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001). In group II, the mean physical score of children was significantly lower compared to their parents' scores (P = 0.003). Conclusions According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents' concern about foot deformity.The purpose of this study was to compare 2D femoral torsional values to measurements made from 3D reconstructions, in pediatric patients with torsional pathology. Seventeen patients were included in this study. Femoral torsion was measured in 2D and 3D and compared using interclass correlation and Bland-Altman plots. The 2D and 3D measurements had excellent correlation (r > 0.79, P less then 0.001). However, we found a fixed bias of -5.1 ± 11.3°, with 3D being consistently lower than 2D. This bias persisted when looking at only subjects with normal neck shaft angles. A proportional bias of 1.2 ± 7.8° was found when comparing 2D and 3D MRI measurements indicating that as the magnitude of the torsion changed, the difference between the two measurement techniques also changed. PKC inhibitor Given the proven accuracy of 3D reconstructions in the measurement of femoral torsion, clinicians should consider this method in pediatric patients with torsional pathology. Although 2D and 3D computed tomography (CT)/MRI torsional measurements correlate well, the presence of fixed and proportional biases indicates that the two methods cannot be used interchangeably. We submit that 3D reconstructed CT/MRI imaging, aligned along the mechanical axis, should be considered to assess femoral torsion in pediatric patients. Level of evidence III Diagnostic Study.Focal fibrocartilaginous dysplasia (FFCD) of the distal femur is a rare disorder that results in a varus or valgus of knee. Due to the small number of cases and unconfirmed natural history of the disease, treatment methods remain variable. This study aimed to determine a strategy to successfully manage distal femoral FFCD. Nine case of femoral FFCD treated in our department between 2008 and 2018, together with 22 cases from literature, were retrospectively reviewed. Tibiofemoral anatomical axis angle (TFA) was used to evaluate and follow the deformities. Treatment methods and outcome were analyzed. Five methods were used to manage the disease osteotomy with tether release in 14 cases with mean TFA of 29°; simple tether release in eight cases with mean TFA of 31°; guide growth without tether release in 3 case with mean TFA of 27°; guide growth with tether release in 3 case with mean TFA of 27°; and observation in three cases with mean TFA of 23°.Deformity was resolved in all 31 patients. The analysis of the 31 cases in the literature and our experience suggests that femoral FFCD can be successfully managed by simple tether release and curettage. Osteotomy can be avoided. In case of mild deformity (TFA less then 25°), it is reasonable to follow-up till 2-3 years of age; if no progress occurs, spontaneous resolution can be expected.Closed reduction is an effective treatment method for developmental dysplasia of the hip (DDH). Still, there are certain controversial issues regarding the timing of the treatment. In this study, we investigated the results of closed reduction and Outcomes of 302 hips of 218 patients treated with closed reduction have been analyzed retrospectively. One hundred fifty-two hips that had ossific nucleus [ossific nucleus (+)] during reduction have been compared with 150 hips that had no ossific nucleus [ossific nucleus (-)] during reduction. Also, the patients have been divided into two groups, the patients treated with closed reduction before the sixth month and the patients treated with closed reduction after the sixth month. Groups have been compared between themselves in terms of avascular necrosis (AVN) and redislocation. Seventy-seven of the 112 hips treated with closed reduction in the first six months were ossific nucleus (-), and AVN has been noted in 5 (6%) patients. However, although no AVN has been seen in any of the 35 ossific nucleus (+) hips, no statistically significant difference has been found between two groups. Seventy-three of the 190 hips treated with closed reduction after the sixth month were ossific nucleus (-), and AVN has been seen in 13 (17%) of these hips. AVN has been seen in 9 (7%) of the 117 ossific nucleus (+) hips. The AVN ratio was found significantly lower in the ossific nucleus (+) hips (P less then 0.034). Although the presence of ossific nucleus does not provide extra protection against AVN in before the sixth month, the presence of ossific nucleus is protective against AVN after the sixth month.A quality improvement protocol was implemented in a large tertiary care pediatric hospital to reduce the rate of transitions from emergency department (ED)-applied casts to another form of immobilization (waterproof cast, removable brace, or sling). The local standard of care prior to implementing this quality improvement project involved applying long-arm casts in the ED for children presenting with stable upper extremity injuries (those not requiring a reduction). We created a multidisciplinary quality improvement team with orthopedic and ED providers, as well as cast technicians, with the aim of reducing the transition rate of ED-applied casts in clinic by 50%. Multiple Plan-Do-Study-Act cycles were performed and data were evaluated monthly. Charge fees were determined to assess differences in costs between splints and casts. An independent samples t-test for equality of means was used to determine the ED length of stay of each group. Baseline data determined a cast transition rate of 59.9%. After implementing the quality improvement protocol, the cast transition rate was reduced to 25.0%, a 58% reduction. The length of stay in the ED for a patient receiving a splint as opposed to a cast was 26.2 ± 8.0 min shorter. The charge to a patient receiving a splint rather than an ED-applied cast was $291.25 less. In conclusion, implementation of a multidisciplinary quality improvement protocol resulted in a more than 50% reduction in the transition rate of ED-applied casts in the clinic. Furthermore, healthcare charges to families were reduced by nearly $130 000 annually after implementation of this protocol.