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Length unstable femoral fractures:A misnomer?

World Journal of Orthopedics 2020年第9期11卷 380-390页

作者： Eric Andrew Mussell achraf jardaly Shawn R Gilbert Department of Orthopaedic Surgery University of Alabama at Birminghamand Andrews Sports Medicine and Orthopaedic CenterBirminghamAL 35205United States Department of Orthopedic Surgery University of Alabama at Birmingham and Lebanese American UniversityGilbert and Rose-Marie Chagoury School of MedicineByblos 00000Lebanon Department of Pediatric Orthopaedics University of Alabama at BirminghamBirminghamAL 35233United States

BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral *** To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 *** This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and *** unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with *** criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up *** who had a length stable femoral fracture treated with modalities other than FIMN were excluded as *** Ninety-five fractures from ninety-two patients were included in the study and consists of three *** three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically *** characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically *** complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixato

关键词： Flexible intramedullary nail Titanium elastic mail Elastic stable intramedullary nail Pediatrics Length unstable Femoral fractures Bone fracture Orthopedics

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Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease:A database study

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World Journal of Orthopedics 2022年第4期13卷 373-380页

作者： achraf jardaly Timothy W Torrez Gerald McGwin Shawn R Gilbert Department of Orthopaedics Hughston Foundation/Hughston ClinicColumbusGA 31909United States Department of Orthopedics University of AlabamaBirminghamAL 35205United States Department of Epidemiology Center of Clinical and Translational ScienceUniversity of Alabama at BirminghamBirminghamAL 35205United States Department of Pediatric Orthopaedics University of Alabama at BirminghamBirminghamAL 35233United States

BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient *** recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s *** indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either *** believed there would be no increase in adverse outcomes associated with outpatient treatment of either *** To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse *** The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s *** Total 1788 SCFE database entries were included,30%were performed in an outpatient *** situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%*** Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our *** majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a *** differences in complication and readmission risks were found between inpatients and *** The current trend is shifting towards earlier discharges and performing procedures in an outpatient *** can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of compl

关键词： Outpatient surgery Early discharge Slipped capital femoral epiphysis Blount’s disease

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Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

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World Journal of Orthopedics 2022年第4期13卷 365-372页

作者： Shane F Strom Matthew C Hess achraf H jardaly Michael J Conklin Shawn R Gilbert Department of Orthopaedics University of Alabama at BirminghamBirminghamAl 35294United States Department of Orthopaedics The Hughston Clinic/Hughston FoundationColumbusGA 31908United States

BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic *** in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and *** consensus is reached regarding the proximal starting point of fusion,controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic *** To assess the role of pelvic fusion in posterior spinal instrumentation and fusion,particularly it impact on pelvic obliquity correction,and to assess if the rate of complications differed as a function of pelvic *** This was a retrospective,cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single *** follow-up was six *** were stratified into two groups:Those who were fused to the pelvis and those fused to L4/*** major outcomes were complications and radiographic *** former were stratified into major and minor complications,and the latter consisted of preoperative and final Cobb angles,L5-S1 tilt and pelvic *** The study included 47 *** correction of the L5 tilt was 60%in patients fused to the pelvis and 67%in patients fused to L4/L5(P=0.22).The pelvic obliquity was corrected by 43%and 36%in each group,respectively(P=0.12).Regarding complications,patients fused to the pelvis had more total complications as compared to the other group(63.0%vs 30%,respectively,P=0.025).After adjusting for differences in radiographic parameters(lumbar curve,L5 tilt,and pelvic obliquity),these patients had a 79%increased chance of developing complications(Relative risk=1.79;95%CI:1.011-3.41).CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative *** added value that pelvic fusion offers in terms of correcting

关键词： Cerebral palsy Scoliosis Pelvic fusion Pelvic obliquity Spinal fusion Distal lumbar level

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