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Moore HG, Patibandla SD, McClung AM, Grauer JN, Sucato DJ, Wise CA, Johnson ME, Rathjen KE, McIntosh AL, Ramo BA, Brooks JT. Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions? J Pediatr Orthop 2023; 43:615-619. [PMID: 37694695 DOI: 10.1097/bpo.0000000000002504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS). METHODS A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using the International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ 2 tests and continuous variables were compared using independent t tests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set at P -value <0.05. RESULTS A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) ( P <0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively ( P =0.223). CONCLUSION Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Makarov MR, Polk JL, Shivers CR, Jo CH, Rathjen KE, Birch JG. Clinical and Radiographic Assessment of Adult Function After Blount Disease in Childhood: An Exercise in Futility. J Pediatr Orthop 2023; 43:e757-e760. [PMID: 37493033 DOI: 10.1097/bpo.0000000000002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Few studies evaluate long-term function of patients with Blount disease. We sought to document patient radiographic and functional status 20 to 30 years after sugical treatment for infantile or adolescent Blount disease. METHODS We reviewed the medical records and radiographs of patients operated at our institution for Blount disease between 1985 and 1995. Over a 4-year period, we recruited subjects for an IRB-approved call-back study. RESULTS One hundred five patients were eligible for the call-back study. Thirty-one (30%) had a criminal record, 18 of sufficient gravity to preclude invitation to return. Of the remaining 87, 40 (46%) could not be contacted. Of 47 with valid contact information, 10 (21%) were reported as deceased (although this could not be objectively confirmed), 20 (43%) did not respond or failed to show for assessment, and 1 (2%) declined to participate. 16 subjects returned at average age 36, 22 to 31 years post-index surgery. Body mass index (BMI) averaged 45.8 (range 23.9 to 67.6). Physical Score correlated most strongly and inversely with BMI ( P <0.01). Satisfaction with life correlated strongly and inversely with mechanical axis deviation ( P =0.02) and radiographic osteoarthritis of the knee ( P =0.02), but not BMI. There also was no correlation between severity of radiographic osteoarthritis and mechanical axis deviation ( P =0.46) or BMI ( P =0.52). CONCLUSIONS The small fraction of patients returning for evalutation minimize clinical conclusions that can be drawn from this study, despite an intensive 4-year effort to conduct it. Management of obesity and other socioeconomic characteristics are likely the most important aspects of treatment of patients with Blount disease. Our primary conclusion is that meaningful long-term functional studies of pediatric orthopaedic conditions will not be answered by retrospective call-back studies, and must be conducted within prospective registries and regular longitudinal follow-up. LEVEL OF EVIDENCE III-Case-controlled study.
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Riepen D, Lachmann EE, Wahlig B, Thornberg DC, Rathjen KE. Spinal Fusion in Patients With Classic Amyoplasia and General Arthrogryposis. J Pediatr Orthop 2023; 43:e751-e756. [PMID: 37503867 DOI: 10.1097/bpo.0000000000002483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Arthrogryposis multiplex congenita is a group of conditions characterized by joint contractures affecting 2 or more joints. This study describes results of spinal fusion in patients with classic amyoplasia and general arthrogryposis. METHODS IRB approved retrospective review of patients with a diagnosis of classic amyoplasia and general arthrogryposis who had a primary definitive posterior spinal fusion between 1990 and 2017 at a single pediatric institution. Patients with distal and syndromic arthrogryposis were excluded as well as patients treated with growth-sparing spinal instrumentation. The Modified Clavien-Dindo-sink (MCDS) classification system was used to describe postoperative complications. RESULTS Over the 28-year period, 342 patients were diagnosed with amyoplasia and general arthrogryposis. Among the 342 patients, 60 (18%) had scoliosis, and 22 (6% of the cohort and 37% of those with scoliosis) were treated surgically. Six patients had growth-sparing techniques, initial fusion elsewhere, or ˂1 year of follow-up, leaving 15 patients. Of the 15, 9 (60%) had a posterior spinal fusion (PSF) and 6 (40%) had a combined anterior spinal fusion (ASF)/PSF. The ASF/PSF group was significantly younger at surgery, had a greater American Society of Anesthesiologists status, longer surgery duration, and lower implant density. The average preoperative major coronal deformity in ASF/PSF patients (108 degrees) was greater than patients treated with PSF alone (88 deg). There were 11 complications in 7 patients, with the most common being deep infection requiring reoperation (5/11, 45%). There was 1 instance (1/11, 9%) of each: prolonged intensive care unit admission (>72 h), superficial wound dehiscence, symptomatic implants requiring removal/revision, coronal plane progression requiring extension of fusion, recurrent pneumothorax requiring return to OR, and pseudoarthrosis leading to implant failure (without revision). Complications occurred in 1/9 (11%) PSF-only patients and 6/6 (100%) ASF/PSF patients with all 6 ASF/PSF patients requiring at least 1 reoperation. The average coronal correction was 48% in the PSF-only group and 28% in the ASF/PSF group. CONCLUSION Complication rates after spinal fusion for scoliosis in arthrogryposis multiplex congenita patients are high, especially in patients undergoing ASF/PSF, deep infection is common, and major coronal plane curve correction is modest. LEVEL OF EVIDENCE II Retrospective Study.
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Affiliation(s)
| | | | - Brian Wahlig
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN
| | | | - Karl E Rathjen
- UT Southwestern Medical Center
- Texas Scottish Rite Hospital for Children, Dallas, TX
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Hubbard EW, Rathjen KE, Elliott M, Wimberly RL, Riccio AI. Predictors of appointment adherence following operative treatment of pediatric supracondylar humerus fractures: which patients are not following up? J Pediatr Orthop B 2022; 31:25-30. [PMID: 33136798 DOI: 10.1097/bpb.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aims to identify characteristics associated with poor appointment adherence after surgical stabilization of supracondylar humerus fractures (SCHFX) in children. A retrospective review of 560 consecutive, surgically managed patients with SCHFX from 2010 to 2015 was performed. One missed follow-up appointment was classified as 'low adherence', whereas missing two or more appointments was classified as 'very low adherence'. Demographics, insurance status, estimated family income and distance from clinic were analyzed to identify differences in variables between adherent and low-adherent groups. Of 560, 121 (21.8%) missed one follow-up visit and 39/560 (7.1%) missed more than two visits. Age, gender, distance traveled, insurance status and primary language were nonpredictive. Estimated income <$50 000 was associated with a >200% increase in low adherence vs patients with estimated income >$50 000 (9.3 vs 3.8%; P = 0.012). African American patients had significantly lower adherence vs patients of other races (47.5 vs 19.6%; P < 0.0001). Ethnicity remained the only significant factor correlated to adherence after multivariate analysis. African Americans were three times more likely demonstrate low adherence (P = 0.0014). Ethnicity and estimated income <$50 000 were predictors of missing two or more visits. African American patients were four times more likely to miss two or more visits [odds ratio (OR), 4.17; P = 0.0026] than others; estimated income <$50 000 was associated with a two-fold increase in missing two or more visits (OR, 2.33; P = 0.035). By identifying at-risk patient populations, healthcare systems can adopt strategies to remove barriers of accessing follow-up care.
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Affiliation(s)
- Elizabeth W Hubbard
- Department of Orthopaedic Surgery, Duke University Medical Center, Lenox Baker Children's Hospital, Durham, North Carolina
| | - Karl E Rathjen
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas
| | - Marilyn Elliott
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert L Wimberly
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas
| | - Anthony I Riccio
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas
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Floccari LV, Poppino KF, Mundluru SN, McIntosh AL, Rathjen KE, Sucato DJ. Two AIS spine surgeries on the same day by the same surgeon: is performance and outcome the same for the second patient? Spine Deform 2020; 8:977-981. [PMID: 32447574 DOI: 10.1007/s43390-020-00136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Retrospective case-controlled study. OBJECTIVES To analyze the overall performance and outcome of two-a-day surgery days for adolescent idiopathic scoliosis (AIS). As a method to improve efficiency and operating room utilization, some surgeons are now performing two surgeries for AIS in a single day. METHODS A prospectively collected series of AIS patients who underwent posterior spinal fusion on the same day as a second AIS patient by the same surgeon and surgical team were retrospectively reviewed. Patients who underwent same-day surgery (SD) were grouped according to whether they were the first (SD1) or second (SD2) case of the day and were matched (M1 and M2) by surgeon, curve magnitude, Lenke classification, and fusion levels. Comparisons were made: SD1 vs. SD2, SD1 vs. M1, and SD2 vs. M2. RESULTS There were 56 patients, with no differences between groups in age, gender, BMI, or curve magnitude (66° vs. 62° vs. 65° vs. 63°). Surgical time was shorter for the SD1 group (17.2 min/level) compared to M1 (20.5 min/level) for a 15% operative time reduction of 44 min (p = 0.008). There were no differences between the groups in curve correction (65.8% vs. 62.8% vs. 66.1% vs. 58.5%), estimated blood loss (EBL), length of stay, or complication rate. One SD2 patient had a malpositioned screw that required revision. There were no other complications. CONCLUSIONS When performing two AIS surgeries on the same day, surgical time was reduced by 44 min, or 15%, on the first case compared to a matched control. This may be a reflection of the team moving along more efficiently, given the full operative day scheduled. The performance measures of curve correction, EBL, complications, and length of stay did not decline in this new model, and no increased incidence of complications was seen.
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Affiliation(s)
- Lorena V Floccari
- Akron Children's Hospital, Akron, OH, USA.,Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA
| | - Kiley F Poppino
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA
| | - Surya N Mundluru
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA.,University of Texas Houston McGovern School of Medicine, Houston, TX, USA
| | - Amy L McIntosh
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA
| | - Karl E Rathjen
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA
| | - Daniel J Sucato
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA.
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Herman MJ, Brown KO, Sponseller PD, Phillips JH, Petrucelli PM, Parikh DJ, Mody KS, Leonard JC, Moront M, Brockmeyer DL, Anderson RCE, Alder AC, Anderson JT, Bernstein RM, Booth TN, Braga BP, Cahill PJ, Joglar JM, Martus JE, Nesiama JAO, Pahys JM, Rathjen KE, Riccio AI, Schulz JF, Stans AA, Shah MI, Warner WC, Yaszay B. Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group. J Bone Joint Surg Am 2019; 101:e1. [PMID: 30601421 DOI: 10.2106/jbjs.18.00217] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Martin J Herman
- Orthopedic Center for Children, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Kristin O Brown
- Orthopedic Center for Children, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Paul D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | | | - Philip M Petrucelli
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Darshan J Parikh
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Kush S Mody
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew Moront
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Douglas L Brockmeyer
- Department of Neurological Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Richard C E Anderson
- Department of Neurosurgery, Columbia University, Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY
| | - Adam C Alder
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - John T Anderson
- Department of Orthopedic Surgery, Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Robert M Bernstein
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Timothy N Booth
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Bruno P Braga
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Patrick J Cahill
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeanne M Joglar
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Jeffrey E Martus
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jo-Ann O Nesiama
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Joshua M Pahys
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Karl E Rathjen
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Anthony I Riccio
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Jacob F Schulz
- Department of Orthopedic Surgery, The Children's Hospital at Montefiore, Bronx, New York
| | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Manish I Shah
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - William C Warner
- Department of Orthopedic Surgery, University of Tennessee - Campbell Clinic and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital and University of California-San Diego Medical Center, San Diego, California
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Abstract
BACKGROUND Lateral tibial hemiepiphysiodesis is an accepted surgical treatment for skeletally immature patients with adolescent tibia vara. However, the results of this procedure are unpredictable. This study was conducted to identify the risk factors associated with failure of hemiepiphysiodesis. METHODS We studied patients with adolescent tibia vara who were at least ten years of age, had open physes, had been treated with a lateral hemiepiphysiodesis, and had been followed for at least two years. The mechanical axis deviation, medial proximal tibial angle, and lateral distal femoral angle were measured on radiographs preoperatively, at six months postoperatively, and at the time of final follow-up. Failure was defined as a residual varus deformity requiring osteotomy or a mechanical axis deviation exceeding 40 mm (moderate or severe varus) at the time of final follow-up. RESULTS Forty-nine patients (forty-six male) with a total of sixty-four involved extremities met the inclusion criteria. The average age was 13.4 years, the average body mass index was 40.7 kg/m(2), and the average duration of follow-up was 3.3 years. The lateral hemiepiphysiodesis was unsuccessful in 66% of the patients. In a multivariate Cox proportional hazards regression analysis, the variables associated with a higher risk of failure included an age of fourteen years or more (hazard ratio = 3.9, p = 0.0009) and a body mass index of > or =45 kg/m(2) (hazard ratio = 2.8, p = 0.01). Greater deformity at baseline as indicated by a smaller medial proximal tibial angle was also found to be a significant factor in the multivariate analysis (p = 0.03). CONCLUSIONS Lateral hemiepiphysiodesis may be a valuable treatment option for non-morbidly obese patients with less severe adolescent tibia vara, but it is likely to fail in older adolescents with a high body mass index and greater deformity.
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Affiliation(s)
- Amy L McIntosh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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8
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Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CE, Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am 2008; 90:2313-21. [PMID: 18978399 DOI: 10.2106/jbjs.g.01621] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the treatment of idiopathic clubfeet, the Ponseti method and the French functional method have been successful in reducing the need for surgery. The purpose of this prospective study was to compare the results of these two methods at one institution. METHODS Patients under three months of age with previously untreated idiopathic clubfeet were enrolled. All feet were rated for severity prior to treatment. After both techniques had been described to them, the parents selected the treatment method. Outcomes at a minimum of two years were classified as good (a plantigrade foot with, or without, a heel-cord tenotomy), fair (a plantigrade foot that had or needed to have limited posterior release or tibialis anterior transfer), or poor (a need for a complete posteromedial surgical release). Two hundred and sixty-seven feet in 176 patients treated with the Ponseti method and 119 feet in eighty patients treated with the French functional method met the inclusion criteria. RESULTS The patients were followed for an average of 4.3 years. Both groups had similar severity scores before treatment. The initial correction rates were 94.4% for the Ponseti method and 95% for the French functional method. Relapses occurred in 37% of the feet that had initially been successfully treated with the Ponseti method. One-third of the relapsed feet were salvaged with further nonoperative treatment, but the remainder required operative intervention. Relapses occurred in 29% of the feet that had been successfully treated with the French functional method, and all required operative intervention. At the time of the latest follow-up, the outcomes for the feet treated with the Ponseti method were good for 72%, fair for 12%, and poor for 16%. The outcomes for the feet treated with the French functional method were good for 67%, fair for 17%, and poor for 16%. CONCLUSIONS Nonoperative correction of an idiopathic clubfoot deformity can be maintained over time in most patients. Although there was a trend showing improved results with use of the Ponseti method, the difference was not significant. In our experience, parents select the Ponseti method twice as often as they select the French functional method.
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Affiliation(s)
- B Stephens Richards
- Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
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9
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Abstract
To assess the role of stainless steel flexible intramedullary fixation in unstable pediatric femur fractures, we compared a group of 41 stable (transverse or oblique) fractures with a group of 40 unstable (spiral and/or comminuted) fractures treated with stainless steel (Ender) nails placed through a single lateral insertion. The fractures were followed up until clinical and radiographic union was evident with an average follow-up period of 13 months. All fractures were healed at an average of 1.4 months. No infections or refractures occurred. Although minor radiographic angular deformities and shortening were present in both groups, no patient had a clinically detectable angular deformity. Two patients with stable fracture patterns had 10 to 20 degrees of asymmetry in foot progression angles, and 1 patient with an unstable fracture pattern (Winquist grade IV comminution) had a 3-cm limb length difference at final follow-up. Stainless steel flexible intramedullary fixation is effective for unstable pediatric femur fractures if cortical abutment is present.
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Affiliation(s)
- Karl E Rathjen
- Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
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10
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Zhang D, Herring JA, Swaney SS, McClendon TB, Gao X, Browne RH, Rathjen KE, Johnston CE, Harris S, Cain NM, Wise CA. Mutations responsible for Larsen syndrome cluster in the FLNB protein. J Med Genet 2006; 43:e24. [PMID: 16648377 PMCID: PMC2564529 DOI: 10.1136/jmg.2005.038695] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 11/02/2005] [Accepted: 11/04/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND A gene for Larsen syndrome was recently described, and mutations were reported in five cases. OBJECTIVE To test whether mutations in this gene, FLNB, could explain the disease in our independent collection of sporadic and dominant Larsen syndrome cases; and to test whether mutations occurred in a non-random pattern. RESULTS Missense mutations were found in each of five cases. Four of the five were new; one was reported in a sporadic case in the original Larsen syndrome study of five cases. All mutations from the two studies were compiled. Clustered mutations were observed within three filamin B protein domains: the calponin homology 2 domain, repeat 14, and repeat 15. This suggested that as few as five (of the total of 46) coding exons of FLNB could be screened to detect Larsen syndrome mutations. Four of these exons were screened in a sixth (sporadic) case and a previously reported G1691S substitution mutation detected. CONCLUSIONS Mutations in FLNB may be responsible for all cases of Larsen syndrome. They appear to occur in specific functional domains of the filamin B protein. This should simplify diagnostic screening of the FLNB gene. Analyses in larger patient series are warranted to quantify this. The study confirmed the extreme variability in clinical presentation and the presence of unaffected carriers. A molecular screen would be valuable for diagnosis and genetic counselling.
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Affiliation(s)
- D Zhang
- Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA
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Abstract
Bicycle accidents have been documented as one of the most common mechanisms of accidents in children. Several reports describe intra-abdominal injury secondary to bicycle handlebars. Reported injuries include liver and spleen trauma, bowel perforation, and pancreatitis. However, there are few reports of penetrating handlebar injuries. We report a case of a penetrating bicycle handlebar producing an open iliac wing fracture. A number of reports have stressed the dichotomy between the benign external appearance and the potential severity of the intra-abdominal injury after a bicycle handlebar injury. Thus, a high index of suspicion must be maintained when evaluating a child after such an injury. All patients with a significant mechanism should have a thorough and complete evaluation, including radiographs. As with all traumatic injuries, a multidisciplinary approach is often required to efficiently manage these injuries. Although uncommon, open pelvic injuries in children do occur. The principles of management are the same in children as they are in adults. All children with open pelvic fractures require emergent operative debridement and, if indicated, stabilization. Special attention should be given to ensure that the gastrointestinal and genitourinary tracts do not communicate with the fracture. With attention to these fundamental principles, severe pelvic injuries in children can be managed with few long-term sequelae.
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Affiliation(s)
- Sumant G Krishnan
- W.B. Carrell Memorial Clinic and the Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
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12
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Sanchez AA, Rathjen KE, Mubarak SJ. Subtalar staple arthroereisis for planovalgus foot deformity in children with neuromuscular disease. J Pediatr Orthop 1999; 19:34-8. [PMID: 9890283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-two patients (34 feet) with severe, flexible, planovalgus feet due to neuromuscular conditions were treated with subtalar staple arthroereisis. Patients were followed up for an average of 5 years (range, 2.5-9 years). Of the 34 feet, 18 did not require revision surgery; however, the remaining 16 feet required revision at an average of 39 months after surgery (range, 9-63 months). Revision procedures consisted of hardware removal in four cases, repeated subtalar stapling in one, triple arthrodesis in two, and calcaneal with or without cuboid and cuneiform osteotomy in nine feet. The long-term results of subtalar staple arthroereisis were unpredictable, and although it was effective in approximately half of our patients, we no longer recommend this procedure for the correction of the neuromuscular planovalgus foot deformity.
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Affiliation(s)
- A A Sanchez
- Children's Hospital San Diego, California 92123, USA
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Rathjen KE, Mubarak SJ. Calcaneal-cuboid-cuneiform osteotomy for the correction of valgus foot deformities in children. J Pediatr Orthop 1998; 18:775-82. [PMID: 9821135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We performed combination calcaneal-cuboid-cuneiform osteotomies in 18 patients (26 feet) with severe valgus foot deformity. The operation consists of a sliding calcaneal osteotomy, an opening-wedge cuboid osteotomy, and a pronation, plantar flexion closing-wedge osteotomy of the medial cuneiform in addition to appropriate soft-tissue releases. The preoperative goals of restoring the axis of the foot parallel to the axis of progression and relieving pain, as well as shoe, brace, and skin problems, were met in 23 of the 24 feet available for review at an average of 18 months after surgery. This procedure has the advantage of localized correction of deformity without the problems associated with arthrodesis.
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Affiliation(s)
- K E Rathjen
- Children's Hospital, San Diego, CA 92123, USA
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