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Summer 2012

Mending and Preventing Pediatric Injuries

When a child breaks a bone, treatment demands more than an understanding of the injury and medications to ease the pain. "Part of any child's healing process involves helping him or her understand what happened and how the body will mend," says pediatric orthopaedic surgeon Coleen Sabatini, M.D., M.P.H.

That's the advantage, she says, of having children with orthopaedic injuries receive treatment in a child-friendly environment, with clinicians specifically trained to work with children.

"Orthopaedic exams with children, especially young children, can be difficult," says Sabatini. "To build the level of trust necessary for a proper exam and treatment — and for a child to recognize he or she plays a role in healing — you have to be very creative in evaluating and discussing the injury. It's a challenge and a responsibility, so you have to love taking care of kids and relish the opportunity to participate in their lives."

State-of-the-Art, Clinically Integrated Care

The combination of pediatrics and orthopaedic surgery is not always easy to find, which is why Sabatini and her colleagues in the UCSF Department of Orthopaedic Surgery are available not only at UCSF Benioff Children's Hospital, but also at satellite clinics in Greenbrae, San Ramon and Santa Rosa. Whether they're treating complicated trauma or a simple fracture, their goal is to return children to their normal activities as soon as it's safe.

Sabatini also notes that for children with more complex diagnoses — where other medical issues complicate an orthopaedic concern — it's especially important that specialists from different disciplines communicate directly with one another to better coordinate treatment. For example, children with cerebral palsy frequently have pulmonary issues as well. When surgery becomes necessary, close communication between the orthopaedic surgeon and the pulmonologist, as occurs at an academic medical center, can ensure each child is medically optimized before surgery.

Public Health Perspective

Such optimal medical care is important, but Sabatini's strong background in public health also fuels a drive to dramatically reduce the demand for her surgical expertise. She expects to begin a research effort with that goal in mind.

"I'm committed to looking at how and why children sustain injuries, and what we can do to prevent their occurrence," she says. "For every kid with a cardiac event, there are hundreds of preventable orthopaedic events. By evaluating the origins of injuries in a community, it is possible to mitigate the risks and see demonstrable improvements. If we can avert the loss of time from school and parents work, as well as the social implications of a child not participating in normal activities, that's a real community benefit."

Dr. Coleen Sabatini can be contacted at (415) 353-2967 or (925) 866-2660.

Tried-and-True Teaching Methods Advance Innovation

Mohammad Diab, M.D., believes his fellow physicians are tired of attending educational events where they passively participate in professionally produced presentations.

Diab speaks frequently on issues in pediatric orthopaedics, and his talks are always among the most highly rated among attendees at sessions ranging from UCSF review courses for primary care physicians to national meetings such as those hosted by the American Academy of Pediatrics.

"I use the old-fashioned Socratic method and a fundamental case-based approach," says Diab. He might, for example, use the stage to demonstrate the gait of a child with a lower limb deformity, then have a volunteer show how they'd conduct an examination. And he'll frequently ask the audience questions to keep them engaged and to make them active learners.

"While we indeed are in an age where technology is dominant and pervasive, I seek a balance, to revive what has worked since the ancient Greeks and not to abandon such methods for what must be thought of, in the view of history, as novel and still largely unproven," he says.

Dr. Mohammad Diab can be contacted at (415) 353-2967.

 

Orthopaedic Surgery News — Summer 2012 Index

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