Fate of acetabular dysplasia after closed and open reduction of hips in children with developmental hip dislocation.

Acetabular underdevelopment (acetabular dysplasia) is a common finding in children with hip dislocation, and residual acetabular dysplasia can remain after hip reduction. Residual dysplasia leads to unsatisfactory long-term outcomes and osteoarthritis. Dynamics of acetabular dysplasia [measured as Acetabular Index (AI)] in a pediatric cohort that underwent open (OR) or closed reduction are reported.

Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia.

The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified.

Outcomes of Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade.

Background: Open reduction of the hip is commonly performed in children with severe developmental dysplasia of the hip, or in cases that are refractory to nonoperative forms of treatment. The open reduction has been associated with numerous complications including avascular necrosis (AVN) of the femoral head, the need for reoperation, and residual radiographic dysplasia. This study seeks to determine the effects of preoperative severity of dysplasia, associated procedures (femoral and acetabular osteotomies), age on AVN, and the need for reoperation.

Pediatric and Adult Fracture Incidence: A Decreasing Trend With Increasing Hospital Admissions.

Large-scale studies examining fracture trends and epidemiological data are lacking. The purpose of this study was to evaluate the incidence of fractures presenting to US emergency departments using the National Electronic Injury Surveillance System. A total of 7,109,078 pediatric and 13,592,548 adult patients presenting to US emergency departments with a fracture between 2008 and 2017 were analyzed for patterns.

Prediction of Late Dysplasia Based on Ultrasound and Plain X-Ray at 6 Months.

Background: Developmental dysplasia of the hip represents a spectrum of deformity. Residual dysplasia at 2 years of age is associated with an increased risk for osteoarthritis and functional limitations. We compared the prognostic value of 6-month imaging modalities and aimed to identify optimal diagnostic metrics for the prediction of residual dysplasia.

Application of Accepted Use Criteria for the Treatment of Developmental Dysplasia of the Hip Decreases the Number of Infants Treated With a Pavlik Harness.

Background: This analysis examined how the application of the American Academy of Orthopedic Surgeons appropriate use criteria (AUC) for developmental dysplasia of the hip in infants would change treatment patterns and outcomes for Graf IIA hips at a single quaternary pediatric hospital.

Methods: After Institutional Review Board approval, patient medical records were reviewed and data were collected. Graf IIa hips were defined as alpha angle (AA) 50 to 59 degrees.

The Bridged Digital Artery Perforator Flap as an Alternative Reconstructive Option for Dorsal Digital or Toe Soft Tissue Defects.

Background: Dorsal digital soft tissue defects are considered among the most challenging to reconstruct. Numerous treatment options are proposed, including advancement flaps, antegrade, retrograde flow flaps, adipofascial flaps, and digital artery perforator flaps. However, the optimal treatment remains controversial.

Lower extremity physeal fractures and post-traumatic surgical deformities; National Trauma Data Bank and institutional cohorts.

Background: Pediatric lower extremity physeal fractures carry a risk of developing deformities. Most epidemiological evidence is over 25 years old, single institution, and lacks follow-up, while recent studies report variable results. Understanding their epidemiology and deformity risk is important for patient counseling and follow-up.

Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness.

Best treatment protocols for infants with developmental dysplasia of the hip (DDH) are poorly defined. This study estimates the time to normalization among Graf IIc hips undergoing Pavlik harness treatment. Following institutional review board approval, patients referred for DDH evaluation at a pediatric institution between 2009 and 2018 (n = 1424 hips/712 patients) were identified.

Multi-day delay to care identified in pediatric trauma cases during COVID-19.

This study aims to establish how pediatric fracture patterns were altered at a level 1 trauma center in a state that implemented a shutdown during the initial height of COVID-19. After IRB approval, we identified 2017 patients treated at a pediatric institution for definitive management of a fracture between 26 March and 31 May 2018, 2019, or 2020. Dates were chosen based on statewide stay-at-home orders for Colorado.

Sequential Bilateral Achilles Tendon Rupture in a Teenager After Ponseti Treatment for Bilateral Clubfoot: A Case Report.

Case: Our patient was born with bilateral congenital clubfeet and underwent standard Ponseti treatment. At 8 months of age, bilateral percutaneous Achilles tenotomies were performed, with an excellent outcome. At 16 years, he suffered a unilateral Achilles tendon rupture, and at 18 years, he suffered a contralateral Achilles rupture, both of which were successfully repaired.

Tonnis Angle and Acetabular Retroversion Measurements in Asymptomatic Hips Are Predictive of Future Hip Pain: A Retrospective, Prognostic Clinical Study.

Background: This study evaluated the prevalence of radiographic abnormalities potentially indicative of femoroacetabular impingement on AP pelvic radiographs in asymptomatic adolescents and young adults and aimed to determine whether the abnormalities were predictive of future hip pain.

Methods: AP pelvis images from scoliosis radiographs were obtained from patients 12 to 25 years of age free of any clinical hip/lower extremity symptoms between January 2006 and September 2009. The following radiographic abnormalities were collected: lateral center-edge angle of Wiberg >40° or <25°, Tönnis angle <0° or >10°, acetabular retroversion (crossover sign with a posterior wall sign), acetabular overcoverage (crossover sign without a posterior wall sign), and anterior offset alpha angle, calculated using alpha angle of Nötzli >50°.

Implementation of a Ponseti Clubfoot Program Decreases Major Surgery: A Quality Improvement Initiative.

Unlabelled: Clubfoot describes a congenital condition. If untreated, clubfoot can cause long-term functional issues. The Ponseti method is the gold-standard treatment; it emphasizes casting over surgery.

White Matter Connectivity in Youth at Risk for Serious Mental Illness: A Longitudinal Analysis.

Longitudinal changes in white matter connectivity were assessed in a sample of youth at-risk for serious mental illness (n=183; age 12-25). Diffusion tensor imaging (DTI) was acquired at baseline and 12 months from youth recruited across two sites and classified as healthy controls (n=36), familial risk (n=30), mild-symptoms (n=41), attenuated syndromes (n=70), or transition (n=9) based on clinical assessments. Fractional anisotropy (FA) and mean diffusivity (MD) values were derived for the whole brain white matter, forceps minor, anterior cingulate, anterior thalamic radiations, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, and uncinate fasciculus.

Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?

Background: The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified.

Methods: Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected.

Trends in Trampoline Fractures: 2008-2017.

Objectives: In this study, we aim to evaluate the current trends in pediatric fractures related to trampolines.

Methods: The National Electronic Injury Surveillance System was queried for fractures occurring between 2008 and 2017 in individuals aged 0 to 17 years. Sex, anatomic region, locale of injury, admission status, and year of injury were recorded.

Functional and Surgical Outcomes After Endoprosthetic Reconstruction With Expandable Prostheses in Children: A Systematic Review.

Treatment of bone sarcomas in children is associated with wide tumor re-section and segmental reconstruction. The optimal surgical approach is still under debate in the literature. During the past decade, the application of expandable prostheses has gained remarkable attention because it improves patients' appearance and allows limb growth preventing leg length discrepancy.

Clubfoot and Tethered Cord Syndrome: Results of Treatment With the Ponseti Method.

Background: The Ponseti technique has demonstrated high success rates worldwide for the treatment of idiopathic clubfoot. The purpose of this study was to determine whether clubfoot associated with tethered cord syndrome (TCS) was more resistant to Ponseti treatment than isolated clubfoot.

Methods: An IRB-approved retrospective cohort study of subjects undergoing Ponseti treatment of clubfoot between 2002 and 2013 was conducted.

Dimeglio Score Predicts Treatment Difficulty During Ponseti Casting for Isolated Clubfoot.

Background: The Dimeglio score (DS) is widely used to assess clubfoot severity, but its ability to predict long-term outcomes following Ponseti treated isolated clubfoot (IC) is controversial. This study tested the association between the initial DS and its individual parameters with the number of Ponseti clubfoot casts required to achieve correction and the rate of early recurrence following treatment.

Methods: Data were retrospectively collected from patients who underwent treatment of IC between March 2012 and March 2015 and were followed for ≥2 years.

Fassier-Duval Rods are Associated With Superior Probability of Survival Compared With Static Implants in a Cohort of Children With Osteogenesis Imperfecta Deformities.

Background: The survival of Fassier-Duval (FD) telescoping rods as compared with static implants in children affected by osteogenesis imperfecta is not well characterized. The purpose of this study was to compare risk of lower extremity implant failure in FD rods versus static implants.

Methods: Data were retrospectively collected from patients with osteogenesis imperfecta who underwent surgical treatment using either FD rods or static implants (Rush rods, flexible nails, or Steinmann pins) between 1995 and 2015.

No difference in outcomes in a matched cohort of operative versus nonoperatively treated displaced medial epicondyle fractures.

The purpose of our study was to compare the treatment outcomes and complications between operatively and nonoperatively treated displaced medial epicondyle fractures. Pediatric patients treated for an acute, displaced medial epicondyle fracture between 2005 and 2015 were retrospectively reviewed. A total of 22 operative participants were matched to 22 nonoperative participants, with an average displacement of 9.

Total Scapulectomy and Shoulder Reconstruction Using a Scapular Prosthesis and Constrained Reverse Shoulder Arthroplasty.

Malignant tumors of the scapula are rare, and limb salvage surgery after tumor resection is challenging. The authors present a series of 6 patients who were treated by total scapulectomy and reconstruction with a custom-made scapular prosthesis and a constrained reverse shoulder arthroplasty. Postoperative oncologic and functional outcomes were assessed.

Complications, Results, and Risk Factors of Spinal Fusion in Patients With Myelomeningocele.

Study Design: Retrospective prognostic study.

Objective: The purpose of this study assess was to assess the results of spinal fusion and identify factors associated with the development of post-spinal fusion infections in patients with myelomeningocele.

Background: Surgical correction of neuromuscular scoliosis secondary to myelomeningocele is known to be associated with a high complication rate.

Changing the Paradigm in Medial Canthal Reconstruction: The Bridge Principle and the Croissant-Like Keystone Island Perforator Flap as An Alternative for Medium Size Soft Tissue Defects in Internal Canthus Reconstruction.

Introduction: Medial canthus is a common area of skin cancer prevalence. Defects in this region represent a challenging reconstructive task. The nasal version of keystone perforator island flap (KPIF) has proven its versatility.