Age is a predictor of elbow stiffness after type III or IV supracondylar humerus fractures.

PURPOSE: Supracondylar humerus (SCH) fractures account for approximately 30% of injuries for those younger than 7 years of age (Cheng et al. in J Pediatr Orthop 19:344-350, 1999). Recent studies examining the association of patient age and SCH fracture outcomes have provided conflicting findings. The purpose of this study is to investigate SCH fracture outcomes in children at different ages of skeletal development. METHODS: Retrospective review of a Level I pediatric trauma center between 2010 and 2014 was conducted. 190 patients with SCH fractures, age < 14 years, fracture type Gartland III or IV (AO/OTA 13-M 3.1 III and IV) were included. Patients were sorted into age groups: < 2 years, 4-6 years, and > 8 years. Patients were treated with either a closed or open reduction with percutaneous fixation. Clinical outcomes including postoperative elbow range of motion, nerve palsy, compartment syndrome, infection, and cubitus varus were assessed. RESULTS: Patients in younger age groups were more likely to obtain postoperative full elbow flexion (< 2 years = 77%; 4-6 years = 66%; > 8 years = 43%) and full elbow extension (< 2 years = 96%; 4-6 years = 88%; > 8 years = 64%). Age was a significant predictor of nerve palsy on admission, mean operative time (< 2 years = 21.8 min; 4-6 years = 43.0 min; > 8 years = 80.7 min), and mean fluoroscopy time (< 2 years = 22.9 s; 4-6 years = 59.5 s; > 8 years = 171.9 s). There were no differences in rates of open reduction, compartment syndrome, pin tract infection, cubitus varus, or reoperation among groups. CONCLUSION: Increasing age is associated with increased elbow stiffness after percutaneous fixation of Gartland Type III and Type IV SCH fractures. Older patients with SCH fractures may benefit from formal rehabilitation. LEVEL OF EVIDENCE: III.

Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline. SUMMARY OF BACKGROUND DATA: Patients with NMS are at high risk for surgical site infection following spine surgery. In 2013, a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery patients reported strategies to decrease incidence. To date, no studies have looked at the efficacy of these strategies. METHODS: A retrospective review of surgical site infection in NMS patients was performed. NMS patients undergoing primary posterior spinal fusion from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2) were included, with 2013 excluded as a transition year. The primary outcome was incidence of surgical site infection within 1 year of surgery, as defined by the Centers for Disease Control and National Healthcare Safety Network. All patients had at least 1 year of documented follow-up. RESULTS: One hundred ninety eight patients were included, 62 in Group 1 and 136 in Group 2. Age, BMI, sex, fusion to pelvis, preoperative Cobb angle, incontinence, drain use, blood loss, surgical time, and other perioperative values were similar (P > 0.05). Deep surgical site infection occurred in 10 (16.1%) patients in Group 1 and six (4.4%) patients in Group 2 (P = 0.005). Thirteen (59.1%) identified organisms were gram-negative, with 11 (84.6%) isolated from Group 1 (P = 0.047). Polymicrobial infections accounted for six (37.5%) infections overall. CONCLUSION: The incidence of surgical site infection in NMS patients decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. Further studies are required to continue to decrease the incidence in this high-risk population.Level of Evidence: 3.

Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction.

Previous research has shown that delays in pediatric anterior cruciate ligament (ACL) reconstruction are associated with increased prevalence of concomitant knee injuries and worse outcomes following surgery. However, few studies have described factors that may contribute to these delays and adverse outcomes. This study seeks to determine the effect of socioeconomic status on clinical outcomes following ACL reconstruction.A retrospective review of patients who underwent primary ACL reconstruction at a tertiary pediatric hospital between 2009 and 2015 was conducted. Variables included chronologic, demographic, and socioeconomic data, and postoperative complications. Socioeconomic status was measured using health insurance type and median household income levels derived from 2009 to 2015 US Census Bureau.A total of 127 patients (69 male, 58 female) were included. The mean age at time of surgery was 15.0 years. Overall, 68 patients had commercial insurance and 59 patients had government-assisted insurance. The mean household median income for patients with commercial insurance was $87,767 compared to $51,366 for patients with government-assisted insurance. Patients with government-assisted insurance plans demonstrated greater delays in time from injury to initial orthopaedic evaluation (P = .0003), injury to magnetic resonance imaging (MRI) examination (P = .021), injury to surgery (P < .0001), initial orthopaedic evaluation to surgery (P = .0036), and injury to return to play clearance, P = .044. Median household income was significantly related to time from injury to MRI examination (P = .0018), injury to surgery (P = .0017), and initial orthopaedic evaluation to surgery (P = .039). Intraoperatively, 81% of patients with government-assisted insurance had concomitant meniscal injuries compared 65% of patients with commercial insurance, P = .036. Postoperatively, 22% of patients with government-assisted insurance were found to have decreased knee range of motion ("stiffness") compared to 9% of patients with commercial insurance, P = .034.Pediatric patients who have government-assisted plans may experience delays in receiving definitive injury management and be at risk for postoperative complications. Our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and postoperative complications between government and commercial insurance types.Level of Evidence: III.

Evaluation of repair of the hip labrum under simulated full weight-bearing.

INTRODUCTION: Repairs of labral tears are performed for unstable tears, hip instability, and after detachment concomitant to the treatment of femoroacetabular impingement (FAI), but limited data is known about the strength of repair. This study evaluated the effect of simulated axial weight-bearing on suture anchor based repair of the acetabular labrum. METHODS: 3 cadaveric pelvises underwent creation of a 1.5 cm anterior-superior labral tear in each hip. The tears were then repaired using 2 suture anchors per hip. Following repair, the hip joint underwent axial cyclic loading to 756 N, and were inspected for separation of the labrum from the acetabulum. The strength of the suture anchor repair was evaluated by testing load to failure, in-line with insertion. RESULTS: Upon visual examination, all 6 repairs remained fully intact following loading with no visible gap formation or damage at the repair site. In all cases an arthroscopic probe could not be inserted under the edge of the repair. The mean failure force of the 12 suture anchors, in-line with insertion, was 154 N ± 44 N. CONCLUSIONS: Acetabular labral suture anchor repairs may be able to immediately withstand the physiological loads of axial weight-bearing. Labral repair may be able to tolerate axial weight-bearing immediately after repair, preserving the strength and integrity of muscles and soft tissues.