bluuebunny/crossref_metadata_2025 huggingface dataset:
Biologics and severe asthma in children
Authors: Saxena Shikha , Rosas-Salazar Christian , Fitzpatrick Anne , Bacharier Leonard B.
Published: February 2023

Purpose of review

Severe asthma can carry significant morbidity and mortality for patients, and it places a burden on families and the healthcare system. Biologic agents have revolutionized the care of patients with severe asthma in recent years. Evidence surrounding some of these therapies is limited in the pediatric population, but recent studies show that they significantly improve asthma care when used appropriately. In this review, we discuss the biologic therapies currently approved to treat severe asthma in school-age children and adolescents.

Recent findings

Randomized controlled trials have been published in support of biologics in children and/or adolescents. These therapies have been shown to reduce the annual rate of severe asthma exacerbations by at least 40–50%, and some up to about 70%. Improvements in asthma control, lung function, oral corticosteroid use, and quality of life have also been demonstrated, although these vary by agent. Furthermore, these therapies have reassuring safety profiles in pediatric patients.

With three biologic agents approved for children ages 6–11 years and five approved for adolescents ages >12 years, it can be challenging to select one. The therapy should be chosen after careful consideration of the patient's asthma phenotype and biomarkers. Additional pediatric-specific clinical trials would be helpful in developing evidence-based guidelines on biologic therapies in this population.
Air pollution and childhood asthma
Authors: Mukharesh Lana , Phipatanakul Wanda , Gaffin Jonathan M.
Published: February 2023

Purpose of review

Asthma is the most common chronic disease of childhood. Environmental exposures, such as allergens and pollutants, are ubiquitous factors associated with asthma development and asthma morbidity. In this review, we highlight the most recent studies relevant to childhood asthma risk, onset, and exacerbation related to air pollution exposure.

Recent findings

In this article, we review current research that has been published between 2021 and 2022, demonstrating the effects of early-life exposure to key air pollutants (e.g., particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO2) and ground-level ozone (O3), environmental tobacco smoke, radon, and volatile organic compounds (VOC) on respiratory health.

Air pollution continues to be a global burden with serious consequences related to respiratory health. Interventions aimed at reducing air pollution in the environment must be achieved in an effort to improve asthma outcomes and pediatric health.
COVID-19 and autoimmune diseases: is there a connection?
Authors: Votto Martina , Castagnoli Riccardo , Marseglia Gian Luigi , Licari Amelia , Brambilla Ilaria
Published: February 2023

Purpose of review

This review summarizes current evidence on the potential link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and autoimmunity.

Recent findings

Several viral infections are potential triggers of reactive and autoimmune diseases by inducing type II and type IV hypersensitivity reactions. Recent evidence demonstrated that SARS-CoV-2 infection is not an exception, triggering the production of tissue-specific autoantibodies during the acute phase of coronavirus disease 2019 (COVID-19) and leading to autoimmune diseases development as long-term complication. The significant immune dysregulation with cytokine storm and organ damage observed in patients with severe to critical COVID-19 is considered the main mechanism explaining the high levels of autoantibodies, which are also implicated in disease severity and the need for an intensive care assessment. Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated disease where the recent viral infection leads to systemic inflammation, as already observed in other reactive and autoimmune diseases.

Autoimmunity may be a complication of SAR-CoV-2 infection. Understanding the pathogenesis of autoimmune manifestations in COVID-19 might help prevent the incidence or exacerbation of autoimmune disorders and design better and more efficient treatment strategies in children and adult populations.
Injection of Methamphetamine Has Increased in Boston, Massachusetts: 5 Waves of Centers for Disease Control and Prevention State Surveillance Data
Authors: Streck Joanna M. , Klevens R. Monina , O’Cleirigh Conall , Batchelder Abigail W.
Published: February 2023

Objectives

In the United States, the number of overdose deaths related to opioids in combination with stimulants has increased; however, the Northeast has typically been less impacted by stimulant overdose. Injection drug use (IDU) results in high mortality from overdose and infectious disease and there are racial disparities observed in overdose death rates. We examined trends in stimulant and opioid IDU, including trends stratified by race, using 5 waves of cross-sectional state surveillance data.

Methods

Data came from the Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance system Boston, Massachusetts site, which includes 5 waves of data (2005–2018) among adults in the Boston metropolitan area reporting IDU (N = 2550). Outcome measures were type of substance injected in the past 12 months (heroin, prescription opioids, “speedball,” cocaine, crack, and/or methamphetamine).

Results

Participants were 70% male, 58% non-Hispanic White, and injected a mean of 3 different drugs in the past 12 months. From 2015 to 2018, there was a more than 2-fold increase in injection of methamphetamine (15% vs 38%, P < 0.001), a pattern which held across racial groups. Combination heroin and methamphetamine injection increased from 2015 (15%) to 2018 (35%, P < 0.001). Multiple drug injection (injecting >1 drug) increased significantly across years compared with single drug injection (P = 0.03).

Conclusions

Findings suggest that increased use of methamphetamine and opioids extends to Boston. There is an urgent need for enhanced screening of methamphetamine use among those using opioids and increased access and payor coverage of efficacious treatments for stimulant and opioid use disorders (eg, contingency management and medication treatment for opioid use disorder).
Adverse Childhood Experiences Are Associated With History of Overdose Among Patients Presenting for Outpatient Addiction Care
Authors: Asheh Angelo M. , Courchesne-Krak Natasia , Kepner Wayne , Marienfeld Carla
Published: February 2023

Objectives

Adverse childhood experiences (ACEs) are associated with mental health issues and substance use. Having a substance use disorder increases the risk of overdose (OD). Research on ACEs and risk of OD is limited. This study examined the relationship between ACE scores and a self-reported history of OD among patients in an addiction and mental health outpatient setting.

Methods

This single-center, cross-sectional design included adults in a dual-diagnosis addiction and mental health outpatient recovery and treatment program from November 2017 to August 2020. Patients (N = 115) were assessed with self-report questionnaires, which included ACEs and history of OD. Bivariate and multivariable logistic regression was used to determine factors associated with self-reported OD history. We assessed the reliability and validity of the ACEs scale.

Results

Of the 115 participants, 26 (22.6%) reported a past OD at intake. The mean ACE score for participants with an OD history, as compared with those with no history of OD, was 4.0 (standard deviation, 2.7) vs 2.3 (standard deviation, 2.2). In the multivariable regression, a higher ACE score was associated with history of OD (adjusted odds ratio, 1.23; 95% confidence interval, 1.00–1.50; P = 0.0456).

Conclusions

Given the observed association between OD and higher ACE scores, patients presenting for treatment in outpatient dual-diagnosis clinics should be screened for ACEs and OD history, providing the opportunity for treatment with trauma-informed care and/or referral to appropriate services.
Testing and Case Rates of Gonorrhea, Chlamydia, Syphilis, and HIV among People with Substance Use Disorders in the Veterans Health Administration
Authors: Villamagna Angela Holly , Beste Lauren A. , Borgerding Joleen , Lowy Elliott , Hauser Ronald G. , Ross David , Maier Marissa M.
Published: February 2023

Background

Little is known about national patterns of sexually transmitted infection (STI) testing and infections among people with substance use disorders (SUDs).

Methods

This study used a national retrospective analysis of people with SUDs receiving healthcare in the Veterans Health Administration in 2019 (N = 485,869). We describe testing rates, test positivity, and case rates for gonorrhea, chlamydia, syphilis, and HIV among individuals with alcohol, opioid, cocaine, and noncocaine stimulant use disorders in a national cohort of Veterans Health Administration patients.

Results

Test and case rates for all STIs were highest among people with noncocaine stimulant use. People with alcohol use disorder had the lowest testing rates but intermediate incidence for all STIs. People with multiple SUDs had higher incidence of all STIs than those with single SUDs. Mental health diagnoses and houselessness were common. The HIV test positivity was 0.14% to 0.36% across SUD groups.

Conclusions

Sexually transmitted infection testing rates between SUD groups were discordant with their respective case rates. High STI rates in people with SUDs suggest a need for more comprehensive testing, particularly for those with noncocaine stimulant use and those with comorbid houselessness or mental health diagnoses.
Patient Preferences for Mobile Health Applications to Support Recovery
Authors: Fleddermann Kathryn , Molfenter Todd , Vjorn Olivia , Horst Julie , Hulsey Jessica , Kelly Braeden , Zawislak Kayla , Gustafson David H. , Gicquelais Rachel E.
Published: February 2023

Introduction

Smartphone apps to support individuals in recovery from substance use disorders (SUDs) are increasingly available. Although many people with SUDs express interest in recovery support apps, few try them or use them long-term. Strategies like gamification and contingency management are increasingly being considered to sustain engagement. This study sought to describe features of a recovery support app called the Addiction version of the Comprehensive Health Enhancement Support System (A-CHESS) that are most used by individuals in SUD recovery and what makes individuals more likely to use these apps.

Methods

A total of 202 people with A-CHESS accounts completed an online survey assessing their experiences using A-CHESS between April and June 2021. We described app features reported to be most beneficial for managing anxiety, loneliness, and isolation during COVID-19; reasons for not using A-CHESS; and suggested app features for future recovery support apps.

Results

Respondents had a mean age of 41 years, 85% were White, and 61% were female. Respondents reported that app features related to messaging (ie, open discussion boards and private messaging) and informational or motivational resources were the most useful for managing isolation, anxiety, and loneliness. Reasons for not using A-CHESS were not knowing how to use the app and the app not being part of a personalized treatment plan. The most common suggested components for future apps were rewards for meeting goals and a support meeting locator.

Conclusions

Ensuring that health apps are intuitive and include features that appeal to patients and educating patients about features apps already include that help them meet goals may enhance engagement with recovery apps.
Evaluating a Novel EEG-Based Index for Stroke Detection Under Anesthesia During Mechanical Thrombectomy
Authors: Baron Shahaf Dana , Abergel Eitan , Sivan Hoffmann Rotem , Meirovitch Eran , Konstadt Steven , Feierman Dennis E. , Derman Raphaell , Shahaf Goded
Published: February 2023

Background:

The rapid identification of acute stroke (AS) during and after anesthesia might lead to early interventions and improved outcomes. We investigated a novel 2-channel electroencephalogram (EEG)-based marker for stroke detection—the lateral interconnection ratio (LIR)—in AS patients having endovascular thrombectomy (EVT) with general anesthesia (GA) or sedation. The LIR in 2 reference groups of patients without postoperative neurological complications was used for comparison.

Methods:

The National Institutes of Health stroke scale score was assessed before and after thrombectomy in 100 patients having EVT with GA or sedation. The EEG was monitored during and for 4 hours following EVT in the AS group and during surgery in the 2 reference groups. We compared: (1) LIR between AS and reference groups; (2) LIR and stroke dynamics (clinical improvement or deterioration after EVT assessed by the National Institutes of Health stroke scale score); (3) the impact of stroke site (anterior vs. posterior circulation) and anesthesia type (GA vs. sedation) on the LIR.

Results:

Median (interquartile range) LIR was lower in patients with AS compared with reference patients (0.09, 0.05 to 0.16 vs. 0.39, 0.24 to 0.52, respectively; P<0.000002), and LIR increased in AS patients whose clinical status recovered after EVT compared with nonrecovered patients (0.20, 0.12 to 0.29 vs. 0.09, 0.05 to 0.11, respectively; P<0.007). The LIR might be more sensitive to anterior circulation stroke but is not impacted by anesthesia type.

Conclusions:

We demonstrated the utility of using AS patients undergoing EVT as a platform for assessing a novel EEG marker for the identification of stroke during anesthesia. Further, large-scale studies in AS patients during EVT and in patients undergoing different surgeries and anesthesia are required to validate the LIR.
Ultrasound-guided Greater Occipital Nerve Block in Children Undergoing Posterior Fossa Craniotomy: A Randomized, Controlled Trial
Authors: Nassar Heba , Sarhan Khaled , Gamil Maha , Elgohary Manal , El-Hadi Hany , Mahmoud Sahar
Published: February 2023

Background:

Posterior fossa surgery is commonly associated with severe postoperative pain. This study assessed the impact of ultrasound-guided greater occipital nerve (GON) block on postoperative pain and hemodynamic profiles in pediatric posterior fossa craniotomy.

Materials and Methods:

Children aged 2 to 12 years undergoing elective posterior fossa craniotomy with general anesthesia were randomly allocated to a control group receiving standard care (n=18) or a GON block group receiving standard care plus bilateral ultrasound-guided GON block (=17). Outcomes were postoperative pain assessed using the objective pain scale, time to first postoperative analgesia, intraoperative fentanyl consumption, perioperative blood pressure and heart rate, incidence of nausea and vomiting, and nerve-block-related complications.

Results:

Objective pain scale scores were lower in the GON block group than in the control group at 2, 4, 6, 8 (all P=0.0001), 12 (P=0.001), 16 (P=0.03), and 24-hour (P=0.004) postoperatively. The time to first analgesic request was 13.4±7.4 hours in the GON block group and 1.8±1.5 hours in the control group (P <0.001). Intraoperative fentanyl consumption was 2.68±0.53 μg/kg−1 in the GON block group and 4.1±0.53 μg/kg−1 in the control group (P=0.0001). Systolic blood pressure was lower in the GON block group at several intraoperative and postoperative time points, whereas heart rate was similar in the two groups at most time points. The incidence of postoperative nausea and vomiting was similar between groups (P=0.38), and there were no nerve-block-related complications.

Conclusions:

In children undergoing posterior fossa craniotomy, GON block was associated with superior quality and duration of postoperative analgesia and better hemodynamic profile compared with standard care.
An Evolutionary Concept Analysis of Precision Medicine, and Its Contribution to a Precision Health Model for Nursing Practice
Authors: Curtin Martha , Dickerson Suzanne S.
Published: February 2023

Precision medicine is a new concept that has been routinely encountered in the literature for little more than a decade. With increasing use, it becomes crucial to understand the meaning of this concept as it is applied in various settings. An evolutionary concept analysis was conducted to develop an understanding of the essential features of precision medicine and its use. The analysis led to a comprehensive list of the antecedents, attributes, and consequences of precision medicine in multiple settings. With this understanding, precision medicine becomes part of the broader practice of precision health, an important process proposed by nursing scholars to provide complete, holistic care to our patients. A model for precision health is presented as a framework for care.
Association Between Influenza Vaccination During Pregnancy and Infant Influenza Vaccination
Authors: Zhou Fangjun , Lindley Megan C. , Lee James T. , Jatlaoui Tara C.
Published: February 2023

OBJECTIVE:

To examine the association between influenza vaccination during pregnancy and infant influenza vaccination.

METHODS:

We conducted a retrospective analysis of individuals aged 15–49 years who were continually privately insured from August 2017 to May 2019 and had singleton live births between September 2017 and February 2018 and their infants. Influenza vaccination coverage was assessed for pregnant people during the 2017–2018 influenza season and for their infants during the 2018–2019 season using the 2017–2019 MarketScan data. Multivariate log-binomial regressions were conducted to examine the association between influenza vaccination during pregnancy and infant influenza vaccination.

RESULTS:

Of the 34,919 pregnant people in this analysis, 14,168 (40.6%) received influenza vaccination during pregnancy. Of the infants born to people vaccinated during pregnancy, 90.0% received at least one dose of influenza vaccine during the 2018–2019 season and 75.5% received at least two doses. Of the infants born to those not vaccinated during pregnancy, 66.3% received at least one dose of influenza vaccine and 51.8% received at least two doses. At-least-one-dose coverage was 35.7% higher (adjusted risk ratio [aRR] 1.34, 95% CI 1.33-1.36) and at-least-two-dose coverage was 45.8% higher (aRR 1.43, 95% CI 1.41-1.46) for infants born to people who received influenza vaccination during pregnancy compared with infants born to people who did not.

CONCLUSION:

Our results show a positive and statistically significant relationship between influenza vaccination during pregnancy and infant influenza vaccination status in their first season eligible for vaccination. Interventions to increase influenza vaccination coverage among pregnant people may also increase infant influenza vaccination coverage, offering greater protection against serious complications of influenza in both vulnerable populations.
Patients With Simple Posterior Hip Dislocations Have Higher Rates of Hip Dysplasia and Borderline Dysplasia
Authors: Haase Lucas , Maheshwer Bhargavi , Boes Kirsten , Ina Jason , Haase Douglas , Napora Joshua , Ochenjele George
Published: February 2023

Objectives:

To determine if patients suffering simple, posterior hip dislocations are more likely to display dysplastic characteristics of their acetabulum as compared with those suffering fracture dislocations.

Design:

Retrospective cohort study.

Setting:

Level 1 trauma center.

Patients/Participants:

Eighty-six patients suffering posterior, native hip dislocations over a 5-year period.

Main Outcome Measurement:

The primary outcome was measurement of the lateral center edge angle (LCEA), acetabular index (AI), acetabular version, and femoro-epiphyseal acetabular roof (FEAR) index.

Results:

Eighteen patients (20.9%) sustained simple dislocations, whereas 68 patients (79.1%) suffered fracture dislocations. Patients with simple dislocations had decreased LCEA (25.7 vs. 34.3; P < 0.001), increased AI (7.4 vs. 5.8; P = 0.019), and decreased acetabular anteversion (14.02 vs. 18.45; P = 0.011). Additionally, patients with simple dislocations had higher rates of dysplasia and borderline dysplasia (61.1% vs. 7.3%; P < 0.001). Patients with fracture dislocations had higher rates of concomitant injuries (60.9% vs. 29.4%; P = 0.039) and higher injury severity scores (8.1 vs. 12.3; P = 0.022).

Conclusion:

Patients who sustain simple hip dislocations are more likely to have undercoverage of the femoral head by the acetabulum as compared with patients suffering fracture dislocations. In addition, the simple dislocation group had a lower ISS and fewer concomitant injuries, which likely relates to a lower energy required for dislocation in the setting of lesser bony constraint. Surgeons treating these complicated injuries should consider measurements of LCE and AI when counseling patients on treatment strategies.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Induced Membrane Technique Is Effective for the Management of Acute Traumatic Bone Loss in Both Diaphyseal and Metaphyseal Lower Extremity Fractures
Authors: Steffenson Lillia , Roszman Alex , Wallace Cameron , Kot Taylor Corbin , Wallace Stephen , Spitler Clay , Bergin Patrick , Githens Michael , Haller Justin
Published: February 2023

Objective:

To compare outcomes of Masquelet-induced membrane technique (IMT) in metaphyseal and diaphyseal fractures with acute bone loss.

Design:

Retrospective cohort study.

Setting:

Four Level 1 Academic Trauma Centers.

Patients/Participants:

Patients acutely treated with IMT for traumatic lower extremity bone loss at 4 Level 1 trauma centers between 2010 and 2020.

Intervention:

Operative treatment with placement of cement spacer within 3 weeks of initial injury followed by staged removal and bone grafting to the defect.

Main Outcome Measurements:

Fracture union, infection, revision grafting, time to union, and amputation.

Results:

One hundred twenty fractures met inclusion criteria, including 43 diaphyseal fractures (DIM) and 77 metaphyseal fractures (MIM). Demographic characteristics were not significantly different, except for age (DIM 34 years vs. MIM 43 years, P < 0.001). Union after treatment with IMT was 89.2% overall. After controlling for age, this was not significantly different between DIM (41/43, 95.3%) and MIM (66/77, 85.7%) (P = 0.13) nor was the rate of infection between groups. There was no difference in any secondary outcomes.

Conclusions:

The overall union rate in the current series of acute lower extremity fractures treated with the induced membrane technique was 89%. There was no difference in successful union between patients with diaphyseal bone loss or metaphyseal bone loss treated with IMT. Similarly, there was no difference in patients with tibial or femoral bone loss treated with induced membrane. Defect size after debridement may be more prognostic for secondary operations rather than the limb segment involved or the degree of soft-tissue injury.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Use of Vancomycin Powder in Tibial Plateau Fractures at Lower Risk of Infection
Authors: Zingas Nicolas , Hannan Zachary D. , Healey Kathleen M. , McKibben Natasha S. , Burke Cynthia E. , McKegg Phillip C. , Ghulam Qasim M. , O'Hara Nathan N. , Joshi Manjari , Dubina Andrew , O'Toole Robert V.
Published: February 2023

Objective:

To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection.

Design:

Retrospective cohort study.

Setting:

Single, Level I trauma center.

Patients/Participants:

This study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006 to 2018 and were considered at low risk of infection based on not meeting the “high risk” definition of the VANCO trial.

Intervention:

Vancomycin powder administration on wound closure at the time of definitive fixation.

Main Outcome Measurements:

Deep surgical site infection with at least 1 gram-positive bacteria culture.

Results:

Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (odds ratio, 0.12; 95% confidence interval, 0.04–0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (odds ratio, 2.71; 95% confidence interval, 0.11–69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%).

Conclusions:

Among patients with low-risk tibial plateau fractures, vancomycin powder at the time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Superior Outcomes With Reverse Shoulder Arthroplasty versus Nonoperative Management for Proximal Humerus Fractures: A Matched Cohort Analysis
Authors: Haws Brittany E. , Samborski S. Andrew , Karnyski Steven , Soles Gillian , Gorczyca John T. , Nicandri Gregg T. , Voloshin Ilya , Ketz John P.
Published: February 2023

Objective:

To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA).

Design:

Retrospective cohort.

Setting:

Academic level 1 trauma center, level 2 trauma/geriatric fracture center.

Patients/Intervention:

Seventy-one patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology.

Main Outcome Measurements:

Patient-reported outcomes, range of motion, and complications rates within 1 year of treatment.

Results:

RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared with nonoperative patients throughout the first 6 months after treatment (P < 0.05 for all). RSA patients achieved satisfactory ROM (>90 degrees aFF) at higher rates than nonoperative patients (96.2% vs. 62.2%, P < 0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment (P < 0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared with the nonoperative group (P < 0.05 for all). Similar complication rates were experienced in both groups (nonoperative = 8.9%, RSA = 7.7%; P = 0.36).

Conclusions:

In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared with nonoperative management, without significant differences in short-term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Closed displaced femur fractures in children with nonambulatory cerebral palsy
Authors: Silva Luiz Carlos A. , Asma Ali , Ulusaloglu Armagan Can , Rogers Kenneth J. , Bowen James Richard , Howard Jason J. , Shrader Michael Wade , Miller Freeman
Published: February 2023

Femoral fractures in children withcerebral palsy (CP) represent a frequent medical problem, and treatment represents a challenge. The purpose of this study was to review the closed displaced femoral fractures in our population of nonambulatory children with CP to compare the results of nonoperative and operative treatment modalities to improve the care of these children. From 2006 to 2020, children with nonambulatory CP were selected with inclusion criteria of displaced femoral fracture and were divided into nonoperative and operative groups. Forty-four children met the inclusion criteria. The nonoperative group included 23 children and the operative group included 21 children. Mechanism of injury was unknown in 48% of the fractures. Fourteen (25%) fractures occurred after a femoral plate fixation during a reconstructive hip surgery, and 38 (86%) children had osteopenia. Our results reveal a high prevalence of osteopenia, low-energy trauma, malunion in nonoperative treatment, and peri-implant fractures. Suspicion of child abuse should be considered when the fracture has an unclear mechanism of the injury. Removal of proximal femoral implants may be considered to prevent peri-implant fractures. Femoral fractures should preferably be treated nonoperatively. Operative treatment should be considered for diaphyseal fractures in children capable of standing transfers, larger children, children with more severe spasticity or movement disorder or those who have suffered a high-energy fracture. Due to the high prevalence of proximal fractures in the presence of hardware, operative treatment is usually required for these fractures. In contrast, distal fractures are adequately managed nonoperatively.
Flat-top talus after clubfoot treatment: a literature review
Authors: Zioupos Stephanie , Westacott Daniel
Published: February 2023

Flat-top talus (FTT) is a complication well-known to those treating clubfoot. Despite this, it receives little attention in textbooks, so our knowledge and understanding can be limited to anecdote and hearsay. In particular, its association with different treatments, especially the Ponseti method, is not well understood. This review provides some clarity on the possible pathoanatomical, radiological and iatrogenic causes of FTT. It summarises its prevalence following different treatments. It is seen after surgery, ‘pre-Ponseti’ casting and the Ponseti method, and seems least common following Ponseti. Potential surgical management strategies are also discussed.
Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?
Authors: Onay Tolga , Çelen Zekeriya Ersin , Öncül Samet , Abul Mehmet Süleyman
Published: February 2023

Background:

Olecranon fractures are rare conditions in childhood. The aim of this study was to investigate the factors affecting the results in surgically treated pediatric and adolescent olecranon fractures.

Methods:

The orthopaedic trauma database of a large academic tertiary center was retrospectively searched for patients who had sustained an olecranon fracture and were treated surgically between 2005 and 2021. Data related to demographic features, additional fractures, and the presence of any disease were obtained from the patient files. Mayo elbow performance score and the Turkish-language version of the shortened version of the disabilities of arm, shoulder, and hand scale were the main functional outcome measurements.

Results:

The study included 37 elbows of 34 patients with an average age at the time of surgery of 10.9±3.1 years. The mean follow-up period was 78.2±48.0 months (range, 12 to 196 mo). The 1-year fracture rate of contralateral olecranon was 75% in osteogenesis imperfecta patients. Concomitant fractures were 7 proximal radius, 1 medial epicondyle, and 2 capitellum fractures. The surgical treatment methods were tension band wiring (TBW), open reduction and isolated K-wire fixation, closed reduction and percutaneous fixation (CR-PP), and open reduction-plate fixation. The mean implant removal time in patients treated with closed reduction and percutaneous fixation was 2.2 months, open reduction and isolated K-wire fixation 4.7 months, and TBW 12.7 months (P=0.004). The mean disabilities of arm, shoulder, and hand scale was 1.9. The mean Mayo elbow performance score was 100. Grade 1 elbow arthritis was determined in 3 patients. No patient underwent revision surgery.

Conclusions:

All treatment modalities provided excellent long-term functional results and low complication rates without the need for revision. Closed reduction-percutaneous fixation and open reduction-isolated K-wire fixation were associated with shorter implant removal times compared with TBW.

Level of Evidence:

Level III.
Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience
Authors: Whitmarsh-Brown Meghan A. , Christ Alexander B. , Lin Adrian J. , Siddiqui Ali A. , Herman Renee Y. , Allison Daniel C. , Goldstein Rachel Y.
Published: February 2023

Introduction:

Pediatric hip disorders represent a broad range of pathology and remain a significant source of morbidity for children and young adults. Surgical intervention is often required for joint preservation, but when salvage is not possible, joint replacement may be indicated to eliminate pain and preserve function. Although there have been significant updates in the management of both pediatric hip disease and the field of total hip arthroplasty (THA), there is a paucity of literature reflecting advancements in the area of pediatric and young adult (PYA) arthroplasty. No study has investigated the impact of approach on outcomes after PYA THA. The purpose of this study is to describe the indications, techniques, and early outcomes of THA in the PYA population in a modern practice setting.

Methods:

We performed a retrospective descriptive analysis of all patients undergoing primary THA performed at a tertiary care children’s hospital from 2004 to 2019. Ninety-three hips in 76 patients were evaluated. Demographics, intraoperative variables, postoperative pain and function ratings, and complication and revision rates were collected.

Results:

Eighty-five hips in 69 patients were included. Patients were aged 12 to 23 years old, with males and females represented equally (33 vs. 36, respectively). The most common cause of hip pain was avascular necrosis (AVN, 56/85, 66%), most commonly due to slipped capital femoral epiphysis (13/56, 23%) idiopathic AVN (12/56, 21%), and chemotherapy (12/56, 21%). Half of all hips had been previously operated before THA (43/85). Thirty-six procedures were performed via the posterolateral approach (36/85, 42%), 33 were performed via direct anterior approach (33/85, 39%), and 16 were performed via the lateral approach (LAT, 16/85, 19%). At final follow-up, 98% (83/85) of patients had complete resolution of pain, 82% (70/85) had no notable limp, and 95% (81/85) had returned to all activities. There were 6 complications and 1 early revision. Average Hip disability and Osteoarthritis Outcomes Score for Joint Replacement scores increased by 37 points from 56 to 93. The overall revision-free survival rate for PYA THA was 98.8% (at average 19-mo follow-up).

Conclusions:

Modern PYA THA is dissimilar in indications and surgical techniques to historic cohorts, and conclusions from prior studies should not be generalized to modern practice. In our practice, PYA patients most commonly carry a diagnosis of AVN, and THA can be performed with modern cementless fixation with large cup and head sizes and ceramic-on-cross-linked polyethylene bearings utilizing any approach. Further study is required to better characterize middle-term and long-term results and patient-reported outcomes.

Level of Evidence:

Therapeutic Level IV—retrospective case series.
Younger Age and Left Side Are Risk Factors for Contralateral Trigger Thumb in Children
Authors: Huang Peng , Wang Dahui , Wu Chunxing , Song Jun , Ning Bo
Published: February 2023

Background:

The metachronism of bilateral trigger thumb (TT) may lead to additional surgery under anesthesia. The aim of this study was to investigate the temporal development of bilateral TT, find risk factors for contralateral TT, and provide evidence for clinical practice.

Methods:

A retrospective analysis was performed on children diagnosed with TT in our hospital from January 2016 to December 2019. Age at onset, laterality, sex, the interval time of onset of contralateral symptoms, age at the time of surgery, and preoperative and postoperative follow-up times were collected. The cases were divided into 3 groups: (1) the unilateral group, (2) the simultaneous bilateral group, and (3) the separate bilateral group.

Results:

A total of 783 patients with 967 TTs were enrolled. There were 599 (76.5%) cases in the unilateral group, 157 (20.1%) cases in the simultaneous bilateral group, and 27 (3.4%) cases in the separate bilateral group. Seven (0.9%) patients underwent additional surgery on the contralateral side under anesthesia. Of these 7 patients, 6 (85.7%) had left-side onset and 5 (71.4%) patients developed bilateral TT by the age of 4. The mean age at the initial onset in the separate bilateral group was 20.1 months, and the mean age at diagnosis of the contralateral thumb was 33.6 months. Binary logistic regression analysis showed that age and side at initial onset had significant differences (P=0.043 and 0.000, respectively). Receiver operating characteristic curve analysis showed that the cutoff value of age at initial onset was 16 months.

Conclusions:

There was a low incidence of metachronous bilateral TT with additional surgery for the contralateral thumb. Age and side at initial onset are risk factors for contralateral TT.

Level of Evidence:

Level II; prognostic studies.
A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy
Authors: Adulkasem Nath , Wongcharoenwatana Jidapa , Ariyawatkul Thanase , Chotigavanichaya Chatupon , Eamsobhana Perajit
Published: February 2023

Introduction and Objective:

Several predictive factors for infantile Blount disease recurrence after tibial osteotomy were discovered. This study aimed to examine and utilize various predictors to develop a prediction score for infantile Blount disease recurrence after tibial osteotomy.

Methods:

We conducted a retrospective cohort study of infantile Blount disease patients who underwent tibial osteotomy between January 1998 and December 2020. Potential predictors, including clinical and radiographic parameters, were examined for their association with the disease recurrence after receiving tibial osteotomy. A predictive score was subsequently developed based on those potential predictors through multivariable logistic regression modeling.

Results:

A total of 101 extremities diagnosed with infantile Blount disease from 58 patients who underwent tibial osteotomy were included. Of those, 15 extremities (14.9%) recurred. Univariable logistic regression analysis identified age older than 42 months [odds ratio (OR)=4.28; P=0.026], Langenskiöld classification stage III (OR=9.70; P <0.001), LaMont classification type C (OR=15.44; P <0.001), preoperative femorotibial angle <−14 degrees (OR=4.21, P=0.021), preoperative metaphyseal-diaphyseal angle >16 degrees (OR=8.61, P=0.006), preoperative medial metaphyseal slope angle >70 degrees (OR=7.56, P=0.001), and preoperative medial metaphyseal beak angle >128.5 degrees (OR=13.46, P=0.001) as potential predictors of infantile Blount disease recurrence after tibial osteotomy. A predictive score comprised of age younger than 42 months, LaMont classification type C, and medial metaphyseal beak angle >128 degrees demonstrated an excellent predictive performance (area under the receiver operating characteristic curve =0.87), good calibration, and high internal validity.

Conclusions:

Our developed predictive score accurately predicted infantile Blount disease recurrence after tibial osteotomy. The results from our developed prediction tool allow physicians to inform prognosis, increase awareness during the follow-up period, and consider additional interventions to prevent disease recurrence.

Level of Evidence:

Level II
4-in-1 Quadricepsplasty for Habitual and Fixed Lateral Patellar Dislocation in Children
Authors: Parikh Shital N. , Lopreiato Nicholas , Veerkamp Matthew
Published: February 2023

Background:

Habitual and fixed patellar dislocations represent extreme forms of patellar instability and can lead to significant functional loss. The underlying complex pathoanatomy of a laterally positioned and shortened extensor mechanism poses challenges in its management. The purpose of our study was to evaluate the anatomic risk factors and outcomes of a 4-in-1 quadricepsplasty (wide lateral releases, Insall proximal tube realignment, Roux-Goldthwait patellar tendon hemi-transfer, and step-wise quadriceps lengthening) for stabilization of habitual and fixed patellar dislocation.

Methods:

In a retrospective study, all patients with habitual and fixed patellar dislocation who underwent 4-in-1 quadricepsplasty and had a minimum 2-year follow-up were identified. Preoperative magnetic resonance imagings were evaluated for the presence of anatomic risk factors. As a prospective part of the study, patient-reported outcomes were collected using validated instruments including Pedi-IKDC, HSS-Pedi FABS activity score, BPII 2.0 score, Kujala score, and KOOS score.

Results:

Seventeen knees (12 patients) formed the study cohort. Twelve knees had habitual dislocation (9 in extension and 4 in flexion) and 5 had fixed dislocation. Mean age was 9 years. 6/17 (35.3%) knees were associated with syndromes. On magnetic resonance imaging, trochlear dysplasia was the most common anatomic risk factor present in 15/17 (88.2%) knees. 13/17 (76%) knees had presence of 2 or more risk factors. At the mean follow-up of 43.3 months, the mean Pedi-IKDC score was 88.1, the HSS-Pedi FABS activity score was 15.6, the BPII 2.0 score was 78.2, the Kujala score was 90, KOOS score was 93.9, and overall patient satisfaction score was 83.3. For complications, 3/17 knees (17.6%) had recurrent patellar instability, 1 knee had postoperative stiffness that required manipulation under anesthesia and 1 knee had a superficial wound infection.

Conclusions:

Most patients with habitual and fixed patellar dislocation present during the first decade of life. There are several underlying anatomic risk factors, the most common being trochlear dysplasia and patellar tilt. The 4-in-1 quadricepsplasty technique provides reliable patellar stabilization, satisfactory clinical results, and acceptable patient-reported outcomes at a minimum 2-year follow-up, with a 17.6% redislocation rate.

Level of Evidence:

Level IV.
Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome
Authors: Galán-Olleros María , Ramírez-Barragán Ana , Rodríguez-Zamorano Patricia , Egea-Gámez Rosa M. , Serrano J. Ignacio , Martínez-Caballero Ignacio
Published: February 2023

Introduction:

Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies.

Methods:

Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function.

Results:

Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV.

Conclusions:

Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended.

Level of Evidence:

Level IV, Case series.
Clinical Improvements in Myelopathy Result in Improved Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion
Authors: Lambrechts Mark J. , Toci Gregory R. , Karamian Brian A. , Siniakowicz Claudia , Canseco Jose A. , Woods Barrett I. , Hilibrand Alan S. , Schroeder Gregory D. , Vaccaro Alexander R. , Kepler Christopher K.
Published: February 2023

Study Design.

Retrospective cohort study.

Objective.

To determine if myelopathy severity predicted the magnitude of improvement in health-related quality of life metrics following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Surgery for myelopathy is primarily performed to halt disease progression. However, it is still controversial if these patients can expect significant health-related quality-of life improvements following ACDF. We explore the relationship between modified Japanese Orthopaedic Association (mJOA) improvements and its effect on other health-related quality-of life metrics.

Materials and Methods.

Patients undergoing ACDF for myelopathy were grouped based on preoperative mJOA scores into mild (15–17), moderate (12–14), and severe (<12) groups. Patients were subsequently categorized based on if they attained the minimum clinically detectable improvement (MCID) threshold for mJOA. Multivariate linear regression was performed to determine the magnitude of improvement in ∆patient-reported outcome measures.

Results.

A total of 374 patients were identified for inclusion. Of those, 169 (45.2%) had mild myelopathy, 125 (33.4%) had moderate, and 80 (21.4%) had severe myelopathy. Only the moderate and severe groups had significant improvements in mJOA following surgery (mild: P=0.073, moderate: P<0.001, severe: P<0.001). There were no significant differences in the magnitude of improvement for any patient-reported outcome measure based on myelopathy severity, except for mJOA (mild: 0.27, moderate: 1.88, severe: 3.91; P<0.001). Patients meeting the MCID for mJOA had better ∆Short-Form 12 Mental Component Score (3.29 vs. −0.21, P=0.007), ∆Short-Form 12 Physical Component Score (6.82 vs. 1.96, P<0.001), ∆Visual Analog Scale Neck (−3.11 vs. −2.17, P=0.001), ∆Visual Analog Scale Arm (−2.92 vs. −1.48, P<0.001), ∆Neck Disability Index (−18.35 vs. −7.86, P<0.001), and ∆mJOA (3.38 vs. −0.56, P<0.001) compared with patients who did not.

Conclusions.

Worse baseline myelopathy severity predicts worse postoperative outcomes. However, baseline myelopathy severity is not predictive of the magnitude of postoperative improvement with the exception of mJOA. Patients who attain MCID improvement in mJOA had greater postoperative improvement for other health-related quality of life metrics.