Introduction: The COVID-19 pandemic has affected the practice of orthopaedic surgeons internationally. In addition to procedural barriers and safety concerns decreasing the rates of elective procedures, lockdown measures have decreased the incidence of orthopaedic traumas. The purpose of this study was to determine the impact of the COVID-19 pandemic on pediatric orthopaedic surgery in New Jersey. Methods: We compared surgical cases performed at 4 hospitals in New Jersey during the COVID pandemic between March and December 2020 with the same time period in 2019. Cases were subcategorized into traumas, elective procedures, and urgent cases which included septic arthritis, acute osteomyelitis, and SCFE. Pearson chi-square test was used to compare the proportions of trauma cases between 2019 and 2020. Results: There were a total of 221 operative cases in March-December 2020 compared to 577 cases in the same time period in 2019 (61.7% decrease). During the pandemic there were 116 vs 346 trauma cases (66.5% decrease), 97 vs 196 elective procedures (50.5% decrease), and 8 vs 35 urgent cases (77.1% decrease). Trauma cases represented 60.0% of operations in 2019 and 52.2% of operations in 2020. There was no significant decrease in the proportion of orthopedic trauma cases in 2020 compared to 2019 (χ²=3.66; p=0.06). Conclusions: During the pandemic there were multiple obstacles to obtaining orthopaedic care which impacted case volumes internationally. In addition to the decrease in pediatric orthopaedic elective procedures, the social impact of the pandemic also resulted in a decrease in total pediatric orthopaedic traumas.

During the COVID-19 pandemic, the government of Ireland on the advice of the National Public Health Emergency Team introduced public health measures with an aim to reduce the spread of COVID-19. These lockdown measures included social distancing, limiting social gatherings, closure of schools and cancellation of sporting activities. As a result, a change in paediatric fracture epidemiology was expected. With more time spent at home it was hypothesised that there would be a decrease in fractures related to sporting activities however an increase in fractures related to home activity. One such activity would be the use of trampolines. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics. A retrospective review of the data from 2019 was compared to 2020 data to assess the fracture characteristics and management undertaken. The results found that there was a decrease in the number of total fractures presenting to the hospital and a decrease in the number of fractures requiring operative fixation. A number of factors may have contributed to this. An increase in adult supervision at home during lockdown as well as less simultaneous bouncing of multiple children may have increased the safety for children. With some proponents calling for limiting of use of trampolines due to safety concerns and injuries clogging up emergency departments this has implications for childhood obesity levels particularly in a time when children are living a more sedentary lifestyle. We would propose the continued supervised use to maintain healthy activity levels.

Introduction: The outbreak of COVID-19 and the resultant lockdown has had a great impact on global healthcare. This study was done to analyse the spectrum of paediatric orthopaedic trauma in a tertiary care hospital during the initial phase of the pandemic in United Kingdom. Methods: Outpateint and inpatient data registry during the first lockdown from March to July 2020 was used to analyse the spectrum of paediatric orthopaedic trauma. This study was performed in a paediatric orthopaedic department at a tertiary orthopaedic centre. Results: Total of 381 patients presented with orthopaedic trauma to the hospital of which 69(18.11%) patients required management in operation theatre. Amongst the 381 patients 186(48.81%) had fractures and 195(51.18%) had soft tissue injury. There were 100 upperlimb fracture and 86 lowerlimb fractures. Most common upperlimb fractures were Elbow (51) and Forearm (19) whereas in the lowerlimb foot and ankle (42) and tibia (26) were the highest. Vehicular accidents, falls during playing and trampoline related injury were the most common mechanisms. Conclusion: This study has implications as to developing resources particular to COVID19 era injuries.

Introduction : Growth modulation through temporary Hemiepiphysiodesis is becoming the preferred treatment in treating pediatric lower limb deformities as it is minimally invasive than the traditional osteotomy. Infections around the knee in a skeletally immature child have been known to result in various progressive deformities. In this study we focused on evaluating the deformity correction achieved, outcome and complications of use of 8-plates for guided growth in post-infective deformities of the knee. Methodology : We studied 17 patients with knee angular deformities secondary to infective etiology managed with 8-Plate guided growth. Plain radiographs were analyzed at the time of operation and at hardware removal that included measurement of deformity. Time until hardware removal, correction achieved and complications were recorded. Results :The plates were inserted for an average of 16 months. 82% patients showed improvement in the mechanical axis. In both genu valgum and in genu varum the tibiofemoral angle improved significantly and 8-plate prevented further worsening of the deformity. Two patients had no significant improvement in deformity. Screw loosening was observed in 2 patients. There were no other complications noted or recurrent infections. Conclusion : Growth modulation with 8-plate is an effective method to correct post-infective deformities around the knee with minimal complications. Its ease of application, good deformity corrections achieved and lesser morbidity makes it a good option in post-infective deformities of the knee in skeletally immature child.

Objective: To compare between immediate and delay weight bearing with the use of Hydroxyapatite-coated Schanz pins in external fixation as regard osteointegration and pin tract infection.
Methods and materials: Our protocol included 43 adult patients: all treated for nonunion or deformity by uniplanar external fixation (orthofix or similar devices) and Hydroxyapatite-Coated Schanz pins for fixation. We compared pins osteointegration and pin tract infection rate and timing in 2 groups based on duration of delay for weight bearing of 6 weeks. Group A (16 patients): immediate post-operative weight bearing “early group”. Group B (27 patients): weight bearing delayed for 6 weeks “6w group”.
Results: Patients were followed up for 6 weeks. Non-significant difference between both groups as regards age and duration of external fixation (p>0.05), non-Significant difference between both groups as regards sex distribution (p>0.05). The same for diagnosis and number of pins used. Significant difference between both groups as regards number of infected pins; (The early group (n=27); 59.3% are 0; 22.2% are 1; 14.8% are 2; while 3.7% are 3. Among the 6w group (n=29); 93.1% are 0; 6.9% are 1 (p<0.001).).
Conclusion: The results of 6 weeks duration of delayed weightbearing is superior to the results of immediate post-operative weightbearing in adult patients treated for nonunion or deformity by uniplanar external fixation (orthofix or similar devices) and Hydroxyapatite-Coated Schanz pins regarding osteointegration and pin tract infection rate and timing.

Introduction: A promising application of Mesenchymal stem cells (MSCs) is the treatment of non-unions. Substituting bone grafts, MSCs are directly injected into the fracture gap. High cell viability seems to be a prerequisite for therapeutic success. Administration of the MSCs via injection creates shear stresses possibly damaging or destroying the cells. Aim of this study was to investigate the effect of the injection process on cell viability. Methods: MSCs were isolated and cultivated from femoral tissue of five subjects undergoing arthroplasty. Prior to injection, the cells were identified as MSCs. After dissolving to a concentration of 1 Million cells/ml, 1 ml of the suspension was injected through a cannula of 200 mm length and 2 mm diameter (14 G) with flow rates of 38 and 100 ml/min. The viability of the MSCs at different flow rates was evaluated by staining to detect the healthy cell fraction. It was analyzed statistically against a control group via the Kruskal-Wallis-test and for equivalence via the TOST procedure. Significance level was set to 5 %, equivalence margin to 20 %. Results: The healthy cell fraction of the control group was 85.88 ± 2.98 %, 86.04 ± 2.53 % at 38 ml/min and 85.48 ± 1.64 % at 100 ml/min. There was no significant difference between the fraction of healthy cells (p = 0.99) for different volume flows, but a significant equivalence between the control group and the two volume flows (38 ml/min: p = 0.002, 100 ml/min: p = 0.001).

Great controversy exists on the ideal treatment of displaced supracondylar Type II Gartland fractures of the humerus in the pediatric population.The purpose of this study is to compare which method, the Closed Reduction Application of Long Arm Posterior Splint versus the Closed Reduction Percutaneous Pinning, is superior in the repair of this fracture thru the comparison of the post- operative radiographic outcome using Baumann’s angle and Anterior Humeral Line radiographic parameters and functional outcome by evaluation thru Mayo Elbow Performance Score.
Methodology:This is a prospective, randomized, double-blind study with 51 pediatric patients.The enrolled participants were randomly allocated to one of the two groups to receive either Non Operative technique or Operative Technique. Radiographic and Functional outcome was evaluated postoperatively.
Results: The Operative Group exhibited significant superiority vs the Non Operative Group thru the results in the post-operative radiographic outcome utilizing the Anterior Humeral Line with a p-value of 0.03. The Baumann’s Angle have no significant difference between the two groups.The resultant Baumann’s Angle of the respondents in both interventions from the third week to one-year post operatively were within 64 to 80 degrees. Moreover, the Operative group demonstrated a better Mayo Elbow Performance Score Total per follow up with a p-value of 0.00, respectively.
Conclusion: We therefore conclude that the Operative technique and Non Operative technique may be both effective as an interventional management to patients with Gartland II supracondylar fracture; with the Operative technique exhibiting advantage over the Non Operative technique as manifested by post-operative radiographic and functional outcome.

Supracondylar humeral fracture are the most frequent around the elbow in the pediatric population. However, treating these fractures represents a challenge. The ai mis to review the literature based on a case. An 8-year-old boy presented with a distal humerus fracture type III with an intermediate fragment. The reduction was performed, immobilized with a plaster splint, and follow-up was scheduled for the following week. Then the loss of reduction was verified and the patient was admitted for surgical treatment. Intramedullary nailing was initially considered, but due to the pattern of the fracture that extended to the metaphysis and the presence of a third fragment, a lateral external fixator was chosen. At follow-up, there was a gradual improvement in range of motion. The external fixator was removed 6 weeks after surgery, when union was demonstrated. Closed reduction and percutaneous Kirschner wire fixation represents the classic treatment for displaced supracondylar humerus fractures in pediatric patients. This type of treatment requires satisfactory reduction of the fracture. Failure to achieve adequate reduction may result in instability of the fragments, which may result in an unsatisfactory cosmetic or functional outcome. These problems can be overcome with the use of a lateral external fixator. It prevents the occurrence of a secondary displacement and ulnar nerve injury can be avoided. This method allows immediate elbow range of motion and is well accepted by children and parents. This technique is useful to avoid open reduction when satisfactory reduction cannot be achieved with standard closed manipulation methods.

Background: Few studies have evaluated the impact of supracondylar humeral fractures on children’s development. This work aims to clarify to what extent the surgical treatment of these fractures affects life experiences and functional outcome of a young adult. Methods: Retrospective long term follow-up study of children with supracondylar fracture of the humerus treated surgically. Mobility deficits and Mayo score were evaluated between 2-4 years after the fracture. In adulthood, 15 years after fracture, a questionnaire was carried out assessing the limitations during growth, pain, cosmetics, function and mobility. Results: Initial sample included 111 patients with mean age of 6,3 years. 37 patients attended to the first evaluation and 69 answered to final inquiry. Non dominant limb and Gartland type III fractures were predominant. In the first evaluation mean Mayo score was 98,04 and 40,5% of patients showed some mobility deficit (18,9% < 5° and 21,6% > 10°). 85,5% practiced sports during childhood. In the long-term, patients with fractures at an older age had more complaints regarding mobility deficits. There was no relation between worse results in the first follow up and long-term results. Patients with neurologic complications demonstrated more pain at rest and worse satisfaction with function in the long term. Conclusions: The short and long-term outcomes of supracondylar surgical factures of the humerus is generally satisfactory. No relation between mobility deficit and long-term results was found. Older age at the time of fracture and nerve injuries may be associated with slightly worse functional satisfaction and long-term pain, respectively.

Introduction: ankle valgus (AV) is a common deformity in patients with multiple hereditary exostoses (MHE). Surgical treatment options include growth modulation techniques and corrective osteotomy at CORA level. We developed differential approach to AV treatment in MHE patients depending on age and severity of the deformity
Methods: We treated 11 Pts - 21 limbs (9♂ and 2♀). Av.age – 9 y 8m (range 7-17 years). PreOp X-ray (AP&Lat) with CORA and ankle radiographic parameters (LDTA, ADTA) were assessed. Differential approach to the AV surgical treatment were used. In Group 1 (6 patients, 11 limbs) who were < 13 years with mild to moderate deformity (78⁰≤LDTA≤86⁰) we used growth modulation techniques. In Group 2 ( 5 patients, 10 limbs) - who reached skeletal maturity or had severe deformity ((≤LDTA≤78⁰)) we performed corrective distal tibia osteotomy with ExFix application. PostOp ankle radiographic parameters and complication rate were analyzed in 1-2 years after completed surgical treatment. Variables were tested with the Mann– Whitney U-test.
Results: Mean PreOp ankle radiographic parameters In Group 1: LDTA – 81±3⁰; ADTA -80±3⁰. In Group 2 –LDTA – 75±4⁰; ADTA - 77±3⁰.
Mean PostOp ankle radiographic parameters in Group 1: LDTA – 87±2⁰; ADTA - 80±2⁰. In Group 2 – LDTA – 88±2⁰; ⁰; ADTA - 78±3⁰.
Ankle radiographic parameters were changed significantly (p<0.05) in all Pts from both groups after surgical correction. 3 minor complications observed which were treated conservatively
Conclusions: proposed differential approach to AV surgical treatment in MHE patients is effective and safe

Inclusion criteria - patients with severe deformation of long bone segment i.e. 60 or more degrees of deformity in one plane, prolonged treatment with BPs, and no previous surgery. Medical records were reviewed for number of BPs infusions before the surgery, as well as preoperative radiographs with IM obliteration or sclerosis of the tibia or femur. IM sclerosis was measured on lateral radiographs because severe deformed segments had a specific "rib shape". Both ends points of sclerotic area were determined, and a whole surface of sclerotic area as well as percentage of sclerotic part was calculated. Measurements were three times and final result was arithmetic value. Varus and procurvatum angles were measured. Our control group were surgically treated OI patients without IM sclerosis but matched to age and severity of disease. 17 segments (14 femurs and 3 tibias) in 9 patients which had some amount of IM sclerosis, most often on the place of the apex of the deformity. Obstacles during surgery : splitting of bone during drilling; drill breakage; “false route”; prolonged surgical time and increased blood losses. Suggestion on how to avoid surgical obstacles: precise preoperative planning; careful surgical technique due to poor bone quality; gradual, slow IM reaming; exchange of usage of surgical drill and manufacturer designed drill; many orthogonal radiographic intra-operative controls; excision of triangular sclerotic bone block. The prolonged BPs therapy leads to long bone IM sclerosis and one should correct deformity earlier. The threshold for operative treatment should be 15 cycles of BPs infusions.

Orthopaedic surgery is the most effective intervention to correct deformities and break the fracture cycle in Osteogenesis imperfecta (OI). This allows better motor function and independence. This study evaluated functional results of patients with OI who underwent correction of lower limb deformities with Fassier Duval telescopic nails. 49 patients were treated between 2007 and 2020. 24 boys and 25 girls with a mean age of 7.8 years (87 femurs and 64 tibias with a mean follow-up time of 6.85 years).Number of fractures, acquisition or improvement of gait, need for reoperation and quality of life were analyzed. Fractures decreased significantly (483 to 25). Improvement in gait was significant (motor functional scale).Group I, with 22 patients and 77 bone segments operated on in the first half of the total time, with average follow-up of 11.06 years. Group II, with 27 patients and 74 bone segments operated, had an average follow-up of 3.42 years. Average duration of the surgical procedure was 134.6 minutes for Group I and 127.1 minutes for Group II. All patients had physical scores below the average of healthy children. The FD nail is a good method of intramedullary fixation for the long bones of the lower limbs. All children showed a decrease in the fracture rate and an improvement in the gait pattern. The reoperation rates were within the expected average according to the literature. Surgical time and the mean age of the operated patients decreased with the increase in the team's experience.