Background: Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries. Methods: A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings. Results: Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9). Conclusions: We found that older adolescents (≥14 y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12 y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population. Level of Evidence: Level—IV.
Currently, the majority of distal radius reduction models use fractured synthetic bones, however, the lack of soft tissues lowers the fidelity of the simulation causing poor discriminative abilities between individuals of different experience levels. When soft tissues are incorporated into the model to increase haptic feedback, the outer shell of the model makes it difficult to accurately assess the adequacy of the reduction. Thus, while these models can provide biofeedback to develop a feel for the process of fracture reduction, they may not truly simulate the process of fracture reduction and casting. We thus sought to create a model that requires the learner to master all of the steps of the process to achieve a good final result. When combined with fluoroscopy, the simulation training with the fracture reduction model described here can recapitulate the entire process of distal radius fracture reduction and give the learner haptic and visual feedback on their reduction and casting performance in real-time. The exercise also helps them think through some of the logistical challenges that they are likely to face with real patients. This is the first distal radius fracture model to incorporate this objective feedback, allowing the participant to appreciate the effectiveness of their reduction and casting technique.
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