Background: Opioids are a commonly utilized component of pain management following pediatric extremity fractures, yet an increasing number of adolescents and children are falling victim to their negative effects. The purpose of this study was to examine opioid use in the pediatric fracture population by determining and comparing the average hospital opioid dosage utilized in the operative pediatric elbow and femur fractures and determining and comparing the average dose prescribed following operative treatment of elbow and femur fractures. Methods: All elbow and femur fractures treated operatively between January and December 2016 were identified. Patients aged 0 to 17 years with closed injuries who presented to the emergency department (ED) within 24 hours of injury and underwent operative treatment were included. Demographic information, opioid and nonopioid analgesic medication doses administered in the ED and while inpatient, and postdischarge prescription information were recorded. Opioid doses were converted to oral morphine equivalents. Results: In total, 91.9% and 78.1% of patients received opioids during the ED and inpatient periods, respectively. Only 30% of patients in either cohort received a nonopioid analgesic in the ED and only 44% received ibuprofen while inpatient. Average total opioid dose per hour of hospital stay was not significantly different between elbow fracture and femur fracture cohorts, which was unexpected. There was no significant difference between the average opioid dose or number of doses prescribed for postdischarge use between cohorts. Conclusions: This study provides data on average hospital opioid and nonopioid use following pediatric elbow and femur fractures. The results reveal inconsistent nonopioid analgesic use and similar hospital opioid use in elbow and femur fracture patients. This study provides baseline analgesic use data for future investigations. Level of Evidence: Level IV.
Background: This study aimed to assess the accuracy of the external remote control (ERC) digital readout to the radiographic measurement of magnetically controlled growing rod (MCGR) actuators undergoing lengthenings/expansions and to analyze the impact of patient and spinal deformity factors on the accuracy of the ERC digital readout. Methods: Single-surgeon database at 2 tertiary-care pediatric hospitals identified early-onset scoliosis patients with MCGR constructs. There were 14 males and 16 females with a minimum of 2 lengthenings included in the analysis. ERC readouts at each lengthening were recorded. Results: Sixty-six MCGR actuators were assessed in 30 patients which underwent 280 lengthenings (mean of 5.7 lengthenings). At individual lengthening sessions the ERC and radiographic measurements were correlated (r = 0.69, P<0.001). The summed radiographic measurements averaged 15% less than the summed ERC readouts (SD = 19%). The difference between the sum of radiographic measurements and ERCs was positively correlated with subsequent lengthenings (r = 0.94, P = 0.015). The accuracy of the ERC did not improve with increased grouped sessions (r = −0.54, P = 0.388) with no difference between the group with 2 and the group with ≥5 lengthenings (P = 0.670). In patients with dual rods, the difference was correlated between rods (r = 0.66, P<0.001) and the distraction of each rod was not significantly different from the other (P = 0.124). Patient weight correlated with the difference between the radiographs and ERC readouts (r = 0.27, P = 0.032). In patients with multiple grouped lengthenings, increased weight was positively correlated with an increase in measurement difference (mean r = 0.972). Conclusions: Summed radiographic measurements during lengthening sessions averaged 15% less than the summed ERC readouts. The accuracy of radiographic measurements did not increase when sessions were grouped together (2 vs. ≥5). There was no difference in the ERC accuracy over lengthening sessions early versus late. Patient weight, but not body mass index, was positively correlated with the discrepancy between the ERC and radiographic measures. Level of Evidence: Level III.
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