First Aid
Immobilize the limb – broken bones hurt less if they aren’t moving so stabilize the arm or leg with something stiff – a rolled newspaper or stick strapped to the limb work well.

Seek Medical Care
See your doctor or attend the emergency department where they will assess and image the suspected break.If the patient is unable to be moved, call an ambulance.  Emergency doctors will often refer you to an orthopaedic surgeon like Mr Brian Loh. Some orthopaedic surgeons primarily see adults while Mr Loh has experience with both adult and paedicatric trauma.

If the bone is broken, a cast will probably be applied.  Initially it might be a back slab which might be revised to a full cast when the swelling has come down.

It is common to have an x-ray 1-2 weeks after the injury to assess the position of the bones, and then, again, when the cast comes off.  If the growth plate or nerves are affected, Mr Brian Loh will generally review you more frequently and for a longer time to ensure all is going well.

First Few Days
Expect some pain and soreness in the first few days- over the counter pain medications and rest will help, as will elevating the limb.

Keep An Eye On Fingers And Toes
If there are any changes in sensation or colour of the fingers and toes, let your health care team know ASAP.  These could be an indication that the cast is too tight or the area is swelling a lot and this will need to be managed quickly. Wriggling fingers are toes is fine and should be encouraged.

Itchy Casts
Avoid scratching with skewers or chopsticks – the best way to manage itching is with cool air from a hairdryer on its coolest setting.

Leave The Cast Alone
Avoid picking at the padding or the cast.  Changes to the cast and its padding can affect the position of the fracture and impact healing.  Jagged edges can irritate skin.  Leave it to your doctor to make any adjustments to the cast.  But decorate the outside as much as you like!  Permanent markers are terrific!

Keep It Clean And Dry
Sand, dirt, and spaghetti sauce will all irritate the skin and get stinky.  The cast will be on for a while so make sure to do your best to keep it clean.  Only a couple of types of cast can get wet, so make sure the cast is kept dry -this can be done by wrapping a plastic bag around the limb and keeping it out of the bath.

Keeping a cast in good condition is key in helping the bones heal as quickly as possible and in the best possible position.

The post How To Care For A Broken Bone appeared first on Dr Brian Loh.

Elective surgery
Elective surgery is not always optional. “Elective” pertains to having the time to schedule the surgery.  Some elective surgeries are categorised as urgent where they need an operation in 30 days, some are semi-urgent, and others are non-urgent and can wait longer.  Cancer surgery is often elective and categorised as urgent.

Elective operations in children can be time dependant as the opportunity to effect change is finite as they grow so rapidly.  This includes the ability to affect the direction of growth in limbs and joints.  Brian Loh will operate on some kids with hip dysplasia or with growth problems at the most optimal time in their development.  Sometimes fractures that affect the growth plate result in a growth deficiency or an overgrowth of bone and these may need to be corrected by an operation by Brian Loh to equalise leg lengths  

Elective operations often have the flexibility of waiting until the optimal time such as when you have recovered from a cold, reach a safe weight to be operated on, or have the time to prepare for surgery emotionally and physically.

As an orthopaedic surgeon, Brian Loh will discuss with you the best time for any surgery that may be required.  

The post Elective Vs Emergency Surgery appeared first on Dr Brian Loh.

When babies are investigated for DDH, Dr Brian Loh will refer them for an ultrasound, and as they get older, he will transition to x-ray.

A baby’s bones are primarily cartilaginous at birth, for which the birth canal is very thankful!  However, this means they do not show up on x-ray very well.

Consequently, Dr Brian Loh uses Ultrasound to see the hip bones.  The quality of the pictures we get from ultrasound are dependent on the sonographer’s skill, a bit like different photographers produce different quality photos.

As a baby get older, the cartilage ends of the bones get more and more calcified. Generally, at about 6 months of age there is a bony nucleus in the head of the femur (thigh bone) and it is now time for x-ray’s to be used to get a good view of the hip bones.

Xrays do contain radiation, and Dr Loh uses the minimum number of x-rays possible to adequately monitor how the hips are growing. X-rays are also less dependent on the “photographer” to get a good image.

If DDH is missed or failed to be managed appropriately, many more x-rays and CT scans will be needed to help diagnose any problems, and the surgery that Dr Brian Loh will need to perform is much more complex. 

So, ultrasounds and x-rays offer images of the hip at different times in a child’s life.

The post Imaging Baby Hips – DDH appeared first on Dr Brian Loh.

When done best, they leave the patients and surgeons better equipped to manage moving forward.

Recently Brian and some other australian orthopaedic surgeons flew to Vietnam to volunteer at a hospital in Hanoi.

The surgeons in Vietnam are amazing. Their capacity to manage complex trauma is second to none. Unfortunately, their experience with motorbike accidents, workplace accidents and explosive trauma from mines has given them much practice.
However, as Vietnam continues to prosper and move away from the trauma of its past, they are working on better managing more elective cases and complex congenital and developmental problems.

Brian spent his time teaching the local surgeons about the management of paediatric problems including neuromuscular, developmental, and congenital problems. He scrubbed in to assist and teach with some complex procedures and the Australian team fostered relationships to help give their Vietnamese colleagues and the kids they treat the best outcomes possible in the future.

This was Brian’s third trip to Vietnam, and he hopes to return again soon.

The post Orthopaedic Outreach appeared first on Dr Brian Loh.

1. Firmly on both shoulders! One-sided carrying leads to a side bent posture and back and shoulder pain. Loose bags can swing causing chaffing. Too much pressure can cause arm tingles if the circulation or nerves are compromised in the shoulder region. It is much better to evenly disperse the weight across both shoulders.

2. Higher on the shoulders, about an inch above the waist.  Carrying backpacks too low can cause a sway back posture or for you to lean forward to much, and can add pressure to the shoulders causing pins and needles in the arms.

3. If there is a waist or chest strap, use it as this helps disperse the pressure more evenly.

4. Kids backpacks should weigh no more than 15% of their body weight. So 30kg child should not carry more than 4.5kg

6. Clean bags out regularly to minimise unnecessary weight.

7. Consider a second bag for all those library books.

8.  Pack the bag well. Heavier items should be down the bottom and closest to your back

The post Backpacks And How To Wear Them! appeared first on Dr Brian Loh.

A rheumatologist can help diagnose & manage the signs & symptoms of inflammatory arthritis in the long term & an orthopaedic surgeon may be called upon if surgical intervention is warranted.

The post Inflammatory Arthritis appeared first on Dr Brian Loh.

How to minimise the risk of osteoarthritis developing? What strategies help when it does develop?
– Rehab injuries well
– Have good technique and take rest breaks in all your work & leisure activities
– Maximise strength and control of your joints
– Maintain a healthy body weight – the pressure that goes through your knees in walking is 3-6 times your body weight, so losing a small amount of weight can take a significant amount of strain off your joints.

What can a surgeon do?
A surgeon can tell you if surgery is an option for you.  Factors that are considered are the amount of pain you are in, do simple analgesia and conservative management strategies help, and the state of the joints as seen on imaging. Sometimes a joint replacement is necessary and the type and timing of surgery will be discussed with you.

The post What is Osteoarthritis? appeared first on Dr Brian Loh.

There are about 100 different types of arthritis that have different symptoms, different causes and different treatments. 

Arthritis can be divided into two main types – Osteoarthritis which is the wear and tear arthritis and Inflammatory arthritis, of which there are many different types.  Some affect children but most affect adults.

The common feature of all types of arthritis is a disruption to the joint surface resulting in pain, stiffness and sometimes swelling.   If arthritis becomes severe enough, surgery may be an option.

The post What is Arthritis? appeared first on Dr Brian Loh.

There is a wonderful not-for-profit charity called MACA – Mobility and Accessibility for Children in Australia, that is “dedicated to advancing the rights of children with disabilities and medical conditions to safe and accessible transport.”

MACA is undertaking important research into how to best keep children with medical conditions and disabilities safe- including reviewing and assessing restraint systems and buckles.  MACA has information on a wide variety of challenges and strategies to help you transport your child safely.  They also keep a register of special purpose car seats that might be a better fit for your child.

MACA also offers training to allied health professional on the assessing and prescribing for a children’s transport needs.

Check out this fabulous resource and let your health team know about it if they don’t already!

The post Safe Transport appeared first on Dr Brian Loh.

There is a 5-step test to determine if your typically developing child is ready to sit in the car with a regular vehicle seatbelt.  This is usually at the age of about 10-12 years and needs to be reviewed in each car the child travels in as cars come in all shapes, sizes & dimensions.

The 5 steps are:

1. Back:  Can the child sit all the way back against the vehicle seat back?
2. Knee:  Do the child’s knees bend comfortably in front of the front edge of the vehicle seat?
3. Lap belt:  Is the lap belt sitting low across the hip bones touching the thighs?
4. Sash belt:  Does the sash (shoulder) belt sit across the middle of the shoulder, not on the neck or out near the arm?
5. Stay:  Can the child stay seated like this for the whole trip?

If the answer is no to any of these questions pop the booster seat back in!

For further information check out MACA

The post Car safety – When to move out of a booster seat? appeared first on Dr Brian Loh.