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1.
Pediatr Radiol ; 52(1): 12-21, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34518936

RESUMO

Children with cerebral palsy are at increased risk of hip dislocation. Detecting hip subluxation through radiographic hip screening is an essential component of hip surveillance and has been shown to prevent hip dislocations. Large-scale hip surveillance programs are being implemented nationwide, highlighting the importance of uniform technical and reporting standards.


Assuntos
Paralisia Cerebral , Luxação do Quadril , Paralisia Cerebral/diagnóstico por imagem , Criança , Diagnóstico por Imagem , Luxação do Quadril/diagnóstico por imagem , Humanos , Radiografia
2.
Pediatr Dermatol ; 39(1): 5-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34888924

RESUMO

Cast immobilization is performed in pediatric patients to support fracture healing, provide post-operative protection, or correct congenital deformities. Pediatric dermatologists will likely encounter the casted patients in their practice. These patients may present with cast-related complications that can arise due to the cast application or removal process, the inner cast environment, direct physical effects of the cast, or other external factors. This article provides a review of the dermatologic complications of cast immobilization, as well as useful recommendations for patients and their families.


Assuntos
Moldes Cirúrgicos , Moldes Cirúrgicos/efeitos adversos , Criança , Humanos
3.
Foot Ankle Surg ; 27(5): 480-485, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32958391

RESUMO

BACKGROUND: The Ponseti method is the standard of care for managing idiopathic congenital talipes equinovarus (clubfoot) in the outpatient setting, but there are no clinical guidelines for inpatient treatment. Children in the neonatal intensive care unit (NICU) with clubfoot often delay treatment initiation due to medical reasons. METHODS: We systematically reviewed literature related to the treatment of clubfoot in the NICU, non-idiopathic clubfoot, and older infants, as well as barriers to care. RESULTS: In a mixed NICU population of syndromic and idiopathic clubfoot, the Ponseti method has good functional outcomes with minimal interference with medical management. The Ponseti method has good functional outcomes with reduced need for extensive surgical procedures in non-idiopathic clubfoot and idiopathic clubfoot with delayed presentation (under one year of age). CONCLUSIONS: It is possible to begin Ponseti treatment in the NICU without compromising medical management. It is not clear if this confers an advantage over waiting for outpatient casting.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/cirurgia , Hospitalização , Unidades de Terapia Intensiva Neonatal , Procedimentos Ortopédicos/métodos , Criança , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
4.
Clin Orthop Relat Res ; 475(1): 264-270, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27549989

RESUMO

BACKGROUND: Acute hip fractures carry a high risk of morbidity and are associated with low vitamin D levels. Improvements in screening and treating low vitamin D levels may lead to lower fall rates and a lower likelihood of additional fragility fractures. However, patients with low vitamin D levels often remain unassessed and untreated, even after they experience these fractures. QUESTIONS/PURPOSES: We wished to determine whether a resident-led initiative can improve (1) screening for and (2) treatment of vitamin D deficiency in patients with acute hip fractures. METHODS: Our department initiated a housestaff-led, quality improvement project focused on screening and treating vitamin D deficiency in patients with acute hip fractures. Screening encompassed checking serum 25-hydroxyvitamin D level during the acute hospitalization, and treating was defined as starting supplementation before discharge when the serum 25-hydroxyvitamin D level was less than 30 ng/mL. To evaluate the efficacy of this program, an administrative database identified 283 patients treated surgically for an acute hip fracture between July 2010 and June 2014. This period included 2 years before program initiation (Year 1, n = 65 patients; Year 2, n = 61 patients), the initial program year (Year 3, n = 66 patients), and the subsequent program year (Year 4, n = 91 patients). Followup was extended to 6 weeks after treatment with 9.2% (26/282) of patients lost to followup. Eight patients were excluded owing to documented intolerance of vitamin D supplementation. There were no differences regarding patient demographics, fracture type, or treatment rendered across these 4 years. The primary endpoints were the proportion of patients screened and treated for vitamin D deficiency. The secondary endpoint was the continuation of vitamin D supplementation at the patient's 6 week followup, according to the patient's medication list at that visit. This analysis included all patients, assuming those lost to followup had not continued supplementation. ANOVA and chi-square tests were used to evaluate the differences in demographic data and in screening and treating rates. RESULTS: Screening for vitamin D deficiency improved after initiation of the resident-led quality improvement program, with screening performed for 31% of patients in Year 1 (20/65; odds ratio [OR], 0.44; 95% CI, 0.26-0.75), 20% of patients in Year 2 (12/61; OR, 0.24; 95% CI, 0.13-0.46), 46% of patients in Year 3 (30/66; OR, 0.83; 95% CI, 0.51-1.35), and 88% of patients in Year 4 (80/91; OR, 7.27; 95% CI, 3.87-13.7) (p < 0.001). Vitamin D supplementation was initiated for 33% of patients in Year 1 (21/63; OR, 0.5; 95% CI, 0.30-0.84), 28% in Year 2 (17/61; OR, 0.39; 95% CI, 0.22-0.68), 50% in Year 3 (32/64; OR,1.00; 95% CI, 0.61-1.63), and 76% in Year 4 (65/86; OR, 3.10; 95% CI, 1.89-5.06) (p < 0.001). At early postoperative followup, we saw substantial improvement in the proportion of patients who continued receiving vitamin D supplementation: Year 1, 12% (8/64; OR, 0.14; 95% CI, 0.07-0.30); Year 2, 15% (9/61; OR, 0.17; 95% CI, 0.09-0.35); Year 3, 26% (16/64; OR, 0.33; 95% CI, 0.19-0.59); and Year 4, 46% (40/86; OR, 0.87; 95% CI, 0.57-1.33) (p < 0.001). CONCLUSIONS: Implementation of a resident-led quality improvement program resulted in higher rates of screening and treating vitamin D deficiency for patients with acute hip fractures. Housestaff-based initiatives may be an effective way to improve care processes that target improvements in bone health.


Assuntos
Fraturas do Quadril/complicações , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/sangue , Humanos , Internato e Residência , Masculino , Programas de Rastreamento , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico
5.
Orthop Clin North Am ; 53(3): 311-317, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35725039

RESUMO

The transfer of the tibialis posterior tendon has been used to correct hindfoot varus and dorsiflexion weakness in cerebral palsy. It is expendable, has a favorable direction for dorsiflexion and eversion posterior to the tibia, and is the source of hindfoot varus in most cases. However, the foot and ankle must be flexible without skeletal deformity. The electromyography of the tibialis posterior should be present in the swing phase for the tendon transfer to function correctly. Techniques and pitfalls are described to plan and execute a successful tibialis posterior tendon transfer.


Assuntos
Paralisia Cerebral , Neuropatias Fibulares , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Pé/cirurgia , Humanos , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia
6.
Spine Deform ; 10(6): 1415-1421, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35764871

RESUMO

PURPOSE: Cerebral palsy (CP) is the most common motor disorder in childhood. Scoliosis is a common complication of CP that can reach clinically severe levels, but predictors for scoliosis in CP are not well understood. Some variables identified in the literature involve the severity of the brain injury and the presence of hip deformity. We aimed to identify associations with developing severe scoliosis in a prospective cohort of patients with cerebral palsy at higher risk for severe curve progression. METHODS: This study reviewed a prospectively collected database at a tertiary children's hospital. We evaluated a panel of potential associations with severe scoliosis-including age, sex, Gross Motor Function Classification System (GMFCS) class, history of hip surgery, epilepsy, and feeding tube presence-in a population of children with limited ambulatory ability defined as GMFCS level IV or V CP. Univariate analysis and multivariate logistic regression with stepwise selection was used for analysis. RESULTS: Descriptive analysis showed that female sex, higher GMFCS class, history of hip surgery, non-upright seating, pelvic obliquity, presence of epilepsy, and presence of a feeding tube were associated with an increased risk for scoliosis. Multivariate logistic regression analysis revealed that the presence of a feeding tube was associated with severe scoliosis even when controlling for GMFCS and age. CONCLUSIONS: Feeding tube use may stratify risk for severe scoliosis progression in patients with GMFCS IV or V CP.


Assuntos
Paralisia Cerebral , Epilepsia , Escoliose , Criança , Humanos , Feminino , Paralisia Cerebral/complicações , Escoliose/complicações , Escoliose/cirurgia , Estudos Prospectivos , Epilepsia/complicações , Epilepsia/epidemiologia
7.
Spine Deform ; 10(6): 1349-1358, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35852786

RESUMO

BACKGROUND: Juvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention. METHODS: This is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded. RESULTS: Children were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear. CONCLUSIONS: This large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.


Assuntos
Escoliose , Fusão Vertebral , Humanos , Pré-Escolar , Criança , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Braquetes , Cooperação do Paciente
8.
Pediatr Qual Saf ; 6(6): e485, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34934874

RESUMO

Detection of hip migration in children with cerebral palsy (CP) through radiographic surveillance can prevent dislocations. Migration Percentage (MP) is the accepted method for quantifying hip subluxation in CP on pelvis x-ray but was not being reported at our institution. Our objective was to improve care for children with CP by standardizing radiographic techniques and reporting radiographs obtained as part of a hip surveillance program. METHODS: A baseline retrospective review of CP surveillance pelvis x-ray reports was performed. We then educated radiologists and technologists, standardized imaging techniques, and required structured radiology reporting to include MP measurement and dislocation risk categories. We tracked compliance with the reporting template for 10 months. Images and reports were also assessed for quality and accuracy by an orthopedic surgeon. RESULTS: Baseline period reports showed no consistency. In total, 449 children with CP (mean age: 7.3 years ± 4.2) had a surveillance pelvis radiograph during the postintervention study period (May 2019-February 2020). An estimated 90% reporting compliance was achieved and sustained by 5 months. Eight (89%) of the children with high-risk hips were newly diagnosed during our study period; all had a progressive increase in MP from prior examinations. All clinicians surveyed agreed that the standardized reports, including MP, were helpful to their practice. CONCLUSIONS: Using evidence-based process measures and quality improvement methodology, we standardized hip surveillance for children with CP. Radiology reports that include MP and risk category for hip dislocation enable clear communication for referrals across specialties and early detection and treatment for better outcomes.

9.
Spine Deform ; 8(5): 911-920, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32394324

RESUMO

STUDY DESIGN: Retrospective case-series. OBJECTIVES: To evaluate the outcomes of bracing in skeletally immature patients with moderate-severe idiopathic scoliosis (IS) curves ≥ 40°. BACKGROUND: In contrast to prior beliefs, the recent studies have reported successful outcomes with brace treatment may occur in some patients with moderate-severe scoliosis ≥ 40°. Despite other encouraging case-series, non-operative treatment is rarely attempted and the efficacy of bracing large curves remains uncertain. METHODS: 100 skeletally immature children (mean 11.8 ± 2.36 years; range 6.1-16.5) with IS ≥ 40° were identified. 80 were adolescent IS (80%) and 20 juvenile IS (20%). The Risser plus score was used to evaluate skeletal maturity. 66 children were Risser 0 (66%). SRS-SOSORT outcome guidelines were used: > 5° progression, stabilization between - 5° and 5° and, > 5° improvement. RESULTS: Mean initial Cobb was 45° ± 3.9° (range 40°-59°), with in-brace and  % correction of 30° ± 8.7° (range 7°-48°) and 34 ± 17.5% (range 2-84%), respectively. 57 progressed (57%), 32 stabilized (32%), and 11 improved (11%) after a median of 1.8 years (IQR 1.2-2.9). Open triradiate cartilage at presentation (p = 0.005) and less in-brace correction (p = 0.009) were associated with progression. 58 children (58%) underwent surgery after a mean of 3.0 years (range 0.7-7.3). Surgical patients were younger (11.2 vs. 12.7 years; p = 0.003), more often Risser 0 (79% vs. 48%; p < 0.001); however, presented with similar curves (45° vs. 44°; p = 0.31). Open triradiate cartilage at presentation (OR 15.3; 95% CI 4.3-54.6; p < 0.001) and less in-brace correction (p = 0.03) increased the likelihood of surgery. All 20 JIS patients avoided temporary growth rods, with 18 (90%) eventually requiring surgery. CONCLUSION: Non-operative treatment was successful in 42% of children. Risk factors for surgery were younger age, open triradiates, and less in-brace correction. Bracing can be effective in delaying surgery until skeletal maturity in patients with curves ≥ 40°. Patients should be counseled on the risks and benefits of bracing and surgery. LEVEL OF EVIDENCE: Level IV.


Assuntos
Desenvolvimento Ósseo , Braquetes , Escoliose/terapia , Coluna Vertebral/patologia , Adolescente , Fatores Etários , Criança , Tratamento Conservador , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Escoliose/patologia , Escoliose/cirurgia , Índice de Gravidade de Doença
10.
Top Stroke Rehabil ; 16(5): 357-66, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19903654

RESUMO

PURPOSE: Fear of falling (FoF) has a negative impact on older adults, however there is a paucity of research regarding the development and impact of FoF after stroke. Therefore, our objectives were to determine the proportion of individuals with FoF and the affect of FoF during the immediate poststroke period. METHODS: This observational study of baseline data from a pilot cohort study includes a convenience sample of 28 adults with acute stroke before discharge home. Measures include self-reported FoF, the Falls Efficacy Scale-Swedish Version [FES(S)], Stroke-Specific Quality of Life (SS-QOL), performance and satisfaction with performance (Canadian Occupational Performance Measure), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9). RESULTS: Fifteen (54%) of the participants reported FoF. Those with FoF were more likely to have decreased SS-QOL domain scores for energy (p = .013), personality (p = .015), and thinking (p = .008); decreased performance (self-care, productivity, and leisure) (p = .019) and satisfaction with performance (p = .010); and increased anxiety (p = .002) than those without FoF. CONCLUSIONS: Those with FoF demonstrated significantly increased anxiety and showed decreased performance and satisfaction with performance, energy, thinking, and personality than those without FoF. This suggests that poststroke FoF is related not only to physical challenges but also to cognitive and emotional factors in the poststroke period. Identifying and treating these conditions should be evaluated as a means to decrease FoF and improve outcomes post stroke.


Assuntos
Acidentes por Quedas/prevenção & controle , Medo/psicologia , Acidente Vascular Cerebral/psicologia , Acidentes por Quedas/estatística & dados numéricos , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Estudos de Coortes , Depressão/etiologia , Emprego , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Personalidade , Projetos Piloto , Psicometria , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Inquéritos e Questionários
11.
Medicine (Baltimore) ; 97(12): e9770, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29561460

RESUMO

RATIONALE: The sciatic nerve runs a predictable course combining L4-S3 nerve roots through the true pelvis and under the greater sciatic notch. There are reports of bony protuberances from the sacrum and ilium in cases of spinal dysraphism; however advanced imaging, treatment, or outcomes are not described. There are no cases with associated fibular hemimelia in the current literature. PATIENT CONCERNS: This is a 4-year-old girl with tethered cord, acetabular dysplasia with hip subluxation, congenital short femur, anterior cruciate ligament (ACL) deficiency, and fibular hemimelia with her sciatic nerve coursing through the ilium. DIAGNOSIS: Aberrant course of the sciatic nerve through the ilium in the setting of spinal dysraphism. OUTCOMES: The hip subluxation was treated with a femoral varus derotation osteotomy and Salter osteotomy with transposition of the sciatic nerve into the greater sciatic notch resulting in a stable hip with no sciatic nerve symptoms at last follow-up. LESSONS: The combination of spinal dysraphism with acetabular dysplasia should be a warning for anomalous sciatic nerveanatomy, possibly through the ilium. Preoperative imaging (MRI, CT scan) may be obtained and carefully reviewed for the course of the sciatic nerve prior to pelvic or femoral osteotomy. Decompressing the sciatic nerve from the aberrant foramen may be considered as part of the procedure.


Assuntos
Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/cirurgia , Ílio , Nervo Isquiático/anormalidades , Disrafismo Espinal/complicações , Disrafismo Espinal/cirurgia , Pré-Escolar , Feminino , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Osteotomia , Nervo Isquiático/diagnóstico por imagem , Disrafismo Espinal/diagnóstico por imagem
12.
Local Reg Anesth ; 11: 25-29, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760560

RESUMO

Spinal anesthesia (SA) has been used relatively sparingly in the pediatric population, as it is typically reserved for patients in whom the perceived risk of general anesthesia is high due to comorbid conditions. Recently, concern has been expressed regarding the potential long-term neurocognitive effects of general anesthesia during the early stages of life. In view of this, our center has developed a program in which SA may be used as the sole agent for applicable surgical procedures. While this approach in children is commonly used for urologic or abdominal surgical procedures, there have been a limited number of reports of its use for orthopedic procedures in this population. We present the use of SA for 6 infants undergoing tendon Achilles lengthening, review the use of SA in orthopedic surgery, describe our protocols and dosing regimens, and discuss the potential adverse effects related to this technique.

13.
Biol Open ; 6(3): 358-364, 2017 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-28167493

RESUMO

Smad4 is an intracellular effector of the TGFß family that has been implicated in Myhre syndrome, a skeletal dysplasia characterized by short stature, brachydactyly and stiff joints. The TGFß pathway also plays a critical role in the development, organization and proliferation of the growth plate, although the exact mechanisms remain unclear. Skeletal phenotypes in Myhre syndrome overlap with processes regulated by the TGFß pathway, including organization and proliferation of the growth plate and polarity of the chondrocyte. We used in vitro and in vivo models of Smad4 deficiency in chondrocytes to test the hypothesis that deregulated TGFß signaling leads to aberrant extracellular matrix production and loss of chondrocyte polarity. Specifically, we evaluated growth plate chondrocyte polarity in tibiae of Col2-Cre+/-;Smad4fl/fl mice and in chondrocyte pellet cultures. In vitro and in vivo, Smad4 deficiency decreased aggrecan expression and increased MMP13 expression. Smad4 deficiency disrupted the balance of cartilage matrix synthesis and degradation, even though the sequential expression of growth plate chondrocyte markers was intact. Chondrocytes in Smad4-deficient growth plates also showed evidence of polarity defects, with impaired proliferation and ability to undergo the characteristic changes in shape, size and orientation as they differentiated from resting to hypertrophic chondrocytes. Therefore, we show that Smad4 controls chondrocyte proliferation, orientation, and hypertrophy and is important in regulating the extracellular matrix composition of the growth plate.

15.
Curr Rev Musculoskelet Med ; 9(4): 454-461, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27709486

RESUMO

The pediatric lower extremity has well known growth patterns. When deformities or growth disturbances occur, there are several methods to measure and predict the resulting discrepancy, including the Green-Anderson, Moseley, and Multiplier methods. Many techniques exist to correct leg length discrepancy and deformity such and temporary epiphysiodesis, permanent epiphysiodesis, external fixators, and internal lengthening devices. All of these methods have numerous complications and limitations; however, with careful planning and patient selection, length and alignment can be improved with high patient satisfaction.

16.
J Child Orthop ; 10(5): 439-43, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27447466

RESUMO

PURPOSE: There are over 500 medically related applications (apps) for mobile devices. Very few of these applications undergo testing and peer-review for accuracy. The purpose of this study is to assess the accuracy of limb deformity measurements on the Bone Ninja app compared to PACS and to determine the intra- and inter-observer variability among different orthopaedic practitioners. METHODS: Four participants (attending, senior and junior resident, and physician assistant) measured the leg length (LL), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) of 48 limbs (24 patients), twice with both Bone Ninja and PACS. The difference between the measurements obtained with the Bone Ninja app and PACS were measured. We determined the consistency of the intra-observer intra-class correlation coefficient (ICC) for both systems. RESULTS: There were no statistical differences in leg length discrepancy (LLD), MPTA, or LDFA measurements between Bone Ninja and PACS (p = 0.96, 0.87, and 0.97, respectively). The intra-observer ICC for the LL, LDFA, and MPTA was similar between Bone Ninja and PACS (0.83, 0.89, and 0.96 vs. 0.96, 0.93, and 0.95, respectively). The inter-observer ICC was similar between Bone Ninja and PACS (0.95, 0.96, and 0.99 vs. 0.99, 0.98, and 0.98, respectively). CONCLUSIONS: This study demonstrates that Bone Ninja is an accurate educational tool for measuring LLD, LDFA, and MPTA. Both systems are reliable instruments for evaluating limb length differences and angles on standing radiographs for pre-operative deformity planning and education. This is the first study to evaluate the accuracy of Bone Ninja compared to the gold standard of PACS.

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