Stable childhood osteochondral lesions of the talus: short-term radiographic outcomes suggest risk for early osteoarthritis.

Recent literature suggests that adults do not necessarily develop osteoarthritis if they have an osteochondral lesion of the talus (OLT). The purpose of this study was to determine if children with OLT are at risk to develop any radiographic evidence of early joint degeneration despite treatment efforts. Fifty-six ankles were identified over 6 years with stable OLT that underwent operative treatment.

Efficacy of Self-Directed Learning in the Supracondylar Fracture Performance Improvement Module at an Academic Pediatric Orthopedic Institution.

Maintenance of certification (MOC) within a medical society requires continuing medical education that demonstrates life-long learning, cognitive expertise, and practice-based self-assessment. This prospective study sought to evaluate whether a self-directed Practice Improvement Module (PIM) would improve pediatric orthopedic patient outcomes, thus demonstrating evidence of life-long learning (Part II MOC credit) in treating supracondylar humerus fractures. Six surgeons and 113 patients were included.

Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study.

Background: Little League throwing guidelines have recently been implemented in an attempt to lessen the growing number of elbow injuries occurring in youth baseball players.

Hypothesis/purpose: The purpose of this study was to examine pre- and postseason changes seen on magnetic resonance imaging (MRI) in youth baseball players' elbows in an attempt to identify risk factors for pain and MRI abnormalities, with a particular focus on the current Little League guidelines. We hypothesized that MRI abnormalities would be common in pitchers with high pitch counts and poor guideline compliance.

The Pediatric/Adolescent Shoulder Survey (PASS): A Reliable Youth Questionnaire With Discriminant Validity and Responsiveness to Change.

Background: Health-related quality of life tools for shoulder pathology in adults have been developed, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH. However, some content is not applicable to or readily grasped by a younger population.

Purpose: To evaluate the psychometric properties of a new 13-item pediatric/adolescent shoulder survey (PASS).

Does Allograft Augmentation of Small-Diameter Hamstring Autograft ACL Grafts Reduce the Incidence of Graft Retear?

Background: Small-diameter hamstring tendons are frequently encountered during anterior cruciate ligament (ACL) reconstructions in patients with short stature or those who are skeletally immature. The role of augmenting these small-diameter autografts with allograft is unclear.

Purpose: To assess clinical outcomes and failure rates in adolescent patients with small hamstring tendon autografts (<7 mm) that were either augmented with soft tissue allograft or accepted "as is" and not augmented.

Femoral Neck Aspiration Aids in the Diagnosis of Osteomyelitis In Children With Septic Hip.

Background: The role of femoral aspiration (FA) in the treatment of septic arthritis of the hip is controversial. The purpose of this study was to determine if FA conducted concomitantly with irrigation and debridement (I&D) of the septic hip aids in microorganism and osteomyelitis identification and alters the treatment plan, or if the risks of the procedure outweigh its potential benefit. We also compare preoperative magnetic resonance imaging (MRI) with FA for diagnosis of osteomyelitis cooccurring with septic arthritis.

Significance of the Lateral Humeral Line for Evaluating Radiocapitellar Alignment in Children.

Background: The radiocapitellar line (RCL) was originally described for evaluation of the alignment of the RC joint on lateral images of the elbow. Although, many authors have translated the utilization of RCL into coronal imaging, previous studies have not been performed to confirm validity. The purpose of this paper was to identify an accurate way of evaluating pediatric RC alignment in the coronal plane.

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

Purpose: Long-term functional results remain equivocal between operative fixation and closed management of displaced humeral medial epicondyle fractures. The purpose of this study was to determine whether a functional difference exists between treatment types.

Methods: One hundred and forty patients with a displaced medial epicondyle fracture between 2007 and 2014 met the inclusion criteria.

Preseason Assessment of Radiographic Abnormalities in Elbows of Little League Baseball Players.

Background: Youth baseball has been associated with elbow pain and elbow abnormalities, leading to the implementation of throwing and pitching guidelines. The purpose of the current study was to examine elbow abnormalities on magnetic resonance imaging (MRI) in asymptomatic Little League baseball players and to correlate these findings with the players' throwing history and physical examinations.

Methods: A prospective study of Little League players who were 10 to 13 years of age was performed.

Rate and Risk Factors for Delayed Healing Following Surgical Treatment of Lateral Condyle Humerus Fractures in Children.

Background: Lateral condyle humerus fracture nonunion after surgical fixation has been reported to be <1%. The purpose of this study was to evaluate the rate and risk factors for delayed healing of pediatric lateral condyle fractures after surgical fixation.

Methods: Retrospective study of all operatively treated lateral condyle fractures at a single institution from 2006 to 2013 was performed.

Incomplete Follow-up After Growth Modulation Surgery: Incidence and Associated Complications.

Background: Extraperiosteal tension plates have become the predominant method for angular deformity correction in skeletally immature patients, with some surgeons using them in very young children with the intent of removing the implants once the correction is complete. The purpose of this study is to determine the incidence of incomplete follow-up and to assess the outcomes of children who were lost to follow-up with retained implants.

Methods: A quality initiative survey was performed at 2 institutions on children treated with extraperiosteal tension plates around the knee because of sentinel events that occurred at each institution.

Results of Displaced Pediatric Tibial Spine Fractures: A Comparison Between Open, Arthroscopic, and Closed Management.

Background: Displaced tibial spine fractures are frequently treated with surgical reduction and fixation, but no comparison studies have been performed. This study was undertaken to compare fragment reduction and adverse outcomes between open arthrotomy [open reduction and internal fixation (ORIF)], arthroscopy [arthroscopic-assisted internal fixation (AAIF)], and closed management [closed management and casting (CMC)] of pediatric tibial spine fractures.

Methods: A retrospective review of children treated for displaced tibial spine fractures from 2003 to 2011 was performed after categorizing into the 3 treatment groups.

Diagnostic shortcomings of magnetic resonance arthrography to evaluate partial rotator cuff tears in adolescents.

Background: Recent evidence suggests an increase in the incidence of partial articular-sided rotator cuff tears in adolescent athletes, but the accuracy of diagnostic studies has not been previously assessed in this cohort. This study was performed to assess the ability of magnetic resonance imaging with arthrography (MRIa) to diagnose partial rotator cuff (PRC) pathology in the adolescent age group.

Methods: All patients under the age of 19 years who underwent shoulder arthroscopy, between August 2008 and August 2010, were grouped based on the presence of a PRC tear diagnosed by either MRIa or arthroscopy.

Spectrum of operative childhood intra-articular shoulder pathology.

Purpose: With increased sports participation and medical community awareness, there appears to be an increase in pediatric musculoskeletal injuries. Our purpose was to identify the intra-articular injury pattern seen within the pediatric shoulder.

Methods: A retrospective review was performed at two tertiary-care children's hospitals between 2008 and 2011 on all patients who underwent magnetic resonance imaging (MRI) and subsequent shoulder arthroscopy.

The use of a portable CT scanner for the intraoperative assessment of talocalcaneal coalition resections.

Background: Intraoperative assessment of talocalcaneal (TC) coalition resection can be challenging, with no reliable plain radiographic view available for evaluation. Therefore, in March of 2011, we began using a CereTom portable CT scanner to assess TC coalition resections intraoperatively. This study evaluates the use of intraoperative CT during surgical resection of TC coalitions.

Spectrum of shoulder injuries in skeletally immature patients.

This article evaluates the spectrum of epidemiology and treatment of children presenting with shoulder pain. These injuries are discussed to further understand the mechanism of injury, the variation of these injuries with age, treatment options, and outcomes and complications that may arise. A retrospective clinical review was performed to compliment the findings of the literature review.

Childhood metatarsal shaft fractures: treatment outcomes and relative indications for surgical intervention.

Purpose: Although the epidemiology of childhood metatarsal fractures is known, the appropriate treatment has not been elucidated. This study was undertaken to ascertain the outcomes of both non-operative and surgical treatment of these common childhood injuries and to discern any indications for treatment.

Methods: A retrospective review was performed of all children identified from 2006 to 2007 with a metatarsal fracture by the ICD-9 code, 825.

Partial rotator cuff tears in adolescents: factors affecting outcomes.

Introduction: In the adult population, rotator cuff tears are common and established treatment methods yield satisfactory results. In adolescents, however, these injuries are uncommon and few treatment methods and outcome reports exist. The purpose of this study was to examine a series of adolescent rotator cuff tears, identify associated pathology, and report treatment outcomes.

Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment.

Background: Adolescent tibial tubercle fractures are uncommon, complex, high-energy injuries. The use of lateral radiographs in isolation to diagnose and treat these injuries is the standard of practice. However, with a single 2-dimensional (2D) view, there may be a risk that the degree of injury can be underestimated.

Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique.

Introduction: Treatment of displaced Gartland type 3 supracondylar humerus fractures in children may include closed reduction and percutaneous pinning. The pin configuration may be all-lateral entry or cross-pin. Despite the improved stability possible with cross-pinning, there is an inherent iatrogenic risk to the ulnar nerve of about 6%.

Treatment of talocalcaneal coalitions.

Background: The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft.

Methods: A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision and fat graft interposition by 6 surgeons.

Underestimation of labral pathology in adolescents with anterior shoulder instability.

Background: Shoulder instability is not uncommon in the adolescent athlete, and yet the ability for either clinical examination or magnetic resonance imaging (MRI) with arthrogram to accurately detect pathology in this younger population has not been elucidated yet. This study was performed to characterize the ability of physical examination and MRI to identify intra-articular pathology in those adolescents suspected of having anterior shoulder instability.

Methods: A retrospective review of patients treated over a year between 2008 and 2009 was undertaken.