What's New in Pediatric Orthopaedic Tumor Surgery.

BACKGROUND: Pediatric Orthopaedic Oncology is a developing subspecialty within the field of Pediatric Orthopaedics. Traditionally, the field of Orthopaedic Oncology has been focused on the skeletally mature individual, and the research tends to be all encompassing rather than truly evaluating isolated populations. The purpose of this review is to summarize the most clinically relevant literature in the field of Pediatric Orthopaedic Oncology over the last 6 years. METHODS: We evaluated the PubMed database utilizing keywords for pediatric orthopaedic oncology: sarcoma, osteosarcoma, Ewing sarcoma, bone cyst. In additionally, we further broadened our search by searching for relevant articles in the contents sections of major orthopaedic surgery journals that routinely publish both pediatric and orthopaedic oncology literature. In keeping with "What's New," we selected the most clinically relevant articles published in the last 6 years from January 1, 2014 through February 2020. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included. RESULTS: Our search yielded 60 articles that met general criteria, from which 14 were determined to be most relevant to the goals of this paper. Of the papers presented in this review, there were papers related to management of benign tumors/tumor-like conditions, bone cysts, limb salvage procedures, and amputation procedures. Ultimately included in the review were 5 studies related to limb salvage, 4 related to bone cysts, 1 related to multiple hereditary exostoses, 2 related to osteofibrous dysplasia, 1 related to chondroblastoma, and 1 discussing cementation in skeletally immature patients. They were level III, IV, and V studies. Basic science and systemic therapies literature was widely reviewed and the research and clinical trials most relevant to pediatric sarcoma and neoplastic processes found in the pediatric population were included. Our search of the basic science and systemic therapies literature yielded 19 sources were found to be pertinent to our aims and 18 of those sources were published between 2015 and 2020. CONCLUSIONS: There are many, varied, and creative procedures in the realm of limb salvage, though there remains a lack of high-level evidence to support some of the more novel procedures. In regards to benign bone tumors, despite a more solid base of literature, there still does not seem to be consensus as to the best treatment. In particular, there continue to be many schools of thought on the treatment of benign bone cysts. Research in the basic science arena and systemic therapies are advancing in exciting ways in regards to pediatric sarcoma. Orthopaedic oncologic research specific to the pediatric population overall continues to be impeded by low sample sizes and inadequate levels of evidence, which limits the ability of surgeons to draw definitive conclusions from the literature.

Patient Safety Checklists: Do They Improve Patient Safety for Supracondylar Humerus Fractures?

BACKGROUND: The purpose of the study was to investigate whether a safety checklist could be used consistently in an academic center, and, whether its presence correlates with a decreased rate of complications, and therefore, improved overall patient safety. METHODS: Data from 3 years before and after the implementation of the checklist were compared. Prechecklist data from August 2008 through August of 2011, including all operative supracondylar humerus fractures treated at our institution, were retrospectively reviewed. Postchecklist data, from August 2011 to August 2014 were prospectively collected. Patients' charts and their imaging were all reviewed for: fracture type, nerve injury, placement of a medial pin, infection, loss of alignment, loss of fixation, and return to the operating room (OR). Patients who were within the checklist group were reviewed for checklist compliance and concordance of resident and attending-attested checklists. RESULTS: Nine hundred thirty-one operative supracondylar humerus fractures were reviewed-394 in the prechecklist group and 537 in the postchecklist group. There was no significant difference in fracture type between the prechecklist and postchecklist groups. No significant differences were found between prechecklist and postchecklist patients in regards to loss of fixation, loss of alignment, infection, or nerve injury. In the postchecklist group, the number of medial pins placed was significantly less than in the prechecklist group (P=0.0001), but this was not found to have clinical significance. In the prechecklist group, 11 patients returned to the OR for a second procedure, whereas 4 in the postchecklist group had a return to the OR. This finding was significant (P=0.015), but the returns to the OR were not related to checklist parameters. The checklist compliance of the attending physicians was 85.85% and the residents were compliant 83.11% of the time. There were documented discrepancies between resident and attending checklists in 7.38% of all total checklists. CONCLUSIONS: Our patient safety checklists are not necessarily affecting patient care in a clinically significant manner. It is important that we validate and refine these specialty-specific checklists before becoming reliant on them. LEVEL OF EVIDENCE: Level III.

Benefits of Passive Warming on Surgical Patients Undergoing Regional Anesthetic Procedures.

PURPOSE: The purpose of this quality improvement project was to determine if application of preoperative passive warming methods would maintain body temperature in patients receiving regional anesthetic procedures (RAPs). DESIGN: A nonrandomized quasi-experimental design was used. METHODS: A passive warming trial using a convenience sample of 53 RAP patients warmed with passive measures was compared with data collected from 67 retrospective chart reviews of RAP patients warmed per standard unit policy-typically active forced warm air. Passive measures included a thermal reflective surgical cap and an activated chemical warmer. FINDINGS: Passive warming methods maintained temperatures throughout the perioperative process. No significant variations in mean temperatures were noted. As age increased, the difference in temperature from admit to transfer to operating room also increased (P = .0182). CONCLUSIONS: Passive warming is a suitable cost-effective alternative when forced-air warming is not feasible. Additional inquiry into the use of passive warming is warranted.