Adolescent Injury Research Articles

What is the optimal treatment strategy for ACL injuries in children and adolescents?

What is the optimal treatment strategy for ACL injuries in children and adolescents?

Long-term outcome and rehabilitation needs after acquired brain injury in children and adolescents – an evaluation in a Swedish cohort

Children with acquired brain injury (ABI) are at risk of developing cognitive, physical, or emotional impairments that affect their daily lives at home, school, and in society. Purpose: To explore this, we used the Swedish version of the Child and Family Follow-up Survey (CFFS-SWE) to describe the participation of 39 children (aged 5–17 years) who had sustained ABIs. Materials and Methods: We assessed their participation using the CFFS-SWE at three points: upon discharge from the acute hospital, six months post-discharge, and between one and four years after discharge. Results: Findings revealed that 69% of the children had rehabilitation needs at discharge, with physical symptoms, pain, mobility, and visual difficulties being the most common. Environmental barriers to participation included family stress, inadequate information about diagnosis and/or treatment, lack of assistance in school, and lack of family finances. Additionally, 31% of the sample had unmet support needs in everyday life. Conclusion: The study underscores the necessity of implementing structured follow-up and early rehabilitation interventions for children with ABI to improve their long-term outcomes.

Prevalence and Pattern of Traumatic Dental Injuries in Children and Adolescents With Severe to Profound Hearing Impairment: A Hospital-Based Cross-Sectional Study.

Traumatic Dental Injuries (TDIs) are an emerging public health problem and a realm of research for oral health enthusiasts. Certain populations can be more vulnerable to injuries such as those with a sensory deficit. Nevertheless, literature is scarce, especially for those with hearing impairment. Therefore, the aim of the study was to compare the prevalence and patterns of TDI in children and adolescents with severe-to profound hearing impairments and children without hearing impairments. Three hundred and ninety participants (195 severe to profound hearing impaired and 195 age and sex-matched controls) between 4 and 18 years were recruited from a tertiary care setting. A single calibrated examiner evaluated TDI for both groups. Among those with TDI, a vestibular function test (VFT) was also performed to assess postural balance. A single examiner from the Department of Otorhinolaryngology evaluated the VFT results. The overall prevalence of TDI was found to be 12.82% among the severe to profound hearing-impaired individuals, and 11.79% in controls. The majority of participants were aged between 7 and 13 years, in the mixed dentition stage, and were males. Among the cases, the majority had profound hearing loss (≥ 91 dB HL) and bilateral ear involvement. The most common type of TDI was uncomplicated crown fractures. Falls were identified as the most common cause of TDI in both groups. Vestibular dysfunction and loss of postural control were identified in 12 out of 14 patients tested with VFT. A significant association was found between TDI and the dentition type, that is, primary dentition was more affected among the severe to profound hearing impaired as compared to controls (p < 0.05). There was no significant association between the severity of hearing impairment and the prevalence of dental trauma in children and adolescents with severe to profound hearing impairment. However, hearing-impaired individuals were susceptible to trauma at an early age compared to their healthy counterparts.

High speed, high risk: the rise of e-scooter injuries in adolescents.

The popularity of eco-friendly electric scooters has led to a rise in significant injuries, especially in adolescents. Teens riding e-scooters are more prone to severe traffic accidents and head injuries compared to those using traditional scooters. Risk-taking behaviors, susceptibility to peer influence, limited road safety experience and a lack of protective headgear exacerbate the risks. These injuries impose a significant burden to patients and to the health care system. To mitigate these risks, age and helmet laws should be strictly enforced, with enhanced public education, safety training, and engineering innovations such as rentable helmets and speed-limiting technology. This public health imperative requires immediate action.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China.

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear. This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies. A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008). Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Allograft versus autograft ACL reconstruction in skeletally immature patients: a systematic review.

Anterior cruciate ligament (ACL) injuries in children and adolescents with open physes are common. Evidence of ACL reconstruction using allografts in children with open physes is limited. Whether the outcomes of ACL allograft reconstruction in children and adolescents with open physes are superior to autograft ACL reconstruction is unclear, with contrasting evidence. In October 2024, the Web of Science, PubMed, and Embase were accessed with no additional filters. Only clinical investigations evaluating ACL reconstruction in children or adolescents with open physes were eligible. Only studies reporting a minimum length of 24months of follow-up were included. Children who undergo allograft ACL reconstruction demonstrate similar functional outcomes to those who undergo autograft ACL reconstruction. Although allografts allow a faster return to sport, the greater laxity, the reduced activity level, and the higher failure and reoperation rates make their use dubious as a first-choice option for ACL reconstruction in skeletally immature patients.

Epidemiology of Wrestling Injuries in Female Athletes at US Emergency Departments.

Purpose Wrestling injuries in female athletes is an understudied topic. The aim of this study is to characterize the injuries that occur in female wrestlers aged five to 18who presented to United States (US) emergency departments (ED) from 2014-2023 and compare patterns between youth and adolescent wrestlers. Method This was a retrospective comparative study including female patients aged five to 18 years of age presenting to the ED due to an injury related to their participation in the sport of wrestling. Data was extracted from the National Electronic Injury Surveillance System (NEISS) from 2014 to 2023. Information extracted included patient demographics, injury location, disposition, diagnosis as well as a narrative for each patient. Injury distribution for youth (five to 11) and adolescents (12-18) was evaluated using chi-squared. Results An estimated 28,824 female wrestlers (841 NEISS cases) presented to US EDs during the study period. The most frequently injured body parts were the head (16.5%), shoulder (14.0%), knee (11.1%), and elbow (10.7%). Strains/sprains were the most common injuries in both youth (27.9%) and adolescents (30.3%). Fractures were significantly more common among youth wrestlers (23.1%) compared to adolescents (13.6%, p < 0.05). The distribution of injured body parts was also significantly different between groups (p < 0.05). In youth wrestlers, the most common injury sites were the head (11.5%, 95% CI 20.0-57.7%), wrist (10.6%, 95% CI 9.85-47.4%), and elbow (9.6%, 95% CI 16.3-56.6%). For adolescents, the head (17.2%, 95% CI 24.9-34.9%), shoulder (14.9%, 95% CI 31.4-43.5%), and knee (11.7%, 95% CI 27.7-41.0%) were most frequently injured. Overall, more than 60% of injuries occurred above the waist in both groups. Conclusion Adolescent female wrestlers experienced more injuries compared to youth wrestlers, with most injuries occurring above the waist. Factors such as increased mat time, hormonal changes, and higher practice intensity may contribute to this disparity. Injury prevention strategies, including adequate mat spacing and rule enforcement during practices as well as upper body strength training, are recommended. Further research is needed to identify mechanisms and specific techniques linked to higher injury risks to enhance safety in female wrestling.

Acute Kidney Injury and Outcomes in Infants, Children, and Adolescents, Supported With Extracorporeal Life Support for Cardiopulmonary Failure.

In neonatal and pediatric patients who require extracorporeal life support (ECLS), 60-70% develop acute kidney injury (AKI). Acute kidney injury has been associated with increased morbidity and mortality. We sought to describe our center's experience with AKI in patients requiring ECLS and its effect on outcomes. We conducted a retrospective single-center study at an academic children's hospital. All patients 0-18 years of age who required ECLS between January 2014 and December 2019. During the study period, there were 313 ECLS runs. The majority were neonates (66.8%) and 68.7% of runs were veno-arterial. Using Kidney Disease Improving Global Outcomes (KDIGO) criteria, 227 patients (72.5%) developed stage 2 or 3 AKI. The AKI group were younger (median age: 0.9 vs. 11.7 months, p < 0.001), more likely to experience a hemorrhagic complication (46.9% vs. 31.9%, p = 0.0298), and had higher mortality rates (44.9% vs. 24.4%, p = 0.0009). Neonates who required ECLS were more likely to develop stage 2 or 3 AKI (78%) than pediatrics (63%) (p = 0.005). Adjusting for confounders, patients who developed AKI had 2.38 times higher odds of mortality (95% confidence interval [CI]: 1.34-4.25, p = 0.003). We conclude that the majority of patients requiring ECLS develop stage 2 or 3 AKI. Those with AKI were twice as likely to die when controlling for confounding variables. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.

Study on the Influence of Physical Activity Intensity and Maturation on Sports Injuries in Children and Adolescents

Intensive training combined with a growing body can predispose children to sports injuries. Our aim was to identify the importance of physical activity (PA) intensity and maturity as predictors of injury in youth. Information about injuries was collected using a questionnaire (LESADO), the PA intensity was assessed via accelerometry, and maturity was assessed using the Tanner–Whitehouse III bone age method and maturity offset. A total of 121 participants aged between 10 and 18 years were selected from four different schools. Regression analyses were used to determine the significant predictors of the injury profile. Only the injury type presented significant results. The time spent on moderate PA (χ2(2) = 6.701, p = 0.035) and bone age (χ2(2) = 7.196, p = 0.027) were the final predictors. The odds of having a strain or a fracture relative to a sprain increased 1.04 times for each minute of time spent on moderate PA. Likewise, the odds of having a strain or a fracture relative to a sprain decreased by 1.7 times per year of bone age. The PA intensity and bone age proved to be injury predictors in the growing athletes, with more predictive power in injury type. No meaningful associations were found for the injury occurrence, injury rate and body area injury location.

Osteochondral Lesion of the Lateral Femoral Condyle Following Patellar Dislocation – Treatment of a Rare Injury in Adolescents: A Case Study

Introduction: Osteochondral injuries of the knee are increasingly common among active adolescents, often resulting from acute trauma, repetitive microtrauma, or conditions like osteochondritis dissecans. Patellar dislocation is a frequent cause of osteochondral lesions (OCL). Studies indicate that a significant percentage of patients with patellar dislocation exhibit OCLs, particularly in the anterior lateral femoral condyle and medial portion of the patella. Case presentation: A case study of a 15-year-old female athlete illustrates the clinical presentation and management of such injuries. After sustaining a knee injury during a football match, she experienced significant pain and swelling, with imaging revealing an osteochondral defect in the lateral gutter. Surgical intervention confirmed the presence of a larger deffect and involved stabilizing the osteochondral fragment and repairing the surrounding cartilage. Postoperative management included a period of non-weight-bearing followed by gradual rehabilitation. Follow-up MRIs showed complete integration of the cartilage defect, and the patient successfully returned to football practice six months post-surgery. Conclusion: This case highlights the importance of early recognition and appropriate treatment of osteochondral injuries in adolescents. Surgical techniques, including chondral fixation, can be effective, particularly in skeletally immature patients, facilitating a successful return to athletic activities. Early intervention is crucial for preserving joint function and ensuring optimal recovery outcomes.

Traumatic Dental Injuries in Children and Adolescents from a Major Dental Clinic in Bosnia and Herzegovina: A 5-Year Retrospective Study.

This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7-9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time.

The possible role of serum NGAL and MMP-9 in the assessment of kidney impairment and cardiovascular risk in children and adolescents with type 1 diabetes mellitus or obesity.

Type 1 diabetes mellitus (DM1) and obesity represent two chronic pediatric diseases characterized by increased risk for renal impairment and cardiovascular disease. The potential usefulness of neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinase-9 (MMP-9), two novel biomarkers, for predicting early kidney injury or increased cardiovascular risk in children and adolescents with DM1 or obesity, was investigated in this cross-sectional study. Serum samples were obtained from children and adolescents aged 12.7 ± 3.8 years old with DM1 (n = 38) or obesity (n = 34) and normal renal function, as well as from healthy controls (n = 24). NGAL and MMP-9 concentrations were measured using commercially available sandwich ELISA kits (NGAL: DY1757-05, MMP-9: DMP900; R&D systems, Minneapolis, MN, USA). NGAL serum values were found significantly higher in patients with obesity but not in those with DM1. A positive correlation was found in patients with DM1 with diabetes duration, and in the total population with body mass index (BMI) z-score. Also, serum MMP-9 levels were significantly increased in patients with DM1 and in patients with obesity compared to controls. Circulating NGAL and MMP-9 levels may prove useful as surrogate biomarkers to creatinine, glomerular filtration rate (GFR), and albumin excretion rate for early detection of kidney injury and cardiovascular complications in children and adolescents with DM1 or obesity.

Injuries to the lower limbs and associated injuries in children and adolescents resulting from road traffic incidents.

Fractures occurring in the lower extremities as a result of road traffic accidents (RTAs) can lead to considerable morbidity and constitute a large proportion of nonfatal injuries that necessitate hospitalization. The present study aimed to examine the epidemiology of lower extremity fractures linked with RTAs in pediatric patients. This is a descriptive retrospective research study carried out between 2015 and 2022 at St. Mary's Children's Hospital, Iasi, Romania, targeting the population below the age of 18 years who experienced trauma from RTAs and received treatment from the trauma department. Data pertaining to various aspects, including age distribution, the frequency of accidents, the types of injuries incurred, and surgical treatment, were gathered. The findings revealed a total of 358 cases of RTAs, out of which 112 fit the required criteria, and a total of 22 patients, accounting for 19.64%, had open fractures. This research provides information on lower extremity fractures and associated injuries in the pediatric population living in urban and rural areas throughout the Moldova region in Romania, subsequent to RTAs. The objective is to deliver the most relevant information at the patient's bedside and provide proper healthcare services.

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 (&amp;lt;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 &amp; 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 &amp; 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.

Management of Syndesmotic Ankle Injuries: Results of a Survey of Pediatric Orthopaedic Society of North America 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. MethodsThe Pediatric 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 posttraining and technique preference. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for significance (P-values<.05). ResultsAmong 103 respondents to the survey (with 102 complete responses), 25% were <5 years posttraining, 24% between 5 and 10 years, 21% between 11 and 15 years, and 28% ​> ​15 years posttraining. Twenty-four percent (24/102) preferred screw versus 76% (78/102) preferring suture-button implants for syndesmotic injuries. Members >15 years posttraining were 4.7 times more likely to prefer screw implants compared to members <5 years posttraining (OR ​= ​4.7; 95% CI, 1.14–19.34; P ​= ​.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 the suture-button in 70%–79% of respondents for skeletally mature patients versus 71%–81% for skeletally immature patients. ConclusionsOur 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. Key Concepts(1)Literature for operative syndesmotic injury management in adults has shown improved outcomes of dynamic suture-button fixation over static screw fixation, but data in pediatric and adolescent populations is limited.(2)A survey of 102 POSNA members shows that 76% prefer suture-button, 24% prefer screw fixation with members >15 years posttraining 4.7 times more likely to prefer screw fixation to members <5 years posttraining.(3)Among 62 respondents who switched implant preference during their clinical practice, avoidance of secondary surgery and extrapolation from outcomes in adults were the two most cited reasons.(4)Among 40 respondents who did not switch implant preference, comfort with the procedure was the most cited reason.(5)Comparative studies of suture-button versus screw implants for treatment of pediatric and adolescent syndesmotic ankle injuries are needed to establish an evidence-based standard of care management. Level of EvidenceLevel V: Expert Opinion