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BACKGROUND Congenital scoliosis (CS) is associated with more rigid, complex deformities relative to adolescent idiopathic scoliosis (AIS) which theoretically increases surgical complications. Despite extensive literature studying AIS patients, few studies have been performed on CS patients. The purpose of this study was to evaluate complications associated with spinal fusions for CS and AIS. METHODS A retrospective review of the Kid's Inpatient Database (KID) years 2000 to 2009 was performed. Inclusion: patients under 20 years with ICD-9 diagnosis codes for idiopathic scoliosis (IS-without concomitant congenital anomalies) and CS, undergoing spinal fusion from the KID years 2000 to 2009. Two analyses were performed according to age below 10 years and 10 years and above. Univariate analysis described differences in demographics, comorbidities, intraoperative complications, and clinical values between groups. Binary logistic regression controlling for age, sex, race, and invasiveness predicted complications risk in CS (odds ratios; 95% confidence interval). RESULTS In total, 25,131 patients included (IS, n=22443; CS, n=2688). For patients under age 10, CS patients underwent 1 level shorter fusions (P

Study Design:Retrospective review of prospective database.Objective:Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes.Methods:Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores.Results:Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05).Conclusion:The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

Congenital talipes equinovarus (CTEV), more commonly known as clubfoot, is a deformity of the foot that is not well understood. The tarsal navicular is at the center of the disease process and exhibits abnormal development and delayed ossification. However, its role in the pathologic process is not clear. The aim of the present study was to better understand the role of the tarsal navicular in CTEV by correlating the presence of the navicular ossification center and relapse of clubfoot deformity after surgical treatment. The medical records and radiographs of 34 patients (41 feet) with surgically treated CTEV were reviewed for the presence of the navicular ossification center and the lateral talocalcaneal angles. Of the 41 feet, 17 (41.46%) did not have the tarsal navicular ossification center present before surgery, and 24 (58.54%) did have the ossification center present. The talocalcaneal angles were similar between those with and without the navicular ossification center present. No significant difference was found in the incidence of relapse between the nonossified navicular group (17.6%) and the ossified navicular group (16.7%; p = .63). The presence of the navicular ossification center before surgery does not appear to have prognostic value for the relapse of CTEV after surgical intervention.

The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator.This is a prospective trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant (driving) extremity. Multiple variables, including number of collisions, off-road excursions, and centerline crossings, were measured with a validated driving simulator. Trials were separated by 2 weeks to control for "adaptations" to the simulator. Statistical significance was found in collisions between sling and no-sling tests.The total number of collisions for trial 1 (no sling) was 36 (mean, 1.7 ± 1.2) compared with 73 (3.7 ± 1.6) (P .01) for trial 2 (sling immobilization). Approximately 70% of participants with upper extremity immobilization were involved in ≥3 collisions; approximately 70% of no-sling participants were involved in ≤2 collisions. There was no statistically significant difference between groups with respect to overall vehicle road position and control.Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit (P .01). There were no significant differences in driving parameters that are indicative of overall vehicle position and control. The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions.

The incidence of ankle fractures is rapidly increasing in geriatric populations. Of the 4 fracture patterns described by the Lauge-Hansen classification system, supination-external rotation (SER) accounts for most ankle fractures. This video demonstrates surgical repair of a SER type 4 ankle fracture in a geriatric patient.SER type 4 ankle fractures are considered unstable and are generally treated with surgical fixation. After placement of plate and screws, intraoperative stress tests can be used to assess for syndesmotic widening. If necessary, the syndesmosis can be reduced open, with screw fixation placed parallel to the joint. Patients are kept non-weight-bearing for 6 weeks after surgery.This video, shot on an iPhone 6S, shows the case of a 66-year-old female status after a fall with twisting mechanism resulting in an unstable SER type 4 fracture requiring operative repair. Intraoperative stress test revealed medial clear space widening requiring syndesmotic reduction.SER type 4 ankle fractures are a common injury that must be properly managed to return patients to baseline functional status. The surgical technique described in this video provides for good stabilization and allows for early range of motion with advancement to weight-bearing as tolerated at 6 weeks postoperatively.

This study aims to study femoral tunnel lengths drilled with a flexible reamer and the distance to important lateral structures obtained by flexing the knee at various angles and by drilling the guide pins arthroscopically to resemble clinical practice. The purpose of this cadaveric study was twofold: 1. to determine whether femoral tunnel lengths of greater than 20 mm can be created with a flexible reamer system at 90 ° of knee flexion and 2. to determine whether the lateral structures of the knee are safe with this technique.Ten fresh cadaveric knees were utilized. The intra-osseous length can be measured with a specially de - signed flexible guide pin. Flexible pins were inserted with the knee at 70°, 90°, and 120° of flexion. The intra-osseous length was measured with the measuring device. Each speci - men was dissected around the lateral aspect of the knee to identify the critical structures, the common peroneal nerve, and the LCL. The distance from the guide pins to the com - mon peroneal nerve and femoral attachment of the LCL were measured with a standard flexible paper ruler to the nearest millimeter.There is a trend for progressively increasing mean intra-osseous length associated with increased flexion of the knee. The mean intra-osseous length for 70° flexion was 25.2 mm (20 mm to 32 mm), which was statistically significant when compared to mean intra-osseous lengths of 32.1 mm (22 mm to 45 mm) and 38.0 mm (34 mm to 45 mm) in the 90° and 120° flexion groups, respectively (p0.05). There were no significant differences among the groups with respect to distance to the LCL. There is a trend toward longer distances to the common peroneal nerve with increased flexion. There was a statistically significant dif - ference when comparing 120° versus 70° (p0.05).This study that shows that adequate femoral tunnel lengths can be safely created without knee hyperflex - ion using flexible instruments via an anteromedial portal.

Purpose Operative fixation of displaced patella fractures is considered to be standard of care. However, patients with inferior pole patella fractures have limited options in terms of fixation. This video demonstrates the repair of an inferior pole patella fracture using nonabsorbable suture fixation. Methods Suture repair of patella fractures is a clinically acceptable technique, yielding similar functional results to patella fractures treated with K-wires or cannulated screws while reducing the rates of removal of hardware after fixation. Results This video features the repair of a displaced, comminuted inferior pole patella fracture using 5 Ethibond and Fiberwire. Postoperative radiographs confirm bony union. Conclusions Suture fixation for pole patella fractures provides reliable fixation and reduces the risk of postoperative complications secondary to hardware irritation. This case highlights the success of this technique.

Situs Inversus is a rare condition with unique clinical and radiographic characteristics. We present a case highlighting important clinical factors associated with Situs Inversus.

mm (range 26-45) with all but one tunnel greater than 30 mm. The average knee flexion angle was 134.3 / 5.0 degrees (range 122-147). The average BMI was 27.7 / 7.9 kg/m2 (range 17.7-63.3), calculated from average height 173.3 / 9.1 cm (range 150-195.6) and weight 83.3 / 24.8 kg (range 49.7-172.2). Average LFC width was 32.6 / 4.8 cm (range 26.1-60.3), and depth was 60.6 / 5.0 cm (range 48.1-73.3). Height (r 0.52, P 0.001) and weight (r 0.34, P 0.002), but not BMI, correlated positively with tunnel length. Width (r 0.33, P 0.006) and depth (r 0.34, P 0.005) of the LFC also correlated positively with tunnel length. Knee flexion angle was not correlated with tunnel length (r 0.08, P 0.45), or width (r 0.06, P 0.62) and depth (r 0.14, P 0.28) of the LFC. Knee flexion angle was negatively correlated with weight (r 0.55, P 0.001) and BMI (r 0.55, P 0.001). Conclusion: Using an accessory medial portal for independent femoral tunnel drilling with maximal knee hyperflexion in ACL reconstruction produced only one tunnel less than 30mm. This technique, therefore, consistently produces tunnels of adequate length. Tunnel lengths tend to be longer with increasing patient height, mass, and larger LFC dimensions. Maximum knee flexion angle achieved intraoperatively tends to be less for patients with increasing weight and BMI.

Background: Approximately 192,370 women were diagnosed with breast cancer in the United States in 2009. This represents approximately 1 in 8 American women facing the challenge of Breast Cancer therapy in their lifetime. Further, more than 40,000 women will die of breast cancer annually. These statistics represent a significant improvement in the U.S. mortality rate for breast cancer. There continues to be a disparity in outcome from breast cancer with a significantly lower survival in African American women and the uninsured. Our multidisciplinary treatment team includes physicians, nurse navigator and clinical trials specialist are all focused on optimizing multimodal treatment, clinical trial participation, improved quality of life and survival. Methods: All patients with invasive breast cancer diagnosed between 2004 and 2008 at our inner city, public safety-net hospital were included in this evaluation. Each patient had a confirmed histological diagnosis of breast adenocarcinoma. Patient demographic data, tumor staging, treatment and outcomes/survival were evaluated. Tumor Registry Data from our institution was compared to data from the National Cancer Database for the above mentioned time period. All patients at our hospital were treated by the same clinicians and staff utilizing a multidisciplinary team approach. Results: There were 120 patients included in this study during the 5 year period. Of these, 4 patients were men. The majority of patients were between age 40 and 60. Our patients were significantly younger at initial diagnosis compared to the national findings. The ethnic distribution of our patient population: 54% African American, 41 % Caucasian, 3% Asian, 1 % American Indian, and 2% other. Evaluation of our payer status demonstrated that approximately 30% of our patients were self-pay and 32% indigent. Only 5% of our patients were insured with managed care organizations and less than 1% had private insurance. Conclusion: Carefully coordinated multidisciplinary team management of patients with breast cancer resulted in improved clinical outcomes regardless of the patient's ethnicity or insurance status. Implementation of best practice protocols (coordinate multidisciplinary team management; nurse navigator and a vibrant clinical trials program) should become standard at all Community hospitals and academic medical centers, particularly medical facilities serving minority and uninsured patients. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A94.