Pediatric Patients with Osteomyelitis and/or Septic Joint Undergoing Surgical Debridement Have Equivalent Short-Term Outcomes with or without Preoperative MRI.

The purpose of this study was to determine if short-term outcomes differed for pediatric patients with suspected musculoskeletal infection with or without a preoperative MRI. This was a multicenter, retrospective review of patients aged 0-16 years who presented with atraumatic extremity pain, underwent irrigation and debridement (I&D), and received at least one preoperative or postoperative MRI over a 10-year period. Primary outcomes were time to OR, total I&Ds, readmission rate, time from OR to discharge, and total number of MRIs. Secondary outcomes entailed the rate at which concurrent osteomyelitis was identified in patients with septic arthritis and the extent of the resulting surgical debridement. Of the 104 patients, 72.1% had a preoperative MRI. Patients with a preoperative MRI were significantly less likely to have surgery on the day of admission. No difference was found between groups regarding total I&Ds, readmission rate, time from OR to discharge, and total number of MRIs. Of the 57 patients diagnosed with septic arthritis, those with a preoperative MRI were significantly more likely to have concurrent osteomyelitis identified and to undergo bony debridement in addition to arthrotomy of the joint. In conclusion, patient outcomes are not adversely affected by obtaining a preoperative MRI despite the delay in time to OR. Although preoperative MRI can be beneficial in ruling out other pathologies and identifying the extent of concurrent osteomyelitis, the decision to obtain a preoperative MRI and timing of surgery should be left to the discretion of the treating surgeon.

Reamer irrigator aspirator (RIA) reduces risk of fat embolism in bilateral pediatric femur shaft fractures: a case report.

A 14-year-old male patient was successfully treated with the reamer irrigator aspirator for femur intramedullary rod preparation after sustaining right and left closed femur fractures because of an all-terrain vehicle accident. In patients already categorized as high risk for fat embolism syndrome, such as those with bilateral femur fractures, reaming both femora greatly increases the likelihood of this complication. The reamer irrigator aspirator provides an effective tool that potentially mitigates the risk of fat embolism syndrome in pediatric patients with this type of orthopedic trauma.

First report of mobile colistin resistance gene mcr-1 in avian pathogenic Escherichia coli isolated from turkeys in the Gaza Strip, Palestine.

Background and Aim: Colistin is used to treat avian pathogenic Escherichia coli (APEC), a microorganism that affects turkey meat production in the Gaza Strip and worldwide. However, the recent emergence of plasmid-borne mobile colistin resistance (mcr) genes in pathogenic E. coli strains is a serious antimicrobial resistance (AMR) challenge for both human and animal health. In December 2018, colistin was banned as a veterinary antimicrobial in the Gaza Strip. This study aimed to detect and track the prevalence of colistin-resistant APEC isolated from turkey flocks in the Gaza Strip. Materials and Methods: This study investigated 239 APEC isolates from turkey flocks in the Gaza Strip between October 2018 and December 2021 (at 6-month intervals). The colistin-resistant APEC strains were detected using the broth microdilution method. The mcr-1 gene was identified using a polymerase chain reaction. Results: The overall colistin resistance among the isolated APECs was 32.2% during the study period. The average resistance in the first interval was 37.5%, which significantly decreased to 9.3% in the last interval. Among the 77 phenotypically resistant isolates, 32.4% were positive for mcr-1. The average abundance of mcr-1 in the first interval was 66.6%, which decreased to 25% in the last interval. Conclusion: To the best of our knowledge, this is the first study reporting the presence of the mcr-1 gene among the APEC isolates from turkeys in the Gaza Strip. Banned veterinary use of colistin significantly decreased the percentage of resistant APEC isolates from turkeys in Gaza Strip. Further studies are needed to investigate other colistin resistance genes and track the emergence of AMR.

Injuries Sustained With Falls From Height in Crossing the United States-Mexico Border at a Level I Trauma Center: A Prospective Cohort Study.

INTRODUCTION: The US Department of Homeland Security has reported increases in encounters and apprehensions at the US Southwest border for the past several years. The purposes of this study were to assess the demographics, patterns of injuries, and surgical interventions, associated with falls from height along the US-Mexico border. METHODS: A prospective cohort study was conducted at a Level I trauma center from January 2016 through December 2021 of all patients who fell from height crossing the US-Mexico border and presented with injuries requiring admission. RESULTS: A total of 448 patients were admitted with a median age of 30 years (interquartile range [IQR] 16, range 6 to 65). Monthly frequency of admissions increased markedly with a median of 18.5 (IQR 5.3) in 2021. Patients presented with limited health data, and comorbidities were identified in 111 patients (24.7%). Median height fallen was 5.5 m (18 ft). Patients sustaining a fall from ≥ 5.5 m were markedly more likely to have an Injury Severity Score (ISS) of > 15. Median length of stay was 9 days (IQR 11). There were a total of 1,066 injuries with 723 extremity and pelvic; 236 spine; and 107 head or neck, face, thorax, or abdominal injuries. Median ISS was 9.0 (IQR 7, range 1 to 75, 33% > 15). Tibial plafond fracture and spine injury were markedly associated with longer lengths of stay and ISS > 15. All injuries resulted in 635 separate surgical events and 930 procedures. Clinical follow-up occurred in 55 patients (12.2%), with median duration of 28 days (range 6 days to 8 months). DISCUSSION: Injuries associated with border crossings and falls from height were serious and increased in frequency. As the US policy on border security evolves, surgeons in these regions should be prepared to handle the associated injuries and sequelae. Prevention of these serious and debilitating injuries should be undertaken to decrease the burden of disease.

Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial.

Purpose: A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy. Methods: Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours. Results: A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points. Conclusion: Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.

Occurrence and phylogenetic analysis of fowl adenovirus E in broiler flocks from Gaza Strip Palestine.

INTRODUCTION: Inclusion-body hepatitis (IBH) and hydropericardium syndrome (HPS) are highly infectious diseases caused by fowl adenoviruses (FAdVs). IBH and HPS cause major economic losses in poultry production. IBH is caused by multiple FAdV serotypes such as FAdV-11, FAdV8a, and FAdV8b; while HPS is mainly caused by the FAdV-4 serotype. In 2018, we detected FAdVs in West Bank - Palestine for the first time. This study aims to monitor the emergence of new FAdVs in broiler farms in Gaza Strip-Palestine in 2022. METHODOLOGY: The clinical signs, necropsy, and histopathological findings associated with IBH in the suspected birds were recorded. Polymerase chain reaction (PCR) was performed using primers matching the virus-encoded L1 loop of the hexon gene. The sequences of the L1 loop were analyzed and a phylogenetic tree was constructed and compared with the related FAdV field isolates and reference strains from different regions of the world available in GenBank. RESULTS: The infected broiler displayed FAdVs-induced clinical symptoms and pathological lesions with mortality rates ranging from 20-46%. The L1 loop sequences from the infected flocks were submitted to GenBank with accession numbers ON638995, ON872150, and ON872151. The identified L1 loop gene has high nucleotide homology (96.7-97.9%) to the highly pathogenic FAdV E serotype 8b strain FAdV_isolate_04-53357-122_Canada_2007 (GenBank: EF685489) and 94.5-94.6% to FAdV_10_Belgium_2010 isolate 11-15941 (GenBank: AF339924.1). Furthermore, the phylogenetic analysis indicated that they belong to FAdV-E serotype 8b. CONCLUSIONS: Our study reports the emergence of FAdV-E causing IBH disease in broiler chickens for the first time in Gaza in Palestine.

Soft Tissue Benign Hand Masses in the First Web Space: A Retrospective Case Series.

INTRODUCTION: Hand masses are fairly common. While most of these masses are either ganglion cysts or benign tumors, masses in the first web space are not rare, and they may in fact represent a variety of lesions. These include both benign and malignant tumors, metastases, or congenital and anomalous structures, and may involve nerves, vascular structures, connective tissue, and joints. METHODS: In this retrospective case series, data on 12 cases of first dorsal web space hand mass treated at our center over a period of five years were collected and analyzed. RESULTS:  Twelve consecutive patients presenting with a first dorsal web space hand mass over a period of five years were reviewed. This represented a group of nine females and three males, with a mean age of 53 years (range = 16-70 years). Seven patients had a mass on the right side and five on the left side. The surgical approach to resect the mass in all 12 patients was dorsal. The most common diagnosis was ganglion cyst (50%), followed by lipoma (25%) and aneurysm (16.6%). There was one case of eccrine spiradenoma. CONCLUSION: First dorsal web space hand masses can encompass multiple different pathologies, and the first web space has an intricate anatomy. Both of these factors mandate a careful approach that includes meticulous preoperative planning with appropriate advanced imaging studies, which helps to make the surgical procedure more efficient and accurate.

Antegrade Flexible Nailing for Pediatric Metaphyseal-diaphyseal Junction Distal Radius Fracture, is it Safe?

Fractures involving the distal radius metaphyseal-diaphyseal junction (MDJ) present a unique challenge for pediatric orthopedic surgeons. These fractures are too proximal for percutaneous K -wire fixation and too distal for retrograde flexible nailing. The purpose of this study was to: (1) determine the safety of a described antegrade approach from the posterior interosseous nerve (PIN); (2) assess the efficacy of antegrade nailing in cases of distal MDJ fractures; and (3) describe a standardized lateral approach to the proximal radius. A cadaveric study was performed using 10 adult forearms. Anterograde flexinail was introduced at the proximal radius based on the described "safe zone". Distal MDJ fractures were created using osteotomes. We evaluated the distance between the entry point to the PIN in addition to the quality of the reduction for the fracture. The average distance between the entry point and piercing instrument to the PIN was 5.4 cm (range: 4.7 to 6.0 cm). When grouped based on sex, the average distance was significantly further for males (5.8 cm, range: 5.2 to 6.0 cm) versus females (4.9 cm, range: 4.7 to 5.2 cm), P =0.004. Fracture reduction was not maintained after the introduction of the antegrade flexible nail across the fracture site. For all specimens, >25% displacement was seen on the anterior-posterior imaging. Our modified lateral approach to the starting point in the proximal radius is safe as long as the entry point for antegrade flexible nailing stays proximal to the radial tuberosity during the lateral approach to the proximal radius while the elbow is flexed and the forearm pronated.

Correction of Cubitus Varus Using Computer-Assisted Hexapod Multiplanar External Fixators: A Report of 3 Cases.

CASE: Three male patients, 8-, 13-, and 18-year-old, all developed posttraumatic cubitus varus elbow deformity after distal humerus supracondylar fractures. Each underwent a distal humerus osteotomy with application of a hexapod external fixator to gradually correct the deformity. CONCLUSION: In patients with cubitus varus malunion, the stability of the hexapod external fixation, percutaneous nature of the osteotomy, and availability of running a residual computer-assisted program provides a consistent technique for deformity correction.

Operative challenges of intramedullary nailing for subtrochanteric blastic pathological femur fracture: a case report.

Prostate adenocarcinoma metastasizes to bone and forms fragile blastic lesions, which can present as dense obstacles intraoperatively. There are limited reports on the challenges surgeons face when operating through these lesions. A 60-year-old male with a pathologic subtrochanteric femur fracture in the presence of blastic lesions was successfully treated with intramedullary (IM) fixation. Pathologic fractures from blastic bone lesions are expected to increase in prevalence as survivability improves for metastatic prostate cancer. Orthopedic surgeons, when performing IM fixation for these fractures, should be prepared to utilize accessory equipment and should adopt creative techniques for reduction and fixation.

Tendon Transfers to Restore Shoulder Function for Obstetrical Brachial Plexus Palsy: A Systematic Review of the Literature.

BACKGROUND: Obstetrical brachial plexus palsy (OBPP) is a relatively common stretch injury of the brachial plexus sustained during delivery. Tendon transfers are commonly performed to improve shoulder function among patients with OBPP. Although several techniques for the surgical management of OBPP exist, it is unclear whether tendon transfers to the rotator cuff vs. posterior humerus yield different outcomes. METHODS: A systematic search in PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar up to January 1, 2021, was performed. Relevant publications were classified by surgical technique of tendon transfers to the rotator cuff or posterior humerus. The standard mean difference (SMD) and 95% confidence intervals were calculated to compare preoperative and postoperative aggregate Mallet scores as well as abduction and external rotation scores using the Mallet scale. A p value of <0.01 was considered significant. RESULTS: Data from 26 studies and 951 patients (46.2% male patients) with a mean age of 68.9 ± 29.3 months were included. Eight hundred three patients underwent tendon transfer to the rotator cuff and 148 to the posterior humerus. The average postoperative follow-up period was 45.2 ± 21.7 months. The pooled cohort had an overall improvement in postoperative aggregate Mallet scores (SMD = 5.53, p < 0.001), abduction scores (SMD = 1.79, p < 0.001), and external rotation scores (SMD = 1.99, p < 0.001). Tendon transfer to the rotator cuff had a greater postoperative improvement in abduction (SMD = 1.90, p < 0.001) than transfer to the posterior humerus (SMD = 1.32, p < 0.001) while both techniques yielded similar improvements in external rotation (rotator cuff SMD = 2.01, p < 0.001, posterior humerus SMD = 1.98, p < 0.001). CONCLUSION: This is the first systematic review comparing outcomes for tendon transfers to the rotator cuff vs. the posterior humerus for improving shoulder function in patients with OBPP. Overall, tendon transfers are an effective treatment for improving shoulder function. Transfer of the latissimus dorsi and teres major to the rotator cuff compared with transfer to the posterior humerus results in greater improvement in abduction while both techniques have similar results in improving external rotation. LEVEL OF EVIDENCE: Level I Systematic review of Level I and Level II studies.

Malpractice lawsuits in orthopedic trauma surgery: a meta-analysis of the literature.

Introduction: The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Methods: Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity. Results: The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error. Conclusion: Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent. Level of Evidence: Economic and Decision Analyses Level VI.

Unroofing osteotomy for dissociated tibial intramedullary magnetic rod during implant removal: a case report.

The PRECICE® intramedullary rod (NuVasive, San Diego, CA) utilizes multiple telescopic components to magnetically drive limb lengthening. These devices are routinely explanted after desired growth correction is met. To the author's knowledge, this is the first description of an osteotomy assisted extraction of a disassociated tibial magnetic lengthening rod. A 17-year-old girl with fibular hemimelia and resolved left tibial length discrepancy after successful surgical lengthening underwent a complex implant removal approximately seven years after regenerate consolidation. During implant removal, the telescopic portion of the rod remained lodged in the tibial medullary canal and a subsequent unroofing osteotomy of the tibia was performed. Tibial limb length discrepancies are oftentimes corrected with complex implants comprised of multiple fragile components that are routinely explanted. During the unfortunate event of a telescopic intramedullary rod dissociation, an unroofing osteotomy can be successfully performed to removal all implant components.

Premalignant Conditions of Bone.

Development of malignancy is a multifactorial process, and there are multitude of conditions of bone that may predispose patients to malignancy. Etiologies of malignancy include benign osseous conditions, genetic predisposition, and extrinsic conditions. New-onset pain or growth in a previously stable lesion is that should concern for malignant change and should prompt a diagnostic workup for malignancy.

Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study).

Purpose: Breast surgeons seek simple, safe, effective, and novel regional anesthesia techniques for postoperative analgesia. Erector spinae plane (ESP) block is a new ultrasound-guided technique. We aimed to explore the analgesic effect of adding ketamine and magnesium sulfate as adjuvants to levobupivacaine in ESP. Patients and Methods: Sixty female patients (aged 18-60 years) with breast cancer, weighing 50-90 kg who were scheduled for modified radical mastectomy (MRM) were randomly allocated into three groups (20 patients each) to receive an ESP block with 20 mL 0.25% levobupivacaine with adjuvants according to the following groups: group C: levobupivacaine; group K: levobupivacaine + 2 mg/kg ketamine; and group M: levobupivacaine + 2 mg/kg magnesium sulfate. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 48 hours. Results: The total amount of Morphine rescue analgesia was significantly lower in groups M (7.00 ± 0.61 mg) and K (7.50 ± 0.58 mg) than in group C (14.40 ± 3.47 mg) during the first 48 h postoperatively. Nine (45%) patients in group M and 13 (65%) patients in K, compared with 20 (100%) patients in group C, requested analgesia. The time to first request of analgesia was significantly longer in groups M (30 h) and K (24 h) than in group C (7 h). No hemodynamic changes or serious side effects were observed. Conclusion: Magnesium sulphate and ketamine seem to be both effective adjuvants to levobupivacaine in ESP blocks for postoperative analgesia in patients undergoing MRM, with slightly better analgesia provided by magnesium sulphate.

COVID-19 Infection in Patients with Comorbidities: Clinical and Immunological Insight.

AIM: Our study's objectives were to study the clinical and laboratory characteristics that may serve as biomarkers for predicting disease severity, IL-10 levels, and frequencies of different T cell subsets in comorbid COVID-19 patients. METHODS: Sixty-two hospitalized COVID-19 patients with comorbidities were assessed clinically and radiologically. Blood samples were collected to assess the T lymphocyte subsets by flow cytometry and IL-10 levels by ELISA. RESULTS: The most common comorbidities observed in COVID-19 patients were diabetes mellitus (DM), hypertension, and malignancies. Common symptoms and signs included fever, cough, dyspnea, fatigue, myalgia, and sore throat. CRP, ferritin, D dimer, LDH, urea, creatinine, and direct bilirubin were significantly increased in patients than controls. Lymphocyte count and CD4+ and CD8+ T-cells were significantly decreased in comorbid COVID-19 patients, and CD25 and CD45RA expression were increased. CD4+ and CD8+ regulatory T cells (Tregs) and IL-10 levels were significantly decreased in patients. CONCLUSIONS: Many parameters were found to be predictive of severity in the comorbid patients in our study. Significant reductions in the levels and activation of CD4+ and CD8+ T-cells were found. In addition, CD4+ and CD8+ Tregs were significant decreased in patients, probably pointing to a prominent role of CD8+ Tregs in dampening CD4+ T-cell activation.

Arthroereisis: Treatment of Pes Planus.

Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar arthroereisis is to relieve pain and restore function. This is primarily done by restoring the medial foot arch without fusing the subtalar joint and without requiring a long recovery period needed after osteotomies. Although the procedure can be performed in isolation to treat flexible flatfoot, it can also be performed as an ancillary in the treatment of tarsal coalition, posterior tibial tendon dysfunction, and accessory navicular syndrome. Various implants and multiple surgical techniques exist for arthroereisis, such as the sinus tarsi implant and calcaneo-stop. The type of device and the surgical approach to proceed with are based on the surgeon's discretion rather than an evidence-based protocol. Multiple complications can arise from subtalar arthroereisis, most commonly sinus tarsi pain. Currently, there is a dearth of quality clinical data and evidence on the long-term outcomes and complications of arthroereisis. This lack of literature for a commonly performed procedure validates the need for future studies to better guide a standard protocol, reach consensus on well-defined indications and contraindications, provide expected complications, and improve the practice of evidence-based medicine.

Early internal fixation of open ankle malleolar fractures is not associated with increased complications: case control study.

The timing of definitive fixation of open ankle malleolar fractures is still controversial. This study intended to evaluate the outcome of patients who were managed by immediate definitive fixation in comparison to delayed definitive fixation following open ankle malleolar fractures. This was an IRB approved retrospective case control study of 32 patients who were treated with open reduction and internal fixation (ORIF) for open ankle malleolar fractures at our Level I trauma center 2011-2018. Patients were divided into 2 groups; immediate ORIF group (within 24 hours) and delayed ORIF group (first stage included debridement and external fixator or splinting followed by second stage of delayed ORIF). Outcomes assessed were postoperative complications (wound healing, infection, nonunion). Logistic regression models were used to access the unadjusted and adjusted associations between post- operative complications and selected co factors. The immediate definitive fixation group included 22 patients while the delayed staged fixation group included 10 patients. Gustilo type II and III open fractures were associated with higher complications rate (p-value = 0.012) in both groups. Comparing the 2 groups, There was no increase in complication in the immediate fixation group compared to the delayed group. Complications following open ankle malleolar fractures are usually associated with Gustilo type II and III open fractures. Immediate definitive fixation after adequate debridement was not found to increase complication rate compared to staged management.

Tibial shaft fractures in the adolescents: treatment outcomes and the risk factors for complications.

BACKGROUND: Tibial shaft fractures are common injuries in the adolescent age group. The optimal method of treatment in this age group is still controversial. It relies on several factors including patient's age, fracture pattern, fracture location, and the condition of the soft tissue envelope. The purpose of this study was to report the clinical and radiographic outcomes of adolescent tibial shaft fractures treatment at a level-I trauma center. METHODS: This retrospective study reviewed consecutive patients between 10 and 18 years of age who suffered from tibial shaft fractures between 2009 and 2018 at a level-I trauma center. Outcomes of interest were the successful fracture union (primary outcome) as evaluated by the Radiographic Union Scale in Tibial fractures (RUST) and the complications (secondary outcomes). RESULTS: Fifty-two consecutive adolescent patients treated for tibial shaft fractures using elastic stable intramedullary nails (ESIN), interlocking nails, plates and screws, external fixators, and casts were included in the study. The mean follow-up period was 27.4 months. There was no statistically significant difference in the union rate and time to fracture union between the different treatment methods. Subject weight, fracture type, and method of treatment were significant predictors for the RUST scores at 12 weeks post-operative. Adolescents with heavier bodyweight correlated with lower RUST scores (p<0.001). Open fractures were associated with significantly longer time to union (p<0.001) and lower RUST scores (p<0.001) compared to closed fractures. The patients treated with interlocking nailing showed higher RUST scores than the casting treatment group (p = 0.01). There were no statistically significant differences in complication rates between the fixation methods. Union time was significantly longer with complications than without complications (p = 0.01). Open fractures had higher complication rates compared to closed fractures. In the multivariate logistic model, patients with open fracture were 5.5 times more likely to have complications (OR=5.46; p = 0.04). CONCLUSION: Tibial shaft fractures in adolescents can be treated with several methods including ESIN, interlocking nail, plate and screws, external fixation, and casting. All are valid treatments for adolescent tibial shaft fractures and can achieve favorable outcomes. No single treatment method applies to all patients. Each method has advantages, disadvantages, and specific indications.

Novel Utilization of Anterior Intrapelvic (Stoppa) Approach for Periacetabular Ganz Osteotomy: A Report of 2 Cases.

CASE: The Ganz periacetabular osteotomy (PAO) is widely used to correct developmental hip dysplasia in the adolescent and young adult population. The aim of this case study was to examine the novel utility and safety of Stoppa approach for the Ganz PAO in a 15-year-old girl and 25-year-old man. The Stoppa approach is traditionally used for acetabular fractures, and its use for a Ganz PAO is relatively novel. CONCLUSION: The Stoppa approach allows surgeons to successfully perform the Ganz PAO while simultaneously providing direct visualization for all osteotomies and vital structures.