Body mass index adjustments in children with early onset scoliosis: arm span BMI.

Purpose: Body mass index (BMI), is a nutritional index based on standing height and weight. Children with early onset scoliosis (EOS) have shorter height due to their spine curvature. In these patients' pulmonary function tests, which are also based off height, arm span is standardly used as a surrogate for height to allow for normative comparisons.

Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.

Purpose: As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function.

The Clinical Significance of the Lowest Instrumented Vertebra in Adolescent Idiopathic Scoliosis.

Selecting the lowest instrumented vertebra (LIV) in fusion for adolescent idiopathic scoliosis is potentially the most nuanced decision a surgeon has to make. This article reviews the literature on the range-of-motion loss related to the LIV, ability to return to sports based on LIV, correlation between LIV and disk degeneration, and short-term and long-term clinical outcomes related to LIV.

Femur Fractures in 5 Individuals With Pantothenate Kinase-associated Neurodegeneration: The Role of Dystonia and Suggested Management.

Background: Pantothenate kinase-associated neurodegeneration (PKAN) is a rare, neurodegenerative disorder that manifests with progressive loss of ambulation and refractory dystonia, especially in the early-onset classic form. This leads to osteopenia and stress on long bones, which pose an increased risk of atraumatic femur fractures. The purpose of this study is to describe the unique challenges in managing femur fractures in PKAN and the effect of disease manifestations on surgical outcomes.

Flexible Titanium Intramedullary Nail Displacement After Magnetic Resonance Imaging.

Case: A previously healthy 7-year-old boy presented with midshaft radius and ulna malunion after 8 weeks of nonsurgical treatment. He underwent open reduction and internal fixation of both bones with titanium alloy nails and was placed in a long arm cast. Four weeks after surgery, the patient underwent sedated brain MRI and woke up from anesthesia with elbow pain.

Femoral Magnetic Lengthening After Distal Femur Endoprosthetic Reconstruction in a Pediatric Patient: A Case Report.

Case: A 10-year-old boy with osteosarcoma of the left distal femur underwent resection with compressive osseointegration endoprosthetic reconstruction, gradually resulting in a 4.5-cm leg-length difference with significant predicted progression. Two years after resection, he underwent right distal femur and proximal tibia epiphysiodesis and placement of a left femoral magnetic lengthening nail.

Human Variability and the Explore-Exploit Trade-Off in Recommendation.

The enormous scale of the available information and products on the Internet has necessitated the development of algorithms that intermediate between options and human users. These algorithms attempt to provide the user with relevant information. In doing so, the algorithms may incur potential negative consequences stemming from the need to select items about which it is uncertain to obtain information about users versus the need to select items about which it is certain to secure high ratings.

The Inner Loop of Collective Human-Machine Intelligence.

With the rise of artificial intelligence (AI) and the desire to ensure that such machines work well with humans, it is essential for AI systems to actively model their human teammates, a capability referred to as Machine Theory of Mind (MToM). In this paper, we introduce the inner loop of human-machine teaming expressed as communication with MToM capability. We present three different approaches to MToM: (1) constructing models of human inference with well-validated psychological theories and empirical measurements; (2) modeling human as a copy of the AI; and (3) incorporating well-documented domain knowledge about human behavior into the above two approaches.

Salmonella Osteomyelitis in a Pediatric Patient with a Proximal Humerus Fracture: A Case Report.

Case: A 5-year-old previously healthy girl sustained a left proximal humerus fracture after a fall from a trampoline. The injury was initially treated nonoperatively, but during routine follow-up, the patient was found to have a previously unrecognized bony erosion at the fracture site. Workup was negative for neoplasm but instead demonstrated Salmonella osteomyelitis.

Reliability and Validity of Visual Estimation of Femoral Head Hypoperfusion on Perfusion MRI in Legg-Calve-Perthes Disease.

Background: Assessing the severity of Legg-Calve-Perthes disease is important for treatment decision-making and determining prognosis. Perfusion magnetic resonance imaging (MRI) scans have improved our ability to assess femoral head hypoperfusion, and the use of an image analysis software called HipVasc (Scottish Rite for Children, Dallas TX) has allowed precise quantification for research purposes. In the clinical setting, using HipVasc software is not practical, and visual estimation is used to assess hypoperfusion.

Optimizing Graft Extraction From the Femoral Condyle for Fresh Osteochondral Allograft Transplantation in Treating Osteochondritis Dissecans of the Capitellum: Best Fit Based on Radius of Curvature.

Background: Osteochondritis dissecans (OCD) of the capitellum is a common cause of pain and dysfunction in adolescents that engage in repetitive elbow loading. For large, unstable lesions fresh osteochondral allograft transplantation (FOCAT) from the femoral condyle has been described as an effective treatment. Current practice involves significant guesswork in obtaining an appropriately sized graft, with anatomic variations resulting in poor graft fit.

Is the Iliac Cortical Density Similarly Positioned in the Developing Pediatric Pelvis?

Objectives: The iliac cortical density (ICD) is a critical fluoroscopic landmark for pelvic percutaneous screw placement. Our purpose was to evaluate the ICD as a landmark in pediatrics and quantify the diameter of osseous pathways for 3 screw trajectories: iliosacral (IS) at S1 and transiliac-transsacral (TSTI) at S1 and S2.

Methods: Two hundred sixty-seven consecutive pelvic CT scans in children 0-16 years of age were analyzed.

Mitigating belief projection in explainable artificial intelligence via Bayesian teaching.

State-of-the-art deep-learning systems use decision rules that are challenging for humans to model. Explainable AI (XAI) attempts to improve human understanding but rarely accounts for how people typically reason about unfamiliar agents. We propose explicitly modelling the human explainee via Bayesian teaching, which evaluates explanations by how much they shift explainees' inferences toward a desired goal.

Adolescents with spondylolysis have lower SRS-22 scores than controls and peers with pre-operative idiopathic scoliosis.

Purpose: The Scoliosis Research Society Outcomes Questionnaire (SRS-22) is a health-related quality-of-life (HRQL) tool for scoliosis patients. Since no equivalent questionnaire exists for spondylolysis patients, we characterized patient-reported scores in pediatric spondylolysis patients using the SRS-22, and compared these scores to previously published values for age-matched controls and patients with pre-operative adolescent idiopathic scoliosis (AIS).

Methods: A single-institution cross-sectional observational study was performed using SRS-22 data from spondylolysis patients aged 12-18 years.

A Systematic Review of the Utility of Postoperative Imaging in the Management of Pediatric Supracondylar Humerus Fractures.

Background: Recently published studies call into question the clinical utility of postoperative radiographs in the management of pediatric supracondylar humerus (SCH) fractures. This topic has been addressed as part of the American Academy of Orthopaedic Surgeons Appropriate Use Criteria, although recommendations regarding serial radiographs were not included as part of the discussion. The purpose of this systematic review is to summarize the recent literature regarding the utility of postoperative radiographs as part of the management of SCH fractures.

Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis.

Study Design: Retrospective cohort study.

Objectives: This study investigates postoperative urinary retention (POUR) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and the effects of postoperative analgesia and mobility on retention. High opioid use and decreased postoperative mobility are proposed risk factors for retention in adults.

Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis.

Background: Opioids are commonly used after posterior spinal instrumented fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Prescription opioids use can potentially lead to misuse, abuse, dependence, and overdose death. Prolonged opioid use has not been extensively studied in the postoperative AIS population.

Utility of Follow-up Radiographs After Pin Removal in Supracondylar Humerus Fractures: A Retrospective Cohort Study.

Introduction: Displaced supracondylar humerus fractures (SCFs) are common pediatric injuries, typically treated by closed reduction and percutaneous pinning (CRPP). Radiographs are obtained at pin removal and subsequently to evaluate fracture healing. We evaluated the utility of radiographs obtained after pin removal in pediatric SCF management.

Hip Arthrography Complicated by Air Embolism in Infants: A Report of 2 Cases.

Case: We report 2 cases of infants with developmental dysplasia of the hip who underwent arthrography of the hip with use of air for structure identification, which resulted in a presumed air embolism and deep oxygen desaturation. This led to the hypothesis that there is an increased potential of air embolism in the pediatric population given the vascular anatomy of the hip.

Conclusion: These 2 cases document the important and not well-known complication of air embolism during air arthrography, which resulted in a change of practice for the authors.

A Unifying Computational Framework for Teaching and Active Learning.

Traditionally, learning has been modeled as passively obtaining information or actively exploring the environment. Recent research has introduced models of learning from teachers that involve reasoning about why they have selected particular evidence. We introduce a computational framework that takes a critical step toward unifying active learning and teaching by recognizing that meta-reasoning underlying reasoning about others can be applied to reasoning about oneself.

Developmental Dysplasia of the Hip.

Pediatricians are often the first to identify developmental dysplasia of the hip (DDH) and direct subsequent appropriate treatment. The general treatment principle of DDH is to obtain and maintain a concentric reduction of the femoral head in the acetabulum. Achieving this goal can range from less-invasive bracing treatments to more-invasive surgical treatment depending on the age and complexity of the dysplasia.

Theoretical perspectives on active sensing.

A key component of interacting with the world is how to direct ones' sensors so as to extract task-relevant information - a process referred to as active sensing. In this review, we present a framework for active sensing that forms a closed loop between an ideal observer, that extracts task-relevant information from a sequence of observations, and an ideal planner which specifies the actions that lead to the most informative observations. We discuss active sensing as an approximation to exploration in the wider framework of reinforcement learning, and conversely, discuss several sensory, perceptual, and motor processes as approximations to active sensing.