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https://www.readbyqxmd.com/read/29210908/does-using-pas-in-the-closed-treatment-of-pediatric-forearm-fractures-increase-malunion-risk
#1
Stephanie Garrison, Emily A Eismann, Roger Cornwall
PURPOSE: This study assessed whether using physician assistants (PAs) for fracture follow-up during nonoperative management of pediatric forearm fractures was associated with an increased risk of malunion. METHODS: The study was a retrospective review of charts of 141 children under age 18 years who were treated nonoperatively in the division of orthopedics over 12 months for forearm fractures. The effect of type and number of follow-up providers on risk of malunion was determined and controlled for fracture type, location, and initial angulation...
December 2017: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/29189532/pediatric-supracondylar-humerus-fractures-aaos-appropriate-use-criteria-versus-actual-management-at-a-pediatric-level-1-trauma-center
#2
Joanne H Wang, William Z Morris, Blaine T Bafus, Raymond W Liu
OBJECTIVES: The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations. METHODS: A query revealed 556 patients with diagnoses of SCHF between 2013 and 2015 at a pediatric level 1 trauma center. Patients were excluded if they were younger than 2 years of age, older than 12 years of age, were polytrauma patients, or if there was not sufficient clinical or radiographic documentation, resulting in 449 patients...
November 16, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29135565/pediatric-and-adolescent-anterior-shoulder-instability-clinical-management-of-first-time-dislocators
#3
Kenneth M Lin, Evan W James, Elad Spitzer, Peter D Fabricant
PURPOSE OF REVIEW: The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. RECENT FINDINGS: Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed...
November 11, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29099471/is-an-operation-always-needed-for-pediatric-triplane-fractures-preliminary-results
#4
Seung Min Ryu, Jae Woo Park, Se Dong Kim, Chul Hyun Park
We compared the outcomes of nonoperative and operative treatments of triplane fractures. Thirty-three patients with triplane fractures were treated conservatively (n=19) or surgically (n=14). Bone union and postoperative complications were radiographically examined. The mean American Orthopedic Foot and Ankle Society scores were 100 (nonoperative group) and 98.1 (operative group) (P=0.304). The modified Weber protocol scores were excellent in both groups. One patient in each group showed a leg-length discrepancy of more than 10 mm at the last follow-up...
November 2, 2017: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/29078712/management-modalities-and-outcomes-following-acute-scaphoid-fractures-in-children-a-quantitative-review-and-meta-analysis
#5
Ashkaun Shaterian, Pauline Joy F Santos, Christine J Lee, Gregory R D Evans, Amber Leis
BACKGROUND: Early evaluation and appropriate management of pediatric scaphoid fractures are necessary to avoid complications. To date, current management of pediatric fractures varies among providers. The objective of this study was to compare clinical outcomes following different treatment modalities. METHODS: A PubMed literature search identified studies involving acute scaphoid fractures in children. Studies were evaluated for treatment provided and their respective effects on union rate, wrist range of motion, and wrist pain...
October 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/29053500/the-community-orthopaedic-surgeon-taking-trauma-call-pediatric-femoral-shaft-fracture-pearls-and-pitfalls
#6
J Eric Gordon, Charles T Mehlman
Pediatric femoral shaft fractures present many challenging patient care decisions. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention is commonplace in virtually all older children. Treatment is determined primarily by patient age as modified by clinical factors including mechanism of injury, weight, and skeletal maturity. Infants can be successfully treated by placement into a Pavlik harness, whereas children younger than 5 years are most commonly treated by early reduction and spica cast immobilization...
November 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29053498/the-community-orthopaedic-surgeon-taking-trauma-call-pediatric-forearm-shaft-fracture-pearls-and-pitfalls
#7
Martin J Herman, Matthew Simon, Charles T Mehlman
Pediatric forearm shaft fractures are the third most common fracture in children, and the forearm is the third most mobile joint in the body (with a nearly 180 degree arc of motion). The goals of treatment are aimed squarely at achieving satisfactory anatomic alignment (within defined parameters) as the consequences of malunion can be permanent forearm stiffness and deformity. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention has become increasingly common in older children...
November 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29049268/patient-and-parent-satisfaction-with-sling-use-after-pediatric-upper-extremity-fractures-a-randomized-controlled-trial-of-a-customized-cast-sling-versus-standard-cast-and-sling
#8
Aristides I Cruz, Steven F DeFroda, Joseph A Gil, Heather Hansen, Alexandre Bolous, Michaela Procaccini, Mark R Zonfrillo
BACKGROUND: Long arm cast immobilization after operative and nonoperative treatment of pediatric upper extremity fractures is common. The use of a sling to aid in carrying the casted extremity as well as provide further immobilization is also common practice. Off-the-shelf slings vary in quality and fit, can be confusing for parents/patients to apply, and lead to frustration and dissatisfaction with its use. The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial...
October 18, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28763414/capitellar-fractures-in-children-and-adolescents-classification-and-early-results-of-treatment
#9
Praveen G Murthy, Carley Vuillermin, Manahil N Naqvi, Peter M Waters, Donald S Bae
BACKGROUND: There has been limited published information regarding capitellar fractures in the pediatric population. The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes. METHODS: A retrospective analysis of 37 children and adolescents with capitellar fractures presenting to a tertiary pediatric hospital from 2004 to 2014 was performed. The mean patient age at the time of injury was 11...
August 2, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28720982/single-incision-pediatric-flexible-intramedullary-tibial-nailing
#10
John G Coury, Zachary C Lum, Nicholas P O'Neill, Joseph A Gerardi
BACKGROUND: There has been a trend towards flexible intramedullary nailing for unstable tibial shaft fractures in the pediatric population, traditionally, utilizing a 2-incision technique with passage of one nail medially and one nail laterally. Our study aims to compare a single incision approach for flexible nailing of unstable tibial shaft fractures in pediatric patients to the traditional 2-incision approach. METHODS: Patients were selected for operative fixation if they had a length unstable tibial shaft fracture confirmed by fluoroscopy...
September 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28593062/elastic-intramedullary-nailing-of-a-medial-clavicle-fracture-in-a-pediatric-patient
#11
Michael J Stark, Michael J DeFranco
INTRODUCTION: Injuries to the medial clavicle in pediatric patients typically involve the physis and/or sternoclavicular joint. Clavicle fractures are one of the most common injuries in children, but ones at its medial end are rare. Most medial clavicle fractures are treated nonoperatively, but surgery is indicated in some cases. This original case report is unique in describing the use of an elastic intramedullary nail for fixation of a completely displaced medial clavicle fracture in a pediatric patient...
2017: Case Reports in Orthopedics
https://www.readbyqxmd.com/read/28520680/acute-pediatric-monteggia-fractures-a-conservative-approach-to-stabilization
#12
Ian Foran, Vidyadhar V Upasani, Charles D Wallace, Elise Britt, Tracey P Bastrom, James D Bomar, Andrew T Pennock
BACKGROUND: In 2015, a multicenter study group proposed a treatment algorithm for pediatric Monteggia fractures based upon the ulnar fracture pattern. This strategy recommends surgical stabilization for all complete ulna fractures. The purpose of this study was to evaluate whether an initial nonoperative approach to pediatric Monteggia fractures resulted in poorer outcomes and a higher rate of complications. METHODS: This institutional review board approved retrospective study evaluated all Monteggia fractures presenting to a level 1 pediatric trauma center between 2008 and 2014...
September 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28441278/the-utility-of-routine-postoperative-radiographs-after-pinning-of-pediatric-supracondylar-humerus-fractures
#13
Vytas P Karalius, Jacob Stanfield, Philip Ashley, Laura W Lewallen, Casey M DeDeugd, Janet Walker, Annalise N Larson, Todd A Milbrandt
BACKGROUND: The purpose of this study was to determine the frequency with which postoperative radiographs resulted in a change in management following closed reduction and percutaneous pinning of displaced pediatric supracondylar humerus fractures. We hypothesize that only the initial postoperative radiograph will lead to changes in management of operative supracondylar humerus fractures. METHODS: A retrospective review was performed at 2 level I pediatric trauma centers...
July 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
#14
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/28288080/management-of-pediatric-type-i-open-fractures-in-the-emergency-department-or-operating-room-a-multicenter-perspective
#15
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
https://www.readbyqxmd.com/read/28027145/chance-fractures-in-the-pediatric-population-are-often-misdiagnosed
#16
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/27898493/complex-monteggia-fracture-in-a-5-year-old
#17
Tyler R Clark, Daniel S Merriott, Joseph A Gonzales
Monteggia fractures comprise a small subset of fractures in the pediatric population that are normally reduced nonoperatively. Complex Monteggia fractures can be more difficult to identify and require operative intervention. We describe a case of a Bado type I Monteggia fracture with a posteriorly dislocated radial head and neck fracture that has not been described before in the literature. The patient required advanced imaging because of ossification delays and led to an operative intervention to reduce the radial head and neck...
January 2017: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/27861213/what-s-new-in-pediatric-medial-epicondyle-fractures
#18
Jennifer J Beck, Richard E Bowen, Mauricio Silva
BACKGROUND: Medial epicondyle fractures are predominantly seen in adolescent, male patients. Historically, nonoperative intervention was the mainstay of treatment. With increasing upper extremity demands of young athletes and reports of valgus instability after nonoperative treatment, there has been an increased interest in operative indications. Controversy regarding proper imaging and measurement of displacement complicates decision-making algorithms. Review of recent literature is required for improved decision making...
November 17, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27741036/outcomes-of-nonoperative-pediatric-medial-humeral-epicondyle-fractures-with-and-without-associated-elbow-dislocation
#19
REVIEW
Derrick M Knapik, Cameron L Fausett, Allison Gilmore, Raymond W Liu
BACKGROUND: Medial epicondyle fractures may occur in isolation or with associated elbow dislocation. In the absence of open fracture or fragment incarceration, nonoperative management with immobilization has been shown to result in generally successfully outcomes comparable with those reported after surgical fixation. However, no comparative investigation has assessed outcomes after nonoperative treatment based on the presence or absence of elbow dislocation. METHODS: A systematic review was conducted investigating all studies in the literature reporting nonoperative outcomes for isolated medial epicondyle fractures and fracture-dislocations...
June 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27686572/fractures-of-the-axis-a-review-of-pediatric-adult-and-geriatric-injuries
#20
REVIEW
Megan E Gornet, Michael P Kelly
Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with high-energy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery...
December 2016: Current Reviews in Musculoskeletal Medicine
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