Childhood acute flaccid myelitis, including the first confirmed cases of enterovirus D68 myelitis, in Singapore and Southeast Asia.

Aim: We report the epidemiology, treatment and outcomes of acute flaccid myelitis (AFM), including the first two cases of enterovirus (EV) D68 myelitis, in Singapore.

Methods: Retrospective observational study from a paediatric hospital in Singapore, from January 2012 to December 2022. Clinical, laboratory, neuroimaging and outcome data were analysed.

Factors Affecting Appearance after Thumb Polydactyly Reconstruction - A Caregiver's Perspective in an Asian Population.

Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction.

The natural history of paediatric trigger thumbs. A prospective cohort study.

The aim of this study was to report the natural history of paediatric trigger thumbs, determining the rate and factors predictive of spontaneous resolution. A total of 62 patients presenting with 79 thumbs locked in flexion were observed for a mean of 4.2 years.

The right turn around: Penrose tourniquet application in paediatrics.

Introduction: Commercially available tourniquets are ill-suited for paediatric patients with limb circumferences smaller than the required mechanism, forcing surgeons to improvise. This study aimed to quantify pressures exerted by the Penrose tourniquet when applied on a phantom model and evaluate the intra-/inter-rater reproducibility of the technique previously proposed.

Methods: Eight calibrated pressure sensors were distributed evenly along the inner and outer circumference of a silicon-based model.

An Unusual Case of Cold Burn Injury in a Tropical Country.

Cold burn injury is a relatively uncommon type of burn and is especially rare in the tropics. We present an unusual case of cold burn injury secondary to prolonged contact with a cold surface in a tropical country. Failure of conservative treatment required early excision and reconstruction with free tissue transfer and dermal substitute grafting.

Using the radiocoronoid line for diagnosis of elbow dislocation.

The radiocapitellar line (RCL) has been widely used to diagnose elbow dislocation. However, there are limitations to the RCL, with the cartilaginous portion of bone making interpretation of radiographs difficult. The study aims to show that the radiocoronoid line, which connects two points on the medial aspect of the radius, proximal to the radial tuberosity, is more suited to diagnose elbow dislocations in the anterior-posterior projection.

Retrospective analysis: risk factors predicting failure of closed reduction in pediatric diaphyseal forearm fractures treated with elastic stable intramedullary nails (ESINs).

Level IV.

Polymetatarsia of the Foot without Polydactyly: A Case Report.

Case: We report a rare case of polymetatarsia without polydactyly. Our patient presented with pain and difficulty with shoewear. Radiographs showed an accessory metatarsal arising from the lateral aspect of the fourth metatarsal proximal metaphysis, fusing distally with the medial aspect of the fifth metatarsal head to form a single metatarsophalangeal joint.

Dose reduction for minimizing radiation in displaced paediatric supracondylar humerus fractures: single vs. automated pulse mode.

Conventional C-arm image intensifiers (CCA) are an essential and indispensable aid in modern orthopaedic surgery. CCAs are defaulted to auto-pulse mode which emit multiple pulses (or bursts) of radiation to obtain optimum image quality. The number of pulses per shot can be configured manually.

Suture osteosynthesis in the bony reconstruction of thumb duplication.

Metacarpal osteotomies are done to correct deviation deformity in thumb duplication. We describe a suture-only technique of metacarpal osteosynthesis, without using K-wires. Thirteen Flatt Type IV thumbs and five Wassel Type VII thumbs were reconstructed with this technique.

Lateral Pinning of the Pediatric Phalangeal Neck Fracture.

Closed reduction and percutaneous pinning is the treatment of choice for displaced pediatric phalangeal neck fractures. Multiple techniques have been described to address challenges in managing these unstable fractures. We describe our technique of closed reduction and percutaneous pinning, which avoids the physis and increases the wire insertion accuracy, minimizing the number of attempts and wire passes made at percutaneous pinning.

Sliding the Medial Pin: A Safer Approach to Cross-pinning Humerus Supracondylar Fractures?

Introduction: Many methods have been described to minimize the risk of ulnar nerve injury during the insertion of a medial pin for the percutaneous pinning of pediatric supracondylar humerus fractures (SCHF). The most recent AAOS Clinical Practice Guidelines suggests that physicians might want to avoid the use of medial-entry pins due to considerations of potential injury to the ulnar nerve. However, there are circumstances whereby a cross pin configuration is required.

An assessment of 2 objective measurements of web space position.

Purpose: To describe 2 simple objective clinical methods of measuring the web position between fingers and to determine their intra-observer and inter-observer reliabilities.

Methods: Two observers examined the second, third, and fourth web spaces on both hands of 30 adult healthy volunteers. The web index measured the web height as a relative ratio to constant anatomical landmarks on both fingers subtending the web.

Antipronation spiral tenodesis--a surgical technique for the treatment of perilunate instability.

Perilunate dislocations involve avulsion or rupture of both intrinsic and extrinsic ligaments around the lunate. If inadequately treated, these ligaments may not heal properly, inducing a particular type of carpal instability characterized by the loss of the ability of the carpus to resist pronation torques. Six ligaments protect the carpus against excessive intracarpal pronation: long radiolunate, palmar and dorsal lunotriquetral, dorsal scapholunate, dorsal intercarpal, and palmar scaphocapitate ligaments.

Hand fractures in children: epidemiology and misdiagnosis in a tertiary referral hospital.

Purpose: To determine the local epidemiology of pediatric hand fractures and the rate of misdiagnosis.

Methods: A retrospective study was performed on children aged 17 years and younger who were referred for actual or suspected metacarpal and phalangeal fractures. Medical records were reviewed for age at the time of injury, sex, fracture pattern, venue where the injury was sustained, injury mechanism, and diagnoses made by the referring doctor and hand surgeon.