Survey of the POSNA Membership Reveals Variability in Use of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot.

Purpose: The aim of this project was to survey members of the Pediatric Orthopaedic Society of North America (POSNA) regarding the use of tibialis anterior tendon transfer (TATT) in the management of recurrent clubfoot with dynamic supination and no deformity. We aimed to assess which techniques for TATT are most utilized by pediatric orthopedists. As there has been no general consensus in the literature regarding best methods, we hypothesized that treatment methods would vary widely among POSNA members.

Reliability of the Clinical Measurement of Joint Motion and Muscle Length in the Upper and Lower Extremities of Children with Cerebral Palsy: A Systematic Review.

Reliability of joint motion and muscle length measurement in children with cerebral palsy was examined. Twenty-one studies of intraobserver and/or interobserver reliability were reviewed: joint motion of upper extremities in four and lower extremities in 13; muscle length of upper extremities in one and lower extremities in 15. Intraclass correlation coefficients for goniometric interobserver reliability varied widely for joint motion (range 0.

Reliability of the Clinical Measurement of Upper and Lower Extremity Joint Motion in the Pediatric Population: A Systematic Review.

Aim: To examine intraobserver and interobserver reliability of the clinical measurement of pediatric joint motion of upper and lower extremities, based on participant condition and measurement technique.

Methods: PubMed, CINAHL, and Web of Science were searched using combinations of children or adolescents, range of motion, and reliability. Reference lists and citations of reviewed studies were searched for additional publications.

Parent Reported Perspectives on Pediatric Radiation Exposure in a Pediatric Orthopedic Clinic.

Background: Few studies have investigated the perspective of caregivers as it pertains to their children having xrays performed. This study sought to identify which factors contribute to the varying views that caregivers have toward giving their children x-rays.

Methods: The data was collected through an anonymous survey administered during visits to the pediatric orthopedic surgery clinic.

Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study.

Importance: Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses.

Objective: To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V.

Design: Pilot study.

Opioid Prescription Patterns in Pediatric Orthopedics Following Closed Reduction and Percutaneous Pinning for Supracondylar Humerus Fractures.

Background: There is currently an alarming upward trend in the use of prescription opioids in the pediatric population. Previous medical use of prescription opioids has shown to correlate to non-medical use of prescription opioids. To combat this, institutions have started to look at prescribing patterns to understand and eventually standardize a pain protocol to reduce unnecessary analgesics after surgery.

Transition program: Initial implementation with adults with neuromuscular conditions.

Purpose: To identify current medical and psychosocial needs and to examine the effectiveness of healthcare transition program for adult-aged patients with neuromuscular conditions transitioning from pediatric to adult services.

Design And Methods: At Neuromuscular Transition Clinic visit, 46 patients were evaluated and referred to adult-based providers, if did not currently have one, from an acquired list of interested clinicians. At mean follow-up of 22 months, 42 were interviewed by phone regarding referrals for Core Services (primary care, physiatry, dental care and gynecology), Medical Specialties and Rehabilitation Services.

Impact of tranexamic acid on blood loss and transfusion rate in children with cerebral palsy undergoing hip reconstruction with two or more osteotomies.

Purpose: Tranexamic acid (TXA), a synthetic lysine analogue, has been used in orthopedic procedures to limit blood loss and prevent allogeneic blood transfusions. However, data are scarce on its use in hip reconstruction of patients with cerebral palsy (CP). This study examines the effect of TXA on patients with CP undergoing hip reconstruction with at least two osteotomies.

Perfusion is Not Measurably Decreased in Idiopathic Clubfoot.

Background: Vascular aberration has been accepted as a potential etiology of clubfoot, and abnormal vasculature has been observed in as high as 85% of children with severe clubfoot. The perfusion index (PI) corresponds to the ratio of pulsatile to nonpulsatile blood flow at a monitoring site and can be used to quantify perfusion of the extremities. The purpose of this study was to use PI to compare the perfusion of clubfeet to controls in order to further assess the role of abnormal vasculature in clubfoot.

Identifying Predictive Factors of Pediatric Septic Arthritis of the Knee in a Lyme Endemic Area.

Background: Septic arthritis of the knee in the pediatric patient is a diagnosis that requires prompt identification and treatment. The purpose of this study was to identify clinical and laboratory parameters that allow differential diagnosis of septic arthritis from non-septic arthritis in children.

Methods: Fifty-four pediatric patients with atraumatic isolated knee pain were retrospectively identified at three institutions and diagnosed with septic arthritis (SA, N = 28), Lyme arthritis (LA, N = 11), or transient synovitis (TS, N = 15).

The Validity of Patient-reported Outcome Measurement Information System (PROMIS) Parent Proxy Instruments to Assess Function in Children With Talipes Equinovarus.

Background: Idiopathic talipes equinovarus (ITEV) is a prevalent structural deformity of the foot and ankle in children. The disease-specific instrument (DSI) has commonly been used as an outcomes metric in these patients. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to examine the quality of life across various medical conditions.

Measuring ambulation with wrist-based and hip-based activity trackers for children with cerebral palsy.

Aim: To assess the accuracy of consumer available wrist-based and hip-based activity trackers in quantitatively measuring ambulation in children with cerebral palsy (CP).

Method: Thirty-nine children (23 males, 16 females; mean age [SD] 9y 7mo [3y 5mo]; range 4-15y) with CP were fitted with trackers both on their wrist and hip. Each participant stood for 3 minutes, ambulated in a hallway, and sat for 3 minutes.

Single-Bone Intramedullary Nailing of Pediatric Both-Bone Forearm Fractures A Systematic Review.

Traditional operative management of unstable, pediatric both-bone forearm fractures is fixation of both ulna and radius. Literature suggests single-bone fixation with intramedullary nailing obtains good results and is less technically demanding and invasive. This systematic review evaluates the efficacy of single-bone intramedullary nailing of pediatric both-bone forearm fractures.

Age of Recurrence in Idiopathic Clubfoot Treated with the Ponseti Method.

Objectives: While studies of patients undergoing the Ponseti method for idiopathic clubfoot demonstrate excellent correction after initial treatment, recurrence can occur in more than half of the cases. Few studies have demonstrated the age at which recurrence typically occurs or if age at discontinuation of the foot ankle orthosis (FAO) is associated with risk for surgical intervention.

Methods: Patients with idiopathic clubfoot treated with the Ponseti method with greater than 3 years of follow-up were evaluated.

Evaluation of Self-Concept and Emotional-Behavioral Functioning of Children with Brachial Plexus Birth Injury.

 The reported incidence of brachial plexus birth injury (BPBI) is 0.87 to 2.2 per 1,000 live births.

Wound Closure in Nonidiopathic Scoliosis: Does Closure Matter?

Background: Postoperative wound complications after posterior spinal fusion are difficult to manage. The incidence in the nonidiopathic patient population is significantly higher than the adolescent idiopathic population. A comparison of wound complications after posterior spinal fusion for nonidiopathic scoliosis between the utilization of the orthopaedic surgical team at the time of closure performing a nonstandardized wound closure versus a plastic surgeon with a plastic multilayered closure technique and rotational flap coverage when needed had not previously been evaluated.

Not All Hip Dysplasias are the Same: Preoperative CT Version Study and the Need for Reverse Bernese Periacetabular Osteotomy.

Background: Dysplastic hip may present with acetabular retroversion with or without femoral retroversion. This retroversion, if not accounted for when performing a periacetabular osteotomy (PAO), will lead to anterior hip pain and early osteoarthritis. A reverse PAO involves anteverting the acetabulum while still obtaining lateral coverage.

Current Practice in the Management of Slipped Capital Femoral Epiphysis.

Background: The most widely used treatment for slipped capital femoral epiphysis (SCFE) is in situ fixation. In an attempt to reduce the chances of impingement, osteoarthritis, and osteonecrosis, surgeons have started adopting newer surgical techniques. The purpose of this study was to determine the current pattern of treating SCFE.

Idiopathic clubfoot treated with the Ponseti method: factors associated with patient follow-up.

Background: Follow-up after treatment with the Ponseti method is important because of the known association be- tween lack of brace wear and recurrence. This study was designed to ascertain factors associated with patients who did not return for the recommended follow-up versus those who did.

Methods: Between January 1, 2000, and December 31, 2009, 222 patients were treated for idiopathic clubfoot at the New York Ponseti Clubfoot Center at NYU Hospital for Joint Diseases, of which 93 patients (143 feet) were potentially available for follow-up (i.

Predicting the need for surgical intervention in patients with idiopathic clubfoot.

Background: The purpose of this study was to determine the early factors associated with the need for surgical interventions in patients with idiopathic clubfoot treated with the Ponseti method.

Methods: All patients with idiopathic clubfoot treated with Ponseti method at our institution with >3 years of follow-up were evaluated. Age at presentation, history of previous treatment, number of casts used, need for percutaneous Achilles tenotomy (PAT), age of initiation of foot abduction orthosis (FAO), compliance with FAO, and need for additional casts were recorded.

A radiographic study of pediatric ulnar anatomy.

Background: The adult ulna has a unique bony architecture that has been described in the literature, but, to the best of our knowledge, the ulnar anatomy in children has not been described.

Methods: We examined 75 anteroposterior (AP) and 64 lateral radiographs (29 were bilateral) of 50, 0.5- to 11-year-old, healthy children's forearms.

Calcaneocuboid arthrodesis for recurrent clubfeet: what is the outcome at 17-year follow-up?

Purpose: Calcaneocuboid arthrodesis was used during revision clubfoot surgery in order to maintain midfoot correction. The purposes of this study were to determine: (1) functional level at 17-year follow-up compared to 5-year follow-up; (2) patients' current functional level, satisfaction, and pain; and (3) current arthropometric measurements.

Methods: Twenty patients (27 clubfeet) with clubfoot relapse underwent revision soft tissue release and calcaneocuboid fusion between 1991 and 1994.

The labrum: structure, function, and injury with femoro-acetabular impingement.

Background: The recognition of the importance of femoro-acetabular impingement (FAI) as a potential cause of hip pain has been stimulated by major efforts to salvage hip joints by reconstruction to prevent or delay the need for replacement. A previous review addressed the nature of FAI, the various types, and how to make the diagnosis. When FAI occurs, the structure between the femur and acetabular rim, the labrum, is initially impinged upon and subsequently injured.

Femoro-acetabular impingement: the diagnosis-a review.

Background: The recognition of the importance of femoral acetabular impingement (FAI) as a potential cause of hip pain has been stimulated by major efforts to salvage hip joints by reconstruction in order to prevent or delay the need for replacement. The purpose of this review is to define the nature of FAI, the various types, and how to make the diagnosis.

Methods: The review describes the characteristics of the hip that cause FAI and emphasizes understanding that the femoral and acetabular components normally function as a unit, complementing each other.

Gait component changes observed during independent ambulation in young children.

The components of gait of the new independent ambulator can differ from that of the more experienced ambulator. The purposes of this review were to describe observable gait components exhibited at the onset of independent ambulation, the progression of changes in these components, and the time when a more mature pattern should be present consistently. Cross-sectional, longitudinal and single-recording studies, which analyzed children's gait at the onset of independent ambulation and followed changes in the components, were reviewed.