Pub Date : 2020-01-01DOI: 10.1097/BPB.0000000000000649
Brian J Deignan, S. Washburn, Emily Pilc, H. R. Tuten
The objective of this study is to present the clinical and radiographic data collected from patients who were treated with a varus derotational osteotomy using Rush rod fixation and compare this to published norms of outcomes using blade plate fixation. A retrospective chart and radiograph review was conducted after identifying 44 patients with 61 hips who underwent varus derotational osteotomy with Rush rod fixation at our institution between 2006 and 2016. We identified 44 patients with 61 hips who underwent the procedure. Information from follow-up clinic visits was gathered and any complications were noted. The patients' radiographs were analyzed to measure neck-shaft angle, center-edge angle, and acetabular index. At the time of surgery, 44 patients (61 hips) also had soft tissue releases performed, 44 (61 hips) had an open reduction of the hip, and 39 (55 hips) had Dega acetabular osteotomies performed as well. The average pre-operative neck-shaft angle was measured at 163.0° (range 128-180) with average post-operative neck-shaft angles measuring 111.3° (range 85-167). The acetabular index improved from an average of 33.3° (range 16-60) to 16.4 (range 4-35). Post-operative Center-Edge Angle measured 29.7° (range 5-45). There were no infections or cases of avascular necrosis of the femoral head. We present an alternative fixation method for performing varus derotational osteotomy of the proximal femur in children with cerebral palsy using the Rush rod. In our retrospective analysis of 61 hips undergoing this procedure, we present comparable radiographic outcomes with decreased complication rates. Level of evidence: Retrospective comparative study to previously published results, Level III.
{"title":"An alternative fixation method for femoral varus derotational osteotomy in spastic cerebral palsy: the Rush rod.","authors":"Brian J Deignan, S. Washburn, Emily Pilc, H. R. Tuten","doi":"10.1097/BPB.0000000000000649","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000649","url":null,"abstract":"The objective of this study is to present the clinical and radiographic data collected from patients who were treated with a varus derotational osteotomy using Rush rod fixation and compare this to published norms of outcomes using blade plate fixation. A retrospective chart and radiograph review was conducted after identifying 44 patients with 61 hips who underwent varus derotational osteotomy with Rush rod fixation at our institution between 2006 and 2016. We identified 44 patients with 61 hips who underwent the procedure. Information from follow-up clinic visits was gathered and any complications were noted. The patients' radiographs were analyzed to measure neck-shaft angle, center-edge angle, and acetabular index. At the time of surgery, 44 patients (61 hips) also had soft tissue releases performed, 44 (61 hips) had an open reduction of the hip, and 39 (55 hips) had Dega acetabular osteotomies performed as well. The average pre-operative neck-shaft angle was measured at 163.0° (range 128-180) with average post-operative neck-shaft angles measuring 111.3° (range 85-167). The acetabular index improved from an average of 33.3° (range 16-60) to 16.4 (range 4-35). Post-operative Center-Edge Angle measured 29.7° (range 5-45). There were no infections or cases of avascular necrosis of the femoral head. We present an alternative fixation method for performing varus derotational osteotomy of the proximal femur in children with cerebral palsy using the Rush rod. In our retrospective analysis of 61 hips undergoing this procedure, we present comparable radiographic outcomes with decreased complication rates. Level of evidence: Retrospective comparative study to previously published results, Level III.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80685805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-29DOI: 10.1097/BPB.0000000000000697
Christine A. Ho, D. Podeszwa, A. Riccio, R. Wimberly, Brandon A. Ramo, Mary Yang, Surekha Patel
This pilot study was performed to describe changes in arterial flow in completely displaced neurovascularly intact Gartland III pediatric supracondylar humerus fractures using Duplex ultrasonography. This is a prospective study of 11 Gartland type III supracondylar humerus fractures with no cortical continuity but with palpable radial pulse and normal neurologic examination. Duplex ultrasonography was performed on injured and uninjured arms, both preoperatively and postpinning, and interpreted by a board-certified pediatric radiologist. Degree of artery stenosis and peak systolic velocity (PSV) of arterial flow were recorded from the duplex. Ultrasound wrist/brachial indexes (WBI) were calculated using the higher value of the radial/brachial or the ulnar/brachial index. Only three patients had normal Duplexes without stenosis and with flow comparable in the brachial, radial, and ulnar arteries of the affected arm, compared to the unaffected arm, both preoperatively and postpinning. One group of six patients had brachial artery stenosis at the fracture site when compared to the artery proximal to the fracture site, increased PSV at the fracture site compared to proximal to the fracture site, and the WBI was variable when compared to the contralateral side. A third group of two patients also had brachial artery stenosis at the fracture site but had decreased PSV and decreased WBI compared to the contralateral side. Type III supracondylar humerus patients with a normal neurovascular examination may have abnormal Duplex ultrasonography with brachial artery stenosis and elevated peak systolic velocity preoperatively although distal flow remains comparable to the contralateral side. Level of evidence: prognostic – Level II.
{"title":"Pathologic arterial changes in neurovascularly intact Gartland III supracondylar humerus fractures: a pilot study","authors":"Christine A. Ho, D. Podeszwa, A. Riccio, R. Wimberly, Brandon A. Ramo, Mary Yang, Surekha Patel","doi":"10.1097/BPB.0000000000000697","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000697","url":null,"abstract":"This pilot study was performed to describe changes in arterial flow in completely displaced neurovascularly intact Gartland III pediatric supracondylar humerus fractures using Duplex ultrasonography. This is a prospective study of 11 Gartland type III supracondylar humerus fractures with no cortical continuity but with palpable radial pulse and normal neurologic examination. Duplex ultrasonography was performed on injured and uninjured arms, both preoperatively and postpinning, and interpreted by a board-certified pediatric radiologist. Degree of artery stenosis and peak systolic velocity (PSV) of arterial flow were recorded from the duplex. Ultrasound wrist/brachial indexes (WBI) were calculated using the higher value of the radial/brachial or the ulnar/brachial index. Only three patients had normal Duplexes without stenosis and with flow comparable in the brachial, radial, and ulnar arteries of the affected arm, compared to the unaffected arm, both preoperatively and postpinning. One group of six patients had brachial artery stenosis at the fracture site when compared to the artery proximal to the fracture site, increased PSV at the fracture site compared to proximal to the fracture site, and the WBI was variable when compared to the contralateral side. A third group of two patients also had brachial artery stenosis at the fracture site but had decreased PSV and decreased WBI compared to the contralateral side. Type III supracondylar humerus patients with a normal neurovascular examination may have abnormal Duplex ultrasonography with brachial artery stenosis and elevated peak systolic velocity preoperatively although distal flow remains comparable to the contralateral side. Level of evidence: prognostic – Level II.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85635343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-12DOI: 10.1097/BPB.0000000000000694
A. Ranade, M. Belthur, G. Oka, Jason D Malone
Idiopathic clubfoot is the most common congenital anomaly of the lower extremity. YouTube has emerged as an important source of health-related information for patients and families. Parents seek information about clubfoot on YouTube. However, the quality of these videos remains unknown. Therefore, we decided to evaluate the quality of YouTube videos about clubfoot. We searched YouTube for clubfoot videos using appropriate keywords. English language videos with more than 10 000 views were included. Three fellowship trained pediatric orthopedic surgeons independently assessed the videos and classified them into corporate, hospital, education and private. The quality of information was assessed using the Modified DISCERN and JAMA benchmark scores. The search yielded 12 060 videos of which 42 were analyzed. There were 9 (21%) videos from corporate organizations, 12 (29%) from hospitals, 3 (7%) from educational organizations and 18 (43%) by private individuals. The mean Modified DISCERN score was 2.1 ± 1.07 (range 0.3–4) and mean JAMA benchmark score was 0.9 ± 0.65 (range 0–2). Educational videos had highest mean Modified DISCERN score (3.1 ± 0.85) and private videos, the least (1.43 ± 1). This difference was statistically significant (P = 0.004). Hospital videos had highest mean JAMA benchmark score of 1.3 ± 0.6 as compared with private videos which had the least mean score of 0.5 ± 0.6. This difference was also statistically significant (P = 0.001). The results of our study indicate that the quality of information on idiopathic clubfoot on YouTube needs improvement. Videos from educational and hospital sources should be preferred over private sources.
{"title":"YouTube as an information source for clubfoot: a quality analysis of video content","authors":"A. Ranade, M. Belthur, G. Oka, Jason D Malone","doi":"10.1097/BPB.0000000000000694","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000694","url":null,"abstract":"Idiopathic clubfoot is the most common congenital anomaly of the lower extremity. YouTube has emerged as an important source of health-related information for patients and families. Parents seek information about clubfoot on YouTube. However, the quality of these videos remains unknown. Therefore, we decided to evaluate the quality of YouTube videos about clubfoot. We searched YouTube for clubfoot videos using appropriate keywords. English language videos with more than 10 000 views were included. Three fellowship trained pediatric orthopedic surgeons independently assessed the videos and classified them into corporate, hospital, education and private. The quality of information was assessed using the Modified DISCERN and JAMA benchmark scores. The search yielded 12 060 videos of which 42 were analyzed. There were 9 (21%) videos from corporate organizations, 12 (29%) from hospitals, 3 (7%) from educational organizations and 18 (43%) by private individuals. The mean Modified DISCERN score was 2.1 ± 1.07 (range 0.3–4) and mean JAMA benchmark score was 0.9 ± 0.65 (range 0–2). Educational videos had highest mean Modified DISCERN score (3.1 ± 0.85) and private videos, the least (1.43 ± 1). This difference was statistically significant (P = 0.004). Hospital videos had highest mean JAMA benchmark score of 1.3 ± 0.6 as compared with private videos which had the least mean score of 0.5 ± 0.6. This difference was also statistically significant (P = 0.001). The results of our study indicate that the quality of information on idiopathic clubfoot on YouTube needs improvement. Videos from educational and hospital sources should be preferred over private sources.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79363803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-12DOI: 10.1097/BPB.0000000000000693
S. Kearney
Pediatric fracture reductions can create anxiety for the child and parent. While cross-cultural evidence supports parental presence during some pediatric procedures, no study addresses parental presence during fracture reductions. This study investigates parent experiences during their child’s reduction and provides guidance regarding parental attendance during fracture reductions. Sixty consecutive parents were retrospectively surveyed about their experience during their child’s fracture reduction. Parents were grouped according to presence or absence during the reduction and were compared. Forty parents attended the reduction and 20 parents were absent. All parents attending the reduction were satisfied with their experience. Thirty-nine parents (98%) believed their presence was helpful for their child and 36 (90%) believed it was personally helpful. Of the 20 absent parents, four (20%) were dissatisfied with their experience, five (25%) believed it was personally harmful, and two (10%) thought it was harmful to their child. All parents reporting negative experiences were prohibited from attending the reduction. When deciding about parental presence during reductions, 55 (92%) parents wanted to be included in this process. Overall, 47 parents (78%) wanted to attend the reduction and 52 (87%) would prefer to attend a future reduction. Most parents prefer to attend their child’s fracture reduction and believe their presence is helpful personally and for their child. Parents in attendance report a positive experience, while parents prohibited from attending report dissatisfaction with the experience and believe their absence is harmful to themselves and their children. It is recommended that healthcare workers consider parental attendance during pediatric reductions.
{"title":"Parents want to attend pediatric fracture reductions","authors":"S. Kearney","doi":"10.1097/BPB.0000000000000693","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000693","url":null,"abstract":"Pediatric fracture reductions can create anxiety for the child and parent. While cross-cultural evidence supports parental presence during some pediatric procedures, no study addresses parental presence during fracture reductions. This study investigates parent experiences during their child’s reduction and provides guidance regarding parental attendance during fracture reductions. Sixty consecutive parents were retrospectively surveyed about their experience during their child’s fracture reduction. Parents were grouped according to presence or absence during the reduction and were compared. Forty parents attended the reduction and 20 parents were absent. All parents attending the reduction were satisfied with their experience. Thirty-nine parents (98%) believed their presence was helpful for their child and 36 (90%) believed it was personally helpful. Of the 20 absent parents, four (20%) were dissatisfied with their experience, five (25%) believed it was personally harmful, and two (10%) thought it was harmful to their child. All parents reporting negative experiences were prohibited from attending the reduction. When deciding about parental presence during reductions, 55 (92%) parents wanted to be included in this process. Overall, 47 parents (78%) wanted to attend the reduction and 52 (87%) would prefer to attend a future reduction. Most parents prefer to attend their child’s fracture reduction and believe their presence is helpful personally and for their child. Parents in attendance report a positive experience, while parents prohibited from attending report dissatisfaction with the experience and believe their absence is harmful to themselves and their children. It is recommended that healthcare workers consider parental attendance during pediatric reductions.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85047341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-12DOI: 10.1097/BPB.0000000000000691
Ebeed Yasin, H. Amin, H. A. Ghani
Tibialis anterior tendon transfer was described as an effective method in the management of dynamic supination as well as prevention of clubfoot relapse in children. Different successful methods were described for anchoring the transferred tibialis anterior tendon; however, each of which has its own complications that were avoided by using this novel technique. This study included 26 feet in 18 patients, who underwent tibialis anterior tendon transfer as a part of management of their congenital clubfoot. The mean age was 3.6 years (ranging from 2.5 to 5 years), all patients were followed up for 6 to 30 months (mean = 14 months). The transferred tibialis anterior tendon was anchored in the third cuneiform using transfixing K wires. This novel technique resulted in successful and stable anchoring of the transferred tibialis anterior tendon. The transferred tendon was well palpated in all patients with active dorsiflexion, with no associated tendon rupture, anchoring problems, or wound complication. Our technique is secure, reliable, and economic with no special equipment needed. It could successfully avoid the plantar skin complications associated with pullout sutures and neurovascular injury.
{"title":"A new anchoring technique for tibialis anterior tendon transfer","authors":"Ebeed Yasin, H. Amin, H. A. Ghani","doi":"10.1097/BPB.0000000000000691","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000691","url":null,"abstract":"Tibialis anterior tendon transfer was described as an effective method in the management of dynamic supination as well as prevention of clubfoot relapse in children. Different successful methods were described for anchoring the transferred tibialis anterior tendon; however, each of which has its own complications that were avoided by using this novel technique. This study included 26 feet in 18 patients, who underwent tibialis anterior tendon transfer as a part of management of their congenital clubfoot. The mean age was 3.6 years (ranging from 2.5 to 5 years), all patients were followed up for 6 to 30 months (mean = 14 months). The transferred tibialis anterior tendon was anchored in the third cuneiform using transfixing K wires. This novel technique resulted in successful and stable anchoring of the transferred tibialis anterior tendon. The transferred tendon was well palpated in all patients with active dorsiflexion, with no associated tendon rupture, anchoring problems, or wound complication. Our technique is secure, reliable, and economic with no special equipment needed. It could successfully avoid the plantar skin complications associated with pullout sutures and neurovascular injury.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83672594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-12DOI: 10.1097/BPB.0000000000000692
J. du Plessis, G. Firth, A. Robertson
The Langenskiöld classification is the most commonly utilized classification system for the radiological features of Blount’s disease. Although there is only a single study found on the interobserver variability and none found on the intraobserver variability, it is commonly used for prognostication and guiding management decisions. The aim of this study was to determine the reliability and reproducibility of the Langenskiöld classification. A retrospective review of radiographs was done of patients treated for infantile and juvenile Blount’s disease at Chris Hani Baragwanath Academic Hospital from 2006 to 2016. There were 70 radiographs of acceptable quality, which were reviewed and staged on two occasions according to the Langenskiöld classification by three orthopaedic consultants and three orthopaedic surgery senior residents. Pearson correlation coefficients, percentage agreements, and κ statistics were used to evaluate both the reliability and reproducibility. Of the 70 images staged, only two (2.9%) were staged the same by all six observers, and 20 (28.6%) images differed by a single stage. The consultants had 17 (24.3%) images staged the same whereas the residents had 12 (17.1%) images staged the same. The overall κ for all six observers showed a fair agreement of 0.24. Again, the consultants had a higher κ-value compared to residents of 0.25 and 0.24, respectively. The reproducibility amongst all observers was fair with a κ-value of 0.38. The consultants had a higher mean score of 0.48 compared to 0.26 for the residents. There was only a fair overall reliability and reproducibility amongst the six observers. We recommend the Langenskiöld classification be used with caution when being used for prognostication and management planning as well as when interpreting any research relying on this classification. Level of evidence: Level III, diagnostic study.
{"title":"Assessment of the reliability and reproducibility of the Langenskiöld classification in Blount’s disease","authors":"J. du Plessis, G. Firth, A. Robertson","doi":"10.1097/BPB.0000000000000692","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000692","url":null,"abstract":"The Langenskiöld classification is the most commonly utilized classification system for the radiological features of Blount’s disease. Although there is only a single study found on the interobserver variability and none found on the intraobserver variability, it is commonly used for prognostication and guiding management decisions. The aim of this study was to determine the reliability and reproducibility of the Langenskiöld classification. A retrospective review of radiographs was done of patients treated for infantile and juvenile Blount’s disease at Chris Hani Baragwanath Academic Hospital from 2006 to 2016. There were 70 radiographs of acceptable quality, which were reviewed and staged on two occasions according to the Langenskiöld classification by three orthopaedic consultants and three orthopaedic surgery senior residents. Pearson correlation coefficients, percentage agreements, and κ statistics were used to evaluate both the reliability and reproducibility. Of the 70 images staged, only two (2.9%) were staged the same by all six observers, and 20 (28.6%) images differed by a single stage. The consultants had 17 (24.3%) images staged the same whereas the residents had 12 (17.1%) images staged the same. The overall κ for all six observers showed a fair agreement of 0.24. Again, the consultants had a higher κ-value compared to residents of 0.25 and 0.24, respectively. The reproducibility amongst all observers was fair with a κ-value of 0.38. The consultants had a higher mean score of 0.48 compared to 0.26 for the residents. There was only a fair overall reliability and reproducibility amongst the six observers. We recommend the Langenskiöld classification be used with caution when being used for prognostication and management planning as well as when interpreting any research relying on this classification. Level of evidence: Level III, diagnostic study.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72799383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1097/BPB.0000000000000655
Neeraj M. Patel, Christopher R. Gajewski, Anthony M. Ascoli, J. Lawrence
The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Of the 137 patients included in the study, a washer was utilized in 90 (66%). Thirty-one patients (23%) ultimately underwent hardware removal. There was not an increased need for implant removal in those with a washer (P = 0.11). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (P = 0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9 ± 9.7 weeks after surgery with no significant difference along the lines of washer use. Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of medial epicondyle fractures, even in athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.
{"title":"Washers do not affect the rate of implant removal or elbow motion in medial epicondyle fractures.","authors":"Neeraj M. Patel, Christopher R. Gajewski, Anthony M. Ascoli, J. Lawrence","doi":"10.1097/BPB.0000000000000655","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000655","url":null,"abstract":"The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Of the 137 patients included in the study, a washer was utilized in 90 (66%). Thirty-one patients (23%) ultimately underwent hardware removal. There was not an increased need for implant removal in those with a washer (P = 0.11). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (P = 0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9 ± 9.7 weeks after surgery with no significant difference along the lines of washer use. Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of medial epicondyle fractures, even in athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91261246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1097/BPB.0000000000000652
A. Agarwal, S. Barik
We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (-2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.
{"title":"Effect of bar length on foot abduction and ankle dorsiflexion in Steenbeek foot abduction brace.","authors":"A. Agarwal, S. Barik","doi":"10.1097/BPB.0000000000000652","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000652","url":null,"abstract":"We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (-2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86556060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1097/BPB.0000000000000576
M. Silva, Erin M. Delfosse, Bianka Aceves-Martin, A. Scaduto, E. Ebramzadeh
Telehealth has seldom been used in the field of pediatric orthopaedics. The purpose of this study is to assess the efficacy of telehealth as a tool for the follow-up of children with nondisplaced elbow fractures. We hypothesize that patients treated via telehealth will have comparable clinical outcomes as those treated at our institution, with increased patient satisfaction. We conducted a randomized trial, which included 52 children with type I supracondylar humeral fractures, or occult elbow injuries, divided in two groups, based on the type of care provided during the fourth-week follow-up appointment: cast removal at our institution (group A) or cast removal at home via telehealth appointment (group B). The time duration and professional fees for this week 4 follow-up were calculated. Patients in both groups returned to our institution for a final follow-up in week 8. We measured the amount of fracture displacement, range of motion, pain, and patient satisfaction. There was no statistically significant difference in fracture displacement, range of motion, or pain scores between groups. The mean length of the fourth-week clinical encounter was higher in group A than group B (47.2 vs. 17.6 min, respectively; P < 0.001). Initially, the mean patient satisfaction scores were nearly identical in both groups (97%) until patients in group A were made aware of this difference in time duration, at which their mean satisfaction score decreased to 76.4% (P = 0.05). The use of telehealth as a tool in the treatment of nondisplaced pediatric elbow fractures is appealing. Patients managed via telehealth had higher satisfaction rates and spent only a third of the time for their clinical encounter.
{"title":"Telehealth: a novel approach for the treatment of nondisplaced pediatric elbow fractures.","authors":"M. Silva, Erin M. Delfosse, Bianka Aceves-Martin, A. Scaduto, E. Ebramzadeh","doi":"10.1097/BPB.0000000000000576","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000576","url":null,"abstract":"Telehealth has seldom been used in the field of pediatric orthopaedics. The purpose of this study is to assess the efficacy of telehealth as a tool for the follow-up of children with nondisplaced elbow fractures. We hypothesize that patients treated via telehealth will have comparable clinical outcomes as those treated at our institution, with increased patient satisfaction. We conducted a randomized trial, which included 52 children with type I supracondylar humeral fractures, or occult elbow injuries, divided in two groups, based on the type of care provided during the fourth-week follow-up appointment: cast removal at our institution (group A) or cast removal at home via telehealth appointment (group B). The time duration and professional fees for this week 4 follow-up were calculated. Patients in both groups returned to our institution for a final follow-up in week 8. We measured the amount of fracture displacement, range of motion, pain, and patient satisfaction. There was no statistically significant difference in fracture displacement, range of motion, or pain scores between groups. The mean length of the fourth-week clinical encounter was higher in group A than group B (47.2 vs. 17.6 min, respectively; P < 0.001). Initially, the mean patient satisfaction scores were nearly identical in both groups (97%) until patients in group A were made aware of this difference in time duration, at which their mean satisfaction score decreased to 76.4% (P = 0.05). The use of telehealth as a tool in the treatment of nondisplaced pediatric elbow fractures is appealing. Patients managed via telehealth had higher satisfaction rates and spent only a third of the time for their clinical encounter.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82527226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1097/BPB.0000000000000653
Pooya Hosseinzadeh, C. DeVries, R. Saldana, S. Scherl, L. Andras, Mathew D. Schur, F. Shuler, Megan E. Mignemi, Arya Minaie, A. Chu, E. Fornari, S. Frick, M. Caird, A. Riccio, Kristen Pierz, Christos Plakas, M. Herman
With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study. Circumstances of the injury, location, severity, associated injuries, and the required treatment were recorded and analysed using descriptive analysis to report the most common injuries. Between-group differences in injury location were examined using chi-squared statistics among (1) children versus adolescents and (2) males versus females. Seventy-eight patients (M/F ratio: 1.8) with average age of 11 ± 2.4 years were included in the study. Of the 78 documented injuries, upper extremity fractures were the most common (84.6%) and the most frequent fracture location overall was at the distal radius and ulna (52.6%), while ankle fractures comprised most of the lower extremity fractures (66.6%). Majority of the distal radius fractures (58.3%) and ankle fractures (62.5%) were treated with immobilization only. Seventeen displaced distal radius fractures and three displaced ankle fractures were treated with closed reduction in the majority of cases (94.1% versus 66.7%, respectively). The distal radius and ulna are the most common fracture location. Use of appropriate protective gear such as wrist guards, as well as adult supervision, may help mitigate the injuries associated with the use of this device; however, further studies are necessary to demonstrate the real effectiveness of these preventions.
{"title":"Hoverboard injuries in children and adolescents: results of a multicenter study.","authors":"Pooya Hosseinzadeh, C. DeVries, R. Saldana, S. Scherl, L. Andras, Mathew D. Schur, F. Shuler, Megan E. Mignemi, Arya Minaie, A. Chu, E. Fornari, S. Frick, M. Caird, A. Riccio, Kristen Pierz, Christos Plakas, M. Herman","doi":"10.1097/BPB.0000000000000653","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000653","url":null,"abstract":"With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study. Circumstances of the injury, location, severity, associated injuries, and the required treatment were recorded and analysed using descriptive analysis to report the most common injuries. Between-group differences in injury location were examined using chi-squared statistics among (1) children versus adolescents and (2) males versus females. Seventy-eight patients (M/F ratio: 1.8) with average age of 11 ± 2.4 years were included in the study. Of the 78 documented injuries, upper extremity fractures were the most common (84.6%) and the most frequent fracture location overall was at the distal radius and ulna (52.6%), while ankle fractures comprised most of the lower extremity fractures (66.6%). Majority of the distal radius fractures (58.3%) and ankle fractures (62.5%) were treated with immobilization only. Seventeen displaced distal radius fractures and three displaced ankle fractures were treated with closed reduction in the majority of cases (94.1% versus 66.7%, respectively). The distal radius and ulna are the most common fracture location. Use of appropriate protective gear such as wrist guards, as well as adult supervision, may help mitigate the injuries associated with the use of this device; however, further studies are necessary to demonstrate the real effectiveness of these preventions.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74063651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：