Predicting pediatric patient rehabilitation outcomes after spinal deformity surgery with artificial intelligence.

Background: Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, affecting 1-4% of adolescents. The Scoliosis Research Society-22R (SRS-22R), a health-related quality-of-life instrument for AIS, has allowed orthopedists to measure subjective patient outcomes before and after corrective surgery beyond objective radiographic measurements. However, research has revealed that there is no significant correlation between the correction rate in major radiographic parameters and improvements in patient-reported outcomes (PROs), making it difficult to incorporate PROs into personalized surgical planning.

Psychometric analysis and the implications for the use of the scoliosis research society questionnaire (SRS-22r English) for individuals with adolescent idiopathic scoliosis.

Background: Despite widespread usage of the SRS-22r questionnaire (Scoliosis Research Society Questionnaire-22r), the English version has only sparingly been subjected to analysis using modern psychometric techniques for patients with adolescent idiopathic scoliosis (AIS). The study purpose was to improve interpretation and clinical utility of the SRS-22r for adolescents with AIS by generating additional robust evidence, using modern statistical techniques. Questions about (1) Structure and (2) Item and Scale Functioning are addressed and interpreted for clinicians and researchers.

AFOs Improve Stride Length and Gait Velocity but Not Motor Function for Most with Mild Cerebral Palsy.

Ankle-foot orthoses (AFOs) are prescribed to children with cerebral palsy (CP) in hopes of improving their gait and gross motor activities. The purpose of this retrospective study was to examine if clinically significant changes in gross motor function occur with the use of AFOs in children and adolescents diagnosed with CP (Gross Motor Function Classification System levels I and II). Data from 124 clinical assessments were analyzed.

The Costs of Interfacility Transfers for Nonurgent Pediatric Supracondylar Fractures.

Background: Unnecessary transfers of nonemergent pediatric musculoskeletal injuries to regional trauma centers can be costly. The severity of fracture displacement in supracondylar humerus fractures dictates the risk of complications, the urgency of transfer and the need for surgical treatment. The purpose of this study is to examine the transfer patterns of Gartland type II pediatric supracondylar humerus fractures to identify strategies for improving patient care, improving health care system efficiency, and reducing costs.

What is the minimum torque required to obtain passive elbow end range of motion?

Background: Passive range of motion is a common clinical assessment. The point at which passive end range of motion is measured is typically described by the 'end-feel'of the joint.

Research Question: What is the minimum amount of torque required to obtain passive elbow flexion and extension in children?

Methods: Twenty-five children (age, 7.

Evaluating Perioperative Complications Surrounding Supracondylar Humerus Fractures: Expanding Indications for Outpatient Surgery.

Background: Supracondylar humerus (SCH) fractures are one of the most common pediatric orthopaedic injuries. Described using the Wilkins modification of the Gartland Classification system, current practice guidelines give moderate evidence for closed reduction and percutaneous pinning of type 2 and 3 injuries, but little evidence exists regarding the appropriate surgical setting for fixation. The goal of this study was to evaluate the perioperative complication profile of type 3 fractures with maintained metaphyseal contact and determine their suitability for outpatient surgery.

Assessment of Lateral Rotation Percentage and Rotational Deformity of the Elbow in Type 3 Supracondylar Humerus Fractures: A Biomechanical Study.

Background: Supracondylar humerus (SCH) fractures are the most common elbow fractures in children. Historically, displaced (Gartland type 3) SCH fractures have been treated with closed reduction and percutaneous pinning. Fluoroscopic imaging is used intraoperatively in order to assess adequate reduction of the fracture fragments before pinning.

Preoperative supine traction radiographs often result in higher Lenke classifications than supine bending radiographs in adolescent idiopathic scoliosis.

Study Design: Retrospective chart and radiographic review.

Objective: The purpose of this study is to determine if both traction and side-bending radiographs yield the same Lenke classification. Supine side-bending radiographs are used to evaluate curve flexibility and assign Lenke classification in Adolescent Idiopathic Scoliosis (AIS).

Midstance hamstring length is a better indicator for hamstring lengthening procedures than initial contact length.

Background: Children with static encephalopathy often walk with excessive knee and hip flexion throughout the gait cycle. This crouch gait pattern can be debilitating. These children may undergo hamstring-lengthening procedures to correct this crouch gait.

Idiopathic Genu Valgum and Its Association With Obesity in Children and Adolescents.

Background: Obesity as a cause of lower extremity deformity in children has been well established. This deformity is most often seen as tibia vara, however, at our institution we have observed more obese children and adolescents over age 7 years with excessive or progressive idiopathic genu valgum. Our hypothesis is that children with idiopathic genu valgum have high rates of obesity which impact the severity of their disease.

Is It Growth or Natural History? Increasing Spinal Deformity After Sanders Stage 7 in Females With AIS.

Background: Accurate prognosis and treatment decisions in adolescent idiopathic scoliosis (AIS) demand a reliable radiographic marker of growth cessation. Specifically, Sanders Stage 7 (SS7) is a useful marker of spine growth cessation in females and is proposed as a bracing endpoint. The purpose of this study was to determine the amount of curve progression noted in female individuals with AIS after achieving SS7.

Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus.

Background: Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.

Methods: After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor.

Hamstring lengthening in females with cerebral palsy have greater effect than in males.

Children with spastic diplegia cerebral palsy often demonstrate crouched gait patterns, and typically undergo hamstring lengthenings. The objective of this retrospective study was to determine if the surgical response to medial and lateral hamstring lengthenings is different between males and females. Preoperative and postoperative kinematic data of 109 (71 males and 38 females) patients with cerebral palsy were evaluated.

Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis.

This study assessed the rate of adverse wound events in individuals with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and sought to determine if obesity was related to the rate of adverse wound events. A retrospective review of patients with adolescent idiopathic scoliosis that underwent posterior spinal fusion between 2001 and 2013 was performed. Preoperative, perioperative, and postoperative data, including wound adverse events, were obtained through medical record review.

Effect of Amputation Level on Quality of Life and Subjective Function in Children.

Background: Our aim was to discern whether children with amputations have differences in subjective function based on amputation level. We hypothesized that children with more proximal amputations would report poorer function and quality of life.

Methods: An IRB-approved, retrospective chart review of patients aged 0 to 21 years old with lower extremity amputations was performed.

Magnetic Resonance Imaging in Infantile Idiopathic Scoliosis: Is Universal Screening Necessary?

Study Design: Retrospective chart review.

Objective: Determine if there is a subset of presumed infantile idiopathic scoliosis (IIS) patients who have a low incidence of neural axis abnormalities (NAAs) such that screening magnetic resonance imaging (MRI) may be delayed.

Summary Of Background Data: Individuals with presumed IIS have an increased incidence of NAA.

Foot size asymmetry following Ponseti treatment versus comprehensive surgical releases for unilateral clubfeet.

Using age and height matched cohorts with unilateral idiopathic clubfeet (n=40 each), we retrospectively reviewed pedobarographic studies to determine the impact of treatment, Ponseti versus comprehensive surgical releases (CSR), on the foot length, width, and contact area. The foot pressures were determined by self-selected walking across a force plate. Ponseti treatment results in more symmetrical foot lengths, widths, and total contact areas with an improvement of 1.

Pain and overcorrection in clubfeet treated by Ponseti method.

Long-term outcomes of Ponseti casting have consistently shown improvement over soft-tissue release. The incidence of foot pain and overcorrection in clubfeet treated by Ponseti method has not been reported. We studied the rate of overcorrection and its association with pain in clubfeet treated with Ponseti casting.

Classification of Cruciate Ligament Dysplasia and the Severity of Congenital Fibular Deficiency.

Background: Dysplasia of the cruciate ligaments has been found in many patients with congenital fibular deficiency. A recent classification system has shown that radiographic tibial spine changes can predict the hypoplasia and aplasia of the cruciate ligaments. We used this radiographic classification to determine the frequency of these abnormalities and how they correlate with the severity of fibular deficiency and lateral femoral condylar hypoplasia.

A Prospective Comparison of Pulmonary Function Using Traditional and Kinematic Measures in Children With and Without Adolescent Idiopathic Scoliosis.

Purpose: Traditional pulmonary function testing can be difficult for both the subject and the test administrator and are dependent on the subject's effort and ability to follow directions. An alternative to traditional pulmonary function testing is the kinematic analysis of the chest wall. Kinematic analysis is a reliable and accurate method to evaluate pulmonary function testing that does not have the restrictions of traditional methods.

Oral Sucrose for Pain Relief During Clubfoot Casting: A Double-Blinded Randomized Controlled Trial.

Background: Idiopathic clubfoot treatment is treated by manipulation and casting utilizing the Ponseti technique which can make the infant fussy and irritable. The goal of this study was to determine which intervention could decrease this pain response in infants undergoing Ponseti casting for idiopathic clubfeet. Our hypothesis was that the administration of oral sucrose solution or milk would be the most effective in accomplishing that goal.

Three Methods Of Guided Growth For Pediatric Lower Extremity Angular Deformity Correction.

Background: Different methods of guided growth are used for correction of angular deformity in growing children. The differences between these different methods are not well described in the literature.

Methods: A retrospective review was undertaken comparing the effectiveness and complication rates of titanium staples, titanium eight-plates, and the stainless steel Pedi-plate at a tertiary pediatric hospital after IRB approval.

A Cross-sectional Study of Chest Kinematics and VO2 in Children With Adolescent Idiopathic Scoliosis During Steady-state Walking.

Study Design: A cross-sectional study.

Objective: The aim of this study was to identify the differences in oxygen consumption in children with adolescent idiopathic scoliosis (AIS) and age-matched control subjects using traditional methods and chest kinematics.

Summary Of Background Data: AIS is a disorder affecting 2 to 3% of children between the ages of 10 and 16 and accounts for up to 85% of all scoliosis cases.

Residual forefoot deformity predicts the need for future surgery in clubfeet treated by Ponseti casting.

Tibialis anterior tendon transfer (TATT) is performed for treatment of recurrent clubfeet. We investigated the predictability of residual adductus on the future need for TATT. A retrospective review of 143 patients with clubfoot was performed.

Pedobarographic changes in Ponseti-treated clubfeet with and without anterior tibialis tendon transfer: changes due to growth and surgical intervention.

The aim of this study was to identify significant changes in pedobarographic parameters attributed to growth versus growth and surgical intervention for uninvolved feet, clubfeet (CF) subjected to anterior tibialis tendon transfer surgery, and unilateral nonsurgical CF. Participants underwent foot-pressure analysis preoperatively and 3 years postoperatively. Six parameters related to the lateral midfoot showed increases for uninvolved and nonsurgical CF, whereas CF subjected to surgery decreased.