Clinical Orthopaedics & Related Research最新文献

{"title":"Cochrane in CORR®: Exercise for Improving Outcomes after Osteoporotic Vertebral Fracture.","authors":"P. Thornley, M. Bhandari","doi":"10.1097/CORR.0000000000001070","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001070","url":null,"abstract":"Osteoporosis is characterized by low bone mineral density changing the architecture of bone, which increases susceptibility to low-energy fractures [9]. Patients with osteoporotic vertebral fractures, the most-common type of osteoporosis fracture, are more likely to have increased spine-related disability, increased risk of future vertebral fracture, heightened fear of falling, and even increased risk of death [2, 5, 6]. Among US women older than 50 years of age, there is an estimated 25% prevalence of vertebral fractures however only 30% of vertebral fractures come to clinical attention, making estimates of the impact of all vertebral fractures difficult to assess [1]. Exercise programs have the potential to decrease the rate of bone resorption and may improve muscle strength and balance, preventing falls [7, 10]. Therapeutic exercise is often recommended for patients sustaining vertebral fractures to reduce pain and morbidity. However, there is controversy about how effective such exercise programs are, and which type of exercise program—if any—is most effective. This Cochrane systematic review with limited meta-analysis [4] is an update of a previous Cochrane review of the same title from 2013 and includes two additional studies (216 more patients) [3, 11]. In the current review, the authors reviewed all randomized and quasi-randomized controlled trials (nine trials, 749 patients) and compared exercise or active physical therapy interventions with placebo or non-exercise control group patients with a history of vertebral fracture [4]. The authors found that low-level evidence showed that exercise likely improves physical","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83674014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicolegal Sidebar: Clinical Practice Guidelines-Do They Reduce Professional Liability Risk?","authors":"J. McMenamin, W. Teo, B. S. Bal","doi":"10.1097/CORR.0000000000001073","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001073","url":null,"abstract":"Clinical practice guidelines represent prima facie authority (meaning, that which is presumed correct unless proven otherwise) such that diligent adherence to practice guidelines should reduce the risk of malpractice litigation. In practice, however, this is not always the case. While guidelines can sometimes be introduced as a defense by an accused physician, injured patients can just as well use them to allege a breach of the standard of care. Given the limitations and shortcomings associated with clinical practice guidelines— including obsolescence, conflicts of interest, and inconsistencies with the standard of care—we believe that clinical practice guidelines should not be admissible as evidence in medical malpractice litigation.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82269449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Spotlight/Take 5: When is it Safe to Drive After Total Ankle Arthroplasty?","authors":"S. Leopold","doi":"10.1097/corr.0000000000001069","DOIUrl":"https://doi.org/10.1097/corr.0000000000001069","url":null,"abstract":"When we talk about driving after orthopaedic surgery, the conversation really has two parts: When do patients return to driving, and when should they? One recent, high-quality survey study [13] suggests that a high proportion of patients returned to driving after major lower-extremity reconstructions within a couple weeks of surgery and another systematic review [3] found that some resumed driving within days. I’m going to try to keep a neutral tone and say this as scientifically as I can: That’s nuts. We know that most patients who were opioid-naı̈ve prior to undergoing THA and TKA are still using narcotic analgesics a month after surgery (and the proportion is higher among those who took opioids before surgery) [4], and that opioid use is associated with an increased risk of fatal motor-vehicle accidents [7] as well as with increased culpability in such crashes [1]. And, of course, being off of narcotics is just one element of driving readiness; medical impairment (as is present in the weeks following surgery) [15], and things like brake-response time and brake pressure—which may not normalize for amonth or longer aftermajor surgery [3]—are some of the many others. While the senior author of that last study expressed in an interview that the patient is responsible to decide when to resume driving [5], others suggest that relying on patients’ judgment is neither scientific nor prudent [14], as human psychology suggests that they are likely to overestimate their abilities and underestimate the risks [6]. This matters to surgeons mainly because we care about the health and well-being of our patients. But I hasten to add that it also matters to us because physicians are considered “mandatory reporters” in some states (that is, we are responsible to report patients to the state if we believe their level of impairment meets the state’s threshold) [11], and because patients have successfully sued their physicians for car accidents that occur after surgery [2]. With this as background, I’m excited to present some of the highest-quality experimental evidence I’ve read on this topic in this month’s Clinical Orthopaedics and Related Research [9]. A team lead by Steven M. Raikin MD, from the Rothman Institute in Philadelphia, PA, USA, found that nearly 10% of patients did not pass a brakereaction time test 6 weeks after undergoing right-sided total ankle arthroplasty, tending to reinforce the concern that patients who drive within a few weeks of major lower-limb surgery really are taking a big risk. Since surgeons are not going to give a driving test, Dr. Raikin’s team also found some easy-toidentify parameters that were associated with failing the test they administered: More pain (and even a little bit counts: those who passed had a median VAS score of 1 out of 10, while those who failed had a median of 3), and greater joint stiffness. A note from the Editor-In-Chief: In “Editor’s Spotlight,” one of our editors provides brief commentary on a paper we bel","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88113892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: How Does Perioperative Ketorolac Affect Opioid Consumption and Pain Management After Ankle Fracture Surgery?","authors":"A. Barg","doi":"10.1097/CORR.0000000000001059","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001059","url":null,"abstract":"Ankle fractures are one of the most-common fractures of the lower extremity, with a reported incidence of about 190 per 100,000 persons per year. Up to 25% of all patients with ankle fractures undergo surgery (most commonly, open reduction and internal fixation), which may help to avoid post-operative long-term sequelae including post-traumatic ankle osteoarthritis [8]. Post-operative pain is inevitable, and physicians who manage it must be mindful of the opioid epidemic in the United States. Although less than 5% of the world’s population, Americans consume more than 80% of the world’s prescribed opioids [13]. Beyond the serious nature of opioid abuse and dependence, physicians must also consider that postoperative opioid administration may inhibit bone healing. One animal model showed that post-operative use of opioid pain medication resulted in weaker and slower callus formation compared with controls [6]. One study demonstrated that patients with surgical fracture treatment who take more opioids reported greater pain intensity and less satisfaction with pain relief [4]. Another clinical study of 9995 humeral shaft fractures found that post-operative use of opioids was associated with fracture nonunion [3]. In the last two decades, post-operative opioid monotherapy gained prominence both because of aggressive marketing by pharmaceutical companies, and concerns about side effects of non-steroidal anti-inflammatory drugs (NSAIDs), including evidence associating them with delayed union or nonunion [13]. Multimodal analgesia typically includes several classes of analgesics and antiinflammatory drugs (such as NSAIDs, selective cyclooxygenase-2 inhibitors, acetaminophen, paracetamol, neuromodulatorymedications, opioid agonists, glucocorticoids, N-Methyl D-Aspartate antagonists) as well as local anesthetic techniques (wound infiltration and intraarticular injections), and sometimes peripheral nerve blocks [9]. One study found that multimodal analgesia substantially reduced the length of hospitalization in patients who underwent fusion surgery of the ankle and hindfoot [12]. However, this study has several limitations including retrospective character of the study, small number of patients included into this study, and the heavy selections bias as the selection for receiving the pain protocol was solely left to the surgeon’s discretion [12]. Therefore, the results of this study should be interpreted with great caution [10]. In the current study, McDonald and colleagues [11] found that perioperative ketorolac administration may help to reduce the post-operative opioid consumption. This study is important because it demonstrates a simple protocol how to reduce opioid consumption and to improve pain management in patients who had ankle fracture surgery. Surgical treatment of the ankle is one of the most common surgical procedures in foot and ankle as well as in general traumatology. It is our “daily This CORR Insights is a commentary on the article “How ","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89553891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Art in Science: Velázquez and Dwarfism-The Art of Observation.","authors":"G. Friedlaender, L. Friedlaender","doi":"10.1097/CORR.0000000000001076","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001076","url":null,"abstract":"The terms “dwarf” and “dwarfism” (generally applied to individuals with achondroplasia) have a relatively recent appearance in the medical literature [3, 9]. The terms were first used in a clinical manner in the late 19th [13] and early 20th century [12], but did not become established for this purpose until associated with the detailed descriptions of the genetically based condition of achondroplasia in the 1950s [8]. Regardless of when the first medical reference to dwarfism appeared, that date is far more recent than the descriptions depicted with incredible accuracy by Spanish painter Diego Rodrı́guez de Silva y Velázquez (1599-1660), under the patronage of King Philip IV [7]. Born in Seville, in southwest Spain, Velázquez was a descendent of tradesfolk from Portugal who probably were Jewish conversos (products of the Inquisition) [14, 15]. He pursued his passion for art with formal training prior to the age of 12. Before leaving for Madrid in 1622, Velázquez was already established as an outstanding artist in Seville. With the introductions and opportunities afforded by his regional fame and his demonstrated talents (and the recent death of King Philip IV’s previously favorite painter, Rodrigo de Villandrando), he quickly won favor at the royal palace. Approaching the end of his highly acclaimed career, and despite his humble lineage, Velázquez was knighted in 1658 [4, 6]. Velázquez’s portraits, with their outstanding detail and perspective that reflected both technical realism and emotional transparency, remained his primary focus toward the end of his formidable career. One of his most acclaimed portraits, Las Meninas (The Ladies-in-Waiting; [Fig. 1]), includes images of dwarfs, and serves as an incredible example of his observational skills [7] Velázquez has likely contrived the scene depicted in Las Meninas, and done so to make several points [6, 10]. Most obvious is the insertion of the artist himself at the far left, as he is the largest figure in the painting. Depicted with brush, palette, and mahlstick in hand, he is in command of the content of the canvas by virtue of skill and observation. Indeed, Velázquez is making a statement about the control the artist has in the creative process of painting. The scene also provides commentary on the nature of the royal court, but his focus on the young infanta (Princess Margaret Theresa), absent the physical presence of King Philip IV and QueenMariana (although their reflections are seen in the mirror on the back wall), allows an informality and relaxation unavailable, by convention, in formal depictions of adult nobility [5]. The young regent, in the center of the painting is surrounded by attendants, including a chaperone, body guard, the queen’s chamberlain and head of the royal tapestries standing in the doorway, as well as her dog and two dwarfs at the far right of the canvas (Fig. 2). The dwarfs, A note from the Editor-in-Chief: I am pleased to present the next installment of “Art in Sc","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"289 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77038530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Isolated Trochanteric Descent and Greater Trochanteric Apophyseodesis Are Not Effective in the Treatment of Post-Perthes Deformity.","authors":"A. Grzegorzewski","doi":"10.1097/CORR.0000000000001057","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001057","url":null,"abstract":"Osteonecrosis of the femoral head in children, known as Legg-Calvé-Perthes disease (LCPD), behaves unpredictably [1, 5, 9]. A long list of factors can influence the surgeon’s treatment options, including age of the onset, size of the lesion, femoral head subluxation, presence or absence of greater trochanter hypertrophy, premature growth plate arrest, bilaterality, limitation of hip motion (particularly in abduction). Surgeons can use radiographs to diagnose LCPD, although MRI has proven more useful [2, 12]. There is a debate regarding the choice of treatment for patients in the Herring B, B/C, or C groups, and among patients with Catterall Group III or IV LCPD [5, 9, 16]. Using the Stulberg classification, which has prognostic implications for further function and development of hip degeneration [5, 9, 16], comparable results have been found at the end of growth whether we treat LCPD with non-surgical containment treatment methods or surgically. Hypertrophy of the greater trochanter in the course of LCPD sometimes results in shortening of the resting length and lever arm of the abductors, leading to functional hip weakness and/or restricting the abduction in the hip joint. To assess greater trochanteric hypertrophy, we can use articulotrochanteric distance, articulotrochanteric distance index, and center-trochanteric distance [3, 6, 13]. Two surgical procedures—greater trochanteric apophyseodesis and greater trochanteric descent—have been used to try to prevent this condition, which can impair functional hip biomechanics [4, 8, 15]. The current study by Haskel and colleagues [7] quantifies the change in the hip joint morphology and strength of gluteus muscles under greater trochanteric apophyseodesis or greater trochanteric descent and compared those changes with patients who did not have surgery. Even after surgical treatment, neither greater trochanteric apophyseodesis nor greater trochanteric descent improved the neck-shaft angle, neck length, Stulberg type, or gluteus muscle strength of patients with LCPD compared with those treated non-surgically [7].","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"1883 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89895303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They?","authors":"Breana Siljander, Sara S. Van Nortwick, Jessica C Flakne, A. V. Van Heest, Deborah C. Bohn","doi":"10.1097/CORR.0000000000001041","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001041","url":null,"abstract":"BACKGROUND\u0000Parental leave during graduate medical education is a component of wellness in the workplace. Although every graduate medical education program is required by the Accreditation Council for Graduate Medical Education (ACGME) to have a leave policy, individual programs can create their own policies. The ACGME stipulates that \"the sponsoring institution must provide a written policy on resident vacation and other leaves of absence (with or without pay) to include parental and sick leave to all applicants.\" To our knowledge, a review of parental leave policies of all orthopaedic surgery residency programs has not been performed. QUESTION/PURPOSES: (1) What proportion of orthopaedic surgery residency programs have accessible parental (maternity, paternity, and adoption) leave policies? (2) If a policy exists, what financial support is provided and what allotment of time is allowed?\u0000\u0000\u0000METHODS\u0000All ACGME-accredited orthopaedic surgery residency programs in 2017 and 2018 were identified. One hundred sixty-six ACGME-accredited allopathic orthopaedic surgery residency programs were identified and reviewed by two observers. Reviewers determined if a program had written parental leave policy, including maternity, paternity, or adoption leave. Ten percent of programs were contacted to verify reviewer findings. The search was sequentially conducted starting with the orthopaedic surgery residency program's website. If the information was not found, the graduate medical education (GME) website was searched. If the information was not found on either website, the program was contacted directly via email and phone. Parental leave policies were classified as to whether they provided dedicated parental leave pay, provided sick leave pay, or deferred to unpaid Family Medical Leave Act (FMLA) policies. The number of weeks of maternity, paternity, and adoption leave allowed was collected.\u0000\u0000\u0000RESULTS\u0000Our results showed that 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated policy on their program website. Overall, 81% (134 of 166) had policy information on the institution's GME website; 7% (12 of 166) of programs required direct communication with program coordinators to obtain policy information. Further, 9% (15 of 166) of programs were deemed to not have an available written policy as mandated by the ACGME. A total of 21% of programs (35 of 166) offered designated parental leave pay, 29% (48 of 166) compensated through sick leave pay, and 50% (83 of166) deferred to federal law (FMLA) requiring up to 12 weeks of unpaid leave.\u0000\u0000\u0000CONCLUSIONS\u0000Although 91% of programs meet the ACGME requirement of written parental leave policies, current parental leave policies in orthopaedic surgery are not easily accessible for prospective residents, and they do not provide clear compensation and length of leave information. Only 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated leave policy accessible on the program's websit","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81644936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What Is the Normal Ulnar Bow in Adult Patients?","authors":"B. Nolan","doi":"10.1097/CORR.0000000000001062","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001062","url":null,"abstract":"Although the restoration of the normal radial bow has long been known to be a key step in the fixation of forearm fractures [7], similar attention has not been paid to restoring anatomic curvature of the ulna. In fact,we use straight plates forwhat has traditionally been thought of as a straight bone. But as Hreha and colleagues [2] show in the current study, sometimes it is important to bend or contour a plate before applying it to a fractured ulna. It is well established that the articulation between the radius and ulna, including the interosseous membrane, substantially affects pronation and supination of the forearm [1, 3, 5, 6]. But might we further improve functional outcomes following treatment of forearm fractures by meticulously restoring the native anatomyof the ulna in the same fashion as we restore the radial bow? Hreha and colleagues [2] cleverly adapted the methods of earlier studies (one that measured the ulna’s sagittal bow [4] and another that measured the radius in the coronal plane [7]) to define normal ranges of anatomic bowing of the ulna in an adult population. They found that the ulna is anything but straight; it is bowed substantially both in the coronal and sagittal planes. Knowing this can help us in practice because we must understand normal anatomy in order to restore it","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90479394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guest Editorial: The Current Use of Biologics and Cellular Therapies in Orthopaedics: Are We Going Down the Right Path?","authors":"P. Manner, S. Goodman","doi":"10.1097/CORR.0000000000001068","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001068","url":null,"abstract":"","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88440037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Does Kyphectomy Improve the Quality of Life of Patients With Myelomeningocele?","authors":"R. El-Hawary","doi":"10.1097/CORR.0000000000001058","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001058","url":null,"abstract":"Kyphosis in patients with myelomeningocele can cause skin ulceration, pain, and substantial sitting imbalance. Bracing may stabilize the deformity or delay surgical intervention until skeletal maturity, but it is not always effective. Surgical indications include breakdown of the soft-tissue envelope overlying the gibbus, sagittal imbalance, and progressive deformity. This condition is difficult to treat surgically because complications, such as loss of correction, loss of fixation, revision surgery, and even death after surgery are disconcertingly common [1-3, 5, 6, 8-11]. Wound healing and infection are common reasons for reoperation in this population and are likely a result of operating through the tenuous soft-tissue scar of patients with myelomeningocele. By avoiding incisions through the soft-tissue scar, Hyndman’s Halifax kyphectomy and Torode’s technique may decrease the risk of wound-healing problems [3, 12], but they do not eliminate it. Loss of fixation may be caused by anatomic deficiency of the posterior elements and poor bone quality, though pedicle screw fixation has demonstrated some promise in mitigating these issues [1, 5]. In the current study, Petersen and colleagues [9] evaluated the risk of complications and reoperation as well as the impact of surgery on healthrelated quality of life (HRQoL) in children with myelomeningocele undergoing surgical correction of their lumbar kyphosis. Their technique involves posterior fixation using \"Sshaped\" rods inserted through the foramina of S1 and pedicle screws in the thoracic spine. The authors found that complications (including infection requiring débridement and wound breakdown requiring plastic surgery with advancement flap for coverage) were common and 68% of the patients underwent reoperation [9]. Their study supports several others that have documented a high risk of complications and reoperations in this patient population [2, 8, 10]. The results in the current study are important because the authors evaluated HRQoL in patients treated with kypectomy [9]. While previous studies have focused on surgical outcomes alone, the current study focuses on outcomes from the patient’s perspective. Because they reported improvement in HRQoL, despite a high complication rate, their findings allow clinicians to more confidently counsel patients about the potential impacts of the surgery [9]. Patients will expect that there may be future unplanned reoperations but that their quality of life should still be improved.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84375474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}