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Anderson KG, Bompadre V, Parker C, Varakitsomboon S, Krengel WF, Lockhart J, Tremonti C, Schmale GA. Abbreviated Outpatient Upper Extremity Fracture Care to Avoid Clinic and Hospital Environmental Encounters During the COVID-19 Pandemic: A New Approach to Fracture Care? J Pediatr Orthop 2022; 42:e367-e372. [PMID: 35125413 DOI: 10.1097/bpo.0000000000002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To minimize in-person visits during the COVID-19 pandemic, a new fracture care protocol for children with complete and stable, nondisplaced or minimally displaced upper extremity (UE) fractures has been implemented. This protocol involves immobilization with a bivalved cast, which allows for home cast removal during a telemedicine visit, and no follow-up radiographs, thus eliminating the requirement for a return to clinic. The purpose of this study is to evaluate the outcomes and parent satisfaction of this new abbreviated fracture care protocol. METHODS Between May 2020 and April 2021, during the COVID-19 pandemic, children with complete and stable, nondisplaced or minimally displaced UE fractures were treated with a bivalved cast and 1 follow-up telemedicine visit for home cast removal. A prospective longitudinal study of these patients was performed. The PROMIS Upper Extremity questionnaire was administered at enrollment and 3 months follow-up. Parents completed a satisfaction survey after home cast removal. Demographic data and information regarding complications were collected. A historical cohort of controls treated with standard cast in 2019 was used for comparison. RESULTS A total of 56 patients with a mean age of 8±3 years (range 2 to 15) were prospectively enrolled in this study. Parent-reported PROMIS Upper Extremity scores showed a significant increase from 24.9 (95% confidence interval=20.8-29.1) at enrollment to 51.6 (95% confidence interval=50.8-52.5) at 3 months follow-up (P<0.001). Results of the satisfaction survey (n=39) showed all parents were either very satisfied (85%) or satisfied (15%). In addition, 10% of parents would have initially preferred to come into clinic for cast removal and 90% of parents would prefer this new treatment plan in the future. Patients in the abbreviated care cohort returned to clinic for a median 1 in-person visits, compared with 2 for historical controls (n=183, P<0.001). Abbreviated care patients received fewer (1.0) radiographs than controls (2.0, P<0.001). Complication rate did not differ between the groups (P=0.77). CONCLUSIONS Complete and stable, nonminimally or minimally displaced UE fractures can be cared for safely and effectively in a single in-person visit, with a telemedicine cast removal visit. Parents are satisfied with this abbreviated protocol and prefer it to additional in-person visits. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kathryn G Anderson
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
| | - Cheryl Parker
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
| | | | - Walter F Krengel
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
- Departments of Orthopaedics and Sports Medicine
| | - John Lockhart
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
- Pediatrics, University of Washington School of Medicine, Seattle, WA
| | | | - Gregory A Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital
- Departments of Orthopaedics and Sports Medicine
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Thomas CS, Schiffman CJ, Faino A, Bompadre V, Schmale GA. Diagnostic Criteria for the Painful Swollen Pediatric Knee: Distinguishing Septic Arthritis From Aseptic Effusion in a Non-Lyme Endemic Area. Front Surg 2021; 8:740285. [PMID: 34790694 PMCID: PMC8591062 DOI: 10.3389/fsurg.2021.740285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The child with a painful swollen knee must be worked-up for possible septic arthritis; the classic clinical prediction algorithms for septic arthritis of the hip may not be the best models to apply to the knee. Materials and methods: This was a retrospective case-control study of 17 years of children presenting to one hospital with a chief complaint of a painful swollen knee, to evaluate the appropriateness of applying a previously described clinical practice algorithm for the hip in differentiating between the septic and aseptic causes of the painful knee effusions. The diagnoses of true septic arthritis, presumed septic arthritis, and aseptic effusion were established, based upon the cultures of synovial fluid, blood cultures, synovial cell counts, and clinical course. Using a logistic regression model, the disease status was regressed on both the demographic and clinical variables. Results: In the study, 122 patients were included: 51 with true septic arthritis, 37 with presumed septic arthritis, and 34 with aseptic knee effusion. After applying a backward elimination, age <5 years and C-reactive protein (CRP) >2.0 mg/dl remained in the model, and predicted probabilities of having septic knee arthritis ranged from 15% for the lowest risk to 95% for the highest risk. Adding a knee aspiration including percent polymorphonucleocytes (%PMN) substantially improved the overall model performance, lowering the lowest risk to 11% while raising the highest risk to 96%. Conclusions: This predictive model suggests that the likelihood of pediatric septic arthritis of the knee is >90% when both "age <5 years" and "CRP > 2.0 mg/dl" are present in a child with a painful swollen knee, though, in the absence of these factors, the risk of septic arthritis remains over 15%. Aspiration of the knee for those patients would be the best next step.
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Affiliation(s)
- Claudia S Thomas
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States
| | - Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States
| | - Anna Faino
- Seattle Children's Hospital, Seattle, WA, United States
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Gregory A Schmale
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States.,Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, United States
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Saper MG, Bompadre V, Schmale GA, Menashe S, Burton M, Nagle K, Thapa M. Association Between 45° Flexion Anteroposterior Elbow Radiographs and Diagnostic Accuracy of Capitellum Osteochondritis Dissecans. Am J Sports Med 2021; 49:2778-2782. [PMID: 34255576 DOI: 10.1177/03635465211027178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An anteroposterior (AP) radiograph of the elbow in 45° of flexion has been suggested to increase the diagnostic accuracy of capitellum osteochondritis dissecans (OCD). PURPOSE To assess the diagnostic performance, inter- and intraobserver reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP). STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS This was a retrospective study of pediatric and adolescent patients with capitellum OCD and a control group. Six independent clinicians who were blinded to the official radiologists' reports reviewed images on 2 separate occasions, 1 week apart. A 5-point Likert scale was used to assess the clinicians' level of confidence. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for individual and combinations of radiographic views. Inter- and intraobserver reliability was determined using Cohen kappa (κ) coefficients. RESULTS A total of 28 elbows (mean age, 12.5 ± 2 years) were included. There were no differences in age (P = .18), sex (P = .62), or laterality (P > .999) between groups. There were marked variations in the diagnostic accuracy between views: sensitivity (AP, 85.1; lateral, 73.2; 45° flexion AP, 91.7), specificity (AP, 89.3; lateral, 91.7; 45° flexion AP, 91.1), PPV (AP, 88.8; lateral, 89.8; 45° flexion AP, 91.1), NPV (AP, 85.7; lateral, 77.4; 45° flexion AP, 91.6), and accuracy (AP, 87.2; lateral, 82.4; 45° flexion AP, 91.4). Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the 3 combined views was 100%. Confidence intervals in the clinicians' diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (κ = 0.65 and κ = 0.60, respectively) but highest for the 45° flexion AP radiographs (κ = 0.72). Intraobserver reliability for the 45° flexion AP view was moderate to almost perfect (κ = 0.45 to 0.93). CONCLUSION The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, the 45° flexion AP view aids in the identification of capitellum OCD.
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Affiliation(s)
- Michael G Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, WA, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, WA, USA
| | - Gregory A Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, WA, USA
| | - Sarah Menashe
- Department of Radiology, Seattle Children's, Seattle, Washington, USA
| | - Monique Burton
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, WA, USA
| | - Kyle Nagle
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, WA, USA
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's, Seattle, Washington, USA
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Van de Velde SK, Cola K, Bompadre V, Steinman SE. Seasonal Variation in Parental Satisfaction With Pediatric Orthopaedics. J Pediatr Orthop 2021; 41:e296-e300. [PMID: 33417390 DOI: 10.1097/bpo.0000000000001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The degree of parental satisfaction with health care is determined by the family's characteristics and expectations. Many aspects of human physiology and behavior have seasonal rhythms. The purpose of the present study was to determine whether parental satisfaction scores vary across the year in a pediatric orthopaedic outpatient population. METHODS We retrospectively reviewed a total of 22,951 parental satisfaction scores related to outpatient pediatric orthopaedic encounters between October 2015 and April 2019. Parental satisfaction was measured using the provider subdomain of the shortened version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Families were stratified according to various pediatric orthopaedic subspecialty services. RESULTS The satisfaction scores of all pediatric orthopaedic encounters combined did not vary significantly across the year (P=0.8745). When the families were stratified into groups by pediatric orthopaedic subspecialty clinic, variation in seasons was not associated with statistically significant variation in satisfaction scores for the elective surgery, sports medicine, trauma/fracture care, and hand/upper extremity services. However, satisfaction with the spine service was significantly lower in the winter compared with the summer and fall (73.9±3.8 vs. 83.5±5.3 and 82.6±3.6, respectively; P=0.0147). CONCLUSIONS The provision of pediatric spine care in a region with 4 distinct seasons received lower parental satisfaction scores during the winter than during the summer and fall. This seasonal variation is an additional source of bias in the measurement of satisfaction with health care. LEVEL OF EVIDENCE Level II-retrospective study.
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Affiliation(s)
| | - Kristin Cola
- Pediatric Orthopedics of Southwest Florida, Fort Myers, FL
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Hinkle A, Dickason CQ, Jinguji T, Shenoi S, Thapa M, Saper MG, Bompadre V, Schmale GA. Prevalence and Severity of Juvenile Osteochondritis Dissecans in Patients With Juvenile Idiopathic Arthritis. Orthop J Sports Med 2021; 9:2325967120984139. [PMID: 33718500 PMCID: PMC7917878 DOI: 10.1177/2325967120984139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic
arthritides presenting in patients aged ≤16 years, with a prevalence of 16
to 150 per 100,000. Juvenile osteochondritis dissecans (OCD) is an
idiopathic disease of articular cartilage and subchondral bone, has an onset
age of 10 to 16 years, and often affects the knee, with a prevalence of 2 to
18 per 100,000. Currently, there are few studies that have evaluated the
relationship between JIA and OCD. Hypothesis: OCD is more prevalent in children with JIA, and when diagnosed in such
patients, OCD often presents at an advanced state. Study Design: Case series; Level of evidence, 4. Methods: The medical records of patients with diagnoses of both JIA and OCD treated
between January 2008 and March 2019 at a single children’s hospital were
retrospectively reviewed. Associations between timing of diagnoses, number
and types of corticosteroid treatments, category of arthritis, timing of
diagnoses, and lesion stability were examined with Spearman correlation
coefficients. Results: A total of 2021 patients with JIA were identified, 20 of whom (19 female, 1
male) had OCD of the knee and/or talus for a prevalence of 1 in 100 or 1000
in 100,000, or approximately 50 to 500 times that of the general population.
These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were
radiographically stable over time, 50% (10 femur, 2 patella, 2 talus) were
unstable at initial diagnosis, and 7% (2 femur) were initially stable but
progressed to unstable lesions despite drilling. Twelve patients (60%)
underwent surgery: 4 (20%) with stable femoral lesions for persistent
symptoms despite prolonged nonoperative treatment and 8 (40%) for treatment
of their unstable lesions (femoral and patellar). Within our study design,
we could identify no significant associations between lesion stability and
timing of diagnoses, number of joint injections, or limb deformities, nor
were there associations between timing of JIA and OCD diagnoses and category
of arthritis. Conclusion: In our population of patients with JIA, OCD lesions were found to be 50 to
500 times more prevalent when compared with published rates in the general
population and often presented at an advanced state, with instability or
delayed healing requiring surgery for stabilization or resolution of
symptoms.
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Affiliation(s)
- Andrew Hinkle
- Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Celeste Quitiquit Dickason
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas Jinguji
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Susan Shenoi
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh Thapa
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael G Saper
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Gregory A Schmale
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
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Savarirayan R, Tunkel DE, Sterni LM, Bober MB, Cho TJ, Goldberg MJ, Hoover-Fong J, Irving M, Kamps SE, Mackenzie WG, Raggio C, Spencer SA, Bompadre V, White KK. Best practice guidelines in managing the craniofacial aspects of skeletal dysplasia. Orphanet J Rare Dis 2021; 16:31. [PMID: 33446226 PMCID: PMC7809733 DOI: 10.1186/s13023-021-01678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background Recognition and appropriate management of the craniofacial manifestations of patients with skeletal dysplasia are challenging, due to the rarity of these conditions, and dearth of literature to support evidence-based clinical decision making. Methods Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, best practice guidelines in the management of craniofacial aspects of these patients. Results After a comprehensive literature review, 23 initial statements were generated and critically discussed, with subsequent development of a list of 22 best practice guidelines after a second round voting. Conclusions The guidelines are presented and discussed to provide context and assistance for clinicians in their decision making in this important and challenging component of care for patients with skeletal dysplasia, in order standardize care and improve outcomes.
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Affiliation(s)
- Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC, 3052, Australia. .,Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Sterni
- Eudowwod Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael B Bober
- Division of Orthogenetics - Nemours/ A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Michael J Goldberg
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Julie Hoover-Fong
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Melita Irving
- Department of Clinical Genetics Guy's, St Thomas NHS, London, UK
| | - Shawn E Kamps
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - William G Mackenzie
- Department of Orthopedic Surgery - Nemours/ A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Cathleen Raggio
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Holland E, Low D, Bompadre V, Saper M. Continuous interscalene catheters for ambulatory shoulder surgery provide effective intraoperative and early postoperative analgesia in adolescent patients. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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White KK, Bober MB, Cho TJ, Goldberg MJ, Hoover-Fong J, Irving M, Kamps SE, Mackenzie WG, Raggio C, Spencer SA, Bompadre V, Savarirayan R. Best practice guidelines for management of spinal disorders in skeletal dysplasia. Orphanet J Rare Dis 2020; 15:161. [PMID: 32580780 PMCID: PMC7313125 DOI: 10.1186/s13023-020-01415-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. METHODS Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, "best practice" guidelines in the care of spinal disorders in patients with skeletal dysplasia. RESULTS Starting with 33 statements, the group a developed a list of 31 "best practice" guidelines. CONCLUSIONS The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.
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Affiliation(s)
- Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way, OA.9.120, Seattle, Washington, 98105, USA. .,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Michael B Bober
- Division of Orthogenetics, Nemours/ A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Michael J Goldberg
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way, OA.9.120, Seattle, Washington, 98105, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Julie Hoover-Fong
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Melita Irving
- Department of Clinical Genetics Guy's and St Thomas NHS, London, UK
| | - Shawn E Kamps
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - William G Mackenzie
- Department of Orthopedic Surgery, Nemours/ A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Cathleen Raggio
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way, OA.9.120, Seattle, Washington, 98105, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
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MacKintosh EW, Ho M, White KK, Krengel W, Bompadre V, Chen ML, Redding GJ. Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis. Spine Deform 2020; 8:523-530. [PMID: 32072486 DOI: 10.1007/s43390-020-00080-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/03/2019] [Indexed: 02/03/2023]
Abstract
This study describes the utility of overnight sleep studies in children with early onset scoliosis (EOS). Children with EOS have diminished respiratory reserve which is associated with abnormal breathing and sleep quality in children. Currently, there are no criteria for referral of these children to evaluate breathing during sleep or data on the use of sleep treatments as part of their supportive care. A review of the 159 patients with EOS who were followed at a single institution from 2003 to 2016 identified 68 who underwent overnight polysomnograms (PSGs). Sixty-five of 68 (96%) had elevated apnea-hypopnea index (AHI) and a majority (56%) were prescribed nighttime respiratory support. A majority of young children (< 5 years) with PSG were referred for a history of snoring, apnea, or restless sleep; all 30 had abnormal PSGs. Twenty-seven (90%) had nighttime hypoxemia (nadir oxygen saturation values < 92%). Eighteen (60%) were referred to otolaryngology, of whom 11 (37%) subsequently underwent tonsil and/or adenoid removal. In older children (≥ 5 years), those referred for PSGs had more severe restrictive chest wall disease [lower forced vital capacity (FVC) values] than those who were not sent for PSG. Correlation between FVC and apnea-hypopnea index, however, was not significant. Pre-operative coronal curve magnitude did not strongly correlate with nadir SaO2 or AHI in either age group. These results suggest that sleep studies are underutilized in the management of children with EOS. Inadequate and poor-quality sleep adversely affects growth, behavior, and cognitive function in children. This study suggests that screening for sleep abnormalities should be incorporated into assessment and treatment of more patients with EOS.
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Affiliation(s)
- E W MacKintosh
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - M Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - K K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - W Krengel
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - V Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - M L Chen
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - G J Redding
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.
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10
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Holland EL, Robbins RE, Low DK, Bosenberg AT, Bompadre V, Schmale GA. Comparison of Continuous Adductor Canal and Femoral Nerve Blocks for Analgesia and Return of Quadriceps Function After Anterior Cruciate Ligament Reconstruction in Adolescent Patients. Arthrosc Sports Med Rehabil 2020; 2:e121-e128. [PMID: 32368748 PMCID: PMC7190540 DOI: 10.1016/j.asmr.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/09/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To compare early pain relief and late quadriceps function after anterior cruciate ligament reconstruction (ACLR) with hamstring autograft in adolescent patients treated with either a continuous femoral nerve block (cFNB) or continuous adductor canal block (cACB). METHODS We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR and received either a cACB or cFNB for postoperative pain management. Over a 1-year period, all patients underwent ACLR with cFNBs. Over the subsequent 9 months, all patients underwent their ACLR with cACBs. Patient demographics, postoperative pain scores, opioid consumption, satisfaction and complications, and dates and results of quadriceps function derived at the Return to Sports evaluation were compared. RESULTS Ninety-one patients (53 cFNB, 38 cACB) were reviewed. There were no differences in the demographics of the 2 groups. There were no statistically significant differences between groups in variations in postoperative pain scores (P = .21), or satisfaction with the blocks (P = .93). Patients in the cFNB group consumed a greater number of opioid doses on postoperative day 3 (2.2 ± 2.1 doses cFNB, 1.1 ± 1.6 doses cACB, P = .03) and a greater number of opioid doses overall for postoperative days 1 to 3 (mean 6.8 ± 5.3 doses cFNB, 3.8 ± 2.1 doses cACB, P = .03). There was no difference in time to return of acceptable quadriceps strength and function when comparing the 2 groups (30.9 ± 7.7 weeks cFNB, 28.9 ± 6.6 weeks cACB, P = .087). CONCLUSIONS We found few differences in postoperative analgesic requirements when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Return of quadriceps strength and function by six months did not appear to vary with regional technique, either cACB or cFNB, employed at surgery. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Erica L. Holland
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Robin E. Robbins
- Department of Anesthesiology, Legacy Emanuel Medical Center, Portland, Oregon, U.S.A
| | - Daniel K. Low
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Adrian T. Bosenberg
- Department of Anesthesiology and Pain Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children’s, Seattle, Washington, U.S.A
| | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children’s, Seattle, Washington, U.S.A
- Address correspondence to Gregory A. Schmale, M.D., Department of Orthopedics and Sports Medicine, M/S MB.10.620, P.O. Box 5371, Seattle, WA 98145-5005.
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Bouchard M, Shefelbine L, Bompadre V. C-Reactive Protein Level at Time of Discharge Is Not Predictive of Risk of Reoperation or Readmission in Children With Septic Arthritis. Front Surg 2019; 6:68. [PMID: 31850363 PMCID: PMC6901673 DOI: 10.3389/fsurg.2019.00068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose: C-reactive protein (CRP) level is used at our tertiary pediatric hospital in the diagnosis, management, and discharge evaluation of patients with septic arthritis. The purpose of this study was to evaluate the efficacy of a discharge criterion of CRP < 2.0 mg/dL for patients with septic arthritis in preventing reoperation and readmission. We also aimed to identify other risk factors of treatment failure. Methods: Patients diagnosed with septic arthritis between January 1, 2007 and December 31, 2017 were identified with ICD 9/10 and related CPT codes. Systematic chart reviews were performed to obtain demographic data, infection characteristics, and treatment details. Bivariate tests of associations between potential risk factors and readmission and reoperation were performed. Quantitative variables were analyzed using Mann-Whitney tests and categorical variables were analyzed using Chi-square tests. Results: One hundred and eighty-three children with septic arthritis were included in the study. Seven (3.8%) were readmitted after hospital discharge for further management, including six who required reoperation. Mean CRP at discharge for single-admission patients was 1.71 mg/dL (± 1.07) and 1.96 mg/dL (± 1.19) for the readmission group (p = 0.664). Forty-eight children (25.9%) had CRP values greater than the recommended 2.0 mg/dL at discharge. Only three of these patients (6.2%) were later readmitted. The only common variable of the readmitted children was an antibiotic-resistant or atypical causative bacteria. Conclusions: CRP levels are useful in monitoring treatment efficacy of septic arthritis in children but are not reliable as a discharge criterion to prevent readmission or reoperation. We recommend determining discharge readiness on the basis of clinical improvement and down-trending CRP values. There was a higher risk of readmission in children with an antibiotic-resistant or atypical causative bacteria. Close monitoring of these patients and those with negative cultures at time of discharge is suggested to identify signs of persistent infection. Level of evidence: III, retrospective cohort study.
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Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lara Shefelbine
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Viviana Bompadre
- Division of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, United States
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12
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Bouchard M, Bauer JM, Bompadre V, Krengel WF. An Updated Algorithm for Radiographic Screening of Upper Cervical Instability in Patients With Down Syndrome. Spine Deform 2019; 7:950-956. [PMID: 31732007 DOI: 10.1016/j.jspd.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective evaluation of cervical spine images from 2006-2012 for the purposes of "screening" children with Down syndrome for instability. OBJECTIVE To determine whether a full series of cervical spine images including flexion/extension lateral (FEL) radiographs was needed to avoid missing upper cervical instability. SUMMARY OF BACKGROUND DATA The best algorithm, measurements, and criteria for screening children with Down syndrome for upper cervical instability are controversial. Many authors have recommended obtaining flexion and extension views. We noted that patients who require surgical stabilization due to myelopathy or cord compression typically have grossly abnormal radiographic measurements on the neutral upright lateral (NUL) cervical spine radiograph. METHODS The atlanto-dental interval, space available for cord, and basion axial interval were measured on all films. The Weisel-Rothman measurement was made in the FEL series. Clinical outcome of those with abnormal measurements were reviewed. Sensitivity, specificity, and positive and negative predictive values of NUL and FEL radiographs for identifying clinically significant cervical spine instability were calculated. RESULTS A total of 240 cervical spine series in 213 patients with Down syndrome between the ages of 4 months and 25 years were reviewed. One hundred seventy-two children had an NUL view, and 88 of these patients also had FEL views. Only one of 88 patients was found to have an abnormal atlanto-dental interval (≥6 mm), space available for cord at C1 (≤14 mm), or basion axial interval (>12 mm) on an FEL series that did not have an abnormal measurement on the NUL radiograph. This patient had no evidence of cord compression or myelopathy. CONCLUSIONS Obtaining a single NUL radiograph is an efficient method for radiographic screening of cervical spine instability. Further evaluation may be required if abnormal measurements are identified on the NUL radiograph. We also propose new "normal" values for the common radiographic measurements used in assessing risk of cervical spine instability in patients with Down syndrome. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedics, Department of Surgery, The Hospital for Sick Children, University of Toronto, 555 University Avenue, m/s S107, Toronto, ON, M5G1X8, Canada.
| | - Jennifer M Bauer
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA, 98105, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA, 98105, USA
| | - Walter F Krengel
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA, 98105, USA; Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
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13
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Bayomy AF, Bompadre V, Schmale GA. The Impact of Transphyseal Anterior Cruciate Ligament Reconstruction on Lower Extremity Growth and Alignment. Arthroscopy 2019; 35:940-949. [PMID: 30733028 DOI: 10.1016/j.arthro.2018.10.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of transphyseal anterior cruciate ligament (ACL) reconstruction on lower extremity radiographic growth and alignment. METHODS We retrospectively reviewed patients who underwent transphyseal ACL reconstruction and were followed to skeletal maturity or at least 2 years, with the nonoperative limb used as an internal control. Changes in coronal plane alignments and tibial slope of the operative limb were compared with a Wilcoxon test. Associations among sex, tunnel, and graft characteristics and failure; changes in coronal plane measures and tunnel size; and tunnel angles and the development of deformity were examined by χ-square and correlation coefficients. RESULTS Fifty-nine patients (41 boys and 18 girls) underwent surgery at a mean age of 12.5 years (range, 6.8-16.0 years). There were differences in changes in the mechanical lateral distal femoral angle comparing operative and nonoperative limbs (decreased 1.1° in girls and 1.9° in boys ≤13 years of age, P = .0008 and .025, respectively) and in changes in tibial slope of the operative limb (decreased 2.1° in male patients >13 years, P = .012). No patient developed a new limb length difference >1 cm. Two boys were treated for deformities. Eight additional patients developed >5° difference in alignment for a rate of radiologic deformity of 10 of 59 or 17%. Neither graft failure nor the presence of deformity was associated with sex, tunnel size, mode of femoral tunnel positioning, inclination of tunnels, or the use of allograft. CONCLUSIONS Radiographically evident limb deformities following transphyseal ACL reconstruction occurred at a rate of 17%, although these deformities were clinically evident in only 5% of patients. Tunnels intersecting physes near cortical margins may increase the risk of developing deformity. Regular follow-up should include alignment radiographs to detect deformities despite the clinical appearance of neutral limb alignment. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Ahmad F Bayomy
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A.; Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A.; Department of Orthopedic Surgery, Columbia University Children's Hospital of New York-Presbyterian, New York, New York, U.S.A
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Gregory A Schmale
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A..
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14
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Saper MG, Fantozzi P, Bompadre V, Racicot M, Schmale GA. Return-to-Sport Testing After Medial Patellofemoral Ligament Reconstruction in Adolescent Athletes. Orthop J Sports Med 2019; 7:2325967119828953. [PMID: 30854403 PMCID: PMC6399765 DOI: 10.1177/2325967119828953] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Return to sport (RTS) after patellar stabilization surgery involves the return of strength and dynamic knee stability, which can be assessed using isometric strength and functional performance testing. Purpose To investigate the results of isometric strength and functional RTS testing between the surgical and uninvolved limbs in adolescent patients who underwent medial patellofemoral ligament (MPFL) reconstruction for patellar instability. Study Design Case series; Level of evidence, 4. Methods A retrospective review of adolescent patients who underwent MPFL reconstruction identified 28 patients (20 female, 8 male) who also underwent isometric and functional RTS testing. Data were compared with the uninvolved limb. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences in peak torque were compared using the Wilcoxon signed-rank test. Correlations were examined between dependent and independent variables using the Spearman correlation. Results The mean age of the patients was 14.9 years (range, 12-16 years). Reconstruction was performed with a hamstring autograft in 17 (60.7%) patients. Concomitant tibial tubercle osteotomy was performed in 10 (35.7%) patients. Testing was performed at a mean 7.4 months (range, 5.5-11.9 months) postoperatively. The mean LSIs for quadriceps and hamstring strength were 85.3% and 95.1%, respectively. For knee extension, there was a statistically significant difference between isometric peak torque measured in the surgical and uninvolved limbs (P = .001). Only 32.0% of patients passed all 4 hop tests. Also, 63.0% of patients achieved an anterior reach asymmetry of <4 cm on the Lower Quarter Y-Balance Test (YBT-LQ). There were no statistically significant differences in isometric strength testing, hop tests, or the YBT-LQ based on graft type or concomitant procedures. There was no correlation between isometric strength and performance on the YBT-LQ or hop tests. Conclusion Adolescent athletes undergoing MPFL reconstruction may need prolonged rehabilitation programs beyond 8 months to allow the adequate recovery of muscle strength for safe RTS. There is a significant deficit in isometric quadriceps strength in the surgical limb after surgery. Further investigation is needed to determine safe RTS criteria after MPFL reconstruction in the pediatric and adolescent population.
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Affiliation(s)
- Michael G Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | | | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Mimi Racicot
- Department of Rehabilitation Medicine, Seattle Children's, Seattle, Washington, USA
| | - Gregory A Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA.,Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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15
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Abstract
PURPOSE Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction. METHODS A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope. RESULTS Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator's measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator's measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs. CONCLUSIONS Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- G. A. Schmale
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Correspondence should be sent to Gregory A. Schmale, MD, Department of Orthopedics and Sports Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, MS-OA.931, Seattle, Washington 98105, USA. E-mail:
| | - A. F. Bayomy
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA,Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - A. O. O’Brien
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA,Department of Orthopaedics & Sports Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - V. Bompadre
- Department of Orthopedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA
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16
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Savarirayan R, Bompadre V, Bober MB, Cho TJ, Goldberg MJ, Hoover-Fong J, Irving M, Kamps SE, Mackenzie WG, Raggio C, Spencer SS, White KK. Best practice guidelines regarding diagnosis and management of patients with type II collagen disorders. Genet Med 2019; 21:2070-2080. [PMID: 30696995 DOI: 10.1038/s41436-019-0446-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/16/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Skeletal dysplasias comprise a heterogeneous group of inherited disorders of development, growth, and maintenance of the human skeleton. Because of their relative rarity and wide phenotypic variability, patients should be accurately identified, uniformly assessed, and managed by clinicians who are aware of their potential complications and possess the knowledge and resources to treat them effectively. This study presents expert guidelines developed to improve the diagnosis and management of patients with type II collagen skeletal disorders to optimize clinical outcomes. METHODS A panel of 11 multidisciplinary international experts in the field of skeletal dysplasia participated in a Delphi process, which comprised analysis of a thorough literature review with subsequent generation of 26 diagnosis and care recommendations, followed by two rounds of anonymous voting with an intervening face-to-face meeting. Those recommendations with more than 80% agreement were considered as consensual. RESULTS After the first voting round, consensus was reached to support 12 of 26 (46%) statements. After the panel discussion, the group reached consensus on 22 of 24 revised statements (92%). CONCLUSIONS Consensus-based, expert best practice guidelines developed as a standard of care to assist accurate diagnosis, minimize associated health risks, and improve clinical outcomes for patients with type II collagen skeletal dysplasias.
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Affiliation(s)
- Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, University of Melbourne, VIC, Parkville, Australia.
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Michael B Bober
- Division of Genetics, Nemours A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Michael J Goldberg
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Julie Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Melita Irving
- Department of Clinical Genetics, Guy's and St Thomas NHS, London, UK
| | - Shawn E Kamps
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - William G Mackenzie
- Department of Orthopedic Surgery, Nemours A.I. duPont Hospital for Children, Wilmington, DE, USA
| | - Cathleen Raggio
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samantha S Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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17
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White KK, Bompadre V, Shah SA, Redding GJ, Krengel WF, Mackenzie WG. Early-Onset Spinal Deformity in Skeletal Dysplasias: A Multicenter Study of Growth-Friendly Systems. Spine Deform 2019; 6:478-482. [PMID: 29886923 DOI: 10.1016/j.jspd.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Severe, early-onset spinal deformity is common in patients with skeletal dysplasia. These deformities often present at young ages and are associated with significant pulmonary dysfunction. The objective of this study is to verify the effectiveness of growth-friendly spinal instrumentation systems in promoting growth in patients with skeletal dysplasia and early-onset kyphoscoliosis. METHODS A retrospective, multicenter comparative cohort study was performed. Twenty-three patients identified to have a skeletal dysplasia (SKD) were evaluated for diagnosis, age at treatment, gender, and type of growing rod construct (spine vs. rib constructs). Patients were matched by age and construct type with similarly treated patients with early-onset scoliosis (CON) without skeletal dysplasia. Radiographic parameters including maximum coronal and sagittal Cobb angle with levels, T1-S1 height, and T1-T12 height were measured. RESULTS T1-T12 (12.8 vs. 15.2 cm, p = .01) and T1-S1 (21.2 vs. 24.5 cm, p = .05) heights were significantly shorter for the SKD group at implantation, and kyphosis tended to be more severe in children with SKD (p = .80 and .07, respectively). Kyphosis did not improve with treatment. Scoliosis improved (p < .01), and ΔT1-T12 and ΔT1-S1 significantly increased in both groups (p < .01). Complication rates were similar between the two groups; however, patients with SKD had more intraoperative monitoring changes and hardware failures (p < .005). CONCLUSION Although patients with SKD start with shorter spine lengths, gains in spine length appear to be comparable to other forms of EOS. Neuromonitoring changes and implant failures are more common in the SKD group. SIGNIFICANCE The effectiveness of growth-friendly techniques in promoting growth in early-onset spinal deformities in patients with skeletal dysplasia has not been previously studied. We report the first comprehensive review of this topic. Growth-friendly techniques are an appropriate treatment option in this patient population.
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Affiliation(s)
- Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA 98105, USA; Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA 98105, USA
| | - Suken A Shah
- Department of Orthopedic Surgery, Nemours Alfred I. DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Gregory J Redding
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way, OC.7.720, Seattle, WA 98105, USA
| | - Walter F Krengel
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way OA.9.120, Seattle, WA 98105, USA; Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - William G Mackenzie
- Department of Orthopedic Surgery, Nemours Alfred I. DuPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
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Savarirayan R, Rossiter JP, Hoover-Fong JE, Irving M, Bompadre V, Goldberg MJ, Bober MB, Cho TJ, Kamps SE, Mackenzie WG, Raggio C, Spencer SS, White KK. Best practice guidelines regarding prenatal evaluation and delivery of patients with skeletal dysplasia. Am J Obstet Gynecol 2018; 219:545-562. [PMID: 30048634 DOI: 10.1016/j.ajog.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skeletal dysplasia comprises a heterogeneous and collectively common group of inherited disorders of development, growth, and maintenance of the human skeleton. There is potential for increased perinatal morbidity and mortality in pregnant women who themselves have skeletal dysplasia, and for affected fetuses where skeletal dysplasia is suspected in utero. OBJECTIVE We sought to establish guidelines for perinatal health care professionals who should be aware of these risks, to optimize maternal and child health pregnancy outcomes through best prenatal and delivery management practices. STUDY DESIGN A panel of 13 multidisciplinary international experts participated in a Delphi process, which comprised consideration of thorough literature review and a list of 54 possible care recommendations subject to 2 rounds of anonymous voting and a face-to-face meeting. Those recommendations with >80% agreement were considered as consensual. RESULTS During the first round, consensus was reached to support 30 out of the 54 statements. After the panel discussion, the group reached consensus on 40 statements. These statements include guidelines for the evaluation and treatment of pregnant women with skeletal dysplasia and for the unborn child with or suspected to have skeletal dysplasia. CONCLUSION Consensus-based best practice guidelines are provided as a minimum of standard care to minimize associated health risks, and improve clinical outcomes for patients with skeletal dysplasia.
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Abstract
PURPOSE Paediatric hand injuries are a frequent reason for acute medical evaluation. Previous studies have reported only fracture rates, surgical injuries or are limited to database diagnosis coding. The average fracture rates and injury distributions across the hand for all mechanical injuries have not been well-described. METHODS We performed a retrospective review of all emergent/urgent care visits over 18 months at a US paediatric tertiary hospital with hand injuries recorded anywhere in the encounter. Patient, injury and encounter details were recorded with additional imaging review, categorized and described. RESULTS A total of 523 patient visits (0.64% of all encounters) were for mechanical hand trauma. The injury mechanism was 42% crush, 19% jammed, 12% impact, 12% fall on outstretched hand, 7% hyperextension and 8% other/unclear. Crush was responsible for 80% of injuries in patients aged 0 to six years old but only 17% in patients aged 13 to 18 years. Crush resulted in fractures only 26% of the time, while other mechanisms were more likely to fracture (33% to 87%). Border digits were injured more often than others (21% to 23% versus 13% to 17%), and were most commonly fractured in the proximal phalanx (57% to 67% versus 22% to 34% for non-border digits). Providers correctly coded for basic fracture presence in 89.1% of injuries, but 53% of codes were not finger or laterality-specific, and only 15% specified a bony segment demonstrating that International Classification of Diseases-9 coding was nonspecific for injury patterns. CONCLUSION Patients with paediatric hand injuries frequently utilize emergency care and understanding the basic patterns of injury can guide resource utilization and future studies on optimal treatment algorithms in this setting. LEVEL OF EVIDENCE IV, Prognostic, Case Series.
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Affiliation(s)
- R. F. Gibly
- Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA, USA
| | - T. Shomaker
- Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - V. Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - S. E. Steinman
- Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, Seattle, WA, USA, Correspondence should be sent to S. E. Steinman, MD, Department of Orthopaedics and Sports Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105-5371, USA. E-mail:
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20
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Saper M, Shung J, Pearce S, Bompadre V, Andrews JR. Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players. Orthop J Sports Med 2018; 6:2325967118769328. [PMID: 29780844 PMCID: PMC5954308 DOI: 10.1177/2325967118769328] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied. Purpose/Hypothesis: The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire. Results: The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball. Conclusion: UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.
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Affiliation(s)
- Michael Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Joseph Shung
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Stephanie Pearce
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - James R Andrews
- Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, USA
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White KK, Bompadre V, Goldberg MJ, Bober MB, Cho TJ, Hoover-Fong JE, Irving M, Mackenzie WG, Kamps SE, Raggio C, Redding GJ, Spencer SS, Savarirayan R, Theroux MC. Best practices in peri-operative management of patients with skeletal dysplasias. Am J Med Genet A 2017; 173:2584-2595. [DOI: 10.1002/ajmg.a.38357] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/20/2017] [Accepted: 06/18/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Klane K. White
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Michael J. Goldberg
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Michael B. Bober
- Division of Genetics; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics; Seoul National University Children's Hospital; Seoul South Korea
| | - Julie E. Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine; Johns Hopkins University; Baltimore Maryland
| | - Melita Irving
- Department of Clinical Genetics; Guy's and St Thomas NHS; London United Kingdom of Great Britain and Northern Ireland
| | - William G. Mackenzie
- Department of Orthopedic Surgery; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Shawn E. Kamps
- Department of Radiology; Seattle Children's Hospital; Seattle Washington
| | - Cathleen Raggio
- Department of Orthopedic Surgery; Hospital for Special Surgery; New York New York
| | - Gregory J. Redding
- Division of Pulmonary Medicine; Seattle Children's Hospital; Seattle Washington
| | - Samantha S. Spencer
- Department of Orthopedic Surgery; Boston Children's Hospital; Boston Massachusetts
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services; Murdoch Children's Research Institute, University of Melbourne, Parkville; Victoria Australia
| | - Mary C. Theroux
- Department of Anesthesia; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
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22
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Abstract
PURPOSE Early detection and intervention for developmental dysplasia of the hip (DDH) is important for normal hip development. Previous studies have shown disparities in access to paediatric specialty care among different racial and socioeconomic backgrounds. This study aims to identify whether these factors are related to timely referral for infants with DDH. METHODS A retrospective cohort study of patients seen and treated for DDH between July 2006 and June 2011 at a single institution were reviewed. The patients were divided into early-presenting (seen before six months of age) and late-presenting patients (seen at six months of age or later). RESULTS A total of 457 patients met the eligibility criteria. There were 378 early and 79 late presentations. Late presentations were significantly more likely to be vertex at birth (85% vs 41%, p < 0.001). Bivariate analysis also demonstrated that late presentations were more likely to be non-white (65% vs 45%, p = 0.004), non-English speaking (20% vs 8%, p = 0.003), from lower income areas ($70 769 vs $61 591, p < 0.001) and hold public insurance (25%, p = 0.001). However, a logistic multiple regression analysis showed that only vertex birth presentation (p = 0.000), absent family history of DDH (p = 0.047) and affected right side (p = 0.001) were significantly associated with late presentation. CONCLUSION Despite screening algorithms to facilitate early diagnosis of infants with DDH, better research is needed to understand how different demographic and socioeconomic factors play into the delayed access to paediatric orthopaedic care for DDH so that we may ultimately improve rates of early treatment.
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Affiliation(s)
- A. W. Lindberg
- Seattle Children’s Hospital – Department of Orthopaedics and Sports Medicine, 4800 Sandpoint Way NE M/S MB.10.620, Seattle, WA 98105, USA,University of Washington – Department of Orthopaedics and Sports Medicine, Seattle, Washington, USA,Correspondence should be sent to: Dr A. W. Lindberg, Seattle Children’s Hospital, 4800 Sandpoint Way NE M/S MB.10.620, Seattle, WA 98105, USA. E-mail:
| | - V. Bompadre
- University of Washington – Department of Orthopaedics and Sports Medicine, Seattle, Washington, USA
| | - E. K. Satchell
- University of Pennsylvania Perelman School of Medicine – Department of Psychiatry, Center for Neuromodulation in Depression and Stress, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, USA
| | - A. C. R. Larson
- Cincinnati Children’s Hospital Medical Center – Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA
| | - K. K. White
- Seattle Children’s Hospital – Department of Orthopaedics and Sports Medicine, 4800 Sandpoint Way NE M/S MB.10.620, Seattle, WA 98105, USA,University of Washington – Department of Orthopaedics and Sports Medicine, Seattle, Washington, USA
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23
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Gundle KR, Bhatt EM, Punt SE, Bompadre V, Conrad EU. Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort. Open Orthop J 2017; 11:486-492. [PMID: 28694887 PMCID: PMC5481615 DOI: 10.2174/1874325001711010486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/18/2017] [Accepted: 02/23/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC. METHODS Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center. RESULTS The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute. CONCLUSION A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments. LEVEL OF EVIDENCE Level IV retrospective cohort study.
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Affiliation(s)
- Kenneth R Gundle
- Oregon Health & Science University, Department of Orthopaedics & Rehabilitation, Portland, USA.,Portland VA Medical Center, Operative Care Division, Portland, USA
| | - Etasha M Bhatt
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Stephanie E Punt
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Viviana Bompadre
- Department of Orthopaedics & Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ernest U Conrad
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, Seattle, Washington, USA.,Department of Orthopaedics & Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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24
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Bompadre V, Mattioli-Lewis T, Yassir WK, Goldberg MJ. A comparison of the functional health of children with Costello syndrome in 1999 and in 2015. Am J Med Genet A 2017; 173:1792-1795. [PMID: 28488342 DOI: 10.1002/ajmg.a.38262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/27/2017] [Indexed: 11/11/2022]
Abstract
Costello Syndrome is a rare congenital condition characterized by failure-to-thrive, cardiac abnormalities, distinctive facial features, predisposition to malignant tumors, and developmental delay. In 1999, we analyzed the functional health in a cohort of 18 patients. Since then, a mutation in the HRAS gene has been found to be causative, medical management has been refined, and the level of awareness has increased. The purpose of this study is to compare the functional health outcomes from the 1999 cohort with data prospectively collected from a comparable cohort in 2015. The Pediatric Outcome Data Collection Instrument (PODCI) was administered to parents of children with Costello syndrome during the 2015 International Costello Syndrome Conference. The same instrument and setting were used in the 1999 study. We compared functional health scores from the two groups. A total of 21 participants were included in the 2015 cohort; 15 females (71%) and 6 males (29%). Average age was 5.8 years (range 2-16). When comparing functional health outcomes, we found that the 2015 cohort scored slightly higher in Upper Extremity and Physical Function (57 vs. 54) and Comfort scales (86 vs. 82). However, there was no significant difference in any of the PODCI scales between the two groups. When compared with normative scores, both groups scored significantly lower in every scale except for happiness (p = 0.2952). Despite recent advancements, functional health outcomes in 2015 were similar to those measured in a different cohort in 1999.
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Affiliation(s)
| | | | - Walid K Yassir
- Wayne State University School of Medicine, Detroit, Michigan.,Children's Hospital of Michigan, Detroit, Michigan
| | - Michael J Goldberg
- Seattle Children's Hospital, Seattle, Washington.,University of Washington, Seattle, Washington
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25
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Telleria JJM, Cotter RA, Bompadre V, Steinman SE. Laboratory predictors for risk of revision surgery in pediatric septic arthritis. J Child Orthop 2016; 10:247-54. [PMID: 27174186 PMCID: PMC4909651 DOI: 10.1007/s11832-016-0736-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 04/17/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Reported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not. METHODS The medical records for 105 children who underwent operative management of septic arthritis were retrospectively reviewed. Single and multivariate analyses were performed. RESULTS Eighty-four children required one surgical intervention [mean age 5.18 years (±4.01); 38 females (45 %), 46 males (55 %)], 21 children required revision surgery [mean age 8.16 years (±4.54); 4 females (19 %), 17 males (81 %)], and the overall rate of revision surgery was 20 %. Delayed diagnosis (p = 0.015), elevated CRP at presentation (p = 0.000), positive blood culture (p = 0.000), and age (p = 0.009) were all associated with revision surgery in bivariate analysis. In multivariate analysis, CRP at presentation and positive blood culture were significant risk factors for revision surgery (p = 0.005 and p = 0.025, respectively). Additionally, markedly elevated CRP levels on post-operative days (POD) 1-4 were each independently significant risk factors for requiring multiple surgeries (all p < 0.000). Fever, elevated erythrocyte sedimentation rate, and leukocyte count were not risk factors for multiple surgeries. CONCLUSIONS In this study, a positive blood culture or marked elevation in CRP at presentation or on POD 1-4 were associated with revision surgery. These findings may help improve surgical planning for both the initial surgery in order to avoid revisions, as well as revision surgery, should it be indicated. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jessica J. M. Telleria
- Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
| | - Rosemary A. Cotter
- Department of Orthopaedics and Sports Medicine, OA.9.120.1—Orthopedics Administration, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, OA.9.120.1—Orthopedics Administration, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Suzanne E. Steinman
- Department of Orthopaedics and Sports Medicine, OA.9.120.1—Orthopedics Administration, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
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26
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Walker BJ, Schmale GA, McCreary F, McFadyen JG, Bompadre V, Flack SH, Bosenberg AT. Regional anesthesia for anterior cruciate ligament reconstruction in adolescents. Paediatr Anaesth 2016; 26:668-9. [PMID: 27119304 DOI: 10.1111/pan.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin J Walker
- Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, WI, USA.
| | - Gregory A Schmale
- Department of Orthopedic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - J Grant McFadyen
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Viviana Bompadre
- Department of Orthopedic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sean H Flack
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Adrian T Bosenberg
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
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27
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White KK, Savarirayan R, Goldberg MJ, MacKenzie W, Bompadre V, Bober MB, Cho TJ, Hoover-Fong J, Parnell SE, Raggio C, Spencer SA, Campbell JW, Rapoport DM, Kifle Y, Blackledge M. Response: “Best practices in the evaluation and treatment of foramen magnum stenosis in achondroplasia during infancy” and “is there a correlation between sleep disordered breathing and foramen magnum stenosis in children with achondroplasia?”. Am J Med Genet A 2016; 170A:1101-3. [DOI: 10.1002/ajmg.a.37546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/22/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Klane K. White
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services Murdoch Children's Research Institute University of Melbourne; Parkville Victoria Australia
| | - Michael J. Goldberg
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - William MacKenzie
- Department of Orthopedic Surgery; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine; Seattle Children's Hospital; Seattle Washington
| | - Michael B. Bober
- Division of Genetics; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics; Seoul National University Children's Hospital; Seoul Republic of Korea
| | - Julie Hoover-Fong
- McKusick-Nathans Institute of Genetic Medicine; Johns Hopkins University; Baltimore Maryland
| | - Shawn E. Parnell
- Department of Radiology; Seattle Children's Hospital; Seattle Washington
| | - Cathleen Raggio
- Department of Orthopedic Surgery; Hospital for Special Surgery; New York New York
| | - Samantha A. Spencer
- Department of Orthopedic Surgery; Boston Children's Hospital; Boston Massachusetts
| | - Jeffery W. Campbell
- Department of Neurosurgery; Nemour's Alfred I du Pont Hospital for Children; Wilmington Delaware
| | - David M. Rapoport
- Division of Pulmonary Medicine; New York University School of Medicine; New York New York
| | - Yemiserach Kifle
- Division of Pulmonary Medicine; Seattle Children's Hospital; Seattle Washington
| | - Marcella Blackledge
- Division of Pulmonary Medicine; Seattle Children's Hospital; Seattle Washington
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28
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Ng VY, Jones R, Bompadre V, Louie P, Punt S, Conrad EU. The effect of surgery with radiation on pelvic Ewing sarcoma survival. J Surg Oncol 2015; 112:861-5. [PMID: 26525492 DOI: 10.1002/jso.24081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/17/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) has poorer outcomes than extremity-based lesions and the method of local control is controversial. METHODS A retrospective review was performed of 40 primary pelvic or sacral ES treated by a single surgeon. All received modern chemotherapy and those that received radiation were treated with modern dosages. RESULTS Fifty-five percent were disease-free at latest follow-up (median, 83.1 mos). Sixty-one percent had ≥ 99% necrosis, which was associated with 65% disease-free survival. Larger size (P = 0.016) and the absence of metastatic disease (P = 0.005) was predictive of survival. Eighty-three percent of relapsed patients were DOD. Half of patients who received surgery alone or RT alone have NED while 57% of those who received S/RT have NED. Complication rates were 69% (S/RT), 75% (surgery alone), 10% (RT alone). Functional outcomes were similar. CONCLUSION Primary pelvic ES is localized at presentation in 50% and the absence of metastases is the strongest predictor for survival. Chemotherapy is key, but excellent histologic response is neither a guarantee nor a necessity for survival. More than one-third die despite an excellent histologic response and at least one-third with lung metastases survive. With chemotherapy, radiation, and surgery, reasonable control of disease can be achieved. LEVEL OF EVIDENCE III Case-control or retrospective cohort study.
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Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - Robin Jones
- Sarcoma Unit Royal Marsden Hospital, London, United Kingdom
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Philip Louie
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Stephanie Punt
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Ernest U Conrad
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
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29
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White KK, Bompadre V, Goldberg MJ, Bober MB, Campbell JW, Cho TJ, Hoover-Fong J, Mackenzie W, Parnell SE, Raggio C, Rapoport DM, Spencer SA, Savarirayan R. Best practices in the evaluation and treatment of foramen magnum stenosis in achondroplasia during infancy. Am J Med Genet A 2015; 170A:42-51. [PMID: 26394886 DOI: 10.1002/ajmg.a.37394] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/31/2015] [Indexed: 11/08/2022]
Abstract
Achondroplasia is the most common inherited disorder of bone growth (skeletal dysplasia). Despite this fact, consistent and evidence-based management approaches to recognized, life-threatening complications, such as foramen magnum stenosis, are lacking. This study aims to outline best practice, based on evidence and expert consensus, regarding the diagnosis, assessment, and management of foramen magnum stenosis in achondroplasia during infancy. A panel of 11 multidisciplinary international experts on skeletal dysplasia was invited to participate in a Delphi process. They were: 1) presented with a list of 26 indications and a thorough literature review, 2) given the opportunity to anonymously rate the indications and discuss in face to face discussion; 3) edit the list and rate it in a second round. Those indications with more than 80% agreement were considered as consensual. After two rounds of rating and a face-to-face meeting, consensus was reached to support 22 recommendations for the evaluation and treatment of foramen magnum stenosis in infants with achondroplasia. These recommendations include indications for surgical decompression, ventriculomegaly, and hydrocephalus, sleep-disordered breathing, physical exams and the use of polysomnography and imaging in this condition. We present a consensus-based best practice guidelines consisting of 22 recommendations. It is hoped that these guidelines will lead to more uniform and structured evaluation, standardizing care pathways, and improving mortality and morbidity outcomes for this cohort.
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Affiliation(s)
- Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Michael J Goldberg
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Michael B Bober
- Division of Genetics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jeffrey W Campbell
- Department of Neurosurgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William Mackenzie
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Shawn E Parnell
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Cathleen Raggio
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - David M Rapoport
- Division of Pulmonary Medicine, New York University School of Medicine, New York, New York
| | - Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
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30
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White KK, Parnell SE, Kifle Y, Blackledge M, Bompadre V. Is there a correlation between sleep disordered breathing and foramen magnum stenosis in children with achondroplasia? Am J Med Genet A 2015; 170A:32-41. [PMID: 26394798 DOI: 10.1002/ajmg.a.37385] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 08/31/2015] [Indexed: 11/10/2022]
Abstract
Children with achondroplasia have midface hypoplasia, frontal bossing, spinal stenosis, rhizomelia, and a small foramen magnum. Central sleep apnea, with potential resultant sudden death, is thought to be related to compression of the spinal cord at the cervicomedullary junction in these patients. Screening polysomnography and/or cervical spine MRI are often performed for infants with achondroplasia. Decompressive suboccipital craniectomy has been performed in selected cases. We aim to better delineate the relationship between polysomnography, cervical spine MRI, and indications for surgical decompression in achondroplasia.We retrospectively review electronic medical records of all children with achondroplasia in our IRB-approved skeletal dysplasia registry who had received screening polysomnography and cervical spine MRI examination was performed. We explored correlations of polysomnography, MRI parameters, and need for decompressive surgery. Seventeen patients with both polysomnography and MRI of the cervical spine met inclusion criteria. The average age at time of the sleep study was 2.4 ± 3.6 years. An abnormal apnea-hypopnea index was found in all patients, with central sleep apnea found in 6/17. Five patients (29%) required foramen magnum decompression. We found no statistically significant correlation between central sleep apnea and abnormal MRI findings suggestive of foramen magnum stenosis. Screening polysomnography is an important tool but does not appear to correlate with MRI findings of foramen magnum stenosis. Cord compression, with either associated T2 cord signal abnormality or clinical findings of clonus, was most predictive of subsequent surgical decompression.
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Affiliation(s)
- Klane K White
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Shawn E Parnell
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Yemiserach Kifle
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Marcella Blackledge
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington
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31
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Schmale GA, Bompadre V. Aspirations of the ilium and proximal femur increase the likelihood of culturing an organism in patients with presumed septic arthritis of the hip. J Child Orthop 2015; 9:313-8. [PMID: 26169257 PMCID: PMC4549341 DOI: 10.1007/s11832-015-0669-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/27/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To test the hypothesis that collecting material for culture from metaphyseal bone of the ilium and proximal femur at the time of a hip aspiration will increase the sensitivity to detect an infectious organism in patients with presumed septic arthritis of the hip. METHODS We retrospectively reviewed a series of 36 patients with presumed septic arthritis of the hip, based on clinical exam and serum inflammatory markers, who underwent aspirations of hip synovial fluid as well as blood from the ilium and proximal femur. Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection. RESULTS The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included. The specificities were equivalent in both modalities (≥90 %). We conclude that obtaining aspirates of the ilium and proximal femur at the time of hip synovial fluid aspiration increases the likelihood that the procedure will return an infectious organism. CONCLUSION Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment. The child with a septic hip or peri-articular hip infection and positive cultures is likely to receive more narrow-spectrum therapy, potentially decreasing the overuse of broad-spectrum antibiotics. LEVEL OF EVIDENCE DIAGNOSTIC STUDY LEVEL III: Development of diagnostic criteria on the basis of a series of non-consecutive patients (with universally applied reference "gold standard").
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Affiliation(s)
- Gregory A Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OA.9.120, Seattle, WA, 98105, USA,
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32
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Khwaja A, Parnell SE, Ness K, Bompadre V, White KK. Opsismodysplasia: Phosphate Wasting Osteodystrophy Responds to Bisphosphonate Therapy. Front Pediatr 2015; 3:48. [PMID: 26157786 PMCID: PMC4476261 DOI: 10.3389/fped.2015.00048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/14/2015] [Indexed: 01/27/2023] Open
Abstract
UNLABELLED We present two siblings affected with opsismodysplasia (OPS), a rare skeletal dysplasia caused by mutations in the inositol polyphosphate phosphatase-like 1 gene. The skeletal findings include short stature with postnatal onset micromelia, marked platyspondyly, squared metacarpals, delayed skeletal ossification, metaphyseal cupping, and postnatal micromelia. Respiratory compromise, delayed ambulation, and progressive lower extremity deformities are described. The severity of findings is variable. Renal phosphate wasting is associated with severe bone demineralization and a more severe phenotype. This report represents the first described cases of opsismodysplasia treated with intravenous bisphosphonate (pamidronate). Surgical management for lower extremity deformities associated with OPS is also reviewed. LEVEL OF EVIDENCE IV Case series.
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Affiliation(s)
- Ansab Khwaja
- Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington , Seattle, WA , USA
| | - Shawn E Parnell
- Department of Radiology, Seattle Children's Hospital, University of Washington , Seattle, WA , USA
| | - Kathryn Ness
- Division of Endocrinology, Department of Pediatrics, Seattle Children's Hospital, University of Washington , Seattle, WA , USA
| | - Viviana Bompadre
- Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington , Seattle, WA , USA
| | - Klane K White
- Orthopedics and Sports Medicine, Seattle Children's Hospital, University of Washington , Seattle, WA , USA
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33
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Schmale GA, Kweon C, Larson RV, Bompadre V. High satisfaction yet decreased activity 4 years after transphyseal ACL reconstruction. Clin Orthop Relat Res 2014; 472:2168-74. [PMID: 24634094 PMCID: PMC4048436 DOI: 10.1007/s11999-014-3561-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND ACL injuries in preteens and teens are common occurrences. Reconstruction is believed to be optimum treatment for those wishing to return to running, cutting, and jumping sports. Rates of reoperation, satisfaction, and long-term return to and maintenance of preinjury activity after ACL reconstruction in young athletes are important information for physicians, patients, and parents. QUESTIONS/PURPOSES The purposes of this study were to address the following questions in this skeletally immature patient population undergoing ACL reconstruction: (1) What is the reinjury rate and the need for subsequent surgeries? (2) How do patient satisfaction and function as assessed by patient and physician correlate with return to sport? (3) What factors contribute to failure to return to preinjury activity levels? METHODS This is a retrospective review of 29 patients who underwent transphyseal ACL reconstruction using soft tissue grafts passed through open physes and followed to skeletal maturity, and at least 2 years from their index surgery, who were invited and returned for a study interview and examination. Pre- and postinjury activity levels were assessed via the Tegner activity score, satisfaction was determined using a 10-point Likert scale, function was assessed via the Lysholm score and IKDC grade, and an open-ended questionnaire was used for explanations of changes in activity levels. Reoperations were classified as major or minor, determined from a review of the medical records conducted after interview and examination. RESULTS At a minimum followup of 2 years (mean, 4 years; range, 2-8 years), four revision reconstructions and seven minor operations were performed for a reoperation rate of 11 of 29 (38%). Eight of 29 patients (28%) sustained contralateral ACL ruptures. The mean satisfaction score was 9 (range, 4-10) and mean Lysholm score was 91 (range, 61-100). Only 12 of 29 (41%) patients returned to and maintained their preinjury level of sport. High satisfaction correlated with return to prior level of sports, although there was no relationship between function and activity level. Reoperation on the index knee or contralateral ACL tear did not correlate with a change in activity level; rather, most patients who were less active indicated a change in interest with advancing age. CONCLUSIONS Despite high satisfaction and function, less than 50% of patients maintained their preinjury level of play 4 years after ACL reconstruction. Satisfaction correlated significantly with knee function; highly satisfied patients were more likely to return to and maintain their prior level of participation in sports. Contributing factors to decreased activity include changes in lifestyle with increasing age. Reoperation did not correlate with lower activity scores or failure to return to sports. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory A Schmale
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA,
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Schmale GA, Mazor S, Mercer LD, Bompadre V. Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture: A Randomized Controlled Trial. J Bone Joint Surg Am 2014; 96:944-950. [PMID: 24897743 PMCID: PMC4049240 DOI: 10.2106/jbjs.l.01696] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture. METHODS The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group). The ASK-p (Activities Scale for Kids-performance version) and self-assessments of activity were used to assess function at one, nine, fifteen, and twenty-seven weeks after injury. Motion was measured at nine and fifteen weeks after injury by a blinded therapist. Anxiety was measured at one and nine weeks after injury with a self-assessment. Differences in ASK-p scores and anxiety level were analyzed with use of multivariate generalized estimating equations. RESULTS ASK-p scores were significantly better in the no-PT group at nine and fifteen weeks after injury (p = 0.02 and 0.01, respectively) but the difference at twenty-seven weeks was not significant. There were no differences between groups with respect to performance of activities of daily living or time to return to sports. Anxiety at nine weeks was associated with worse ASK-p scores at nine and fifteen weeks in the PT group and with better ASK-p scores in the no-PT group at these time points (p = 0.01 and 0.02, respectively). There were no differences between the groups with respect to elbow motion in the injured arm at any time. Severity of injury had no impact on function or elbow motion in either the PT or the no-PT group. CONCLUSIONS Children undergoing closed treatment of a supracondylar humeral fracture that was limited to approximately three weeks of cast immobilization received no benefit involving either return of function or elbow motion from a short course of physical therapy. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory A. Schmale
- Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children’s Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale:
| | - Suzan Mazor
- Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children’s Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale:
| | - Laina D. Mercer
- Children’s Core for Biomedical Statistics, Seattle Children’s Hospital, 2001 8th Avenue, CW8-5B, Seattle, WA 98121
| | - Viviana Bompadre
- Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children’s Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale:
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Bompadre V, Jinguji TM, Yanez ND, Satchell EK, Gilbert K, Burton M, Conrad EU, Herring SA. Washington State's Lystedt law in concussion documentation in Seattle public high schools. J Athl Train 2014; 49:486-92. [PMID: 24870293 DOI: 10.4085/1062-6050-49.3.30] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT The Lystedt law requires high school athletes who have sustained a concussion to be removed from practice and play and not to be allowed to return until cleared by a medical professional. OBJECTIVE To determine the effect of the Lystedt law on injury and concussion documentation in the Seattle public high schools. DESIGN Cross-sectional study. SETTING Seattle public high schools. PATIENTS OR OTHER PARTICIPANTS The numbers of students, aged 13 to 19 years in the 2008-2009, 2009-2010, and 2010-2011 school years, were 4348, 4925, and 4806, respectively. MAIN OUTCOME MEASURE(S) All injuries documented in SportsWare by athletic trainers in Seattle public high schools. We evaluated all injuries, including concussions recorded during the 2008-2009 school year, before the Lystedt law, and during the 2 school years after the law took effect (2009-2010 and 2010-2011). Incidence rates before and after the law were estimated and compared. RESULTS The concussion rate was -1.09% in 2008-2009, 2.26% in 2009-2010, and 2.26% in 2010-2011. A comparison of relative risks showed that the incidence rates of concussions were different before and 1 year after the Lystedt law (relative risk = 2.10; 95% confidence interval [CI] = 1.50, 2.93) and 2 years after the law (relative risk = 2.10; 95% CI = 1.49, 2.93). Overall, the mean number of days out of play after 2008-2009 was almost 7 days greater after the law took effect (difference = 6.9 days; 95% CI = 0.70, 13.1). For females, the mean number of days out of play after 2008-2009 was more than 17 days in 2009-2010 (difference = 17.2 days; 95% CI = 4.81, 29.5) and was more than 6 days in 2010-2011 (difference = 6.3 days; 95% CI = 1.62, 11.0). CONCLUSIONS The number of documented concussions more than doubled after the institution of the Lystedt law, which may be attributed to heightened awareness and closer monitoring.
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Affiliation(s)
- Viviana Bompadre
- Orthopedics and Sports Medicine, Seattle Children's Hospital, WA
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Krengel WF, Wiater BP, Pace JL, Jinguji TM, Bompadre V, Stults JK, Schmale GA. Does using the medial or lateral humeral line improve reliability of Baumann angle measurement on plain x-ray? The effect of humeral length visualized on the x-ray. J Pediatr Orthop 2012; 32:373-7. [PMID: 22584838 DOI: 10.1097/bpo.0b013e318251969f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Baumann angle (BA) is a common measure of coronal plane alignment of the distal humerus. We hypothesize that the reliability of measuring BA would be improved by using the medial and lateral cortical margins of the humerus seen on plain x-ray, rather than the estimated central humeral line, which is the "standard" technique. Further, we analyze whether the amount of humerus visible on the film improves the reliability of the method. METHODS A total of 71 anteroposterior elbow digital radiographs from patients aged 0 to 12 were measured 3 times by 5 qualified observers. Each digital measurement included (1) BA using the estimated central humeral line; (2) BA using the medial humeral line (BA-MHL); and (3) BA using the lateral humeral line (BA-LHL). Inadequate radiographs or those showing any indication of current or previous fracture were excluded. Intraobserver reliability was estimated for each rater using a 1-way analysis of variance model and interobserver reliability of each set of measurements was estimated using a 2-way analysis of variance. RESULTS The mean and SD for the BA, BA-MHL, and BA-LHL in females were 70.0 (6.73), 68.0 (6.84), and 72.3 (7.93), respectively, and for males 73.0 (5.22), 70.0 (5.56), and 76.0 (6.18), respectively. Intraobserver reliability (intraclass correlation coefficient) for BA, BA-MHL, and BA-LHL averaged 0.85, 0.92, and 0.90, respectively. Average interobserver reliability (intraclass correlation coefficient) for BA, BA-MHL, and BA-LHL were 0.79, 0.71, and 0.76, respectively. Intraobserver and interobserver reliability of BA and BA-LHL were significantly improved when at least 7 cm of humerus was visible on the x-ray, as compared with <7 cm visible. CONCLUSIONS Intrarater reliability is better for both BA-LHL and BA-MHL than for standard BA (using the estimated central humeral axis). Interrater reliability was best using standard BA. Reliability of all methods is improved when >7 cm of the distal humerus is visible on the radiograph. In addition, at least 7 cm of the distal humerus on anteroposterior radiographs improves reliability of measuring BA. LEVEL OF EVIDENCE Diagnostic study-Level II.
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Affiliation(s)
- Walter F Krengel
- Department of Orthopedics and Sports Medicine, Seattle Children's and University of Washington, WA 98145-5005, USA.
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Jinguji TM, Bompadre V, Harmon KG, Satchell EK, Gilbert K, Wild J, Eary JF. Sport Concussion Assessment Tool-2: baseline values for high school athletes. Br J Sports Med 2012; 46:365-70. [PMID: 22228554 DOI: 10.1136/bjsports-2011-090526] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Concussion head injuries are common in high school athletes. The Sport Concussion Assessment Tool-2 (SCAT2) has been recommended and widely adopted as a standardised method of evaluating an injured athlete with a suspected concussion. Sideline return to play decisions can hinge on the results of a SCAT2 score. However, most athletes will not have had baseline testing performed for comparison if injury occurs. Therefore, establishing of age-, sex- and sport-matched normative data for the high school athlete population is critical. PURPOSE To determine baseline scores in all SCAT2 domains among high school athletes with no prior history of a concussion and to examine subgroup differences for girls and boys, age and sport to establish normative ranges. MATERIALS AND METHODS The SCAT2 was administered to 214 high school athletes (155 males and 59 females) who participated in football, women's soccer, men's basketball, gymnastics, baseball, softball and track with no prior history of concussion. There were 111 athletes in the 13-15-year-old cohort and 103 in the 16-19-year-old group with a mean age of 15.7 years of age. In all SCAT2 domains the mean and SD of the results were determined. The domains were analysed using age, sex and sport as covariates. Component parts of the cognitive (concentration) domain (digit sequencing and months of year in reverse order) were also analysed by age, sex and sport. The percentage of high school athletes able to perform each digit-sequencing test was calculated as was the percentage of participants who could recite the months of the year in reverse order. RESULTS The average SCAT2 score for these high school athletes was 89 of a possible 100 with a SD of 6 units. Athletes reported two or three symptoms at baseline with older students reporting more symptoms than younger ones. The average balance score was 25.82 (of 30), and all athletes were able to complete the double-leg stance. Females scored significantly higher on the balance, immediate memory and concentration scores. Concentration scores in non-concussed high school athletes were low. Only 67% of high school athletes could recite the months of the year backward and only 41% could correctly sequence 5 digits backward. Only 55% of high school football players could correctly recite the months of the year backward and 32% could sequence 5 digits. CONCLUSIONS Non-concussed high school athletes scored near the total possible in most domains of the SCAT2 with the exception of concentration testing and balance testing. All athletes were able to complete the double-leg stance at baseline; however, there was significant variability of tandem and single-leg stance. Baseline testing is important when considering balance tests. Concentration testing in high school athletes is unreliable because of high baseline error and is likely to result in a high rate of false positives and false negatives. Return to play decisions should not rely on concentration testing without a baseline test for comparison.
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Affiliation(s)
- Thomas M Jinguji
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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