Journal of pediatric orthopedics
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Comparative Study
Interstate variability of the statute of limitations for medical liability: a cause for concern?
Widespread variation in state laws produces significant differences in state-to-state liability risk and insurance cost. These variations may produce higher medical liability for certain pediatric practitioners because many states have a significantly longer period of potential liability for physicians caring for children. This study reviewed state laws for variability in the period of medical liability for pediatric and adult patients and considered some of the impacts resulting from such variability. ⋯ Descriptive study (audit of existing laws), level of evidence 2.
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Comparative Study
Spinal cord monitoring for scoliosis surgery in Rett syndrome: can these patients be accurately monitored?
A level III retrospective comparative study. ⋯ Patients with Rett syndrome undergoing scoliosis surgery can be successfully monitored with SSEPs. A history of seizures is a relative contraindication to transcranial motor-evoked potentials. Monitoring can accurately alert the surgeon to potential intraoperative spinal cord compromise and, therefore, decrease postoperative morbidity.
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A full-length standing radiograph of the entire lower extremity is the standard imaging modality for assessing lower limb alignment. However, the effect of an overlying circular external fixator on the radiographic alignment of the lower extremity is not well documented. ⋯ Diagnostic level II.
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The duration of symptoms in children with stable slipped capital femoral epiphysis (SCFE) varies widely, and radiographic metaphyseal changes develop at some point. It was the purpose of this study to investigate if metaphyseal changes correlate with symptom duration and other demographic parameters. A retrospective review of 97 children with idiopathic stable SCFE between 1998 and 2005 was performed. ⋯ Those with more metaphyseal changer were older, had a longer duration of symptoms, had higher BMI, and had more severe SCFEs. Although SCFE severity generally increased with longer symptoms, some had prolonged symptoms with a mild SCFE, whereas others had short symptoms with a severe SCFE; perhaps the SCFE remains silent for varying periods of time before symptoms occur. Those children with more metaphyseal changes had higher BMIs; perhaps the larger body mass per unit of height translates into more bony adaptation following Wolf law.
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Nonaccidental injury (NAI) in children is a major cause of morbidity and mortality, with fractures being the second most common presentation. The presence of a femur fracture has been reported to be suggestive of nonaccidental trauma in 30% to 60% of young children. The purpose of this study was to determine the percentage of NAI in children younger than 3 years presenting with a femur fracture to a single institution within a western Canadian population. ⋯ Retrospective cohort study, level IV.