One is not like the other: health quality of life scores vary in neuromuscular EOS by diagnosis.

Purpose: The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HrQOL). In combining these etiology groups, we obligatorily lump together many disparate diagnoses, particularly true in the neuromuscular (NM) cohort. We sought to evaluate the influence of underlying neuromuscular diagnosis on the HrQOL at 5 years following surgery for EOS.

A Biomechanical Analysis of Instrumentation Constructs During Vertebral Column Resection: Stability When You Need It!

Study Design: Biomechanical Testing.

Objective: Investigate the optimal construct for stabilization of the spine during vertebral column resection (VCR).

Summary Of Background Data: VCR is a powerful technique for achieving correction in severe cases of spinal deformity.

In Science Journals.

Highlights from the family of journals.

Vertebral body tethering for Lenke 1A curves: the lumbar modifier predicts less optimal outcomes.

Introduction: The addition of the L4 "AR" and "AL" lumbar modifier for Lenke 1A idiopathic scoliosis (IS) has been shown to direct treatment in posterior spinal fusion; however, its utility in vertebral body tethering (VBT) has yet to be evaluated.

Methods: A review of a prospective, multicenter database for VBT in IS was performed for patients with Lenke 1A deformities and a minimum of 2 years follow-up. Patients were categorized by their lumbar modifier (AR vs AL).

Health-related quality of life and clinical outcomes for magnetically controlled growing rod patients after treatment termination.

Purpose: To determine the health-related quality of life (HRQoL) and clinical outcomes of children with early onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR) followed to definitive fusion (DF).

Methods: A retrospective review of EOS patients treated with MCGR and followed to DF was performed. Outcomes included HRQoL scores, radiographic, clinical, and unplanned returns to the operating room (UPROR) data collected at pre-MCGR implantation, immediately post-MCGR implantation, pre-DF, and post-DF.

Postoperative CT imaging to characterize fusion in pediatric and adolescent vertebral column resection.

Background: Vertebral column resection (VCR) is a powerful corrective technique for the management severe, rigid spinal deformities but does carry a relatively high complications rate. One of the feared complications is pseudarthrosis which places the patient at risk for implant failure. We present a single-center experience with post-operative computed tomography (CT) imaging at the osteotomy site to screen for impending pseudarthrosis.

Social media, extremism, and radicalization.

Fears that YouTube recommendations radicalize users are overblown, but social media still host and profit from dubious and extremist content.

Increasing soft tissue depth is associated with stalling of magnetically controlled growing rods.

Background: Magnetically controlled growing rods (MCGR) represent the most used implant for the treatment of early onset scoliosis (EOS). These implants lengthen through the application of a remote magnetic field but distraction force generation has been negatively correlated with increasing soft tissue depth. Given the high rate of MCGR stalling, we proposed to investigate the impact of preoperative soft tissue depth on the rate of MCGR stalling at a minimum of 2 years following implantation.

Consensus and Equipose in the Management of Military Trainee Femoral Neck Stress Fractures: A Survey of Military Surgeons.

Background: Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF.

Questions: We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF.

Skeletal Maturity in Legg-Calve-Perthes Disease: Significant Discrepancy Present Between the Hand and the Hip.

Background: The concept of delayed skeletal maturity in Legg-Calve-Perthes Disease (LCPD) has been well identified with the Greulich and Pyle (GP) atlas showing 1 to 2 years delay. Recently the optimized Oxford hip skeletal age (Optimized Oxford) system has been developed and shown to have similar accuracy as the GP atlas for assessing skeletal maturity. However, this system has not been used to assess skeletal maturity in LCPD.

Senior Military Rank Is Associated With Higher Rates of Return to Running and Unrestricted Activity Among Military Servicemembers After Surgical Repair of Patellar Tendon Rupture at 1-Year Follow-up.

Purpose: To evaluate 1-year outcomes in active-duty servicemembers who underwent patellar tendon rupture repair and to identify baseline variables associated with return to activity.

Methods: We performed a retrospective review of all active-duty servicemembers undergoing primary patellar tendon rupture repair between 2009 and 2014. All patients had a minimum 12-month follow-up.

Avoiding PICU admission following PSF for neuromuscular scoliosis in non-ambulatory cerebral palsy managed with ERAS protocol.

Purpose: Children with neuromuscular scoliosis (NMS) undergoing posterior spinal fusion (PSF) have historically been managed post-operatively in the pediatric intensive care unit (PICU) due to institutional tendencies. This study sought to define risk factors for PICU admission when using an enhanced recovery after surgery (ERAS) pathway.

Methods: A retrospective review of children with non-ambulatory (GMFCS 4 or 5) cerebral palsy undergoing PSF for NMS performed at two institutions by 5 surgeons.

The evolving stall rate of magnetically controlled growing rods beyond 2 years follow-up.

Purpose: Magnetically controlled growing rods (MCGR) have become the dominant distraction-based implant for the treatment of early onset scoliosis (EOS). Recent studies, however, have demonstrated rising rates of implant failure beyond short-term follow-up. We sought to evaluate a single-center experience with MCGR for the treatment of EOS to define the rate of MCGR failure to lengthen, termed implant stall, over time.

The Subcapital Femoral Neck Stress Fracture: A Novel Subtype of Compression-sided Stress Fracture-A Report of Three Cases.

Femoral neck stress fractures (FNSFs) are increasingly common, particularly in military training. The usual mode of classifying these injuries is based on the involvement of the compression or tension side of the femoral neck; however, this may oversimplify and fail to address factors such as the orientation of the fracture line. We present a novel subtype of a compression-sided FNSF affecting the subcapital femoral neck and report the treatment outcomes in a military trainee population.

Effects of distraction-based distal fixation on pelvic parameter development in early onset scoliosis.

Purpose: Prior studies have suggested that distraction-based treatment for early onset scoliosis (EOS) may impede the natural development of the sagittal spinal alignment and pelvic parameters. However, to date no study has investigated the effect of distal fixation on pelvic development.

Methods: Ambulatory children with EOS undergoing index distraction-based treatment with distal fixation below T11 were retrospectively reviewed.

Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2 years.

Purpose: The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HRQoL) measures as assessed by the Early Onset Scoliosis Questionnaire (EOSQ). We sought to assess the influence of distraction-based surgery and scoliosis etiology on EOSQ 2 years following surgical intervention remains unclear.

Methods: A retrospective review of a multi-center prospective EOS database was performed.

Bigger Is Not Always Better: Effects of Electrocautery Setting on Tissue Injury in a Porcine Model.

Introduction Electrosurgery for dissection and hemostasis remains one of the foundational tools for the field of surgery as a whole. Monopolar cautery remains the most utilized modality for achieving the aforementioned goals. Given the prolonged history and pre-modern development of "Bovie" cautery, there remains a paucity of data regarding appropriate settings and intensity for various tissue types, procedures, or locales.

1- vs. 2-year follow-up after posterior spinal fusion for AIS: what additional information is gained?

Purpose: Traditionally, 2-year follow-up data have been the established standard for reporting clinical outcomes following spinal deformity surgery. However, previous studies indicate that 2-year follow-up does not represent long-term outcomes. Currently, there is no clear data that demonstrate a difference in outcomes between the 1 and 2 years postoperative time-periods following posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS).

Understanding Noise Exposure During Cast Removal: The Effect of Cast Saw Type and Casting Material.

Background: Cast removal can be associated with considerable noise exposure, especially impacting the pediatric patient and provider. Although noise generation from cast saws has been deemed safe by the U.S.

Pectoralis Major Tendon Tears During Airborne Operations: Are These Injuries Isolated?

Introduction: Pectoralis major tendon tears are an injury pattern often treated in military populations. Although the majority of pectoralis major tendon tears occur during eccentric loading as in bench press weightlifting, military service members may also experience this injury from a blunt injury and traction force produced by static line entanglement during airborne operations. Although these injuries rarely occur in isolation, associated injury patterns have not been investigated previously.

Surgically Treated Femoral Neck Stress Fractures Are Likely to Result in Military Separation During Basic Combat Training.

Background: Femoral neck stress fractures are a common condition affecting military service members, most noticeably during basic combat training. Previous studies have investigated the risk factors for femoral neck stress fracture development in basic trainees and outcomes associated with treatment; however, few studies have focused on operatively treated femoral neck stress fracture in the military trainee. Doing so would be important not only for the military, but also providers caring for athletes, such as distance runners, who have a heightened risk for femoral neck stress fracture development.

Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Introduction: Previous studies have demonstrated decreased hospital length of stay (LOS) for children undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: Hospitalization event data from the Kids Inpatient Database were queried for all PSF events for AIS performed in 2009, 2012, and 2016 using diagnosis and surgical codes. Data were subdivided into two groups: pre-enhanced recovery after surgery (ERAS) (2009 and 2012) and post-ERAS (2016).