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In adults, the incidence of ipsilateral femoral neck fractures in the setting of femoral shaft fractures is reported to be as high as 9%; however, scant literature exists on the same clinical scenario in pediatric/adolescent populations. Therefore, the purpose of this study was to investigate the incidence of ipsilateral femoral neck fracture in the setting of femoral shaft fractures in children and adolescents treated in pediatric hospitals across the United States.The Pediatric Health Information System database was queried for patients aged 18 years or younger who were treated for a femoral neck, femoral shaft, and pertrochanteric femur fractures through an emergency department, inpatient, ambulatory surgery, or observation visit. Patients were identified using ICD-9 and ICD-10 diagnosis codes. Data from 49 pediatric hospitals between the years 2002 and 2020 were included. Incidence was calculated as the number of cases including the event divided by the total number of cases.A total of 90,146 records were identified from a cohort of 55,733,855 (0.16%). Distal femur fractures, pathologic fractures, and periprosthetic fractures were excluded, resulting in 65,651 unique cases. Of the 65,651 cases, 7104 (11%) were identified as isolated neck fractures. The combined incidence of femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture was 82.3 per 10,000 cases (0.82%). Only 283 cases of concomitant femoral neck and shaft fractures were found among 55,169 femoral shaft fractures (0.5%).The incidence of ipsilateral femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture is 82.3 per 10,000 patients (0.82%) based on data from Pediatric Health Information System-participating institutions. The incidence of femoral neck/pertrochanteric femur fractures and femoral shaft fractures in children and adolescents is more than 10 times lower than reported for adults; therefore, the routine use of advanced diagnostic imaging in pediatric patients with femoral shaft fractures should be considered cautiously.Level IV; cross-sectional analysis.

The utilization of nerve transfer procedures in the upper extremity following brachial plexus injury, trauma, spinal cord injury, tumors, infection or other etiologies are well established. Nerve injuries in the lower extremity pose several additional challenges, including longer distance to target motor end plates, far-proximal injuries in the lumbar plexus or pelvis, delayed presentation, and concomitant limb trauma. Nerve transfers in the lower extremity have the potential to provide functional (sensory or motor) recovery distally after direct surgical coaptation of a functional donor nerve to a non-functional recipient nerve. In addition, the ability to perform pure motor or sensory fascicular transfers allows for focused recovery while limiting donor morbidity. Indications for nerve transfers in the lower extremity are evolving, but have been utilized for non-recovering peroneal, obturator, femoral or tibial nerve palsies, to provide protective sensation to the plantar aspect of the of foot, as well as for painful neuropathies/neuromas. There is a paucity of orthopaedic literature on this topic and our review aims to highlight the current state of lower extremity nerve transfers as they relate to the practicing orthopaedist, including future directions in the field.

Proximal femur varus derotation osteotomy (VDRO) is the primary component of hip reconstruction surgery for the management of hip subluxation/dislocation in patients with neuromuscular dysplasia. Understanding the pathophysiology and abnormal proximal femur geometry is crucial to performing a successful surgery and dosing the surgical correction accurately. Children with neuromuscular hip dysplasia experience increased coxa valga, femoral anteversion and variable degrees of acetabular dysplasia. Understanding the relationship between these three anatomic aberrations can be difficult with standard two-dimension plain radiography. In this paper, we will review our novel three-dimensional imaging protocol to assess the pathologic anatomy of the proximal femur and acetabulum in children undergoing neuromuscular hip reconstruction. Understanding the anatomic relationship between the neck shaft angle, anteversion and acetabular dysplasia aids in the planning and execution of effective VDRO and hip reconstruction surgery.

Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.

Cerebral palsy (CP) is the most common childhood motor disability, yet its link to single-gene disorders is under-characterized. To explore the genetic landscape of CP, we conducted whole exome sequencing (WES) in a cohort of patients with CP.We performed comprehensive phenotyping and WES on a prospective cohort of individuals with cryptogenic CP (who meet criteria for CP; have no risk factors), non-cryptogenic CP (who meet criteria for CP; have at least one risk factor), and CP masqueraders (who could be diagnosed with CP, but have regression/progressive symptoms). We characterized motor phenotypes, ascertained medical comorbidities, and classified brain MRIs. We analyzed WES data using an institutional pipeline.We included 50 probands in this analysis (20 females, 30 males). Twenty-four had cryptogenic CP, 20 had non-cryptogenic CP, five had CP masquerader classification, and one had unknown classification. Hypotonic-ataxic subtype showed a difference in prevalence across the classification groups (p = 0.01). Twenty-six percent of participants (13/50) had a pathogenic/likely pathogenic variant in 13 unique genes (ECHS1, SATB2, ZMYM2, ADAT3, COL4A1, THOC2, SLC16A2, SPAST, POLR2A, GNAO1, PDHX, ACADM, ATL1), including one patient with two genetic disorders (ACADM, PDHX) and two patients with a SPAST-related disorder. The CP masquerader category had the highest diagnostic yield (n = 3/5, 60%), followed by the cryptogenic CP category (n = 7/24, 29%). Fifteen percent of patients with non-cryptogenic CP (n = 3/20) had a Mendelian disorder on WES.WES demonstrated a significant prevalence of Mendelian disorders in individuals clinically diagnosed with CP, including in individuals with known CP risk factors.

Tibial shaft fractures are common injuries in emergency departments (EDs). Although many of these fractures require surgery, nearly all are stabilized in the ED with a long leg splint or bivalved cast. Long leg splinting is often challenging for a single health care provider. Further, even with assistance or previously described techniques for fracture reduction and stabilization, fracture angulation may occur, potentially leading to pain for the patient, fracture displacement, or further soft tissue injury. The authors propose a method for splinting tibial fractures that avoids fracture angulation, is cost-effective and quick, and can be easily performed by a single health care provider. [ Orthopedics . 2015; 38(2):113–116.]

BackgroundRecent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection.Methodology/principal findingsSubjects were identified from 2002-2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p59 years-old age strata (pConclusions/significanceIn this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.