Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.

BACKGROUND: Much attention has been given to the relationship between various training factors and athletic injuries, but no study has examined the impact of sleep deprivation on injury rates in young athletes. Information about sleep practices was gathered as part of a study designed to correlate various training practices with the risk of injury in adolescent athletes. METHODS: Informed consent for participation in an online survey of training practices and a review of injury records was obtained from 160 student athletes at a combined middle/high school (grades 7 to 12) and from their parents. Online surveys were completed by 112 adolescent athletes (70% completion rate), including 54 male and 58 female athletes with a mean age of 15 years (SD=1.5; range, 12 to 18 y). The students' responses were then correlated with data obtained from a retrospective review of injury records maintained by the school's athletic department. RESULTS: Multivariate analysis showed that hours of sleep per night and the grade in school were the best independent predictors of injury. Athletes who slept on average <8 hours per night were 1.7 times (95% confidence interval, 1.0-3.0; P=0.04) more likely to have had an injury compared with athletes who slept for ≥8 hours. For each additional grade in school, the athletes were 1.4 times more likely to have had an injury (95% confidence interval, 1.2-1.6; P<0.001). CONCLUSION: Sleep deprivation and increasing grade in school appear to be associated with injuries in an adolescent athletic population. Encouraging young athletes to get optimal amounts of sleep may help protect them against athletic injuries. LEVEL OF EVIDENCE: Level III.

Bilateral proximal femur and femoral head regrowth following proximal femoral resection in a child with spastic cerebral palsy.

This is a case of a child with spastic quadriplegic cerebral palsy who had regrowth of her proximal femurs following bilateral proximal femur resections.

Abduction bracing after Pavlik harness failure: an effective alternative to closed reduction and spica casting?

BACKGROUND: Previous studies have reported that the use of abduction bracing after Pavlik harness failure in patients with developmental dysplasia of the hip (DDH) is often effective in achieving hip reduction. METHODS: This is a retrospective study of consecutive patients with DDH at a single institution between 2006 and 2011. Patients in this study met all 4 inclusion criteria: (1) DDH, (2) a dislocated or dislocatable hip, (3) unsuccessful treatment with a Pavlik harness, and (4) subsequent treatment with abduction bracing. Exclusion criteria were dislocated hips associated with neurological, teratologic, syndromic, or other nonidiopathic conditions. RESULTS: Seven hips met inclusion criteria. Mean age at Pavlik harness initiation was 2.1 months (range, 1 d to 6 mo) and patients spent an average of 1.2 months (range, 0.4 to 2.7 mo) in the harness. After ultrasound demonstrated a persistently dislocated hip, patients were transitioned to an abduction brace and spent an average of 1.3 months (range, 0.1 to 3 mo) in the brace. One hundred percent (7/7) of hips treated with an abduction orthosis failed to reduce and required further treatment; 4 with closed reduction and spica casting, and 3 with open reduction. Patients were followed for an average of 33.6 months (range, 10 to 60 mo), and all patients had stable hips at latest follow-up. CONCLUSIONS: In this series of 7 patients with developmentally dislocated hips who failed Pavlik harness treatment, subsequent abduction bracing provided no benefit, in contrast to previous studies. All patients who failed Pavlik harness treatment went on to require closed or open reduction of the hip. Abduction bracing may unnecessarily prolong the time to definitive treatment. LEVEL OF EVIDENCE: Case series, level 4.

Ten percent of patients with adolescent idiopathic scoliosis have variations in the number of thoracic or lumbar vertebrae.

BACKGROUND: Surveys have demonstrated that wrong-site surgery of the spine is performed by up to 50% of spine surgeons over the course of a career. Inaccurate identification of appropriate vertebral levels is a common reason for wrong-site spine surgery. The present study examined the prevalence of variations in the number of vertebrae in patients with adolescent idiopathic scoliosis. METHODS: A retrospective review of radiographs and reports of 364 consecutive patients undergoing operative treatment for adolescent idiopathic scoliosis at a single center was performed. The study included eighty-eight male patients (24%) and 276 female patients (76%) with a mean age of fourteen years (range, ten to twenty years). Radiographs were reviewed to assess the number of thoracic and lumbar vertebrae and the presence of a lumbosacral transitional vertebra. RESULTS: Ten percent of the patients (thirty-eight) had an atypical number of vertebrae in the thoracic and/or lumbar spine. Twenty-one patients (5.8%) had an atypical number of thoracic vertebrae, with fourteen having eleven thoracic vertebrae and seven patients having thirteen. Twenty-four patients (6.6%) had an atypical number of lumbar vertebrae, with four having four lumbar vertebrae and twenty patients having six. A lumbosacral transitional vertebra was present in 6.3% (twenty-three) of the patients. Multilevel vertebral anomalies were present in 1.9% of the patients (seven of 364). A variation in the number of vertebrae had been identified in 0.5% (two) of the reports by the radiologist. CONCLUSIONS: Variations in the number of thoracic or lumbar vertebrae were found in 10% of patients with adolescent idiopathic scoliosis but had been identified in only 0.5% of the radiology reports.