A PUBLICATION OF THE ALFRED AND NORMA LERNER CHILDREN’S PAVILION AT HOSPITAL FOR SPECIAL SURGERY Volume 4 – Issue 1 Fall 2013
Pediatric Fractures by Emily Dodwell, MD, MPH, FRCSC
MEDICAL STAFF Pediatric Orthopedists John S. Blanco, MD Emily R. Dodwell, MD, MPH Shevaun M. Doyle, MD Daniel W. Green, MD Cathleen L. Raggio, MD Leon Root, MD David M. Scher, MD Ernest L. Sink, MD Roger F. Widmann, MD Pediatricians H. Susan Cha, MD Lisa S. Ipp, MD Stephanie L. Perlman, MD Pediatric Rheumatologists Alexa B. Adams, MD Thomas J.A. Lehman, MD Nancy Pan, MD Pediatric Anesthesiologists Adam Booser, MD Kathryn (Kate) DelPizzo, MD Naomi Dong, MD Chris R. Edmonds, MD Andrew C. Lee, MD Victor M. Zayas, MD Hospital for Special Surgery is an affiliate of NewYork-Presbyterian Healthcare System and Weill Cornell Medical College. For more information about HSS Pediatrics, visit http://www.hss.edu/peds The Pediatric Orthopedic Service provides coverage to the Phyllis & David Komansky Center for Children’s Health at NewYorkPresbyterian Hospital.
On average, 40% of boys and 30% of girls will have a fracture during childhood. Orthopedic trauma in children requires the expertise of pediatric orthopedic surgeons, primarily due to the sensitive areas of growth within children’s bones: the physes, more commonly known as growth plates. Most long bones have an area of growth on each end. These areas are constructed of discs of cartilage cells. Cartilage cells in this area multiply and grow in size, with eventual replacement by bone cells and calcification into new bone. This process accounts for the lengthening of bones. Physes inherently are less strong than other parts of the bone. When a child has an impact, twisting, bending, or traction injury, they are more likely to fracture through the physis than have a ligament tear to the neighboring joint.
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Mixed Connective Tissue Disease by Thomas J.A. Lehman, MD
Mixed connective tissue disease (MCTD) sounds like a diagnosis made up by doctors to describe a confusing patient. In actuality, the diagnosis is a very specific one that describes a group of patients with a unique condition.
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In the 1970s, Gordon Sharp, MD, a rheumatologist and pioneer in the field of autoimmune and autoantibody research, was testing antinuclear antibodies (ANA) when he discovered that a few patients who were ANA-positive became ANA-negative if cells were exposed to a special buffer. This revelation led to the discovery of extractable nuclear antigens (ENA), which we now know as Ro, La, Sm, and RNP.
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When Sharp looked more carefully at those patients with ENA, he found that they were
For more information about the Komansky Center, visit http://www.cornellpediatrics.org
Approximately 20% of pediatric fractures involve the growth plate. Even when fractures occur in other parts of the bone, they are heavily influenced by the presence of the physes. Surgeons fixing pediatric fractures need to treat the physes with care; due to the sensitive physes, many fixation techniques used in adults cannot be used in children.
most often patients whose disease looked like a mixture of lupus and rheumatoid arthritis, hence the term “mixed connective tissue disease.” ENA is always present in these patients, usually with a high titer of Ro, and low or no Sm. This is different than “undifferentiated connective tissue disease,” a term that refers to patients where we don’t really know what they have. CONTINUED on page 2