Pediatric lower limb peripheral nerve blocks: Indications, effectiveness, and the incidence of adverse events.

AIM: While the proportion of pediatric anesthetics with regional anesthesia in pediatric patients has steadily increased, there are only a few series that describe the use of lower limb peripheral nerve blocks in children. Our aim was to describe the indications, anesthetic approach, and complications associated with lower limb blocks in children undergoing orthopedic surgery in a center with a large caseload of complex patients. METHODS: In a retrospective analysis of prospectively collected data, we reviewed children who had a peripheral nerve block for orthopedic surgery placed between January 2016 and January 2021 at the Royal Children's Hospital Melbourne. Block data were sourced from the electronic medical record and departmental regional anesthesia database. Data collected included demographics, the site of catheter placement and technique of nerve block, presence of sensory/motor blockade, the use of perioperative opioids, and any complications related to peripheral nerve block. RESULTS: A total of 1438 blocks were performed in 1058 patients. Four patients had clinical features of perioperative neurological injury giving an incidence of 3 per 1000 blocks (95% CI 1.1-8:1000). Only one patient had a sensory deficit persisting longer than 6 months for an incidence of 0.8 per 1000 blocks (95% CI 0.1-5:1000). All four peripheral nerve injury followed tibial osteotomy for lengthening procedures or correction of tibial torsion. The etiology of the injury could not be determined despite imaging and surgical exploration and the contribution of popliteal sciatic nerve block to the subsequent PNI could not be confirmed. There were no cases of local anesthetic systemic toxicity. CONCLUSION: An increased risk of perioperative peripheral nerve injury is associated with pediatric tibial osteotomy for congenital deformity. While popliteal sciatic nerve block was not directly implicated in the nerve injury the presence of a prolonged sensory block can delay early recognition and treatment of peripheral nerve injury.

Update on the management of infant and toddler developmental dysplasia of the hip.

BACKGROUND: This article is the third in a commissioned series on paediatric orthopaedics. Developmental dysplasia of the hip (DDH) encompasses the pathological spectrum of hip instability that produces subluxation or dislocation and radiological features of abnormal acetabular development. It is important to approach DDH with sound prior knowledge to recognise, diagnose and manage its variety of presentations. OBJECTIVE: The aim of this article is to summarise contemporary practice in DDH with an emphasis on recent changes in diagnosis, surveillance and treatment recommendations for general practitioners (GPs), who see infants and toddlers in practice. DISCUSSION: The management of DDH requires accurate diagnosis of the pathoanatomy and depends on the age of the child. GPs are essential for the early detection of DDH, which then allows for harnessing of the remodelling potential of the hip cartilaginous anlage to achieve a stable and mature hip. GPs also play an important part in surveillance, and this article provides an update on the pivotal points.

Paediatric rotational abnormalities: A primer.

BACKGROUND: Idiopathic rotational abnormalities of the lower limb have been studied extensively in children through to adulthood, but there remains concern among parents and the community whether a normal variant is pathological. OBJECTIVE: The aim of this article is to draw attention to deformities in the transverse plane and to highlight the variation in normal over time, and according to sex. DISCUSSION: Rotational malalignment of the lower limb can be a rare cause of pain in the hip, knee, ankle and foot. Understanding common presentation and physical examination findings is the first step in diagnosing and, ultimately, managing symptomatic rotational abnormalities in children and adolescents.

Deep learning for cardiac computer-aided diagnosis: benefits, issues & solutions.

Cardiovascular diseases are one of the top causes of deaths worldwide. In developing nations and rural areas, difficulties with diagnosis and treatment are made worse due to the deficiency of healthcare facilities. A viable solution to this issue is telemedicine, which involves delivering health care and sharing medical knowledge at a distance. Additionally, mHealth, the utilization of mobile devices for medical care, has also proven to be a feasible choice. The integration of telemedicine, mHealth and computer-aided diagnosis systems with the fields of machine and deep learning has enabled the creation of effective services that are adaptable to a multitude of scenarios. The objective of this review is to provide an overview of heart disease diagnosis and management, especially within the context of rural healthcare, as well as discuss the benefits, issues and solutions of implementing deep learning algorithms to improve the efficacy of relevant medical applications.

Congenital bipartite lunate presenting as a misdiagnosed lunate fracture: a case report.

INTRODUCTION: A rare case of congenital bipartite lunate in a child is reported. Carpal variants are very uncommon as independent entities, with only three previous reports of this condition in the English literature. CASE PRESENTATION: An 11-year-old Caucasian boy presented with pain in the left wrist after a fall. Radiographs in the emergency department demonstrated a lunate that was divided into palmar and dorsal parts, causing a misdiagnosis of fractured lunate. Magnetic resonance imaging was then used to differentiate between the two diagnoses. CONCLUSION: Very few cases of bipartite lunate have been reported in the literature, and unless awareness is raised about congenital anomalies such as this variant, confusion may arise.