Background: The frequency, pattern, and treatment of pediatric hand fractures are rarely reported. We sought to review our institution’s experience in the management of pediatric hand fractures. Methods: A retrospective review of children and adolescents (younger than 18 years) treated for hand fractures between January 1990 and June 2017 was preformed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, or intra-articular metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) fractures. Patients were categorized into 3 age groups (0-5, 6-11, and 12-17 years). Results: A total of 4356 patients were treated for hand fractures at a mean ± SD age of 12.2 ± 3.5 years. Most fractures occurred in patients aged 12 to 17 years (n = 2775, 64%), followed by patients aged 6 to 11 years (n = 1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the proximal/middle phalanx (48%), followed by metacarpal (33%), distal phalangeal (12%), and intra-articular MCP/PIP/DIP joints (7%). Proximal/middle phalangeal fractures were the most common in all age groups. About 58% of intra-articular MCP/PIP/DIP fractures in patients aged between 0 and 5 years required open reduction ± fixation, and the remaining 42% fractures were amenable to closed reduction. In patients older than 5 years, about 70% of these fractures were amenable to closed reduction. All age groups included, most metacarpal (93%), proximal/middle phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed reduction alone. Conclusions: The frequency, pattern, and treatment of hand fractures vary among different age groups. Understanding the pattern of these fractures helps making the right diagnosis and guides choosing the appropriate treatment.

Introduction: Cholecystocolonic fistula is a rare condition and is found in roughly 1 in every 10,000. It represents 6.3% to 26.5% of all cholecystenteric fistulas (Chowbey et al., 2006; Angrisani et al., 2001; Yamashita et al., 1997). Cholecystocolonic fistula is the second most common intestinal fistula after cholecystoduodenal fistula (Costi et al., 2009). Rarity of this condition, atypical presentation, diagnostic and management challenges, makes it a unique surgical entity. Case presentation: A 77-year old male presented with progressive abdominal distension and diarrhea. After initial evaluation, a cholecystocolonic fistula was suspected. Further diagnostic studies including Hepatobiliary Imino-Diacetic Acid (HIDA) scan and Endoscopic Retrograde Cholangiography (ERC) revealed complete occlusion of the cystic duct that could not be relieved. Shortly after, the patient developed septic shock likely of biliary origin and required an urgent open partial cholecystectomy and segmental resection of the involved colonic segment. Discussion: In this particular case, the acute presentation together with the inflammatory features around the gallbladder pointed toward an acute inflammatory process and therefore we have tried to delay any operative intervention to allow the inflammation to subside and avoid operating in an inflamed field. Furthermore, our aim was to relieve any sort of biliary obstruction to allow the fistula −if present- to heal by minimizing bile flow through the fistula. Relieving biliary obstruction was not successful in our patient. Conclusion: Based on our experience with this particular case, we could safely conclude that an operation for cholecystocolonic fistula presence in the setting of biliary obstruction that failed decompressive attempts should be performed in an urgent fashion to avoid biliary sepsis development. Highlights:

Background: Despite increased adoption of virtual surgical planning (VSP) in various craniofacial indications, the incorporation of VSP/3DP into facial trauma care remains limited. Therefore, Expedited Preoperative Point of Care for Fracture Reduction to Normalized Anatomy and 3DP to Improve Surgical Outcomes (EPPOCRATIS) was introduced in 2021. This study evaluates our experience with EPPORATIS in craniomaxillofacial trauma over 10 years. Methods: A retrospective review of patients who underwent facial trauma repair between September 2014 and September 2024 was conducted. For each VSP/3DP case, a patient with similar facial trauma patterns, who was treated without VSP, was selected. Evaluation metrics included operative time, blood loss, length of stay, complication rates, and fracture reduction accuracy through 3D heatmap analyses. Operative metrics were normalized by implant (i.e., fracture plates and screws) count to account for fracture complexity. A value of p < 0.05 was deemed statistically significant. Results: The VSP group presented with more complex injuries and higher involvement of various surgical specialties (p < 0.5) and demonstrated longer operative times (p < 0.03). Although the difference was not statistically significant (p = 0.4), when adjusted for implant count, the VSP group had shorter operative times (median: 15.4 vs. 19.3 min/implant) and reduced blood loss compared to non-VSP cases (median: 3.4 mL/implant vs. 4.2 mL/implant). Complications, revision rates, and length of stay showed no significant differences. Conclusions: The use of VSP/3DP (EPPOCRATIS) in craniomaxillofacial trauma reconstruction demonstrated operative efficiency and accurate fracture reduction in complex cases. Further studies are needed to examine the feasibility and cost-effectiveness of point-of-care VSP/3DP in trauma centers.

Objective: Our goal is to address the health literacy gap concerning cleft lip and palate using artificial intelligence (AI), specifically OpenAI's ChatGPT-4, to enhance the readability of patient educational materials (PEMs). Additionally, we aim to explore the integration of interactive educational materials into these resources. Design: A cross-sectional study. Setting: Websites of craniofacial teams approved by the American Cleft Palate-Craniofacial Association (ACPA). Patients/Participants: PEMs collected from these websites. Interventions: First, we examined the PEMs for interactive educational content such as videos, photos, case examples, and audio clips. Subsequently, we used the WebFX online readability calculator and Grammarly to evaluate the texts’ readability and clarity. After that, we used ChatGPT-4 to simplify the PEM texts to a 6th-grade reading level and re-evaluated their readability and clarity. Main Outcome Measure(s): Readability levels (grade level) and clarity scores of PEMs before and after AI modification, and the presence of interactive educational content. Results: Initial evaluations using the Flesch-Kincaid Grade Level formula showed that the texts were written at a median 9th-grade reading level. Modifications using ChatGPT-4 significantly improved readability, achieving a median 6th-grade level and enhanced clarity. Only 27% of the websites featured interactive educational content, indicating a gap in utilizing educational enhancements. Conclusion: The use of AI improved the readability and clarity of patient educational materials, aligning with recommended standards. However, the underutilization of interactive tools suggests a need for broader integration of these resources to optimize patient education and engagement.