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MR Perfusion Index as a Quantitative Method of Evaluating Epiphyseal Perfusion in Legg-Calve-Perthes Disease and Correlation With Short-term Radiographic Outcome: A Preliminary Study.

J Pediatr Orthop. 2013 Jul 17;

Authors: Du J, Lu A, Dempsey M, Herring JA, Kim HK

Abstract
BACKGROUND:: Current radiographic prognosticators of the outcome of Perthes disease can only be applied after femoral head deformity has occurred. Quantification of femoral head perfusion using the gadolinium-enhanced subtraction magnetic resonance imaging (MRI) technique may serve as an early prognosticator of outcome. The purposes of this study were 2-fold: (1) to develop a reliable method to quantify femoral head perfusion using this MRI technique; and (2) to determine whether the perfusion at early stages of Perthes disease correlates with radiographic deformity after a 2-year follow-up.
METHODS:: A total of 20 patients meeting the following inclusion criteria were studied: radiographs and MRI obtained of femoral heads predeformity, age between 5 and 13 years, and unilateral disease. MR perfusion index, a measure of perfusion in the epiphysis, was obtained using digital image analysis of subtraction gadolinium-enhanced MRI. Intraobserver and interobserver agreement of this index was assessed by 2 independent observers. MR perfusion index was correlated with a radiographic deformity index (a measure of femoral head deformity) obtained after a minimum of

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Medial Ulnar Collateral Ligament Origin in Children and Adolescents: An MRI Anatomic Study.

J Pediatr Orthop. 2013 Jul 16;

Authors: Larsen N, Moisan A, Witte D, Ellzey A, Sawyer JR, Warner WC, Beaty JH, Kelly DM

Abstract
BACKGROUND:: The medial ulnar collateral ligament (MUCL) is the primary stabilizer against valgus stress on the elbow. The anatomy of the 3 bundles of the MUCL has been well studied in adults, but our review of the English literature found no study evaluating the origin of the MUCL in a large group of asymptomatic, skeletally immature elbows as it relates to the medial epicondylar physis.
METHODS:: Magnetic resonance T1-coronal images of 44 skeletally immature elbows (ages 5 to 17 y) with no history of fracture were evaluated by 2 independent musculoskeletal radiologists, a board-certified orthopaedic surgeon with fellowship training in pediatric orthopaedics, and an orthopaedic surgery resident. The location of the origin of the anterior bundle of the MUCL (aMUCL) was identified and its distance from the medial epicondylar physis was measured.
RESULTS:: All 44 images showed that the aMUCL attached either on or medial to the medial epicondylar physis. The average distance from the origin of the aMUCL to the medial epicondylar physis was 3.1 mm. There was no statistically significant relationship between age and location of the aMUCL insertion relative to the physis (P=0.183).

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The Effect of Rod Diameter on Correction of Adolescent Idiopathic Scoliosis at Two Years Follow Up.

J Pediatr Orthop. 2013 Jul 16;

Authors: Prince DE, Matsumoto H, Chan CM, Gomez JA, Hyman JE, Roye DP, Vitale MG

Abstract
STUDY DESIGN:: The review of multicenter national pediatric scoliosis database.
OBJECTIVE:: The purpose of this study was to compare the radiographic outcomes of patients who underwent scoliosis surgery utilizing different rod diameter constructs by the posterior approach.
BACKGROUND:: Little attention has specifically been focused on the effect of rod diameter on correction of spinal deformity after posterior spinal instrumentation and fusion in children with adolescent idiopathic scoliosis (AIS).
METHODS:: The review of national database comprised of 1125 patients, of which 352 patients had a minimum follow-up of 2 years. Of these, 163 patients received 5.5 mm and 189 patients received 6.35 mm diameter rods for posterior spinal instrumentation.

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Results of Single-staged Rotational Osteotomy in a Child With Congenital Proximal Radioulnar Synostosis: Subjective and Objective Evaluation.

J Pediatr Orthop. 2013 Jul 16;

Authors: Shingade VU, Shingade RV, Ughade SN

Abstract
BACKGROUND:: For congenital proximal radioulnar synostosis, both conservative and operative treatments have been described. Most of the studies describing surgical interventions are based on subjective evaluation of the forearm function and have used severe degree of forearm pronation as an indication for surgery. This study describes a single-staged rotational osteotomy of the proximal third ulna and distal third radius. The aim of the study was to assess the utility of the described surgical procedure by subjective and objective evaluations of the forearm function.
METHODS:: Forty-eight children with congenital proximal radioulnar synostosis were evaluated by subjective and objective assessments and were followed up prospectively. Subjective evaluation consisted of a set of 12 questions regarding the basic activities of life. Objective evaluation was made using the Jebsen-Taylor hand-function test and a classification system used by Failla and colleagues for 15 tasks described by Morrey and colleagues. Eleven children were treated conservatively. Thirty-six children underwent a single-staged rotational osteotomy of the proximal third ulna and distal third radius. After surgery, the evaluations were

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Musculoskeletal Functional Outcomes in Children With Osteogenesis Imperfecta: Associations With Disease Severity and Pamidronate Therapy.

J Pediatr Orthop. 2013 Jul 16;

Authors: Sousa T, Bompadre V, White KK

Abstract
BACKGROUND:: Intravenous pamidronate has been used off-label in the treatment of severe osteogenesis imperfecta (OI) for almost 20 years. Previous studies have found correlations between function and bone density in patients with OI, but have not studied the functional outcomes of these patients after bisphosphonate therapy with a validated outcome measure. The goal of this investigation is to describe the functionality and comfort of children with OI. We hypothesize that function is impaired in children with severe OI as measured using the Pediatric Outcomes Data Collection Instrument (PODCI) and that improvements in the function of children with severe OI may be observed in association with intravenous bisphosphonate therapy.
METHODS:: A total of 25 patients with OI were evaluated, of those, 15 received pamidronate therapy. Children with >2 long bone fractures per year were classified as having severe OI and were eligible for pamidronate therapy. Functional evaluation was performed using the PODCI for children who qualified for pamidronate therapy (severe OI) and those who did not qualify for pamidronate therapy (mild OI). PODCI evaluation was also performed after treatment with pamidronate in the group that

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Challenges of Spine Surgery in Patients With Chondrodysplasia Punctata.

J Pediatr Orthop. 2013 Jul 3;

Authors: Lykissas MG, Sturm PF, McClung A, Sucato DJ, Riordan M, Hammerberg KW

Abstract
BACKGROUND:: Chondrodysplasia punctata (CDP) is a common manifestation of an etiologically heterogenous group of disorders. There is very little data regarding the development and management of spinal deformity in patients with CDP. The purpose of this study was to present a multicenter series of CDP, to describe the surgical outcomes of spinal deformities in CDP patients and to emphasize important considerations that may influence choice of surgical treatment of spinal deformity in this patient population.
METHODS:: The medical records and spinal radiographs of patients with the diagnosis of CDP followed in 2 centers between 1975 and 2011 were retrospectively reviewed. Epiphyseal stippling was present on radiographs in all patients who fulfilled the clinical criteria.

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The modulation of spinal growth with nitinol intervertebral stapling in an established swine model.

J Child Orthop. 2012 Jul;6(3):241-53

Authors: Carreau JH, Farnsworth CL, Glaser DA, Doan JD, Bastrom T, Bryan N, Newton PO

Abstract
PURPOSE: Anterior spinal stapling for the treatment of adolescent idiopathic scoliosis has been shown to slow progression in small curves; however, its role in larger curves remains unclear. The purpose of this study was to evaluate the effectiveness of nitinol staples to modulate spinal growth by evaluating the two-dimensional and three-dimensional morphological and histological effects of this method in a well-established porcine model.
METHODS: Three immature Yucatan miniature pigs underwent intervertebral stapling. Two staples spanned each of three consecutive mid-thoracic discs and epiphyses. Monthly radiographs were obtained. Computed tomography (CT) was conducted at harvest after 6 months of growth. Measurements of wedging and height for each disc and vertebral body were conducted. Micro CT was used to compare physeal closure between stapled and non-stapled levels. Histology of the growth plate also compared the hypertrophic zone thickness for control and stapled vertebrae.

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Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy.

J Child Orthop. 2012 Jul;6(3):229-35

Authors: Feng L, Patrick Do K, Aiona M, Feng J, Pierce R, Sussman M

Abstract
PURPOSE: Children with spastic diplegic and hemiplegic cerebral palsy frequently ambulate with flexed knee gait. There has been concern that hamstring lengthening used to treat this problem may weaken hip extension. This study evaluates the primary outcome of hamstring transfer plus lengthening in comparison with traditional hamstring lengthening in treating flexed knee gait in ambulatory patients with cerebral palsy.
METHODS: A total of 47 children (67 lower limbs) ranging in age from 5 to 17 years old were included in this study. All subjects underwent a variety of additional surgeries at the time of the hamstring surgery as part of a multilevel treatment plan. All patients who met the inclusion criteria were divided into two groups, the hamstring lengthening alone group (HSL) and the hamstring transfer plus lengthening group (HST). Full gait analysis studies were done for all subjects pre-operatively and 1 year post-operatively.

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Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy.

J Child Orthop. 2012 Jul;6(3):217-27

Authors: Kadhim M, Holmes L, Church C, Henley J, Miller F

Abstract
PURPOSE: Planovalgus foot deformity is common in diplegic and quadriplegic patients. Surgery is the definitive treatment to restore the alignment of the talus, calcaneus, and navicular bones. We aimed, in the current study, to compare the effectiveness of subtalar fusion and calcaneal lengthening, and to assess the recurrence in ambulatory children with cerebral palsy.
METHODS: This is a retrospective study of 78 patients (138 feet diagnosed with planovalgus deformity) who underwent surgical correction using subtalar fusion or calcaneal lengthening. Range of motion, radiographic indices, kinematic, and pedobarographic data were used to examine the deformity and the outcome of surgery. A repeated measures analysis of variance (ANOVA) was used to test the study hypothesis.