Peds Ortho

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.

Drs. Tyler McDonald from the University of South Alabama and Phil Nowicki from Grand Rapids host this year’s coverage of the IPOS meeting. Guests include Dr. Todd Milbrant from Mayo who discusses IPOS planning and Ponseti casting pitfalls, Dr. Kishore Mulpuri from the University of British Columbia who discusses orphan hip conditions, Dr. Tony Riccio from TSRH who discusses foot deformities including pearls for the arthrogrypotic foot, Dr. Christine Ho from TSRH who discusses operative vs. nonoperative management of various dislocations and other sports-related injuries, Dr. Reid Nichols from Nemours who discusses teaching and bunions, Valerie Parrish, PA-C and Tracy Warhoover, RN who discuss the education of APP’s at IPOS, and Dr. Derek Kelly from Campbell Clinic who presents the 2023 IPOS award winners. 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.

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.