Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review.

OBJECTIVE: Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution's experience with TTAF and associated compartment syndrome in pediatric patients. METHODS: All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy. RESULTS: A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days. CONCLUSIONS: The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Management Principles and Current Debates Surrounding Common Pediatric Elbow Fractures.

Elbow fractures are among the most common fractures sustained in pediatric patients. A specific set of pediatric elbow fractures (olecranon, radial neck, and lateral condyle fractures) comprises the ones that occur most often. It is important to review commonly accepted principles in the evaluation and treatment of these injuries as well as highlight some debates that exist within the literature regarding the optimal management of these injuries. Although management of pediatric olecranon, radial neck, and lateral condyle fractures has been well described, controversy persists among orthopaedic surgeons regarding the surgical indications and preferred fixation techniques for these injuries.

Update on Pediatric Medial Epicondyle Fractures.

The ideal evaluation and treatment of pediatric patients with medial epicondyle fractures remain controversial. It is important to examine the most recent literature and provide an update on the current clinical practices, imaging modalities, treatment techniques, outcomes, and complications associated with displaced pediatric medial epicondyle fractures. There remains substantial variability across recommended treatment options and the outcomes between surgical versus nonsurgical management of these injuries. Despite the lack of consensus regarding management of pediatric medial epicondyle fractures, both nonsurgical and surgical approaches have demonstrated equivocal results.

Epidemiology With Video Analysis of Knee Injuries in the Women's National Basketball Association.

Background: Knee injuries are the most common type of injury seen in the Women's National Basketball Association (WNBA). However, there are sparse epidemiologic data regarding these injuries over the past 20 years. Purpose/Hypothesis: The purpose of this study was to determine the prevalence, return to play (RTP) rate/length, and mechanism of knee injuries in the WNBA. We hypothesized that anterior cruciate ligament (ACL) tears would have the highest prevalence and longest RTP times. Study Design: Descriptive epidemiology study. Methods: Publicly available WNBA injury reports were used to find WNBA athletes who sustained knee injuries. The RTP length was determined by calculating the number of days between the date of the injury and the date of the first game they played after returning. The RTP rate was determined by calculating the number of players who returned to play from each injury compared with the total number of each injury. Incidence of knee injuries, frequency, and time to RTP were calculated for each injury. Available videos were analyzed to determine the mechanism and body position at the time of injury. Results: Overall, 99 WNBA players were identified as having sustained a knee injury during the study period resulting in loss of play. ACL tears (n = 37; 37%) were the most devastating injury, resulting in the longest time before RTP (n = 375 days; 70%). The position with the highest incidence of knee injuries was guard, accounting for 53% of knee injuries. Video analysis conducted on 12 knee injuries revealed that such injuries were most commonly noncontact (83%).The mechanisms of injury were most commonly planting (58%) and landing from a jump (33%) with the knee flexed in the valgus position (100%). Conclusion: Study findings indicated that ACL tears are the most common clinically significant knee injuries sustained in the WNBA, accounting for 37% of total knee injuries with a mean RTP rate of 375 days. The most common mechanism of injury was planting the foot or landing from a jump with a flexed knee in the valgus position. Knee injuries had a high RTP rate in WNBA players but resulted in them missing a significant amount of playing time.

Appendicitis Following Blunt Abdominal Trauma: An Illustrative Case.

Acute appendicitis is the most common abdominal surgical emergency, with an average of 7-9% of individuals developing the condition within their lifetime.1 While cases of acute traumatic appendicitis are rare, medical literature supports their plausibility with the most famous case stretching back to the controversial 1926 death of stunt performer, Harry Houdini. Several mechanisms have been proposed by which blunt abdominal trauma results in acute appendicitis. In this review, we describe a young, otherwise healthy male, who developed epigastric abdominal pain after being struck in the abdomen while wrestling with his cousin of similar age. The patient was found to have peri-appendiceal inflammatory change, appendiceal mural thickening and edema consistent with acute uncomplicated appendicitis.