Journal of the Pediatric Orthopaedic Society of North America最新文献

{"title":"Pediatric Orthopaedic Surgeon Coding Trends After Changes to the Current Procedural Terminology Evaluation and Management Coding Guidelines in 2021.","authors":"Dylan S Koolmees, Alec Kadrie, Clayton C Bettin, Derek M Kelly, Benjamin W Sheffer","doi":"10.1016/j.jposna.2024.100113","DOIUrl":"10.1016/j.jposna.2024.100113","url":null,"abstract":"<p><strong>Background: </strong>Starting in 2021, the Centers for Medicare and Medicaid Services and the American Medical Association revised the Evaluation and Management (E&M) criteria of the Current Procedural Terminology coding selection. This retrospective study determined the changes in E&M coding level for pediatric orthopaedic patients and examined the effect of the changes on percentage of work relative value units (wRVUs) from clinic and surgery.</p><p><strong>Methods: </strong>Coding levels for all outpatient visits at our institution were analyzed from 2020, January 2021, December 2021, and January 2023. The total number of pediatric orthopaedic visits were collected, tabulated under the corresponding E&M code, and expressed as a percentage of total E&M codes within the corresponding time frame. The total change in wRVU generated from the E&M coding changes was compared between the clinic and operating room by examining the total average coding and percentage of total average for each group and the overall total and total percentage change in wRVUs.</p><p><strong>Results: </strong>There was a statistically significant difference in level of coding for both established and new patients from 2020 compared with January 2021, December 2021, and January 2023. Established patients showed a large decrease in level-2 visits and a complimentary increase in level-3 visits. New patients demonstrated a statistically significant increase in level-4 visits, which was sustained at the 2-year mark. From 2020 to 2021, there was a 29% increase in percentage of wRVUs from clinic, and a 6-point increase in wRVUs from clinic compared with surgery.</p><p><strong>Conclusions: </strong>Our study found an increase in level of coding after the E&M guideline changes, especially for new patients. This finding does not indicate that there were more complex pediatric orthopaedic cases but rather the new E&M guidelines accurately captured the complexity of each visit. There was a substantial increase in wRVUs from clinics, comparing immediately before and after the guideline change, which was largely sustained at the 2-year mark.</p><p><strong>Key concepts: </strong>(1)This study is important because it highlights specific specialty information for pediatric orthopaedic surgeons before and after the evaluation and management (E&M) guideline changes.(2)It is vital for pediatric orthopaedic surgeons to understand and appropriately apply the guidelines to each patient visit to ensure accurate coding.(3)Our study was the first to demonstrate the changes in level of coding after the E&M guidelines changed, and the effects of percent of work relative value units originating from clinic encounters.</p><p><strong>Level of evidence: </strong>Level III, retrospective case control.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100113"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Dysphoria and Scoliosis: Pediatric Orthopaedists Are Very Much Members of the Healthcare Team.","authors":"Eden N VanderHoek, Jung U Yoo, Natalie L Zusman","doi":"10.1016/j.jposna.2024.100119","DOIUrl":"10.1016/j.jposna.2024.100119","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adolescence is a pivotal time of change, and in treating adolescent idiopathic scoliosis (AIS), pediatric orthopaedists form lasting relationships with adolescents. Gender dysphoria (GD) also affects a significant number of adolescents, and with high rates of mental health disorders seen in both GD and AIS, the pediatric orthopaedic surgeons can play an important role in recognizing psychological challenges present in those patients with concurrent AIS and GD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A national database investigation was performed using PearlDiver Technologies, Inc., queried for AIS and GD using the International Classification of Diseases codes in patients aged 10-18 years in the period of October 2015 through 2020. Psychological disorders of interest included anxiety, depression, suicidal ideation, and suicide attempt. Descriptive statistics and chi-squared analyses were performed comparing the prevalence of psychological disorders between cohorts of AIS ​+ ​GD patients, AIS-only patients, and GD-only patients. Additionally, mental health outcomes were compared based on the presence or absence of bracing and fusion interventions for AIS between the AIS ​+ ​GD and AIS-only cohorts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over the 12-year study period, 820 adolescent patients were identified as having concurrent AIS and GD, representing 0.32% of adolescent AIS patients in the database. In the population with both AIS and GD, diagnoses of mental health issues were observed to be more common across the evaluated parameters. Depression was 7-fold more common (22.2% vs. 3.6%), anxiety 3-fold (79.0% vs. 25.9%), suicidal ideation 12-fold (36.2% vs. 3.8%), and suicidal attempt nearly 13-fold (5.1% vs. 0.4%, &lt;i&gt;P&lt;/i&gt; ​&lt; ​.01 for all, AIS ​+ ​GD and AIS only, respectively). Of all included parameters, only suicidal ideation was significantly different between the AIS ​+ ​GD and GD-only cohorts (36.2% vs. 41.7%). No significant differences in psychological disorders were present between AIS ​+ ​GD patients and AIS-only patients based on treatment interventions; however, significant differences were present between groups relative to presence or absence of GD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While the overall occurrence of adolescents diagnosed with both GD and AIS is low, those with both conditions exhibit notably higher rates of psychological comorbidities than those with AIS alone. Comorbidities in AIS ​+ ​GD were not, however, significantly different from those in the GD-only population. The findings emphasize the importance of mental health awareness by pediatric orthopaedists, especially in the context of patients additionally struggling with GD-associated manifestations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)The frequency of mental health diagnosis is high in both the adolescent idiopathic scoliosis (AIS) and gender dysphoria (GD) populations. Mental health diagnoses range from 3- to 13-fold greater in the AIS ​+ ","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100119"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a New, Satellite Inpatient Hospital Maintain the Efficiency of an Ambulatory Surgery Center with No Difference in Patient-reported Outcomes? A Prospective Study.","authors":"Vineet M Desai, Christopher J DeFrancesco, Morgan E Swanson, Divya Talwar, Alexandra Stevens, Nathan Chaclas, David P VanEenenaam, Kevin M Landrum, Akbar N Syed, Brendan A Williams, Theodore J Ganley","doi":"10.1016/j.jposna.2024.100120","DOIUrl":"10.1016/j.jposna.2024.100120","url":null,"abstract":"<p><strong>Background: </strong>Previous research has found that anterior cruciate ligament (ACL) reconstructions performed at ambulatory surgery centers (ASCs) are more time-efficient. However, recent literature investigating this phenomenon within the pediatric population is limited and primarily retrospective. The goal of this study was to prospectively compare the operating room (OR) efficiency of pediatric ACL reconstructions performed across different surgical settings.</p><p><strong>Methods: </strong>Adolescent patients (12-18 years) undergoing ACL reconstruction by a single surgeon were prospectively enrolled from 2020 to 2024. Patients were cohorted based on the location of their surgery at one of three sites: 1) a traditional, tertiary care academic hospital, 2) hospital-owned ASCs, or 3) a satellite inpatient hospital that was built and connected to an ASC in January 2022. Patient preoperative, surgical, and postoperative data were collected, and surgical efficiency was compared across surgical sites using a variety of metrics. Patient-reported outcomes (PROMs) were collected using the Pedi-FABS and Pediatric International Knee Documentation Committee questionnaires.</p><p><strong>Results: </strong>A total of 115 patients (56.5% female, mean age: 15.4 ​± ​1.7 years) met inclusion criteria and were enrolled. Thirty-one patients (27.0%) had ACL reconstructions at the main inpatient hospital, 36 (31.3%) at hospital-owned ASCs, and 48 (41.7%) at the new satellite inpatient hospital. When controlling for concomitant procedures, regional anesthesia type, and staff, there was a significant difference in total OR in-room, anesthesia induction, surgery preparation, surgery duration, and dressing application/wake-up times among the three cohorts (<i>P</i> ​< ​.001). Both the ASCs and the satellite inpatient hospital had shorter total OR in-room and surgery duration times than the main inpatient hospital (<i>P</i> ​< ​.001). There were no differences in PROMs among the three cohorts (<i>P</i> ​> ​.05).</p><p><strong>Conclusions: </strong>Adolescent ACL reconstructions performed at either an ASC or a satellite inpatient hospital were more time-efficient than those performed at a traditional, main inpatient hospital, with no differences in PROMs. Institutions should consider implementing strategies used at ASCs, such as standardized surgical teams, at main hospitals to increase efficiency.</p><p><strong>Key concepts: </strong>(1)A satellite inpatient hospital and ambulatory surgery centers are more time-efficient for adolescent ACL reconstruction than a main, inpatient hospital.(2)There were no differences in patient-reported functional outcomes after adolescent ACL reconstruction among ASCs, a main inpatient hospital, and a satellite inpatient hospital.(3)A satellite inpatient hospital can be as efficient as an ASC, with no significant difference in quality.</p><p><strong>Level of evidence: </strong>II (Prospective Cohort Study).</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100120"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-surgical Dental Precautions/Prophylaxis in Pediatric Patients: Results of a 2023 Survey of the Membership of the Pediatric Orthopaedic Society of North America.","authors":"James F Mooney, Ariel Brotherton, Garrett Bullock, Robert F Murphy","doi":"10.1016/j.jposna.2024.100111","DOIUrl":"10.1016/j.jposna.2024.100111","url":null,"abstract":"<p><strong>Introduction: </strong>Guidelines regarding postsurgical dental care have been common in adult total joint arthroplasty patients despite limited supporting evidence in the literature. There is anecdotal evidence that similar precautions are implemented frequently in postoperative pediatric orthopaedic patients without any published evidence to guide clinicians.</p><p><strong>Methods: </strong>A survey of the Active Members of the Pediatric Orthopaedic Society of North America (POSNA) was performed to assess the use of postsurgical guidelines regarding dental care (procedures and prophylaxis) in pediatric patients. A 20-question survey regarding this subject was developed with the input of, and approved by, the Evidence-Based Practice Committee of POSNA, and a link to participate was distributed to the Active Membership.</p><p><strong>Results: </strong>One hundred seventy-three POSNA Members opened the link to the survey. One hundred sixty-three respondents self-identified as Active, for a response rate of 19.8%. One hundred fifty-seven (96.3%) reported direct involvement in surgical and postsurgical care of pediatric orthopaedic patients. Sixty-two (39.4%) indicated use of a postoperative protocol regarding dental interventions. Forty percent of those indicating use of guidelines were uncertain of the specifics of the protocol(s) used at their institution. Eighty-five percent of those utilizing protocols felt that the use of guidelines was a valuable topic for investigation.</p><p><strong>Conclusions: </strong>These results demonstrate that many of the active Members of POSNA utilize postsurgical guidelines for dental care, particularly for those patients who have undergone spinal surgery with permanent implants. This is despite the fact that there is limited evidence to support their use in adult total joint patients and no literature regarding use of such guidelines in pediatric orthopaedic patients.</p><p><strong>Key concepts: </strong>(1)There is limited and contradictory evidence that postsurgical dental guidelines are indicated in adult orthopaedic patients.(2)There is no published evidence supporting postsurgical dental guidelines in pediatric orthopaedic patients.(3)Almost 40% of active Pediatric Orthopaedic Society of North America Members responding to a survey appear to utilize postsurgical dental care guidelines in pediatric patients, particularly after spinal procedures utilizing implants.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100111"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Orthopaedic Burden of Gun-shot Injury in Children: A Single-Institution Analysis.","authors":"Devin A Maez, Samuel L Flesner, Angela M Martz, Patrick P Bosch, Richard J Miskimins","doi":"10.1016/j.jposna.2024.100117","DOIUrl":"10.1016/j.jposna.2024.100117","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The rates of firearm injuries among pediatric patients have risen significantly in recent years. Extremity injuries resulting from gunshot wounds (GSWs) often require orthopaedic management. In addition to rare nationwide database studies, there are 2 regional studies examining this trend in the South only. Our state has notably high gun ownership and lenient gun protection laws. To examine the orthopaedic burden of gunshot injuries in our region, we reviewed the pediatric patients presenting with GSWs at a tertiary level-1 trauma center over a 7-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review was conducted of pediatric patients &lt;18 years of age presenting with GSW-related injuries at our state's only level-1 trauma center from 2016 through 2022. Data collected included demographics, injury characteristics, fracture locations, surgical management, antibiotic treatment, and long-term complications. Statistical analysis was performed to identify significant trends and disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;GSW-related presentations increased 109% from 2016 to 2022 (&lt;i&gt;P&lt;/i&gt; ​= ​.005), while orthopaedic consults increased 83% (&lt;i&gt;P&lt;/i&gt; ​= ​.032), and GSW-related fractures increased 280% (&lt;i&gt;P&lt;/i&gt; ​= ​.009). A total of 46.4% of all patients required orthopaedic consultation.Most patients were male (80.2%), with a mean age of 14.6 years (range: 16 months-17 years). Hispanic patients were over-represented compared to the state population (64.1% versus 47.7%, &lt;i&gt;P&lt;/i&gt; ​&lt; ​.001), as were African Americans (6.1% versus 1.8%, &lt;i&gt;P&lt;/i&gt; ​&lt; ​.001).A total of 4.8% of patients were uninsured. Privately insured individuals were under-represented (16.9% versus 35.9%, &lt;i&gt;P&lt;/i&gt; ​&lt; ​.001), whereas publicly insured patients were over-represented (78.2% versus 56.5%, &lt;i&gt;P&lt;/i&gt; ​&lt; ​.001). As per chart documentation, accidental discharge was the most common cause of injury (56.5%), followed by assault (33.9%).The overall fracture rate was 43.1%. Long-bone fractures accounted for 50.5% of all fractures. A total of 57.4% of orthopaedic consults required operative management. Documented antibiotic administration was noted in 84.4% of patients, predominantly cefazolin. Complications were observed in 36.5% of orthopaedic consults, with nerve injury being the most frequent (17.4%). Only 5.2% experienced infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pediatric GSW-related injuries in our state present a significant orthopaedic burden, with increasing trends in presentations and ballistic fractures over the study period. Orthopaedic surgeons have a significant role in managing these patients, improving treatment protocols and providing guidance for evidence-based approaches to improve laws to protect children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)The study analyzes a 7-year trend of pediatric gunshot wound (GSW) presentations at our state's only level-1 trauma center, focusing on those requiring orthopaedic cons","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100117"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Syndesmotic Ankle Injuries: Results of a Survey of Pediatric Orthopaedic Society of North America Members.","authors":"Caroline E Williams, Blair Stewig, Sang Won Lee, Danielle Cook, Benjamin J Shore, Collin J May","doi":"10.1016/j.jposna.2024.100114","DOIUrl":"10.1016/j.jposna.2024.100114","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although utilization of dynamic suture-button fixation for adult syndesmotic injuries has shown improved outcomes over static screw fixation, data in pediatric populations is limited. This study evaluated trends in management and identified factors influencing surgeon choice of implant for pediatric syndesmotic injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Pediatric Orthopaedic Society of North America (POSNA) members were surveyed regarding syndesmotic injury implant preferences between October 2021 and May 2022. Respondents that opted out, treated &lt;1 syndesmotic ankle injury in the past year, or had conflicting financial obligations were excluded. Results were summarized and analyzed using logistic regression to assess for significance between years posttraining and technique preference. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for significance (&lt;i&gt;P&lt;/i&gt;-values&lt;.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 103 respondents to the survey (with 102 complete responses), 25% were &lt;5 years posttraining, 24% between 5 and 10 years, 21% between 11 and 15 years, and 28% ​&gt; ​15 years posttraining. Twenty-four percent (24/102) preferred screw versus 76% (78/102) preferring suture-button implants for syndesmotic injuries. Members &gt;15 years posttraining were 4.7 times more likely to prefer screw implants compared to members &lt;5 years posttraining (OR ​= ​4.7; 95% CI, 1.14-19.34; &lt;i&gt;P&lt;/i&gt; ​= ​.03). Since starting their clinical practice, 62 respondents (60%) reported an implant preference change, with avoidance of secondary surgery (46/62; 74%) and extrapolation from adult outcomes (39/62; 63%) cited as primary motivating factors. Of the 40 members with no preference change, comfort with the procedure was the primary cited reason (33/40; 83%). Among those choosing operative intervention, radiograph-based cases showed preference for the suture-button in 70%-79% of respondents for skeletally mature patients versus 71%-81% for skeletally immature patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our data shows that the shift over time from screw to suture-button implant fixation for pediatric and adolescent syndesmotic ankle injuries is largely due to interest in avoiding implant removal and extrapolation from superior outcomes seen with suture-button use in adults. Larger comparative studies of pediatric and adolescent patients treated with suture-button versus screw fixation are needed to establish standards of care for these challenging injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Literature for operative syndesmotic injury management in adults has shown improved outcomes of dynamic suture-button fixation over static screw fixation, but data in pediatric and adolescent populations is limited.(2)A survey of 102 POSNA members shows that 76% prefer suture-button, 24% prefer screw fixation with members &gt;15 years posttraining 4.7 times more likely to prefer screw fixation to members &lt;5 years posttraining.(3)","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100114"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Talectomy for the Treatment of Rigid Nonidiopathic Clubfoot Deformity: Long-term Follow-up.","authors":"Pedro Poggiali, Jared M May, Jill E Larson, Luciano S Dias","doi":"10.1016/j.jposna.2024.100112","DOIUrl":"10.1016/j.jposna.2024.100112","url":null,"abstract":"<p><strong>Background: </strong>Clubfoot occurs in 30% of patients with myelomeningocele (MM) and is the most frequent foot deformity in patients with arthrogryposis (ART). Patients have high recurrence rates with more conservative interventions and may require talectomy. This study investigated the long-term clinical outcomes of talectomy in patients with MM and ART and identified factors associated with favorable outcomes.</p><p><strong>Methods: </strong>A retrospective chart review was performed on cases of clubfoott in MM and ART between 1975 and 2010, excluding if follow-up was <5 years or had incomplete charts. A plantigrade, stable, and braceable foot was graded as a good result. Statistical analysis included descriptive statistics, chi-square with continuity correction, Spearman correlation, and Mann-Whitney, with <i>P</i> ​< ​.05 reaching significance.</p><p><strong>Results: </strong>In total, 944 cases of clubfoot in patients with MM and ART were identified. Of those, 53 underwent talectomy and 31 feet were included in the analysis. Average age on talectomy date was 4.16 ​± ​2.46 years and the mean follow-up since surgery was 15.71 ​± ​8.43 years. \"Good results\" were found in 24 (77.4%) feet, while 7 feet (22.6%) required additional surgery. Older age at talectomy date was associated with good results at the last clinical visit (<i>P</i> ​= ​.03). Primary talectomies were associated with more subsequent surgeries per foot when compared with salvage talectomies (<i>P</i> ​= ​.03). A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with a good outcome (<i>P</i> ​= ​.022) and all \"poor results\" (7 feet, 22.6%) were found in patients with FMS lower than 3-1-1.</p><p><strong>Conclusions: </strong>Talectomy was performed in 5.6% of cases, demonstrating its rare use in treatment of clubfoot in patients with MM and ART. Nevertheless, these long-term outcomes demonstrate that talectomy surgery may be a good option for the treatment of nonidiopathic clubfoot. Good outcomes are maintained at long-term follow-up, suggesting a satisfactory correction remained until adulthood. Finally, a higher FMS was a predictor of success, suggesting that this procedure should be performed in ambulatory patients.</p><p><strong>Key concepts: </strong>(1)Talectomy remains a rare procedure, utilized in only 5.6% of clubfoot cases of patients with myelomeningocele or arthrogryposis.(2)\"Good\" results, defined as a plantigrade, stable, and braceable foot was achieved in 77.4% of patients.(3)Older age at time of talectomy was associated with improved results.(4)A Functional Mobility Scale (FMS) of 3-1-1 or higher was associated with good outcomes and thus may be a predictor of success.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100112"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hashtag Healthcare: An Assessment of Current Educational Quality and Patient Perceptions of Scoliosis on TikTok.","authors":"Reid Chambers, Anthony Yassall, Adam Mansour, Julie Balch Samora, Allen Kadado, Alexis Day, Noor Alkahlout, Kirsten Tulchin-Francis","doi":"10.1016/j.jposna.2024.100115","DOIUrl":"10.1016/j.jposna.2024.100115","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Significant racial disparities exist in healthcare, including in the diagnosis and treatment of scoliosis. The social media platform TikTok is estimated to reach over 1.7 billion monthly users in 2023. It is one of the most popular social media platforms for teenagers and young adults. This study aimed to explore TikTok content metrics related to scoliosis and determine demographic differences across videos.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study included TikTok posts searched using Exolyt analytics software for the top hashtags related to scoliosis from Sept 2020-Aug 2022. Data were collected for race and role of the creator and underlying themes. A staged approach was used to analyze content through familiarization, identifying thematic framework, indexing, summarizing, and interpreting data. The educational quality of videos was determined using the DISCERN scale by two independent reviewers (very poor: &lt;26, poor: 27-38, fair: 39-50, good: 51-62, very good: 63-75).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The top five viewed hashtags #scoliosis, #scoliosisawareness, #scoliosischeck, #scoliosissurgery, #scoliosisgang yielded 220 unique, eligible posts for inclusion. Videos were grouped by the race of individuals seen in the video:176 (80%) white, 25 (11%) black, indigenous, and persons of color (BIPOC), and 19 (9%) unknown/not applicable (UK/NA). Posts by creators where race was UK/NA had significantly more views compared to other groups (&lt;i&gt;P =&lt;/i&gt; .046). There was no difference in positive/negative tone (&lt;i&gt;P&lt;/i&gt; ​= ​.900) between groups. BIPOC creators had a higher percentage of posts on body image (&lt;i&gt;P =&lt;/i&gt; .023), embarrassment (&lt;i&gt;P =&lt;/i&gt; .031), and relationships (&lt;i&gt;P =&lt;/i&gt; .047), while white creators had more videos addressing pain (&lt;i&gt;P =&lt;/i&gt; .012). There were no differences in the DISCERN score between racial groups (&lt;i&gt;P&lt;/i&gt; ​= ​.711).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this analysis of the most popular scoliosis-related posts on TikTok, we identified important thematic content and video analytic differences by race. Only 8% of posts involved healthcare providers, and based on the DISCERN scale, the educational quality of the videos was very poor. This study highlights that racial differences in scoliosis extend to social media, and an opportunity exists for healthcare providers and professional organizations to create more diverse, educational content.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)TikTok is the most commonly used social media platform within the adolescent population.(2)Content related to scoliosis presented on TikTok is of low to no educational quality.(3)While black, indigenous, and people of color (BIPOC) represent the majority of users, they are underrepresented as content creators.(4)TikTok can be utilized as an educational platform if presented by a diverse patient population and supported by healthcare providers.(5)Continued monitoring of patient presented themes can ","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100115"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valgus-related Elbow Pathology Is Not Associated With Decreased Baumann's Angle: A Case-control Study.","authors":"Nicolas Pascual-Leone, Olivia C Tracey, Ruth H Jones, Nnaoma Oji, Douglas N Mintz, Peter D Fabricant","doi":"10.1016/j.jposna.2024.100116","DOIUrl":"10.1016/j.jposna.2024.100116","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated that varus alignment of the elbow has been associated with lateral condyle fractures. However, for other pediatric and adolescent elbow pathologies, the influence of upper extremity alignment has not been investigated. This study aimed to compare elbow alignment (quantified using Baumann's angle) among patients with medial epicondyle humeral fractures and capitellum osteochondritis dissecans (OCD) and age- and sex-matched control patients.</p><p><strong>Methods: </strong>Pediatric and adolescent patients (ages: 5-18 years, inclusive) treated at a tertiary care hospital for medial epicondyle fractures (MEFxs) and capitellum OCD lesions from January 2016 to October 2023 were retrospectively reviewed. Patients aged 5-18 years with anteroposterior elbow radiographs demonstrating no elbow pathology were included as controls. Patients were matched 1:1:1 based on sex and chronologic age within 2 years and placed into cohorts by injury. Baumann's angle was compared across groups using 1-way analysis of variance after data normality was established via Shapiro Wilk tests. Linear regression was used to assess whether fracture displacement in millimeters (in the MEFx group) or OCD lesion size (in the capitellum OCD group) correlated with Baumann's angle. A two-tailed significance threshold was set as <i>P</i> ​≤ ​.05.</p><p><strong>Results: </strong>A total of 72 matched patients were included (24 MEFx, 24 OCD, and 24 controls). The mean age of the overall sample was 13.8 ​± ​1.9 years, with 79% being male. Mean Baumann's angle was 75.7 ​± ​5.9° in the MEFx group, 71.7 ​± ​7.9° in the OCD group, and 74.1 ​± ​5.2° in controls (<i>P</i> ​= ​.181). There was no association between fracture displacement and Baumann's angle in the MEFx group (<i>P</i> ​= ​.75), and there was no association between OCD lesion size and Baumann's angle in the OCD group (<i>P</i> ​= ​.31).</p><p><strong>Conclusions: </strong>There was no difference in Baumann's angle among pediatric and adolescent patients with MEFx, capitellum OCD lesions, and age- and sex-matched controls. These findings suggest that static distal humerus alignment does not increase the risk for these injuries. Future studies should seek to evaluate dynamic alignment and its influence on these pathologies.</p><p><strong>Key concepts: </strong>(1)Baumann's angle does not differ among pediatric and adolescent patients with medial epicondyle fractures (MEFxs), capitellum osteochondritis dissecans (OCD) lesions, and age- and sex-matched controls.(2)Static distal humerus alignment does not increase the risk for MEFxs or capitellum OCD lesions.(3)Future studies should evaluate the influence of dynamic alignment on these pathologies.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100116"},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Psychology in Emergent Pediatric Limb Salvage and Reconstruction.","authors":"Whitney M Herge, Mikhail Samchukov, Emily Elerson, Alexander Cherkashin, Elizabeth Hubbard, David Podeszwa","doi":"10.1016/j.jposna.2024.100110","DOIUrl":"https://doi.org/10.1016/j.jposna.2024.100110","url":null,"abstract":"<p><p>Similar to elective pediatric limb lengthening and reconstruction (LLR) cases, treatment of pediatric patients undergoing emergent limb salvage and reconstruction (LSR) is approached as a multidisciplinary process. Unlike elective pediatric LLR, however, where the patient's individual interest in and motivation for LLR drives treatment decisions, emergent LSR treatment must be approached differently. In particular, the timing of emergent LSR treatment is driven by the risks associated with the patient's medical diagnosis and the potential consequences of nonintervention. Multidisciplinary treatment shifts from optimizing the patient's preoperative physical and psychological health to triaging and stabilizing the patient's physical and psychological health concurrent with LSR treatment. Without the luxury of preoperative time, the team must instead focus on physical and psychological risk mitigation, as well as the implementation of trauma-informed care, as appropriate.This work reviews the application of pediatric LLR preparation principles to emergent LSR scenarios. Our team's established six-step preparation workflow is adapted such that the timing, location, and focus of each step are individualized to the LSR patient's care needs. The team psychologist plays a particularly important role in this process in educating the multidisciplinary care team regarding the patient's specific psychological trauma symptoms, as appropriate, as well as ensuring the medical team takes a trauma-informed approach in their treatment provision and planning.</p><p><strong>Key concepts: </strong>(1)Pediatric patients undergoing emergent LSR rarely have time for preoperative treatment preparation and, instead, typically must be evaluated after the index surgery.(2)Rather than focusing on preoperative physical and psychological optimization, the multidisciplinary team focuses on physical and psychological triage and stabilization concurrent with LSR intervention.(3)Treatment should be provided through a trauma-informed lens in recognition of the enormous stress that emergent LSR treatment often places on pediatric patients and families.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100110"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}