Journal of pediatric orthopedics
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Evidence-based medicine has become the cornerstone to guide clinical practice decision-making. Evidence-based medicine integrates the strongest available evidence with clinical expertise to make decisions about clinical care. The quality of the evidence depends upon the soundness of the study methodology to allow for meaningful interpretation of the clinical results. The purpose of this review is to analyze the methodological design and clinical findings of published pediatric orthopaedic studies to determine their ability to change or influence clinical practice. ⋯ Interpretation of superiority studies with nonsignificant findings must be done with caution. The findings of both of these RCTs highlight the need for more noninferiority trials in the pediatric orthopaedic literature in order to appropriately demonstrate no difference between 2 treatment options.
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Preoperative spinal parameters are used to guide the fusion levels in adolescent idiopathic scoliosis (AIS) spinal surgery. However, the impact of the factors modifiable by the surgeon in varying levels of preoperative patient-specific variables is not fully explored. The goal of this study was to identify the association between axial rotation correction of the lower instrumented vertebra (LIV) and spontaneous correction of the uninstrumented lumbar spine as a function of preoperative 3 dimensional (3D) curve characteristics in Lenke 1 AIS. ⋯ The relationship between LIV rotation correction and spontaneous lumbar curve correction after selective thoracic fusion varied based on the patient's 3D preoperative curve characteristics. Patients with lumbar modifier C and apical vertebrae translation ratios >1.5 showed improved lumbar Cobb correction in 2-years when 50% or more LIV rotation correction was achieved surgically.
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It is important to estimate the likelihood that a pediatric fracture is caused by osteogenesis imperfecta (OI), especially the least severe type of OI (type 1). ⋯ Level III.