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Ellsworth BK, Bram JT, Haeberle HS, DeFrancesco CJ, Scher DM. Back to Basics: Pediatric Casting Techniques, Pearls, and Pitfalls. Iowa Orthop J 2023; 43:79-89. [PMID: 38213863 PMCID: PMC10777705] [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: 01/13/2024]
Abstract
Cast application is a critical portion of pediatric orthopaedic surgery training and is being performed by a growing number of non-orthopaedic clinicians including primary care physicians and advanced practice providers (APPs). Given the tremendous remodeling potential of pediatric fractures, correct cast placement often serves as the definitive treatment in this age population as long as alignment is maintained. Proper cast application technique is typically taught through direct supervision from more senior clinicians, with little literature and few resources available for providers to review during the learning process. Given the myriad complications that can result from cast application or removal, including pressure sores and cast saw burns, a thorough review of proper cast technique is warranted. This review and technique guide attempts to illustrate appropriate upper and lower extremity fiberglass cast application (and waterproof casts), including pearls and pitfalls of cast placement. This basic guide may serve as a resource for all orthopaedic and non-orthopaedicproviders, including residents, APPs, and medical students in training. Level of Evidence: IV.
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Affiliation(s)
- Bridget K. Ellsworth
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Hospital for Special Surgery, New York, New York, USA
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Harimtepathip P, Puneky G, Lomax J, Bryan C. Non-operative Management of a Rare Segmental Clavicle Fracture in an Adolescent Patient: A Case Report. Cureus 2023; 15:e42508. [PMID: 37637629 PMCID: PMC10457149 DOI: 10.7759/cureus.42508] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
A 12-year-old Caucasian male presented to the clinic with a displaced, segmental left clavicle fracture involving the distal clavicle after falling from a zip line. He was treated non-operatively in a sling and returned to normal activities without restrictions after three months. At one year, the patient was able to maintain his pre-injury baseline function without limitations of his left shoulder. While no clear guidelines for operative treatment of segmental clavicle fractures in the adolescent population exist in the current literature, this report illustrates an excellent patient outcome following conservative therapy of a segmental clavicle fracture involving the middle one-third and distal clavicle in a young adolescent with open physis.
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Affiliation(s)
- Peter Harimtepathip
- Department of Orthopedics, Augusta University Medical College of Georgia, Augusta, USA
| | - George Puneky
- Department of Orthopedics, Augusta University Medical College of Georgia, Augusta, USA
| | - Justin Lomax
- Department of Orthopedics, Augusta University Medical College of Georgia, Augusta, USA
| | - Cory Bryan
- Department of Orthopedics, Augusta University Medical College of Georgia, Augusta, USA
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3
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Jauregui JJ, Shaw NM, Weir TB, Barvarz SA, McClure PK. Risk of Avascular Necrosis with The Modified Dunn Procedure in SCFE Patients: A Meta-Analysis. Children (Basel) 2022; 9:children9111680. [PMID: 36360408 PMCID: PMC9688411 DOI: 10.3390/children9111680] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
In situ stabilization is a widely accepted treatment for slipped capital femoral epiphysis (SCFE) despite risks of avascular necrosis (AVN) and femoroacetabular impingement (FAI). The modified Dunn procedure with surgical hip dislocation attempts to maintain epiphyseal perfusion and allows anatomic epiphyseal repositioning, theoretically reducing AVN and FAI risks. We systematically evaluated the literature, elucidating overall and stability-stratified rates of AVN following the modified Dunn procedure, and revision rates in non-AVN patients. Using Ovid and MEDLINE (PubMed), studies involving the modified Dunn procedure were evaluated for age, stability, preoperative slip (Southwick) angle, ROM at follow-up, outcome metrics, and revisions. Utilizing a random effect model of proportions, we determined overall and stability-stratified AVN rates, and revision rates in patients without AVN.673 patients (688 SCFEs) who underwent modified Dunn procedure were included. Overall AVN rate was 14.3% with a 95% Confidence Interval (CI) of 9.3 to 20.2%. AVN rate in stable slips was 10.9% (95% CI: 6.0 to 17.1%) and 19.9% (95% CI: 12.8% to 28.1%) in unstable slips. Revision rate in non-AVN patients was 13.3% (95% CI: 8.3% to 19.2%). Fixation failures occurred following K-wire or small-caliber (<6.5 mm) screw fixation. Overall mean Harris Hip Score (HHS) was excellent (>90 points). Mean HHS was 98.9 points (range of means: 86 to 99 points) in stable cases, and 90.5 points (range of means: 73 to 98 points) in unstable cases. Patients undergoing modified Dunn procedure had excellent clinical outcomes and low incidences of AVN. Further studies are needed to determine if modified Dunn osteotomy with surgical hip dislocation is a viable alternative to in situ pinning for treatment of severe SCFE.
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Affiliation(s)
- Julio J. Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Nichole M. Shaw
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Tristan B. Weir
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Sherwin A. Barvarz
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Philip K. McClure
- Rubin Institute for Advanced Orthopaedics, Baltimore, MD 21215, USA
- Correspondence: ; Tel.: +1-410-601-9562
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Montgomery BK, Welch JM, Shapiro LM, Shea KG, Kamal RN. Quality Measures for Pediatric Orthopaedic Surgery: A Systematic Review. J Pediatr Orthop 2022; 42:e682-e687. [PMID: 35667057 PMCID: PMC9178678 DOI: 10.1097/bpo.0000000000002126] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quality measures provide a way to assess health care delivery and to identify areas for improvement that can inform patient care delivery. When operationalized by a hospital or a payer, quality measures can also be tied to physician or hospital reimbursement. Prior work on quality measures in orthopaedic surgery have identified substantial gaps in measurement portfolios and have highlighted areas for future measure development. This study aims to identify the portfolio of quality measures in pediatric orthopaedic surgery. METHODS We used methodology of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and reviewed PubMed/ MEDLINE and EMBASE, the American Academy of Orthopaedic Surgery (AAOS), National Quality Forum (NQF), and the Agency for Healthcare Research and Quality (AHRQ), for quality measures and candidate quality measures. Quality measure and candidate quality measures were categorized as structure, process, or outcome. Measures were also classified into 1 of the 6 National Quality Strategy priorities (safety, effective, patient centered, timely, efficient, and equitable). RESULTS A review of PubMed/EMBASE returned 1640 potential quality measures and articles. A review of AAOS, NQF, and AHRQ databases found 80 potential quality measures. After screening we found a total of 18 quality measures and candidate quality measures specifically for pediatric orthopaedic surgery. Quality measures addressed conditions such as supracondylar humerus fractures, developmental dysplasia of the hip, and osteochondritis dissecans. There were 10 process measures, 8 outcome measure, and 0 structure measures. When we categorized by National Quality Strategy priorities and found 50% (9/18) were effective clinical care, 44% (8/18) were person and care-giver centered experience and outcomes, 6% (1/18) were efficient use of resources. CONCLUSIONS There are few quality measures and candidate quality measures to assess pediatric orthopaedic surgery. Of the quality measure available, process measures are relatively over-represented. Pediatric orthopaedic surgeons can lead the development of outcome (eg, patient-reported outcomes after surgery) and structure measures (eg, subspecialty training certification) to assess quality of care in pediatric orthopaedic surgery. LEVEL OF EVIDENCE Level II-systematic review.
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Affiliation(s)
| | - Jessica M Welch
- Department of Orthopaedic Surgery, Stanford University, Stanford
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Lucile Packard Children's Hospital
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Stanford
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Cohen SA, Shea K, Imrie M. An Update on the Accessibility and Quality of Online Information for Pediatric Orthopaedic Surgery Fellowships. Cureus 2021; 13:e17802. [PMID: 34660012 PMCID: PMC8497116 DOI: 10.7759/cureus.17802] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The internet is an important tool for applicants seeking information on pediatric orthopaedic surgery fellowship programs. Previous analysis of pediatric orthopaedic surgery fellowship websites demonstrated they were often inaccessible and incomplete. As such, the purpose of this study was to (1) perform an updated assessment of the accessibility and content of pediatric orthopaedic fellowship program websites and (2) compare the results to the previous study to discern temporal trends in website accessibility and quality. Methods A list of pediatric orthopaedic fellowship programs was compiled from the San Francisco Match (SF Match) and the Pediatric Orthopaedic Society of North America (POSNA) online databases. All identified websites were evaluated for (1) accessibility and (2) the presence of 12 education and 12 recruitment criteria. These criteria were determined by prior fellowship website analyses and the needs of current fellowship applicants. Website accessibility and quality were compared with previously reported metrics. Results Approximately 91% of pediatric orthopaedic surgery fellowship programs had a functioning website. While the SF Match and POSNA databases listed nearly identical programs, there were discrepancies in the information provided by the two databases, and individual program website links provided on both databases were often nonfunctional. Fellowship program websites contained an average of 15.1 ± 3.9 total education and recruitment criteria (range: 3 - 21). The most common education criteria featured on program websites included information about research, affiliated hospital information, and rotations. The most common recruitment criteria featured on program websites included program descriptions, contact information, and social media links. There was an increased frequency in nearly all education and recruitment criteria evaluated when compared with 2014 metrics. Discussion Although website accessibility and content have improved since 2014, information on pediatric orthopaedic fellowship program websites remains incomplete, with many websites failing to provide information on criteria deemed important by fellowship applicants. In addition, many discrepancies exist between the SF Match and POSNA databases, the two primary sources of information for pediatric orthopaedic fellowship applicants. Increased consistency on pediatric orthopaedic fellowship websites and both the SF Match and POSNA databases may help applicants to better assess which programs to apply to and which programs to rank highly on their match list.
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Affiliation(s)
- Samuel A Cohen
- Orthopaedic Surgery, Stanford University School of Medicine, Stanford, USA
| | - Kevin Shea
- Orthopaedic Surgery, Stanford University School of Medicine, Stanford, USA
| | - Meghan Imrie
- Orthopaedic Surgery, Stanford University School of Medicine, Stanford, USA
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Munger AM, Yu KE, Li DT, Furdock RJ, Boeyer ME, Duren DL, Weber DR, Cooperman DR. The More the Merrier: Integrating Multiple Models of Skeletal Maturity Improves the Accuracy of Growth Prediction. J Pediatr Orthop 2021; 41:e580-4. [PMID: 35087259 DOI: 10.1097/bpo.0000000000001847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple systems using radiographic skeletal markers to measure development have been described, including the Greulich and Pyle Atlas (GP), the Fels Method (Fels), and the Sanders Hand Classification (Sanders). The purpose of this study was to quantitatively assess whether the integration of skeletal maturity assessment methods and demographic variables improves the accuracy of pediatric growth predictions over the use of skeletal markers or chronologic age alone. METHODS The Brush Inquiry contains prospectively collected longitudinal data on children who lived in Cleveland, Ohio between 1926 and 1942. A total of 16 boys and 29 girls were selected for study. All had age, height, and an anteroposterior radiograph of the hand at each of 3 visits. Those visits occurred at 85%, 90%, and 95% of final height. We determined the growth completed at each visit by dividing the height observed by the final height at skeletal maturity. Boys and girls were analyzed separately using chronologic age, height, GP, Fels, and Sanders. The residual difference between the height predicted and actual height, as well as the SD of the prediction error of the cohort at each time point was calculated. To account for multiple visits from each subject, all linear models were produced using the generalized estimating equations (GEEs) procedure. RESULTS For boys, age, GP, and Fels performed similarly in predicting growth remaining at all 3 time points. For girls, age, GP, and Fels performed similarly in predicting growth remaining at the 85% and 95% time points; however, the Fels Method demonstrated improved performance at the 90% time point compared with chronologic age (P = 0.0076) and GP alone (P = 0.0155). For both boys and girls, the most accurate multivariate GEE model with the lowest SD of prediction error integrated Fels, age, GP, Sanders, and height. CONCLUSIONS The most accurate multivariate GEE model of growth prediction for both boys and girls integrated Fels, age, GP, Sanders, and height. When calculating the amount of growth remaining, it is prudent to integrate multiple systems for greater predictive accuracy. LEVEL OF EVIDENCE Level III.
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Volpi A, Matzko C, Feghhi D, Matheney T, Bharam S. Conservative Treatment of Avulsion Injuries of the Lesser Trochanter in Adolescent Athletes. Cureus 2021; 13:e15638. [PMID: 34306849 PMCID: PMC8278968 DOI: 10.7759/cureus.15638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Avulsion injuries of the lesser trochanter apophysis are relatively uncommon injuries and there have been no peer-reviewed case series dedicated to the evaluation and treatment of this injury. The purpose of this study is to characterize avulsion injuries of the lesser trochanter apophysis, review treatment protocols, and time to return to sport. Methods: We reviewed 30 confirmed avulsion fractures of the lesser trochanter. Clinical data were reviewed to evaluate treatment protocols, duration, and time to return to sport. Radiographs were reviewed to confirm lesser trochanter avulsion and fracture displacement. RESULTS There were 26 males and 4 females, with the average age at the time of injury being 14.2 years. Treatment modalities consisted of protective weight-bearing, discontinuation of the patient's sport in all cases, and formal physical therapy in 18 cases. The average treatment duration was 30.7 days. The mean follow-up time was 102 days. The radiographic assessment demonstrated an average fracture displacement of 5.1 mm. The average return to sport was 11 weeks. CONCLUSION This is the first large case series studying avulsion injuries of the lesser trochanter. We have shown that these athletes can be managed non-surgically and can successfully return back to sport within three months.
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Affiliation(s)
| | | | - Daniel Feghhi
- Orthopaedic Surgery, Lenox Hill Hospital, New York, USA
| | - Travis Matheney
- Orthopaedic Surgery, Boston Children's Hospital, Boston, USA
| | - Srino Bharam
- Orthopaedic Surgery, Lenox Hill Hospital, New York, USA
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Mody KS, Henstenburg J, Herman MJ. The Health & Economic Disparities of Congenital Musculoskeletal Disease Worldwide: An Analysis of 25 Years (1992-2017). Glob Pediatr Health 2021; 8:2333794X21994998. [PMID: 33718527 PMCID: PMC7917875 DOI: 10.1177/2333794x21994998] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Large disparities exist in congenital musculoskeletal disease burden worldwide. The purpose of this study is to examine and quantify the health and economic disparities of congenital musculoskeletal disease by country income level from 1992 to 2017. Methods: The Global Burden of Disease database was queried for information on disease burden attributed to "congenital musculoskeletal and limb anomalies" from 1992 to 2017. Gross national income per capita was extracted from the World Bank website. Nonparametric Kruskal-Wallis tests were used to compare morbidity and mortality across years and income levels. The number of avertable DALYs was converted to an economic disparity using the human-capital and value of a statistical life approach. Results: From 1992 to 2017, a significant decrease in deaths/100 000 was observed only in upper-middle and high income countries. Northern Africa, the Middle East, and Eastern Europe were disproportionately affected. If the burden of disease in low- and middle- income countries (LMICs) was equivalent to that in high income countries (HICs), 10% of all DALYs and 70% of all deaths attributable to congenital musculoskeletal disease in LMICs could be averted. This equates to an economic disparity of about $2 billion to $3 billion (in 2020 $USD). Conclusion: Considerable inequity exists in the burden of congenital musculoskeletal disease worldwide and there has been no change over the last 25 years in total disease burden and geographical distribution. By reducing the disease burden in LMICs to rates found in HICs, a large proportion of the health and economic consequences could be averted.
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Affiliation(s)
- Kush S Mody
- Columbia Business School, New York, NY, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Martin J Herman
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Jenkins KA, South S, Bovid KM, Kenter K. Pediatric Supracondylar Humerus Fractures Can Be Safely Treated by Orthopaedic Surgeons With and Without Pediatric Fellowship Training. Iowa Orthop J 2021; 41:69-75. [PMID: 34552406 PMCID: PMC8259185] [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: 06/13/2023]
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of pediatric patients who were surgically treated for a supracondylar humerus fracture by pediatric fellowship-trained orthopaedic surgeons (PFT) to the outcomes of those surgically treated by orthopaedic surgeons without pediatric fellowship training (NPFT). We hypothesized that there would be no differences in patient outcomes. METHODS A retrospective review of pediatric patients who underwent surgical treatment for a supracondylar humerus fracture with closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP) at a regional level 1 trauma center over a 5-year period was performed. Exclusion criteria were inadequate follow up or absence of postoperative radiographs. RESULTS A total of 201 patients met the inclusion criteria. Pediatric-fellowship trained orthopaedic surgeons treated 15.9% of patients. There was no statistically significant difference in carrying angle, Baumann's angle, or lateral rotation percentage at final follow up between PFT and NPFT groups. There was no permanent neurovascular compromise in either group. Patients treated by NPFT were more likely to return to the operating room for pin removal. CONCLUSION In this study, there was no difference in radiographic outcomes for patients with supracondylar humerus fractures surgically treated by either group. This suggests that pediatric supracondylar humerus fractures may be appropriately treated in communities without a pediatric-fellowship trained orthopaedic surgeon without compromised outcomes.Level of Evidence: III.
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Affiliation(s)
- Kelly A. Jenkins
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | | | - Karen M. Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Keith Kenter
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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Abstract
PURPOSE Changes to routine clinical approaches during the corona virus disease 2019 (COVID-19) pandemic are necessary to decrease the risk of infection in patients and healthcare providers. Because the treatment of many conditions is time sensitive, it is crucial to modify the management of paediatric orthopaedic cases by minimizing any subsequent morbidity. Our purpose was to describe the different measures and management strategies that have been applied by paediatric orthopaedic surgeons and to show how paediatric orthopaedic practice is affected in Turkey. METHODS All active practicing members of the Turkish Society of Children's Orthopedic Surgery (TSCOS) were contacted via telephone and asked to fill out a survey (24 questions). For participants, either an email or web link was sent to their mobile phones. An online survey generator was used. RESULTS A total of 54 survey responses were collected, for a response rate of 55%. In all, 62% reported a 75% decrease in their outpatient frequency, whilst 75% reported a 75% decrease in their surgery frequency. A total of 86% of the performed surgeries were emergency cases. None of the participants performed elective surgeries, and 61% did not have the consent form specific to COVID. Choice of protective measures have changed considerably; 96% stated that they needed an algorithm to follow for situations such as pandemic. CONCLUSION This national survey revealed that the COVID-19 pandemic has had a detrimental effect on paediatric orthopaedic practice and practitioner response varies in terms of reactions and precautions. The necessity of creating a protocol based on what we have learned must be taken into consideration. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Sema Ertan Birsel
- Atlas University, Istanbul Medicine Hospital, Department of Orthopaedics and Traumatology, Bağcılar, Istanbul, Turkey
| | - İlker Abdullah Sarıkaya
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey,Correspondence should be sent to İlker Abdullah Sarıkaya, Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey. E-mail:
| | - Ali Şeker
- Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopaedics and Traumatology, Kocamustafapasa, Istanbul, Turkey
| | - Ozan Ali Erdal
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Barış Görgün
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
| | - Muharrem İnan
- Ortopediatri Academy of Pediatric Otrhopaedics, Department of Orthopaedics and Traumatology, Beşiktaş, Istanbul, Turkey
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Abstract
Septic arthritis of the wrist in pediatric patients is a rare diagnosis and is not well described in the literature. We present a case of a 4-month old patient with monoarticular septic arthritis of the wrist treated with surgical drainage and antibiotics. Although a rare diagnosis, septic arthritis of the wrist should be considered in patients with pseudoparalysis of the upper extremity and systemic signs of inflammation. Prompt diagnosis and treatment is critical to prevent permanent damage to the joint. Further data is needed to describe the epidemiology, microbiology, diagnostic findings and treatment of septic arthritis of the pediatric wrist.
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Affiliation(s)
- Jeremy M Silver
- Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - William Hennrikus
- Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
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12
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Abstract
Background Although clubfoot that was corrected in childhood rarely recurs in adulthood, persistent deformities or arthritic pain may require further treatment during adulthood. Little evidence exists on the operative procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood, for residual or recurrent deformity or pain. Objective The objective of this study is to characterize the types and frequencies of procedures utilized in adult clubfoot patients, who were previously treated for congenital clubfoot in childhood. Methods A two-pronged approach was employed to describe the operative procedures used in adult clubfoot patients. First, a literature review of all reported cases of operative treatment in adult clubfoot patients who were previously treated in childhood was performed. Second, an analysis of the operative treatments used in adult patients with a diagnosis of congenital clubfoot was conducted using a large, administrative claims database. Results In the literature review, arthrodesis was the most cited operative treatment and reported in four out of the eight studies included. Osteotomies were also reported in the literature. In the database analysis, 94 hindfoot arthrodesis procedures were identified in 73 patients, out of 1,198 adult patients in the database with a diagnosis of congenital clubfoot. Sixty-two patients out of 1,198 adult clubfoot patients received osteotomies. An insufficient number of total ankle arthroplasties were reported for further analysis. Conclusions Operative treatment in adult clubfoot patients who were treated for congenital clubfoot in childhood includes hindfoot arthrodesis and osteotomy procedures. Total ankle arthroplasty has not been reported in the literature for these patients.
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Affiliation(s)
| | | | - Steve Frick
- Orthopaedics, Stanford University, Stanford, USA
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13
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Lee RJ, Margalit A, Nduaguba A, Gunderson MA, Ganley TJ. Risk Factors for Concomitant Collateral Ligament Injuries in Children and Adolescents With Anterior Cruciate Ligament Tears. Orthop J Sports Med 2018; 6:2325967118810389. [PMID: 30480025 PMCID: PMC6249661 DOI: 10.1177/2325967118810389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Risk factors for concomitant ligament injuries (CLIs) of the lateral collateral ligament (LCL) and medial collateral ligament (MCL) in children and adolescents with anterior cruciate ligament (ACL) tears are unknown. Purpose: To determine whether body mass index (BMI), sex, age, and injury mechanism are associated with CLIs in children and adolescents with ACL tears and whether CLIs are associated with meniscal and chondral injuries and a delay to surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of patients aged ≤18 years with ACL tears from 2009 through 2013 for sex, age, height, weight, CLI, injury mechanism, intra-articular injury, and time to surgery. Patients were assigned to groups according to the presence of a CLI (CLI group) compared with the presence of an isolated ACL tear (ACL group). BMI was categorized as underweight, normal weight, or overweight/obese. The older group was defined as age ≥14 years for girls and ≥16 years for boys. Logistic regression, Mann-Whitney U tests, and chi-square tests were performed (alpha = 0.05). Results: We included 509 patients (267 girls) with a mean age of 15 years (range, 6-18 years) at the time of injury. There were 396 patients (78%) in the ACL group and 113 patients (22%) in the CLI group (90 with MCL, 11 with LCL, and 12 with both MCL and LCL injuries). Groups had similar proportions of overweight/obese patients (P = .619) and girls (P = .104). Older age (odds ratio [OR], 2.0 [95% CI, 1.3-3.3]) and contact injuries (OR, 2.2 [95% CI, 1.4-3.4]) were associated with CLIs. The CLI group had a higher proportion of chondral injuries (P = .001) but not meniscal injuries (P = .295) and presented to surgery earlier than the ACL group (P = .002). Conclusion: Older age and contact injuries were associated with CLIs in children and adolescents with ACL tears, whereas BMI category and sex were not. CLIs were associated with a higher proportion of chondral injuries but not meniscal injuries and were not associated with a delay to surgery.
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Affiliation(s)
- R Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam Margalit
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Afamefuna Nduaguba
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Melissa A Gunderson
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Investigation performed at the Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Geisbüsch A, Auer C, Dickhaus H, Niklasch M, Dreher T. Electromagnetic bone segment tracking to control femoral derotation osteotomy-A saw bone study. J Orthop Res 2017; 35:1106-1112. [PMID: 27325569 DOI: 10.1002/jor.23348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/04/2016] [Accepted: 06/14/2016] [Indexed: 02/04/2023]
Abstract
Correction of rotational gait abnormalities is common practice in pediatric orthopaedics such as in children with cerebral palsy. Femoral derotation osteotomy is established as a standard treatment, however, different authors reported substantial variability in outcomes following surgery with patients showing over- or under-correction. Only 60% of the applied correction is observed postoperatively, which strongly suggests intraoperative measurement error or loss of correction during surgery. This study was conducted to verify the impact of error sources in the derotation procedure and assess the utility of a newly developed, instrumented measurement system based on electromagnetic tracking aiming to improve the accuracy of rotational correction. A supracondylar derotation osteotomy was performed in 21 artificial femur sawbones and the amount of derotation was quantified during the procedure by the tracking system and by nine raters using a conventional goniometer. Accuracy of both measurement devices was determined by repeated computer tomography scans. Average derotation measured by the tracking system differed by 0.1° ± 1.6° from the defined reference measurement . In contrast, a high inter-rater variability was found in goniometric measurements (range: 10.8° ± 6.9°, mean interquartile distance: 6.6°). During fixation of the osteosynthesis, the tracking system reliably detected unintentional manipulation of the correction angle with a mean absolute change of 4.0° ± 3.2°. Our findings show that conventional control of femoral derotation is subject to relevant observer bias whereas instrumental tracking yields accuracy better than ±2°. The tracking system is a step towards more reliable and safe implementation of femoral correction, promising substantial improvements of patient safety in the future. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1106-1112, 2017.
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Affiliation(s)
- Andreas Geisbüsch
- Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, Heidelberg 69117, Baden-Württemberg, Germany
| | - Christoph Auer
- Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, Heidelberg 69117, Baden-Württemberg, Germany
| | - Hartmut Dickhaus
- Department of Medical Biometrics and Computer Sciences, University Hospital Heidelberg, Heidelberg 69117, Baden-Württemberg, Germany
| | - Mirjam Niklasch
- Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, Heidelberg 69117, Baden-Württemberg, Germany
| | - Thomas Dreher
- Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, Heidelberg 69117, Baden-Württemberg, Germany
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15
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Reynolds SL, Studnek JR, Bryant K, VanderHave K, Grossman E, Moore CG, Young J, Hogg M, Runyon MS. Study protocol of a randomised controlled trial of intranasal ketamine compared with intranasal fentanyl for analgesia in children with suspected, isolated extremity fractures in the paediatric emergency department. BMJ Open 2016; 6:e012190. [PMID: 27609854 PMCID: PMC5020878 DOI: 10.1136/bmjopen-2016-012190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage. METHODS AND ANALYSIS This double-blind, randomised controlled, pilot trial will compare INSD ketamine (1 mg/kg) to IN fentanyl (1.5 μg/kg) for analgesia in 80 children aged 4-17 years with acute pain from a suspected, single extremity fracture. The primary safety outcome for this pilot trial will be the frequency of cumulative side effects and adverse events at 60 min after drug administration. The primary efficacy outcome will be exploratory and will be the mean reduction of pain scale scores at 20 min. The study is not powered to examine efficacy. Secondary outcome measures will include the total dose of opioid pain medication in morphine equivalents/kg/hour (excluding study drug) required during the ED stay, number and reason for screen failures, time to consent, and the number and type of protocol deviations. Patients may receive up to 2 doses of study drug. ETHICS AND DISSEMINATION This study was approved by the US Food and Drug Administration, the local institutional review board and the study data safety monitoring board. This study data will be submitted for publication regardless of results and will be used to establish feasibility for a multicentre, non-inferiority trial. TRIAL REGISTRATION NUMBER NCT02521415.
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Affiliation(s)
- Stacy L Reynolds
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - Kathleen Bryant
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kelly VanderHave
- Department of Orthopedics, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Eric Grossman
- Department of Pediatric Surgery, Levine Children's Hospital, Concord, North Carolina, USA
| | - Charity G Moore
- Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - James Young
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Melanie Hogg
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
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16
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Baker D, Sherrod B, McGwin G Jr, Ponce B, Gilbert S. Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population. J Am Acad Orthop Surg 2016; 24:196-206. [PMID: 26855119 DOI: 10.5435/JAAOS-D-15-00481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures. METHODS The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated. RESULTS Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P < 0.001), pneumonia (P < 0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P < 0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died. CONCLUSION In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population.
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