Value of Outpatient Surgery in Pediatric Orthopedic Surgery.

To achieve excellence in patient care in today's health care environment, physicians must have an eye on maximizing outcomes and safety while balancing resource utilization. Evidence is mounting to support the expanded use of ambulatory surgery centers (ASC) as safe and effective locations for performing pediatric orthopedic surgery for various conditions. Patient selection is crucial to patient diagnosis and comorbid factors to allow ambulatory surgery to be performed safely and may require consultation with the ASC anesthesiologist.

Academic Faculty Demonstrate Weak Agreement in Evaluating Orthopaedic Surgery Residents.

Background: As objective metrics fade, subjective elements of orthopaedic surgery applicants carry increasing importance during recruitment. Academic orthopaedic surgeons believe they can select for high-performing orthopaedic residents. However, can they agree? The purpose of this study was (1) to analyze an academic orthopaedic surgery department to determine whether they agree on which residents performed best during residency and; (2) to correlate preresidency and intraresidency factors with postresidency evaluations of resident performance.

The Costs of Interfacility Transfers for Nonurgent Pediatric Supracondylar Fractures.

Background: Unnecessary transfers of nonemergent pediatric musculoskeletal injuries to regional trauma centers can be costly. The severity of fracture displacement in supracondylar humerus fractures dictates the risk of complications, the urgency of transfer and the need for surgical treatment. The purpose of this study is to examine the transfer patterns of Gartland type II pediatric supracondylar humerus fractures to identify strategies for improving patient care, improving health care system efficiency, and reducing costs.

Outpatient Bryant's Overhead Traction Does Not Affect the Rate of Open Reduction or Avascular Necrosis in Developmental Dislocation of the Hip.

Background: The efficacy of preliminary traction to increase the likelihood of closed reduction and/or decrease the incidence of avascular necrosis in the management of developmental dysplasia of the hip (DDH) is controversial. We sought to document compliance with and effectiveness of Bryant's outpatient traction in patients with idiopathic DDH.

Methods: Patients presenting between 6 and 24 months of age with idiopathic irreducible DDH were prospectively enrolled in the study.

Proximal Femoral Deformity Following Threaded Prophylactic Fixation for Slipped Capital Femoral Epiphysis: Risk Stratification Using the Modified Oxford Score.

Background: This study assesses the effect of skeletal maturity on the development of iatrogenic proximal femoral deformity following threaded prophylactic screw fixation in patients presenting with unilateral slipped capital femoral epiphysis (SCFE).

Methods: Children who underwent threaded screw prophylaxis of the uninvolved hip (Group P) and those who were observed with no prophylaxis (Group N) on presentation with unilateral SCFE were compared. Skeletal maturity was assessed with the Modified Oxford Score (MOS).

Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus.

Background: Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.

Methods: After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor.

Hamstring lengthening in females with cerebral palsy have greater effect than in males.

Children with spastic diplegia cerebral palsy often demonstrate crouched gait patterns, and typically undergo hamstring lengthenings. The objective of this retrospective study was to determine if the surgical response to medial and lateral hamstring lengthenings is different between males and females. Preoperative and postoperative kinematic data of 109 (71 males and 38 females) patients with cerebral palsy were evaluated.

Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction.

Introduction: Following closed reduction and initial casting of pediatric forearm fractures, loss of reduction (LOR) occurs in ∼5% to 75% of fractures. Sugar-tong splinting has been shown to maintain acceptable reduction in pediatric distal radius fractures while potentially avoiding issues associated with circumferential casting. We hypothesized that the sugar-tong splint would be an acceptable method for initial immobilization to prevent LOR in distal, mid-shaft, and proximal pediatric forearm fractures.

Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis.

This study assessed the rate of adverse wound events in individuals with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and sought to determine if obesity was related to the rate of adverse wound events. A retrospective review of patients with adolescent idiopathic scoliosis that underwent posterior spinal fusion between 2001 and 2013 was performed. Preoperative, perioperative, and postoperative data, including wound adverse events, were obtained through medical record review.

Magnetic Resonance Imaging in Infantile Idiopathic Scoliosis: Is Universal Screening Necessary?

Study Design: Retrospective chart review.

Objective: Determine if there is a subset of presumed infantile idiopathic scoliosis (IIS) patients who have a low incidence of neural axis abnormalities (NAAs) such that screening magnetic resonance imaging (MRI) may be delayed.

Summary Of Background Data: Individuals with presumed IIS have an increased incidence of NAA.

Foot size asymmetry following Ponseti treatment versus comprehensive surgical releases for unilateral clubfeet.

Using age and height matched cohorts with unilateral idiopathic clubfeet (n=40 each), we retrospectively reviewed pedobarographic studies to determine the impact of treatment, Ponseti versus comprehensive surgical releases (CSR), on the foot length, width, and contact area. The foot pressures were determined by self-selected walking across a force plate. Ponseti treatment results in more symmetrical foot lengths, widths, and total contact areas with an improvement of 1.

Development of the HOOS to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures.

Background: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations.

Hypothesis: The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created.

Pain and overcorrection in clubfeet treated by Ponseti method.

Long-term outcomes of Ponseti casting have consistently shown improvement over soft-tissue release. The incidence of foot pain and overcorrection in clubfeet treated by Ponseti method has not been reported. We studied the rate of overcorrection and its association with pain in clubfeet treated with Ponseti casting.

Residual forefoot deformity predicts the need for future surgery in clubfeet treated by Ponseti casting.

Tibialis anterior tendon transfer (TATT) is performed for treatment of recurrent clubfeet. We investigated the predictability of residual adductus on the future need for TATT. A retrospective review of 143 patients with clubfoot was performed.

The Effectiveness of the Ponseti Method for Treating Clubfoot Associated With Amniotic Band Syndrome.

Background: Amniotic band syndrome (ABS) is a congenital disorder with an associated incidence of clubfoot deformity in over 50% of patients. Although early reports in the literature demonstrated a poor response to casting treatments, recent application of the Ponseti technique in ABS patients have been more promising.

Methods: A retrospective review of all patients with clubfoot and a concurrent diagnosis of ABS were reviewed at a single institution.

Efficacy of 2 Regional Pain Control Techniques in Pediatric Foot Surgery.

Background: Peripheral nerve blocks (PNBs) have the potential to reduce postoperative pain. The use of ultrasound (US) to guide PNBs may be more beneficial than nerve stimulation (NS); however, very few studies have studied this technique in children. The objective of this study was to compare postoperative pain control in pediatric patients who had general anesthesia (GA) alone compared with those who had PNB performed by NS, or PNB with both NS and US guidance.

Initial Correction Predicts the Need for Secondary Achilles Tendon Procedures in Patients With Idiopathic Clubfoot Treated With Ponseti Casting.

Background: The Ponseti method is the most common method to treat idiopathic clubfoot in North America. Despite initial correction, recurrence is common with this method. The factors predictive of recurrence are not well defined in the literature.

Factors predictive of second recurrence in clubfeet treated by ponseti casting.

Background: Ponseti serial casting is the most commonly used method in North America to treat children with clubfeet. Despite initial correction, recurrence is common. tibialis anterior tendon transfer (TATT) is commonly used to treat recurrent clubfeet.

Syringomyelia and vertebral osteochondromas in patients with multiple hereditary exostosis.

Involvement of osteochondromas in the spinal canal occurs in patients with multiple hereditary exostosis, but the exact prevalence is unknown. A recent study found an incidence of 68%, with 27% of these lesions encroaching into the spinal canal. We studied MRI findings of 27 patients with multiple hereditary exostosis and found only six (23.

Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children.

Background: Approximately 5% of supracondylar humerus fractures in children are associated with an ipsilateral forearm fracture, often referred to as a floating elbow when both injuries are displaced. Historically, these patients have higher complication rates than patients with an isolated supracondylar humerus fracture. The purpose of this study was to review the acute neurologic and vascular injuries in patients with ipsilateral, operative supracondylar humerus and forearm fractures and compare the findings with a cohort of isolated, operative supracondylar humerus fractures.

The results of preoperative halo-gravity traction in children with severe spinal deformity.

Halo-gravity traction has been used preoperatively for patients with severe spinal deformity but there are limited data in the literature on the results and complications. We studied the outcomes of perioperative halo-gravity traction in children with severe spinal deformity. A retrospective study was carried out on patients who were treated at our center.

Spinal Cord Monitoring With Transcranial Motor Evoked Potentials in Patients With Neural Axis Abnormalities Undergoing Spinal Deformity Surgery.

Study Design: Retrospective, case-control study.

Objectives: To report the effectiveness of transcranial motor evoked potentials (TcMEPs) in patients undergoing scoliosis surgery with neural axis abnormalities (NAAs).

Summary Of Background Data: Transcranial motor evoked potentials are a safe and sensitive modality to identify impending spinal cord injury in adolescent idiopathic scoliosis (AIS).

Theoretical breast cancer induction risk from thoracic spine CT in female pediatric trauma patients.

Objectives: To quantify the radiation dose received during thoracic spine computed tomography (CT) versus plain radiographs as well as the theoretical risk of breast cancer induction in a pediatric trauma population.

Methods: A retrospective evaluation of 179 female pediatric trauma patients who received CT or plain radiographs for clearance of the thoracic spine was performed. Subjects were secondarily grouped as children (0-<12 years) or adolescents (≥12-17.