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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.

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.)