Peds Ortho

Dr. Jennifer Bauer from Seattle Children’s Hospital is our special guest on this episode in which we discuss her recent randomized controlled trial which tested the effect of pre-operative carbohydrate drink on post-operative return of bowel function in pediatric spine fusion patients. This episode also highlights some recent work looking at the reversibility of hemiepiphysiodesis after PETS technique, a multicenter study of short versus long leg casting for distal tibial physeal fractures, and a 3D study of the distal femoral physis. Your hosts are Tyler McDonald from University of South Alabama, Craig Louer from Vanderbilt, and Julia Sanders from Children’s Hospital Colorado. Music by A. A. Aalto.

References:

1) Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial. Bauer et al. Spine Deform. 2024 Sep. PMID: 38769218.

2) Transphyseal Hemiepiphysiodesis: Is it Truly Reversible? Abdelaziz et al. JPO. 2024 Aug. PMID: 39187967.

3) Long Leg Versus Short Leg Cast Immobilization for Treatment of Salter-Harris II Distal Tibial Fractures After Closed Reduction: A Multisite Retrospective Study. Souder et al. JPOSNA. 2024 Aug.

4) Physeal Location on the Distal Femoral Cortical Surface Is Consistently Proximal to Apparent Location on the Perfect Lateral Radiograph: A 3-Dimensional Digitally Reconstructed Radiograph Study. Rosenthal et al. JAAOS. 2024 Aug. PMID: 38773850.

Dr. Dan Sucato from TSRH joins the show to discuss his recent research comparing osteotomy types for severe stable SCFE: Modified Dunn vs. Imhauser. The episode also covers multiple controversies in the worlds of hip preservation and spine deformity. The crew also discusses research spanning Perthes, CP, compartment syndrome, and more. Your hosts are Carter Clement from Children’s Hospital of New Orleans, Josh Holt from University of Iowa, Craig Louer from Vanderbilt, and Tyler McDonald from University of South Alabama. Music by A. A. Aalto.

References:

1) Surgeon recommendations for physical activity in patients with pediatric hip conditions. Li et al. JPO 2024. PMID: 38835293.

2) Hip Surgery is Not More Painful Than Spine Surgery in Children With Cerebral Palsy. Padilla et al. JPO 2024. PMID: 38934603.

3) The Prevalence of Acute Compartment Syndrome in Pediatric Tibial Tubercle Fractures. Martinez et al. JPO 2024. PMID: 39021084.

4) Preliminary Study of Motion Preservation Following Posterior Dynamic Distraction Device in Adolescent Idiopathic Scoliosis Patients. Todderud et al. JPO 2024. PMID: 38946041.

5) Single Versus 3-incision Triple Pelvic Osteotomy: Comparison of Clinical and Radiologic Results. Kolac et al. JPO 2024. PMID: 38783820.

6) Predictors of Persistent Limp Following Proximal Femoral Varus Osteotomy for Perthes Disease. Orellana et al. JPO 2024. PMID: 38659309.

Dr. Todd Blumberg from Seattle Children's joins the show to discuss his recent research proving the importance of careful patient positioning while obtaining a hip ultrasound in a Pavlik Harness. This episode also covers recent research on intra-op imaging after reducing a dislocated hip, screening scoliosis patients for hip dysplasia, and more. Your hosts are Carter Clement from Children’s Hospital of New Orleans, Josh Holt from University of Iowa, and Craig Louer from Vanderbilt. Music by A. A. Aalto.

References:

1) Standardized in-harness Ultrasound Protocol Improves Success Rate of Brace Treatment for Dislocated Hips. Pargas-Colina et al. JPO 2024. PMID: 38647138.

2) Epidemiology of Pediatric Dog Walking-Related Injuries Among Children Presenting to US Emergency Departments, 2001 to 2020. Maxson et al. JPO 2024. PMID: 38899976.

3) Adolescent Athletes with Stronger Athletic Identity Perceptions Have Weaker Fear Avoidance Perceptions During Musculoskeletal Injury Rehabilitation Return to Sports Preparation. Ferman et al. JPO 2024. 38767118.

4) The Prevalence of Hip Dysplasia on Radiographs for Adolescent Idiopathic Scoliosis. Fowler et al. JPO 2024. 38826034.

5) Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI. Baljoun et al. JPO 2024. 38779959.

The Pediatric Spine Study Group (PSSG), Scoliosis Research Society (SRS), and POSNA collaborate in this episode about new technology in spine surgery, including navigation, robotics, AI, 3D-printed screw guides, patient-specific rods, and more. Your hosts Carter Clement (Children’s New Orleans), Dominick Tuason (Yale), and Anthony Catanzano (Duke) lead a discussion with an esteemed panel of pediatric spine surgeons including Mark Erickson (Colorado Children’s), Chris Hardesty (Rainbow Babies and Children’s), Jason Anari (CHOP), Jaysson Brooks (TSRH), and David Skaggs (Cedars-Sinai). Panelists discuss their individual work flows, learning curves, and pearls/pitfalls for new adopters.

This episode concludes our coverage of EPOSNA 2024, the combined meeting of POSNA and EPOS. Guests include: Dr. Jack Flynn (POSNA) and Dr. Manoj Ramachandran (EPOS) – co-moderators of Session 5 ("Bag O’ Bones"), Dr. Nick Fletcher (POSNA) and Dr. Dan Sucato (POSNA) – moderators of Sessions 6 & 7 (Award-Nominated Papers), Dr. Jill Flanagan (POSNA) and Dr. Franck Accadbled (EPOS) – co-moderators of Session 8C (Lower Extremity & Deformity), Dr. Corinna Franklin (POSNA) and Dr. Marco Turati (EPOS) – co-moderators of Session 9B (ACL & Misc. Sports), Dr. Eric Edmonds (POSNA) – winner of best clinical paper, and Dr. Pooya Hosseinzadeh (POSNA) – winner of best e-poster. Your hosts are Tyler McDonald from University of South Alabama, Jessica McQuerry from University of Florida, Melissa Allen from Duke, and Breann Tisano from Boston Children’s. Music by A. A. Aalto.

This episode covers highlights from EPOSNA 2024, the combined meeting of POSNA and EPOS. Guests include: Dr. Jonathan Schoenecker (POSNA) and Dr. Melinda Witbreuk (EPOS) – co-moderators of Session 1 (Trauma), Dr. Peter Newton (POSNA) and Dr. Carol Hasler (EPOS) – co-moderators of Session 2 (Best of Spine), Prof. Deborah Eastwood (EPOS) and Dr. Steven Frick (POSNA) – co-moderators of Session 3B (Foot & Ankle), Dr. Yrjänä Nietosvaara (EPOS) and Dr. Julie Samora (POSNA) – co-moderators of Session 4B (Hand & Upper Extremity), Dr. Unni Narayanan (POSNA) and Dr. Ana Presedo (EPOS) – co-moderators of Session 4C (Neuromuscular). Your hosts are Tyler McDonald from University of South Alabama, Jessica McQuerry from University of Florida, Melissa Allen from Duke, and Breann Tisano from Boston Children’s. Music by A. A. Aalto.

Dr. Jonathan Schoenecker from Vanderbilt joins the show to discuss his recent research on using CRP to manage musculoskeletal infections. This episode also covers recent research on the value of axial imaging in infections, numerous hip preservation treatments and considerations, and more. This episode is sponsored by OrthoFix. Your hosts are Craig Louer from Vanderbilt, Carter Clement from Children’s Hospital of New Orleans, Josh Holt from University of Iowa, and Julia Sanders from Children’s Hospital Colorado. Music by A. A. Aalto.

"Main Event" Citations

1. CRP Predicts the Need to Escalate Care After Initial Debridement for Musculoskeletal Infection. Moore-Lotridge et al. JPO. 2024 Mar. PMID: 37997444

2. Clinical Utility of Repeat Magnetic Resonance Imaging Studies Among Children With Acute Hematogenous Osteomyelitis. Thorne et al. JPO. 2024 Mar. PMID: 38477331

1. A Role for Thyroid Testing in Slipped Capital Femoral Epiphysis? 32% Rate of Abnormal Values in Tested Patients. Nielsen et al. JPO. 2024 Feb. PMID: 38415747

2. Intraoperative Epiphyseal Perfusion Monitoring Does Not Reliably Predict Osteonecrosis Following Treatment of Unstable SCFE. Ellsworth et al. JPO. 2024 Feb. PMID: 38411144

3. Traditional Versus Water-resistant Short Leg Casting: A Randomized Controlled Pilot Study. Carveth et al. JPO. 2024 Feb. PMID: 38329338

4. Microwave Ablation of the Pig Growth Plate: Proof of Concept for Minimally Invasive Epiphysiodesis. Noonan et al. CORR. 2024 Mar. PMID: 38471002

This month we are joined by Dr. Raymond Liu from Case Western Reserve and Rainbow Babies in Cleveland to discuss his work on skeletal maturity grading systems, patient reported outcomes in limb deformity, and 3D anatomical studies. Hear about Mongolia pushing the limits in rigid nailing of pediatric femur fractures and stick around for highlights from the lightning round including ultrasound for fracture diagnosis, guided growth for patellar instability and 3D analysis after spinal fusion.

Your hosts are Julia Sanders from Children’s Hospital Colorado, Carter Clement from Children’s Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. Music by A. A. Aalto.

For more information on the JPO Journal Club organized by Dr Liu, please contact Caroline Eaton from Advancing Pediatric Orthopaedics at [email protected].

To download the "What's the Skeletal Maturity" app for free, visit your device app store (Android currently undergoing upgrades, but available soon!)

Citations for papers discussed:

Moon TJ, Canitia E, Amakoutou K, et al. Prospective Multicenter Preliminary Validation of Limb Deformity-modified Scoliosis Instruments in Pediatric Patients With Limb Deformity. J Pediatr Orthop. 2024;44(3):e260-e266.

Furdock RJ, Sun KJ, Ren B, et al. The Reliability of the Modified Fels Knee Skeletal Maturity System. J Pediatr Orthop. 2024;44(2):e192-e196.

Nedder VJ, Chen KJ, May CC, Abzug JM, Liu RW. Developmental Anatomy of the Radial Bow in Pediatric Patients using 3D Imaging. J Pediatr Orthop. Published online February 23, 2024.

Catanzano, A. , Upasani, V. , Bryan, T. , Yaszay, B. & Newton, P. (2024). Breaking the Rules in Three Dimensions: What to Expect After a Thoracic-only Fusion With Structural Thoracic and Thoracolumbar Curves. Journal of Pediatric Orthopaedics, 44 (3), e242-e248. 

Combs, K. & Kocher, M. (2024). US for Initial Diagnosis of a Suspected Distal Radial Fracture in Children Was Noninferior to Radiography for Arm Function at 28 Days. The Journal of Bone and Joint Surgery, 106 (4), 354. doi: 10.2106/JBJS.23.01337.

Tomasevich, Kelly M.a; Kantor, Adam H.a; Metz, Allan K.a; Hanson, Indiana T.b; Froerer, Devin L.c; Rosenthal, Reece M.a; Aoki, Stephen K.a. Mid-term outcomes of temporary medial distal femoral hemiepiphysiodesis with and without medial patellofemoral ligament repair for recurrent patellar instability in skeletally immature patients with genu valgum. Journal of Pediatric Orthopaedics B 33(2):p 119-129, March 2024.

Dr. Mark Seeley from Geisinger Health System joins the show for a stimulating discussion on a wide range of topics including his practice as an employed surgeon in a healthcare system with its own health plan and some of the unique opportunities this provides. We discuss the role of surgeons in stewardship of healthcare spending. Dr. Seeley elaborates on his work in education and his recent study evaluating a novel femur osteotomy simulation tool. Articles selected for the lightning round include MRI predictors of residual hip dysplasia 10-years after hip reduction, risks of refracture after operatively treated both bone forearm fractures, and complications of operative treatment for lateral condyle humeral fractures with associated elbow dislocation. Your hosts are Josh Holt from University of Iowa and Julia Sanders from Children's Hospital Colorado. Music by A. A. Aalto.

Dr. Dan Perry, a children’s orthopaedist and NIHR research professor from Liverpool, joins the show to discuss his recent research, including numerous ongoing multicenter trials spanning the UK and beyond: SCIENCE, CRAAFT, FORCE, BASIS, ODD SOCKS, to name a few. The lightning round touches on compartment syndrome in ECMO, why pedipods get low online reviews, and more. Your hosts are Carter Clement from Children’s Hospital of New Orleans and Craig Louer from Vanderbilt. Music by A. A. Aalto.

References:

Joseph et al. Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set. Bone & Joint Open. Nov 2023. PMID 37909150.

Bridges et al. Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support. JPO. Dec 2023 Epub. PMID 38084004.

Torres-Izquierdo et al. Is There a Role for Isolated Closed Reduction in the Emergency Department Without Fixation for Displaced Proximal Humerus Fractures in Adolescents? JPO. Dec 2023 Epub. PMID 38151963.

Martino et al. The Optimal Age for Surgical Management of DDH Differs by Treatment Method. JPO. Nov 2023 Epub. PMID 37970702.

Hitchman et al. An Analysis of Negative One-star Patient Reviews and Complaints for Pediatric Orthopaedic Surgeons throughout the United States: A Retrospective Study. JPO. Nov 2023 Epub. PMID 37970712.