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Journal of Pediatric Orthopedics

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https://www.readbyqxmd.com/read/30080773/differentiation-of-deep-venous-thrombosis-among-children-with-or-without-osteomyelitis
#1
John A Ligon, Janna M Journeycake, Shellie C Josephs, Naureen G Tareen, Eduardo A Lindsay, Lawson A B Copley
BACKGROUND: Children with osteomyelitis are at risk for deep venous thrombosis (DVT). This study evaluates the characteristics of DVT among children to differentiate between those with and without osteomyelitis. METHODS: Children with DVT of any cause were studied between 2008 and 2016. Children with DVT and osteomyelitis were compared with those with DVT without osteomyelitis. Another comparison cohort included children with osteomyelitis but without DVT. Comorbidities, severity of illness (SOI), and clinical course were compared between cohorts...
August 4, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30080772/clinical-impact-of-corrective-cast-treatment-for-early-onset-scoliosis-is-it-a-worthwhile-treatment-option-to-suppress-scoliosis-progression-before-surgical-intervention
#2
Noriaki Kawakami, Izumi Koumoto, Yoshihiro Dogaki, Toshiki Saito, Ryoji Tauchi, Kazuki Kawakami, Teppei Suzuki, Koki Uno
BACKGROUND: Although corrective cast (CC) has been back in use for the treatment of early onset scoliosis (EOS), no studies have reported how clinically meaningful CC was in comparison with brace-only treatment (BT) in EOS. The aim of this study was to investigate the effect of CC treatment in terms of suppression of scoliosis progression before surgery. METHODS: This study was designed to conduct a comparison of patients treated at 2 spine institutions differing in treating methods (one: mainly CC with brace, the other: BT)...
August 4, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30080771/increasing-brace-treatment-for-pediatric-distal-radius-buckle-fractures-using-quality-improvement-methodology-to-implement-evidence-based-medicine
#3
Kevin J Little, Jenna Godfrey, Roger Cornwall, Preston Carr, Kevin Dolan, Julie Balch Samora
BACKGROUND: Multiple randomized trials have showed equivalent outcomes and improved patient/family satisfaction using a removable brace to treat pediatric distal radius buckle fractures (DRBF). We tested the hypothesis that we could use quality improvement (QI) methodology to increase the proportion of patients with DRBF treated with removable braces at 2 tertiary care orthopaedic clinics from a baseline of 34.8% to 80%. METHODS: Clinic billing records were reviewed monthly to determine treatment (brace vs...
August 4, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30080770/pulseless-supracondylar-humerus-fracture-with-anterior-interosseous-nerve-or-median-nerve-injury-an-absolute-indication-for-open-reduction
#4
Liam R Harris, Alexandre Arkader, Alexander Broom, John Flynn, Joseph Yellin, Patrick Whitlock, Ashley Miller, Jeffrey Sawyer, John Roaten, David L Skaggs, Paul D Choi
BACKGROUND: Optimal management for a pulseless supracondylar humerus fracture associated with anterior interosseous nerve (AIN) or median nerve injury is unclear. The purpose of this study was to determine the incidence of pulseless supracondylar humerus fractures associated with AIN or median nerve injury, to assess open versus closed surgical management, to determine factors associated with the need for neurovascular intervention, and to report the outcome. METHODS: A retrospective review was performed at 4 pediatric trauma hospitals on all patients who sustained a Gartland III or IV supracondylar humerus fracture with the combination of absent distal palpable pulses and AIN or median nerve injury between 2000 and 2014...
August 4, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074591/what-s-new-in-pediatric-orthopaedic-quality-safety-and-value-a-systematic-review-with-results-of-the-2016-posna-quality-safety-and-value-initiative-qsvi-challenge
#5
Daniel J Miller, Patrick J Cahill, Joseph A Janicki, Lindsay P Stephenson, Paul D Choi
BACKGROUND: Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care. METHODS: We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers. RESULTS: A total of 36 papers were selected for review based upon new findings...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074590/evidence-based-recommendations-for-pediatric-orthopaedic-practice
#6
Kishore Mulpuri, Emily K Schaeffer, James Sanders, Ira Zaltz, Mininder S Kocher
BACKGROUND: The evidence-based approach to guide clinical practice has gained great importance in the medical field. High-quality evidence is of paramount importance to inform clinical decision-making and optimize patient outcomes. The generation of high-quality evidence relies on sound methodology and study design to facilitate appropriate interpretation and subsequent application of the clinical findings. The purpose of this review is to objectively critique the methodological design and clinical findings of 2 pediatric orthopaedic studies on children with cerebral palsy (CP) to assess their potential to impact clinical practice...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074589/posttraumatic-subfibular-ossicle-formation-in-children-experience-in-a-single-primary-care-unit
#7
Dong Yeon Lee, Doo Jae Lee, Dong Han Kim, Hyuck Soo Shin, Whan Ik Jung
BACKGROUND: Although subfibular ossicles have been linked to various clinical problems, whether its origin is congenital or traumatic remains unclear. The objectives of this study were to determine the incidence of subfibular ossicle formation after ankle inversion in children. METHODS: Among 896 pediatric patients who visited a single primary care unit after foot and ankle trauma, 593 patients sustaining ankle inversion injury were included in this study. For each pediatric patient, physical examination and radiographic examination were performed...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074588/consequences-following-distal-femoral-growth-plate-violation-in-an-ovine-model-with-an-intramedullary-implant-a-pilot-study
#8
Derrick M Knapik, Lewis G Zirkle, Raymond W Liu
BACKGROUND: Retrograde femoral nailing in skeletal immature patients would broaden the surgical options for fracture care and reconstructive procedures but involves violation of the open, active distal femoral physis with the potential for growth disturbance. The tolerance for putting a large diameter metal implant across the physis is largely unknown. The purpose of this pilot investigation was to define the upper limit of cross-sectional violation with a metal implant before causing premature growth arrest or inhibition using a sheep model...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074587/the-role-of-the-basement-plate-in-physeal-bar-formation
#9
John Michael Wattenbarger, Amanda Marshall, Michael D Cox, Helen Gruber
BACKGROUND: Physeal fractures and resultant physeal bars can pose significant problems in skeletal development for the injured growing child. Although now well-recognized, only a small body of experimental literature covering this problem is available. The goal of this study was to help further develop an understanding of the different regions of the physis and the way in which each region responds to injury/fracture. METHODS: This Institutional Animal Care and Use Committee (IACUC)-approved study assessed bar formation using radiologic and histologic methods and measured leg lengths of skeletally immature rats...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074586/the-recognition-incidence-and-management-of-spinal-cord-monitoring-alerts-in-pediatric-cervical-spine-surgery
#10
Waleed Mohammad, Denise Lopez, Michael Isley, Jonathan H Phillips
BACKGROUND: Perioperative spinal cord injury and postoperative neurological deficits are the major complications in spinal surgery. Monitoring of spinal cord function is of crucial importance. Somatosensory evoked potentials and transcranial electric motor-evoked potentials are now widely used in cervical spine surgery. Although much has been written on spinal cord monitoring in adult spinal surgery, very little has been published on the incidence and management of monitoring of cervical spine surgery in the pediatric population...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30074585/magnetic-intramedullary-lengthening-nails-and-mri-compatibility
#11
Charles Gomez, Scott Nelson, Joshua Speirs, Samuel Barnes
BACKGROUND: Magnetic intramedullary nails (IMNs) are fully implantable lengthening devices that became available in the United States in 2011 for the correction of limb length discrepancies. This device represents a major advancement in the field of limb lengthening surgery as it is typically tolerated better than external fixation. Unlike traditional IMNs, surgeons recommend routine removal following limb lengthening. One such reason involves patient safety as it pertains to magnetic resonance imaging (MRI)...
August 1, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30045360/humeral-head-ossification-predicts-peak-height-velocity-timing-and-percentage-of-growth-remaining-in-children
#12
Don T Li, Jonathan J Cui, Stephen DeVries, Allen D Nicholson, Eric Li, Logan Petit, Joseph B Kahan, James O Sanders, Raymond W Liu, Daniel R Cooperman, Brian G Smith
BACKGROUND: Understanding skeletal maturity is important in the management of idiopathic scoliosis. Iliac apophysis, triradiate cartilage, hand, and calcaneal ossification patterns have previously been described to assess both peak height velocity (PHV) and percent growth remaining; however, these markers may not be present on standard spine radiographs. The purpose of this study was to describe a novel maturity assessment method based on proximal humeral epiphyseal ossification patterns...
July 24, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30036291/classifying-adverse-events-following-lower-limb-orthopaedic-surgery-in-children-with-cerebral-palsy-reliability-of-the-modified-clavien-dindo-system
#13
Leena Zhou, Kate Willoughby, Natalie Strobel, Pam Thomason, Charles Gallagher, Mela Harambasic, Abhay Khot, H Kerr Graham
BACKGROUND: The modified Clavien-Dindo (MCD) system is a reliable tool for classifying adverse events (AEs) in hip preservation surgery and has since been utilized in studies involving lower limb surgery for ambulant and nonambulant children with cerebral palsy (CP). However, the profile of AEs recorded in children with CP compared with typically developing children is different, and the reliability of the MCD in CP is unknown. This study aimed to evaluate the interrater and intrarater reliability of the MCD system for classifying AEs following lower limb surgery in children with CP...
July 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30036290/gram-stain-is-not-clinically-relevant-in-treatment-of-pediatric-septic-arthritis
#14
Joshua T Bram, Keith D Baldwin, Todd J Blumberg
BACKGROUND: The diagnosis of pediatric septic arthritis (SA) can be challenging due to wide variability in the presentation of musculoskeletal infection. Synovial fluid Gram stain is routinely obtained and often used as an initial indicator of the presence or absence of pediatric SA. The purpose of this study was to examine the clinical utility of the Gram stain results from a joint aspiration in the diagnosis and management of pediatric SA. METHODS: All patients with suspected SA who underwent arthrocentesis and subsequent surgical irrigation and debridement at an urban tertiary care children's hospital between January 2007 and October 2016 were identified...
July 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30036289/predictability-of-clinical-knowledge-through-mobile-app-based-simulation-for-the-treatment-of-pediatric-septic-arthritis-a-pilot-study
#15
Benjamin J Shore, Patricia E Miller, Kenneth J Noonan, Donald S Bae
BACKGROUND: Recently the American Board of Orthopaedic Surgery and the Accreditation Council of Graduate Medical Education have identified the treatment of septic arthritis of the hip in children as a milestone skill for all US orthopaedic residents. The purpose of this study was to test correlation between clinical knowledge and examination score on a mobile app-based training module for the treatment of pediatric septic hip arthritis. METHODS: A 4-part simulation model on surgical decision-making associated with the treatment of pediatric septic arthritis was developed through expert consensus...
July 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/30036288/the-sensitivity-and-specificity-of-preoperative-history-physical-examination-and-magnetic-resonance-imaging-to-predict-articular-cartilage-injuries-in-symptomatic-discoid-lateral-meniscus
#16
Brian C Lau, Toure Vashon, Abhinav Janghala, Nirav K Pandya
BACKGROUND: Discoid lateral meniscus (DLM) is a morphologic variant in which concomitant articular cartilage defects lead to poor outcomes. The purpose of this study was to quantify the prognostic ability of history, physical examination, and magnetic resonance imaging (MRI) to identify arthroscopically confirmed articular cartilage injury in pediatric and adolescent DLM patients. METHODS: An analysis of 34 consecutive patients (mean, 12.5 y) who underwent surgical treatment for DLM...
July 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29985868/range-of-motion-improvement-following-surgical-management-of-knee-arthrofibrosis-in-children-and-adolescents
#17
Peter D Fabricant, Frances A Tepolt, Mininder S Kocher
BACKGROUND: Arthrofibrosis of the knee is well-described in adults as a potentially debilitating postoperative complication following anterior cruciate ligament reconstruction, total knee arthroplasty, or fracture fixation. Knee arthrofibrosis in children and adolescents, however, has received little attention. The primary purpose of this study was to report improvements in range of motion (ROM) following lysis of adhesions and manipulation under anesthesia (LOA/MUA) in children and adolescents with knee arthrofibrosis, and, secondarily, to evaluate for any effect of preoperative dynamic splinting on ROM outcomes...
July 6, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29985867/hip-power-and-stiff-knee-gait-a-tool-for-identifying-appropriate-candidates-for-rectus-transfer
#18
Brunno L Moreira, Tasos Karakostas, Luciano S Dias
BACKGROUND: Rectus femoris transfer (RFT) is performed in children with cerebral palsy to treat stiff-knee gait. However, the results are variable in part because there is no gold standard to identify appropriate candidates. Hip flexion kinematics and kinetics are important factors in the determination of peak knee flexion during gait. This study aimed to evaluate whether a kinetic preoperative analysis of hip power can be a predictor of RFT outcomes and determine its usability for identifying appropriate candidates for the procedure...
July 6, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29979332/the-fragility-of-statistically-significant-results-in-pediatric-orthopaedic-randomized-controlled-trials-as-quantified-by-the-fragility-index-a-systematic-review
#19
Sariah Khormaee, Judy Choe, Joseph J Ruzbarsky, Kunal N Agarwal, John S Blanco, Shevaun M Doyle, Emily R Dodwell
BACKGROUND: The randomized controlled trial (RCT) is the gold standard study design allowing critical comparison of clinical outcomes while minimizing bias. Traditionally clinical trials are evaluated through statistical significance, expressed by P-values and confidence intervals. However, until recently, the robustness of a study's conclusions has been given little attention. A new metric, the fragility index, quantifies the number of patients theoretically required to switch outcomes in order to reverse the study conclusions...
July 3, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29975297/a-comparison-of-transphyseal-neck-head-tunneling-and-multiple-epiphyseal-drilling-on-femoral-head-healing-following-ischemic-osteonecrosis-an-experimental-investigation-in-immature-pigs
#20
Olumide O Aruwajoye, Felipe Monte, Audrey Kim, Harry K W Kim
BACKGROUND: Two operative procedures are currently advocated to stimulate the necrotic femoral head healing in children with Legg-Calve-Perthes disease: transphyseal neck-head tunneling (TNHT) and multiple epiphyseal drilling (MED). The purpose of this study was to compare the bone healing and physeal function after treatment with TNHT or MED in a piglet model of ischemic osteonecrosis. METHODS: Eighteen piglets were induced with osteonecrosis by surgically placing a ligature tightly around the right femoral neck...
July 2, 2018: Journal of Pediatric Orthopedics
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