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Journal of Pediatric Orthopedics

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https://www.readbyqxmd.com/read/28430703/evidence-based-recommendations-for-pediatric-orthopaedic-practice
#1
Kishore Mulpuri, Emily K Schaeffer, H Kerr Graham, Mininder S Kocher, James Sanders, Ira Zaltz
BACKGROUND: Evidence-based medicine has become the cornerstone to guide clinical practice decision-making. Evidence-based medicine integrates the strongest available evidence with clinical expertise to make decisions about clinical care. The quality of the evidence depends upon the soundness of the study methodology to allow for meaningful interpretation of the clinical results. The purpose of this review is to analyze the methodological design and clinical findings of published pediatric orthopaedic studies to determine their ability to change or influence clinical practice...
April 20, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399051/clubfoot-infants-initially-thought-to-be-idiopathic-but-later-found-not-to-be-how-do-they-do-with-nonoperative-treatment
#2
B Stephens Richards, Shawne Faulks
BACKGROUND: Infants thought to be normal with idiopathic clubfeet when nonoperative treatment begins may later be found to have other complicating diagnoses. The purpose of this study was to determine the incidence of this occurrence, and to compare the clinical outcomes of these "nonidiopathic" patients with idiopathic clubfoot patients. METHODS: Infants below 3 months old with clubfeet who were thought to be normal (idiopathic) at presentation and had ≥2-year follow-up were studied...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399050/veptr-are-we-reducing-respiratory-assistance-requirements
#3
Sarah B Nossov, Evan Curatolo, Robert M Campbell, Oscar H Mayer, Sumeet Garg, Patrick J Cahill
BACKGROUND: The assisted ventilation rating (AVR) indicates the degree of external respiratory support required in children with thoracic insufficiency syndrome (TIS) and early onset scoliosis. For skeletally immature patients with TIS, the vertical expandable prosthetic titanium rib (VEPTR) device can be used to improve lung volume and growth. We hypothesized that patients who underwent early thoracic reconstruction by VEPTR treatment had an improved respiratory status. METHODS: Preoperative and postoperative AVR ratings were prospectively collected in a multicenter study group and compared with determine change after VEPTR treatment...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399049/evaluation-of-gabapentin-and-clonidine-use-in-children-following-spinal-fusion-surgery-for-idiopathic-scoliosis-a-retrospective-review
#4
Dinesh K Choudhry, B Randall Brenn, Karen Sacks, Suken Shah
BACKGROUND: Opioids are the mainstay of therapy for pain relief following posterior spinal fusion (PSF) surgery. Various adjunctive medications are being used to augment analgesia and to reduce opioid-related side effects. At our institution, we have sequentially added 2 adjuncts to a standard morphine patient-controlled analgesia (PCA) regimen. The goal of our study was to evaluate pain control and the benefit of gabapentin and the combination of gabapentin and clonidine, whereas morphine PCA was in use in children following PSF surgery...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399048/pediatric-femoral-shaft-fractures-a-multicenter-review-of-the-aaos-clinical-practice-guidelines-before-and-after-2009
#5
John D Roaten, Derek M Kelly, Joseph L Yellin, John M Flynn, Micaela Cyr, Sumeet Garg, Alexander Broom, Lindsay M Andras, Jeffrey R Sawyer
BACKGROUND: To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013). METHODS: Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399047/assessing-quality-and-safety-in-pediatric-supracondylar-humerus-fracture-care
#6
Christopher A Iobst, Matthew Stillwagon, Deidre Ryan, Eric Shirley, Steven L Frick
BACKGROUND: Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28375968/curve-modulation-and-apex-migration-using-shilla-growth-guidance-rods-for-early-onset-scoliosis-at-5-year-follow-up
#7
John T Wilkinson, Chad E Songy, David B Bumpass, Francis L McCullough, Richard E McCarthy
BACKGROUND: The Shilla procedure was designed to correct and control early-onset spinal deformity while harnessing a child's remaining spinal growth. It allows for controlled axial skeletal growth within the construct, avoiding the need for frequent surgeries to lengthen implants. We hypothesized that curve characteristics evolve over time after initial apex fusion and placement of the Shilla implants. The purpose of this study was to identify trends in curve evolution after Shilla implantation and understand how these changes influence ultimate outcome...
April 3, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28375967/rectus-femoris-transfer-surgery-worsens-crouch-gait-in-children-with-cerebral-palsy-at-gmfcs-levels-iii-and-iv
#8
Ted C Sousa, Alexander Nazareth, Susan A Rethlefsen, Nicole M Mueske, Tishya A L Wren, Robert M Kay
BACKGROUND: Previous study has shown that children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels III and IV do not benefit from distal rectus femoris transfer (DRFT) due to lack of improvement in stance knee extension. The fate of knees in such subjects who do not undergo DRFT is unknown. The purpose of this study was to compare knee kinematic outcomes in patients with CP and stiff knee gait who underwent single-event multilevel surgery with and without DRFT...
April 3, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28375966/simultaneous-bilateral-hip-arthroscopy-in-adolescent-athletes-with-symptomatic-femoroacetabular-impingement
#9
Mark O McConkey, Vivek Chadayammuri, Tigran Garabekyan, Stephanie W Mayer, Matthew J Kraeutler, Omer Mei-Dan
BACKGROUND: Femoroacetabular impingement represents a common cause of hip pain in adolescents. The purpose of the present study was to evaluate the safety and efficacy of simultaneous bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement in adolescent athletes. METHODS: Clinical data were collected in a prospective database on patients who underwent unilateral or simultaneous bilateral hip arthroscopy and included complications, reoperation rate, and return to play time...
April 3, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28350557/double-versus-single-tendon-transfers-to-improve-shoulder-function-in-brachial-plexus-birth-palsy
#10
Dustin A Greenhill, William R Smith, F V Ramsey, Scott H Kozin, Dan A Zlotolow
BACKGROUND: In children with brachial plexus birth palsy (BPBP) undergoing tendon transfers to augment shoulder external rotation, it is unclear whether transfer of the latissimus dorsi with its combined latissimus dorsi and teres major (cLT) versus isolated teres major (iTM) tendon transfer yield different outcomes. METHODS: Records of patients with BPBP who underwent shoulder tendon transfers to augment external rotation were retrospectively reviewed. Transfer type (cLT or iTM) was considered indiscriminate by virtue of surgeon preference...
March 27, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28346328/guided-growth-a-novel-treatment-for-anterolateral-bowing-of-the-tibia
#11
Jim Kennedy, Patrick O'Toole, Joseph F Baker, David Moore
BACKGROUND: Tibial pseudoarthrosis is a source of considerable morbidity in children with neurofibromatosis. Preventing the progression of anterolateral bowing of the tibia (ALBT) to tibial pseudoarthrosis is difficult. The aim of this paper is to report the successful use of guided growth to prevent tibial pseudoarthrosis in a child with neurofibromatosis. METHODS: With local ethical approval, we reviewed the case notes and radiographs of a child with pronounced ALBT who was treated with guided growth to correct the deformity and prevent fracture...
March 24, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328567/effects-of-a-simulated-game-on-upper-extremity-pitching-mechanics-and-muscle-activations-among-various-pitch-types-in-youth-baseball-pitchers
#12
Gretchen D Oliver, Hillary Plummer, Lisa Henning, Michael Saper, Gabrielle Glimer, Allison Brambeck, James R Andrews
BACKGROUND: Throwing requires proper stability and orientation of the pelvis and scapula for efficient energy transfer during pitching. Fatigue of the pelvis and scapular musculature throughout the course of a game can impair pitching performance, and place excessive demands on the throwing arm leading to injury. The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328566/physeal-and-subphyseal-distraction-osteogenesis-in-atrophic-type-congenital-pseudarthrosis-of-the-tibia-efficacy-and-safety
#13
Woo Young Jang, Yoon Hyo Choi, Moon Seok Park, Won Joon Yoo, Tae-Joon Cho, In Ho Choi
PURPOSE: To examine the efficacy, safety, and clinical outcomes of distraction osteogenesis through the physis (PDO) or through subphyseal osteotomy (SPDO) in patients with atrophic-type congenital pseudarthrosis of tibia with proximal tibial dysplasia. METHODS: To validate the efficacy and safety of PDO and SPDO, radiographic and clinical parameters were compared between 5 patients who underwent proximal tibial metaphyseal or metadiaphyseal lengthening as a control (group 1) and 7 patients who underwent PDO or SPDO (group 2)...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328565/control-of-walking-speed-in-children-with-cerebral-palsy
#14
Jon R Davids, Nina Q Cung, Suzy Chen, Mitell Sison-Williamson, Anita M Bagley
BACKGROUND: Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328564/variation-in-national-acgme-case-log-data-for-pediatric-orthopaedic-fellowships-are-fellow-coding-practices-responsible
#15
Philip K McClure, Marcella Woiczik, Lori Karol, Wudbhav N Sankar
BACKGROUND: The introduction of the 80-hour work week for Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs initiated many efforts to optimize surgical training. One particular area of interest is on recording and tracking surgical experiences. The current standard is logging cases based on Current Procedural Terminology codes, which are primarily designed for billing. Proposed guidelines from the ACGME regarding logging exist, but their implementation is unknown, as is the variation in case volume across fellowship programs...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328563/patients-without-intraoperative-neuromonitoring-ionm-alerts-during-veptr-implantation-did-not-sustain-neurological-injury-during-subsequent-routine-expansions-a-retrospective-multicenter-cohort-study
#16
Jaren LaGreca, Tara Flynn, Patrick J Cahill, Amer Samdani, Michael G Vitale, Ron El-Hawary, John T Smith, Jonathan H Phillips, John M Flynn, Michael Glotzbecker, Sumeet Garg
BACKGROUND: The purpose of this study was to determine the rate of intraoperative neurological monitoring (IONM) alerts and neurological injury during vertical expandable prosthetic titanium rib (VEPTR) treatment and evaluate the utility of IONM during VEPTR expansion procedures in patients who have not previously had neurological injury or IONM alerts. METHODS: After institutional review board approval, VEPTR procedures and IONM records were reviewed at 17 institutions for patients treated with VEPTR from 2005 to 2011...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328562/treatment-of-unstable-versus-stable-slipped-capital-femoral-epiphysis-using-the-modified-dunn-procedure
#17
Richard L Davis, Walter P Samora, Freddie Persinger, Kevin E Klingele
BACKGROUND: The modified Dunn procedure (open subcapital realignment via a surgical dislocation approach) has been shown to be a safe and effective way of treating acute, unstable slipped capital femoral epiphysis (SCFE). There is a paucity of literature comparing the modified Dunn procedure in stable SCFE. The purpose of this study was to compare acute, unstable versus chronic, stable SCFE managed with the modified Dunn procedure. METHODS: A retrospective chart review was performed on 44 skeletally immature patients who underwent the modified Dunn procedure for SCFE...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328561/does-orientation-of-the-femoral-head-affect-acetabular-development-an-experimental-study-in-lamb
#18
Luis Moraleda, Christian Bravo, Francisco Forriol, Javier Albiñana
BACKGROUND: Derotational osteotomy of the proximal femur has proved to be effective in the treatment of residual acetabular dysplasia. However, the reason why this osteotomy is effective remains debatable. The purpose of this study is to investigate if an alteration of femoral head orientation affects acetabular growth. METHODS: A proximal femoral osteotomy was performed in 21 lambs aged 3 months: 5 varus osteotomies (110 degrees), 4 valgus osteotomies (150 degrees), and 12 derotation osteotomies...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28328560/surgical-treatment-of-congenital-and-obligatory-dislocation-of-the-patella-in-children
#19
Ronen Sever, Michael Fishkin, Yoram Hemo, Shlomo Wientroub, Moshe Yaniv
BACKGROUND: Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature.We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications. METHODS: We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013...
March 21, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28288080/management-of-pediatric-type-i-open-fractures-in-the-emergency-department-or-operating-room-a-multicenter-perspective
#20
Jenna Godfrey, Paul D Choi, Lior Shabtai, Sarah B Nossov, Amy Williams, Antoinette W Lindberg, Selina Silva, Michelle S Caird, Mathew D Schur, Alexandre Arkader
BACKGROUND: The management of pediatric type I open fractures remains controversial. The aim of this study is to compare outcomes in type I open fractures managed with superficial wound debridement and antibiotics in the emergency department (ED) (nonoperative management) to patients managed with operative debridement and antibiotics (operative management). METHODS: A multicenter retrospective review was performed of all pediatric type I open forearm, wrist, and tibia fractures treated at 4 high volume pediatric centers between 2000 and 2015...
March 10, 2017: Journal of Pediatric Orthopedics
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