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The aim of the study was to determine if the use of an Instructional Video will decrease anxiety during cast removal. We enrolled 60 healthy children undergoing their first cast removal following conservative fracture treatment. Patients were divided into one of three groups (1) No Video (control group), (2) watching a video of a well-tolerated pediatric cast removal (Instructional Video), or (3) watching a nonmedical Children's Video during cast removal. We assessed anxiety to the cast saw by recording heart rate in the waiting room, during the procedure, and 1-2 min after the procedure. There were no significant differences in waiting room, procedure, and post-procedure heart rates between the two interventions and the control group. The mean change in heart rate from baseline to the procedure room for the Instructional Video cohort exhibited a similar increase (25.8 beats/min) in heart rate during cast removal as the No Video group (26.3 beats/min), while the Children's Video had the smallest change in heart rate (17.7 beats/min) with a trend towards significance (P = 0.12). The results were not statistically significant for the full linear mixed-effect model on the three measurements. When we use age to control for variability in the data, we have a moderate effect size between Children's Video and control (η2P = 0.0592), revealing that certain ages likely benefited from the Children's Video intervention. Distraction using a Children's Video may help reduce anxiety during cast removal whereas the Instructional Video did not reduce anxiety as hypothesized., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

This report documents a rare case of isolated trochlear shear fracture in an adolescent patient and provides a literature review. Radiographic analysis of the distal humerus revealed an intra-articular fracture of the anterior trochlea, evidenced by a full moon-shaped osteochondral fragment. Open reduction and internal fixation with two headless Herbert screws secured the fragment. Because of the paucity of information on this injury, standard treatment and management have not been established. Prospective studies with longer follow-up are needed before a consensus with regard to these fractures is established.

Background: Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures., Methods: A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed., Results: A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956., Conclusions: Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major complications., Levels of Evidence: Level III--retrospective review.

Supracondylar humerus fractures occur frequently in children and can be repaired by the lateral or crossed pinning technique, although the importance of pin divergence is unknown. A surgeon's experience using the crossed (N=46) and lateral (N=57) pinning technique was reviewed to determine whether the pin-spread ratio (PSR), the distance between the pins at fracture level divided by the fracture width, was associated with fixation loss. No association existed between the PSR and change in Baumann's angle for fractures repaired by lateral pinning, although one existed for type III fractures repaired with crossed pinning. The PSRs employed in pediatric supracondylar humerus repair appear sufficient for fixation., (© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.)

Objective: To evaluate the utility of quantitative computerized pain drawings (CPDs) in a sample of spine patients before and after surgery., Design: Analysis of changes in quantified CPDs, the Oswestry Disability Index (ODI), the Short Form-36 Health Survey Questionnaire (SF-36), and numerical ratings of pain intensity before and after surgery., Setting: Private clinic in large metropolitan area. Patients. Forty-six patients with spinal stenosis. Interventions. Surgery for the relief of pain due to spinal stenosis., Outcome Measures: A total points (TP) score was calculated from the CPD that reflected the total number of pixels filled by the patient, and the percentage of total pain area indicated as aching, stabbing, numbness, pins and needles, burning, and other, were each calculated separately. CPD scores, ODI score, Physical Components Summary (PCS) and Mental Components Summary scores of the SF-36, and pain intensity ratings (0-10 scale) were all recorded before and after surgical intervention. Results. After surgery, patients showed significant improvements in the extent of shaded pain area of the CPD, pain intensity ratings, ODI, and SF-36 PCS scores (paired t-test, P < or = 0.01). Changes in TP scores calculated from the CPDs were significantly correlated (P < or = 0.05) with changes in ODI scores (r = 0.34) and pain intensity ratings (r = 0.37). Changes in the percentage of total pain area covered by specific qualities of pain were not significant., Conclusions: Results from the present study provide initial support for the use of automated quantified data collected from CPDs to evaluate treatment interventions and to serve the clinician as a record of changes in spatial location, radiation or extent of pain, and the sensory quality of pain when evaluating individual patient needs.

Unlabelled: The need for segmental resection versus intralesional treatment of low-grade chondrosarcomas of the appendicular skeleton remains controversial. We hypothesized extended intralesional treatment would equally control malignant disease but with improved functional outcomes and decreased postoperative complications. We retrospectively reviewed 31 patients with 32 Grade I intracompartmental chondrosarcomas of the long bones of the appendicular skeleton treated with either resection (15 lesions) or extended intralesional curetting (17) at a minimum followup of 2 years (median, 55 months; range, 24-203 months). Lesions were larger and median followup was longer in the resection cohort. One local recurrence developed in each treatment cohort and neither transitioned to a higher grade of tumor. No patient had metastases develop or died of disease. The mean final Musculoskeletal Tumor Society functional scores were greater after extended intralesional versus resection treatment (29.5 versus 25.1). Complications were observed more frequently after resection and reconstruction (seven of 15) as compared with extended intralesional treatment (one of 17). Extended intralesional treatment of Grade I intracompartmental chondrosarcomas of the long bones of the appendicular skeleton therefore appears safe with improved functional scores and decreased complications versus segmental resection and reconstruction., Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Background: To determine the incidence and severity of injuries caused by Heelys., Methods: A retrospective review of all fractures presenting to an orthopaedic emergency room at a metropolitan children's hospital during a 90-day period. The type of fracture, mechanism of injury, and management were recorded for each patient. For those injuries related to the use of Heelys, further data were collected including total number of visits, cast changes, and cost. Each Heelys patient/family was contacted and answered a questionnaire detailing their use of Heelys and the events surrounding the injury., Results: A total of 953 patients with fractures were evaluated for 90 days. Sixteen patients with 17 fractures (1.68%) were identified as being related to the use of Heelys. This compares to the incidence of fractures in our sample from basketball (6.19%), bicycle (4.41%), football (4.09%), monkeybars (3.78%), skateboarding (3.25%), soccer (2.62%), baseball (2.52%), and trampoline (2.31%). The average age of each Heelys patient was 8.9 years, and 13 patients were girls. There were 16 upper extremity and 1 lower extremity fracture. No patient needed operative treatment or admission. Average number of follow-up visits was 1.6, with an average of 1.4 casts per patient. Average cost per patient was $1368. Ninety-two percent of the Heelys injuries occurred outdoors. Fifty-four percent of children were being supervised when they fell, but only 31% were wearing any safety equipment. Sixty-two percent of parents were not aware that safety equipment was recommended. All 13 parents indicated that they would not purchase another pair of Heelys, and only 23% of the children wanted to keep using Heelys after the injury., Conclusions: The incidence of Heelys injuries (1.68%) was relatively low compared with other common childhood play activities. The fractures were mostly in the upper extremity, and no fracture required surgical intervention or admission to the hospital. Sixty-two percent of the parents were not aware that safety equipment was recommended, and only 31% of the children were wearing safety equipment.