The Role of Patient and Parent Education in Pediatric Cast Complications.

Cast immobilization remains the standard of care in managing pediatric fractures. Cast complications often result in emergency department visits, office calls and visits, or lasting patient morbidities that burden the healthcare institution from a time and economic standpoint. The purpose of this quality improvement project was to create a multimodal cast care education protocol with an aim of decreasing cast complications over a 6-week period. Qualified patients (0-18) placed in cast immobilization received a quick response (QR) code sticker on their casts linked to a custom cast care website with text, pictures, and video instructions. Incidence of cast complications, complication type, effect(s) on workflow, and patient demographics were recorded. The complication rate declined 7.6%, but it was not statistically significant. Continuous access to clinic-specific cast instructions demonstrates decreased cast complications in pediatric populations, and this approach to patient education can be easily utilized across all medical specialties.

Bernoulli-Assisted Percutaneous Removal of an Intra-articular Foreign Body: A Case Report.

CASE: A 4-year-old child presented with an intra-articular broken sewing needle in her knee. It was removed arthroscopically using a spinal needle percutaneously placed posterior to the tibia in line with the long axis of the sewing needle. The stylet was partially withdrawn to allow the sewing needle to lay within the spinal needle hollow. When the stylet was removed, the foreign body was propelled through the spinal needle by the increased velocity of the outflowing fluid and decreased pressure (Bernoulli's principle) and was caught in a specimen container. CONCLUSION: This percutaneous technique is one of several for removing a small foreign body.

Special Considerations for Pediatric Patellar Instability.

Patellar instability in children and adolescents is a challenging subset to treat. Varied forms of instability, ranging from episodic dislocation to fixed dislocation, have been recognized. It is of utmost importance for the treating physician to recognize these different patterns of instability and their associated risk factors, as more complex patterns of instability would require more extensive surgical procedures. Medial patellofemoral ligament (MPFL) reconstruction, by itself, may not suffice or may not be appropriate for the more complex instability patterns. Appropriate and early treatment of such instability in children would allow for functional progression and possible remodeling of the trochlea. However, early treatment has the associated risk of growth disturbances when surgical procedures are performed around open physis or if adult-type bony procedures are performed in children. Recent knowledge about the relationship between trochlea, MPFL femoral attachment, and distal femoral physis could help to advance safe surgical care for these patients. This article reviews the pathophysiology, risk factors, and the existing classification systems for patellar instability in children and adolescents. It focuses on varied surgical techniques, which are unique to the pediatric population, and summarizes the outcomes of these surgical techniques.