Miami, FL
Nov. 28, 2018
Volume IX | Issue No. 48
Annular ligament displacement (ALD) (formerly called Radial Head  
"Nursemaids elbow/pulled elbow injury" 
ALD is a common pediatric orthopedic problem most often seen in children 1-4 years of age, more commonly in girls and in the left arm, occurring as a result of a sudden forceful longitudinal traction of the hand while the elbow is extended and the forearm pronated. This results in the annular ligament being displaced from its normal position covering the head of the radius into the radio -humeral joint.

A study to determine the incidence of annular ligament displacement during the first three years of life indicates that 7.8% of children have a history of a ALD (51% girls), median age of first occurrence is 25 months (median) with 40% of children with ADL having 1.8 (mean) recurrences. 17% resolve spontaneously and few suffer long-term sequelae.

See related video HERE and HERE.
Crash risk and risky driving behavior among adolescents during learner and independent driving periods 
From a study of 90 adolescent drivers with learner driving permits and 131 experienced adult drivers, data indicates that "crash/near-crash" and "risky driving rates" are similar for adolescents and adult drivers during the learner period. During the transition from "learner" to "independent driver" however adolescent risk is dramatically higher than adult rates.
See related video HERE and HERE.
Antibiotic treatment of uncomplicated appendicitis (again!) 
Following the publication (in 2015) of a trial which compared open appendectomy with antibiotic therapy for acute UNCOMPLICATED APPENDICITIS, a 5-year follow-up study of 237 appendicitis patients randomized to either receive antibiotics, or appendectomy (256), indicates that in patients (18-60 years of age) with acute UNCOMPLICATED APPENDICITIS (proven by computed tomography (CT) imaging) and
no fecalith present, antibiotic therapy for suspected acute uncomplicated appendicitis is a reasonable alternative to deferring surgery with little risk of subsequent complications (there is however a 39% chance of developing recurrent appendicitis within a 5 year period).
Childhood Obesity Facts 
Factors associated with early death after neonatal circumcision in the USA
In the USA, circumcision in boys is usually performed out-of-hospital on healthy newborns; in rare instances the procedure is medically indicated occurring in children with recurrent, pathologic phimosis. Circumcision like any surgery carries risks for infection, bleeding and inflammation as well as the development of fistulae, skin bridges, torsion, buried penis, meatal stenosis, penile amputation (partial or complete) and other penile injuries.
Death following circumcision is rare (1 in approximately 50,000 circumcisions) and is more likely to occur associated with cardiac disease, coagulopathy, fluid and electrolyte disorders or pulmonary vascular disease. "Recognizing these factors...potentially reduces associated risks."
See related video HERE
Nebulized normal saline solution for treatment of bronchial asthma exacerbation and bronchiolitis 
In spite of National guidelines which outline the lack of benefits for this modality of treatment for these diseases, nebulized normal saline apparently continues to be prescribed in Emergency Departments (EDs) / in-patient settings and by community pediatricians.
An investigation which examined the number of prescriptions in a single center before and following dissemination of educational material to all potential providers indicates that ED/in-patient use decreases significantly, however community pediatricians continue to prescribe this futile treatment resulting in preventable ED visits and admissions for bronchial asthma.
Video Feature
Cincinnati Sports Medicine - Neck & Spinal Cord Injury | Cincinnati Children's
Cincinnati Sports Medicine - Neck & Spinal Cord Injury | Cincinnati Children's
Cervical spine injuries in children associated with sports and recreational activities 

A secondary analysis of a multicenter retrospective case-controlled study involving children <16 years of age who presented to an Emergency Department (ED) after blunt trauma and spinal radiography, indicates:
Common injury patterns are sub axial (49%) and fractures (56%).
  1. Spinal cord injury is more common without radiographic abnormalities compared to children with cervical spine injury from other mechanisms.
  2. Focal neurologic signs, neck pain, injury while diving or sustained axial loading impacts all have an increased likelihood of having spinal cord injury.
  3. Football, diving and bicycle crashes are leading activities associated with cervical spine injuries.
High flow nasal cannula (HFNC) use vs. nasal continuous positive airway pressure (NCPAP) as first-line support in preterm neonates
The use of HFNC to treat preterm infants has apparently dramatically increased in developing communities during the past few years primarily because for its ease of application and care (plus other factors). While HFNC initiated after extubation appears equally effective as NCPAP, uncertainty remains as to its efficacy as a first-line support for preterm infants with respiratory distress.
A systematic review of 6 randomized controlled trials that compared HFNC to NCPAP as the primary support for 1,227 neonates <37 weeks gestation, with or at risk for respiratory distress indicates that HFNC is associated with a higher rate of failure, and when HFNC fails intubation is avoided in some neonates by switching to NCPAP.
ACL Injury Signs & Symptoms - Dr. Craig Spurdle Explains
ACL Injury Signs & Symptoms - Dr. Craig Spurdle Explains
Take the November Quiz !

Can you describe the Congenital Heart Assessment Tool?

How important are gut microbiota to human health?

Does 'Dragon's Breath' pose risks to teenagers?

Click HERE to take Quiz.

Need to Study? 
Click HERE to view past issues of  Updates in Pediatrics .
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