Peter D. Gibson

Hoverboards: A New Cause of Pediatric Morbidity

INTRODUCTION The hoverboard, a self-balancing powered scooter, was introduced to the market in 2015 and quickly became one of the most popular purchases of the year. As with similar products, this scooter brought a host of concerns surrounding injuries. The purpose of this study is to determine the incidence of injuries that coincided with the popularity of hoverboard. METHODS The National Electronic Injury Surveillance System (NEISS) was queried from 2011 through 2015 for injuries related to scooters/skateboards, powered (product number, 5042), which includes the hoverboard. Patient data on sex, age, race, diagnosis, most severely injured body part, location where the injury occurred, and narrative of the injury were collected. The estimated injury incidence was calculated and compared on a yearly and monthly basis. Google Trends was used to determine the popularity of the hoverboard over the same time period. RESULTS During the 5-year study period, there were an estimated 47,277 injuries associated with the hoverboard. In 2015, there was an average 208% (range, 167-278%; standard deviation (SD), 51.8%) increase in the number of injuries compared to any of the previous 4 years. Further analysis of these injuries revealed a significant increase in the number of forearm (475%; range, 310-662%; SD, 159%), leg (178%; range, 133-206%; SD, 34%), and head and neck (187%; range, 179-197%; SD, 7.6%) injuries in 2015 compared to the previous 4 years. The most common type of injury in 2015 was a fracture (38.9%). Analysis of the sites of these fractures between 2014 and 2015 revealed a 752% increase in forearm fractures, which included over a 4000% increase in the number of wrist fractures. CONCLUSIONS Given the number of injuries caused by these products, safety equipment, such as wrist guards and helmets, should be worn in an attempt to reduce the number of injuries. Additionally, this study highlights the importance of physicians keeping up to date with current trends to best advise their patients on safe practices.

Pediatric gunshot wound recidivism: Identification of at-risk youth.

BACKGROUND Although penetrating injury is the most common reason for pediatric trauma recidivism, there is a paucity of literature specifically looking at this population. The objective of this study was to identify those in the pediatric community at the highest levels of risk for experiencing gunshot wound (GSW) on multiple occasions. METHODS A retrospective review querying our urban Level I trauma database was performed. Patients aged 0 year to 18 years sustaining GSW from 2000 to 2011 were selected. This was further refined to include those who returned to the hospital for another firearm injury. Demographic data, including age of initial and subsequent presentation, sex, race, zip code, home address, and disposition were compiled. RESULTS During the 12-year study period, 896 pediatric patients were discharged from the hospital after initial firearm injury with subsequent 8.8% recidivism rate. All recidivists were male, and 86% were 16 years to 18 years old at the time of the first injury. The subsequent incident occurs within the first year, 2 years, and 3 years 32%, 53%, and 66% of the time, respectively. Nine individuals in our study group experienced GSW on three separate occasions, with a mortality rate of 22%. Regarding the domicile, 53% of the patients were located in a 3-sq mi area containing four public high schools. CONCLUSION Using demographic data, we have been able to identify an at-risk population where there is a greater than 1 in 12 chance of getting shot multiple times. Use of this type of demographic data can help target those at highest risk by allocating resources that can have the greatest impact on this societal burden. LEVEL OF EVIDENCE Prognostic study, level III.

Inadvertent Reduction of Symphyseal Diastasis During Computed Tomography.

Objective: To determine the quantifiable difference in pubic symphysis diastasis when comparing computed tomography (CT) and pelvic radiographs in individuals with anterior pelvic ring injuries. Design: Retrospective chart and radiographic review. Setting: Level 1 trauma center. Patients/Participants: Between 2002 and 2013, all individuals requiring internal fixation of the anterior pelvic ring were reviewed. Of the 163 patients, 72 met the inclusion criteria. Patients with a symphysis dislocation were included if the pelvic radiograph and CT were performed without a pelvic binder, and imaging was adequate for required measurements. Intervention: Symphyseal diastasis was measured on the initial pelvic radiograph, the CT scout, and axial views. Main Outcome Measurements: Comparison of measured symphyseal diastasis on CT and pelvic radiographs. Results: Seventy-two patients met the inclusion criteria. Ninety-seven percent (70/72) had a reduction of their symphysis diastasis in the CT with an average reduction of 6.6 mm (Range, −2.6 to 35.5 mm). The average diastasis on radiograph was 26.3 mm compared with 19.7 mm on CT scout (P < 0.001). Fourteen patients (19.2%) had a reduction from greater than 25 mm to less than 25 mm—a traditional cutoff for operative intervention. Conclusions: The anteroposterior pelvis radiograph remains an important part of the workup for trauma patients. Reliance on CT alone may underestimate the true degree of pelvic displacement. Failure to obtain pelvic radiographs in the acute setting limits the information in which the medical team can base both immediate and definitive decisions about pelvic ring injuries. Level of Evidence: Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.

Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

Giant cell tumor of tendon sheath is one of the most common soft tissue tumors of the hand. These tumors typically occur in the third or fourth decade of life and present as solitary nodules on a single digit. Currently, the greatest reported number of lesions found within a single digit is five. Although uncommon, giant cell tumor of tendon sheath does occur in the pediatric population. Herein we present a report of a rare case of GCTTS in a child in which seven lesions were identified within a single digit—the greatest number of lesions within a single digit reported to date.

Low Incidence of Neurovascular Complications After Placement of Proximal Tibial Traction Pins

Skeletal tibial traction is a temporizing measure used preoperatively for femoral fractures to improve the length and alignment of the limb and provide pain relief. The goal of this study was to identify possible neurovascular morbidity associated with the use of bedside skeletal tibial traction to treat femur fractures. All femoral fractures treated with proximal tibial traction during a 10-year period at an urban level I trauma center were retrospectively reviewed. The medical record was reviewed to determine whether a pin-related complication had occurred. Records also were reviewed to identify ipsilateral multi-ligamentous knee injuries that were not diagnosed until after the application of traction. In total, 303 proximal tibial traction pins were placed. A total of 7 (2.3%; 95% confidence interval, 0.60%-4.0%) pin-related neurologic complications and zero vascular complications were noted. All complications involved motor and/or sensory deficits in the distribution of the peroneal nerve. Of the 7 complications, 6 resolved fully after surgery and removal of the pin. After traction placement, 6 (2.0%) ipsilateral multiligamentous knee injuries were diagnosed. None of these patients had a neurovascular complication. This study suggests that bedside placement of proximal tibial traction for femoral fractures is associated with a low incidence of neurovascular complications and that traction can be safely placed at the bedside by residents. A thorough neurovascular examination should be performed before insertion, and care should be taken to identify the proper starting point and reduce soft tissue trauma during pin placement. [Orthopedics. 2017; 40(6):e1004-e1008.].