Journal of the Pediatric Orthopaedic Society of North America最新文献

{"title":"Delay in Time to Physical Therapy After Orthopaedic Treatment","authors":"Jacquelyn N. Valenzuela-Moss, K. Antoniak, Natalya Sarkisova, Curtis VandenBerg, Joshua Yang, Deirdre Ryan, Rachel Y. Goldstein","doi":"10.55275/jposna-2023-649","DOIUrl":"https://doi.org/10.55275/jposna-2023-649","url":null,"abstract":"","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"32 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139272982","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}

{"title":"Parental Awareness and Attitudes Towards ACL Injury Prevention Programs in Youth Athletes","authors":"Paola R. Sparagana, Bayley Selee, H. Ellis, Matthew Ellington, Jennifer J. Beck, S. Carsen, Allison E. Crepeau, Aristides I. Cruz Jr., B. Heyworth, Stephanie W. Meyer, Emily L. Niu, Neeraj Patel, Andrew Pennock, Curt VandenBerg, Kelly Vanderhave, Brendan A. Williams, Z. Stinson","doi":"10.55275/jposna-2023-788","DOIUrl":"https://doi.org/10.55275/jposna-2023-788","url":null,"abstract":"","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"49 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139272052","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}

{"title":"Triple Fusion in Children and Adolescents","authors":"James Recordon, Dawson Muir","doi":"10.55275/jposna-2023-779","DOIUrl":"https://doi.org/10.55275/jposna-2023-779","url":null,"abstract":"","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"51 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139271828","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}

{"title":"Lapidus Procedure for Adolescent Hallux Valgus","authors":"A. Padgett, Michael D. Johnson, Michael J. Conklin","doi":"10.55275/jposna-2023-745","DOIUrl":"https://doi.org/10.55275/jposna-2023-745","url":null,"abstract":"","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275697","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}

{"title":"Dr. Robert Bruce Salter: Memories from His Mentees","authors":"B. Willis, G. Thompson, P. Armstrong, Heather Kong, C. Lawing, S. Nossov","doi":"10.55275/jposna-2023-746","DOIUrl":"https://doi.org/10.55275/jposna-2023-746","url":null,"abstract":"An argument could be made that the most recognized name in the history of pediatric orthopaedics belongs to Dr. Robert Salter. Every medical student in the last 50 years has at least heard of his classification of growth plate injuries and most have been tested on it. His innovations and contributions to pediatric orthopaedics are numerous and have stood the test of time. In 2020, the Journal of Orthopaedics listed the most impactful pediatric orthopaedic literature, and Dr. Salter’s name is cited in 56 of the top 100 referenced papers. As time passes, the name and the impact made remain. Yet who was this man? What made him a legend and such an impactful figure? How did he educate, nurture, and raise the grandparents of our current pediatric orthopaedic family? The editorial staff is indebted to Drs. Heather Kong, Cheryl Lawing, and Sarah B. Nossov, from the POSNA History and Archives Committee, and to friends and colleagues Drs. Baxter Willis, George Thompson, and Peter Armstrong for shedding light on this remarkable man.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122708433","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}

{"title":"Non-Operative Treatment of Tibial Tubercle Fractures: Who is at Risk for Failure?","authors":"Lauren Spirov, Konstantin Brnjoš, N. Kaushal, F. Edobor-Osula, Alexander Griffith, J. Blanco, Clare Kehoe, J. Schlechter, Evelyn S. Thomas, Lindsay M. Crawford, Abhi Rashiwala, D. Greenhill, Haley N Tornberg, B. Williams, Kevin Huang, Neeraj M. Patel","doi":"10.55275/jposna-2023-732","DOIUrl":"https://doi.org/10.55275/jposna-2023-732","url":null,"abstract":"Introduction: Given the relative rarity of tibial tubercle fractures and the high proportion that undergo surgical treatment, there is little data on non-operative management of these injuries. Some patients that are initially treated non-surgically may ultimately require operative intervention. The purpose of this study was to identify risk factors for failed non-operative management of tibial tubercle fractures. Methods: This retrospective comparative study included patients younger than 18 years that underwent initial non-operative treatment of a tibial tubercle fracture at six tertiary children’s hospitals. Those that underwent primary surgical intervention were excluded. Demographic, radiographic, and clinical data were reviewed. Conversion to surgical fixation was considered a failure of non-operative treatment. Univariable analysis was followed by multivariate regression to adjust for confounders. Results: A total of 136 patients were included, of which 19.1% failed non-operative treatment and subsequently underwent surgery. The median age of patients that ultimately required surgery was 14.0 y [IQR (interquartile range) 2.5 y] compared to 12.0 y (IQR 2.0 y) for those that were successfully managed without surgery. Non-operative treatment failed in 7.8% of Ogden type I fractures, 66.7% of type II, 81.8% of type III, 35.7% of type IV, and 7.1% of type V (p<0.001). After adjusting for confounders, including weight and initial weight-bearing status, each year of increasing age raised the odds of failure by 1.9 (95% CI 1.2-3.0, p=0.006). Additionally, Ogden type II fractures had 23.4 times higher odds than type I (95% CI 2.1-260.8, p=0.01). Ogden type III fractures had 36.3 times higher odds of failing non-operative treatment than type I (95% CI 4.2-315.4, p=0.001). Conclusion: In this study of patients with a tibial tubercle fracture initially treated non-operatively, 19.1% ultimately underwent surgery. Increasing age and Ogden type II and III fracture classification were associated with failure of non-operative management. These results may help guide decision-making regarding surgical versus non-surgical treatment. Significance: There is little data on non-operative treatment of tibial tubercle fractures. This study identifies risk factors for failure of non-operative treatment and may aid clinical decision-making.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122794484","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}

{"title":"Opioid Prescription Trends for Isolated Diaphyseal Femur Fractures in Pediatric Patients","authors":"Jennifer N Grauberger, D. Larson, A. Stans, W. Shaughnessy, A. Larson, T. Milbrandt","doi":"10.55275/jposna-2023-663","DOIUrl":"https://doi.org/10.55275/jposna-2023-663","url":null,"abstract":"Purpose: Despite the ongoing opioid epidemic, there is a lack of research on narcotic prescribing in the pediatric orthopaedic population. The Pediatric Orthopaedic Society of North America (POSNA) therefore published a survey on pain management to provide recommendations for opioid dosing. The goal of this study was to characterize opioid prescribing patterns for pediatric femur fractures in the context of the opioid epidemic and emerging national studies/guidelines. Methods: A retrospective review of 128 pediatric patients (age < 16) with isolated diaphyseal femur fractures was conducted between 2003-2019 at a level I pediatric trauma center. Comparison groups included before distribution of the POSNA survey (pre-POSNA = 01/01/2016 or earlier, N = 85) and after the survey (post-POSNA, N = 43). Results: Median total hospital post-operative opioids prescribed was 27.2 morphine milligram equivalents (MME). The two groups differed in: age (pre-POSNA = 9.0 years, post-POSNA =3.7 years, P =0.0381), hospital length of stay (LOS) (pre-POSNA = 2 days, post-POSNA =1 day, P < 0.0001), and procedural incision required for fracture reduction (pre-POSNA = 28.3%, post-POSNA = 58.1%, P = 0.0019). Adjusted post-operative opioid dosing was significantly lower post-POSNA (median reduction of 18.351 MME per year, P = 0.0408). Conclusions: The period following the POSNA survey was associated with a significant decline in post-operative narcotic prescriptions for pediatric femur fractures. The timing of the survey likely represents an increased concern for pediatric opioid use and a shift in clinical practice. Further work is needed to optimize injury and patient-specific narcotic prescribing.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130163494","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}

{"title":"Retrospective Review of 181 Patients with Pathologic Vertebral Compression Fractures","authors":"Tristen N. Taylor, Callie S. Bridges, Lauren Pupa, Beatrice Morrow, Brian G. Smith, Nicole I. Montgomery","doi":"10.55275/jposna-2023-697","DOIUrl":"https://doi.org/10.55275/jposna-2023-697","url":null,"abstract":"Background: Compression fractures are often associated with lower energy trauma and may occur in the setting of abnormal bone health associated with genetic disorders and endocrine disorders, neoplastic disease, infection, and inflammatory disorders. There is no significant series in the literature describing the prevalence or etiology of pathologic pediatric compression fractures. Methods: IRB-approved retrospective study was performed at a tertiary children’s hospital from 2012-2022. Patients <18 years old diagnosed with atraumatic vertebral compression fractures were included and reviewed for demographics, underlying diagnosis/comorbidity, presentation, mobility, deformities, imaging data, treatments, and outcomes. Results: 181 patients (54% Male) were included with mean age 14.17 years and follow-up of 20 months. A compression fracture was the presenting symptom of an underlying diagnosis in 32% of patients. Primary osteoporosis was the cause in 15%, and secondary osteoporosis was in 65% of patients; primarily due to immunosuppressants (46%) and ALL (10%). Primary lesions were the etiology in 20% of patients. There was a median of 3 fractures per patient, mostly of the midthoracic (82%) and thoracolumbar spine (51%). Radiographs revealed wedge fractures in 82% and vertebra plana in 11%. Patients were managed with careful observation or bracing (78%) and only 6% received an operation. By last follow-up, more patients developed scoliosis and were wheelchair-bound. Overall, there was a 16% mortality rate which was mostly associated with cancer. Conclusion: About 32% of patients presented with a compression fracture as the presenting symptom of an underlying disease. Pathologic vertebral compression fractures in children frequently occurred due to immunosuppressants, ALL, and metastatic disease. The fractures are often wedge or non-structural in the thoracolumbar and mid-thoracic regions of the spine. MRI’s may be useful for distinguishing between benign fractures and malignancy. Most children were treated by observation, but bracing for kyphosis was often necessary.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115587911","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}

{"title":"Proximal Femoral Growth Alterations Can Be Seen Prior to Treatment of Developmental Dysplasia of the Hip: A Multicenter Cohort Study","authors":"P. England, E. Schaeffer, Charles Price, K. Mulpuri, W. Sankar","doi":"10.55275/jposna-2023-669","DOIUrl":"https://doi.org/10.55275/jposna-2023-669","url":null,"abstract":"Background: Avascular necrosis (AVN), better considered proximal femoral growth disturbance (PFGD), following treatment for developmental dysplasia of the hip (DDH) remains poorly defined. In addition to limited reliability, it has been our experience that some radiographic features attributed to AVN/PFGD may be present prior to surgery. Our purpose was to determine the baseline prevalence of radiographic features suggestive of PFGD in a diverse population with surgically-treated DDH. Methods: The prospectively collected database for an international multicenter study group was retrospectively queried for patients undergoing surgery for DDH with minimum one-year radiographic and clinical follow-up. Preoperative radiographs were evaluated for findings typically used to define PFGD at follow-up. Development of actual AVN/PFGD was determined by consensus review of follow-up radiographs by three experts separate from this study. Results: 145 patients were evaluated, with median preoperative age of 16.8 months (IQR:10.7-25.60). The proportion of patients with initial IHDI grades of 2, 3, or 4 was 18%, 32%, and 50%, respectively. Prior to surgery, 20 hips (14%) had a heterogenous or “fragmented” epiphysis. Eight of the 145 epiphyses (6%) were significantly ellipsoid in shape. Depending on the definition, between 5-10% of hips had a wider neck at baseline compared to the contralateral, normal hip. At final follow-up, 42% of the hips were determined to have PFGD based on consensus review. Of all the patients that were considered to have PFGD at follow-up, 59% of patients had one feature of PFGD at baseline, and 20% had two or more. Conclusions: The current study suggests that several factors used to define the development of PFGD following DDH surgery may be present prior to surgical intervention. Our data demonstrates that 20% of the patients who develop AVN have at least two markers of PFGD, per Salter criteria, prior to receiving any treatment. This suggests that some of these hips may not be morphologically “normal” at baseline and adds to the mounting body of evidence about the limitations of the Salter classification for AVN.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128273505","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}

{"title":"How Reliable is a J-sign Severity Scale When Assessing Lateral Patellar Instability?","authors":"Oksana Klimenko, T. Sousa, Ryan Baker, J. Carl, S. Mader, Kristopher Holden, M. McMulkin","doi":"10.55275/jposna-2023-630","DOIUrl":"https://doi.org/10.55275/jposna-2023-630","url":null,"abstract":"Background: Patellar instability is a common cause of anterior knee pain and can limit function and sports participation. To help assess patellar instability, the clinical J-sign test consists of observing the patella translate laterally in the shape of an inverted J over the anterolateral femur proximal to the trochlear groove during active knee extension. Only positive or negative categorization of the J-sign test has typically been used without rating the severity. The purpose of this study was to assess the inter- and intra-observer reliability of a proposed grading/severity scale of the J-sign test. Methods: A scale for J-sign severity was developed as follows: grade 0: ≤1 quadrant of translation; grade 1: >1quadrant of translation; grade 2: >2 quadrants of translation; grade 3: complete patellofemoral dislocation; grade 4: unable to complete J-sign due to pain or apprehension. This retrospective cross-sectional study assessed J-sign ratings (0 to 4) from videos of patients undergoing evaluation for patellar instability. Six healthcare professionals rated the severity of the J-sign using the proposed scale, two different times, for all knees presented in random order. Inter- and intra-observer reliability were calculated using a Fleiss Kappa, k. Results: Forty-four patients (87 knees) ages 10-18 were included in this study. Both knees were rated, including unaffected knees to serve as a control. The proposed standardized grading scale for the J-sign had fair agreement for inter-observer reliability, k = 0.31, and moderate agreement for intra-observer reliability, k = 0.58. Conclusion: The proposed scale for determining J-sign severity yielded fair inter-observer reliability moderate intra-observer reliability, similar to the Kappa scores evaluating only the presence or absence of the J-sign. Further study into developing a standardized scale for J-sign severity grading might improve clinical descriptors of the test, and expand on other factors including clarity of knee extension ability, video standardization, and training materials.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128590713","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}