Yazan Alasadi

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Randomized controlled trials (RCTs) are essential for guiding the treatment of vertebral compression fractures with kyphoplasty, yet the statistical robustness of their findings has not been thoroughly evaluated. This systematic review assessed the fragility of dichotomous outcomes in kyphoplasty RCTs using the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ). A comprehensive search of PubMed, Embase, and MEDLINE identified eligible RCTs, yielding 282 dichotomous outcomes for analysis. The overall median FI was 4 (interquartile range [IQR], 4-5), corresponding to a median FQ of 0.020 (IQR, 0.013-0.040). Statistically significant outcomes (n=18) demonstrated greater fragility, with a median FI of 2 (IQR, 1-4) and FQ of 0.015 (IQR, 0.011-0.029), compared with nonsignificant outcomes (n=264; FI, 5 [IQR, 4-5]; FQ, 0.020 [IQR, 0.013-0.041]). Subgroup analyses revealed that pain and complication outcomes had median FIs of 4 and 5, respectively, with FQs ranging from 0.016 to 0.025. Cement leakage outcomes were the most fragile (FI, 4; FQ, 0.048). More than half of the analyzed outcomes involved a greater number of patients lost to follow-up than their corresponding FI, underscoring the need for cautious interpretation of kyphoplasty trial results and supporting the inclusion of fragility metrics in future trial reporting to better inform clinical decision-making.

Background: Sports injuries are a leading cause of pediatric emergency department (ED) visits in the United States (US), accounting for approximately 20% of all injury-related visits, with 41% requiring operation. Football, basketball, baseball, soccer, and ice hockey are the 5 most popular US sports by viewership and participation, and pose a high risk of lower-extremity orthopedic injury. Despite increasing youth participation, previous studies have focused on a single sport or diagnosis, leaving limited population-level data to compare injury patterns across sports and sexes. Purpose: This study used nationally representative ED data to characterize the epidemiology, anatomical distribution, and temporal trends of pediatric lower extremity injuries from 2015 to 2024 across the 5 most popular US sports. Study Design: Descriptive epidemiology study. Methods: Pediatric lower extremity injuries from January 1, 2015, to December 31, 2024, in football, baseball, basketball, ice hockey, and soccer were queried using the National Electronic Injury Surveillance System (NEISS). Descriptive data, injury site, diagnosis, and product codes were recorded for patients aged between 0 and 18 years. National estimates (NEs) were calculated using NEISS sample weighting, and injury trends were evaluated using linear regression modeling. Results: A total of 77,654 cases representing an estimated 2,308,476 national injuries were identified, with a mean age of 13.74 ± 2.85 years. The injury distribution by sport was as follows: basketball (41.9%); football (27.7%); soccer (24.7%); baseball (4.8%); and ice hockey (0.9%). The most injured body parts were the ankle (42.9%) and the knee (29.3%). Sprains/strains accounted for 50.6%, followed by fractures (13.6%) and contusions (10.2%). Injuries occurred most frequently in boys, accounting for 78.7% of cases; however, girls experienced disproportionately higher rates of sprains/strains, ankle, and knee injuries. Injury levels peaked in 2015, with a 53.5% decline between 2019 and 2020 during the coronavirus disease 2019 pandemic. By 2024, injury frequencies rebounded to 94.9% of prepandemic levels. Conclusion: Despite a temporary pandemic-related decline, pediatric lower-extremity injuries remain prevalent and have nearly returned to prepandemic levels. While injury rates were highest among boys, girls experienced disproportionately high rates of noncontact injuries in soccer and basketball. Targeted prevention efforts should address sport- and sex-specific risks to improve youth athlete safety.