Pediatric orthopedic all-terrain vehicle injury patterns, surgeries, and complications: appreciating the true morbidity and impact.

All-terrain vehicle (ATV) accidents frequently cause orthopedic injuries. Previous studies have reported the frequency of fractures in ATV injuries. No studies have provided detailed assessments of fracture patterns, types of operative intervention, or risks for multiple surgeries.

Spinal height for growth guidance treatment in early onset idiopathic scoliosis: analysis through final surgical treatment.

Background: The growth guidance (GG) method for treatment of early onset scoliosis has as its primary goal the restoration of apical spinal alignment, facilitating normal spinal growth to achieve a suitable adult thoracic height.

Purpose: To evaluate whether GG surgical treatment achieves comparable thoracic and spinal height to distraction-based treatment (DBT) in idiopathic early onset scoliosis (I-EOS) patients. We hypothesized that GG would prove superior to DBT at the time of definitive fusion surgery.

Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus.

Introduction: Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees.

Perioperative Complications and Health-related Quality of Life Outcomes in Severe Pediatric Spinal Deformity.

Study Design: Prospective multicenter cohort study.

Objective: To evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity.

Summary Of Background Data: Few studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity.

Medical complications and health-related quality of life in complex pediatric spine deformities exceeding 100 degrees or treated by 3CO.

Study Design: Retrospective review of prospectively collected data.

Objective: To determine the incidence of medical complications in the pediatric population aged 10-20 years with baseline deformities exceeding 100 degrees or who had 3CO at surgery. Severe pediatric spine deformity poses a great challenge to the treating physician and carries a high complication rate.

Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study.

Objective: Cervical spine disorders in children are relatively uncommon; therefore, paradigms for surgical and nonsurgical clinical management are not well established. The purpose of this study was to bring together an international, multidisciplinary group of pediatric cervical spine experts to build consensus via a modified Delphi approach regarding the clinical management of children with cervical spine disorders and those undergoing cervical spine stabilization surgery.

Methods: A modified Delphi method was used to identify consensus statements for the management of children with cervical spine disorders requiring stabilization.

Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up.

Background Context: Published rates for disc reherniation following primary discectomy are around 6%, but the ultimate reoperation outcomes in patients after receiving revision discectomy are not well understood. Additionally, any disparity in the outcomes of subsequent revision discectomy (SRD) versus subsequent lumbar fusion (SLF) following primary/revision discectomy remains poorly studied.

Purpose: To determine the 8-year SRD/SLF rates and time until SRD/SLF after primary/revision discectomy respectively.

Alvimopan for the reduction of postoperative ileus after long posterior spinal fusion: placebo-controlled double-blind randomized trial.

Objective: The aim of this study was to evaluate the efficacy of alvimopan administration after posterior spinal fusion (PSF) in adult spine surgery patients who are taking opioid agents.

Methods: In this placebo-controlled, double-blind randomized trial, PSF patients were randomized in blocks to placebo or study drug. Primary and secondary outcome measures were return to normal bowel function, including time to passage of flatus and stool, time to tolerance of oral nutrition, and time to hospital discharge.

Mechanical Analysis of 3 Posterior Fusion Assemblies Intended to Cross the Cervicothoracic Junction.

Study Design: This was a biomechanical comparison study.

Objective: The objective of this study is to evaluate the mechanical properties of 3 posterior spinal fusion assemblies commonly used to cross the cervicothoracic junction.

Summary Of Background: When posterior cervical fusions are extended into the thoracic spine, an instrumentation transition is often utilized.

The Hip and Femur Fracture Bundle: Preliminary Findings From a Tertiary Hospital.

Background: The voluntary hip and femur fracture Bundled Payments for Care Improvement Advanced (BCPI-A) includes Diagnosis Related Groups (DRG) 480, 481, and 482, which include diverse and medically complex patients undergoing urgent inpatient surgery without optimization. Concern exists that this bundle is financially unfavorable for hospitals, and this study aimed to identify the costliest services.

Methods: We retrospectively reviewed a 12-month cohort of 32 consecutive patients in the DRG 480-482 bundle at our academic tertiary referral center.

Infant inclined sleep product safety: A model for using biomechanics to explore safe infant product design.

Over 450 adverse incidents have been reported in infant inclined sleep products over the past 17 years, with many infants found dead in both the supine and prone positions. The unique design of inclined sleep products may present unexplored suffocation risks related to how these products impact an infant's ability to move. The purpose of this study was to assess body movement and muscle activity of healthy infants when they lie supine and prone on different inclined sleep products.

Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States.

Background: Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF).

Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative.

Study Design: Multi-center, prospective, observational cohort.

Objective: To compare myelopathic vs. non-myelopathic ambulatory patients in short- and long-term neurologic function, operative treatment, and patient-reported outcomes.

Delayed diagnosis of a flexion-distraction spinal injury and occult small bowel injury in a pediatric trauma patient: Importance of recognizing the abdominal "seatbelt sign".

Spine trauma in the pediatric population can present with occult spinal and visceral injuries, presenting unique diagnostic challenges. Subtle imaging findings, as well as difficulty in patient participation with history and examination can contribute to a delayed or missed diagnosis. This in turn can be detrimental to recovery, leading to significant delay in care, additional morbidity, and cost.

Changes in kinematics, kinetics, and muscle activity in patients with lumbar spinal stenosis during gait: systematic review.

Background Context: Lumbar spinal stenosis (LSS) is one of the most common orthopaedic conditions and affects more than half a million people over the age of 65 in the US. Patients with LSS have gait dysfunction and movement deficits due to pain and symptoms caused by compression of the nerve roots within a narrowed spinal canal.

Purpose: The purpose of the current systematic review was to summarize existing literature reporting biomechanical changes in gait function that occur with LSS, and identify knowledge gaps that merit future investigation in this important patient population.

The Alpha-Defensin Prosthetic Joint Infection Test Has Poor Validity for Native Knee Joint Infection.

Background: The alpha-defensin test known as Synovaure has been very effective in diagnosis of prosthetic joint infections (PJIs). Being able to easily and accurately differentiate septic and inflammatory arthropathies in native joints would improve diagnostic workup and management. We tested the ability of an alpha-defensin test to distinguish septic from inflammatory or crystalline arthropathy in the native knee.

Do inclined sleeping surfaces impact infants' muscle activity and movement? A safe sleep product design perspective.

The design of inclined sleep products may be associated with an increased risk of suffocation when an infant finds themselves prone in the product. It is important to understand how different inclined sleep surface angles impact infants' muscle activity when considering a safe sleep environment. The purpose of this study was to assess muscle activity of healthy infants when they lie supine and prone on different inclined crib mattress surfaces (0° vs.

Infant carrying method impacts caregiver posture and loading during gait and item retrieval.

Background: Human babies are carried by their caregivers during infancy, and the use of ergonomic aids to wear the baby on the body has recently grown in popularity. However, the effects of wearing or holding a baby in-arms on an individual's mechanics during gait and a common object retrieval task are not fully understood.

Research Question: What are the differences in: 1) spatiotemporal, lower extremity kinematics, and ground reaction force variables during gait, and 2) technique, center of mass motion, and kinematics during an object retrieval task between holding and wearing an infant mannequin?

Methods: In this prospective biomechanics study, 10 healthy females performed over-ground walking and an object retrieval task in three conditions, holding: (1) nothing (unloaded), (2) an infant mannequin in-arms, and (3) an infant mannequin in a baby carrier.

Accuracy of the Spinal Pain Diagram Is Influenced by Patient Health Literacy in Completion of the Scoliosis Research Society30 Questionnaire.

The Scoliosis Research Society Questionnaire (SRS30) was designed to measure healthrelated quality of life in scoliosis patients. Patients with low health literacy may need specific guidance when providing feedback on the SRS30 so that reliable and valid results are collected for clinical decision making. The purpose of this research study was to investigate the health literacy demands of the Scoliosis Research Society Questionnaire (SRS30) and to determine if health literacy best practices mitigate errors for patients with low health literacy.

Positioning and baby devices impact infant spinal muscle activity.

Infant positioning in daily life, particularly in relation to active neck and back muscles, may affect spinal development, psychosocial progression, and motor milestone achievement. Yet the impact of infant body position on muscle activity is unknown. The objective of this study was to evaluate neck and back muscle activity of healthy infants in common positions and baby devices.

Validation of a custom spine biomechanics simulator: A case for standardization.

Mechanical testing machines used in cadaveric spine biomechanics research vary between labs. It is a necessary first step to understand the capabilities and limitations in any testing machine prior to publishing experimental data. In this study, a reproducible protocol that uses a synthetic spine was developed and used to quantify the inherent rotation error and the ability to apply loads in a single physiologic plane (pure-moment) of a custom spine biomechanics simulator.

Curve Modulation and Apex Migration Using Shilla Growth Guidance Rods for Early-onset Scoliosis at 5-Year Follow-up.

Background: The Shilla procedure was designed to correct and control early-onset spinal deformity while harnessing a child's remaining spinal growth. It allows for controlled axial skeletal growth within the construct, avoiding the need for frequent surgeries to lengthen implants. We hypothesized that curve characteristics evolve over time after initial apex fusion and placement of the Shilla implants.

Outcomes and cost-minimization analysis of cement spacers versus expandable cages for posterior-only reconstruction of metastatic spine corpectomies.

Background: Reconstruction of the thoracolumbar spine after tumor corpectomy can be accomplished using either an expandable metallic cage (EC) or a polymethylmethacrylate (PMMA) cement spacer. Few studies have compared the relative successes between these two forms of reconstructions in the management of metastatic spine disease (MSD). The purpose of this study was to compare both the outcomes and costs of EC and PMMA spacers in the treatment of MSD.

Expansion Thoracoplasty as a Life-Saving Procedure in an Adolescent With Severe Spinal Deformity and Sacral Agenesis.

Study Design: Case report.

Objectives: To describe use of expansion thoracoplasty (ET) for severe thoracic insufficiency syndrome (TIS) in an adolescent with severe spinal deformity.

Background: ET is typically performed in young patients with TIS to increase chest cavity volume, improve alveolar expansion, and potentially improve alveolar proliferation.

Key Role of Preoperative Recumbent Films in the Treatment of Severe Sagittal Malalignment.

Study Design: Retrospective cohort study.

Objective: To determine if severe sagittal malalignment (SM) patients without fixed deformities require a three-column osteotomy (3CO) to achieve favorable clinical and radiographic outcomes.

Summary Of Background Data: 3CO performed for severe SM has significantly increased in the last 15 years.