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Barrett K.K.,Childrens Orthopaedic Center
Journal of Pediatric Orthopaedics | Year: 2014

BACKGROUND:: Proximal junctional kyphosis (PJK) is a known complication of spinal fusion and has been shown to occur in the setting of growing rod instrumentation. Previous studies have shown good reliability in measuring PJK in adolescent idiopathic scoliosis.METHODS:: Four pediatric orthopaedic spine surgeons measured the proximal junction in 10 patients with growing rod instrumentation using 2 methods. In method 1, measurements were made from the inferior endplate of the upper instrumented vertebrae (UIV) to the superior endplate of 1 level above the UIV. In method 2, measurements were made from the inferior endplate 2 levels below the UIV to the superior endplate 2 levels above the UIV. These measurements were repeated 1 week later.RESULTS:: Method 1 had an intraobserver variability of ±13.2 degrees and interobserver variability of ±21.6 degrees, whereas method 2 had an intraobserver variability of ±18.3 degrees and interobserver variability of ±20.7 degrees.CONCLUSIONS:: Interobserver variability of PJK is >20 degrees. As PJK is commonly defined as >10 degrees of kyphosis above the UIV, measurement of PJK in patients with distraction-based growing rods on lateral radiographs has too much variability to be useful.LEVEL OF EVIDENCE:: Level III—diagnostic studies. © 2014 by Lippincott Williams & Wilkins Source


Weiss J.M.,Childrens Orthopaedic Center
American journal of orthopedics (Belle Mead, N.J.) | Year: 2010

Previous studies have found a wide range of perioperative complications associated with distal humerus osteotomies for malunion of supracondylar fractures in children. Our hypothesis was that the surgery would have few perioperative complications when performed at a pediatric center. We examined perioperative complications of corrective osteotomy for malunited supracondylar humerus fractures in 41 patients treated at Children's Hospital Los Angeles between 1987 and 2002, and we established the risk factors associated with these complications. The overall complication rate was 32% (13/41). In the early surgeries, performed between 1987 and 1997, the complication rate was 53% (10/19); 6 (32%) of the 19 patients required reoperation. In the later surgeries performed during 1998 and 2002, the complication rate was 14% (3/22); no patient required reoperation. The complication rate was significantly lower (P = .0005) when lateral-entry pins were used to fix the osteotomy (13% [2/15]) than when other fixation methods were used (42% [11/26]). Using current techniques and performing the surgery in a pediatric center, we report a 0% reoperation rate and a 14% complication rate in distal humerus osteotomies for surgeries performed after 1997, a rate that we believe is acceptable. Furthermore, there are fewer complications of the surgery when lateral-entry pins are used to fix the osteotomy compared with other fixation methods. Source


Wren T.A.L.,Childrens Orthopaedic Center
Developmental Medicine and Child Neurology | Year: 2015

This commentary is on the original article by Grossberg et al. on pages 1064-1069 of this issue. Developmental Medicine and Child Neurology. © 2015 Mac Keith Press. Source


Joiner E.R.,Childrens Orthopaedic Center
The Journal of bone and joint surgery. American volume | Year: 2013

Brachial plexus injuries have been reported in association with distraction-based instrumentation for early-onset scoliosis. The purpose of this study was to describe brachial plexus injuries associated with distraction-based spine instrumentation with rib anchors and the mechanisms and risk factors responsible. We performed a retrospective single-center review of a consecutive series of forty-one patients with early-onset scoliosis who underwent distraction-based instrumentation with rib anchors from 2000 to 2011. Four (10%) of the forty-one patients experienced an intraoperative brachial plexus injury. Three mechanisms of brachial plexus injuries were identified: (1) injury of the brachial plexus by the first rib being pushed superiorly by rib-anchored growing instrumentation, (2) direct injury to the brachial plexus by the superior pole of the retracted scapula, and (3) injury of the brachial plexus when the scapula was moved inferiorly during Sprengel deformity reconstruction. The last two mechanisms are independent of spinal instrumentation. Two patients had neurological symptoms or neuromonitoring signal changes when the arm was in the adducted position but not when the arm was abducted. All patients had complete neurological recovery. Patients with Sprengel deformity appear to be at increased risk for brachial plexus injury when undergoing distraction-based spine instrumentation with rib anchors. Injury to the brachial plexus can occur with scapular elevation alone, presumably by direct compression of the superior end of the scapula on the brachial plexus. Brachial plexus injuries may be "hidden" during monitoring of an arm in shoulder abduction but symptomatic with shoulder adduction, as the brachial plexus is draped over the elevated first rib. Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence. Source


Wren T.A.L.,Childrens Orthopaedic Center | Wren T.A.L.,University of Southern California | Gorton G.E.,Shriners Hospitals for Children | Ounpuu S.,Connecticuit Childrens Medical Center | Tucker C.A.,Temple University
Gait and Posture | Year: 2011

The aim of this systematic review was to evaluate and summarize the current evidence base related to the clinical efficacy of gait analysis. A literature review was conducted to identify references related to human gait analysis published between January 2000 and September 2009 plus relevant older references. The references were assessed independently by four reviewers using a hierarchical model of efficacy adapted for gait analysis, and final scores were agreed upon by at least three of the four reviewers. 1528 references were identified relating to human instrumented gait analysis. Of these, 116 original articles addressed technical accuracy efficacy, 89 addressed diagnostic accuracy efficacy, 11 addressed diagnostic thinking and treatment efficacy, seven addressed patient outcomes efficacy, and one addressed societal efficacy, with some of the articles addressing multiple levels of efficacy. This body of literature provides strong evidence for the technical, diagnostic accuracy, diagnostic thinking and treatment efficacy of gait analysis. The existing evidence also indicates efficacy at the higher levels of patient outcomes and societal cost-effectiveness, but this evidence is more sparse and does not include any randomized controlled trials. Thus, the current evidence supports the clinical efficacy of gait analysis, particularly at the lower levels of efficacy, but additional research is needed to strengthen the evidence base at the higher levels of efficacy. © 2011. Source

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