Accidents in agriculture involving muscle skeletal system in children. Analysis based on hospitalization in the Paediatric Orthopaedics and Rehabilitation Department University Children’s Hospital in 2010-2019

Introduction. Accidents in agriculture involving children happen every year. They are attributable to a lack of safety and low awareness of caretakers, who oftentimes don’t pay enough attention to the little ones. Injuries in agriculture involve mainly falls from great heights: ladders, trailers, tractors; crushing by various types of agricultural machinery; partial or complete amputations within the regions of upper and lower limbs: amputations of feet or fingers. Those cases often include multi-tissue damages, which means that in addition to bone fractures, there might also occur other concurrent injuries like interstitial infections, crushing, neurovascular damages, or soft tissue damage. Material and Methods. In the years 2010-2019 there were 207 patients hospitalized in the Paediatric Orthopaedics and Rehabilitation Department of University Children’s Hospital in Lublin due to accidents in agriculture. Patients who suffered bone injuries, either caused by falling from heights or falling from agricultural machines, constitute the majority of the total 207 cases. The second case in terms of frequency, were the children whose limbs got stuck, or struck, by moving parts of agricultural machines and devices, which resulted in amputations at different levels. The third group consisted of patients crushed by agricultural machines or livestock. Results. The following data indicate a gradual decrease in the number of children requiring hospitalization. Between 2010 and 2019 there was a year-onyear decrease of 38.4%. Conclusions. After the analysis of causes and mechanisms of the injuries mentioned before, we conclude that the vast of these accidents could have been avoided if the caretakers looked after children with due attention, and the children were not allowed in the vicinity of currently functioning agricultural machines.

Paediatric Orthopaedics

This chapter contains practice questions based on a broad range of orthopaedic topics that may be encountered within the ‘Hand & Paediatrics’ station of the FRCS (Trauma & Orthopaedics) viva examination. The paediatric questions include important causes of hip pain in children, such as developmental dysplasia of the hip (DDH), slip of the right upper femoral epiphysis (SUFE), Perthes’ disease, and septic arthritis. Trauma topics include supracondylar and femoral fractures, and the chapter also discusses congenital deformities including fibular hemimelia and talipes.

Editorial

Warm greetings to all from the International Journal of Paediatric Orthopaedics Editorial Team. We are pleased to present the 3rd POSI issue of IJPO. Thanks to the overwhelming response to our invitation for submissions, our team of reviewers and editors have been kept busy in the past few months. We would like to express our gratitude to the entire POSI family from around the world and to all the authors for their submissions. With your continued support, the journal will reach great heights in the years to come. This issue has an informative and exhaustively researched symposium on lateral condyle fractures of the humerus. The articles in the symposium will provide a comprehensive and updated overview about this condition that poses significant challenges to the treating surgeon. The authors are acknowledged experts in paediatric trauma from India and around the world. It has been specially designed to supplement the material available in orthopaedic textbooks for the benefit of trainees, in addition to providing treatment pearls for the practising orthopaedic surgeon. We have original articles and interesting case reports from India, United Kingdom, Portugal, Senegal on a wide variety of paediatric orthopaedic conditions including DDH, infection and its sequelae and clubfoot managed in diverse healthcare systems. Due to the unprecedented increase in submissions, we call upon the POSI fraternity to help the society journal by joining our team of reviewers. This will help us to complete the peer review process in a timely manner. Being a part of our team will help also young surgeons to better understand the review process and develop their writing skills. We look forward to hearing from you with suggestions for further improvement. Sincerely Jayanth S Sampath FRCSEd (Tr & Orth) Editor, International Journal of Paediatric Orthopaedics [email protected]

The use of virtual reality in reducing anxiety during cast removal: a randomized controlled trial

Purpose While virtual reality (VR) has been shown to be an effective distractor in children across a range of procedures, no studies have looked at its use within paediatric orthopaedics. The purpose of this study was to look at the use of VR in reducing anxiety levels in children during cast removal. In addition, the study aimed to find ways to enhance the efficiency of future VR trials in paediatrics. Methods A non-blinded randomized control trial took place in children aged four to 18 years. Intraprocedural anxiety was measured using the Children’s Emotional Manifestation Scale (CEMS), while pre- and post-procedural anxiety was measured using the Short State Anxiety Inventory Scale. Additional data was collected on trait anxiety, nausea levels, desire for future VR use and areas of improvement for future VR studies. Results A total of 90 subjects were included in the study (control n = 45, intervention n = 45) with a mean age of 10.25 years (sd 3.35). Post-procedural anxiety and intraprocedural anxiety were 18% (p = 0.03) and 24% (p = 0.01) lower in the VR group, respectively, with the CEMS facial component showing a 31% (p < 0.001) reduction in the VR group. In all, 99% (n = 89) of subjects experienced no nausea, with one patient experiencing mild nausea that may have been present prior to VR use. Finally, 90% (n = 81) of subjects said they would like to use VR again, 1% (n = 1) said ‘no’ and 9% (n = 8) said ‘maybe’. Conclusion VR appears to be an effective distraction technique in reducing anxiety levels in children during cast removal.

3D - Printed Patient Specific Instrumentation in Corrective Osteotomy of the Femur and Pelvis: A Review of the Literature

Background The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons. Methods A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: “What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?” Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions. Results In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods. Conclusion Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use.

Recommendations for early diagnosis of Developmental Dysplasia of the Hip (DDH): working group intersociety consensus document

This consensus document has been prepared by a multidisciplinary group of experts (Paediatricians, Radiologists, Paediatric Orthopaedics) and it is mainly aimed at paediatricians, hospitals and primary care providers. We provide recommendations for the early diagnosis and treatment of Developmental Dysplasia of the Hip (DDH) and indications on its management.

Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Changes in the focus of clinical paediatric orthopaedics in the period 1980-2021 on the example of the Department of Children’s Orthopaedics and Rehabilitation in Lublin

For 40 years we have been observing clear changes in the interest of pediatric orthopedists. Some malformations and diseases have almost disappeared in pediatric orthopedic departments, such as developmental hip dislocation, multiple congenital clubfoot surgeries, torticollis, varus of the shin, Blounts disease,Volkmann syndrome, shin mower amputations and others described in this article. The reason for this phenomenon is usually the emergence of new diagnostic methods (e.g. hip joint ultrasound), new treatment methods (e.g. botulinum toxin) or new birth techniques or technical progress in agricultural machinery.