Youth Kicker's Knee: Lateral Distal Femoral Hemiphyseal Arrest Secondary to Chronic Repetitive Microtrauma.

Year-round competitive sports place the youth athlete at risk for injury from chronic repetitive stress. Stress injuries to the distal femoral physis in adolescents are rare. This report highlights three male youth soccer players who presented with a lateral distal femoral hemiphyseal arrest and a subsequent unilateral genu valgum deformity in their dominant "kicking leg" due to repetitive microtrauma, a phenomenon we refer to as youth kicker's knee. Mean age was 14.2 years, and all participated in year-round soccer and American football. Imaging demonstrated aberration of the distal lateral femoral physis. All patients were surgically treated. Our series illustrates a unique presentation of a chronic overuse injury in hyper sporting adolescents resulting in an ipsilateral genu valgum deformity. Understanding adolescent growth and developmental characteristics is paramount to appropriate care, prevention, and treatment of physeal injuries that may occur from repetitive overuse and avoid surgery in these young athletes when possible.

Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety.

BACKGROUND: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described. METHODS: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale (VAS) pain scores were collected. RESULTS: One hundred and two patients filled a prescription opioid medication and were included in the study. A total of 3,765 pills were prescribed, and a total of 573.5 were consumed. For the 102 patients who filled a prescription, the average time consuming opioid medication was 2 ± 2 days (range, 0 to 13 days) postoperatively. No cases of persistent use were recorded. Of the 102 patients who filled a prescription, 29.4% did not take any prescription opioids postoperatively. A total of 3,191.5 pills (or 22,183.75 morphine milligram equivalents [MME]) were unused and were potentially available to the community. CONCLUSIONS: Following simple knee arthroscopy, the amount of prescribed opioid medication exceeds the need for postoperative pain management. In general, 68% of patients require a maximum of 13 pills postoperatively for 6 days. Surgeons should adjust prescribing standards accordingly to limit the amount of prescription opioids available to the community. Furthermore, a comprehensive response to include increased patient screening and monitoring as well as opioid use and disposal education is recommended.

The utility of radiographs prior to pin removal after operative treatment of supracondylar humerus fractures in children.

PURPOSE: To determine the safety, utility, and efficacy of pin removal prior to radiographs during the postoperative care of surgically treated displaced pediatric supracondylar humerus fractures. METHODS: Retrospective review of 532 children with supracondylar humerus fractures treated with closed reduction and pinning from 2007 to 2012. Group 1: children who had their splint/cast removed and radiographs prior to pin removal. Group 2: children with radiographs taken after removal. Data recorded and analyzed included: demographic and radiographic data at the time of surgery and at final follow-up, including the number of radiographs taken prior to pin removal and if pins were ever retained after radiographs were performed on the date of intended removal. RESULTS: There was no difference between the groups' demographics. The number of postoperative radiographs taken prior to pin removal ranged from zero to two. No statistically significant change in Baumann's (p = 0.79) or lateral humeral capitellar angles (p = 0.19) was noted between the groups. No children in group 1 (0/438) had their pins retained after radiographs were taken on the date of intended removal. CONCLUSION: Obtaining postoperative radiographs prior to pin removal, although commonplace, is not necessary. If fracture stability is noted intraoperatively, and there is an uneventful postoperative course, it is safe and effective to discontinue immobilization and remove pins prior to X-ray. This is safely done without change in alignment or clinical sequelae. Doing so can aid in clinic flow, may decrease child anxiety, and limit multiple cast room visits. LEVEL OF EVIDENCE: Level III therapeutic study.