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Purpose: Direct Discharge protocols (DD) can alleviate strain on healthcare systems by reducing routine outpatient follow-up. These protocols include low-complex musculoskeletal injuries, such as isolated greenstick fractures or torus fractures of the wrist in children. While there is consensus on the effectiveness of DD, there is a lack of injury-specific powered studies. This study compares treatment satisfaction between DD and traditional treatment in children with a greenstick fracture or torus fractures of the wrist. Methods: Children with isolated torus or greenstick fractures of the distal radius or ulna were eligible for inclusion before (pre-DD cohort) and after (DD cohort) the implementation of DD in four hospitals. Traditionally, patients receive a (soft) cast and minimally one routine outpatient follow-up appointment. With DD, patients are discharged directly from the ED after receiving a brace and information, summarized in a smartphone app and a helpline for questions during recovery. The primary outcome was patient or proxy treatment satisfaction (0 to 10), and a power analysis was performed to assess non-inferiority. Secondary outcomes included complications, functional outcomes measured in Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE), primary healthcare utilisation, and secondary healthcare utilisation (follow-up appointments and imaging). Results: In total, 274 consecutive children were included to analyse the primary endpoint. Of these, 160 (58%) were male with a median age of 11 years (IQR 8 to 12). Pre-DD and DD treatment satisfaction did not vary statistically significantly for greenstick fractures (p = 0.09) and torus fractures (p = 0.93). No complications were observed. PROMIS UE showed no statistically significant differences before and after implementation of direct discharge protocol for torus (p = 0.99) or greenstick (p = 0.45) fractures. Secondary healthcare utilisation regarding follow-up was significantly lower in the DD-torus cohort compared to the pre-DD torus cohort, with a mean difference (MD) of − 1.00 follow-up appointments (95% Confidence Interval (CI) − 0.92 to − 1.13). Similar results were found in the pre DD-greenstick cohort compared to the pre-DD-greenstick cohort (MD): − 1.17 follow-up appointments, 95% CI − 1.09 to − 1.26). Conclusion: Direct Discharge is non-inferior to traditional treatment in terms of treatment satisfaction for paediatric patients with greenstick or torus fractures of the wrist compared to children treated with rigid immobilisation and routine follow-up. Furthermore, the results demonstrate no complications, comparable functional outcomes, and a statistically significant reduction of secondary healthcare utilisation, making DD a good solution to cope with strained resources for children with an isolated greenstick fracture or torus fracture of the wrist. [ABSTRACT FROM AUTHOR]

Background: Avulsion fractures of the sublime tubercle of the ulna are a cause of medial elbow pain and instability in overhead athletes. Purpose: To compare outcomes after sublime tubercle avulsion fracture managed as a fracture (with cast immobilization) versus a soft tissue injury (without immobilization and with early range of motion [ROM]) to determine how to achieve the best outcomes for these injuries in adolescent throwing athletes. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review using an institutional database query of radiology reports to identify sublime tubercle fractures between July 2005 and December 2020 was performed. Inclusion criteria were baseball players aged ≤19 years, fracture identified on ≥1 imaging study (radiograph, computed tomography, or magnetic resonance imaging), and ≥24 months of follow-up (unless failure of management occurred earlier). Fractures were classified as simple or complex injuries and then grouped according to management strategy: cast or early ROM. Data collected included patient characteristics, clinical presentation (injury mechanism and acuity), initial treatment, and outcomes (complications, final ROM, patient-reported symptoms, radiographic union, and return to activities or sport). Results: A total of 13 baseball players (6 in the cast cohort and 7 in the early ROM cohort) with a mean age of 16.5 years (range, 15-19 years) met the inclusion criteria, with a mean follow-up of 4.1 years (range, 2.0-6.7 years) in the cast cohort and 3.8 years (range, 2.1-7.4 years) in the early ROM cohort. All injuries were classified as simple fractures. Five patients (83%) in the cast cohort achieved radiographic union, return to sports, and symmetric ROM, compared with only 2 patients (29%) in the early ROM cohort who achieved the same without having to undergo ulnar collateral ligament reconstruction (P =.026). Conclusion: The present study demonstrated that, whereas management of sublime tubercle avulsion fractures in adolescents via early ROM had a high failure rate, a mean of 4 weeks of immobilization led to a high rate of return to sports with successful union of the avulsed fragment. Unlike purely ligamentous injuries, bony avulsions may not necessarily require surgical intervention for adolescent patients to return to baseball. [ABSTRACT FROM AUTHOR]

Background: The treatment results of the Ponseti method for arthrogrypotic clubfoot have been described in only a few case series. Further evaluations are necessary. Methods: Children from two German paediatric orthopaedic hospitals with arthrogryposis-associated clubfoot treated with the Ponseti method between 2004 and 2011 and who were at least five years of age at their last follow-up were retrospectively evaluated. The endpoints were the clinical foot position, necessary surgeries during the follow-up period and radiological constellations. A comprehensive literature review was conducted after a systematic literature search. Results: Seventeen patients (47% with amyoplasia [AP] and 53% with distal arthrogryposis [DA]) met the inclusion criteria. Thirty-one feet were evaluated. The period between the treatment start and the last follow-up examination covered 8.9 ± 2.5 years. After the last cast removal within the initial Ponseti cast series, 74% of the clinical results were good to excellent. However, the clinical outcomes in the patients with AP were significantly worse. Overall, in 23 feet (74%), at least one major surgery at the age of 2.9 ± 2.2 years was necessary during the clinical course. Major surgeries were much more frequent on the feet of the patients with AP than with DA. Lateral X-rays showed normal age-appropriate radiological angles in 4% of the feet, hindfoot equinus in 19%, under-corrected hindfoot in 44%, under-corrected clubfoot in 26% and rocker bottom deformity in 7%. The radiological residual deformities in AP were much more severe than in DA (p = 0.042). Most of the studies reviewed (11 case series, 144 patients) reported high initial clinical correction rates, followed by high recurrence rates and the need for further surgeries. Conclusion: About a quarter of the arthrogrypotic patients benefited from the Ponseti therapy without further major surgery. However, the clinically observed high initial correction rate after Ponseti therapy of arthrogrypotic clubfoot was not accompanied by a correction of the bony foot position in the X-rays. The feet of the patients with DA had better outcomes than those of the patients with AP. Therefore, in outcome studies, a clear distinction between patients with AP and those with DA is necessary. [ABSTRACT FROM AUTHOR]

En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis. [ABSTRACT FROM AUTHOR]

Casting is an effective adjunctive treatment, which increases the effects of botulinum toxin on patients with spasticity. The evidence for casting as an adjunctive therapy post-botulinum toxin has been well documented in the literature. However, standardized casting protocols are lacking, with no published descriptions of upper limb casting application post-botulinum toxin injection for spasticity. In this article, we will describe our experience regarding the application of upper limb casting as an adjunctive therapy for elbow spasticity, detailing indications, contraindications, and description of our protocol (materials required and technique). [ABSTRACT FROM AUTHOR]

Objective: This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities. Methods: 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up. Results: Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results. Conclusion: Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes. Level of evidence: IV Retrospective study. [ABSTRACT FROM AUTHOR]

Hamate fractures are uncommon, but early and accurate diagnosis is critical to prevent negative outcomes. Hamate fractures may present initially to emergency departments, and diagnosis can be challenging. This case report of a common hamate fracture may aid in increasing emergency advanced practice nurse knowledge to identify these fractures in practice. [ABSTRACT FROM AUTHOR]

Data in the literature on the results of Kinesio taping (KT) application after cast removal in patients with distal radius fracture (DRF) are quite limited. It was aimed to evaluate the effectiveness of KT applied immediately after cast removal in addition to the exercise program on edema, functionality, range of motion, and muscle strength in patients with conservatively followed DRF. Randomized controlled single-blinded clinical study. This study was conducted with 64 patients with a diagnosis of DRF. The patients were randomized as Kinesio taping group (KTG) and control group. Both groups received a conventional home exercise program. KT was applied to patients in KTG for 10 days. Circumference and volume measurements were taken at baseline and day 10. Arm, Shoulder, and Hand Questionnaire for Disability, Visual Analog Scale, grip strength, and wrist joint range of motion measurements were taken at baseline, day 5, and day 10. The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the fifth day at the wrist level (<0.001) and 6 cm proximal to the wrist (p = 0.001). The circumference difference between the affected extremity and the healthy extremity was statistically greater in the control group on the 10th day at the wrist level (p < 0.05) and 6 cm proximal to the wrist (p = 0.01). Wrist extension angle (<0.001), wrist flexion angle (p = 0.001), and supination angle (p = 0.001) were higher in KTG on the 10th day. On the 10th day, the grip strength (p < 0.05) was higher in the KTG, while the Visual Analog Scale value (p < 0.01), Arm, Shoulder, and Hand Questionnaire for Disability score (p < 0.01), and the percentage of strength loss in the healthy arm (p < 0.01) were lower in the KTG. In patients with DRF who were treated conservatively with a cast, the inclusion of Kinesio taping (KT) in the rehabilitation program was found to be effective in reducing edema and pain, as well as improving functionality, strength, and range of motion. • Kinesio tape application is effective on edema in the postoperative subacute period. • Kinesio tape KT application is effective in pain control, improvement of function and muscle strength. • Kinesio tape KT application is effective in wrist flexion, extension and supination range of motion. [ABSTRACT FROM AUTHOR]

Purpose: Compare two simple ways for treating boxer's fractures in active adults; conservative management by ulnar gutter slab and transverse pinning in fixation of fifth metacarpal's neck fracture regarding union, functional outcomes, and complications. Patients and methods: Ninety patients with fifth metacarpals' neck fractures with palmar angulation (30–70°) were managed either conservatively by an ulnar gutter slab or surgically by transverse pinning technique from January 2020 to December 2021. Only 84 patients completed a 1-year follow-up. Patients with old, open, or mal-rotated fractures were excluded. The block-randomization method was used to create equal groups. Patients were evaluated clinically and radiologically every 2–3 weeks until union, then at 6 and 12 months. Functional assessment at the final visit was done using the quick DASH score, total active motion (TAM), and total Active Flexion (TAF). Results: The mean radiological union time for the conservative group in this study was 7.76 weeks, while for the transverse pinning group, it was 7.38 weeks. There was no statistically significant difference between the two techniques regarding union rates and functional outcomes. All patients returned to their pre-injury jobs and level of activity. Conclusion: Both conservative management in ulnar gutter slab and percutaneous transverse pinning are considered effective methods in the treatment of simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees (AO: 77 A3.1). The functional and radiological results using both methods were satisfactory and statistically comparable. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the paediatric population after injuries. 3--10% of them are multiple primary malignant neoplasms, which are a huge problem both in diagnosis and treatment. We present a case of a boy, nearly 2 years old, with synchronous coexistence of T-cell acute lymphoblastic leukaemia and Langerhans cell histiocytosis. During the M AIEOP BFM ALL 2017 Protocol, the patient suffered an injury to the right elbow joint. Despite the limb being provided with a plaster cast and orthopaedic intervention, local improvement was not achieved. The obtained result of the histopathological examination revealed a disseminated aggressive form of histiocytosis affecting the skeletal system and lungs. In the presence of non-specific symptoms for the diagnosed cancer, one should be vigilant and suspect the coexistence of another proliferative process, which may cause no improvement despite proper therapeutic management. [ABSTRACT FROM AUTHOR]

Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical and sonographic outcomes of percutaneous Achilles tendon tenotomy in children with idiopathic clubfoot who underwent the Ponseti procedure. Methods: A prospective study was conducted at the JIPMER Department of Orthopaedics, involving 41 feet with residual equinus deformity following Ponseti treatment. Infants with idiopathic clubfoot were included. Clinical and sonographic evaluations were performed, percutaneous Achilles tendon tenotomy was performed. Parameters were measured, Data were statistically analyzed using Kolmogorov-Smirnov tests, paired t-tests, ANOVA, and correlation analysis. Results: 29 infants (41 feet), primarily boys (89.7%) were studied. Following percutaneous tenotomy, clinical improvement was observed, with a mean increase in dorsiflexion of 20-25 degrees. Sonographic parameters showed significant improvement in tibio calcaneal distance, talocalcaneal divergence, and metaphyseal-talocalcaneal angle posttenotomy (p<0.05). Positive correlations were found between clinical and sonographic improvements. Conclusion: Clinical improvement of hindfoot deformity following percutaneous Achilles tendon tenotomy in idiopathic clubfeet correlates with the sonological improvement of talo calcaneal, tibio calcaneal angles and tibio calcaneal distance. [ABSTRACT FROM AUTHOR]

Cast removal is a common procedure that can involve risks to the patient and should be done by a qualified and experienced provider. Indications for removal, assessment parameters, and careful procedural steps should be understood by all technicians, practitioners, and physicians who will participate in the removal of casting materials. Because this procedure can also produce anxiety for the patient and their family members, it is good practice to thoroughly inform the patient and answer any questions in advance to help reduce anxiety and promote cooperation from all during the process. This article describes common techniques for cast removal and provides tips to facilitate safe and efficient outcomes during this procedure. [ABSTRACT FROM AUTHOR]

To describe hand function, and investigate adherence to a rehabilitation protocol and factors associated with upper extremity disability in non-surgically treated proximal phalangeal fractures. In a prospective cohort study, 86 patients (58 women, mean age of 49 years) were assessed at cast removal and 6 weeks follow-up. Adherence was registered in a diary. Factors potentially associated with disability were assessed in a logistic regression model. At 6 weeks, the mean total active range of motion in the injured finger was 84% of the uninjured finger and median pain intensity levels were low (VAS <20). Mean grip strength was 66% of the uninjured hand and 28% perceived high upper extremity disability (QuickDASH score ≥30). Most patients adhered to exercise and night splint regime. The strongest associated factors with high upper extremity disability were more days in cast (Odds ratio 1.429, 95% CI 1.110–1.840) and fear of movement (Odds ratio 1.119, 95% CI 0.990–1.256) in the final regression model (Nagelkerke R Square 0.46). Most patients regain early satisfactory hand function, but a quarter still perceives high upper extremity disability. Longer immobilisation time in particular and fear of movement are important factors that may negatively affect the early outcome. [ABSTRACT FROM AUTHOR]

Background: The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized. The purpose of this study was to evaluate the clinical outcomes at the end of the casting period while addressing these issues. Methods: A retrospective study of 17 patients with 25 complex clubfeet over a period of 2 years was conducted. Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads. Results: The mean age of patients at diagnosis was 4.41 months (2–7 months). The mean pre-casting Pirani score was 4.8 (4–6) and post casting Pirani score was 0.4 (0–1). A total of 128 casts were applied to correct 25 complex clubfeet. The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4–7). Overall, four incidences of cast slippage occurred. Conclusion: The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast. Level of evidence Level 4. [ABSTRACT FROM AUTHOR]

Mirror hand (ulnar dimelia) is a very rare congenital anomaly of the upper extremity. This report presents the results of a therapy programme given to a patient with mirror hand. Pollicisation, opponensplasty, triceps lengthening and elbow arthrolysis were performed when the child was 2, 3, 4 and 7 years old respectively. Hand rehabilitation was planned in early (4–8 weeks), mid (9–12 weeks), and late (12 weeks) postoperative periods. The main purposes of the rehabilitation were to help the child recognise their hands and to use them functionally, ensure cortical reorganisation, improve independence and participate in activities of daily living. Range of motion, muscle and grip strength, sensation and hand function assessment results from an 8-year follow-up are presented. After 8 years of follow-up, the child was able to use his hand functionally, his grip strength was 1 kg, and his sensation was typical. Although he was independent in performing activities of daily living, because he did not have sufficient elbow flexion, he used excessive wrist flexion in some activities. The treatment was satisfactory for the child and the family. The child displayed typical motor development similar to his peers. Planning the treatment and therapy in coordination with hand surgeons is essential for optimal hand function. [ABSTRACT FROM AUTHOR]

Displaced calcaneal fractures encompass a spectrum of fracture patterns, many of which are associated with soft tissue complications. Displaced tongue-type calcaneal fractures often cause pressure on the posterior heel skin, particularly when treatment is delayed. Resultant partial- or full-thickness skin necrosis presents significant challenges to the treating surgeon. In this article, the authors report on a case of full-thickness skin necrosis associated with a displaced tongue-type calcaneus fracture. The authors describe the use of a specialized heel window casting technique, which eliminates posterior heel pressure and greatly facilitates soft tissue surveillance and local wound care. The article also reviews the literature on soft tissue complications associated with displaced calcaneus fractures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the clinical outcome of patients treated with a functional Lucerne Cast (LuCa) for different types of hand fractures. Static casting has traditionally been the preferred treatment for hand fractures. However, functional casting may lead to good functional outcomes, less stiffness, and earlier return to work. Methods: A retrospective case series of all consecutive patients with a metacarpal or proximal phalangeal fracture treated with a LuCa between 2018 and 2019 was conducted. A total of 90 patients were included. Clinical data were collected directly from the patient's medical records. Functional outcome was assessed with the Michigan Hand Outcomes Questionnaire (MHQ). Results: The median MHQ score was 95 (IQR 83–100) with a median follow-up of 23 months. Complications occurred in 7 of 90 patients (8%). Functional impairment occurred in two (2%) patients. Functional impairment was defined as stiffness, persisting rotational deformity, a boutonnière or swanneck deformity. Persisting pain or CRPS occurred in six (7%) patients. Conclusion: The LuCa shows to be effective in the functional treatment of both metacarpal and proximal phalangeal fractures with excellent patient-reported outcomes but at a relatively high rate of persisting pain. [ABSTRACT FROM AUTHOR]

Because of their low incidence, studies about carpal fractures are rare. The aim of the present study was to analyze epidemiology and treatment of fractured carpal bones. We retrospectively analyzed data of 178 patients admitted to our emergency room with carpal fractures over 6 years. More males than woman were injured. In 91%, a CT scan was performed. The most commonly affected bone was the triquetrum followed by the scaphoid. Almost all triquetral fractures were treated conservatively as opposed to perilunate dislocations that were all operated on. Half of all patients with scaphoid fractures were operated. Young men had the highest risk to sustain a carpal fracture. The triquetrum and the scaphoid are most frequently affected. Usually a CT scan is needed. Treatment of scaphoid and perilunate luxation fractures is rather operative whereas the other fractures mostly allow conservative casting. Nevertheless, correct indication for treatment is important to avoid sequelae. [ABSTRACT FROM AUTHOR]

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Lateral humeral condyle fractures are frequently seen in pediatric patients and have a high risk of unfavorable outcomes. A fall on the outstretched arm with supination of the forearm is the most common trauma mechanism. A physical examination combined with additional imaging will confirm the diagnosis. Several classifications have been described to categorize these fractures based on location and comminution. Treatment options depend on the severity of the fracture and consist of immobilization in a cast, closed reduction with percutaneous fixation, and open reduction with fixation. These fractures can lead to notable complications such as lateral condyle overgrowth, surgical site infection, pin tract infections, stiffness resulting in decreased range of motion, cubitus valgus deformities, 'fishtail' deformities, malunion, non-union, avascular necrosis, and premature epiphyseal fusion. Adequate follow-up is therefore warranted. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: This study aims to evaluate the influence of foot deformity severity, as assessed by radiographic measurements, on the efficacy of total contact casting (TCC) in patients with Charcot neuroarthropathy. TCC is a common treatment in this patient population that aims to immobilize the foot and ankle to mitigate trauma, preventing additional damage, and safeguard the foot structure. There is limited data on the optimal radiographic measurement in predicting which patients will be successfully treated with TCC (Griffiths et al., 2021). By comparing radiographic outcomes between patients who were successfully treated with TCC and those who required surgical intervention following TCC failure, we seek to clarify the role of anatomical deformity in treatment prognosis. Methods: We retrospectively analyzed a cohort of Charcot neuroarthropathy patients treated within a single healthcare system. Patients with radiographs of the affected foot within 2 years prior to or 1 year after the initiation of TCC. Patients were divided into two groups: those successfully managed with TCC (n=10) and those necessitating surgery due to TCC failure (n=16). Ten measurements of standard radiographic parameters used for quantifying the level of deformity in Charcot (Wukich et al., 2014) were included in this study. These measurements were Meary's angle, Calcaneal pitch, medial and lateral column height, calcaneal 5th metatarsal angle, talar declination, tibiotalar angle, Kite's angle, hindfoot-forefoot angle, and talonavicular coverage angle. All measurements were collected using Phillips PACS Software (Release 4.7) by three trained evaluators with two evaluators assigned per scan. Differences in the average [value] between groups were assessed using an unpaired t-test. Results: The cohort was comprised of 26 patients (16 males, 10 females). Our analysis revealed that lateral column height was the only parameter with a statistically significant difference in the height measurement (p< 0.05) between the groups. There were no other significant differences detected amongst any of the 9 other measurements. Conclusion: This study revealed that there is a lack of significant differences in most radiographic measurements between patients successfully treated with TCC and those requiring surgical intervention. This may suggest that standard radiographic measurements used for characterizing foot deformity does not help to predict the outcomes of TCC for CN. These findings emphasize the need for a more comprehensive understanding of treatment success predictors beyond anatomical considerations. [ABSTRACT FROM AUTHOR]

Background: There is room for improvement of prevention of venous thromboembolism (VTE) after lower-leg cast application or knee arthroscopy. Information about the mechanism of clot formation in these patients may be useful to identify new prophylaxis targets. We aimed to study the effect of 1) lower-leg injury and 2) knee arthroscopy on thrombin generation. Methods: A cross-sectional study was conducted using plasma samples of POT-(K)CAST trials to measure ex vivo thrombin generation (Calibrated Automated Thrombography [CAT]) and plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin (TAT), fibrinopeptide A (FPA). Plasma was obtained shortly after lower-leg trauma or before and after (< 4 h) knee arthroscopy. Participants were randomly selected from those who did not develop VTE. For aim 1, samples of 88 patients with lower-leg injury were compared with 89 control samples (i.e., preoperative samples of arthroscopy patients). Linear regression was used to obtain mean differences (or ratios if ln-retransformed because of skewedness) adjusted for age, sex, body mass index, comorbidities. For aim 2, pre- and postoperative samples of 85 arthroscopy patients were compared, for which mean changes were obtained. Results: In patients with lower-leg injury (aim 1), endogenous thrombin potential, thrombin peak, velocity index, FPA and TAT were increased as compared with controls. In arthroscopy patients (aim 2), pre- and postoperative levels were similar for all parameters. Conclusion: Lower-leg trauma increases thrombin generation both ex vivo and in vivo, in contrast to knee arthroscopy. This may imply that the pathogenesis of VTE is different in both situations. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) is a prevalent congenital foot deformity. The Ponseti method is a non-surgical treatment for clubfoot, which entails a sequence of casts and braces. The accelerated Ponseti method is a modified version of the standard Ponseti method, involving more frequent cast changes. Methods: A total of 60 patients with idiopathic congenital talipes equinovarus (CTEV) under the age of one were carefully chosen and assigned to two groups of A (standard) and B (accelerated). The Pirani score was used to evaluate each clubfoot before applying a cast. In group A, aboveknee casting was performed once a week, while in group B, it was done twice a week. Results: The study involved 60 children with a total of 75 feet. The results indicated a shorter treatment duration with the accelerated Ponseti method, while the occurrence of skin complications was comparable between the two methods. Conclusion: In conclusion, both the accelerated and standard Ponseti methods are equally effective in correcting clubfoot. The accelerated method offers the advantage of reducing the overall treatment duration and has clear benefits, while no notable difference is observed in skin complications between the two methods. [ABSTRACT FROM AUTHOR]

Background and The tibial shaft fracture is the most common long bone fracture in children. This type of fracture has a high capacity for deformity correction, a process known as remodeling. In many circumstances, casting is the choice of treatment. Objectives: This study aims to investigate the rate of tibial fracture remodeling after 6 months of non-rigid fixation. Methods: This research was a retrospective study conducted from March 2017 to March 2018. The study population included 74 children with tibial shaft fracture, treated with a long leg plaster under general anesthesia. Patients were evaluated by obtaining anteroposterior (AP) and lateral view x-rays in the first week, second week, 2 months, and 6 months after casting. Results: Seventy-four individuals were admitted with a diagnosis of tibial shaft fracture. A total number of 39 patients (52%)-13 girls and 26 boys-were treated with the long-leg casting under general anesthesia. The patients' average age was 7.94±2.69 years (2-14 years). In the second week, four cases were excluded. Remodeling in the fracture site was significant in AP radiography at the end of the second month (P=0.044). Six-month follow-up showed that the remodeling in AP was significant (P=0.017) while in lateral was partially significant (P=0.05). Conclusion: Due to the presence of the growth plate and a dense periosteum, remodeling of the tibial shaft fracture is extremely likely, and the remaining deformity is corrected over time by casting, and no surgical intervention is required. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study was to determine the effectiveness and biocompatibility of the use of solid clasp dentures with silver plating in the restoration of partial defects of the dentition. Methods: The study involved 23 patients with partial secondary adontia after oral rehabilitation. At the first stage, before the start of treatment and after a month of using a clasp prosthesis, patients underwent studies of blood biochemical parameters, Schiller-Pisarev's test and Papillary-marginal-alveolar index. At the second stage of the research, silver electroplating was applied to the metal parts of the clasp prosthesis and after a month of use, its effect on oral hygiene and blood biochemical parameters was assessed. Results: After installation of the removable prosthesis with solid structures, the PMA index after the use of silver-plated clasp prosthesis decreased to medium severity, which is explained by positive impact on the inflammatory process in the gums. We can see the stability of biochemical parameters of blood in patients with solid removable prostheses can serve as a justification for the administration of silver electroplating for prophylactic and therapeutic purposes. Conclusions: The effectiveness of the use of silver plating in the treatment of partial defects of the dentition eliminates the clinical manifestations of the pathological condition and prevents possible complications in the oral cavity. [ABSTRACT FROM AUTHOR]

The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents. [ABSTRACT FROM AUTHOR]

Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years' experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell–Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications. [ABSTRACT FROM AUTHOR]

Diametaphyseal forearm fractures are difficult to treat because standard methods for long-bone fracture stabilization in the metaphyseal or diaphyseal regions are less effective in this transition zone. We hypothesized that there is no difference in outcomes between conservative and surgical treatment of diametaphyseal forearm fractures. This retrospective analysis included 132 patients who had undergone treatment for diametaphyseal forearm fracture between 2013 and 2020 at our institution. The primary analysis compared complications occurring in patients treated conservatively with those occurring in patients managed surgically (ESIN, K-wire fixation, KESIN stabilization, or open reduction and plate osteosynthesis). In a subgroup analysis, we compared the two most frequently applied surgical stabilization techniques in distal forearm fractures (i.e., ESIN and K-wire) with conservative treatment. The mean age of the patients at the time of intervention was 9.43 ± 3.78 years (mean ± SD). Most patients were male (91; 68.9%), and 70 of 132 (53.1%) patients underwent surgical stabilization. The rate of re-intervention or complications was similar after conservative and surgical treatment, and ESIN or K-wire fixation achieved comparable complication rates. Recurrent displacement of fragments was the most frequent reason for re-interventions (13 of 15 patients; 86.6%). There was no permanent damage as a result of a complication. The median time of exposure to image intensifier radiation was comparable between ESIN (95.5 s) and K-wire fixation (85.0 s), but significantly lower during conservative treatment (15.0 s; p = 0.001). [ABSTRACT FROM AUTHOR]

Background and purpose -- Most displaced distal radius fractures (DRF) are treated nonoperatively, with reduction and immobilization in a cast. Studies assessing intra- or inter-observer agreement on radiologic measurements of casting position have not been published, which was the aim of our study. Patients and methods -- Our study is based on the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. All detected DRFs during the OSTPRE follow-up were retrieved and based on sample size calculations 50 fractures were randomly selected for the study. 5 independent reviewers measured dislocation parameters and wrist position in a cast from the radiographs. A linear mixed model was used to estimate the concordance correlation coefficient (CCC) and total deviance index (TDI) that were used to evaluate intra- and inter-observer agreement. We used Kappa values to determine intra- and inter-rater agreement on radiographically acceptable reduction of the DRF. Limits of acceptable position were those defined by Finnish Current Care Guidelines. Results -- For radial inclination, radial shortening, and dorsal/volar tilt, intra- and inter-observer correlations were high (CCC > 0.76). In addition, measurements of wrist angle in a splint had high correlations (CCC > 0.78), whereas measurement of intra-articular gap and step had poor correlations (CCC < 0.52). The Kappa value for overall agreement on the radiographically acceptable position of the DRF was modest (0.59). Conclusion -- Intra- and inter-observer repeatability of casting position of radial inclination, radial shortening, and dorsal/volar tilt were high whereas intra-articular gap and step had poor correlations. [ABSTRACT FROM AUTHOR]

Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: "Idiopathic Clubfoot" (All Fields) AND "Management" OR "Outcomes" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0–12 months). A full-text review of these articles was then performed looking for "complications" or "errors" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients. [ABSTRACT FROM AUTHOR]

Objective: Dynamic spasticity may develop into static contractures in children with cerebral palsy. The study aimed to evaluate the efficacy of multilevel botulinum toxin type A (BtA) in children with spastic cerebral palsy, when combined with casting, followed by physical therapy and orthotics. Methods: We retrospectively evaluated changes in physical examination and walking in 12 children treated at our institution between January and December 2014 using three-dimensional gait analysis at baseline, and 3 months and 6 months after treatment. We administered BtA 6-8 IU/ kg to four points in gastrocnemius and 4-6 IU/kg BtA to two points in the hamstrings. A long-leg cast was applied for 10 days after the injections, after which an ankle-foot orthosis was supplied to all carers and an intensive physical therapy program was undertaken. Results: Three months after injection, we observed significant improvements in cadence, stride time and velocity, and knee flexion at initial contact and maximum knee extension during the stance phase, but these had returned to baseline by 6 months. However, significant improvements from baseline in ankle plantar flexion at initial contact, maximum ankle dorsiflexion during the stance phase and maximum ankle plantar flexion during the terminal stance phase persisted for 6 months. Conclusion: A single session of multilevel BtA treatment combined with casting, intensive physical therapy and orthosis use appears to be an effective means of preventing static contractures in children with cerebral palsy for up to 6 months. [ABSTRACT FROM AUTHOR]

Torus fracture of the distal radius is one of the most common pediatric fractures. Though inherently stable, the literature lacks data about the complications or refracture rates after these fractures. The aim of this study was to evaluate the epidemiology of torus fractures of the distal radius in Turkey and to compare rigid and non-rigid immobilization modalities. 598 patients were enrolled in this retrospective study. Medical data such as age, gender, mechanism of the injury, duration and type of treatment were collected as well as the complications during this period. "The Faces Pain Scale -- Revised" (FPSR) was used for the assessment of pain before and after the treatment. The mean age was 7.1± 3.6 and the median follow-up was 12 (9-15) months. 181 patients were treated with plaster of paris, 149 with soft casts, 80 with hard casts and 188 with splints. The mean duration of the immobilization was 22.6±5.39 days. FPSR scores before and after the treatment were 2.837(95%CI, 2.686-2.989) and 0.255 (95%CI, 0.186-0.324), respectively (p=0.001). There was no statistically significant difference between the immobilization modalities in terms of FPSR decline before and after the treatment (p=0.403). The overall complication rate was 7.4% among all patients (95% CI, 5.3%-9.5%). Complication rates for each stabilization modality were 13.3% for the plaster of paris, 6.7% for the soft cast, 10% for hard cast and 1.1% for the splint group. The complication rate in the patients treated with splints was statistically significantly lower in the splint group (p=0.001; p=0.033; p=0.002, respectively). The pain was the most common complication (47.8% of all complications). There were 2 refractures during the follow-up period. In conclusion, torus fractures are stable and do not require rigid immobilization. The refracture rate is below 1% and any increase in this rate should be further questioned in order to rule out a misdiagnosis of "green-stick" fracture. [ABSTRACT FROM AUTHOR]

Objective: To investigate the healing response of juvenile osteochondritis dissecans (JOCD) of the talus after conservative treatment, identify healing predictors, and develop a predictive model for healing. Design: Retrospective study. Setting: Clinics at a tertiary-level pediatric medical center. Patients: Fifty-five patients (55 ankles) who presented with JOCD. Interventions: Patients were managed with cast immobilization followed by activity restriction. Main Outcome Measures: The primary outcome measure of progressive lesion reossification was determined from the latest radiograph, after at least 6 months of nonoperative treatment. Final clinical evaluation was performed by a questionnaire and complementary telephone interview. Multivariate logistic regression was used to determine the influence of age, sex, lesion size, classification, location, duration of symptoms, containment lesion, and the occurrence of cyst-like lesions on healing potential. Results: After nonoperative treatment, 18 (33%) of 55 lesions had failed to progress toward healing. An older age (P = 0.034) and a completely detached but undisplaced (grade III) lesion (P < 0.001) at the time of diagnosis were predictive for the failure of conservative treatment. A multivariate logistic regression best predictor model that included age and grade resulted in the best predicted healing and yielded an area under the curve of 0.920 (P < 0.001). Conclusion: In two-thirds of skeletally immature patients, conservative treatment resulted in the progressive healing of JOCD of the talus. For older patients with grade III lesions showing a lower healing probability, surgical treatment should be considered. [ABSTRACT FROM AUTHOR]

Purpose: About 20% of all fractures in children occur at the lower extremity. This study aims to investigate the epidemiology and injury pattern of lower extremity fractures within the pediatric population consulting a tertiary referral hospital in Switzerland. Methods: Study population included all patients up to 16 years presenting with a lower extremity fracture over a period of one year. Recorded data were age, gender, side, season of the year, mechanism, type of fracture and applied treatment. Results: Fractures of the lower extremity represent 23% of all fractures with a mean age of 9 years and 6 months. The tibia, with 94 fractures (38%), represents the most frequently injured bone. Peak incidence is seen in winter and 24% of tibia shaft fractures were due to board sports. Overall, 82% of fractures were treated by cast with or without closed reduction, and only 18% requested surgery. Conclusion: Board sports seems to be a leading cause of tibial shaft fracture in our region. Nevertheless, only 18% of fractures had recourse to an orthopedic surgeon, hence the importance of the teaching quality of pediatric residents for conservative fracture treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Casting is the most commonly used method of treating fractures and protecting injured limbs. Nevertheless, inappropriate casting can cause severe complications. This study investigated the frequency of cast-related complications and some of the associated factors. Materials and Methods: A cross-sectional study was conducted on 289 patients with limb fractures requiring casting. The study was conducted from November 1, 2020, to December 31, 2021. Postcasting complications were assessed using a checklist. Patients were instructed to examine the cast at home and report any complications to the researcher by telephone. Frequency, percentage, Chi-square, Fisher's exact test, and univariate and multivariate logistic regression were used to analyze the data. Results: The mean age of the patients was 36.51 ± 1.72 years. Most patients (52.6%) had a short-leg cast. The mean duration of the cast was 2.66 ± 1.23 weeks. Most casts (82%) were applied by nurses. Totally, 85.5% of patients experienced at least one complication. Pain, numbness, movement disorders, swelling, and burning under the cast were the most common complications in the 1st week and occurred in 69.9%, 50.5%, 45%, 43.3%, and 39.4% of patients, respectively. In the regression analysis, patients' marital status, age, place of residence, mobility status, sex, and body mass index of patients as well as the person who applied the cast and his work experience, were associated with some of the complications (P < 0.05). Conclusion: More than two-thirds of the patients who participated in this study experienced at least a cast-related complication, indicating a high frequency of complications and the need to develop an appropriate follow-up program to prevent or timely diagnose and treat cast-related complications. [ABSTRACT FROM AUTHOR]

Purpose: Pure ankle dislocation without associated fracture is extremely rare. The current study reports eight cases of this type of injury, aiming to add some new material to the published data and present our clinical experience. Methods: Six open and two closed posteromedial tibiotalar dislocations without associated fractures treated in our department from 2015 to 2019 were retrospectively analyzed. Emergent reduction was performed for all patients followed by an average of 6 weeks of immobilization with external fixators in open cases and a short leg cast in closed cases. No patients underwent ligament or capsule repair except one case. The clinical data were recorded and analyzed. Results: At a mean follow-up of 33 months (range 13–61), the average AOFAS score was 91 (range 78–100) with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed pre-injury activity level. The average range of motion (ROM) loss of the ankles was 9 degrees for plantarflexion and 3 degrees for dorsiflexion. Complications included superficial infection, moderate ankle stiffness, ankle degenerative change and residual numbness. None of the eight patients showed obvious ankle instability. Conclusion: Pure ankle dislocation without associated fracture is a rare injury. Emergent reduction, appropriate wound care in open injuries and proper joint stabilisation with a cast or external fixator provide good clinical results and could be the mainstay of treatment. [ABSTRACT FROM AUTHOR]

We describe the technical feasibility of a new technique of ultrasound lumbar sympathectomy validated by fluoroscopy. In the pron position, a curved probe (SonoScape P20 curvilinear probe 3-CA, 2-5 MHz) was placed transversely at the iliac crest left side. An echogenic needle was inserted in plane, below the lower pole of the kidneys, directed anterior to the vertebral body below. The needle tip was visualized and bone contact guided needle placement, which was confirmed on fluoroscopy and contrast injection.7ml of injection 1% lignocaine was followed by after 10 minutes with 10ml of 70% alcohol. Other parameters noted were the number of needle insertions, vertebral level (fluroscopy), pain NRS at baseline and at 4 hours, 24 hours and 48 Hours after block, temperature rise, and any other complications. The needle tip was correctly placed in three attempts. The needle tip was at L3. Baseline pain NRS was 10, which decreased to 6 at 1 hour after the procedure, and it was maintained in this range until 48 hours later. A temperature rise of >1.5°C was noted immediately. Ultrasound lumbar sympathectomy can be performed safely in patients with CRPS disease by an in plane approach in the pron patient position., Aspiration of blood should be ruled out before injection of the drug. [ABSTRACT FROM AUTHOR]

Introduction: Knee dislocation were defined as complete loss of tibiofibular articulation confirmed by radiography. The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. We report a case of 37 years old women who comes to our ER. She complained pain at her right knee since 30 minutes after hit by motorcycle. Internal rotation of tibia could be seen in this patient. There were no damaged found on vascular and additional injuries. Knee radiography were carried out to confirm diagnosis. Discussion: According the Good and Johnson, they defined knee dislocation to include the grossly unstable knee, with a minimum of 2 of the 4 major knee ligaments injured. In this patient we performed operative immediately by closed reduction and cast fixation on knee with guidance of fluoroscopy. During the intraoperative we got the valgus test, varus test, Lachman's test and anterior drawer test were positive. Every week, we follow up by radiography to check is there any shifting or loss reduction on the cast. After three weeks, we open the cast and found the negative result on valgus and varus test, but the anterior/posterior drawer test and Lachman's test still positive. It confirmed by MRI with total tear on ACL, partial tear on PCL and partial tear on lateral meniscus. Then we planned to do two arthroscopy, first is ACL, second is PCL. During first arthroscopy we found many hematoma, then we performed harvest from the hamstring: semimembranosus and gracilis tendon as graft for ACL reconstruction. Result: Three weeks after the external fixation was removed, the result of valgus and varus test were negative. The outcome of ACL reconstruction is a stable ACL, it confirmed with the negative result of anterior drawer test. Conclusion: Delayed reconstruction may resulted resolution of swelling, less stiffness, better ROM of knee and some structures healed by itself, but more hematoma. This also support other studies about delay reconstruction could potentially yield equivalent stability outcomes compared with acute surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the marginal and internal adaptation of endocrowns produced using conventional technique, digital technique, and combination (cast digitization) techniques using microcomputed tomography (micro‐CT). Materials and Methods: Ten freshly extracted human mandibular molar teeth were prepared for all‐ceramic endocrowns. A total of 40 Lithium Disilicate (IPS e.max) endocrowns were fabricated and grouped according to the impression and production technique to four groups: Group (CO): Conventional impression/heat pressed endocrowns (n = 10), Group (CAD): Direct scanning of teeth/CAD‐CAM endocrowns (n = 10), Group (COMIO): Combination; Cast digitization using Intraoral scanner/CAD‐CAM endocrowns (n = 10), Group (COML): Combination; Cast digitization using laboratory scanner/CAD‐CAM endocrowns (n = 10). Micro‐computed tomography was used to measure the marginal and internal gaps in 11 predetermined sites. Mean marginal and internal gaps were compared using analysis of variance and Scheffe's post hoc test. Results: CO, CAD, COMIO, and COML groups showed significant differences in the mean marginal gap (150 ± 35 μm, 120 ± 27 μm, 110 ± 24 μm, 120 ± 29 μm, respectively p = 0.013), gap at line angle (280 ± 70 μm, 130 ± 37 μm, 140 ± 54 μm, 130 ± 33 μm, respectively, p < 0.001), gap at cavity wall (210 ± 76 μm, 140 ± 43 μm, 140 ± 52 μm, 150 ± 44 μm, respectively, p = 0.010) and gap at pulpal floor (500 ± 150 μm, 240 ± 58 μm, 260 ± 59 μm, 240 ± 64 μm, respectively, p < 0.001). Conclusion: Digitally fabricated endocrowns showed superior marginal and internal fit compared to the conventionally fabricated endocrowns. Clinical Significance: Marginal and internal adaptation are detrimental factors for the success and survival of dental restorations including endocrowns. When compared with the conventional impressions and conventional production techniques, Digital workflow is more predictable and reliable as it reduces errors and improves the accuracy of fit. [ABSTRACT FROM AUTHOR]

Purpose: The position of the wrist during cast immobilisation following closed reduction of distal radius fractures is disputed. A systematic review was initiated to assess if there was any relation between wrist position in the cast and outcome in adult patients with non-operatively treated distal radius fractures. Methods: A comprehensive search was performed in the bibliographic databases Medline, Embase and Wiley/Cochrane Library from inception up to 27 November 2020. Eligible studies were: randomised controlled trials, prospective and retrospective comparative cohort studies, analysing different positions of the wrist in cast-immobilisation following closed reduction. Primary outcome of the study was functional outcome measured by range of motion. Secondary outcomes were functional outcomes measured by grip strength, patient-reported outcome, radiological outcome and complications such as secondary dislocation and pain. Results: The initial search yielded 2733 studies. Five trials, with 519 patients, were included in this systematic review. Range of motion and radiological outcome was significantly better in patients who were immobilised in dorsiflexion compared to palmar flexion or neutral position, although no clinical important difference was found. There were no significant differences in patient-reported outcome, pain, grip strength or complications. Due to heterogeneity of the included studies, data were unsuitable for a meta-analysis. Conclusion: This systematic review showed statistically significant better results in favour of cast immobilisation in dorsiflexion, although this small difference does not seem to be relevant in patients daily activities. Systematic review registration number: Systematic review registration number: PROSPERO 2018 CRD42018085546. [ABSTRACT FROM AUTHOR]

Background: The most common conservative treatment for Adolescent Idiopathic Scoliosis (AIS) is bracing. However, several papers questioned the effectiveness of bracing for curves between 40° and 50° Cobb: the effectiveness in preventing curve progression could be as low as 35%. Seriate casting is considered a standard approach in early onset scoliosis; however, in the setting of AIS, cast treatment is seldom utilized, with only few studies reporting on its effectiveness. Aim of the study: The main aim of the study is to determine whether a seriate casting with Risser casts associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. Furthermore, the secondary endpoints were: (1) is there a difference in effectiveness of casting between Thoracic (T) and Thoracolumbar/Lumbar (TL/L) curves? (2) Does the 'in cast' correction predicts the treatment outcome? (3) What is the effect on thoracic kyphosis of casting? Methods: This is a retrospective monocentric case–control study; through an Institutional Database search we identified all the patients treated at our institution between 1 January 2017 and 31 December 2020, with a diagnosis of AIS, Risser grade between 0 and 4 at the beginning of the treatment, at least one curve above 40° Cobb and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Standing full spine X-rays in AP and LL are obtained before and after the cast treatment; only AP standing full spine X-rays 'in-cast' are obtained for each cast made. Patients were stratified according to the curve behavior at the end of treatment (Risser 5): progression was defined as ≥6° increase in the curve magnitude or fusion needed; stabilization is defined as a change in curve by ±5°; and improvement was defined as ≥6° reduction in the curve. Results: For the final analysis, 55 compliant patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 27 (4 M, 23 F, mean age 13.6 ± 1.6) in the CG. Eight (14.5%) patients in the SG failed the conservative treatment while 14 (51.3%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1, 3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. No significant difference was found between the T and TL/L curves concerning the 'progressive' endpoint (z-score 0.263, p = 0.79). The mean percentage of 'in cast' curve reduction was 40.1 ± 15.2%; no significant correlation was found between the percentage of correction and the outcome (Spearman Correlation Coefficient 0.18). Finally, no significant differences between baseline and end of FU TK were found (32° ± 16.2 vs. 29.6 ± 15.8, p = ns). Discussion: Seriate Risser casting for AIS with larger curves (>40° Cobb) is effective in reducing curve progression when compared with full time bracing alone in treatment compliant patients. The treatment is equally effective in controlling T and TL/L curves; furthermore, a slight but non-significant decrease in TK was observed in patients treated with casting. This type of treatment should be considered for AIS patients who present with large curves to potentially reduce the percentage of surgical cases. Short Abstract: The aim of the study is to determine whether seriate Risser casting associated with bracing is more effective in preventing curve progression than bracing alone in curves larger than 40°. This is a retrospective monocentric case–control study; we identified all the patients treated at our institution with a diagnosis of AIS, Risser grade 0–4 at the beginning of the treatment, at least one curve above 40° Cobb (35° if treated with bracing alone) and treatment with either seriate Risser casting and bracing (Study Group, SG) or bracing alone (Control Group, CG). Fifty-five patients (12 M, 43 F, mean age 13.5 ± 1.6) were included in the SG and 30 (5 M, 25 F, mean age 13.9 ± 1.7) in the CG. Eight (14,5%) patients in the SG failed the conservative treatment while fifteen (50%) failed in the CG. Consequently, the Relative Risk for progression in the Efficacy Analysis was 1.8 (95% CI 1.3–2.6, p = 0.001), and the Number Needed to Treat was 2,4. Seriate Risser casting for AIS with larger curves (>40°) is effective in reducing curve progression when compared with full time bracing alone. This type of treatment should be considered for AIS patients who present with large curves. [ABSTRACT FROM AUTHOR]

Background: Care of the child after hip-spica application is the most challenging issue faced by parents. Reduced mobility and recumbency can cause respiratory problems, skin irritation and discomfort for the child. Parents need to lift the child in a spica to make him upright and to mobilize. To improve the comfort of the family in post spica care, we have designed a 'Hip Spica Stroller' which is low profile, comfortable, easy to construct and relatively inexpensive. This manuscript discusses our early experience with this hip-spica stroller use. Methods: A sturdy, relatively lightweight and portable stroller was designed in collaboration with local mechanical engineering team. The stroller allowed safe upright placement of the child with spica and their easy mobility. From the second post-operative day, children were mobilised in the stroller. We looked for development of any complications related to the stroller such as spica breakage, skin irritation or excoriation development. Parents were also inquired about their feedback and satisfaction with the device upon spica removal. Results: We used the spica stroller in nine patients after Developmental Dysplasia Hip (DDH) treatment and in eight patients post shaft femur fracture treatment. None of the patients experienced any stroller-related complications. All the patients maintained the joint reduction and the fractured bone fragment alignment. High satisfaction rates were reported by parents. Conclusion: Hip Spica Stroller is an innovative and easy-to-make device which would enhance the post spica care. It can aid alleviating the fear of parents for their child's hip-spica treatment. [ABSTRACT FROM AUTHOR]

• The post-immobilization sequelae are pain, local motor changes and central changes. • Immobilization post fracture can induce changes in sensory and motor cortical areas causing modification of sensorimotor memories. • Implicit memory affects after 4-6 weeks of Immobilization. Hand laterality, an important ability to determine the orientation of a limb is common to get affected after short term immobilization. Distal radius and/or ulna fracture is a commonly encountered fracture resulting from upper-limb trauma. Conservative treatment using closed reduction and plaster cast application to immobilize the joint remains choice of treatment over surgery in the treatment of these fractures. There is a paucity of literature reporting impairment in hand laterality after long term immobilization as commonly performed in patients with distal radius and/or ulna fractures. Understanding effect of immobilization on hand laterality in distal-end radius/ulna fractures warranted present investigation. To evaluate hand laterality based on the accuracy and response time for hand determination after plaster cast removal in distal radius and/or ulna fracture. Prospective cross sectional study. Subjects (n = 60, age range = 40-59 years, females (n) = 28 and males (n) = 32) were shown 24 real-hand images with various degrees of angular rotation and instructed to identify the hand as left and/or right. Accuracy (% correctly identified) and Response time (milliseconds to identify left or right hand in the image) of motor imagery during hand laterality task were recorded. Pain intensity before and after the hand laterality task were noted using Visual Analogue Scale. Repeated measures of ANOVA and t tests were used to analyze the accuracy and response times among two groups. The experimental group showed significantly (P <.05) lower accuracy and longer response time as compared to the control group. No significant difference in the accuracy and response time were noted in the immobilization of the dominant and the non-dominant hand within the experimental group (P >.05). Also, there was no change in pain pre- to post-hand laterality task. Findings of this study could aid in enhancing the understanding of post-immobilization effect on hand laterality and open new arenas for assessment and rehabilitation of distal-end radius and/or ulna fractures where immobilization is the principal treatment. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your clinical understanding of children's forearm fractures and their management in the emergency department • To familiarise yourself with the assessment of forearm fractures in children • To develop techniques for managing painful procedures that affect children Forearm fractures are the most common fractures among children and young people aged up to 19 years and these patients frequently present to the emergency department (ED). Many of these fractures can be treated in the ED without the need for inpatient admission. This article examines the assessment, diagnosis and management of forearm fractures. The authors also use a case study format to demonstrate best practice in the treatment of forearm fractures in this age group. The information in this article will enable ED nurses to enhance the experience of children and their families who present with forearm fractures. [ABSTRACT FROM AUTHOR]