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Independent Analysis of a Clinical Predictive Algorithm to Identify Methicillin-resistant Staphylococcus aureus Osteomyelitis in Children.

J Pediatr Orthop. 2013 Jul 17;

Authors: Wade Shrader M, Nowlin M, Segal LS

Abstract
BACKGROUND:: The number of serious, life-threatening musculoskeletal infections in children due to methicillin-resistant Staphylococcus aureus (MRSA) infections is increasing. The early identification of the bacteria causing osteomyelitis is critical to determine the appropriate antibiotic treatment. A recent study proposed a clinical algorithm to predict which infections were caused by MRSA by stratifying basic clinical values at the time of admission for children with osteomyelitis. The purpose of this study is to apply that predictive algorithm on an independent patient population to determine its wider applicability.
METHODS:: This was a retrospective chart review at a tertiary care children's hospital. All children who were treated for a culture-positive osteomyelitis were identified over a 3-year period. The previously reported predictors, determined by multivariate regression analysis, of MRSA infection (temperature >38°C, hematocrit <34%, white blood cell count >12,000/µL, and C-reactive protein >13 mg/L) were determined for each patient. The number of positive predictors was then correlated with the percentage of cases that were MRSA positive.

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Complications and Outcomes of Diaphyseal Forearm Fracture Intramedullary Nailing: A Comparison of Pediatric and Adolescent Age Groups.

J Pediatr Orthop. 2013 Jul 17;

Authors: Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA

Abstract
BACKGROUND:: Flexible intramedullary nailing (IMN) has become a popular technique for the management of unstable or open forearm fractures. Recent publications have suggested an increased incidence of delayed union and poor outcomes in older children and adolescents. The objective of this study was to review forearm fractures treated with IMN, comparing the rate of complications and outcomes between the 2 age groups. Our hypothesis was that IMN is an effective technique with a similar rate of complications in both age groups.
METHODS:: An Institutional Review Board-approved retrospective review was conducted of pediatric forearm fractures treated from 1998 to 2008 at a single institution. Over the study time period, 4161 pediatric forearm fractures were managed nonoperatively (92%) and 353 were treated operatively with plate, cross-pin, or intramedullary fixation (8%). Patients with inadequate follow-up, cross-pin, or plate fixation were excluded. Medical records were reviewed for indications and complications. Complications were graded with a modification of the Clavien-Dindo classification. Outcomes were judged by a new grading system.
RESULTS:: A total of 205

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Do Children With Blount Disease Have Lower Body Mass Index After Lower Limb Realignment?

J Pediatr Orthop. 2013 Jul 17;

Authors: Sabharwal S, Zhao C, Sakamoto SM, McClemens E

Abstract
INTRODUCTION:: Children with Blount disease are typically obese. The goal of our study was to assess whether children with Blount disease had lower body mass index (BMI) after surgical correction of their lower limb deformity.
METHODS:: A surgical data base was used to identify children with Blount disease. Demographic information including age of disease onset, ethnicity, health insurance status, and laterality was noted. Preoperative and most recent BMI values were documented. Using full-length standing radiographs, the mechanical axis deviation (MAD) and leg length discrepancy (LLD) were measured preoperatively and at latest follow-up. The relationship of the change in BMI with various demographic and radiologic parameters was evaluated.

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Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report.

J Pediatr Orthop. 2013 Jul 17;

Authors: Lykissas MG, Li T, Eismann EA, Parikh SN

Abstract
BACKGROUND:: The purpose of this study was to evaluate the hypothesis that medial patellofemoral ligament (MPFL) reconstruction for patellar instability decreases patellar height.
METHODS:: Preoperative and postoperative lateral knee radiographs of 38 adolescents who underwent MPFL reconstruction between 2005 and 2011 were reviewed. The Insall-Salvati index, Blackburne-Peel index, Caton-Deschamps index, and plateau-patella angle were measured on all radiographs to identify differences in patellar height. These patellar height indices were also measured on lateral knee radiographs of 25 adolescents (control group) who were treated conservatively for osteochondritis dissecans of the knee. The 2 groups were compared to account for patellar height changes secondary to growth and ossification. Intrarater reliability was measured for all patellar height indices at 1-month interval.

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Femoral Lengthening Over a Pediatric Femoral Nail: Results and Complications.

J Pediatr Orthop. 2013 Jul 17;

Authors: Gordon JE, Manske MC, Lewis TR, O'Donnell JC, Schoenecker PL, Keeler KA

Abstract
BACKGROUND:: Limb lengthening by callotasis as described by Ilizarov has become the standard method of lower extremity lengthening. Lengthening over an intramedullary nail to allow early removal of the external fixator has also become common in adults but few studies have addressed the efficacy in children.
METHODS:: A retrospective review of 37 consecutive children who had undergone femoral lengthening with external fixator over an intramedullary nail was performed. Charts were reviewed for demographics, surgical details, and complications. Radiographs were examined to determine magnitude of lengthening and to calculate lengthening index.

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Psychosocial Effects of Repetitive Surgeries in Children With Early-Onset Scoliosis: Are We Putting Them at Risk?

J Pediatr Orthop. 2013 Jul 17;

Authors: Matsumoto H, Williams BA, Corona J, Comer JS, Fisher PW, Neria Y, Roye BD, Roye1 DP, Vitale MG

Abstract
BACKGROUND:: The use of growing instrumentation in children with early-onset scoliosis (EOS) has created interest in determining if these repetitive procedures are prompting the development of lasting psychosocial problems. Given the increasing role of this treatment modality in the management of EOS, this study aimed to assess the psychological status of this patient population and to determine factors associated with worse scores in various psychosocial domains.
METHODS:: A cross-sectional assessment of 34 EOS patients was performed utilizing 2 well-established, caregiver-completed psychiatric instruments: the Child Behavior Checklist (CBCL) and the Strength and Difficulties Questionnaire. Scores were calculated for 15 CBCL and 6 Strength and Difficulties Questionnaire domains and subdomains and grouped as "Normal" or "Abnormal" according to published normative values. The prevalence of abnormal scores was within each instrument subdomain and was compared with the national norms. Domain scores were also correlated with age at first scoliosis surgery, total number of operative procedures, and total number of growing instrumentation surgeries.

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Dual 8-Plate Technique Is Not as Effective as Ablation For Epiphysiodesis About the Knee.

J Pediatr Orthop. 2013 Jul 17;

Authors: Stewart D, Cheema A, Szalay EA

Abstract
BACKGROUND:: Lower extremity length inequality can be problematic in children and is often addressed surgically. Several techniques have traditionally been utilized for epiphysiodesis, the goal being physeal ablation. Recently, 8-plates, initially developed for hemiepiphysiodesis, have been extended to epiphysiodesis by placing the plates on both medial and lateral sides of the physis. No prior studies have compared 8-plates with physeal ablation techniques.
METHODS:: Between January 2003 and August 2009, 27 patients underwent epiphysiodesis surgery using either physeal ablation or 8-plate technique. Sixteen patients had physeal ablation and 11 had dual 8-plates. A retrospective chart review sought demographic data, outcomes, and complications. Radiographs were reviewed to measure pretreatment and posttreatment limb lengths.
RESULTS:: The median improvement in limb length discrepancy was 15.5 mm in the physeal ablation group and 4 mm in the 8-plate group (P<0.001). This difference was maintained following linear regression factoring out the effect of time (10.78 mm for ablation vs. 5.62 mm for 8-plates; P=0.016). There was no statistically significant difference in complication rate between the groups (P=0.112).

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Prevention of Postoperative Osteopenia Using IV Pamidronate: A Pilot Study.

J Pediatr Orthop. 2013 Jul 17;

Authors: Hobby BD, Dominguez-Bartmess S, Szalay EA

Abstract
BACKGROUND:: Postoperative bone mineral density (BMD) loss, especially after cast immobilization and/or non-weight-bearing, is a well-known phenomenon in children that can cause fracture. Children with marginal bone density are at greatest risk. This prospective randomized control trial compared the effect of single-dose intravenous (IV) pamidronate versus placebo to prevent postoperative BMD loss.
METHODS:: Children between the ages of 4 and 18 were included in the study; inclusion criteria included a predisposition to low bone density and hip or lower extremity surgery that would require cast immobilization or non-weight-bearing for at least 4 weeks. Dual-energy x-ray absorptiometry (DXA) scans of the lumbar spine and bilateral distal femora were performed preoperatively and at least 4 weeks postoperatively. Subjects were randomized to receive either a single, low dose of IV pamidronate (1 mg/kg) or placebo, given during the immediate postoperative period. Changes in the BMD were compared using the Mann-Whitney test for significance in the lumbar spine. A multivariate general linear model was used to compare the effect of surgery, DXA region, and treatment on BMD.
RESULTS:: A total of 24 subjects were included in the study, and 20 completed the

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Meta-analysis of Function After Secondary Shoulder Surgery in Neonatal Brachial Plexus Palsy.

J Pediatr Orthop. 2013 Jul 17;

Authors: Louden EJ, Broering CA, Mehlman CT, Lippert WC, Pratt J, King EC

Abstract
BACKGROUND:: Shoulder internal rotation contracture, active abduction, and external rotation deficits are common secondary problems in neonatal brachial plexus palsy (NBPP). Soft tissue shoulder operations are often utilized for treatment. The objective was to conduct a meta-analysis and systematic review analyzing the clinical outcomes of NBPP treated with a secondary soft-tissue shoulder operation.
METHODS:: A literature search identified studies of NBPP treated with a soft-tissue shoulder operation. A meta-analysis evaluated success rates for the aggregate Mallet score (≥4 point increase), global abduction score (≥1 point increase), and external rotation score (≥1 point increase) using the Mallet scale. Subgroup analysis was performed to assess these success rates when the author chose arthroscopic release technique versus open release technique with or without tendon transfer.
RESULTS:: Data from 17 studies and 405 patients were pooled for meta-analysis. The success rate for the global abduction score was significantly higher for the open technique (67.4%) relative to the arthroscopic technique (27.7%, P<0.0001). The success rates for the global abduction score were significantly different among