Background: The Edinburgh Visual Gait Score (EVGS) is a comprehensive measure of gait abnormalities in children with cerebral palsy (CP) and has good psychometric properties. We conducted this study to determine if a smartphone video protocol could be used to improve the usability and reliability of the EVGS for daily use in a clinic setting. Methods: We used a handheld smartphone camera with slow-motion video technology and a motion analysis application to record and measure the EVGS of 30 ambulatory children with spastic CP. We tested the inter- and intra-rater reliability of various components of the EVGS between two observers. Results: Average age was 7 years 3 months (range 4 – 14 years). The mean (range) EVGS scores for the trunk, pelvis, hip, knee, ankle, and foot were 1.18 (0–3), 0.68 (0–3), 1.1 (0–4), 3.95 (1.5–7.5), 1.87 (0–4) and 4.13 (2–6.5) respectively. Total score was 12.92 (7–21.5). The mean (SD) scores for Gross Motor Function Classification System (GMFCS) levels II and III were 10.73 (3.86) and 14.96 (4.2) (p<0.001). The intra-observer and inter-observer reliability using percentage of complete agreement was 65 – 98.3% and 61.7 – 92.5% respectively, with kappa values ranging from 0.15 – 0.87. Reliability was more for distal limb segments as compared to proximal segments. Conclusion: We have described a simple and reliable method for quantitative OGA of children with CP, using smartphone video technology and motion analysis application, which can be performed by every clinician in an office setting.

The aim of our study was to develop a Cerebral Palsy hip surveillance programme (CPHSP) and analyze short-term results for early diagnosis of hip displacement. Since November 2019, our tertiary paediatric institution adapted (AACPDM) guidelines , considering local needs & resources. All children with CP above age of 2 years were enrolled. Demography, motor type of CP , topography and (GMFCS) level was recorded. Clinically passive hip abduction angle (HAA) and radiographically migration percentage (MP) were measured using HipScreen, a smartphone app on standard AP hip radiographs. Results: Over a year of Covid pandemic , 150 patients were enrolled in CPHSP. 63 patients from Orthopaedics (42%), 56 from Neurology (37.33%), and 31 from Physiotherapy (20.67%). Mean age was 4.99 years , mean HAA was 350 and mean MP was 18.2%. Forty-two cases (28%) unilateral and 108 (72%) were bilateral . There were 16 (10.66%), 40 (26%), 15 (10%), 42 (28.6%) and 37 (24%) patients in GMFCS levels 1.2.3.4.and 5 respectively. 33 patients (22%) with MP ≥ 30% or HAA ≤300 were red flagged as ‘hip-at-risk’. Thirty of these patients (90%) were GMFCS levels IV & V. Average age of hip-at-risk cases was 5.3 years. Mean HAA was 190 with mean MP of 42% . Despite the short duration, a well-organized CPHSP was able to enroll as well as identify at-risk hips more efficiently especially in non-ambulatory children.

Introduction: American football, the most popular sport in the United States, is a contact sport associated with high injury rates. There is a lack of high powered, nationwide analyses characterizing the types of injuries and associated procedures among American football injuries requiring hospitalization. Methods: The Kid’s Inpatient Database was queried for American football sports injuries from 1997-2012. Patient characteristics, hospitalization details, diagnoses, procedures, and perioperative outcomes. Results: 2420 American football injuries were isolated. The most prevalent primary diagnoses were concussion (7.7%), closed fracture of femoral shaft (7.6%), closed fracture of the tibia/fibial shafts (6.5%), unspecified closed fracture of lower leg (4.9%), close fracture of radial/ulnar shafts (2.6%), closed fracture of upper end tibia (2.4%), and closed fracture of lower end radius (2.0%). The most prevalent primary procedures were open reduction of fracture/internal fixation of tibia/fibula (13.8%), open reduction fracture and internal fixation of femur (7.4%), closed red-int fixation of femur (5.4%), open red-int fixation of radius and ulna (5.1%), closed red-int fixation of radius/ulna (3.2%), closed red-int fixation of tibia and fibula (2.7%). 99 patients (4.1%) experienced a complication, the most common being anemia (34, 1.4%), followed by bowel complications (30, 1.0%) and neurologic complications (10, 0.4%). Conclusion: Child and adolescent American football players were most likely to present with concussion, followed by closed femoral, tibial/fibular, or radial/ulnar fractures. 1/3 of hospitalizations occurred on weekends.

Introduction: Track and field (TAF) is a relatively safe, non-contact sport. However, little is known of injuries, procedures, and hospital course. Methods: The Kid’s Inpatient Database was queried for TAF injuries from 1997-2012. Hospitalizations were dichotomized to running and non-running injuries. Patient characteristics, hospitalization details, prevalent diagnoses, procedures, and perioperative outcomes were investigated. Results: 1849 TAF injuries were isolated (951 Runners, 898 Field Athletes). The most prevalent diagnoses for runners were closed fracture of femoral shaft (11.0%), closed supracondylar fracture of the humerus (8.0%), closed ankle fracture (3.0%), closed fracture of the tibia/fibular shafts (2.8%), closed fracture of the upper tibia (2.5%), and concussion with coma (2.5%). The most prevalent procedures were open reduction/internal fixation (ORIF) of tibia/fibula (8.9%), closed reduction internal fixation (CRIF) humerus (7.0%), and (ORIF) of femur (5.7%). The most prevalent diagnoses for field athletes were unspecified lower leg fracture (4.9%), closed fracture of femoral shaft (4.8%), closed supracondylar fracture of the humerus (4.7%), closed fracture of fibular/tibial shafts (3.6%), and concussion with loss of consciousness (2.2%). The most prevalent procedures were ORIF of the tibia/fibula (12.8%), ORIF of radius/ulna (4.9%), CRIF of humerus (3.9%), and ORIF of femur (3.7%). Conclusion: Runners were likely to present with closed femoral shaft, humerus, and ankle fractures. Field athletes were likely to present with lower leg, closed femoral shaft, and humerus fractures.

Pediatric ankle fractures are the second most common physeal injuries, accounting for almost 40% of all physeal injuries. Salter-Harris (SH), Ogden and Dias & Tachdjian (DT) are currently the most used descriptive and surgical planning classifications. Case report radiological exams showed a complex physeal fracture of the distal tibia, combining a SH classification type 2 and 5 in the sagittal view - a type 5 crush injury to the physis anteriorly and a type 2 in the middle-posterior, forming a big and free Thurston-Holland fragment block composed of the tibial metaphysis displaced posteriorly. There is no apparent involvement of the epiphysis and the fracture it's barely visible in AP radiograph. According to the fracture pattern, the mechanism seems to be an axial compression in dorsiflexion position - this faith is also favored by the presence of a calcaneus posterior aspect fracture that is rare, especially by direct trauma. According to DT classification, the most similar mechanism already described is the supination-plantarflexion type, however, in this case there is also a transversal suprasyndesmotic metaphyseal fibular fracture in the tibial fracture level. According to Ogden classification, the most similar pattern described is the type 2A that involves propagation of the fracture forces on the tensile side to create a free metaphyseal fragment. According to our research, it is the first description of this type of fracture - an important warning about a new specific pattern, caused by a particular mechanism, with a new radiological translation and its own treatment requirements.

Purpose: School attendance is closely related to academic achievement according to Department of Education research. We aimed to quantify the amount of days school age children missed due to a fracture, and use this data to assess the likely effect on educational attainment. Method: Data was collected prospectively from A&E records over four months, including all children who had sustained a fracture, between the ages of 5 and 15 years. School attendance data was collected retrospectively from family members via a telephone questionnaire. Results: 108 families responded. In total, average numbers of days spent off school was 5.1days . 8 children were admitted with an average of 1.875 inpatient days. 71 patients were followed up in clinic with an average of 1.85 days off to attend clinic . On average, 3.15 days of missed school due to parental concern [R: 1-27]. DoE data shows that at both Key stage 2 and Key stage 4, the likelihood of achieving expected and excellent educational attainment levels falls as soon as the pupil misses more than 5% of the school days, which is equivalent to 9.75 days. By the time this reaches 15% (29.25 days) the likelihood of achieving top results in GCSE exams has fallen from 81% in pupils with no absence to 29% in children missing 15-20% of the school year. Conclusion: Most children miss only a small number of days. However, in some cases, significant amount of schooling is lost with negative impact education and examination results.

Septic arthritis of the hip in infancy is an orthopaedic emergency that must be treated immediately and effectively to prevent septic sequelae of hip joint. Sequelae following septic arthritis of hip in infants is diverse and include both acetabular and femoral changes. The study was conducted to assess the outcomes and management of septic sequelae of hip following infection during infancy. METHOD: We present our experience of 21 children with post septic sequelae of hip. The hips were classified according to Johari’s classification and managed accordingly. Post-operative children were followed at regular intervals. Outcome was analysed using Hunka’s criteria. RESULTS: 21 hips with mean follow up of 3.1 years. Three children each had Johari type 2 and type 5, 8 children with type 3 and 7 with type 4. They were managed by various surgeries such as pelvic support osteotomy, open reduction of hip, valgus/varus osteotomy and relative neck lengthening surgeries. Patients with type 3A, 3B, and majority of type 4 children had satisfactory results. Treatment of type 5 was challenging and it required multiple surgeries and we achieved satisfactory result in 1 child out of 3 and rest 2 had unsatisfactory result. Stiffness of knee was found in 1 child among 3 children who underwent Pelvic support osteotomy with lengthening. CONCLUSION: Depending on type of sequelae and severity, clinical outcome varies. Early identification of sequelae and appropriate management provides better functional outcome. Procedures like pelvic supportive osteotomy for unstable hip gives satisfactory outcome in terms of painless gait.

Introduction: Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents and has been associated with childhood obesity. It is unclear whether age of onset and body mass index (BMI) affects postoperative outcomes following surgical treatment for nontraumatic SCFE. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Pediatric database was retrospectively analyzed from 2012-2016. Patients with relevant ICD-9 and ICD-10 codes that underwent surgical repair were isolated. Patients were stratified by BMI and age, and postoperative outcomes investigated included complications, readmissions, reoperations, and length of stay. Binary logistic regression analysis was used to analyze the impact of BMI and age on postoperative outcomes. Results: 2700 nontraumatic SCFE patients were identified. In total, 27 (1%) patients had postoperative complications, 31 (1.1%) required reoperations and 6 (0.2%) readmissions. Binary logistic regression analysis revealed patients with BMI ≥35 kg/m^2 were more likely to experience complications than patients with BMI ≤24 (OR=3.0 [1.1-8.6], p=0.041). Patients with BMI 30-34 (OR=1.6 [1.1-2.3], p=0.028) and ≥35 (OR=1.9 [1.2-2.9], p=0.004) were more likely to have extended lengths of stay than patients with BMI 25-29. Regression analysis determined patients aged 12-18 to be more likely to experience complications than patients aged 6-12 (OR=3.4 [1.2-9.9], p=0.023). Conclusion: Patients with BMI ≥35 and those aged 12-18 were at increased risk for post-operative complications. These findings suggest obesity and later age of onset to be predictors of worse postoperative outcomes, and that early adjustments to postoperative management plans in these patients may be necessary.