Children's Orthopedic Hospital Research Articles

Distribution of fractured bones among children: Experience with the Comprehensive Pediatric AO classification in a children's orthopedic hospital in Bogotá-Colombia

IntroductionFractures in children and adolescents are a public health issue. However, reliable epidemiological descriptions of the South American population must be improved. This study aims to present epidemiological data on fractures from a children's orthopedic hospital in one of the five largest cities in Latin America. Patients and methodsDescriptive epidemiological data from 2015 to 2019 were used to characterize children's fractures. Demographic variables, the number of fractured bones, high-energy trauma findings, fracture characteristics, fingertip injuries, and associated complications discriminated by the type of treatment are presented. Long bone fractures were classified according to the AO classification. All children less than 18 years of age were included. ResultsIn a population of 3,616 children, 4,596 fractures were identified. More boys than girls sustain a fractured bone, with ratios as high as 6:1 around 15 years old. Distal forearm fractures were the most common (31.9%), followed by distal humerus (20.2%). Most of the complications were related to these two sites of fractures. The OR of complications between surgical and conservative management was 2.86. ConclusionEpidemiological data of fractures from the authors’ institution display the usual trending reported in most populations. Gender-related and age-related differences were relevant. Most fractures and complications are related to upper limb low-energy trauma. The most frequent are loss of ROM and loss of reduction. Level of evidenceLevel III – retrospective cohort study.

Can Burn Centers Evacuate Safely in Response to Disasters?

One of the U S's worst national disasters occurred on Monday August 29, 2005 as the Gulf Coast was hit by category 4 Hurricane Katrina. The storm was responsible for over 1000 deaths and the displacement of hundreds of thousands of people. New Orleans hospitals evacuated because of complete collapse of infrastructure. This event was influential in the decisions and actions taken to protect patients, families, and staff of a 30 bed pediatric burn center in the projected path of a second catastrophic Hurricane three weeks later. Approximately 80 hours before projected landfall, the local government announced that a mandatory evacuation of the community surrounding the burn center would occur. A coordinated decision was made by Administration, Nursing, and Medical Staff to cancel upcoming clinics and elective surgeries and evacuate the 14 inpatients, 52 outpatients and 66 guardians. The first group would include 6 critical care inpatients (average TBSA 70%, average age 6) who were to be transferred by medical jets to a sister pediatric burn care facility with equivalent capabilities. These children were followed to the same location by their guardians, four nursing staff and one faculty acute burn surgeon. The second group, non-critical inpatients and high acuity outpatients, numbered 12 children and 12 family members and were accompanied by 8 clinical care staff and one acute burn faculty member. This group was moved by ground transportation to children's orthopedic hospital, chosen for its proximity and affiliation with the primary hospital. The third group was made up of 25 outpatients, 25 guardians, 9 clinical care staff and a clinical burn fellow. All were evacuated via ground transportation to a university school of veterinary medicine. In addition, arrangements were made for 27 outpatients and their guardians to return to their homes. The above evacuation plan was completed by 32 hours following the decision for complete evacuation. The eye wall of the Hurricane passed 65 miles east of the burn center. No significant damage to the physical plant noted. The repopulation of the hospital by patients and acceptance of new acute burn referrals began approximately 40 hours after the all clear to return was given by the local government. No morbidity or mortality has been attributed to the evacuation. Planned evacuation of threatened burn centers can be safely accomplished with adequate prior planning of evacuation sites, modes of transportation and established communication command center.

The early history of orthopaedic surgery in Philadelphia. 1976.

Alfred Rives Shands, Jr, MD (1899-1981) Alfred Rives Shands, Jr. (Fig 1) was born in Washington DC. His father was the first orthopaedist to practice in the district. When he was 14 years of age, his father, Alfred R. Shands, Sr., was president of the American Orthopaedic Association. The young man graduated from the University of Virginia in 1918 and enrolled in Johns Hopkins Medical School. He remained at Johns Hopkins Hospital for surgical and orthopaedic training until 1927. He returned to Washington, DC to join his father in practice until 1930 when he was invited to Duke University Medical School to initiate the Department of Orthopaedic Surgery and the orthopaedic residency program. In 1937, Shands left Duke University to become Medical Director of the Alfred I. duPont Institute in Wilmington, DE.Fig 1: Alfred R. Shands, Jr, MD (Reprinted with permission from J Bone Joint Surg 64A:314-315, 1982).His first task at the institute was to plan and supervise the construction of a children's orthopaedic hospital on the grounds of Nemours, the estate of Alfred I. duPont. The hospital was completed in 1940 and Shands became Surgeon in Chief, a position he held until 1962. He remained Medical Director of the institute until 1969. During World War II, Shands served as the senior consultant for orthopaedics for the United States Air Force. Shands made many contributions to the care of children who are crippled, which are reflected in his numerous publications. His Handbook of Orthopaedic Surgery became an important educational resource, nine editions were published. Perhaps his greatest contribution to orthopaedics was his essential role in the formation of the Orthopaedic Research and Education Foundation, and his support of the Orthopaedic Research Society. He was honored by elected positions in various orthopaedic and other groups. He was a recipient of numerous honorary memberships and honorary degrees. His distinguished presence was noted at the annual meetings of orthopaedic societies, where he was especially friendly and encouraging to the young investigators. As a historian, Shands will be remembered for his article about the development of orthopaedics as a specialty in the United States. Many historic articles were published in The Early Orthopaedic Surgeons of America.1 The following article is an example of his historic scholarship. Leonard F. Peltier, MD, PhD

Coma Scales in Pediatric Practice

Interobserver variability for six coma scales was assessed prospectively on a sample of 15 comatose children, by two physicians, in a double-blind fashion. The six scales were the Glasgow Coma Scale, the Simpson and Reilly Scale, the Children's Coma Score, the Children's Orthopedic Hospital and Medical Center Scale, the Jacobi Scale, and the 0 to IV Scale. Interobserver variability was measured by using disagreement rate and the kappa statistic. The results from both methods were generally concordant. The disagreement rate for the various items in the different scales ranged from a high of 0.20 to a low of 0.03. The disagreement rate was greater than 0.10 for verbal responses in the Children's Coma Score and Glasgow Coma Scale and for both items in the Children's Orthopedic Hospital and Medical Center Scale. The disagreement rate was 0.10 or less for the 0 to IV Scale and for all items in the Simpson and Reilly and Jacobi scales. The relatively high interobserver agreement for these scales makes them more suitable for the pediatric setting than the other three scales, since good agreement is essential for interpreting data reliably, both in clinical practice and for research.

History of Conjoined Twins

Departments of Anesthesiology and Pediatrics Ochsner Clinic and Alton Ochsner Medical Foundation New Orleans, Louisiana Tulane University School of Medicine New Orleans, LouisianaDepartment of Anesthesiology Children's Orthopedic Hospital & Medical Center Seattle, Washington University of Washington School of Medicine Seattle, Washington

Morphine Pharmacokinetics in Early Infancy

Departments of Anesthesiology, Pediatrics, and Pharmaceutics, University of Washington School of Medicine, and Children's Orthopedic Hospital and Medical Center, Seattle, Washington

Pathogenesis of Haemophilus influenzae meningitis.

The hypoxia induced by decreased cerebrocortical blood flow contributes to the neurologic deficits found in many survivors of Hib meningitis. Because reduced blood flow is measurable within 48 hours of acquisition of bacteria, the inability of antibiotic therapy to prevent sequelae is more easily understood insofar as damage has already occurred by the time treatment is initiated. Hydrocephalus is probably due to severe choroid plexus necrosis with aqueductal occlusion. These deficiencies, along with the neuronopathy, contribute to permanent cerebrocortical deficits, including impaired learning ability.

Psychosocial Adjustment of Adult Women with Turner Syndrome

Departments of Psychiatry and Behavioral Sciences and Pediatrics, and Division of Medical Genetics, University of Washington Medical School and Children's Orthopedic Hospital and Medical Center, Seattle, Washington; Department of Psychiatry, College of Physicians and Surgeons, Columbia University; and New York State Psychiatric Institute, New York, New York Clin. Genet. 29: 284, 1986

Infectious complications of intraventricular reservoirs in cancer patients.

Drug administration via an intraventricular reservoir is useful in the treatment of leukemic and carcinomatous meningitis that occurs in patients who have previously received lumbar intrathecal chemotherapy. The intraventricular route, however, is associated with a higher incidence of infectious complications compared with therapy given by the lumbar route. To characterize the infectious complications associated with such reservoirs, we reviewed the 10-year experience of the Pediatric Branch, National Cancer Institute, National Institutes of Health, and Children's Orthopedic Hospital, Seattle, WA, with 61 patients (49 with leukemia, 8 with lymphoma, 4 with solid tumors) who had intraventricular reservoirs placed for administration of chemotherapy. The reservoirs were in place for a median of 36 weeks and were punctured a median of 29.5 times, Infectious complications occurred in 14 of 61 patients (23%) and Propionibacterium acnes was the most common organism recovered from cultures. Twelve patients (19.7%) had 19 episodes of clinically suspected and microbiologically documented meningitis or of positive intraventricular reservoir cerebrospinal fluid cultures without symptoms which were treated successfully. Local cellulitis occurred at the site of intraventricular reservoir placement in 2 patients (3.3%) and removal of the intraventricular reservoir was necessary for successful management. Nine patients had their intraventricular reservoir removed (5 because of associated infection and 4 because of malfunction unassociated with infection).(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal Activity and Light Anesthesia

Donald R. Peterson, MD, MPH Department of Epidemiology University of Washington Seattle, WA 98195 Nora Davis, MD Children's Orthopedic Hospital and Medical Center Seattle, WA 98105

Esophageal Activity and Light Anesthesia

Donald R. Peterson, MD, MPH Department of Epidemiology University of Washington Seattle, WA 98195 Nora Davis, MD Children's Orthopedic Hospital and Medical Center Seattle, WA 98105

Medical Center Report: “Sarah Kubitschek” Rehabilitation Center

Department of Orthopedics, University of Washington and Children's Orthopedic Hospital and Medical Center, Seattle, Washington, U.S.A.

ANTIBIOTIC CHOICE IN HAEMOPHILUS INFLUENZAE MENINGITIS

Worcester, MA University of Washington School of Medicine Children's Orthopedic Hospital and Medical Center Seattle, WA

Therapeutic Drug Monitoring in Pediatric Acute Drug Intoxications

*Department of Laboratories, Children's Orthopedic Hospital and Medical Center, and †Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A.

Improved survival in children with osteosarcoma following resection of pulmonary metastases

Despite the effectiveness of improved chemotherapy and radiotherapy, surgical resection of all gross metatastic disease from the lung appears to improve the survival of children with osteosarcoma. At Children's Orthopedic Hospital and Medical Center (COHMC), from 1952 through 1980, 55 patients were treated for osteosarcoma. Twenty-eight of these patients (4 with active disease) were surviving in January 1981. Six patients had pulmonary metastases at diagnosis and 28 patients developed pulmonary metastases after diagnosis. From 1964 through 1980, 17 patients had 34 thoracotomies for resection of metastases. Seven of these 17 patients (41%) are surviving and remain free of disease. The disease was often bilateral, and in most patients more than one thoracotomy was required to erradicate recurrent disease. No patient who developed pulmonary metastases from osteosarcoma survived without surgical resection of all gross disease. An aggressive surgical approach to the treatment of osteosarcoma metastatic to the lung in children appears worthwhile.

INCREASING THE USEFULNESS OF RADIONUCLIDE RENAL STUDIES IN PEDIATRIC PATIENTS

Departments of Pediatrics and Radiology, Children's Orthopedic Hospital and Medical Center, Seattle, Washington.

Congenital Distal Femoral Focal Deficiency

An 8-year-old Chinese boy with congenital leg length discrepancy is believed to be the first reported case of unequivocal distal femoral focal deficiency. A pseudarthrosis is present between the normal appearing distal femoral epiphysis and the lower end of the femoral diaphysis. The patient's family history is negative for congenital limb deficiency, psuedarthrosis and neurofibromatosis. There is no history of trauma or infection. Congenital lack of distal femoral physis in this case is analogous to Aitken's Classification Type B proximal femoral focal deficiency.

Tap Water Burns in Handicapped Children

The original tap water burn series included three handicapped children, but the extent of their special risk of injury was not appreciated or emphasized.1 When I (K.W.F.) presented that burn series to the medical staff at Children's Orthopedic Hospital and Medical Center, my colleagues in the handicapped children's clinic suggested the possible increased risk to their patients because of their anesthesia and motor dysfunction. In September 1978, we sent letters to the 730 families of those clinic patients informing them that tap water can cause severe burns and that their children might be at a greater risk of injury. We suggested that they set back their water heater thermostats to 49 to 54 C (120 to 130 F).

Esophageal atresia and tracheoesophageal fistula: Review of thirteen years’ experience

A review of the treatment of esophageal atresia (EA) was undertaken to examine current methods of management and to ascertain the influence of prematurity and associated medical defects on survival. One hundred patients with EA presented at The Children's Orthopedic Hospital and Medical Center, Seattle, between 1967 and 1979. Eighty-two percent had a blind proximal esophageal pouch and distal tracheoesophageal fistula (TEF). Ninety-two patients were initially treated by gastrostomy. Fifty-nine patients were born at term and had no major medical problems. They underwent either primary or delayed (up to 1 week) repair of the esophagus. The survival rate was 93% and surgical mortality was 3%. Twenty-two patients born prematurely or having major medical problems underwent a staged repair. Survival in the staged group was 55% with a surgical mortality of 27%. Overall survival for the entire series was 79% (79/100). The use of air rather than contrast material for the radiographic diagnosis of EA was associated with fewer subsequent pulmonary abnormalities. There was an 18% incidence of minor anastomotic leaks, regardless of technique. The route of approach (transpleural, retropleural) did not influence mortality or morbidity in this series. There were more than three times as many significant strictures among patients who had double-layer anastomoses (18%) as among those who had single-layer repairs (5%). The surgical treatment of infants with EA has reached a level in which associated illness, anomalies, or prematurity are now the most significant determinants of survival.

An interdisciplinary teacher education program

In 1975 the faculty of the University of Washington School of Dentistry, in conjunction with the College of Education and the affiliated Children's Orthopedic Hospital and Medical Center, developed a 36-month formal teacher education program in combination with joint specialty training in pedodontics and orthodontics. The program goal was to produce a professional dental educator/administrator who could function primarily in the teaching and practice of child and adolescent comprehensive care. After four years and three graduates, the faculty terminated this program. This paper outlines the rationale and structure of the original program and discusses the reasons for its termination.