Utility of Follow-up Radiographs in Type 1 Supracondylar Humerus Fractures.

OBJECTIVE: Supracondylar humerus (SCH) fractures are common among pediatric patients, with the severity categorized using the Gartland classification system. Type 1 SCH fractures are nondisplaced and treated with immobilization, while more displaced fractures require surgery. The need for follow-up radiographs, particularly for type 1 fractures, is an area where evidence is lacking. This study investigates the clinical value and financial implications of follow-up radiographs for type 1 SCH fractures, hypothesizing that they do not alter clinical management and, therefore, represent an unnecessary expense. METHODS: This retrospective cohort study, approved by the Institutional Review Board, focused on patients under 18 with nondisplaced SCH fractures treated nonoperatively. One hundred one type 1 SCH fractures, in which the fracture was visible on presenting radiographs, were chosen from patients presenting between January 2021 and December 2022. Charts were reviewed for demographic information, time of cast removal, and complications. A pediatric orthopaedic surgeon and orthopaedic resident reviewed the radiographs to confirm the injury to be a type 1 SCH fracture. RESULTS: Among the 101 patients, after the initial presentation, 79 attended an interim visit and 101 attended a "3-week follow-up" at an average of 23 days postinjury. All patients underwent radiographs during these visits for a total of 180 radiographs after confirmation of type 1 SCH fracture. No changes in management resulted from follow-up radiographs. One instance of refracture was noted ~3 months after cast removal. There were 180 superfluous follow-up radiographs taken at subsequent clinic visits. The total charge for these radiographs was $76,001.40, averaging $752.49 per patient. CONCLUSION: Follow-up radiographs for type 1 SCH fractures did not lead to changes in clinical management, aligning with previous findings in more severe SCH fractures. This approach can reduce costs, radiation exposure, and clinic time without compromising patient care. The study can reassure providers and parents about the lack of necessity for follow-up radiographs to document healing. LEVEL OF EVIDENCE: Level-IV.

Prevalence of Abnormal Ultrasonographic Findings in Asymptomatic Peroneal Tendons.

Background: The peroneus longus (PL) and peroneus brevis (PB) tendons comprise the lateral compartment of the leg and stabilize the foot during weightbearing. Peroneal tendinopathy can precipitate lateral ankle pain and induce functional disability. The progression of peroneal pathology to lateral ankle dysfunction is thought to stem from asymptomatic, subclinical peroneal tendinopathy. There may be clinical benefit to identifying asymptomatic patients with this condition before progression to disability. Various ultrasonographic characteristics have been observed in peroneal tendinopathy. The purpose of this study is to identify the frequency of subclinical tendinopathic characteristics in asymptomatic peroneal tendons. Methods: One hundred seventy participants underwent bilateral foot and ankle ultrasonographic examination. Images were assessed for abnormalities of the PL and PB tendons by a group of physicians who recorded frequencies of abnormalities. This team consisted of an orthopaedic surgeon specializing in foot and ankle surgery, a fifth-year orthopaedic surgery resident, and a family medicine physician with musculoskeletal sonographer certification. Results: A total of 340 PL and 340 PB tendons were assessed. Sixty-eight (20%) PL and 41 (12.1%) PB tendons had abnormal traits. Twenty-four PLs and 22 PBs had circumferential fluid, 16 PLs and 9 PBs had noncircumferential fluid, 27 PLs and 6 PBs had thickening, 36 PLs and 12 PBs had heterogenicity, 10 PLs and 2 PBs had hyperemia, and 1 PL had calcification. In Caucasian participants, male gender was associated with increased frequency of abnormal findings, but there were no other significant differences based on age, body mass index, or ethnicity. Conclusion: In our studied population of 170 patients who had no complaints of associated symptoms, we found that 20% of PLs and 12% of PBs displayed ultrasonographic abnormalities. When we included all unusual findings within and around the tendons, prevalence rates of ultrasonographic abnormalities were 34% for PLs and 22% for PBs. Level of Evidence: Level II, prospective cohort study.

Seasonal and annual abundance of Ephuta wasp (Hymenoptera: Mutillidae) in Panama / Abundancia estacional y anual de la avispa Ephuta (Hymenoptera: Mutillidae) en Panamá

Introduction: Ephuta Say is a widespread New World genus of mutillid wasp whose ecology is poorly understood. Objective: The objective of this study was to determine how Ephuta species abundance varies annually and seasonally driven by weather conditions and hosts. Methods: Ephuta specimens, located in the "old forest" at Barro Colorado Island, were examined from weekly samples (2001-2006) of ten Malaise traps. The monthly abundance of each Ephuta species was compared with monthly average humidity, solar radiation, temperature and rainfall. Results: Nine species and ten morphospecies were identified. Most specimens were collected from March to June. April was the month reported with the greatest abundance. Of the four abiotic variables measured, only average monthly temperature was correlated with Ephuta abundance. Months with the highest number of Ephuta specimens were correlated with suspected host abundance, as indicated by the monthly abundance of Pompilidae (Hymenoptera) captured during the year 2007. Conclusions: We concluded that Ephuta display strong seasonal variation in abundance, with the peaks occurring during the end of the dry season and beginning of the rainy season, which correlate broadly with temperature and the abundance of their pompilid hosts.

Introducción: Ephuta es un género de avispas mutílidas ampliamente distribuido en el Nuevo Mundo y cuya ecología es poco conocida. Objetivo: El objetivo de este trabajo fue determinar cómo varía la abundancia de especies de Ephuta anualmente y estacionalmente debido a las condiciones climáticas y sus hospederos. Métodos: Se examinaron especímenes de Ephuta tomados de muestras semanales (2001-2006) de diez trampas Malaise, ubicadas en el "bosque viejo" de Isla Barro Colorado. La abundancia mensual de cada especie de Ephuta se comparó con el promedio mensual de la humedad, la radiación solar, la temperatura y las precipitaciones. Resultados: Se identificaron nueve especies y diez morfoespecies. La mayoría de los especímenes fueron recolectados de marzo a junio. La mayor abundancia mensual promedio se dio en abril. De las cuatro variables abióticas medidas, solo la temperatura mensual promedio se correlacionó con la abundancia de Ephuta. Los meses con el mayor número de especímenes de Ephuta se correlacionan con la sospechosa abundancia del huésped, como lo indica la abundancia mensual de Pompilidae (Hymenoptera) capturada durante el 2007. Conclusiones: Ephuta muestra una fuerte variación estacional en la abundancia, con picos durante el final de la estación seca y el comienzo de la temporada de lluvias. Esta se correlaciona ampliamente con la temperatura y la abundancia de sus huéspedes pompílidos.