Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Background: Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results.

The "6th R" of sustainability: Repurposing operating room waste for community benefit.

Background: Operating rooms contribute greatly to hospital waste and greenhouse gas production. Efforts to "green the operating room" have focused on the 5R's of sustainability: reduce, reuse, recycle, rethink, and research. We propose a "6th R" -repurposing- as simple yet effective means of addressing operating room waste.

Arthroscopic Bankart Repair for Anterior Glenohumeral Instability in 488 Adolescents Between 2000 and 2020: Risk Factors for Subsequent Recurrent Instability Requiring Revision Stabilization.

Background: After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making.

Purpose: To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR.

Single versus double percutaneous pinning of pediatric distal radius fractures.

The aim of this study was to compare early clinical and radiographic results of single- versus double-pin fixation of unstable pediatric distal radius fractures. A total of 103 consecutive closed distal radius fractures treated with either single or double percutaneous pinning at a tertiary level I pediatric hospital were analyzed. All patients had open physes and had fractures that failed initial closed reduction and casting.

MRI Features That Contribute to Decision-Making for Treatment of Capitellar OCD Lesions: An Expert Consensus Using the Delphi Method.

Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined.

Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol.

Nonoperative Versus Operative Treatment of Z-Type Comminuted Clavicle Fractures in Adolescents: A Prospective Substratified Cohort Analysis.

Objectives: To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures.

Design: Prospective observational cohort.

Setting: Eight tertiary care pediatric centers.

Pediatric and Adolescent Distal Radius Fractures: Current Concepts and Treatment Recommendations.

Distal radius fractures are the most common skeletal injuries requiring intervention in children. These injuries are classified by fracture pattern, location, displacement, and angulation. While each unique fracture pattern warrants slightly modified treatment plans and follow-up, the goals of treatment remain constant.

Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain.

Background: Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges.

Methods: Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits).

5-Year Radiographic and Functional Outcomes of Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers.

Background: Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes.

Purpose: To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling ≥5 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures.

Treatment of Severely Shortened or Comminuted Clavicular Fractures in Older Adolescent Athletes.

Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion.

Hypothesis: The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and/or severely shortened clavicular fractures.

Syndromic Involvement of Patients Presenting With Congenital Upper Limb Anomalies: An Analysis of 4,317 Cases.

Purpose: This study investigated the patterns of syndromic involvement for patients with congenital upper limb anomalies (CULAs). We hypothesize that patients with CULAs will present with predictable syndromic patterns.

Methods: This retrospective study queried the multicenter Congenital Upper Limb Differences (CoULD) Registry.

Do Nails and Nubbins Matter? A Comparison of Symbrachydactyly and Transverse Deficiency Phenotypes.

Purpose: Transverse deficiency (TD) and symbrachydactyly may be difficult to distinguish due to shared phenotypes and a lack of pathognomonic features. The 2020 Oberg-Manske-Tonkin classification update modified these anomalies to include "with ectodermal elements" for symbrachydactyly and "without ectodermal elements" for TD as a defining differentiating characteristic. The purpose of this investigation was to characterize ectodermal elements and the level of deficiency and to examine whether ectodermal elements versus the level of deficiency was a greater determining factor for Congenital Upper Limb Differences (CoULD) surgeons making the diagnosis.

Bony Remodeling of Adolescent Displaced Clavicle Fractures: A FACTS Study.

Background: Bony remodeling of displaced clavicle fractures in adolescents remains poorly understood.

Purpose: To evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures, which were treated nonoperatively, to better understand the factors that may influence this process.

Study Design: Case series; Level of evidence, 4.

Early Surgical Results of Pediatric Unicondylar Phalangeal Fractures.

Purpose: Conventional teaching dictates that timely diagnosis and expeditious treatment of unicondylar phalangeal fractures are essential to restore articular congruity, which allows for optimal range of motion and function. The objective of this study was to compare the radiographic and clinical results of surgical treatment of acute and chronic unicondylar phalanx fractures in pediatric patients.

Methods: Thirty-four patients with unicondylar phalangeal fractures underwent surgical intervention at a pediatric tertiary care center from 2004 to 2016.

Corrective Osteotomy for Symptomatic Radial Head and Neck Malunions in the Skeletally Immature.

Background: Radial head and neck fracture malunion can lead to pain, stiffness, deformity, and functional limitations. This study analyzed the early radiographic and functional outcomes of corrective osteotomy for symptomatic radial head and/or neck malunion in skeletally immature patients.

Methods: Thirteen pediatric patients treated with corrective osteotomy for symptomatic radial head and/or neck malunion from 2004 to 2018 were identified.

Reliability of Radiographic Imaging Characteristics for Osteochondritis Dissecans of the Capitellum.

Background: A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking.

Purpose: To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions.

Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter Registry.

Introduction: More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry.

Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study).

Introduction: This study investigates how previous simulation training and clinical experience affects trainee performance when manipulating a foot, applying a Ponseti clubfoot cast, and performing an Achilles tenotomy on a clubfoot simulator.

Methods: Sixty-four Accreditation Council for Graduate Medical Education orthopaedic trainees participated in the 2017 to 2018 Top Gun (TG) skills competition at the International Pediatric Orthopaedic Symposium. Trainees were judged by expert pediatric orthopaedic surgeons on how they manipulated a clubfoot model, applied a cast, and performed a simulated tendoachilles tenotomy (TAT).

Reliability of an Observational Biomechanical Analysis Tool in Adolescent Baseball Pitchers.

Background: Improper pitching mechanics are a risk factor for arm injuries. While 3-dimensional (3D) motion analysis remains the gold standard for evaluation, most pitchers and clinicians do not have access to this costly technology. Recent advances in 2-dimensional (2D) video technology provide acceptable resolution for clinical analysis.

Triangular Fibrocartilage Complex Injuries in Children and Adolescents.

Triangular fibrocartilage complex (TFCC) tears can cause ulnar-sided wrist pain in children and adolescents following acute rotational injury or prior distal radius fracture. Surgical treatment, guided by the Palmer classification, is considered after activity modification and occupational therapy. All concomitant wrist pathologies, such as distal radioulnar joint instability, ulnocarpal impaction, and distal radius malunion, must be recognized and addressed at the time of TFCC debridement or repair.

The Effect of Casting Simulation on Maintenance of Fracture Alignment Following Closed Reduction of Pediatric Distal Radius Fractures: Does More Simulation Matter?

Background: The purpose of this study was to evaluate the effectiveness of a simulation curriculum on performance of closed reduction (CR) and casting of distal radius and distal both-bone forearm fractures by orthopaedic surgery residents. The secondary aim was to identify if repeated simulation training during the clinical rotation provided additional benefit.

Methods: Orthopaedic surgery residents performed simulated distal radius fracture (DRF) reduction and cast application near the beginning and end of their 6-month pediatric orthopaedic clinical rotation at a tertiary care children's hospital.