Background: To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén’s view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. Methods: Six observers estimated the size of step-offs and gaps on Brodén’s view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). Results: An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. Conclusion: Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén’s view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. Level of Evidence: Level IV, case series.

Intraoperative resection level in patients with Hirschsprung disease (HD) is determined by contrast enema, surgeon's intraoperative judgement and full thickness biopsy (FTB) identifying ganglia. This study aims to evaluate diagnostic accuracy of contrast enema and FTB in determination of resection level and whether this can be improved by measuring submucosal nerve fiber diameter. We retrospectively analyzed contrast enema and intraoperative FTBs obtained in our center, determining diagnostic accuracy for level of resection. Gold standard was pathological examination of resection specimen. Secondly, we matched transition zone pull-through (TZPT) patients with non-TZPT patients, based on age and length of resected bowel, to blindly compare nerve fibers diameters between two groups using group comparison. From 2000-2021, 209 patients underwent HD surgery of whom 180 patients (138 males; median age at surgery: 13 weeks) with 18 TZPTs (10%) were included. Positive predictive value of contrast enema was 65.1%. No caliber change was found in patients with total colon aganglionosis (TCA). Negative predictive value of surgeon's intraoperative judgement and FTB in determining resection level was 79.0% and 90.0% (91.2% single-stage, 84.4% two-stage surgery) respectively. Mean nerve fiber diameter in TZPT was 25.01 µm (SD= 5.63) and in non-TZPT 24.35 µm (SD= 6.75) (p = 0.813). Determination of resection level with combination of contrast enema, surgeon's intraoperative judgement and FTB results in sufficient diagnostic accuracy in patients with HD. If no caliber change is seen with contrast enema, TCA should be considered. Resection level or transition zone cannot be determined by assessment of submucosal nerve fiber diameter in FTB. clinical research paper.

Introduction: This study aimed to understand the influence of diet and nutrition items on gastrointestinal symptoms in patients with Hirschsprung Disease (HD). Method: An online questionnaire was created to obtain patient-reported outcomes using the multinational Holistic Care in Hirschsprung Disease Network. This was distributed in Dutch, English, German, Italian, Polish, and Swedish via patient associations. Information on demographics, the extension of disease, current diet, and the influence of food ingredients on bowel function were obtained. Results: In total, 563 questionnaires were answered by parents or patients themselves. The length of the aganglionic segment was short in 33%, long in 45%, total colonic aganglionosis (TCA) in 11%, and involved the small intestine in 10%. Overall, 90% reported following a mixed diet, and 31% reported taking probiotics, with twice as many patients taking probiotics in the TCA group compared to standard HD. Mealtimes and behaviours around eating were affected by 61%, while 77% had established food items that worsened symptoms, and of these, 80% stated that they had worked these items out themselves. A high-fibre diet was followed by 24% and 18% a low-fibre diet. Symptoms were reported, particularly from dairy in 30%, fruits in 39%, pulses in 54%, and sugar in 48%. Conclusions: This first multinational survey on diet and bowel function in HD reports an association between certain dietary items with gastrointestinal symptoms. This study can support an improved understanding of the interaction between food items and bowel function in children with HD. We suggest a multidisciplinary approach to balance dietary exclusions and support adequate growth, preventing nutrition deficiencies and enhancing quality of life.

Background: Go-karting has become an increasingly popular motorsport and leisure activity among children of all ages. However, go-karting is not without risks. The main purpose of this study was to assess the number of pediatric patients presenting at the emergency department of a level-I trauma center following a go-kart-related injury event over a nine-year period. Additionally, this study aimed to provide a comprehensive overview of patient characteristics, trauma mechanisms, injury types and use of safety devices. Methods: A retrospective single-center cohort study identified all patients that presented at the emergency department from January 2015 to December 2023. Data from the Dutch Nationwide Trauma Registry and medical files were assessed, descriptive statistics were conducted, and cohorts—defined by date—were compared: the first cohort from January 2015 to December 2021, and the second from January 2022 to December 2023, with December 2021 marking the moment when Max Verstappen became the first dutchman to win the Formula One World Driver’s Championship. Results: A total of 14 patients were identified, with an incidence rate of respectively 0.86 and 4.0 per year for the cohorts. In the total study population, 86% were male and the mean age was 12 years (range 4–17). Collision was the most common trauma mechanism with velocities even exceeding 70 km/h. Reported use of a helmet and seatbelt were respectively 64% and 29%. The mean Injury Severity Score (ISS) was 8.6 (±8.6). 57% of the patients encountered minor injuries (ISS ≤ 8), encompassing mostly soft tissue injuries, whereas truncal injuries occurred most frequently in moderately (ISS 9–15) and severely (ISS ≥ 16) injured children. Conclusions: This study has found that although the number of cases was relatively low, an increase in injuries was seen after 2021 in go-karting in children. Almost half of patients were seriously injured, requiring admission at the least. Resulting from this, considerations on minimum age for participation, enforcement of the use of safety devices including additional safety measures targeting truncal protection, and more clear laws and regulations are advised.

Purpose: Pediatric renal trauma is uncommon but potentially serious, and is often managed conservatively. Complications may occur, and the clinical value of renal scintigraphy during follow-up remains unclear. This study aimed to assess morbidity and mortality after pediatric renal trauma and to assess the clinical value of renal scintigraphy during follow-up. Methods: This retrospective single-center cohort study included pediatric trauma patients (< 18 years) with renal injuries admitted to a Level 1 trauma center in the Netherlands between January 1, 2001, and December 31, 2024. Mortality and in-hospital complications were assessed, and associations between renal scintigraphy abnormalities and complications during follow-up were evaluated. Results: A total of 72 patients were included, of whom all injuries resulted from blunt trauma. Conservative management was applied in 88% of cases; embolization and nephrectomy were performed in 8% and 3% of patients, respectively. In-hospital mortality was 11% and was attributed exclusively to concomitant traumatic brain injury. Complications occurred in 25% of patients, primarily infections (19%), followed by hypertension during follow up (4%). Renal scintigraphy was performed in 53% of patients, predominantly in those with high-grade injuries; abnormalities were frequently observed (77%) but did not correlate with the occurrence of hypertension, proteinuria, or renal insufficiency during follow-up. Conclusion: Pediatric renal trauma, including high-grade injuries, can often be managed conservatively, and most complications can be treated using medical therapy or minimally invasive interventions. Renal scintigraphy showed no clear association with long-term morbidity and had limited additional value in routine follow-up. Given the potential for late-onset hypertension, structured long-term clinical surveillance with periodic monitoring of blood pressure, proteinuria, and renal function is warranted, particularly after high-grade injuries.