This is an erratum to an already published paper.We found an error in the results section and Table 1.Specifically,we have revised results with n≤10 to be reflected as such,which is consistent with the reporting inst...This is an erratum to an already published paper.We found an error in the results section and Table 1.Specifically,we have revised results with n≤10 to be reflected as such,which is consistent with the reporting instructions by the Agency for Healthcare Research and Quality.Please note,these changes do not affect our results,and we had previously listed this requirement in the results section.We apologize for our unintentional mistake.展开更多
BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and ...BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in children.METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017.Demographic data included age,gender,race,hospital type and insurance type.Clinical data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP database.Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included.This cohort was 62.3%male,with mean age of 9.0(±6.1)years.Approximately 46%of patients were white and approximately half had Medicaid insurance.Thirty-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any point.The mean readmission LOS was 11.6(±11.3)d.Higher CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients presented.Multivariate analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of RTS.CONCLUSION Septic arthritis of the knee is an important condition in children.The CCI was associated with RTS at a minimum of 2 years after index procedure.No association was found with age,gender,race,insurance type,or hospital type.Shorter LOS and CCI were associated with RTS in multivariate analysis.Overall,risk of subsequent surgery and readmission after pediatric septic knee arthritis is low,and CCI and shorter LOS are predictive of RTS.展开更多
BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,th...BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing.We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure.The outcomes of interest were delayed union or nonunion.Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available evidence.RESULTS A total of 120 articles were identified and screened,of which 6 articles were included for final review.Nonunion in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period.Additionally,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse side-effects.CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing.Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.展开更多
Lymphangiomas are a group of benign malformations of the lymphatic system, and hemolymphangioma(or hemangiolymphangioma) is a rare congenital malformation of the lymphatic system with vascular involvement. These benig...Lymphangiomas are a group of benign malformations of the lymphatic system, and hemolymphangioma(or hemangiolymphangioma) is a rare congenital malformation of the lymphatic system with vascular involvement. These benign malformations are most commonly diagnosed at an early age, and may be present as a part of an associated syndrome. In this case report, we describe the first case of adolescent scoliosis associated with a large, paraspinous hemolymphangioma. A 15-year-old girl with an incidental finding of a paraspinous hemolymphangioma is presented along with her history, physical exam, radiographic findings, and operative course. The possible pathogenesis, treatment approach, and clinical dilemmas are also discussed. Given the well-known relationship between tumors and scoliosis, a benign paraspinous vascular and lymphatic tumor may be responsible for the presence of scoliosis in a small number of patients.展开更多
BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New Y...BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York State.AIM To describe the incidence and surgical management of patients with syndactyly using an America’s population-based database.METHODS We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were used.RESULTS There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births.A small number of patients underwent surgical correction in New York State(178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two(79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery(P = 0.02).CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be severalbarriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.展开更多
BACKGROUND The national rates of readmission and reoperation after open reduction internal fixation(ORIF)of midshaft clavicle fractures in adolescents is unknown.AIM To determine rates of and risk factors for readmiss...BACKGROUND The national rates of readmission and reoperation after open reduction internal fixation(ORIF)of midshaft clavicle fractures in adolescents is unknown.AIM To determine rates of and risk factors for readmission and reoperation after ORIF of midshaft clavicle fractures in adolescents.METHODS This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included 11728 patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and 2012.Readmissions within ninety days,reoperations within two years,and differences in patient demographic factors were determined through descriptive,univariate,and multivariate analyses.RESULTS In total,3.29%(n=11)of patients were readmitted within 90 d to a hospital at an average of 18.91±18 d after discharge,while 15.87%(n=53)of patients underwent a reoperation within two years at an average of 209.53±151 d since the index surgery.The most common reason for readmission was a postoperative infection(n<10).Reasons for reoperation included implant removal(n=49)at an average time of 202.39±138 d after surgery,and revision ORIF(n<10)with an average time of 297±289 d after index surgery.The odds of reoperation were higher for females(P<0.01)and outpatients(P<0.01),while the odds of reoperation were lower for patients who underwent surgery in California(P=0.02).CONCLUSION There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in adolescents.There are significant differences for reoperation based on patient sex,location,and hospital type.展开更多
BACKGROUND Firearm-associated injuries(FAIs)are among the leading causes of morbidity and mortality in children living in the United States.Most victims of such injuries survive,but may experience compromised function...BACKGROUND Firearm-associated injuries(FAIs)are among the leading causes of morbidity and mortality in children living in the United States.Most victims of such injuries survive,but may experience compromised function related to musculoskeletal injuries.Although complex firearm-associated fractures(FAFs)often require specialized orthopaedic,vascular,and plastic surgical intervention,there is minimal research describing their management and outcomes.The purpose of this study is to describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these injuries.AIM To describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these injuries.METHODS A retrospective chart review was performed at a major,pediatric level 1 trauma center.The study included patients aged 18 or younger who presented with FAIs between 2008-2018.Additional data was collected on patients with FAFs including demographic and clinical data such as age,sex,race,payor type,fracture location,injury severity score(ISS),and radiographic and clinical outcomes.The management of FAFs was analyzed as well as need for readmission and reoperation.Descriptive statistics were used to summarize the results and univariate analyses were performed to assess differences between groups.RESULTS Between 2008 and 2018,there were a total of 61 patients who presented with FAIs.In this cohort,21 patients(34%)sustained FAFs(25 fractures)with a mean age of 11(Range:10 mo to 18 years old)at the time of presentation.Approximately 52%(n=11)of patients with FAFs were male,76%(n=8 and n=8,respectively)identified as black or other,and 71%(n=15)had government insurance.FAFs were most commonly noted in the upper extremity(n=7)and lower extremity(n=6).In patients with FAFs,the mean ISS at presentation was 11.38(Range:2-38),and 24%of patients(n=5)were classified as having a major trauma.There were no significant differences in age,sex,race,and payor type in FAF patients that presented with and without major trauma(P>0.05).When comparing FAF and non-FAF patients,there was a statistically significant difference in ISS(11.38 vs 14.45,P=0.02).In total,33%(n=7)of patients with FAFs required orthopaedic surgical management,which was most commonly comprised of debridement(n=6/7,86%),and 14%(n=1/7)of these patients required coordinated care with plastic and/or vascular surgery.There were no significant differences in age and payor type in patients with FAFs treated with and without orthopaedic surgery.Of the patients with FAFs,52%(n=11)had a minimum 90-d follow-up,and 48%(n=10)had a minimum 2-year follow-up.Two patients were readmitted within 90-d,while one patient required a reoperation within 2-years.CONCLUSION Over 25%of FAIs in pediatric patients result in FAFs.FAFs often present to pediatric trauma centers and the majority of these injuries occur in non-Caucasian males with government insurance.Most FAFs do not need orthopaedic surgical management;14%of these injuries require subspecialty care by orthopaedic surgery,vascular surgery,or plastic surgery.Patients with FAFs also have lower ISS compared to patients who sustained FAIs without fracture.Thus,these patients should be treated at pediatric trauma centers with specialty care and additional research is needed to focus prevention efforts,understand reasons for poor follow-up,and evaluate outcomes after injury.展开更多
文摘This is an erratum to an already published paper.We found an error in the results section and Table 1.Specifically,we have revised results with n≤10 to be reflected as such,which is consistent with the reporting instructions by the Agency for Healthcare Research and Quality.Please note,these changes do not affect our results,and we had previously listed this requirement in the results section.We apologize for our unintentional mistake.
文摘BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in children.METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017.Demographic data included age,gender,race,hospital type and insurance type.Clinical data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP database.Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included.This cohort was 62.3%male,with mean age of 9.0(±6.1)years.Approximately 46%of patients were white and approximately half had Medicaid insurance.Thirty-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any point.The mean readmission LOS was 11.6(±11.3)d.Higher CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients presented.Multivariate analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of RTS.CONCLUSION Septic arthritis of the knee is an important condition in children.The CCI was associated with RTS at a minimum of 2 years after index procedure.No association was found with age,gender,race,insurance type,or hospital type.Shorter LOS and CCI were associated with RTS in multivariate analysis.Overall,risk of subsequent surgery and readmission after pediatric septic knee arthritis is low,and CCI and shorter LOS are predictive of RTS.
文摘BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing.We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure.The outcomes of interest were delayed union or nonunion.Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available evidence.RESULTS A total of 120 articles were identified and screened,of which 6 articles were included for final review.Nonunion in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period.Additionally,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse side-effects.CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing.Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.
文摘Lymphangiomas are a group of benign malformations of the lymphatic system, and hemolymphangioma(or hemangiolymphangioma) is a rare congenital malformation of the lymphatic system with vascular involvement. These benign malformations are most commonly diagnosed at an early age, and may be present as a part of an associated syndrome. In this case report, we describe the first case of adolescent scoliosis associated with a large, paraspinous hemolymphangioma. A 15-year-old girl with an incidental finding of a paraspinous hemolymphangioma is presented along with her history, physical exam, radiographic findings, and operative course. The possible pathogenesis, treatment approach, and clinical dilemmas are also discussed. Given the well-known relationship between tumors and scoliosis, a benign paraspinous vascular and lymphatic tumor may be responsible for the presence of scoliosis in a small number of patients.
文摘BACKGROUND There is paucity of literature focusing on the incidence and surgical management of syndactyly. In this study, we describe the incidence and rates of surgical management of patients with syndactyly in New York State.AIM To describe the incidence and surgical management of patients with syndactyly using an America’s population-based database.METHODS We conducted a retrospective study using the New York State Statewide Planning and Research Cooperative System. All patients with a diagnosis of syndactyly at birth were identified and followed longitudinally to determine yearly incidence as well as demographic and surgical factors. Descriptive statistics and univariate analyses were used.RESULTS There were 3306 newborns with a syndactyly diagnosis between 1997 and 2014 in New York State. The overall incidence was 0.074% or 7 cases per 10000 live births.A small number of patients underwent surgical correction in New York State(178 patients, 5.4%). Among the surgical patients, most of the operations were performed before the age of two(79%). Approximately 87% of surgeries were performed at teaching hospitals, and 52% of procedures were performed by plastic surgeons. Skin grafting was performed in 15% of cases. Patients having surgery in New York State were more likely to have Medicaid insurance compared to patients not having surgery(P = 0.02).CONCLUSION Syndactyly occurs in approximately 7 per 10000 live births, and the majority of patients undergo surgical correction before age two. There may be severalbarriers to care including the availability of specialized hand surgeons, access to teaching hospitals, and insurance status.
文摘BACKGROUND The national rates of readmission and reoperation after open reduction internal fixation(ORIF)of midshaft clavicle fractures in adolescents is unknown.AIM To determine rates of and risk factors for readmission and reoperation after ORIF of midshaft clavicle fractures in adolescents.METHODS This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included 11728 patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and 2012.Readmissions within ninety days,reoperations within two years,and differences in patient demographic factors were determined through descriptive,univariate,and multivariate analyses.RESULTS In total,3.29%(n=11)of patients were readmitted within 90 d to a hospital at an average of 18.91±18 d after discharge,while 15.87%(n=53)of patients underwent a reoperation within two years at an average of 209.53±151 d since the index surgery.The most common reason for readmission was a postoperative infection(n<10).Reasons for reoperation included implant removal(n=49)at an average time of 202.39±138 d after surgery,and revision ORIF(n<10)with an average time of 297±289 d after index surgery.The odds of reoperation were higher for females(P<0.01)and outpatients(P<0.01),while the odds of reoperation were lower for patients who underwent surgery in California(P=0.02).CONCLUSION There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in adolescents.There are significant differences for reoperation based on patient sex,location,and hospital type.
文摘BACKGROUND Firearm-associated injuries(FAIs)are among the leading causes of morbidity and mortality in children living in the United States.Most victims of such injuries survive,but may experience compromised function related to musculoskeletal injuries.Although complex firearm-associated fractures(FAFs)often require specialized orthopaedic,vascular,and plastic surgical intervention,there is minimal research describing their management and outcomes.The purpose of this study is to describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these injuries.AIM To describe the epidemiology and presentation of pediatric FAFs,as well as evaluate the management and outcomes of these injuries.METHODS A retrospective chart review was performed at a major,pediatric level 1 trauma center.The study included patients aged 18 or younger who presented with FAIs between 2008-2018.Additional data was collected on patients with FAFs including demographic and clinical data such as age,sex,race,payor type,fracture location,injury severity score(ISS),and radiographic and clinical outcomes.The management of FAFs was analyzed as well as need for readmission and reoperation.Descriptive statistics were used to summarize the results and univariate analyses were performed to assess differences between groups.RESULTS Between 2008 and 2018,there were a total of 61 patients who presented with FAIs.In this cohort,21 patients(34%)sustained FAFs(25 fractures)with a mean age of 11(Range:10 mo to 18 years old)at the time of presentation.Approximately 52%(n=11)of patients with FAFs were male,76%(n=8 and n=8,respectively)identified as black or other,and 71%(n=15)had government insurance.FAFs were most commonly noted in the upper extremity(n=7)and lower extremity(n=6).In patients with FAFs,the mean ISS at presentation was 11.38(Range:2-38),and 24%of patients(n=5)were classified as having a major trauma.There were no significant differences in age,sex,race,and payor type in FAF patients that presented with and without major trauma(P>0.05).When comparing FAF and non-FAF patients,there was a statistically significant difference in ISS(11.38 vs 14.45,P=0.02).In total,33%(n=7)of patients with FAFs required orthopaedic surgical management,which was most commonly comprised of debridement(n=6/7,86%),and 14%(n=1/7)of these patients required coordinated care with plastic and/or vascular surgery.There were no significant differences in age and payor type in patients with FAFs treated with and without orthopaedic surgery.Of the patients with FAFs,52%(n=11)had a minimum 90-d follow-up,and 48%(n=10)had a minimum 2-year follow-up.Two patients were readmitted within 90-d,while one patient required a reoperation within 2-years.CONCLUSION Over 25%of FAIs in pediatric patients result in FAFs.FAFs often present to pediatric trauma centers and the majority of these injuries occur in non-Caucasian males with government insurance.Most FAFs do not need orthopaedic surgical management;14%of these injuries require subspecialty care by orthopaedic surgery,vascular surgery,or plastic surgery.Patients with FAFs also have lower ISS compared to patients who sustained FAIs without fracture.Thus,these patients should be treated at pediatric trauma centers with specialty care and additional research is needed to focus prevention efforts,understand reasons for poor follow-up,and evaluate outcomes after injury.
