Dr Millar Obituary
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Obituary Source Type: research

Regionalization of Isolated Pediatric Femur Fracture Treatment: Recent Trends Observed Using the Kids’ Inpatient Database
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Treatment of Closed Femoral Shaft Fractures in Children Aged 6 to 10
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

The Heterogeneity of Pediatric Knee Infections: A Retrospective Analysis
Conclusions: When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis. Level of Evidence: Level III—retrospective research study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Selected Topics Source Type: research

Syme Amputation: Function, Satisfaction, and Prostheses
Conclusions: Our study found no trend indicating that a very low LLD was functionally optimal, and indeed found participants with a moderate LLD (zone E) to have the least mean restriction with regard to their prosthesis. Our study demonstrates that ambulation without a prosthesis depends on the environment (ie, flooring), and rates decrease significantly into adulthood. Optimal care should not focus simply “preserving length,” but rather functional optimization and length modulation in parallel with a nuanced understanding of actual daily activities and prosthetic options. Level of Evidence: Level III&mda...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Selected Topics Source Type: research

Evaluation of Spanish Language Proficiency and Resources Available in Academic Pediatric Orthopaedic Centers
Conclusions: There is a scarcity of surgical providers in pediatric orthopaedic centers proficient in Spanish, demonstrating a large discrepancy with the growing Hispanic population. Interpreter services are widely available, although there is variability in the services provided. Considerable barriers exist to Spanish-speaking patients who attempt to access care by phone or online. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Selected Topics Source Type: research

Pediatric Orthopaedists Are Not Immune: Characterizing Self-reported Burnout Rates Among POSNA Members
Background: There are no published data characterizing burnout rates for pediatric orthopaedic surgeons. The primary purpose of this study was to identify the rates of self-reported personal and team burnout among members of the Pediatric Orthopaedic Society of North America (POSNA). A secondary aim was to determine whether specific demographic variables were more likely to be associated with self-reported burnout. Methods: During its 2018 annual meeting, the POSNA Wellness Taskforce launched a web-based survey in which members were asked to respond to 2 previously validated questions related to personal and team burn...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Selected Topics Source Type: research

Evaluation of Risk Factors for Cerebrospinal Leakage in Pediatric Patients With Cerebral Palsy Treated With Intrathecal Baclofen
Background: Insertion of an intrathecal baclofen (ITB) pump can provide significant benefits in patients with cerebral palsy (CP). However, there are little data describing the risk of complications. Specifically, there is a lack of data describing the incidence of cerebrospinal fluid (CSF) leakage and risk factors following ITB placement. The purpose of our study was to describe risk factors for developing CSF leak in pediatric patients with CP treated with ITB and to report the treatment and outcome of CSF leaks. Methods: Following institutional review board approval, 720 ITB procedures in 341 children with CP were ...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Development and Validation of a Mobile Application for Measuring Femoral Anteversion in Patients With Cerebral Palsy
Background: Computed tomography (CT) provides benefits for 3-dimensional (3D) visualization of femur deformities. However, the potential adverse effects of radiation exposure have become a concern. Consequently, a biplanar imaging system EOS has been proposed to enable reconstruction of the 3D model of the femur. However, this system requires a calibrated apparatus, the cost of which is high, and the area occupied by it is substantial. The purpose of this study was to develop a mobile application that included a new method of 3D reconstruction of the femur from conventional radiographic images and to evaluate the validit...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Improved Clinical and Functional Outcomes in Crouch Gait Following Minimally Invasive Hamstring Lengthening and Serial Casting in Children With Cerebral Palsy
Conclusions: Hamstring lengthening combined with a serial casting protocol was associated with significant postoperative improvements in a range of clinical (eg, knee contracture), functional (eg, pediatric outcomes data collection instrument Global), and kinematic (eg, knee extension in stance) parameters. Improvements following this minimally invasive surgery were comparable to outcomes from procedures with higher complication rates. Level of Evidence: This is a Level III Therapeutic Study (retrospective study investigating the results of a treatment). (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Association of Knee Pain and Crouch Gait in Individuals With Cerebral Palsy
Conclusions: The data suggest that there is not a meaningful association between crouch gait and knee pain. Having patella alta was associated with pain. Further studies that use validated pain questionnaires are needed to understand the multifactorial etiology of knee pain within ambulatory individuals with CP. Level of Evidence: Level III—case-control study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

What’s New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis
Conclusions: Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance. Level of Evidence: Level IV—literature review. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Outcomes of Expandable Prostheses for Primary Bone Malignancies in Skeletally Immature Patients: A Systematic Review and Pooled Data Analysis
Conclusions: Despite its limitations, which include entirely heterogenous and retrospective case series data, this systematic review provides clinicians with pooled summary data representing the largest summary of outcomes after reconstruction with expandable prostheses to date. This analysis can assist surgeons to better understand and educate their patients and their families on functional outcomes, mortality, and complication rates after limb-sparing reconstruction with expandable prostheses for primary bone malignancies. Level of Evidence: Level IV—retrospective case series with pooled data. (Source: Journal...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Limb Lengthening Source Type: research

Lengthening of the Humerus Using a Motorized Lengthening Nail: A Retrospective Comparative Series
Conclusions: Humeral lengthening using motorized intramedullary nails is a safe technique that mitigates some of the complications of EF including pin site infection. It is well tolerated by patients. For lengthenings of a large magnitude, reversal and reuse of MN can be considered. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Limb Lengthening Source Type: research

Functional Elbow Range of Motion in Children and Adolescents
Background: The functional elbow range of motion in children and adolescents has not been previously reported. In adults, a functional motion arc of 30 to 130 degrees of elbow flexion and 50 degrees of pronation to 50 degrees of supination is well established. Contemporary tasks such as cellular phone use and keyboarding require greater elbow flexion and pronation than the functional motion arc. Whether or not this is true in children has yet to be established. We hypothesize that to perform functional and contemporary tasks, children and adolescents use a greater range of elbow motion and forearm rotation as compared wi...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Upper Extremity Source Type: research

Wrist Joint Skeletal Changes in Children With Transfusion-dependent Thalassemia
Conclusion: Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children. Level of Evidence: Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Upper Extremity Source Type: research

Minimally Invasive Subscapularis Release: A Novel Technique and Results
Background: Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. We hypothesized that subscapularis can be released through minimally invasive approach from the medial border of scapula and thus avoiding formal open procedures and risk of weakening the internal rotation strength. Methods: Safety zones to a...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Upper Extremity Source Type: research

Brachial Plexus Birth Injury: Epidemiology and Birth Weight Impact on Risk Factors
Background: Brachial plexus birth injury (BPBI) is a condition in which the brachial plexus is thought to be damaged during the birth process. Studies have cited a varying incidence rate ranging from 0.5 to 4.0 per 1000 live births. The purpose of this study is to evaluate birth claims data over a 15-year period to identify risk and protective factors for BPBI in the state of Colorado. Methods: A data request was made to the state hospital association for birth claims data. We requested all birth claims from the years 2000 to 2014. ICD9 codes for variables of interest included: BPBI, shoulder dystocia, heavy-for-dates...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Upper Extremity Source Type: research

Pulling the Trigger: Recommendations for Surgical Care of the Pediatric Trigger Thumb
Conclusions: On the basis of the data in this study, the authors would recommend that stage IV thumbs undergo surgery without an observational period. Second, stage II and stage III thumbs can be safely observed for at least 1 year before surgery. Finally, our study concurs with the literature that surgery can be successful with low rates of complications and recurrence. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Upper Extremity Source Type: research

Effect of Intravenous Aminocaproid Acid on Blood Loss and Transfusion Requirements After Bilateral Varus Rotational Osteotomy: A Double-blind, Placebo-controlled Randomized Trial
Conclusions: There was no difference in blood loss or transfusion requirements associated with EACA compared with placebo; however, this study is underpowered to detect smaller differences in blood loss. Additional studies with larger sample sizes are needed to confirm these findings and further elucidate the indications for antifibrinolytic agents in pediatric patients. Level of Evidence Level I. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Hip Source Type: research

Risk Factors for Contralateral Slipped Capital Femoral Epiphysis: A Meta-analysis of Cohort and Case-control Studies
Conclusion: There are several risk factors for subsequent contralateral SCFE. On the basis of the available data, younger patients with a high PSA of the unaffected hip would most likely benefit from prophylactic fixation of the unaffected hip. Level of Evidence: Level II. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Hip Source Type: research

Coronal Flexion Versus Coronal Neutral Sonographic Views in Infantile DDH: An Important Source of Variability
Background: Ultrasound (US) is the preferred imaging modality for the diagnosis and treatment of infantile developmental dysplasia of the hip (DDH). Currently accepted indices that distinguish normal from dysplastic hips in the coronal plane include percent femoral head coverage (FHC), α angle, and β angle. Recent data suggests that significant user and interscan variability may exist for these metrics. Less studied, however, is potential variability because of patient positioning, specifically coronal flexion versus coronal neutral views. The purpose of this study was to compare standard DDH indices between c...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Hip Source Type: research

Can EOS Imaging Substitute for Conventional Radiography in Measurement of Acetabular Morphology in the Young Dysplastic Hip?
Conclusions: Measures of acetabular morphology performed on EOS images have similarly high intra-rater and inter-rater reliability compared with CR. Measures performed on EOS also have similar intra-rater agreement as compared with CR. Intermodality agreement had similar LOA as intra-rater agreement on either individual imaging modality. Small biases between imaging modalities were detected. Levels of Evidence: Level I—diagnostic study: investigating a diagnostic test. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Hip Source Type: research

Management of Gustilo-Anderson Type II and IIIA Open Long Bone Fractures in Children: Which Wounds Require a Second Washout?
Conclusion: The majority of grade II and IIIA pediatric long bone fractures may be safely treatable with EPWC without additional washouts. Future prospective research is required to further define the subgroups that can benefit from DWC. Level of Evidence: Level IV—therapeutic, case cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Lower Extremity Source Type: research

Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures
Conclusions: Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Lower Extremity Source Type: research

Regionalization of Isolated Pediatric Femur Fracture Treatment: Recent Trends Observed Using the Kids’ Inpatient Database
Background: Isolated pediatric femur fractures have historically been treated at local hospitals. Pediatric referral patterns have changed in recent years, diverting patients to high volume centers. The purpose of this investigation was to assess the treatment location of isolated pediatric femur fractures and concomitant trends in length of stay and cost of treatment. Methods: A cross-sectional analysis of surgical admissions for femoral shaft fracture was performed using the 2000 to 2012 Kids’ Inpatient Database. The primary outcome was hospital location and teaching status. Secondary outcomes included the len...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Lower Extremity Source Type: research

Does Shorter Time to Treatment of Pediatric Femur Shaft Fractures Impact Clinical Outcomes?
Background: Annual rankings by US News and World Report are a widely utilized metric by both health care leaders and patients. One longstanding measure is time to treatment of femur shaft fractures. Hospitals able to provide at least 80% of pediatric patients with an operating room start time within 18 hours of admission to the emergency department score better as part of the overall pediatric orthopaedic ranking. Therefore, it is important to determine whether the 18-hour treatment time for pediatric femur shaft fractures is a clinically meaningful metric. Methods: A retrospective review of clinical outcomes of 174 p...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Lower Extremity Source Type: research

Concomitant Posterolateral Corner Injuries in Skeletally Immature Patients With Acute Anterior Cruciate Ligament Injuries
Conclusions: Missed PLC injuries are a significant source of morbidity and poor clinical outcomes in the management of concomitant ACL injuries in adults. This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the unique skeletally immature patient population. Incomplete PLC injuries are relatively common. Complete PLC injuries are relatively uncommon. PLC injury was more common in older patients. No other concomitant injury predicted the likelihood of PLC injury. Further research is needed regarding the risk of ACL reconstruction failure from associated PLC injury and the in...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Lower Extremity Source Type: research

Medial Epicondyle Fractures: Current Practices and Preferences Between SLAOTI Members (Sociedad Latinoamericana de Ortopedia y Traumatología Infantil)
Conclusions: There are significant differences in opinions between SLAOTI members as to the optimal management of medial epicondyle fractures. Implications of disagreement in evaluation and treatment support the need for multicenter prospective studies to develop evidence-based guidelines for the management of this fracture. Level of evidence: Level V—expert opinion. Cross-sectional electronic survey. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Upper Extremity Source Type: research

A Systematic Review of the Utility of Postoperative Imaging in the Management of Pediatric Supracondylar Humerus Fractures
Conclusions: There is a paucity of articles focusing on the utility or appropriate use of postoperative radiographs in changing management of SCH fractures, one of the most common upper extremity fractures in children. There is a very low rate of change in management on the basis of imaging, and frequently authors commented that the management change could have been prompted without routine serial radiographs. The cumulate findings of these studies suggest routine postoperative radiographs after SCH fractures are infrequently associated with changes in management. Practitioners should consider postoperative protocols wit...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Upper Extremity Source Type: research

Transphyseal Humeral Separations: What Can We Learn? A Retrospective, Multicenter Review of Surgically Treated Patients Over a 25-Year Period
Conclusions: This multicenter review provides the largest known demographic and outcomes data on TPHS. TPHS have excellent outcomes in the vast majority of patients when treated surgically. Nonaccidental trauma accounted for 27% of these injuries so it needs to remain high on the differential diagnosis. Level of Evidence: Level III—retrospective cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Trauma – Upper Extremity Source Type: research

Elevated Serum Titanium Levels in Children With Early Onset Scoliosis Treated With Growth-friendly Instrumentation
Conclusions: Elevated serum titanium levels may be present in EOS patients treated with all forms of GFI. Although our TGR patients had indwelling implants for the longest period of time, they had the lowest serum titanium level. Repetitive chest wall motion during respiration may lead to continued wear and metal ion release with VEPTR. Level of Evidence: Level II—therapeutic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Early Onset Scoliosis Source Type: research

Early Results of a Management Algorithm for Collapsing Spine Deformity in Young Children (Below 10-Year Old) With Spinal Muscular Atrophy Type II
Conclusions: Short-term results indicate that MCGR may be a good option in SMA-associated collapsing spine deformity to reduce the burden of repetitive lengthening procedures. The authors recommend apical deformity control in the convex side in case of curve rigidity. In addition, including the pelvis in the instrumentation at index surgery is critical to prevent distal adding-on. Level of Evidence: Level IV—retrospective case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Early Onset Scoliosis Source Type: research

VEPTR Treatment of Early Onset Scoliosis in Children Without Rib Abnormalities: Long-term Results of a Prospective, Multicenter Study
This study examines whether, at 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth. Methods: A prospective, multicenter, observational cohort design was used. Patients underwent traditional VEPTR implantation ≥5 years before analysis. Preimplantation and last available images were compared, regardless of whether VEPTR remained in vivo. Additional analysis was performed if VEPTR was in vivo ≥5 years. Results: This study included 59 patients (mean age at VEPTR implantation, 6.1±2.4 y; mean follow-up, 6.9±1.4 y). Currently, 24 patients still have VEPTR, where...
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Early Onset Scoliosis Source Type: research

The Effect of Spinopelvic Parameters on the Development of Proximal Junctional Kyphosis in Early Onset: Mean 4.5-Year Follow-up
Conclusions: In EOS patients undergoing growth-friendly surgery for EOS, preoperative TK>50 degrees was associated with increased risk for radiographic PJK. Postoperative PI−LL>20 degrees, PT≥30 degrees, and overcorrection of PT and PI−LL increased risk for PJF. Rib-based distraction construct decreased the risk for radiographic PJK in contrast with the spine-based constructs. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Early Onset Scoliosis Source Type: research

COVID-19 and Pediatric Orthopaedics: What’s Different?
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 6, 2020 Category: Orthopaedics Tags: Special Report Source Type: research

Pelvic Tilt Changes After Hamstring Lengthening in Children With Cerebral Palsy
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Congenital Forearm Pseudarthrosis: A Systematic Review for a Treatment Algorithm on a Rare Condition
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Regionalization of Isolated Pediatric Femur Fracture Treatment: Recent Trends Observed Using the Kids’ Inpatient Database
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Frontal Crash Injury Metrics Are Below Mandated Limits for a Spica Casted Child Dummy in Currently Available Restraints
Conclusions: The results suggest safe transport in commercially available seats is possible with the child properly restrained in a correctly fitting seat. However, parents should not assume a child restraint system is appropriate for use just based on fit as, for example, seats with harnesses outperformed an easy to fit booster seat. Clinical Relevance: Each child and the position of the child’s cast are unique and discharge planning involves consideration of safe transportation. Although this study suggests several seats used to transport spica casted children pass the federal head and chest injury prevention ...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Selected Items Source Type: research

The Role of MRI in Children With Congenital Limb Deficiencies With Associated Scoliosis
Conclusions: There is a high incidence of neural axis abnormalities (63%) in children with congenital limb deficiencies and scoliosis. A large portion of these require neurosurgical intervention. MRI should be considered soon after presentation in this population of children. Level of Evidence: Level IV. Design: Retrospective cohort. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Selected Items Source Type: research

Practice Patterns for Management of Pediatric Femur Fractures in Low- and Middle-Income Countries
This study surveys surgeons from low (LIC), lower-middle (LMIC), and upper-middle income (UMIC) countries regarding treatment patterns for pediatric femur fractures. Methods: Surgeons completed an electronic survey reporting surgeon demographics and treatment preference for pediatric femur fractures. Treatment preferences and indications for treatment were separated into 4 groups: infant (0 to 6 mo); toddler (7 mo to 4 y); child (5 to 12 y); adolescent (12 to 17 y). The survey was available in English, Spanish, and French. Analysis was completed with t test and χ2 test for continuo...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Selected Items Source Type: research

How Often Are Study Design and Level of Evidence Misreported in the Pediatric Orthopaedic Literature?
Conclusions: The majority of observational pediatric orthopaedic studies did not report a study design or reported the wrong study design. Similarly, the majority of studies did not report or misreported their LOE. Greater epidemiological rigor in evaluating observational studies is required on the part of investigators, reviewers, and editors. Level of Evidence: Level II. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Selected Items Source Type: research

Comparison of the Results of Primary Versus Repeat Hamstring Surgical Lengthening in Cerebral Palsy
Background: Hamstring surgical lengthening (HSL) has been frequently performed for the correction of knee flexion deformity in cerebral palsy (CP), although recurrence is described in long-term follow-up. Repeat hamstring surgical lengthening (RHSL) can be an option for recurrent knee flexion deformity; however, the results of this approach are still controversial. The purpose of this study was to compare the results of primary HSL and RHSL in CP. Methods: Patients with spastic diplegic CP, Gross Motor Function Classification System levels I to III, underwent bilateral medial HSL with complete documentation in the gai...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Neuromuscular Source Type: research

Incidence of Pediatric Venous Thromboembolism After Elective Spine and Lower-Extremity Surgery in Children With Neuromuscular Complex Chronic Conditions: Do we Need Prophylaxis?
Conclusion: The rate of non–central-venous-catheter-related VTE associated with orthopaedic surgery in children with NCCC is very low and lower than rates reported in healthy children. Significance: To our knowledge, this is the first multi-institutional study reporting the incidence of VTE in children with NCCCs undergoing elective hip and spine surgery. These data support no additional prophylaxis is required in children with NCCC undergoing elective hip and spine surgery unless other known risk factors are also present. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Neuromuscular Source Type: research

Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition
Conclusions: Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice. Level of Evidence: Level IV—therapeutic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Syndromes Source Type: research

Comparison of Hip and Knee Arthroplasty Rates of Individuals With and Without Prader-Willi Syndrome
Background: Prader-Willi syndrome (PWS) is a complex genetic condition, affecting between 1:10,000 and 1:30,000. The prevalence of hip dysplasia in children with PWS is reportedly between 8% and 30%, but the long-term consequences of residual hip dysplasia remain largely unknown in this population. The purpose of this study was to comparatively estimate the number of total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed on adults with and without PWS, using a national hospital discharge database, in an effort to elucidate long-term outcomes and guide clinicians treating orthopaedic concerns ...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Syndromes Source Type: research

Evolution of Hip Dysplasia in Pediatric Patients With Prader-Willi Syndrome Treated With Growth Hormone Early in Development
Background: Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by obesity, hypotonia, feeding difficulties, obesity, musculoskeletal manifestations including scoliosis, and hip dysplasia (HD). The aim of this study was to characterize the clinical and radiographic evolution of HD in the pediatric PWS population. Methods: The authors performed a retrospective cohort study of 72 patients (147 anteroposterior pelvic radiographs) between January 2004 and December 2016. Center-edge angle (CEA) of Wiberg, acetabular index (AI), and neck-shaft angle (NSA) were measures in all hips. The relationship between ...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Syndromes Source Type: research

The Reliability of the AOSpine Thoracolumbar Classification System in Children: Results of a Multicenter Study
Conclusions: The reliability for the AOSpine thoracolumbar spine injury slassification System was high amongst POSNA surgeons when applied to pediatric patients. Given a lack of a uniform classification in the pediatric population, the AOSpine thoracolumbar spine injury classification system has the potential to be used as the first universal spine fracture classification in children. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Scoliosis Source Type: research

Can We Save the Implant: Rib-based Implant Removal Rates and Risk Factors Following Irrigation and Debridement (I&D) Surgery?
This study aims to identify predictive factors associated with the need for implant removal to decrease unnecessary attempts at implant retention. Methods: A retrospective review of early-onset scoliosis patients at a single institution treated with rib-based vertical expandable prosthetic titanium rib implants who developed infection requiring irrigation and debridement (I&D) due to wound problems including surgical site infection, skin slough, and wound dehiscence. All patients had a minimum of a 2-year follow-up. Univariate and multivariate logistic regression analyses were conducted to determine the odds of impl...
Source: Journal of Pediatric Orthopaedics - April 11, 2020 Category: Orthopaedics Tags: Scoliosis Source Type: research