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.
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Comparative Study
Titanium Elastic Nailing has Superior Value to Plate Fixation of Midshaft Femur Fractures in Children 5 to 11 Years.
American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for pediatric femoral shaft fractures indicate titanium elastic nails (TENs) for children 5 to 11 years old. Growing evidence suggests these fractures may also be treated with open or submuscular plating. The purpose of this study was to compare estimated blood loss (EBL), operative time, fluoroscopy time, cost, and subjective and objective pain scores between TENs and plating techniques used in 5- to 11-year-old children with midshaft femur fractures based on length stability. We hypothesized that EBL, operative time, and fluoroscopy time would be greater and pain would be lower with plate fixation. ⋯ Level III.
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The goal of early-onset scoliosis (EOS) treatment is to improve health-related quality of life (HRQoL) for patients and to reduce the burden on their parents or caregivers. The purpose of this study is to develop and finalize the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24), and examine the validity, reliability, and responsiveness of the EOSQ-24 in measuring patients' HRQoL, the burden on their caregivers, and the burden on their caregiver's finances. The study also established aged-matched normative values for the EOSQ-24. ⋯ Level II-diagnostic study with consecutive patients enrolled in national registries.