6,192 results match your criteria Journal of Pediatric Orthopaedics [Journal]


The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning.

J Pediatr Orthop 2019 Feb 11. Epub 2019 Feb 11.

Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.

Background: Retrograde percutaneous pinning often involves intra-articular pin placement. Classic teaching has cautioned about the risk of septic arthritis with intra-articular pins, although an incidence has not been reported for this complication. The purpose of this study was to determine the incidence of pin tract infections and septic arthritis following retrograde percutaneous pinning of the distal femur. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001346DOI Listing
February 2019
3 Reads

Medical Malpractice in Pediatric Orthopaedics: A Systematic Review of US Case Law.

J Pediatr Orthop 2019 Feb 5. Epub 2019 Feb 5.

Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS.

Background: Compared with other orthopaedic subspecialties, pediatric orthopaedic surgeons are thought to be at greater risk for malpractice claims; however, there is scant research on this topic. The purpose of our study was to characterize publicly available malpractice cases pertaining to pediatric orthopaedics to determine the (1) most common specialties of the physicians implicated, (2) most common diagnoses involved, (3) rate of verdicts in favor of the plaintiff, (4) amount of indemnity payments resulting from all verdicts versus verdicts in which only an orthopaedic surgeon was involved, and (5) outcomes of cases that were appealed.

Methods: The Westlaw legal database was queried for jury verdicts, settlements, and appellate cases using the search terms "pediatric" AND "orthopaedic" from December 31, 1984, to January 1, 2016, yielding 176 appellate court cases and 189 jury reports/settlements. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001348DOI Listing
February 2019
1 Read

Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection.

J Pediatr Orthop 2019 Mar;39(3):158-162

Departments of Orthopaedics.

Introduction: Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000884DOI Listing

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity.

J Pediatr Orthop 2019 03;39(3):153-157

Department of Pediatrics, Division of Hospital Medicine.

Objective: There are currently no algorithms for early stratification of pediatric musculoskeletal infection (MSKI) severity that are applicable to all types of tissue involvement. In this study, the authors sought to develop a clinical prediction algorithm that accurately stratifies infection severity based on clinical and laboratory data at presentation to the emergency department.

Methods: An IRB-approved retrospective review was conducted to identify patients aged 0 to 18 who presented to the pediatric emergency department at a tertiary care children's hospital with concern for acute MSKI over a 5-year period (2008 to 2013). Read More

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http://dx.doi.org/10.1097/BPO.0000000000000880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368021PMC

Comparison of Percutaneous Reduction and Pin Fixation in Acute and Chronic Pediatric Mallet Fractures.

J Pediatr Orthop 2019 Mar;39(3):146-152

Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas, Dallas, TX.

Background: Although pediatric mallet fractures are more common than adult fractures, no techniques have focused on surgical fixation of pediatric mallet fractures. This study aims to describe the technique and results of percutaneous reduction and fixation in acute and chronic pediatric mallet fractures.

Methods: This is a retrospective review of 51 pediatric mallet fractures treated with percutaneous wire fixation from 2007 to 2014; 38 were acute fractures and 13 were chronic (>4 wk from injury). Read More

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http://dx.doi.org/10.1097/BPO.0000000000000896DOI Listing

Spinal Instrumentation in Growing Children Retards the Natural Development of Pelvic Incidence.

J Pediatr Orthop 2019 Mar;39(3):141-145

Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine, Ankara.

Background: Pelvic incidence increases gradually throughout growth until skeletal maturity. Growing rod instrumentation has been suggested to have a stabilizing effect on the development of the normal sagittal spinal alignment. The purpose of this study is to determine the effect of fixed sagittal plane caused by dual growing rod instrumentation on the natural progression of sagittal spinopelvic parameters in children with idiopathic or idiopathic-like early onset scoliosis. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000882DOI Listing

Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children's Tertiary Hospital Study.

J Pediatr Orthop 2019 Mar;39(3):130-135

Department of Paediatric Orthopaedic Surgery, Maternal and Child Hospital, Sant Joan de Déu of Barcelona.

Background: Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000883DOI Listing
March 2019
1 Read

Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy.

J Pediatr Orthop 2019 Mar;39(3):125-129

Medical University of South Carolina, Charleston, SC and Boston Children's Hospital, Boston, MA.

Background: The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000894DOI Listing
March 2019
2 Reads

Capital Femoral Epiphyseal Extension May Confer Physeal Stability in Slipped Capital Femoral Epiphysis.

J Pediatr Orthop 2019 Mar;39(3):119-124

Division of Pediatric Orthopaedics, Department of Orthopaedics, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, OH.

Background: Factors including obesity and morphologic parameters around the hip that increase physeal stress are associated with an increased risk of slipped capital femoral epiphysis (SCFE). Recent evidence suggests that superior epiphyseal extension may confer stability to the physis and help protect against SCFE. The purpose of this study is to investigate the relationship between epiphyseal extension and SCFE using an age-matched and sex-matched cohort study. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000881DOI Listing
March 2019
2 Reads

Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort.

J Pediatr Orthop 2019 Mar;39(3):111-118

Arnold Palmer Medical Center, Orlando, FL.

Background: Closed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR.

Methods: Prospectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Read More

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http://dx.doi.org/10.1097/BPO.0000000000000895DOI Listing
March 2019
2 Reads

Perioperative Ketorolac for Supracondylar Humerus Fracture in Children Decreases Postoperative Pain, Opioid Usage, Hospitalization Cost, and Length-of-Stay.

J Pediatr Orthop 2019 Feb 1. Epub 2019 Feb 1.

Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.

Background: There is a need for improved opioid stewardship in orthopedic surgery through multimodal analgesia strategies. Perioperative administration of ketorolac in children undergoing closed reduction and percutaneous pinning (CRPP) for displaced supracondylar humerus (SCH) fracture may decrease pain, reduce opioid requirements, and decrease hospitalization costs.

Methods: Retrospective case-control investigation of children (aged, 1 to 14) treated with CRPP for closed, modified Gartland type III extension-type SCH fractures at a single children's hospital between 2011 and 2017. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001345DOI Listing
February 2019
3 Reads

Humeral Simple Bone Cysts: Observational Versus Interventional Management.

J Pediatr Orthop 2019 Jan 29. Epub 2019 Jan 29.

Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield.

Aims: Our study aims to review the outcomes of conservative and interventional management of simple bone cysts (SBC) in the humerus.

Methods: We retrospectively reviewed our center's prospectively collected database. All patients with a diagnosis of a humeral SBC and a minimum of 1-year follow-up or complete healing and discharge within the first year were included. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001344DOI Listing
January 2019

Is Anteromedial Drilling Safe in Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescents with Growth Remaining?

J Pediatr Orthop 2019 Jan 29. Epub 2019 Jan 29.

Texas Scottish Rite Hospital for Children.

Background: Previous reports of transphyseal drilling in anterior cruciate ligament (ACL) reconstruction have demonstrated good clinical outcomes without subjective changes in further skeletal development. The purpose of this study is to evaluate radiographic changes during continued growth following a transphyseal ACL reconstruction using an anteromedial femoral (AM) drilling technique in patients with >18 months of growth remaining.

Methods: A review of consecutive adolescents who underwent a soft tissue transphyseal ACL reconstruction using an AM drilling technique was performed. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001289DOI Listing
January 2019

Pediatric Emergency Room Transfers: Are They Warranted?

J Pediatr Orthop 2019 Jan 25. Epub 2019 Jan 25.

University of Maryland School of Medicine, Baltimore, MD.

Background: Emergency room transfers to a higher level of care are a vital component of modern health care, as optimal care of patients requires providing access to specialized personnel and facilities. However, literature has shown that orthopaedic transfers to a higher level of care facility are frequently unnecessary. The purpose of this study was to assess the appropriateness of pediatric orthopaedic transfers to a tertiary care center and the factors surrounding these transfers. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001343DOI Listing
January 2019
1 Read

Adolescent and Caregiver-derived Utilities for Traumatic Patella Dislocation Health States.

J Pediatr Orthop 2019 Jan 25. Epub 2019 Jan 25.

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.

Introduction: The treatment of a first-time traumatic patella dislocation in children and adolescents remains controversial. Preference-based health utility assessments can provide health-related quality of life information for orthopaedic conditions and their subsequent treatment. The purpose of this study was to determine utilities for pediatric acute traumatic patella dislocation and subsequent treatment health states from both children with patellar dislocation, and their parents. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001341DOI Listing
January 2019
4 Reads
1.426 Impact Factor

Friberg Equation to Predict Pediatric Distal Forearm Fracture Remodeling.

J Pediatr Orthop 2019 Jan 25. Epub 2019 Jan 25.

Department of Orthopaedic Surgery, University of South Alabama, Mobile, AL.

Background: This study is the first to test Friberg's equation's (Vt=V0[e]) accuracy in predicting the residual angular deformity in pediatric distal forearm fractures.

Methods: Angular deformities from distal forearm fractures in 50 children (mean age, 9 y) were retrospectively measured on follow-up radiographs once healed and compared to extrapolated angles at respective follow-up intervals from 2013 to 2015.

Results: The predicted and actual angulations from 120 radiographs (mean follow-up, 3mo) showed that the mean predicted angle was similar to the measured angle in the radioulnar plane and only 2 degrees greater than the measured angle in the dorsovolar plane. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001342DOI Listing
January 2019

The Association Between the Classification of Early-onset Scoliosis and Smith Complications After Initiation of Growth-friendly Spine Surgery: A Preliminary Study.

J Pediatr Orthop 2019 Jan 19. Epub 2019 Jan 19.

Columbia University Medical Center, New York, NY.

Background: Early-onset scoliosis (EOS) is a complex, heterogeneous condition involving multiple etiologies, genetic associations, and treatment plans. In 2014, Williams and colleagues proposed a classification system of EOS (C-EOS) that categorizes patients by etiology, Cobb angle, and kyphosis. Shortly after, Smith and colleagues validated a classification system to report complications of growth-friendly spine instrumentation. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001337DOI Listing
January 2019

Predicting Ambulatory Function Based on Infantile Lower Extremity Posture Types in Amyoplasia Arthrogryposis.

J Pediatr Orthop 2019 Jan 19. Epub 2019 Jan 19.

Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

Background: Arthrogryposis multiplex congenita (AMC) is a nonprogressive syndrome with multiple rigid joints, fibrotic periarticular tissue, and muscular fibrosis. The most common subgroup is amyoplasia. Ambulation is one of the most significant functions of the lower extremities as it translates to increased functionality and independence in adulthood. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001322DOI Listing
January 2019

Radiographic Outcome and Complication Rate of 34 Graduates After Treatment With Vertical Expandable Prosthetic Titanium Rib (VEPTR): A Single Centre Report.

J Pediatr Orthop 2019 Jan 17. Epub 2019 Jan 17.

Orthopaedic Department, University Children's Hospital Basel (UKBB), University of Basel, Basel.

Background: The final strategy for graduates from growth-sparing surgery is challenging. The purpose of this study was to evaluate the radiographic outcome and complications of patients with early onset scoliosis (EOS) who have graduated from vertical expandable prosthetic titanium rib (VEPTR) treatment, either undergoing final fusion surgery or following a nonfusion approach.

Methods: Final treatment for VEPTR graduates was divided in "VEPTR in situ without final fusion," "removal of VEPTR without final fusion," and "removal of VEPTR with instrumented final fusion. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001338DOI Listing
January 2019
1 Read

Evaluation of Skeletal Maturity Using the Distal Femoral Physeal Central Peak is Not Significantly Affected by Radiographic Projection.

J Pediatr Orthop 2019 Jan 14. Epub 2019 Jan 14.

Rainbow and Babies Hospitals at Case Western Reserve University.

Background: Accurate estimation of skeletal maturity is important in several pediatric orthopaedic conditions. The current gold standard for estimating skeletal maturity using the Greulich and Pyle Bone Atlas is complex and shown to have significant interobserver variability. Recent data have shown peak height velocity to occur on average at 90% of final adult height, providing an improved gold standard to quantify skeletal maturity, facilitating the investigation of different skeletal maturity systems. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001340DOI Listing
January 2019

Outcomes of Arthroscopy-assisted Closed Reduction and Percutaneous Pinning for a Displaced Pediatric Lateral Condylar Humeral Fracture.

J Pediatr Orthop 2019 Jan 14. Epub 2019 Jan 14.

Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Olympic-ro, Songpa-gu, Seoul, Republic of Korea.

Background: Since 2015, we have performed arthroscopy-assisted closed reduction and percutaneous pinning (A/S-CRPP) for children with a displaced lateral condylar humeral fracture (LCF). The purpose of this study is to introduce our A/S-CRPP method and present its outcomes.

Methods: In total, 39 displaced (>2 mm) LCFs for which A/S-CRPP was initially attempted and with available follow-up data of >12 months were retrospectively reviewed. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001319DOI Listing
January 2019
4 Reads

Clinical and Radiographic Characteristics of Atypical Slipped Capital Femoral Epiphysis.

J Pediatr Orthop 2019 Jan 14. Epub 2019 Jan 14.

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Slipped capital femoral epiphysis (SCFEs) can be idiopathic or atypical (associated with renal failure, radiation therapy, and endocrine disorders). It is important to estimate the likelihood that atypical SCFE shows different clinical and radiographic characteristics and complications with typical SCFEs.

Methods: We retrospectively reviewed 53 patients (66 hips) with SCFEs managed between 1995 and 2016. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001339DOI Listing
January 2019
6 Reads

Pelvic Tilt Changes After Hamstring Lengthening in Children With Cerebral Palsy.

J Pediatr Orthop 2019 Jan 14. Epub 2019 Jan 14.

Alder Hey Children's Hospital, Liverpool, UK.

Background: Flexion deformity of the knee is a common presentation in children with cerebral palsy with hamstring surgery as an option for addressing this. However, concerns with regard to increased pelvic tilt have been raised. The purpose of this study was to compare preoperative and postoperative pelvic tilt after isolated hamstring lengthening versus combined hamstring lengthening and the influence of Gross Motor Function Classification System (GMFCS) levels on pelvic tilt. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001326DOI Listing
January 2019
4 Reads

Nonarticular Base and Shaft Fractures of Children's Fingers: Are Follow-up X-rays Needed? Retrospective Study of Conservatively Treated Proximal and Middle Phalangeal Fractures.

J Pediatr Orthop 2019 Jan 8. Epub 2019 Jan 8.

Children's Research Center.

Background: Phalangeal fractures of the hand are common in children, and most extra-articular fractures can be treated with nonoperative management. Minimally or nondisplaced fractures may simply be immobilized, whereas displaced fractures need closed reduction before immobilization. Although few of these fractures displace secondarily, most schemes currently recommend follow-up x-rays after initial diagnosis. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001335DOI Listing
January 2019
1 Read

Growth-Friendly Spine Surgery in Escobar Syndrome.

J Pediatr Orthop 2019 Jan 8. Epub 2019 Jan 8.

Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA.

Background: The aims of this study were to characterize the spinal deformity of patients with Escobar syndrome, describe results of growth-friendly treatments, and compare these results with those of an idiopathic early-onset scoliosis (EOS) cohort to determine whether the axial stiffness in Escobar syndrome limited correction.

Methods: We used 2 multicenter databases to review the records of 8 patients with EOS associated with Escobar syndrome who had at least 2-year follow-up after initiation of growth-friendly treatment from 1990 to 2016. An idiopathic EOS cohort of 16 patients matched for age at surgery (±1 y), postoperative follow-up (±1 y), and initial curve magnitude (±10 degrees) was identified. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001315DOI Listing
January 2019
10 Reads

Confirming the Presence of Unrecognized Meniscal Injuries on Magnetic Resonance Imaging in Pediatric and Adolescent Patients With Anterior Cruciate Ligament Tears.

J Pediatr Orthop 2019 Jan 8. Epub 2019 Jan 8.

Elite Sports Medicine, Connecticut Children's Medical Center.

Background: Prior research has shown decreased accuracy of meniscal injury detection using magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL)-deficient adult patients as well as ACL-deficient pediatric and adolescent patients. The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries.

Methods: The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001331DOI Listing
January 2019
4 Reads

Concomitant Anterior Cruciate Ligament Reconstruction and Temporary Hemiepiphysiodesis in the Skeletally Immature: A Combined Technique.

J Pediatr Orthop 2019 Jan 8. Epub 2019 Jan 8.

Department of Orthopedics and Sports Medicine, Seattle Children's Hospital.

Background: Young athletes with an anterior cruciate ligament (ACL) disruption and limb malalignment pose a treatment dilemma. Little has been published regarding limb malalignment in this population. Our aim is to review the results of combined treatment of an ACL deficient knee and genu valgum in skeletally immature patients. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001330DOI Listing
January 2019
3 Reads

Olecranon Fractures in Pediatric Patients With Osteogenesis Imperfecta.

J Pediatr Orthop 2019 Jan 8. Epub 2019 Jan 8.

Department of Orthopaedic Surgery, Shriners Hospital for Children-Chicago, Chicago, IL.

Background: Osteogenesis imperfecta (OI) is a hereditary disorder characterized by an abnormality of the quality or quantity of type I collagen, leading to bone fragility. Fractures in children with OI may result from minor trauma and have atypical patterns. Previous studies have found a strong relationship between olecranon fractures and OI in pediatric populations, but the characteristics of olecranon fractures within the OI patient population have not been fully described. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001333DOI Listing
January 2019

Wash, Rinse, Repeat: Which Patients Undergo Serial Joint Irrigation in Pediatric Septic Hip Arthritis?

J Pediatr Orthop 2019 Jan 7. Epub 2019 Jan 7.

Boston Children's Hospital, Harvard University, Boston, MA.

Background: The purpose of this study is to identify risk factors associated with repeat surgical irrigation in pediatric septic hip arthritis.

Methods: A single center retrospective case-control study was performed. Patients who underwent ≥2 washouts (cases) were compared with those who had only 1 washout (controls). Read More

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http://dx.doi.org/10.1097/BPO.0000000000001323DOI Listing
January 2019
2 Reads

Association Between Government Health Insurance Status and Physical Activity in American Youth.

J Pediatr Orthop 2019 Jan 7. Epub 2019 Jan 7.

Hospital for Special Surgery.

Background: Health insurance plans provide health programming access and affect physical activity levels in American youth, leading to health disparities in American children. The primary purpose of the current study was to investigate the relationship between health insurance status and physical activity level in American youth.

Methods: A national, United States census weighted cross-sectional survey was performed analyzing 2002 noninstitutionalized children living in the United States between the ages of 10 to 18 years, equally split by age and sex, with state of residency and race/ethnicity proportional to the 2010 census distribution. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001329DOI Listing
January 2019

Can Patients and Families Read The Questionnaires For Patient-related Outcome Measures?

J Pediatr Orthop 2019 Jan 2. Epub 2019 Jan 2.

Shriners Hospital for Children, Portland, OR.

Background: Patient-reported Outcome Measures (PROMs) quantifying health-related quality of life are widely used to evaluate illness and the impact of health care interventions. The questionnaires must be comprehensible by the persons completing them. Literacy Surveys in the United States reveal nearly half of the US adult population have a literacy level below the 8th grade. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001327DOI Listing
January 2019

Dimeglio Score Predicts Treatment Difficulty During Ponseti Casting for Isolated Clubfoot.

J Pediatr Orthop 2019 Jan 2. Epub 2019 Jan 2.

Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO.

Background: The Dimeglio score (DS) is widely used to assess clubfoot severity, but its ability to predict long-term outcomes following Ponseti treated isolated clubfoot (IC) is controversial. This study tested the association between the initial DS and its individual parameters with the number of Ponseti clubfoot casts required to achieve correction and the rate of early recurrence following treatment.

Methods: Data were retrospectively collected from patients who underwent treatment of IC between March 2012 and March 2015 and were followed for ≥2 years. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001325DOI Listing
January 2019
2 Reads

Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats.

J Pediatr Orthop 2019 Jan 2. Epub 2019 Jan 2.

Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.

Background: Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001317DOI Listing
January 2019
1 Read

Effect of Amputation Level on Quality of Life and Subjective Function in Children.

J Pediatr Orthop 2019 Jan 2. Epub 2019 Jan 2.

Lexington Shriners Hospitals for Children and University of Kentucky, Lexington, KY.

Background: Our aim was to discern whether children with amputations have differences in subjective function based on amputation level. We hypothesized that children with more proximal amputations would report poorer function and quality of life.

Methods: An IRB-approved, retrospective chart review of patients aged 0 to 21 years old with lower extremity amputations was performed. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001321DOI Listing
January 2019
2 Reads

Reliability of Radiographic Assessments of the Hip in Cerebral Palsy.

J Pediatr Orthop 2018 Dec 26. Epub 2018 Dec 26.

Child Health Evaluative Sciences, Research Institute.

Introduction: Children with cerebral palsy are at risk for progressive hip displacement. Since surveillance for hip displacement uses specific radiographic measurements to guide decision making, it is important to establish the reliability of these measurements, which include Reimer's migration percentage (MP), acetabular index or acetabular angle (AI or AA), and pelvic obliquity (PO). The purpose of this study was to determine the intraobserver and interobserver reliability of these radiographic measures among an international group of pediatric orthopaedic surgeons participating in the prospective international multicenter Cerebral Palsy Hip Outcomes Project (CHOP) currently underway to evaluate the outcomes of hip interventions in cerebral palsy. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001318DOI Listing
December 2018
2 Reads

Fassier-Duval Rods are Associated With Superior Probability of Survival Compared With Static Implants in a Cohort of Children With Osteogenesis Imperfecta Deformities.

J Pediatr Orthop 2018 Dec 26. Epub 2018 Dec 26.

Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO.

Background: The survival of Fassier-Duval (FD) telescoping rods as compared with static implants in children affected by osteogenesis imperfecta is not well characterized. The purpose of this study was to compare risk of lower extremity implant failure in FD rods versus static implants.

Methods: Data were retrospectively collected from patients with osteogenesis imperfecta who underwent surgical treatment using either FD rods or static implants (Rush rods, flexible nails, or Steinmann pins) between 1995 and 2015. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001324DOI Listing
December 2018
10 Reads

The Role of Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Pediatric Thoracolumbar Compression Fractures.

J Pediatr Orthop 2018 Dec 26. Epub 2018 Dec 26.

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic.

Background: Because of concerns about radiation exposure, some centers consider magnetic resonance imaging (MRIs) the preferred imaging modality for pediatric thoracic and/or lumbar compression fractures. The purpose of this study was to evaluate the sensitivity of computed tomography (CT) and MRI in diagnosing thoracolumbar compression fractures and the utility of MRI in their management.

Methods: Retrospective review identified 52 patients aged 0 to 18 years with 191 thoracic and/or lumbar compression fractures who had both CT and MRI during the initial trauma evaluation. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001316DOI Listing
December 2018
1 Read

Quantitative Assessment of Muscle Strength Following "Slow" Surgical Lengthening of the Medial Hamstring Muscles in Children With Cerebral Palsy.

J Pediatr Orthop 2018 Dec 18. Epub 2018 Dec 18.

Shriners Hospital for Children Northern California, Sacramento, CA.

Background: Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). Read More

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http://dx.doi.org/10.1097/BPO.0000000000001313DOI Listing
December 2018
1 Read

Range of Motion Improvement Following Surgical Management of Knee Arthrofibrosis in Children and Adolescents.

J Pediatr Orthop 2018 Dec 14. Epub 2018 Dec 14.

Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA The authors declare no conflicts of interest. DOI: 10.1097/BPO.0000000000001320.

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December 2018

Radiation Prophylaxis for Hip Salvage Surgery in Cerebral Palsy: Can We Reduce the Incidence of Heterotopic Ossification?

J Pediatr Orthop 2018 Dec 12. Epub 2018 Dec 12.

Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA.

Background: Heterotopic ossification (HO) is a well-recognized complication of proximal femoral resection (PFR) surgery in children with cerebral palsy (CP). Although single-dose radiation prophylaxis (SDRP) has been shown to be effective at lowering the rates of HO following adult total hip arthroplasty; there has been limited study examining the efficacy of SDRP for HO prevention in children with CP undergoing PFR. The purpose of this study was to assess the efficacy of SDRP in children with CP undergoing PFR. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001314DOI Listing
December 2018
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A Quartet of Elastic Stable Intramedullary Nails for More Challenging Pediatric Femur Fractures.

J Pediatr Orthop 2019 Jan;39(1):e12-e17

Children's Healthcare of Atlanta.

Introduction: The insertion of 2 elastic stable intramedullary nails (ESINs) is a common treatment for pediatric femur fractures. However, the use of this technique in length-unstable or metadiaphyseal fractures has historically been associated with higher complication rates. To improve stability, the addition of a third ESIN has been assessed biomechanically and clinically, but the addition of a fourth nail has only been evaluated biomechanically. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001273DOI Listing
January 2019
2 Reads

Minimally Displaced Humeral Lateral Condyle Fractures: Immobilize or Operate When Stability is Unclear?

J Pediatr Orthop 2018 Dec 8. Epub 2018 Dec 8.

Texas Scottish Rite Hospital for Children, Dallas, TX.

Background: Either casting or in situ fixation (to prevent displacement) are recommended for minimally displaced pediatric lateral condyle fractures of indeterminate stability with ≤2 mm lateral displacement and narrowed fracture extension to the epiphyseal articular cartilage. This study compares casting only, acute prophylactic in situ pinning, and surgery if casting fails due to displacement.

Methods: In total, 738 fractures at a level 1 trauma center between 2008 and 2014 were reviewed. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001311DOI Listing
December 2018
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Anterior Guided Growth of the Distal Femur for Knee Flexion Contracture: Clinical, Radiographic, and Motion Analysis Results.

J Pediatr Orthop 2018 Dec 8. Epub 2018 Dec 8.

Gillette Children's Specialty Healthcare.

Background: Fixed knee flexion deformity is common in children with neuromuscular disorders. Anterior guided growth (AGG) of the distal femur can achieve gradual correction in patients who are skeletally immature. Little outcome data are available on this procedure. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001312DOI Listing
December 2018
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Treatment of Closed Femoral Shaft Fractures in Children Aged 6 to 10.

J Pediatr Orthop 2018 Dec 8. Epub 2018 Dec 8.

Department of Orthopaedic Surgery, St. Christopher's Hospital for Children, Philadelphia, PA.

Background: Management of pediatric femoral shaft fractures remains controversial, particularly in children between the ages of 6 and 10. In the current push toward cost containment, hospital type, and surgeon subspecialization have emerged as important factors influencing this treatment decision. Thus, in the present study, we use a nationwide pediatric inpatient database to compare the: (a) incidence; (b) demographic characteristics; (c) hospital costs; (d) length of stay; and (e) treatment method of pediatric closed femoral shaft fractures admitted to general versus children's hospitals. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001310DOI Listing
December 2018

"Next Day" Examination Reduces Radiation Exposure in Cervical Spine Clearance at a Level 1 Pediatric Trauma Center: Preliminary Findings.

J Pediatr Orthop 2018 Nov 30. Epub 2018 Nov 30.

Department of Pediatric Orthopaedic Surgery, St. Christopher's Hospital for Children, Philadelphia, PA.

Background: Safe and effective clearance of the pediatric cervical spine presents a challenging problem due to a myriad of reasons, which has often led to further imaging studies such as computed tomographic (CT) scans being performed, exposing the pediatric patient to significant radiation with a potential increased cancer risk. The goal of this study is to develop an effective algorithm for cervical spine clearance that minimizes radiation exposure.

Methods: A cervical spine clearance protocol had been utilized in our institution from 2002 to 2011. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001309DOI Listing
November 2018

Bilateral Developmental Dysplasia of the Hip: Does Closed Reduction Have a Role in Management? Outcome of Closed and Open Reduction in 92 Hips.

J Pediatr Orthop 2018 Nov 20. Epub 2018 Nov 20.

Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.

Background: Bilateral developmental dysplasia of the hip (DDH) is believed to have a worse outcome than unilateral DDH with the optimal treatment unclear. To define indications for treatment we report a retrospective series of 92 hips (46 patients) who underwent closed reduction (CR) and/or open reduction (OR).

Methods: A total of 58 hips in 29 patients underwent attempted CR using our standardized protocol. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001297DOI Listing
November 2018
13 Reads

Use of Magnetic Spinal Growth Rods (MCGR) With and Without Preoperative Halo-gravity Traction (HGT) for the Treatment of Severe Early-onset Scoliosis (EOS).

J Pediatr Orthop 2018 Nov 20. Epub 2018 Nov 20.

Department of Orthopaedic Surgery, Shriner's Hospital for Children, Portland, OR.

Background: Correction of severe scoliosis through distraction-based techniques poses a challenge. Magnetically controlled growing rod (MCGR) hardware complications are common with a 27.8% to 46. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001282DOI Listing
November 2018
9 Reads

High Correlation Between Achieved and Expected Distraction Using Magnetically Controlled Growth Rods (MCGR) With Rib to Pelvis Fixation in Pediatric Spine Deformity.

J Pediatr Orthop 2018 Nov 16. Epub 2018 Nov 16.

Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.

Purpose: Magnetically controlled implant systems have been established to treat severe progressive spinal deformity in children. The purpose of this study was to evaluate (1) the ratio between achieved and expected distraction length, (2) the complication rate and its risk factors as well as (3) the correlation of the distraction length and the length of the spine.

Methods: A total of 40 patients with an average follow-up of 34 (14 to 57) months were prospectively included in the study. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001303DOI Listing
November 2018
10 Reads

Use of Combined Botulinum Toxin and Physical Therapy for Treatment Resistant Congenital Muscular Torticollis.

J Pediatr Orthop 2018 Nov 16. Epub 2018 Nov 16.

Department of Orthopaedic Surgery, Washington University in St. Louis.

Background: Physical therapy (PT) alone is not always effective for treatment of congenital muscular torticollis (CMT). The adjunctive use of botulinum toxin (BTX) injection into the sternocleidomastoid, followed by PT, could provide correction and avoid more invasive surgery. Aims of the study were to review clinical and caregiver-reported outcomes of children with resistant CMT treated by BTX injection combined with a guided-PT program. Read More

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http://dx.doi.org/10.1097/BPO.0000000000001302DOI Listing
November 2018
7 Reads

The Spatial Order of Physeal Maturation in the Normal Human Knee Using Magnetic Resonance Imaging.

J Pediatr Orthop 2018 Nov 16. Epub 2018 Nov 16.

Department of Orthopaedic Surgery, The Johns Hopkins Hospital.

Background: The spatial order of physeal maturation around the distal tibia has been shown to place adolescent patients at risk for certain transitional injuries, such as Tillaux or triplane fractures. Less is known about physeal maturation around the knee. The purpose of this study was to establish the spatial order of physeal maturation in the normal human knee using magnetic resonance imaging (MRI). Read More

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http://dx.doi.org/10.1097/BPO.0000000000001298DOI Listing
November 2018
10 Reads