Impact of tranexamic acid on blood loss and transfusion rate in children with cerebral palsy undergoing hip reconstruction with two or more osteotomies.

PURPOSE: Tranexamic acid (TXA), a synthetic lysine analogue, has been used in orthopedic procedures to limit blood loss and prevent allogeneic blood transfusions. However, data are scarce on its use in hip reconstruction of patients with cerebral palsy (CP). This study examines the effect of TXA on patients with CP undergoing hip reconstruction with at least two osteotomies. METHODS: This is a single-center, retrospective study of patients with CP who underwent hip reconstruction with two or more osteotomies from January 2013 to April 2019. There were 43 patients, with a mean age of 9.9 years. Age, procedure, preoperative and postoperative hemoglobin/hematocrit, estimated blood loss (EBL), transfusions and length of stay were recorded. The patients were split into the following two groups: 24 patients who had received intraoperative TXA and 19 who had not. RESULTS: Age, EBL, mean preoperative and postoperative hemoglobin or hematocrit, preoperative to postoperative hematocrit drop, and length of stay were similar for the two groups (p > 0.05). The risk for intraoperative transfusion (21 vs. 17%), postoperative transfusion (26 vs. 8%), and any transfusion (42 vs. 21%) appeared to be greater in the group that did not receive TXA, but this difference did not achieve statistical significance. CONCLUSION: This pilot study shows patients with CP undergoing hip reconstruction with two or more osteotomies; the use of TXA, while not statistically significant, shows a trend toward a decreased need for allogeneic blood transfusion.

Is the incidence of paediatric stress fractures on the rise? Trends in New York State from 2000 to 2015.

The purpose of this study is to analyze trends in the epidemiology of paediatric stress fractures. The New York Statewide Planning and Research Cooperative System database was queried for stress fractures in children between the ages of 6 and 18 years. After checking for monotonicity of the data, Spearman's correlation coefficient was calculated. Multivariate regressions were used to test for associations between demographic variables and risk of stress fracture. Analysis of 11 475 386 outpatient visits between 2000 and 2015 showed that the annual incidence of paediatric stress fractures increased from 1.37 cases per 100 000 outpatient visits in 2006 to 5.32 per 100 000 visits in 2015 (ρ = 0.876, P < 0.01). The mean age at the time of injury was 14.4 ± 2.8 years. Children younger than 14 years accounted for 33.6% of the cohort. Age, male sex, white ethnicity, and private insurance were statistically significant predictors of stress fractures in a multivariate model. This study is the first to document an increase in the annual incidence of paediatric stress fractures.

Measuring ambulation with wrist-based and hip-based activity trackers for children with cerebral palsy.

AIM: To assess the accuracy of consumer available wrist-based and hip-based activity trackers in quantitatively measuring ambulation in children with cerebral palsy (CP). METHOD: Thirty-nine children (23 males, 16 females; mean age [SD] 9y 7mo [3y 5mo]; range 4-15y) with CP were fitted with trackers both on their wrist and hip. Each participant stood for 3 minutes, ambulated in a hallway, and sat for 3 minutes. The number of steps and distance were recorded on trackers and compared to manually counted steps and distance. Pearson correlation coefficients were determined for the number of steps during ambulation from each tracker and a manual count. Mean absolute error (MAE) and range of errors were calculated for steps during ambulation for each tracker and a manual count and for distance for each tracker and hallway distance. RESULTS: For the number of steps, a weak inverse relationship (r=-0.033) was found for the wrist-based tracker and a strong positive relationship (r=0.991) for the hip-based tracker. The MAE was 88 steps for the wrist-based and seven steps for the hip-based tracker. The MAE for distance was 0.06 miles for the wrist-based and 0.07 miles for the hip-based tracker. INTERPRETATION: Only the hip-based tracker provided an accurate step count; neither tracker was accurate for distance. Thus, ambulation of children with CP can be accurately quantified with readily available trackers. WHAT THIS PAPER ADDS: Consumer available activity trackers accurately measure ambulation in children with cerebral palsy (CP). The hip-based tracker is more accurate than the wrist-based tracker for children with CP. The hip-based Fitbit activity tracker accurately measures step counts of children with CP during ambulation.

MEDICIÓN DE LA AMBULACIÓN CON RASTREADORES DE ACTIVIDAD DE MUÑECA Y CADERA PARA NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Evaluar la precisión de los rastreadores de actividad basados ​​en la muñeca y en la cadera disponibles para el consumidor en la medición cuantitativa de la ambulación en niños con parálisis cerebral (PC) METODO: Treinta y nueve niños (23 varones, 16 mujeres; edad media [DS] 9 años y 7 meses [3 años y 5 meses]; rango 4-15 años) con PC fueron equipados con rastreadores en su muñeca y cadera. Cada participante se paró durante 3 minutos, caminó por un pasillo y se sentó durante 3 minutos. La cantidad de pasos y la distancia se registraron en los rastreadores y se compararon con los pasos y la distancia contados manualmente. Los coeficientes de correlación de Pearson se determinaron para el número de pasos durante la ambulación de cada rastreador y un conteo manual. El error absoluto medio (MAE) y el rango de errores se calcularon para los pasos durante la ambulación y la distancia del pasillo para cada rastreador y para el conteo manual. RESULTADOS: Para el número de pasos, se encontró una relación inversa débil (r = -0.033) para el rastreador ubicado en la muñeca y una relación positiva fuerte (r = 0.991) para el rastreador ubicado en la cadera. El MAE fue de 88 pasos para la muñeca y siete pasos para el rastreador de la cadera. El MAE para la distancia fue de 0.06 millas para la muñeca y 0.07 millas para el rastreador ubicado en la cadera. INTERPRETACIÓN: Solo el rastreador ubicado en la cadera proporcionó un conteo de pasos preciso; ninguno de los rastreadores era preciso para la distancia. Por lo tanto, la deambulación de los niños con PC se puede cuantificar con precisión con rastreadores fácilmente disponibles.

MEDINDO A DEAMBULAÇÃO COM RASTREADOR DE ATIVIDADE POSICIONADO NO PUNHO E QUADRIL COMERCIALMENTE DISPONÍVEL EM CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Avaliar a precisão de rastreadores de atividade posicionados no punho e quadril, disponíveis para o consumidor, para mensurar qualitativamente a deambulação em crianças com paralisia cerebral (PC). MÉTODO: Trinta e nove crianças (23 meninos, 16 meninas; média da idade [DP] 9 anos e 7 meses [3 anos e 5 meses]; amplitude 4-15 anos) com PC foram equipados com rastreadores em punho e quadril. Cada participante permaneceu em pé durante 3 minutos, andando em um corredor, e sentado por 3 minutos. O número de passos e distância foram registrados nos rastreadores e comparados com os passos e distância medidos manualmente. Coeficientes de correlação de Pearson foram determinados para o número de passos durante a deambulação para cada rastreador e a contagem manual. O Erro Médio Absoluto (EMA) e variância de erros foram calculados para os passos durante a deambulação para cada rastreador e a contagem manual e para a distância de cada rastreador e a distância do corredor. RESULTADOS: Para o número de passos, uma relação inversa fraca (r=-0,033) foi encontrada entre o rastreador do punho e uma relação positiva forte (r=0,991) para o reastreador do quadril. A EMA foi de 88 passos para o rastreador do punho e sete passos para o rastreador do quadril. A EMA para a distância foi de 0,06 milhas (9,66km) para o rastreador do punho e 0,07 milhas (11,26km) para o rastreador do quadril. INTERPRETAÇÃO: Somente o rastreador do quadril forneceu a contagem precisa dos passos; nenhum rastreador foi preciso para a distância. Assim, a deambulação em crianças com PC pode ser quantificada com precisão com os rastreadores atualmente disponíveis.

Neuromuscular Foot: Spastic Cerebral Palsy.

Foot and ankle deformities in cerebral palsy can be effectively treated with surgery. Surgery should be considered in patients with significant deformity and those who have pain or difficulty with orthotic and shoe wear. Equinus contracture of both gastrocnemius and soleus can be treated with open tendoachilles lengthening; ankle valgus with medial epiphysiodesis. Equinovarus is more commonly seen in hemiplegic patients and this deformity can usually be treated with tendon transfers. Triple arthrodesis is an option in children with severe degenerative changes. It is important to address all aspects of the child's pathology at the time of surgical correction.

Postoperative radiographs after pinning of supracondylar humerus fractures: are they necessary?

BACKGROUND: The purpose of this study was to evaluate the necessity of early postoperative radiographs after pinning of supracondylar humerus fractures by determining both the percentage of patients who displayed change in fracture fixation and whether these changes affected their outcome. METHODS: A series of 643 consecutive patients who underwent operative management of Gartland type II and III fractures at our institution between January 2002 and December 2010 were reviewed. Demographic data were obtained through chart review, including age, sex, extremity, fracture type, and mechanism. Intraoperative fluoroscopic images were compared with postoperative radiographs to identify changes in fracture alignment and pin placement. RESULTS: A total of 643 patients (320 females, 323 males) with a mean age of 6.1 years (range, 1.1 to 16.0) were reviewed. Fifty-seven percent of fractures were classified as type II and 43% were type III. The overall complication rate was 8.8% (57/643). Pin backout or fracture translation was seen in 32 patients (4.9%) at the first postoperative visit. All of these patients sustained type III fractures. One of these patients required further operative management. Patients with changes in pin or fracture alignment did not demonstrate a statistically significant difference in time to first postoperative visit (P=0.23), days to pin removal (P=0.07), or average follow-up time (P=0.10). Fracture severity did not correlate with change in alignment (P=0.952). No postoperative neurological complications were observed in patients with alignment changes. CONCLUSIONS: Mild alignment changes and pin migration observed in postoperative radiographs after pinning of supracondylar humerus fractures have little effect on clinical management parameters or long-term sequelae. Radiographs can therefore be deferred until the time of pin removal provided adequate intraoperative stability was obtained. LEVEL OF EVIDENCE: Level IV.