Background:Nursemaid's elbow injuries occur in young children, with axial traction on the arm as a commonly-described mechanism. Prior demographic studies have noted a significant increase in this injury over the last three decades. We sought to examine incidence of nursemaid's elbow over time and assess the impact of COVID-19 on injury frequency. Additionally, certain household products and female gender have been frequently seen in cases presenting to emergency departments. The present study aims to further investigate injury scenarios to better understand the difference in injury rates and mechanisms. Methods:Using the National Electronic Injury Surveillance System database, this study analyzed 4,075 cases of nursemaid's injuries presenting to emergency departments from 2019-2023 in children from birth to six-years-old. The events' narrative case descriptions were searched for keywords to identify terms used to describe the injury. Cases were examined in groups by age, gender, location of the injury event, mechanism of injury ("fall" versus "pull"), and product involved. Results:There was no significant change in rate of cases during the time period, although there was a non-significant drop in 2020. Females had a higher incidence of injury. Two-year-olds represented the largest affected age group. Common injury mechanisms were "falls" (44% of events) and "pulls" (29%), with twisting motions rarely described. The most common household products involved in injuries were beds and bed frames (21% of cases). The higher incidence in females compared to males persisted across age groups, mechanisms, and most products involved, with the exception of more daywear-related "fall" injuries in males. Conclusion:Unlike previous studies, incidence of nursemaid's elbow did not statistically increase during the pandemic. Females continued to account for most injuries, a trend that remained largely stable when data were subdivided by product, age, and mechanism. This could be due to a possible anatomic difference in young female elbows compared to those of males, which represents an area for future investigation. Educating caretakers about nursemaid's elbow and implementing household safeguards may help prevent injury.Level of Evidence: III.
Background:Spine infections are associated with significant morbidity and mortality. Despite Infectious Diseases Society of America (IDSA) guidelines recommending treatment be assessed through clinical examination and inflammatory markers rather than routine magnetic resonance imaging (MRI), repeat MRIs are frequently obtained. The clinical utility and consequences of repeat MRI in this setting remain unclear. Methods:We performed a retrospective singleinstitution study of adult patients with infectious spine pathology who underwent repeat MRI between January 2019 and December 2023. Patients were stratified by timing of repeat MRI (≤90 days vs >90 days from index MRI). The primary outcome was surgical intervention prompted by repeat MRI findings. Secondary outcomes included changes in physical examination prior to repeat MRI, need for fast-acting anxiolytic medication, and acute kidney injury. Results:A total of 222 repeat MRIs were identified in 141 patients. Of these, 163 (73%) were performed ≤90 days and 59 (27%) were performed >90 days from the index MRI. Patients undergoing repeat MRI >90 days were significantly more likely to undergo spine surgery (p=0.04) and to have a documented change in physical examination prior to imaging (p<0.001). Repeat MRI ≤90 days was not associated with increased surgical intervention. Overall, 30% of repeat MRIs required pre-procedure anxiolytic medication, with higher rates in the ≤90-day cohort (p=0.04). AKI occurred after 9/164 (5%) repeat MRIs, with no difference between groups. Conclusion:Repeat MRI within 90 days in patients with spine infections rarely alters surgical management and is often obtained in the absence of clinical deterioration. Clinical examination appears to be a more reliable indicator of treatment response. These findings support IDSA guidelines recommending selective use of repeat MRI and highlight potential patient-centered consequences of unnecessary imaging.Level of Evidence: III.
Background:This study aimed to comprehensively assess the most recent data on the prognostic effects of hematologic markers, including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII), on deep vein thrombosis (DVT) following lower limb fractures. Methods:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in PROSPERO (CRD420251006336). We performed a comprehensive search in the PubMed, EMBASE, Web of Science, and Scopus electronic databases. Date of publication and language were not restricted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated and all statistical analyses were performed using Stata 18 software. Results:Ten studies, involving a total of 6183 patients with lower extremity fractures, of whom 896 developed DVT, were included in the final analysis. The results indicated that, compared to the non-DVT group, patients with DVT had higher levels of NLR (SMD = 0.48, 95% CI = 0.02-0.94, p = 0.04) and SII (SMD = 1.01, 95% CI = 0.121.89, p = 0.02). However, PLR and MLR level was not different between the two groups. Among the evaluated biomarkers, SII demonstrated the highest specificity (80%, PLR = 74%), while NLR had the highest sensitivity (68%). Conclusion:The literature supported that, compared to the non-DVT group, patients with DVT had higher levels of NLR and SII. Among these biomarkers, SII demonstrated the highest specificity, while NLR had the highest sensitivity. Composite inflammatory markers, particularly SII, may hold value in DVT risk stratification during post-fracture period.Level of Evidence: II.
Background:Supracondylar humerus (SCH) fractures comprise about 20% of pediatric fractures. Displaced SCH fractures require reduction and percutaneous pinning, most commonly making use of conventional C-arm (CCA) fluoroscopy. Many authors have proposed the use of mini C-arm (MCA) in the upper extremity, given multiple proposed benefits including decreased radiation. We investigated the utility of MCA in the operative treatment of pediatric SCH fractures. Methods:Patients who underwent operative fixation of SCH fractures using MCA from 20202022 were reviewed. Demographic, surgical, and radiographic data were collected, along with clinical outcomes through final follow-up. Data were analyzed to assess rates of fluoroscopy use depending on various patient and fracture characteristics. Complication rates were quantified to assess the safety and efficacy of MCA for this procedure. Results:171 patients were included with an average age of 5.5 years. 55% of fractures were Gartland type 3/4, and most were treated with three lateral pins (69%). The median fluoroscopy time per case was 113 seconds with 61 images taken. Fluoroscopy use increased both with fracture severity and number of pins used. The overall complication rate was 2% with only one patient requiring reoperation (0.6%). Conclusion:Utilizing MCA fluoroscopy in the treatment of SCH fractures is associated with a low rate of complications, consistent with previously reported rates when using CCA. We report a higher rate of fluoroscopy use compared to CCA which does not necessarily translate to an increase in radiation exposure. Utilizing MCA to surgically treat SCH fractures may have benefits over CCA, especially in certain practice settings. Level of Evidence:IV.
Background:Total hip arthroplasty (THA) has continued to increase in incidence. With expanding focus on value-based care and adoption of bundled payments at some facilities, cost containment measures, including discharging patients to home as soon as possible postoperatively, have gained attention. Therefore, it is important to determine patient characteristics associated with discharge disposition. The purpose of this study was to develop and utilize an artificial neural network (ANN) model to determine the most important non-modifiable and modifiable factors that can predispose patients to be discharged to a non-home destination following primary THA.. Methods:The National Surgical Quality Improvement Program database was used to identify patients who underwent primary THA from 20162019. Demographic, comorbidity, preoperative, and intraoperative variables were analyzed in this study. Statistically significant variables, with a p-value < 0.05, were inputted into the ANN model. Results:In total, 124,691 patients were analyzed in the study, of which 19,275 (15.5%) were discharged to a non-home destination. The ANN reached a Receiver Operating Characteristic (ROC) Area-Under-the-Curve (AUC) of 0.793. The five most important variables which helped to predict non-home discharge following primary THA were age, operative time, preoperative hematocrit, functional status, and preoperative international normalized ratio (INR). Conclusion:The present study used an ANN model and identified several significant factors which can help predict patients being discharged to a non-home location following primary THA. Clinical Relevance:Clinicians should be aware of these variables and explore reductions to nonhome discharges through preoperative patient optimization, where possible.
