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Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 2023 Oct 01
Authors:
Burton MG
Abstract
A 12-year-old girl developed a distal femoral shaft fracture treated with lateral trochanteric entry intramedullary nail fixation. The nail was retained after union because of a persistent nonossifying fibroma at the previous fracture site. At 16 months after surgery, marked valgus deformity was noted at the distal femur, with signs of implant haloing and loosening, suggesting repetitive motion and stress concentration of forces at the distal femur. Owing to recognition before skeletal maturity, the valgus was corrected with hemiepiphysiodesis. This finding illustrates the importance of follow-up up to skeletal maturity for pediatric femoral shaft fractures and consideration of routine removal of implants after fracture union to avoid this previously unreported complication.
PMID:
37801646
[PubMed - as supplied by publisher]
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Journal of pediatric orthopedics 2018 Apr
Authors:
Roberts DW, Saglam Y, De La Rocha A, Frasquillo BN, Tulchin-Francis K, Kim HKW
Abstract
Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery.
Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery.
Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (P<0.0001), but radiographic outcomes were similar at follow-up. Most nonoperative hips had normal FNL growth rates (80%), but resolution of varus NSA occurred in only 21%. In contrast, 56% of operative hips showed decreased FNL growth rates. Interobserver reliability was excellent for HEA (0.98), NSA (0.90), and FNL (0.89), and good for HSA (0.79). Repeat osteotomy was performed in 6 cases (22%). No significant predictors for recurrence were identified. At long-term follow-up for recalled patients, 72% had significantly abnormal gait, and 50% had fair-poor functional outcomes (mHHS<79).
Valgus osteotomy corrects severe deformity in CCV with improved clinical and radiographic outcomes. HEA and NSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment.
Level III-retrospective cohort.
PMID:
27261966
[PubMed - as supplied by publisher]
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The Journal of bone and joint surgery. American volume 2014 Dec 17
Authors:
Ramo BA, Roberts DW, Tuason D, McClung A, Paraison LE, Moore HG
Abstract
Surgical site infection is a serious complication of posterior spinal fusion for neuromuscular scoliosis, with a reported prevalence of 6% to 24%. A single-institution experience over a thirty-year period was reviewed to determine the prevalence of surgical site infection after posterior spinal fusion for neuromuscular scoliosis, and to identify patient and treatment-related risk factors.
Our retrospective review included all patients treated with posterior spinal fusion (alone or in combination with an anterior procedure) for neuromuscular scoliosis from 1980 to 2009 and followed for a minimum of two years. Univariate and multivariate statistical analysis was performed to identify significant risk factors for occurrence of deep surgical site infection (p < 0.05).
The study included 428 patients with an average duration of follow-up of 4.9 years. The mean Cobb angle was 74.3°. Most (74%) were treated with posterior spinal fusion alone. Deep infection developed in forty-four patients (10.3%); 57% of the infections occurred within three months after the surgery and 73%, within twelve months. Nearly half (45%) of the infections were polymicrobial; 59% of the organisms were gram-positive and 41% were gram-negative. Implant removal was required in 58% of the patients. Surgical site infection was more frequent from 1980 to 1989 (20.3%) than it was from 1990 to 2009 (8.4%) (odds ratio [OR] = 2.8, p = 0.01 in univariate analysis). Surgical site infection was more common in patients with spina bifida (21.5%) than in those with other diagnoses (8.3%) (OR = 3.0, p = 0.001). Other patient factors associated with surgical site infection were a body mass index (BMI) of >25 kg/m(2) (OR = 2.4, p = 0.04) and incontinence (OR = 2.4, p = 0.009). Treatment factors associated with surgical site infection were inadequate prophylactic antibiotic dosing (cefazolin ≤ 20 mg/kg) (OR = 3.3, p = 0.0002), length of fusion (p = 0.002), pelvic fixation (OR = 2.4, p = 0.04), length of hospital stay (p = 0.005), and other complications (OR = 3.2, p = 0.0003). Drain output (p = 0.04) and lower hemoglobin levels (p = 0.008) were significantly associated with surgical site infection in patients with spina bifida, and drain use (superficial to the fascia) was protective in those without spina bifida (OR = 0.5, p = 0.046).
This study identified modifiable factors, especially antibiotic dosing and drain use, associated with surgical site infection in patients with neuromuscular scoliosis.
PMID:
25520337
[PubMed - as supplied by publisher]
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Authors:
Roberts DW, Roc GJ, Hsu WK
Abstract
The effects of disk herniations on the career and performance outcomes of Major League Baseball (MLB) pitchers are unknown. The purpose of this study is to determine the outcomes after a cervical or lumbar disk herniation for MLB pitchers. Forty MLB pitchers from 1984 to 2009 with a cervical disk herniation or lumbar disk herniation were identified using a previously established protocol. Cervical disk herniation was identified in 11 pitchers, 8 of which were treated operatively. The majority of pitchers with cervical disk herniation (8/11) returned to play at an average of 11.6 months. Lumbar disk herniation was identified in 29 pitchers, 20 of which were treated operatively. All pitchers with lumbar disk herniation (29/29) returned to play at an average of 7.3 months after diagnosis.
PMID:
21800814
[PubMed - as supplied by publisher]
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The spine journal : official journal of the North American Spine Society 2011 Mar
Authors:
Hsu WK, McCarthy KJ, Savage JW, Roberts DW, Roc GC, Micev AJ, Terry MA, Gryzlo SM, Schafer MF
Abstract
Although clinical outcomes after lumbar disc herniations (LDHs) in the general population have been well studied, those in elite professional athletes have not. Because these athletes have different measures of success, studies on long-term outcomes in this patient population are necessary.
This study seeks to define the outcomes after an LDH in a large cohort of professional athletes of American football, baseball, hockey, and basketball.
Retrospective cohort study.
A total of 342 professional athletes from four major North American sports from 1972 to 2008 diagnosed with an LDH were identified via a previously published protocol. Two hundred twenty-six players underwent lumbar discectomy, and 116 athletes were treated nonoperatively. Only those players who had at least 2 years of follow-up were included.
Functional outcome measures as defined by successful return-to-play (RTP), career games, and years played for each player cohort were recorded both before and after treatment. Conversion factors based on games/regular season and expected career length (based on individual sport) were used to standardize the outcomes across each sport.
Using Statistical Analysis Software v. 9.1, outcome measures were compared in each cohort both before and after treatment using linear and mixed regression analyses and Cox proportional hazards models. A Kaplan-Meier survivorship curve was calculated for career length after injury. Statistical significance was defined as p<.05.
After the diagnosis of an LDH, professional athletes successfully returned to sport 82% of the time, with an average career length of 3.4 years. Of the 226 patients who underwent surgical treatment, 184 successfully returned to play (81%), on average, for 3.3 years after surgery. Survivorship analysis demonstrated that 62.3% of players were expected to remain active 2 years after diagnosis. There were no statistically significant differences in outcome in the surgical and nonoperative cohorts. Age at diagnosis was a negative predictor of career length after injury, whereas games played before injury had a positive effect on outcome after injury. Major League Baseball (MLB) players demonstrated a significantly higher RTP rate than those of other sports, and conversely, National Football League (NFL) athletes had a lower RTP rate than players of other sports (p<.05). However, the greatest positive treatment effect from surgery for LDH was seen in NFL players, whereas for MLB athletes, a lumbar discectomy led to a shorter career compared with the nonoperative cohort (p<.05).
Professional athletes diagnosed with an LDH successfully returned to play at a high rate with productive careers after injury. Whereas older athletes have a shorter career length after diagnosis of LDH, experienced players (high number of games played) demonstrate more games played after treatment than inexperienced athletes. Notably, surgical treatment in baseball players led to significantly shorter careers, whereas for NFL athletes, posttreatment careers were longer than those of the corresponding nonoperative cohort. The explanation for this is likely multifactorial, including the age at diagnosis, respective contractual obligations, and different physical demands imposed by each individual professional sport.
PMID:
21269889
[PubMed - as supplied by publisher]
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Authors:
Roberts DW, Savage JW, Schwartz DG, Carreon LY, Sucato DJ, Sanders JO, Richards BS, Lenke LG, Emans JB, Parent S, Spinal Deformity Study Group, Sarwark JF
Abstract
Longitudinal cohort study.
To compare functional outcomes between male and female patients before and after surgery for adolescent idiopathic scoliosis (AIS).
There is no clear consensus in the existing literature with respect to sex differences in functional outcomes in the surgical treatment of AIS.
A prospective, consecutive, multicenter database of patients who underwent surgical correction for adolescent idiopathic scoliosis was analyzed retrospectively. All patients completed Scoliosis Research Society-30 (SRS-30) questionnaires before and 2 years after surgery. Patients with previous spine surgery were excluded. Data were collected for sex, age, Risser grade, previous bracing history, maximum preoperative Cobb angle, curve correction at 2 years, and SRS-30 domain scores. Paired sample t tests were used to compare preoperative and postoperative scores within each sex. Independent sample t tests were used to compare scores between sexes. A P value of <0.05 was considered statistically significant.
Seven hundred forty-four patients (621 females and 123 males) were included. On average, males were 1 year older than females. There were no differences between sexes in Risser grade, bracing history, maximum curve magnitude, or correction after surgery. Both males and females had similar improvement in all SRS-30 domains after surgery. Self-image/appearance had the greatest relative improvement. Males had better self-image/appearance scores preoperatively, better pain scores at 2 years, and better mental health and total scores both preoperatively and at 2 years. Both males and females were similarly satisfied with surgery.
Males treated with surgery for AIS report better preoperative self-image, less postoperative pain, and better mental health than females. These differences may be clinically significant. For both males and females, the most beneficial effect of surgery is improved self-image/appearance. Overall, the benefits of surgery for AIS are similar for both sexes.
PMID:
21192215
[PubMed - as supplied by publisher]