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Study Design: Retrospective multicenter cohort study., Objective: To investigate the impact of night-time bracing (NTB) and full-time bracing (FTB) on the sagittal profile in adolescent idiopathic scoliosis (AIS) patients., Summary of Background Data: Recent studies have shown that FTB in AIS patients may induce hypokyphosis. Whether this effect differs between NTB and FTB is unknown., Methods: We included skeletally immature AIS patients with main curves ranging from 20-45° treated with either NTB or FTB. The two cohorts were propensity-score matched on Risser stage, age, major curve size, and kyphosis at brace initiation. Coronal and sagittal radiographic parameters were gathered at the initiation and completion of brace treatment., Results: Two-hundred fifty-seven patients were eligible for inclusion. The matched cohorts included 62 patients in each group. During bracing, the thoracic kyphosis increased from 31±11° to 35±13° in the NTB group compared to a decrease from 30±12° to 28±13° in the FTB group (P=0.011). Eight percent were hypokyphotic (<20°) after bracing in the NTB group compared to 24% in the FTB group (P=0.015). Pelvic incidence, sacral slope, and pelvic tilt were not significantly different between the groups. In the coronal plane, curve progression >50° was seen in 50% in the NTB group and 31% in FTB (P=0.028)., Conclusion: We saw a small increase in thoracic kyphosis in the NTB group vs. a small decrease in the FTB group. Eight percent in the NTB group vs 24% in the FTB group showed substantial hypokyphosis after bracing. The impact of minor changes in thoracic kyphosis remains uncertain; however, a threefold difference in the occurrence of hypokyphosis is notable and merits further attention., Competing Interests: Conflict of interest: No conflict of interest directly related to the submitted manuscript. Conflict of interest outside of the submitted manuscript: MG: Institutional grants from Cerapedics, institutional grants from Globus Medical, Stryker (consultancy); BD: Stryker (consultancy), supported by The Alfred Benzon Foundation; DJS: Globus Medical (royalties); MEJ: Globus Medical (consultancy), Orthopediatrics (consultancy); ALM: Globus Medical (consultancy) ; the remaining authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this study is to describe the surgical treatment of osteoid osteomas in a pediatric cohort of patients who were found not to be candidates for percutaneous ablative therapies. Medical records for 29 pediatric patients who were treated surgically for osteoid osteomas were reviewed. Reasons for surgical management included diagnostic uncertainty or lesions that were in close proximity to an articular surface or neurovascular structure. Twenty-eight patients experienced complete symptom resolution. Surgical treatment may still be indicated in a select group of osteoid osteoma patients who are not candidates for percutaneous treatment. (Journal of Surgical Orthopaedic Advances 27(4):299-302, 2018).

Purpose: The purposes of this study were to determine the frequency of acute and subacute complications (within 6 months) of arthroscopic knee procedures in patients aged 17 years or younger and to determine associated risk factors., Methods: We identified all patients aged 17 years or younger who underwent arthroscopic knee procedures at our institution from 1997 to 2009. Patient demographic and surgical data were collected from the medical and surgical records, with specific focus on intraoperative and postoperative complications., Results: During the study period, 1,002 knee arthroscopies were reviewed. The overall complication rate was 14.7%. Major complications occurred in 21 surgeries (2.1%) and included the following: septic arthritis (n = 3, 0.3%), wound complication requiring operative revision (n = 9, 0.9%), arthrofibrosis requiring manipulation (n = 4, 0.4%), other unplanned subsequent surgery (n = 4, 0.4%), and death (n = 1, 0.1%). Surgeries with an anesthesia time of 265 minutes or greater (P = .026), operative time of 220 minutes or greater (P = .013), or tourniquet time of 114 minutes or greater (P < .001) and surgeries with 3 or more Current Procedural Terminology codes (P = .003) had a statistically significant increase in risk of major complications. The incidence of minor complications was 12.6%, which included persistent effusion/hemarthrosis requiring arthrocentesis (n = 59, 5.9%) and superficial wound infection (n = 18, 1.8%)., Conclusions: Major complications after knee arthroscopy in children and adolescents are rare, but minor complications are more common. If possible, surgeons should avoid prolonged anesthesia, surgery, and tourniquet times. The pediatric patient's medical and family history should be reviewed to identify important risk factors., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Off-road motorsports are popular in rural and suburban areas, and allow for racing, recreation, and easy access to backcountry destinations. This chapter will review the incidence and types of injuries sustained in off-road motorsports. We completed a structured review of motocross and all-terrain vehicle (ATV) injuries, assessing for injury rates, risk factors, and mortality figures. Information for this study was obtained from a PubMed search under the terms 'motocross', 'motorcross', 'all-terrain vehicles', 'injury', 'motorcycle', 'ATV'. Abstracts and articles in the English language from 1980 onward were reviewed. Further statistics were obtained from the US Consumer Product Safety Commission publications. Operating vehicles off-road requires coordination, experience, and training. Motocross is an organized sport with national associations governing the competition of highly trained athletes. ATVs are used both recreationally and commercially, typically for farming and ranching. ATV use appears more dangerous that motocross, with a higher mortality rate, disproportionately for children. Both sports continue to have high rates of head, spinal cord, and extremity injury. Future prospective studies in off-road motorsports should evaluate the risk factors for injury and target specific areas for injury prevention. Improved training programs, use and improvement of safety helmets, and for ATV use, limiting access to minors, may improve the overall safety of off-road motorsports., (Copyright © 2012 S. Karger AG, Basel.)

Osteochondritis dissecans (OCD) of the humeral capitellum most commonly affects young athletes engaged in sports that repetitively stress the elbow. It is characterized by localized injury of subchondral bone of the humeral capitellum. To determine the best treatment option for OCD in young athletes, it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be treated with rest, whereas unstable lesions, as well stable lesions that do not respond to conservative therapy, may require a surgical approach. Magnetic resonance imaging is the diagnostic study of choice to evaluate capitellar OCD lesions and loose bodies and to accurately determine the stability and viability of the OCD fragment. A variety of surgical approaches have been reported, from internal fixation of large fragments to autologous chondrocyte grafts. Arthroscopic surgery is becoming the standard treatment of capitellar OCD. This minimally invasive approach shows good results, a low risk of operative morbidity, and early recuperation postoperatively. The distal ulnar portal we describe here allows for ergonomic exposure to the posterolateral capitellum, providing easier access for drilling, burring, and local debridement of lesions amenable to arthroscopy., (Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)