Drs. Phil Nowicki of Grand Rapids and Tyler McDonald of University of South Alabama host this year’s coverage of the IPOS meeting. Guests include Dr. Woody Sankar of CHOP who discusses hip preservation in Charcot Marie Tooth and balancing our national workforce, Dr. Wade Shrader of Nemours who discusses neuromuscular care including 1st ray fusions, Dr. Bob Cho of the Los Angeles Shriners who presents tips for severe scoliosis cases, course directors Drs. Derek Kelly and Suken Shah who discuss the evolution of the IPOS meeting, Dr. Phil McClure of the University of Maryland who discusses limb length differences, and Dr. Kali Tileston of Stanford who discusses the emotional side or scoliosis bracing. This episode is produced by Tyler McDonald and Phil Nowicki along with Carter Clement from Children’s Hospital of New Orleans. Music by A.A. Aalto.

Dr. Noelle Larson from Mayo Clinic joins the show to discuss her recent research.  We discuss pearls and pitfalls of RCTs in orthopedics when discussing her famed Minimize Implants Maximize Outcomes study. We discuss new ways for eliciting patient and family surgery preferences with regards to VBT vs. PSF choices. We also touch on the evolving role of AI in pediatric orthopedics and enabling technologies such as navigation-assisted surgery. Highlights from the lightning round include long-term Dega osteotomy outcomes and some impressive results from Halo-Pelvic traction for severe spine deformities. Your hosts are Craig Louer from Vanderbilt, Carter Clement from Children’s Hospital of New Orleans, and Josh Holt from University of Iowa. Music by A. A. Alto.

Nov 2023 Show Notes – Noelle Larson

Main Event

The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion: Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial. The Journal of Bone and Joint Surgery ():10.2106/JBJS.23.00178, November 16, 2023. | Larson, A. Noelle MD1,a,*; Polly, David W. MD2,*; Sponseller, Paul D. MD3; Kelly, Michael P. MD, MSc4; Richards, B. Stephens MD5; Garg, Sumeet MD6; Parent, Stefan MD, PhD7; Shah, Suken A. MD8; Weinstein, Stuart L. MD9; Crawford, Charles H. MD10; Sanders, James O. MD11; Blakemore, Laurel C. MD12; Oetgen, Matthew E. MD13; Fletcher, Nicholas D. MD14; Kremers, Walter K. PhD15; Marks, Michelle C. PT, MA16; Brearley, Ann M. PhD17; Aubin, Carl-Eric PhD18; Sucato, Daniel J. MD, MS5; Labelle, Hubert MD7; Erickson, Mark A. MD6;  the Minimize Implants Maximize Outcomes Study Group†

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family?

A Noelle Larson, Michelle Claire Marks, Juan Marcos Gonzalez Sepulveda, Peter O Newton, Vincent J Devlin, Raquel Peat, Michelle E Tarver, Olufemi Babalola, Allen L Chen, David Gebben, Patrick Cahill, Suken Shah, Amer Samdani, Keith Bachmann, Baron Lonner

Journal of Bone and Joint Surgery. American Volume 2023 November 10

Radiation exposure in navigated techniques for AIS: is there a difference between pre-operative CT and intraoperative CT?

Mikaela H Sullivan, Lifeng Yu, Beth A Schueler, Ahmad Nassr, Julie Guerin, Todd A Milbrandt, A Noelle Larson

Spine Deformity 2023 October 24

• Settings on the intraoperative scanner typically were 80 kV, 20 mA, and 20 mAs, but occasionally 70 kV, 16 mA, and 64 mAs for patients < 60 kgs.

Automated Measurements of Interscrew Angles in Vertebral Body Tethering Patients with Deep Learning.

Kellen L Mulford, Christina Regan, Charles P Nolte, Zachariah W Pinter, Todd A Milbrandt, A Noelle Larson

Spine Journal : Official Journal of the North American Spine Society 2023 September 28

Lightning Round

Twelve to Twenty-year Follow-up of Dega Acetabuloplasty in Patients With Developmental Dysplasia of the Hip: Is it as Effective as Expected?

Murat Danişman, Gökay Dursun, İsmail Aykut Koçyiğit, Caglar Yilgor, Mehmet Cemalettin Aksoy

Journal of Pediatric Orthopedics 2023 November 2

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction.

Lijin Zhou, Hanwen Zhang, Honghao Yang, Zhangfu Li, Chaofan Han, Yiqi Zhang, Yong Hai

Journal of Bone and Joint Surgery. American Volume 2023 September 22

Dr Henry Ellis from TSRH joins the show to discuss his research on the functional outcomes of open vs. arthroscopic cam resection. Highlights from the lightning round include the impacts of seemingly benign parts of care like saw blades/Dermabond/Pavlik harnesses, the recovery process after femoral flex nails, and more. Your hosts are Carter Clement from Children’s Hospital of New Orleans, Julia Sanders from Children’s Hospital Colorado, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. This episode is sponsored by Nuvasive. Music by A. A. Alto.

Citations for papers discussed:

1) Morris et al. Comparison of Gait and Functional Outcomes between Arthroscopic and Open Treatment of Adolescent and Young Adult Femoroacetabular Impingement. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37791636/

2) Koritz et al. Incidence of Skin Sensitivity Following Dermabond Application in Pediatric Orthopaedic Surgery. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37820062/

3) Gettleman et al. Use of Surgical Adjuvants does not Decrease Recurrence of Aneurysmal Bone Cysts in Surgical Intervention with Pediatric Patients. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37815299/

4) Greenhill et al. Metaphyseal Fracture Displacement is Predictive of Intra-articular Diastasis in Adolescent Triplane Ankle Fractures. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37779308/

5) Batley et al. What are the Psychosocial Effects of Pavlik Harness Treatment? A Prospective Study on Perceived Impact on Families and Maternal-Infant Bonding. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37807604/

6) Stevens et al. Coated Cast Saw Blades Decrease Temperature During Cast Removal. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37796155/

7) Flinck et al. Recovery of Gait in Children and Adolescents after Pediatric Femoral Shaft Fracture treated with Intramedullary Nail Fixation: a Longitudinal Prospective Study. JPO E-pub Oct 2023. https://pubmed.ncbi.nlm.nih.gov/37791633/

Dr Ishaan Swarup from UCSF joins the show this month to discuss distal tibial physeal fractures. Highlights from the lightning round include the interplay of race, socioeconomic status and self-image in scoliosis, measuring rotation with advanced imaging and clinical examination, and selective dorsal rhizotomy. 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. Alto.

Citations for papers discussed can be found below:

Swarup I, Pearce R, Sanborn R, Shore BJ; Children’s Orthopaedic Trauma and Infection Consortium for Evidence Based Studies (CORTICES). Variations in the Management of Closed Salter-Harris II Distal Tibia Fractures. J Pediatr Orthop. 2023;43(9):e742-e746.

Onay T, Çelen ZE, Bayhan M, Kandemir İ, Kiliç NC, Kayaalp ME. A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures. J Pediatr Orthop. 2023;43(9):e734-e741.

Sheth M, Kitziger R, Bindner C, Rosenfeld SB. Computed Tomography Analysis of Distal Tibia Physeal Fracture Patterns: A Classification and Technique for Optimizing Screw Trajectory [published online ahead of print, 2023 Aug 29]. J Pediatr Orthop. 2023;10.1097/BPO.0000000000002498.

Erkkila, I. P., Reynolds, C. A., Weissman, J. P., Levine, O. P., Aronson, H., Knoll, J. M., & Larson, J. E. (2023). Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis: Original Research. Journal of the Pediatric Orthopaedic Society of North America, 5(3).

Cirrincione PM, Thakur A, Zucker CP, et al. Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements [published online ahead of print, 2023 Aug 21]. J Pediatr Orthop. 2023;10.1097/BPO.0000000000002493.

Edmonds, E. W., Parvaresh, K. C., Price, M. J., Farnsworth, C. L., Bomar, J. D., Hughes, J. L., & Upasani, V. V. (2023). The Reliability of Measurements for Tibial Torsion: A Comparison of CT, MRI, Biplanar Radiography, and 3D Reconstructions With and Without Standardized Measurement Training: Original Research. Journal of the Pediatric Orthopaedic Society of North America, 5(3).

Miller SD, Juricic M, Bone JN, Steinbok P, Mulpuri K. The Effect of Selective Dorsal Rhizotomy on Hip Displacement in Children With Cerebral Palsy: A Long-term Follow-up Study. J Pediatr Orthop. 2023;43(9):e701-e706.

Dr. Christopher Makarewich from University of Utah and the Salt Lake City Shriners Hospital returns to the show to discuss his recent research on guided growth in achondroplasia. The lightning round delves deeper into achondroplasia including medical treatment and elective limb lengthening. Your hosts are Josh Holt from University of Iowa, Carter Clement from Children’s Hospital of New Orleans, and Julia Sanders from Children's Hospital Colorado. Music by A. A. Aalto.

Citations

Hemiepiphysiodesis for Lower Extremity Coronal Plane Angular Correction in the Distal Femur and Proximal Tibia in Children with Achondroplasia. Makarewich et al. JPO Sept 2023.

Once-daily, subcutaneous vosoritide therapy in children with achondroplasia: a randomised, double-blind, phase 3, placebo-controlled, multicentre trial. Savarirayan et al. Lancet 2020.

What’s New in Limb Lengthening and Deformity Correction? Bafor and Iobst. JBJS Aug 2023.

Achondroplasia and limb lengthening: Results in a UK cohort and review of the literature. Donaldson et al. Journal of Orthopaedics 2015.

Extensive Limb Lengthening for Achondroplasia and Hypochondroplasia. Paley. Children 2021.

Ira Zaltz, Peter Newton, James Wall, Rene Caissie, and Manoj Ramachandran join the show to discuss their experiences developing innovative products in the field of pediatric orthopaedic surgery and beyond. The broad-ranging conversation covers their personal journeys, raising funding for new ventures, partnering with industry, mistakes they made, and more! Your hosts are Carter Clement from Children's Hospital of New Orleans and Kevin Shea from Stanford. Music by A.A. Aalto.

Ira Zaltz, Peter Newton, James Wall, Rene Caissie, and Manoj Ramachandran join the show to discuss their experiences developing innovative products in the field of pediatric orthopaedic surgery and beyond. The broad-ranging conversation covers their personal journeys, raising funding for new ventures, partnering with industry, mistakes they made, and more! Your hosts are Carter Clement from Children's Hospital of New Orleans and Kevin Shea from Stanford. Music by A.A. Aalto.

Dr. Ben Shore from Boston Children's joins the show to discuss his recent research on trauma, infection, discharge planning, neuromuscular hips, and more. The lightning round covers Vitamin D deficiency, scoliosis bracing, guided growth, and shared decision making. This episode is sponsored by Depuy Synthes Spine. Your hosts are Craig Louer from Vanderbilt, Carter Clement from Children’s Hospital of New Orleans, Julia Sanders from Children's Hospital Colorado, and Josh Holt from University of Iowa. Music by A. A. Aalto.

References:

Watkins et al. The Reliability of Intraoperative Hip Arthrography in Cerebral Palsy Hip Reconstruction. JPOSNA 2023. https://doi.org/10.55275/JPOSNA-2023-595

Flaugh et al. Barriers to Discharge After Hip Reconstruction Surgery in Non-ambulatory Children With Neurological Complex Chronic Conditions. JPO Sept 2022.

Upasani et al with CORTICES Study Group. Practice Variation in the Surgical Management of Children With Acute Hematogenous Osteomyelitis. JPO 2022.

Montgomery et al. Minimizing Surgeon Radiation Exposure During Operative Treatment of Pediatric Supracondylar Humerus Fractures. JPO 2023.

Lightning Round

Karkenny et al. Pediatric Fractures: Does Vitamin D Play a Role? JPO 2023.

Catanzano et al. Cast or Nail? Using a Preference-Based Tool for Shared Decision-Making in Pediatric Femoral Shaft Fracture Treatment. JPO 2023.

Zapata et al. Early brace treatment for idiopathic scoliosis may change the paradigm to improve curves. Spine Deformity 2023.

McGinley et al. Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. JBJS 2023.

Dr. Coleen Sabatini from UCSF joins the show to discuss implicit bias and bullying in our field, changing and international trends in supracondylars, and two international orthopedic public health issues she is immersed in solving: gluteal fibrosis and post-injection paralysis. The lightning round highlights new ultrasound techniques, SCFE implants, and more. 

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

References:

New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars. Soriano et al. JPO Apr 2023. https://pubmed.ncbi.nlm.nih.gov/36662751/

Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. Challa et al. International Orthopedics 2020. https://pubmed.ncbi.nlm.nih.gov/32691122/

Implicit Racial Bias in Pediatric Orthopaedic Surgery. Guzek et al. JPO 2022. https://pubmed.ncbi.nlm.nih.gov/35522848/

The Prevalence of Bullying Among Pediatric Orthopaedic Patients. Carrillo et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/34294669/

Epidemiology and treatment outcomes in pediatric patients with post-injection paralysis. Song et al. BMC Musculoskeletal Disorders 2022. https://pubmed.ncbi.nlm.nih.gov/35932071/

Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up. Reilly et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/33481480/

Gluteal Fibrosis and Its Surgical Treatment. Alves et al. JBJS 2019. https://pubmed.ncbi.nlm.nih.gov/30801376/

Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis. Alves et al. BMC Health Services Research 2018. https://pubmed.ncbi.nlm.nih.gov/30477506/

Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda. BMC Musculoskeletal Disorders 2018. https://pubmed.ncbi.nlm.nih.gov/30249239/

Lightning Round:

The Usefulness of Dynamic Ultrasonography in Nursemaid's Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid's Elbow. Tsai et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36962080/

Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation. Folkman et al. JPO June 2023. https://pubmed.ncbi.nlm.nih.gov/37072917/

The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression. Zapata et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36922003/

Who Benefits From Allowing the Physis to Grow in Slipped Capital Femoral Epiphysis? Winger et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36977364/

This special episode brings you highlights from the 2023 annual POSNA meeting in Nashville. Guests include Pat Cahill from CHOP, Jeanne Franzone from Nemours, Neeraj Patel from Lurie Children's Hospital, Greg Mencio from Vanderbilt, and Jonathan Schoenecker from Vanderbilt. Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Julia Sanders from Children's Hospital Colorado. Music by A.A. Aalto.