Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes?

BACKGROUND: Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. METHODS: Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ 2 tests and ANOVA. Two group comparisons were made with Student t test. RESULTS: There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan's system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. CONCLUSIONS: Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. LEVEL OF EVIDENCE: Therapeutic, Level III.

Explaining Adherence to American Academy of Pediatrics Screen Time Recommendations With Caregiver Awareness and Parental Motivation Factors: Mixed Methods Study.

BACKGROUND: With the increasing integration of technology into society, it is advisable that researchers explore the effects of repeated digital media exposure on our most vulnerable population-infants. Excessive screen time during infancy has been linked to delays in language, literacy, and self-regulation. OBJECTIVE: This study explores the awareness of and adherence to the American Academy of Pediatrics' (AAP) recommendations related to avoiding screen time for infants younger than 2 years and the motivational factors associated with screen time exposure. METHODS: A mixed methods survey design was used to gather responses from 178 mothers of infants younger than 2 years. The measures included infant screen time use and duration, maternal awareness of screen time use recommendations, and motivations related to screen time exposure. A variety of statistical procedures were used to explore associations between caregiver awareness of and adherence to AAP guidelines for screen time exposure, motivations related to screen time for infants, and the duration of infant screen time exposure. RESULTS: The results indicated that 62.2% (111/178) of mothers were aware of the AAP screen time recommendations, but only 46.1% (82/178) could cite them accurately, and most mothers learned of them via the internet or from a medical professional. Mothers who were aware of the guidelines allowed significantly less screen time for infants than those who were unaware (P=.03). In addition, parents who adhered to the AAP guidelines reported significantly less infant screen time per day than those who did not adhere (P<.001). Among mothers who reported not adhering to the guidelines, the greatest motivation for allowing screen time was perceived educational benefits. Less educated mothers rated an infant's relaxation as a motivational factor in allowing screen time significantly higher than more highly educated mothers (P=.048). The regression analysis indicated that none of the parental motivation factors predicted daily infant screen time. CONCLUSIONS: These results indicate 2 key approaches to improving adherence to screen time recommendations. First, the awareness of the AAP recommendations needs to be increased, which tends to improve adherence. Second, the myth that screen time can be educational for infants needs to be dispelled.

Closed rupture of flexor digitorum profundus in zone III.

Closed ruptures of the flexor digitorum profundus (FDP) tendon cause a loss of active flexion at the distal interphalangeal joint. Commonly referred to as a 'jersey finger' because of its association with tackling sports, the distal aspect of FDP is avulsed from its insertion on the distal phalanx in zone I, with or without a fragment of bone. Because of this classic injury mechanism and pattern, providers may not seek advanced imaging beyond plain radiographs. Although rare, injury to FDP more proximally may occur. More often this injury is associated with a weak underlying tendon because of repetitive microtrauma or anomalous anatomy, for example. We present a case of a closed rupture of the FDP in zone III, and stress the importance of maintaining a high clinical suspicion and the potential use of adjunct ultrasound imaging to localise the site of injury.

Normativity and Desirability in Observational Assessments of Family Interaction.

Issues of normativity (responding in a typical or average fashion) and desirability (the tendency for raters to endorse positive characteristics rather than neutral or more negative ones) are common in areas of the social sciences that frequently utilize profile correlations to measure dyadic similarity. They have implications for family scholars as well. In the present study, a pre-existing data set was used to make an initial, though limited, investigation into potential confounds of normativity and desirability for macrolevel observational assessments of family interaction. An empirical example is presented using q-sort ratings of family interaction, with variance in observational assessments decomposed into component parts. High levels of both normativity and desirability were found, indicating possible problems in terms of both reliability and validity of assessment. While the results provide an interesting beginning, they are limited due to the use of a q-sort methodology as well as an instrument with limited background and use. These limitations are discussed, as well as alternative interpretations for normativity and desirability and implications for future research.

Las cuestiones de normatividad (responder de una forma típica o promedio) y de deseabilidad (la tendencia de los calificadores a avalar características positivas en lugar de neutras o más negativas) son comunes en las áreas de las ciencias sociales que con frecuencia utilizan las correlaciones de los perfiles para medir la similitud diádica. Pero estas también tienen consecuencias para los investigadores de las familias. En el presente estudio se utilizó un conjunto preexistente de datos para llevar a cabo una investigación inicial, aunque limitada, sobre posibles factores de confusión de la normatividad y la deseabilidad en las evaluaciones observacionales a nivel macro de la interacción familiar. Se presenta un ejemplo práctico utilizando las calificaciones de la técnica de Q-sort de la interacción familiar, con la varianza de las evaluaciones observacionales dividida en componentes. Se encontraron niveles altos tanto de normatividad como de deseabilidad, lo cual indica posibles problemas en relación con la fiabilidad y la validez de la evaluación. Si bien los resultados ofrecen un comienzo interesante, son limitados debido al uso de una metodología Q-sort así como de un instrumento con pocos antecedentes y uso. Se debaten estas limitaciones así como interpretaciones alternativas de la normatividad y la deseabilidad, y las consecuencias para futuras investigaciones.

Plasma and electrolyte changes in exercising humans after ingestion of multiple boluses of pickle juice.

CONTEXT: Twenty-five percent of athletic trainers administer pickle juice (PJ) to treat cramping. Anecdotally, some clinicians provide multiple boluses of PJ during exercise but warn that repeated ingestion of PJ may cause hyperkalemia. To our knowledge, no researchers have examined the effect of ingesting multiple boluses of PJ on the same day or the effect of ingestion during exercise. OBJECTIVE: To determine the short-term effects of ingesting a single bolus or multiple boluses of PJ on plasma variables and to characterize changes in plasma variables when individuals ingest PJ and resume exercise. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Nine euhydrated men (age = 23 ± 4 years, height = 180.9 ± 5.8 cm, mass = 80.7 ± 13.8 kg, urine specific gravity = 1.009 ± 0.005). INTERVENTION(S): On 3 days, participants rested for 30 minutes, and then a blood sample was collected. Participants ingested 0 or 1 bolus (1 mL · kg(-1) body weight) of PJ, donned sweat suits, biked vigorously for 30 minutes (approximate temperature = 37 °C, relative humidity = 18%), and had a blood sample collected. They either rested for 60 seconds (0- and 1-bolus conditions) or ingested a second 1 mL · kg(-1) body weight bolus of PJ (2-bolus condition). They resumed exercise for another 35 minutes. A third blood sample was collected, and they exited the environmental chamber and rested for 60 minutes (approximate temperature = 21 °C, relative humidity = 18%). Blood samples were collected at 30 and 60 minutes postexercise. MAIN OUTCOME MEASURE(S): Plasma sodium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume. RESULTS: The number of PJ boluses ingested did not affect plasma sodium concentration, plasma potassium concentration, plasma osmolality, or changes in plasma volume over time. The plasma sodium concentration, plasma potassium concentration, and plasma osmolality did not exceed 144.6 mEq · L(-1) (144.6 mmol · L(-1)), 4.98 mEq · L(-1) (4.98 mmol · L(-1)), and 289.5 mOsm · kg(-1)H2O, respectively, in any condition at any time. CONCLUSIONS: Ingesting up to 2 boluses of PJ and resuming exercise caused negligible changes in blood variables. Ingesting up to 2 boluses of PJ did not increase plasma sodium concentration or cause hyperkalemia.

Pre-exercise ingestion of pickle juice, hypertonic saline, or water and aerobic performance and thermoregulation.

CONTEXT: Ingesting high-sodium drinks pre-exercise can improve thermoregulation and performance. Athletic trainers (19%) give athletes pickle juice (PJ) prophylactically for cramping. No data exist on whether this practice affects aerobic performance or thermoregulation. OBJECTIVE: To determine if drinking 2 mL/kg body mass of PJ, hypertonic saline, or deionized water (DIW) pre-exercise affects aerobic performance or thermoregulation. DESIGN: Crossover study. SETTING: Controlled laboratory study. PATIENTS OR OTHER PARTICIPANTS: Nine euhydrated men (age = 22 ± 3 years, height = 184.0 ± 8.2 cm, mass = 82.6 ± 16.0 kg) completed testing. INTERVENTION(S): Participants rested for 65 minutes. During this period, they ingested 2 mL/kg of PJ, hypertonic saline, or DIW. Next, they drank 5 mL/kg of DIW. Blood was collected before and after ingestion of all fluids. Participants were weighed and ran in the heat (temperature = 38.3°C ± 1°C, relative humidity = 21.1% ± 4.7%) at increasing increments of maximal heart rate (50%, 60%, 70%, 80%, 90%, 95%) until exhaustion or until rectal temperature exceeded 39.5°C. Participants were weighed postexercise so we could calculate sweat volume. MAIN OUTCOME MEASURE(S): Time to exhaustion, rectal temperature, changes in plasma volume, and sweat volume. RESULTS: Time to exhaustion did not differ among drinks (PJ = 77.4 ± 5.9 minutes, hypertonic saline = 77.4 ± 4.0 minutes, DIW = 75.7 ± 3.2 minutes; F2,16 = 1.1, P = .40). Core temperature of participants was similar among drinks (PJ = 38.7°C ± 0.3°C, hypertonic saline = 38.7°C ± 0.4°C, DIW = 38.8°C ± 0.4°C; P = .74) but increased from pre-exercise (36.7°C ± 0.2°C) to postexercise (38.7°C ± 0.4°C) (P < .05). No differences were observed for changes in plasma volume or sweat volume among drinks (P > .05). CONCLUSIONS: Ingesting small amounts of PJ or hypertonic saline with water did not affect performance or select thermoregulatory measures. Drinking larger volumes of PJ and water may be more effective at expanding the extracellular space.

Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency.

OBJECTIVE: Many clinicians believe that exercise-associated muscle cramps (EAMC) occur because of dehydration. Experimental research supporting this theory is lacking. Mild hypohydration (3% body mass loss) does not alter threshold frequency (TF), a measure of cramp susceptibility, when fatigue and exercise intensity are controlled. No experimental research has examined TF following significant (3-5% body mass loss) or serious hypohydration (>5% body mass loss). Determine if significant or serious hypohydration, with moderate electrolyte losses, decreases TF. DESIGN: A prepost experimental design was used. Dominant limb flexor hallucis brevis cramp TF, cramp electromyography (EMG) amplitude and cramp intensity were measured in 10 euhydrated, unacclimated men (age=24±4 years, height=184.2±4.8 cm, mass=84.8±11.4 kg). Subjects alternated exercising with their non-dominant limb or upper body on a cycle ergometer every 15 min at a moderate intensity until 5% body mass loss or volitional exhaustion (3.8±0.8 h; 39.1±1.5°C; humidity 18.4±3%). Cramp variables were reassessed posthypohydration. RESULTS: Subjects were well hydrated at the study's onset (urine specific gravity=1.005±0.002). They lost 4.7±0.5% of their body mass (3.9±0.5 litres of fluid), 4.0±1.5 g of Na(+) and 0.6±0.1 g K(+) via exercise-induced sweating. Significant (n=5) or serious hypohydration (n=5) did not alter cramp TF (euhydrated=15±5 Hz, hypohydrated=13±6 Hz; F1,9=3.0, p=0.12), cramp intensity (euhydrated= 94.2±41%, hypohydrated=115.9±73%; F1,9=1.9, p=0.2) or cramp EMG amplitude (euhydrated=0.18±0.06 µV, hypohydrated= 0.18±0.09 µV; F1,9=0.1, p=0.79). CONCLUSIONS: Significant and serious hypohydration with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.

The hierarchical structure of childhood personality in five countries: continuity from early childhood to early adolescence.

Childhood personality is a rapidly growing area of investigation within individual differences research. One understudied topic is the universality of the hierarchical structure of childhood personality. In the present investigation, parents rated the personality characteristics of 3,751 children from 5 countries and 4 age groups. The hierarchical structure of childhood personality was examined for 1-, 2-, 3-, 4-, and 5-factor models across country (Canada, China, Greece, Russia, and the United States) and age group (3-5, 6-8, 9-11, and 12-14 years of age). Many similarities were noted across both country and age. The Five-Factor Model was salient beginning in early childhood (ages 3-5). Deviations across groups and from adult findings are noted, including the prominent role of antagonism in childhood personality and the high covariation between Conscientiousness and intellect. Future directions, including the need for more explicit attempts to merge temperament and personality models, are discussed.

The Inventory of Children's Individual Differences: development and validation of a short version.

As more researchers utilize the Five-factor model (FFM) of personality with children and adolescents, the need for instruments designed specifically for use with children and adolescents increases. In the United States, the 108-item Inventory of Children's Individual Differences (ICID; Halverson et al., 2003), has provided researchers with an age and culture neutral instrument designed specifically to assess the FFM of personality in children and adolescents, ages 2 to 15, using parental, nonparental, or self-reports. This article presents a shorter, 50-item version of the ICID (the ICID-S) that maintains the levels of validity and reliability previously established for the full instrument.

Personality structure as derived from parental ratings of free descriptions of children: the inventory of child individual differences.

Based on over 50,000 parental descriptors of children gathered in eight different countries, we used a combination of focus group sorting of descriptors in each country and factor analyses of instruments developed in four of the countries (United States, China, Greece, and the Netherlands) to describe children ages 3 to 12 years to select items for an instrument that would work well across countries to access personality. Through many factor analyses of indigenous items in each country, a core set of 141 items was used in three of the countries, with over 3000 parents responding to our instruments in China, Greece, and the United States. Much cross-comparative research analysis has resulted in 15 robust midlevel scales that describe the structures of parental descriptors that are common to the three countries. The data on the English (U.S.) sample are presented in detail. Links to temperament and behavior problems are presented and discussed.