Interobserver and Intraobserver Agreement are Unsatisfactory When Determining Abstract Study Design and Level of Evidence.

Background: Understanding differences between types of study design (SD) and level of evidence (LOE) are important when selecting research for presentation or publication and determining its potential clinical impact. The purpose of this study was to evaluate interobserver and intraobserver reliability when assigning LOE and SD as well as quantify the impact of a commonly used reference aid on these assessments.

Methods: Thirty-six accepted abstracts from the Pediatric Orthopaedic Society of North America (POSNA) 2021 annual meeting were selected for this study.

Use of Telemedicine in Pediatric Orthopaedics Prior to the Pandemic: A Survey of POSNA Members.

Background: Telemedicine, or telehealth, is broadly defined as the use of technology to deliver health care or health education at distance. Synchronous communication telemedicine, which involves the use of real time audio and video between patient and provider, is a developing field and its use in the pediatric orthopaedic population is not well defined. To better understand the existing use of and challenges posed by telemedicine for pediatric orthopaedic providers, the Pediatric Orthopaedic Society of North America (POSNA) practice management committee conducted a survey of current POSNA members.

Characteristics of Pyogenic Musculoskeletal Infections in Older Children and Adolescents.

The characteristics and clinical consequences of pyogenic bone and joint infections in older children and adolescents have received little attention. This study evaluated the presentation and complications of musculoskeletal infections involving the pelvis and extremities in children older than 10 years. Thirty patients 10 to 17 years old (mean, 12.

Blood Loss Trends and Financial Implications in Adolescent Idiopathic Scoliosis.

Study Design: This was a retrospective cohort study.

Objective: The primary goal was to evaluate risk factors related to increased blood loss in adolescent idiopathic surgery (AIS) surgery with the secondary goal being to evaluate the financial implications around the use of intraoperative cell salvage (ICS) and the routine preallocation of autogenous blood products.

Summary Of Background Data: Deformity correction for AIS is a complex procedure and can be associated with significant blood loss.

Orthopaedic Manifestations of Sickle Cell Disease.

Sickle cell disease (SCD) is an autosomal recessive disorder that results in hemolytic anemia related to abnormal hemoglobin and erythrocyte levels. SCD is characterized by vascular occlusive episodes, visceral sequestration, and aplastic or hemolytic crises. These crises most commonly occur in bone.

Study protocol of a randomised controlled trial of intranasal ketamine compared with intranasal fentanyl for analgesia in children with suspected, isolated extremity fractures in the paediatric emergency department.

Introduction: Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage.

Adolescent Distal Humerus Fractures: ORIF Versus CRPP.

Background: Although supracondylar humerus fractures are common in young children, the incidence in adolescents is much lower. As a result, there is a paucity of literature to guide treatment. The purpose of this study was to review the treatment and outcomes for a consecutive series of distal humerus fractures in adolescents and to compare outcomes between patients treated with percutaneous skeletal fixation and those treated with open reduction and fixation.

Weightbearing Versus Nonweightbearing After Meniscus Repair.

Context: Optimal rehabilitation after meniscal repair remains controversial.

Objective: To review the current literature on weightbearing status after meniscal repairs and to provide evidence-based recommendations for postoperative rehabilitation.

Data Sources: MEDLINE (January 1, 1993 to July 1, 2014) and Embase (January 1, 1993 to July 1, 2014) were queried with use of the terms meniscus OR/AND repair AND rehabilitation.

Orthopaedic firearm injuries in children and adolescents: An eight-year experience at a major urban trauma center.

Introduction: The purpose of this study is to describe the epidemiology of orthopaedic injuries incurred secondary to firearms among children and adolescents at a major metropolitan trauma center and to identify risk factors for complications and long-term morbidity.

Methods: A retrospective review was performed of consecutive patients 17 years of age and younger who sustained a firearm injury and required orthopaedic treatment at a major trauma center from 2006 to 2013. Patient demographics, injury mechanism, fracture classification, neurovascular injury, antibiotic administration, and length of hospitalization were recorded.

Applications of musculoskeletal ultrasonography in pediatric patients.

Ultrasonography is an excellent adjunct to other musculoskeletal imaging tools utilized in the pediatric population and in some instances offers advantages over CT and MRI. It permits dynamic examination of anatomic structures and assists in guiding minimally invasive procedures. In the lower extremity, ultrasonography assists in screening for such disorders as developmental dysplasia of the hip and in detecting slipped capital femoral epiphysis and femoral acetabular impingement.

Obesity and its effects on pediatric supracondylar humeral fractures.

Background: This study evaluates the effects of childhood obesity on fracture complexity and associated injuries in pediatric supracondylar humeral fractures.

Methods: A billing query identified all patients who were two to eleven years of age and had undergone operative treatment for extension-type supracondylar humeral fractures over a 12.5-year period.

Outcomes following removal of instrumentation after posterior spinal fusion.

Background: Although there is good evidence to support the removal of instrumentation for infection following posterior spine fusion, there are few studies that report outcomes following removal for late operative site pain. The purpose of this study was 3-fold: (1) to determine whether removal of instrumentation following posterior spinal fusion resolves preoperative pain, (2) to determine whether indolent infection not detected before removal of instrumentation is related to late operative site pain, and (3) to determine whether curve progression differs when spinal hardware is removed for infection versus late operative site pain.

Methods: A retrospective study of consecutive patients aged 10 to 21 years, who underwent removal of instrumentation after posterior spinal fusion over a 10-year-period was conducted.

Evaluation of a Novel Method for Determining Transverse Plane Pelvic Obliquity.

Study Design: This was a retrospective review of neuromuscular scoliosis radiographs evaluating interobserver and intra-observer error for a novel method of transverse plane pelvic obliquity.

Objectives: To evaluate the utility of a previously described method by Lucas et al. of determining transverse plane pelvic obliquity using standard radiographs in patients with cerebral palsy and neuromuscular scoliosis.

Postoperative spine and VEPTR infections in children: a case-control study.

Background: Surgical site infection (SSI) after pediatric scoliosis surgery is a major cause of morbidity. We compared the odds ratios of various potential risk factors for infection among patients who developed a deep SSI following spinal deformity surgery and those who remained infection free.

Methods: This was a case-control study, not a matched study.

Flexible cavovarus foot in children and adolescents.

Flexible cavovarus feet in children and adolescents can be challenging. A careful history and physical examination are paramount for determining the best treatment strategy and a multitude of options are available. Specific treatment strategies should be individualized and any bony correction must be in conjunction with a muscle balancing procedure.

Distal femoral physeal fixation: are smooth pins really safe?

Background: Distal femoral physeal fractures have a high incidence of physeal arrest. Several factors have been postulated to contribute to this high incidence, including fracture type, displacement, the undulating nature of the physis, and fracture reduction/fixation. The purpose of this study was to determine whether the position of percutaneous smooth pins across the physis contributes to physeal bar formation.

Osteochondral injury after acute patellar dislocation in children and adolescents.

Background: Acute patellar dislocation (APD) is a common injury in the pediatric patient population and may be associated with a spectrum of soft tissue and osteochondral injuries. This study describes the incidence of osteochondral fracture and associated injury patterns in a pediatric population after first-time APD and assesses functional outcomes after treatment.

Methods: One hundred twenty-two patients, aged 11 to 18 years, who were evaluated after first-time APD over a 10-year period were identified, 46 of whom had confirmed osteochondral injury on magnetic resonance imaging (MRI).

The modified Dunn procedure for unstable slipped capital femoral epiphysis: a multicenter perspective.

Background: The modified Dunn procedure has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis (SCFE), but limited data exist regarding its safety and efficacy. The purpose of this study was to present results and complications following this procedure in a large multicenter series.

Methods: We reviewed the outcomes of all patients who had been treated with the modified Dunn procedure by five surgeons from separate tertiary-care institutions.

Reliability of measurements of clavicle shaft fracture shortening in adolescents.

Background: A relative indication for surgical treatment of midshaft clavicle fractures is shortening ≥2.0 cm. A standard method for determining shortening with routine clavicle radiographs has not been established.