Blood pressure in adults with short stature skeletal dysplasias.

Hypertension, compounded by obesity, contributes to cardiovascular disease and mortality. Data describing hypertension prevalence in adults with short stature skeletal dysplasias are lacking, perhaps due to poor fit of typical adult blood pressure cuffs on rhizomelic or contracted upper extremities. Through health screening research, blood pressure was measured in short stature adults attending support group meetings and skeletal dysplasia clinics.

Medical Malpractice in Pediatric Orthopaedics: A Systematic Review of US Case Law.

Background: Compared with other orthopaedic subspecialties, pediatric orthopaedic surgeons are thought to be at greater risk for malpractice claims; however, there is scant research on this topic. The purpose of our study was to characterize publicly available malpractice cases pertaining to pediatric orthopaedics to determine the (1) most common specialties of the physicians implicated, (2) most common diagnoses involved, (3) rate of verdicts in favor of the plaintiff, (4) amount of indemnity payments resulting from all verdicts versus verdicts in which only an orthopaedic surgeon was involved, and (5) outcomes of cases that were appealed.

Methods: The Westlaw legal database was queried for jury verdicts, settlements, and appellate cases using the search terms "pediatric" AND "orthopaedic" from December 31, 1984, to January 1, 2016, yielding 176 appellate court cases and 189 jury reports/settlements.

External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes.

Objective: To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries undergoing either external fixation or surgical fusion.

Patients And Methods: Baseline and outcome data were obtained from the 2002-2011 Nationwide Inpatient Sample (NIS) for patients under the age of 18 with a diagnosis of cervical spine fracture without spinal cord injury or cervical spine subluxation. Patients who underwent external immobilization or internal fixation were included for analysis.

Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis.

OBJECTIVE Spinal arthrodesis is routinely performed in the pediatric population. However, there is limited information on the short-term outcomes of pediatric patients who have undergone spine fusion. Thus, the authors conducted a retrospective review of the Pediatric National Surgical Quality Improvement Program (NSQIP) database to determine the short-term mortality, complication, reoperation, and readmission rates of pediatric patients who underwent spinal arthrodesis for all indications.

Prevalence of Scoliosis and Thoracolumbar Kyphosis in Patients With Achondroplasia.

Study Design: Retrospective chart review, case series.

Objectives: To determine the prevalence of scoliosis and kyphosis in patients with achondroplasia.

Summary Of Background Data: There is little published research on the prevalence of scoliosis and thoracolumbar kyphosis in patients with achondroplasia.

Factors associated with health-related quality of life (HRQOL) in adults with short stature skeletal dysplasias.

Introduction: Numerous factors associate with health disparities. The extent to which such factors influence health-related quality of life (HRQOL) among adults with short stature skeletal dysplasias (SD) is unknown. In an effort to update and clarify knowledge about the HRQOL of adults with SD, this study aimed to quantify HRQOL scores relative to the American average and assess whether specific indicators are associated with lower scores.

Walking Out of the Curve: Thoracolumbar Kyphosis in Achondroplasia.

Background: Thoracolumbar kyphosis (TLK) is common in infants with achondroplasia. Our goals were to examine the natural history of TLK and identify factors associated with persistent TLK.

Methods: We reviewed records of patients with achondroplasia seen by a board-certified orthopaedic surgeon at a tertiary care medical center between 1997 and 2013.

Intraoperative Neuromonitoring in Pediatric and Adult Spine Deformity Surgery.

Study Design: Review of techniques and description of institutional clinical experience.

Objective: To provide a historical review and description of key neuromonitoring concepts, focusing on neurogenic motor-evoked potentials and descending neurogenic evoked potentials, and to review the authors' experience with neuromonitoring techniques in children and adults undergoing spinal deformity surgery.

Summary Of Background Data: The original form of neuromonitoring, the Stagnara wake-up test, remains the "gold standard" for detecting true neurological deficits.

Percutaneous Screw Fixation of Lateral Condylar Humeral Fractures.

Lateral condylar humeral fractures are the second most common elbow injury in children and commonly occur between the ages of 5 and 10 years. There are several systems for classification of this fracture, including those of Milch (fracture line location) and Jakob et al. (displacement).

Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database.

Background Context: Perioperative visual loss (POVL) after spinal deformity surgery is an uncommon but severe complication. Data on the incidence and risk factors of this complication after corrective surgery in the pediatric population are limited.

Purpose: The present study aimed to investigate nationwide estimates of POVL after corrective surgery for pediatric scoliosis.

Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

Background: Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions.

Methods: We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014.

Evaluation of the Child with Short Stature.

Orthopedic surgeons frequently encounter short statured patients. A systematic approach is needed for proper evaluation of these children. The differential diagnosis includes both proportionate and disproportionate short stature types.

Cannulated Lag Screw Fixation of Displaced Lateral Humeral Condyle Fractures Is Associated With Lower Rates of Open Reduction and Infection Than Pin Fixation.

Background: Open reduction/internal fixation remains the most common way to surgically stabilize displaced pediatric lateral humeral condyle fractures, but closed reduction and internal fixation is being increasingly used. Our goal was to compare the clinical and functional results of treating displaced pediatric lateral humeral condylar fractures with traditional smooth or threaded pin fixation versus single cannulated screw fixation.

Methods: From 1998 through 2012, the lateral humeral condyle fractures of 48 patients were treated with pin fixation (22 patients, until 2006) or cannulated, partially threaded screw fixation (26 patients, from 2006 onward).

The Tibial Slope in Patients With Achondroplasia: Its Characterization and Possible Role in Genu Recurvatum Development.

Background: Genu recurvatum, a posterior resting position of the knee, is a common lower extremity deformity in patients with achondroplasia and has been thought to be secondary to ligamentous laxity. To the best of our knowledge, the role of the tibial slope has not been investigated, and no studies describe the tibial slope in patients with achondroplasia. Our goals were to characterize the tibial slope in children and adults with achondroplasia, explore its possible role in the development of genu recurvatum, and compare the tibial slope in patients with achondroplasia to that in the general population.

Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients.

Background: Cervical spine fractures with spinal cord injury (CFSCI) can be devastating. We describe the epidemiology of children and adolescents with CFSCI.

Methods: Using the Nationwide Inpatient Sample (NIS) database, we identified 4418 patients (≤18 years old) who had CFSCI from 2000 through 2010.

Implant-related Fractures in Children With Proximal Femoral Osteotomy: Blade Plate Versus Screw-side Plate Constructs.

Background: Implant design may affect risk of fracture, especially in the proximal femur, which has been shown to have the highest risk of implant-related fracture (IRF). Blade plate (BPL) and screw-side plate (SSP) implants are used to stabilize proximal femoral osteotomies (PFOs). Our goal was to compare BPL and SSP constructs with regard to the rate, location, and timing of IRF in children undergoing PFOs.

Is nonoperative treatment of pediatric type I open fractures safe and effective?

Purpose: There is limited literature on nonoperative treatment of open type I pediatric fractures. Our purpose was to evaluate the rate of infection in pediatric patients with type I open fractures treated nonoperatively at our institution without admission from the emergency department (ED).

Methods: We performed a retrospective chart review of all patients who sustained a type I open fracture of the forearm or tibia from 2000 through 2013.

Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases.

Background: This manuscript describes the clinical and operative characteristics of achondroplastic children who undergo multilevel thoracolumbar decompressions using either the high-speed drill or the ultrasonic bone curette (BoneScalpel).

Methods: We retrospectively reviewed 30 thoracolumbar decompressions in achondroplastic patients at a single institution between 2008 and 2013. Patients were classified into either the high-speed drill cohort or the BoneScalpel cohort, depending on which instrument was utilized to perform the decompression.

Clinical Results and Functional Outcomes in Adult Patients After Revision Surgery for Spinal Deformity Correction: Patients Younger than 65 Years Versus 65 Years and Older.

Study Design: Retrospective comparison.

Objective: To compare complications and radiographic and functional outcomes of patients undergoing revision spinal deformity surgery, who were 40-64 years of age and 65 years of age or older.

Summary Of Background Data: The effect of age on radiographic and functional outcomes has not been well established in the literature for patients undergoing revision adult deformity surgery.

Prevalence of Allograft Contamination During Intraoperative Processing for Spinal Deformity Correction Surgery.

Study Design: Prospective study.

Objectives: To prospectively evaluate bone allografts during spinal fusion surgery for 1) the rate of contamination as a result of perioperative preparation, and 2) the types of bacterial organisms that may be transmitted through the contaminated bone allograft.

Summary Of Background Data: Bone allografts are routinely used to enhance spinal arthrodesis procedures.

A retrospective identification of gastroesophageal reflux disease as a new risk factor for surgical site infection in cerebral palsy patients after spine surgery.

Background: Neuromuscular scoliosis is a known risk factor for surgical site infection (SSI) after spinal fusion, with reported infection rates as high as 11.2%. Although risk factors such as antibiotic timing have been previously addressed, our objective was to identify intrinsic risk factors for SSI in cerebral palsy (CP) patients with neuromuscular scoliosis.

Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications.

Study Design: Retrospective review.

Objective: To report and analyze the perioperative complications, radiographical results, and functional outcomes in elderly patients undergoing pedicle subtraction osteotomy (PSO) and/or vertebral column resection (VCR) procedures for spinal deformity correction.

Summary Of Background Data: To our knowledge, no studies have focused on 3-column osteotomies in the elderly.

Is the 22 modifier worth it?

The 22 modifier is a Current Procedural Terminology code modifier that allows surgeons to receive additional reimbursement for complex procedures. The goal of this study was to evaluate the rate of, time to, and factors affecting reimbursement for 22-modifier cases filed by orthopedic surgeons. The authors reviewed the charts and billing data of the 150 noncharity spine and total joint replacement cases filed with a 22 modifier at 1 academic institution from 2004 through 2011.

Implant-related fractures in children: a 15-year review.

Background: To our knowledge, there are no comprehensive clinical studies of implant-related fractures in children. Our goal was to identify the incidence, skeletal location, and associated diagnoses of implant-related fractures.

Methods: We reviewed our institutional database to identify cases of implant insertion (7584 cases) in patients less than 18 years old from January 1, 1995 through December 31, 2009.

Spica casting for pediatric femoral fractures: a prospective, randomized controlled study of single-leg versus double-leg spica casts.

Background: At many centers, double-leg spica casting is the treatment of choice for diaphyseal femoral fractures in children two to six years old. We hypothesized that such patients can be effectively treated with single-leg spica casting and that such treatment would result in easier care and better patient function during treatment.

Methods: In a prospective, randomized controlled study, fifty-two patients two to six years old with a diaphyseal femoral fracture were randomly assigned to be treated immediately (after consent was obtained) with a single-leg (twenty-four patients) or double-leg (twenty-eight patients) spica cast.