Hoverboard injuries in children and adolescents: results of a multicenter study.

With the increasing popularity of hoverboards in recent years, multiple centers have noted associated orthopaedic injuries of riders. We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study.

Changes in Pediatric Spine Surgery Patterns Over the Last 10 Years Among ABOS Part II Candidates.

Study Design: A retrospective review of prospectively collected data.

Objective: Our purpose was to evaluate the volume of pediatric spine cases being done by surgeons applying for American Board of Orthopaedic Surgeons (ABOS) certification.

Summary Of Background Data: Pediatric orthopedic surgery has become increasingly subspecialized over the past decade.

Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection.

Introduction: Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI.

A Clinical Prediction Algorithm to Stratify Pediatric Musculoskeletal Infection by Severity.

Objective: There are currently no algorithms for early stratification of pediatric musculoskeletal infection (MSKI) severity that are applicable to all types of tissue involvement. In this study, the authors sought to develop a clinical prediction algorithm that accurately stratifies infection severity based on clinical and laboratory data at presentation to the emergency department.

Methods: An IRB-approved retrospective review was conducted to identify patients aged 0 to 18 who presented to the pediatric emergency department at a tertiary care children's hospital with concern for acute MSKI over a 5-year period (2008 to 2013).

Pediatric Sports Medicine, A New Subspeciality in Orthopedics: An Analysis of the Surgical Volume of Candidates for the American Board of Orthopaedic Surgery Part II Certification Exam Over the Past Decade.

Background: Pediatric orthopaedic surgery has become increasingly subspecialized over the past decade. The purpose of this study was to analyze the volume of pediatric sports medicine cases performed by surgeons applying for the American Board of Orthopaedic Surgeons (ABOS) Part II certification exam over the past decade, comparing caseloads according to the type(s) of fellowship completed.

Methods: The ABOS database was reviewed for all surgeons applying for the ABOS Part II certification exam from 2004 to 2014.

Orthopaedic Care for Children: Who Provides It? How Has It Changed Over the Past Decade? Analysis of the Database of the American Board of Orthopaedic Surgery.

Background: The field of orthopaedic surgery has subspecialized over the past decade with an increasing number of graduates of orthopaedic residency programs entering fellowship training. The number of graduates from pediatric orthopaedic fellowships has also increased over the past decade. We hypothesize as the number of pediatric orthopaedic fellowship graduates has increased, the proportion of orthopaedic cases completed by pediatric surgeons in comparison with adult surgeons has also increased.

Dilutional coagulopathy in pediatric scoliosis surgery: A single center report.

Background: Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions.

Changes in the Practice of Pediatric Orthopaedic Surgeons Over the Past Decade: Analysis of the Database of the American Board of Orthopaedic Surgery.

Background: There has been an increase in the number of the graduates of pediatric orthopaedic fellowship programs over the past decade creating the potential for increased competition in the field. The purpose of this study was to analyze the effect of increased number of pediatric orthopaedic fellowship graduates on case volume as well as the type of procedures performed by recent graduates of pediatric orthopaedic fellowship programs from 2004 to 2014.

Methods: Case logs submitted for the American Board of Orthopaedic Surgery Part II examination by applicants with the self-declared subspecialty of pediatric orthopaedics from 2004 to 2014 were analyzed.

Repeat Surgical Interventions Following "Definitive" Instrumentation and Fusion for Idiopathic Scoliosis: 25-Year Update.

Study Design: Single-institution, retrospective review of prospectively collected data on pediatric patients with adolescent idiopathic scoliosis (AIS) undergoing spinal fusion with a minimum two-year follow-up.

Objective: To determine the rate of reoperation in AIS patients undergoing spine fusion from 2008 to 2012.

Summary Of Background Data: Recent trends in the surgical treatment of AIS have included increased use of all-pedicle screw constructs, smaller implants, more posterior-only approaches, and improved correction techniques.

Key Concepts of Musculoskeletal Infection.

Over the past few decades, musculoskeletal infections have increased in both incidence and severity. The clinical manifestations of musculoskeletal infections range from isolated osteomyelitis to multisite infections with systemic complications. Although this increased incidence of musculoskeletal infections correlates with the increased incidence of methicillin-resistant Staphylococcus aureus infections, other nonresistant infectious organisms have been associated with severe musculoskeletal infections; this finding supports the likelihood that an antibiotic resistance profile is not a major factor in bacterial virulence.

Similar Clinical Severity and Outcomes for Methicillin-Resistant and Methicillin-Susceptible Pediatric Musculoskeletal Infections.

Background: Prior studies of pediatric musculoskeletal infection have suggested that methicillin-resistant (MRSA) infections result in worse outcomes compared with infections with methicillin-susceptible (MSSA) strains. Based on these results, clinical prediction algorithms have been developed to differentiate between MRSA and MSSA early in a patient's clinical course. This study compares hospital outcomes for pediatric patients with MRSA and MSSA musculoskeletal infection presenting to the emergency department at a large tertiary care children's hospital.

Double-Edged Sword: Musculoskeletal Infection Provoked Acute Phase Response in Children.

The acute phase response has a crucial role in mounting the body's response to tissue injury. Excessive activation of the acute phase response is responsible for many complications that occur in orthopedic patients. Given that infection may be considered continuous tissue injury that persistently activates the acute phase response, children with musculoskeletal infections are at markedly increased risk for serious complications.

Pediatric Musculoskeletal Infection: Hijacking the Acute-Phase Response.

Tissue injury activates the acute-phase response mediated by the liver, which promotes coagulation, immunity, and tissue regeneration. To survive and disseminate, musculoskeletal pathogens express virulence factors that modulate and hijack this response. As the acute-phase reactants required by these pathogens are most abundant in damaged tissue, these infections are predisposed to occur in tissues following traumatic or surgical injury.

Validation and Modification of a Severity of Illness Score for Children With Acute Hematogenous Osteomyelitis.

Background: Children with osteomyelitis demonstrate a wide spectrum of illness. Objective measurement of severity is important to guide resource allocation and treatment decisions, particularly for children with advanced illness. The purpose of this study is to validate and improve a previously published severity of illness scoring system for children with acute hematogenous osteomyelitis (AHO).

A Novel Classification System Based on Dissemination of Musculoskeletal Infection is Predictive of Hospital Outcomes.

Background: Musculoskeletal infections (MSKIs) are a common cause of pediatric hospitalization. Children affected by MSKI have highly variable hospital courses, which seem to depend on infection severity. Early stratification of infection severity would therefore help to maximize resource utilization and improve patient care.

Stuffed Animals in the Operating Room: A Reservoir of Bacteria With a Simple Solution.

Background: Despite hand washing and other protocols surgical-site infections (SSIs) have not been eliminated. This implies that either current measures are not effective or there are alternative sources of bacterial exposure to the surgical wound. In this study we tested the hypothesis that stuffed animals or other items allowed to accompany pediatric patients to the operating room as a way to ease anxiety may represent a reservoir of bacteria.

Hemiepiphysiodesis Implants for Late-onset Tibia Vara: A Comparison of Cost, Surgical Success, and Implant Failure.

Background: The purpose of this study was to compare hemiepiphysiodesis implants for late-onset tibia vara and to evaluate patient characteristics that may predict surgical failure.

Methods: This is a retrospective review of late-onset tibia vara patients treated with temporary hemiepiphysiodesis from 1998 to 2012. Mechanical axis deviation (MAD), mechanical axis angle, mechanical lateral distal femoral angle, and medial proximal tibial angle were measured on standing bone length radiographs.

Fingertip injuries: an update on management.

Injuries to the fingertip are common. The goal of treatment is restoration of a painless, functional digit with protective sensation. The amount of soft-tissue loss, the integrity of the nail bed, and the age and physical demands of the patient should be considered when selecting a treatment method.

Medial approach for drainage of the obturator musculature in children.

Background: In a recent study designed to determine the anatomic location of infection in children presenting with acute hip pain, fever, and elevated inflammatory markers, we demonstrated the incidence of infection of the musculature surrounding the hip to be greater than twice that of septic arthritis. Importantly, the obturator musculature was infected in >60% of cases. Situated deep in the pelvis, surrounding the obturator foramen, debridement of these muscles and placement of a drain traditionally requires an extensive ilioinguinal or Pfannenstiel approach, placing significant risk to the surrounding neurovascular structures.

Epidemiology, diagnosis, and treatment of pericapsular pyomyositis of the hip in children.

Background: The yield of synovial fluid cultures in patients meeting clinical criteria for septic hip arthritis remains low. In the presence of positive blood cultures, these patients are diagnosed and treated as "presumed septic arthritis." We hypothesized that some of these patients may instead have an extra-articular infection, such as pericapsular pyomyositis.

Radiographic outcomes of volar locked plating for distal radius fractures.

Purpose: To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures.

Methods: We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff.

The spectrum of group A streptococcal joint pathology in the acute care setting.

Objectives: Group A streptococcus (GAS) is a frequent cause of pediatric musculoskeletal infections including septic arthritis, acute rheumatic fever (ARF), and a more benign arthritis called post-streptococcal reactive arthritis. Children with painful joints are frequently evaluated in the acute care setting, and because the presentation of each of these entities is similar, the diagnosis can be difficult to make. Five cases of children with GAS arthridities are presented to demonstrate the spectrum of GAS-associated joint pathologies encountered in the acute care setting and also to discuss how GAS laboratory tests may assist in the evaluation and management of children presenting with a painful joint.