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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/28399047/assessing-quality-and-safety-in-pediatric-supracondylar-humerus-fracture-care
#2
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/28374350/teaching-the-basics-development-and-validation-of-a-distal-radius-reduction-and-casting-model
#3
Mark A Seeley, Peter D Fabricant, J Todd R Lawrence
BACKGROUND: Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool. QUESTIONS/PURPOSES: Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement...
April 3, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28328564/variation-in-national-acgme-case-log-data-for-pediatric-orthopaedic-fellowships-are-fellow-coding-practices-responsible
#4
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/28244925/variation-among-pediatric-orthopaedic-surgeons-when-diagnosing-and-treating-pediatric-and-adolescent-distal-radius-fractures
#5
Karan Dua, Matthew K Stein, Nathan N O'Hara, Brian K Brighton, William L Hennrikus, Martin J Herman, J Todd Lawrence, Charles T Mehlman, Norman Y Otsuka, M Wade Shrader, Brian G Smith, Paul D Sponseller, Joshua M Abzug
BACKGROUND: Distal radius fractures are the most common injury in the pediatric population. The purpose of this study was to determine the variation among pediatric orthopaedic surgeons when diagnosing and treating distal radius fractures. METHODS: Nine pediatric orthopaedic surgeons reviewed 100 sets of wrist radiographs and were asked to describe the fracture, prescribe the type of treatment and length of immobilization, and determine the next follow-up visit...
February 27, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28241727/-analysis-of-outcomes-of-one-stage-operation-for-treatment-of-late-diagnosed-developmental-dysplasia-of-hip
#6
Y Liu, J Sun
Objective: To evaluate and identify the middle-term results of one-stage open reduction of patients in late-diagnosed developmental dysplasia of the hip, and to explore the best age group for treatment. Methods: A total number of 311 patients (390 hips) with LDDH in Department of Pediatric Orthopaedic of Anhui Provincial Children's Hospital from June 2006 to December 2010 were retrospectively reviewed. The patients were divided into 3 groups according to age at the start of surgical treatment: 1.5-2.5 years, 2...
March 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28213747/bone-morphogenetic-protein-2-for-the-treatment-of-congenital-pseudarthrosis-of-the-tibia-or-persistent-tibial-nonunion-in-children-and-adolescents-a-retrospective-study-with-a-minimum-2-year-follow-up
#7
Tim N Hissnauer, Norbert Stiel, Kornelia Babin, Martin Rupprecht, Michael Hoffmann, Johannes M Rueger, Ralf Stuecker, Alexander S Spiro
There is a lack of studies reporting on rhBMP-2 application in pediatric orthopaedics, although few reports demonstrated promising results of the use of rhBMP-2 in children, especially for spine fusion and for the treatment of congenital pseudarthrosis of the tibia. The objectives of this study were (1) to examine clinical and radiographic healing after rhBMP-2 application for the treatment of congenital pseudarthrosis of the tibia (CPT) or persistent tibial nonunion in children and adolescents, and (2) to investigate the safety of rhBMP-2 use in these cases...
April 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/28208961/fracture-supracondylar-humerus-a-review
#8
REVIEW
Vineet Kumar, Ajai Singh
Fracture supracondylar humerus is one of the most common fractures encountered in pediatric age group at all levels (both rural and urban). Thus it needs a special review in its management protocol as per the changing trend. Modified Gartland classification is the most accepted classification and has its importance in decision making regarding management and prognosis. Neurovascular complications are mostly associated with Type III A, III B and Type IV variety and they most of the time need surgical intervention for stabilization, exploration of brachial artery, sometimes median nerve exploration and reduction of fracture...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28178918/global-health-training-among-u-s-residency-specialties-a-systematic-literature-review
#9
Duncan K Hau, Luke R Smart, Jennifer I DiPace, Robert N Peck
BACKGROUND: Interest in global health training during residency is increasing. Global health knowledge is also becoming essential for health-care delivery today. Many U.S. residency programs have been incorporating global health training opportunities for their residents. We performed a systematic literature review to evaluate global health training opportunities and challenges among U.S. residency specialties. METHODS: We searched PubMed from its earliest dates until October 2015...
2017: Medical Education Online
https://www.readbyqxmd.com/read/28165797/strategies-of-enhancing-bone-regenerate-formation-in-distraction-osteogenesis
#10
Mohammad Mesfer Alzahrani, Emad Anam, Saad M AlQahtani, Asim M Makhdom, Reggie C Hamdy
Distraction osteogenesis (DO) is a commonly used technique in multiple orthopedic specialties, including trauma, oncology and pediatrics. This technique aims to produce new bone formation in the distraction gap in a controlled manner. The issue with this technique has been the high risk of complications, one of which is poor regenerate formation during the distraction process. Although several factors (including patient and operative factors) and techniques (including surgical, mechanical and pharmacological) have been described to ensure successful regenerate formation during the process of DO, these factors are sometimes difficult to control clinically...
February 6, 2017: Connective Tissue Research
https://www.readbyqxmd.com/read/28107301/implementation-of-a-pediatric-orthopaedic-bundle-to-reduce-surgical-site-infections
#11
Jan Schriefer, James Sanders, Julie Michels, Kori Wolcott, Connor Ruddy, Jenna Hanson
Surgical site infections (SSIs) cost an estimated $27,288 per case. An analysis of the National Surgical Quality Improvement Program data at the University of Rochester Medical Center suggested that rates of SSIs could be lowered in comparison with both peers and baseline. The aim of this study was to reduce the number of SSIs to zero through the implementation of a "bundle" or a combination of practices. Meetings were held with the multidisciplinary care team that includes surgeons and staff from pediatric pharmacy, pediatric infectious diseases, anesthesia, and nursing to create a care bundle for all pediatric orthopaedic surgery patients...
January 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28106673/outcomes-of-pediatric-fractures-managed-with-closed-reduction-by-orthopaedic-residents-in-the-emergency-department
#12
Vivek Natarajan, Ermias Abebe, James Dunlap, Patrick Bosch, Ozgur Dede, W Timothy Ward, James Roach
BACKGROUND: Closed reduction of pediatric fractures is commonly performed by orthopaedic residents using conscious sedation in the emergency department (ED). The purpose of this study was to determine the rate of satisfactory reductions as performed by residents, and to determine the outcomes of these procedures. METHODS: A retrospective review was performed of all fractures that underwent closed reduction under conscious sedation in the ED of a level 1 pediatric trauma center between January 1, 2010 and November 30, 2014...
January 18, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28027145/chance-fractures-in-the-pediatric-population-are-often-misdiagnosed
#13
Lindsay M Andras, Kira F Skaggs, Haleh Badkoobehi, Paul D Choi, David L Skaggs
BACKGROUND: Flexion injuries of the spine range from mild compression fractures to severe flexion-distraction injuries, that is, Chance fractures. Chance fractures are often unstable and Arkader and colleagues demonstrated improved outcomes when Chance fractures are treated operatively compared with those managed nonoperatively. METHODS: A retrospective review was conducted of all patients treated over a 5-year period (2008 to 2013) for a flexion injury, either a Chance or a compression fracture, of the thoracolumbar spine at our tertiary pediatric level I trauma center...
December 23, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28009800/is-there-value-in-having-radiology-provide-a-second-reading-in-pediatric-orthopaedic-clinic
#14
Vivek Natarajan, Patrick Bosch, Ozgur Dede, Vincent Deeney, Stephen Mendelson, Timothy Ward, Maria Brooks, Tanya Kenkre, James Roach
BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic...
December 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28009798/vitamin-d-deficiency-the-missing-etiological-factor-in-the-development-of-juvenile-osteochondrosis-dissecans
#15
Gerrit S Maier, Djordje Lazovic, Uwe Maus, Klaus E Roth, Konstantin Horas, Jörn B Seeger
BACKGROUND: Vitamin D deficiency can result in rickets and hypocalcemia during infant and childhood growth. There is an increasing interest in the role of vitamin D with regards to childhood bone health. Osteochondrosis dissecans (OD) is a common disease affecting different joints. To date, the exact etiology of OD still remains unclear. The aim of this study was to evaluate a possible association of vitamin D deficiency and juvenile OD. METHODS: A retrospective chart review of the years 2010 to 2015 of all orthopaedic patients with an initial diagnosis of juvenile OD admitted to undergo operative treatment of the OD was performed...
December 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28009797/what-s-new-in-congenital-scoliosis
#16
Joshua M Pahys, James T Guille
BACKGROUND: Congenital scoliosis is a failure of vertebral formation, segmentation, or a combination of the 2 arising from abnormal vertebral development during weeks 4 to 6 of gestation. The associated spinal deformity can be of varying severity and result in a stable or progressive deformity based on the type and location of the anomalous vertebra(e). Bracing for congenital scoliosis is rarely indicated, while recent reports have demonstrated the utility of serial derotational casting for longer curves with multiple anomalous vertebrae as an effective "time buying strategy" to delay the need for surgery...
December 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27979366/does-the-saline-load-test-still-have-a-role-in-the-orthopaedic-world-a-systematic-review-of-the-literature
#17
REVIEW
Benjamin B Browning, Anthony V Ventimiglia, Anant Dixit, Emmanuel Illical, William P Urban, Julio J Jauregui
INTRODUCTION: The aim of this systematic review was to assess the efficacy of Saline load tests (SLTs) to evaluate extension of periarticular wounds into capsule in emergent settings. METHODS: We systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle. RESULTS: The SLT values to determine knee arthrotomies vary from 73.8 mL to 194 mL with sensitivities ranging between 91% and 99% depending on the size of the laceration...
December 2016: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/27977498/evaluation-of-pediatric-questions-on-the-orthopaedic-in-training-examination-an-update
#18
Robert F Murphy, Leah Nunez, William R Barfield, James F Mooney
BACKGROUND: Pediatric orthopaedics is tested frequently on the Orthopaedic In-Training Examination (OITE). The most recent data on the pediatrics section of the OITE were generated from content 10 years old. The purpose of this study is to assess the pediatric orthopaedic questions on the 2011 to 2014 OITE, and to compare question categories and cognitive taxonomy with previous data. METHODS: Four years (2011 to 2014) of OITE questions, answers, and references were reviewed...
December 13, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27917331/percutaneous-cannulated-screw-fixation-for-pediatric-epiphyseal-ankle-fractures
#19
Özgür Çiçekli, Güzelali Özdemir, Mustafa Uysal, Vedat Biçici, İzzet Bingöl
BACKGROUND: Ankle injuries are among the most common injuries in children. The aim of this study was to compare the efficacies of two percutaneous fixation methods after closed reduction in physeal ankle fractures. METHODS: We reviewed the cases of 24 patients with a mean age of 12.29 years; 16 were male, and 8 were female. Only patients with fractures of Salter-Harris types 2, 3, and 4 with displacements greater than 2 mm were included in the study. Patients were treated with closed reduction manipulation and percutaneous screw fixation...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27826907/the-unstable-knee-in-congenital-limb-deficiency
#20
REVIEW
Gabriel T Mindler, Christof Radler, Rudolf Ganger
PURPOSE: Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee...
December 2016: Journal of Children's Orthopaedics
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