Melanie Cole (Host): Welcome, today we’re talking about upper extremity care for children and my guest is Dr. Krister Freese. He’s a pediatric orthopedic surgeon at Shriner’s Hospital for Children in Portland. Dr. Freese, I’m so glad to have you with us today. You’re a pediatric orthopedic surgeon at the Portland Shriner’s Hospital who specializes in hand and upper extremity. Can you tell us a little bit about the schooling you had to go through to become this specialized?

Dr. Krister Freese (Guest): Yeah, you know I started off with medical school and I was fortunate enough to go to the University of Washington, and while I was there I found a real love for orthopedic surgery. After that I spent five years in Hawaii doing orthopedic surgery residency where I equally loved taking care of kids but also hand problems as well, and so when I finished residency I decided to do some extra training and I went to the University of Colorado where I spent a year at Colorado Children’s Hospital taking care of pediatric orthopedic problems and then a second year doing a hand and microvascular fellowship where I took care of both kids and adults but complex hand problems.

Host: Dr. Freese, is this a very common specialty or are there many pediatric hand surgeons in the state of Oregon?

Dr. Freese: Yeah it’s not that common. I think if you looked in Oregon, I think there’s approximately two pediatric hand surgeons and in the field in the United States, maybe 50 or 60 people who are doing this full time.

Host: Wow so it’s super specialized. Tell us a little bit about what the range of conditions that you see and what children are going through as far as upper extremity care.

Dr. Freese: I think people kind of expect to hear about the sort of bread and butter things. So I take care of things like elbow fractures and hand fractures. If, for instance, the patient falls on the trampoline or falls off the jungle gym, but we also take care of more complicated things too, so congenital hand differences. For instance, I have some patients who are born without a thumb, and on occasion we’ll use the index finger to reconstruct their thumb or I have some patients who are born with too many fingers or fingers joined together and there are things we can do to help them, and I also see other patients who maybe have things like cerebral palsy, so a neuromuscular disorder, where basically their muscles in their arm aren’t getting normal nerve signal from their brain and we can sometimes do both nonoperative and operative things to help their hands look a little bit better for them.

Host: Wow, so important and some of us we really take our hands for granted. Tell us about some of the support services that you offer at the Portland Shriner’s Hospital that you provide to your patients other than just working with their hands, what else do they need to learn, how do they need to learn to live their lives with whatever’s going on?

Dr. Freese: Yeah, I’m really lucky. I have a great team that I work with here. I work really closely with our occupational therapists, or our hand therapists, and we work really closely with our orthotics and prosthetics department. So I can think of many examples, you know our occupational therapists will see patients to help them learn to adapt to their environment or help them adapt to their environment – things like adaptive equipment for feeding or teaching a child how to tie a shoe one handed, things like that, and oftentimes we work in collaboration with the prosthetics department. So I have some patients who might only have one hand and they want to ride their bicycle, and so between myself, the occupational therapist, and the prosthetics, we are able to develop a device so that they can ride their bike with one hand and use their other arm to grab onto the handlebar, things like that.

Host: And what about walk in clinic, fracture clinic, sports injury because obviously hand injuries in sports with our kids must be pretty common today.

Dr. Freese: They are very common – they’re very common and the nice thing about the fracture clinic, be seen, and you may not see the doctor who’s going to treat you that day, but if there’s for instance a finger fracture that’s really complicated and it needs my attention, one of my partners will see that patient and then get them referred to me straight away so that there’s really no delay in care. One of the tricky things about kid’s hand fractures is that they heal very, very quickly, and so if you’re seeing a patient a week or two weeks out from their injury, it’s almost too late to treat the fracture if it needs surgery, for instance.

Host: What sports do you most commonly see hand injury, for parents, Dr. Freese? What should they be looking out for if their kids are in certain sports?

Dr. Freese: Oh gosh, I don’t know, I mean I think I see a lot of basketball players with injuries to their hand, and sometimes folks think that it’s just that I jammed my finger or I sprained my finger, and in kids – things that look relatively benign or innocuous can sometimes actually be fairly significant injuries, so I always tell families if they have a concern, it’s better just to be seen. It’s good to come in and get reassurance and not have a real issue, and if it’s a real issue then we can help take care of it.

Host: Sticking with the sports injuries for just a minute Dr. Freese – we hear about ACL in girls and we learn that plyometrics can help and that there are certain training techniques, but for the hands, if you’re a volleyball player or a gymnast or as you said a basketball player, baseball player, is there anything that you would like parents and coaches to know about prevention of hand injuries?

Dr. Freese: Yeah, I don’t know about hands specifically, but if we look at the upper extremities in general, we see a lot of increased injuries in both the shoulder and elbow in people who are throwers and gymnasts and a lot of this has to do over training. I mean kids are specializing in sports at a very young age, and they’re playing the same sport year round, they don’t get breaks, they’re on multiple teams, and so some of these patients and some of these kids are just not getting enough rest between seasons, and so I try to encourage families to give their kids an opportunity to rest and to not specialize in sports too early on.

Host: Well some sports like baseball have limits on throwing for their pitchers but other sports do not. So really your main message for parents and coaches is to cross train, to get your kids to take some time off of their sport and not be so specific all year round.

Dr. Freese: Yup, I think that’s absolutely true. I think kids need a break, they at least need a period of rest during the year at some point, and playing multiple sports I think can be really beneficial.

Host: Well it certainly can. We’re learning more and more about that all the time. Dr. Freese, why is it so important for parents to look for a pediatric orthopedic specialist over an adult orthopedic specialist?

Dr. Freese: I think that when you see a pediatric orthopedic surgeon, that care provider is going to be sort of in tune with the developmental stage of your child, and beyond that there are some unique things about kids and their bones. We can sometimes harness bone growth to our advantage to take care of our problem, or sometimes we’re concerned if a patient has a fracture, for instance, that goes through a growth plate, that’s a patient that we want to watch really carefully to make sure they’re not going to have a growth arrest after that injury and pediatric orthopedic surgeons are really aware of those issues. The other thing that I think pediatric orthopedic surgeons do really well is communicate with families and with kids, and hopefully because we do this on a sort of all day basis and we have these relationships with families and not just the patient; hopefully we do a good job communicating what needs to be done, and also reassuring families and children what can be sometimes a scary time for them.

Host: Well I think any time you’re visiting a doctor with a child, it’s a scary time all around. Tell us about the Portland Shriner’s Hospital was recently gifted an operating microscope through a donation – explain this incredible piece of equipment and how it’s benefiting you and your patients.

Dr. Freese: We got a really generous donation, and so we were able to get a new operating microscope, which I think really just expands the number of things that we can do here. Operating microscope lets us do microsurgical procedures. As an example, if you cut a nerve in your arm, we’re able to repair that nerve but we need to do it with a very, very fine suture and the suture is actually smaller than a thread of hair, and so to do that with the naked eye is really almost impossible, and so using the operating microscope we can see these really fine structures and repair nerves and blood vessels and so it really opens up the scope of procedures that we can do here which is I think really beneficial for our patient.

Host: Isn’t that amazing. So what else would you like us to take away from this segment – for parents, for coaches, for kids, about upper extremity injuries and visiting a pediatric orthopedic specialist and the importance of prevention, and as we said cross training and really keeping our kids healthy so they can stay in the game.

Dr. Freese: You know I think my biggest takeaway for parents and kids who have an upper extremity injury, a traumatic injury is to really not to delay their care. I think it’s again much better to come in and be reassured with a normal x-ray and be seen than have a delay in your care and then have a difficult problem that’s not easily fixed because things have already started to heal but maybe not in the optimal position.

Host: Well it’s so important and really, really great information. Thank you so much Dr. Freese for joining us and sharing your incredibly specialized expertise in this area and giving us such great advice, and that wraps up this episode with Shriner’s Hospitals for Children in Portland. Head on over to out website at portlandshrinershospital.org for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other fascinating podcasts in our library. I’m Melanie Cole.