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Objectives: To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on post-operative complications and iatrogenic changes in tibial slope due to anterior physeal arrest., Methods: Design: Retrospective case series., Setting: A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center., Patient Selection Criteria: Included were skeletally immature patients within 2 years of skeletal maturity undergoing tibial RIMN for OTA/AO 42 A to C fractures between March 2009 and January 2024 with post-operative follow-up more than 1-year., Outcome Measures and Comparisons: The primary outcome was change in tibial slope after RIMN. Secondary outcomes included post-operative weight-bearing status and complications., Results: Thirty-seven skeletally immature patients were included (mean age 15.2 ± 1.3 years, 76% male). For 22 patients with minimum 6-month post-operative radiographs (mean 18.4 ± 12.7 months), there was no significant change from pre- to post-operative tibial slope (80.0 ± 1.9° vs 80.1 ± 1.6°, p=0.86). Time to achievement of full weightbearing across the series averaged 45.4 ± 35.6 days. Five (14%) of patients necessitated hardware removal, and 89% of patients reported they had returned to "normal" activity at latest follow-up (mean 56.2 ± 42.5 months)., Conclusions: This study demonstrated that RIMN for tibial shaft fractures in skeletally immature pediatric patients within 2 years of maturity was not associated with iatrogenic physeal injury and resultant changes in tibial slope. Additional favorable clinical outcomes, the potential for early weight-bearing, and few associated post-operative complications, indicate that RIMN is a safe option for skeletally immature patients with tibial shaft fractures. Caution should be exercised when extrapolating these results to younger pediatric patients with >2 years of skeletal growth remaining., Level of Evidence: IV., Competing Interests: Potential Conflicts of Interest and Funding Sources: Jessica L. Koshinski BS: None are declared. Joshua T. Bram MD: None are declared. Preston W. Gross BS: None are declared. Sarah H. Hine MD: None are declared. Daniel S. Hayes BS: None are declared. Peter D. Fabricant MD, MPH: BICMD, Inc. (Paid consultant), Clinical Orthopaedics and Related Research (Editorial or governing board), HS2, LLC (Stock or stock Options), HSS ASC Development Network, LLC (Stock or stock options), Joint Effort Administrative Services Organization, LLC (Stock or stock options), Osso VR (Stock or stock options) Mark A. Seeley MD: Consultant for OrthoPediatrics., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Prospective cohort., Objective: To determine if distal spinal fusion level is associated with postoperative sport participation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS)., Summary of Background Data: The concept of "saving a level" during PSF for AIS refers to minimizing the distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and a more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports., Materials and Methods: Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their presurgical visit to participate in this prospective study. Participants were followed for a minimum of 2 years after surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each postoperative visit, it was noted whether patients returned to the same sport type and level of competitiveness., Results: After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14 ± 2 years. Distal fusion levels ranged from T11 to L4. There was no significant association between distal fusion level and return to the same level of sports participation ( P = 0.192). Of the participants, 93% returned to sports with no significant differences by distal fusion level ( P = 0.081). Distal fusion level demonstrated no difference in return to preoperative sport ( P = 0.486) or return to the same type of sport ( P = 0.247)., Conclusions: This study found no association between distal fusion level and postoperative sports participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients returned to the same level of sports competition or higher after PSF for AIS., Competing Interests: P.D.F.: Clinical Orthopedics and Related Research: Editorial or governing board, Osso VR: Stock or stock Options, WishBone Orthopedics: Paid consultant. D.W.G.: American Academy of Orthopaedic Surgeons (AAOS): Board or committee member, AO Trauma International: Paid presenter or speaker, Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker, Current Opinion in Pediatrics: Editorial or governing board; Publishing royalties, financial or material support, New York County Medical Society: Board or committee member, New York State Society of Orthopedic Surgeons: Board or committee member, PatelloFemoral Foundation: Board or committee member, Pediatric Orthopedic Society of North America: Board or committee member, Pediatric Research in Sport Medicine: Board or committee member, Pega Medical: IP royalties, Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support. J.S.B.: OrthoPediatrics: Paid consultant, Wishbone: Paid consultant. R.F.W.: Medtronic: Paid consultant, OrthoPediatrics: IP royalties, Spine Deformity Journal Editorial Board: Editorial or governing board, Springer: Journal of Children’s Orthopedics Editorial Board: Editorial or governing board. The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR., Methods: This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05., Results: A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006)., Conclusions: This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated., Level of Evidence: Level IV; retrospective cohort study., Competing Interests: D.W.G.: AAOS: Board or committee member. AO Trauma International: Paid presenter or speaker. Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker. Current Opinion in Pediatrics: Editorial or governing board; Publishing royalties, financial or material support. New York County Medical Society: Board or committee member. New York State Society of Orthopaedic Surgeons: Board or committee member. PatelloFemoral Foundation: Board or committee member. Pediatric Orthopaedic Soceity of North America: Board or committee member. Pediatric Research in Sport Medicine: Board or committee member. Pega Medical: IP royalties. Wolters Kluwer Health—Lippincott Williams and Wilkins: Publishing royalties, financial or material support. P.D.F.: Clinical Orthopaedics and Related Research: Editorial or Governing board. Pediatric Orthopaedic Society of North America: Board or committee member. Osso VR: Stock or stock options. Wish Bone Orthopaedics: Paid consultant. Research in Osteochondritis of the Knee (ROCK): Board or committee member. The remaining authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Supracondylar humerus (SCH) fractures are common pediatric injuries, typically requiring closed reduction and percutaneous pinning or open reduction. These injuries are managed frequently by both pediatric-trained (PTOS) and nonpediatric-trained (NTOS) orthopaedic surgeons. However, some literature suggests that complications for pediatric injuries are lower when managed by PTOS. Therefore, this meta-analysis sought to compile existing literature comparing patients treated by PTOS and NTOS to better understand differences in management and clinical outcomes., Methods: Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology, a systematic review was conducted for all articles comparing SCH fractures managed by PTOS and NTOS in 4 online databases (PubMed, Embase, CINAHL, Cochrane). Study quality was assessed through the use of the Newcastle-Ottawa Scale. Meta-analyses were then performed for postoperative outcomes using pooled data from the included studies. Statistics were reported as odds ratios and 95% CI., Results: This search strategy yielded 242 unique titles, of which 12 underwent full-text review and 7 met final inclusion. All studies were retrospective and evaluated patients treated in the United States. There were a total of 692 and 769 patients treated by PTOS and NTOS, respectively. PTOS had shorter operative times [mean difference, 13.6 min (CI, -23.9 to -3.4), P=0.01] and less frequently utilized a medial-entry pin [odds ratios, 0.36 (CI, 0.2 to 0.9), P=0.03]. There were no differences in time to treatment, the necessity of open reduction, postoperative Baumann angle, or complications including surgical site infection or iatrogenic nerve injury., Conclusions: Despite shorter operative times and lower frequency of cross-pinning when treated by PTOS, pediatric SCH fracture outcomes are similar when treated by PTOS and NTOS. These findings demonstrate that these fractures may possibly be treated safely by both PTOS and experienced fellowship-trained academic NTOS who are comfortable managing these injuries in pediatric patients., Level of Evidence: Level III; Meta-analysis., Competing Interests: P.D.F.: Clinical Orthopaedics and Related Research: Editorial or Governing board. Pediatric Orthopaedic Society of North America: Board or committee member. Osso VR: Stock or stock options. WishBone Orthopaedics: Paid consultant. Research in Osteochondritis of the Knee (ROCK): Board or committee member. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)