Evaluation of Anterior Coverage in Children With Developmental Dysplasia of the Hip Using Transverse Magnetic Resonance Imaging at 2 Years Is Predictive of Future Radiographic Coverage
Background: Although normal anterior acetabular coverage provides stability to the hip, acetabular retroversion leads to femoroacetabular impingement related to hip osteoarthritis. Previous studies have focused on acetabular version and anteroposterior coverage in children with developmental dysplasia of the hip (DDH); however, the correlation between anteroposterior coverage and acetabular development is unclear. We measured anteroposterior acetabular coverage in DDH patients using transverse magnetic resonance imaging (MRI) and subsequent bony acetabular growth, and evaluated the correlation of those findings. Met...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Hip Source Type: research

Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study
Background: Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Methods: AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients show...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Scoliosis Source Type: research

Measurable Lumbar Motion Remains 1 Year After Vertebral Body Tethering
Conclusions: Lumbar VBT resulted in preserved flexion and extension motion at 1 year postoperatively. We also noted some preserved coronal plane motion, but this was decreased compared with preoperative values by ~50%. These findings provide proof of concept that some spinal motion is preserved after lumbar VBT in contrast to lumbar fusion where no motion is retained over the instrumented segments. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Scoliosis Source Type: research

Disparities in Pediatric Scoliosis: The Impact of Race and Insurance Type on Access to Nonoperative Treatment for Adolescent Idiopathic Scoliosis
Background: Adolescent idiopathic scoliosis (AIS) has evidence-based, nonoperative treatments proven to be effective with early diagnosis and prompt treatment. The purpose of this study was to identify potential disparities in access to nonoperative treatment for AIS. Specifically, we sought to determine the interaction of socioeconomic factors on a major curve magnitude and recommend treatment at the initial presentation. Methods: A retrospective review of AIS patients who underwent surgery at a single tertiary pediatric hospital between January 1, 2013 and December 31, 2018 was conducted. Patients were divided...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Scoliosis Source Type: research

Treatment of Osteochondral Lesions of the Talus in the Skeletally Immature Population: A Systematic Review
Conclusions: This study showed that for skeletally immature patients presenting with symptomatic OLTs, conservative treatment is clinically successful in 4 out of 10 children, whereas the different surgical treatment options were found to be successful in 7 to 10 out of 10 children. Specifically, fixation was clinically successful in 8 out of 10 patients and showed radiologically successful outcomes in 9 out of 10 patients, and would therefore be the primary preferred surgical treatment modality. The treatment provided should be tailor-made, considering lesion characteristics and patient and parent preferences. Leve...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee
Conclusions: Understanding the position of the popliteal artery in pediatric patients can help when stabilizing tibial tubercle fractures. Because the artery is close to the posterior cortex, a drill exiting in line with the popliteal artery risks vascular injury. Therefore, we recommend that screws exit within the medial 60% of the tibia. Level of Evidence: IV (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Predictive Scoring for Recurrent Patellar Instability After a First-time Patellar Dislocation
Conclusion: This study presented a scoring system that incorporated radiographic knee kinematics in the risk assessment for recurrent patellofemoral instability for patient stratification. The scoring system could guide the decision for early surgical intervention after the first-episode patellofemoral dislocation for patients at high risk of recurrent patellofemoral dislocation. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Orthopaedic Surgery Pediatric Sports Medicine: Characterizing Practice Patterns and Subspecialization
Background: Pediatric sports medicine is a new and rapidly growing subspecialty within orthopaedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America. Therefore, the purpose of this study was to evaluate and describe the current practice patterns of orthopaedic surgeons specializing in pediatric sports medicine. Methods: An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through the Pediatric Research in Sports Medicine Society. The purpose of the survey was to characterize (1) surgeon demographics, (2) ...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Sports Medicine Source Type: research

Nonoperative Management of Closed Displaced Tibia Shaft Fractures in Patients Under 18 Years of Age: Low Failure Rate
Background: Tibial shaft fractures are the third most common pediatric long bone fracture pattern. Historically, these fractures have been initially treated with closed reduction and casting (CRC). Recently, there has been an increasing trend toward surgical intervention as an initial treatment for these injuries. In an effort to better understand whether this trend is warranted, this study seeks to characterize the clinical and radiographic outcomes of a large number of children who underwent nonoperative treatment with CRC as their initial treatment for pediatric tibial shaft fractures at a single tertiary care cente...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

An Alternative Fixation Option for Subtrochanteric Femur Fractures in Children: Adult Proximal Humerus Plate
Conclusion: This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures. Level of Evidence: Level IV, Case series (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

Risk Factors for Upper Extremity Refractures in Children
Conclusions: Our practice saw a refracture occurrence in 2% of patients, with median time to refracture of ~6 months. The factors most strongly associated with refracture were midshaft fracture location, forearm fracture as opposed to clavicle or humerus, and noncompliance as defined in the study. Falls and high energy activities, such as use of wheeled devices, skis, or trampolines, were important mechanisms of refracture. Level of Evidence: This study is a Level II prognostic study. It is a retrospective study that evaluates the effect of patient and fracture characteristics on the outcome of upper extremity r...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

The Frequency and Outcomes of Nerve Palsies in Operatively Treated Supracondylar Humerus Fractures
Background: A high index of suspicion for nerve palsy is essential in the setting of a displaced supracondylar humerus fracture (SCHF) with careful attention to the examination. We hypothesize that nerve injuries are more prevalent in higher energy type III and flexion SCHFs compared with type II fractures. Methods: A retrospective review was performed of 1085 operatively treated SCHFs in pediatric patients, aged 0 to 14 years, between January 1, 2015 and December 31, 2018. There were 979 patients eligible for analysis. Exclusion criteria included follow-up (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

Is There a Chance to Treat Modified Gartland Type IIB Pediatric Supracondylar Humerus Fractures With Closed Reduction and Casting?
Conclusions: Although the initial reduction success is not high among WMGC type IIB fractures, the results are like those of conservatively managed type IIA fractures if successful reduction is achieved. This study showed that the treatment results of all type II SCHFs with no loss of reduction in the first week after CR&LAC are satisfactory. No reduction loss was observed in any of the cases after the first week. Level of Evidence: Level III, case-control study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

Impact of the COVID-19 Pandemic on Pediatric Elbow Fractures: Marked Change in Management and Resource Utilization, Without a Change in Incidence
Conclusions: These data provide a contrasting viewpoint to prior reports, illustrating that the incidence of elbow fractures remained consistent during the COVID-19 period, whereas the operative volume and need for hospital admission increased compared with years prior. Furthermore, this study demonstrated how the COVID-19 pandemic altered the interface between pediatric patients with elbow fractures and our institution regarding the location of presentation and transportation. Level of Evidence: Level III—retrospective cohort study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research

Epidemiologic Changes in Pediatric Fractures Presenting to Emergency Departments During the COVID-19 Pandemic
Background: Fractures are a common pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life that could impact the incidence of pediatric fractures. The purpose of this study was to compare the incidence of pediatric fractures in the United States during the COVID-19 pandemic to previous seasonally adjusted fracture incidence rates using the National Electronic Injury Surveillance System (NEISS) database and the American Community Survey (ACS). Methods: The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0 to 17 y) patient...
Source: Journal of Pediatric Orthopaedics - August 11, 2022 Category: Orthopaedics Tags: Trauma Source Type: research