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Background Estimation of skeletal maturity, classically performed using Risser sign, plays a crucial role in the treatment of AIS. Recent data, however, has shown the simplified Tanner-Whitehouse (Sanders) classification, based on an anteriorposterior (AP) hand radiographs, to correlate more closely to the rapid growth phase and thus curve progression. This study evaluated the interobserver and intraobserver reliability of the Sanders and Risser classifications among clinicians at different levels of training. Methods Twenty AP scoliosis radiographs and 20 AP hand radiographs were randomized and distributed to 11 graders. The graders consisted of 3 orthopaedic residents, 3 spine fellows, 3 spine surgeons, and 1 radiologist. The graders were then asked to classify the radiographs according to the Sanders and Risser classifications. There were 3 rounds of grading, each done 3 weeks apart. The overall κ coefficient was then calculated for each system to evaluate the interobserver and intraobserver reliability. Results For all graders the average κ coefficient for the interobserver and intraobserver reliability of the Sanders classification was 0.54 and 0.62, respectively, and 0.46 and 0.49 for the Risser classification. With respect to spine attendings alone, the average κ coefficient for the interobserver and intraobserver reliability of Sanders classification was 0.72 and 0.77, respectively, and 0.46 and 0.67 for the Risser classification. Conclusions Our study demonstrated that the Sanders classification had moderate reliability with respect to physicians at various levels of training and had good reliability with respect to attending spine surgeons. Interestingly, the Risser staging was found to have less interobserver and intraobserver reliability overall. The Sanders classification is a reliable and reproducible system and should be in the armamentarium of surgeons who treat adolescent idiopathic scoliosis. Level of evidence Level III.

Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (

Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.

Objectives: There has been a renewed interest in UCL repair in overhead athletes. This is largely due to greater understanding of UCL pathology, improvement in fixation technology and the extensive rehab required to return from UCL reconstruction. Initial data regarding UCL repair in overhead athletes was poor and therefore UCL repair was largely abandoned in favor of reconstruction. However, recent literature examining UCL repair with anchor only fixation demonstrated an excellent rate of return to play, reduced time to return to play and a low complication rate. Based on this promising data, we have developed a novel technique of UCL repair with internal brace augmentation that we have used in overhead throwing athletes. We performed a prospective study evaluating the outcomes of this procedure with respect to return to play, time to return to play, functional outcome score and complications. Methods: Overhead athletes undergoing UCL repair with internal brace augmentation were prospectively followed for a minimum of one year. Patients were carefully selected from those who would traditionally be considered for UCL reconstruction. Initially, patients were considered if they had an avulsion of the UCL with otherwise healthy UCL tissue and had a vested interest in shortened rehab. As the study progressed, interest in shortened rehab became a less stringent criteria. Demographic and operative data were collected at the time surgery. This data was compiled for both desciption and comparison between subgroups. Patients were then contacted 1 year postoperatively and assessed for return to play, time to return to play and KJOC scores. Complications were documented and patients having complications were detailed. Results: 66 overhead athletes underwent UCL repair with internal brace augmentation during the study period. 8 were lost to follow up, leaving 58 athletes included in the study. Average age at the time of surgery was 17.9 years old. There were 43 baseball pitchers, 8 baseball position players, 4 softball players, 2 football quaterbacks, and 1 javelin thrower. 96% (54/56) of those who desired to return to the same or higher level of competition were able to do so at an average time of 6.1 months (range 3.2-12 months). 65% of these were able to return in less than 6 months. Many of those who took longer than 6 months did so due to timing within the season. Average KJOC score was 90.2 at 1-year follow-up. 3 patients required return to the operating room, 2 of which were eventually able to return to their previous level of play. There was 1 late failure over 3 years from the index procedure. Comparative subgroup data is presented in table 1. Conclusion: UCL repair with internal brace augmentation is a viable option for overhead throwers with selected UCL pathology who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction. Comparative Analysis of Subgroups. Time to return to N KJOC P-value play (Months) P-value Location of tear Distal 34 89.6 6.00 Proximal 24 90.6 P=0.71 6.19 P=0.74 Severity of tear Partial 35 89.5 6.14 Complete 23 91.4 P=0.51 6.08 P=0.86 Ulnar Nerve Transposition UNT performed 32 90.9 6.40 UNT not performed 26 89.4 P=0.17 5.75 P=0.16 Overall 58 90.2 6.13