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Natural History of Kids’ Benign Bone Tumors; Sarcoma Staging; Pathologic Fractures

Almost 20% of asymptomatic children and adolescents had benign bone tumors of the extremities, a review of a longitudinal radiographic collection showed.

Overall, 35 benign tumors were identified in 33 pediatric patients whose median age was 8. The most commonly identified tumor types were non-ossifying fibromas (NOF, 7.5%), enostoses (5.2%), osteochondromas (4.5%), and enchondromas (1.8%).

The findings came from a review of the Brush Inquiry, a collection of 25,555 radiographs and 262 healthy children. The x-rays were all left-sided views of each patient’s upper and lower extremities. The overall incidence of benign tumors in the asymptomatic population was 18.9%, and the median age at detection after a previous negative radiograph was 9 years. NOFs were the only tumor type that resolved over time, Christopher D. Collier, MD, of the University of Chicago, reported during the Musculoskeletal Tumor Society (MSTS) virtual meeting.

“The goal of this study was to give us more accurate information on the overall incidence of these [tumors] and the natural history,” MSTS program co-chair Thomas J. Scharschmidt, MD, of Ohio State University in Columbus, said during a review of selected abstracts. “The impetus for the study is that those of us in the oncology world have a lot of consults for NOFs, osteochondromas, and other things that can cause a lot of anxiety for families. This information provides us with some numbers to be able to counsel families when they are sent to us.”

Following are summaries of two other abstracts from the meeting.

Skeletal Staging in Bone Sarcomas

As many as 35% of patients with bone sarcomas and bony metastases at diagnosis would have gone undetected if staging had included only a CT scan of the lungs, a separate review of 9,855 patients showed.

The analysis of the National Cancer Database included patients with newly diagnosed bone sarcomas during 2010-2015: 4,013 patients with chondrosarcoma, 4,105 with osteosarcoma, and 1,737 with Ewing sarcoma. The data showed that 11.7% of patients had lung metastases and 4.8% had bone metastases at diagnosis. The presence of bone metastases was associated with worse survival in each of the three histologies and in all histologies combined (P<0.01).

The study had its origin in the growing interest in modified staging protocols that challenge the value of skeletal staging, Collier and colleagues noted in a poster presentation. The data showed that lung-only staging would have missed metastatic disease in 16% of patients with osteosarcoma, 25% of those with chondrosarcoma, and 35% of patients with Ewing sarcoma.

“I think we probably routinely get bone staging, more so in our bone sarcomas and soft-tissue sarcomas, but I think this study really highlighted the importance of that as well as the poor outcomes with bone metastases overall across all of these bone sarcomas,” said Scharschmidt.

Pathologic Fracture and Limb Salvage Outcomes

Pathologic fracture did not adversely affect patient or implant survival following limb salvage surgery for osteosarcoma, a review of 304 cases showed.

During a median follow-up of 13 years, 17 (5.6%) patients had a

Spine Fractures More Common at Trampoline Parks, Study Shows

Across the United States, an explosive growth in recreational facilities boasting trampolines coincides with alarming growth in trampoline-related injuries in children, including those to the spine, according to new research.



Dr Serena Freiman

Among youths, the risk for trampoline park–related fractures is about three times higher than for home-based trampoline fractures, said study author Serena Freiman, MD, of Washington University in St. Louis, in St. Louis, Missouri.

Recreational sports facilities with trampolines “pose a public health hazard,” Freiman said during a presentation at the virtual American Academy of Pediatrics (AAP) 2020 National Conference.

“There aren’t any set regulations for these parks, so the American Society for Testing and Materials released a set of standards, but only Michigan and Arizona enforced those,” Freiman explained.

“Hopefully, since we’re showing a significant increased risk of injuries, the federal government will enforce regulations throughout the United States,” she told Medscape Medical News.

The first trampoline park in the United States opened in 2004, Freiman said. By 2018, there were more than 800 recreational facilities with trampolines across the country. This rapid growth coincided with a 45% increase in emergency department (ED) visits for trampoline-related injuries, from 61,509 in 2014 to more than 89,000 in 2017.

“There’s been exponential growth since their founding,” she said, “and with that we’ve also seen an exponential growth in injuries, whereas home injuries [from trampolines] remained stable during that time period.”

To assess the rates of trampoline-related injuries, Freiman and colleague analyzed data from the National Electronic Injury Surveillance System (NEISS). They included all patients whose records include a code for trampoline injury and who presented to a hospital ED between 1998 and 2017. They compared home trampoline injuries with those sustained at recreational facilities.

During the study period, more than 1.37 million patients presented to the ED for trampoline-related injuries. Of those, 125,473 occurred at recreational facilities, and 1.22 million occurred at home. Injuries at trampoline parks increased 90-fold between 2004 and 2017 (0.04 per 10,000 ED visits in 2004 to 0.9 per 10,000 in 2017), with 69% of those injuries occurring between 2012 and 2017.

Home-based trampoline injuries dropped during the study period, from 2.8 per 10,000 ED visits in 2014 to 1.6 in 2017.

Patients injured at trampoline facilities tended to present at large hospitals, Freiman noted, likely because of these parks being located in more populated regions.

The type of injury differed between locations. Severe injuries, such as spine fractures, occurred three times as often at trampoline parks than at home (2.7% vs 0.9%; P = .016).

Internal organ injuries occurred more frequently on home-based trampolines (20.1% home-based trampolines vs 2.3% trampoline parks; P < .001), whereas strains and sprains were more common at trampoline parks (32% vs 51%; P < .001).

“Since home trampolines are often off the ground, I would speculate that you’re more likely to hit the edge of the trampoline or fall from it,” she said, “whereas at recreational sports facilities, there are often multiple jumpers, and you’re not falling

Pediatric Fractures Shift During Pandemic

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Pediatric fractures dropped by 2.5-fold during the early months of the COVID-19 pandemic, but more breaks happened at home and on bicycles, and younger kids were more affected, new research indicates.

The study of 1745 patients also found that those with distal radius torus fractures were more likely to receive a Velcro splint during the pandemic. Experts said this key trend points toward widespread shifts to streamline treatment, which should persist after the pandemic.

“We expected to see a drop in fracture volume, but what was a bit unexpected was the proportional rise in at-home injuries, which we weren’t immediately aware of,” said senior author Apurva Shah, MD, MBA, of Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania Perelman School of Medicine in Philadelphia.

“As time went on, it became more apparent that trampoline and bicycle injuries were on the rise, but at the beginning of the pandemic, we didn’t intuitively expect that,” he added.

“Whenever there’s a major shift in how the world is working, we want to understand how that impacts child safety,” Shah told Medscape Medical News. “The message to get out to parents is that it’s obviously difficult to supervise kids while working from home” during the pandemic, “and that supervision obviously is not always working as well as intended.”

Joshua T. Bram, a medical student, presented the study at the virtual American Academy of Pediatrics (AAP) 2020 National Conference.

Bram, Shah, and colleagues compared patients with acute fractures who presented at CHOP between March and April 2020 with those who presented during the same months in 2018 and 2019.

Overall, the number of patients with pediatric fractures who presented to CHOP fell to an average of just under 10 per day, compared with more than 22 per day in prior years (P < .001). In addition, the age of the patients fell from an average of 9.4 years to 7.5 years (P < .001), with fewer adolescents affected in 2020.

“I think when you cancel a 14-year-old’s baseball season” because of the pandemic, “unfortunately, that lost outdoor time might be substituted with time on a screen,” he explained. “But canceling a 6-year-old’s soccer season might mean substituting that with more time outside on bikes or on a trampoline.”

As noted, because of the pandemic, a higher proportion of pediatric fractures occurred at home (57.8% vs 32.5%; P < .001) or on bicycles (18.3% vs 8.2%; P < .001), but there were fewer organized sports–related (7.2% vs 26.0%; P < .001) or playground-related injuries (5.2% vs 9.0%; P < .001).

In the study period this year, the researchers saw no increase in the amount of time between injury and presentation. However, data suggest that in more recent months, “kids are presenting with fractures late, with sometimes great consequences,” Shah said.

“What has changed is that a lot of adults have lost their jobs, and as a consequence,