The objectives of this study are to ascertain primary caregivers' understanding of risks associated with home trampoline use; to educate caregivers in regard to documented literature based risks associated with home trampoline use; and to evaluate if this information will have any influence on their future regulation of home trampoline use for their children.

One hundred primary caregivers of patients treated in the paediatric orthopaedic surgery outpatient clinic at London Health Sciences centre were surveyed. All caregivers in clinic were invited to participate. The only exclusion criteria was the inability to provide consent. Caregivers' baseline perceptions on the risks associated with home trampoline use were assessed using a questionnaire. Caregivers then received an information pamphlet outlining documented trampoline safety data. They were then sent the same questionnaire to complete within one week of reading the pamphlet. Using our research electronic database capture (Redcap), the results of the surveys were compiled and analysed using spss 22, paired t-test and repeated measures anova. A sample size of 55 was calculated to result in a power of 80%.

Of primary caregivers surveyed, 36% owned a home trampoline, and only 5% had personal experiences with their child sustaining a trampoline injury. Pre-education, when caregivers were asked on a scale of one (not dangerous) to 10 (very dangerous) how dangerous they felt a trampoline was for their child, the average response was six. Post-education, this number changed to eight. Providing education to primary caregivers significantly changed their perceptions on all sections of the questionnaire, yet 47% of primary caregivers were willing to allow their child to use a trampoline at home despite their new understanding of trampoline injury and safety.

Providing education to primary caregivers significantly changed their perceptions on all trampoline safety questions, indicating effective comprehension. Despite caregivers' understanding of the risks associated with home trampoline use, approximately half of the study population continue to permit this activity for their children. There is potential to reduce paediatric orthopaedic injuries associated with home trampoline use if safer trampoline related practices are implemented based on information provided.

The benefit of using a long intramedullary device for the treatment of geriatric intertrochanteric hip fractures is unknown. The InterTAN device (Smith and Nephew, Memphis TN) is offered in either Short (180–200 mm) or Long (260–460 mm) constructs and was designed to provide stable compression across primary intertrochanteric fracture fragments. The objective of our study was to determine whether Short InterTANs are equivalent to Long InterTANs in terms of functional and adverse outcomes for the treatment of geriatric intertrochanteric hip fractures.

108 patients with OTA classification 31A–1 and 31A–2 intertrochanteric hip fractures were included in our study and prospectively followed at one of four Canadian Level-1 Trauma Centres. Our primary outcomes included two validated primary outcome measures: the Functional Independence Measure (FIM), to measure function, and the Timed Up and Go (TUG), to measure motor performance. Secondary outcome measures included blood loss, length of procedure, length of stay and adverse events. A pre-injury FIM was measured by retrospective recall and all postoperative outcomes were assessed on postoperative day 3, at discharge, at 6 weeks, 3 months, 6 months and 12 months postoperatively. Unpaired t-tests and Chi-square tests were used for the comparison of continuous and categorical variables respectively between the Short and Long InterTAN groups. A statistically significant difference was defined as p<0.05.

Our study included 71 Short InterTAN and 37 Long InterTAN patients with 31A–1 and 31A–2 intertrochanteric hip fractures. Age, sex, BMI, side, living status and comorbidities were similar between the two groups. The mean operative time was significantly lower in the Short InterTAN group (61 mins) as compared to the Long InterTAN group (71 mins)(p0.05). There were 5 periprosthetic femur fractures in the short InterTAN group versus 1 in the long InterTAN group. Non-mechanical adverse outcomes such as myocardial infarction, pulmonary embolism, urinary tract infections, pneumonia and death all had similar incidence rates between the two InterTAN groups.

Both the Short and Long InterTAN patient cohorts displayed similar improvements in performance and overall function over the course of a year following intertrochanteric hip fracture fixation. The recorded operative times for Short InterTAN fixation were significantly shorter than those recorded for the Long InterTAN patients. Alternatively, a significantly higher proportion of Short InterTAN patients sustained periprosthetic femur fractures within a year of implantation as compared to the Long InterTAN group.

Chronic spastic hip dislocation in patients with spastic quadriplegia can lead to restricted range of movement and severe pain, inability to sit, respiratory and urinary infections, perineal hygiene problems and decubitus ulceration. The Castle procedure is designed to relieve pain and prevent these complications. This investigation evaluates whether the Castle procedure succeeds as a salvage procedure in a pediatric population.

Patients with cerebral palsy who had undergone a proximal femoral resection according to Castle’s description were identified. Exclusion criteria included age over nineteen years at time of surgery, acute hip dislocation, and diagnoses other than cerebral palsy. Eight children completed a chart and radiographic review, and a clinical review. A staff physician evaluated range of motion, apparent discomfort of the child, and the state of the perineal skin. A questionnaire was given the primary caregiver assessing post-operative improvement in pain, sitting duration, infections, ulcers, ease of postoperative care, and overall satisfaction.

Five males and three females with mean age at surgery of 13 ± 1 years, and an average follow-up of 42 ± 13 months were enrolled. All had proximal migration of the residual femur to at least the midpoint of the acetabulum. The average heterotopic ossification score post-op was Brooker one with no symptoms. Five of eight had mild discomfort, with two having moderate to severe discomfort. Five had reduced pain post-op such that they didn’t require analgesics, and were able to sit the entire day. One had a urinary infection post-op, and two had recurrent pneumonias and decubitus ulcerations postop. One child underwent a revision resection for pain and proximal migration, and one was rehospitalised for failure to thrive and pain control. Seven of eight caregivers were somewhat or very satisfied with the procedure, but only five of eight would recommend it to others. Problems identified by the caregivers included treatment failure, difficulty with post-operative care, and significant leg length discrepancy.

The Castle procedure is a successful salvage in severe spastic hip disease, but not universally so. Education concerning potential outcomes and rehabilitation period is also essential in achieving satisfaction.

Serial casting (SC) and Botulinum toxin-A (Btx-A) have been used to treat ankle equinus contractures in cerebral palsy. Previous studies that examined the effects of combining Btx-A injections with SC and either one of the treatments alone in terms of passive ankle range of motion (PROM) have shown mixed results [two-four]. Therefore, the goal of this study is to examine PROM and gait characteristics in children with CP who have undergone SC, either with or without Btx-A injections to the plantarflexors.

Patients who underwent SC +/− Btx-A injections were evaluated for improvement in PROM at the end of treatment. The participants’ age at beginning of SC treatment, Gross Motor Function Classification System (GMFCS) level, treatment duration, PROM, and gait characteristics observed by the treating physiotherapist were obtained from the charts. Only one side per treatment is included in this study (treated side for unilateral treatments, randomly chosen side for bilateral treatments). Table One shows the characteristics of the two groups.

Independent samples t-tests showed that the two groups are similar in terms of age, treatment duration and pre PROM. A repeated measures ANCOVA, using the pre- and post- treatment range of motion as the within subject variables, treatment type as the between subject variable, and GMFCS and age as the covariates showed that the PROM changed significantly regardless of treatment type (p< 0.001). However, the treatment type does not influence the outcome (p=0.411). The changes in range of motion obtained from the two types of treatments were not significantly different using the independent t-test (p=0.957).

Based on these results, it appears that both types of interventions resulted in significant changes in ankle passive range of motion, which is in agreement with Kay et al [4]. Similar ranges of motion at the end of the treatment were obtained from both treatments, and the treatments have similar success rates. Future work is needed to further explore the outcomes associated with serial casting only and Btx-A and serial casting treatments

Scaphoid fractures are rare injuries in the pediatric population. A clinical and radiographic review over a six-year period at our institution revealed ninety-nine suspected scaphoid fractures. All of these patients presented with post-traumatic tenderness in the anatomic snuffbox and were treated with thumb spica cast immobilization. Only 9% of these patients demonstrated radiographic evidence of scaphoid fracture on initial presentation. At subsequent follow-up, six additional patients revealed radiographic evidence of scaphoid fracture. Positive predictive value of snuffbox tenderness for scaphoid fracture was 6% for patients with initially normal radiographs.

To review the clinical and radiographic results of suspected pediatric scaphoid fractures, as well as to determine the predictive value of anatomic snuffbox tenderness for occult fracture.

Pediatric scaphoid fractures are rare injuries that were found to be non-displaced and to involve the waist and distal scaphoid in most cases. Snuffbox tenderness had a positive predictive value of 6% in the identification of occult fracture.

In cases of suspected scaphoid fracture and normal radiographs, reliance on anatomic snuffbox tenderness alone will result in unnecessary immobilization in the majority of children.

Ninety-nine potential injuries were identified. Average age was 13.9 years. Although all patients in this group had tenderness in the snuffbox, only nine of the original x-rays revealed a true scaphoid fracture. The ninety “clinical scaphoid fractures” were immobilized for twenty-three days on average. Of these, only six demonstrated future radiographic evidence of fracture. No injuries required surgery for non-union.

All pediatric scaphoid fractures that were diagnosed clinically or radiographically at our institution between 1998 and 2003 were reviewed. Initial and follow-up radiographs were examined for evidence of fracture.

Given the sequelae of untreated scaphoid fractures in adults, tenderness in the snuffbox has been used to diagnose “clinical scaphoid fractures”. Although never validated in children, this test continues to be used in this population. As the natural history of scaphoid fracture in children is more favorable than in adults, reliance on snuffbox tenderness alone has resulted in the over-treatment of this injury.

The majority of pediatric proximal humerus fractures are successfully treated non-operatively. Significantly displaced fractures have traditionally been treated surgically with percutaneous pinning. This review of twenty-three surgically treated patients demonstrates a high rate of infection associated with percutaneous pinning. The technique of cannulated screw fixation offers a safe surgical alternative for the treatment of these fractures in the adolescent population.

To compare the results of percutaneous pinning to cannulated screw fixation for the treatment of pediatric proximal humerus fractures.

A high complication rate, including pin tract infection and loss of reduction, was observed in the percutaneous pinning group.

Given the rigid fixation afforded by cannulated screws and the minimal morbidity associated with proximal humeral physeal arrest in the older adolescent, this technique offers a safe alternative for the treatment of proximal humerus fractures.

Average age was 13.0 years for the pinning group and 14.7 years for the cannulated screw group. Regardless of fixation technique, all fractures healed completely with no difference in rates of physeal closure. Significant pin tract drainage was encountered in six of twenty patients treated with pinning: Two with Staphylococcus Aureus infection and one deep infection requiring surgical debridement. Loss of reduction and pin migration was noted in a seventh patient. The only complication observed in the cannulated screw group was a transient axial nerve paresthesia. There were no significant differences in operative time, rate of open reduction, or length of hospitalization (p> 0.05).

Twenty-three pediatric proximal humerus fractures treated operatively over a seven-year period were followed clinically and radiographically.

Thirty percent of the patients treated with pinning developed pin tract infections. Similar to femoral external fixation pins, proximal humeral pins also cross a large muscle group that may result in pin micro-motion. This may create persistent drainage that ultimately leads to infection.