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https://www.readbyqxmd.com/read/30179898/minimum-clinically-important-difference-current-trends-in-the-orthopaedic-literature-part-ii-lower-extremity-a-systematic-review
#1
Anne G Copay, Blake Eyberg, Andrew S Chung, Kenneth S Zurcher, Norman Chutkan, Mark J Spangehl
BACKGROUND: The minimum clinically important difference (MCID) attempts to define the patient's experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of the MCID calculation, so as to help practitioners to understand and utilize the MCID and to guide future efforts to calculate the MCID...
September 3, 2018: JBJS Reviews
https://www.readbyqxmd.com/read/30179897/minimum-clinically-important-difference-current-trends-in-the-orthopaedic-literature-part-i-upper-extremity-a-systematic-review
#2
Anne G Copay, Andrew S Chung, Blake Eyberg, Neil Olmscheid, Norman Chutkan, Mark J Spangehl
BACKGROUND: The minimum clinically important difference (MCID) attempts to define the patient's experience of treatment outcomes. Efforts at calculating the MCID have yielded multiple and inconsistent MCID values. The purposes of this review were to describe the usage of the MCID in the most recent orthopaedic literature, to explain the limitations of its current uses, and to clarify the underpinnings of MCID calculation. Subsequently, we hope that the information presented here will help practitioners to better understand the MCID and to serve as a guide for future efforts to calculate the MCID...
September 3, 2018: JBJS Reviews
https://www.readbyqxmd.com/read/30093334/a-structured-review-instrument-improves-the-quality-of-orthopaedic-journal-club
#3
Sean T Campbell, John P Kleimeyer, Jeffrey L Young, Michael J Gardner, Kirkham B Wood, Julius A Bishop
OBJECTIVE: We asked the following questions: 1. Does the use of an structured review instrument (SRI) at journal club increase presentation quality, as measured objectively by a standardized evaluation rubric? 2. Does SRI use increase the time required to prepare for journal club? 3. Does SRI use positively impact presenter perceptions about confidence while presenting, satisfaction, and journal club effectiveness, as measured by postparticipation surveys? DESIGN: A prospective study was designed in which a grading rubric was developed to evaluate journal club presentations...
August 7, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/30092107/pediatric-pelvic-ring-injuries
#4
Laura W Lewallen, Amy L McIntosh, S Andrew Sems
The purpose of this study was to determine whether pelvic fracture pattern is associated with transfusion requirements or concomitant injuries in pediatric patients. This was a single-institution, retrospective review from 1970 to 2000. Pelvic ring injuries were classified using the Orthopaedic Trauma Association system. Injury Severity Scores were assigned. Ninety patients were included in this study. There were 27 A-type (30.0%), 51 B-type (56.7%), and 12 C-type (13.3%) injuries. Mean Injury Severity Scores were 8...
August 9, 2018: Orthopedics
https://www.readbyqxmd.com/read/30084823/immobilization-versus-observation-in-children-with-toddler-s-fractures-a-retrospective-review
#5
COMPARATIVE STUDY
Lauren C Leffler, Stephanie L Tanner, Michael L Beckish
While long leg casts have been historically recommended for immobilization of toddler's fractures, short leg casts are often used by treating physicians. Others question whether any immobilization is necessary because of the internal stability provided by the thickened periosteum of pediatric bones. The purpose of this study is to review the results of toddler's fractures treated with long leg casts, short leg casts, or without immobilization. Eighty-five patients were included in a retrospective review of nondisplaced spiral or oblique tibial shaft fractures in children under 6 years old from 2007 to 2012...
December 0: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/30080771/increasing-brace-treatment-for-pediatric-distal-radius-buckle-fractures-using-quality-improvement-methodology-to-implement-evidence-based-medicine
#6
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/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
#7
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
#8
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...
October 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
#9
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...
September 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29975292/what-s-new-in-pediatric-orthopaedic-trauma-the-lower-extremity
#10
Kathleen D Rickert, Pooya Hosseinzadeh, Eric W Edmonds
BACKGROUND: Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity. METHODS: An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures...
September 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29917011/pigmented-villonodular-synovitis-of-the-knee-an-underappreciated-source-of-pain-in-children-and-adolescents
#11
Samuel Clifton Willimon, Michael T Busch, Crystal A Perkins
BACKGROUND: Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described in adults. The purpose of this study is to describe the presentation and management of a large single-center series of pediatric patients with PVNS of the knee. METHODS: A retrospective review was performed of consecutive pediatric patients treated for PVNS at a single institution from 2001 to 2016. Inclusion criteria were patients below 20 years of age with surgical treatment of histologically proven PVNS of the knee...
September 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29778751/cortical-erosion-after-elastic-stable-intramedullary-nail-fixation-for-pediatric-long-bone-fractures-case-series-according-to-the-site
#12
Kun-Bo Park, Je-Hyun Yoo, Seok Woo Kim, Yoon Hae Kwak
BACKGROUND: Elastic stable intramedullary nail (ESIN) is widely used for treatment of long bone fractures in children. However, migration of the nail or cortical bone erosion in children has been reported. This study was conducted to investigate the incidence of cortical erosion according to the site and cortical erosion type. MATERIALS AND METHODS: A total of 221 normally developing children (223 fractures) who were treated with ESIN for fractures of the long bones without cortical breakage at immediate postoperative radiography and with the ESIN in position for more than 6 months were included...
July 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29762118/pediatric-orthopaedic-consults-from-chiropractic-care
#13
Andy B Awwad, William L Hennrikus, Douglas G Armstrong
Alternative medicine in pediatrics is expanding, with chiropractic now a common choice for families seeking alternative medical care. Currently, there is sparse information in the literature exploring the role of chiropractic in orthopaedic pathology. The objective of this case series is to present pediatric patients who received treatment from chiropractors and orthopaedic physicians as well as to review the respective existing research. Data collected included chiropractic diagnosis, orthopaedic diagnosis, imaging studies, treatments, and complications...
December 0: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/29727412/evidence-based-medicine-in-pediatric-orthopaedics-evidence-based-practice-committee-summary-of-levels-of-evidence-clinical-practice-guidelines-appropriate-use-criteria-and-best-practice-guidelines
#14
Jigar S Gandhi, Kevin G Shea, Paul D Sponseller, Brian K Brighton, Theodore J Ganley
The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based guidelines, the American Academy of Orthopaedic Surgeons has instituted concerted efforts since 2006 to develop clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) for certain orthopaedic conditions. Many of these CPGs and AUCs detail the management of pediatric orthopaedic conditions...
July 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29698303/closed-reduction-osteotomy-and-fibular-graft-are-effective-in-treating-pediatric-femoral-neck-pseudarthrosis-after-infection
#15
Rajesh Kumar Kanojia, Sumit Gupta, Ajay Kumar, Bachha Kanakeya Reddy
BACKGROUND: When treatment of acute septic arthritis of the hip is delayed, severe sequelae can occur. This may take the form of coxa breva, vara, or valga. Pseudoarthrosis of the femoral neck is a rare complication with only a few studies to guide treatment. QUESTION/PURPOSES: In a small series of patients with pseudarthrosis of the femoral neck after acute septic arthritis, we wanted to determine (1) whether femoral neck union can be achieved using a variety of surgical approaches; (2) whether these patients satisfied criteria outlined by Hunka and Choi, defined as a stable hip, a flexion arc ≥ 70° and no fixed adduction or abduction contractures, fixed flexion deformity not more than 20°, pain relief, and restoration of activities of daily living after surgery; and (3) any treatment-related complications if observed...
July 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29664879/surgical-treatment-of-supracondylar-humeral-fractures-in-a-freestanding-ambulatory-surgery-center-is-as-safe-as-and-faster-and-more-cost-effective-than-in-a-children-s-hospital
#16
Carson M Rider, Victor Y Hong, Timothy J Westbrooks, Jiajing Wang, Benjamin W Sheffer, Derek M Kelly, David D Spence, John M Flynn, Jeffrey R Sawyer
BACKGROUND: Despite an 88% increase in the number of pediatric fractures treated in ambulatory surgery centers (ASCs) over a 10-year period, few studies have compared outcomes of fracture treatment performed in a freestanding ASC compared with those performed in the hospital (HOSP) or hospital outpatient department (HOPD). The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of Gartland type II supracondylar humeral (SCH) fracture in the ASC, HOSP, and HOPD...
July 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29664878/c2-translaminar-screw-fixation-in-children
#17
Brian W Yang, Michael P Glotzbecker, Michael Troy, Mark R Proctor, Michael T Hresko, Daniel J Hedequist
BACKGROUND: Axis (C2) screw fixation has been shown to be effective in treating disorders that necessitate cervical stabilization. Although translaminar C2 screws have demonstrated clinical efficacy in adults, this technique has not yet been thoroughly investigated in children. This study describes the indications, technique, and results of translaminar C2 screw fixation in a case series of pediatric cervical spine disorders. METHODS: We searched the orthopaedic database at our institution for patients who had undergone a cervical spinal fusion that encompassed C2 between 2007 and 2017...
July 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29581924/distinguishing-pediatric-lyme-arthritis-of-the-hip-from-transient-synovitis-and-acute-bacterial-septic-arthritis-a-systematic-review-and-meta-analysis
#18
Aristides I Cruz, Jason B Anari, Jose M Ramirez, Wudbhav N Sankar, Keith D Baldwin
Objective Lyme arthritis is an increasingly recognized clinical entity that often prompts orthopaedic evaluation in pediatric patients. While Lyme arthritis is most common in the knee, the clinical presentation of Lyme arthritis of the hip can be similar to both acute bacterial septic arthritis and transient synovitis. Accurately distinguishing these clinical entities is important since the definitive treatment of each is distinct. Because there is limited literature on monoarticular Lyme arthritis of the hip, the purpose of this study was to perform a systematic review and meta-analysis of clinical and laboratory parameters associated with Lyme arthritis (LA) of the hip and compare them to septic arthritis (SA) and transient synovitis (TS)...
January 25, 2018: Curēus
https://www.readbyqxmd.com/read/29554020/what-s-new-in-pediatric-hip
#19
Matthew R Schmitz, Todd J Blumberg, Susan E Nelson, Julieanne P Sees, Wudbhav N Sankar
BACKGROUND: Developmental dysplasia of the hip (DDH), which encompasses a wide spectrum of disease from mild dysplasia to frank dislocation, is one of the most common developmental deformities of the lower extremities and one of the leading causes of future osteoarthritis and hip arthroplasty. Legg-Calvé-Perthes disease (LCPD) results from a vascular insult to the growing femoral epiphysis, which in turn can create permanent morphologic changes to the hip joint. Slipped capital femoral epiphysis (SCFE) occurs when the proximal femoral physis fails allowing the epiphysis to displace in relation to the metaphysis...
July 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29509609/using-the-medial-and-lateral-humeral-lines-as-an-adjunct-to-intraoperative-elbow-arthrography-to-guide-intraoperative-reduction-and-fixation-of-distal-humerus-physeal-separations-reduces-the-incidence-of-postoperative-cubitus-varus
#20
Andrew Chia Chen Chou, Ho Yin Kevin Wong, Sumanth Kumar, Arjandas Mahadev
BACKGROUND: Distal humerus physeal separations are rare pediatric elbow fractures that are often misdiagnosed and difficult to treat. Adequate reduction is often technically challenging and up to 71% of children develop postoperative cubitus varus. We propose using the medial and lateral humeral lines as an adjunct to elbow arthrography in order to guide intraoperative fixation of distal humerus physeal separations to reduce the incidence of postoperative cubitus varus. METHODS: From 2009 to 2014, all pediatric patients under the age of 3 diagnosed with a distal humerus physeal separation and treated surgically at our institution were included for analysis...
May 2018: Journal of Pediatric Orthopedics
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