Epidemiology of Acute Compartment Syndrome After Pediatric Tibial Tubercle and Tibial Shaft Fractures.

Background: While acute compartment syndrome (ACS) is a well-reported complication after pediatric tibial shaft fractures, prior literature has suggested that pediatric patients with tibial tubercle fractures may be at increased risk of ACS due to the proximity of the tibial tubercle to the anterior tibial recurrent artery. However, this theory was largely based on a series of early case reports without substantiation in larger-scale studies.

Hypothesis/purpose: The purpose of this study is to conduct a population-level analysis of the incidence and risk factors of acute compartment syndrome following pediatric tibial tubercle and tibial shaft fractures.

Evaluation of Tibial Slope on Radiographs in Pediatric Patients With Tibial Spine Fractures: An Age- and Sex-Matched Study.

Background: A recent study has reported that the radiographic measurement of posterior tibial slope (PTS) is larger in male pediatric patients with tibial spine fractures (TSF) than in controls. However, they found no difference in PTS between female patients and controls.

Purpose: (1) To identify whether PTS is larger in female pediatric patients with TSF than in female controls and (2) to validate the relationship between PTS and pediatric TSF in male patients.

Do Social Deprivation and Surgical Volume Influence Outcomes Following Distal Radius Fracture Fixation?

Background: Distal radius fractures account for nearly 25% of fractures in adults, with a trend toward operative fixation. The objective of this study was to assess the relationship between surgeon and hospital volume with complications following distal radius fixation.

Methods: A retrospective study was performed using the New York Statewide Planning and Research Cooperative System database from 2009 to 2015.

In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically.

Purpose: The purpose of the current study was to evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear.

Methods: From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)-9th Revision-Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York.

Incidence of Tibial Tubercle Fractures in Patients With and Without Osgood-Schlatter Disease.

Background: Patients with Osgood-Schlatter disease (OSD) may be at increased risk of tibial tubercle fractures due to an underlying weakness of the tibial tubercle apophysis relative to the patellar tendon as a result of repetitive microtrauma.

Hypothesis/purpose: The purpose of this study is to analyze the incidence of tibial tubercle fractures in patients with and without Osgood-Schlatter disease. We hypothesized that the incidence of tibial tubercle fractures would be higher in patients with Osgood-Schlatter disease.

Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review.

Objective: Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries.

Social deprivation index affects time to MRI after knee injury in pediatric patients and is predicted by patient demographics.

Objectives: This study aims to characterize the association between the timing of MRI ordering and completion for pediatric knee injuries and Social Deprivation Index (SDI), which is a comprehensive, validated, county-level, measure of socioeconomic variation in health outcomes based upon combining geography, income, education, employment, housing, household characteristics, and access to transportation.

Methods: A retrospective chart review was completed of patients 21 years old and younger from our institution with a history of knee sports injury (ligamentous/soft tissue injury, structural abnormality, instability, inflammation) evaluated with MRI between 5/26/2017 and 12/28/2020. Patients were from three states and attended to by physicians associated with an urban academic institution.

Higher complication rates following primary total shoulder arthroplasty in patients presenting from areas of higher social deprivation.

Aims: The aim of this study was to characterize the influence of social deprivation on the rate of complications, readmissions, and revisions following primary total shoulder arthroplasty (TSA), using the Social Deprivation Index (SDI). The SDI is a composite measurement, in percentages, of seven demographic characteristics: living in poverty, with < 12 years of education, single-parent households, living in rented or overcrowded housing, households without a car, and unemployed adults aged < 65 years.

Methods: Patients aged ≥ 40 years, who underwent primary TSA between 2011 and 2017, were identified using International Classification of Diseases (ICD)-9 Clinical Modification and ICD-10 procedure codes for TSA in the New York Statewide Planning and Research Cooperative System database.

Management Principles and Current Debates Surrounding Common Pediatric Elbow Fractures.

Elbow fractures are among the most common fractures sustained in pediatric patients. A specific set of pediatric elbow fractures (olecranon, radial neck, and lateral condyle fractures) comprises the ones that occur most often. It is important to review commonly accepted principles in the evaluation and treatment of these injuries as well as highlight some debates that exist within the literature regarding the optimal management of these injuries.

Update on Pediatric Medial Epicondyle Fractures.

The ideal evaluation and treatment of pediatric patients with medial epicondyle fractures remain controversial. It is important to examine the most recent literature and provide an update on the current clinical practices, imaging modalities, treatment techniques, outcomes, and complications associated with displaced pediatric medial epicondyle fractures. There remains substantial variability across recommended treatment options and the outcomes between surgical versus nonsurgical management of these injuries.

Association of Emergency Department Evaluation With Public Insurance Use and Treatment Delays for ACL Injury.

Background: Utilization of an emergency department (ED) visit for anterior cruciate ligament (ACL) injury is associated with high cost and diagnostic unreliability.

Hypothesis: Patients initially evaluated at an ED for an ACL injury would be more likely to be from a lower income quartile, use public insurance, and experience a delay in treatment.

Study Design: Cohort study; Level of evidence, 3.

Anterior Displacement of Tibial Spine Fractures: Does Anatomic Reduction Matter?

Background: Operative treatment of displaced tibial spine fractures consists of fixation and reduction of the fragment in addition to restoring tension of the anterior cruciate ligament.

Purpose: To determine whether residual displacement of the anterior portion of a tibial spine fragment affects the range of motion (ROM) or laxity in operatively and nonoperatively treated patients.

Study Design: Cohort study; Level of evidence, 3.

Fixation Strategy Does Not Affect Risk of Growth Disturbance After Surgical Treatment of Pediatric Tibial Spine Fracture.

Purpose: To characterize growth abnormalities after surgical treatment of tibial spine fractures and to investigate risk factors for these abnormalities.

Methods: A retrospective analysis of children who underwent treatment of tibial spine fractures between January 2000 and January 2019 was performed, drawing from a multicenter cohort among 10 tertiary care children's hospitals. The entire cohort of surgically treated tibial spine fractures was analyzed for incidence and risk factors of growth disturbance.

The Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Femoral Shaft Fractures.

Objectives: The aim of this study was to characterize the case volume dependence of both facilities and surgeons on morbidity and mortality after femoral shaft fracture (FSF) fixation.

Methods: Adults who had an open or closed FSF between 2011 and 2015 were identified in the New York Statewide Planning and Research Cooperative System database. Claims were identified by International Classification of Disease-9, Clinical Modification diagnostic codes for a closed or open FSF and International Classification of Disease-9, Clinical Modification procedure codes for FSF fixation.

Posterior Cruciate Ligament and Patellar Tendon Can Predict Anterior Cruciate Ligament Size for Planning During ACL Reconstruction in Pediatric Patients.

Purpose: To establish correlations between the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and patellar tendon in normal pediatric knees to inform surgical planning for ACL reconstruction graft size.

Methods: Magnetic resonance imaging scans of patients ages 8 to 18 years were assessed. Measurements included ACL and PCL length, thickness, and width, and ACL footprint thickness and width at the tibial insertion.

Atraumatic Displaced Femoral Neck Insufficiency Fracture Because of Severe Hypocalcemia in a Pediatric Patient: A Case Report.

Case: This is a case of a 14-year-old autistic boy who presented with an atraumatic transcervical femoral neck fracture in the setting of significant hypocalcemia and vitamin D deficiency. We discuss his surgical and medical management and metabolic derangements associated with atraumatic femoral neck fractures.

Conclusion: Pediatric femoral neck fractures in the absence of trauma are uncommon and often have underlying metabolic abnormalities.

Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction.

Background: The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population.

A Comparison of the Rates of Postoperative Infection Following Distal Radius Fixation Between Pediatric and Young Adult Populations: An Analysis of 32 368 Patients.

Background: Infection following surgical fixation of a distal radius fracture can markedly compromise a patient's functional outcome. This study aimed to compare infection rates in pediatric (5-14 years) and adolescent (15-17 years) patients undergoing fixation of a distal radius fracture to a cohort of young adult (18-30 years) patients.

Methods: A matched retrospective study was performed using PearlDiver to determine the rates of postoperative infection following distal radius fixation.

Tibial Spine Fractures in Young Athletes.

Tibial spine fractures are a relatively rare injury in the young athlete. Previously thought to be the equivalent of a "pediatric anterior cruciate ligament (ACL) tear," contemporary understanding of these injuries classifies them as distinct from ACL injuries in this patient population. Successful treatment hinges on accurate diagnosis paying special attention to fracture displacement and the presence of concomitant intraarticular injury.

Visual Joint Angle Assessment: Does Accuracy Improve with a Higher Level of Orthopaedic Surgery Training?

Introduction: The purpose of this study was to evaluate the accuracy of visual joint angle assessments by orthopaedic surgery trainees amongst various levels of training.

Methods: Sagittal plane photographs of several joints at various angles were distributed to trainees within an orthopaedic residency program. Joint angles were estimated and compared to those obtained with a goniometer.

Trends and Reported Complications in Ankle Arthroplasty and Ankle Arthrodesis in the State of New York, 2009-2018.

Background: Ankle arthroplasty has emerged as a viable alternative to ankle arthrodesis due in large part to recent advancements in both surgical technique and implant design. This study seeks to document trends of arthroplasty and arthrodesis for ankle osteoarthritis in New York State from 2009-2018 in order to determine if patient demographics play a role in procedure selection and to ascertain the utilization of each procedure and rates of complications.

Methods: Patients 40 years and older from 2009-2018 were identified using and ( and ), () diagnosis and procedure codes for ankle osteoarthritis, ankle arthrodesis, and ankle arthroplasty in the New York statewide planning and research cooperative system database.

Social and Demographic Factors Impact Shoulder Stabilization Surgery in Anterior Glenohumeral Instability.

Purpose: To assess independent predictors of surgery after an emergency department visit for shoulder instability, including patient-related and socioeconomic factors.

Methods: Patients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015 to 2018 by diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes (23455, 23460, 23462, 23466, and 29806).

Risk of reoperation after primary anterior cruciate ligament reconstruction in children and adolescents.

Objective: To examine the incidence and risk factors of any-cause reoperation after primary ACLR in children and adolescents.

Design: Retrospective Cohort.

Setting: Electronic medical records from a large tertiary care, single institution integrated healthcare delivery system.