Safety and efficacy of waterproof casting for early onset scoliosis.

Purpose: The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction.

Waterproof Hip Spica Casts for Pediatric Femur Fractures.

Background: Hip spica casting is the treatment of choice for femur fractures in children ages 6 months to 5 years. Traditional spica (TS) casting utilizes cotton padding that precludes patient bathing. Waterproof (WP) casting has inherent advantages, including clearance for bathing and improved family satisfaction.

Concave rod first vs. convex rod first in AIS instrumentation with differential rod contouring: computer modeling and simulations based on ten AIS surgical cases.

Purpose: To assess biomechanical differences between AIS instrumentations using concave vs. convex rod first.

Methods: Instrumentations of ten AIS patients were simulated first with major correction maneuvers using the concave rod then with convex rod.

Biomechanical analysis of rod contouring in posterior spinal instrumentation and fusion for 3D correction of adolescent idiopathic scoliosis.

Purpose: To biomechanically evaluate 3D corrective forces and deformity correction attributable to key parameters of rod contouring in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: Computerised patient-specific biomechanical models of six AIS cases were used to simulate PSF and evaluate the effects of 5.5-mm cobalt-chrome rod contouring angle (concave-convex angles: 30°-15°, 45°-15° and 60°-15°), length (spanning 4 and 7 vertebrae), and apex location (T7, T9).

Do Preoperative Supine Radiographs Predict Postoperative Residual Lumbar Curvatures in Adolescent Idiopathic Scoliosis? A Retrospective Cohort Study.

Study Design: Retrospective comparative study.

Objectives: This study compares supine vs bending flexibility radiographs and evaluates their ability to predict residual postoperative lumbar curvature after selective thoracic fusion for Lenke 1 and 2 curves across different lumbar modifiers (A, B, and C) in adolescent idiopathic scoliosis (AIS).

Methods: This was a retrospective review of AIS Lenke 1 and 2 patients who underwent posterior fusion.

The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis.

Sagittal balance is widely recognized as the primary determinant of optimal outcomes in adult spinal deformity. In adolescent idiopathic scoliosis (AIS), coronal correction risks being obtained at the expense of sagittal malalignment after posterior spinal fusion. Apical lordosis, often underestimated on two-dimensional imaging, is the primary deforming factor in AIS.

Cast-Related Complications.

Despite advances in surgical techniques and technology, casting remains an important treatment modality in the armamentarium of orthopedic surgery. Opportunities for skill development and complication management are a decreasing commodity for the surgeon in training. Appropriate indications for casting and technical expertise of cast application are key to complication avoidance.

Perioperative Safety: Keeping Our Children Safe in the Operating Room.

The entire operating room team is responsible for the safety of children in the operating room. As a leader in the operating room, the surgeon is impactful in ensuring that all team members are committed to providing this safe environment. This is achieved by the use of perioperative huddles or briefings, the use of appropriate surgical checklists, operating room standardization, surgeons proficient in the care they provide, and team members that embrace Just Culture.

Evaluation of Limited Screw Density Pedicle Screw Constructs in Posterior Fusions for Adolescent Idiopathic Scoliosis.

Study Design: Retrospective case series.

Objectives: To compare radiographic and clinical outcomes in posterior spine fusions with pedicle screw instrumentation of varying screw densities in the treatment of adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Posterior spinal fusion with pedicle screw instrumentation is the mainstay of surgical treatment for AIS.

Transphyseal Distal Humerus Fracture.

Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture.

The Difficult Supracondylar Humerus Fracture: Flexion-Type Injuries.

Although flexion-type supracondylar humerus fractures account for a minority of all supracondylar humerus fractures, they warrant special attention because of their relatively high rate of requirement for open reduction and their potential for ulnar nerve injury or entrapment. The severity of flexion-type supracondylar humerus fractures may be difficult to appreciate on initial radiographs; therefore, surgeons must have a high index of suspicion in the evaluation of a patient who has a suspected flexion-type supracondylar humerus fracture. Nondisplaced or minimally displaced flexion-type supracondylar humerus fractures can be treated with long arm casting.

Open Reduction Techniques for Supracondylar Humerus Fractures in Children.

Supracondylar humerus fractures are the most common elbow fractures in children. Displaced supracondylar humerus fractures that are associated with neurologic and/or vascular injuries should be treated with timely reduction via closed techniques. If closed reduction fails, reduction via open techniques is indicated.

Current Strategies for the Management of Pediatric Supracondylar Humerus Fractures: Tips and Techniques for Successful Closed Treatment.

Pediatric supracondylar humerus fractures are the most commonly encountered type of elbow fractures in children that require surgical fixation. Many pediatric supracondylar humerus fractures can be treated with closed reduction and percutaneous skeletal fixation. In difficult fractures, adjunct pin techniques, such as joystick wires and leverage pins, can be used to help attain a satisfactory and stable reduction before an open approach is used.

Transphyseal Fracture of the Distal Humerus.

Transphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of the injury is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiography can aid in the diagnosis of the injury.

Open Reduction Techniques for Supracondylar Humerus Fractures in Children.

Supracondylar humerus fractures are the most common elbow fractures in children. Displaced supracondylar humerus fractures that are associated with neurologic and/or vascular injuries are treated with timely reduction through closed techniques. When closed techniques fail, reduction by open methods is indicated.

The effects of hypothyroidism on the proximal femoral physis in miniature swine.

As a potential means of comparing hypothyroidism in humans, this work intended to establish a defined hypothyroid state in immature miniature swine and evaluate specific molecular, cellular, and extracellular responses of their growth plates. Two male, 11-week-old Sinclair miniature swine were given 6-propyl-2-thiouracil (PTU) in their water and two other like animals (controls) were provided water without PTU. Blood levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxin (T4) were monitored weekly.

A prospective comparison of computer-navigated and fluoroscopic-guided in situ fixation of slipped capital femoral epiphysis.

Background: Slipped capital femoral epiphysis (SCFE) is usually treated with percutaneous in situ screw fixation to prevent further progression of deformity. The purpose of this investigation is to compare computer navigation (CN) techniques with traditional fluoroscopic (fluoro) techniques for in situ fixation of SCFE.

Methods: This study was an IRB-approved prospective study of 39 hip pinnings in 33 children.

Comparison of compensatory curve spontaneous derotation after selective thoracic or lumbar fusions in adolescent idiopathic scoliosis.

Study Design: Retrospective review of a multicenter prospectively collected series of adolescent idiopathic scoliosis (AIS) patients.

Objective: To compare uninstrumented compensatory curve spontaneous derotation of the rib hump and lumbar prominence after selective lumbar or thoracic fusions in AIS.

Summary Of Background Data: Coronal correction of the unfused minor curve after selective fusions in AIS has been well-documented previously.

Return of shoulder girdle function after anterior versus posterior adolescent idiopathic scoliosis surgery.

Study Design: Multicenter, prospective, cohort study.

Objective: To compare minimum 2-year postoperative shoulder function after 3 different surgical approaches for the treatment of primary thoracic curves in patients with adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Thoracic spinal instrumentation and fusion can be performed via posterior (PSF), open anterior (OASF), or thoracoscopic anterior (TASF) techniques.

Testing of a new one-stage bone-transport surgical procedure exploiting the periosteum for the repair of long-bone defects.

Background: A recently proposed one-stage bone-transport surgical procedure exploits the intrinsic osteogenic potential of the periosteum while providing mechanical stability through intramedullary nailing. The objective of this study was to assess the efficacy of this technique to bridge massive long-bone defects in a single stage.

Methods: With use of an ovine femoral model, an in situ periosteal sleeve was elevated circumferentially from healthy diaphyseal bone, which was osteotomized and transported over an intramedullary nail into a 2.