Medium-long-term follow-up of slipped capital femoral epiphysis treated with in situ fixation and patient-acceptable symptom state evaluation.

This study evaluates the Patient Acceptable Symptom State (PASS) in patients with slipped capital femoral epiphysis (SCFE) treated with in situ fixation, focusing on medium to long-term outcomes and quality of life. Its primary goal is to establish a subjective well-being cutoff, using subjective methods and the iHOT33 scale, for assessing patients in future studies. Additionally, it explores functionality differences between mild and moderate-severe SCFE, case series epidemiology and potential complications. A retrospective analysis of 63 patients (73 hips), treated for SCFE between 2000 and 2017 at our facility using in situ fixation, was conducted. These patients underwent clinical, anamnestic, and radiological assessments, with PASS determined based on iHOT33 questionnaire results and statistical analysis. The mean age at surgery was 12.95 years (±1.64, range 9-17), with an average follow-up of 11 years (±4.60, range 5-20). At follow-up, 87% of patients reported achieving PASS, with higher iHOT33 scores correlating to PASS. A cutoff of >68 on the iHOT33 scale showed strong predictive ability for assessing PASS (area under the curve 0.857, 88.89% sensitivity, 79.69% specificity). The findings indicate that 87% of patients achieved PASS at medium to long-term follow-up, with better clinical function than those who did not report PASS. The iHOT33 scale's effectiveness in predicting PASS, especially with a cutoff of >68, suggests this method's efficacy. Given these positive outcomes, including in moderate-severe cases treated with in situ fixation, this approach is considered a viable therapeutic option.

Arthroscopic treatment of tibial intercondylar eminence fractures in skeletally immature patients with bioabsorbable nails.

Fractures involving tibial eminence caused by ACL avulsion lesion most frequently occur paediatric patients. Satisfactory reduction in displaced fractures cannot be achieved through conservative treatment, while arthroscopy-assisted fixation technique represents the gold standard to reduce and to fix articular fractures and several effective implants have been used to treat this kind of fractures. In our retrospective study, we proposed a different arthroscopic technique to fix Type II and Type III tibial eminence fractures by using bioabsorbable nails. Nineteen patients, aged 6 to 13 years were treated with arthroscopic reduction and fixation of the fragment using bioabsorbable nails. At 6-month follow-up, all patients showed a decrease of less than 2mm of the anterior edge. All patients at maximum follow-up reached a full knee flexion/extension. IKDC subjective mean score at six-month was 88.14.2 points (range 80-95; p<0.01). For what concerns the Tegner Activity Scale, the mean value of 5.51 (range 3-7) prior to the surgery changed into 5.10.9 (range 3-6) at 6 months. No inflammatory reactions were reported and all fractures healed without complications. The objective IKDC grade A was reported in 18 patients and grade B in one patient, having a "nearly normal" range of motion item (92% compared to contralateral). Results can be compared to other surgical procedures described in the literature, having the same fast learning curve increase and limited complications, beside the fact that a second operation for metallic implants removal was avoided.

ACL lesions surgical treatment in pediatric patients. Our all-epiphyseal experience.

The prevalence of traumatic knee disease in children and young athletes has steadily increased over the past few years. The subjects who have engaged in intense sporting activities since a young age were especially vulnerable to developing an anterior cruciate injury. With the development of new imaging and clinical examination methods, diagnosis has also improved. The need to ensure joint growth without complications and the rising demands for a return to competitive sport are driving the search for an appropriate surgical technique. Today, only a few cases should receive conservative treatment. The main flaw of the extra-articular technique is that it doesn't respect the anatomy and results in excessive rigidity. Even precocious subjects can use the allepyphiseal technique, which allows for the respect of the growth plates. It does not present a particularly high complication rate and permits a full return to sports activities prior to the trauma with an adequate learning curve on the part of the surgeon. However, in more mature subjects with still open physis, the traditional transepiphyseal arthroscopic technique is possible as long as the tunnel is not too large. In any case, it is crucial to provide a thorough and ongoing follow-up until the end of growth as well as individualized rehabilitation.

How the pandemic spread of COVID-19 affected children's traumatology in Italy: changes of numbers, anatomical locations, and severity.

BACKGROUND: The study aim is to share our experience in hospital re-organization and management of paediatric traumatology in the early stage of COVID-19 pandemic. We centralized paediatric traumatology supposing a reduction of ER admissions, with increased severity of conditions, and a change in fracture patterns and consequently re-organized our structure. The COVID-19 epidemic in Europe has seen Italy as the first focus starting from the 21st of February 2020. Lombardy has been the most affected area. The initial NHS approach determined a high percentage of hospital admissions that led to early overload of hospitals, and we had to reorganize our structure to face the emergency. METHODS: We retrospectively evaluated the admission and treatment data to observe the epidemiological evolution of paediatric trauma during the lockdown ordinance and compared them with the same period in 2019. RESULTS: We found a reduction of 78% paediatric visits in the ER but no decrease in the amount of paediatric fractures, rather we found a rate of paediatric fractures increased by 21,62 %. The upper limb fractures being the most representative. CONCLUSIONS: Our expectations were confirmed. We believe that the reorganization and the guidelines by us designed has been effective to spare resources and subtract the paediatric traumatology load from those hospitals dealing with an unexpected number of critical COVID-19 patients. Even if we experienced a significant reduction of paediatric admissions to our trauma E.R., the presence of a determined number of fractures justifies the necessity of a specialized hub to collect all paediatric fractures.