Adolescent Injury Research Articles

Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)

Abstract Background The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions. Methods A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents. Results A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%). Conclusions The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.

Machine Learning powered Patient Records Analysis for Injury Monitoring in Children and Adolescents

Abstract Background Injuries to children and adolescents are common and are associated with individual suffering and costs. Switzerland lacks data of injuries in children and adolescents. This study investigates the feasibility of utilizing machine learning (ML) methodology to automatically extract relevant data from electronic pediatric patient records needed for monitoring and prevention purposes. Methods The feasibility study follows three steps. 1. Utility evaluation of text data from electronic pediatric patient records regarding ML, injury monitoring and prevention requirements in a test-sample. 2. The development of an ML-based approach to extract relevant information based on electronic pediatric patient records (N = 30’884) of children treated for injuries at the University Children’s Hospital Zurich emergency department between 2018-2022. 3. The performance of the ML methodology is evaluated. Results Qualitative and ML expert assessment of the sample showed that the desired data on injuries is contained in the test-sample and necessary requirements are met. Data records differ in detail with severe injuries providing especially rich information records. The international IDB code-tree was proved to be too elaborate and adult-orientated and was adapted. Preliminary data analyses indicate that the number of accidents is highest in the age group from 0 to 4 years (36%). More male (58%) children were treated. Majority of accidents were classified as less severe (73%), few (<1%) as very severe. Further lessons learned, along with more detailed prevalence data on injuries in children and adolescents, will be available by August 2024. Conclusions Extraction of injury information from electronic patient record by means of ML may provide valuable information for injury monitoring and prevention, so far missing in Switzerland. Prerequisites for the successful application of ML are digital record access, usable coding-tree, and detailed text input by the emergency departments. Key messages • An ML-based approach has the potential to improve the data basis by extracting valuable accidents information from existing texts of patient records. • To successfully apply this method, digital record access and detailed text data are needed.

Preventing unintentional injuries in children: the parents’ beliefs matters (CHILD Vigilance)

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention & Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. For children the majority of these injuries occur in or around the home when their safety is the responsibility of a parent or other caregiver. The study aims contribute to the epidemiological knowledge of injuries through the study of the perceptions of parents and caregivers of children and adolescents. A descriptive, observational, cross-sectional study was developed under the CHILD Vigilance project, developed at European level within the scope of the Injury Prevention & Safety Promotion Section of the European Public Health Association. The information was collected by survey, from parents’ associations and schools in the EU countries represented in the EUPHA INJ Section. A total of 916 valid responses were obtained, involving 1229 children (51,4% male; mean age 7,8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). However it was found differences in these countries as to the most common type of injury in adolescents, pointing out road traffic crashes (41.2% in Greece vs 39.5% in Portugal) and poisonings in Lithuania (38,1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported the main cause in the pre-schoolers (62,5%; 35,1%) and in primary education (55,1%; 29,7%), being injuries pointed as the most frequent cause only in the oldest. The study emphasizes the need to invest in the identification of appropriate determinants of child unintentional injuries and harmonised injury outcomes across global initiatives. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • The need for adequate epidemiological data on the burden of child injuries and validated tools to accurately measure injuries.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Paediatric e-scooter riders at high risk of life-threatening traffic accidents.

This study presents the epidemiology and the development of e-scooter and non-electric scooter injuries in children and adolescents to highlight the nature and the severity of such injuries. All children and adolescents with electric or non-electric scooter related injuries between January 2019 until December 2022 were included in this single-centre study and retrospectively evaluated. An epidemiological overview including age, sex, type of scooter, injury mechanism, diagnosed injuries and surgical interventions were presented. Further, statistical comparisons of the means and proportions of injuries and the number of surgical interventions between electric and non-electric scooter riders were made. The study consists of 633 children and adolescents (9.1 ± 5.0 years; 231 female, 36.5%, 402 male, 63.5%). 80.1% (8.0 ± 4.1 years) used non-electric scooters, while 19.9% (14.2 ± 4.1 years) used e-scooters. In comparison, adolescent e-scooter riders were significantly more likely to be involved in traffic accidents (non-electric scooter: 16/507; e-scooter: 21/126; p = 0.0001) and suffered severe head injuries more often (non-electric scooter: 8/134; e-scooter: 7/37; p = 0.0217) than patients riding non-electric scooters. Adolescent e-scooter riders were more likely to be involved in potentially life-threatening traffic accidents having a higher risk of severe head injuries requiring surgery compared to non-electric scooter riders. Adolescent e-scooter riders have a higher risk to be involved in potentially life-threatening traffic accidents than riders of non-electric scooters. E-scooter riders have a higher risk of sustaining serious head injuries requiring surgical intervention than non-electric scooter riders. The data highly recommends the implementation of prevention strategies especially educating youth and parents and wearing protective clothing. Legislation and law enforcement could help prevent such injuries and potentially life-threatening traffic accidents involving children and adolescents who ride e-scooters.

Cognitive Behavioral Therapy (CBT) in Reducing Symptoms of Self Injury in Adolescents with Depression Major Disorder

Self injury is the behavior of self injuring in various ways regardless of whether or not there is an intention and desire to die. Self injury behavior in adolescents can have a long-term impact on adulthood. The purpose of this study is to reduce the behavior of adolescents who injure their hands with major depressive disorder using Cognitive Behavior Therapy (CBT) techniques. To achieve this goal, CBT therapy was conducted for 3 weeks with 3 times a week. This study uses CBT theory helping clients to examine the validity of their thinking and to see how they interpret or evaluate something that happens and its effect on emotional and behavioral experiences. The subjects in this study were junior high school students. The data analysis process used visual graph techniques. The results of this study showed that CBT therapy was able to reduce self-harm behavior in adolescents with major depressive disorder.

Epidemiology of injuries among children and adolescents from the Xinglin District in Xiamen, 2016-2019.

To investigate the epidemiology of injuries among children and adolescents in the Xinglin District of Xiamen from 2016 to 2019. This study collected data from patients who attended the outpatient and emergency departments of the Xinglin District at the First Affiliated Hospital of Xiamen University between January 2016 and December 2019, diagnosed with injuries. A total of 13,123 patients were included, categorized into age groups 0-4 (n = 4,834), 5-9 (n = 3,924), 10-14 (n = 2,671), and 15-18 (n = 1,694). The rates of unintentional injuries were 97.00%, 96.94%, 94.50%, and 90.08% in the 0-4, 5-9, 10-14, and 15-18 age groups, respectively (P < 0.001). The proportion of head injuries decreased with age (from 41.13% in the 0-4 age group to 18.00% in the 15-18 age group), compensated by an increase in rates of injuries to upper and lower extremities and multisite injuries (P < 0.001). The most common causes of injuries were fall-related injuries (30.46%-52.05%), followed by mechanical injuries (18.35%-36.42%), with the rates of fall-related injuries decreasing with age and rates of mechanical injuries increasing with age (P < 0.001). Age-period-cohort models revealed that the time factor was not significant for fall-related injuries and mechanical injuries (all P > 0.05) despite apparent increases in incidence over time. Injuries in children and adolescents continue to be a significant public health concern in the Xinglin District (China), predominantly driven by fall-related injuries and mechanical injuries.

Neural response to monetary incentives in acquired adolescent depression after mild traumatic brain injury: Stage 2 Registered Report.

Depression is a common consequence of traumatic brain injury. Separately, spontaneous depression-arising without brain injury-has been linked to abnormal responses in motivational neural circuitry to the anticipation or receipt of rewards. It is unknown if post-injury and spontaneously occurring depression share similar phenotypic profiles. This issue is compounded by the fact that nearly all examinations of these psychiatric sequelae are post hoc: there are rarely any prospective assessments of mood and neural functioning before and after a brain injury. In this Stage 2 Registered Report, we used the Adolescent Brain Cognitive Development Consortium dataset to examine if a disruption in functional neural responses to rewards is present in patients with depression after a mild traumatic brain injury. Notably, this study provides an unparalleled opportunity to examine the trajectory of neuropsychiatric symptoms longitudinally within-subjects. This allowed us to isolate mild traumatic brain injury-specific variance independent from pre-existing functioning. Here, we focus on a case-control comparison between 43 youth who experienced a mild traumatic brain injury between MRI visits, and 43 well-matched controls. Contrary to pre-registered predictions (https://osf.io/h5uba/), there was no statistically credible increase in depression in mild traumatic brain injury cases relative to controls. Mild traumatic brain injury was associated with subtle changes in motivational neural circuit recruitment during the anticipation of incentives on the Monetary Incentive Delay paradigm. Specifically, changes in neural recruitment appeared to reflect a failure to deactivate 'task-negative' brain regions (ventromedial prefrontal cortex), alongside blunted recruitment of 'task-positive' regions (anterior cingulate, anterior insula and caudate), during the anticipation of reward and loss in adolescents following mild brain injuries. Critically, these changes in brain activity were not correlated with depressive symptoms at either visit or depression change scores before and after the brain injury. Increased time since injury was associated with a recovery of cognitive functioning-driven primarily by processing speed differences-but depression did not scale with time since injury. These cognitive changes were also uncorrelated with neural changes after mild traumatic brain injury. This report provides evidence that acquired depression may not be observed as commonly after a mild traumatic brain injury in late childhood and early adolescence, relative to findings in adult cases. Several reasons for these differing findings are considered, including sampling enrichment in retrospective cohort studies, under-reporting of depressive symptoms in parent-report data, and neuroprotective factors in childhood and adolescence.

Dynamic point of care ultrasound is effective in the early diagnosis of anterior cruciate ligament injuries in children and adolescents

IntroductionSeveral studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury. Materials and methodsWe reviewed the data of children and adolescents who were examined with ultrasound between 2018 and 2021 for suspected ACL injury. ACL POCUS was done immediately after the physical examination, according to a standard technique. The tests were performed by an orthopaedic resident and young and a senior orthopaedic surgeon. The inclusion criteria were as follows: the child's age is between 0–15 years, the growth zones are open, the child later underwent MRI and/or arthroscopy, which confirmed or excluded the fact of an ACL injury. We excluded patients with incomplete recordings and documentation. Results119 children met the above criteria. The children were between 8 and 15 years old (mean = 13.29). Positive findings were found in 47, negative findings in 72 children with ACL POCUS. During the subsequent treatment, 57 children underwent only MRI examination, 11 children only arthroscopy, and 51 children both MRI and arthroscopy. The specificity of the test was measured as 0.958 and the sensitivity as 0.917 for complete ACL rupture. Regarding all ACL injuries (complete + partial), we found the sensitivity to be 83.019 and the specificity to be 95.45. The interrater agreement between radiologist and clinicians was 94.957 %. (Cohen's k: 0.8945). ConclusionsPOCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences.

Predictors of Anterior Cruciate Ligament Tears in Adolescents and Young Adults

Background: Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports. Purpose: To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth. Study Design: Cohort study; Level of evidence, 2. Methods: Data from the Growing Up Today Study (GUTS), a prospective cohort study of youth throughout the United States, were used in this study. From 1996 to 2003, questionnaires were sent to GUTS participants every 12 to 18 months to assess a variety of self-reported factors; in a related 2004 questionnaire, ACL tears and other diagnoses among the participants were reported. Cox proportional hazard models were run to determine the sex-specific association of activity patterns and pubertal timing with risk of developing an ACL tear. Results: A total of 4519 boys and 5622 girls (age: 9-15 years) were included, with 2.4% and 2.0% sustaining an ACL injury, respectively. Age was found to be a significant risk factor for ACL injury in both sexes (male: hazard ratio [HR] = 1.30 [95% CI, 1.14-1.48]; female: HR = 1.23 [95% CI, 1.10-1.38]). Mean hours per week engaged in vigorous activity was also predictive of a higher risk of ACL injury (male: HR = 1.04 [95% CI, 1.01-1.08]; female: HR = 1.10 [95% CI, 1.07-1.14]). The sports that were the most predictive of injury were running, basketball, soccer, and cheerleading/gymnastics in girls and running, football, and karate/martial arts in boys. Additionally, in boys, overweight/obese status was found to be a significant predictor of ACL injury (HR = 2.61 [95% CI, 1.60-4.26]). Furthermore, among 9- to 13-year-old girls, advanced Tanner stage was a strong predictor of injury risk (HR = 2.43 [95% CI, 1.10-5.36]). Conclusion: Age, time engaged in vigorous activity, overweight/obese status, and advanced Tanner stage were associated with an increased risk of ACL injury in young adults and adolescents. Further research with follow-up data will help complement this study and continue to highlight the risk factors associated with ACL reconstruction in adolescents and young adults.

Management of Syndesmotic Ankle Injuries: Results of a Survey of POSNA Members

BackgroundAlthough utilization of dynamic suture-button fixation for adult syndesmotic injuries has shown improved outcomes over static screw fixation, data in pediatric populations is limited. This study evaluated trends in management and identified factors influencing surgeon choice of implant for pediatric syndesmotic injuries. MethodsPediatric Orthopaedic Society of North America (POSNA) members were surveyed regarding syndesmotic injury implant preferences between October 2021 and May 2022. Respondents that opted out, treated <1 syndesmotic ankle injury in the past year, or had conflicting financial obligations were excluded. Results were summarized and analyzed using logistic regression to assess for significance between years post-training and technique preference. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for significance (P-values<0.05). ResultsAmong 103 respondents to the survey (with 102 complete responses), 25% were <5 years post-training, 24% between 5-10 years, 21% between 11-15 years, and 28% >15 years post-training. Twenty-four percent (24/102) preferred screw versus 76% (78/102) preferring suture-button implants for syndesmotic injuries. Members >15 years post-training were 4.7 times more likely to prefer screw implants compared to members <5 years post-training (OR=4.7; 95% CI, 1.14-19.34; p=0.03). Since starting their clinical practice, 62 respondents (60%) reported an implant preference change, with avoidance of secondary surgery (46/62; 74%) and extrapolation from adult outcomes (39/62; 63%) cited as primary motivating factors. Of the 40 members with no preference change, comfort with the procedure was the primary cited reason (33/40; 83%). Among those choosing operative intervention, radiograph-based cases showed preference for suture-button in 70-79% of respondents for skeletally mature patients versus 71-81% for skeletally immature patients. ConclusionOur data shows that the shift over time from screw to suture-button implant fixation for pediatric and adolescent syndesmotic ankle injuries is largely due to interest in avoiding implant removal and extrapolation from superior outcomes seen with suture-button use in adults. Larger comparative studies of pediatric and adolescent patients treated with suture-button versus screw fixation are needed to establish standards of care for these challenging injuries. Levels of EvidenceLevel V: Expert opinion

Understanding the mechanism of injury and fracture pattern of paediatric triplane ankle fractures versus adult trimalleolar fractures.

Paediatric triplane fractures and adult trimalleolar ankle fractures both arise from a supination external rotation injury. By relating the experience of adult to paediatric fractures, clarification has been sought on the sequence of injury, ligament involvement, and fracture pattern of triplane fractures. This study explores the similarities between triplane and trimalleolar fractures for each stage of the Lauge-Hansen classification, with the aim of aiding reduction and fixation techniques. Imaging data of 83 paediatric patients with triplane fractures and 100 adult patients with trimalleolar fractures were collected, and their fracture morphology was compared using fracture maps. Visual fracture maps were assessed, classified, and compared with each other, to establish the progression of injury according to the Lauge-Hansen classification. Four stages of injury in triplane fractures, resembling the adult supination external rotation Lauge-Hansen stages, were observed. Stage I consists of rupture of the anterior syndesmosis or small avulsion of the anterolateral tibia in trimalleolar fractures, and the avulsion of a larger Tillaux fragment in triplanes. Stage II is defined as oblique fracturing of the fibula at the level of the syndesmosis, present in all trimalleolar fractures and in 30% (25/83) of triplane fractures. Stage III is the fracturing of the posterior malleolus. In trimalleolar fractures, the different Haraguchi types can be discerned. In triplane fractures, the delineation of the posterior fragment has a wave-like shape, which is part of the characteristic Y-pattern of triplane fractures, originating from the Tillaux fragment. Stage IV represents a fracture of the medial malleolus, which is highly variable in both the trimalleolar and triplane fractures. The paediatric triplane and adult trimalleolar fractures share common features according to the Lauge-Hansen classification. This highlights that the adolescent injury arises from a combination of ligament traction and a growth plate in the process of closing. With this knowledge, a specific sequence of reduction and optimal screw positions are recommended.

A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values.

The impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI. A total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined. The questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with disease-specific HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender). In combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.

Pattern of anxiety, depression, and suicidality among in-school adolescents in Bauchi, North-East Nigeria

Background: Adolescence is a crucial period of development resulting in significant changes in physical appearance, and psychological functioning. Globally, mental health disorders account for 16% of the global burden of disease and injury in adolescents. The study aims to provide baseline information on adolescents' mental health in Bauchi State. Methods: A cross-sectional study design was employed in this study. Using systematic sampling technique, 672 in-school adolescents aged 10-19 who gave assent/consent were selected. SPSS was used to analyze the data. Results: The mean age of the respondents was 15±2.0, more respondents had no or minimal depression (65.0). However, 0.7% were moderately severely depressed. Most respondents (88.7%) had minimal anxiety, while 1.5% and 0.3% had moderate and severe anxiety respectively. Almost one-quarter of the respondents (23.2%) had thought of ending their life in the past month before the survey with up to 4.2% attempting suicide. Adolescents from polygamous settings were up to 70% less likely to attempt suicide compared to those in a monogamous setting and this was statistically significant with a p-value of 0.039 and CI (0.167-0.785). Furthermore, those whose parents were not in a marital union were 2.9 times more likely to attempt suicide compared to those whose parents were still in union and living together. This was statistically significant with a p-value of 0.018 and CI (1.203-7.060). Conclusions: Early intervention and a multi-pronged public health approach are crucial to safeguard this vulnerable population's mental well-being to enable them to thrive and reach their full potential.

Modern technologies for medical rehabilitation of children with knee joint injuries

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7 % in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

Management of Syndesmotic Injuries in Children and Adolescents: Results of a Cross-Sectional Survey of Pediatric Orthopaedic Surgeons

Management of Syndesmotic Injuries in Children and Adolescents: Results of a Cross-Sectional Survey of Pediatric Orthopaedic Surgeons

Osteochondral fractures in childhood and adolescence

Osteochondral fractures (OCF) are traumatic shearing injuries to portions of cartilage and bone. The most common cause is patellar dislocation, with the main localisation being the medial patellar facet and the lateral femoral condyle. They can occur in all age groups. Clinically, there is apainful knee joint effusion (haemarthrosis) with a"dancing patella". This is usually accompanied by restricted movement and/or alocking phenomenon. In addition to the standard X‑ray of the knee in three planes (lateral, anterior-posterior and tangential patella), an MRI should be performed promptly in the case of haemarthrosis and suspicious symptoms, as concomitant injuries are present in up to 70% of cases. The aim of treatment is to restore joint congruence in order to prevent the risk of secondary osteoarthritis. Small chondral and stable osteochondral fractures can be treated conservatively. Surgery is indicated for all other OCFs. In addition to refixation with various materials (bioresorbable screws, bone plugs, suture material and Kirschner wires), cartilage regeneration procedures (AMIC, MACI, OAT, etc.) are available for late diagnosed or non-refixable fragments. However, the number of cases is small. Osteochondral fractures are rare injuries in children and adolescents. Prompt MRI is recommended for diagnosis in cases of suspected OCF. Refixation is the preferred treatment method, with bioresorbable implants showing promising results in reducing the need for additional surgery. The risk of secondary osteoarthritis can be reduced with regular treatment.

Imaging of sports injuries in adolescents.

Musculoskeletal injuries in adolescents tend to occur in particular locations and have distinct characteristics, as they affect an immature skeleton. Increased engagement in sports, extended training and competition periods, and early specialization in specific sports, among other factors, have contributed significantly to the rise in musculoskeletal sports injuries in adolescents. Furthermore, females show a particularly pronounced increase in sports participation, where anatomical and hormonal factors play crucial roles in the development and increased frequency of sports-related injuries. Consequently, there is a growing demand for diagnostic imaging techniques. Musculoskeletal and pediatric radiologists require a comprehensive understanding of intrinsic and extrinsic risk factors and the successive stages of skeletal development that can influence the specific characteristics of sports injuries in adolescents. These aspects are crucial for the diagnostic, prognostic, and therapeutic management of these injuries and for mitigating chronic conditions that could compromise future sports participation. This review analyzes the primary musculoskeletal injuries in adolescent athletes and highlights the pivotal role of different imaging methods in their diagnosis and management.

Psychological Well-Being From Sports Injuries in Adolescence: A Narrative Review.

The objective of this paper is to review how the mental and psychological well-being of the adolescent athlete population may be impacted by sports injuries, specifically the development of their personal identities. To answer this question, we conducted a narrative review using keywords such as "adolescence," "psychological," "injury," and "sport" in the PubMed database. When conducting the research, we included sources from the past 15 years in order to gain a more present and accurate analysis of our question, and no countries were excluded from our population. Through our research, we identified risk factors that contribute to the rising psychological stress on adolescents. The return to sport was also found to be primarily affected by implied psychological illnesses such as self-confidence and identity, along with parental and coach guidance through the rehabilitation process. Despite the lack of research, scientists work to pursue additional psychological interventions to ensure the emotional well-being of adolescent athletes. Through this review, we aim to inform athletes, coaches, parents, and pediatricians about psychological issues that they may face as they continue to pursue their respective roles in sports. This study also paves a path for future research concerning potential interventions to prevent such psychological issues and ensure both physical and mental health for young athletes.

Fighting behavior, conflict perceptions, and firearm access among U.S. adolescents in a pediatric emergency department

ObjectivePrior evidence demonstrates that both firearm access and fighting can predict future violence and injury in adolescents. We aimed to examine associations between firearm access with fighting behavior and conflict perception in a sample of adolescents in an urban emergency department (ED) setting. MethodsIn 2023, we conducted a secondary analysis of 13,610 adolescent encounters in the ED of a U.S. children's hospital from 2013 to 2020, using a universally applied, self-administered computerized behavioral health survey. We compared patient characteristics by reported firearm access and fighting behavior using chi-squared tests. Generalized estimating equations (GEE) were used to investigate associations between 1) fighting behavior and firearm access, and 2) between fighting behavior and respondent preference to and reporting of fighting incident to law enforcement after adjusting for race and ethnicity, age, and gender. ResultsApproximately one-quarter of the sample reported past year fighting. Youth who reported fighting were more likely to report firearm access (AOR = 1.66, 95%CI = [1.49–1.86]). This association strengthened among youth who perceived continued conflict after a fight (AOR = 2.05, 95%CI = [1.73–2.43]). Youth who perceived continued conflict following a fight were more likely to report (AOR = 1.97, 95%CI = [1.65–2.36]) or want to report (AOR = 2.63, 95%CI = [1.81–3.81]) the fight to law enforcement. ConclusionsThose perceiving continued conflict after a fight were more likely to report access to firearms and endorse retaliation; however, they were more likely to want to report the fight to law enforcement. These findings highlight the potential for more comprehensive ED risk assessment to reduce retaliation and reinjury for adolescents reporting fighting behavior.