Background: Distal tibia fractures are common in the pediatric patient population. Recent reports suggest that patients with closed low-energy distal tibial fractures treated with short leg casts (SLCs) have similar radiographic outcomes with improved functional outcomes compared to those treated with long leg casts (LLCs). However, to date there has not been a study comparing these treatment modalities for Salter-Harris (SH) II distal tibia fractures. The purpose of this study was to compare the radiographic and time to weightbearing outcomes between patients with SH-II tibial ankle fractures treated with an SLC vs an LLC. Methods: A retrospective review on SH-II distal tibia fractures was performed at a Level I pediatric trauma center from 2013 to 2020. Primary outcomes included final coronal angulation, sagittal angulation, and time to weightbearing. Results: A total of 59 patients with SH-II distal tibia fractures were treated with an SLC (22 patients, median age 11.79 years) or an LLC (37 patients, median age 12.17 years). There was no statistically significant difference between the 2 treatment groups for coronal angulation at final follow-up, sagittal angulation at final follow-up, or percentage of patients fully weightbearing at 6 weeks ( P > .05). No patients required subsequent remanipulation or operative treatment in either treatment group. Conclusion: In this retrospective review with relatively short-term follow-up, SLCs were found to be noninferior to LLCs for treatment of reduced SH-II distal tibia fractures. This casting option may still be considered by surgeons who are nonoperatively managing pediatric distal tibia fractures. Level of Evidence: Level III, retrospective comparative study.

Background/Objectives: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder characterized by the posterior and inferior slippage of the femoral head through the growth plate. This study aimed to assess seasonal trends in the incidence of SCFE above 40° N latitude using cosinor regression analysis. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registration in Prospero. A keyword search of PubMed, Scopus, Web of Science, and Ovid was conducted using terms related to SCFE and seasonal or monthly variation. Studies were included if they reported month-by-month SCFE incidence in pediatric populations. Studies were excluded if they had duplicated population cohorts. Data from studies conducted above 40° N were extracted for cosinor regression analysis. Quality assessment was performed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: A total of seventeen studies were included, amassing a total of 21,428 children analyzed. Six investigations reported monthly incidence data for populations > 40° N. The highest pooled monthly incidence was observed in August (482 cases). Alternatively, February was the month with the lowest SCFE incidence (293). Cosinor regression analysis demonstrated that SCFE occurs more frequently during early summer and fall months (p < 0.0001). Conclusions: SCFE incidence follows a significant seasonal trend in higher-latitude (>40° N) populations, with a consistent late-summer peak. Recognizing seasonal variation patterns may inform early diagnosis and intervention in SCFE, improving outcomes in pediatric physeal injuries.

Case: A 12-year-old adolescent boy presented after a low-energy fall with groin pain, inability to bear weight, painful passive range of motion, fever, elevated inflammatory markers, and upper respiratory symptoms. Initial radiographs did not demonstrate any abnormality, and magnetic resonance imaging suggested infection. Posterior wall acetabular fracture was not diagnosed until a computed tomography–guided biopsy was performed. Conclusion: Pediatric acetabular fractures are exceedingly rare. They can be difficult to diagnose after low-energy trauma as symptoms mimic infectious hip pathologies. Children presenting with infectious hip symptomology and a history of trauma may benefit from more extensive trauma imaging before costly and invasive infectious diagnostic procedures.