The Prevalence of Bullying Among Pediatric Orthopaedic Patients

Surgical Treatment of Congenital Muscular Torticollis: Significant Improvement in Health-related Quality of Life Among a 2-year Follow-up Cohort of Children, Adolescents, and Young Adults

OBJECTIVE

Surgical treatment of congenital muscular torticollis (CMT) has been proven clinically effective in cases that fail to normalize after conservative treatment, but reports on self-reported outcome and quality of life have been scarce. This study aimed to assess health-related quality of life (HRQoL) in children, adolescents, and young adults undergoing surgical treatment for CMT, comparing HRQoL with clinical outcomes.

METHODS

We conducted a level 2 prospective observational study on a surgically treated CMT cohort at a single tertiary center. The surgeries focused on releasing all tightness, and the medial head was routinely elongated to preserve cosmetic function. Patients underwent rigorous pre/postoperative assessments and follow-up. A strict postoperative protocol entailing stretching, physiotherapy, and positional exercises was adhered to for a minimum of 6 months. The Cheng and Tang torticollis scoring system and PedsQLTM 4.0 generic core scales were used to evaluate clinical outcome and HRQoL, respectively.

RESULTS

The study included 31 patients, averaging 11.4 years. Significant improvements in range of motion, deformities, and overall subjective satisfaction were observed 2 years postoperatively. The Cheng and Tang score improved overall significantly from fair (9.9 points) to excellent (17.9 points) after 2 years ( P <0.001). The oldest patients showed less improvement than the youngest ones, especially regarding craniofacial asymmetry ( P =0.004). Patient PedsQL scores significantly improved 2 years post-surgery ( P =0.040), with no discernable age differences.

CONCLUSION

Our findings demonstrated significant improvements in both HRQoL and clinical outcomes after surgical treatment of CMT. The PedsQL score seemed sensitive to the clinical changes.

The post-surgical transition in adolescents who have idiopathic scoliosis. A qualitative study

OBJECTIVE

To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity.

METHOD

Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out.

RESULTS

Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support.

CONCLUSIONS

The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life» to which they constantly refer in their speeches.

A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics

Bullying annually affects 20%-25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months.

Methods

Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5-18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners.

Results

The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health.

Conclusions

Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.

Introduction to Limb Deficiency for the Pediatrician

Owing to the lack of trained professionals in amputee care, the pediatrician is often required to assist in the care of children with limb deficiencies. An overview of the causes and epidemiology of limb deficiency is provided, as well as an evaluation and diagnostic workup. Important considerations for surgical interventions are discussed and an introduction to prosthetic prescribing and care of the amputee is described. Common overuse syndromes and mental health issues are also reviewed. Finally, resources for funding of prosthetic devices, as well as support and education for clinicians and families are provided.