Impact of fractures on school attendance.

BACKGROUND: The purpose of this study was to determine the average prevalence of children across the nation who experience difficulty in attending school after an acute orthopaedic injury. METHODS: A survey was created to obtain information on school absence for children with acute orthopaedic injuries. All members of the Pediatric Orthopaedic Society of North America were invited to complete the survey. RESULTS: The survey was sent by e-mail to 936 members of the Pediatric Orthopaedic Society of North America. A total of 283 surgeons from 45 states responded to the survey, which resulted in a response rate of 30.2%. The survey found a correlation with difficulty in attending school with a cast and the size of the population served. Communities with the larger populations are less likely to permit children to attend school with a cast. The most common reasons given by schools for a child not being permitted to attend school with a cast were concern for the safety of the child and inability to accommodate the needs of the child. CONCLUSIONS: Most physicians participating in the survey reported no difficulty with their patients attending school with a cast. There was more difficulty with children in attending school with a cast in metropolitan areas and in communities with greater than 1 million people. To decrease or to eliminate absence from school, it may be best to identify schools in a physician's community that do not allow attendance of children with a cast. Once individual schools are identified, advocacy can be targeted. At the very least, when it is known which schools are involved, the surgeon can anticipate difficulties and plan accordingly. As a child's absence from school has substantial negative consequences, we strongly support intervention to enable injured children to appropriately return to a regular educational setting in a timely manner. Future studies with school participation would help to identify reasons for school absence after a musculoskeletal injury. LEVEL OF EVIDENCE: Level V, Prognostic.

Prevalence of Hip Ultrasound Abnormalities in Newborns With a Hip Click.

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

Tibia fractures in children sustained on a playground slide.

BACKGROUND: The purpose of this study is to investigate the relationship between children who sustain tibia fractures on a playground slide and the mechanism of injury. METHODS: This retrospective review included the chart and radiographs of all children diagnosed with a tibia fracture, over an 11-month period. All patients were originally seen in either the emergency room of a level 1 trauma center or the treating physician's office. RESULTS: During the period of study, 58 fractures of the tibia were found. Eight (13.8%) of the tibia fractures were sustained while playing on a playground slide. The 8 fractures identified are the focus of this study. The tibia fractures were nondisplaced, diaphyseal, with an intact fibula. There were 5 female and 6 male children included in the study. The age range of the patients with a tibia fracture sustained while going down a slide was 14 months to 32 months; the average age of the 8 children in this study was 20.6 months. The average age of boys sustaining a tibia fracture on a playground slide was found to be 20.7 months and the average age of girls was found to be 20.6 months. All tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult. None of the 8 children studied went down the slide alone. CONCLUSIONS: Children at risk for tibia fractures sustained while going down a playground slide, on the lap of an adult, were found to be less than 32 months of age. Many parents believe they are increasing the safety of their young child by placing the child on their lap while going down a playground slide. Parents should be educated not to go down a slide with a child on their lap. If the child is unable to use the slide independently, another activity would be more appropriate. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Decreasing Unplanned Office Visits Due to Cast Problems in the Pediatric Population.

INTRODUCTION: Unplanned office visits due to cast-related problems in the pediatric orthopedic office are common. Decreasing problems associated with the use of a cast would improve patient safety, increase office productivity, and decrease inconvenience to the child and family. METHODS: Pediatric patients treated with a cast in our office were included in the study if they returned for an unplanned office visit due to a cast-related problem. Group 1 received verbal cast care instruction. Group 2 had the same verbal instruction in addition to a written handout identical to the verbal instructions. Group 3 was provided the same verbal instructions and a revised handout limiting the number of instructions and focused on keeping the cast away from water. RESULTS: The study included 550 patients with 146 in group 1, 124 in group 2, and 280 in group 3. Comparing group 1 (10.3%) and group 2 (10.5%), there was almost no difference in the rate of unplanned office visits due to cast-related problems. Combining the revised handout with verbal instructions in group 3, the percentage of patients returning for an unplanned visit was 6%. There was a relative decrease in office visits by 55% and an absolute decrease of 4.5% when comparing group 2 and group 3. CONCLUSIONS: There was a decrease in the number of unplanned office visits due to cast problems utilizing a handout focused on keeping the cast dry in collaboration with verbal cast care instructions. However, the decrease was not statistically significant.