Objective. To determine the effectiveness of diagnostic ultrasound (US) at evaluating the condition of the radial nerve in the setting of humeral shaft fractures.Materials and Methods. An observational study was performed of 18 patients with radial nerve palsy associated with humeral shaft fractures who underwent US examination to assess the condition of the radial nerve.Results. Six patients with humeral shaft fractures treated nonoperatively in a functional brace had US findings consistent with contusion or stretch radial nerve injury. Twelve patients ultimately underwent surgery either because US showed an entrapped or lacerated radial nerve, or for other operative indications. There was a 92% concordance (11/12 patients) between US and intraoperative findings with regards to the condition and location of the radial nerve, with the remaining case being complicated by delayed surgical treatment secondary to patient factors.Conclusion. Our study demonstrates that US is an effective diagnostic tool in evaluating radial nerve injuries in the setting of humeral shaft fractures and can aid in clinical decision making by differentiating between patients with nerve laceration or entrapment who may benefit from surgery from those with neurapraxia managed nonoperatively.

Background: Several methods are available to estimate leg lengths at maturity to facilitate the determination of timing of epiphysiodesis. We compared the Paley multiplier, Sanders multiplier, and White-Menelaus methods in an epiphysiodesis-aged cohort. We assessed intra- and interrater reliability for Sanders skeletal stages and Greulich and Pyle atlas skeletal age. Methods: Actual growth was recorded in healthy, unoperated femoral and tibial segments from an epiphysiodesis database. The predicted and actual lengths were compared with use of the Paley multiplier and White-Menelaus methods, Greulich and Pyle skeletal age, and the Sanders multiplier using Sanders stages. Intra- and interrater reliability were assessed in a separate group of 76 skeletal age films. Results: The cohort included 148 femora and 195 tibiae in 197 patients. Femoral length at maturity was slightly underestimated by the Sanders multiplier and staging, was overestimated by the Paley multiplier and skeletal age, and was most accurately predicted with use of the White-Menelaus formula and skeletal age. All methods overestimated tibial length at maturity. The whole-leg prediction accuracy of the Sanders multiplier and White-Menelaus formula were comparable and were more accurate than that of the Paley multiplier. For Sanders skeletal staging, the interrater reliability varied from 0.86 to 0.88 and the intrarater reliability varied from 0.87 to 0.96. For Greulich and Pyle skeletal age, the interrater reliability varied from 0.87 to 0.89 and the intrarater reliability varied from 0.91 to 0.95. Conclusions: Use of the Sanders multiplier and skeletal stages was more accurate than the Paley multiplier and skeletal age in this cohort. Use of the White-Menelaus formula and skeletal age was slightly more accurate in predicting femoral length and slightly less accurate in predicting tibial length compared with the Sanders multiplier. Intra- and interrater reliability were similar between Sanders skeletal stages and Greulich and Pyle atlas skeletal age. The White-Menelaus formula and skeletal age was the recommended method for predicting lower-extremity segment lengths at maturity and epiphysiodesis effect. Although easier to recall without referencing an atlas and not sex-specific, Sanders skeletal staging does not correspond directly to years of growth remaining, and thus cannot be used with the White-Menelaus formula. Clinical Relevance: The Greulich and Pyle atlas to determine skeletal age and the White-Menelaus formula to determine growth remaining are reliable predictors of epiphysiodesis effect in the lower extremities.

Constriction band syndrome (CBS) is a rare condition where fibrous bands constrict one or more parts of the fetus with varying manifestations such as autoamputation, acrosyndactyly, and neuropathy. However, isolated extremity fractures in the setting of constriction band syndrome are even more rare, with only two reported cases in the literature. There are few guidelines on the management of CBS due to small case numbers, the variability of presentation between patients, and the lack of consensus on etiology and pathogenesis. In this small case series, we describe the presentation and management of three patients at our institution with extremity fractures at the site of severe constriction bands with neurologic injuries or vascular compromise. We also review the literature on this topic to provide further context. Intramedullary stabilization of the fracture with a k-wire allowed for soft tissue healing in two of our patients.

Case An 11-year-old male presented with a mass on the plantar aspect of his right foot initially noted two months prior. The mass was large, firm, and non-tender and was the only presenting symptom. Exam revealed cavovarus foot deformity and altered gait with increased weight bearing on the lateral border of the foot. Work-up revealed a solitary osteochondroma of the plantar aspect of the second metatarsal, which was resected via a dorsal approach. Conclusion Osteochondromas are benign tumors which can present as solitary lesions and are rarely found in the foot. We present the first case in the literature of a solitary osteochondroma arising from the plantar aspect of the second metatarsal, successfully excised via a dorsal approach.

Introduction: Ethnic, racial, and socioeconomic disparities are well-documented in orthopaedics, including pediatric scoliosis. Spanish-speaking patients face compounding disparities in accessing linguistically and culturally concordant physician-patient interactions and patient resources. This study contributes to existing literature by providing an updated and extended analysis of the quality, credibility, and readability of online Spanish-language patient educational materials on pediatric scoliosis. Methods: A search for the top 50 results of “escoliosis en los niños” (scoliosis in children) was conducted across search engines. Spanish-speaking patients are likely to interact with Google, Yahoo, and Bing. Duplicates were removed, primary review assessed inclusion and exclusion criteria, and secondary review evaluated relevance. Each source was assessed independently by two reviewers for the following: categorization, Journal of American Medical Association Benchmark Criteria, Brief DISCERN questionnaire, and the Fernández-Huerta Index for credibility, quality, and readability, respectively. Scores were compared using Wilcoxon rank-sum tests. Results: Of the 61 sources, most were categorized as Physician/Community Hospital, Industry, and News. The median readability score aligned with an eighth-grade to ninth-grade reading level. No websites achieved the recommended reading level (16 threshold for adequate quality. No statistical differences were observed in quality, credibility, or readability between the two most common categories: Physician/Community Hospital and Industry. Discussion and Conclusion: These findings revealed an insufficient standard of resources on pediatric scoliosis that Spanish-speaking patients are likely to access through online search engines. Given disparities in orthopaedic care for Spanish-speaking patients, this highlights a need for increased awareness among healthcare professionals and institutions to create accessible, credible, transparent, and readable resources on pediatric scoliosis in Spanish.

Case: Three cases of pediatric patients with knee injuries from cactus thorns are included. These cases are variable in presentation ranging from acute inflammatory responses to permanent limb deformity secondary to growth arrest. Definitive treatment also varied widely from nonoperative conservative management to multiple arthroscopic and open surgeries. Conclusion: Pediatric cactus thorn injuries have varied presentations, requiring a high level of clinical suspicion for diagnosis and treatment to prevent permanent damage.