National Trends in Inpatient Hospital Outcomes of Children with Osteogenesis Imperfecta and the Importance of Extra-skeletal Manifestations: A Kids' Inpatient Database Study.

OBJECTIVE: To investigate the extent of extra-skeletal manifestations along with inpatient outcomes and complications associated with osteogenesis imperfecta (OI). STUDY DESIGN: This cross-sectional study utilized the Kids' Inpatient Database (KID) as part of the Healthcare Cost and Utilization Project (HCUP) to investigate inpatient hospital outcomes and management in patients with OI from 1997 through 2016. Data regarding hospital characteristics, cost of treatment, inpatient outcomes, and procedures were collected and analyzed. RESULTS: There were 7,291 admissions that listed OI as a diagnosis in the KID database from 1997 through 2016. Unexpectedly, over one third of all admissions in these children with OI presented with an extra-skeletal manifestation. The rate of major complications was 3.85%. The rate of minor complications was 19.4%, most commonly respiratory problems. Mortality rate was 18.2 % in the neonatal period and 1.0% in all other admissions. Total charges of hospital stay increased over the years. CONCLUSION: We identified a striking prevalence of extra-skeletal manifestations in OI along with inpatient outcomes and complications associated with OI, of which respiratory complications were predominant. We observed a significant financial burden for patients with OI and identified additional risks for financial crisis, in addition to disparities in care identified among socioeconomic groups. These data contribute to a more holistic understanding of OI from diagnosis to management.

A novel method of applying a split cast.

Split plaster casts have been shown to be better than back slabs at accommodating increasing intracompartmental pressure due to swelling. Splitting a wet plaster cast can be time consuming and difficult both for the patient and the medical staff. We describe a novel method of applying a split plaster of Paris cast, which is safe, quick, convenient and inexpensive.

Late orthopaedic sequelae following meningococcal septicaemia. A multicentre study.

Between 1990 and 2001, 24 children aged between 15 months and 11 years presented with late orthopaedic sequelae after meningococcal septicaemia. The median time to presentation was 32 months (12 to 119) after the acute phase of the disease. The reasons for referral included angular deformity, limb-length discrepancy, joint contracture and problems with prosthetic fitting. Angular deformity with or without limb-length discrepancy was the most common presentation. Partial growth arrest was the cause of the angular deformity. Multiple growth-plate involvement occurred in 14 children. The lower limbs were affected much more often than the upper. Twenty-three children underwent operations for realignment of the mechanical axis and limb-length equalisation. In 15 patients with angular deformity around the knee the deformity recurred. As a result we recommend performing a realignment procedure with epiphysiodesis of the remaining growth plate when correcting angular deformities.

A physiotherapy specialist clinic in paediatric orthopaedics: is it effective?

A physiotherapy specialist clinic was set up to reduce waiting times for non-urgent, new paediatric orthopaedic referrals. The outcome was reviewed at a minimum of 12 months for 1046 referrals assessed in the physiotherapy support clinic to analyse its effectiveness. Altogether 114 patients failed to attend the clinic. The remaining 932 patients form the basis of this study. Ninety three percent of these patients were managed without direct consultant intervention-72% with advice and reassurance, 17% by referral to the physiotherapy department, and 4% with surgical appliances. Only 7% needed consultant evaluation. Median waiting time for non-urgent conditions was reduced from 72 weeks in May 1996 to five weeks in May 1999. A majority of the parents were satisfied with the clinic. The clinic was found to be cost effective. The success of the clinic was attributable to good cooperation between the consultant and physiotherapist and a well defined protocol for assessment and management of patients.