Fever after varus derotational osteotomy is common, but not a risk factor for infection.

Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified.

Impact of gait analysis on pathology identification and surgical recommendations in children with spina bifida.

Background: Gait analysis provides quantitative data that can be used to supplement standard clinical evaluation in identifying and understanding gait problems. It has been established that gait analysis changes treatment decision making for children with cerebral palsy, but this has not yet been studied in other diagnoses such as spina bifida.

Research Question: To determine the effects of gait analysis data on pathology identification and surgical recommendations in children with spina bifida.

Advanced skeletal maturity in children and adolescents with myelomeningocele.

Purpose: Atypical skeletal development is common in youth with myelomeningocele (MM), though the underlying reasons have not been fully elucidated. This study assessed skeletal maturity in children and adolescents with MM and examined the effects of sex, age, sexual development, ethnicity, anthropometrics and shunt status.

Methods: Forty-three males and 35 females with MM, 6-16 years old, underwent hand radiographs for bone age determination.

Walking activity during daily living in children with myelomeningocele.

Purpose: To quantify the walking activity of children with myelomeningocele during daily living.

Method: Walking activity was measured using a StepWatch activity monitor over one week in 47 children with myelomeningocele (27 males; 9 years 11 months SD 2 years 7 months; 18 sacral, 9 low lumbar, 20 mid-high lumbar) and seven children with typical development (5 males; 11 years 1 month SD 1 year 11 months) in a prospective, cross-sectional study. Average total steps per day, number of steps and minutes spent at low, medium and high intensity stepping were evaluated.

Differentiating Transient Synovitis of the Hip from More Urgent Conditions.

A variety of traumatic and infectious processes can cause acute onset of hip pain and difficulty walking. Without a history of trauma, a common cause is transient (or "toxic") synovitis, but serious infectious causes, such as septic arthritis of the hip or osteomyelitis, must be ruled out. Differentiating between septic arthritis of the hip (a true emergency) and transient synovitis of the hip (a much more benign inflammatory process) can be difficult.

Quantitative Analysis of Lower Leg Adipose Tissue Distribution in Youth with Myelomeningocele.

Children with myelomeningocele have a high prevalence of obesity and excess fat accumulation in their lower extremities. However, it is not known if this is subcutaneous or intramuscular fat, the latter of which has been associated with insulin resistance and metabolic disorders. This study quantified lower leg bone, muscle, and adipose tissue volume in children with myelomeningocele, classifying adipose as subcutaneous or muscle-associated.

Fasting serum blood measures of bone and lipid metabolism in children with myelomeningocele for early detection of cardiovascular and bone fragility risk factors.

Objective: This study examined serum levels in children with myelomeningocele to identify the prevalence of pre-clinical signs of disease.

Design: A prospective, cross-sectional study.

Setting: Patients were actively recruited from multidisciplinary care clinics at tertiary children's hospitals from 2010-2012.

Variability of the Anterior Humeral Line in Normal Pediatric Elbows.

Background: The anterior humeral line (AHL) is considered a valuable radiographic tool in the assessment of pediatric elbow sagittal plane alignment following injury. However, few studies exist that examine the validity of the AHL. The purpose of this study is to report the variability of the AHL in skeletally immature children with normal elbows.

Foam padding in casts accommodates soft tissue swelling and provides circumferential strength after fixation of supracondylar humerus fractures.

Background: Varying casting techniques are used after surgical treatment of pediatric supracondylar humerus fractures. The goals are to maintain fracture reduction, while accommodating soft tissue swelling and minimizing the risk of compartment syndrome.

Methods: A retrospective chart review of consecutive patients aged 0 to 14 years who underwent surgical treatment of supracondylar humerus fractures over a 9½-year period at a pediatric trauma center was performed.

Fat distribution in children and adolescents with myelomeningocele.

Aim: To evaluate fat distribution in children and adolescents with myelomeningocele using dual-energy X-ray absorptiometry (DXA).

Method: Cross-sectional DXA measurements of the percentage of fat in the trunk, arms, legs, and whole body were compared between 82 children with myelomeningocele (45 males, 37 females; mean age 9y 8mo, SD 2y 7mo; 22 sacral, 13 low lumbar, 47 mid lumbar and above) and 119 comparison children (65 males, 54 females; mean age 10y 4mo, SD 2y 4mo). Differences in fat distribution between groups were evaluated using univariate and multivariate analyses.

A line drawn along the radial shaft misses the capitellum in 16% of radiographs of normal elbows.

Background: The radiocapitellar line (RCL) is a routinely referenced radiographic measurement for evaluating injury of the pediatric elbow, such as a Monteggia fracture. It is most commonly described as a line drawn along the radius that should intercept the center of the capitellum in a normal elbow. However, the RCL has not been rigorously defined or validated in young children.

Iatrogenic nerve injuries in the treatment of supracondylar humerus fractures: are we really just missing nerve injuries on preoperative examination?

Background: Recent studies report the rate of iatrogenic nerve injury in operatively treated supracondylar humerus (SCH) fractures is 3% to 4%. A reliable neurological examination can be difficult to obtain in a young child in pain. We hypothesized that nerve injuries may be missed preoperatively, later noted postoperatively in a more compliant patient, and then falsely considered an iatrogenic injury.

Heterogeneity of muscle fat infiltration in children with spina bifida.

Children with spina bifida have well recognized functional deficits of muscle, but little is known about the associated changes in muscle anatomy and composition. This study used water-fat magnetic resonance imaging (MRI) to measure fat infiltration in the lower extremity muscles of 11 children with myelomeningocele, the most severe form of spina bifida. MRI measurements of muscle fat fraction (FF) were compared against manual muscle test (MMT) scores for muscle strength.

Differences in implementation of gait analysis recommendations based on affiliation with a gait laboratory.

This study examined the extent to which gait analysis recommendations are followed by orthopedic surgeons with varying degrees of affiliation with the gait laboratory. Surgical data were retrospectively examined for 95 patients with cerebral palsy who underwent lower extremity orthopedic surgery following gait analysis. Thirty-three patients were referred by two surgeons directly affiliated with the gait laboratory (direct affiliation), 44 were referred by five surgeons from the same institution but not directly affiliated with the gait laboratory (institutional affiliation), and 18 were referred by 10 surgeons from other institutions (no affiliation).

Orthopaedic issues in children and adolescents with central nervous system tumors.

Musculoskeletal deficits remain significant impediments to the function and independence of children and adolescents following successful treatment of Central Nervous System Tumors (CNS) tumors. The sequelae often impair the function of the upper and lower extremities and manifest themselves as difficulties in gross and fine motor skills, which encompasses self care and walking. Overall, the five-year survival rate for children younger than 15 years with brain tumors is between 60 to 90 percent.

Increased incidence of sacroiliac joint infection at a children's hospital.

Background: Pyogenic sacroiliitis (PSI) is an uncommon type of osteoarticular infection. A study is undertaken to confirm an observed increase in incidence of PSI at our pediatric institution and to evaluate any associations with increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection and other factors.

Methods: All inpatients with osteoarticular infection were identified from the periods of 1992 to 1996 and 2004 to 2007.

Classification systems in cerebral palsy.

Because of increasing interest in conducting large-scale, multicenter investigations into the epidemiology of cerebral palsy and its prevention and treatment, efforts have been made to establish a standard definition and classification systems for cerebral palsy. In recent years there has also been increased focus on measurement of functional status of patients and new classifications for gross and fine motor function have been developed. The purpose of this article is to update the orthopaedic community on the current classification systems for patients with cerebral palsy.

Results of tibial rotational osteotomy without concomitant fibular osteotomy in children with cerebral palsy.

A retrospective review was performed of 46 consecutive ambulatory children with cerebral palsy and tibial torsion who underwent 72 distal tibial derotational osteotomies without concomitant fibular osteotomy. The average amount of derotation measured at surgery was 21 +/- 5 degrees. The average change in thigh-foot angle at follow-up was 21 +/- 9 degrees.