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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
#1
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/29975292/what-s-new-in-pediatric-orthopaedic-trauma-the-lower-extremity
#2
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...
July 2, 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
#3
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...
June 18, 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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/29489736/current-state-of-the-opioid-epidemic-as-it-pertains-to-pediatric-orthopaedics-from-the-advocacy-committee-of-the-pediatric-orthopaedic-society-of-north-america
#13
Ellen M Raney, Harold J P van Bosse, Kevin G Shea, Joshua M Abzug, Richard M Schwend
INTRODUCTION: The opioid epidemic in the United States has reached crisis proportions. Urgent response is needed. Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States. The most common source of opioids available for misuse is the unused portions of postoperative prescriptions. Among high school seniors, 80% of those who reported nonmedical use of prescription opioids previously had legitimate prescriptions but recreationally used leftover doses...
May 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29409070/orthopaedic-fixation-devices-used-in-children-a-radiologist-s-guide
#14
Hailey Allen, Kirkland W Davis, Kenneth Noonan, Yoshimi Endo, Jie C Nguyen
Fractures are common in children with some requiring surgical reduction and fixation to maintain anatomical alignment. Although various surgical techniques and principles are shared between children and adults, certain unique considerations in children can influence the surgical approach and device selection. In particular, for skeletally immature children, it is of utmost importance to protect certain critical open growth plates because permanent injury can produce severe growth disturbances. The often robust healing response and potential limited patient compliance can also influence the treatment algorithm and decision making...
February 2018: Seminars in Musculoskeletal Radiology
https://www.readbyqxmd.com/read/29409066/extensor-mechanism-injury-in-the-pediatric-population-a-clinical-review
#15
William Cody Sessions, Matthew Herring, Walter H Truong
The extensor mechanism of the knee-consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament-is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis...
February 6, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29369894/is-the-appropriate-use-criteria-for-type-ii-supracondylar-humerus-fractures-really-appropriate
#16
Mauricio Silva, Erin M Delfosse, Howard Park, Hemali Panchal, Edward Ebramzadeh
INTRODUCTION: The Appropriate Use Criteria for the treatment of supracondylar humerus fractures (SCHFs), developed by American Academy of Orthopaedic Surgeons, recommends pinning for all type II SCHFs. However, previous studies have suggested that, with close follow-up some of the less severe type II SCHF's can be successfully treated without surgery. Our purpose was to analyze data collected prospectively on a large cohort of type II SCHF's. METHODS: We reviewed clinical and radiographic information on all type II pediatric SCHF (n=1120) that were enrolled in a prospective registry and were followed for a minimum of 8 weeks...
January 24, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29360659/high-risk-of-mismatch-between-sanders-and-risser-staging-in-adolescent-idiopathic-scoliosis-are-we-guiding-treatment-using-the-wrong-classification
#17
Anas Minkara, Nicole Bainton, Masashi Tanaka, Justin Kung, Christopher DeAllie, Alexandra Khaleel, Hiroko Matsumoto, Michael Vitale, Benjamin Roye
BACKGROUND: Despite known limitations, Risser staging has traditionally been the primary marker of skeletal maturity utilized in decision-making for treatment of adolescent idiopathic scoliosis (AIS). The purpose of this study is to assess the incidence and factors associated with mismatch between Risser Staging and Sanders classification, and determine interobserver reliability. METHODS: We reviewed the medical records of consecutive patients aged 10 to 18 referred to our institution for evaluation of AIS from January to June 2016 with a closed triradiate cartilage...
January 22, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29329145/orthopaedic-management-of-leg-length-discrepancy-in-proteus-syndrome-a-case-series
#18
Molly M Crenshaw, Cara G Goerlich, Lauren E Ivey, Julie C Sapp, Kim M Keppler-Noreuil, Allison C Scott, Leslie G Biesecker, Laura L Tosi
INTRODUCTION: Proteus syndrome (PS) is a rare mosaic disorder comprising asymmetric bony and soft tissue overgrowth leading to significant morbidity. Placement of growth inhibition hardware with subsequent epiphyseal arrest improves leg-length and angular deformities in pediatric patients without PS. The purpose of this study was to review the surgical approach and present outcomes, complications, and recommendations in 8 patients with PS and leg-length discrepancy (LLD). METHODS: We conducted a retrospective chart review of 8 patients with PS whose primary reason for surgery was LLD...
March 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29324529/inappropriately-timed-pediatric-orthopaedic-referrals-from-the-emergency-department-result-in-unnecessary-appointments-and-financial-burden-for-patients
#19
Taylor J Jackson, Todd J Blumberg, Apurva S Shah, Wudbhav N Sankar
BACKGROUND: Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system...
March 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29324526/do-professional-society-advocacy-campaigns-have-an-impact-on-pediatric-orthopaedic-injuries
#20
Alexa J Karkenny, Denver A Burton, Kathleen J Maguire, Regina Hanstein, Norman Y Otsuka
PURPOSE: The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) both advocate for childhood injury prevention by publishing recommendations to orthopaedic surgeons, pediatricians, and the public. Popular topics of advocacy campaigns have included trampolines, all-terrain vehicles (ATVs), and lawnmowers. The purpose of this study was to investigate the temporal relationship between AAOS/AAP advocacy and pediatric orthopaedic injury rates, using these topics as examples...
March 2018: Journal of Pediatric Orthopedics
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