Objective To determine the impact of maternal obesity and gestational weight gain across pregnancy on fetal indices of inflammation and iron status. Study design Eighty-five healthy term newborns delivered via elective cesarean were categorized by 2 maternal body mass index (BMI) thresholds; above or below 30 kg/m2 or above or below 35 kg/m2. Umbilical cord plasma levels of C-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-α, ferritin, and hepcidin were assayed. Cytokines released by phytohemagglutinin-stimulated umbilical cord mononuclear cells (MNCs) were assayed. Results Maternal class II obesity, defined as BMI of 35 kg/m2 and above, predicted higher C-reactive protein and TNF-α in umbilical cord plasma (P< .05 for both), and also proinflammatory cytokines (IL-1β, IL-6, and TNF-α) from stimulated MNC (P < .05 for all). The rise in plasma TNF-α and MNC TNF-α was not linear but occurred when the threshold of BMI 35 kg/m2 was reached (P < .005, P < .06). Poorer umbilical cord iron indices were associated with maternal obesity. When ferritin was low, IL-6 was higher (P < .04), but this relationship was present primarily when maternal BMI exceeded 35 kg/m2 (P < .03). Ferritin was correlated with hepcidin (P < .0001), but hepcidin was unrelated to either maternal BMI or inflammatory indices. Conclusions Class II obesity and above during pregnancy is associated with fetal inflammation in a threshold fashion. Although maternal BMI negatively impacted fetal iron status, hepcidin, related to obesity in adults, was related to iron status and not obesity in fetuses. Pediatricians should be aware of these relationships.

Septic arthritis continues to present challenges regarding the clinical diagnosis, workup, and definitive management. Urgent management is essential, so treating surgeons must efficiently work through differential diagnoses, identify concomitant infections, and do a timely irrigation and débridement. The incidence of methicillin-resistant Staphylococcus aureus is increasing, typically resulting in a more rapid progression of symptoms with more severe clinical presentation. The diagnostic utility of MRI has resulted in improved detection of concomitant septic arthritis and osteomyelitis, although MRI must not substantially delay definitive management. Early diagnosis followed by urgent irrigation and débridement and antibiotic therapy are essential for satisfactory long-term outcomes. Antibiotics should not be administered until blood cultures and arthrocentesis fluid are obtained, except in rare cases of a septic or toxic patient. Once cultures are obtained, empiric antibiotic therapy should commence and provide coverage for the most likely pathogens, given the patient's age. Laboratory markers, especially C-reactive protein, should be followed until normalization and correlate with resolution of clinical symptoms. Definitive antibiotic selection should be shared with a pediatric infectious disease specialist, who can help guide the duration of treatment.

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Although some of the fetal responses involving Epo were similar to adults, we did not find a hepcidin-Epo relationship like that of adults, where fetal liver is the site of both hepcidin and Epo production.

Operative fixation of medial epicondyle fractures is becoming increasingly popular due to a rising concern for symptomatic valgus instability, stiffness, and long-term functional effects of nonunion in patients treated non-operatively. Damage to medial stabilizing structures is recognized as a risk for poor outcome and operative decision-making has shifted, with less emphasis on medial epicondyle displacement and more focus on operative fixation for valgus instability and desire to return to high-level athletics or employment. Expanding surgical indications and the desire to restore elbow stability has led to the development of a novel fixation method that stabilizes soft tissues, promotes bony healing, and does not necessitate a second implant removal surgery. This paper presents a novel, minimally traumatic technique for operative fixation of medial epicondyle fractures that restores ligamentous stability of the ulnar collateral ligament (UCL) and flexor-pronator mass utilizing a bone suture anchor to augment k-wire fixation without the need for operative implant removal and with reduced risk of avulsion fragment comminution and postoperative stiffness.

This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique presented here eliminates the risk of avulsion fragment comminution and provides stable fixation that allows for early mobilization.

Tibial spine/eminence fractures are uncommon fractures, usually seen in patients with open physes and are considered as equivalent to ACL tear in adults. The aim of treatment is appropriate reduction of the fracture, restoring the ACL length for appropriate healing and avoiding complications. There are many techniques described to treat these fractures with no current consensus on the optimal method of fixation. The purpose of this paper was to describe and demonstrate with videos, various pearls, technical tricks, and tips by members of PRiSM tibial spine fracture research interest group which can help facilitate management of these fractures.