Background: Obtaining ideal serum 25-vitamin D (25VitD) levels (>30 ng/mL) is imperative in childhood to achieve peak bone mass. Supplementation compliance in children recommended to take vitamin D postfracture was evaluated. The questions we sought to answer were: Is there (1) a compliance difference between patients with known versus unknown 25VitD levels; (2) an association between compliance and age; and (3) an association between fracture severity and initial 25VitD level. Methods: One physician analyzed compliance in 1818 fracture patients 2 to 18 years (42% female) with known (48%) and unknown 25VitD. Patient/caregiver’s self-reported adherence to supplementation as “yes” (4 d/wk minimum) or “no” defined compliance. Compliance relating to fracture severity via Abbreviated Injury Scale (AIS), 25VitD level, and age, was analyzed. Results: Patients with 25VitD levels were more compliant than patients without (61%, n=532/872; 21%, n=206/946; P<0.001). In total, 83% (n=104/125) of AIS 3 patients were compliant, compared with 49% (n=628/1292) of AIS 1/2 patients (P<0.001). Compliance increased with age (odds ratio: 1.09, 95% confidence interval: 1.061-1.120, P<0.001). Conclusions: Compliance increased when 25VitD levels were obtained, improving with fracture severity. Clinicians should order 25VitD levels on fracture patients to improve supplementation compliance. Level of Evidence: This is a level IV prognostic study which aims to investigate the effects of various patient characteristics on compliance.

Substance abuse and addiction represent a worldwide problem and cause a number of family, social and health problems. Digestive system damage caused by substance intake is an increasing problem amoung drug addicts. Many studies show that substances can cause cancer of all parts of the digestive system. Alcohol consumption was significantly associated with colon and rectal cancer. For rectal cancer, the risk was increased in association with drinking of alcoholic beverages, specialy for beer consumption. Sinthetic drugs such as ecstasy may lead also to digestive and hepatic damage, as well as vascular complications of the stomach. Many studies show the existance of supstance associated enterocolitis as well as ishemic colitis. Diagnosis of ishemic colitis is based on the presence of rectal bleeding, abdominal pain, a history of substance use, supportive endoscopic and histopathologic findings, and the absence of other etiologic mechanisms of ischemic colitis. Great damage to the digestive system is also produced by smuggling narcotics packed into small pages that are afterwards been swallowed or implemented on other sorts of ways inside the smugglers natural body spaces as the rectum or vagina. In the paper authors reviewed literature conserning digestive system damage caused by substance abuse and drug smuggling.

Case: A 7-year-old boy presented with excruciating hip pain for 1 day, unable to bear weight. Magnetic resonance imaging (MRI) revealed small hip joint effusion and synovitis, which was treated by urgent operative aspiration to rule out infection. Subsequently, the postoperative site bled continuously, despite compression. The hip wound and blood cultures showed no growth. He was examined by a hematologist and had normal coagulopathy lab results. He was discharged and went home 4 days after aspiration and was scheduled for outpatient hematology work-up. He was readmitted 11 days after aspiration with continued pain and MRI was repeated, showing large hip hemarthrosis. Lab results at that time showed a prolonged partial thromboplastin time of 43.9 seconds. The patient was given fresh frozen plasma. The hip effusion was stable on ultrasound. He was found to have low factor IX <17% consistent with hemophilia B and was given recombinant factor IX (Benefix) of 2,000 units. The following day, his pain was markedly improved and he was discharged. At the 4-month follow-up, the patient was fully ambulatory. Conclusions: This is a case of unexpected bleeding after hip aspiration which led to the life-changing diagnosis of Hemophilia B in a pediatric patient. Orthopedists should be wary of bleeding dyscrasias and involve consultants as needed.

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figure 1A and B. Anterior-posterior and oblique views of the pelvis show portions of a fetal skeleton compatible with a 28-week pregnancy with visualization of a head, multiple vertebral bodies, multiple ribs, and upper and lower extremities.figure 2A: Anterior-posterior and B. oblique views of the pelvis show portions of a fetal skeleton compatible with a 28-week pregnancy with visualization of a head, multiple vertebral bodies, multiple ribs, and upper and lower extremities. The findings are drawn onto the radiographs.