Peds Ortho

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/

IPOS 2022, Part II

A special episode recorded live at IPOS, the International Pediatric Orthopaedic Symposium. Esteemed guests include Woody Sankar from CHOP, Jennifer Bauer from Seattle Children's, David Skaggs from Cedars Sinai, Jaysson Brooks from TSRH, Sandra Jarvis-Selinger from University of British Columbia, Suken Shah from Nemours, and Derek Kelly from Campbell Clinic. This episode is sponsored by Depuy Synthes. Your hosts are Carter Clement from Children's Hospital of New Orleans and Craig Louer from Vanderbilt. Music by A.A. Aalto.

IPOS 2022, Part I

A special episode recorded live at IPOS, the International Pediatric Orthopaedic Symposium. Esteemed guests include Jon Schoenecker from Vanderbilt, Will Mackenzie from Nemours, Michelle Wellborn from the Portland Shriners Hospital, Tom McPartland from Rutgers, Haemish Crawford from Starship Hospital in New Zealand, and Deborah Eastwood from Great Ormond Street Hospital in London. In lieu of sponsorship, the episode includes a feature on OrthoKids.org, POSNA's informational website for patients and parents (posters and other material for your clinic available at www.cliniccreative.net). Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Nick Fletcher from Children's Healthcare of Atlanta. Music by A.A. Aalto.

Lit. Update with Dustin Greenhill

Dustin Greenhill from St. Luke’s in Pennsylvania discusses femur fractures, subspecialty consultation before high-risk spine surgery, forearm fractures in obese children, and a variety of hip-related issues from recent publications. 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 OrthoFix. Music by A. A. Aalto.

 

Papers discussed:

 

Greenhill, Allred, Feldman, Herman. Vascular Safe Zone During Percutaneous Pinning of the Distal Femur. JPO 2022.

 

Greenhill, Herman. Treatment of Pediatric Femoral Shaft Fractures. JAAOS 2022.

 

Bauer, Sienko, Roy, et al. The incidence of avascular necrosis in children with cerebral palsy after hip containment surgery. JCO 2022.

 

Visser, Lehman, Armstrong. Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications? JPO 2022.

 

Murphy, Howells, Gallagher, et al. Children's Hip Predictive (CHiP) Score: A Triage Tool for Hip Dislocation in Children Referred With Suspected Hip Dysplasia. JPO 2022.

 

Lyons, McGregor, Hoyt, et al. Do Forearm Fracture Characteristics and Outcomes Differ Between Obese and Non-Obese Children? Original Research. JPOSNA 2022.

 

Smith, Block, Eisenberg, Shoenecker, Clohisy, Nepple. Characterizing the Residual SCFE Deformity: Utility of the 45-degree Dunn View. JPO 2022.

Lit. Update with Heather Kowalski

Heather Kowalski of The University of Iowa joins the show to discuss her recent JPOSNA publications on resident education through state-of-the-art simulation and her efforts to promote diversity and inclusion in our field. She “stirs the pot” on a variety of controversial topics in pediatric trauma and limb length inequality. Your hosts are Josh Holt from University of Iowa, 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.

  

Main Event Articles:

 

1) Holt et al. Integrating Simulation for Developing Pediatric Supracondylar Humeral Fracture Reduction and Fixation Skills into an Orthopaedic Surgery Residency Program. JPOSNA 2022.

 

2) Holt et al. Integrating Simulation for Developing Slipped Capital Femoral Epiphysis Fixation Skills into an Orthopaedic Surgery Residency Program. JPOSNA 2022.

 

3) Thomas et al. A Vision for Using Simulation & Virtual Coaching to Improve the Community Practice of Orthopedic Trauma Surgery. Iowa Orthop J. 2020.

 

Lightning Round Articles:

 

1) Georgiadis et al. Motorized Plate Lengthening of the Femur in Children: A Preliminary Report. JPO 2022.

 

2) Mahan et al. Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night? JCO 2022.

 

3) Weinmayer et al. Angular deformities after percutaneous epiphysiodesis for leg length discrepancy. JCO 2022.

 

4) Miller et al. Unilateral versus bilateral reconstructive hip surgery in children with cerebral palsy: A survey of pediatric orthopedic surgery practice and decision-making. JCO 2022.

 

5) Vij et al. Ethnic and Sex Diversity in Academic Orthopaedic Surgery: A Cross-sectional Study. JAAOS Glob Res Rev. 2022.