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Kwong JZ, Lapidus-Krol E, Langer JC, Gulack BC. Early post-operative fever after colorectal surgery in infants is common and rarely associated with infection. Pediatr Surg Int 2024; 40:235. [PMID: 39160337 DOI: 10.1007/s00383-024-05823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Early post-operative fever (< 48 h) is common in adults and children and seldom indicative of an infection. Guidance to limit excessive evaluation in adults is well-characterized but similar studies for the pediatric population is scarce. This study was performed to better clarify which infants should undergo investigation for post-operative fever after colorectal reconstructive surgical procedures. METHODS We performed a retrospective chart review of all infants under one year of age who underwent elective reconstruction for anorectal malformations (ARM) and Hirschsprung Disease (HD) between June 2018 and April 2020 at a single institution. Patient and perioperative characteristics were analyzed to evaluate for possible factors associated with infection. RESULTS Sixty-eight infants met study criteria - 38 (55.9%) had HD and 30 (44.1%) had ARM. Twenty-two infants (32.4%) had early post-operative fever. A definitive infectious cause was identified in only two infants. The presence of a colostomy pre-operatively and longer operative times were associated with increased risk of post-operative fever (62.5% vs. 22.7% and 175 min vs. 150 min respectively, p < 0.05). CONCLUSION Early post-operative fever in infants after colorectal surgery is common and rarely associated with an infection. Further research is needed to determine which infants require further work-up and which can be safely observed.
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Affiliation(s)
- Jacky Z Kwong
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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Zhou L, Cui X, Mo G, Wei J, Mo M, Zhong Y. Immediate fever during anaesthesia recovery after surgical procedure with scoliosis: A case report and literature review. Int J Surg Case Rep 2024; 121:110027. [PMID: 39003972 DOI: 10.1016/j.ijscr.2024.110027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Fever is a common clinical symptom in patients with postoperative scoliosis. However, there are rare reports of immediately fevers occurring following operative procedures. CASE PRESENTATION A 15-year-old female with a 1-year history of scoliosis was admitted to the hospital after a health examination. The patient was diagnosed with idiopathic scoliosis and underwent a posterior idiopathic scoliosis procedure and correction for pedicle fixation. The clinical symptoms, including chills, fever, increased heart rate and increased blood pressure, were observed immediately following surgery during anaesthesia recovery. The patient was discharged from the hospital 12 days post-surgery. Over the 90-day follow-up, no chills, fever (≥38 °C), deep tissue infection, or surgery-related complications were reported. This remained consistent for the subsequent 3-year follow-up. CLINICAL DISCUSSION The patient was discharged 12 days after the operation, and no chills or fever (≥38 °C) occurred during the 90-day follow-up. Furthermore, there were no instances of deep tissue infection or any other surgery-related complications throughout the subsequent 3-year follow-up duration. A literature review has performed for this subject by systematic review. We identified only three reports that specifically examined postoperative fever as an observational measure among spine surgical patients. Unfortunately, none of these reports mentioned immediate postoperative fever. CONCLUSION Based on the available clinical data and research evidence, it is recommended to exercise caution when treating patients who experience postoperative chill and fever, as it may be caused by a combination of intraoperative hypothermia and anaesthesia inhibition. While these symptoms may be self-limiting in nature, close monitoring and appropriate management should be implemented to ensure patient safety and to identify any potential complications.
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Affiliation(s)
- Limin Zhou
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Xiumei Cui
- Department of Nursing, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China.
| | - Guixi Mo
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Jingsong Wei
- Department of Spine Surgery, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Meizhen Mo
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Yiyue Zhong
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China.
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Shaw KA, Murphy JS, Koehler R, Harris H, Sachwani N, Bruce R, Devito D, Schmitz M, Fabregas J, Raftis D, West J, Fletcher N. In-hospital post-operative fever after posterior spinal fusion for neuromuscular scoliosis in non-ambulatory cerebral palsy patients: is there value for clinical workup for an isolated fever? Spine Deform 2024:10.1007/s43390-024-00930-y. [PMID: 39069587 DOI: 10.1007/s43390-024-00930-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Children with neuromuscular scoliosis (NMS) resultant to cerebral palsy (CP) are at a heightened risk for complications following surgical treatment. These children have a reported 22-64% rate of post-operative fever development, and additional fever workup has been shown to have limited clinical utility. However, this has yet to be investigated in the setting of an accelerated discharge (AD) pathway. METHODS A retrospective review of children with non-ambulatory CP treated at 2 centers with posterior spinal fusion (PSF) for NMS was performed. One institution uses a standardized AD post-operative pathway for NMS patients, whereas the second institution had no standard pathway. A post-operative fever was defined as temperature > 38.5 °C. Target outcome variables included the development of a fever as well as re-admission within 90 days of surgery. RESULTS A total of 122 non-ambulatory children were identified (82% GMFCS V, mean 14.3 ± 3.4 years at surgery). A post-operative fever was documented in 75.4% of patients (N = 92) and all additional culture studies reported negative results. Children admitted to the PICU were more likely to undergo a fever workup (P < 0.001) and more likely to receive additional or extended antibiotic therapy (P < 0.001). Children treated at the AD pathway had a significantly lower rate of PICU admission (P < 0.001). Post-operative PICU admission was associated with a post-operative fever (49.5% vs 25%, P = 0.03). CONCLUSION Non-ambulatory CP children with NMS undergoing PSF have a 75.4% rate of developing early post-operative fevers. Reflexive fever work-ups provided limited clinical utility while increasing the hospital length of stay and potentially exposing patients to antibiotic-related complications.
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Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Joshua S Murphy
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, USA.
| | - Ryan Koehler
- Department of Pediatric Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hilary Harris
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Numera Sachwani
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Robert Bruce
- Department of Pediatric Orthopaedic Surgery, Emory University at Children's Healthcare of Atlanta Egelston, Atlanta, GA, USA
| | - Dennis Devito
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Michael Schmitz
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Jorge Fabregas
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Daniel Raftis
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Just West
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta Scottish Rite, Atlanta, GA, USA
| | - Nicholas Fletcher
- Department of Pediatric Orthopaedic Surgery, Emory University at Children's Healthcare of Atlanta Egelston, Atlanta, GA, USA
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Hudec J, Prokopová T, Kosinová M, Gál R. Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review. J Clin Med 2023; 12:jcm12113651. [PMID: 37297846 DOI: 10.3390/jcm12113651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.
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Affiliation(s)
- Jan Hudec
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Tereza Prokopová
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Roman Gál
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
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Hariharan A, Sees JP, Pargas C, Rogers KJ, Niiler T, Shrader MW, Miller F. Mortality after spinal fusion in children with cerebral palsy and cerebral-palsy-like conditions: A 30-year follow-up study. Dev Med Child Neurol 2023. [PMID: 36882978 DOI: 10.1111/dmcn.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
AIM To report survival probability of a large cohort of children with cerebral palsy (CP) after spinal fusion. METHOD All children with CP who had spinal fusion between 1988 and 2018 at the reporting facility were reviewed for survival. Death records of the institutional CP database, institutional electronic medical records, publicly available obituaries, and the National Death Index through the US Centers for Disease Control were searched. Survival probabilities with different surgical eras, comorbidities, ages, and curve severities were compared using Kaplan-Meier curves. RESULTS A total of 787 children (402 females, 385 males) had spinal fusion at a mean age of 14 years 1 month (standard deviation 3 years 2 months). The 30-year estimated survival was approximately 30%. Survival decreased for children who had spinal fusion at younger ages, longer postoperative hospital stays, longer postoperative intensive care unit stays, gastrostomy tubes, and pulmonary comorbidities. INTERPRETATION Children with CP who required spinal fusions had reduced long-term survival compared with an age-matched typically developing cohort; however, a substantial number survived 20 to 30 years after the surgery. This study had no comparison group of children with CP scoliosis; therefore, we do not know whether correction of scoliosis affected their survival.
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Affiliation(s)
- Arun Hariharan
- Paley Orthopedic & Spine Institute, West Palm Beach, FL, USA
| | | | - Carlos Pargas
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | - Kenneth J Rogers
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | - Tim Niiler
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | | | - Freeman Miller
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
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Ashour HA, Almohaisen GA, Hawsawi SA, Aljrayed MA, AlKhelaiwi SM, Alsayegh S, Aleissa SI, Alshaya WA. The Early and Late Postoperative Complications of Pediatric Neuromuscular Scoliosis at King Abdulaziz Medical City, Riyadh, Saudi Arabia: A Case Series. Cureus 2022; 14:e28154. [PMID: 36148194 PMCID: PMC9482685 DOI: 10.7759/cureus.28154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Neuromuscular Scoliosis (NMS) is defined as “a coronal plane spinal curvature of 10 degrees or more, measured by the Cobb method, in the setting of muscle imbalance secondary to an underlying neuropathic or myopathic disease”. Patients who have the disease usually manifest with diminished balance, asymmetrical seating, abnormal gait, and decreased pulmonary function, which are related to the change in spine posture. Surgery benefits patients with NMS in terms of stopping disease advancement and improving quality of life, but is known to be associated with certain complications in this population. The aim of this study is to identify the most common complication in NMS patients after surgical correction. Methods This study is a chart review-based retrospective case series that has covered patients’ data going from 2015 to 2019. The study focused on patients who underwent scoliosis correction surgery of both genders and mainly of a single ethnicity, with the inclusion of patients aged 9 to 18 years old. Under consecutive sampling, the study has met a sample size of 14 patients. Results Most of the study subjects nine (64%) were female. The age median was 13 years (2.25). The highest documented intraoperative complication was blood loss in 11 (79%) patients. The most prevalent early postoperative complication was urinary tract infection in two (14%) patients. No late postoperative complications were documented in the study. Conclusion The study concluded that blood loss was the most common intraoperative complication. Pulmonary problems were one of the least reported complications. Possible reasons for these findings and prevention methods should be the focus of future studies.
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Kim HS, Kwon JW, Park KB. Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era. Neurospine 2022; 19:177-187. [PMID: 35130428 PMCID: PMC8987549 DOI: 10.14245/ns.2143246.623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hak Sun Kim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Kwon
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding Author Kun-Bo Park https://orcid.org/0000-0002-8839-4870 Division of Pediatric Orthopedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea ,
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Hwang CJ, Park S, Park JY, Cho JH, Lee CS, Lee DH. Sustained Postoperative Fever Without Evident Cause After Spine Instrumentation as an Indicator of Surgical Site Infection. J Bone Joint Surg Am 2020; 102:1434-1444. [PMID: 32590401 DOI: 10.2106/jbjs.19.01490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical site infection after spinal instrumentation increases morbidity and mortality as well as medical costs and is a burden to both patients and surgeons. Late-onset or sustained fever increases the suspicion for comorbid conditions. This retrospective, exploratory cohort study was conducted to identify the rate of and risk factors for sustained or late-onset postoperative fever after spinal instrumentation operations and to determine its relationship with surgical site infection. METHODS Five hundred and ninety-eight patients who underwent lumbar or thoracic spinal instrumentation were retrospectively reviewed. The patients were divided according to (1) whether or not they had had a sustained fever (SF[+] or SF[-]) and (2) whether or not they had had a surgical site infection (SSI[+] or SSI[-]). Clinical characteristics, surgical factors, prophylactic antibiotic usage, fever pattern, and laboratory/imaging findings were recorded for all patients by electronic medical chart review. RESULTS In total, 68 patients (11.4%) had a sustained fever. The rate of surgical site infection was significantly higher when the patient had sustained fever (13.2% [9 of 68] compared with 0.9% [5 of 530]; p < 0.001). Comparison of the patients who had a sustained fever but no surgical site infection (SF[+], SSI[-]) and those with both a sustained fever and surgical site infection (SF[+], SSI[+]) showed that continuous fever, an increasing or stationary pattern of inflammatory markers, and a C-reactive protein (CRP) level of >4 mg/dL on postoperative days 7 to 10 were diagnostic clues for surgical site infection. The sensitivity and specificity of postoperative magnetic resonance imaging (MRI) for the detection of surgical site infection were 40.0% and 90.9%, respectively, when MRI was performed within 1 month after surgery. CONCLUSIONS Although most patients with sustained fever did not have surgical site infection, fever was significantly related to surgical site infection. Continuous fever, increasing patterns of inflammatory markers, and high CRP on postoperative days 7 to 10 were diagnostic clues for surgical site infection. This study demonstrated provisional results for factors that can discriminate febrile patients with surgical site infection from febrile patients without infection. Further investigation with a larger sample size is warranted for clarification. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jin Yeob Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Obana KK, Lin AJ, Yang J, Ryan DD, Goldstein RY, Kay RM. Fever after varus derotational osteotomy is common, but not a risk factor for infection. Medicine (Baltimore) 2020; 99:e18613. [PMID: 31895814 PMCID: PMC6946189 DOI: 10.1097/md.0000000000018613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified. Variables included diagnosis, inpatient stay, daily maximum temperature, duration of fever, fever workup, and administration of scheduled anti-pyretics. Fever was defined as temperature ≥38°C.In total, 123/222 (55.4%) and 70/222 (31.5%) had postoperative fevers of ≥38°C and ≥38.5°C, respectively. Average inpatient stay was 2.7 days postoperatively. Temperature (mean = 38.0°C) was greatest on postoperative day 1 (POD1), and 43.7% of patients had T ≥38°C on POD1. Anti-pyretics did not influence the duration of fever. Anti-pyretics on the day of surgery (POD0) did not influence the incidence of fever. Acetaminophen on POD0 significantly reduced likelihood of fever on POD1 (P = .02). Average length of fevers ≥38°C and 38.5°C were 8.4 and 4.2 hours, respectively. 3/18 (16.7%) fever workups administered were positive. Postoperative fever did not predict infection. 9/222 (4/1%) patients had postoperative infection - 5/123 (4.1%) with fever ≥38°C and 4/70 (5.7%) with fever ≥38.5°C. Rates of infection in patients with and without fevers were not significantly different (P = .97 for T ≥38°C and P = .38, for T ≥38.5°C).Though common, postoperative fever does not increase risk of infection. The low prevalence of positive cultures indicates routine fever workups can safely be avoided in most patients.Level of Evidence: III, retrospective comparative study.
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Affiliation(s)
- Kyle K. Obana
- Children's Orthopedic Center, Children's Hospital Los Angeles
| | - Adrian J. Lin
- Children's Orthopedic Center, Children's Hospital Los Angeles
| | - Joshua Yang
- Children's Orthopedic Center, Children's Hospital Los Angeles
| | | | - Rachel Y. Goldstein
- Children's Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert M. Kay
- Children's Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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VanderHave KL, Cho RH, Kelly DM. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2019; 101:289-295. [PMID: 30801367 DOI: 10.2106/jbjs.18.01078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Robert H Cho
- Shriners for Children Medical Center, Pasadena, California
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