bluuebunny/crossref_metadata_2025_split huggingface dataset:
PEDIATRIC SPORTS INJURY EPIDEMIOLOGY DURING COVID-19 PANDEMIC
Authors: Johnson Mitchell A. , Pascual-Leone Nicolas , Shah Apurva S. , Bram Joshua T. , Ganley Theodore J. 
Published: July 2021

Background: The COVID-19 pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. A change in the epidemiology of injuries commonly caused by sporting activities is expected. Hypothesis/Purpose: Examine the effect of public health measures on the incidence and characteristics of common pediatric sports injuries. Methods: This is a retrospective cohort study comparing sporting injuries presenting to a level I pediatric trauma hospital during the COVID-19 pandemic to sporting injuries during a pre-pandemic period at the same institution. Nine specific injury types were evaluated including ACL injury, meniscus injury, patellar dislocation, osteochondritis dissecans (OCD), shoulder dislocation, ankle sprain, clavicle fracture, medial epicondyle fracture, and tibial spine fracture. Patients were included if they presented for initial care between 3/15/20 and 4/15/20 for the “pandemic” group and the same time window in 2018 and 2019 for the “pre-pandemic” group. Results: 487 patients were included in our study with an average of 222.5 patients in 2018 and 2019 compared to 42 patients in 2020. The average patient age decreased during the pandemic compared to the pre-pandemic period (9.4 ± 6.0 vs 12.4 ± 4.2, p=0.007). Additionally, a decrease in the proportion of injuries attributed to sports (26.2% vs 47.6%, p=0.005) and those occurring at school/daycare (4.8% vs 10.3%, p<0.001) were observed. During the pandemic there was an increase in the proportion of injuries occurring at the patients home (50.0% vs 16.9%, p<0.001)(Table 1). The distribution was significantly different across the nine injury types included with a decrease in the proportion of ankle sprains (31.0% vs 59.8%, p<0.001) and an increase in the proportion of clavicle fractures (50.0% vs 16.2%, p<0.001)(Figure 1). For ankle sprains, there was no significant difference in the proportion of anterior talofibular ligament injuries to high ankle sprains (p=0.898). There was no delay in presentation in the “pandemic” group compared to the “pre-pandemic” group (6.6 ± 9.6 vs 5.4 ±9.9, p=0.424). Conclusion: At our institution, we observed an over fivefold reduction in presentation for common pediatric musculoskeletal injuries typically associated with sports. The dramatic drop off in injuries occurring across both sports and non-sports injury mechanisms raises concern for presentation of untreated injuries in the future. Additionally, the increased proportion of injuries occurring in the home setting creates an opportunity for emphasis to be placed on basic safety precautions, especially for young children. Tables/Figures: [Table: see text][Figure: see text]
PEDIATRIC ORTHOPAEDIC TRAUMA AND ASSOCIATED INJURIES AT AN INNER-CITY LEVEL 1 TRAUMA CENTER
Authors: Levidy Michael , Rai Rahul , Chu Alice , Kaushal Neil , Edobor-Osula O. Folorunsho 
Published: July 2021

Background/Purpose: Pediatric orthopaedic trauma in inner city communities often present with unique and modifiable risk factors. The purpose of this study was to characterize and evaluate the pattern and nature of orthopaedic and associated injuries in pediatric patients involved in motor vehicle accidents (MVA), falls, sports related injuries and pedestrian struck either on foot or on bicycle at an inner-city level 1 trauma center. Methods: 260 pediatric patients who presented to the emergency department after a fall, a sports related injury, MVA, pedestrian struck on foot (PSoF), or pedestrians struck on bicycle (PSoB) with orthopaedic injuries at our institution between 2013 and 2020 were retrospectively reviewed. Results: The mean age of our cohort was 9.1 years (SD ±4.60). 36.5% (95/260) were girls, 63.5% (165/260) were boys. There were a total of 260 patients with a total of 331 fractures. 96.3% (319/331) of the fractures were appendicular while 3.6% (12/331) were axial. 43.8% (114/260) of patients had lower extremity fractures and 49.2% (128/260) had upper extremity fractures. Of all mechanisms, MVAs were most commonly associated with axial fractures (p<0.01). Falls were associated most commonly with upper extremity fractures (p<0.01), lower patient age (p<0.01) and negatively correlated with lower extremity fractures (p<0.01). Sports related injuries were most commonly correlated with tibia fractures (p<0.01). Sports etiologies were subdivided into Basketball (29%), Football (27%), Soccer (11%), and other physical activities like Rollerblading (11%) and Skateboarding (9%). PSoF was associated with tibia fractures (p<0.05) and open fractures (p<0.01). PSoB was the most likely mechanism to lead to lower extremity fractures (p=0.01) and head trauma (p<0.01). 75% (6/8) of PSoB were not wearing a helmet at the time of injury. Conclusion: Not surprisingly, falls represent the most common mechanism of pediatric orthopaedic injury. Other mechanism of injuries included MVAs, pedestrian struck on foot or bicycle were associated with more significant trauma including vertebral fractures, open fractures, head trauma and compartment syndrome. Preventative measures including education on car seat and seat belt use, helmet use and bicycle safety in children may reduce the incidence of these serious injuries. [Figure: see text]
OSTEOCHONDRAL ALLOGRAFTING IN THE SKELETALLY IMMATURE KNEE: HIGH RATES OF INCORPORATION AND EXCELLENT EARLY OUTCOMES
Authors: Tisano Breann , Ellis Henry B. , Wyatt Charles W. , Wilson Philip L. 
Published: July 2021

Background: While an excellent option for osteochondral defects in the adult knee, outcomes following fresh osteochondral allograft (OCA) the skeletally immature are limited. Purpose: To compare radiographic and patient reported outcomes (PROs) in mature and skeletally immature adolescents following OCA of the knee. Methods: An IRB-approved review of fresh size-matched OCA treatment of knee lesions in patients aged < 19 years within a pediatric sports medicine practice from 1/2006-3/2019 was completed. Following exclusion of patients with less than 12 months follow-up, demographics, lesion characteristics, reoperations, and PROs were evaluated. A novel grading scale (k= 0.832) was utilized to evaluate radiographic OCA incorporation: A=complete, B= >50%, or C= <50% healed. Results: Forty-four patients [15.5 years (9.6-19.8) treated with OCA of the distal femur or patella (LFC= 18, MFC=17, Trochlea=6, Patella=3), 24 with open and 20 with closed physes, with 2.2 year follow up (range 1-5.3 years) were evaluated. Overall average graft size was 4.76cm2 and did not differ significantly between groups. Thirty-nine patients underwent at least one prior procedure to the ipsilateral knee, most frequently for attempted osteochondral lesion healing (77%), followed by realignment (22.7%), and meniscal pathology (15.9%). Graft failure occurred in only one skeletally immature patient with a trochlear lesion. Those with open physes were more likely to demonstrate complete graft incorporation (66.6%, p=0.001). 21(88%) patients with open physes and 17(85%) patients with closed physes had radiographic healing grades of A or B one year post-operatively. There was no difference in healing grade based on graft size, depth, or location within the knee. There was no difference in pre-operative PROs or activity scores. At final follow-up, open physes OCA patients demonstrated better KOOS scores (KOOS daily living 97.0 vs 89.5, p=0.02; KOOS pain 95.7 vs 84.6, p= 0.04; KOOS quality of life 157.2 vs 59.6, p= 0.005). Final activity scores did not vary by skeletal maturity (Pedi-IKDC 75.8 vs 77.99; Pedi-FABS 17.2 vs 13.5,) or radiographic healing grade. Daily living and pain scores were better in those with more radiographic healing (KOOS daily living 98.6 vs 86,2, p= 0.02; KOOS pain 96.7 vs 82.3, p= 0.048). Conclusion: Fresh osteochondral allograft treatment in the young knee may be expected to yield good early results. Despite relatively large graft size, when indicated for patients with open physes, equivalent or improved healing and patient reported outcomes may be expected.
ORTHOPEDIC INJURIES IN ADOLESCENT GYMNASTS: A SYSTEMATIC REVIEW
Authors: Kim Katie , Saper Michael 
Published: July 2021

Background: Gymnastics exposes the body to many different types of stressors ranging from repetitive motion, high impact loading, extreme weight bearing, and hyperextension. These stressors predispose the spine and upper and lower extremities to injury. In fact, among female sports, gymnastics has the highest rate of injury each year. Purpose: The purpose of this study was to systematically review the literature on location and types of orthopedic injuries in adolescent (≤20 years) gymnasts. Methods: The Pubmed, Medline, EMBASE, EBSCO (CINAHL) and Web of Science databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting orthopedic injuries in adolescent and young adult gymnasts. All aspects of injuries were extracted and analyzed including location, type and rates of orthopedic injuries. Results: Screening yielded 22 eligible studies with a total of 427,225 patients. Twenty of 22 studies reported upper extremity injuries of which four specifically focused on wrist injuries. Eight studies reported lower extremity injuries. Nine studies reported back/spinal injuries. Seven studies investigated each body location of injury; one study reported the upper extremity as the most common location for injury and six studies reported the lower extremity as the most common location for injury. Of those seven studies, five (23%) reported sprains and strains as the most common injury. One study reported fractures as the most common injury. Conclusion: There is considerable variation in reported injury location. Some studies focused specifically on the spine/back or wrist. The type of gymnastics each patient participated in was also different, contributing to which area of the body was more heavily stressed, or lacking. Current literature lacks data to fully provide evidence regarding which body region is more frequently injured and the type of injury sustained.
SURGICAL TREATMENT OF PATELLAR INSTABILITY IN ADOLESCENT DANCERS
Authors: Nunally KD , Micheli LJ , Zheng E , Hussain Z , Wilson B , Kocher M , Yen YM , Kramer DE , Heyworth BE 
Published: July 2021

Background: Adolescent dancers may be a high-risk population for patellofemoral instability (PFI), but the condition remains under-investigated, to date, in this sub-group of athletes. Purpose: The purpose of this study was to (1) investigate the descriptive epidemiology of PFI in adolescent dancers, (2) analyze the efficacy of various patellar stabilization procedures within this population, and (3) compare PFI in dancers to a larger control group of matched, non-dancer athletes. Methods: A retrospective review of athletes, ages 10 to 19, who presented to a single tertiary care center with PFI between 2008 and 2017 was performed. Based on each patient’s primary sport, the cohort was divided into a dancer and a non-dancer control group. Demographics, clinical and radiologic features, surgical stabilization technique, and postoperative course and clinical outcomes were collected. Independent categorical groups were tested using chi squared and Fisher exact tests. Results: 258 adolescent athletes were included, 41 of whom were dancers, all females. This group was therefore matched with a control group of similarly aged, all-female athletes with PFI (Table 1). 54 athletes had bilateral PFI, yielding 285 knees for analysis. There was no difference between dancer and non-dancer athletes’ age, BMI, laterality, mechanism of injury, nor number of preoperative instability events. However, dancers had lower Dejour Classifications (p=0.044), smaller patella inclination angles (20.9±8.14 versus 25.0±9.84; p=0.004), and smaller Caton-Deschamps Indices (1.18±0.161 versus 1.25±0.189; p=0.041). Among dancers, there was no association between surgical stabilization technique and rates of recurrent instability (p=0.418) nor re-stabilization procedures (p=1.0) (Table 2). However, dancers who underwent tibial tubercle osteotomy (TTO) had higher rates of subsequent, non-stabilization procedures (66.7%), all for implant removal, compared to those undergoing isolated medial retinacular repairs (MRP) (3.8%) (p<0.001). There was no difference between the dancer and non-dancer athletes’ rates of recurrent instability (p=0.297), re-stabilization procedures (p=0.061), nor subsequent non-stabilization procedures (p=0.242). Conclusions: Female dancers with PFI have similar demographic and clinical features as other female athletes with PFI, but have lower rates or less severe trochlear dysplasia, lateral tilt and patella alta. Therefore, the ligamentous laxity inherent in dancers may be a more powerful risk factor for PFI than other non-modifiable risk factors. Notably, the TTO was a powerful stabilization procedure for this sub-population with low rates of recurrent instability episodes and no revision stabilization procedures performed. Rates of implant removal surgery following TTO may be substantial, though this may be technique or surgeon dependent. Tables/Figures: [Table: see text][Table: see text]
SPORT	TYPE AND BASELINE NEUROCOGNITIVE SCORES AMONG HEALTHY HIGH SCHOOL ATHLETES
Authors: Oldham Jessie R. , Howell David R. , Lanois Corey J. , Berkner Paul D. , Mannix Rebekah C. , Meehan William P. 
Published: July 2021

Background: Athletes who participate in collision sports may experience more repetitive head impacts than other sport types. These repetitive head impacts have been theorized as a potential catalyst for cognitive problems later in life. It is unknown, however, if sport type influences neurocognitive performance. Hypothesis/Purpose: Our purpose was to investigate the association between sport type and baseline neurocognitive scores in a high school athletic population. We hypothesized that athletes participating in collision sports would demonstrate worse scores on baseline neurocognitive tests compared to those in contact or non-contact sports. Methods: We conducted a cross-sectional, observational study using baseline computerized neurocognitive scores of 186,117 high school student-athletes (age: 15.47±2.28 years, height: 168.53±10.77 cm, weight: 63.02±14.83 kg, 45% female) in the state of Massachusetts. The dependent variables were five composite scores (verbal memory, visual memory, visual motor, reaction time, and impulse control) and total symptom score. The independent variables included sport type (collision, contact, non-contact), age, sex, and concussion history. We used univariable one-way ANOVAS to compare composite scores between sport type. We conducted a series of multivariable regression models, controlling for age, sex, and number of previous concussions, to examine the independent association between sport type and composite scores. Results: There was a minimal but statistically significant association between sport type and composite scores, with collision sport athletes performing slightly worse than other athletes on most composite scores. Collision sport athletes had a slightly lower symptom burden. (Tables 1 and 2) Conclusion: While statistically significant, the differences in neurocognitive function and symptom burden between sport type are of questionable clinical significance. In fact, all of them fall within the reliable change index values of each respective score. As participants were in high school at the time of the study, we cannot determine the potential for associations later in life. Tables/Figures: [Table: see text][Table: see text]
UNEVEN PLAYING FIELD: INSURANCE STATUS ADVERSELY AFFECTS CHILDREN WITH TIBIAL SPINE FRACTURES
Authors: Patel Neeraj M. , Leska Tomasina M. , Ganley Theodore J. , Aoyama Julien T. , Cruz Aristides I. , Ellis Henry B. , Fabricant Peter D. , Green Daniel W. , Jagodzinski Jason , Johnson Benjamin , Kushare Indranil , Lee Rushyuan J. , McKay Scott D. , Rhodes Jason T. , Sachleben Brant C. , Sargent M. Catherine , Schmale Gregory A. , Yen Yi-Meng , Mistovich R. Justin 
Published: July 2021

Background: Previous studies have reported disparities in medical and surgical care resulting from demographic factors, including insurance status. Hypothesis/Purpose: The purpose of this study is to assess the impact of insurance status on the treatment of tibial spine fractures in children and adolescents. Methods: We performed a retrospective cohort study of tibial spine fractures treated at 10 institutions between 2000 and 2019. Polytraumas and patients older than 18 years were excluded. Demographic data was collected as was information regarding pre-operative, intra-operative, and post-operative treatment, with attention to delays in management and differences in care. Both surgical and non-surgical fractures were included, but a separate analysis of operative patients was performed subsequently. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: Data was collected on a total of 434 subjects with a mean age of 11.7±3.0. Of these, 61.1% had commercial insurance and 38.9% had public insurance. Publicly insured children were more likely to be injured in a motor vehicle accident. Among athletes, those with public insurance were injured more frequently during football while commercially insured patients were more likely to be injured while skiing. When analyzing the overall cohort of surgical and non-surgical fractures in multivariate analysis, those with magnetic resonance imaging (MRI) performed 21 or more days after injury were 5.3 times more likely to have public insurance (95% CI 1.3-21.7, p=0.02). Similar results were found with the 365 patients that required surgery. In this cohort, those with MRI delayed ≥21 days from injury were 4.8 times more likely to have public insurance (95% CI 1.2-19.6, p=0.03). Children that underwent surgery ≥21 days after injury were 2.2 times more likely to have public insurance (95% CI 1.1-4.1, p=0.02). Those that were publicly insured had 2.5 times higher odds of undergoing open surgery rather than arthroscopic (95% CI 1.1-6.1, p=0.04). These children also had 4.5 times lower odds of receiving a continuous passive motion machine (CPM) after surgery (95% CI 1.7-11.7, p=0.002) and were 4.0 times more likely to be immobilized in a cast rather than a brace post-operatively (95% CI 2.0-8.2, p<0.001). Conclusion: Children with public insurance and a tibial spine fracture were more likely to experience delays with MRI and surgical treatment than those with commercial insurance. Additionally, these patients were more likely to undergo open surgery and post-operative casting and less likely to receive a CPM machine.
TIBIAL PHYSEAL RESPECTING TUNNEL DRILLING TECHNIQUE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN SKELETALLY IMMATURE ATHLETES
Authors: Pearce Stephanie S. , Gagliardi Alexia G. , Howell David R. , Albright Jay C. 
Published: July 2021

Background: ACL reconstruction is common in young patients. Hypothesis/Purpose: To report outcomes of a novel tibial drilling technique using an inside-out socket drilling method, with a drill pin and epiphyseal socket drilling in skeletally immature patients. Minimizing disruption to the tibial physis, attempting to prevent growth disturbance with an anatomic ACL that eliminates the graft bend angle at the tibial tunnel. Methods: We used a standard all-epiphyseal drilling technique for femoral preparation. The tibial drill guide, set at 55° for our tibial physeal respecting approach, is positioned in the posterior third of the ACL footprint in-line with the posterior aspect of the lateral meniscus anterior root. The FlipCutter (Arthrex Inc., Naples, FL) is drilled from the external proximal tibia. Thus, only a 3.5mm diameter tunnel crosses the proximal tibial physis. With the FlipCutter deployed, the cutting radius is checked to confirm proper position without risk of damage to the meniscal root, PCL, or articular cartilage. With fluoroscopic guidance, the tibial socket is drilled from the intra-articular surface towards the physis, stopping proximal to the physis. This results in a 15 to 20 mm all-epiphyseal socket length. We collected demographics, re-tear rate, physeal arrest (partial/complete), and patient reported outcomes in order to understand potential problems and mid-term outcomes of this procedure. Results: Eight male patients were included in the study (average age=10.6±1.5 years). All patients had radiographs >6months post-surgery, and no patient had a clinically significant leg length discrepancy (>2cm) or deformity. The two patients followed >24months post-operatively were cleared to return to sports by one year. No patients demonstrated a positive Lachman or pivot shift test at >6months follow-up. No Patients had a ROM deficit at >6months follow-up. Five patients completed Pedi-IKDC and Lysholm assessments (time from surgery=16.2months+10.6months; range 7–28.8months). Average IKDC and Lysholm scores were 88+10 and 95+9, respectively. There were no graft ruptures in the cohort (average follow-up: 13.8months±8.9 months; range 6.8–30.6months). Conclusion: Our preliminary data from this novel tibial physeal respecting technique suggest it may be appropriate for skeletally immature patients with sufficiently large enough femoral epiphyses to hold a 10mm graft tunnel without disturbance to the physis. This technique seems successful in terms of graft survival, patient reported outcomes, and no growth disturbance within 2 years of surgery, although we recognize our small sample size as a limitation. Further studies will better evaluate long-term outcomes of this pediatric ACLR technique.