Peds Ortho

Innovation in Pediatric Orthopaedics, Part I

Ira Zaltz, Peter Newton, James Wall, Rene Caissie, and Manoj Ramachandran join the show to discuss their experiences developing innovative products in the field of pediatric orthopaedic surgery and beyond. The broad-ranging conversation covers their personal journeys, raising funding for new ventures, partnering with industry, mistakes they made, and more! Your hosts are Carter Clement from Children's Hospital of New Orleans and Kevin Shea from Stanford. Music by A.A. Aalto.

Lit. Update with Ben Shore

Dr. Ben Shore from Boston Children's joins the show to discuss his recent research on trauma, infection, discharge planning, neuromuscular hips, and more. The lightning round covers Vitamin D deficiency, scoliosis bracing, guided growth, and shared decision making. This episode is sponsored by Depuy Synthes Spine. Your hosts are Craig Louer from Vanderbilt, Carter Clement from Children’s Hospital of New Orleans, Julia Sanders from Children's Hospital Colorado, and Josh Holt from University of Iowa. Music by A. A. Aalto.

 

References:

 

Watkins et al. The Reliability of Intraoperative Hip Arthrography in Cerebral Palsy Hip Reconstruction. JPOSNA 2023. https://doi.org/10.55275/JPOSNA-2023-595

 

Flaugh et al. Barriers to Discharge After Hip Reconstruction Surgery in Non-ambulatory Children With Neurological Complex Chronic Conditions. JPO Sept 2022.

 

Upasani et al with CORTICES Study Group. Practice Variation in the Surgical Management of Children With Acute Hematogenous Osteomyelitis. JPO 2022.

 

Montgomery et al. Minimizing Surgeon Radiation Exposure During Operative Treatment of Pediatric Supracondylar Humerus Fractures. JPO 2023.

 

Lightning Round

 

Karkenny et al. Pediatric Fractures: Does Vitamin D Play a Role? JPO 2023.

 

Catanzano et al. Cast or Nail? Using a Preference-Based Tool for Shared Decision-Making in Pediatric Femoral Shaft Fracture Treatment. JPO 2023.

 

Zapata et al. Early brace treatment for idiopathic scoliosis may change the paradigm to improve curves. Spine Deformity 2023.

 

McGinley et al. Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity: Age- and Sex-Matched Cohorts of Skeletally Immature Patients. JBJS 2023.

Lit. Update with Coleen Sabatini

Dr. Coleen Sabatini from UCSF joins the show to discuss implicit bias and bullying in our field, changing and international trends in supracondylars, and two international orthopedic public health issues she is immersed in solving: gluteal fibrosis and post-injection paralysis. The lightning round highlights new ultrasound techniques, SCFE implants, and more. 

 

Your hosts are Carter Clement from Children’s Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. Music by A. A. Alto.

 

References:

 

New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars. Soriano et al. JPO Apr 2023. https://pubmed.ncbi.nlm.nih.gov/36662751/

 

Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. Challa et al. International Orthopedics 2020. https://pubmed.ncbi.nlm.nih.gov/32691122/

 

Implicit Racial Bias in Pediatric Orthopaedic Surgery. Guzek et al. JPO 2022. https://pubmed.ncbi.nlm.nih.gov/35522848/

 

The Prevalence of Bullying Among Pediatric Orthopaedic Patients. Carrillo et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/34294669/

 

Epidemiology and treatment outcomes in pediatric patients with post-injection paralysis. Song et al. BMC Musculoskeletal Disorders 2022. https://pubmed.ncbi.nlm.nih.gov/35932071/

 

Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up. Reilly et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/33481480/

 

Gluteal Fibrosis and Its Surgical Treatment. Alves et al. JBJS 2019. https://pubmed.ncbi.nlm.nih.gov/30801376/

 

Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis. Alves et al. BMC Health Services Research 2018. https://pubmed.ncbi.nlm.nih.gov/30477506/

 

Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda. BMC Musculoskeletal Disorders 2018. https://pubmed.ncbi.nlm.nih.gov/30249239/

 

Lightning Round:

 

The Usefulness of Dynamic Ultrasonography in Nursemaid's Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid's Elbow. Tsai et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36962080/

 

Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation. Folkman et al. JPO June 2023. https://pubmed.ncbi.nlm.nih.gov/37072917/

 

The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression. Zapata et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36922003/

 

Who Benefits From Allowing the Physis to Grow in Slipped Capital Femoral Epiphysis? Winger et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36977364/

 

 

 

 

POSNA Annual Meeting 2023 Part II

This special episode brings you highlights from the 2023 annual POSNA meeting in Nashville. Guests include Pat Cahill from CHOP, Jeanne Franzone from Nemours, Neeraj Patel from Lurie Children's Hospital, Greg Mencio from Vanderbilt, and Jonathan Schoenecker from Vanderbilt. Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Julia Sanders from Children's Hospital Colorado. Music by A.A. Aalto.

POSNA Annual Meeting 2023 Part I

This special episode brings you highlights from the 2023 annual POSNA meeting in Nashville. Special guests include Colin May from Boston Children's and Jaime Denning from Cincinnati Children's (foot & ankle subspecialty session), Ben Sheffer from Campbell Clinic and Ryan Muchow from the Lexington Shriners Hospital (trauma subspecialty session), Ben Shore from Boston Children's (CORTICES study group), Salil Upasani from Rady Children's Hospital (hip subspecialty session), and Nirav Pandya from UCSF (sports subspecialty session). Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Julia Sanders from Children's Hospital Colorado. Music by A.A. Aalto.

Lit. Update with Matt Ellington

Dr Matt Ellington from Central Texas Pediatric Orthopedics joins the show this month! We discuss pain management for ACL reconstruction and the danger of opioid use disorders, as well as grit scores and Dr Ellington’s pearls for a variety of sports cases. The lightning round highlights the outcomes of THA in pediatric patients, spinal trauma classification systems, and long term outcomes after scoliosis surgery. 

 

Your hosts are Julia Sanders from Children’s Hospital Colorado, Carter Clement from Children’s Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. This episode is sponsored by Nuvasive. Music by A. A. Alto.

 

References:

 

Akazawa et al. Health-Related Quality of Life of Patients With Adolescent Idiopathic Scoliosis at Least 40 Years After Surgery. Spine (Phila Pa 1976). 2023.

 

Pascual-Leone N et al. Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients. JPO. 2023.

 

Sborov KD et al. Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC. JPOSNA. 2023.

 

Whitmarsh-Brown MA et al. Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience. JPO. 2023..

 

Cahan et al. Opioid Represcriptions After ACL Reconstruction in Adolescents Are Associated With Subsequent Opioid Use Disorder. JPO. 2023..

 

O'Neill NP et al. The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study. JPO. 2023.

 

Wagner et al. Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction. JPO. 2023.

Lit. Update with Josh Klatt

Joshua Klatt of The University of Utah joins the show to discuss his recent randomized prospective trial on casting material in pediatric forearm fractures. He will then enlighten the audience with the "one right way" to approach a variety of controversial spine, hip, and trauma conditions. Host Joshua Holt from University of Iowa leads the session with co-hosts Carter Clement (Children's Hospital of New Orleans) and Julia Sanders (Children's Hospital Colorado).

Plaster Versus Ortho-Glass®: Does Initial Splint Material Matter in Pediatric Forearm Fracture Outcomes? A Randomized, Prospective Trial. Ludwig et al. JPOSNA 2023. https://doi.org/10.55275/JPOSNA-2023-597

 

Does Transitioning to a Brace Improve HRQoL After Casting for Early Onset Scoliosis? Henstenburg et al and the PSSG. JPO Epub 2023. PMID: 36728464

 

Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children. Chen et al. JBJS Am Epub 2023. PMID: 36727888.

 

Imposter Syndrome Among Surgeons Is Associated With Intolerance of Uncertainty and Lower Confidence in Problem Solving. Lin et al. and The Science of Variation Group. CORR Epub 2022. PMID: 36073997.

 

A Practical Guide for Improving Orthopaedic Care in Children with Autism Spectrum Disorder. Maloy et al. JPOSNA 2023. https://doi.org/10.55275/JPOSNA-2023-640

Lit. Update with Dr. Derek Kelly

Dr. Derek Kelly from Campbell Clinic Orthopedics in Memphis, TN joins the show to discuss his recent article about Ponseti casting performed by MDs and PTs. We will "stir the pot" by asking Dr. Kelly about his treatment preferences in controversial foot and hip cases. The lightning round focuses on recent publications from top peds orthopedic journals. Your hosts are Craig Louer from Vanderbilt, Josh Holt from University of Iowa, and Julia Sanders from Children's Hospital Colorado. Music by A. A. Alto.

 

“Main Event” article:

Chen, Stephanie N. MD*; Ragsdale, Tyler D. MD†; Rhodes, Leslie N. DNP, PPCNP-BC‡,§; Locke, Lindsey L. MSN, CPNP-PC§; Moisan, Alice BSN, RN∥; Kelly, Derek M. MD*. Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists. Journal of Pediatric Orthopaedics 43(2):p e93-e99, February 2023. | DOI: 10.1097/BPO.0000000000002291

 

Lightning Round articles:

 

1. Yu, Sze-Hon1; Ng, Cheuk-Man1; Pui-Yin Cheung, Jason MD, MS, MMedSc, PDipMDPath, Med, FRCSEd1; Ka-Hon Shea, Graham MBBS, PhD, FRCSEd1,a. Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°. The Journal of Bone and Joint Surgery ():10.2106/JBJS.22.00939, January 23, 2023. | DOI: 10.2106/JBJS.22.00939

 

2. Stults, William P. MD*; Peljovich, Allan E. MD, MPH†. Surgical Excision of Postaxial Polydactyly Type B in the Office Setting. Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002346, January 10, 2023. | DOI: 10.1097/BPO.0000000000002346

 

3. Pradhan, Pratik BS; Townsend, Tracy K. MD; Cook, Danielle MA; Feldman, Lanna MS; Canizares, Maria Fernanda MD, MPH; Watkins, Colyn MD; Shore, Benjamin J. MD, MPH. Do All Pediatric Femoral Shaft Fractures Need a Computed Tomography Scan of the Ipsilateral Femoral Neck? Calculating the Incidence of Concomitant Femoral Neck and Shaft Fractures. Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002334, December 26, 2022. | DOI: 10.1097/BPO.0000000000002334

 

4. Shah, Hitesh MS Orth; Singh, Kumar Amerendra MS Orth; Joseph, Benjamin MS Orth, MCh Orth, FRCS Ed. Does Prolonged Weight Relief Increase the Chances of a Favourable Outcome After Containment for Perthes Disease?. Journal of Pediatric Orthopaedics 43(2):p e144-e150, February 2023. | DOI: 10.1097/BPO.0000000000002302

 

5. Sanders, Julia S. MD*; Ouillette, Ryan J. MD†; Howard, Roland MD†; Boutelle, Kelly BS‡; Carroll, Alyssa N. MPH‡; Bastrom, Tracey P. MA‡; Paik, Christina PA-C‡; Stearns, Philip CPNP‡; Pennock, Andrew T. MD†,‡; Upasani, Vidyadhar V. MD†,‡. Nonoperative Versus Operative Treatment of Type IIA Supracondylar Humerus Fractures: A Prospective Evaluation of 99 Patients. Journal of Pediatric Orthopaedics 43(1):p e9-e16, January 2023. | DOI: 10.1097/BPO.0000000000002282

 

Posterior Column Osteotomies Expert Panel: JPOSNA Collaboration

Spine enthusiasts, rejoice!  An expert panel joins the podcast to discuss and debate the techniques, indications, and all aspects of performing Posterior Column Osteotomies for pediatric spine deformity. Your hosts are Lorena Floccari from Akron Children's Hospital, Kenneth Illingworth from Cedars-Sinai Hospital LA, and Craig Louer from Vanderbilt Children's Hospital. Music by A. A. Alto.

Expert Panel:

Haemish Crawford, FRACS.  Starship Children’s Hospital; Auckland, New Zealand

James O. Sanders, MD.   University of North Carolina; Chapel Hill, NC

Suken A. Shah, MD.  Nemours Children's Health; Wilmington, DE

Daniel J. Sucato, MD, MS.   Scottish Rite Hospital; Dallas, TX

 

This installment is performed in conjunction with the Journal of the Pediatric Orthopedic Society of North America (JPOSNA). The Feb 1, 2023 release of JPOSNA includes a critical concepts review article on PCO technique and use in addition to a transcript form of this panel discussion. 

February 2022 JPOSNA Table of Contents: https://jposna.org/index.php/jposna

PCOs in AIS Current Concepts Review: https://jposna.org/index.php/jposna/article/view/638

PCO Expert Panel: https://jposna.org/index.php/jposna/article/view/639

 

 

Lit. Update with Drs. Flynn & Gornitzky

Jack Flynn and Alex Gornitzky from CHOP and University of Michigan, respectively, join the show to discuss their recent article on the psychology of scoliosis bracing. The lightning round focuses on recent publications by Dr. Flynn with some controversies mixed in to give the guests a chance to "stir the pot." Your hosts are Carter Clement from Children’s Hospital of New Orleans, Josh Holt from University of Iowa, and Craig Louer from Vanderbilt. The episode is sponsored by nView Medical. Music by A. A. Alto.

 

“Main Event” article:

 

Why Don't Adolescents Wear Their Brace? A Prospective Study Investigating Psychosocial Characteristics That Predict Scoliosis Brace Wear. Gornitzky et al. JPO Jan 2023. https://pubmed.ncbi.nlm.nih.gov/36194756/

 

Lightning (a.k.a. “Jumpin Jack Flash”) Round articles:

 

Lengthening Behavior of Magnetically Controlled Growing Rods in Early-Onset Scoliosis: A Multicenter Study. Heyer et al. JBJS Oct 2022. https://pubmed.ncbi.nlm.nih.gov/36367763/

 

Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment. Badin et al. JPO Nov-Dec 2022. https://pubmed.ncbi.nlm.nih.gov/36037438/

 

A Modern Day Timeline for In-Hospital Monitoring in Perfused, Pulseless Pediatric Supracondylar Humerus Fractures. Heyer et al. JPO Nov-Dec 2022. https://pubmed.ncbi.nlm.nih.gov/35980760/

 

Preoperative MRI Reliably Predicts Pedicle Dimensions on Intraoperative CT Images in Structural Main Thoracic Curves in Patients With Adolescent Idiopathic Scoliosis. Mitchell et al. Spine (Phila PA 1976) Sept 2022. https://pubmed.ncbi.nlm.nih.gov/35867611/

 

Early Knee Range of Motion Following Operative Treatment for Tibial Tubercle Avulsion Fractures Is Safe. Huang et al. JPO Oct 2022. https://pubmed.ncbi.nlm.nih.gov/35968996/

 

Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents. Krakow et al. JBJS Jul 2022. https://pubmed.ncbi.nlm.nih.gov/35793795/

 

Complications following surgical treatment of adolescent idiopathic scoliosis: a 10-year prospective follow-up study. Hariharan et al. Spine Deformity Sept 2022. https://pubmed.ncbi.nlm.nih.gov/35488969/

 

Evidence Behind Upper Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review. Baghdadi et al. JBJS Reviews Sept 2021. https://pubmed.ncbi.nlm.nih.gov/35417439/

 

Better Patient Care Through Physician Extenders and Advanced Practice Providers. Milewski et al. JPO May-June 2022. https://pubmed.ncbi.nlm.nih.gov/35405696/

 

Thoracic Curve Correction Ratio: An Objective Measure to Guide against Overcorrection of a Main Thoracic Curve in the Setting of a Structural Proximal Thoracic Curve. Landrum et al. Journal of Clinical Medicine Mar 2022. https://pubmed.ncbi.nlm.nih.gov/35329871/

 

Benchmarking surgical indications for adolescent idiopathic scoliosis across time, region, and patient population: a study of 4229 cases. Heyer et al. Spine Deformity July 2022. https://pubmed.ncbi.nlm.nih.gov/35258846/

 

When Is an Isolated Olecranon Fracture Pathognomonic for Osteogenesis Imperfecta? VanEenenaam et al. JPO May-June 2022. https://pubmed.ncbi.nlm.nih.gov/35200208/

 

Unplanned Return to the Operating Room (UpROR) After Pediatric Diaphyseal Femoral Fractures. Baghdadi et al. JPO Feb 2022. https://pubmed.ncbi.nlm.nih.gov/34923506/

 

Awake serial body casting for the management of infantile idiopathic scoliosis: is general anesthesia necessary? LaValva et al. Spine Deformity Oct 2020. https://pubmed.ncbi.nlm.nih.gov/32383143/

 

Do Year-Out Programs Make Medical Students More Competitive Candidates for Orthopedic Surgery Residencies? Bram et al. Journal of Surgical Education Nov-Dec 2020. https://pubmed.ncbi.nlm.nih.gov/32505668/

 

Why Irrigate for the Same Contamination Rate: Wound Contamination in Pediatric Spinal Surgery Using Betadine Versus Saline. Cohen et al. JPO Nov-Dec 2020. https://pubmed.ncbi.nlm.nih.gov/33044376/

 

Mistakes Made and Lessons Learned: A Mid-Career Pediatric Orthopaedic Surgeon's Journey to Sustain Energy and Avoid Burnout. Flynn. JPO July 2020. https://pubmed.ncbi.nlm.nih.gov/32502065/