Complications occurred in 16.2% of MPFL reconstruction surgeries for patellar instability in young patients, with almost half resulting from technical problems. Patients should be counseled preoperatively on the risk of potential complications.

Parental ACE exposures can negatively impact child development in multiple domains, including problem solving, communication, personal-social, and motor skills. Research is needed to elucidate the psychosocial and biological mechanisms of intergenerational risk. This research has implications for the value of parental ACE screening in the context of pediatric primary care.

This project sought to assess the generalizability, barriers, and facilitators of implementing the Safe Environment for Every Kid (SEEK) model for addressing psychosocial risk factors for maltreatment across multiple primary care settings, including a pediatric practice, federally qualified health center, and family medicine practice. The SEEK model includes screening caregivers for psychosocial risk factors at well-child visits age 0 to 5 years, brief intervention incorporating principles of motivational interviewing to engage caregivers, and referral to treatment. All practices successfully implemented SEEK, with screening completion rates from 75% to 93% and brief intervention rates from 61% to 81%. Major parental stress (14%) and food insecurity (11%) were the most common risk factors. Providers found SEEK worthwhile for improving their knowledge, skills, and ability to address psychosocial concerns and provide whole person care. Barriers included limited time and resources, incomplete resource knowledge, and lack of follow-up. Facilitators included on-site support staff to assist with communication and referrals.

The pathophysiology of paradoxical elbow flexion contractures following neonatal brachial plexus injury (NBPI) is incompletely understood. The current study tests the hypothesis that this contracture occurs by denervation-induced impairment of elbow flexor muscle growth. Unilateral forelimb paralysis was created in mice in four neonatal (5-day-old) BPI groups (C5-6 excision, C5-6 neurotomy, C5-6 neurotomy/repair, and C5-T1 global excision), one non-neonatal BPI group (28-day-old C5-6 excision), and two neonatal muscle imbalance groups (triceps tenotomy AE C5-6 excision). Four weeks post-operatively, motor function, elbow range of motion, and biceps/brachialis functional lengths were assessed. Musculocutaneous nerve (MCN) denervation and reinnervation were assessed immunohistochemically. Elbow flexion motor recovery and elbow flexion contractures varied inversely among the neonatal BPI groups. Contracture severity correlated with biceps/brachialis shortening and MCN denervation (relative axon loss), with no contractures occurring in mice with MCN reinnervation (presence of growth cones). No contractures or biceps/brachialis shortening occurred following non-neonatal BPI, regardless of denervation or reinnervation. Neonatal triceps tenotomy did not cause contractures or biceps/brachialis shortening, nor did it worsen those following neonatal C5-6 excision. Denervation-induced functional shortening of elbow flexor muscles leads to variable elbow flexion contractures depending on the degree, permanence, and timing of denervation, independent of muscle imbalance. Neonatal brachial plexus injury (NBPI) occurs in 1.5 per 1,000 live births. 1 In the 20-30% of children without immediate neurological recovery, 2 secondary contractures occur, most notably shoulder internal rotation contractures and elbow flexion contractures. 3 In contrast to the wealth of literature addressing the shoulder contracture, relatively few studies have addressed the elbow flexion contracture, despite the fact that the latter contracture has been described for over 100 years 4 and affects 62-89% of children following unresolved NBPI. 5,6 These elbow contractures range from mild (10-208) 6,7 to severe (40-908), [8][9][10] limiting the functional range of elbow motion 11 and exacerbating the cosmetic deformity of an already short, malpositioned upper extremity. 9 Recommendations for treatment vary widely, with proponents of no treatment, 12 serial casting, 8 surgical release, 5,13 external fixator distraction, 10 flexor-to-extensor muscle transfers, 14 and humeral osteotomy. 9 Underlying the paucity of literature and lack of treatment consensus is an incomplete understanding of the contracture's etiology. Despite the fact that this paradoxical flexion contracture occurs in the setting of elbow flexor paralysis, 6,15,16 several authors believe muscle imbalance to be the cause, 3,8,10,17 proposing that the imbalance may be caused by earlier 6 or anomalous 1014 reinnervation of the elbow flexors. Additional proposed etiologies of the elbow ...