The Orthopedic Center at CHOP is one of the largest and most established pediatric programs in the world dedicated to treating orthopedic and sports medicine conditions in children and adolescents. A core part of our mission is to improve children's lives through research. Our staff investigate a wide spectrum of topics including bone and joint disorders, congenital anomalies and injuries. Below are some highlights of publications from 2024 authored by our orthopedic and sports medicine staff.
Do Patients of Different Levels of Affluence Receive Different Care for Pediatric Osteosarcomas?
In a study led by Alexandre Arkader, MD, the team investigated the impact of socioeconomic status, measured by the Childhood Opportunity Index, on pediatric osteosarcoma care and outcomes. Contrary to prior findings, it observed no significant association between socioeconomic status and time to diagnosis, treatment timing, surgical approaches, or survival outcomes. According to the authors, structural factors like public transit access, regional healthcare density, and institutional resources likely mitigated disparities. CORR Editorial further wrote a commentary article highlighting that pediatric cancer care, particularly for bone sarcomas, has achieved more equitable outcomes than adult care due to standardized protocols, such as those from the Children’s Oncology Group, and less fragmented delivery models. Addressing health inequities requires shifting focus from patient blame to systemic improvements, utilizing evidence-based protocols, and fostering innovation, as seen during the COVID-19 pandemic. Limitations of the study included the study's single-center, retrospective design and lack of control for confounding variables such as race and insurance. These results suggest that institutional and regional factors may play a critical role in reducing care inequities. Read the publication.
Kell, David BA; Yang, Daniel MD; Lee, Juliana MD; Orellana, Kevin MD; Wetzl, Sarah BS; Arkader, Alexandre MD. CORR Insights(R). Do Patients of Different Levels of Affluence Receive Different Care for Pediatric Osteosarcomas? One Institution’s Experience. Clinical Orthopaedics and Related Research ():10.1097/CORR.0000000000003299, October 30, 2024. | DOI: 10.1097/CORR.0000000000003299
Skeletal growth is enhanced by a shared role for SOX8 and SOX9 in promoting reserve chondrocyte commitment to columnar proliferation
The study led by Véronique Lefebvre, PhD, explores the roles of SOX8 and SOX9 transcription factors in skeletal growth, particularly in the growth plate cartilage. Using mouse models, the research demonstrates that while both factors coexpress and function together, SOX8 is more efficient than SOX9 due to greater protein stability. SOX8 and SOX9 deficiency leads to delayed skeletal elongation, emphasizing their redundancy in growth plate activity. The study also identifies SOX8 as a potential therapeutic target for cartilage regeneration in skeletal disorders. These findings from the study team enhance our understanding of skeletal development mechanisms and provide insights into human height regulation and treatment for degenerative cartilage diseases. Read the publication.
Molin AN, Contentin R, Angelozzi M, Karvande A, Kc R, Haseeb A, Voskamp C, de Charleroy C, Lefebvre V. Skeletal growth is enhanced by a shared role for SOX8 and SOX9 in promoting reserve chondrocyte commitment to columnar proliferation. Proc Natl Acad Sci U S A. 2024 Feb 20;121(8): e2316969121. DOI: 10.1073/pnas.2316969121. Epub 2024 Feb 12. PMID: 38346197; PMCID: PMC10895259.
Tibial spine fractures in the child and adolescent athlete: a systematic review and meta-analysis
Theodore J. Ganley, MD, and Tibial Spine Study Group collaborated on this systematic review focusing on tibial spine fractures (TSFs). The authors assessed data from 47 studies involving 1,922 patients to evaluate treatments like open reduction (ORIF) and arthroscopic techniques (ARIF) with fixation methods such as screws and sutures. It finds good overall outcomes with low nonunion rates but highlights arthrofibrosis and range-of-motion (ROM) loss were prevalent in more severe fractures. No significant differences in outcomes were noted between ORIF and ARIF or between fixation methods. Concomitant injuries are prevalent, emphasizing the need for advanced imaging for diagnosis and surgical planning. Larger studies are recommended to standardize treatment approaches. Read the publication.
Tibial Spine Research Interest Group; Orellana KJ, Houlihan NV, Carter MV, Baghdadi S, Baldwin K, Stevens AC, Cruz AI Jr, Ellis HB Jr, Green DW, Kushare I, Johnson B, Kerrigan A, Kirby JC, MacDonald JP, McKay SD, Milbrandt TA, Justin Mistovich R, Parikh S, Patel N, Schmale G, Traver JL, Yen YM, Ganley TJ. Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis. Am J Sports Med. 2024 Apr;52(5):1357-1366. DOI: 10.1177/03635465231175674. Epub 2023 Jun 16. PMID: 37326248.
Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family?
Patrick J. Cahill, MD, co-authored this paper with A. Noelle Larson, MD, and the Harms Study Group to investigate patient and family preferences regarding fusion versus non-fusion surgeries for treating pediatric idiopathic scoliosis (AIS). The study, involving 344 respondents, highlights that appearance and spinal motion preservation are key factors influencing decision-making. Fusion surgery is favored for its higher confidence in correction, durability and lower reoperation rates, despite its limitation in preserving motion. Non-fusion approaches like vertebral body tethering are valued for maintaining motion and shorter recovery but have higher reoperation rates and uncertain long-term benefits. Patients’ and families’ choices vary based on pre- or post-surgery experiences, emphasizing personalized care. The findings aim to guide patient-centered decisions and inform regulatory and clinical practices for scoliosis treatment. Read the publication.
Larson AN, Marks MC, Gonzalez Sepulveda JM, Newton PO, Devlin VJ, Peat R, Tarver ME, Babalola O, Chen AL, Gebben D, Cahill P, Shah S, Samdani A, Bachmann K, Lonner B; the Harms Study Group. Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family? J Bone Joint Surg Am. 2024 Jan 3;106(1):2-9. DOI: 10.2106/JBJS.23.00503. Epub 2023 Nov 9. PMID: 37943944.
Community and Patient Features and Health Care Point of Entry for Pediatric Concussion
In a study led Christina L. Master, MD, FAAP, CAQSM, FACSM, FAMSSM, Kristy B. Arbogast, PhD & Daniel J. Corwin, MD, MSCE, the team examined disparities in pediatric concussion care across various healthcare entry points, including emergency departments, primary care and specialty care within a regional network. Among the study sample of 15,631 patients, non-Hispanic Black children and those with public insurance were more likely to seek initial care in EDs. ED patients also had lower Child Opportunity Index scores, reflecting limited neighborhood resources compared to PC and SC settings. These patients also resided in areas with lower Child Opportunity Index scores, indicating limited access to resources that promote recovery. The findings highlight the need for enhanced education for emergency clinicians and better community resources to ensure equitable concussion care. Results from this study emphasizes addressing structural disparities and improving access to advanced, individualized concussion treatments. Read the publication.
Corwin DJ, Fedonni D, McDonald CC, Peterson A, Haarbauer-Krupa J, Godfrey M, Camacho P, Bryant-Stephens T, Master CL, Arbogast KB. Community and Patient Features and Health Care Point of Entry for Pediatric Concussion. JAMA Netw Open. 2024 Oct 1;7(10): e2442332. DOI: 10.1001/jamanetworkopen.2024.42332. PMID: 39476230; PMCID: PMC11525599
Who Is Considered a Pediatric Athlete?
In this editorial written by Theodore J. Ganley, MD, section editor for American Journal for Sports Medicine, he explores the complexity of defining “pediatric athletes” in sports medicine and pediatric orthopedics. Dr. Ganley articulates that age-based classifications lack standardization across organizations like the AAP, NICHD, and WHO. It highlights the need to consider anatomical, developmental and healing factors unique to children, including physeal status and growth potential, which influence injury presentation and treatment. The author notes disparities in research methodologies, particularly regarding adolescents transitioning to adult care, and calls for a consensus to standardize language and criteria. Such alignment is essential to improve research quality, ensure effective communication, and optimize care for pediatric athletes. Read the publication.
Ganley TJ. Who Is Considered a Pediatric Athlete? Am J Sports Med. 2024 Aug;52(10):2448-2449. DOI: 10.1177/03635465241270357. PMID: 39171947.
Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures
In a study led by J. Todd Lawrence, MD, PhD, the authors examined refracture rates in pediatric both-bone forearm fractures based on fixation methods. The study team estimated a refracture rate of 5.5%, with younger patients (≤10 years) and single-bone intramedullary fixation having significantly higher rates. Comparatively, both-bone fixation, particularly using intramedullary devices, showed reduced refracture incidences. Plate fixation had similar refracture rates across single- and both-bone treatments. The findings suggest that optimizing fixation strategy, especially intramedullary fixation of both bones, may mitigate refracture risk, particularly in younger patients. This study was also highlighted in the official POSNA podcast “Peds Ortho: Lit. Update with Mark Seely, MD.” Read the publication.
Syed AN, Ashebo L, Lawrence JTR. Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures. J Pediatr Orthop. 2024 Feb 1;44(2): e124-e130. DOI: 10.1097/BPO.0000000000002552. Epub 2023 Oct 31. PMID: 37904588.
Revision Surgery Following Primary Reconstruction for Hand Syndactyly
This study, designated as “Editor’s Choice” and led by Apurva S. Shah, MD, MBA, analyzed revision surgery following primary reconstruction of congenital hand syndactyly, examining 514 web spaces across 231 children. Approximately 13% of web spaces required revision, most within four years post-surgery. Web creep and scar contracture were the primary revision indications, frequently affecting the first web space. Multivariable analysis identified first web space involvement, complete syndactyly and early postoperative complications as significant risk factors. Interestingly, age at primary reconstruction was not predictive of revision risk. Outcomes post-revision showed recurrence of web creep or contracture in 10-14% of cases. The findings underscore the need for tailored surgical strategies and long-term follow-up to optimize patient outcomes. Read the publication.
Belardo ZE, Graham EM, Pehnke M, Chang B, Mendenhall SD, Mori S, Shah AS. Revision Surgery Following Primary Reconstruction for Hand Syndactyly. J Hand Surg Am. 2024 Dec;49(12):1228-1238. DOI: 10.1016/j.jhsa.2024.08.012. Epub 2024 Oct 2. PMID: 39365243.
Perfusion Magnetic Resonance Imaging Correlates with the Duration of Stages and Lateral Pillar Class in Legg-Calvé-Perthes Disease
In this study led by Wudbhav N. Sankar, MD, along with investigators from International Perthes Study Group, the team investigated the prognostic utility of perfusion MRI in Legg-Calvé-Perthes disease, focusing on correlations between epiphyseal hypoperfusion and disease progression. Data from 107 patients showed that global and regional hypoperfusion strongly correlated with longer durations of fragmentation and reossification stages, critical indicators of disease severity. Hypoperfusion in the lateral femoral head was significantly associated with lateral pillar classification, reinforcing its role in predicting disease outcomes. The findings suggest pMRI provides valuable early prognostic information, enabling stratification of disease severity and guiding timely interventions. These results highlight the importance of advanced imaging for optimizing LCPD management. Read the publication.
Sankar WN, Lee J, Chong D, Hailer YD, de Angeli LR, Yang S, Laine J, Kim HK, Study Conducted by The International Perthes Study Group. Perfusion Magnetic Resonance Imaging Correlates with The Duration of Stages and Lateral Pillar Class in Legg-Calvé-Perthes Disease. JPOSNA. 2024 Feb 1; 6:100019.
Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review
In a study led by Keith D. Baldwin, MD, MPH, MSPT, the team conducted a systematic review among 34 studies from 1991 to 2022 to assess the incidence and management of postoperative nausea and vomiting (PONV) in adolescents undergoing spinal fusion surgery for scoliosis. Despite the high prevalence of PONV, data on this complication remains limited, with most studies addressing it as a secondary outcome. Key findings reveal that evidence for PONV mitigation strategies, such as opioid-sparing techniques, dexamethasone and enhanced recovery pathways, is often conflicting or inconclusive. The authors emphasize the need for research focusing on PONV as a primary outcome to establish targeted guidelines, particularly for high-risk pediatric patients. Read the publication.
Syed AN, Baghdadi S, Muhly WT, Baldwin KD. Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review. JBJS Rev. 2024 Jan 9;12(1). DOI: 10.2106/JBJS.RVW.23.00176. PMID: 38194592.
Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial
In a study led by Patrick J. Cahill, MD, in collaboration with the Harms Study Group, investigators evaluated the effect of spinal fusion surgery on health-related quality of life (HRQoL) in children with cerebral palsy and scoliosis. Among 335 participants, significant improvements were observed in HRQoL, as measured by the CPCHILD questionnaire, for those undergoing surgery compared to nonoperative controls. Operative patients demonstrated enhanced outcomes in five of six HRQoL domains, including mobility, comfort and overall health, while the nonoperative group showed no significant changes. The pivotal study confirms the effectiveness of spinal fusion in addressing severe deformities, halting progression, and improving balance and functionality. Despite challenges like surgical risks and variability in patient characteristics, the research underscores the clinical benefits of surgery over nonoperative management. It advocates for continued exploration of long-term outcomes and strategies to optimize surgical interventions for this population. Read the publication.
Cahill PJ, Narayanan U, Bowen M, Sarkar S, Pahys JM, Miyanji F, Yaszay B, Shah SA, Sponseller PD; Harms Study Group. Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial. J Pediatr Orthop. 2024 Nov-Dec 01;44(10): e901-e907. DOI: 10.1097/BPO.0000000000002774. Epub 2024 Jul 30. PMID: 39077879.
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The Orthopedic Center at CHOP is one of the largest and most established pediatric programs in the world dedicated to treating orthopedic and sports medicine conditions in children and adolescents. A core part of our mission is to improve children's lives through research. Our staff investigate a wide spectrum of topics including bone and joint disorders, congenital anomalies and injuries. Below are some highlights of publications from 2024 authored by our orthopedic and sports medicine staff.
Do Patients of Different Levels of Affluence Receive Different Care for Pediatric Osteosarcomas?
In a study led by Alexandre Arkader, MD, the team investigated the impact of socioeconomic status, measured by the Childhood Opportunity Index, on pediatric osteosarcoma care and outcomes. Contrary to prior findings, it observed no significant association between socioeconomic status and time to diagnosis, treatment timing, surgical approaches, or survival outcomes. According to the authors, structural factors like public transit access, regional healthcare density, and institutional resources likely mitigated disparities. CORR Editorial further wrote a commentary article highlighting that pediatric cancer care, particularly for bone sarcomas, has achieved more equitable outcomes than adult care due to standardized protocols, such as those from the Children’s Oncology Group, and less fragmented delivery models. Addressing health inequities requires shifting focus from patient blame to systemic improvements, utilizing evidence-based protocols, and fostering innovation, as seen during the COVID-19 pandemic. Limitations of the study included the study's single-center, retrospective design and lack of control for confounding variables such as race and insurance. These results suggest that institutional and regional factors may play a critical role in reducing care inequities. Read the publication.
Kell, David BA; Yang, Daniel MD; Lee, Juliana MD; Orellana, Kevin MD; Wetzl, Sarah BS; Arkader, Alexandre MD. CORR Insights(R). Do Patients of Different Levels of Affluence Receive Different Care for Pediatric Osteosarcomas? One Institution’s Experience. Clinical Orthopaedics and Related Research ():10.1097/CORR.0000000000003299, October 30, 2024. | DOI: 10.1097/CORR.0000000000003299
Skeletal growth is enhanced by a shared role for SOX8 and SOX9 in promoting reserve chondrocyte commitment to columnar proliferation
The study led by Véronique Lefebvre, PhD, explores the roles of SOX8 and SOX9 transcription factors in skeletal growth, particularly in the growth plate cartilage. Using mouse models, the research demonstrates that while both factors coexpress and function together, SOX8 is more efficient than SOX9 due to greater protein stability. SOX8 and SOX9 deficiency leads to delayed skeletal elongation, emphasizing their redundancy in growth plate activity. The study also identifies SOX8 as a potential therapeutic target for cartilage regeneration in skeletal disorders. These findings from the study team enhance our understanding of skeletal development mechanisms and provide insights into human height regulation and treatment for degenerative cartilage diseases. Read the publication.
Molin AN, Contentin R, Angelozzi M, Karvande A, Kc R, Haseeb A, Voskamp C, de Charleroy C, Lefebvre V. Skeletal growth is enhanced by a shared role for SOX8 and SOX9 in promoting reserve chondrocyte commitment to columnar proliferation. Proc Natl Acad Sci U S A. 2024 Feb 20;121(8): e2316969121. DOI: 10.1073/pnas.2316969121. Epub 2024 Feb 12. PMID: 38346197; PMCID: PMC10895259.
Tibial spine fractures in the child and adolescent athlete: a systematic review and meta-analysis
Theodore J. Ganley, MD, and Tibial Spine Study Group collaborated on this systematic review focusing on tibial spine fractures (TSFs). The authors assessed data from 47 studies involving 1,922 patients to evaluate treatments like open reduction (ORIF) and arthroscopic techniques (ARIF) with fixation methods such as screws and sutures. It finds good overall outcomes with low nonunion rates but highlights arthrofibrosis and range-of-motion (ROM) loss were prevalent in more severe fractures. No significant differences in outcomes were noted between ORIF and ARIF or between fixation methods. Concomitant injuries are prevalent, emphasizing the need for advanced imaging for diagnosis and surgical planning. Larger studies are recommended to standardize treatment approaches. Read the publication.
Tibial Spine Research Interest Group; Orellana KJ, Houlihan NV, Carter MV, Baghdadi S, Baldwin K, Stevens AC, Cruz AI Jr, Ellis HB Jr, Green DW, Kushare I, Johnson B, Kerrigan A, Kirby JC, MacDonald JP, McKay SD, Milbrandt TA, Justin Mistovich R, Parikh S, Patel N, Schmale G, Traver JL, Yen YM, Ganley TJ. Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis. Am J Sports Med. 2024 Apr;52(5):1357-1366. DOI: 10.1177/03635465231175674. Epub 2023 Jun 16. PMID: 37326248.
Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family?
Patrick J. Cahill, MD, co-authored this paper with A. Noelle Larson, MD, and the Harms Study Group to investigate patient and family preferences regarding fusion versus non-fusion surgeries for treating pediatric idiopathic scoliosis (AIS). The study, involving 344 respondents, highlights that appearance and spinal motion preservation are key factors influencing decision-making. Fusion surgery is favored for its higher confidence in correction, durability and lower reoperation rates, despite its limitation in preserving motion. Non-fusion approaches like vertebral body tethering are valued for maintaining motion and shorter recovery but have higher reoperation rates and uncertain long-term benefits. Patients’ and families’ choices vary based on pre- or post-surgery experiences, emphasizing personalized care. The findings aim to guide patient-centered decisions and inform regulatory and clinical practices for scoliosis treatment. Read the publication.
Larson AN, Marks MC, Gonzalez Sepulveda JM, Newton PO, Devlin VJ, Peat R, Tarver ME, Babalola O, Chen AL, Gebben D, Cahill P, Shah S, Samdani A, Bachmann K, Lonner B; the Harms Study Group. Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family? J Bone Joint Surg Am. 2024 Jan 3;106(1):2-9. DOI: 10.2106/JBJS.23.00503. Epub 2023 Nov 9. PMID: 37943944.
Community and Patient Features and Health Care Point of Entry for Pediatric Concussion
In a study led Christina L. Master, MD, FAAP, CAQSM, FACSM, FAMSSM, Kristy B. Arbogast, PhD & Daniel J. Corwin, MD, MSCE, the team examined disparities in pediatric concussion care across various healthcare entry points, including emergency departments, primary care and specialty care within a regional network. Among the study sample of 15,631 patients, non-Hispanic Black children and those with public insurance were more likely to seek initial care in EDs. ED patients also had lower Child Opportunity Index scores, reflecting limited neighborhood resources compared to PC and SC settings. These patients also resided in areas with lower Child Opportunity Index scores, indicating limited access to resources that promote recovery. The findings highlight the need for enhanced education for emergency clinicians and better community resources to ensure equitable concussion care. Results from this study emphasizes addressing structural disparities and improving access to advanced, individualized concussion treatments. Read the publication.
Corwin DJ, Fedonni D, McDonald CC, Peterson A, Haarbauer-Krupa J, Godfrey M, Camacho P, Bryant-Stephens T, Master CL, Arbogast KB. Community and Patient Features and Health Care Point of Entry for Pediatric Concussion. JAMA Netw Open. 2024 Oct 1;7(10): e2442332. DOI: 10.1001/jamanetworkopen.2024.42332. PMID: 39476230; PMCID: PMC11525599
Who Is Considered a Pediatric Athlete?
In this editorial written by Theodore J. Ganley, MD, section editor for American Journal for Sports Medicine, he explores the complexity of defining “pediatric athletes” in sports medicine and pediatric orthopedics. Dr. Ganley articulates that age-based classifications lack standardization across organizations like the AAP, NICHD, and WHO. It highlights the need to consider anatomical, developmental and healing factors unique to children, including physeal status and growth potential, which influence injury presentation and treatment. The author notes disparities in research methodologies, particularly regarding adolescents transitioning to adult care, and calls for a consensus to standardize language and criteria. Such alignment is essential to improve research quality, ensure effective communication, and optimize care for pediatric athletes. Read the publication.
Ganley TJ. Who Is Considered a Pediatric Athlete? Am J Sports Med. 2024 Aug;52(10):2448-2449. DOI: 10.1177/03635465241270357. PMID: 39171947.
Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures
In a study led by J. Todd Lawrence, MD, PhD, the authors examined refracture rates in pediatric both-bone forearm fractures based on fixation methods. The study team estimated a refracture rate of 5.5%, with younger patients (≤10 years) and single-bone intramedullary fixation having significantly higher rates. Comparatively, both-bone fixation, particularly using intramedullary devices, showed reduced refracture incidences. Plate fixation had similar refracture rates across single- and both-bone treatments. The findings suggest that optimizing fixation strategy, especially intramedullary fixation of both bones, may mitigate refracture risk, particularly in younger patients. This study was also highlighted in the official POSNA podcast “Peds Ortho: Lit. Update with Mark Seely, MD.” Read the publication.
Syed AN, Ashebo L, Lawrence JTR. Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures. J Pediatr Orthop. 2024 Feb 1;44(2): e124-e130. DOI: 10.1097/BPO.0000000000002552. Epub 2023 Oct 31. PMID: 37904588.
Revision Surgery Following Primary Reconstruction for Hand Syndactyly
This study, designated as “Editor’s Choice” and led by Apurva S. Shah, MD, MBA, analyzed revision surgery following primary reconstruction of congenital hand syndactyly, examining 514 web spaces across 231 children. Approximately 13% of web spaces required revision, most within four years post-surgery. Web creep and scar contracture were the primary revision indications, frequently affecting the first web space. Multivariable analysis identified first web space involvement, complete syndactyly and early postoperative complications as significant risk factors. Interestingly, age at primary reconstruction was not predictive of revision risk. Outcomes post-revision showed recurrence of web creep or contracture in 10-14% of cases. The findings underscore the need for tailored surgical strategies and long-term follow-up to optimize patient outcomes. Read the publication.
Belardo ZE, Graham EM, Pehnke M, Chang B, Mendenhall SD, Mori S, Shah AS. Revision Surgery Following Primary Reconstruction for Hand Syndactyly. J Hand Surg Am. 2024 Dec;49(12):1228-1238. DOI: 10.1016/j.jhsa.2024.08.012. Epub 2024 Oct 2. PMID: 39365243.
Perfusion Magnetic Resonance Imaging Correlates with the Duration of Stages and Lateral Pillar Class in Legg-Calvé-Perthes Disease
In this study led by Wudbhav N. Sankar, MD, along with investigators from International Perthes Study Group, the team investigated the prognostic utility of perfusion MRI in Legg-Calvé-Perthes disease, focusing on correlations between epiphyseal hypoperfusion and disease progression. Data from 107 patients showed that global and regional hypoperfusion strongly correlated with longer durations of fragmentation and reossification stages, critical indicators of disease severity. Hypoperfusion in the lateral femoral head was significantly associated with lateral pillar classification, reinforcing its role in predicting disease outcomes. The findings suggest pMRI provides valuable early prognostic information, enabling stratification of disease severity and guiding timely interventions. These results highlight the importance of advanced imaging for optimizing LCPD management. Read the publication.
Sankar WN, Lee J, Chong D, Hailer YD, de Angeli LR, Yang S, Laine J, Kim HK, Study Conducted by The International Perthes Study Group. Perfusion Magnetic Resonance Imaging Correlates with The Duration of Stages and Lateral Pillar Class in Legg-Calvé-Perthes Disease. JPOSNA. 2024 Feb 1; 6:100019.
Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review
In a study led by Keith D. Baldwin, MD, MPH, MSPT, the team conducted a systematic review among 34 studies from 1991 to 2022 to assess the incidence and management of postoperative nausea and vomiting (PONV) in adolescents undergoing spinal fusion surgery for scoliosis. Despite the high prevalence of PONV, data on this complication remains limited, with most studies addressing it as a secondary outcome. Key findings reveal that evidence for PONV mitigation strategies, such as opioid-sparing techniques, dexamethasone and enhanced recovery pathways, is often conflicting or inconclusive. The authors emphasize the need for research focusing on PONV as a primary outcome to establish targeted guidelines, particularly for high-risk pediatric patients. Read the publication.
Syed AN, Baghdadi S, Muhly WT, Baldwin KD. Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review. JBJS Rev. 2024 Jan 9;12(1). DOI: 10.2106/JBJS.RVW.23.00176. PMID: 38194592.
Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial
In a study led by Patrick J. Cahill, MD, in collaboration with the Harms Study Group, investigators evaluated the effect of spinal fusion surgery on health-related quality of life (HRQoL) in children with cerebral palsy and scoliosis. Among 335 participants, significant improvements were observed in HRQoL, as measured by the CPCHILD questionnaire, for those undergoing surgery compared to nonoperative controls. Operative patients demonstrated enhanced outcomes in five of six HRQoL domains, including mobility, comfort and overall health, while the nonoperative group showed no significant changes. The pivotal study confirms the effectiveness of spinal fusion in addressing severe deformities, halting progression, and improving balance and functionality. Despite challenges like surgical risks and variability in patient characteristics, the research underscores the clinical benefits of surgery over nonoperative management. It advocates for continued exploration of long-term outcomes and strategies to optimize surgical interventions for this population. Read the publication.
Cahill PJ, Narayanan U, Bowen M, Sarkar S, Pahys JM, Miyanji F, Yaszay B, Shah SA, Sponseller PD; Harms Study Group. Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial. J Pediatr Orthop. 2024 Nov-Dec 01;44(10): e901-e907. DOI: 10.1097/BPO.0000000000002774. Epub 2024 Jul 30. PMID: 39077879.
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