purpose. To survey caregivers with regard to the pain they perceived their children were having during the removal of the percutaneous Kirschner wires, as well as the need for analgesia. Methods. 23 male and 18 female patients aged 1 to 15 (mean, 7) years who underwent closed reduction and percutaneous Kirschner wire fixation for elbow fractures and subsequent removal of the wires were included. Before the removal procedure, caregivers of these patients were asked to select one of 4 options for the procedure: no analgesia, paracetamol, sedation, and general anaesthesia. Approximately one month following the procedure, the caregivers were interviewed via telephone to retrospectively score the pain (on a scale of 1 to 10) they perceived their children were having during the removal procedure. results. The mean retrospective pain score given by these caregivers was 3.88. Of the 41 caregivers, 30 considered analgesia unnecessary, 10 opted for paracetamol, and only one opted for sedation. None

Dislocation of the peroneal tendons associated with calcaneus fractures should be repaired during fracture fixation to prevent complications. The only documented approach for repair is by proximal extension of the vertical limb of the lateral extensile approach to the calcaneus. However, enlarging the inherently fragile calcaneus flap places it at further risk of damage. Using a separate anterior incision to repair the dislocation, thus avoiding problems caused by excessive flap elevation, seemed intuitive. This approach proved technically effective and reliable in producing favorable outcomes in a series of 14 patients.

No abstract

We describe a percutaneous modification of the Brostrom-Gould procedure for lateral ankle instability. Our surgical technique involves making a stab incision at the anterior aspect of the distal fibula. Dissection is made down to bone and a double-loaded suture anchor is placed at the anterior talofibular ligament (ATFL) origin. The sutures are loaded individually onto a trocar needle and passed underneath the remnant ATFL and inferior extensor retinaculum at its distal extent. Percutaneous stab incisions are made to allow retrieval of the sutures which are passed subcutaneously back to the ATFL origin. The 2 sets of sutures, positioned to reconstruct the ATFL and calcaneofibular fibular ligament, are then secured with the ankle in eversion and plantigrade position. Patients are placed on a short walker boot and 2 to 3 weeks of non-weight-bearing postoperatively.

Introduction: Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents. Materials and Methods: Patients aged 6–17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast. Results: A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs (P <0.05), and the dorsal surface of the arm (P <0.05). Likewise, SC hydration was significantly increased at most sites (P <0.05), except the volar surface of the leg (P = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores. Conclusions: Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients’ skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted. Ann Acad Med Singapore 2020;49:285–93 Ann Acad Med Singapore 2020;49:354–59 Key words: Cast immobilisation, Transepidermal water loss, Stratum corneum hydration