Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling.

INTRODUCTION: Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs. METHODS: This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software. DISCUSSION: The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling. CONCLUSION: Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.

Prevention of arm injury in youth baseball pitchers.

The advent of youth year-round baseball has come with an increased incidence of pitching related injury and surgery, most notably involving the shoulder and elbow (ulnar collateral ligament). These injuries become evident in high school and college, but begin at the youth level. Several studies have identified baseball pitching risk factors during youth that increase likelihood for injury and surgery in subsequent years. Based on these studies, the USA Baseball Medical & Safety Advisory Committee has published guidelines for pitching that include limits on pitch count and pitches per week and season as well as recommendations for number of rest days between pitching. Also, recommendations include the restriction of breaking balls prior to puberty, the importance of instruction for proper pitching mechanics as early as possible in development, and at least three months of rest after a season. This review is intended to help guide primary care physicians and pediatricians when discussing youth pitching and injury prevention with parents and coaches.