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  • 1
    Online Resource
    Online Resource
    Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Pediatric Orthopaedics Vol. 42, No. 7 ( 2022-08), p. e713-e719
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 7 ( 2022-08), p. e713-e719
    Abstract: Children with medical complexity are at increased risk of low bone mineral density (BMD) and complications after spinal fusion compared with idiopathic scoliosis patients. Our aim was to compare treatments and outcomes of children with medical complexity undergoing spinal fusion in those who had dual-energy x-ray absorptiometry (DXA) scans versus those who did not in an effort to standardize the workup of these patients before undergoing spinal surgery. Methods: We conducted a retrospective review of patients with low BMD who underwent spinal fusion at a tertiary care pediatric hospital between 2004 and 2016. We consulted with a pediatric endocrinologist to create standard definitions for low BMD to classify each subject. Regardless of DXA status, all patients were given a clinical diagnosis of osteoporosis [at least 2 long bone or 1 vertebral pathologic fracture(s)], osteopenia (stated on radiograph or by the physician), or clinically low bone density belonging to neither category. The last classification was used for patients whose clinicians had documented low bone density not meeting the criteria for osteoporosis or osteopenia. Fifty-nine patients met the criteria, and 314 were excluded for insufficient follow-up and/or not meeting a diagnosis definition. BMD Z -scores compare bone density ascertained by DXA to an age-matched and sex-matched average. Patients who had a DXA scan were also given a DXA diagnosis of low bone density (≤−2 SD), slightly low bone density (−1.0 to −1.9 SD), or neither ( 〉 −1.0 SD) based on the lowest BMD Z -score recorded. Results: Fifty-nine patients were analyzed. Fifty-four percent had at least 1 DXA scan preoperatively. Eighty-one percent of DXA patients received some form of treatment compared with 52% of non-DXA patients ( P =0.03). Conclusions: Patients referred for DXA scans were more likely to be treated for low BMD, although there is no standardized system in place to determine which patients should get scans. Our research highlights the need to implement clinical protocols to optimize bone health preoperatively. Level of Evidence: Level II—retrospective prognostic study.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000002188
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2049057-4
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  • 2
    Online Resource
    Online Resource
    Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Pediatric Orthopaedics Vol. 43, No. 4 ( 2023-04), p. 204-210
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 4 ( 2023-04), p. 204-210
    Abstract: Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides a comprehensive analysis of demographic, anatomic, pathophysiological, clinical, and athletic-related variables associated with such injuries in an extensive population of affected adolescents. Methods: A retrospective review was performed of records of patients presenting to a single tertiary care pediatric hospital between January 1, 2005, and July 31, 2020, collecting variables including patient sex, age, body mass index, fracture location, injury mechanism, sport at the time of injury, and duration of prodromal symptoms. Results: Seven hundred nineteen fractures were identified in 709 patients. The average patient age was 14.6, and 78% of the fractures occurred in male patients. The anterior inferior iliac spine (33.4%), anterior superior iliac spine (30.5%), and ischial tuberosity (19.4%) were the most common fracture sites. The most common injury mechanisms were running (27.8%), kicking (26.7%), and falls (8.8%). The most common sports at the time of injury were soccer (38.1%), football (11.2%), and baseball (10.5%). Fracture site was significantly associated with patient sex, age, body mass index, laterality, mechanism, sport, time from injury, and presence of prodromal symptoms. The annual volume of pelvic avulsion fractures treated at the institution increased significantly from n=17 in 2005 to n=75 in 2019. Conclusions: Adolescent pelvic and hip avulsion fractures occur during a narrow window of age and skeletal maturation and are frequently sustained during sporting activities. Each fracture location is associated with certain demographic, mechanistic, and patient-specific characteristics. The associations between fracture site and patient-specific or injury-specific variables offer insights into the pathophysiology and possible underlying biomechanical risk factors that contribute to these injuries. Level of Evidence: This is a level III retrospective study.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000002355
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2049057-4
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  • 3
    Online Resource
    Online Resource
    Anterior Displacement of Tibial Spine Fractures: Does Anatomic Reduction Matter?
    SAGE Publications ; 2023
    In:  Orthopaedic Journal of Sports Medicine Vol. 11, No. 8 ( 2023-08-01)
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 11, No. 8 ( 2023-08-01)
    Abstract: Operative treatment of displaced tibial spine fractures consists of fixation and reduction of the fragment in addition to restoring tension of the anterior cruciate ligament. Purpose: To determine whether residual displacement of the anterior portion of a tibial spine fragment affects the range of motion (ROM) or laxity in operatively and nonoperatively treated patients. Study Design: Cohort study; Level of evidence, 3. Methods: Data were gathered from 328 patients younger than 18 years who were treated for tibial spine fractures between 2000 and 2019 at 10 institutions. ROM and anterior lip displacement (ALD) measurements were summarized and compared from pretreatment to final follow-up. ALD measurements were categorized as excellent (0 to 〈 1 mm), good (1 to 〈 3 mm), fair (3 to 5 mm), or poor ( 〉 5 mm). Posttreatment residual laxity and arthrofibrosis were assessed. Results: Overall, 88% of patients (290/328) underwent operative treatment. The median follow-up was 8.1 months (range, 3-152 months) for the operative group and 6.7 months (range, 3-72 months) for the nonoperative group. The median ALD measurement of the cohort was 6 mm pretreatment, decreasing to 0 mm after treatment ( P 〈 .001). At final follow-up, 62% of all patients (203/328) had excellent ALD measurements, compared with 5% (12/264) before treatment. Subjective laxity was seen in 11% of the nonoperative group (4/37) and 5% of the operative group (15/285; P = .25). Across the cohort, there was no association between final knee ROM and final ALD category. While there were more patients with arthrofibrosis in the operative group (7%) compared with the nonoperative group (3%) ( P = .49), this was not different across the ALD displacement categories. Conclusion: Residual ALD was not associated with posttreatment subjective residual laxity, extension loss, or flexion loss. The results suggest that anatomic reduction of a tibial spine fracture may not be mandatory if knee stability and functional ROM are achieved.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671231192978
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 4
    Online Resource
    Online Resource
    Variability in Antibiotic Treatment of Pediatric Surgical Site Infection After Spinal Fusion at A Single Institution
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Pediatric Orthopaedics Vol. 41, No. 6 ( 2021-07), p. e380-e385
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 6 ( 2021-07), p. e380-e385
    Abstract: Recent focus on surgical site infections (SSIs) after posterior spine fusion (PSF) has lowered infection rates by standardizing perioperative antibiotic prophylaxis. However, efforts have neglected to detail antibiotic treatment of SSIs. Our aim was to document variability in antibiotic regimens prescribed for acute and latent SSIs following PSF in children with idiopathic, neuromuscular, and syndromic scoliosis. Methods: This study included patients who developed a SSI after PSF for scoliosis at a pediatric tertiary care hospital between 2004 and 2019. Patients had to be 21 years or younger at surgery. Exclusion criteria included growing rods, staged surgery, and revision or removal before SSI diagnosis. Infection was classified as acute (within 90 d) or latent. Clinical resolution of SSI was measured by return to normal lab values. Each antibiotic was categorized as empiric or tailored. Results: Eighty subjects were identified. The average age at fusion was 14.7 years and 40% of the cohort was male. Most diagnoses were neuromuscular (53%) or idiopathic (41%). Sixty-three percent of patients had an acute infection and 88% had a deep infection. The majority (54%) of subjects began on tailored antibiotic therapy versus empiric (46%). Patients with a neuromuscular diagnosis had 4.0 times the odds of receiving initial empiric treatment compared with patients with an idiopathic diagnosis, controlling for infection type and time ( P =0.01). Ninety-two percent of patients with acute SSI retained implants at the time of infection and 76% retained them as of August 2020. In the latent cohort, 27% retained implants at infection and 17% retained them as of August 2020. Conclusions: Patients with acute infections were on antibiotics longer than patients with latent infections. Those with retained implants were on antibiotics longer than those who underwent removal. By providing averages of antibiotic duration and lab normalization, we hope to standardize regimens moving forward and develop SSI-reducing pathways encompassing low-risk patients. Level of Evidence: Level III.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001811
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2049057-4
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  • 5
    Online Resource
    Online Resource
    Seasonal Variation of Pediatric Septic Arthritis in the United States: A PHIS Database Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Pediatric Orthopaedics Vol. 43, No. 3 ( 2023-03), p. e266-e270
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 3 ( 2023-03), p. e266-e270
    Abstract: The presence of seasonal patterns in pediatric septic arthritis cases is a common orthopaedic teaching. Seasonal variation has been seen in centers outside of the United States and with other inflammatory and infectious joint-related conditions within the country, but it is unknown if a seasonal pattern exists among different regions of the United States. The purpose of this study was to examine the seasonal variation of septic arthritis within specific regions across the United States. Methods: The Pediatric Health Information System database was queried for all patients 19 years or younger who were treated for septic arthritis. Data from 34 pediatric hospitals in the Pediatric Health Information System initiative were included. Centers were organized by geographical region, and season of presentation was determined using equinoxes/solstices. χ 2 tests were performed to detect seasonal differences in septic arthritis for the entire cohort and separated by geographical region. Proportion differences along with 95% CIs were provided. Results: Between 2016 and 2019, there were 5764 cases of septic arthritis. Median age at diagnosis was 6.2 years (range: 0 to 19.0 y). Each season contributed 24% to 25% of the total septic arthritis cases, and there were no significant differences detected between the 4 seasons ( P =0.66). There was no seasonal variation seen in the Midwest, South, or West ( P =0.71, 0.98, 0.36, respectively). However, there was seasonal variation in the Northeast ( P =0.05), with fall and summer having a higher percentage of cases (28%) than the winter (21%). Conclusions: This study showed no clear seasonal variation in septic arthritis in children across the United States using a national database of pediatric hospital centers. However, there is regional seasonal variation in the Northeast, which may relate to climate differences. With no clear seasonal variation across the United States, continued diligence is needed in diagnosing septic arthritis throughout the year. Level of Evidence: Prognostic II.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000002337
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2049057-4
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  • 6
    Online Resource
    Online Resource
    SARS-CoV-2 receptor binding domain displayed on HBsAg virus–like particles elicits protective immunity in macaques
    American Association for the Advancement of Science (AAAS) ; 2022
    In:  Science Advances Vol. 8, No. 11 ( 2022-03-18)
    Details
    In: Science Advances, American Association for the Advancement of Science (AAAS), Vol. 8, No. 11 ( 2022-03-18)
    Abstract: A modular protein subunit vaccine candidate produced in yeast confers protection against SARS-CoV-2 in nonhuman primates.
    Type of Medium: Online Resource
    ISSN: 2375-2548
    URL: Article
    DOI: 10.1126/sciadv.abl6015
    Language: English
    Publisher: American Association for the Advancement of Science (AAAS)
    Publication Date: 2022
    detail.hit.zdb_id: 2810933-8
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  • 7
    Online Resource
    Online Resource
    Did the Covid-19 Pandemic Affect Psychological Readiness to Return-To-Sport in Young Athletes Undergoing ACL Reconstruction?
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0043-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0043-
    Abstract: Return-to-sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is influenced by multiple physical and psychological variables. Psychological readiness has been associated with improved patient reported outcomes as well as RTS rates in young athletes. The COVID-19 pandemic may have altered the typical recovery process for patients undergoing ACLR. Hypothesis/Purpose: To compare 6-month postoperative levels of psychological readiness to RTS in ACLR patients before and during the pandemic. Methods: Patients were prospectively enrolled 6 months after primary ACLR at a single academic sports medicine practice, from December 2018 until May 2021. Patients were categorized into pre-COVID (enrollment prior to March 13, 2020) and COVID groups (March 13, 2020 - May 26, 2021). Demographic information, outcomes scores including the ACL-Return to Sport after Injury Scale (RSI) and PROMIS Psychological Stress Experiences (PROMIS-PSE), and physician RTS clearance were obtained and compared for both groups. Comparisons were performed utilizing Chi-square, Student’s t-tests and linear regression. A matched analysis was conducted between groups controlling for age, sex, and graft type. Results: 231 patients were included in the present study (89 males, 142 females; mean age 16.9 years), with 76% (176/231) in the pre-COVID group and 24% (55/231) in the COVID group. There were no significant differences in age and sex between the two population cohorts. There was a significant difference in time from surgery to enrollment in the COVID group compared to the pre-COVID group (7.1 vs 6.2 months, p 〈 0.001). In the matched cohort (n=126, 37/126 COVID group), the COVID group was cleared earlier by their physician to RTS compared to the pre-COVID group (6.9 months vs 8.5 months, p 〈 0.001). While there was no significant difference between groups in 6 month ACL-RSI scores (63.8 pre-COVID vs 66.6 COVID, p=0.48), both groups yielded globally low scores. There were no significant associations between matched groups in PROMIS-PSE (p=0.71), IKDC (p=0.55), Pedi-IKDC (p=0.15), and Pedi-FABS (p=0.77) scores (Table 1). Conclusion: Young athletes demonstrated similar levels of psychological readiness to RTS at 6 months following ACLR prior to and during the COVID-19 pandemic. Patient-reported outcome scores were similar in pre-COVID and COVID ACLR patients, suggesting that the pandemic may not have played a detrimental role in perceptions of recovery. Psychological readiness may not be fully optimized at 6 months post-ACLR and young athletes may benefit from additional time and training for progressive confidence, muscle strength, and performance. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00433
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 8
    Online Resource
    Online Resource
    Utility of Routine Postoperative Laboratory Testing After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
    Elsevier BV ; 2024
    In:  Journal of the Pediatric Orthopaedic Society of North America Vol. 6 ( 2024-02), p. 100003-
    Details
    In: Journal of the Pediatric Orthopaedic Society of North America, Elsevier BV, Vol. 6 ( 2024-02), p. 100003-
    Type of Medium: Online Resource
    ISSN: 2768-2765
    URL: Article
    DOI: 10.1016/j.jposna.2024.100003
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
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  • 9
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    Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 11 ( 2022-09), p. 2909-2916
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 11 ( 2022-09), p. 2909-2916
    Abstract: The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment. Hypothesis: Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction. Study Design: Descriptive epidemiology study. Methods: The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. Results: A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P 〈 .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P 〈 .05). There were no associations detected between income bracket and the outcomes in this study. Conclusion: This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221109607
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 10
    Online Resource
    Online Resource
    Manipulation of the miR-378a/mt-ATP6 regulatory axis rescues ATP synthase in the diabetic heart and offers a novel role for lncRNA Kcnq1ot1
    American Physiological Society ; 2022
    In:  American Journal of Physiology-Cell Physiology Vol. 322, No. 3 ( 2022-03-01), p. C482-C495
    Details
    In: American Journal of Physiology-Cell Physiology, American Physiological Society, Vol. 322, No. 3 ( 2022-03-01), p. C482-C495
    Abstract: Diabetes mellitus has been linked to an increase in mitochondrial microRNA-378a (miR-378a) content. Enhanced miR-378a content has been associated with a reduction in mitochondrial genome-encoded mt-ATP6 abundance, supporting the hypothesis that miR-378a inhibition may be a therapeutic option for maintaining ATP synthase functionality during diabetes mellitus. Evidence also suggests that long noncoding RNAs (lncRNAs), including lncRNA potassium voltage-gated channel subfamily Q member 1 overlapping transcript 1 (Kcnq1ot1), participate in regulatory axes with microRNAs (miRs). Prediction analyses indicate that Kcnq1ot1 has the potential to bind miR-378a. This study aimed to determine if loss of miR-378a in a genetic mouse model could ameliorate cardiac dysfunction in type 2 diabetes mellitus (T2DM) and to ascertain whether Kcnq1ot1 interacts with miR-378a to impact ATP synthase functionality by preserving mt-ATP6 levels. MiR-378a was significantly higher in patients with T2DM and 25-wk-old Db/Db mouse mitochondria, whereas mt-ATP6 and Kcnq1ot1 levels were significantly reduced when compared with controls. Twenty-five-week-old miR-378a knockout Db/Db mice displayed preserved mt-ATP6 and ATP synthase protein content, ATP synthase activity, and preserved cardiac function, implicating miR-378a as a potential therapeutic target in T2DM. Assessments following overexpression of the 500-bp Kcnq1ot1 fragment in established mouse cardiomyocyte cell line (HL-1) cardiomyocytes overexpressing miR-378a revealed that Kcnq1ot1 may bind and significantly reduce miR-378a levels, and rescue mt-ATP6 and ATP synthase protein content. Together, these data suggest that Kcnq1ot1 and miR-378a may act as constituents in an axis that regulates mt-ATP6 content, and that manipulation of this axis may provide benefit to ATP synthase functionality in type 2 diabetic heart.
    Type of Medium: Online Resource
    ISSN: 0363-6143 , 1522-1563
    URL: Article
    DOI: 10.1152/ajpcell.00446.2021
    Language: English
    Publisher: American Physiological Society
    Publication Date: 2022
    detail.hit.zdb_id: 1477334-X
    SSG: 12
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