Patellofemoral Arthritis after Conservative Management for Post-operative Arthrofibrosis: A Case Report.

Introduction: Arthrofibrosis of the knee is an adverse outcome after anterior cruciate ligament (ACL) reconstruction. Definitions and classifications vary widely based on extension and flexion losses, patellar mobility, and location. In general, it is understood as a restricted range of motion (ROM) due to scar tissue, and it is often defined as symptomatic limitation in knee ROM compared to the opposite knee.

Isolated Left Extensor Hallucis Longus Palsy Secondary to Deep Peroneal Nerve Injury in a 15-Year-Old Boy: A Case Report.

Introduction: Nerve palsies are potential consequences of fractures that can result in temporary loss of muscular function. Nerve palsies have not been extensively described in the context of tibial tubercle fractures in the pediatric population. Although the symptoms accompanying nerve palsies concern patients, evidence suggests that non-operative management often results in full functional recovery over time.

Regeneration of a Discoid Meniscus: A Case Report.

Case: A 4-year-old girl with no relevant medical history presented with left knee swelling. Knee laxity, magnetic resonance imaging findings of anterior cruciate ligament (ACL) deficiency and discoid meniscus, and the chronicity of symptoms prompted arthroscopic ACL reconstruction and meniscal saucerization. Pain and swelling continued, and repeat arthroscopy revealed regeneration of the discoid meniscus at 18-month follow-up.

Flexible nailing: Pushing the indications for diametaphyseal lower-extremity fractures.

Elastic stable intramedullary nailing (ESIN) has been shown to be an effective form of surgical management for lower-extremity diametaphyseal fractures in pediatric patients, but studies are limited because ESIN treatment for these fractures is relatively uncommon. We sought to determine whether ESIN can be used effectively in the most distal or proximal short-segment forms of these fractures. We queried the electronic medical record system at Johns Hopkins Hospital using Current Procedural Terminology codes for femur and tibia fractures treated with ESIN in patients under 18 years old between January 2015 and October 2022.

Thinner Tibial Spine Fracture Fragments Are Associated With Risk of Fixation Failure.

Purpose: To determine the rate of and risk factors for failure of tibial spine fracture (TSF) repair.

Methods: This was a retrospective review of patients aged 18 years or younger with TSF who underwent arthroscopic repair performed by a single orthopaedic surgeon at a large tertiary academic hospital between 2015 and 2022. Demographic, clinical, injury, fracture, and surgical characteristics were collected.

Discoid Meniscus.

Discoid meniscus is the most common congenital variant of the meniscus. Its variability in pathology leads to a spectrum of clinical presentations in patients. Treatment must be tailored to the specific pathology of the discoid meniscus.

Tibial Spine Fractures in Young Athletes.

Tibial spine fractures are a relatively rare injury in the young athlete. Previously thought to be the equivalent of a "pediatric anterior cruciate ligament (ACL) tear," contemporary understanding of these injuries classifies them as distinct from ACL injuries in this patient population. Successful treatment hinges on accurate diagnosis paying special attention to fracture displacement and the presence of concomitant intraarticular injury.

Financial Burden of Pediatric Anterior Cruciate Ligament Reconstruction.

Background: High costs and lack of price transparency for common pediatric orthopaedic procedures create financial burden for patients. We assessed (1) how patient medical debt after anterior cruciate ligament reconstruction (ACLR) correlates with health insurance type; and (2) factors associated with patient financial burden and worry after ACLR.

Methods: We reviewed records of 122 patients aged below 18 years who underwent ACLR at our US academic hospital from 2016 to 2020.

Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee.

Background: Displaced pediatric tibial tubercle fractures are commonly stabilized with screws directed posteriorly toward neurovascular structures. Here, we (1) characterize the variation of the popliteal artery among pediatric patients; and (2) recommend a safe screw trajectory for fixation of tibial tubercle fractures.

Methods: We retrospectively identified 42 patients (42 knees; 29 female) aged 12-17 years with lower-extremity magnetic resonance imaging (MRI) at a tertiary academic center.

Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee.

Objective: The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model.

Methods: Participants were randomly assigned to one of the three groups: (1) reading/video control group (n = 7), (2) VR group (n = 7), or (3) PS group (n = 7). Participants in the VR group completed a VR slipped capital femoral epiphysis module while participants in the PS group practiced the placement of a screw in the physical module before evaluation of percutaneous screw placement in the PS model.

Development and Validation of SCFE Percutaneous Pinning Surgical Simulation.

Background: In situ screw fixation with a single percutaneously placed femoral screw remains widely accepted for femoral head fixation in adolescent patients with slipped capital femoral epiphysis (SCFE). Given the potential risks involved with this procedure, a simulation whereby surgical skills could be refined before entering the operating room may be of benefit to orthopaedic trainees.

Methods: We developed a synthetic model for the simulated treatment of SCFE.

Does Insurance Status Affect Treatment of Children With Tibial Spine Fractures?

Background: Previous studies have reported disparities in orthopaedic care resulting from demographic factors, including insurance status. However, the effect of insurance on pediatric tibial spine fractures (TSFs), an uncommon but significant injury, is unknown.

Purpose: To assess the effect of insurance status on the evaluation and treatment of TSFs in children and adolescents.

Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience.

Background: The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies.

Methods: Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers.

Classification and Treatment of Pediatric Tibial Spine Fractures: Assessing Reliability Among a Tibial Spine Research Interest Group.

Background: Treatment decisions for patients with tibial spine fractures depend heavily on radiographic measurements. The purpose of this study was to determine whether existing classification systems and radiographic measurements are reliable among a multicenter tibial spine research interest group. A secondary purpose was to evaluate agreement in treatment of tibial spine fractures.

Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects.

Rationale: Traumatic hemipelvectomy is a rare but lethal catastrophic injury.

Patient Concerns: A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects.

Diagnosis: Traumatic hemipelvectomy.

10-Min 3D Turbo Spin Echo MRI of the Knee in Children: Arthroscopy-Validated Accuracy for the Diagnosis of Internal Derangement.

Background: Ten-minute MRI of the pediatric knee can add value through increased cost-effectiveness and decreased sedation needs but requires validation of its clinical efficacy.

Purpose: To determine the arthroscopy-based diagnostic accuracy and interreader reliability of 10-min 3D Controlled Aliasing In Parallel Imaging Results In Higher Acceleration (CAIPIRINHA) turbo spin echo (TSE) MRI with two isotropic pulse sequences for the diagnosis of internal derangement in children with painful knee conditions.

Study Type: Prospective.

Residual Neurological Symptoms After Peripheral Nerve Blocks for Pediatric Knee Surgery.

Background: Peripheral nerve blocks (PNBs) provide excellent pain control and reduce the need for systemic analgesics in orthopaedic surgery. PNBs rarely cause complications; however, a few studies of adults have reported neurological complications during the early postoperative period. We investigated complications associated with the use of PNBs during pediatric knee surgery.

Body Mass Hides the Curve: Thoracic Scoliometer Readings Vary by Body Mass Index Value.

Background: Guidelines suggest referral for scoliosis when rib slope (scoliometer measurement, angle of trunk rotation) is ≥7 degrees. We hypothesized that overweight and obese patients would have lower scoliometer measurements compared with normal-weight and underweight patients for a given spinal curvature, causing overweight and obese patients with adolescent idiopathic scoliosis to present for treatment later and with larger curves. Our goal was to determine the association between scoliometer readings and major curve magnitudes in relation to body mass index (BMI).

Distal Humeral Epiphyseal Separation in a Newborn.

Distal humeral epiphyseal separations are rare and treatment strategies are not well defined. The case of a full-term male newborn with a distal humeral epiphyseal separation as the result of a birth trauma was reviewed. A literature review of this topic was undertaken to better understand its occurrence, diagnosis, and treatment options.

Titanium Elastic Nailing for Pediatric Tibia Fractures: Do Older, Heavier Kids Do Worse?

Background: Elastic nailing is a common method of fixation for tibial shaft fractures in skeletally immature individuals. Poor outcomes of titanium elastic nails for femoral shaft fractures have been associated with increasing patient age and weight, especially patients weighing >50 kg. Our objective is to determine if there is an upper weight or age limit to the safe and effective use of titanium elastic nails for tibial shaft fractures in the pediatric population.

The 5-strand hamstring graft in anterior cruciate ligament reconstruction.

The use of anterior cruciate ligament reconstruction in the pediatric and adolescent population has been increasing in recent years. Autograft hamstring graft is favored in this population, but these patients often have smaller hamstring tendons that yield smaller final graft constructs. These smaller grafts are associated with an increased need for revision surgery.

Does obesity affect fracture healing in children?

Background: Obesity is a risk factor for various orthopaedic diseases, including fractures. Obesity's influence on circulating hormones and cytokines and bone mineralization ultimately influences the body's osteogenic response and bone mineralization, potentially increasing the risk of fracture and impacting fracture healing.

Questions/purposes: Does obesity delay fracture recovery in overweight or obese children as measured by the time to release to normal activity? Is this average time for return to activity influenced by the mechanism of the injury? Does obesity's effect on mineralization and loading in overweight or obese children lead to a greater proportion of upper extremity fracture versus lower extremity fracture?

Methods: We prospectively followed 273 patients with nonpathologic long bone fractures treated from January 2010 to October 2011.

Reducing and recycling in joint arthroplasty.

Reducing the need for costly contaminated waste processing after total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) could decrease hospital overhead and the environmental impact. From March through April 2011, we prospectively identified 20 consecutive patients undergoing primary THA or TKA by 1 surgeon in 1 operating room at our institution. For each case, waste (excluding liquids) was collected and sorted as it was produced.