The role of public policy in reducing moped and scooter injuries in South Carolina.

INTRODUCTION: Mopeds and electric scooters have grown in popularity in recent years. A South Carolina (SC) law was passed on November 19, 2018, aimed to regulate mopeds and scooters. This study aims to evaluate whether this SC law was associated with a decrease in the moped injury rate in a Level 1 Trauma Center. METHODS: A retrospective review of trauma registry data was used to identify a cohort of patients 14 years and older who came to a Level 1 trauma center for a moped/scooter accident between January 2014 - December 2022. The proportion of moped injuries before and after the passing of the law was calculated. The chi-square test and Wilcoxon Rank Sum test were used to compare differences in proportions for categorical factors and continuous factors, respectively. RESULTS: A total of 350 moped injury cases were identified. There was a significant decrease in the moped injury rate after the passing of the 2018 SC law (0.9 % vs 1.8 %, p<0.001). Additionally, those treated post-law implementation were significantly older (47.4 vs 43.2 years, p = 0.013) and more likely to be male (95.5 % vs 87.9 %, p = 0.025) than those treated pre-law. Patients treated post-law were significantly more likely to be uninsured (45.1 % vs 42.7 %, p = 0.009) and less likely to have commercial (16.2 % vs 20.1 %, p = 0.009), or government (29.7 % vs 35.6 %, p = 0.009) health insurance compared to those treated pre-law. There was no significant difference between the two groups in Glascow Coma Scale, Injury severity score, Trauma Injury Severity Score, or rate of fatalities. CONCLUSION: After the implementation of a SC law, we found that the local proportion of injuries due to moped and scooter accidents was significantly lower than pre-law proportions. These findings suggest that public policies aimed at increasing regulations for mopeds may decrease the rate of injury, but not severity, from moped use.

Idiopathic Genu Valgum and Its Association With Obesity in Children and Adolescents.

BACKGROUND: Obesity as a cause of lower extremity deformity in children has been well established. This deformity is most often seen as tibia vara, however, at our institution we have observed more obese children and adolescents over age 7 years with excessive or progressive idiopathic genu valgum. Our hypothesis is that children with idiopathic genu valgum have high rates of obesity which impact the severity of their disease. METHODS: Retrospective review of existing data was performed on 66 consecutive children/112 limbs over age 7 years with idiopathic genu valgum, seen from 2010 to 2013. Children with known metabolic or skeletal disease were excluded. Genu valgum was defined as mechanical axis in zone II or III and mechanical tibiofemoral angle ≥4 degrees on standing anteroposterior radiograph of the lower extremities. Body mass index (BMI) was calculated and classified by Center for Disease Control percentiles. Skeletal maturation was rated by closure of pelvic and peri-genu physes. Severity of genu valgum was also assessed by femoral and tibial mechanical axes and the mechanical axis deviation. RESULTS: Mean patient age was 12.2±2.2 years. 47% of patients had BMI≥30 and 71% were categorized as obese (>95th percentile). No sex differences were identified. Skeletal maturation explained 25% of the variance in the mechanical axis deviation and 22% of the mechanical tibiofemoral angle. BMI predicted 9.8% of the tibial valgus. Because of its skewed distribution, BMI percentile was a less useful parameter for assessment. CONCLUSIONS: The 71% obesity rate found in our children with idiopathic genu valgum is significantly higher than the normal population. Higher BMI is associated with more tibial valgum but skeletal maturation was the main predictor of overall valgus severity. This suggests that obesity may play a role in the etiology of idiopathic genu valgum which progresses with skeletal maturation, thereby increasing the risk of osteoarthritis in adulthood. LEVEL OF EVIDENCE: Level III.

Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years.

BACKGROUND: American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability. We hypothesized that EBL, operative time, and fluoroscopy time would be greater and pain would be lower with plate fixation. METHODS: We retrospectively identified all pediatric midshaft femur fractures treated with TENs, submuscular plating, or open plating between 2004 and 2014. Demographic, injury, and surgical data were obtained for analysis. Cost data were obtained from Synthes Inc. Outcomes were determined using the TEN outcome scoring system. Variables were compared between the 3 fixation methods using paired t tests or Fisher exact test as appropriate. Cost data were compared with Mann-Whitney nonparametric test. RESULTS: There were 65 midshaft femur fractures in 63 patients included. TENs accounted for 77% and plating 23%. There were no statistical differences in injury severity score, length of stay, length unstable fractures, open fractures, fluoroscopy time, or pain. However, there was a significantly greater operative time (P=0.007) and a notably greater EBL (P=0.057) for the plating technique compared with TENs. Patient outcomes were found to be equivalent. Implant cost was not significantly different although increased surgical costs were seen in plating (P=0.0007). CONCLUSIONS: This study supports the use of TENs or plating for midshaft femur fractures in children 5 to 11 years old, regardless of length stability. The use of plates resulted in higher EBL, longer operative time, increased cost, and equivalent pain compared with TENs. To our knowledge, this study represents the first direct comparison of the common fixation methods specifically for midshaft femur fractures and favors the use of TENs. LEVEL OF EVIDENCE: Level III.

Pain and overcorrection in clubfeet treated by Ponseti method.

Long-term outcomes of Ponseti casting have consistently shown improvement over soft-tissue release. The incidence of foot pain and overcorrection in clubfeet treated by Ponseti method has not been reported. We studied the rate of overcorrection and its association with pain in clubfeet treated with Ponseti casting. A retrospective review of clubfoot patients treated with Ponseti method with at least 8 years of follow-up was carried out. Patient charts were reviewed for demographic data, recurrence, type and number of procedures, and patient-reported complaints of foot pain. Pedobarographs were used to document overcorrection. Eighty-one patients comprising 115 clubfeet were included in the study. There were 14 (12.2%) feet with valgus overcorrection and 101 feet that had achieved a normal, plantigrade position. Overall, 50% of patients with overcorrected clubfeet and 32% with corrected, plantigrade clubfeet experienced pain. Overcorrection was found to be predictive of pain complaints (P<0.001). Hence, valgus overcorrection occurs after Ponseti casting, with an incidence of 12%.