Epidemiology and management of appendicular fractures occurring in neonatal intensive care patients.

AIM: To describe the epidemiology and management of appendicular fractures occurring in the neonatal ICU in a large series of patients treated a single, quaternary care neonatal intensive care unit. METHODS: Patients <1 years old with appendicular fractures treated from 2012 to 2016 at a quaternary-level NICU were identified. Bivariate testing compared fractures, work-up and management based on designated mechanism (presumed birth-related vs unknown). In patients with unknown mechanism, factors with potential fracture association were analysed in a descriptive fashion. RESULTS: Eighty-five fractures (54 patients) were included. Mechanistic cohorts differed by birthweight (P < .001) and gestational age at birth (P < .001). Presumed birth-related fractures were more commonly upper extremity (P < .001), solitary (P = .001) and radiographically diagnosed in the acute state (<.001). The biochemical profile of the cohorts differed significantly. The prevalence of factors with potential fracture association was high in patients with unknown mechanism. Only one patient required surgery, while all others resolved with minimal orthopaedic intervention. CONCLUSION: Findings indicate these injuries rarely require operative intervention and that two distinct injury profiles appear to exist based on fracture mechanism. Steroid use, ventilation use, diuretic use, nutritional supplementation and recent bedside procedures were common among patients without known fracture mechanism. LEVEL OF EVIDENCE: Level III-Retrospective Cohort Study.

A Year into the Pandemic: An Update on Women in Science, Technology, Engineering, Math, and Medicine.

The coronavirus pandemic revealed long-standing, unaddressed fissures in our systems, including dramatic gender inequities in science, technology, engineering, mathematics, and medicine (STEMM) fields. Women have disproportionately carried the burden of childcare and other caregiving responsibilities during the pandemic, and there are strong indications that the pandemic will likely exacerbate preexisting disparities in the pipeline of women in STEMM and in leadership positions. Based on a literature review, our own experiences, and the experiences of our colleagues, we review promising strategies that have been implemented by funding bodies, journals, professional societies, and colleges/universities as well as additional strategies that might be helpful for these entities to implement to move forward with policies in place that address gender inequities and rebuild our institutional systems better. At this moment in time, institutions should collect data on metrics such as recruitment, retention, tenure/promotion, funding, professional society membership, awards/honors, and scientific publishing. These data will be essential in determining the impact of policies on women in STEMM to ensure they are having the intended effect as well as what future actions might be necessary in an iterative process.