What Happens to Youth Baseball Players Diagnosed With Little League Shoulder and Little League Elbow Syndrome?

BACKGROUND: The long-term prognosis of baseball and softball players diagnosed with Little League elbow (LLE) and Little League shoulder (LLS) is unknown. Many of these athletes are potentially at risk of developing future shoulder and elbow injuries that may require surgical intervention. This study's purpose is to retrospectively assess 5-year patient-reported outcomes and career progression of a series of youth baseball and softball players diagnosed with LLE and LLS. METHODS: This institutional review board-approved, single-center, retrospective study evaluated 5-year outcomes of a cohort of youth baseball and softball players diagnosed with LLE and LLS between 2013 and 2017. Demographic and clinical data was recorded including age, gender, primary position, and months played per year. A standardized phone survey was obtained approximately 5 years post-treatment to assess upper extremity function, career progression, and pain recurrence. RESULTS: Sixty-one patients (44 LLE, 17 LLS) met the inclusion criteria and participated in a standardized phone survey. The mean age at the time of diagnosis was 13.2 years and all but one of the athletes were male. On average, about 80% (34/44 LLE, 15/17 LLS) played baseball 9 months or more per year. After diagnosis and nonoperative management, more than 80% (37/44 LLE, 14/17 LLS) were able to return to competition, but up to 40% of players changed positions (9/44 LLE, 7/17 LLS). Five years later, less than half (21/44 LLE, 8/17 LLS) were playing baseball actively. The recurrence rate was >20% (9/42 LLE, 6/17 LLS) with a mean time of recurrence of 8.8 months. Patients who experienced symptom recurrence were less likely to play baseball 5 years later and had lower patient-reported outcomes. CONCLUSIONS: A diagnosis of LLE and LLS in early adolescence can be a setback for a young athlete. Fortunately, most athletes will be able to return to competition with ∼50% still competing at 5 years. Very few will progress to future arm surgery, but recurrence rates are relatively high, and these athletes are less likely to participate in their sport 5 years later. LEVEL OF EVIDENCE: Level IV-Retrospective cohort study.

Proximal Femur Guided Growth: A Systematic Review.

Children with cerebral palsy (CP) and those with avascular necosis (AVN) after treatment of developmental hip dysplasia (DDH) are at risk of developing coxa valga. Proximal femur guided growth is a minimally invasive option to correct this deformity. A systematic review of articles that described treatment of coxa valga with proximal femur guided growth (PFGG) and reporting on primary radiographic outcomes, demographic variables, surgical variables and complications. One hundred and seventy-nine hips underwent PFGG (117 with CP and 62 with lateral overgrowth). Average age at surgery was 8.1 years; average follow-up was 52.5 months. Migration percentage improved from 11.2% (p < 0.0001). Neck-shaft angle improved by 11.9° (p < 0.0001). The most common complication was screw growth out of the physis (30% of cases). PFGG can correct coxa valga, improve radiographic parameters, and in children with CP prevent further subluxation. This technique modulates proximal femur growth, induces changes to the acetabulum and can correct valgus deformity. Evidence Level III. (Journal of Surgical Orthopaedic Advances 32(4):049-052, 2024).

The Anterior Modified San Diego Acetabuloplasty Does Not Increase Superior-Anterior Coverage in Patient-Specific 3D-Printed Models.

BACKGROUND: Patients with developmental dysplasia of the hip may require pelvic osteotomies to improve acetabular coverage. The purpose of this study was to compare the changes in acetabular version, tilt, and regional coverage angles following the San Diego acetabuloplasty (SDA), the modified San Diego acetabuloplasty (mSDA), and the Pemberton acetabuloplasty (PA). METHODS: Fourteen patients with developmental dysplasia of the hip and computed tomography (CT) imaging were identified. From CT images, 2 identical pelvises were 3-dimensional-printed for each patient. Bone was printed with rigid material, and cartilage with flexible material. For each model pair, the SDA was performed on one and the PA was performed on the other. CT scans were obtained before and after acetabuloplasties. Next, the bone graft in the SDA model was moved anteriorly, representing the mSDA, and the model was rescanned. Acetabular version, tilt, and coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were calculated. Preoperative to postoperative differences were compared (repeated measures analysis of variance or Wilcoxon signed rank test). The significance was set to P <0.05. RESULTS: The mean age at CT was 5.8±1.2 years (range: 3.9 to 7.5 y). All 3 procedures (SDA, mSDA, and PA) significantly increased acetabular tilt; P <0.045), with a similar change observed for all 3 ( P =0.868). PA was the only procedure to significantly decrease relative acetabular version (6.5±6.5 degrees, preoperative: 12.9±5.3 degrees; P =0.004). Both the SDA and mSDA procedures significantly increased coverage in the superior-posterior octant (SDA: 92.6±9.3 degrees, mSDA: 92.3±9.8 degrees, preoperative: 81.9±9.5 degrees; P <0.02), with a similar percent change among the 2 ( P =1.0). All 3 procedures significantly increased superior coverage ( P <0.04); the increase was similar among the 3 ( P =0.205). The PA was the only procedure to produce a significant increase in coverage in the superior-anterior octant (91.0±16.7 degrees, preoperative: 74.0±12.1 degrees; P =0.005) or the anterior octant (50.7±11.7 degrees, preoperative: 45.8±8.9 degrees; P =0.012). CONCLUSIONS: The SDA and mSDA procedures produced similar postoperative changes, primarily in the superior and superior-posterior acetabular octants. Placing the graft more anteriorly did not increase anterior coverage in the mSDA, and only the PA increased coverage in the superior and superior-anterior acetabular octants.

Operative Versus Non-operative Treatment of Medial Epicondyle Fractures in Pediatric Athletes: A Systematic Review.

Treatment of medial epicondyle fractures is controversial in pediatric orthopaedics with a recent trend towards operative fixation in overhead athletes. We performed a systematic review to compare outcomes in operative and non-operatively overhead athletes. A systematic review of the literature was performed. Articles investing pediatric athletes with medial epicondyle fractures treated operatively and non-operatively that reported functional and radiographic outcomes were compiled. We identified 6 studies with a total of 99 patients (52 treated operatively and 47 treated non-operatively). We found a significantly higher union rate with operative treatment (100%) compared to non-operative treatment (76%, p = 0.0025), with equivalent return to sport time and rate. Non-operative treatment had a lower complication and repeat surgery rates (p = 0.009). This study demonstrates lower complication rates and equivalent functional outcomes between operative and non-operatively treated medial epicondyle fractures in athletes. Non-operative treatment is a valid option in these patients. (Journal of Surgical Orthopaedic Advances 32(1):009-013, 2023).

Treatment trends in distal humerus fractures between ABOS part II candidates.

PURPOSE: The purpose of this study was to determine how fellowship training influences the treatment of distal humerus fractures with either total elbow arthroplasty (TEA) or open reduction internal fixation (ORIF). METHODS: The American Board of Orthopaedic Surgery (ABOS) Part II Examination Database was queried for all orthopaedic surgeons who sat for the Part II examination between the years 2003-2019. Inclusion criteria were ORIF or TEA cases, selected by individual CPT codes for each procedure, and patients of at least age 65 years who sustained acute distal humerus fractures. Analysis was performed for each type of fellowship training completed, total number of procedures performed, the type of procedure performed, patient demographics, and any complications. RESULTS: There were 149 TEAs and 1306 ORIFs performed for distal humerus fractures between the exam years of 2003-2019. The proportion of TEA to ORIF increased from 7.6% to 11.0%. Partitioned by fellowship training, Hand and Upper Extremity surgeons performed 69 (17.4%) TEAs and 328 (82.6%) ORIFs, Shoulder and Elbow surgeons performed 34 (29.6%) TEAs and 81 (70.4%) ORIFs, Sports Medicine surgeons performed 14 (5.1%) TEAs and 263 (94.6%) ORIFs, and Trauma surgeons performed 16 (4.2%) TEAs and 366 (95.8%) ORIFs. Hand and Upper Extremity surgeons treated the most distal humerus fractures (397, 27.3%), followed by Trauma surgeons (382, 26.3%). CONCLUSION: Our data suggests that fellowship training does influence the surgical decision-making process for treating distal humerus fractures in elderly populations. Hand and Upper Extremity surgeons performed the greatest number of TEA for acute distal humerus fractures, followed by Shoulder and Elbow surgeons. Conversely, trauma surgeons performed the lowest proportion of TEA to ORIF. LEVEL OF EVIDENCE: III.