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Book ; Online ; E-Book: Pediatric femur fractures

Hedequist, Daniel J. / Heyworth, Benton E.

a practical guide to evaluation and management

2016

Author's details	Daniel J. Hedequist, Benton E. Heyworth editors
Keywords	Femoral Fractures / therapy ; Femoral Fractures / diagnostic imaging ; Orthopedic Procedures / methods ; Child
Language	English
Size	1 Online-Ressource (xiii, 234 Seiten), Illustrationen
Publisher	Springer
Publishing place	New York
Publishing country	United States
Document type	Book ; Online ; E-Book
Remark	Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
HBZ-ID	HT019484129
ISBN	978-1-4899-7986-5 ; 9781489979841 ; 1-4899-7986-7 ; 1489979840
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article: Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients.

Bixby, Elise C / Heyworth, Benton E

Current reviews in musculoskeletal medicine

2024

Abstract: Purpose of review: Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries ... ...

Abstract	Purpose of review: Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered. Recent findings: Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.
Language	English
Publishing date	2024-04-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2407827-X
ISSN	1935-9748 ; 1935-973X
ISSN (online)	1935-9748
ISSN	1935-973X
DOI	10.1007/s12178-024-09897-9
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Article: Assessment of Return to Sport After ACL Reconstruction With Soft Tissue Autograft in Adolescent Athletes: Quadriceps Versus Hamstring Tendon.

Kay, Jeffrey / Liotta, Elizabeth S / Sugimoto, Dai / Heyworth, Benton E

Orthopaedic journal of sports medicine

2023 Volume 11, Issue 11, Page(s) 23259671231207113

Abstract: Background: Quadriceps tendon soft tissue autograft represents an increasingly popular graft option for anterior cruciate ligament reconstruction (ACLR), particularly for adolescents, some of whom have an open physis, precluding use of graft options ... ...

Abstract	Background: Quadriceps tendon soft tissue autograft represents an increasingly popular graft option for anterior cruciate ligament reconstruction (ACLR), particularly for adolescents, some of whom have an open physis, precluding use of graft options with bone plugs. Purpose/hypothesis: The purpose of this study was to quantify return-to-sport performance assessments in adolescents at 6 months after ACLR with all-soft tissue quadriceps tendon autograft (ACLR-Q) versus hamstring tendon autograft (ACLR-HS). It was hypothesized that ACLR-Q would be associated with improved hamstring strength and hamstring-to-quadriceps (HS:Q) ratios compared with ACLR-HS, albeit with decreased quadriceps strength. Study design: Cross-sectional study; Level of evidence, 3. Methods: Included were patients aged 12 to 19 years who underwent primary ACLR by a single surgeon and who completed a return-to-sport performance assessment between 5 and 9 months postoperatively. The performance assessment included manual muscle strength tests (hamstring, quadriceps, hip abductor and adductor), dynamic balance test (Y-balance), and functional hop tests (single hop, triple hop, crossover hop, 6-m timed hop). Data were converted to limb symmetry indices, and limb symmetry index deficits were compared between the ACLR-Q and ACLR-HS cohorts using the Student Results: An initial cohort of 90 ACLR-Q patients was compared with 54 ACLR-HS patients, with no significant differences in patient characteristics. Differences in meniscal repair rates, however, prompted use of propensity score matching on age, sex, body mass index, meniscectomy, and meniscal repair to produce comparable subcohorts. The matching resulted in 67 ACLR-Q and 52 ACLR-HS patients. Hamstring strength deficits were significantly greater in ACLR-HS versus ACLR-Q patients (-40.5% vs -5.7%; Conclusion: Adolescent athletes who underwent ACLR-Q showed significantly greater quadriceps strength deficits but significantly smaller hamstring strength deficits than those who underwent ACLR-HS, leading to more favorable HS:Q ratios in ACLR-Q patients at 6 months postoperatively.
Language	English
Publishing date	2023-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671231207113
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Article: Pediatric and Adolescent Shoulder Instability.

Kay, Jeffrey / Heyworth, Benton E / Milewski, Matthew D / Kramer, Dennis E

Current reviews in musculoskeletal medicine

2023 Volume 16, Issue 7, Page(s) 263–273

Abstract: Purpose of review: Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review ... ...

Abstract	Purpose of review: Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations. Recent findings: Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.
Language	English
Publishing date	2023-04-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2407827-X
ISSN	1935-9748 ; 1935-973X
ISSN (online)	1935-9748
ISSN	1935-973X
DOI	10.1007/s12178-023-09837-z
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Article ; Online: Anterior Cruciate Ligament Reconstruction Procedures Using the Iliotibial Band Autograft.

Baxter, Tara / Majumdar, Aditi / Heyworth, Benton E

Clinics in sports medicine

2022 Volume 41, Issue 4, Page(s) 549–567

Abstract: The Micheli anterior cruciate ligament (ACL) procedure is a combined intra-articular and extra-articular knee stabilization technique that combines lateral augmentation with ACL reconstruction using the iliotibial band as an autograft for both aspects of ...

Abstract	The Micheli anterior cruciate ligament (ACL) procedure is a combined intra-articular and extra-articular knee stabilization technique that combines lateral augmentation with ACL reconstruction using the iliotibial band as an autograft for both aspects of the technique. Its primary indication is for ACL reconstruction in skeletally immature patients with more than 2 years of growth remaining. Studies have shown it to be effective at restoring knee biomechanics to have minimal risk of complications, including those associated with growth disturbances and a relatively low ACL graft rupture rate. Additional studies are needed to better understand the potential utilization of this technique and related modifications in the marginally skeletally immature patient, skeletally mature adolescent, adult, and revision ACL reconstruction settings.
MeSH term(s)	Adolescent ; Adult ; Anterior Cruciate Ligament/surgery ; Anterior Cruciate Ligament Injuries/surgery ; Anterior Cruciate Ligament Reconstruction/methods ; Autografts/surgery ; Humans ; Knee Joint/surgery
Language	English
Publishing date	2022-10-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	779944-5
ISSN	1556-228X ; 0278-5919
ISSN (online)	1556-228X
ISSN	0278-5919
DOI	10.1016/j.csm.2022.05.001
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Article: Evaluation and Surgical Management of Knee Osteochondritis Dissecans and Adolescent Cartilage Injuries.

Zheng, Evan T / Heyworth, Benton E

Instructional course lectures

2020 Volume 70, Page(s) 415–432

Abstract: Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall ... ...

Abstract	Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall physical health, the knee also happens to be the most injured or adversely affected joint in preadolescent and adolescent athletes. However, cartilage injuries are unique among other musculoskeletal pathologies in children, in that the healing potential of articular cartilage tissue is limited, and minor injuries or small focal defects can have devastating implications on the lifelong health of the joint. Although the most common form of degenerative joint disease affecting the general population is, of course, osteoarthritis, other conditions such as osteochondritis dissecans or acute, traumatic osteochondral shear injuries can activate their own arthritic pathway, whereby focal injuries precipitate an eventual cascade of diffuse degeneration. Thus, it is important for sports medicine and pediatric orthopaedic specialists alike to understand, diagnose, and initiate early, evidence-based management for cartilage conditions of the knee in pediatric patients. This chapter reviews principles of diagnosis and management of both knee osteochondritis dissecans (a chronic condition of subchondral bone that often secondarily affects the articular cartilage) and acute traumatic cartilage shear injuries. Although the two entities are quite different from an etiologic standpoint, there is significant overlap in technical considerations and treatment principles between these two conditions.
MeSH term(s)	Adolescent ; Bone and Bones ; Cartilage Diseases ; Cartilage, Articular/surgery ; Child ; Humans ; Knee Joint/diagnostic imaging ; Knee Joint/surgery ; Osteochondritis Dissecans/diagnostic imaging ; Osteochondritis Dissecans/etiology
Language	English
Publishing date	2020-11-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	802490-x
ISSN	0065-6895
ISSN	0065-6895
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Article ; Online: Clavicular Fractures in the Adolescent.

Patel, Midhat / Heyworth, Benton E / Dehghan, Niloofar / Mehlman, Charles T / McKee, Michael D

The Journal of bone and joint surgery. American volume

2023 Volume 105, Issue 9, Page(s) 713–723

Abstract: Current evidence suggests that the majority of clavicular fractures in adolescents can and should be treated nonoperatively.: ➤: Although rare, in certain patients or fracture patterns, nonoperative management may be associated with delayed ... ...

Abstract	➤: Current evidence suggests that the majority of clavicular fractures in adolescents can and should be treated nonoperatively. ➤: Although rare, in certain patients or fracture patterns, nonoperative management may be associated with delayed healing, prolonged disability, and/or poor functional outcome requiring secondary reconstruction. ➤: When warranted, primary open reduction and internal fixation with plate and screw application has consistently good outcomes with a low complication rate, with the most common complication being implant-related symptoms requiring a secondary surgical procedure for implant removal. ➤: Prospective, comparative studies examining operative and nonoperative treatment, including measures of early return to function, injury burden, return to athletic activity, complication and reoperation rates, and shoulder-girdle-specific, long-term outcome measures are warranted to further elucidate which fractures may benefit from primary fixation.
MeSH term(s)	Humans ; Adolescent ; Prospective Studies ; Fracture Healing ; Treatment Outcome ; Fractures, Bone/surgery ; Fracture Fixation, Internal/methods ; Bone Plates ; Clavicle/surgery ; Clavicle/injuries ; Retrospective Studies
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.22.01036
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Article ; Online: Discoid Meniscus.

Niu, Emily L / Lee, Rushyuan Jay / Joughin, Elaine / Finlayson, Craig J / Heyworth, Benton E

Clinics in sports medicine

2022 Volume 41, Issue 4, Page(s) 729–747

Abstract: Discoid meniscus is the most common congenital variant of the meniscus. Its variability in pathology leads to a spectrum of clinical presentations in patients. Treatment must be tailored to the specific pathology of the discoid meniscus. Imaging studies ... ...

Abstract	Discoid meniscus is the most common congenital variant of the meniscus. Its variability in pathology leads to a spectrum of clinical presentations in patients. Treatment must be tailored to the specific pathology of the discoid meniscus. Imaging studies such as radiographs and magnetic resonance imaging can be useful in confirming the diagnosis, but may be the most accurate in determining specific pathology. Thorough intraoperative evaluation of the discoid is critical to appropriate surgical management. Rim preservation and repair is preferred to prevent degenerative changes in the knee.
MeSH term(s)	Arthroscopy/methods ; Humans ; Joint Diseases/pathology ; Knee Joint/surgery ; Magnetic Resonance Imaging ; Menisci, Tibial/diagnostic imaging ; Menisci, Tibial/surgery ; Meniscus ; Tibial Meniscus Injuries/diagnostic imaging ; Tibial Meniscus Injuries/surgery
Language	English
Publishing date	2022-07-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	779944-5
ISSN	1556-228X ; 0278-5919
ISSN (online)	1556-228X
ISSN	0278-5919
DOI	10.1016/j.csm.2022.05.009
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Article: Bilateral osteochondritis dissecans of the knee in pediatric and adolescent patients presenting with unilateral symptoms: An epidemiological and radiographic analysis.

Yellin, Joseph L / Tysklind, Robert G / Hussain, Zaamin B / Zheng, Evan T / Heyworth, Benton E / Kocher, Mininder S

Journal of children's orthopaedics

2023 Volume 17, Issue 5, Page(s) 481–488

Abstract: Purpose: This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease.: Methods: Records ...

Abstract	Purpose: This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease. Methods: Records of patients ≤18 years old from 2003 to 2016 with a diagnosis of osteochondritis dissecans of the knee and strictly unilateral knee pain were identified. Contralateral (asymptomatic) knee imaging within 1 year of initial presentation was required. Lesion characteristics were evaluated by assessing size, location, and Hefti staging. Both surgical and nonoperative treatments were recorded. Patients with unilateral osteochondritis dissecans were compared to those with bilateral disease. Results: Eighty patients, 63 males (79%) and 17 females (21%), with an average age of 13.1 years old, were included. Twenty (25%) of the presenting/symptomatic lesions were deemed stable on magnetic resonance imaging. A positive correlation between lesion size and Hefti classification was appreciated. Twelve patients (15%) were found to have bilateral osteochondritis dissecans on contralateral imaging. There was no significant difference in skeletal maturity between patients with bilateral versus unilateral disease. Fifty-two patients (77%) with unilateral disease underwent surgical intervention, while 9 (75%) of those with bilateral disease underwent surgery on either knee. In patients with an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee. Conclusions: In patients presenting with unilateral osteochondritis dissecans symptoms, there was a 15% prevalence of bilateral disease, with no difference in age, sex, physeal status, or lesion characteristics between patients with unilateral vs bilateral osteochondritis dissecans lesions. Given the prevalence of asymptomatic contralateral lesions and the required intervention, this study supports early bilateral radiologic knee evaluation. Level of evidence: IV, Retrospective Case series.
Language	English
Publishing date	2023-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2279410-4
ISSN	1863-2548 ; 1863-2521
ISSN (online)	1863-2548
ISSN	1863-2521
DOI	10.1177/18632521231193711
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Article ; Online: Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases.

Ferraro, Samantha L / Batty, Miles / Heyworth, Benton E / Cook, Danielle L / Miller, Patricia E / Novais, Eduardo N

Journal of pediatric orthopedics

2023 Volume 43, Issue 4, Page(s) 204–210

Abstract: Background: Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides ... ...

Abstract	Background: Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides a comprehensive analysis of demographic, anatomic, pathophysiological, clinical, and athletic-related variables associated with such injuries in an extensive population of affected adolescents. Methods: A retrospective review was performed of records of patients presenting to a single tertiary care pediatric hospital between January 1, 2005, and July 31, 2020, collecting variables including patient sex, age, body mass index, fracture location, injury mechanism, sport at the time of injury, and duration of prodromal symptoms. Results: Seven hundred nineteen fractures were identified in 709 patients. The average patient age was 14.6, and 78% of the fractures occurred in male patients. The anterior inferior iliac spine (33.4%), anterior superior iliac spine (30.5%), and ischial tuberosity (19.4%) were the most common fracture sites. The most common injury mechanisms were running (27.8%), kicking (26.7%), and falls (8.8%). The most common sports at the time of injury were soccer (38.1%), football (11.2%), and baseball (10.5%). Fracture site was significantly associated with patient sex, age, body mass index, laterality, mechanism, sport, time from injury, and presence of prodromal symptoms. The annual volume of pelvic avulsion fractures treated at the institution increased significantly from n=17 in 2005 to n=75 in 2019. Conclusions: Adolescent pelvic and hip avulsion fractures occur during a narrow window of age and skeletal maturation and are frequently sustained during sporting activities. Each fracture location is associated with certain demographic, mechanistic, and patient-specific characteristics. The associations between fracture site and patient-specific or injury-specific variables offer insights into the pathophysiology and possible underlying biomechanical risk factors that contribute to these injuries. Level of evidence: This is a level III retrospective study.
MeSH term(s)	Humans ; Male ; Adolescent ; Child ; Fractures, Avulsion/epidemiology ; Fractures, Avulsion/complications ; Retrospective Studies ; Prodromal Symptoms ; Fractures, Bone/epidemiology ; Fractures, Bone/etiology ; Hip Fractures/complications ; Ischium ; Pelvis/injuries ; Athletic Injuries/therapy
Language	English
Publishing date	2023-01-23
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.0000000000002355
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