Sherman S Coleman: Beloved Surgeon, Educator, and Friend.

Dr. Sherman S. Coleman was a superior surgeon, a pioneer of multiple orthopedic organizations, and a remarkable educator of surgical principles.

Pericardiocentesis in Severe Pulmonary Arterial Hypertension Guided by a Pulmonary Artery Catheter.

Patients, often with underlying rheumatologic disease, may present with pericardial effusions in the setting of pulmonary hypertension (PHTN). Pericardial drainage in PHTN is associated with significant morbidity and mortality. We describe a patient with PHTN who developed cardiac tamponade that was managed safely and effectively with pulmonary artery catheter-guided pericardiocentesis.

Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics.

Purpose Of Review: Musculoskeletal imaging serves a critical role in clinical care and orthopaedic research. Image-based modeling is also gaining traction as a useful tool in understanding skeletal morphology and mechanics. However, there are fewer studies on advanced imaging and modeling in pediatric populations.

Is peak hamstrings muscle-tendon length criterion a sufficient indicator to recommend against surgical lengthening of hamstrings?

Background: Excessive knee flexion during stance in children with cerebral palsy is often treated by surgical hamstrings lengthening. Pre-operative hamstrings muscle-tendon length can be estimated from kinematics and often used for decision making to rule out surgical lengthening if peak hamstrings muscle-tendon length is 'Not Short'.

Research Question: If peak hamstrings muscle-tendon length is within two standard deviations of typical, is that a sufficient indicator to rule out surgical hamstrings lengthening?

Methods: Three motion analysis centers retrospectively identified children with cerebral palsy, age 6-17 years, who had consecutive gait analyses with knee flexion at initial contact > 20° and popliteal angle > 35° at initial study.

The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy.

Background: Selective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function.

Research Question: Does aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management?

Methods: This study was a secondary analysis - focused on joint-level kinematics - of a previous study evaluating the long-term outcomes of SDR.

Patient-reported Outcomes of Adolescents Treated With Guided Growth to Correct Idiopathic Genu Valgum.

Background: Guided growth is commonly used to treat frontal plane alignment deformities in skeletally immature individuals. Treatment aims are to correct the biomechanical loading of the knee and to avoid more invasive surgery that would be required after skeletal maturity. There is little published evidence of pain perception or functional limitations in this population.

Discrimination between hereditary spastic paraplegia and cerebral palsy based on gait analysis data: A machine learning approach.

Background: There is no current consensus on how to differentiate between hereditary spastic paraplegia and spastic cerebral palsy on the basis of clinical presentation. Several previous studies have investigated differences in kinematic parameters obtained from clinical gait analysis. None have attempted to combine multiple gait and physical exam measures to discriminate between these two diagnoses.

Outcome of Gastrocnemius Soleus Facial Lengthening in Ambulatory Patients With Cerebral Palsy.

Background: Treatment of equinus contractures in children with cerebral palsy (CP) varies across centers. Existing literature utilizes mixed study populations with a variety of procedures. As such, there is limited knowledge regarding recurrence rates and efficacy of a single procedure performed on a homogenous cohort.

Bruton's Tyrosine Kinase Inhibition for the Treatment of Rheumatoid Arthritis.

Bruton's tyrosine kinase (BTK) inhibitors are an emerging class of drugs that inhibit B cell receptor activation, FC-γ receptor signaling, and osteoclast proliferation. Following on approval for treatment of hematologic malignancies, BTK inhibitors are now under investigation to treat a number of different autoimmune diseases, including rheumatoid arthritis (RA). While the results of BTK inhibitors in RA animal models have been promising, the ensuing human clinical trial outcomes have been rather equivocal.

Circulating tumor cells, circulating tumor DNA, and disease characteristics in young women with metastatic breast cancer.

Background: Clinical and genomic data from patients with early-stage breast cancer suggest more aggressive disease in premenopausal women. However, the association between age, disease course, and molecular profile from liquid biopsy in metastatic breast cancer (MBC) is not well characterized.

Methods: Patients were classified as premenopausal (< 45 years), perimenopausal (45-55 years), or postmenopausal (> 55 years).

Factors Influencing Outcomes of the Dysplastic Hip in Nonambulatory Children With Cerebral Palsy.

Background: Hip dysplasia in the nonambulatory child with spastic cerebral palsy (CP) is a common condition not always effectively treated with conservative measures even when recognized early. Optimal surgical intervention strategies and timing are not clear from previous studies. Contralateral hips with less severe subluxation in these patients also often undergo surgery and little is known of outcomes of these less severe hips.

Unsuspected osteochondroma-like outgrowths in the cranial base of Hereditary Multiple Exostoses patients and modeling and treatment with a BMP antagonist in mice.

Hereditary Multiple Exostoses (HME) is a rare pediatric disorder caused by loss-of-function mutations in the genes encoding the heparan sulfate (HS)-synthesizing enzymes EXT1 or EXT2. HME is characterized by formation of cartilaginous outgrowths-called osteochondromas- next to the growth plates of many axial and appendicular skeletal elements. Surprisingly, it is not known whether such tumors also form in endochondral elements of the craniofacial skeleton.

Utilization and efficacy of computational gait analysis for hamstring lengthening surgery.

A retrospective analysis of computational gait studies performed in a single lab over a 12 year period was undertaken to characterize how recommendations to perform or not to perform hamstring lengthenings were utilized by physicians and the effect on outcomes. 131 Subjects were identified as either having hamstring lengthening considered by the referring surgeon, recommended by gait analysis data, or performed. A subset of this data meeting inclusion criteria for pre- and post-surgical timeframes, and bilateral diagnosis was further analyzed to assess the efficacy of the recommendations.

The Occurrence of Occult Acetabular Dysplasia in Relatives of Individuals With Developmental Dysplasia of the Hip.

Background: This study sought to determine the hip pathology of family members of patients with developmental dysplasia of the hip (DDH). The authors evaluated 120 people from 19 families known to have at least 1 member with surgically treated DDH. Each individual's functional outcome scores and pelvic radiographs were assessed for hip symptoms or pathology.

Total hip arthroplasty, hip osteoarthritis, total knee arthroplasty, and knee osteoarthritis in patients with developmental dysplasia of the hip and their family members: a kinship analysis report.

Background: Developmental dysplasia of the hip (DDH) is a familial condition with a wide phenotypic expression. Families with high rates of DDH may have individuals with subtle phenotypic expression that can progress to osteoarthritis and require total hip arthroplasty (THA). This study compares the rates of THA in relatives of individuals with DDH with individuals in control families.

Long-term follow-up of open reduction surgery for developmental dislocation of the hip.

Background: We posed 2 questions: what is the long-term result of open reduction surgery in developmental dysplasia of the hip, and is there an age at surgery above which the outcome was too poor to recommend the operation?

Methods: Between 1955 and 1995, 148 patients with 179 dislocated hips had open reduction surgery for developmental dysplasia of the hip (141 anterior and 38 Ludloff medial approaches). We attempted to locate all 148 patients for the follow-up evaluation.

Results: Fifty-three patients (36%) with 66 hips (37%) were located and participated in the study.

Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm: intraobserver and interobserver reliability revisited.

Background: Numerous studies underscore the poor intraobserver and interobserver reliability of both the center edge angle (CEA) and the Severin classification using plain film measurements. In this study, experienced observers applied a computer-assisted measurement program to determine the CEA in digital pelvic radiographs of adults who had been previously treated for dysplasia of the hip (DDH). Using a teaching aid/algorithm of the Severin classification, the observers then assigned a Severin rating to these hips.

Cerebral palsy: physical activity and sport.

Physical activity and fitness are well recognized as essential to the health of able-bodied people, both young and old. The exact role of athletics and fitness in the lives of people with cerebral palsy is less well defined. In this review we examine the benefits of physical activity and athletics for people of all ages with cerebral palsy.

The clinical presentation of pediatric thoracolumbar fractures.

Background: The initial evaluation of suspected pediatric thoracolumbar fractures can be challenging. We aimed to describe the clinical presentation of thoracolumbar fractures in children and adolescents including an evaluation of physical examination sensitivity and specificity, and a description of injury severity and disposition.

Methods: This was a case control, retrospective study.

Human skin allograft used to treat open wounds after club foot release.

The inversion deformity of club foot is characterized by shortened ligaments and tendons on the medial side of the foot. The condition, when refractory to castings, is treated easily by operative intervention with neutralization of the foot and ankle. Closure of the resulting incision creates tension on the skin that is well tolerated in most children.

Medial compartment syndrome of the foot: an unusual complication of spine surgery.

Study Design: Descriptive case report.

Objectives: To report the case of a child with medial compartment syndrome of the foot following posterior spinal instrumentation and fusion.

Summary Of Background Data: No previous study has reported medial compartment syndrome of the foot following spinal surgery.