Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study.

BACKGROUND: Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types: Supracondylar (SC), lateral condyle (LC), and medial epicondyle (ME) fractures. AIM: To evaluate the epidemiology of pediatric distal humerus fractures (SC, LC, and ME) from an American insurance claims database. METHODS: A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC, LC and ME fractures based on the IBM Truven MarketScan® Commercial and IBM Truven MarketScan Medicare Supplemental databases. Patients from 2015 to 2020 were queried for treatments, patient age, sex, length of hospitalization, and comorbidities. RESULTS: A total of 1133 SC, 154 LC, and 124 ME fractures were identified. SC fractures had the highest percentage of operation at 83%, followed by LC (78%) and ME fractures (41%). Male patients were, on average, older than female patients for both SC and ME fractures. CONCLUSION: In the insurance claims databases used, SC fractures were the most reported, followed by LC fractures, and finally ME fractures. Age was identified to be a factor for how a pediatric distal humerus fractures, with patients with SC and LC fractures being younger than those with ME fractures. The peak age per injury per sex was similar to reported historic central tendencies, despite reported trends for younger physiologic development.

Intensity of resistance training via self-reported history is critical in properly characterizing musculoskeletal health.

BACKGROUND: Intensity of resistance training history might be omitted or poorly ascertained in prescreening or data questionnaires involving musculoskeletal health. Failure to identify history of high-versus low-intensity training may overlook higher effect sizes with higher intensities and therefore diminish the precision of statistical analysis with resistance training as a covariate and bias the confirmation of baseline homogeneity for experimental group designation. The purpose was to determine the degree to which a single question assessing participant history of resistance training intensity predicted differences in musculoskeletal health. METHODS: In the first research aim, participants were separated into groups with a history (RT) and no history (NRT) of resistance training. The second research aim evaluated the history of resistance training intensity on muscular strength, lean mass, and bone mineral density (BMD), RT participants were reassigned into a low- (LIRT) or high-intensity resistance training group (HIRT). 83 males and 87 females (19.3 ± 0.6 yrs., 171.1 ± 9.9 cm, 67.1 ± 10.5 kg, 22.9 ± 2.8 BMI, 26.2 ± 7.2% body fat) completed handgrip dynamometry (HG) and dual-energy x-ray absorptiometry scans (DXA) for BMD and bone mineral-free lean mass (BFLM). RESULTS: A 3-group method (NRT, LIRT, HIRT) reduced type-I error compared with the 2-group method (NRT, RT) in characterizing the likely effects of one's history of resistance training. For the second aim, HIRT had significantly (p < 0.05) greater HG strength (76.2 ± 2.2 kg) and arm BFLM (6.10 ± 0.16 kg) than NRT (67.5 ± 1.3 kg; 4.96 ± 0.09 kg) and LIRT (69.7 ± 2.0 kg; 5.42 ± 0.14 kg) while also showing significantly lower muscle quality (HG/BFLM) than NRT (13.9 ± 0.2 vs. 12.9 ± 0.3). HIRT had greater BMD at all sites compared to NRT (whole body = 1.068 ± 0.008 vs. 1.120 ± 0.014; AP spine = 1.013 ± 0.011 vs. 1.059 ± 0.019; lateral spine = 0.785 ± 0.009 vs. 0.846 ± 0.016; femoral neck = 0.915 ± 0.013 vs. 0.970 ± 0.022; total hip = 1.016 ± 0.012 vs. 1.068 ± 0.021 g/cm2) while LIRT revealed no significant skeletal differences to NRT. CONCLUSIONS: Retrospective identification of high-intensity history of resistance training appears critical in characterizing musculoskeletal health and can be ascertained easily in as little as a single, standalone question. Both retrospective-questionnaire style investigations and pre-screening for potential participation in prospective research studies should include participant history of resistance training intensity.

Indicators of Sarcopenia: Sex Differences in Competitive Runners Prior to Peak Muscle Mass.

Strength, muscle mass, and muscle quality have been observed to be compromised in low body-mass index individuals such as competitive runners, increasing their risk for sarcopenia. The purpose was to compare indices of sarcopenia in young runners to age, height, body-mass, and body-mass index-matched non-runners. Handgrip strength and arm composition from dual-energy x-ray absorptiometry (baseline-T1, T2=5.3±1.4, T3=11.5±0.7 months later) were assessed in 40 non-runners and 40 runners (19.3±0.7 vs. 19.2±1.1 years, 170.7±10.3 vs. 171.1±9.1 cm, 60.2±7.4 vs. 60.2±7.9 kg, 20.6±0.9 vs. 20.5±1.5 kg m-2). The unitless variable of muscle quality, was defined as the sum of right and left maximal handgrip (in kg) divided by the sum of bone-free lean mass of both arms (in kg). Female runners displayed the highest muscle quality (T1=15.3±1.7; T3=15.7±2.0) compared to male runners (T1=13.7±1.4, p < 0.001; T3=14.2±1.6, p < 0.001) and male non-runners (T1=12.4±1.8, p=0.001; T3=13.2±1.6, p < 0.001), while female non-runners (T1=14.6±2.5, p=0.154; T3=15.1 ±2.2, p=0.124) showed higher muscle quality than male non-runners. Higher muscle quality in low-body-mass index females persists over one-year during young-adulthood and while running contributes to whole-body muscle mass accrual, it does not appear to be significantly associated with improvements in the most commonly used upper-body diagnostic indicator of sarcopenia.