d'Heurle, A; McCarthy, J; Klimaski, D; Stringer, K. Proximal Femoral Growth Modification: Effect of Screw, Plate, and Drill on Asymmetric Growth of the Hip. Journal of Pediatric Orthopaedics. 2018; 38(2):100-104.
This study builds on previous work that indicates screw hemiepiphysiodesis can effectively alter the shape of the proximal femur, and result in a lower neck-shaft angle (NSA) (or lesser valgus). This study suggests that implantation of a screw is likely to be more effective than a plate or drilling procedure in decreasing the NSA in skeletally immature hips. If further preclinical, and later clinical, studies demonstrate reproducible efficacy, guided growth of the proximal femur may eventually become a viable option for treatment or prevention of hip deformity in select patients.
Wall, EJ; Reynolds, JE; Jain, VV; Bylski-Austrow, DI; Thompson, GH; Samuels, PJ; Barnett, SJ; Crawford, AH. Spine Growth Modulation in Early Adolescent Idiopathic Scoliosis: Two-Year Results of Prospective US FDA IDE Pilot Clinical Safety Study of Titanium Clip-Screw Implant. Spine Deformity. 2017; 5(5):314-324.
A spine growth modulation system designed by researchers at Cincinnati Children's Hospital Medical Center for patients diagnosed in the early stages of adolescent idiopathic scoliosis and who had a high probability of curve progression to posterior spinal fusion (PSF), is a study under an FDA IDE. Determination is that this new implant is safe, though variability in curve response to the implant was high, ranging from progression to correction. Investigational approval granted by the FDA for the next cohort of 30 subjects. If eventually proven efficacious, the system may obviate PSF or years of brace wear for select patients with late juvenile to early adolescent idiopathic scoliosis.
Brower, LH; Kremer, N; Meier, K; Wolski, C; McCaughey, MM; McKenna, E; Anadio, J; Eismann, E; Shaughnessy, EE. Quality Initiative to Introduce Pediatric Venous Thromboembolism Risk Assessment for Orthopedic and Surgery Patients. Hospital pediatrics. 2017; 7(10):595-601.
Utilizing quality-improvement techniques, pediatric patients screened for venous thromboembolism (VTE) risk increased from 0% to 80% and 0% to 46% in general surgical and orthopaedic surgical patients respectively. Increasing the percentage of patients screened could potentially decrease the incidence of VTE, which is costly, has high morbidity and is often preventable. The implementation of VTE risk assessment required standardizing the assessment process and embedding it within the workflow of providers, particularly by using electronic medical record supports. In general, by using physician and nurse practitioners rather than bedside nurses to evaluate patients for VTE risk factors found more success. Future researchers will seek to apply and expand these learnings to other high-risk populations and use human factors engineering to increase the reliability of the process.
Mayes, T; Anadio, JM; Sturm, PF. Prevalence of Vitamin D Deficiency in Pediatric Patients With Scoliosis Preparing for Spinal Surgery. Spine Deformity. 2017; 5(6):369-373.
Vitamin D enables bone mineralization, bone growth, and remodeling. Low levels of vitamin D potentiate increased parathyroid hormone and hence reduction in skeletal accretion. Additionally, vitamin D may also play a key role in muscle strength, and in immune, inflammatory and scarring processes, resulting in significant clinical impact. This study brings awareness to the risk of D25 deficiency in patients presenting for spine surgery with nearly 75% of the entire study population demonstrating a vitamin D level below normal. Given the widespread tendency toward depressed D25 levels, routine monitoring of vitamin D in scoliosis patients preparing for surgical correction appears warranted. Guideline recommendations would include scheduling lab draws to permit ample time to improve vitamin D levels via supplementation during the preoperative period.
Ghosh, P; Gruber, SMS; Lin, CY; Whitlock, PW. Microspheres containing decellularized cartilage induce chondrogenesis in vitro and remain functional after incorporation within a poly(caprolactone) filament useful for fabricating a 3D scaffold. Biofabrication. 2018; 10(2):025007-025007.
Traditionally, the only solution for joints where destruction of large areas of cartilage is to replace the joint with something artificial. For young people, that’s particularly troublesome, since it means multiple replacements over a lifetime, with the accompanying trauma, expense and limitations that imposes. Research presented here discusses a breakthrough idea for a type of artificial scaffolding that dispenses growth factors and proteins to injured cartilage, helping its regrowth. A novel, thermally stable process established for producing filaments containing chondroinductive microspheres provides evidence supporting subsequent development of a clinically-relevant, 3D scaffold fabricated from them for osteochondral regeneration and repair.