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Journal of Pediatric Orthopedics

Zoe Little, Andrea Yeo, Yael Gelfer
BACKGROUND: After successful primary correction of the deformity in idiopathic clubfoot with the Ponseti method, recurrence has been reported to affect up to 40% of children. So far, it has been difficult to predict which feet are at risk of recurrence, despite numerous studies investigating various potential risk factors. The foot abduction brace (FAB) has been the standard of care in preventing recurrence but, even with excellent compliance, recurrences still occur. Increasingly, evidence points to a congenital neuromuscular imbalance constituting the deforming forces present in clubfoot...
March 6, 2019: Journal of Pediatric Orthopedics
Barbara Minkowitz, Leah Nadel, Meghan McDermott, Zachary Cherna, Jennifer Ristic, Stephanie Chiu
BACKGROUND: Obtaining ideal serum 25-vitamin D (25VitD) levels (>30 ng/mL) is imperative in childhood to achieve peak bone mass. Supplementation compliance in children recommended to take vitamin D postfracture was evaluated. The questions we sought to answer were: Is there (1) a compliance difference between patients with known versus unknown 25VitD levels; (2) an association between compliance and age; and (3) an association between fracture severity and initial 25VitD level. METHODS: One physician analyzed compliance in 1818 fracture patients 2 to 18 years (42% female) with known (48%) and unknown 25VitD...
March 6, 2019: Journal of Pediatric Orthopedics
Jerry Y Du, Pierre Tamer, Joanne H Wang, Raymond W Liu
BACKGROUND: Increased health care costs have driven assessment of value of common practices. The Joint Commission mandates the dual interpretation of musculoskeletal radiographs by radiologists and orthopedic surgeons in hospital-based clinic settings. However, the value of this practice has come under question. The purpose of this study was to investigate whether radiologist interpretations change orthopedists' management during follow-up of pediatric supracondylar humerus fractures...
March 6, 2019: Journal of Pediatric Orthopedics
Derrick M Knapik, Conor McCarthy, Raymond W Liu
BACKGROUND: Trochanteric entry femoral nailing in immature patients is controversial. Although it has become increasingly accepted in pediatric patients aged 8 years and older, complications related to physeal violation have been reported. To date, the appropriate minimum age for safe antegrade nailing in skeletally immature patients remains to be unknown. The purpose of this investigation was to determine the degree of trochanteric bony and cartilage growth with increasing age to provide normative growth values...
March 6, 2019: Journal of Pediatric Orthopedics
Brandon J Yuan, Anthony A Stans, Dirk R Larson, Hamlet A Peterson
OBJECTIVE: In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy. METHODS: Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H...
February 25, 2019: Journal of Pediatric Orthopedics
Norman Ramírez, Gerardo Olivella, Pablo Valentín, José Feneque, Soniely Lugo, Iván Iriarte
INTRODUCTION: Previous studies have suggested that most cases of pediatric back pain do not have an identifiable cause. No reliable sign or indication differentiates between a benign or serious cause of the symptom. Constant pain, night pain, and abnormal neurological examination have been suggested as adequate predictors of an identifiable cause, when plain radiographs could not explain the symptoms. The purpose of this study is to determine the sensitivity, specificity, and likelihood ratios of constant pain, night pain, and abnormal neurological examination to predict the presence of an underlying positive finding as a cause of back pain...
February 25, 2019: Journal of Pediatric Orthopedics
Brian W Yang, Benjamin J Shore, Emily Rademacher, Collin May, Colyn J Watkins, Michael P Glotzbecker
BACKGROUND: There has been little investigation into the epidemiology of Cozen's phenomenon, genu valgum as a complication of proximal tibial metaphysis fractures. In this study, we present a large case series of proximal tibia fractures in children to describe the prevalence, epidemiology, and characteristics associated with Cozen's phenomenon following proximal tibial fracture in children. METHODS: We searched the orthopedic database at our institution for all patients aged 1 to 8 years old with proximal tibia fractures presenting for initial fracture management between January 1, 2014 and December 31, 2017...
February 25, 2019: Journal of Pediatric Orthopedics
Ozan Turhal, Zekeriya O Karaduman, Yalçin Turhan
No abstract text is available yet for this article.
February 20, 2019: Journal of Pediatric Orthopedics
Rajan R Murgai, Edward Compton, Kenneth D Illingworth, Robert M Kay
BACKGROUND: Retrograde percutaneous pinning often involves intra-articular pin placement. Classic teaching has cautioned about the risk of septic arthritis with intra-articular pins, although an incidence has not been reported for this complication. The purpose of this study was to determine the incidence of pin tract infections and septic arthritis following retrograde percutaneous pinning of the distal femur. METHODS: A retrospective review identified patients who underwent retrograde percutaneous pinning of the distal femur for osteotomy or physeal fracture fixation at a tertiary pediatric hospital from 2006 to 2017 and had at least 3 months follow-up...
February 11, 2019: Journal of Pediatric Orthopedics
Scott A Galey, Adam Margalit, Michael C Ain, Jaysson T Brooks
BACKGROUND: Compared with other orthopaedic subspecialties, pediatric orthopaedic surgeons are thought to be at greater risk for malpractice claims; however, there is scant research on this topic. The purpose of our study was to characterize publicly available malpractice cases pertaining to pediatric orthopaedics to determine the (1) most common specialties of the physicians implicated, (2) most common diagnoses involved, (3) rate of verdicts in favor of the plaintiff, (4) amount of indemnity payments resulting from all verdicts versus verdicts in which only an orthopaedic surgeon was involved, and (5) outcomes of cases that were appealed...
February 5, 2019: Journal of Pediatric Orthopedics
Alexander J Adams, Matthew J Buczek, John M Flynn, Apurva S Shah
BACKGROUND: There is a need for improved opioid stewardship in orthopedic surgery through multimodal analgesia strategies. Perioperative administration of ketorolac in children undergoing closed reduction and percutaneous pinning (CRPP) for displaced supracondylar humerus (SCH) fracture may decrease pain, reduce opioid requirements, and decrease hospitalization costs. METHODS: Retrospective case-control investigation of children (aged, 1 to 14) treated with CRPP for closed, modified Gartland type III extension-type SCH fractures at a single children's hospital between 2011 and 2017...
February 1, 2019: Journal of Pediatric Orthopedics
Natalie M Green, Joseph Pagkalos, Lee M Jeys, Jonathan D Stevenson, Jonathan J Gregory
AIMS: Our study aims to review the outcomes of conservative and interventional management of simple bone cysts (SBC) in the humerus. METHODS: We retrospectively reviewed our center's prospectively collected database. All patients with a diagnosis of a humeral SBC and a minimum of 1-year follow-up or complete healing and discharge within the first year were included. Cyst radiographic measurements were collected for all patients with available radiographs. A successful outcome included fully or partially healed cysts with persistent and recurrent cysts marked as unsuccessful...
January 29, 2019: Journal of Pediatric Orthopedics
Stephen Mathew, Henry B Ellis, Charles W Wyatt, Meagan J Sabatino, Aaron J Zynda, Garrett Dennis, Philip L Wilson
BACKGROUND: Previous reports of transphyseal drilling in anterior cruciate ligament (ACL) reconstruction have demonstrated good clinical outcomes without subjective changes in further skeletal development. The purpose of this study is to evaluate radiographic changes during continued growth following a transphyseal ACL reconstruction using an anteromedial femoral (AM) drilling technique in patients with >18 months of growth remaining. METHODS: A review of consecutive adolescents who underwent a soft tissue transphyseal ACL reconstruction using an AM drilling technique was performed...
January 29, 2019: Journal of Pediatric Orthopedics
Xuyang Song, Alexandria L Case, Rory Carroll, Joshua M Abzug
BACKGROUND: Emergency room transfers to a higher level of care are a vital component of modern health care, as optimal care of patients requires providing access to specialized personnel and facilities. However, literature has shown that orthopaedic transfers to a higher level of care facility are frequently unnecessary. The purpose of this study was to assess the appropriateness of pediatric orthopaedic transfers to a tertiary care center and the factors surrounding these transfers. METHODS: All pediatric orthopaedic transfers to the pediatric emergency department (ED) were evaluated over a 4-year period...
January 25, 2019: Journal of Pediatric Orthopedics
Benedict U Nwachukwu, Conan So, Yi Zhang, Beth E Shubin-Stein, Sabrina M Strickland, Daniel W Green, Emily R Dodwell
INTRODUCTION: The treatment of a first-time traumatic patella dislocation in children and adolescents remains controversial. Preference-based health utility assessments can provide health-related quality of life information for orthopaedic conditions and their subsequent treatment. The purpose of this study was to determine utilities for pediatric acute traumatic patella dislocation and subsequent treatment health states from both children with patellar dislocation, and their parents...
January 25, 2019: Journal of Pediatric Orthopedics
Stephanie S Pearce, Michael W Honeycutt, William A Cutchen, Mark D Tillman, Prasit Nimityongskul
BACKGROUND: This study is the first to test Friberg's equation's (Vt=V0[e]) accuracy in predicting the residual angular deformity in pediatric distal forearm fractures. METHODS: Angular deformities from distal forearm fractures in 50 children (mean age, 9 y) were retrospectively measured on follow-up radiographs once healed and compared to extrapolated angles at respective follow-up intervals from 2013 to 2015. RESULTS: The predicted and actual angulations from 120 radiographs (mean follow-up, 3mo) showed that the mean predicted angle was similar to the measured angle in the radioulnar plane and only 2 degrees greater than the measured angle in the dorsovolar plane...
January 25, 2019: Journal of Pediatric Orthopedics
Christen Russo, Evan Trupia, Megan Campbell, Hiroko Matsumoto, John Smith, Amer Samdani, John Emans, David Roye, Michael Vitale
BACKGROUND: Early-onset scoliosis (EOS) is a complex, heterogeneous condition involving multiple etiologies, genetic associations, and treatment plans. In 2014, Williams and colleagues proposed a classification system of EOS (C-EOS) that categorizes patients by etiology, Cobb angle, and kyphosis. Shortly after, Smith and colleagues validated a classification system to report complications of growth-friendly spine instrumentation. Severity refers to the level of care and urgency required to treat the complication, and can be classified as device-related or disease-related complications...
January 19, 2019: Journal of Pediatric Orthopedics
Maureen Donohoe, Blazej Pruszcynski, Kenneth Rogers, James Richard Bowen
BACKGROUND: Arthrogryposis multiplex congenita (AMC) is a nonprogressive syndrome with multiple rigid joints, fibrotic periarticular tissue, and muscular fibrosis. The most common subgroup is amyoplasia. Ambulation is one of the most significant functions of the lower extremities as it translates to increased functionality and independence in adulthood. There is no predicative scale to determine ambulation at maturity for the infant with amyoplasia. It is believed lower extremity resting position of infants with amyoplasia potentially correlates with ambulation at maturity...
January 19, 2019: Journal of Pediatric Orthopedics
Daniel Studer, Philippe Büchler, Carol C Hasler
BACKGROUND: The final strategy for graduates from growth-sparing surgery is challenging. The purpose of this study was to evaluate the radiographic outcome and complications of patients with early onset scoliosis (EOS) who have graduated from vertical expandable prosthetic titanium rib (VEPTR) treatment, either undergoing final fusion surgery or following a nonfusion approach. METHODS: Final treatment for VEPTR graduates was divided in "VEPTR in situ without final fusion," "removal of VEPTR without final fusion," and "removal of VEPTR with instrumented final fusion...
January 17, 2019: Journal of Pediatric Orthopedics
Derrick M Knapik, Mindy M Duong, Raymond W Liu
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...
January 14, 2019: Journal of Pediatric Orthopedics
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