Kyle J Miller, Andrew G Georgiadis, Jennifer C Laine
{"title":"Educating and Preparing Families and Distracting Patients for Cast/Splint Applications.","authors":"Kyle J Miller, Andrew G Georgiadis, Jennifer C Laine","doi":"10.1016/j.jposna.2025.100243","DOIUrl":"10.1016/j.jposna.2025.100243","url":null,"abstract":"<p><p>The casting process can produce anxiety and sometimes discomfort for both patients and caregivers. Proper preparation and education are essential for a successful casting experience. The teaching process should begin as early as possible before cast placement. Strategies to enhance the patient experience include pain management, environmental controls, and distraction techniques. Tailoring the experience to the child's developmental stage is crucial. By implementing these strategies, healthcare professionals can enhance the experience for patients and caregivers, making the process more efficient and less traumatic for everyone involved. The purpose of this chapter is to detail evidence-based strategies, along with insights and challenges from pediatric orthopaedic experts, in preparing patients and caregivers for cast and splint immobilization.</p><p><strong>Key concepts: </strong>(1)Successful pediatric orthopaedic cast and splint application relies on clear, compassionate communication and education for patients and caregivers.(2)When preparing patients and families for the casting and splinting process, the approach should be customized to the child's age and developmental stage.(3)Adequate pain management, environmental controls, and distraction techniques can be helpful in alleviating discomfort and anxiety during the placement and removal of casts and splints.(4)The placement of the cast marks the beginning of a typically much longer process, making proper preparation and education vital for a successful casting or splinting outcome.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100243"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hip Spica Cast Application.","authors":"Amy Steele, Vidyadhar Upasani","doi":"10.1016/j.jposna.2025.100242","DOIUrl":"10.1016/j.jposna.2025.100242","url":null,"abstract":"<p><p>We discuss the indications, technical pearls, and pitfalls of hip spica cast application in pediatric patients. The intent is to teach the proper technique for hip spica cast application and to avoid the known complications of this technique. Hip spica casts covered in this chapter will include spica casting for developmental dysplasia of the hip and for traumatic purposes including femur fracture application as well as a brief discussion regarding the commercially available braces for the treatment of various pediatric traumatic injuries. The figures and videos included will provide illustrations and examples of cast application, tips and tricks for applying these casts, as well as things to avoid.</p><p><strong>Key concepts: </strong>(1)Respect the cast. Ensure that all areas are well padded with layers laid down without wrinkles or kinks.(2)Add additional splints of cast material to areas over joints where motion may occur to strengthen the cast without adding additional circumferential layers.(3)Patient and family education is critical to draw attention to problems early and to mitigate any unnecessary burden.(4)Understand what you are trying to accomplish with a spica cast to determine appropriate configuration (double leg vs single leg) and patient position (open hip reduction vs femur fracture management).(5)Ensure that you have collected all necessary equipment and resources before starting to allow for a successful spica cast application.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100242"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ritt R Givens, Jennifer A Kunes, Riley Sevensky, Kevin Lu, Mark Herbert, Katherine Rosenwasser, Christen M Russo
{"title":"Recommended Treatment for Pediatric Upper Extremity Fractures Varies Among Orthopaedic Surgeons and Trainees.","authors":"Ritt R Givens, Jennifer A Kunes, Riley Sevensky, Kevin Lu, Mark Herbert, Katherine Rosenwasser, Christen M Russo","doi":"10.1016/j.jposna.2025.100247","DOIUrl":"10.1016/j.jposna.2025.100247","url":null,"abstract":"<p><strong>Background: </strong>Given the breadth of findings and recommendations regarding the acceptable alignment and optimal management of pediatric fractures, pervasive questions remain about the current versus best practices. We aimed to identify patterns and assess agreement in the management of pediatric fractures among respondents at various levels of training and practice characteristics.</p><p><strong>Methods: </strong>A cross-sectional survey containing 15 case vignettes of common pediatric fractures was distributed to attendings, fellows, and residents at various institutions. Each vignette included relevant imaging, alignment metrics, and patient age/sex. Participants were given four treatment options for each vignette: (1) no reduction/cast or splint <i>in situ</i>, (2) reduction attempt, will remodel (no need for OR), (3) reduction attempt, needs to be anatomic (possible OR), (4) no reduction attempt, splint for comfort, needs operative intervention. Respondents were separated into three distinct cohorts: individuals in training (i.e., residents/fellows), attending pediatric orthopaedists, and attending non-pediatric orthopaedists.</p><p><strong>Results: </strong>48 individuals completed the survey: 22 trainees (residents and fellows), 19 pediatric attendings, and 7 non-pediatric attendings. Among all subgroups, there was a significant poor-fair overall level of agreement (attendings (peds): K = 0.337, <i>P</i> < .001; attendings (non-peds): K = 0.299, <i>P</i> < .001, trainees K = 0.241, <i>P</i> < .001). Pediatric attendings generally opted for less invasive treatments than trainees in management of distal radius fractures (average response of 1.86 vs. 2.16; <i>P</i> < .05) and both bone fractures (1.92 vs. 2.24; <i>P</i> < .05). The differences in proximal humerus fractures (1.24 vs. 1.46; <i>P</i> = .095) and \"other\" fractures (2.34 vs. 2.51; <i>P</i> = .277) did not reach significance, though the same trend (trainees pursuing more aggressive treatment) persisted. Pediatric attendings reached ≥80% consensus on a single treatment option for 6/15 cases (1/5 DRF, 2/3 PHF, 3/7 other), and on grouped \"non-operative\" and \"possible or certain OR\" for 11/15 (3/5 DRF, 3/3 PHF, 5/7 other cases).</p><p><strong>Conclusions: </strong>To our knowledge, this is the first cross-sectional survey investigating agreement on management of pediatric fractures and expectation of remodeling among attendings, fellows, and residents at various institutions. Overall agreement among attendings was poor-fair and higher than trainees. Trainees were more likely to recommend invasive/operative treatments. Further studies standardizing pediatric upper extremity fracture management, as well as resident education on the topic, are warranted.</p><p><strong>Key concepts: </strong>(1)Treatment recommendations for pediatric upper extremity fractures are not standardized.(2)In comparing 15 case vignettes, agreement among attendings was poor-fair but higher than tra","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100247"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Collin Braithwaite, Ahmad Alhankawi, Katelyn Koschmeder, Rose Zach, Ashlyn Omahen, Jack M Haglin, Melissa Esparza
{"title":"Improving Patient Experience During Casting: A Review and Description of Cast Art Technique That Allows for Creative Designs in Pediatric Casts.","authors":"Collin Braithwaite, Ahmad Alhankawi, Katelyn Koschmeder, Rose Zach, Ashlyn Omahen, Jack M Haglin, Melissa Esparza","doi":"10.1016/j.jposna.2025.100233","DOIUrl":"10.1016/j.jposna.2025.100233","url":null,"abstract":"<p><p>Casting is a common intervention in pediatric orthopaedics, serving to immobilize extremities, maintain alignment of fractures, and provide protection of underlying injury. Although casting plays an integral part in the treatment of orthopaedic conditions, pediatric patients can often feel anxiety and pain during cast application. Several methods have been developed to help reduce the psychological burden associated with cast application, including cast design with a variety of color options, distraction techniques such as videos or art, and utilizing certified child life specialists. Child life specialists support pediatric patients and their families during their medical treatment and have been shown to help increase patient and parent satisfaction. This article proposes a simple casting technique design that adds minimal time to the application process. The technique involves using a standard 8 × 11 sheet of paper with the patient's chosen design, scissors, Ace wrap, and general casting materials such as stockinette, cast padding, and fiberglass cast material. The standard casting procedure is followed, with the addition of printing, cutting, and soaking a patient-specific design in water and applying it to the cast after completion of molding. The design is wrapped with a wet ace wrap and transferred to the cast. The proposed casting technique helps engage pediatric patients and enhances their experience with individualized cast designs, and it takes minimal time to implement.</p><p><strong>Key concepts: </strong>(1)Simple cast art technique for pediatric casting.(2)Role of child life specialists in orthopaedic pediatric casting.(3)Satisfaction in pediatric orthopaedic casting.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100233"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Properties and Pitfalls of Various Casting Materials.","authors":"Brendon C Mitchell, Keith Baldwin","doi":"10.1016/j.jposna.2025.100234","DOIUrl":"10.1016/j.jposna.2025.100234","url":null,"abstract":"<p><p>The purpose of this chapter is to thoroughly review the properties and pitfalls of various casting materials used in pediatric fracture care. Additionally, we will examine the unique characteristics of children that influence decision-making regarding the selection of materials for the under- and over-layers of a cast, as well as considerations based on anatomic location and type of cast. Generally, the underlayer of any cast provides cushioning and protects the underlying soft tissues, whereas the overlayer delivers rigid immobilization intended to maintain the alignment of the fracture. Fracture management can be achieved through splinting or casting. While splints offer rigid immobilization, they do not wrap circumferentially around the extremity, in contrast to casts, which are applied in a circumferential manner. The most common overlayer materials for achieving rigid immobilization in casting are plaster of Paris and fiberglass. Both materials can also be used to form a splint. Waterproof casting can be accomplished by using a water-tolerant underlayer (ie Gore-Tex) and a fiberglass overlayer. Proper material selection and careful application of each layer are crucial to providing immobilization in a safe manner that protects the underlying soft tissues.</p><p><strong>Key concepts: </strong>(1)Stockinette made from a synthetic polyester material often serves as the first layer of a cast, providing an initial barrier to the skin.(2)Soft roll (ie Webril) is the primary padding material used in casting, but it can be supplemented with materials like moleskin, silicone, and foam.(3)Fiberglass and plaster of Paris offer rigid immobilization and can be used as a cast or splint, requiring careful padding to avoid soft tissue injury.(4)The art of casting requires a delicate balance of layer thickness and tautness, along with attention to cast edges, material balance, and pressure points on the skin.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100234"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Waters, Kevin Farrell, Donald Bae, Rebecca Glavin, Steven Frick
{"title":"Handling Risky Situations, Especially the Unexpected, With Elite Performance.","authors":"Peter Waters, Kevin Farrell, Donald Bae, Rebecca Glavin, Steven Frick","doi":"10.1016/j.jposna.2025.100227","DOIUrl":"10.1016/j.jposna.2025.100227","url":null,"abstract":"<p><p>Surgery is stressful and carries real risk for patients, surgeons, operating room professionals, and healthcare organization. To achieve the safest and best possible outcomes, surgeons need to execute a surgical plan based on evidence-based information with the highest level of technical skill. In addition, surgeons and their teams need to \"expect the unexpected,\" manage their emotions and behaviors productively, stay calm and focused under pressure, and enact anticipated and in-the-moment contingency plans to avoid complications.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100227"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"<i>JPOSNA®</i> Primer on Cast and Splint Application.","authors":"Stephanie Holmes, Ishaan Swarup","doi":"10.1016/j.jposna.2025.100235","DOIUrl":"https://doi.org/10.1016/j.jposna.2025.100235","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100235"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven Frick, Rebecca Glavin, Corina Franklin, Peter Waters
{"title":"Author's Reply Regarding \"Work-life Balance in Pediatric Orthopaediatrics: The Role of the Leaders\".","authors":"Steven Frick, Rebecca Glavin, Corina Franklin, Peter Waters","doi":"10.1016/j.jposna.2025.100232","DOIUrl":"10.1016/j.jposna.2025.100232","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100232"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie A Nulty, Ann Van Heest, Andrew G Georgiadis
{"title":"Long Head of the Triceps Transfer to the Proximal Ulna for Active Elbow Flexion in Arthrogryposis.","authors":"Stephanie A Nulty, Ann Van Heest, Andrew G Georgiadis","doi":"10.1016/j.jposna.2025.100226","DOIUrl":"10.1016/j.jposna.2025.100226","url":null,"abstract":"<p><p>Children with amyoplastic arthrogryposis may have absent myotomes (e.g., biceps brachii, brachialis), leading to a lack of active elbow flexion and/or elbow extension contractures. In these cases, the long head of the triceps can be transferred through an extensile approach to the proximal volar ulna, improving both active and passive elbow flexion. Key technical considerations include patient selection, preservation of the long head's neurovascular pedicle, precise dissection of the radial and ulnar nerves, and safe tendon rerouting. This paper highlights technical details with a representative case example and an accompanying technique video. A 6-year-old patient with amyoplasia and absent active flexion underwent a long head of the triceps transfer. The procedure was documented with surgeon point-of-view high-definition footage to emphasize crucial technical steps. Passive and active elbow flexion improved at short-term follow-up and was sustained at 2 years.</p><p><strong>Key concepts: </strong>(1)Elbow flexion can be improved through long head of triceps transfer in children with amyoplastic type of arthrogryposis.(2)Use of one head of the triceps adds elbow flexion and does not sacrifice elbow extension function as the medial and lateral heads of the triceps are preserved as elbow extensors.(3)Most children with arthrogryposis have demonstrated clinically that they can achieve selective control of the long head of the triceps to flex the elbow post-operatively, while relaxing the medial and lateral heads of the triceps for elbow extension.(4)The long head of the triceps originates from the scapula and has separate radial nerve branch proximal innervation allowing dissection away from the other two heads of the triceps.(5)Careful dissection and understanding of the anatomy of the three heads of the triceps is needed for successful surgical transfer of the long head of the triceps.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100226"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strategies for Managing Genu Valgum and Patellar Instability in Skeletally Immature Patients: Weighing One-Stage Against Staged Guided Growth and Medial Patellofemoral Ligament Reconstruction.","authors":"Javier Masquijo, Henry B Ellis","doi":"10.1016/j.jposna.2025.100228","DOIUrl":"10.1016/j.jposna.2025.100228","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100228"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}