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Pediatric + orthopaedic + review

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
Joash R Suryavanshi, Rie Goto, Bridget Jivanelli, Peter D Fabricant, Jamila Aberdeen, Timothy Duer, Kenneth C Lam, Corinna C Franklin, James MacDonald, Kevin G Shea
BACKGROUND: Phenomena including early sport specialization and year-round training and competition have contributed to an increase in pediatric sports injuries. There has been a concomitant increase in clinical studies focusing on physically active children and adolescents. These studies include investigations of patient-reported outcome measures (PROMs). While the use of PROMs in pediatric orthopaedics has been increasing, PROMs are often inappropriately applied to study populations for whom they are not specifically validated...
January 16, 2019: American Journal of Sports Medicine
Henry Bone Ellis, Meagan J Sabatino, Zachary Clarke, Garrett Dennis, Amanda L Fletcher, Charles W Wyatt, Ayesha Zia, Philip L Wilson
INTRODUCTION: Deep vein thrombosis and pulmonary embolism are major complications that can occur in common orthopaedic procedures such as knee arthroscopy. The purpose of this study is to determine the incidence of venous thromboembolism (VTE) risk factors in adolescent patients undergoing elective lower extremity arthroscopy. A second objective is to determine whether a targeted, standardized screening tool is both cost- and clinically effective in the identification of VTE risk factors in adolescents...
January 7, 2019: Journal of the American Academy of Orthopaedic Surgeons
Kevin J Nickel, Aaron C Van Slyke, Aaron D Knox, Kevin Wing, Neil Wells
Background: Tissue expansion in the lower extremity is controversial, with studies reporting complication rates as high as 83%. Few studies have looked at tissue expansion prior to orthopaedic correction of severe foot and ankle deformities, and those available are restricted to clubfoot in the pediatric population. Here, we report the largest case series on the use of tissue expanders for the reconstruction of severe foot and ankle deformity and the only report in adults. Methods: This is a retrospective chart review of the senior author's practice over a 16-year study period...
November 2018: Plastic Surgery
Jenna M Godfrey, Kevin J Little, Roger Cornwall, Thomas J Sitzman
BACKGROUND: Distal radius fractures are the most common fracture of childhood, occurring in ∼1 per 100 children annually. Given the high incidence of these fractures, we explored feasibility of a bundled payment model. We determined the total treatment costs for each child and identified components of fracture management that contributed to variations in cost. METHODS: We retrospectively reviewed all hospital and physician costs related to the treatment of closed distal radius fractures at a large academic children's hospital...
October 29, 2018: Journal of Pediatric Orthopedics
Mitchel R Obey, Joseph Lamplot, Ena D Nielsen, Lindsay M Andras, Megan Mignemi, Jeffrey Sawyer, John M Flynn, Stephen A Albanese, Pooya Hosseinzadeh
BACKGROUND: Pediatric orthopaedic surgery has become increasingly subspecialized over the past decade. The purpose of this study was to analyze the volume of pediatric sports medicine cases performed by surgeons applying for the American Board of Orthopaedic Surgeons (ABOS) Part II certification exam over the past decade, comparing caseloads according to the type(s) of fellowship completed. METHODS: The ABOS database was reviewed for all surgeons applying for the ABOS Part II certification exam from 2004 to 2014...
November 20, 2018: Journal of Pediatric Orthopedics
Nicole M Mueske, Sylvia Õunpuu, Deirdre D Ryan, Bitte S Healy, Jeffrey Thomson, Paul Choi, Tishya A L Wren
BACKGROUND: Gait analysis provides quantitative data that can be used to supplement standard clinical evaluation in identifying and understanding gait problems. It has been established that gait analysis changes treatment decision making for children with cerebral palsy, but this has not yet been studied in other diagnoses such as spina bifida. RESEARCH QUESTION: To determine the effects of gait analysis data on pathology identification and surgical recommendations in children with spina bifida...
January 2019: Gait & Posture
Walter H Truong, Meghan J Price, Kunal N Agarwal, Joash R Suryavanshi, Sahana Somasegar, Micha Thompson, Peter D Fabricant, Emily R Dodwell
PURPOSE: Clinical changes are best evaluated with standardized, validated outcomes, including both patient-reported outcome measures and surgeon-reported outcome measures (PROMs and SROMs). The purpose of this study was to describe the spectrum of outcome measures used in pediatric orthopaedic publications over the past 10 years and to determine the proportion that are in fact age-appropriate, validated, and appropriately applied in terms of condition and population. METHODS: The Journal of Bone and Joint Surgery, The Bone and Joint Journal, Journal of Pediatric Orthopaedics A and B, and Journal of Children's Orthopaedics were systematically searched for studies including children aged 18 and below, over a 10-year period from January 2005 to December 2014...
October 8, 2018: Journal of Pediatric Orthopedics
Ryan J Urchek, Melanie A Morscher, Richard P Steiner, Mark J Adamczyk
INTRODUCTION: Pediatric supracondylar humerus fractures are associated with a high incidence of nerve injury. Therefore, it is imperative that documentation be complete and accurate. This investigation compares orthopaedic resident history and physical (H&P) documentation of pediatric supracondylar fractures for completeness and accuracy with and without the use of an electronic medical record template. METHODS: The electronic medical record H&P documentation of 119 supracondylar humerus fractures surgically treated at a single pediatric institution was retrospectively reviewed...
October 2, 2018: Journal of the American Academy of Orthopaedic Surgeons
Derek T Nhan, Jonathan G Schoenecker, A Noelle Larson, Paul D Sponseller
BACKGROUND: The Pediatric Orthopaedic Society of North America (POSNA) funds grants to improve pediatric musculoskeletal care and maximize new knowledge through publications, presentations, and further funding. We assessed the productivity of POSNA grants by number and rate of grant-specific publications, citations, and extramural funding; determined whether project type or completion status was associated with extramural funding; and compared the success of POSNA-funded versus all other podium presentations by publication rate and POSNA awards...
September 26, 2018: Journal of Pediatric Orthopedics
Anne G Copay, Blake Eyberg, Andrew S Chung, Kenneth S Zurcher, Norman Chutkan, Mark J Spangehl
BACKGROUND: The minimum clinically important difference (MCID) attempts to define the patient's experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of the MCID calculation, so as to help practitioners to understand and utilize the MCID and to guide future efforts to calculate the MCID...
September 2018: JBJS Reviews
Anne G Copay, Andrew S Chung, Blake Eyberg, Neil Olmscheid, Norman Chutkan, Mark J Spangehl
BACKGROUND: The minimum clinically important difference (MCID) attempts to define the patient's experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of MCID calculation. Subsequently, we hope that the information presented here will help practitioners to better understand the MCID and to serve as a guide for future efforts to calculate the MCID...
September 2018: JBJS Reviews
Sean T Campbell, John P Kleimeyer, Jeffrey L Young, Michael J Gardner, Kirkham B Wood, Julius A Bishop
OBJECTIVE: We asked the following questions: 1. Does the use of an structured review instrument (SRI) at journal club increase presentation quality, as measured objectively by a standardized evaluation rubric? 2. Does SRI use increase the time required to prepare for journal club? 3. Does SRI use positively impact presenter perceptions about confidence while presenting, satisfaction, and journal club effectiveness, as measured by postparticipation surveys? DESIGN: A prospective study was designed in which a grading rubric was developed to evaluate journal club presentations...
August 7, 2018: Journal of Surgical Education
Laura W Lewallen, Amy L McIntosh, S Andrew Sems
The purpose of this study was to determine whether pelvic fracture pattern is associated with transfusion requirements or concomitant injuries in pediatric patients. This was a single-institution, retrospective review from 1970 to 2000. Pelvic ring injuries were classified using the Orthopaedic Trauma Association system. Injury Severity Scores were assigned. Ninety patients were included in this study. There were 27 A-type (30.0%), 51 B-type (56.7%), and 12 C-type (13.3%) injuries. Mean Injury Severity Scores were 8...
September 1, 2018: Orthopedics
Lauren C Leffler, Stephanie L Tanner, Michael L Beckish
While long leg casts have been historically recommended for immobilization of toddler's fractures, short leg casts are often used by treating physicians. Others question whether any immobilization is necessary because of the internal stability provided by the thickened periosteum of pediatric bones. The purpose of this study is to review the results of toddler's fractures treated with long leg casts, short leg casts, or without immobilization. Eighty-five patients were included in a retrospective review of nondisplaced spiral or oblique tibial shaft fractures in children under 6 years old from 2007 to 2012...
December 0: Journal of Surgical Orthopaedic Advances
Kevin J Little, Jenna Godfrey, Roger Cornwall, Preston Carr, Kevin Dolan, Julie Balch Samora
BACKGROUND: Multiple randomized trials have showed equivalent outcomes and improved patient/family satisfaction using a removable brace to treat pediatric distal radius buckle fractures (DRBF). We tested the hypothesis that we could use quality improvement (QI) methodology to increase the proportion of patients with DRBF treated with removable braces at 2 tertiary care orthopaedic clinics from a baseline of 34.8% to 80%. METHODS: Clinic billing records were reviewed monthly to determine treatment (brace vs...
August 4, 2018: Journal of Pediatric Orthopedics
Daniel J Miller, Patrick J Cahill, Joseph A Janicki, Lindsay P Stephenson, Paul D Choi
BACKGROUND: Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care. METHODS: We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers. RESULTS: A total of 36 papers were selected for review based upon new findings...
November 2018: Journal of Pediatric Orthopedics
Kishore Mulpuri, Emily K Schaeffer, James Sanders, Ira Zaltz, Mininder S Kocher
BACKGROUND: The evidence-based approach to guide clinical practice has gained great importance in the medical field. High-quality evidence is of paramount importance to inform clinical decision-making and optimize patient outcomes. The generation of high-quality evidence relies on sound methodology and study design to facilitate appropriate interpretation and subsequent application of the clinical findings. The purpose of this review is to objectively critique the methodological design and clinical findings of 2 pediatric orthopaedic studies on children with cerebral palsy (CP) to assess their potential to impact clinical practice...
October 2018: Journal of Pediatric Orthopedics
Sariah Khormaee, Judy Choe, Joseph J Ruzbarsky, Kunal N Agarwal, John S Blanco, Shevaun M Doyle, Emily R Dodwell
BACKGROUND: The randomized controlled trial (RCT) is the gold standard study design allowing critical comparison of clinical outcomes while minimizing bias. Traditionally clinical trials are evaluated through statistical significance, expressed by P-values and confidence intervals. However, until recently, the robustness of a study's conclusions has been given little attention. A new metric, the fragility index, quantifies the number of patients theoretically required to switch outcomes in order to reverse the study conclusions...
September 2018: Journal of Pediatric Orthopedics
Kathleen D Rickert, Pooya Hosseinzadeh, Eric W Edmonds
BACKGROUND: Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity. METHODS: An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures...
September 2018: Journal of Pediatric Orthopedics
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