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Orthopedics

Targeted Muscle Reinnervation Prevents Neuroma and Phantom Limb Pain in Children After Amputation
 Targeted Muscle Reinnervation Prevents Neuroma and Phantom Limb Pain in Children After Amputation 1024 684 Lauren Dembeck
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In certain cases, such as limb traumas and sarcomas, amputation may be chosen to optimize patients’ physical function. Persistent postamputation residual limb or “stump” pain and phantom limb pain can be debilitating and has been associated with prosthetic abandonment in patients who have undergone amputation. This pain is often secondary to symptomatic neuromas, tumor-like disorganized…

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Using 3D Motion Capture Technology to Improve Outcomes
 Using 3D Motion Capture Technology to Improve Outcomes 150 150 Mary Bates, PhD
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  Kirsten Tulchin-Francis, PhD Kirsten Tulchin-Francis, PhD, joined Nationwide Children’s in March 2022 as director of orthopedic research and director of the Honda Center for Gait Analysis and Mobility Enhancement. In a Q&A, she discusses how she uses motion capture technology to improve outcomes for pediatric patients. What is your area of expertise? I have…

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New Guidelines Offer a Clear Path for Expandable Endoprosthesis Use in Post-Sarcoma Limb Reconstruction
 New Guidelines Offer a Clear Path for Expandable Endoprosthesis Use in Post-Sarcoma Limb Reconstruction 150 150 Abbie Miller
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Limb salvage operation is the standard of care for pediatric extremity bone sarcomas. These tumors often occur during the second decade of life, when children are growing rapidly. Reconstructive surgeries must account for anticipated remaining growth and the potential for resulting limb inequity. Osteosarcoma and Ewing sarcoma are the most common primary malignant bone tumors,…

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The Latest Developments in Limb Lengthening and Reconstruction Research
 The Latest Developments in Limb Lengthening and Reconstruction Research 1024 683 Katie Brind'Amour, PhD, MS, CHES
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Dr. Iobst with patient

Orthopedic experts publish an invited review of the past year’s most significant papers in the field of limb deformity correction and lengthening. To aid clinicians and surgeons who don’t have time for an annual deep-dive into the literature of their subspecialty, The Journal of Bone & Joint Surgery publishes yearly reviews courtesy of invited guest…

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Postoperative Management of Flexor Tendon Injuries in Children
 Postoperative Management of Flexor Tendon Injuries in Children 150 150 Mary Bates, PhD
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One month of immobilization followed by a modified Duran protocol leads to good outcomes. Pediatric flexor tendon injuries can be challenging due to children’s smaller anatomy and possible treatment nonadherence. In adults, immediate to early active motion for flexor tendon repairs has become standard, as prolonged postoperative immobilization can lead to adhesion formation and joint…

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Pediatric Bone Density Measures Require Adjusted Scoring for Accurate Interpretation
 Pediatric Bone Density Measures Require Adjusted Scoring for Accurate Interpretation 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Understanding the limits of pediatric bone densitometry reports can make results more useful for clinical decision making. Dual-energy X-ray absorptiometry, or DXA, is the standard scan used to assess bone mineral density (BMD) in children. It uses very little radiation and has extensive normative data from pediatric populations, to which a child’s results can be…

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Multiple Fractures in Children: When to Suspect Medical or Malevolent Causes
 Multiple Fractures in Children: When to Suspect Medical or Malevolent Causes 1024 770 Katie Brind'Amour, PhD, MS, CHES
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Girl with cast on her arm

Rapid growth and high-risk activities during childhood leave kids ripe for repeat fracture opportunities, but key factors can alert clinicians to possible underlying disease-related fragility or non-accidental injury. Fractures are common in childhood, with up to 40% of girls and as many as 50% of boys experiencing a fracture. There are many benign explanations for…

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Targeted Muscle Reinnervation for Amputees Offers Chance at Less Pain, More Prosthetic Options
 Targeted Muscle Reinnervation for Amputees Offers Chance at Less Pain, More Prosthetic Options 1024 684 Katie Brind'Amour, PhD, MS, CHES
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The innovative procedure pioneered by surgeons at The Ohio State University and Nationwide Children’s Hospital reduces postoperative pain and enables control of bioprosthetics.   What started as Department of Defense-funded research in adult amputees at The Ohio State University Medical Center about 6 years ago has morphed into standard of care treatment for children undergoing…

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5 Things to Know About Vertebral Body Tethering for Scoliosis
 5 Things to Know About Vertebral Body Tethering for Scoliosis 150 150 Allan C. Beebe, MD and Crystal D. Seilhamer, FNP
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As the surgical approach to scoliosis grows in popularity, understanding the pros, cons and contraindications becomes increasingly important. At the Center for Comprehensive Spine Care in the Department of Orthopedics at Nationwide Children’s Hospital, patients and providers are increasingly asking about vertebral body tethering for scoliosis. Traditionally, scoliosis is treated with a variety of modalities…

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She for She: Supporting Women in Orthopaedics
 She for She: Supporting Women in Orthopaedics 1024 575 Julie Samora, MD, PhD
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Julie Balch Samora, MD, PhD, MPH, an orthopaedic surgeon at Nationwide Children’s Hospital and the hospital’s associate medical director for quality, is the 2021 President of the Ruth Jackson Orthopaedic Society – the leading international organization championing women in orthopaedics. This column was adapted from her presidential address.   Shalane Flanagan is an American long-distance…

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Surgical Management of Recurrent Patellar Instability in the Pediatric Population
 Surgical Management of Recurrent Patellar Instability in the Pediatric Population 1024 575 Mary Bates, PhD
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Medial patellofemoral ligament reconstruction via the quadriceps turndown technique is safe and effective in young patients. In a new study, researchers from Nationwide Children’s Hospital demonstrate the safety and efficacy of the quadriceps turndown technique for medial patellofemoral ligament reconstruction in pediatric and adolescent patients. Patellar instability is a common knee condition in children and…

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A Quick and Reliable Method to Determine The Time to Full Weight Bearing in Patients Undergoing Intramedullary Limb Lengthening
 A Quick and Reliable Method to Determine The Time to Full Weight Bearing in Patients Undergoing Intramedullary Limb Lengthening 1024 575 Lauren Dembeck
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A new method to objectively measure bone healing may help the patient with an intramedullary lengthening nail make strides to full weight bearing status. Intramedullary limb lengthening is indicated for the treatment of limb length discrepancy and short stature. Traditionally, the procedure was done using external fixators, which must remain on the patient’s limb for…

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Determining the Probability of a Sequential Slipped Hip
 Determining the Probability of a Sequential Slipped Hip 1024 683 Mary Bates, PhD
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Kevin Klingele, MD

A new predictive tool offers an objective method to help guide treatment in patients with unilateral slipped capital femoral epiphysis. In a recent study, researchers at Nationwide Children’s developed a scoring system based on radiological findings to predict sequential hip involvement in patients with unilateral slipped capital femoral epiphysis. They hope this predictive tool will help…

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Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery
 Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery 1024 575 JoAnna Pendergrass, DVM
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In pediatric patients undergoing orthopedic spine surgery, a step-wise bowel management plan can effectively reduce opioid-induced constipation and unplanned emergency department visits after surgery. Orthopedic spine surgery can generate pain in the immediate post-surgery period. Opioids are needed to mitigate this pain but commonly cause constipation and other gastrointestinal side effects. Opioid-induced constipation causes abdominal…

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Finding the Best Treatment for Stable but Severe Slipped Capital Femoral Epiphysis
 Finding the Best Treatment for Stable but Severe Slipped Capital Femoral Epiphysis 1024 575 Katie Brind'Amour, PhD, MS, CHES
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A novel comparison of the modified Dunn procedure for children with stable vs unstable SCFE has identified a new target to improve surgical outcomes. The modified Dunn procedure uses a surgical hip dislocation approach to realign the hip joint in adolescents with slipped capital femoral epiphysis (SCFE) — a condition in which the ball of…

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Combining Multiple Surgical Procedures Helps Children With Patellar Instability Return to Normal Activities
 Combining Multiple Surgical Procedures Helps Children With Patellar Instability Return to Normal Activities 1024 575 JoAnna Pendergrass, DVM
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A four-in-one surgical procedure demonstrates effectiveness in treating pediatric lateral patellar instability and helping children return to their normal pre-surgical activities. Lateral patellar instability in the skeletally immature knee is a complex orthopedic condition with myriad treatment challenges. Classified as obligatory, fixed (congenital) or traumatic, pediatric knee instability can have painful consequences in late adolescence…

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Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment
 Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment 1024 575 Julie Samora, MD, PhD
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Distal radius fractures are among the most common fractures in pediatrics. Although most heal without complication, some result in partial or complete physeal arrest. Risk factors for distal radius growth arrest include physeal fractures, ischemia, infection, radiation, tumor, blood dyscrasias, burns, frostbite and repetitive stress.  The distal radius physis is responsible for 75% of the…

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Open Reduction May Improve Acetabular Remodeling in Developmental Dysplasia of the Hip
 Open Reduction May Improve Acetabular Remodeling in Developmental Dysplasia of the Hip 1024 575 Lauren Dembeck
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Study of children who had reductions for developmental hip dysplasia at age 2 years or younger highlights differences in outcomes for open and closed reductions. In children under 2 years of age with developmental dysplasia of the hip, open reduction with capsulorrhaphy appears to improve acetabular remodeling more than closed reduction, according to a study…

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Better Bone Healing by Reversing Current Techniques?
 Better Bone Healing by Reversing Current Techniques? 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Bones may heal denser and stronger when given room for controlled micro-movement at first, followed by rigid stabilization — a complete flip-flop of the standard of care. A combination of biology and mechanical influence determines how well a bone heals, for better or worse. For half a century, physicians have believed that complete bone immobilization…

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Regional Anesthesia Dramatically Reduces Opioid Use After Limb Lengthening and Reconstructive Surgeries
 Regional Anesthesia Dramatically Reduces Opioid Use After Limb Lengthening and Reconstructive Surgeries 1024 584 Katie Brind'Amour, PhD, MS, CHES
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The peripheral catheter approach to postoperative pain management may also shorten length of stay. When clinicians in the Department of Anesthesiology and Pain Medicine at Nationwide Children’s Hospital first proposed the use of regional anesthesia for the patients of Christopher Iobst, MD, he was resistant to the idea. As an orthopedic surgeon specializing in limb lengthening and…

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When Should Preoperative Neuromonitoring for Adolescent Idiopathic Scoliosis Be Used?
 When Should Preoperative Neuromonitoring for Adolescent Idiopathic Scoliosis Be Used? 150 150 Abbie Miller
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Study leads researchers to recommend against routine use of preoperative SSEP/TMS testing in cases of AIS requiring corrective surgery. Adolescent idiopathic scoliosis (AIS) is a coronal curvature of the spine that affects 1 to 3% of adolescents. Of these, a very small percentage – at most 0.5% – progress to the point of needing surgical…

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How Much Opioid Medication Should Pediatric Orthopedic Patients Receive?
 How Much Opioid Medication Should Pediatric Orthopedic Patients Receive? 150 150 Mary Bates, PhD
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A study suggests doses could be tailored to each particular patient’s injury. Doctors have traditionally used opioids as the primary component of pain management after orthopedic surgery in pediatric patients. But with the misuse and abuse of prescription opioids a growing public health concern, doctors are looking to limit what they prescribe to the minimum…

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What Pediatric Subspecialists Need to Know About Hypophosphatasia and Its Treatment
 What Pediatric Subspecialists Need to Know About Hypophosphatasia and Its Treatment 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Patients with hypophosphatasia may present to a wide range of specialists. Here’s the latest on diagnosis, patient management and clinical need for its only medical treatment: asfotase alfa enzyme replacement therapy (AA ERT). Hypophosphatasia is a rare, inherited condition that results in low serum alkaline phosphatase, which leads to poor construction of bones and teeth.…

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Medicaid Patients With Common “Buckle” Fractures Have Less Access to Primary Care Physicians
 Medicaid Patients With Common “Buckle” Fractures Have Less Access to Primary Care Physicians 150 150 Katie Brind'Amour, PhD, MS, CHES
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Most Seymour Fractures Can be Effectively Treated in the Emergency Room
 Most Seymour Fractures Can be Effectively Treated in the Emergency Room 150 150 Katie Brind'Amour, PhD, MS, CHES
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After decades of unclear optimal management for Seymour fractures, evidence suggests orthopedic surgeons need not treat all of these cases in the operating room. Seymour fractures — open fractures of the distal phalanx with a juxta-epiphyseal pattern — were long managed nonsurgically following their namesake’s landmark study from the 1960s that asserted the risks of…

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Predicting Subsequent Hip Slips in Children Using MRI
 Predicting Subsequent Hip Slips in Children Using MRI 150 150 Lauren Dembeck
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Using Quality Improvement to Customize Opioid Reduction Strategies
 Using Quality Improvement to Customize Opioid Reduction Strategies 1024 681 Abbie Miller
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Different specialties across pediatrics have different uses, indications and practices when it comes to opioids. Many primary care pediatricians do not routinely prescribe them. Pediatric surgical specialties, however, may use opioid medications more frequently depending on the patient and procedure performed. While broad restrictions, such as those enacted on the federal and state levels, aimed…

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How to Reduce Cast Complications in Orthopedics
 How to Reduce Cast Complications in Orthopedics 150 150 Jeb Phillips
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Femoral Nerve Blockade May Reduce Need for Intravenous Opioids
 Femoral Nerve Blockade May Reduce Need for Intravenous Opioids 150 150 Mary Bates, PhD
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Researchers find no differences in postoperative pain measures for patients receiving intravenous opioids and those receiving regional anesthetic. Femur fractures often require surgical fixes and can be quite painful. Although traditionally treated with intravenous opioids, regional anesthesia may offer an alternative option. In a new study, published in the Journal of Pain Research, researchers evaluated the…

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Bracing for Buckle Fractures
 Bracing for Buckle Fractures 150 150 Jeb Phillips
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Shifting from casts to splints for distal radius buckle fractures has saved time and money for providers and families. The traditional treatment for distal radius buckle fractures involves immobilization in a short- or longarm cast. A 2015 multi-institutional study found that more than 70 percent of pediatric orthopedic specialists use this as their standard of…

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Remote Control Treatment
 Remote Control Treatment 1024 575 Jeb Phillips
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Magnetic growing rods help patients who have early-onset scoliosis avoid repeated surgeries. A common surgical treatment for young children with severe early-onset scoliosis is the implantation of growing rods or expandable titanium ribs. The devices are lengthened as the child grows, helping to straighten the spine. Lengthening involves surgery under general anesthesia every six months. Magnetic Expansion Control (MAGEC)…

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Acetabular “Fleck” Sign Predictive of Labral Avulsion
 Acetabular “Fleck” Sign Predictive of Labral Avulsion 150 150 Abbie Miller
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A “fleck” sign on the postreduction CT scan calls for high suspicion of labral pathology, even in cases of congruent closed reductions. Traumatic posterior hip dislocations and subluxations are typically treated with a closed reduction in pediatric patients. For patients who have a congruent hip reduction, the course of treatment often ends here. However, a new study…

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To Rest or Not To Rest?
 To Rest or Not To Rest? 150 150 Kevin Mayhood
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InSight: Working Up the Nerve
 InSight: Working Up the Nerve 150 150 Katie Brind'Amour, PhD, MS, CHES
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Using regional anesthesia to numb nerves reduces pain and speeds recovery in pediatric orthopedic surgery. Ultrasound-guided regional anesthesia has been used in adult patients for more than a decade but is now being used more regularly in pediatric patients, especially for orthopedic procedures. Femoral nerve block, in which the femoral nerve is numbed, is among…

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