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Purpose Since the state of alarm was decreed in Spain on 14 March 2020, the coronavirus disease 2019 (COVID-19) pandemic has had an extraordinary impact in paediatric hospitals. This study shows the effect of the pandemic on our practice in paediatric orthopaedics in a referral third level paediatric hospital. Methods We performed a single-centre retrospective review of the official census from a third level paediatric hospital from 14 March to 14 April for the years 2018, 2019 and 2020. Results The patients seen in our clinic during this period in 2020 decreased in by 82% (p < 0.001) compared with 2018 and 2019, however, the number of telemedicine consultations increased by 90.21% (p < 0.001). The total number of patients attending the clinic (including onsite and virtual) was reduced by 54.25% (p < 0.001). The total surgeries performed plummeted by 81% in this period in 2020 (p < 0.001) due to a reduction in elective cases of 94.6% (p < 0.001). No significant decrease was found in the number of urgent surgical cases per day in 2020 (p = 0.34). Finally, the number of orthopaedic patients admitted to our emergency department dropped by 78.6% during the state of alarm (p < 0.001). Conclusion According to our results, the pandemic has significantly affected our daily practice by decreasing elective surgeries and onsite clinics, but other activities have increased. As we have implemented telemedicine and new technologies to adapt to this setback, we should take advantage of the situation to change our practice in the future to better allocate our health resources and to anticipate outbreaks. Published without peer review. Level of Evidence IV

Drug addiction, one of the major health problems worldwide, is characterized by the loss of control in drug intake, craving, and withdrawal. At the individual level, drugs of abuse produce serious consequences on health and have a negative impact on the family environment and on interpersonal and work relationships. At a wider scale, they have significant socio-economic and public health consequences and they cause delinquency and citizen insecurity. Cocaine, a psychostimulant substance, is one of the most used illicit drugs, especially in America, Western Europe, and Australia. Cocaine use disorders (CUD) are complex multifactorial conditions driven by both genetic and environmental influences. Importantly, not all people who use cocaine develop CUD, and this is due, at least in part, to biological factors that are encoded in the genome of individuals. Acute and repeated use of cocaine induces epigenetic and gene expression changes responsible for the neuronal adaptations and the remodeling of brain circuits that lead to the transition from use to abuse or dependence. The purpose of this review is to delineate such factors, which should eventually help to understand the inter-individual variability in the susceptibility to cocaine addiction. Heritability estimates for CUD are high and genetic risk factors for cocaine addiction have been investigated by candidate gene association studies (CGAS) and genome-wide association studies (GWAS), reviewed here. Also, the high comorbidity that exists between CUD and several other psychiatric disorders is well known and includes phenotypes like schizophrenia, aggression, antisocial or risk-taking behaviors. Such comorbidities are associated with a worse lifetime trajectory, and here we report shared genetic factors that may contribute to them. Gene expression changes and epigenetic modifications induced by cocaine use and chronic abuse in humans are addressed by reviewing transcriptomic studies performed on neuronal cells and on postmortem brains. We report some genes which expression is altered by cocaine that also bear genetic risk variants for the disorder. Finally, we have a glance to the pharmacogenetics of CUD treatments, still in early stages. A better understanding of the genetic underpinnings of CUD will foster the search of effective treatments and help to move forward to personalized medicine.

Introduction Since Jeffery, in 1950, described the type II fracture to the present day, the literature has only twenty-eight cases of children with this type of injury. Material and Methods We would like to present a new concept of fixation of this fracture which, as far as we know, has never been described in the literature. Results Open reduction should be performed with minimal injury to osteochondral, ligamentous and muscular structures to reduce complications associated with this injury. We believe that the best technique, once you decide to perform an open approach is to fix the fracture with mini-screws. Achieve a stable fixation and avoids the distraction of the fracture. Discussion Although there is no consensus regarding the need for internal fixation or the type of fixation system to be used in the Jeffery type II fracture, we recommend an open approach and fix the fracture with screws, in order to stabilize the fracture. Introducción Desde que en 1950, Jeffery describiese la fractura typo II, en la literatura solo se han encontrado 28 casos Material y Metodos Presentamos un nuevo concepto de fijación de esta fractura, que nunca antes ha sido descrito Resultados La reducción abierta, debe realizarse minimizando el riesgo de lesión osteocondral, ligamentosa y muscular para reducir el índice de lesion asociada. La mejor tecnica, una vez que se decide realizar un abordaje abierto es fijar la fractura con tornillos de mini-fragmentos. Adquiriendo una fijación estable que evita la distracción de la fractura Discusión A pesar que no existe consenso sobre el tipo de fijación recomendada para las fractura Jeffery tipo II, nosotros recomendamos, realizar abordaje abierto y fijación con tornillos para estabilizar la fractura

BACKGROUND: The use of electric scooters has increased considerably as they are an accessible means of transportation. The number of injuries from falls and collisions has risen significantly. Therefore, the aim of the study was to describe demographics injury patterns of electric scooter accidents produced over one year. METHODS: A prospective observational study of electric scooter- related injuries presented in the emergency room from May 2019 until May 2020. The inclusion criteria was based on the direct cause of injury produced while an electric scooter was in use. Demographic data, the use of a helmet or the lack thereof, accident mechanism, injury time, type of injury produced, and the treatment applied were collected. RESULTS: Over the study period, 397 patients were identified with a total of 422 injuries. The mean age was 30.8 years, with 12.6% of patients being minors. The patients mainly presented in evening hours and in summertime at the emergency department. Of the total injuries seen, 46.9% were fractures. Some 25% of the total cases required surgery. Only 19% of the riders wore a helmet at the time of the accident. Most of the fractures were to the upper limbs (62.6%). There was a greater incidence of radius fractures. CONCLUSION: Injuries incurred while using electric scooters are an emerging phenomenon, despite existing regulations. In this study, most injuries occurred in young men and were due to falls from the vehicle. Nearly half of those injuries were fractures to the upper limbs. Surprisingly, 50% of the fractures required surgery.

Background: The use of electric scooters has increased considerably as they are an accessible means of transportation. The number of injuries from falls and collisions has risen significantly. Therefore, the aim of the study was to describe demographics injury patterns of electric scooter accidents produced over one year. Methods: A prospective observational study of electric scooter- related injuries presented in the emergency room from May 2019 until May 2020. The inclusion criteria was based on the direct cause of injury produced while an electric scooter was in use. Demographic data, the use of a helmet or the lack thereof, accident mechanism, injury time, type of injury produced, and the treatment applied were collected. Results: Over the study period, 397 patients were identified with a total of 422 injuries. The mean age was 30.8 years, with 12.6% of patients being minors. The patients mainly presented in evening hours and in summertime at the emergency department. Of the total injuries seen, 46.9% were fractures. Some 25% of the total cases required surgery. Only 19% of the riders wore a helmet at the time of the accident. Most of the fractures were to the upper limbs (62.6%). There was a greater incidence of radius fractures. Conclusion: Injuries incurred while using electric scooters are an emerging phenomenon, despite existing regulations. In this study, most injuries occurred in young men and were due to falls from the vehicle. Nearly half of those injuries were fractures to the upper limbs. Surprisingly, 50% of the fractures required surgery.

Calcified aponeurotic fibroma is a rare benign fibrous tumour with characteristic histopathological features commonly observed in children and adolescents. It usually involves the most distal part of the extremities. Despite being a benign tumour, it has a high risk of local recurrence. We report our experience treating four children with calcifying aponeurotic fibroma who underwent surgical excision of the tumour. Two of them developed a local recurrence: one required a surgical revision, whereas the other currently continues to be under observation. The incidence found over a 5-year period (2010-2015) may lead us to consider that this condition is not as rare as reported and may often be misdiagnosed.

Osteochondral lesions of the talus might be a more common cause of pain than previously recognized, especially among those involved in athletic activities. However, the location of an osteochondral lesion on the talar head is much less common than such lesions localized to the dome of the talus and can pose diagnostic difficulties. We present the case of a 14-year-old soccer player who complained of longstanding pain in his left foot. After unsuccessful conservative treatment consisting of rest and bracing, he was ultimately treated with retrograde percutaneous drilling of the talar head performed by a medial approach. This was followed by casting and non-weightbearing for 6 weeks, after which physical therapy was undertaken. He was able to return to full activity and remained asymptomatic during a 5-year observation period. Although rare, osteochondritis dissecans of the talar head should be considered in young athletes with persistent foot pain that is unresponsive to reasonable therapy.

[Resumen] Objetivo: El fibroqueratoma periungueal adquirido es un tumor fibroepitelial benigno, con escasa incidencia a nivel del pie. Es una tumoración cubierta de piel hiperpigmentada con hiperqueratosis en su porción distal, de consistencia firme e indurada, y tamaño variable, que oscila entre los 3 y los 15 mm. de diámetro. Material y métódos: Presentamos un varón de 6 años de edad, con una tumoración de 0,4 x 0,5 cm, dolorosa compatible con fibroqueratoma periungueal adquirido a nivel del hallux. Dada la edad del paciente, hay que realizar diagnóstico diferencial con tumor de Köenen. Resultados: Tras la resección quirúrgica según técnica de colgajo en bandera, el estudio histopatológico confirma la sospecha clínica. Conclusiones: El fibroqueratoma periungueal adquirido, es una entidad clínica e histológica bien definida y muy característica, cuyo diagnóstico puede realizarse con toda certeza y su tratamiento definitivo se realizará por medio de la escisión definitiva de la lesión. [Abstract] Objective: The acquired periungual fibrokeratoma is a benign fibroepithelial tumor, with little incidence at the level of the foot. It presents as a fleshy mass covered with hyperpigmented skin with hyperkeratosis in its distal portion, firm and indurated consistency, and variable size, ranging from 3 to 15 mm. diameter. Methods: We present a 6-year-old male, who presented at the level of the hallux, a tumor 0.4 x 0.5 cm, painful compatible with fibrokeratoma periungueal acquired. Given the patient's age, a differential diagnosis should be made with Köenen's tumor. Results: After surgical resection according to flag flap technique, the histopathological study confirms the clinical suspicion. Conclusion: Acquired periungueal fibrokeratoma is a well-defined and characteristic clinical and histological entity, whose diagnosis can be made with all certainty and its definitive treatment will be carried out through definitive excision of the lesion.

Purpose The frequency of injuries sustained while playing on inflatable toys such as bouncy castles have rapidly increased. These supposedly safe structures are likely unsafe. The objective of this review was to investigate the risk that these attractions represent and the necessary measures to minimize risk of accidents. Methods We conducted a prospective study of 114 patients over a period of one year (2015 to 2016). Demographic data collected included: age, gender, anatomical location and side of involvement as well as supervision of the child whilst on the bouncy castle. The extracted data include mechanism of injury and risk factors, i.e. lack of supervision of the child, amounts of users jumping at the same time. Results The injuries were slightly more frequent in male than female children; 2:1 up to six years of age. From the age of ten to 14 years the ration evened to 1:1, the higher incidence in female children was between the ages of six to eight years. The most common injuries were to the humerus, followed by the distal radius. Only 28% of the parents said they were supervising while the child was jumping. Conclusion Injuries associated with inflatable bouncers have increased over time. The main risk factors: were lack of effective adult supervision and the shared use by an excessive number of participants of different ages and weights. These considerations lead to the conclusion that there is a necessity to enhance child health surveillance and to consider limiting bouncer usage to children over the age of six years, to prevent and control injuries and to minimize their consequences. Level of Evidence II - prospective study

Background: Trigger finger is a rare condition in children and it is even more uncommon in the 5th finger. The etiology of Trigger finger includes congenital cases, which are the most common and usually affects the thumb; posttraumatic cases, more frequent after penetrating injury; and tumoral cases. Methods: In this paper, we report a post-traumatic trigger finger on a 2-year-old girl who was seen in our clinic complaining of triggering in her small left finger, following a slight contusion. As far as we know there is no previous report of this condition involving the fifth finger in toddlers. Conclusions: The natural history of pediatric trigger finger is poorly characterized due to the small number of retrospective cases series available. Based on our experience, the methodology to be followed would be, after a thorough history and after ruling out concomitant pathology, if a congenital trigger finger in a child come into our clinic, the most successful resolution is release of the A1 pulley.