In Reply: Range of Motion Improvement Following Surgical Management of Knee Arthrofibrosis in Children and Adolescents
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Range of Motion Improvement Following Surgical Management of Knee Arthrofibrosis in Children and Adolescents
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Changes in Proximal Femoral Shape During Fetal Development
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Industry Payments to Pediatric Orthopaedic Surgeons Reported by the Open Payments Database: 2014 to 2017
Background: The Open Payments Database (OPD), mandated by the Sunshine Act, is a national registry of physician-industry transactions. Payments are reported as either General, Research, or Ownership payments. The current study aims to investigate trends in OPD General payments reported to pediatric orthopaedic surgeons from 2014 to 2017. Methods: General industry payments made to pediatric orthopaedic surgeons (as identified by OPD) were characterized by median payment, payment subtype, and census region. As fewer Research and Ownership payments were made, only payment totals for these categories were determined. Gene...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

Size Matters: Which Adolescent Patients Are Most Likely to Require Surgical Decompression for Lumbar Disk Herniations?
Background: Lumbar herniated nucleus pulposis (HNP) occurs infrequently in the pediatric/adolescent population. A minority of patients with radicular symptoms fail to improve with conservative management and require discectomy. The authors hypothesize that children who ultimately require surgical intervention have an underlying lumbar stenosis predisposing them to continued symptoms. Methods: Pediatric patients with a lumbar HNP on advanced imaging were retrospectively identified at a tertiary pediatric orthopaedic institution. Patients with spondylolisthesis, fractures, previous spine surgery, or structural thoracolu...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

The Validity of Patient-reported Outcome Measurement Information System (PROMIS) Parent Proxy Instruments to Assess Function in Children With Talipes Equinovarus
Conclusions: These results provide support for the validity of the PROMIS Mobility, Pain Interference, and Pain Intensity domains in this population, however there are no items in PROMIS that can assess overall satisfaction, as with the DSI. Level of Evidence: Level II—prospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Club Foot Source Type: research

A Long-term Follow-up of Young Adults With Idiopathic Clubfoot: Does Foot Morphology Relate to Pain?
Background: Individuals with clubfoot, treated in infancy with either the Ponseti method or comprehensive clubfoot release, often encounter pain as adults. Multiple studies have characterized residual deformity after Ponseti or surgical correction using physical exam, radiographs and pedobarography; however, the relationship between residual foot deformity and pain is not well defined. The purpose of the current study was 2-fold: (1) to evaluate the relationship between foot morphology and pain for young adults treated as infants for idiopathic clubfoot and (2) to describe and compare pedobarographic measures and outcome...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Club Foot Source Type: research

3D Modeling of Lower Extremities With Biplanar Radiographs: Reliability of Measures on Subsequent Examinations
Conclusions: The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment. The torsional profile assessment did not accurately reflect changes obtained by derotational osteotomy. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Evaluation of Skeletal Maturity Using the Distal Femoral Physeal Central Peak Is Not Significantly Affected by Radiographic Projection
Background: Accurate estimation of skeletal maturity is important in several pediatric orthopaedic conditions. The current gold standard for estimating skeletal maturity using the Greulich and Pyle Bone Atlas is complex and shown to have significant interobserver variability. Recent data have shown peak height velocity to occur on average at 90% of final adult height, providing an improved gold standard to quantify skeletal maturity, facilitating the investigation of different skeletal maturity systems. Measurement of topographical changes to the developing distal femoral physis on anteroposterior (AP) radiographs allow ...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Supracondylar Humeral Fracture Documentation: A Performance Improvement Study
Background: Supracondylar fractures of the humerus (SCH) are the most common fractures about the elbow in children that require operative stabilization. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. It also is of prime importance for justification or defense of our care should this arise. One of the common concerns in transition from written documentation to an electronic medical record (EMR) is availability of proper documentation. We sought to develop an established EMR protocol to streamline and improve proper care and d...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Divergent Intramedullary Nailing (DIN): A Modified Intramedullary Nailing Technique to Treat Paediatric Distal Tibial Fractures
Introduction: Elastic stable intramedullary nailing (ESIN) allows for efficient reduction and stabilization of fractures of the tibial shaft in children and adolescents. However, for fractures of the distal third of the tibia, traditional ESIN could be inappropriate, thus compromising the stability and the healing of the fracture. The aim of this study was to present and to assess a new technique of modified ESIN to treat fracture of the distal third of the tibia, called divergent intramedullary nailing (DIN). Methods: We performed a retrospective monocentric study. All patients less than 16 years old, managed in our ...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Pediatric Septic Arthritis of the Knee: Predictors of Septic Hip Do Not Apply
Conclusions: According to the Kocher criteria of the hip, at 3 or more criteria the probability of septic arthritis becomes 93% with a sensitivity of 0.84 provoking many physicians to use this cutoff in their assessment of hip pain. This study suggests that if these criteria were applied to the knee, 52% of septic knee cases could be missed. There is a need for further investigation of specific criteria of the knee as the markers of the hip septic arthritis are not necessarily applicable in the knee. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Knee Source Type: research

Prediction of the Peripheral Rim Instability of the Discoid Lateral Meniscus in Children by Using Preoperative Clinicoradiological Factors
Background: The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI. Methods: Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. P...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Knee Source Type: research

Adolescent and Caregiver-derived Utilities for Traumatic Patella Dislocation Health States
Conclusions: Adolescents and their parents felt that successful treatment of an acute patella dislocation was equivalent to perfect health (utility=1); however, adolescents assigned a significantly higher utility to a stable but lower functioning health state compared with their parents. Baseline functional status is an important modifier of health state preference—highly active adolescents assign a significantly greater disutility to health states in which they are not participating in sports at their regular level of play. These findings provide insight into the health-related quality of life impact for acute pat...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Pediatric ACL Reconstruction and Return to the Operating Room: Revision Is Less Than Half of the Story
Conclusions: Approximately 1 in 6 pediatric ACLR patients underwent ≥1 repeat surgery within 3 postoperative years for indications ranging from wound breakdown to contralateral ACL rupture. While previous studies revealed high rates of complication after pediatric ACLR due primarily to graft failure, we found that re-tear is responsible for less than half of the 3-year RTOR risk. As almost half of re-tears in our sample occurred before clearance to return to full activities, we suspect that the high rate of complication is largely attributable to pediatric patients’ high activity levels and difficulties adhering...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Acetabular Protrusio in Patients With Osteogenesis Imperfecta: Risk Factors and Progression
Conclusions: AP is a common finding in OI patients (54%). Among hips of OI patients that met criteria for AP in early radiographs, 42% (20/48) demonstrated greater CE angles in their latest radiographs. Similar changes were observed in OI patients who did not initially meet criteria for diagnosis for AP. However, CE angle measurements between the 2 groups did not significantly differ (P=0.71). In terms of Kohler line crossing, patients that met criteria for AP in early radiographs had significantly greater change per year than those that did not have AP criteria (P (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

Clinical and Radiographic Characteristics of Atypical Slipped Capital Femoral Epiphysis
Background: Slipped capital femoral epiphysis (SCFEs) can be idiopathic or atypical (associated with renal failure, radiation therapy, and endocrine disorders). It is important to estimate the likelihood that atypical SCFE shows different clinical and radiographic characteristics and complications with typical SCFEs. Methods: We retrospectively reviewed 53 patients (66 hips) with SCFEs managed between 1995 and 2016. Sex, age, weight, height, the duration of symptoms the laterality of the slip, and complications were recorded. Bilateral hip and lower extremity long bone radiographs were utilized to record slip angle, g...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

Radiographic and Clinical Outcomes of Adolescents With Acetabular Retroversion Treated Arthroscopically
Conclusions: Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO. Study Design: Level of evidence 4—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip
Conclusions: The 23- versus 24-hour PH regimen and frequency of clinic visits in the first 4 weeks of PH treatment did not affect the clinical or radiographic success rate of Ortolani+ hips in infantile DDH. A strict weekly clinic visit and 24-hour PH regimen may not be necessary to obtain stable reduced hips in infants presenting (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis
Background: Opioids are commonly used after posterior spinal instrumented fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Prescription opioids use can potentially lead to misuse, abuse, dependence, and overdose death. Prolonged opioid use has not been extensively studied in the postoperative AIS population. The purpose of this study is to identify risk factors associated with prolonged opioid use after PSIF for AIS. Methods: A large insurance database was queried for AIS patients undergoing PSIF. Patients with prolonged postoperative opioid use were defined as those receiving new prescriptions for an opioid m...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Comparison of Ponte Osteotomies and 3-Column Osteotomies in the Treatment of Congenital Spinal Deformity
Background: Congenital spinal deformity (CSD) has traditionally been treated with 3-column osteotomies [hemivertebrectomy (HV) or vertebral column resection (VCR)] to address rigid deformities. Alternatively, multiple Ponte osteotomies (PO) may provide correction while minimizing risk. The purpose of this study was to compare safety and outcomes of patients undergoing surgical treatment for CSD with these 3 procedures. Methods: Retrospective review of CSD patients treated with posterior spinal fusion between 1996 to 2013. Patients treated with multiple Ponte osteotomies (PO group) were compared with those managed with...
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

The Association Between the Classification of Early-onset Scoliosis and Smith Complications After Initiation of Growth-friendly Spine Surgery: A Preliminary Study
Conclusions: The C-EOS simplifies a complex pathology and the Smith complication classification scheme creates a language to discuss treatment of known complications of growth-friendly spine surgery. Although there is an association between more advanced C-EOS and Smith complications, there does not appear to be a correlation that can satisfy a risk stratification at this time. Level of Evidence: Level II. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Radiographic Outcome and Complication Rate of 34 Graduates After Treatment With Vertical Expandable Prosthetic Titanium Rib (VEPTR): A Single Center Report
Conclusions: There is a high complication rate during VEPTR treatment and with final fusion surgery. The stiffness of the spine and thorax allow for only limited correction when performing a final instrumented spondylodesis. Avoiding final fusion may be a viable alternative in case of good coronal and sagittal alignment. Level of Evidence: Level IV—therapeutic. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - October 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Response to Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis
No abstract available (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Application of Low-dose Stereoradiography in In Vivo Vertebral Morphologic Measurements: Comparison With Computed Tomography
This study compares the 3D vertebral morphology measurements using low-dose stereoradiography with the currently accepted imaging modality for such measurements, CT scans. Methods: A total of 86 vertebrae of 6 patients with early-onset scoliosis and 3 patients with congenital scoliosis, age ranged between 7.8 and 12.5 years, who had both thoracic spine CT scan and low-dose stereoradiography of the spine were included. 3D reconstructions of CT and low-dose stereoradiography were generated. Using previously validated image processing techniques, vertebral anterior (A), posterior (P), left (L), and right (R) heights, super...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

Experimental Induction of Physeal Injuries by Fracture, Drill, and Ablation Techniques: Analyses of Immunohistochemical Findings
Conclusions: On the basis of the type of surgical treatment, results show significant differences in the presence of VEGF (reflecting the vascular bed) in the resting and proliferating zones at days 1, 6, and 21. VEGF localization was less abundant in the ED group (which had more physeal bars), suggesting that lack of vascular ingrowth plays a role in physeal bar formation. Clinical Relevance: Basic science data presented here provide insight into the importance of the various regions of the physis and its repair and continued growth after physeal fracture. We suggest that a better understanding of the cellular basis ...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

Electronic Medical Record Use and Satisfaction Among Pediatric Orthopaedic Surgeons
Conclusions: Substantial effort needs to be made to improve subspecialty-specific EMR documentation, order entry, research tools, and clinical workflows to enhance the processes of care for children with orthopaedic conditions in the era of EMR. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

Knee Recurvatum in Children With Spastic Diplegic Cerebral Palsy
Background: The purpose of this study is to determine which factors drive patients with diplegic cerebral palsy to walk without knee recurvatum despite hyperextension of the knee on physical examination. Methods: A retrospective review was conducted of all data collected in the Gait Analysis Laboratory between 1999 and 2014. Patients with spastic diplegic cerebral palsy and at least 5 degrees of knee extension on clinical examination were identified for the study. After IRB approval, a total of 60 children ranging in age from 4 to 17 were included in the study. There were 27 female patients. Gross Motor Function Class...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Rectus Femoris Transfer Surgery Worsens Crouch Gait in Children With Cerebral Palsy at GMFCS Levels III and IV
Background: Previous study has shown that children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels III and IV do not benefit from distal rectus femoris transfer (DRFT) due to lack of improvement in stance knee extension. The fate of knees in such subjects who do not undergo DRFT is unknown. The purpose of this study was to compare knee kinematic outcomes in patients with CP and stiff knee gait who underwent single-event multilevel surgery with and without DRFT. Methods: Preoperative and postoperative gait analysis data were retrospectively reviewed for ambulatory (GMFC...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Incidence and Fusion of Os Trigonum in a Healthy Pediatric Population
Conclusions: This study confirms a relatively large prevalence of os trigonum in a random pediatric population, and clarifies both the average age of onset and high rate of fusion at a relatively narrow range of skeletal maturity. Level of Evidence: Prognostic level II—retrospective study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Use of Paley Classification and SUPERankle Procedure in the Management of Fibular Hemimelia
Conclusions: Our results and a review of the literature clearly suggest that limb reconstruction according to Paley classification, is an excellent option in the management of fibular hemimelia. Our 2-staged procedure (SUPERankle procedure followed by limb lengthening) helps in reducing the complications of limb lengthening and incidence of ankle stiffness. Performing the first surgery at an earlier age (below 5 y) plays a significant role in preventing recurrent foot deformities. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Lengthening With Monolateral External Fixation Versus Magnetically Motorized Intramedullary Nail in Congenital Femoral Deficiency
Background: Limb lengthening for congenital femoral deficiency (CFD) with or without fibular hemimelia can be performed with both external and internal devices. The purpose of this study is to compare clinical outcomes of femoral lengthening utilizing monolateral external fixation versus a magnetically motorized intramedullary nail in patients with CFD with or without fibular hemimelia. Methods: This retrospective review included 62 patients with femoral lengthening, 32 patients had monolateral external fixation (group A), 30 patients had internal lengthening nail (group B). Mean age in years was 9.4±3.8 and 15...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Lower Extremity Source Type: research

Ultrasound Characteristics of Clinically Dislocated But Reducible Hips With DDH
Conclusions: Analysis of a large cohort of patients with dislocated but reducible hips reveals a median percent FHC of 10%, a median α of 43 degrees, and a median β of 66 degrees on initial US. Using a threshold at the 90th percentile, a sensible ultrasonographic definition of a dislocated hip seems to be FHC≤33%, implying that FHC between 34% and 50% may be reasonably termed a subluxation. Although these findings are consistent with previous, smaller reports, further prospective research is necessary to validate these thresholds. Level of Evidence: Level IV—diagnostic study. (Source: Journal of Pe...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience
Conclusions: On the basis of our experience, MRI is an excellent, safe and, reliable modality to confirm maintenance of adequate femoral head position and to evaluate soft tissue interposition. We agree that MRI is the gold standard to early depict dislocation after closed reduction of DDH. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Hip Source Type: research

Intrawound Vancomycin Powder Associated With Reduced Surgical Site Infection in Rib-based Distraction Surgery
Conclusions: Intrawound vancomycin powder significantly reduced the surgical site infection rates following rib-based distraction surgery for EOS. We therefore recommend the use of intrawound vancomycin powder as a standard of care for patients undergoing rib-based distraction surgery. Level of Evidence: Pre-post intervention, retrospective cohort study—therapeutic level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Site-specific Surgical Site Infection Rates for Rib-based Distraction
Background: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. Methods: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our in...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Nasal Swab Screening for Staphylococcus aureus in Spinal Deformity Patients Treated With Growing Rods
Conclusion: The use of SA nasal swab screening in GR patients identified 9 patients (26.5%) whose prophylactic antibiotics (cefazolin) could be altered to permit appropriate SA coverage. Level of Evidence: Level IV—retrospective case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Evaluation of Gabapentin and Clonidine Use in Children Following Spinal Fusion Surgery for Idiopathic Scoliosis: A Retrospective Review
Conclusions: In conclusion, additions of postoperative transdermal clonidine and perioperative oral gabapentin together were found to improve functional outcomes following PSF surgery. Group G and C had reduced opioid use and shorter hospital stay than group P. Addition of these adjuncts together was found to be better since group C patients made fewer PCA attempts to obtain morphine over the first 10-hour period postoperatively and were able to ambulate sooner than group G. The PCA pump usage pattern provides useful information about patient comfort and efficacy of adjunctive medications. Level of Evidence: Level II&...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Scoliosis Source Type: research

Cervical Spine Deformities in Children With Rhizomelic Chondrodysplasia Punctata
Conclusions: This study suggests that, in children with RCDP, cervical spinal stenosis and cord compression are a real risk, and children with this diagnosis should have monitoring for these issues. Tethered cord is also a possible finding that needs to be evaluated. Full sagittal spine MRI is necessary to detect the possible deformities at the cervical and lumbar levels. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Spine Source Type: research

The Clinical Utility of Flexion-extension Cervical Spine MRI in 22q11.2 Deletion Syndrome
Conclusions: Although the upper cervical anomalies are extremely common in 22q, we did not identify cases of instability on dynamic plain radiographs and MRI. Although our findings do not support routine screening with flexion and extension MRI, this study may be required in patients with neurological symptoms and/or findings or abnormalities on dynamic plain radiographs. Level of Evidence: Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Spine Source Type: research

Anterior Cruciate Ligament Injury at the Time of Anterior Tibial Spine Fracture in Young Patients: An Observational Cohort Study
Conclusions: There are demographic characteristics, such as age (older) and sex (male), associated with a higher risk of concomitant ACL injury at the time of ATSF. Type II and type III ATSF patterns had a higher prevalence of ACL injury. MRI failed to correctly identify ACL injury at the time of ATSF. Concomitant ACL injury at the time of ATSF is highly prevalent in the skeletally immature, occurring in 19.4% of patients with ATSF. Level of Evidence: Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Confirming the Presence of Unrecognized Meniscal Injuries on Magnetic Resonance Imaging in Pediatric and Adolescent Patients With Anterior Cruciate Ligament Tears
The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries. Methods: The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Fisher exact tests were used to compare event frequencies between medial meniscal (MM) and lateral meniscal (LM) tears. One-way analysis of variance tests were perform...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Sports Medicine Source Type: research

The Locations of Anterior Cruciate Ligament Tears in Pediatric and Adolescent Patients: A Magnetic Resonance Study
Background: Recently, a resurgence of interest has been noted in anterior cruciate ligament (ACL) preservation in pediatric and adolescent patients. Different tear types, defined by their tear location, require different preservation techniques: proximal and distal avulsion tears can be treated with arthroscopic primary repair, whereas primary repair with biological scaffold has been proposed for midsubstance tears. The goal of this study was to assess the distribution of different tear types in pediatric and adolescent patients, as these are currently unknown. Methods: A retrospective search in an institutional radio...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Nonarticular Base and Shaft Fractures of Children’s Fingers: Are Follow-up X-rays Needed? Retrospective Study of Conservatively Treated Proximal and Middle Phalangeal Fractures
Conclusions: Minimally angulated ( (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Recovery of Motor Nerve Injuries Associated With Displaced, Extension-type Pediatric Supracondylar Humerus Fractures
Conclusions: The majority of nerve injuries associated with pediatric extension SCHF recover within 6 months without acute nerve decompression. The presence of either an isolated radial nerve injury or multiple nerve injuries is associated with prolonged motor recovery. Level of Evidence: Level IV. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Incarcerated Medial Epicondyle Fractures With Elbow Dislocation: Risk Factors Associated With Morbidity
Conclusions: Incarcerated medial epicondyle fractures are commonly associated with ulnar nerve symptoms; however, they are not associated with a significant rate of other complications. There was no increased risk of complications in subjects who had a longer duration between initial presentation and surgery. This suggests that, while the presence of an incarcerated medial epicondyle fracture is certainly an indication for timely operative intervention; the injury in isolation does not need to be considered emergent. Other factors including neurovascular status and ability to achieve joint reduction may still necessitate...
Source: Journal of Pediatric Orthopaedics - September 11, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Surgical Treatment of Congenital and Obligatory Dislocation of the Patella in Children
Background: Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature. We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications. Methods: We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013. The procedure includes extensive subperiosteal...
Source: Journal of Pediatric Orthopaedics - August 9, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

Gait Deviations in Children With Osteogenesis Imperfecta Type I
Conclusions: Together, these findings provide a comprehensive description of gait characteristics among a group of individuals with type I OI. Such data inform clinicians about specific gait deviations in this population allowing clinicians to recommend more focused interventions. Level of Evidence: Level III—case-control study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 9, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research

National Databases in Pediatric Orthopaedic Surgery: A Comparison of Demographics, Procedures, and Outcomes
Conclusions: Clinically and statistically significant differences exist between the KID and NSQIP Pediatric databases. Clinicians and researchers who utilize large databases must understand the differences in data import, quality control, and population sampling in order to provide adequate representation of the population as a whole. Level of Evidence: Level III, prognostic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 9, 2019 Category: Orthopaedics Tags: Selected Topics Source Type: research