Thread Delamination in 4.5 mm AO Cannulated Screws: A Small Case Series in the Pediatric Trauma Population.

Background: Thread delamination associated with cannulated screws have been reported but likely represent an under-recognized complication in the orthopaedic literature. The purpose of this study is to report the occurrence of repeated hardware failures through thread delamination in the setting of a commonly used orthopaedic cannulated screw implant in a small cohort involving pediatric fracture care at a single academic level I trauma center.

Methods: Between August 2015 and December 2020, 9 cases of hardware failure associated with 4.

Acetabular Coverage Decreases at the End of Skeletal Growth: A 3DCT Study of Healthy Hips.

Background: Abnormalities in size and position of the acetabulum have been linked to both developmental dysplasia of the hip and femoroacetabular impingement. Owing to its 3-dimensional (3D) complexity, plain radiography and cross-sectional studies [computed tomography (CT) and magnetic resonance imaging] have limitations in their ability to capture the complexity of the acetabular 3D anatomy. The goal of the study was to use 3D computed tomography reconstructions to identify the acetabular lunate cartilage and measure its size at varying ages of development and between sexes.

Epiphyseal Translation as a Predictor of Avascular Necrosis in Unstable Slipped Capital Femoral Epiphysis.

Background: Physeal instability has been shown to be associated with a higher risk of avascular necrosis (AVN) in patients with slipped capital femoral epiphysis (SCFE). The purpose of this study was to identify additional preoperative factors associated with AVN in patients with unstable SCFE.

Methods: Basic demographic information, chronicity of symptoms, and estimated duration of nonambulatory status were noted.

Intermediate-term annualized curve progression of adolescent idiopathic scoliosis curves measuring 40° or greater.

Study Design: Prospective cohort study.

Objectives: The objective of this study was to examine intermediate-term progression for a large series of patients with adolescent idiopathic scoliosis (AIS) with curves 40° or greater.

Background: Curve progression in AIS has been well documented for smaller curves in adolescence up to skeletal maturity; however, the data on curve progression past 40° or into adulthood are limited.

Comparison of the Coagulation Profile of Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With and Without Tranexamic Acid.

Study Design: Prospective, observational cohort study.

Objective: To improve the understanding of coagulation and bleeding mechanisms during spinal deformity surgery.

Summary Of Background Data: Fibrinolysis is the mechanism of bleeding for adolescent idiopathic scoliosis undergoing posterior spinal fusion.

Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST): Development and Validation of a Prognostic Model in Untreated Adolescent Idiopathic Scoliosis Using the Simplified Skeletal Maturity System.

Study Design: Prognostic study and validation using prospective clinical trial data.

Objective: To derive and validate a model predicting curve progression to ≥45° before skeletal maturity in untreated patients with adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Studies have linked the natural history of AIS with characteristics such as sex, skeletal maturity, curve magnitude, and pattern.

Why intraperitoneal glucose sensing is sometimes surprisingly rapid and sometimes slow: A hypothesis.

The artificial pancreas requires fast and reliable glucose measurements. The peritoneal space has shown promising results, and in one of our studies we detected glucose changes in the peritoneal space already at the same time as in the femoral artery. The peritoneal lining is highly vascularised, covered by a single layer of mesothelial cells and therefore easily accessible for proper sensor technology, e.

Biomechanical Analysis of a Growing Rod with Sliding Pedicle Screw System for Early-Onset Scoliosis.

Early-onset scoliosis (EOS) remains a challenging condition for which current nonfusion surgeries require iterative lengthening surgeries. A growing rod with sliding pedicle screw system (GRSPSS) was developed to treat spinal deformities without repeated operative lengthening. This study was performed to evaluate whether GRSPSS had similar stability as a conventional pedicle screw system to maintain deformity correction.

Biomechanical Analysis of Wide Posterior Releases Compared With Inferior Facetectomy and Discectomy in the Thoracolumbar and Lumbar Spine.

Study Design: In vitro biomechanical analysis.

Objectives: Compare the destabilizing effects of anterior discectomy to posterior spinal releases.

Summary Of Background Data: Posterior release and pedicle screw fixation has become the accepted form of treatment for lumbar and thoracolumbar pediatric scoliotic spinal deformity.

Effect of sensor location on continuous intraperitoneal glucose sensing in an animal model.

Background: In diabetes research, the development of the artificial pancreas has been a major topic since continuous glucose monitoring became available in the early 2000's. A prerequisite for an artificial pancreas is fast and reliable glucose sensing. However, subcutaneous continuous glucose monitoring carries the disadvantage of slow dynamics.

Absent pedicles in campomelic dysplasia.

Objectives: The objective of the present study is to report a case of campomelic dysplasia illustrating the absence of cervical and thoracic pedicles. This report reiterates the importance of this clinical peculiarity in the setting of spine instrumentation.

Materials And Methods: A 10-year-old female patient with campomelic dysplasia presented with progressive kyphoscoliosis and signs of neural compromise.

Outcomes of Pediatric Fractures Managed With Closed Reduction by Orthopaedic Residents in the Emergency Department.

Background: Closed reduction of pediatric fractures is commonly performed by orthopaedic residents using conscious sedation in the emergency department (ED). The purpose of this study was to determine the rate of satisfactory reductions as performed by residents, and to determine the outcomes of these procedures.

Methods: A retrospective review was performed of all fractures that underwent closed reduction under conscious sedation in the ED of a level 1 pediatric trauma center between January 1, 2010 and November 30, 2014.

Is There Value in Having Radiology Provide a Second Reading in Pediatric Orthopaedic Clinic?

Background: The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic.

Coagulation Profile of Patients with Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion.

Background: Blood loss and transfusion requirements during posterior spinal fusion for adolescent idiopathic scoliosis remain a concern. The mechanism of bleeding in these patients is poorly characterized. Thromboelastography is a comprehensive test of a patient's coagulation system commonly used in cardiac surgical procedures.

Defining the Differences in Transverse Plane Trajectories for Thoracic Pedicle Screw Insertion: Anatomic Versus Medial.

Study Design: Comparing thoracic pedicle screw trajectories, screw lengths, and starting points by examining osteologic specimens.

Objective: Describe a medial screw trajectory (MST) compared to a screw trajectory along the anatomic pedicle angle (APA) in terms of trajectory, screw length, and starting point.

Summary Of Background Data: Although thoracic pedicle screw insertion is commonly used for posterior fusion and instrumentation, there is little data to quantify an MST that avoids the great vessels and allows for greater screw purchase.

Does a Weekly Didactic Conference Improve Resident Performance on the Pediatric Domain of the Orthopaedic In-Training Examination?

Background: Performance on the Orthopaedic In-training Examination (OITE) has been correlated with performance on the written portion of the American Board of Orthopaedic Surgery examination. Herein we sought to discover whether adding a regular pediatric didactic lecture improved residents' performance on the OITE's pediatric domain.

Methods: In 2012, a didactic lecture series was started in the University of Pittsburgh Medical Center (UPMC) Hamot Orthopaedic Residency Program (Hamot).

Subscapular Abscess in a Nine-Year-Old Female Patient: A Case Report.

Case: The subscapular space is a clinically concealed anatomic space where soft-tissue abscesses can form. To our knowledge, five cases of a subscapular abscess have been reported in the past thirty-four years, so there is little evidence available to guide treatment. We present a unique case of a spontaneous, subscapular abscess due to methicillin-resistant Staphylococcus aureus in a pediatric host, and we describe a surgical approach for adequate debridement.

Biomechanical comparison of ponte osteotomy and discectomy.

Study Design: Biomechanical cadaver study.

Objective: To evaluate the relative effectiveness of Ponte osteotomies for spinal release in deformity correction.

Summary Of Background Data: Controversy exists as to the role of Ponte osteotomy in deformity correction surgery.

Clinical Decision Making in Early Wound Drainage Following Posterior Spine Surgery in Pediatric Patients.

Study Design: Retrospective.

Objectives: To identify the clinical factors suggestive of infected and non-infected drainage to help clinical decision making.

Summary Of Background Data: Differentiating between drainage caused by a benign seroma and deep spinal infection may be difficult in the early postoperative period.

Using the freehand pedicle screw placement technique in adolescent idiopathic scoliosis surgery: what is the incidence of neurological symptoms secondary to misplaced screws?

Study Design: Retrospective case series.

Objective: This study evaluated the incidence of postoperative neurological symptoms after a freehand pedicle screw insertion technique in idiopathic posterior scoliosis surgery.

Summary Of Background Data: It is generally accepted that pedicle screws can be inserted by a freehand technique in the thoracic and lumbar spine in patients with adolescent idiopathic scoliosis (AIS) with a very low frequency of major complications.

The effect of posterior spinal releases on axial correction torque: a cadaver study.

Purpose: Posterior only approaches for spinal deformity are increasingly popular and posterior spinal release is utilized to gain flexibility for correctional maneuvers. Prior biomechanical data support the use of facetectomy and rib head resection for gaining flexibility in the sagittal and coronal planes but to date there has been no quantification of stiffness reduction provided by these techniques for axial correction through a pedicle screw construct. We sought to determine the contribution of posterior spinal releases (facetectomy, rib head resection) on axial plane stiffness.

Prospective, surgeon-randomized evaluation of crossed pins versus lateral pins for unstable supracondylar humerus fractures in children.

Controversy exists concerning pin placement for supracondylar humerus fractures in children. Both crossed pin and lateral only pin configurations have shown good results; however, prospective studies are lacking. We present a prospective, surgeon-randomized study comparing crossed pin (group A, n = 20) versus preferential lateral only pin (group B, n = 20) fixation for displaced supracondylar humerus fractures.