Response to: Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Art and Pediatric Orthopaedics: Sorolla and a Sad Inheritance
The Sad Inheritance painted by Sorolla depict children with polio. The clarity of the painting enables the viewer to identify gait abnormalities due to muscle paralysis. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Opioid Prescriptions After Pediatric Orthopedic Surgery: Analyzing Rates of Unfilled Prescriptions
Conclusions: This study identified a subset of pediatric orthopaedic surgery patients who were prescribed opioids upon discharge but did not fill those prescriptions. Factors that increased the likelihood that patients did not fill their prescriptions upon discharge included fewer postoperative hospital course opioids, no oral oxycodone, and surgery on the upper extremity. Future studies must be performed to help decrease the number of opioids prescribed unnecessarily. Level of Evidence: Level III—prognostic cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Formal Patient Complaints and Malpractice Events Against Pediatric Orthopaedic Surgeons
Conclusions: The rate of patient complaints within an academic pediatric orthopaedic surgery practice over a decade was 0.15%, or ~1 complaint for every 670 new patients seen. The majority of patient complaints involved communication; a potentially modifiable area that can be targeted for improvement. While complaint rates among surgeons can vary, patient demographic factors are not associated with increased complaints. Understanding patient complaints rates and types may allow surgeons to target areas for improvement and decrease exposure to malpractice litigation. Level of Evidence: Level II—prognostic. ...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

The More the Merrier: Integrating Multiple Models of Skeletal Maturity Improves the Accuracy of Growth Prediction
Conclusions: The most accurate multivariate GEE model of growth prediction for both boys and girls integrated Fels, age, GP, Sanders, and height. When calculating the amount of growth remaining, it is prudent to integrate multiple systems for greater predictive accuracy. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Growth Source Type: research

Humeral Head Ossification Growth Prediction: Can This Method Be Reproduced?
Conclusions: We found fair to moderate interobserver and intraobserver reliability with the HHOS and this was independent of level of orthopaedic experience. This is much lower than reported by the authors who developed the system, and suggests that the HHOS might not be as easy to incorporate into a scoliosis management algorithm as previously noted. The improved reliability achieved when staging the humeral head as pre-PGA or post-PGA might be the true benefit of this system. Level of Evidence: Level III—diagnostic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Growth Source Type: research

Orthopaedic Manifestations of Transverse Myelitis in Children
Conclusions: This report describes the orthopaedic manifestations associated with TM in children, nearly 40% of whom required operative intervention(s). Understanding the breadth of musculoskeletal burden incurred in TM can help develop surveillance programs to identify and treat these deformities in a timely manner. Level of Evidence: Level IV (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Neuromuscular Source Type: research

Variability in Postoperative Immobilization and Rehabilitation Following Reconstructive Hip Surgery in Nonambulatory Children With Cerebral Palsy
Conclusions: Postoperative immobilization and PT recommendations were highly variable among surgeons. This variability may influence surgical outcomes and complication rates and should be considered when evaluating procedures. Further study into the impact of postoperative immobilization and rehabilitation is warranted. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Neuromuscular Source Type: research

The Gait Outcomes Assessment List for Children With Lower Limb Difference (GOAL-LD): Assessment of Reliability and Validity
Background: The Gait Outcomes Assessment List for children with Lower Limb Difference (GOAL-LD) is a patient and parent-reported outcome measure that incorporates the framework of the International Classification of Functioning, Disability, and Health. This prospective multicenter cohort study evaluates the validity and reliability of the GOAL-LD and the differences between parent and adolescent report. Method: One hundred thirty-seven pediatric patients aged over 5 years attending limb reconstruction clinics at the participating sites were assessed at baseline, and a self-selected cohort also completed an asses...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Neuromuscular Source Type: research

Efficacy of Sclerotherapy With Polidocanol (Ethoxysclerol) in Primary Aneurysmal Bone Cysts in Children and Adolescents
Conclusions: Our results show that percutaneous sclerotherapy with polidocanol has high efficacy in the treatment of primary ABC, with a low complication rate. Our only complication may have been an immediate allergic reaction to polidocanol/contrast agent or ropivacaine. Trends toward increased risk for treatment failure were age younger than 5, epiphyseal plate involvement, and lower leg lesions. Level of Evidence: Level IV—therapeutic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Tumors Source Type: research

Sclerotherapy for Aneurysmal Bone Cysts: Scale for Response
The objective of this study was to develop a response scale for aneurysmal bone cysts (ABCs) treated with sclerotherapy and determine its inter-rater reproducibility. Methods: Patients treated with sclerotherapy for an ABC between 1993 and 2014 were identified. An attending orthopaedic surgeon and an attending interventional radiologist independently reviewed the radiographic series for each patient and determined response to treatment using a novel grading system. Pain scores were collected from each visit. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). General estimating e...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Tumors Source Type: research

Operative Pediatric Hand Infections: A Retrospective Review
Conclusions: Hand infections are a common problem in the pediatric population. Cases tend to be associated with accidental trauma and discrete abscesses colonized by MSSA/MRSA. The vast majority of cases require only one operation and a short course of wound care before discharge. Level of Evidence: Level IV—therapeutic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Hand Source Type: research

Classification of Middle Phalangeal Postaxial Polysyndactyly Based on Intraoperative Arthrography Is Useful for Surgical Decision-making in Children Younger Than 2 Years
Conclusions: Our new classification based on IOA helped determine the articular dominance and its detailed morphology, which can help predict postoperative stability and mobility of the remaining toe. IOA is a simple, safe, and useful imaging tool for the surgical treatment of foot MPPP in patients aged below 2 years. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Hand Source Type: research

Human Position Brace Versus Pavlik Harness for Infants Under 6 Months of Age With Developmental Dislocation of the Hip: A Comparison of Therapeutic Efficacy
Background: For 0- to 6-month-old patients with developmental dislocation of the hip, the likelihood of Pavlik harness treatment failure may be increased. The human position brace is an available option. We aimed to compare therapeutic efficacy between the Pavlik harness and human position brace. Methods: We included 87 patients (106 hips) in the human position brace group and 47 patients (62 hips) in the Pavlik harness group. Clinical and radiologic outcomes were recorded and compared, respectively. Results: The mean follow-up was 17.73±14.56 months (range, 5 to 56 mo). Human position brace...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Has There Been a Change in the Age of Presentation of Patients With DDH After the Implementation of a Dedicated Ultrasound-screening Program?
Conclusions: The implementation of a dedicated ultrasound-screening protocol was significantly correlated with a decrease in the mean age of diagnosis of DDH. The results of treatment of DDH are known to be better the sooner the diagnosis is made. Given that the age of presentation remains a challenge, especially in developing countries, a dedicated ultrasound-screening program is one step to improve our ability to detect DDH in patients at a younger age. Level of Evidence: Level IV—diagnostic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Hip Source Type: research

Accessory Cuboid Facet Associated With Calcaneonavicular Coalitions
This study sought to identify differences in the anatomy of the calcaneocuboid (CC) articulation in feet with and without CN coalitions. Methods: An institutional review board approved retrospective analysis of patients with symptomatic CN coalitions presenting to a single tertiary care pediatric orthopaedic hospital was performed. Patients without computed tomographic or magnetic resonance imaging were excluded. The morphology and dimensions of the cuboid portion of the CC joint were documented. When contralateral imaging was available in patients with a unilateral coalition, the morphology of the uninvolved side w...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Limb Lengthening in Russell-Silver Syndrome: An Update Confirming Safe and Speedy Healing
Introduction: Russell-Silver syndrome (RSS) is a unique cause of syndromic, and often severe, limb length discrepancy (LLD). RSS causes growth retardation both in utero and postnatally, with asymmetry in limb length more noticeable as growth progresses throughout childhood and adolescent. We aim to present the largest cohort in the literature on limb lengthening in patients with RSS and to validate previous literature supporting faster bony consolidation in these patients with more robust data. We further aim to establish differences in healing within this cohort based on age, sex, segment lengthened, or type of length...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Prognosis of Congenital Pseudarthrosis of the Tibia: Effect of Site of Tibial Pseudarthrososis and Fibular Involvement
Conclusions: Surgery at an early age was associated with favorable results and minimized deformity. In concurrent fibular and distal third tibial pseudarthrosis, it is recommended to transfix the ankle and subtalar joints to create a cross-union with fibula so that the intense union can be confidently obtained with more cross-section to prevent ankle valgus deformity. Level of Evidence: Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Efficacy of Percutaneous Retrograde Transphyseal Guided Growth Screw in Distal Femoral Angular Deformity Correction: A New Technique
Conclusion: Percutaneous retrograde transphyseal guided growth screw for distal femur coronal angular deformity is a minimally invasive procedure, with a statistically significant correction rate when compared with the original transphyseal screw technique. The new technique has proven to have growth resumption after screw removal with minimal complication risk. Level of Evidence: Level III—prospective observational study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Comprehensive Error Analysis for Robotic-assisted Placement of Pedicle Screws in Pediatric Spinal Deformity: The Initial Learning Curve
Conclusions: Screw time and accuracy improved and the number of breaches decreased after 10 cases. This series had 2 critical breaches (between 2 and 4 mm) on the first case. Overall, excluding the 2 critical breaches, 98.8% of robotically executed screws were placed without a critical breach, which is comparable to previous pediatric deformity studies. Caution should be exercised during the initial training period to avoid complications as experience and training lead to an improved understanding of surgical planning, skive, and soft-tissue pressure on the end-effector all of which can impact accuracy of roboti...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Scoliosis Source Type: research

Posterior Instrumentation and Fusion in Multiple-segment Adolescent Congenital Scoliosis: When Are Posterior Column and Concave Rib Osteotomies Needed?
Background: No clear guidelines exist for appropriate surgical treatment of congenital scoliosis. The spectrum varies from isolated posterior instrumentation and fusion (PIF-only) to vertebral column resections. Multiple posterior column osteotomies (PCOs) with and without concave rib osteotomies have previously been suggested as an alternative to invasive 3-column osteotomies. The aim of the study is to analyze outcomes of spinal surgery in congenital scoliosis patients for a new treatment algorithm based on a traction radiograph under general anesthesia (TruGA). Methods: Surgical intervention was determined ac...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Scoliosis Source Type: research

Radiographic Coronal Imbalance and Shoulder Asymmetry Continue to Improve Between 2 and 5 Years Following Surgery of Adolescent Idiopathic Scoliosis
Conclusions: Having coronal or shoulder imbalance 2 years after surgery for AIS does not guarantee continued imbalance 5 years after surgery. Most patients demonstrate some improvement in these measures of clinical deformity. Anticipating the potential course following a postoperative coronal balance and shoulder height differences can help surgeons manage and counsel their patients appropriately. Levels of Evidence: Level II—therapeutic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Scoliosis Source Type: research

Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Background: Methylnaltrexone, a peripheral opioid antagonist, is used to decrease opioid-induced constipation; however, there is limited evidence for its use in children. The primary objective of the study is to assess the efficacy of per os (PO) methylnaltrexone in inducing bowel movements (BMs) in patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and instrumentation (PSFI). Secondary outcomes include hospital length of stay, postoperative pain scores, and postoperative opioid usage. Methods: Retrospective chart review identified all adolescent idiopathic scoliosis patients a...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Scoliosis Source Type: research

Physeal Fractures of Distal Tibia: A Systematic Review and Meta-analysis
This study aims to describe which factors increase the risk of premature physeal closure (PPC). Material and Methods: A systematic review and meta-analysis were performed. Altogether 395 articles were reviewed, and ultimately 12 of them were found eligible, comprising 1997 patients. The most usual type of fracture was Salter-Harris (SH) II (n=855, 49%) followed by SH III (n=296, 17%) and SH I (n=261, 15%). The risk of PPC according to number of reduction attempts, method of treatment, and residual displacement was the primary outcome. Results: The total rate of PPC was 13% (n=245). The PPC rate varied from 0....
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Intraoperative Burden of Flexible Intramedullary Nailing and Spica Casting for Femur Fractures in Young Children
Background: Spica casting (Spica) remains the widely accepted treatment of closed femoral shaft fractures in young children aged 6 months to 5 years. In some centers, there has been a recent trend towards surgical fixation of these fractures with flexible intramedullary nails (FINs). Despite numerous studies evaluating both Spica and FIN treatment of femoral shaft fractures, there remains a paucity of data regarding patient burden during the intraoperative period. The purpose of this study was to compare the intraoperative burden, defined as anesthetic exposure, fluoroscopic duration, and radiation load, between Spica ...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Operative Versus Nonoperative Management of Acute Pediatric Monteggia Injuries With Complete Ulna Fractures
Conclusions: Even in the presence of a complete ulna fracture, a trial of nonoperative management of acute pediatric Monteggia fractures with closed reduction and casting can result in comparable outcomes to those obtained with immediate surgical management. The nonoperative management of Monteggia fractures requires close clinical follow-up to ensure no loss of reduction. Level of Evidence: Level IV—therapeutic studies, case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Trauma Source Type: research

Traumatic Glenohumeral Dislocation in Pediatric Patients Is Associated With a High Risk of Recurrent Instability
Conclusions: Traumatic glenohumeral dislocation in patients aged 14 years or younger occurs rarely but is not a benign event. One in 2 patients experienced recurrent dislocation and 1 in 5 ultimately underwent surgical stabilization. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Outcomes of MPFL Reconstruction Utilizing a Quadriceps Turndown Technique in the Adolescent/Pediatric Population
Purpose: Recurrent instability following a lateral patellar dislocation is a common indication for surgical intervention. Several surgical procedures are described in the literature to address recurrent patellar instability. Medial patellofemoral ligament (MPFL) reconstruction utilizing the quadriceps turndown technique attempts to restore medial stability. Results of the quadriceps turndown technique have previously only been reported in adult populations. The purpose of this study was to assess the safety, efficacy, and patient-reported outcomes following a quadriceps turndown MPFL reconstruction in the pediatric and...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Optimizing Graft Extraction From the Femoral Condyle for Fresh Osteochondral Allograft Transplantation in Treating Osteochondritis Dissecans of the Capitellum: Best Fit Based on Radius of Curvature
Discussion: No site measured from the femoral condyle demonstrated a subchondral ROC that exactly matched the subchondral ROC of the capitellum at the center location where OCD lesions most commonly occur; of the locations measured, a 10 mm section from MC2 demonstrated the closest match. On the basis of this analysis, extracting a graft from MC2 has the potential to further optimize FOCAT fit to the capitellum. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Predictors of Arthrofibrosis After Pediatric Anterior Cruciate Ligament Reconstruction: What Is the Impact of Quadriceps Autograft?
Background: Recent literature on arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) in children and adolescents is limited, especially with regards to quadriceps tendon (QT) autograft. The purpose of this study was to identify predictors of arthrofibrosis after ACLR, with attention to the impact of graft type. Methods: Patients that underwent primary ACLR at a tertiary children’s hospital were reviewed for this retrospective case-control study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, allografts, or a modified MacIntosh reconstruction were e...
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Diversity and Inclusion in an Orthopaedic Surgical Society: A Longitudinal Study
Conclusions: Membership in POSNA has increased between 2010 to 2020 for every diversity category examined and POSNA membership exhibits significantly more diversity than the orthopaedic specialty as a whole. Leadership as a whole is more diverse in 2020 than it was in 2010. Level of Evidence: Level II—retrospective. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Diversity, Equity, and Inclusion Source Type: research

A Gender Gap in Publishing? Understanding the Glass Ceiling in Pediatric Orthopaedic Surgery
Conclusion: In pediatric orthopaedic surgery, abstracts authored by women are less likely to reach publication, despite no identifiable differences in study quality. Reasons for this discrepancy must be explored including insufficient mentorship, exclusion from study group participation, or potential bias against female researchers in the field of orthopaedic surgery. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Diversity, Equity, and Inclusion Source Type: research

Analysis of Author Gender in the Pediatric Orthopaedic Literature from 2011 to 2020
Conclusion: There is an increasing proportion of publications in the pediatric orthopaedic literature with female authors and female first authors from 2011 to 2020. In addition, there was a statistical difference in female authorship when comparing specific publications, which should be investigated further. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - July 21, 2021 Category: Orthopaedics Tags: Diversity, Equity, and Inclusion Source Type: research

Response to: Flexible Intramedullary Nailing of Femoral Shaft Fractures in Children Weighing ≥40 kg: A Systematic Review and Meta-Analysis
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Flexible Intramedullary Nailing of Femoral Shaft Fractures in Children Weighing ≥40 kg: A Systematic Review and Meta-Analysis
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Does Surgical Experience Decrease Radiation Exposure in the Operating Room?
Background: Intraoperative fluoroscopy facilitates minimally invasive surgery, and although it is irreplaceable in terms of intraoperative guidance, it results in substantial radiation exposure to the patient and surgical team. Although the risk of radiation exposure because of equipment factors has been described, there is little known about the impact of surgeon experience on radiation exposure. The aim of this study was to determine whether there is a relationship between years of surgical experience and total dose of radiation used for an archetypal pediatric orthopaedic surgical procedure that requires intraoperat...
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Trends in Leadership at Pediatric Orthopaedic Fellowships
Conclusions: Pediatric orthopaedic FDs are typically early-career to mid-career when appointed, with a strong research background. Nearly a third completed additional graduate degrees or multiple fellowships. Although male dominated, there are more female FDs leading pediatric orthopaedic programs compared with adult reconstruction, trauma, and spine fellowships. As fellowships continue to grow and diversify, this research will provide a baseline to determine changes in FD leadership. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Pediatric Venous Thromboembolism: Different Rates of Incidence, Anatomic Locations, and Risk Factors Between Orthopaedic and Nonorthopaedic Related Patients
Background: The prevalence of venous thromboembolism (VTE) may be increasing in children; however, scarce literature exists comparing incidence rates between pediatric orthopaedic patients and other pediatric patients. The purpose of this study was to compare the incidence, anatomic locations, and risk factors of VTEs between orthopaedic and nonorthopaedic pediatric related patients to determine if important differences exist. Methods: Computed tomography and ultrasound data were reviewed for children (below 19 y old) with a diagnosed VTE between January 1, 2009 and December 31, 2016. Demographic and clin...
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Use of Telemedicine in Pediatric Orthopaedics Prior to the Pandemic: A Survey of POSNA Members
Conclusion: The survey is an attempt to understand the current landscape of telemedicine use within pediatric orthopaedics. Currently, a minority of survey participants utilize synchronous communication telemedicine. There is a desire for telemedicine training and best billing practices education. Further study to evaluate the limitations and efficacy of telemedicine in the pediatric orthopaedic population will be necessary as its use increases. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Selected Topics Source Type: research

Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries
Discussion: The LTN may be a potential nerve donor for musculocutaneous or axillary nerve reinnervation in patients with brachial plexus injuries when other donors are not available during a primary plexus reconstruction. However, the best use may be for delayed neurotization of a free functioning muscle transfer after the initial plexus reconstruction has failed and no other donors are available. Level of Evidence: Level IV—therapeutic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Trauma Upper Extremity Source Type: research

Complex Fracture-Dislocations of the Elbow in the Pediatric Population
Conclusions: The most common complex elbow fracture-dislocation pattern in this series was an elbow dislocation with fracture of the medial epicondyle and lateral condyle or radial neck. In contrast to adult terrible triad injuries, most patients had a favorable clinical outcome, with nearly 80% excellent results and a low rate of complications. Level of Evidence: Therapeutic Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Trauma Upper Extremity Source Type: research

Streamlining Postoperative Care After Pediatric Supracondylar Humerus Fractures: Is Follow-up After Pin Removal Routinely Needed?
Background: Closed reduction and percutaneous pinning is the standard of care for displaced supracondylar humerus fractures (SCHFs). Although the operative management of SCHFs has achieved good consensus with low complication rates, there remains a paucity of literature on postoperative management. We hypothesized that routine office visits after pin removal can safely be avoided in uncomplicated SCHFs without compromising patient care. Method: A retrospective review was conducted to query the electronic medical record for SCHFs, treated with closed reduction and percutaneous pinning. Patients with complicated S...
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Trauma Upper Extremity Source Type: research

Orthopaedic Problems in 35 Patients With Organic Acid Disorders
Conclusions: Most in this cohort of patients with OAD also had an orthopaedic abnormality. It is important for physicians treating these patients to understand their propensity for musculoskeletal problems. When treating patients with OAD, it is important to initiate and maintain communication with specialists in several disciplines and to develop collaborative treatments for this unique population. Level of Evidence: Level IV—prognostic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Surgical Outcome of Spinal Fusion for Osteogenesis Imperfecta With Scoliosis: Is the Hybrid System With Pedicle Screws Applicable to Weak, Tiny, and Fragile Vertebrae?
This study evaluated the surgical outcome, and the accuracy and safety of PS placement in patients with OI. Methods: Twenty-five patients with OI were included in this study. Mean age was 21.0±9.3 (10 to 49) years. Mean follow-up was 5.8±2.0 years. The Sillence classification showed 16 patients had the mildest type I, 1 patient had moderate type IV, and 8 patients had the most severe type III. Fifteen patients underwent anterior release followed by posterior fusion, and 10 patients underwent only posterior fusion. The accuracy of PS placement was evaluated with postoperative computed tomography. Res...
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Mechanical Analysis of Explanted Telescopic Rods in the Management of Osteogenesis Imperfecta: A Multicenter Study
Conclusions: Current manufacturing techniques result in inferior material strength in female components compared with males, which combined with wear patterns is likely to lead to implant failure. Intraoperative cutting of rods may increase risk of failure due to wear. Considering techniques to improve strength as well as design in new implants may lead to better outcomes. Levels of Evidence: Level IV—cross-sectional study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Metabolic Source Type: research

Combining Lower Extremity Radiographic Markers Begets More Accurate Predictions of Remaining Skeletal Growth
Conclusions: Integration of bone age scores across different regions of the lower extremity has the potential to facilitate orthopaedic decision-making using radiographs already obtained in the treatment of pediatric musculoskeletal conditions. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Limb Lengthing Source Type: research

Retrograde Extramedullary Lengthening of the Femur Using the PRECICE Nail: Technique and Results
Conclusions: Retrograde extramedullary lengthening of the femur is an option that should be considered for limb length equalization in skeletally immature patients. It avoids the inconvenience of external fixation and can be used to simultaneously correct deformities of the distal femur. Although the total amount of length gained is modest, we believe it is a promising limb lengthening technique that merits further investigation. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Limb Lengthing Source Type: research

Limb Lengthening for Congenital Deficiencies Using External Fixation Combined With Flexible Intramedullary Nailing: A Multicenter Study
Background: Hydroxyapatite (HA) coated flexible intramedullary nailing (FIN) stimulates osteogenic activity. The role of HA-coated intramedullary nails remains unclear in normal bone lengthening. The goal of this study was to quantify the influence of FIN on the External Fixation Index (EFI) in patients with congenital lower limb discrepancy. Methods: Patients with femoral deficiency and fibular hemimelia underwent lengthening by the combined technique of external fixation with titanium (Ti) FIN or HA coated FIN and returned for follow-up at least 12 months after frame removal. Results: Seventy patients (...
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Limb Lengthing Source Type: research

Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy
Conclusions: CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers. Level of Evidence: Level III, retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 10, 2021 Category: Orthopaedics Tags: Foot & Ankle Source Type: research