The incidence of ACL tears in pediatric patients increased over the last 20 years. Females were at higher risk except in the 17- to 18-year -old group. Peak incidence is noted during high school years. These data help target the most at-risk patients for ACL prevention programs.

This protocol describes how to grow a Pseudomonas aeruginosa biofilm under low fluid shear close to the air-liquid interface using the drip flow reactor (DFR). The DFR can model environments such as food-processing conveyor belts, catheters, lungs with cystic fibrosis and the oral cavity. The biofilm is established by operating the reactor in batch mode for 6 h. A mature biofilm forms as the reactor operates for an additional 48 h with a continuous flow of nutrients. During continuous flow, the biofilm experiences a low shear as the media drips onto a surface set at a 10 degrees angle. At the end of 54 h, biofilm accumulation is quantified by removing coupons from the reactor channels, rinsing the coupons to remove planktonic cells, scraping the biofilm from the coupon surface, disaggregating the clumps, then diluting and plating for viable cell enumeration. The entire procedure takes 13 h of active time that is distributed over 5 d.

Background Hip dysplasia is prevalent in nonambulatory children with cerebral palsy, and may contribute to a decreased quality of life (Lonstein in J Pediatr Orthop 6:521-526, 1). Reconstructive procedures such as a femoral varus derotation osteotomy with or without a pelvic osteotomy are commonly employed with the goal of achieving and maintaining well reduced hips. Purposes The goals of this study are both to characterize the complications of reconstructive procedures and to identify risk factors that may contribute to these complications. Patients and methods A retrospective analysis was conducted among 61 nonambulatory children (93 hips) with cerebral palsy who underwent a femoral varus derotation osteotomy, with or without an open reduction and/or pelvic osteotomy, from 1992 through 2008 at our institution. The average patient age was 8.1 years (2.6-14.7) and the mean follow-up time was 5.9 years (2.1-15.9). Results The cumulative complication rate per patient including failures to cure was 47.6 %. Spica casting was found to be a risk factor for all complications (P = 0.023); whereas patients younger than 6 years old (P = 0.013) and children with a tracheostomy (P = 0.004) were found to be risk factors for resubluxation following surgery.Conclusions Although reported complication rates of hip reconstructive procedures performed upon children with cerebral palsy have varied considerably, those with more severe disease have experienced more complications. We report our tertiary referral center's complication rate and our institutional experiences with risk factors for complications and failures to cure. Level of evidence IV, Retrospective case series.

Purpose The purpose of this study was to determine the risk factors for loss of reduction in patients with an isolated distal radius fracture and intact ulna. Methods Outpatient records and initial, post-reduction, and follow-up radiographs of children with displaced distal radial metaphyseal fractures and intact ulnas that required closed reduction and casting at our institution were reviewed for demographic factors, body mass index (BMI), initial fracture displacement, residual displacement after reduction, and 3-point cast index. Loss of reduction was defined as angulation C15°in the coronal plane for all ages and/or angulation C20°in the sagittal plane for patients C11 years of age and C30°for children \11 years of age. Additionally, all patients who were remanipulated and/or pinned were considered to have lost reduction. Results Thirty-five of the 76 patients in our series met the criteria for loss of reduction (46%). Multivariate logistic regression revealed that initial angulation in the coronal plane and post-reduction translation in the coronal plane were independent predictors for loss of reduction. Patients with [11°of initial angulation in the coronal plane were 6.3 times as likely to lose reduction (confidence interval [CI]: 1.43-28.3, P = 0.015) and those with any amount of residual translation in the coronal plane after closed reduction were 7.8 times as likely to lose reduction (CI: 2.5-24.0, P \ 0.001). Conclusion Our study, the largest dedicated series of distal radial metaphyseal fractures with intact ulnas, indicates that loss of reduction is common, and that risk factors include initial angulation in the coronal plane and postreduction translation in the coronal plane.

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