Protocol Article: A Cross-Sectional Evaluation of Children's Feet and Lower Extremities.

BACKGROUND: The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children's lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain. METHODS: This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life. RESULTS: We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children's lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children's feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain. CONCLUSIONS: The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children's quality of life and prevent future diseases.

Wrist fracture in children.

Distal radius fractures in children are the most common fractures in children. There is no consensus on when and how to treat these fractures. This review summarises the present knowledge. Children have a capacity to remodel and the remodeling of the bone is reverse correlated to the child's age. The remodeling potential allows us to accept some degree of malunion before intervention. Solely a cast applied with a 3-point fixation can treat most distal radius fractures. It is therefore essential to increase focus on educating doctors in applying a correct molded cast. Unstable fractures can usually be fixated with k-wires alone.

Change in treatment preferences in pediatric diaphyseal forearm fractures: a Danish nationwide register study of 36,244 fractures between 1997 and 2016.

BACKGROUND AND PURPOSE: The choice between invasive and non-invasive treatment of diaphyseal forearm fractures in children can be difficult. We investigated the trends in choice of treatment of pediatric diaphyseal forearm fractures over a 20-year period.  Patients and methods: This is a population-based register study with data from 1997 to 2016 retrieved from the Danish National Patient Registry. The primary outcome was choice of primary treatment within 1 week divided into non-invasive treatment (casting only or closed reduction including casting) and invasive (Kirshner wires, intramedullary nailing [IMN], and open reduction internal fixation [ORIF]). The secondary outcomes were further sub-analyses on invasive treatment and age groups. RESULTS: 36,244 diaphyseal forearm fractures were investigated, yielding a mean incidence of 172 per 105/year. The proportion of fractures treated invasively increased from 1997 to 2016, from 4% to 23%. The use of Kirschner wires increased from 1% to 9%, IMN increased from 1% to 14%, and ORIF decreased from 2% to 1%. The changes were evident in all age groups but smaller in the 0-3-year age group. CONCLUSION: We found an increase in invasive treatment of pediatric diaphyseal forearm fractures over the investigated period. A change in invasive methods was also found, as the rate of IMN increased over the investigated period and became the predominant surgical treatment choice.

Diagnostics, evaluation and treatment of flat feet in children.

Pes planovalgus (PV) in early childhood is a common physiological state, and usually resolves throughout childhood. Parental concern often leads to seeking medical advice. This review summarises the current knowledge of the different types of PV. Asymptomatic PV does not need treatment, but corrective footwear can be utilised for painful PV. Orthopaedic referral is needed if conservative treatment is not sufficient. It is important to distinguish between flexible and rigid PV, since rigid PV can be a sign of underlying pathologies and needs referral to orthopaedic surgeons. Further studies are needed to investigate for predictive factors to develop painful PV.

Pilot Study and Preliminary Results of Biodegradable Intramedullary Nailing of Forearm Fractures in Children.

(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in many patients. Often, the primary minimal invasive incision needs to be widened during implant removal. In order to decrease the burden of care of pediatric fractures, significant efforts were made to develop biodegradable implants, which make hardware removal unnecessary. Our study will conduct an observational trial on the clinical use of the Activa IM-Nail™ in forearm fractures in children between 3 and 13 years of age. The objective of this trial is to evaluate the risks and benefits of the Activa IM-Nail™. Among other objectives, the rate of refracture will be determined. (2) Methods: An international Europe-based, multicenter, prospective, single-arm, open-label study will be performed to ascertain the rate of refracture and to determine the subjective benefits of Activa IM-Nail™ for patients, parents and other caregivers. The study will include clinical follow-up including early post-operative complication, radiographs until bony healing and an additional follow-up after 1 year. At this stage, preliminary results and early complications on 76 patients are analyzed in this study and presented. (3) Results: As of April 2022, 76 patients were enrolled as per study protocol. There were 31 girls (40.8%) and 45 boys (59.2%). The mean age at the time of inclusion was 8.9 years (±2.4 years). The mean operation time was 58.9 ± 22.9 min (range, 15-119 min). The mean follow-up time was 8.9 ± 5.1 months (range, 0.2-18.6). Up to now, one refracture has occurred in one child falling from a height of about one meter 7 months after index surgery (1/76; 1.3%). (4) Conclusion: The research project assesses the safety and effectiveness of Activa IM-Nails™ as part of the surgical treatment of dislocated forearm fractures in children in the context of a PMCF study. The use of Activa IM-Nails™ with regard to various objectives, including postoperative complications and refracture rate, seems to be equal to the standard titan ESIN procedure compared to the literature. Preliminary results are encouraging and are made available.

Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis.

BACKGROUND: Radiographic images in adolescent idiopathic scoliosis (AIS) have a potential radiation-induced oncogenic effect; thus lowering radiation dose by using fluoroscopic imaging technique of low-dose fluoroscopic technique (LFT) which might be relevant for clinical evaluation. PURPOSE: To compare radiographs of LFT with gold standard radiographs for AIS ordinary radiographic technique (ORT). MATERIAL AND METHODS: Image quality was evaluated for LTF and ORT of a child phantom and two 3D-printed models (3DPSs) of AIS. We measured the primary physical characteristics of noise, contrast, spatial resolution, signal-to-noise ratio, and contrast-to-noise ratio. Three independent evaluators assessed the radiographs by observer-based methods of image criteria (ICS) and visual grading analysis(VGAS). Radiation doses were evaluated by the dose-area-product (DAP) of the 25 phantom radiographs. Reliability and agreement of Cobb's angle (CA) and other radiographic parameters were evaluated on the 3DPSs and reliability on 342 LFT. RESULTS: The average noise and contrast were approximately 15-fold higher for LFT. SNR and CNR were similar. Overall, ICS and VGAS were 3-fold higher for ORT than for LFT for L3 and similar for Th6. Reliability and agreement were good for the experimental LFT, and the interclass correlation coefficient for CA was 0.852 for the clinical LFT. The average DAP and effective dose for LFT were 8-fold lower than those for ORT. CONCLUSION: In conclusion, LFT is reliable for CA measurements and is thus useful for clinical outpatient follow-up evaluation. Even though the image quality is lower for LFT than ORT, the merits are the substantially reduced radiation and a lowered malignancy risk without compromising the measurement of Cobb's angle, thus following the principles of ALARA.

[Traumatic hip dislocation after fall during sledging].

Traumatic hip dislocation is uncommon in children. Yet, it represents an orthopaedic emergency, because delayed treatment can lead to avascular necrosis of the femoral head. In this case a four-year-old boy and an eight-year-old girl were treated in an emergency department less than two weeks apart. They both received a posterior hip dislocation after accident during sledging. Their hips were reduced within six hours in the operating theatre, and the patients were discharged few days later. At the follow-up after six and 12 weeks both patients were doing well, and X-rays were normal.

[The personal electronic medicine profile contributes to the avoidance of wrong medication at transfer from primary to secondary sector]. / Personlig elektronisk medicinprofil medvirker til at undgå fejlmedicineringer ved sektorovergang.

INTRODUCTION: It is a well-known phenomenon that there is a lack of information about patients' medicines at their admittance to hospital. By using data from the electronic medicine profile (PEM) the extra information is to be evaluated and compared to normal procedure for collecting medicine information. MATERIAL AND METHODS: This cross-section investigation involves patients admitted with acute hip fractures at Amager Hospital, Copenhagen. After registration of the patients' medication history extra information was extracted from PEM with the consent of the patient. Information from medication history, patient, general practitioner, and PEM was compared in order to reach an overall view of the patients' current medicine status. RESULTS: Sixty-three patients participated; 58 gave consent. The average age was 80 years, and the patients used on average five medicaments each, totalling 323 out of which PEM stated the use of 99, which were not supplied by other sources. Out of 39 patients 2.5 lacked medicaments. 55% of these medicaments were estimated to be of significant clinical importance for further treatment. Two patients could have been exposed to a potential lethal occurrence had information from PEM not been applied. Every third drug that PEM added belonged to the Anatomical Therapeutic Chemical-systemets group N, which has the indication for the nervous system, including pain and depression. CONCLUSION: Information from PEM helps improve medication history. The possibility of wrong medication especially in the form of insufficient medication and interaction due to lack of information on the patients' current medicine is minimised through the use of PEM.

Hibernation reduces pancreatic amylase levels in ground squirrels.

Pancreatic enzyme levels in mammals are influenced by food intake and dietary composition. In this study, we examined the activity and expression of pancreatic amylase in a hibernating mammal, a natural model for long-term fasting. Pancreatic tissues were obtained from summer-active 13-lined ground squirrels and hibernating squirrels that had not eaten for at least 6 weeks. Amylase specific activity was reduced by approximately 50% in the torpid hibernators compared with summer squirrels, and immunoblot analysis revealed that amylase protein expression was reduced by approximately 40% in the hibernators. Similar reductions in amylase specific activity were observed in interbout euthermic hibernators. These results support a strong influence of food intake on pancreatic enzyme expression in hibernating mammals. The maintenance of basal levels of this key digestive enzyme at approximately 50% of summer values despite the extended winter fast likely facilitates the rapid resumption of digestive function after terminal arousal in the spring.