Pub Date : 2023-08-01DOI: 10.55275/jposna-2023-744
Pradeep K. Attaluri, E. Shaffrey, Peter J. Wirth, Natalie M. Gaio, M. Bentz
Congenital orthopaedic anomalies and acquired pediatric wounds of the extremities frequently require reconstruction of the soft tissue envelope. In many of these circumstances, full-thickness skin grafting (FTSG) is a reliable and appropriate reconstructive option. However, FTSG harvest is rarely discussed in the orthopaedic literature. We present a reliable and reproducible method of full-thickness skin grafting that is easily performed. In this technique, we harvest a full-thickness skin graft from the lower abdomen using a symmetric transverse midline suprapubic incision (i.e., Pfannenstiel incision). This donor site allows for abundant skin graft harvest while providing a concealed location and the potential for additional graft harvest. Finally, we discuss the critical importance of postoperative recipient site dressings to optimize skin graft take.
{"title":"“A Little Skin in the Game”: Full Thickness Skin Grafting in Pediatric Orthopaedic Surgery","authors":"Pradeep K. Attaluri, E. Shaffrey, Peter J. Wirth, Natalie M. Gaio, M. Bentz","doi":"10.55275/jposna-2023-744","DOIUrl":"https://doi.org/10.55275/jposna-2023-744","url":null,"abstract":"Congenital orthopaedic anomalies and acquired pediatric wounds of the extremities frequently require reconstruction of the soft tissue envelope. In many of these circumstances, full-thickness skin grafting (FTSG) is a reliable and appropriate reconstructive option. However, FTSG harvest is rarely discussed in the orthopaedic literature. We present a reliable and reproducible method of full-thickness skin grafting that is easily performed. In this technique, we harvest a full-thickness skin graft from the lower abdomen using a symmetric transverse midline suprapubic incision (i.e., Pfannenstiel incision). This donor site allows for abundant skin graft harvest while providing a concealed location and the potential for additional graft harvest. Finally, we discuss the critical importance of postoperative recipient site dressings to optimize skin graft take.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"21 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":"121507801","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 : 2023-08-01DOI: 10.55275/jposna-2023-633
Liane Chun, A. Misaghi, Krishna R. Cidambi, N. McNeil, C. Farnsworth, E. Edmonds
Background: Orthogonal radiographs of the proximal humerus are challenging to obtain because the patient’s body mass can impede a quality lateral view and positioning of the shoulder can cause fracture displacement and patient discomfort. We describe a novel radiograph, the clear view (CL), taken 90° to the scapular Y (SY), developed with the goal to minimize pain and reduce radiation exposure. Evaluate the ability to accurately evaluate proximal humerus fracture displacement utilizing the CL in comparison to the standard available x-rays and assess pain score when obtaining the CL. Methods: Eleven independent observers at different levels of experience evaluated angulation and translation of three proximal humerus fractures: two cadaveric fractures and a third fracture in a 15-year-old to determine intra-observer correlation (ICC). Each fracture underwent the traditional radiographic series of anteroposterior (AP) in internal rotation (IR), AP in external rotation (ER), true axillary lateral (AX), SY, and transthoracic lateral (TRANS) plus computed tomography (CT). CL was obtained on the two cadaver fractures. Pain scores based on the Wong-Baker FACES Pain Scale were assessed for individual radiographic projections in thirteen patients with proximal humerus fractures. Results: ICC was >0.6 for all measures. True fracture angulation was underestimated a majority (>75%) of the time in all radiographic views, TRANS (p<0.001) and AX (p<0.049) views had the least amount of error. Moreover, measures of translation were both underestimated and overestimated in all views, but the most accurate measures of translation were obtained with IR, ER, and CL views. Pain scores ranged from 0-1.2 when the CL was obtained. Conclusions: Our study demonstrates that proximal humerus fracture angulation is often underestimated and translation is difficult to measure regardless of view utilized. However, the clear view, when combined with the AP view offers an orthogonal, reproducible, valid measure of displacement and causes minimal patient discomfort.
{"title":"Validation of a Novel Radiographic View for Evaluating Proximal Humerus Fractures: The Clear View","authors":"Liane Chun, A. Misaghi, Krishna R. Cidambi, N. McNeil, C. Farnsworth, E. Edmonds","doi":"10.55275/jposna-2023-633","DOIUrl":"https://doi.org/10.55275/jposna-2023-633","url":null,"abstract":"Background: Orthogonal radiographs of the proximal humerus are challenging to obtain because the patient’s body mass can impede a quality lateral view and positioning of the shoulder can cause fracture displacement and patient discomfort. We describe a novel radiograph, the clear view (CL), taken 90° to the scapular Y (SY), developed with the goal to minimize pain and reduce radiation exposure. Evaluate the ability to accurately evaluate proximal humerus fracture displacement utilizing the CL in comparison to the standard available x-rays and assess pain score when obtaining the CL. Methods: Eleven independent observers at different levels of experience evaluated angulation and translation of three proximal humerus fractures: two cadaveric fractures and a third fracture in a 15-year-old to determine intra-observer correlation (ICC). Each fracture underwent the traditional radiographic series of anteroposterior (AP) in internal rotation (IR), AP in external rotation (ER), true axillary lateral (AX), SY, and transthoracic lateral (TRANS) plus computed tomography (CT). CL was obtained on the two cadaver fractures. Pain scores based on the Wong-Baker FACES Pain Scale were assessed for individual radiographic projections in thirteen patients with proximal humerus fractures. Results: ICC was >0.6 for all measures. True fracture angulation was underestimated a majority (>75%) of the time in all radiographic views, TRANS (p<0.001) and AX (p<0.049) views had the least amount of error. Moreover, measures of translation were both underestimated and overestimated in all views, but the most accurate measures of translation were obtained with IR, ER, and CL views. Pain scores ranged from 0-1.2 when the CL was obtained. Conclusions: Our study demonstrates that proximal humerus fracture angulation is often underestimated and translation is difficult to measure regardless of view utilized. However, the clear view, when combined with the AP view offers an orthogonal, reproducible, valid measure of displacement and causes minimal patient discomfort.","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":"128234907","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 : 2023-08-01DOI: 10.55275/jposna-2023-730
J. Schoenecker, Rachel M. McKee, Courtney E. Baker, H. Correa, Stephanie N. Moore-Lotridge
Introduction: Legg-Calve-Perthes Disease (LCPD) is a complex condition with limited understanding about its healing process. The healing mechanism of LCPD is believed to differ significantly from adult hip avascular necrosis (AVN), thus necessitating an exploration into alternative mechanisms. Our research focused on understanding these mechanisms using a review of histologic specimens, a thorough literature review, and translational basic science studies. Methods: Histologic Review: IRB-approved biopsies from five Stage 2 LCPD cases undergoing hinged abduction were analyzed to confirm the presence of cartilage in areas of fragmentation. Literature Search: A comprehensive literature review was performed, scrutinizing publications on the role of cartilage during Stage 2 of LCPD from Perthes’ original observations to subsequent studies. Mouse Model: A mouse hip model, chosen for its resemblance to Stage 2 LCPD, was used to study chondrocyte-derived VEGF’s role in angiogenesis and ossification. VEGF blockade was employed to confirm its function. Results: Histologic Review: All five biopsies of Stage 2 LCPD cases showed robust cartilage presence in areas of fragmentation (Figure 1). Histological analysis confirmed cartilage leading to new bone formation areas, akin to the physis’ zone of ossification. Literature Search: Our literature review identified consistent documentation of cartilage presence during Stage 2 of LCPD in past studies dating back to Perthes, but the role of this cartilage in the healing process was previously not clearly defined. Mouse Model: Chondrocytes were observed to produce a significant amount of VEGF right before vascularization of the hip. Blockade of VEGF production halted both vascularization and ossification. These findings point towards a role for chondrocyte-derived VEGF in promoting angiogenesis and ossification of the femoral head. Conclusion: These findings support the theory that chondrification during Stage 2 of LCPD is part of the unique reparative process of LCPD. The production of VEGF by chondrocytes appears to be integral for vascularization and ossification of the femoral head. We propose that the healing mechanism of LCPD is not a superior form of creeping substitution, but rather an endochondral-mediated mechanism of vascularization and ossification, much like a lizard regrowing its tail. Significance: These findings clarify the healing process of LCPD and can inform future treatment protocols. Treatment protocols should consider these biological processes to optimize outcomes in LCPD. Further studies are required to fully elucidate this process and its implications on the management of LCPD. Specifically, it emphasizes the importance of supporting chondrification and the production of VEGF rather than focusing solely on anti-resorptive and osteogenics.
{"title":"Like a Lizard: Repair of Perthes Disease Occurs Through Recapitulation of Development of the Proximal Femoral Epiphysis","authors":"J. Schoenecker, Rachel M. McKee, Courtney E. Baker, H. Correa, Stephanie N. Moore-Lotridge","doi":"10.55275/jposna-2023-730","DOIUrl":"https://doi.org/10.55275/jposna-2023-730","url":null,"abstract":"Introduction: Legg-Calve-Perthes Disease (LCPD) is a complex condition with limited understanding about its healing process. The healing mechanism of LCPD is believed to differ significantly from adult hip avascular necrosis (AVN), thus necessitating an exploration into alternative mechanisms. Our research focused on understanding these mechanisms using a review of histologic specimens, a thorough literature review, and translational basic science studies. Methods: Histologic Review: IRB-approved biopsies from five Stage 2 LCPD cases undergoing hinged abduction were analyzed to confirm the presence of cartilage in areas of fragmentation. Literature Search: A comprehensive literature review was performed, scrutinizing publications on the role of cartilage during Stage 2 of LCPD from Perthes’ original observations to subsequent studies. Mouse Model: A mouse hip model, chosen for its resemblance to Stage 2 LCPD, was used to study chondrocyte-derived VEGF’s role in angiogenesis and ossification. VEGF blockade was employed to confirm its function. Results: Histologic Review: All five biopsies of Stage 2 LCPD cases showed robust cartilage presence in areas of fragmentation (Figure 1). Histological analysis confirmed cartilage leading to new bone formation areas, akin to the physis’ zone of ossification. Literature Search: Our literature review identified consistent documentation of cartilage presence during Stage 2 of LCPD in past studies dating back to Perthes, but the role of this cartilage in the healing process was previously not clearly defined. Mouse Model: Chondrocytes were observed to produce a significant amount of VEGF right before vascularization of the hip. Blockade of VEGF production halted both vascularization and ossification. These findings point towards a role for chondrocyte-derived VEGF in promoting angiogenesis and ossification of the femoral head. Conclusion: These findings support the theory that chondrification during Stage 2 of LCPD is part of the unique reparative process of LCPD. The production of VEGF by chondrocytes appears to be integral for vascularization and ossification of the femoral head. We propose that the healing mechanism of LCPD is not a superior form of creeping substitution, but rather an endochondral-mediated mechanism of vascularization and ossification, much like a lizard regrowing its tail. Significance: These findings clarify the healing process of LCPD and can inform future treatment protocols. Treatment protocols should consider these biological processes to optimize outcomes in LCPD. Further studies are required to fully elucidate this process and its implications on the management of LCPD. Specifically, it emphasizes the importance of supporting chondrification and the production of VEGF rather than focusing solely on anti-resorptive and osteogenics.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"3 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":"121961052","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 : 2023-08-01DOI: 10.55275/jposna-2023-436
Seth R. Cope, Matthew Wideman, Benjamin W. Sheffer, J. Sawyer, J. Beaty, David D. Spence, D. Kelly
Background: Although proximal femoral locking compression plates (PF-LCP) have been used with increasing frequency in the fixation of proximal femoral fractures in the pediatric population, there is a lack of literature regarding their use. The purpose of this study was to examine the failure rates of PF-LCP fixation in comparison to other accepted fixation methods within a pediatric population. Methods: Retrospective review identified consecutive children treated for proximal femoral fractures from September, 2008 to February, 2019, who had a minimum follow-up of 12 weeks. Patient charts and radiographs were reviewed, and demographic information was compiled. In the case of failures, timing and method of failure were documented. Results: Sixty-four proximal femoral fractures (61 children) were studied. The average age at the time of presentation was 10.4 years. Twenty-six fractures were treated with PF-LCPs and 38 with other fixation methods (compression hip screws, rigid locked intramedullary nailing, cannulated screws, or a combination of hip screw side plate and intramedullary nailing). Failure occurred in four of the 26 fractures treated with locking compression plating (15.4%), compared to none of the 38 treated with other fixation types (p<0.05). Conclusions: This study demonstrates an increased risk of failure in proximal femoral fractures treated with locking compression plates (12.9%) compared to 0% other fixation methods (no failures). As a result of this study, we no longer use locked plating systems for pediatric femoral neck fractures at our institution.
{"title":"Early Failure of Locking Compression Plates in Pediatric Proximal Femoral Fracture","authors":"Seth R. Cope, Matthew Wideman, Benjamin W. Sheffer, J. Sawyer, J. Beaty, David D. Spence, D. Kelly","doi":"10.55275/jposna-2023-436","DOIUrl":"https://doi.org/10.55275/jposna-2023-436","url":null,"abstract":"Background: Although proximal femoral locking compression plates (PF-LCP) have been used with increasing frequency in the fixation of proximal femoral fractures in the pediatric population, there is a lack of literature regarding their use. The purpose of this study was to examine the failure rates of PF-LCP fixation in comparison to other accepted fixation methods within a pediatric population. Methods: Retrospective review identified consecutive children treated for proximal femoral fractures from September, 2008 to February, 2019, who had a minimum follow-up of 12 weeks. Patient charts and radiographs were reviewed, and demographic information was compiled. In the case of failures, timing and method of failure were documented. Results: Sixty-four proximal femoral fractures (61 children) were studied. The average age at the time of presentation was 10.4 years. Twenty-six fractures were treated with PF-LCPs and 38 with other fixation methods (compression hip screws, rigid locked intramedullary nailing, cannulated screws, or a combination of hip screw side plate and intramedullary nailing). Failure occurred in four of the 26 fractures treated with locking compression plating (15.4%), compared to none of the 38 treated with other fixation types (p<0.05). Conclusions: This study demonstrates an increased risk of failure in proximal femoral fractures treated with locking compression plates (12.9%) compared to 0% other fixation methods (no failures). As a result of this study, we no longer use locked plating systems for pediatric femoral neck fractures at our institution.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"6 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":"117131601","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 : 2023-08-01DOI: 10.55275/jposna-2023-661
E. Edmonds, Kevin C. Parvaresh, Mason J. Price, C. Farnsworth, J. Bomar, J. Hughes, V. Upasani
Background: Accurate and reliable assessment of tibial torsional is critical for the identification and treatment of tibial rotation malalignment, however the ideal rotational measurement modality and technique are controversial. This study compares rotational measurements between computed tomography (CT), magnetic resonance imaging (MRI), biplanar erect radiograph (BER) reconstructions and three-dimensional (3D) reconstructed CT before and after standardized training to evaluate measurement reliability. Methods: Eight adult cadaveric specimens underwent CT, MRI, and BER imaging. Tibial torsion was measured by three independent observers (one resident and two experienced orthopedic surgeons) both before and after standardized measurement instruction. Reliability for inter-observer measurement was evaluated using the Intraclass Correlation Coefficient (ICC). Measurement values for CT, MRI, and BER reconstructions were compared to 3D CT reconstructions analyzed using custom software to align and measure tibial torsion (used as the reference standard). Results: Before training, there was poor inter-observer reliability for CT (ICC=0.492, p=0.014) and moderate inter-observer reliability for MRI (ICC=0.633, p=0.002). There was no inter-method reliability between 3D CT and MRI for 2 of the 3 surgeons, and moderate to good reliability between 3D CT and CT. After training, the inter-observer reliability for CT improved to 0.536 and the inter-observer reliability for MRI improved to 0.701. The BER measurements (no observer involvement) had moderate reliability compared to the 3D CT reconstructions (ICC=0.69, p = 0.026). Measurement error was 4˚ for CT pre- training and 7˚ post- training), and 7˚ for MRI pre-training and 8˚ post-training. Conclusions: A standardized training regimen for MRI measurements improved both inter-observer and intra-observer reliability. Inter-method reliability between CT, MRI and BER compared to reference 3D CT reconstructions demonstrated that all imaging modalities are a valid means to measure tibial rotation, but that they differ in reliability from moderate to good. When assessing tibial torsional deformities, it is important to consider these variations from true rotation and feel comfortable using them for pre-operative planning purposes.
{"title":"The Reliability of Measurements for Tibial Torsion: A Comparison of CT, MRI, Biplanar Radiography, and 3D Reconstructions With and Without Standardized Measurement Training","authors":"E. Edmonds, Kevin C. Parvaresh, Mason J. Price, C. Farnsworth, J. Bomar, J. Hughes, V. Upasani","doi":"10.55275/jposna-2023-661","DOIUrl":"https://doi.org/10.55275/jposna-2023-661","url":null,"abstract":"Background: Accurate and reliable assessment of tibial torsional is critical for the identification and treatment of tibial rotation malalignment, however the ideal rotational measurement modality and technique are controversial. This study compares rotational measurements between computed tomography (CT), magnetic resonance imaging (MRI), biplanar erect radiograph (BER) reconstructions and three-dimensional (3D) reconstructed CT before and after standardized training to evaluate measurement reliability. Methods: Eight adult cadaveric specimens underwent CT, MRI, and BER imaging. Tibial torsion was measured by three independent observers (one resident and two experienced orthopedic surgeons) both before and after standardized measurement instruction. Reliability for inter-observer measurement was evaluated using the Intraclass Correlation Coefficient (ICC). Measurement values for CT, MRI, and BER reconstructions were compared to 3D CT reconstructions analyzed using custom software to align and measure tibial torsion (used as the reference standard). Results: Before training, there was poor inter-observer reliability for CT (ICC=0.492, p=0.014) and moderate inter-observer reliability for MRI (ICC=0.633, p=0.002). There was no inter-method reliability between 3D CT and MRI for 2 of the 3 surgeons, and moderate to good reliability between 3D CT and CT. After training, the inter-observer reliability for CT improved to 0.536 and the inter-observer reliability for MRI improved to 0.701. The BER measurements (no observer involvement) had moderate reliability compared to the 3D CT reconstructions (ICC=0.69, p = 0.026). Measurement error was 4˚ for CT pre- training and 7˚ post- training), and 7˚ for MRI pre-training and 8˚ post-training. Conclusions: A standardized training regimen for MRI measurements improved both inter-observer and intra-observer reliability. Inter-method reliability between CT, MRI and BER compared to reference 3D CT reconstructions demonstrated that all imaging modalities are a valid means to measure tibial rotation, but that they differ in reliability from moderate to good. When assessing tibial torsional deformities, it is important to consider these variations from true rotation and feel comfortable using them for pre-operative planning purposes.","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":"132720750","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 : 2023-08-01DOI: 10.55275/jposna-2023-738
Elizabeth W. Hubbard, A. Cherkashin, Mikhail Samchukov, D. Podeszwa
Guided growth is one of the most utilized surgical techniques for managing limb deformity in skeletally immature patients. Our understanding of this technique and the types of implants utilized have evolved over the past century. Many of the known risks of this surgery, such as over-correction, under-correction, and rebound deformity, are the same risks initially described when hemiephysiodesis and guided growth techniques were first published. The staple has been a powerful tool for deformity correction but its high rates of implant backout and breakage as well as unpredictable rates of premature physeal closure after removal have contributed to this implant being used less frequently today. Many studies on percutaneous transepiphyseal screws (PETS) are promising but have little follow-up so the risks of this technique with regard to premature physeal closure are not well understood. Tension band plating is currently the most utilized method. However, in specific patient subgroups, the perioperative complication and failure of correction rates are high. Despite the abundance of literature on these techniques, our understanding of guided growth is still quite limited as most studies are small and do not follow patients to skeletal maturity. Guided growth surgery also can restore the mechanical axis of the limb while leaving patients with significant residual diaphyseal or peri-articular deformity and the implications of these secondary deformities have not been studied.
{"title":"The Evolution of Guided Growth for Lower Extremity Angular Correction","authors":"Elizabeth W. Hubbard, A. Cherkashin, Mikhail Samchukov, D. Podeszwa","doi":"10.55275/jposna-2023-738","DOIUrl":"https://doi.org/10.55275/jposna-2023-738","url":null,"abstract":"Guided growth is one of the most utilized surgical techniques for managing limb deformity in skeletally immature patients. Our understanding of this technique and the types of implants utilized have evolved over the past century. Many of the known risks of this surgery, such as over-correction, under-correction, and rebound deformity, are the same risks initially described when hemiephysiodesis and guided growth techniques were first published. The staple has been a powerful tool for deformity correction but its high rates of implant backout and breakage as well as unpredictable rates of premature physeal closure after removal have contributed to this implant being used less frequently today. Many studies on percutaneous transepiphyseal screws (PETS) are promising but have little follow-up so the risks of this technique with regard to premature physeal closure are not well understood. Tension band plating is currently the most utilized method. However, in specific patient subgroups, the perioperative complication and failure of correction rates are high. Despite the abundance of literature on these techniques, our understanding of guided growth is still quite limited as most studies are small and do not follow patients to skeletal maturity. Guided growth surgery also can restore the mechanical axis of the limb while leaving patients with significant residual diaphyseal or peri-articular deformity and the implications of these secondary deformities have not been studied.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"533 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":"123363705","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 : 2023-08-01DOI: 10.55275/jposna-2023-740
L. Bellaire
The goal of the JPOSNA® Reviewer Profile Series is to periodically recognize an outstanding member of our volunteer JPOSNA® peer reviewer board. We aim to highlight the exceptional work these individuals do for our Journal, without whom JPOSNA® would not be possible.
{"title":"Reviewer Profile","authors":"L. Bellaire","doi":"10.55275/jposna-2023-740","DOIUrl":"https://doi.org/10.55275/jposna-2023-740","url":null,"abstract":"The goal of the JPOSNA® Reviewer Profile Series is to periodically recognize an outstanding member of our volunteer JPOSNA® peer reviewer board. We aim to highlight the exceptional work these individuals do for our Journal, without whom JPOSNA® would not be possible.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"7 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":"121115905","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 : 2023-08-01DOI: 10.55275/jposna-2023-695
Meghan Malloy, S. Tarima, B. Canales, David Nelson, J. Hanley
Background: Appointment nonadherence in pediatric orthopaedic clinics negatively affects patient outcomes. While previous studies have examined risk factors for missed appointments, there is a lack of such research in pediatric orthopaedics. This study tests the hypothesis that pediatric orthopaedic patients with greater socioeconomic risk are more likely to miss appointments. Our objective is to identify risk factors contributing to missed appointments. Methods: A retrospective chart review was conducted of all visits in an outpatient pediatric orthopaedic clinic and affiliated Midwest level 1 academic hospital in 2019. Possible covariates with appointment attendance collected included sociodemographic information such as age, gender (male/female), race/ethnicity (non-Hispanic White, Black, Hispanic/Latinx, Other), and insurance (Commercial, Medicaid, Medicaid HMO, Other). The main study outcome was appointment status, defined as either “No-Show” or “Attended/Completed.” Using census data, the Area Deprivation Index (ADI) was determined for a matched case (“No-Show”) control sample to quantify socioeconomic risk. Factors associated with appointment nonadherence were analyzed with a logistic regression model. Results: Out of 10,078 total encounters included in the study, there was a no-show rate of 6.61%. Significant predictors of no-show included race (p<0.001), insurance type (p<0.001), and lag days between appointment scheduling and completion (p<0.001). In a matched case-control sub-study, ADI was positively associated with increased odds of no-show (p<0.001), making this model unique from other studies. Conclusions: This data informs pediatric orthopaedic providers of risk factors for appointment nonadherence in order to individualize patient care plans based on specific socioeconomic needs. Efforts to improve appointment adherence may reduce the rate of poor health outcomes and health disparities in underserved areas. Next steps include qualitative assessments to articulate the experience of families who miss appointments to develop a greater standard for more accessible patient-centered care.
{"title":"Identifying Risk Factors for Appointment No-Shows in a Pediatric Orthopaedic Surgery Clinic","authors":"Meghan Malloy, S. Tarima, B. Canales, David Nelson, J. Hanley","doi":"10.55275/jposna-2023-695","DOIUrl":"https://doi.org/10.55275/jposna-2023-695","url":null,"abstract":"Background: Appointment nonadherence in pediatric orthopaedic clinics negatively affects patient outcomes. While previous studies have examined risk factors for missed appointments, there is a lack of such research in pediatric orthopaedics. This study tests the hypothesis that pediatric orthopaedic patients with greater socioeconomic risk are more likely to miss appointments. Our objective is to identify risk factors contributing to missed appointments. Methods: A retrospective chart review was conducted of all visits in an outpatient pediatric orthopaedic clinic and affiliated Midwest level 1 academic hospital in 2019. Possible covariates with appointment attendance collected included sociodemographic information such as age, gender (male/female), race/ethnicity (non-Hispanic White, Black, Hispanic/Latinx, Other), and insurance (Commercial, Medicaid, Medicaid HMO, Other). The main study outcome was appointment status, defined as either “No-Show” or “Attended/Completed.” Using census data, the Area Deprivation Index (ADI) was determined for a matched case (“No-Show”) control sample to quantify socioeconomic risk. Factors associated with appointment nonadherence were analyzed with a logistic regression model. Results: Out of 10,078 total encounters included in the study, there was a no-show rate of 6.61%. Significant predictors of no-show included race (p<0.001), insurance type (p<0.001), and lag days between appointment scheduling and completion (p<0.001). In a matched case-control sub-study, ADI was positively associated with increased odds of no-show (p<0.001), making this model unique from other studies. Conclusions: This data informs pediatric orthopaedic providers of risk factors for appointment nonadherence in order to individualize patient care plans based on specific socioeconomic needs. Efforts to improve appointment adherence may reduce the rate of poor health outcomes and health disparities in underserved areas. Next steps include qualitative assessments to articulate the experience of families who miss appointments to develop a greater standard for more accessible patient-centered care.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"23 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":"127225960","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 : 2023-08-01DOI: 10.55275/jposna-2023-664
Christopher R. Gajewski, Kevin Chen, Eric Chang, D. Levine, Jennifer Wallace Valdes, Rachel M. Thompson
Background: Duchenne muscular dystrophy (DMD) is a severe, progressive X-linked recessive neuromuscular disorder characterized by muscle weakness and atrophy. Additionally, patients with DMD have significant reductions in bone mineral density compared to age-matched controls, which is exacerbated by concomitant steroid use. These findings dramatically increase fracture risk, which may irreparably decrease functional status. The aim of this case series is to examine outcomes of operative versus nonoperative management of femur fractures in this patient population. Methods: An IRB-approved retrospective chart review was completed for patients with DMD treated at a single institution for a femur fracture between 2013-2022. Patients were excluded for incomplete documentation, treatment initiation at an outside hospital, or diagnosis of a different muscular dystrophy. Demographic variables, treatment information, functional status, and adverse events were collected for each patient. Descriptive statistics were used to summarize demographic and outcome variables. Results: A total of 10 patients with 11 femur fractures were included for analysis. All patients were male with an average age of 12.7 years and clinical follow-up of 286 days. Five fractures in five patients underwent operative fixation (Group A) and six fractures in five patients underwent nonoperative management (Group B). In Group A, three patients were short-distance ambulators prior to injury, and all patients regained a similar functional status postoperatively. All three patients were treated with a locked intramedullary nail. One patient in Group B was a short-distance ambulator prior to injury, the remainder were nonambulatory; all patients in Group B were primary wheelchair users at final follow-up. There were no adverse events as a result of treatment in either group. Conclusion: Nonoperative management with cast immobilization remains an acceptable option for nonambulatory patients and those with minimally-displaced fractures not amenable to surgical intervention. Surgical intervention is recommended for higher-functioning patients with the goal of restoring ambulatory status. Regardless of treatment modality, patients should receive aggressive physical therapy directed at early weight-bearing, range of motion, and mobilization to preserve strength, muscle mass, and mobility.
{"title":"Management and Outcomes of Femur Fractures in Patients with Duchenne Muscular Dystrophy","authors":"Christopher R. Gajewski, Kevin Chen, Eric Chang, D. Levine, Jennifer Wallace Valdes, Rachel M. Thompson","doi":"10.55275/jposna-2023-664","DOIUrl":"https://doi.org/10.55275/jposna-2023-664","url":null,"abstract":"Background: Duchenne muscular dystrophy (DMD) is a severe, progressive X-linked recessive neuromuscular disorder characterized by muscle weakness and atrophy. Additionally, patients with DMD have significant reductions in bone mineral density compared to age-matched controls, which is exacerbated by concomitant steroid use. These findings dramatically increase fracture risk, which may irreparably decrease functional status. The aim of this case series is to examine outcomes of operative versus nonoperative management of femur fractures in this patient population. Methods: An IRB-approved retrospective chart review was completed for patients with DMD treated at a single institution for a femur fracture between 2013-2022. Patients were excluded for incomplete documentation, treatment initiation at an outside hospital, or diagnosis of a different muscular dystrophy. Demographic variables, treatment information, functional status, and adverse events were collected for each patient. Descriptive statistics were used to summarize demographic and outcome variables. Results: A total of 10 patients with 11 femur fractures were included for analysis. All patients were male with an average age of 12.7 years and clinical follow-up of 286 days. Five fractures in five patients underwent operative fixation (Group A) and six fractures in five patients underwent nonoperative management (Group B). In Group A, three patients were short-distance ambulators prior to injury, and all patients regained a similar functional status postoperatively. All three patients were treated with a locked intramedullary nail. One patient in Group B was a short-distance ambulator prior to injury, the remainder were nonambulatory; all patients in Group B were primary wheelchair users at final follow-up. There were no adverse events as a result of treatment in either group. Conclusion: Nonoperative management with cast immobilization remains an acceptable option for nonambulatory patients and those with minimally-displaced fractures not amenable to surgical intervention. Surgical intervention is recommended for higher-functioning patients with the goal of restoring ambulatory status. Regardless of treatment modality, patients should receive aggressive physical therapy directed at early weight-bearing, range of motion, and mobilization to preserve strength, muscle mass, and mobility.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"36 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":"134500998","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 : 2023-08-01DOI: 10.55275/jposna-2023-645
T. R. Johnson, N. Segovia, Xochitl Bryson, Meghan N. Imrie, J. Vorhies
Background: There are currently no evidence-based guidelines addressing the duration of follow-up after spinal fusion. Despite the safety and efficacy of posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS), long-term complications exist, including infection, pseudoarthrosis, adjacent segment disease, deformity progression, persistent pain, and junctional deformities. The objective of this study was to describe practice variation existing among surgeons regarding duration of follow-up after surgical treatment of AIS. Methods: An anonymous online survey was created and subsequently distributed to members of POSNA and SRS to assess practice demographics and surgeon opinions surrounding long-term surveillance following surgery for AIS. Only surgeons who treated at least 5 operative AIS cases within the past year were included. Descriptive statistics and comparative sub-analyses are presented. Results: Forty-nine participants met inclusion criteria. Respondents were mainly Pediatric Orthopaedic Surgeons (92%) in practice for 21-50 years (49%) who performed approximately 21-50 operative AIS cases per year (49%). 48% of providers had an age limit in their practice and 52% regularly followed operative AIS patients over 18 years of age. 62% of surgeons followed operative AIS patients for 2-5 years post-operatively whereas only 4% followed for more than 10 years. The most cited factors impacting follow-up recommendations were junctional deformities, adjacent segment disease, and symptomatic implants. There were no significant associations between years in practice, operative volume and, for long-term follow-up after routine operative AIS cases. Conclusions: Significant variability in long-term follow-up after PSF for AIS exists. Although most patients are clinically followed for 2 years after surgery, only a small percentage of providers follow AIS patients for more than 10 years post-operatively. Numerous AIS revisions occur more than 5 years after the index surgery. Further investigations to determine the benefits of long-term surveillance following PSF for AIS should be conducted.
{"title":"Variations in Duration of Clinical Follow-up After Spinal Fusion for Adolescent Idiopathic Scoliosis: A Survey of POSNA and SRS Membership","authors":"T. R. Johnson, N. Segovia, Xochitl Bryson, Meghan N. Imrie, J. Vorhies","doi":"10.55275/jposna-2023-645","DOIUrl":"https://doi.org/10.55275/jposna-2023-645","url":null,"abstract":"Background: There are currently no evidence-based guidelines addressing the duration of follow-up after spinal fusion. Despite the safety and efficacy of posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS), long-term complications exist, including infection, pseudoarthrosis, adjacent segment disease, deformity progression, persistent pain, and junctional deformities. The objective of this study was to describe practice variation existing among surgeons regarding duration of follow-up after surgical treatment of AIS. Methods: An anonymous online survey was created and subsequently distributed to members of POSNA and SRS to assess practice demographics and surgeon opinions surrounding long-term surveillance following surgery for AIS. Only surgeons who treated at least 5 operative AIS cases within the past year were included. Descriptive statistics and comparative sub-analyses are presented. Results: Forty-nine participants met inclusion criteria. Respondents were mainly Pediatric Orthopaedic Surgeons (92%) in practice for 21-50 years (49%) who performed approximately 21-50 operative AIS cases per year (49%). 48% of providers had an age limit in their practice and 52% regularly followed operative AIS patients over 18 years of age. 62% of surgeons followed operative AIS patients for 2-5 years post-operatively whereas only 4% followed for more than 10 years. The most cited factors impacting follow-up recommendations were junctional deformities, adjacent segment disease, and symptomatic implants. There were no significant associations between years in practice, operative volume and, for long-term follow-up after routine operative AIS cases. Conclusions: Significant variability in long-term follow-up after PSF for AIS exists. Although most patients are clinically followed for 2 years after surgery, only a small percentage of providers follow AIS patients for more than 10 years post-operatively. Numerous AIS revisions occur more than 5 years after the index surgery. Further investigations to determine the benefits of long-term surveillance following PSF for AIS should be conducted.","PeriodicalId":412478,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"44 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":"128567111","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}
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