Pediatric Musculoskeletal Coccidioidomycosis in Central California: A Single Center Experience.

Background: Published literature on musculoskeletal coccidioidomycosis is sparse and limited to case reports and case series. This is one of the largest case series to describe the clinical presentation, diagnosis, medical and surgical management and outcomes of pediatric musculoskeletal coccidioidomycosis at a tertiary care hospital.

Method: A retrospective case review was performed on patients ≤ 21 years old who were followed at a tertiary care center with a diagnosis of musculoskeletal coccidioidomycosis from January 1, 2007, to December 31, 2020.

Unilateral hip reconstruction in children with cerebral palsy: predictors for failure.

Background: Unilateral hip reconstruction in patients with cerebral palsy can be complicated by contralateral subluxation and ipsilateral failure. We sought to identify predictors for failure after unilateral reconstruction in patients with GMFCS IV-V CP with unilateral hip involvement.

Methods: We performed an IRB-approved retrospective study on GMFCS IV-V CP patients with unilateral hip reconstruction at a minimum 2-year follow-up.

Predictors for secondary procedures in walking DDH.

Background: Persistent or recurrent hip dysplasia and/or loss of reduction can complicate the treatment of developmental dysplasia of the hip (DDH) in walking children. In this study, we identify predictors for secondary procedures after open reduction of the hip in walking children with DDH.

Methods: We performed a retrospective study of walking children with idiopathic DDH treated with open reduction of the hip and followed up for >5 years.

Correlation of magnetic resonance imaging and histologic examination of physeal bars in a rabbit model.

Background: The formation of a physeal bony bridge, or bar, is frequently observed in pediatric patients after trauma and is visualized using magnetic resonance imaging (MRI). No study to date has validated the indirect MRI bar area measurements with direct measurements.

Purpose: To create a physeal bar using a radiofrequency (RF) ablation technique in a rabbit model and to validate an indirect measurement of the bar area from MRIs with direct histologic measurements.

Advanced imaging of the cervical spine and spinal cord in 22q11.2 deletion syndrome: age-matched, double-cohort, controlled study.

Purpose: The 22q11.2 deletion syndrome is a common genetic syndrome with a wide spectrum of abnormalities. We have previously described multiple anomalies of the upper cervical spine in this disorder.

Femoral neck fracture as an atypical presentation of child abuse.

Femoral neck fractures account for 46% of the proximal femur fractures in children; however, the overall incidence of proximal femur fractures in children is <1%. Pathologic causes for proximal femur fractures include local or global causes of bone weakness, such as metabolic bone conditions or neoplastic causes. Nonpathologic causes of femur fractures are caused almost exclusively by high-energy trauma and are readily identified.

Slipped capital femoral epiphysis update.

Purpose Of Review: Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip condition. Its importance lies in its high morbidity if not diagnosed and treated in its early stages, not only in childhood but also as a cause of osteoarthritis in adulthood. This article highlights key diagnostic tools and optimal treatment plans for SCFE.

Down syndrome: orthopedic issues.

Purpose Of Review: The purpose of this review is to update the role of the orthopedic surgeon in the management of Down syndrome as these patients are living longer and participating in sporting activities.

Recent Findings: Approximately 20% of all patients with Down syndrome experience orthopedic problems. Upper cervical spine instability has the most potential for morbidity and, consequently, requires close monitoring.

Juvenile dermatomyositis with bilateral progressive knee flexion contracture.

Juvenile dermatomyositis is a multisystem, inflammatory vasculopathy that primarily affects muscles and skin. Calcinosis is one of the most debilitating complications affecting patients with juvenile dermatomyositis. Calcifications resulting from calcinosis frequently are located on the elbows, knees, and other joints and can cause considerable disability with severe pain, joint contractures, skin ulcers, and muscle atrophy.

Normal cervical spine range of motion in children 3-12 years old.

Study Design: This study measured active cervical spine range of motion (ROM) in children ages 3-12 years using 2 methodologies: (1) a cervical spine ROM instrument, and (2) a digital videography based technique.

Objective: To determine the active cervical spine ROM, as defined by flexion/extension, lateral bending, and horizontal rotation, for children ages 3-12 years.

Summary Of Background Data: Review of current literature reveals limited studies of cervical spine ROM in children, many of which do not provide data on children younger than 8 years of age when many of the structural changes of the cervical spine are thought to occur.

Occipitalization of the atlas in children. Morphologic classification, associations, and clinical relevance.

Background: Occipitalization is defined as a congenital fusion of the atlas to the base of the occiput. We are not aware of any previous studies addressing the morphologic patterns of occipitalization or the implications of occipitalization in children. We present data on what we believe is the largest reported series of children with occipitalization studied with computed tomography and/or magnetic resonance imaging, and we provide a description of their clinical characteristics.

Osgood Schlatter syndrome.

Purpose Of Review: Osgood Schlatter syndrome presents in growing children (boys, 12-15 years; girls, 8-12 years) with local pain, swelling and tenderness over the tibial tuberosity. Symptoms are exacerbated with sporting activities that involve jumping (basketball, volleyball, running) and/or on direct contact (e.g.

Giant cell tumor of tendon sheath: largest single series in children.

Giant cell tumors of tendon sheath (GCTTS) are rare in children. We hypothesized that GCTTS in children probably behave in a similar manner to the adult lesions, with regard to clinical features, imaging characteristics, histology, and recurrence rates after surgical excision. We retrospectively reviewed 29 children diagnosed and treated for GCTTS during a 16-year period and evaluated the above characteristics to compare these results with published data for adult patients.

Minimal surgical approach for recurrent hip dislocation using the posterior lip augmentation device for the Charnley hip arthroplasty.

We present the management of recurrent posterior dislocations in cemented Charnley total hip arthroplasties treated with acetabular augmentation. Certain patients are elderly with comorbid conditions and diminished reserves. We have used a minimal surgical approach to implant 21 posterior lip augmentation devices in elderly patients.

A subjective outcome analysis of tendo-Achilles rupture.

This clinical outcomes study examined factors affecting patient satisfaction after treatment of Achilles tendon rupture. There were 35 patients; 14 treated nonsurgically and 21 treated by open surgical repair. A retrospective chart review was performed to determine the mechanism and type of injury, the time to treatment, any comorbidities, and the length of follow-up.