Later in Career Surgeon Performance Assessment: Why, When, What, and by Whom
Conclusions: Our expert panel Delphi method study recognized aging is a risk factor in performance and recommended surgeon assessments should be automatically triggered by the age of 65 years, negative health events, or serious performance concerns. Assessments should be multifaceted, fair, reliable with minimal bias, and performed by an external professional group. Decisions should be managed by departmental and surgical chiefs. Level of Evidence: Level V. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Pediatric Orthopaedic Surgeon Time Utilization in Clinic: A Pilot Study
Conclusion: Pediatric orthopaedic surgeons spend more time on the EMR than with patients. About 70 computer mouse clicks are needed per patient encounter. The excessive computer time can diminish the patient-physician relationship. Click fatigue in physicians is real and needs to be resolved by improved EMR technology, utilization of medical scribes, or a return to partial use of paper. Level of Evidence: Level IV—an observational study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Satisfying Clinical and Functional Results in 12 Apert Children Treated With Soft Tissue Distractor
Conclusion: Soft tissue distraction facilitates the treatment of acrocephalosyndactyly hands, giving 5-fingered hands. Apert children manage many activities independently but struggled with fine motor skills demanding strength. Level of Evidence: Level IV evidence. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Carry on With Raja Ravi Varma, Mary Cassatt, and Renoir
Raja Ravi Varma’s painting “There Comes Papa” depicts his daughter carrying her son astride her hip. The positive implication of the posture of the hips of the child while being carried in this manner on acetabular development is discussed. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Venous Thromboembolism After Pelvic Osteotomy in Adolescent Patients: A Database Study Characterizing Rates and Current Practices
Background: Current risks and practices in medical prophylaxis of venous thromboembolism (VTE) after major elective lower extremity surgeries such as pelvic osteotomies have not been well-defined in the pediatric population. The purpose of this study was to (1) evaluate population rates of VTE in adolescents undergoing pelvic osteotomies, and (2) characterize current practices on types of VTE prophylaxis being utilized after pelvic osteotomies. Methods: The study evaluated the Pediatric Health Information System database between October 1, 2015 and January 1, 2020 for patients between 10 and 18 years of age meet...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Hip Source Type: research

The Ponseti Method for the Treatment of Clubfeet Associated With Amniotic Band Syndrome: A Single Institution 20-Year Experience
Background: Amniotic band syndrome (ABS) is a congenital disorder resulting in fibrous bands that can cause limb anomalies, amputations, and deformities. Clubfoot has been reported in up to 50% of patients with ABS. The purpose of this study is to compare treatment characteristics and outcomes of clubfoot patients with ABS to those with idiopathic clubfoot treated with the Ponseti method. Methods: An Institution Review Board (IRB) approved retrospective review of prospectively gathered data was performed at a single pediatric hospital over a 20-year period. Patients with either idiopathic clubfeet or clubfeet as...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Synthetic Cast Material Versus Plaster of Paris for the Treatment of Idiopathic Clubfoot by the Ponseti Protocol: A Comparative Analysis of 136 Feet
Conclusions: Despite its higher cost and slightly lower moldability, the use of SRF in experienced hands showed comparable results in idiopathic clubfeet treated by the Ponseti technique. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study
Background: It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSL—curved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distraction-based surgeries will affect final spine length. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5 y follow-up, 5 le...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Scoliosis/Kyphosis Source Type: research

Anterior Cruciate Ligament Tear Following Operative Treatment of Pediatric Tibial Eminence Fractures in a Multicenter Cohort
Conclusions: Ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 2.6%. However, in those with at least 2 years of follow-up, the incidence was 21.7%. Subsequent ACL tear was more likely in those with completely displaced (type III or IV) tibial eminence fractures and older patients. Level of Evidence: Level III—retrospective cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study
Conclusions: Adolescents aged 12 to 18 years with displaced midshaft clavicular fractures show good long-term functional results after plate fixation, intramedullary nail, and nonoperative treatment. No additional benefit is demonstrated for surgery in our material. Nonoperatively treated patients are more satisfied with the cosmetic results. Little difference is seen between the operative methods in our study. We conclude that surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents. Level of Evidence: Level III study—retrospective comparative study. (Sou...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position
Background: Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures. Methods: In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute ...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Refracture Rate of Both Bone Forearm Fractures: A Retrospective Comparison of Casting Alone Versus Casting and Extended Functional Bracing
Background: One of the most common pediatric fractures is a midshaft both bone forearm fracture. The preferred nonoperative treatment is cast immobilization for 6 to 8 weeks; however, 4% to 8% refracture within 6 months. There are no comparative studies evaluating the efficacy of bracing after cast immobilization. We hypothesized that children treated with prolonged functional bracing would have a lower rate of refracture than casting alone or short-term bracing. Methods: This is a retrospective review of children younger than 15 years of age treated nonoperatively following radius and ulnar shaft fractures trea...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Outcomes of Patellar Tendon Imbrication With Distal Femoral Extension Osteotomy for Treatment of Crouch Gait
Background: Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO. Methods: After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical...
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Why the Hips Remain Stable When the Spine Strays: A Deeper Analysis of the Relationship Between Hip Displacement and Severe Scoliosis in Patients With Cerebral Palsy
Conclusions: Gestational age 37 weeks or above, female sex, and normal brain MRI findings are independently associated with nondisplaced hips in patients with spastic quadriplegic CP and severe scoliosis. These findings direct attention to characteristics that may place patients at greater risk of displacement. Future work may influence preventative screening practices and improve patient counseling regarding the risk of hip displacement. Level of Evidence: Level III—retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 16, 2021 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Raphael at the Temple
Raphael, in his painting “Healing of the Lame Man” shows one lame man encountering St. Peter and St. John while another lame man waits his turn. Children with unusually muscular bodies are also depicted in the painting. The possible causes of lameness in the men and muscle hypertrophy in the children are discussed. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Pain for Greater Than 4 Days Is Highly Predictive of Concomitant Osteomyelitis in Children With Septic Arthritis
Conclusion: Pain for>4 days before presentation is an independent predictor of osteomyelitis in children with septic arthritis. In pediatric septic arthritis, MRI should be considered, particularly in patients presenting with pain for>4 days as 96% of these patients had concomitant osteomyelitis. Level of Evidence: Level III—retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Problems, Complications, and Factors Predisposing to Failure of Fassier-Duval Rodding in Children With Osteogenesis Imperfecta: A Double-center Study
Background: Although Fassier-Duval (FD) rods have been used for almost 2 decades, knowledge of factors predisposing to their failure is limited. Thus, the purpose of this study was to: (1) present the most common complications of FD rodding, (2) present tips on how to avoid or overcome them, and (3) identify factors predisposing to treatment failure. Methods: Fifty-eight rod segments in 19 patients with osteogenesis imperfecta (mainly type III) underwent analysis with a median follow-up (FU) time of 4.4 years. We assessed the total number of complications clinically and radiographically. Next, the possible predi...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Outcomes of a Minimally Invasive Approach for Congenital Vertical Talus With a Comparison Between the Idiopathic and Syndromic Feet
Conclusion: The minimally invasive method is a valuable option for treatment of CVT. Idiopathic patients had no recurrence and better functional scores compared syndromic patients. There was no requirement for supplementary procedures such as tibialis anterior transfer or anterolateral release at the time of the initial surgery. Level of Evidence: Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Supracondylar Humerus Fractures in Older Children: Success of Closed Reduction and Percutaneous Pinning
Background: The incidence of supracondylar humerus (SCH) fracture declines and fracture types change as children grow. Optimal treatment method is unclear in older children. The aim of the study was to determine if fracture type and configuration of distal humerus fractures changes as patients approach skeletal maturity, and to assess the success of closed reduction and percutaneous pin (CRPP) in extra-articular SCH fractures in this transitional age group. Methods: Inclusion criteria for this retrospective review were (1) distal humerus fractures with extension types 2 and 3, flexion type, T-type; (2) surgicall...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

The Pediatric Open Supracondylar Fracture: Associated Injuries and Surgical Management
Background: While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures. Methods: The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and ...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?
Conclusions: Obesity is a growing concern in the United States and its effect on long-term outcomes after CRPP of supracondylar humerus fractures is unknown. The present study demonstrates no difference in complications or PRO among obese patients compared with nonobese patients. Level of Evidence: Level IV—retrospective cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Surgically Treated Pediatric Hand and Fingers Palmar Wounds Caused by Metal Fences: Analysis Over a 5-Year Period
Conclusions: Metal fences surgical palmar wounds in children are impressive lesions by their extended skin damages. Serious associated lesions (collateral pedicle or flexor tendons) were found in 1 case of 3. However, these injuries are not benign and should be carefully monitored clinically during the first postoperative month to look for potential contractile scars that can require revision. Level of Evidence: Level IV—retrospective cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Upper Limb Source Type: research

Upper Limb Lengthening in Achondroplasia Using Unilateral External Fixation
Conclusions: Callotasis with unilateral external fixation is a reliable and well-tolerated procedure for humeral lengthening in achondroplastic patients, with an acceptable complication rate. Guided fixator placement and a proximal humeral osteotomy are strongly recommended technical tips as they may help prevent complications and improve outcomes. Level of Evidence: Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Upper Limb Source Type: research

Surgical Strategy of Pediatric Benign Sacral Tumors
Conclusions: The proposed surgical strategy can provide an excellent therapeutic effect for pediatric benign tumors and tumor-like lesions at the sacrum. Preoperative SAE and intraoperative ABO can safeguard pediatric patients with high vascularity of benign tumor at the sacrum during the operation. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Spine Source Type: research

Role of Body Cast Application for Scoliosis Associated With Prader-Willi Syndrome
Conclusions: Serial spinal casting is effective in for treating infantile scoliosis in children with PWS. One third of patients had their curve resolved, at least temporarily, where they were braced and cast free. The others were able to delay surgery for a number of years. Initial curves (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Spine Source Type: research

Low Preoperative Lung Functions in Children With Early Onset Scoliosis Predict Postoperative Length of Stay
Introduction: Children with early onset scoliosis (EOS) undergoing spine surgery often have significant respiratory disease. Preoperative risk assessments that predict an increased length of hospital stay (LOS) for this group have not been previously evaluated. Methods: A voluntary protocol using preoperative lung function studies began among participants of a multicenter registry in 2016. Preoperative assessments were standardized to include spirometry, blood hemoglobin levels, serum bicarbonate, albumin and prealbumin; radiographic parameters of the spine, C-EOS classification and need for preoperative pulmona...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Spine Source Type: research

Factors Influencing Outcomes of the Dysplastic Hip in Nonambulatory Children With Cerebral Palsy
Conclusions: The findings from this multicenter retrospective study suggest that PO be added to varus rotational osteotomies in patients with severe hip subluxation. Surgery should be undertaken for severe dysplasia without concern for age. The addition of capsulorrhaphy does not improve rate of success. Level of Evidence: Level III—retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Subtle Slipped Capital Femoral Epiphysis Is not Associated With Idiopathic Cam Morphology
We examined 962 cadaveric hips to measure 2 markers of cam morphology, alpha angle and anterior femoral head-neck offset (AHNO), and a validated, objective marker of subtle SCFE deformity (calcar ridge line offset). When the femur is viewed medially, the calcar ridge line extends from the lesser trochanter proximally along the postero-inferior femoral neck and points toward the fovea. In SCFE-like deformity, the fovea deviates posteriorly from this projected line. Pearson correlations were performed to evaluate for possible association of calcar ridge line offset with alpha angle and AHNO. In addition, a multiple regressio...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis
This study examines femoral neck growth and remodeling over the first 2 postoperative years in stable SCFE treated with FG versus standard screws. Methods: We retrospectively reviewed 32 hips (19 SCFE, 13 prophylactic) in 16 patients treated with FG screws for stable SCFE. We also reviewed 102 hips (63 SCFE, 19 prophylactic, 20 controls) in 55 patients treated with standard screws. Immediate postoperative radiographs were compared with 1- and 2-year follow-up images. Results: For the overall study cohort, mean age at surgery was 12.2±1.9 years, with a mean slip angle of 26.9±18.0 degrees. In FG ...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Establishing a Virtual Clinic for Developmental Dysplasia of the Hip: A Prospective Study
Conclusion: We report the outcomes of the first prospective virtual DDH clinic. This clinic has demonstrated efficiency and cost-effectiveness, without reported adverse outcomes to date. It is an option to provide consultant delivered DDH care, while reducing F2F consults. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Late Hip Dysplasia After Normal Ultrasound in Breech Babies: Implications on Surveillance Recommendations
Conclusions: One in 5 breech babies have dysplasia at presentation, but late dysplasia following normal screening ultrasound may be less common than previously reported and may be due to our prolonged follow-up period. We recommend surveillance of breech babies with follow-up visits after 12 months of age since earlier visits may offer limited benefits. Level of Evidence: Level II—prospective prognostic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Timing of Repeat Ultrasound Examination in Treatment of Stable Developmental Dysplasia of the Hip
Background: Worldwide a wide variation exists in duration of Pavlik harness treatment for infants up to 6 months with stable developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate whether shortening the time to first routine follow-up ultrasound after initiation of Pavlik harness treatment would reduce treatment duration and whether this influenced radiologic outcome at 1 year of age. Furthermore, predictors of higher acetabular index (AI) at 1 year of age were investigated. Methods: A retrospective study was conducted in infants with stable DDH (Graf IIb and IIc) diagnosed and treat...
Source: Journal of Pediatric Orthopaedics - March 12, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Response to: Pediatric Type II Supracondylar Humerus Fractures: Factors Associated With Successful Closed Reduction and Immobilization
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Pediatric Type II Supracondylar Humerus Fractures: Factors Associated With Successful Closed Reduction and Immobilization
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Response to: The Song Classification Is Reliable and Guides Prognosis and Treatment for Pediatric Lateral Condyle Fractures: An Independent Validation Study With Treatment Algorithm
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

The Song Classification Is Reliable and Guides Prognosis and Treatment for Pediatric Lateral Condyle Fractures: An Independent Validation Study With Treatment Algorithm
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Seasonal Variation in Parental Satisfaction With Pediatric Orthopaedics
Conclusions: The provision of pediatric spine care in a region with 4 distinct seasons received lower parental satisfaction scores during the winter than during the summer and fall. This seasonal variation is an additional source of bias in the measurement of satisfaction with health care. Level of Evidence: Level II—retrospective study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Selected Items Source Type: research

Assessing the Impact of the Pediatric Orthopaedic Society of North America (POSNA) Visiting Scholar Program
This study aims to outline the educational and leadership activities pursued by the alumni of the POSNA-COUR Visiting Scholars Program. We hypothesized that there may be a discrepancy between visiting scholar interest level and actual participation in key follow-up educational and leadership activities. Methods: A 32-question online survey developed by the POSNA-COUR committee was electronically delivered to the POSNA-COUR visiting scholarship recipients from 2007 to 2019. The survey inquired about scholars’ educational background, clinical practice, and academic interests. Respondents also reported educationa...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Selected Items Source Type: research

Refilling Opioid Prescriptions After Pediatric Orthopaedic Surgery: An Analysis of Incidence and Risk Factors
Background: Understanding which pediatric patients seek opioid refills is crucial as prescription opioid use in childhood is associated with an increased risk of future opioid misuse. Orthopaedic surgeons are optimally positioned to lead the charge in addressing the opioid epidemic. The aim of this study was to describe the incidence of and risk factors associated with requiring opioid refills after pediatric orthopaedic surgery in children. Methods: This retrospective case-control study included 1413 patients aged 0 to 18 years that underwent orthopaedic surgery at a single tertiary care children’s hospit...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Selected Items Source Type: research

Primary Septic Arthritis Among Children 6 to 48 Months of Age: Implications for PCR Acquisition and Empiric Antimicrobial Selection
Conclusions: K. kingae was the most commonly identified pathogen among 6-month to 4-year-old children. The Kingella and other identified pathogens in this study serve to guide empiric antimicrobial recommendations for this age range. Because of similarities between children with septic arthritis because of K. kingae and those with no identified pathogen, it is likely that an unrecognized burden of Kingella resides in culture negative cases, particularly if no PCR is sent. Systematic evaluation, including PCR acquisition, and a high index of suspicion for K. kingae are recommended to thoroughly evaluate septic arthritis...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Selected Items Source Type: research

Intraoperative Neurological Monitoring in Lower Limb Surgery for Patients With Mucopolysaccharidoses
Conclusions: Patients with MPS undergoing LE orthopaedic surgery may be at risk for SCI, particularly if the procedures are long or are expected to have large EBL. One hypothesis for the etiology of SCI in this setting is hypoperfusion of the upper thoracic spinal cord due to prolonged intraoperative or postoperative hypotension. IONM during these procedures may mitigate the risk of SCI by identifying real-time changes in spinal cord function during surgery, inciting a change in the surgical plan. Level of Evidence: Level III—retrospective comparative series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Pseudo-Protrusio Acetabular Deformity in Osteogenesis Imperfecta Patients
Background: Osteogenesis imperfecta (OI) can develop a protrusio acetabuli deformity. However, the authors observed a pseudo-protrusio-type acetabular deformity (PPAD) on 3-dimensional computed tomography (3D-CT). Hence, we systematically reviewed 3D-CT and pelvis radiographs of OI patients and report the incidence and patterns of acetabular deformity in OI patients and the associated radiographic signs. Methods: The study included 590 hips of 295 OI patients, who were older than 5 years, and did not have a pelvic fracture. The incidence of a deformed acetabulum (center-edge angle>40 degrees) and its correlat...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Modern Day Scurvy in Pediatric Orthopaedics: A Forgotten Illness
Conclusion: The pediatric orthopaedic surgeon should have an increased awareness about the diagnosis of scurvy when consulted on a child with bone pain or inability to walk. The most common orthopaedic presentation was the refusal to bear weight, the most common radiographic finding was the metaphyseal line of increased density (Frankel sign) and treatment with vitamin c supplementation was excellent in all cases. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Management and Complications in Nonoperative Fractures of the Tibial Spine: A Systematic Review
Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial sea...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Decreasing Radiation Exposure in Pediatric Clavicle and Metatarsal Fractures: A QI Initiative
Background: Protecting the pediatric population from unnecessary medical radiation is an important public health initiative. Efforts have been made to reduce radiation exposure in the treatment of pediatric fractures without compromising quality of care. Using a standardized protocol for imaging of pediatric clavicle and metatarsal fractures is a reliable method for reducing pediatric radiation exposure in the management of these fractures. Methods: In the year 2015, the senior author altered follow-up imaging practices for 2 common pediatric fractures: metatarsal and clavicular. Initial radiographic evaluation ...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Patient-reported Outcomes Measurement Information System (PROMIS) Scores for Children With Brachial Plexus Birth Injury
Background: Patient-reported Outcomes Measurement Information System (PROMIS) for pediatrics is a validated patient-reported or parent-proxy–reported outcomes assessment tool used to evaluate health-related quality of life in children and adolescents with chronic medical conditions. The health-related quality of life of children with brachial plexus birth injury (BPBI) as measured by PROMIS is not well understood. We hypothesized that children with BPBI would report impaired upper extremity (UE) function but normal mobility, pain interference, and peer relationships compared with a reference pediatric population,...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Midterm Outcomes After Open Arthrolysis for Posttraumatic Elbow Stiffness in Children and Adolescents
This study evaluated the midterm outcomes after open arthrolysis in children and adolescents with posttraumatic elbow stiffness. Methods: Data of 31 children and adolescents with posttraumatic elbow stiffness following open arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Comparison of Short-leg and Long-leg Casts for the Treatment of Distal Third Tibial Shaft Fractures in Children
Background: Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures. Methods: A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the t...
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Risk Factors for Failure of Cast Treatment in Displaced Pediatric Tibial Shaft Fractures
Conclusions: The TPI>0.855 and postreduction translation>18% are independent risk factors for redisplacement of tibial shaft fractures in children. Although the gap index can be useful, the cast index is not an appropriate tool for these fractures. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Do We Really Need to Worry About Calcaneocuboid Subluxation During Lateral Column Lengthening for Planovalgus Foot Deformity?
Conclusions: Both sagittal and rotatory subluxation seem to occur at the CC joint after LCL regardless of pin stabilization. As a single pin would be expected to limit pure translation while having little effect on rotation, it is possible that the rotational changes identified on 3-dimensional imaging are interpreted as dorsal translation when viewed 2 dimensionally using plain radiography. Consideration should therefore be given to CC stabilization with 2 pins during LCL to prevent this rotatory subluxation. Level of Evidence: Level V—cadaver study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - February 10, 2021 Category: Orthopaedics Tags: Lower Extremety Source Type: research