SpEcIALTy UpDATEWhat’s New in Pediatric OrthopaedicsDerek M. Kelly, MD, Kelly VanderHave, MD, and Jeffrey E. Martus, MDInvestigation performed at Campbell Clinic Orthopaedics, Memphis, TennesseeThe field of pediatric orthopaedics added a large number of high-quality studies to the medical literature recently, withpublications identified in a wide variety of general and sub- specialty journals. The following review summarizes some of the year’s more impactful studies, with selection preference given to studies with higher levels of evidence.GeneralStudies continue to demonstrate that pediatric orthopaedic patients with private insurance have less difficulty obtaining orthopaedic office appointments than those with Medicaid. Potak and Iobst studied the willingness of pediatricians to provide care for a distal radial torus (“buckle” ) fracture. All Medicaid patient refusals were based on the insurance status of the patient, and no office refused to see the patientbecause of the nature of the injury1. In a cohort of patients <21 years of age who were treated operatively for anterior cruciate ligament (ACL) and/or meniscal tears, patients with public insurance were significantly more likely to have a delay in presentation from the time of injury, to have chondralinjuries of greater severity, and to require meniscal debridement2.TraumaPediatric supracondylar fractures requiring surgical inter- vention are increasingly being transferred to metropolitan facilities designated as trauma centers or teaching hospitals3. A study of 2 matched groups was performed to determine if the outcomes of surgical procedures for Type-III pediatric supracondylar fractures were different if the surgical pro- cedure was performed during the daytime compared with nighttime hours (after 5 P.M.)4. The 2 groups did not differ significantly in terms of operative time or rate of openSpecialty Update has been developed in collaboration with the Board ofSpecialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.reduction. A higher rate of poor fixation was noted in the after-hours group; however, there were no differences infunctional outcomes or deformity at the time of follow-up. A prospective study was conducted to evaluate fracture clas- sification and functional outcome in children with extension pediatric supracondylar fractures5. At the time of the latest follow-up, using the Pediatric Outcomes Data CollectionInstrument (PODCI) outcome measures and QuickDASH (a shortened version of the Disabilities of the Arm, Shoulder and Hand outcome measure), the Garland classification did not infiuence functional outcomes, which were generallyexcellent.A systematic review of isolated medial epicondylefractures and fracture-dislocations treated nonoperativelyrevealed that radiographic nonunion occurred in 69% ofpatients with fracture-dislocation compared with 49% ofpatients with isolated fractures6....
