Improving prediction of progression of idiopathic scoliosis based on curve size and skeletal maturity.

Purpose: To define the risk of curve progression of idiopathic scoliosis (IS) to 35°, 40°, 45°, and 50° based on current curve magnitude and Sanders stage for boys and girls, using a large cohort of patients and encounters, to improve granularity and allow more accurate estimations to guide treatment.

Methods: Retrospective analysis of a prospectively collected scoliosis database. Generalized estimation equation logistic regression models estimated probabilities of curve progression to 35°, 40°, 45°, and 50° based on starting curve size and Sanders stage.

Epiphyseal-entry cannulated screws for temporary guided growth of the knees: a retrospective review of 89 cases.

Guided growth affects the physis in children to produce a desired effect. Several devices achieve alteration of growth, including staples, plates, and screws. Complications can include device failures, failure to modulate growth as expected, and unintended physeal arrest.

Conservative Management of Transitional Ankle Fractures in Adolescents: A Pilot Study to Determine Whether Type of Immobilization Affects Outcome.

Intra-articular Tillaux and triplane ankle fractures are treated surgically when displaced. Minimally displaced fractures are treated with immobilization alone. Long leg casts (LLCs) are the most traditional method of immobilization because they can prevent weight bearing by flexing the knee and control ankle rotation.

Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?

Background: Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field.

Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons.

Value in Scoliosis Surgery: Coordinated Surgical and Anesthetic Techniques Avoid Blood Transfusion without Fibrinolytic Medications or Red Blood Cell Salvage.

Study Design: Retrospective chart review.

Objective: The aim of this study was to document the impact of coordinated surgical and anesthetic techniques on estimated blood loss (EBL) and subsequent need for transfusion.

Summary Of Background Data: Scoliosis surgery is typically associated with large quantities of blood loss, and consequently blood transfusion may be necessary.

Anterior vertebral body tethering shows mixed results at 2-year follow-up.

Study Design: Retrospective chart review.

Objective: To report 2-4-year outcomes of anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS). AVBT is a relatively new procedure to correct AIS spine curvature and few outcomes studies have been published.

Vitamin D Status in Children With Forearm Fractures: Incidence and Risk Factors.

Introduction: The association between vitamin D status and fracture characteristics in children remains ambiguous. We hypothesized that vitamin D deficient or insufficient children would have an increased risk of forearm fractures severe enough to require surgical management.

Methods: One hundred children with low-energy forearm fractures were prospectively enrolled from a single hospital.

Blood pressure measurements during intraoperative pediatric scoliosis surgery.

Background: Intraoperative hypotension is frequently encountered during surgery and it can be associated with adverse outcomes. Blood pressure monitoring is critical during surgery, but there are no universally agreed upon standards for interpreting values of hypotension and no consensus regarding interventions.

Material And Methods: We performed a retrospective chart review of pediatric patients who underwent idiopathic scoliosis surgery by a single surgeon.

Improving Quality in the Treatment of Pediatric Forearm Fractures: Minimizing the Need for Repeat Intervention With Long-arm Extension Casting.

Purpose: Repeat intervention for pediatric forearm fractures after closed manipulation is as high as 46% with flexed elbow (FE) long-arm casts. Casting with the elbow extended (EE) has been advocated as an alternative technique. We documented outcomes of patients treated with closed manipulation and casting with EE long-arm casts for displaced, diaphyseal both-bone forearm fractures.

Clavicles continue to grow beyond skeletal maturity: radiographic analysis of clavicle length in adolescents and young adults.

There has been minimal research regarding the clavicle's growth and its clinical implications in the late adolescent and early adult population. Previous studies have evaluated postnatal clavicle growth to age 18 without analysing growth through the age of secondary ossification center closure. The purpose of this study was (1) to determine clavicle length and age-related growth in males and females from age 12 to 25 years and (2) to specifically analyse clavicle growth in late adolescence.

Impact of Race Subgroups on the Assessment of Vitamin D Status in Adolescent Idiopathic Scoliosis.

The authors' main objective was to demonstrate the confounding effect of combining subgroup data, specifically race, on the prevalence of vitamin D deficiency in adolescent idiopathic scoliosis (AIS). This was a retrospective chart review. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25[OH]D) less than 20 ng/mL.

Pitfalls with Vitamin D Research in Musculoskeletal Disorders and Recommendations on How to Avoid Them.

Reports suggesting that vitamin D may have extraskeletal roles have renewed interest in vitamin D research and stimulated publication of an increasing number of new studies each year. These studies typically assess vitamin D status by measuring the blood concentration of 25-hydroxyvitamin D [25(OH)D], the principal circulating metabolite of vitamin D. Unfortunately, variations in assay format, inconsistency in interpreting 25(OH)D concentrations, cohort bias (age, body mass index, race, season of measurements etc.

Orthopaedic Care for Children: Who Provides It? How Has It Changed Over the Past Decade? Analysis of the Database of the American Board of Orthopaedic Surgery.

Background: The field of orthopaedic surgery has subspecialized over the past decade with an increasing number of graduates of orthopaedic residency programs entering fellowship training. The number of graduates from pediatric orthopaedic fellowships has also increased over the past decade. We hypothesize as the number of pediatric orthopaedic fellowship graduates has increased, the proportion of orthopaedic cases completed by pediatric surgeons in comparison with adult surgeons has also increased.

The Potential Value of Dual-Energy X-Ray Absorptiometry in Orthopedics.

Dual-energy X-ray absorptiometry (DXA) is a well-established technology with an important and well-known role in measuring bone mineral density (BMD) for the purpose of determining fracture risk, diagnosing osteoporosis, and monitoring treatment efficacy. However, aside from the assessment of bone status, DXA is likely underutilized in the field of orthopedics, and most orthopedists may not be aware of the full capabilities of DXA, particularly with regard to total body scans and body composition assessment. For example, DXA would be a valuable tool for monitoring body composition after surgery where compensatory changes in the affected limb may lead to right-left asymmetry (eg, tracking lean mass change after knee surgery), rehabilitation regimens for athletes, congenital and metabolic disorders that affect the musculoskeletal system, or monitoring sarcopenia and frailty in the elderly.

Left-Biased Clavicle Length Asymmetry in Children and Young Adults 12 to 25 Years Old.

Management of clavicle fractures depends in part on the magnitude of shortening compared with the contralateral, intact clavicle. However, estimating prefracture length may be complicated by side-to-side asymmetry. The authors retrospectively reviewed chest radiographs using a ruler tool to measure clavicle length in 696 patients 12 to 25 years old.

Maturity Indicators and Adolescent Idiopathic Scoliosis: Evaluation of the Sanders Maturity Scale.

Study Design: Retrospective review.

Objective: To determine the correlation between the Sanders Maturity Scale (SMS) and Risser stages, between both systems and menarche, and whether Risser can be used to predict SMS.

Summary Of Background Data: Predicting curve progression is critical to understanding adolescent idiopathic scoliosis and making treatment recommendations.

Management of Clubfoot Relapses With the Ponseti Method: Results of a Survey of the POSNA Members.

Background: Despite the high rate of initial success using the Ponseti method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet.

Methods: We created a survey to focus on the management of clubfeet after initial correction of deformity.

Prospective Randomized Evaluation of Intraoperative Application of Autologous Platelet-Rich Plasma on Surgical Site Infection or Delayed Wound Healing.

Background: Prevention of surgical site infections and the reduction of wound-related complication rates have become increasingly emphasized by hospital task groups and government agencies given the degree of economic burden it places on the health care system. Platelet-rich plasma (PRP) contains growth factors and other biomolecules that promote endogenous microbicidal activity. We hypothesized that PRP would help prevent postoperative infection and delayed wound healing (DWH).

Glanzmann's Thrombasthenia Diagnosed following Knee Arthroscopy.

A 41-year-old man with an unremarkable medical history presented with a painful knee after a sports injury. He was diagnosed with a medial meniscal tear. Symptoms did not abate after 6 months of physical therapy, and he underwent arthroscopic partial medial meniscectomy.

Isokinetic concentric quadriceps and hamstring normative data for elite collegiate American football players participating in the NFL Scouting Combine.

Isokinetic concentric quadriceps and hamstring strength data using a Cybex dynamometer are collected for elite collegiate American football players invited to the annual National Football League Scouting Combine. We constructed a normative (reference) database of the Cybex strength data for the purpose of allowing comparison of an individual's values to his peers. Data reduction was performed to construct frequency distributions of hamstring/quadriceps (H/Q) ratios and side-to-side strength differences.

Isokinetic concentric quadriceps and hamstring strength variables from the NFL Scouting Combine are not predictive of hamstring injury in first-year professional football players.

Background: There are conflicting reports regarding the association between isokinetic concentric quadriceps and hamstring strength deficits and ratios and risk for hamstring injuries in athletes.

Purpose: To determine if isokinetic concentric Cybex data collected during the annual National Football League (NFL) Scouting Combine are predictive of hamstring injury in professional American football players during their first season.

Study Design: Case-control study; Level of evidence, 3.

Two-year outcome with the AperFix system for ACL reconstruction.

The purpose of the study was to assess the fixation durability of the AperFix System (Cayenne Medical, Inc, Scottsdale, Arizona) used in arthroscopic reconstruction of the anterior cruciate ligament. The AperFix System consists of a femoral and tibial component designed to secure either allograft or autograft. The outcomes of 185 knees (180 patients) were retrospectively reviewed at a minimum of 2 years postoperatively.

Which to use to evaluate change in BMD at follow-up: RMS-SD or RMS-%CV?

There is bias toward the use of root-mean-square standard deviation (RMS-SD) over root-mean-square coefficient of variation (RMS-%CV) to calculate a least significant change (LSC) value that is used to determine if change in bone mineral density (BMD) at follow-up is statistically significant. In part, this bias is based on the assumption that SD is relatively constant over a wide range of BMD as opposed to %CV, which is assumed to increase as BMD decreases. However, evidence to support these assumptions is scant.

Long-term versus short-term precision of dual-energy X-ray absorptiometry scans and the impact on interpreting change in bone mineral density at follow-up.

We hypothesized that increased time between repeat scans would be a critical factor resulting in long-term precision (LTP) being greater than short-term precision (STP) because time erases the short-term mind's eye memory of positioning that makes STP easy to perform. In 2 prospective studies, STP, in which repeat scans were performed within minutes, was compared with LTP in the same patients in whom repeat scans were separated by 3-10 d (n=35) or 2-12 mo (n=30). The first baseline scan and the follow-up scan were used to calculate LTP.

Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis.

Thirty patients (31 elbows) with epicondylitis unresponsive to nonsurgical treatment (including steroid injection) for >6 months received a single treatment of platelet-rich plasma injected with a peppering technique. Patients were followed using a 5-subcategory visual analog scale (VAS) for pain (0, no pain; 10, worst possible pain), modified American Shoulder and Elbow Surgeons assessment survey, and VAS for patient satisfaction (0, not at all satisfied; 10, very satisfied). Successful treatment was defined as a 25% decrease in worst pain at follow-up with no intervention after 1 year.