a triage because they want to avoid the cost of an ER visit and things like that. What advice would you have for those of us who might be triaging orthopedic injuries in the primary care setting and maybe include in there what not to do, what mistakes have you seen or how should we be doing that initial management, if we do end up having to send them on to you or to the ER?
Dr. Eric Lund: Any obvious deformity, if it’s a joint dislocation or a displaced fracture should be reduced to avoid skin breakdown or tension on a nerve or artery. So, if that’s the injury, go to the emergency room. The resources there can provide conscious sedation. Either the ED provider or the orthopedic specialist can provide that initial fracture reduction or joint reduction and get the kid home or admitted. A clinic is not a good setting for some obviously deformed injury. So just go right to the ER for those.
Dr. Angela Kade Goepferd: What about for things that might be more subtle or someone in the clinic is wondering, do I x-ray this here? Do I just send it onto the ER? Any tips that you might offer for if it’s not obviously dislocated? Which I think most of us in primary care would take one look at and ship them out the door.
Dr. Eric Lund: I think the radiation risk in children is low, very low. So if they have a bad enough injury to present to clinic with a fall or whatever, I think an x-ray is super valuable and a low risk of radiation. So I wouldn’t hesitate to shoot those two or three-view x-ray order just to know. I know there’s some criteria for ankle injuries. It’s like the Ottawa criteria, but get an x-ray. It’s like part of your orthopedics physical exam. We don’t even think about it. No, that’s not quite fair to say, but have a low threshold to get imaging that day.
Dr. Angela Kade Goepferd: And any tips on stabilizing. So say you have a kid who has a dislocated fracture that’s pretty obvious in clinic and you’re going to be sending them over to the ER, any tips for how to stabilize those in the clinic or things that people should or shouldn’t do when they’re trying to stabilize a broken bone?
Dr. Eric Lund: Don’t be afraid to stabilize. You think it needs a splint, put it on. We can take it off the next day or whenever they’re able to make the referral. If you are slightly pushing on something, if it’s displaced as a fracture and you’re willing to give it a little bit of a chance at a push to make it better, and you do, get an x-ray after any reduction. A simple splint application without manipulation, I don’t think you need to reimage. If you have a little valiant effort to reduce something, then a postreduction x-ray is very helpful.
Dr. Angela Kade Goepferd: Great. Any last parting words or advice that you would give us relative to pediatric orthopedic trauma or prevention or things we can do to help keep kids safe this summer?
Dr. Eric Lund: You need to encourage fun, but I think establishing the risk and putting it into context for the kids, so then they might be more apt to follow the rules. Like, you’re going to miss your tournament or your vacation if you don’t follow these rules, and here’s why you want to put it on. Now, they might not be able to comprehend that. But I think like any parenting, you tell them ahead of time. Give them that five minute warning. Before you have to leave the park, you tell them before, wear this helmet and you can ride your bike. Multistage delivery helps compliance with children and safety rules.
Dr. Angela Kade Goepferd: Well, Eric, thanks for joining me today. It is really great to meet you and learn more about the adolescent orthopedic offerings here at Children’s Minnesota and get some safety tips for summer and hear some good stories about unfortunate injuries that hopefully we can help kids avoid. So I appreciate you joining me.
Dr. Eric Lund: Thank you. Thanks for having me. I appreciate your time.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amy Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.