Purpose: The purpose of this study is to assess clinical and functional outcomes in separate cohorts of operatively and nonoperatively managed pediatric patella fractures. Methods: A retrospective review was completed for patients aged 5–19 years treated for a unilateral patella fracture at a single pediatric level-1 trauma center. Patients were excluded for osteochondral fracture associated with patellar dislocation, polytrauma presentation with additional fractures, or <3 months of clinical follow-up. Functional outcomes were assessed via the Pediatric International Knee Documentation Committee form and the Marx Knee Activity Scale. Results: A total of 53 patients met inclusion criteria; 30 patients were treated operatively and 23 patients were treated nonoperatively. Patients with patellar sleeve/pole fractures were significantly younger by 5.2 years (p < 0.01) and presented with greater variability in mechanism of injury (p < 0.01). The nonoperative cohort achieved bony healing and returned to sports at a median (interquartile range) of 1.7 (1.2–2.3) months and 2.8 (2.3–3.3) months, respectively, post-injury. The operative group achieved bony healing and returned to sports at 2.8 (2.1–3.5) months and 5.9 (4.0–7.1) months, respectively, following surgery. Median (interquartile range) Pediatric International Knee Documentation Committee and Marx scores were 98 (89–100) and 14 (10–16), respectively, for the nonoperative group, and 92 (84–99) and 13 (12–16), respectively, for the operative group. No significant differences in patient-reported outcomes were observed between fracture patterns or treatment cohorts. Conclusion: Pediatric and adolescent patients sustaining patella fractures reported long-term functional outcomes comparable to normative values, across multiple fracture patterns and with appropriate operative and nonoperative treatment. Fractures requiring surgery were expectedly associated with slower healing and return to sport timelines. Level of evidence: Therapeutic Level III.

Objective: To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. Design: Prospective cohort study. Setting: Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. Interventions: Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. Main Outcome Measures: Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. Results: Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. Conclusions: Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.

Le questionnaire Pedi-IKDC est spécifique à la population pédiatrique et est devenu une mesure de santé déclarée directement par le patient (PROM) utilisée par les orthopédistes du monde entier. Pour étendre son applicabilité aux patients canadiens–français, le questionnaire a été traduit en français par notre équipe. L’adaptation en français du Pedi-IKDC est un outil valide et fiable pour évaluer les enfants francophones ayant une pathologie du genou. Le Pedi-IKDC a d’abord été traduit par des chirurgiens orthopédiques et ensuite retraduit en anglais par un traducteur professionnel. La version retraduite et la version originale en anglais du questionnaire ont été comparées pour confirmer leur similarité et la fiabilité de la traduction en français. La validité de la version en français a ensuite été testée auprès de 203 enfants recrutés dans un grand centre hospitalier pédiatrique francophone du Canada. Les enfants ont été divisés en deux groupes, ceux souffrant de douleur au genou (n = 163) et un groupe contrôle (n = 40). La version adaptée en français a été évaluée pour la validité du construit, sa cohérence interne et sa capacité discriminante. La version en français du Pedi-IKDC a fait preuve d’une excellente cohérence interne (alpha de Cronbach : 0,934 dans le groupe genou). Le questionnaire a aussi montré une forte validité du construit, selon les neuf hypothèses adaptées à partir de l’article original Pedi-IKDC, toutes ayant une forte corrélation (n = 7) ou une corrélation modérée (n = 2) (p < 0,001). La capacité discriminante du questionnaire a aussi été explorée et aucune différence statistique significative n’a été retrouvée dans les scores des participants selon leurs caractéristiques (IMC, groupe d’âge, diagnostic et type de traitement). Toutefois, il y avait une différence significative entre les scores des garçons et des filles. Nos résultats montrent un processus de traduction satisfaisant du Pedi-IKDC en français, conformément à une méthode universellement reconnue pour la traduction des PROMs. L’étude a aussi montré que la version en français du Pedi-IKDC a des propriétés psychométriques similaires au Pedi-IKDC original et aux versions traduites en danois, en italien et en russe. II.

Background:The association between elbow fractures and outdoor playgrounds has always been anecdotal. We sought to determine the impact of closing outdoor playgrounds and other play areas during the COVID-19 lockdown on elbow fractures in a pediatric population. Methods:We conducted a retrospective cohort study of all elbow fractures from a single pediatric referral hospital between 2016 and 2020 for the months of April and May. The months chosen corresponded to the COVID-19 lockdown during which outdoor playgrounds were closed. Inclusion criteria were elbow fracture diagnosis based on radiography and age younger than 18 years. Fracture type, where the injury occurred and the mechanism of injury were recorded. Results:A total of 370 fractures were reported, with an average of 83 (95% confidence interval [CI] 83-84) per year for 2016-19 and only 36 recorded in 2020. The average annual number of fractures before 2020 was 17 (95% CI 16-17) for schools, and 33 (95% CI 31-34) for outdoor playgrounds, including 22 (95% CI 21-24) falls from playground structures. No fracture was reported in schools in 2020, and only 3 were reported from outdoor playgrounds (including 1 associated with falling from playground structures). Conclusion:We found an association between elbow fractures in a pediatric population and outdoor playground accessibility, but also with indoor public locations. Our findings emphasize the importance of safety measures in those facilities.

Background: The Pedi-IKDC is an English-language, knee-specific, paediatric questionnaire used by orthopaedic surgeons around the world as a valuable patient-reported outcome measure (PROM). The objective of this study was thus to extend the applicability of the Pedi-IKDC to French-speaking Canadian patients, for both clinical practice and research, by developing a French-language cross-cultural adaptation of the original version.Hypothesis: The French adaptation of the Pedi-IKDC is valid and reliable for evaluating French-speaking children with knee conditions.Patients and methods: The Pedi-IKDC was translated to French by a panel of orthopaedic surgeons then back-translated by a professional translator. The original English version and the back-translation were compared to assess their similarity and confirm the faithfulness of the French translation. The validity of the French version was then tested at a major paediatric hospital in French-speaking Canada, in 203 children, including 163 with knee pain and 40 without knee symptoms. Internal consistency, construct validity, and discriminant capacity of the French version were assessed. Results: Internal consistency of the Pedi-IKDC adaptation was excellent (Cronbach's alpha, 0.934 in the knee-pain group). Construct validity was robust, with all nine hypotheses adapted from the original Pedi-IKDC article demonstrating strong (n = 7) or moderate (n = 2) correlations (p < 0.001). The evaluation of discriminant capacity identified no statistically significant score differences according to most of the respondent characteristics (body mass index, age group, type of diagnosis, and type of treatment). However, scores differed significantly between females and males.Discussion: The French-language cross-cultural adaptation of the Pedi-IKDC obtained using a universally recognized method for translating PROMs demonstrated good performance, with psychometric properties similar to those of the original Pedi-IKDC and of its Danish, Italian, and Russian adaptations. (c) 2023 Elsevier Masson SAS. All rights reserved.

Background: Syndesmotic injuries have a higher prevalence in athletes and can present long-term complications particularly in pediatric population. Early diagnosis is necessary and can be done using various modalities, but, they either present poor sensitivity, poor clinical feasibility or are exclusively static. Ultrasound (US) could compensate for those drawbacks. Hypothesis/Purpose: The aim of this study was to determine (1) the benefit of direct visualization of the anterior-inferior tibiofibular ligament (AiTFL) and (2) tibiofibular clear space (TFCS) cut-off points regarding the integrity of the syndesmotic ligaments using US imaging. Methods: A prospective cohort study including all suspected syndesmotic injury in a pediatric population was done. Participants had both ankles assessed with US imaging for description of AiTFL integrity as our static assessment and for TFCS measures as our dynamic evaluation. For dynamic assessment, the distance between the distal tibia and fibula was first measure in neutral position then in external rotation for each ankle. This providing a total of five different TFCS combinations for receiver operating characteristics (ROC) curves analysis. Afterward, the syndesmotic ligament complex and deltoid ligament of the injured ankle were examined using MRI as the gold standard. Results: A total of 26 participants with suspected syndesmotic injuries were included. Mean age was 14.8 years (SD = 1.3 years). Mean time between trauma and US imaging was 56 days (SD = 43.9 days). Sensitivity and specificity of direct visualization of the AiTFL were respectively 0.79 and 1.00 with four false negative tests only found on partial tears. Only two TFCS combinations had an area under the curve (AUC) greater than 0.7 and were then considered for further analysis. The two combinations were the TFCS difference between the injured and uninjured ankle in neutral position (TFCS N I-U) and external rotation (TFCS ER I-U). Cut-off points were ranging from 0.23 mm to 0.37 mm for TFCS N I-U and from 0.11 mm to 0. 30 mm for TFCS ER I-U using ROC curve analysis. Conclusion: US imaging does bring an added value as a screening tool for direct visualization of the AiTFL in pediatric patients by having a good sensitivity, an excellent specificity, a low cost and being easily accessible. The complementary use of dynamic evaluation using TFCS measures could also identify dynamic instability. Cut-off points determined in this study had good sensitivity and specificity but, by being under one millimeter, further studies using dynamic US imaging are needed.

Background: Outcomes of bone marrow stimulation for osteochondritis dissecans (OCD) of the talus in pediatric patients is not optimal. The objective was to evaluate the retroarticular drilling technique for talar OCD.Methods: A retrospective case-series study of pediatric cases treated for talar OCD with retroarticular drilling was done. Clinical and radiological outcome scores were recorded as follows: the percentage of patients who had a successful treatment, the percentage for every category of the Berndt and Harty treatment result grading and the percentage for every radiographical outcome score were computed.Results: Nineteen patients (18 girls; mean age: 14.6 +/- 2.1 years) were included. The mean follow-up was 14.8 (+/- 11.7) months. 26.3% required revision surgery. The Berndt and Harty scores were: 57.9% good, 10.5% fair, 31.6% poor. Radiological outcomes were: 21% healed, 47.4% partially healed, 31.6% no healing. The radiological outcome score was better for younger patients (P = 0.01) and those with an open physis (P = 0.001).Conclusion: 26.3% of patients needed revision surgery after talar OCD retroarticular drilling and 21% were healed radiographically. Skeletal immaturity and a younger age were associated to a better radiological outcome.

Background: Many children with injuries, including burns and fractures, experience moderate to severe pain during medical procedures. Recent studies claim that nonpharmacologic pain management using virtual reality (VR) could distract children from procedural pain by engaging multiple senses. Aims: The aims of this pilot randomized clinical trial were to assess the acceptability and feasibility of VR distraction in children with burns or fractures undergoing painful medical procedures, as well as the staff nurses, and assess the preliminary efficacy of VR distraction on pain intensity, pain-related fear, and subsequent recall of both. Materials and Method: A within-subject study design, in which participants served as their own control, was used. A total of 20 children from 7 to 17 years old with an injury were recruited at the surgical-trauma outpatient clinics of the Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine). Each participant received both standard and experimental treatments through randomized order. Pain (numerical rating scale) and pain-related fear (Children's Fear Scale) measures were taken before the procedure and after each sequence, followed by a measure of children's (graphic rating scale) and nurses' acceptability of the intervention through their satisfaction level. Recall of pain intensity and pain-related fear were assessed 24 hours after the procedure. Wilcoxon signed-rank tests were used, with a significance level at 0.05. Results: Results showed that VR distraction was an acceptable and feasible intervention for children and nurses of these outpatient clinics. Preliminary effects showed that, compared to standard of care, children participants reported a significant decrease in pain intensity (p = .023) and pain-related fear (p = .011) during VR as well as less recalled pain-related fear (p = .012) at 24 hours after the procedure. No side effects were reported. Conclusion: VR is a promising intervention with children undergoing painful procedures because it is immersive and engages multiple senses. It is a low-cost intervention well accepted by children and nursing staff at this clinical site and is easy to implement in daily practice for procedural pain management. (C) 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

To review the orthopedic sequelae of pediatric patients diagnosed with osteoarticular infections (OAIs) and identify significant differences between those with and without sequelae. Medical charts between 2010 and 2016 from a tertiary-care pediatric hospital were reviewed to collect demographic and clinical data for this retrospective case series. The main inclusion criteria were: 1. age (<= 10 years old); 2. absence of sickle cell anemia and immunocompromising disease or medication; 3. a minimum follow-up of 12 months with radiographs; and 4. diagnosis of osteomyelitis of long bones and/or septic arthritis. The following late sequelae were observed and aggregated: osteal deformations that led to limb-length discrepancies (LLD) superior to 5 mm, abnormal articular angulations of more than 5 degrees, and symptomatic chondropathies visible on imaging studies after 1 year. The patients were divided into 2 subgroups: with and without sequelae. Chi-Squared tests were used for categorical variables and Mann-Whitney U tests for continuous data to identify statistically significant differences between the 2 subgroups. Among 401 patients with osteomyelitis and/or septic arthritis, 50 (1 2. 5%) were included (24 girls and 26 boys). There were 36 (72%) cases of osteomyelitis, 8 (16%) cases of septic arthritis, and 6 (12%) cases of combined infection (3 acute/subacute and 3 chronic cases). Five (10%) patients had orthopedic sequelae at the latest follow-up. The total duration of antibiotic treatment (P = .002), infectious disease follow-up (P = .002), and the presence of sequestra (P = .005) were significantly different between subgroups. There were no statistically significant differences between the 2 subgroups for the other variables, but some trends could be discerned. Only 4/50 patients developed a sequestrum, 2 of which were in the orthopedic sequelae subgroup. Furthermore, initial C-reactive protein (CRP) values were higher in the sequelae subgroup, as were the CRP values at hospital discharge. The orthopedic follow-up was also longer in the sequelae subgroup. Finally, the delay between the onset of symptoms and the beginning of antibiotic treatment was longer in the sequelae group. Patients with orthopedic sequelae had a longer antibiotic treatment and infectious disease follow-up, and were more likely to have presented with a sequestrum. Level of evidence: IV - case series.

Premature growth arrests are an infrequent, yet a significant complication of physeal fractures of the distal radius in children and adolescents. Through early diagnosis, it is possible to prevent ...