Forearm shaft fractures are common injuries, often caused by falling from a fully-upright position or falling off a bike. They can be treated nonoperatively or surgically with intramedullary nailing or plates. The method of choice for treating pediatric forearm shaft fractures is the application of elastic stable intramedullary nailing (ESIN)|. The aim of the study was to evaluate ESIN in pediatric patients with forearm shaft fractures based on radiological images, and determine the etiology and complication rate associated with the injury. The study included 201 patients, 30.5% female 69.5% male, aged 1 to 17 years (mean 9.1 years; SD = 3.2), all had been diagnosed with a fracture of the forearm shaft and had been treated surgically with ESIN. In addition, all possessed a complete set of X-ray images and had attended a minimum six-month follow-up examination of the forearm. Axial alignment was evaluated retrospectively in the anatomical (AP) and lateral (LAT) positions. In total, 402 radiographs were examined. Of the injuries, 68% occurred during sports activity and 75% involved both the radius and the ulna. Union was observed in all cases. Mean axial alignment values in AP and LAT X-ray or both the ulna and radius were satisfactory. Axial alignment values were not influenced significantly by age, type of surgery, type of fracture or etiology. Plaster cast application (9.8% of cases) significantly influenced radius axial alignment. The complication rate was 11.4% (n = 23). Significantly more complications were observed in patients receiving open reduction internal fixation (ORIF) (p = 0.0025). The ESIN technique is an effective treatment for forearm diaphyseal fractures in children, with good results regarding reduction and bone healing, indicated by x-ray.

Background: In the literature there are divergent results as to the native MPFL length change pattern. The reason for such divergent results may be the heterogeneity of design of studies analyzing MPFL isometry. The hypothesis of this review was that studies assessing MPFL length change pattern are highly heterogenous. The aim was to present a state-of-the-art review of sources of this heterogeneity. Materials and Methods: A total of 816 records were identified through the initial search of MEDLINE and Scopus databases. After eligibility assessment, 10 original articles and five reviews were included. In the included studies, the following 15 potential sources of heterogeneity were assessed: number of patients/cadavers, age, males to females ratio (demographics), identification of measured fibers, measurement method, measurement precision, quadriceps muscle activity, iliotibial band activity, hamstrings activity (study design), patellar height, trochlear or patellar dysplasia, femoral anteversion, mechanical axis of the limb, tibial tubercle–trochlear groove distance, and condylar anteroposterior dimensions (morphology). Each variable was graded in every included article with 1 point if reported precisely and not introducing bias; or with 0 points if reported not precisely, introducing bias, or not reported at all. Results: Within original articles, the highest achieved score was 10 out of 15 possible points with mean score of 6.7, SD = 2.37, and minimum score of just 3 out of 15 points. In the demographics section, mean score was 2.4, SD = 0.8 (80% of maximum possible score of 3); in the study design section it was 3.1, SD = 1.87 (52% of maximum possible score of 6); and in the morphology section it was 1.5, SD = 1.43 (25% of maximum possible score of 6). Conclusions: There is high heterogeneity and incomplete reporting of potential sources of bias in studies assessing native MPFL length change pattern. Future investigators should be aware of the presented factors and their potential impact on MPFL isometry. All methodologic factors should be meticulously reported. Detailed description of demographic data is already a standard; however, authors should more extensively report variables concerning study design and morphology of patients’ patellofemoral joint. Furthermore, future studies should try to meticulously simulate the real-life working environment of MPFL and ensure usage of proper measurement methods.

Background: The FAUCS technique has been proposed as an alternative cesarean section approach potentially associated with improved postoperative recovery. Objective: To compare postoperative pain characteristics, functional recovery, analgesic requirements, and psychological outcomes between women undergoing intraperitoneal cesarean section (CS) and FAUCS cesarean section. Methods: A total of 201 women were included in this prospective single-center observational cohort study (CS: n = 101; FAUCS: n = 100). Postoperative pain intensity was assessed using the Numerical Rating Scale (NRS) and the McGill Pain Questionnaire. Functional recovery, emotional status, analgesic intake, and anxiety levels were evaluated during the early postoperative period. Results: FAUCS was associated with significantly lower pain intensity on postoperative day 0 (adjusted β = −1.97, 95% CI −2.63 to −1.32; p < 0.001), lower total McGill Pain Questionnaire scores (adjusted β = −2.85, 95% CI −4.68 to −1.02; p = 0.002), and lower sensory McGill scores (adjusted β = −2.59, 95% CI −4.31 to −0.86; p = 0.003). Time to first sitting and standing was approximately 10 h shorter following FAUCS (both p < 0.001). FAUCS was also associated with lower anxiety levels, better functional independence and overall well-being, and substantially lower weak opioid use (adjusted RR = 0.11, 95% CI 0.03–0.45; p = 0.002). Conclusions: FAUCS was associated with improved early postoperative functional recovery, lower pain burden, lower anxiety levels, and better overall well-being compared with intraperitoneal cesarean section. These findings should be interpreted in the context of the observational, non-randomized study design.

Not available Keywords: ovarian cancer umbilical hernia