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To assess the self-reported knowledge, education, and practices related to hip-healthy swaddling of newborns among nurses, how they teach this technique to parents, and the relationships among these factors.Descriptive cross-sectional exploratory survey.Academic women and children's hospital with an average of 4,500 annual births.One hundred four registered maternity nurses who work primarily in the maternity unit.At three staff meetings, we surveyed maternity nurses to determine their knowledge, education, and practices related to hip-healthy swaddling and how they teach this technique to parents. We analyzed results using descriptive statistics and chi-square and Fisher's exact tests.Of the 156 nurses in the maternity unit, 104 attended three staff meetings and completed the survey. Among the participants, 18.9% (18/95; 9 participants did not respond) were unable to identify the correct hip swaddling position. Overall, 64.2% (61/95; 9 participants did not respond) reported that they received education on general swaddling technique, yet 14.8% (9/61) of these participants were unable to identify the correct hip-healthy swaddling position. Among the participants, 99.0% (103/104) reported that nurses teach parents how to swaddle infants rather than other health care providers; 12.5% (13/104) of participants responded that medical doctors provide training as well. Overall, 67.0% (69/103; 1 participant did not respond) reported that they taught parents in75% of parent interactions.Our results illustrate a gap in knowledge about hip-healthy swaddling among the maternity nurses who participated in this survey and a need for further education.

Background: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon–femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients. Purpose: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens. Study Design: Descriptive laboratory study. Methods: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface. Results: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. Conclusion: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens. Clinical Relevance: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

The standard bag-valve mask (BVM) used universally requires that a single healthcare practitioner affix the mask to the face with 1 hand while compressing a self-inflating bag with the second hand. Studies have demonstrated that creating a 2-handed seal (with 2 healthcare practitioners) is superior. Our study aims to assess the efficacy of a novel single-practitioner BVM device that uses a foot pedal as the bag compressor, allowing both hands to be available for the seal to facilitate delivery of appropriate tidal volumes during single-practitioner resuscitation.This was a prospective, randomized, cross-over study. Participants with various BVM ventilation experience performed 2 minutes of metronome-guided BVM ventilation using a standard BVM and the pedal-operated compressor on a high-fidelity simulation mannequin. Analysis examining differences in mean tidal volume delivered was conducted using a regression model that adjusted for covariates. A secondary analysis using a series of Wilcoxon tests was conducted to compare differences in the additional out-of-range sensed breaths metrics to compare differences by prior BVM ventilation experience.A total of 58 subjects participated. The pedal-operated compressor unadjusted mean tidal volume delivered was 446.5 mL (95% confidence interval [CI], 425.9-467.1) compared with 340.6 mL (95% CI, 312.2-369.0) by standard BVM (mean change, 105.9 mL [95% CI, 71.2-140.6];Use of a novel pedal-operated compressor may allow a single healthcare practitioner, regardless of prior experience, to deliver consistent, appropriate tidal volumes with more ease compared with the standard BVM during manual respiratory resuscitation.

Background: Radial head subluxation, known as pulled elbow or Nursemaid’s elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an elbow that is pronated and extended. Although the stability of the proximal radioulnar joint has been previously examined in cadaveric models, there are no current studies quantifying the biomechanics of nursemaid’s elbow. The purpose of our study was to demonstrate and quantify the axial traction force required to produce a nursemaid’s elbow in a pediatric cadaver specimen. Methods: Two fresh-frozen cadaveric elbows from a single 3 year-old male donor were dissected by a fellowship-trained orthopedic surgeon. An Instron 5944 testing machine with a 2 kN load cell was used to perform uniaxial testing. The radius and humerus were mounted to the Instron machine, and loaded in the axial direction with the elbow in full extension. Loading occurred at a rate of 10 mm/sec for 4 seconds, during which the force and actuator displacement were continuously recorded. The local instantaneous load and extension displacement at the time of subluxation were recorded, and data was synced with high-frame-rate video footage used to confirm the annular ligament subluxation. Results: The load to failure required to produce the nursemaid’s elbow injury in the first elbow was 31N, with a failure displacement of 4.6mm. The second elbow demonstrated a load to failure of 26N, with a failure displacement of 4.6mm. After subluxation, we reduced the annular ligament from the first specimen. The elbow was then re-tested and demonstrated a load to failure of 20N, with a failure displacement of 2.6mm. Conclusion: Axial traction applied to a pediatric cadaver specimen results in subluxation of the annular ligament into the radiocapitellar joint. The mean load to failure is 28.5N, and a lower load to failure was required to produce a recurrent subluxation in a previously injured specimen. Lower load for a recurrent subluxation may be attributed to damage on the annular ligament due to the first subluxation. [Figure: see text]

Background: For patients with significant growth remaining, the Iliotibial Band ACL reconstruction technique has proven to be reliable procedure with minimal risk for growth disturbance. Recent dissection studies confirm the neuro-vascular bundle is within 1 cm of the ACL graft over the top position, confirming the importance of careful graft passage technique to avoid neurovascular injury. Purpose: The purpose of this study was to evaluate the over the top graft passage technique using pediatric 3-D knee models. Instrument placement for graft passage was assessed for its proximity to the posterior aspect of the femur, maintaining a safe distance from the neurovascular bundle. Materials and Methods: 3D knee models (ages 7, 9, 11 years) were printed from high resolution knee CT scans, including a hinge/pivot mechanism to allow for simulation of knee position during flexion and extension. Various curved tip instruments were used to evaluate the path of the graft passage, with several goals: 1. Allow the instrument to create a graft path through the posterior capsule in the most anatomic femoral position. 2. Keep the tip of the instrument close to posterior and lateral cortex of the femur, to avoid neurovascular injury. The instruments varied in design, arc of curvature, overall length, diameters. Results: Clamp passage was performed using a retrograde approach, i.e. through the notch, passing outside the periosteum of the postero-lateral femur (Figure 1). For some clamps, the arc of the curvature allowed for passage of the instrument with minimal risk of neurovascular injury. For some clamp configurations, the clamps deviated significant from the posterior aspect of the femur during graft passage, which may increase the risk of neurovascular bundle injury. In each case, an instrument was identified that met the criteria for safe passage, but different instruments were required based upon the size of the knee joint. Conclusions: The ITB ACL reconstruction is one of the best options for ACL reconstruction in the skeletally immature. The neurovascular structures are very close to the path for over the top graft placement. Due to the wide range of knee dimensions in this group, different clamp designs may be necessary for optimal over the top graft passage. 3D knee models may guide surgeons for procedure technique and optimal instrument selection for safe graft passage. [Figure: see text]

Objectives: Anatomic meniscus repair is frequently performed in young patients to maximize joint preservation and long-term joint health. Increasingly, surgeons are considering the role and function of the meniscotibial ligament structures during meniscus repair and transplant. The purpose of this study was to determine the distance between the tibial insertion of the meniscotibial ligament capsular attachment and the proximal tibial physis in skeletally immature subjects. Methods: 14 pediatric knee cadaver knee specimens (ages 3 months to 11 years) were dissected to clarify the relationship physis and meniscus/meniscotibial ligament complex. Metallic markers were placed marking the meniscotibial ligament capsular attachment in specific domains (Figure 1). The specimens underwent CT scanning to evaluate pin placement and relationship to the physis. OsiriX was used to measure the distances between the proximal tibial physis and the pins (placed at 5 points on both the lateral and medial meniscus- anterior root, 12 o’clock, 3/9 o’clock, 6 o’clock and posterior root). Specimens were divided into two groups for analysis- Group 1: ages 3 months- 2 years (10 pediatric knee specimens: 8 male, 2 female), and Group 2: ages 10-11 years (4 pediatric knee specimens: 2 male, 2 female). Results: There was an increase in the distance between the proximal tibial physis and the insertion points of the meniscotibial ligament with increasing specimen age. For both the medial and lateral menisci, Group 1’s meniscotibial ligament insertion points were less than 10mm away from the physis. Group 2’s meniscotibial ligament insertion points tended to be further away from the physis, but less than 20mm away, and sometimes even as close as Conclusions: This anatomic study defines the relationship between the physis and meniscotibial ligament capsular attachments that increases with age. These anatomic parameters can be considered as future meniscus repair and reconstruction techniques seek to restore the meniscus anatomy, stability, and mobility provided by the meniscotibial ligament structures. This anatomic information and may be used by surgeons to develop techniques to perform meniscal repair/reconstruction in patients that utilize the meniscotibial ligament structures. Avoiding direct physeal injury during menisco-tibial ligament repair is possible. [Figure: see text][Figure: see text]

Background: Health Systems routinely make investments in clinically driven outreach programs to build for future community needs, improve health outcomes, and serve their community mission. Many community sports programs have limited access to sports medicine care, including access to athletic trainers. Hypothesis/Purpose: The primary purpose of this study was to evaluate the impact of a clinically integrated Certified Athletic Trainer (ATC) Community Sports Outreach Program, by evaluating the outreach into the community, sports clubs, schools, covered events. Methods: The ATC Community Outreach Program monitored key metrics over a 3 and 1/2-year period. Metrics included the partnerships developed with local clubs and schools, number of athletes covered in each organization, games covered and hours spent supporting organizations. Categories were divided into fiscal years (FY) running from September to August. Fiscal Year 2016 was calculated from January – August, as it was the first year of the program. The percentage of growth of the amount of games covered was calculated from the adjacent FY. Results: Over the first 3 and 1/2 years (FY2016-FY2019), the number clubs, schools, programs covered grew from 10, 19, 25, to 31 from FY2016 - FY2019. Number of athletes from 7,363, 12,552, 15,104, to 19,794 from FY2016 - FY2019. The number of community outreach events grew from 6, 11, 57, to 190 from FY2016 - FY2019 (Table/Figure 1.1). The percentage of growth of games covered grew from 183%, 518% to 333% between FY2016 and FY2019. Discussion/Conclusion: Building, maintaining a sports medicine practice is a complex undertaking, and represents a significant investment for the health system and community. In many communities, access to sports medicine care for athletes is very limited. A clinically integrated ATC program can generate a significant impact on the community by building relationships with local sports clubs/schools and improving sports medicine care access to young athletes. Tables/Figures: [Table: see text][Figure: see text]

Background: As regards anterior cruciate ligament (ACL) reconstruction (ACLR), graft diameter has been identified as a major predictor of failure in skeletally mature patients; however, this topic has not been well-studied in the higher risk pediatric population. Hamstring tendon autograft configuration can be adjusted to increase graft diameter, but tendon length must be adequate for ACLR. Historical parameters of expected tendon length have been variable, and no study has quantified pediatric ACL morphology with other osseous parameters. Purpose: To develop magnetic resonance imaging (MRI)–derived predictors of native ACL graft length in pediatric patients so as to enhance preoperative planning for graft preparation in this skeletally immature patient population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: MRI scans of 110 patients were included (64 girls, 46 boys; median age, 10 years; range, 1-13 years). Patients with musculoskeletal diseases or prior knee injuries were excluded. The following measurements were taken on MRI: ACL length; sagittal and coronal ACL inclination; intercondylar notch width and inclination; and femoral condyle depth and width. Associations between these measurements and patient sex and age were investigated. Univariate linear regression and multivariable regression models were created for each radiographic ACL measure to compare R 2. Results: Female ACL length was most strongly associated with the depth of the lateral femoral condyle as viewed in the sagittal plane ( R 2 = 0.65; P < .001). Other statistically significant covariates of interest included distal femoral condylar width, age, and coronal notch width ( P < .05). For males, the ACL length was most strongly associated with the distal femoral condyle width as viewed in the coronal plane ( R 2 = 0.70; P < .001). Other statistically significant covariates of interest for male ACL lengths were lateral femoral condyle depth, age, and coronal notch width ( P < .05). Conclusion: In pediatric populations, femoral condylar depth/width and patient age may be valuable in assessing ACL size and determining appropriate graft dimensions and configuration for ACLRs. The use of this information to optimize graft diameter may lower the rates of ACL graft failure in this high-risk group.

Objectives: The menisci of the knee (Figure 1) play a critical role in maintaining structural integrity, as well as in load bearing and shock absorption. In adolescent patients, meniscal tear is a very common sports injury, and is frequently associated with concomitant traumatic injuries including tibial eminence fracture or ACL tear. Depending on the severity of meniscal tear, surgical treatment options include arthroscopic partial or total meniscectomy, with a reported 78-88% success rate. Given the high incidence of pediatric meniscal injuries and reliance on landmarks to guide arthroscopic meniscus repair, surprisingly few human pediatric cadaveric studies are reported in the current literature. The primary purpose of our research was to evaluate the rates at which different zones of the meniscus rim lengthen with age during early adolescence. Our null hypothesis was that meniscus rim length is unrelated to patient age, tibial plateau width, or to lateral-medial meniscus width. Methods: From images of 29 dissected cadaveric knee specimens between 1 month and 132 months of age obtained on a copy stand (14 left knee, 15 right knee), we made direct length measurements from the inner to outer meniscus rim at 45 degree intervals (12, 1:30/10:30, 3:00/9:00, 4:30/7:30 o’clock, 6 o’clock) using Autodesk Fusion 360 software (Figure 2). We also measured width between the outer medial and lateral meniscus rims, as well as CT measurements of coronal and sagittal width of the tibial plateau using OsiriX DICOM software. Generalized linear models were used to evaluate the associations of meniscal length measurements with age, tibial width, and meniscal width measurements. All statistical analyses were completed with a two-sided level of significance of 0.05. Results: All meniscal length measurements were predicted to increase significantly as age increases (p < 0.01 for all), as coronal tibial width increases (p < 0.05 for all), and as lateral-medial meniscal width increases (p < 0.001 for all). Other than the lateral 3 o’clock measurement (p = 0.119), all meniscal length measurements were predicted to increase significantly as sagittal tibial width increases (p < 0.05 for the rest). Interestingly, the posterior zones of the medial meniscus (6 o’clock and 4:30/7:30 o’clock) were found to increase in length at a faster rate than the anterior zones (Figure 3), which supports our hypothesis that increased weight bearing is correlated with meniscus growth. The same length correlation was not identified in the lateral meniscus. Furthermore, the anterior zones of the medial meniscus (12 o’clock and 1:30/10:30 o’clock) were found to have the slowest rate of growth, presumably due to reduced weight bearing function anteriorly. Conclusions: We reject our null hypothesis that meniscus rim length is unrelated to age, tibial plateau width, or to lateral-medial meniscus width. Surprisingly, the posterior zones of the medial meniscus were found to grow at a faster rate with age compared to the anterior zones, which we attribute to the effect of increased weight bearing experienced by the posterior zones during knee bending exercise. Additionally, the anterior, lesser-weight bearing regions of the medial meniscus were found to develop at the slowest rate out of all zones measured. Further studies are underway to generalize these observations to all adolescent patients. This information will be useful for meniscus repair and transplantation surgical planning.

Planetary exploration requires a balance between preemptive planning and financial feasibility. The risk of mid-mission equipment failure, power shortages, or supply depletion incentivizes precautionary measures, but the financial strain of sending unnecessary mass into space limits this practice.To balance the two, our team explored the advantages of biological solutions, namely the self-sustaining abilities of low-mass organisms, to make planetary exploration more self-sufficient and economical. Prioritizing repair over replacement, we are developing self-healing materials embedded with Bacillus subtilis. For longer-lasting energy, we are designing a “biobactery” using linearly oriented Escherichia coli to generate power. For renewable materials, we are engineering bacteria to synthesize and degrade rubber. Individually, these projects offer sustainable alternatives for repair, power, and materials. But when combined, these consolidated insights can provide us with the power to get to Mars and resources to sustain us while we’re there.