Pediatric Orthopaedics Journal Scan

Long-term Patient-reported Outcome After Fractures of the Clavicle in Patients Aged 10 to 18 Years.

J Pediatr Orthop. 2013 Aug 20;

Authors: Randsborg PH, Fuglesang HF, Røtterud JH, Hammer OL, Sivertsen EA

Abstract
BACKGROUND:: Fractures of the clavicle are common among adolescents and have traditionally been treated nonoperatively. Recent literature has demonstrated less satisfactory results than expected after conservative management of displaced fractures in adults. The purpose of this study was to evaluate the long-term patient-reported outcome after clavicle fractures in older children and adolescents.
METHODS:: Children aged 10 to 18 years who sustained a fracture of the clavicle between 2006 and 2008 were identified in our institution's computerized files. The radiographs were examined and the fracture patterns, degree of dislocation, and shortening were measured. Medical records were reviewed and the patient-reported outcome was assessed using the Oxford Shoulder score and the Quick version of the Disability of Arm, Shoulder, and Hand questionnaire, and specific and general satisfaction scores.
RESULTS:: A total of 185 patients (median age, 14.4 y) with 172 midshaft and 13 lateral fractures were included in the study. Sixty-five (37.8%) of the midshaft fractures were displaced, and 9 of these were operated. There was one case of nonunion and one delayed union. One hundred twenty-two (70.9%) of the patients with a midshaft fracture responded to the questionnaires on an average 4.7 years after injury. Overall results were good to excellent for the majority of nonoperatively treated patients; however, shortening of the fracture

Distal Femoral Physeal Fixation: Are Smooth Pins Really Safe?

J Pediatr Orthop. 2013 Aug 20;

Authors: Dahl WJ, Silva S, Vanderhave KL

Abstract
BACKGROUND:: Distal femoral physeal fractures have a high incidence of physeal arrest. Several factors have been postulated to contribute to this high incidence, including fracture type, displacement, the undulating nature of the physis, and fracture reduction/fixation. The purpose of this study was to determine whether the position of percutaneous smooth pins across the physis contributes to physeal bar formation.
METHODS:: The previously validated New Zealand white rabbit model was used. Power analysis determined that 30 animals were required. All animals had a constant 0.045 smooth Kirschner (K) wire placed under fluoroscopic guidance from the distal lateral femur across the physis centrally. A second 0.045 K-wire was placed in a cross-pin configuration from the medial side in one of 2 positions: zone 1-crossing the physis centrally or zone 2-crossing the physis peripherally. Pins were removed after 4 weeks and micro computed tomography was performed at 8 weeks to assess for physeal bar formation. Histologic analysis was performed to confirm bar formation.
RESULTS:: Two physeal bars (7%) were seen after removal of the constant (lateral pin). The peripheral pin resulted in bar formation in 2 animals (13%) and the central pin in 1 animal (7%). A χ test was performed; there was no statistically significant difference between zones in terms of bar formation (P=0.5428).

Positive Communication Paradigm Decreases Early Recurrence in Clubfoot Treatment.

J Pediatr Orthop. 2013 Aug 20;

Authors: Morin ML, Hoopes DM, Szalay EA

Abstract
BACKGROUND:: The Ponseti method has become the treatment standard for idiopathic clubfoot. Deformity recurrence is most commonly attributed to premature abandonment of the requisite abduction orthosis. A study in 2009 from our center revealed a high rate of deformity recurrence in our patient population. It was surmised that the importance of bracing to maintain correction had not been adequately communicated to some families, especially Native Americans. As a result, the principal investigator developed a different communication protocol for parents of infants.
METHODS:: All children treated for clubfoot at the University of New Mexico Carrie Tingley Hospital, Albuquerque, NM, from 2008 to 2010 were reviewed. They were compared with a historical control group from this institution, the subjects of the 2009 study, and were analyzed for the rate of recurrence and Pirani score improvement.
RESULTS:: Our study cohort comprised 69 infants (104 clubfeet), all of whom were treated with the new communication style. The recurrence rate for the new communication paradigm was 2.88% compared with 18.2% in the control group (P<0.001). The Pirani score improvement was 4.0 in the treatment group compared with 3.5 in the control group (P=0.001). Native American recurrence was zero in the treatment group and 41% in the control group (P=0.011).

Osteochondromas After Radiation for Pediatric Malignancies: A Role for Expanded Counseling for Skeletal Side Effects.

J Pediatr Orthop. 2013 Aug 20;

Authors: King EA, Hanauer DA, Choi SW, Jong N, Hamstra DA, Li Y, Farley FA, Caird MS

Abstract
BACKGROUND:: A relationship has been reported between total body irradiation (TBI) and later development of osteochondromas in children who receive radiation therapy as conditioning before hematopoietic stem cell transplantation (HSCT). The goal of this study was to better characterize osteochondromas occurring in these children.
METHODS:: We identified all children (0 to 18 y) who received an allogeneic HSCT and TBI from 2000 to 2012 from a blood and marrow transplant (BMT) database. Thereafter, we identified those who developed osteochondromas through a chart review. In addition, we searched for diagnosis and operative codes from 1996 to 2012 in our pediatric orthopaedic clinical records, isolating osteochondroma patients with a history of radiation exposure.
RESULTS:: Four patients who underwent allogeneic HSCT and were later diagnosed with osteochondromas were identified from the BMT database (N=233 children); all 4 were among a group of 72 patients who received TBI. Three patients were identified from orthopaedic records. The cohort included 5 boys and 2 girls with acute lymphoblastic leukemia (N=5) or neuroblastoma (N=2), diagnosed at a median age of 2.0 years. Therapy for all patients included chemotherapy, radiation therapy (TBI, N=5; abdominal, N=2), and HSCT. A diagnosis of osteochondroma was made at a median age of 11.7 years (range, 5 to 16 y), on average 8.6 years after radiation

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Venous Thromboembolism in Children: Preliminary Results of a Survey of POSNA Members.

J Pediatr Orthop. 2013 Aug 8;

Authors: Sabharwal S, Passannante MR

Abstract
BACKGROUND:: The term venous thromboembolism (VTE) includes deep venous thrombosis of the extremity and pulmonary embolism, a potentially fatal clinical entity. Although the prevalence of VTE may be lower in children compared with adults, recent reports suggest a possible rise in this diagnosis among pediatric patients, especially in association with certain risk factors. We assessed the clinical experience and practice of members of the Pediatric Orthopaedic Society of North America (POSNA) related to VTE among their pediatric patients.
METHODS:: A 36-question online survey was sent to all 636 active POSNA members. The proportion of surgeons who had encountered at least 1 child with VTE and the respondents' practice of using thromboprophylaxis in children (<18 y old) was assessed. The relationship of responders' experience with VTE among pediatric patients with various practice characteristics was evaluated.
RESULTS:: The response rate was 56% (354/636). More than half (55%) [95% confidence interval (CI), 50%-60%] of the respondents could recall at least 1 (median, 2 cases/member) pediatric patient with deep venous thrombosis and 29% (95% CI, 24%-34%) could recall ≥1 child with pulmonary embolism. Approximately one quarter (23%) (95% CI, 18%-27%)

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The Shilla Growth Guidance Technique for Early-Onset Spinal Deformities at 2-Year Follow-Up: A Preliminary Report.

J Pediatr Orthop. 2013 Aug 8;

Authors: McCarthy RE, Luhmann S, Lenke L, McCullough FL

Abstract
BACKGROUND:: The Shilla growth guidance technique has been developed to treat spinal deformities without the necessity of repeated operative lengthenings. The dual stainless steel rods are fixed to the corrected apex of the curve by pedicle screws with limited fusion about the apex. Vertebral growth occurs in a cephalad and caudad direction through extraperiosteally placed sliding pedicle screws. A retrospective review of patients treated with the Shilla growth guidance technique for early-onset spinal deformity was performed to study patients with >2-year follow-up and describe outcome parameters.
METHODS:: From a cohort of 38 patients, 10 patients with a mean age of 7+6 years were identified as qualifying for 2-year follow-up inclusion.

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Corticosteroids can reduce the severity of scoliosis in Duchenne muscular dystrophy.

J Bone Joint Surg Am. 2013 Jun 19;95(12):e86

Authors: Connolly AM, Kim HJ, Bridwell KH

PMID: 23783217 [PubMed - indexed for MEDLINE]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23783217?dopt=Abstract

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A technical note on improved instrumentation for Blount staple insertion.

J Child Orthop. 2012 Aug;6(4):347-50

Authors: Burghardt RD, Kanellopoulos AD, Herzenberg JE

Abstract
PURPOSE: Temporary hemiepiphysiodesis has gained increasing popularity after the introduction of the eight-Plate Guided Growth System. Since its introduction, the eight-Plate has largely supplanted the traditional Blount staple. The eight-Plate offers better purchase in the bone and a more precise insertion technique. However, the Blount staple is less expensive than the various guided growth plates. Further, some surgeons feel that the Blount staple may work faster, making it more appropriate for children who are approaching skeletal maturity. Unfortunately, the original instrumentation and technique for inserting the Blount staple is over 50 years old and has not been updated.

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The role of osteoblast cells in the pathogenesis of unicameral bone cysts.

J Child Orthop. 2012 Aug;6(4):339-46

Authors: Aarvold A, Smith JO, Tayton ER, Edwards CJ, Fowler DJ, Gent ED, Oreffo RO

Abstract
PURPOSE: The pathogenesis of unicameral bone cysts (UBCs) remains largely unknown. Osteoclasts have been implicated, but the role of osteoblastic cells has, to date, not been explored. This study investigated the pathophysiology of UBCs by examining the interactions between the cyst fluid and human bone marrow stromal cells (hBMSCs) and the effect of the fluid on osteogenesis.
METHODS: Fluid was aspirated from two UBCs and analysed for protein, electrolyte and cytokine levels. Graded concentrations of the fluid were used as culture media for hBMSCs to determine the effects of the fluid on hBMSC proliferation and osteogenic differentiation. The fibrocellular lining was analysed histologically and by electron microscopy.