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Article ; Online: Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures.

Gamble, James G / Vorhies, John S

2021 Volume 41, Issue 8, Page(s) e700–e701

MeSH term(s)	Child ; Fractures, Malunited/diagnostic imaging ; Humans ; Humeral Fractures/diagnostic imaging ; Humeral Fractures/surgery ; Humerus ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000001912
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Article ; Online: Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures.

Gamble, James G / Vorhies, John S

Journal of pediatric orthopedics

2020 Volume 40, Issue 10, Page(s) e903–e909

Abstract: Background: Pediatric supracondylar humeral fractures (SCHFs) can heal in hyperextension malunion after casting or surgical treatment. Here the authors present quantitative evidence concerning the ability of children to remodel sagittal plane malunion. ... ...

Abstract	Background: Pediatric supracondylar humeral fractures (SCHFs) can heal in hyperextension malunion after casting or surgical treatment. Here the authors present quantitative evidence concerning the ability of children to remodel sagittal plane malunion. Their null hypothesis was that like varus and valgus malunion, children have little capacity to remodel sagittal plane malunion after SCHFs. Methods: The authors performed a prospective longitudinal radiographic study of 41 children, aged 22 to 126 months, who were registered during the study interval. They calculated the percent displacement of the center of the capitellum behind the anterior humeral line (AHL) as the distance of the midpoint of the capitellum from the AHL, divided by the diameter of the capitellum, multiplied by 100. Longitudinal measurements were made using the embedded software on our institution's digital radiographic system. The primary outcome focus was the percent displacement of the center of the capitellum relative to AHL on the initial and on the latest radiograph. Results: The average initial displacement (hyperextension) of the capitellum behind the AHL for all patients was 61% (range, 23% to 134%). At an average follow-up of 21 months, 24 children (60%) had remodeled 100% the sagittal plane malunion, 12 children (30%) had remodeled such that the AHL passed through the central third of the capitellum, and 5 children (10%) had minimal or no remodeling. Conclusions: The authors rejected their null hypothesis. Children do have the capacity to remodel radiographically measurable sagittal plane malunion of SCHFs. Children younger than 5 years of age can remodel 100% displacement of the center of the capitellum, whereas those over 8 years of age have minimal remodeling capacity.
MeSH term(s)	Bone Remodeling ; Child ; Child, Preschool ; Female ; Fractures, Malunited ; Humans ; Humeral Fractures ; Humerus/diagnostic imaging ; Humerus/physiology ; Infant ; Male ; Prospective Studies ; Radiography
Language	English
Publishing date	2020-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000001623
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Article ; Online: Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery.

Pan, Stephanie / Lee, Charles K / Caruso, Thomas J / Vorhies, John S / Tsui, Ban C H

Regional anesthesia and pain medicine

2022 Volume 47, Issue 4, Page(s) 251–252

MeSH term(s)	Catheters ; Child ; Humans ; Lidocaine ; Nerve Block ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Paraspinal Muscles/diagnostic imaging
Chemical Substances	Lidocaine (98PI200987)
Language	English
Publishing date	2022-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1136/rapm-2021-103234
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Zs.B 2399: Show issues

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Article ; Online: Does spinal deformity affect adolescents' quality of life before we tell them it should?

Langner, Joanna L / Kaur, Japsimran / Pham, Nicole S / Richey, Ann / Hastings, Katherine / Mehta, Shayna / Bryson, Xochitl / Vorhies, John S

Spine deformity

2023 Volume 11, Issue 5, Page(s) 1057–1063

Abstract: Purpose: The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are ...

Abstract	Purpose: The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are influenced by knowledge of scoliosis and counseling by an orthopedic surgeon. Methods: Patients ages 10-18 years referred for their first visit with an orthopaedic surgeon for scoliosis were enrolled from 9/30/19 to 10/22/20. Patients completed the SRS-22r pre- and post-visit. A Wilcoxon signed-rank test was used to analyze the SRS-22r scores. Results: 52 patients participated in the study at a mean age of 14.3 years (95% CI 13.8-14.8 years) with an average major curve magnitude of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS-22r scores were not correlated to curve magnitude pre- or post-visit. The SRS-22r Satisfaction with care domain exhibited a small increase from pre- to post-visit (pre: 3.3, post: 3.6). All other SRS-22r domains and total scores did not exhibit clinically significant differences. Conclusion: Among new adolescent referrals for scoliosis, it is unlikely that counseling by a surgeon influences perceptions of HRQoL as measured by the SRS-22r. Level of evidence: III.
MeSH term(s)	Humans ; Adolescent ; Quality of Life ; Scoliosis/surgery ; Kyphosis ; Orthopedic Surgeons ; Referral and Consultation
Language	English
Publishing date	2023-05-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2717704-X
ISSN	2212-1358 ; 2212-134X ; 2212-1358
ISSN (online)	2212-1358 ; 2212-134X
ISSN	2212-1358
DOI	10.1007/s43390-023-00691-0
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Article: Spinal fusion is an aerosol generating procedure.

Langner, Joanna Lind / Pham, Nicole Segovia / Richey, Ann / Oquendo, Yousi / Mehta, Shayna / Vorhies, John Schoeneman

World journal of orthopedics

2023 Volume 14, Issue 5, Page(s) 340–347

Abstract: Background: Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. ... ...

Abstract	Background: Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. Aerosolized particles containing infectious coronavirus are typically 0.5-8.0 μm. Aim: To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer (OPS). Methods: We quantified airborne particle counts during five posterior spinal instrumentation and fusions (9/22/2020-10/15/2020) using an OPS near the surgical field. Data were analyzed by 3 particle size groups: 0.3-0.5 μm/m Results: Upon univariate analysis, bovie ( Conclusion: Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range. Further research is warranted to determine if such particles have the potential to contain infectious viruses. Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.
Language	English
Publishing date	2023-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v14.i5.340
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Article ; Online: The effect of intraoperative lidocaine administration in a disrupted erector spinae fascial plane on intercostal transcranial motor evoked potentials.

Pan, Stephanie J / Vorhies, John S / Lee, Leslie H / López, Jaime R / Tsui, Ban C H

Journal of clinical anesthesia

2022 Volume 82, Page(s) 110956

Abstract: Study objective: Erector spinae plane (ESP) blocks have been recently described for postoperative pain management following spine surgery but their effects on intraoperative neuromonitoring are unknown.: Design: Retrospective cohort study.: Setting! ...

Abstract	Study objective: Erector spinae plane (ESP) blocks have been recently described for postoperative pain management following spine surgery but their effects on intraoperative neuromonitoring are unknown. Design: Retrospective cohort study. Setting: Pediatric patients at a tertiary care center. Patients: 26 pediatric patients who received bilateral surgically-placed ESP catheters for single-stage posterior spine fusion (PSF) from August 2020 to June 2021. Interventions: Patients in this study did not receive any special interventions as part of this observational retrospective study. Measurements: This retrospective study investigated the effects of local anesthesia administration through bilateral surgically-placed ESP catheters on intraoperative intercostal transcranial motor evoked potentials (tcMEPs) in the setting of a disrupted erector spinae fascial plane in pediatric patients undergoing single-stage posterior spine fusion. Main results: Of the 26 patients that received bilateral surgically-placed ESP catheters for pediatric posterior spine fusion surgery, none exhibited any changes in intercostal tcMEPs attributable to intraoperative lidocaine administration through the ESP catheters. Conclusions: The administration of a local anesthetic into a disrupted erector spinae fascial plane does not appear to interfere with intraoperative neuromonitoring of posterior spine fusion surgeries.
MeSH term(s)	Child ; Evoked Potentials, Motor ; Humans ; Lidocaine ; Nerve Block ; Pain, Postoperative ; Retrospective Studies
Chemical Substances	Lidocaine (98PI200987)
Language	English
Publishing date	2022-08-25
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2022.110956
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Zs.A 2622: Show issues

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Article ; Online: Opioid Represcriptions After ACL Reconstruction in Adolescents Are Associated With Subsequent Opioid Use Disorder.

Cahan, Eli M / Halvorsen, Kristin C / Pham, Nicole S / Kaur, Japsimran / Bryson, Xochitl M / Chan, Charles M / Vorhies, John S

Journal of pediatric orthopedics

2023 Volume 43, Issue 4, Page(s) e273–e277

Abstract: Introduction: Postoperative opioid prescriptions may confer a risk for subsequent opioid use disorders (OUDs). For many children, postoperative analgesia is often the first opioid exposure. The rates of anterior cruciate ligament (ACL) reconstruction in ...

Abstract	Introduction: Postoperative opioid prescriptions may confer a risk for subsequent opioid use disorders (OUDs). For many children, postoperative analgesia is often the first opioid exposure. The rates of anterior cruciate ligament (ACL) reconstruction in pediatric populations are rising. Here, we use an administrative claims database to describe opioid prescription patterns after ACL reconstruction and their effect on subsequent risk of OUD. Methods: Using International Classification of Diseases (ICD)-9, ICD-10, and CPT codes, we identified patients, with ages 10 to 18, undergoing primary ACL reconstruction between 2014 and 2016 with minimum 1 year follow-up in the Optum Clinformatics Data Mart, which is a nationally representative administrative claims database. Demographic variables and prescription patterns (in morphine milligram equivalents [MMEs]) were analyzed using univariate tests and multivariable logistic regression to determine any potential association with the appearance of anew an ICD-9 or ICD-10 code for OUD within 1 year of the initial procedure. Results: A total of 4459 cases were included and 29 (0.7%) of these patients were diagnosed with an OUD within 1 year of surgery. Upon univariate analysis, opioid represcriptions within 6 weeks were significantly more common among patients with OUD; 27.6% vs. 9.7% of patients that did not develop a new diagnosis of OUD ( P =0.005). Multivariable logistic regression indicated an independent significant relationship between total MMEs initially prescribed and the odds of a subsequent OUD diagnosis: for each additional 100 MMEs prescribed in total, the odds of OUD increased by 13% ( P =0.002). Patients with a represcription within 6 weeks of surgery had an average increase in the odds of OUD by 161% ( P =0.027). Conclusions: In this cohort of patient ages 10 to 18 undergoing primary isolated ACL reconstruction, we found substantial variability in opiate prescribing patterns and higher initial opioid prescription volume, as well as opioid represcription within 6 weeks were predictive of the subsequent development of OUD. Level of evidence: Level III.
MeSH term(s)	Child ; Humans ; Adolescent ; Analgesics, Opioid/therapeutic use ; Opioid-Related Disorders ; Anterior Cruciate Ligament Reconstruction/adverse effects ; Logistic Models ; Prescriptions
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000002340
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Article ; Online: The Influence of Race, Income, and Sex on Treatment and Complications of Common Pediatric Orthopedic Fractures.

Montgomery, Blake K / Joseph, Gaby / Segovia, Nicole / Koltsov, Jayme / Thomas, Terence L / Vorhies, John S / Tileston, Kali R

Orthopedics

2023 Volume 46, Issue 3, Page(s) e156–e160

Abstract: Despite best intentions, health care disparities exist and can consequently impact patient care. Few studies have examined the impact of disparities in pediatric orthopedic populations. The current study aimed to determine if the treatment type or ... ...

Abstract	Despite best intentions, health care disparities exist and can consequently impact patient care. Few studies have examined the impact of disparities in pediatric orthopedic populations. The current study aimed to determine if the treatment type or complication rates of supracondylar, both-bone forearm, or femur fractures are associated with race, ethnicity, sex, or socioeconomic status. The New York Healthcare Cost and Utilization Project's database was used to identify all pediatric patients treated for supracondylar humerus fractures, both-bone forearm fractures, and femoral shaft fractures in 2016. Risk-adjusted relationships with race, ethnicity, sex, hospital location, and median income by zip code were assessed with multivariable logistic regression. Patients who were non-White, resided in the zip codes with the lowest median income (<$42,999 annually), and were treated in metropolitan areas were more likely to receive nonoperative treatments for supracondylar humerus fractures. Female patients with a femoral shaft fracture were less likely to be treated with open reduction and internal fixation vs intramedullary fixation. Finally, complications were not associated with patient race, sex, or socioeconomic statuses. These findings bring attention to health care disparities in the treatment of common pediatric orthopedic fractures. Further studies investigating the underlying etiology behind these disparities are warranted. [
MeSH term(s)	Child ; Humans ; Female ; Orthopedics ; Income ; Fracture Fixation, Internal ; Humeral Fractures/epidemiology ; Humeral Fractures/surgery ; Ethnicity ; Femoral Fractures/therapy ; Retrospective Studies
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20230104-06
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Zs.A 1487: Show issues

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Article ; Online: Temporary Flexible Rods for Correction of Severe Pediatric Spinal Deformity.

Kwong, Jeffrey W / Tileston, Kali R / Kaur, Japsimran / Segovia, Nicole A / Imrie, Meghan N / Rinsky, Lawrence A / Vorhies, John S

Orthopedics

2023 Volume 46, Issue 4, Page(s) 234–241

Abstract: Surgical correction of large, rigid scoliotic and kyphotic curves carries an increased risk of perioperative complications, such as neurological injury and excessive blood loss, compared with correction of less severe curves. Titanium temporary flexible ... ...

Abstract	Surgical correction of large, rigid scoliotic and kyphotic curves carries an increased risk of perioperative complications, such as neurological injury and excessive blood loss, compared with correction of less severe curves. Titanium temporary flexible rods (TFRs), designed for pediatric long bone fracture fixation, may be helpful as adjuncts to achieve gradual, stepwise intraoperative correction of severe pediatric spinal deformities. A retrospective review was conducted of spinal fusion cases for pediatric scoliosis or kyphosis at our institution that used TFRs as a correction technique from 2007 to 2019. Patients underwent posterior spinal fusion with predominantly pedicle screw instrumentation. Intraoperatively, a non-contoured titanium elastic nail was temporarily positioned in the screws unilaterally to achieve partial correction while the contralateral side was instrumented. Then, the TFR was removed and replaced with a permanent rod. Thirty-four patients with severe spinal deformities underwent posterior spinal fusion. Seventeen had scoliosis (mean major Cobb angle, 89.3°) and 17 had kyphosis (mean T5-T12 kyphosis, 73.8°). Idiopathic deformity was the most common etiology; neuromuscular, syndromic, and postsurgical causes contributed to the remainder of cases. All patients had Ponte osteotomies. Four patients (11.8%) had neuromonitoring alerts, 1 of which was related to insertion of the TFR; all were reversible. For patients with scoliosis, the mean postoperative Cobb angle measured 40.2° (53.6% correction). For patients with kyphosis, the mean postoperative T5-T12 angle measured 43.3° (30.4° of correction). TFRs appear to be helpful adjuncts for correction of severe pediatric spinal deformities, facilitating gradual intraoperative correction in a single-stage operation. Neuromonitoring alerts are common but reversible. [
MeSH term(s)	Humans ; Child ; Scoliosis/diagnostic imaging ; Scoliosis/surgery ; Titanium ; Treatment Outcome ; Kyphosis/surgery ; Retrospective Studies ; Spinal Fusion/methods ; Thoracic Vertebrae/surgery
Chemical Substances	Titanium (D1JT611TNE)
Language	English
Publishing date	2023-02-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20230207-03
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Article ; Online: A New Look at Vertebral Body Tethering (VBT): Through the Modified Clavien-Dindo-Sink (mCDS) Classification.

Vorhies, John S / Hauth, Lucas / Garcia, Samantha / Roye, Benjamin D / Poon, Selina / Sturm, Peter F / Glotzbecker, Michael / Fletcher, Nicholas D / Stone, Joseph D / Cahill, Patrick J / Anari, Jason B

Journal of pediatric orthopedics

2024 Volume 44, Issue 5, Page(s) e389–e393

Abstract: Introduction: Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the ... ...

Abstract	Introduction: Anterior vertebral body tethering (AVBT) is increasingly popular as an option for surgical treatment of idiopathic scoliosis (IS). While the technology remains new, it is important for families and patients to be able to compare it to the current standard of care, posterior spinal fusion (PSF). The purpose of this study is to describe the complication rate of AVBT in IS using the mCDS and to compare it to the recently reported complication rate of PSF in IS. Methods: A multicenter pediatric spine deformity database was queried for all idiopathic scoliosis patients who underwent vertebral body tethering. There were 171 patients with a minimum 9-month follow-up included in this study. Complications were retrospectively graded by 2 attending pediatric spine surgeons using the mCDS classification system. Results: Data from 171 patients with idiopathic scoliosis was available for analysis, with 156/171 (91%) of patients being female and an average age of 12.2 years old at surgery. There were 156 thoracic tethers (1 with an LIV below L2), 5 lumbar tethers, 9 staged double tethers, and only 1 patient with same-day double tether. Fifty-five (55) (32%) patients experienced a total of 69 complications. The most common complication type for VBT by mCDS was Grade IIIb, encompassing 29/69 (42%) of complications. The second most frequent complication grade was Grade I at 23/69 (33%). Thirty-four (34) out of 69 (49%) of the VBT complications reported required either procedural/surgical intervention or admission to the ICU. Conclusions: This is the first study to directly compare the complication profile of VBT to PSF using the mCDS. Forty-nine percent (49%) of the VBT complications reported were at least Grade III, while only 7% of complications in the control PSF cohort from the literature were Grade III or higher. The mCDS complication classification brings light to the early learning experience of a new technique compared to the widely accepted standard of PSF for IS. Level of evidence: III - Retrospective comparative study.
MeSH term(s)	Humans ; Female ; Child ; Male ; Scoliosis/surgery ; Retrospective Studies ; Vertebral Body ; Thoracic Vertebrae/surgery ; Lumbar Vertebrae/surgery ; Treatment Outcome ; Spinal Fusion/adverse effects ; Spinal Fusion/methods
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000002653
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