Optimizing the multidisciplinary team to enhance care coordination across the continuum for children with medical complexity.

The number of individual patients needing the support of complex care coordination to help manage chronic illness and functional disability and to negotiate systemic barriers to care continues to grow. Children with medical complexity (CMC) require a multidisciplinary team approach to address their complex health care needs.  CMC may have multiple health conditions affecting numerous body systems, increased use of the health care system, and technology dependence.

Correction of Bowleg Deformity in Achondroplasia through Combined Bony Realignment and Lateral Collateral Ligament Tightening.

Introduction: Achondroplasia is one of the most common osteochondrodysplasias with an incidence of 1 in 26,000 live births. Bowing of lower limbs can cause significant morbidity in this population. The use of the Ilizarov external fixator to tighten collateral ligaments of the knee in children has not been reported in the literature.

Surgical site infection following elective nonspinal paediatric orthopaedic surgery: a prospective review.

The aim of this study was to determine the rate of surgical site infection (SSI) and the factors that predispose to it in children undergoing nonspinal orthopaedic surgery. Over a 6-month period, 326 children who underwent 334 nonspinal elective orthopaedic surgical procedures were prospectively reviewed for the development of surgical site infections. A total of 14 sites became infected, with an overall infection rate of 4.

Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator.

Background: The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management.

Method: A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment.

Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures.

This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.

Screening for spinal stenosis in achondroplastic patients undergoing limb lengthening.

The need for a screening programme for spinal stenosis in children with achondroplasia undergoing limb lengthening was identified in a tertiary limb reconstruction service. The aim of this study was to evaluate whether screening would identify the 'at risk' group. A total of 26 achondroplastic patients underwent our screening programme.

Legg-Calvé-Perthes: interobserver and intraobserver reliability of the modified Herring lateral pillar classification.

Background: The purpose of our study was to independently assess the reliability of the modified Herring lateral pillar classification.

Methods: Thirty-five standardized true anteroposterior radiographs of children in the fragmentation phase were independently assessed by 6 senior observers on 2 separate occasions (6 wk apart). The κ analysis was used to assess the interobserver and intraobserver agreement.

An open-label, randomized, parallel-group study of perioperative epoetin alfa versus standard of care for blood conservation in major elective spinal surgery: safety analysis.

Study Design: Prospective, open-label, randomized, parallel-group study at 80 centers.

Objective: To demonstrate there is no clinically important additional risk for deep vein thrombosis with perioperative use of epoetin alfa versus standard of care in spine surgery without prophylactic anticoagulation.

Summary Of Background Data: Trials of epoetin alfa in orthopedic surgery that demonstrated no additional risk of thrombovascular events included perioperative pharmacologic anticoagulation.

Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children.

Purpose: To demonstrate the effectiveness of intramedullary fixation of severely displaced proximal humeral physeal fractures in skeletally immature children using the elastic stable intramedullary nail (ESIN).

Methods: Retrospective recruitment of 14 patients aged 10-15-years old with severely displaced proximal humeral physeal fractures between 1999 and 2004 in a single regional specialist paediatric orthopaedic hospital. The fractures were graded using the Neer classification; severe displacement constituted Neer II-IV or displacement >1 cm and angulation >45 degrees .

Does smoking affect the quality of bone regenerate in paediatric limb reconstructive surgery?

Purpose: To bring to the attention of the orthopaedic fraternity that adolescent children smoke and this has an adverse effect on the bone regenerate during limb deformity corrective surgery.

Methods: Retrospective review of patients undergoing limb deformity corrective surgery with a prolonged frame time and bone-healing index. Patients operated on between 1993 and 2005 in a single regional specialist paediatric orthopaedic hospital.

Contralateral slip prediction in slipped capital femoral epiphysis: is bone age the answer?

Prophylactic pinning of an asymptomatic hip in Slipped Capital Femoral Epiphysis (SCFE) is controversial. Bone age has been used as a predictor of future contralateral slip risk and also in the decision making for prophylactic intervention. The efficacy of bone age at predicting a contralateral slip was tested in this study.

Joint distraction and reconstruction in complex knee contractures.

We retrospectively reviewed the results of joint distraction and reconstruction in complex knee contractures in 6 patients with 9 knees. The circular Ilizarov fixator was used in all cases. Extensor mechanism alignment with frame in situ was performed in 4 cases and alignment of mechanical axis of the lower limb was done in 2.

Tumoricidal effect of calicheamicin immuno-conjugates using a passive targeting strategy.

Calicheamicin is a potent chemotherapeutic with a low therapeutic index that requires targeting to tumor cells for its use in the clinic. To treat acute myeloid leukemia, calicheamicin has been conjugated to an antibody that recognizes CD33 (gemtuzumab ozogamicin). The application range of this 'active' targeting strategy is limited since it depends on specific antigen expression by tumor cells.

Distal hamstring lengthening in cerebral palsy: the influence of the proximal aponeurotic band of the semimembranosus.

We undertook a prospective review of 24 children with spastic diplegia treated by distal hamstring fractional lengthening at the Sheffield Children's Hospital. In 14 children (24 limbs) the correction achieved (popliteal angle) was inadequate and in these patients in the operating room a further correction was attained by dividing a tight band palpated in the substance of the semimembranosus muscle. Under general anaesthetic (preoperatively) the popliteal angle (a degrees ) was measured using a goniometer, then again (b degrees ) following distal hamstring fractional lengthening and finally (c degrees ) after surgically dividing the tight band.

Three-dimensional tomography of relapsed infantile Blount's disease.

Three-dimensional computed tomography reconstructions were done in the preoperative workup of five patients receiving Ilizarov correction for relapsed infantile Blount's disease. There were four girls and one boy with a mean age of 9 years 11 months. In all patients, the computed tomography reconstruction images made assessment of the deformity easier and revealed abnormalities not readily seen on plain radiographs.

Use of somatosensory evoked potentials to detect peripheral ischemia and potential injury resulting from positioning of the surgical patient: case reports and discussion.

Background: Somatosensory evoked potentials (SSEPs) have long been recognized as an excellent tool for detecting neural and vascular compromise during vascular, neurosurgical and orthopedic procedures. SSEPs have the ability to localize, central versus peripheral, the area of compromise. Many surgeons use only lower-limb SSEP monitoring when performing lumbar spinal surgery.

Interpositional arthroplasty (Jones technique) for the treatment of herniated lumbar disks: a modification of the soft posterior lumbar interbody fusion.

Sixty-six patients underwent posterior lumbar interpositional arthroplasty using a combination of calcium sulfate pellets, decompression bone, and autologous growth factors. Patients who underwent this modification of the soft posterior lumbar interbody fusion (PLIF) (Jones technique) were evaluated using clinical and radiographic ratings. The Jones technique produced significantly improved clinical pain scores in all patients, reducing back pain by 71% and leg pain by 90%.

Connecting bar for hip spica reinforcement: does it help?

The purpose of this prospective study was to determine if a connecting bar prevented mechanical failure of hip spicas. Eighty-two hip spicas were applied to 70 patients between April 2000 and June 2001 following open or closed reduction for developmental dysplasia of the hip. Bilateral hip surgery was undertaken in 12 patients.

Back pain, physical function, and estimates of aerobic capacity: what are the relationships among methods and measures?

Objectives: To establish the correlations of measures of self-reported disability, self-efficacy, physical performance, level of pain, and estimates of aerobic capacity (PvO2 ) in subjects with low back pain.

Design: Fifty-one low back pain subjects, ranging in age from 26 to 65 yr, entered the study. Participants completed the Roland-Morris Disability Questionnaire and the self-efficacy questionnaire.