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Abstract
PURPOSE Blount disease is most common among obese Black children. The reason for Blount's racial predisposition is unclear. Given that obesity is a risk factor for Blount disease and the known associations between race, obesity, and socioeconomic status in the United States, we hypothesized that socioeconomic status and severity of obesity differ between Black and non-Black children with late-onset Blount disease. We additionally examined differences in treatment types between Black and non-Black children. METHODS One hundred twenty-five patients from two institutions were included. Age at presentation, age of onset, body mass index, race, sex, and treatment type were recorded. These variables were compared between Black and non-Black children. Insurance type and estimated household income were used as markers of socioeconomic status. RESULTS Of the 125 patients with late-onset Blount disease, body mass index percentiles were higher for Black patients (96th ± 12th percentile) than non-Black patients (89th ± 22nd percentile) (p = 0.04). Black patients also had lower estimated incomes (US$48,000 ± US$23,000 vs US$62,000 ± US$30,000) (p = 0.01) and much higher rates of Medicaid enrollment (69% vs 24%) (p < 0.01) than did non-Black patients. Regarding treatment types, osteotomy was more common among Black patients (60%) than non-Black patients (38%) (p = 0.033). CONCLUSION The race-related associations we found between obesity and socioeconomic status suggest that non-genetic factors may contribute to observed racial differences in the prevalence of Blount disease. LEVEL OF EVIDENCE level III.
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Affiliation(s)
- Walter Klyce
- Department of Orthopaedic Surgery, Case
Western Reserve University, Cleveland, OH, USA,Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - Daniel Badin
- Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - Jigar S Gandhi
- Department of Orthopaedic Surgery,
Cooper University Hospital, Camden, NJ, USA,Division of Orthopaedics, Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Jay Lee
- Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - B David Horn
- Division of Orthopaedics, Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Honcharuk
- Department of Orthopaedic Surgery, The
Johns Hopkins University, Baltimore, MD, USA,Erin Honcharuk, Department of Orthopaedic
Surgery, The Johns Hopkins University, 1800 Orleans Street, Bloomberg 7360,
Baltimore, MD 21287, USA.
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2
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Du JY, Dumaine AM, Klyce W, Miyanji F, Sponseller PD, Glotzbecker MP. Use of Vancomycin Powder in Spinal Deformity Surgery in Cerebral Palsy Patients is Associated With Proteus Surgical Site Infections. J Pediatr Orthop 2022; 42:280-284. [PMID: 35153286 DOI: 10.1097/bpo.0000000000002079] [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: 02/07/2023]
Abstract
PURPOSE Surgical site infection (SSI) rates in pediatric spinal deformity surgery for cerebral palsy (CP) patients are higher than that in idiopathic scoliosis. The use of vancomycin powder is associated with decreased risk of SSI in neuromuscular patients. Prior studies in adult and pediatric early-onset scoliosis patients have shown that vancomycin powder alters microbacterial profile in patients that develop SSI. However, the effects of topical vancomycin powder on microbiology in spinal deformity surgery for CP patients has not been studied. METHODS An international multicenter database of CP neuromuscular scoliosis patients was used in this retrospective cohort study. All patients that underwent posterior spinal instrumented fusion for CP neuromuscular scoliosis from 2008 to 2019 were queried, and 50 cases complicated by postoperative SSI were identified. Intraoperative antibiotic details were documented in 49 cases (98.0%). Microbiology details were documented in 45 cases (91.8%). Microbiology for patients that received topical vancomycin powder were compared with patients that did not. A multivariate regression model was used to control for potential confounders. RESULTS There were 45 patients included in this study. There were 27 males (60.0%) and 18 females (40.0%). Mean age at surgery was 14.8±2.4 years. There were 24 patients that received topical vancomycin powder (53.3%). The mean time from index surgery to SSI was 4.3±11.3 months.On univariate analysis of microbiology cultures by vancomycin powder cohort, there were no significant differences in culture types. Proteus spp. trended on significance with association with vancomycin powder use (P=0.078). When controlling for potential confounders on multivariate analysis, intraoperative topical vancomycin powder was associated with increased risk for proteus infection (adjusted odds ratio: 262.900, 95% confidence interval: 1.806-38,267.121, P=0.028). DISCUSSION In CP patients undergoing pediatric spinal deformity surgery, the use of vancomycin powder was independently associated with increased risk for proteus infections. Further study into antibiotic regimens for spinal deformity surgery in the CP population should be performed. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Jerry Y Du
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Anne M Dumaine
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Walter Klyce
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Firoz Miyanji
- Department of Orthopaedics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul D Sponseller
- Division of Orthopaedics, Johns Hopkins Children's Center, Baltimore, MD
| | - Michael P Glotzbecker
- Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
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Rogers DL, Klyce W, Kajstura TJ, Lee RJ. Association of Body Mass Index With Severity and Lesion Location in Adolescents With Osteochondritis Dissecans of the Knee. Orthop J Sports Med 2022; 9:23259671211045382. [PMID: 35146035 PMCID: PMC8822100 DOI: 10.1177/23259671211045382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The association between body mass index (BMI) and severity of osteochondritis dissecans (OCD) of the knee at presentation is poorly understood. Hypothesis: We hypothesized that adolescents in higher BMI percentiles for age and sex would have OCD lesions that were more severe at their initial presentation and located more posteriorly on the condyle as compared with adolescents in lower BMI percentiles. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients aged 10 to 18 years who were treated for knee OCD at a tertiary care hospital from 2006 to 2017. Patients with noncondylar OCD or missing BMI data within 3 months of presentation were excluded. Patients were stratified per the Centers for Disease Control and Prevention guidelines as underweight, normal weight, overweight, or obese, and the groups were compared according to age, side of lesion, 4 markers of lesion severity (cystic changes, loose fragments, subchondral fluid, and subchondral edema), and surgical treatment. Lesion angle was measured in reference to a line parallel to the femoral axis drawn through the center of a best-fit circle covering the distal condyle. Data were analyzed using chi-square tests, relative risk, Student t tests, analysis of variance, and linear regression of cumulative running percentages. Bonferroni correction was performed when applicable. Results: A total of 77 patients met our inclusion criteria (mean age, 14.2 years; range, 10.1-18.8): 2 were underweight, 50 had normal BMI, 13 were overweight, and 12 were obese. We found correlations between BMI percentile and surgical treatment (R2 = .732), subchondral fluid (R2 = .716), subchondral edema (R2 = .63), loose fragments (R2 = .835), and the presence of at least 1 marker of lesion severity (R2 = .857) (P < .0001 for all). No correlation was observed for cystic changes (R2 = .026). There were significant associations between BMI ≥80th percentile and subchondral edema (risk ratio, 2.5; 95% CI, 1.3-4.8), medial condylar lesions (risk ratio, 1.3; 95% CI, 1.01-1.7), and lesions more anterior on the condyle (P < .05). Conclusion: Higher BMI in adolescents was strongly correlated with multiple markers of severity of knee OCD at initial presentation as well as with more anterior lesions.
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Affiliation(s)
- Davis L. Rogers
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Walter Klyce
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tymoteusz J. Kajstura
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R. Jay Lee
- Pediatric Division, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- R. Jay Lee, MD, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA ()
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4
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Nhan DT, Belkoff SM, Singh P, Sullivan BT, Klyce W, Lee RJ. Using the Remnant Anterior Cruciate Ligament to Improve Knee Stability: Biomechanical Analysis Using a Cadaveric Model. Orthop J Sports Med 2021; 9:2325967121996487. [PMID: 33889647 PMCID: PMC8033398 DOI: 10.1177/2325967121996487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Injured anterior cruciate ligament (ACL) tissue retains proprioceptive nerve
fibers, vascularity, and biomechanical properties. For these reasons,
remnant ACL tissue is often preserved during the treatment of ACL
injuries. Purpose: To assess through a cadaveric model whether reorienting and retensioning the
residual ACL via an osteotomy improves knee stability after partial ACL
tear, with substantial remnant tissue and intact femoral and tibial
attachments. Study Design: Controlled laboratory study. Methods: In 8 adult cadaveric knees, we measured anterior tibial translation and
rotational laxity at 30° and 90° of flexion with the ACL in its native state
and in 3 conditions: partial tear, retensioned, and ACL-deficient. The
partial-tear state consisted of a sectioned anteromedial ACL bundle. Results: In the native state, the translation was 10 ± 2.7 mm (mean ± SD) at 30° of
flexion and 8.4 ± 3.6 mm at 90° of flexion. Anterior translation of the
knees in the partial-tear state (14 ± 2.7 mm at 30° and 12 ± 2.7 mm at 90°)
was significantly greater than baseline (P < .001 for
both). Translation in the ACL-retensioned state (9.2 ± 1.7 mm at 30° and 7.2
± 2.1 mm at 90°) was significantly less than in the ACL-deficient state
(P < .001 for both), and translation was not
significantly different from that of the intact state. For ACL-deficient
knees, translation (20 ± 4.3 mm at 30° and 16 ± 4.4 mm at 90°) was
significantly greater than all other states (P < .001
for all). Although rotational testing demonstrated the least laxity at 30°
and 90° of flexion in the retensioned and intact states and the most laxity
in the ACL-deficient state, rotation was not significantly different among
any of the experimental states. Conclusion: In a cadaveric model of an incomplete ACL tear, a reorienting and
retensioning core osteotomy at the tibial insertion of the remnant ACL
improved anteroposterior translation of the knee without compromising its
rotational laxity. Clinical Relevance: The findings of this study support the concept of ACL tissue reorienting and
retensioning in the treatment of ACL laxity as an area for future
investigation.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen M Belkoff
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prerna Singh
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian T Sullivan
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Walter Klyce
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Jay Lee
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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5
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Eguia FA, Gottlich CP, Vora M, Klyce W, Hassan S, Sponseller PD, Lee RJ. Radiographic assessments of pediatric supracondylar fractures and mid-term patient-reported outcomes. Medicine (Baltimore) 2020; 99:e22543. [PMID: 33031297 PMCID: PMC7544399 DOI: 10.1097/md.0000000000022543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Radiographic parameters are commonly used to determine the need for surgical supracondylar humeral (SCH) fracture reduction and the postoperative quality of reduction. We studied whether such parameters are correlated with mid-term patient-reported outcome (PRO) scores in pediatric patients.We retrospectively reviewed data from 213 patients (104 girls) treated surgically for Gartland type-II (n = 84) or type-III (n = 129) SCH fractures from 2008-2016. Mean (± standard deviation) age at surgery was 5.1 ± 2.1 years. Mean time from initial treatment to outcome survey completion was 5.0 ± 2.1 years (range, 2.0-10 years). We evaluated preoperative radiographs for coronal/sagittal fracture displacement, presence of impaction/comminution, Gartland classification, and rotation. Patients, parents were asked via telephone to complete the QuickDASH (Quick Disability of the Arm, Shoulder, and Hand) and PROMIS (Patient-Reported Outcomes Measurement Information System) Strength Impact, Upper Extremity, and Pain Interference questionnaires. Parents were also asked whether the previously fractured arm appeared normal or abnormal. We evaluated postoperative radiographs for coronal/sagittal deformity, Baumann angle, and rotation and classified reductions as near complete/complete or incomplete. Anterior humeral line through the capitellum, Baumann angle in the 7.5th to 92.5th percentile of the sample, or rotation ratio between 0.85 and 1.15 were considered near complete/complete reductions; all others were considered incomplete. Bivariate analysis was used to determine whether radiographic parameters and arm appearance were associated with QuickDASH and PROMIS scores.Patients with Gartland type-III fractures had significantly greater disability on the QuickDASH at follow-up compared with those with Gartland type-II fractures (P < .01). It is unknown if this statistical difference translates to clinical relevance. No other preoperative or postoperative radiographic parameter was significantly associated with PRO scores. There was no association between fractured arm appearance at follow-up and PRO scores.Radiographic parameters that are used to evaluate the need for and quality of pediatric SCH fracture reduction are not significantly associated with mid-term PROMIS and QuickDASH scores.LOE: Prognostic Level III.
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Affiliation(s)
- Francisco A. Eguia
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Caleb P. Gottlich
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Molly Vora
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Walter Klyce
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Sherif Hassan
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Paul D. Sponseller
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - R. Jay Lee
- Department of Pediatric Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
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6
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Klyce W, Nhan DT, Dunham AM, El Dafrawy MH, Shannon C, LaPorte DM. The Times, They Are A-Changing: Women Entering Academic Orthopedics Today Are Choosing Nonpediatric Fellowships at a Growing Rate. J Surg Educ 2020; 77:564-571. [PMID: 31932218 DOI: 10.1016/j.jsurg.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/13/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pediatrics and hand surgery have historically been the orthopaedic subspecialties with the highest female representations. We sought to identify the gender distribution of orthopedic surgical faculty by subspecialty, geography, and educational background. We hypothesized that the proportion of women entering pediatric orthopaedics has decreased since 1980. DESIGN The Accreditation Council for Graduate Medical Education was used to generate a list of U.S. orthopedic residencies. Program websites were used to collect data regarding each faculty member's gender, residencies, fellowships, and graduation year. t tests were used to compare quantitative data and Fisher's exact tests to compare categorical data. Significance was defined as p < 0.05. SETTING Publicly available data from official websites of U.S. orthopedic residencies. PARTICIPANTS Of 153 residencies, 142 (93%) had accessible faculty lists. RESULTS Of 3596 orthopedic surgeons, 7.9% were women. Among fellowship-trained faculty, 22% of pediatric orthopedists were women compared with 7.6% of faculty in other orthopedic subspecialties (p < 0.00001). There was a significantly higher percentage of female faculty in the West (13%) than in any other U.S. census region (p < 0.001 vs. Midwest, vs. South, and vs. Northeast). A strong correlation with time was found in number of women completing fellowships other than hand or pediatrics from 1980 to 2014 (R2 = 0.95); a strong inverse correlation with time was found for pediatrics as a percentage of fellowships completed by women during the same period (R2 = 0.94). CONCLUSIONS Although pediatrics remains the most popular fellowship for female orthopedists, women who enter academic orthopedics are increasingly choosing nonpediatric subspecialties.
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Affiliation(s)
- Walter Klyce
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Derek T Nhan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Alexandra M Dunham
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Mostafa H El Dafrawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire Shannon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Dawn M LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
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Abstract
Supracondylar humerus (SCH) fractures are reported to be approximately twice as common among boys as among girls. Little is known about sex-associated differences in fracture patterns and complications. We compared the incidence of pediatric SCH fractures, injury mechanism (high-energy or low-energy), fracture subtypes, associated neurologic injuries, and treatment types by patient sex.We reviewed 1231 pediatric SCH fractures treated at 1 center from 2008 to 2017, analyzing sex distributions overall and by year and fracture subtype. We noted patient demographic characteristics, injury mechanisms, neurologic injuries, and treatments (nonoperative or operative). Binomial 2-tailed, chi-squared, and Student's t tests were used for analysis. Multiple logistic regression was performed to assess associations between sex, age, and injury mechanism. Alpha = 0.05.We found no significant difference in the distribution of girls (52%) vs boys (48%) in our sample compared with a binomial distribution (P = .11). Annual percentages of fractures occurring in girls ranged from 46% to 63%, and sex distribution did not change significantly over time. The mean (± standard deviation) age at injury was significantly younger for girls (5.5 ± 2.5 years) than for boys (6.1 ± 2.5 years) (P < .001). High-energy injury mechanism was associated with older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.06) but not male sex (OR, 1.04; 95% CI, 0.98-1.1). The overall incidence of neurologic injury was 9.5% but boys did not have greater odds of sustaining neurologic injury (OR, 1.03; 95% CI, 1.0-1.1). We found no sex-associated differences in the distribution of Gartland fracture subtypes (P = .13) or treatment type (P = .39).Compared with boys, girls sustain SCH fractures at a younger age. SCH fractures were distributed equally among girls and boys in our sample. Patient sex was not associated with fracture subtype, injury mechanism, neurologic injury, or operative treatment. These findings challenge the perception that SCH fracture is more common in boys than girls.Level III, retrospective study.
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8
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Affiliation(s)
- Walter Klyce
- W. Klyce is a fourth-year medical student, Warren Alpert Medical School of Brown University, Providence, Rhode Island; e-mail:
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9
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Tang X, Lu Y, Pang M, Nhan DT, Klyce W, Fritz J, Lee RJ. An Abbreviated Scale for the Assessment of Skeletal Bone Age Using Radiographs of the Knee. Orthopedics 2018; 41:e676-e680. [PMID: 30052264 DOI: 10.3928/01477447-20180724-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
Hand and wrist radiographs are the most common means for estimating skeletal bone age. There is no widely used scale for estimating skeletal bone age using knee radiographs. Do skeletal bone age estimates from knee-maturity scales correlate sufficiently with both chronologic age and estimates from a hand-wrist scale to potentially substitute for estimates from the latter? The authors reviewed the records of 503 patients 6 to 19 years old who had hand and knee radiographs obtained within 30 days of each other. They analyzed radiographs using the O'Connor knee scale (based on 10 maturation markers) and a new, abbreviated version of the O'Connor scale (based on 7 markers). The authors also analyzed radiographs of the hands of boys 12.5 to 16 years old and girls 10 to 16 years old using the shorthand method. Multivariate linear regression was used for analysis. Inter- and intrarater reliabilities were assessed. Skeletal bone age derived from the O'Connor and abbreviated knee scales correlated with chronologic age (adjusted R2=0.88 and 0.90, respectively). Compared with estimates from the hand-wrist scale, estimates were lower by a mean of 0.91 years for boys and 0.38 years for girls when using the O'Connor scale and 0.96 years for boys and 0.52 years for girls when using the abbreviated scale. Inter- and intrarater reliabilities were very good (κ=0.82 and 0.90, respectively) and were substantial at each bony landmark measured. Knee radiographs can be used to estimate skeletal bone age using an abbreviated knee scale. [Orthopedics. 2018; 41(5):e676-e680.].
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10
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Fritz J, Ahlawat S, Fritz B, Thawait GK, Stern SE, Raithel E, Klyce W, Lee RJ. 10‐Min 3D Turbo Spin Echo MRI of the Knee in Children: Arthroscopy‐Validated Accuracy for the Diagnosis of Internal Derangement. J Magn Reson Imaging 2018; 49:e139-e151. [DOI: 10.1002/jmri.26241] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of Medicine Baltimore Maryland USA
| | - Shivani Ahlawat
- Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of Medicine Baltimore Maryland USA
| | - Benjamin Fritz
- RadiologyBalgrist University Hospital Zurich Switzerland
- Faculty of MedicineUniversity of Zurich Zurich Switzerland
| | - Gaurav K. Thawait
- Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of Medicine Baltimore Maryland USA
| | - Steven E. Stern
- Bond Business SchoolBond University Gold Coast QLD Australia
| | | | - Walter Klyce
- Department of Orthopaedic SurgeryJohns Hopkins University School of Medicine Baltimore Maryland USA
| | - Rushyuan J. Lee
- Department of Orthopaedic SurgeryJohns Hopkins University School of Medicine Baltimore Maryland USA
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11
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Abstract
Background Racquet sports have increased in popularity over the past decade. Although research is available regarding the epidemiological characteristics of tennis injuries, little is known about the frequency and characteristics of injuries in other racquet sports. Hypothesis Given the increase in all racquet sport participation in the United States (US), it is hypothesized that injuries have accordingly become more frequent. Study Design Descriptive epidemiology study. Methods Using the National Electronic Injury Surveillance System database, we reviewed the numbers of badminton and squash/racquetball injuries presenting to a representative sample of US emergency departments (EDs). We used weighted estimates to extrapolate the data to the US population. Incidence estimates were compared with national participation data and stratified. Results A total of 4330 injuries were reported, representing an estimated 173,000 injuries presenting to US EDs from 1997 through 2016. Despite the increase in the number of players from 2006 through 2016, the annual injury rate for squash/racquetball declined significantly, including the rates for each body region assessed. No similar trend was found for badminton injuries. Within our extrapolated ED cohort, the lower extremities were the most common body region injured (37%). Strains/sprains were the most common injury type in the trunk (73%), lower extremities (65%), and upper extremities (32%), whereas lacerations were most common in the head/neck (49%). In badminton, the youngest players (age range, 5-18 years) sustained twice as many fractures (relative risk [RR], 1.96; 95% CI, 1.14-3.38) and almost 3 times as many lacerations as patients in any other age group. Similarly, the youngest squash/racquetball players were at highest risk for lacerations (RR, 1.45; 95% CI, 1.22-1.73) and head and neck injuries (RR, 1.52; 95% CI, 1.26-1.83). Conclusion Although declines in rates of squash/racquetball injuries were observed, the increasing popularity of badminton, squash, and racquetball necessitates further preventive measures to improve player safety, with an emphasis on the youngest players.
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Affiliation(s)
- Derek T Nhan
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Walter Klyce
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - R Jay Lee
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
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12
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Affiliation(s)
- Walter Klyce
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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14
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Yee C, Himmelwright RS, Klyce W, Sankhla T, Bayliss GP. Putting the "No" in Non Nocere: Surgery, Anesthesia, and a Patient's Right to Withdraw Consent. R I Med J (2013) 2017; 100:38-40. [PMID: 28968621] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
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Affiliation(s)
- Claudine Yee
- Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Walter Klyce
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Tina Sankhla
- Warren Alpert Medical School of Brown University, Providence, RI
| | - George P Bayliss
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
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15
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Klyce W, Feller E. Junk science for sale Sham journals proliferating online. R I Med J (2013) 2017; 100:27-29. [PMID: 28686237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A new danger threatens the integrity of scholarly publishing: predatory journals. Internet-only, "open-access" publishing is a valid way for researchers to reach the public without a paywall separating them. But, of thousands of open-access scientific journals today, as many as twenty-five percent are believed to be fake, existing only to make money by charging authors high processing fees. In sham journals, peer review is cursory or absent: as many as eighty to ninety percent of submitted manuscripts are accepted, many within days, without any editorial comment. Predatory journalism can be remarkably good at mimicking reputable publishers. Sham journals use names and logos that closely resemble those of legitimate journals, intentionally confusing site visitors. Untrustworthy publications have not received the widespread, damning publicity they deserve. If junk science is not confronted and eliminated, it will continue to tarnish and undermine ethical, open-access scholarly publishing. [Full article available at http://rimed.org/rimedicaljournal-2017-07.asp].
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Affiliation(s)
- Walter Klyce
- hird-year medical student at the Alpert Medical School of Brown University
| | - Edward Feller
- clinical professor of medical sciences at Brown University
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Gil JA, Waryasz GR, Klyce W, Daniels AH. Heterotopic Ossification in Neurorehabilitation. R I Med J (2013) 2015; 98:32-34. [PMID: 26623453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neurogenic heterotopic ossification (NHO) involves deposition of bone in extraskeletal tissue in the setting of a neurological disorder, and its pathophysiology is incompletely understood. NHO can lead to significant disability and functional impairment. NHO initially manifests as pain and joint stiffness. Early diagnosis requires appropriate suspicion and imaging studies to detect the uncalcified collagen matrix that forms in the early stages of NHO. If diagnosis is made in the early phase of NHO, progression may be halted with bisphosphonates, indomethacin or radiation therapy. If NHO progresses to its final stages without intervention, it may restrict joints and render them dysfunctional. Surgical treatment of NHO may restore function, but complications may occur, and prophylaxis and aggressive rehabilitation are essential.
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Affiliation(s)
- Joseph A Gil
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery
| | - Gregory R Waryasz
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery
| | - Walter Klyce
- Warren Alpert Medical School of Brown University
| | - Alan H Daniels
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery
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