CORR insights: Orthopaedic residency applications increase after implementation of 80-hour workweek.

This CORR Insights™ is a commentary on the article "Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek" by Anakwenze et al. available at DOI 10.1007/s11999-013-2785-1.

Management of fractures in adolescents.

There are well-established treatment standards for adults who sustain fractures; however, these treatment standards are not always applicable when treating adolescents with similar fractures because of the presence of physes. Fractures in adolescents are treated by pediatric orthopaedic surgeons, adult orthopaedic traumatologists, or general orthopaedic surgeons. It is imperative that the principles of fracture management are well defined and discussed in both the pediatric and adult orthopaedic community. Controversial topics include the youngest age at which an adolescent can be treated as an adult and acceptable fracture reduction criteria. The general principles of managing fractures in adolescents regarding classification, treatment options, complications, and estimating skeletal age should be understood by the treating physician.

Opinion survey regarding pediatric orthopaedic trauma call and emergency trauma management.

BACKGROUND: To determine the attitudes and practices of pediatric orthopaedic surgeons regarding on-call coverage and emergency fracture management. METHODS: A 32-question online survey was sent to all 597 active members of the Pediatric Orthopaedic Society of North America. There were 296 completed surveys, for a response rate of 49.6%. RESULTS: Of the respondents, 85.1% were male. The respondents ranged in age from 30 to older than 70 years, with 54% between 36 and 50 years of age, corresponding to an average of 15 years in practice. Seventy-seven percent of the respondents felt that taking trauma call is an integral aspect of being a pediatric orthopaedist. Of the respondents, 64.9% take call 1 to 9 times per month, 15.8% take 10 to 19 calls, 2.7% take 20 or more, and 16.6% take no call. The number of orthopaedists taking call per practice was fairly evenly distributed between 3 and 10. Call was shared equally in 32% of practices, and mandatory in 72%. Twenty-eight percent of the respondents were additionally compensated for taking calls, in amounts ranging from $100 to $2000 per night, with 1000 dollars the most common rate. One third of operative cases are done that night; one third, the next day; and one third, later in the week. Twenty-four percent of the respondents have dedicated operative block time on the day after the call. Forty-seven percent have a dedicated fracture clinic, of which 51% receive institutional support. CONCLUSIONS: Providing emergency trauma care for children is an integral aspect of pediatric orthopaedics. This survey provides information on the attitudes and strategies of practicing pediatric orthopaedic surgeons in the face of decreasing manpower and increasing demand for such services.

Complications of high tibial osteotomy with external fixation in adolescent Blount's disease.

Reported complication rates for tibial osteotomies have been widely variable and no study has focused on a single deformity etiology, surgical technique, or stabilization method. A review of 38 high tibial osteotomies with external fixation in adolescent Blount's disease patients was performed at two institutions. Results showed an overall complication rate of 153% and an elevated (97%) prevalence of morbid obesity in the patients in this series. This study highlights the potential association between comorbidities and elevated complication rates. Recognition of comorbidities will allow more effective risk stratification and preoperative counseling stressing the importance of compliance, wound, and pin care.

Newborn with an open posterior hip dislocation and sciatic nerve injury after intrauterine radiofrequency ablation of a sacrococcygeal teratoma.

Advanced prenatal ultrasonography techniques have allowed for better understanding of the natural history, treatment, and prognosis of sacrococcygeal teratomas. Several intrauterine surgical techniques to debulk the tumor when fetal and maternal life are in jeopardy have been described. Orthopaedic impairment, such as lower extremity weakness and swelling, also has been described in association with sacrococcygeal teratomas. The authors report on a newborn in whom a large soft tissue defect overlying the posterior hip region with direct exposure of the disarticulated hip joint existed at the time of birth, which resulted from intrauterine radiofrequency ablation of a sacrococcygeal teratoma. This unexpected complication has resulted in a loss of sciatic nerve function, malformation of the acetabulum and femoral head, and loss of the left ischium, coccyx, inferior sacrum, gluteal, adductor and piriformis muscles, and posterior hip capsule. At 16 months of age, the patient has a flaccid left lower extremity with a hypoplastic hip joint.