Background Although venous thromboembolism has been well studied in the pediatric trauma population, rates of VTE associated with elective pediatric orthopaedic procedures have not been addressed in current literature. The purpose of this retrospective study was to identify the incidence of venous thromboembolism (VTE) in the elective pediatric orthopaedic surgical population and delineate subsets of this population at greatest risk. This study may provide valuable data to begin the process of resolving the controversy surrounding DVT prophylaxis in the pediatric orthopaedic population. Methods The Pediatric Health Information System (PHIS) was queried for patients admitted on an ambulatory or inpatient basis aged <18 years from 1/2006 to 3/2011 during which an elective orthopaedic surgery was the principal procedure performed. Patients with diagnoses or procedures related to infection, trauma, malignancy, or coagulopathies were excluded. Patients admitted through the emergency department (ED) or whose orthopedic procedure was not performed on the admission date were excluded. Age, gender, ethnicity, race, admission year, and all procedures/diagnoses were recorded. The presence of VTE at the index admission or any subsequent readmission within 90 days was recorded. All criteria were coded using ICD-9-CM codes. Generalized logistic regression analyses were used to identify factors related to VTE. Results 143,808 admissions (117,676 patients) matched the inclusion criteria. 33 had a VTE during the index admission with an additional 41 at subsequent readmissions, for a total incidence of 0.0515% by admission and 0.0629% by patient. In the multivariable model, variables significantly [p<0.05] related to VTE included increasing age, admission type, diagnosis of metabolic conditions, obesity, and/or syndromes, and complications of implanted devices and/or surgical procedures. No procedure variables were significantly related to VTE in the multivariable model. Conclusions The incidence of VTE in this cohort of pediatric patients undergoing elective orthopaedic surgery was 0.0515%. In children, underlying diagnosis appears to be a stronger predictor of VTE than procedures performed. Diagnosis with a metabolic condition, syndrome, and/or obesity, complications of implanted devices and/or surgical procedures, older age, and admission as an inpatient were significantly related to the development of a VTE. Level of Evidence Level II; Retrospective prognostic study

Unstable pelvic fractures in children can result in long-term morbidity and functional problems. Fractures associated with > or =1.1 cm of pelvic asymmetry following closed reduction should be treated with open reduction and internal or external fixation in order to improve alignment and the long-term functional outcome.

The 1 metatarsal double osteotomy is described as an effective procedure for the treatment of severe adolescent hallux valgus (AHV) with low recurrence and complication rates. No study to date has evaluated the functional clinical outcome after 1st metatarsal double osteotomy. The purpose of this paper is to report the results at our institution in the treatment of severe AHV with 1st metatarsal double osteotomy. We performed a review of all patients (N = 9, 14 feet) treated at our institution with 1st metatarsal double osteotomy. We reviewed pre- and postoperative hallux valgus (HVA), 1st-2nd intermetatarsal (IMA), and distal metatarsal articular angles (DMAA) and calculated the average angular correction. Functional outcome was measured via the AOFAS Hallux Metatarsophalangeal-Interphalangeal (HMI) scale as well as the duPont Bunion Rating Score (BRS). The average patient was 15 years old at the time of surgery with an average of 27 months follow-up. The mean angular correction was 21.54 degree, 9.25 degree, and 6.21 degree for HVA, IMA, and DMAA, respectively. Ninety percent of the patients reported good to excellent results. We had 2 complications for an overall rate of 14%. The 1st metatarsal double osteotomy is an effective and reliable technique for treatment of severe adolescent hallux valgus. Stiffness of the 1st MTPJ is the major determinant of patient satisfaction.

Although an ATSF is a relatively rare injury, our cohort of patients suggests that a subset of young patients with all types of tibial spine fractures will require later ACL reconstruction. There is a need to counsel patients that a delayed ACL rupture is a potential risk after an ATSF, especially as children approach skeletal maturity. Further patient follow-up and prospective studies are required.

No abstract

Level III-retrospective comparative study.

Background Despite being recognized as the gold standard in isolated clubfoot treatment, the Ponseti casting method has yielded variable results. Few studies have directly compared common predictors of treatment failure between institutions with high versus low failure rates.

This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado. Patients were excluded for treatment at another institution ( n = 148), no fracture noted in clinic ( n = 18), or other ( n = 13). Data were retrospectively collected from the remaining 1838 patients regarding demographics, fracture injury, mechanism, and treatment. Odds ratios (ORs) were calculated for each variable during COVID-19 relative to prior years. The number of fractures during 2020 decreased by 26% relative to 2019 and 23% to 2018. A larger proportion of patients experienced at least a 5-day delay to definitive treatment [OR: 1.55, confidence interval (CI): 1.23–1.96, P = 0.0002]. Rates of non-accidental trauma (NAT) increased non-significantly (OR: 2.67, CI: 0.86–8.32, P = 0.0900) during 2020 (1.2%) relative to 2018 (0.6%) and 2019 (0.3%). Fractures occurring at home increased to 79.9% (OR: 6.44, CI: 5.04–8.22, P < 0.0001). Despite less overall trauma during shelter-in-place orders, greater fracture numbers were seen among younger children and severe fractures were likely among older children. Patients may hesitate to seek care during 2020. Rates of NAT doubled during 2020. As communities prepare for future waves, treatment centers should warn against common fracture mechanisms and raise awareness of NAT.