Crash Performance of Rear-facing Restraints With a Fracture Type Spica Casted 1-Year-Old Dummy.

BACKGROUND: Motor vehicle crashes represent a significant cause of mortality and morbidity for young children. Safely restraining a child is typically more complicated for special cases such as children treated with a hip spica cast. In the current study, hip spica casts typical for treatment of a femoral fracture were applied to a crash dummy representing the size and weight of a 1-year-old child. This spica casted dummy was used to study the performance of 4 rear-facing car seats in a series of simulated frontal impacts. METHODS: The restrained, rear-facing dummy was subjected to a frontal crash test at 30 mph (48 kph) per federal guidelines. Two of the tested car seats were specifically designed for transporting children with hip spica casts, while the other 2 were conventional seats capable of accommodating the cast. All seats were installed per the manufacturer's instructions. As a control, tests were performed without a cast using the conventional/standard seats. RESULTS: The lowest overall loading of the dummy's head, neck, and chest occurred during tests with the standard seats. While it was easier to seat the casted child in the spica-specific seats, these designs led to greater loading on the dummy's body. In a spica-specific seat, the chest acceleration values exceeded the federal limit in a test where the seat was installed in a reclined orientation that was within the manufacturer's described positioning. CONCLUSIONS: Spica-specific seats more easily accommodate the cast, but conventional seats can provide similar levels of protection in a crash. As cast and seat designs continue to evolve, hospitals might consider having a range of seats available for patient use. It is important to help caregivers make informed decisions on how and when to transport children with hip spica casts.

Type IV tibial tubercle fracture-Salter-Harris type II variant.

Fractures about the tibial tubercle are uncommon fracture patterns, seen most often in adolescent males as they approach skeletal maturity. Compartment syndrome has a high association with these fractures requiring close monitoring, and a heightened level of suspicion. Tibial tubercle fractures are typically stratified using the Ogden classification. The type of intra-articular involvement and degree of displacement guide appropriate treatment. This report highlights a 14-year-old male patient who suffered a type IV tibial tubercle fracture with a unique Salter-Harris II, or transitional, component posteriorly that was unable to be closed reduced and developed compartment syndrome. He underwent fasciotomy, open reduction, and temporary external fixation. Once the status of the soft tissues improved, he underwent staged open reduction and internal fixation with skin grafting. The patient's fracture and soft tissues healed and he currently ambulates without assistance or pain, and has returned to all desired activities including competitive sports.

Review: Medial collateral ligament injuries.

The medial collateral ligament (MCL) is a major stabilizer of the knee joint. It is the most common ligament injured in the knee, particularly in athletes, and has been reported to be torn in 7.9% of all knee injuries.2 The MCL has a complex, layered anatomy with multiple insertions and functions. Minor trauma can cause tearing of the superficial portion whereas higher energy mechanisms can disrupt both the deep and superficial layers. History and physical are often adequate, but the gold standard for diagnosis is MRI. Lesser injuries to the MCL can often be treated conservatively with early rehabilitation, but more significant tears often necessitate surgery. A thorough understanding of the MCL and associated injuries is essential for proper diagnosis and treatment.