Factors associated with subsequent surgery after septic arthritis of the knee in children

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.

Perioperative Outcomes Following Surgical Treatment of the Neuromuscular Hip: An Analysis of the National Surgical Quality Improvement Program—Pediatrics

Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described;however, the acute complication profile is poorly understood. Questions/Purpose: The aim of this study was to identify the rate of and risk factors for complications following surgical treatment of hip subluxation/dislocation, especially as it relate to NM children. Methods: Hip reconstruction cases in patients with a NM diagnosis and non-NM patients were obtained from the 2015 American College of Surgeons NSQIP-Pediatric database by CPT code. 30-day postoperative complications were classified according to the Clavien-Dindo system as minor (grade 1 or 2) or major (grade 3+). Patient and surgical factors were assessed in univariate and multivariate logistic regression analyses for association with post-operative complications. Results: 1081 cases were identified (median age 7.7, 55% female), of whom 420 (39%) had a NM diagnosis. Overall complication rate was significantly higher in NM patients (33% vs. 19%, p < 0.001). Numerous factors were associated with postoperative complication on univariate analysis. Multivariate analysis identified NM diagnosis (OR 1.5), age > 6 years (OR 1.5), or pelvic osteotomy (OR 1.9) as independent risk factors for complication. Conclusion: In pediatric reconstructive hip surgery requiring pelvic osteotomy, a NM diagnosis is associated with an increased risk of 30-day postoperative complications. Older age and increasing surgical complexity were also independently associated with complications. These findings support special attention for the older patients undergoing concomitant pelvic osteotomies to minimize complication rate.

Spinal fusion is an aerosol generating procedure

BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.

Ponseti method compared with soft-tissue release for the management of clubfoot:A meta-analysis study

AIM: To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic measurements.METHODS: A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubM ed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each study.RESULTS: Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery(0.76 and 0.62, respectively), but not quite to the point of statistical significance(Q = 3.73, P = 0.053). Age at surgery wasnot correlated with the functional outcome for the surgically treated patients(r =-0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes(r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic outcomes.CONCLUSION: The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

Current concepts in end-to-side neurorrhaphy

In peripheral nerve injury,end-to-side neurorrhaphy involves coaptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve.It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft.Experimental and clinical data suggests that end-to-side neurorrhaphy can provide satisfactory functional recovery for the recipient nerve,without any deterioration of the donor nerve function.The most accepted mechanism of nerve regeneration following end-to-side neurorrhaphy is collateral sprouting.The source of the regenerating axons traveling in the epineurium of the donor nerve is thought to be the proximal Ranvier’s nodes at the site of end-to-side neurorrhaphy,however,histologic evidence is still lacking.Partial neurotomy of the donor nerve may enhance regeneration of motor neurons through end-to-side neurorrhaphy and reinnervation of motor targets.

Guidelines for management of pediatric acute hyperextension spinal cord injury

Pediatric acute hyperextension spinal cord injury(SCI)named as PAHSCI by us,is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training,which has been increasingly reported.At present,it has become the leading cause of SCI in children,and brings a heavy social and economic burden.Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards,specifications or guidelines.In order to provide standardized guidance,the expert team formulated this guideline based on the principles of science and practicability,starting from the diagnosis,differential diagnosis,etiology,admission evaluation,treatment,complications and prevention.This guideline puts forward 23 recommendations for 14 related issues.

Magnetically controlled growing instrumentation for early onset scoliosis: Caution needed when interpreting the literature

BACKGROUND Magnetically controlled growing rods(MCGR) are a novel treatment option for early onset scoliosis(EOS). Although the complication profile with MCGR use has been reviewed, these reviews do not take into account important implants modifications, termed iterations, that were made due to early on postoperative complications is not well reported or understood.AIM To assess the effect of MCGR implant iterations on post-operative complications in EOS.METHODS A systematic review was performed to identify studies investigating MCGR specifically for the treatment of EOS, refined to those reporting the implant iteration, specifically the incorporation of the keeper plate to the implant design.Articles with mixed implant iteration usage were excluded. Complications following surgery were recorded as well as potential risk factors and compared between implant cohorts.RESULTS Although 20 articles were identified for inclusion, 5 included mixed implant iteration leaving a total of 271 patients identified through 15 clinical studies thatmet inclusion criteria. The average follow-up was 25.4-mo. Pre-keeper plate implants were utilized in 3 studies with a total of 49 patients. Overall, 115(42.4%)post-operative complications were identified, with 87% defined as major. The addition of the keeper plate significantly decreased the rate of post-operative complications per study(35.7% vs 80.6%, P = 0.036), and the rate of distraction failure(8.1% vs 40.8%, P = 0.02). Unplanned reoperation occurred in 69(26.7%)patients but was not different between implant iteration cohorts(25.5% without keeper plate vs 27.1% with keeper plate, P = 0.92).CONCLUSION MCGR for EOS has a cumulative complication rate of 42.4% but this is significantly reduced to 35.7% when reviewing only keeper-plate enabled implants. However, 25% of published articles included mixed implant iterations.Future studies should discern between implants iterations when reporting on the usage of MCGR for EOS.

Effectiveness of psychosocial interventions for pediatric patients with scoliosis:a systematic review

Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multidisciplinary teams delivering holistic care.

Can We Capitalize on Central Nervous System Plasticity in Young Athletes to Inoculate Against Injury?

There are numerous physical,social,and psychological benefits of exercise,sport and play for youth athletes.However,dynamic activities come with a risk of injury that has yet to be abated,warranting novel therapeutics to promote injury-resistance and to keep an active lifestyle throughout the lifespan.The purpose of the present manuscript was to summarize the extant literature and potential connecting framework regarding youth brain development and neuroplasticity associated with musculoskeletal injury.This review provides the foundation for our proposed framework that utilizes the OPTIMAL(Optimizing Performance Through Intrinsic Motivation and Attention for Learning)theory of motor learning to elicit desir-able biomechanical adaptations to support injury prevention(injury risk reduction),rehabilitation strategies,and exercise performance for youth physical activity and play across all facets of sport(Prevention Rehabilitation Exercise Play;PREP).We conclude that both young male and females are ripe for OPTIMAL PREP strategies that promote desirable movement mechanics by leveraging a unique time window for which their heightened state of central nervous system plasticity is capable of enhanced adaptation through novel therapeutic interventions.

Targeted Application of Motor Learning Theory to Leverage Youth Neuroplasticity for Enhanced Injury-Resistance and Exercise Performance: OPTIMAL PREP

Youth athletes are ideal candidates for novel therapeutic motor learning interventions that leverage the plasticity of the central nervous system to promote desirable biomechanical adaptions.We summarize the empirical data supporting the three pillars of the Optimizing Performance Through Intrinsic Motivation and Attention for Learning(OPTIMAL)theory of motor learning and expand on potential neurophysiologic mechanisms that will support enhanced movement mechan-ics in youth to optimize prevention programs for reduced injury risk,injury rehabilitation,exercise performance,and play(Prevention Rehabilitation Exercise Play;PREP).Specifically,we highlight the role of motivational factors to promote the release of dopamine that could accelerate motor performance and learning adaptations.Further,we detail the potential for an external focus of attention to shift attentional allocation and increase brain activity in regions important for sensorimotor integration to facilitate primary motor cortex efficiency.This manuscript serves to provide the most current data in support of the application of OPTIMAL PREP training strategies of the future.

The Influence of Biological Maturity on Dynamic Force-Time Variables and Vaulting Performance in Young Female Gymnasts

Purpose This cross-sectional study investigated dynamic force-time variables and vaulting performance in young female gymnasts of different maturity status.Methods 120 gymnasts aged 5-14 years were sub-divided into maturity groupings using percent of predicted adult height(%PAH)attained.Participants performed three jumping protocols,the squat jump(SJ),countermovement jump(CMJ)and drop jump(DJ),before completing straight jump vaults that were recorded using two-dimensional video.Results Jumping performance improved with biological maturity evidenced by the most mature gymnasts’producing sig-nificantly more absolute force(P<0.05;all d>0.78),impulse(P<0.05;all d>0.75)and power(P<0.05;all d>0.91)than the least mature group,resulting in the greater jump heights(P<0.05;all d>0.70).While,no significant differences were observed in relative peak force across multiple tests,measures of relative peak power did significantly increase with maturity.Based upon regression analyses,maturation was found to influence vertical take-off velocity during vaulting,explaining 41%of the variance in each jumping protocol.Across all tests,the DJ was found to have the highest predictive ability of vaulting vertical take-off velocity,explaining 55%of the total variance.Conclusion Biological maturation impacts jump height and underpinning mechanical variables in young female gymnasts.Vaulting vertical take-off velocity appears to be influenced by maturation and various dynamic force-time variables,par-ticularly those during DJ,which had the highest explained total variance.

Practical Training Strategies to Apply Neuro-Mechanistic Motor Learning Principles to Facilitate Adaptations Towards Injury-Resistant Movement in Youth

Youth may be particularly responsive to motor learning training strategies that support injury-resistant movement mechanics in youth for prevention programs that reduce injury risk,injury rehabilitation,exercise performance,and play more gener-ally(Optimizing Performance Through Intrinsic Motivation and Attention for Learning Prevention Rehabilitation Exercise Play;OPTIMAL PREP)One purpose of the present manuscript was to provide clinical applications and tangible examples of how to implement the proposed techniques derived from OPTIMAL theory into PREP strategies for youth.A secondary purpose was to review recent advances in technology that support the clinical application of OPTIMAL PREP strategies without extensive resources/programming knowledge to promote evidence-driven tools that will support practitioner feedback delivery.The majority of examples provided are within the context of anterior cruciate ligament(ACL)injury rehabilitation,but we emphasize the potential for OPTIMAL PREP strategies to be applied to a range of populations and training scenarios that will promote injury resistance and keep youth active and healthy.

Utility of Kinetic and Kinematic Jumping and Landing Variables as Predictors of Injury Risk: A Systematic Review

Purpose Jump-landing assessments provide a means to quantify an individual’s ability to attenuate ground reaction forces,generate lower limb explosive power and maintain joint alignment.In order to identify risk factors that can be targeted through appropriate training interventions,it is necessary to establish which(scalar)objective kinetic,kinematic,and performance measures are most associated with lower-extremity injury.Methods Online searches of MEDLINE,SCOPUS,EBSCOHost,SPORTDiscus and PubMed databases were completed for all articles published before March 2020 in accordance with PRISMA guidelines.Results 40 articles investigating nine jump-landing assessments were included in this review.The 79%of studies using drop jump(n=14)observed an association with future injury,while only 8%of countermovement jump studies(n=13)observed an association with injury risk.The 57%of studies using unilateral assessments found associations with risk of injury(n=14).Studies using performance measures(jump height/distance)as outcome measure were only associated with injury risk in 30%of cases.However,those using kinetic and/or kinematic analyses(knee abduction moment,knee valgus angle,knee separation distance,peak ground reaction force)found associations with injury in 89%of studies.Conclusion The landing element of jump-landing assessments appears to be superior for identifying individuals at greater risk of injury;likely due to a closer representation of the injury mechanism.Consequently,jump-landing assessments that involve attenuation of impact forces such as the drop jump appear most suited for this purpose but should involve assessment of frontal plane knee motion and ground reaction forces.