Texas Scottish Rite Hospital Research Articles

Global trends in the research on Legg-Calve-Perthes disease in Web of Science.

Legg-Calve-Perthes disease (LCPD) is a form of idiopathic femoral head necrosis that can lead to permanent femoral head deformities and premature osteoarthritis in children under the age of 15. Its pathogenesis is utterly and remains to be clarified. Although many research publications on LCPD have emerged during the last few decades, few systematic bibliometric analyses of these articles have been reported. A bibliometric analysis was performed to investigate the development processes and hotspots, as well as the collaboration and influence among countries, institutions, authors, journals, and keywords of papers relevant to LCPD from the Web of Science Core Collection (WoSCC) during the period from 1 January 2000 to 30 June 2023. A total of 2,205 researchers from 916 institutions across 53 countries/regions have contributed to 673 papers published in 199 academic journals. The research on LCPD has shown significant fluctuations but a gradual increase in the number of articles published over the last two decades. The United States leads in the number of publications of LCPD, with the Texas Scottish Rite Hospital for Children being the most productive institution. English, as the most widely used language in the world, was undoubtedly the most popular language. Herring JA, who acted as both the corresponding and first author, has contributed to the most co-cited papers published. The most number of LCPD papers are published in the Journal of Pediatric Orthopaedics, whereas the Journal of Bone and Joint Surgery American Volume garnered the highest total citations, indicating the great importance of these two journals in the field of orthopedics. The most frequently used keywords in published articles were related to the symptoms, mechanisms, and prognosis, revealing the research focus of most scholars. Our research described the development trends and hotspots in the research field of LCPD and will help researchers make better decisions.

Dual-Rod Instrumentation Via the Anterior Approach for Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis

Background: Posterior spinal fusion with pedicle screw instrumentation is currently the standard technique for spinal surgery. However, the anterior approach remains useful for thoracolumbar and lumbar (TL/L) lesions, such as in adolescent idiopathic scoliosis (AIS) 1–4 and spinal injuries 5,6 . We previously documented that long-term radiographic findings and clinical measures were satisfactory in patients with TL/L AIS treated with anterior dual-rod instrumentation 1 . Description: This surgical technique is indicated for single TL/L (Lenke 5) curves and is performed with use of extrapleural retroperitoneal approaches. The extrapleural cavity is connected to the retroperitoneal space by diaphragmatic transection. The lateral aspect of the vertebral bodies is exposed by retracting the psoas major muscle posteriorly from the intervertebral discs. Segmental vascular bundles are divided with coagulation and/or ligation. Care should be taken to reflect the psoas in its entirety and avoid an intramuscular approach to prevent bleeding injury to nerves, including the femoral, ilioinguinal, and genitofemoral nerves, as well as ureteral injury. After the intervertebral discs and cartilage plates are removed to the vertebral end plates, 2 screws are inserted in each vertebral body through a vertebral staple 1,4 . The anterior rod is then placed in the screw heads and rotated anteriorly, providing 3-dimensional correction of kyphotic deformities with lordosis production 1,4 . After the posterior rod is applied in the same manner as the anterior rod, compression forces are applied between the screws to correct scoliosis 1,4 . The compression force is first applied to the posterior rod so that kyphosis can be corrected more effectively 1,4 . Alternatives: Posterior pedicle screw instrumentation techniques are widely utilized for TL/L AIS curve correction. However, anterior techniques have frequently also been applied to the curve. Dwyer et al. 7 first reported the use of anterior spinal fusion (ASF) with a single braided cable connecting vertebral screws for the treatment of TL/L AIS, and Zielke et al. 8 modified that procedure by replacing the cable with a threaded rod. Although these instrumentation techniques and other single anterior rod techniques such as the Texas Scottish Rite Hospital System effectively correct scoliosis in the coronal plane and improve vertebral derotation 1,9 , poor sagittal and rotational plane deformity correction, implant weakness, and high incidence of pseudarthrosis remain unresolved issues 1 . Rationale: The fundamental advantages of the anterior approach in dual-rod instrumentation are the ability to achieve 3-dimensional correction with extremely low rates of pseudarthrosis and implant failure 1,10–12 . Furthermore, the fusion is expected to include fewer motion segments than with posterior systems (usually 1 level less distally and proximally). However, low skeletal maturity and a TL/L to thoracic Cobb ratio of <1.25 appeared to be important factors for postoperative curve progression of the thoracic coronal deformity following ASF for the treatment of Lenke 5 curves 1,13 . In addition, subjacent disc wedging may occur when the subjacent disc is nearly parallel before surgery 1,14 . Expected Outcomes: The described technique is expected to provide 3-dimensional spinal correction. In a previous study, 30 patients with Lenke 5 AIS were followed for a mean of 17 years 1 . The mean TL/L Cobb angle correction rate and correction loss were 79.8% and 3.4°, respectively, at the time of the latest follow-up 1 . The average percent of predicted forced vital capacity and of forced expiratory volume in 1 second were 91.8% and 81.8%, respectively 1 . The average total score on the Scoliosis Research Society-30 outcome instrument was 4.21. No instrumentation failure, pseudarthrosis, or clinically relevant neurovascular complications were observed 1 . Important Tips: This technique is applicable to Lenke 5 AIS curves. However, the anterior approach can also be utilized for other TL/L lesions.The anterior procedure is accomplished via extrapleural retroperitoneal approaches with diaphragmatic transection.Care should be taken to reflect the psoas in its entirety and avoid an intramuscular approach to prevent bleeding and nerve and ureteral injuries. Acronyms & Abbreviations: SRS-30 = Scoliosis Research Society-30

Outcome of Septic Arthritis With Adjacent Osteomyelitis

Source: Hamilton EC, Villani MC, Klosterman MM, et al. Children with primary septic arthritis have a markedly lower risk of adverse outcomes than those with contiguous osteomyelitis. J Bone Joint Surg Am. 2021;103(13):1229–1237. doi:10.2106/JBJS.20.01685Investigators from Children’s Health System of Texas and Texas Scottish Rite Hospital for Children, both in Dallas, TX, conducted a retrospective study to compare patient and clinical characteristics, hospital course, and outcomes between children with primary septic arthritis and those with osteomyelitis with contiguous septic arthritis. Study participants were identified by reviewing the medical records of patients with suspected septic arthritis who had been consecutively treated by a multidisciplinary team between 2009 and 2019. Children were classified as having primary septic arthritis if they had a hematogenous joint space infection and a pathogen identified by culture or PCR, without known or suspected contiguous osteomyelitis. Osteomyelitis was diagnosed based on clinical and radiologic findings, bone and/or bone aspirate/debridement cultures, and, in most cases, MRI. Patients with osteomyelitis in addition to septic arthritis constituted the osteomyelitis with contiguous septic arthritis group. Data abstracted from the medical records of study children included demographics, microbiology, radiographic and laboratory data, length of stay (LOS), ICU admission, and long-term complications (osteonecrosis, chondrolysis, physeal arrest, pathologic fracture, joint deformities, or need for joint replacement). Differences between children with primary septic arthritis and those with osteomyelitis with contiguous septic arthritis were compared using t-tests, Mann-Whitney U tests or chi-square tests.Data were analyzed on 134 children with primary septic arthritis and 105 with osteomyelitis with contiguous septic arthritis. Compared to those with primary septic arthritis, those with osteomyelitis with contiguous septic arthritis were older (mean ages 7.0 ±4.9 and 4.4 ±4.4 years, respectively; P <0.0001), had higher initial mean C-reactive protein levels (16.7 vs 7.8 mg/dL; P <0.0001), and lower initial mean platelet counts (290,000 vs 353,000 cells/mL; P = 0.0027). An MRI was obtained in 89.5% of children with osteomyelitis with contiguous septic arthritis and 34.3% of those with primary septic arthritis (P <0.0001). The most commonly identified bacterial pathogens in patients with primary septic arthritis were Staphylococcus aureus in 43 (32.1%) and Kingella kingae in 43 (32.1%). For those with osteomyelitis with contiguous septic arthritis, a bacterial etiology was identified in 94.3%; S. aureus was found in 77.1% of these children. ICU admission was more common in patients with osteomyelitis with contiguous septic arthritis than in those with primary septic arthritis (21.0% and 1.5%, respectively; P <0.0001), and LOS longer (mean values 13.0 ±11.9 and 5.3 ±4.2 days, respectively; P <0.0001). Complications were documented in 40 patients (38.1%) with osteomyelitis with contiguous septic arthritis vs 1 (0.7%) of those with primary septic arthritis.The authors conclude that children with primary septic arthritis can be distinguished from those with osteomyelitis with contiguous septic arthritis.Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Children with septic arthritis and osteomyelitis are at risk for adverse outcomes such as joint destruction, chondrolysis, growth disturbance, and osteonecrosis.1 Septic arthritis and osteomyelitis are part of a continuum of disease in which bacteria infect 1 or both foci.2 Historically, authors have proposed but not proven that the combination of septic arthritis with adjacent osteomyelitis is more problematic than simple isolated septic arthritis.3,4 The current investigators attempt to critically compare the outcomes and complications of primary septic arthritis with septic arthritis in combination with adjacent osteomyelitis.In the current study, children with septic arthritis and adjacent osteomyelitis were sicker and presented later. In addition, these patients were older, more often male, and had higher inflammatory marker values in the blood and lower platelet counts.Methicillin-resistant S. aureus was more commonly isolated in children with osteomyelitis compared to those with isolated septic arthritis. Patients with adjacent osteomyelitis needed more ICU care, more surgical procedures, and had longer LOS, longer antibiotic durations, and more re-admissions. Complications included eiphyseolysis and osteonecrosis in 1 patient with septic arthritis and pathologic fractures, chondrolysis, joint collapse, deformity, limb length inequality, and total joint replacement in patients with adjacent osteomyelitis.Based on the results of the current study, osteomyelitis appears to be the primary disease that potentiates osteonecrosis and joint destruction. In contrast to those with primary septic arthritis, children with adjacent osteomyelitis require longer duration of antibiotics and longer follow-up to ensure that adverse outcomes are recognized and addressed.5,6Septic arthritis plus adjacent osteomyelitis is a more severe disease than isolated septic arthritis. To ensure that a patient with septic arthritis does not have adjacent osteomyelitis, MRI is recommended for those with risk factors such as persistently elevated inflammatory markers and sustained S. aureus bacteremia. (See AAP Grand Rounds. 2021;45[2]:19.)7

A reflection from a polio patient at the Texas Scottish Rite Hospital for Children in Dallas

Similar to the current coronavirus pandemic, the polio pandemic during the early 20th century impacted the entire world, leaving many children permanently disabled. The Texas Scottish Rite Hospital for Children was created to address this need. In this article, Dewain Collins tells his story of being treated for polio by Dr. William Beall Carrell at Scottish Rite in the 1930s.

Narrative Review of the objective analysis of long-term outcome of the Ponseti technique: experience from Dallas.

In 2001, Texas Scottish Rite Hospital for Children (TSRH) prospectively began a clubfoot database that included all of our patients with clubfeet who were willing to enroll. Nonoperative treatment, primarily the Ponseti method, was utilized. This article summarizes the experience from Dallas treating idiopathic clubfeet using the Ponseti technique, and is based on previously published studies utilizing information from the database. Patient clinical outcomes were defined as “good” (plantigrade foot achieved either with or without a percutaneous heel-cord tenotomy), “fair” (a plantigrade foot that required a limited procedure, such as tibialis anterior tendon transfer or posterior release), or “poor” (a plantigrade foot that required posteromedial release). Nearly 95% of idiopathic clubfeet obtained initial correction using the Ponseti technique, but relapses occurred and by age two years 24% needed some surgical intervention, usually limited procedures. Use of Dimeglio’s rating system before treatment strongly correlated with the probability of a “good” outcome at two years. Objective measurements of brace wear compliance (iButton) in those who reached age two years with “good” outcomes demonstrated an unexpected pattern of diminishing use of the foot abduction orthoses over the first two years of brace wear. By the 18-month period of brace wear, 1/3 patients wore the orthoses less than 6 hours per day, and nearly half of the patients wore the orthoses less than 8 hours per day. Between ages 2–5 years, nearly 21% of the corrected clubfeet at age two years needed limited procedures to maintain/regain plantigrade positioning. Lateral weight-bearing radiographs between 18–24 months were not helpful in predicting future relapse in these patients, and are no longer routinely obtained. Following these patients for normal development is important, as nearly 9% of infants initially presenting as idiopathic clubfeet were eventually found to have another disorder including neurological, syndromic, chromosomal, or spinal abnormalities. We continue to emphasize the need to devote great attention to detail when using the Ponseti method in an effort to optimize the clinical outcomes.

Trends in Leadership at Pediatric Orthopaedic Fellowships.

Pediatric orthopaedic fellowship directors (FDs) have a valuable impact on the education of trainees and future leaders in the field. There is currently no research on the characteristics of pediatric orthopaedic FDs. Programs were identified using the Pediatric Orthopaedic Society of North America fellowship directory. Operative, nonoperative, and specialty programs were included. Data was collected through Qualtrics survey, e-mail, telephone, and online searches. Variables included demographics (age, sex, race/ethnicity), Hirsch index (h-index) as a measure of research productivity, graduate education, residency and fellowship training, years of hire at current institution and as FD, and leadership roles. Fifty-five FDs were identified. The majority (49/55, 89%) were male and 77% (27/35) were Caucasian. The mean age at survey was 51.1±8.2 years. The mean h-index was 17.2. Older age correlated with higher h-index (r=0.48, P=0.0002). The average duration from fellowship graduation to FD appointment was 9.6±6.7 and 6.9±6.1 years from institutional hire. Sixteen FDs (29%) had additional graduate level degrees. Almost all (52/55, 95%) FDs completed orthopaedic surgery residencies and all graduated fellowship training. Twenty-nine percent (16/55) completed more than 1 fellowship. Most FDs (51/55, 93%) completed a fellowship in pediatric orthopaedic surgery. Ten FDs (18%) completed pediatric orthopaedic surgery fellowships that included spine-specific training. One-third of all current FDs were fellowship-trained at either Boston Children's Hospital (9/55, 16%) or Texas Scottish Rite Hospital for Children (9/55, 16%). Pediatric orthopaedic FDs are typically early-career to mid-career when appointed, with a strong research background. Nearly a third completed additional graduate degrees or multiple fellowships. Although male dominated, there are more female FDs leading pediatric orthopaedic programs compared with adult reconstruction, trauma, and spine fellowships. As fellowships continue to grow and diversify, this research will provide a baseline to determine changes in FD leadership.

JPOSNA Fracture Quiz

This trauma ‘quiz’ represents an interactive session where POSNA members are able to work through 9 clinical scenarios to challenge how they would address the fracture problems. Associated with each scenario is an OITE-style question and multiple choice options that seek the most preferred answer from the clinician. In addition to the answer and follow-up radiographs, we have enlisted the opinions of three POSNA experts in trauma to provide an evidenced-based approach to thinking through each trauma problem. &#x0D; Our panel of experts include:&#x0D; Jeff R. Sawyer, MD. Le Bonheur Children’s Hospital, Campbell Clinic, University of Tennessee Health Science center. Dr. Sawyer has published &gt;50 trauma-related articles, and has established himself as one of our society’s leaders in pediatric orthopedic trauma. &#x0D; Tony I. Riccio, MD. Texas Scottish Rite Hospital for Children, Children’s Health Dallas, UT Southwestern Medical Center. Dr. Riccio, among many trauma-related endeavors, has spearheaded the effort to promote partnership between POSNA and the OTA, and has taught and published extensively on pediatric orthopedic trauma.&#x0D; Susan A. Scherl, MD. Children’s Hospital &amp; Medical Center Omaha, University of Nebraska Medical Center. Dr. Scherl has dedicated her career to the expert care of children with fractures and has published on all aspects of pediatric orthopedic trauma – from NAT to adolescent fractures to supracondylar humerus fractures.

Author-reported affiliations on abstracts accepted for the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting: A retrospective review

Professional education at academic medical meetings is under increasing scrutiny. No data have been published regarding the academic or institutional affiliations of authors who submit abstracts as part of the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting. We sought to study the self-reported institutional affiliations and other factors over a 6-year period. The POSNA annual meeting programs 2011-2016 were reviewed. The number of abstracts, including those for main program podium presentations, posters, e-posters, and subspecialty day were queried. The number of authors on each submission, presenting author’s reported institutional affiliation, and involvement of a study group or database were documented. Over the 5-year study period the abstract number increased (188 abstracts in 2011 and 294 in 2016, abstracts or a 56% increase). The mean number of authors listed per abstract was five (range, 4.9 to 5.4). Nineteen percent of abstracts were affiliated with three institutions: Texas Scottish Rite Hospital (103), Boston Children’s Hospital (95) and Rady Children’s Hospital (84). Boston Children’s Hospital and Texas Scottish Rite Hospital were most frequent in the main program. These two institutions accounted for 16% to 25% of main program podium abstracts across all years. The total number of abstracts with a study group affiliation increased over the evaluated period (five abstracts in 2011, 18 abstracts in 2016, a 4.5-fold increase). The abstract number at the POSNA annual meeting has increased substantially recently. Although the average number of authors listed on the abstract remained consistent over the review period, study groups/databases were reported as an author/source more frequently. Two academic pediatric orthopaedic centers were affiliated with approximately 20% of the main program abstracts each year. Level of Evidence: Level IV.

Retrospective review of immobilization vs. immediate resumption of activity in patients with Oligoarticular juvenile idiopathic arthritis following knee injections

BackgroundIntraarticular corticosteroid injection (IACI) is one of the most common treatments in oligoarticular Juvenile Idiopathic Arthritis (JIA). Activity recommendations following injection vary, as there are no published studies on splinting JIA patients post-IACI (splinting is a form of rest). Texas Scottish Rite Hospital for Children (TSRH) splints patients post-IACI for 24 h while The Children’s Hospital of Philadelphia (CHOP) does not. The aim of this study was to compare the number of cases of recurrent arthritis following IACI between these two post-injection practices.MethodsData were retrospectively collected at CHOP and TSRH. Patients diagnosed with oligoarticular JIA according to International League of Associations for Rheumatology (ILAR) criteria (2nd revision, 2001) between 2008 and 2010 were included. Bivariate analysis (Wilcoxon rank-sum tests, chi-squared tests) was run to assess differences in outcomes by site. Inverse probability of treatment weighted Cox regression was employed to adjust for site differences.ResultsThe population at TSRH was younger than at CHOP (p < 0.05) and had more whites (p = 0.03). Disease duration was significantly longer at TSRH than at CHOP (0.40 vs. 0.74 years, p = 0.014). More children were on biologics at the time of injection at CHOP (p < 0.05). The baseline physician global (p < 0.001) was higher at CHOP, as was the joint disease severity (p < 0.001). CHOP had fewer reoccurrences of knee arthritis compared to TSRH: 26% vs 38% (p = 0.14).ConclusionsThe baseline populations were different in that the TSRH group had more whites and Hispanics, were younger and, perhaps, had less severe disease than CHOP. Patients treated with post-injection splinting had a trend toward more arthritis reoccurrence (38% vs. 26%, p = 0.14). Splinting is not clearly beneficial post-injection.Trial registrationThis is an observational study, so it is not applicable.

The Sports Preparticipation Evaluation.

1. Shane M. Miller, MD, FAAP* 2. Andrew R. Peterson, MD, MSPH, FAAP† 1. *Departments of Orthopaedics and Pediatrics, UT Southwestern, and Texas Scottish Rite Hospital for Children Sports Medicine Center, Dallas, TX 2. †Departments of Pediatrics and Orthopaedics/Rehabilitation, University of Iowa, Iowa City, IA * Abbreviations: AAP: : American Academy of Pediatrics AAS: : anabolic-androgenic steroid AHA: : American Heart Association BP: : blood pressure CDC: : Centers for Disease Control and Prevention DM: : diabetes mellitus ECG: : electrocardiography FDA: : Food and Drug Administration LVH: : left ventricular hypertrophy PES: : performance-enhancing substance PPE: : preparticipation physical evaluation SCAT5: : Sports Concussion Assessment Tool, Version 5 SCD: : sickle cell disease SCT: : sickle cell trait Lack of familiarity with current recommendations diminishes the confidence to perform a preparticipation physical evaluation (PPE). In a 2014 survey, Madsen et al (1) reported, “Only 37% of physicians reported an awareness of the PPE Monograph.” (2) Clinicians should be aware of current guidelines for performing a PPE and identify children who may be at increased risk from sport participation. After completing this article, readers should be able to: 1. Perform a preparticipation history and physical examination and identify children and adolescents who may be at increased risk for morbidity or mortality from sport participation. 2. Recognize that the mandatory preparticipation physical evaluation serves as an opportunity to address medical and psychosocial issues not necessarily associated with sport participation and as an entry point for healthy adolescents into the health-care system. 3. Recognize the cardiac risks associated with sport participation and when additional cardiac evaluation is required. 4. Understand the importance of assessing and documenting neurocognitive function before sport participation. 5. Identify which sports are appropriate for athletes with some common medical conditions. 6. Recognize the effect of a febrile illness on sport participation. In the United States, sport participation is increasing, with more than 60 million children and adolescents competing in organized sports every year. The number of high school athletes has increased from 7.2 million to 7.9 million during the past 10 years. (3) The physical and psychosocial benefits of sport participation are well-documented, and pediatricians serve a vital role …

40th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2018

The Annual Carrell-Krusen Neuromuscular Symposium is a unique conference attended by more than 200 each year at the Texas Scottish Rite Hospital for Children. Its name honors Dr. Brandon Carrell who retired as physician-in-chief at Texas Scottish Rite Hospital in 1978 and Dr. Ed Krusen who organized the first Muscular Dystrophy Association clinic in Dallas. This Symposium began in 1978 under the leadership of Dr. Jay Cook at a Muscular Dystrophy Clinic Directors' meeting and is now jointly sponsored by the hospital, the Muscular Dystrophy Association, Childrens' Medical Center of Dallas, and the University of Texas Southwestern Medical Center. The Symposium has grown to be the most popular clinical meeting for neuromuscular specialists in the country. During the 2 day meeting, attendees participate in lively discussions while meeting interesting and challenging patients. Attendees are invited to contribute interesting electrodiagnostic and histopathologic cases to review with the group. The visiting professor, the recipient of the Carrell-Krusen Award, gives the keynote lecture. Currently, the Program Director is Dr. Susan T. Iannaccone and Co-Directors Dr. Jaya Trivedi and Dr. Diana Castro.

Late neurological complications due to laminar hook compression in idiopathic scoliosis surgery.

To provide a review of unusual neurological complications occurring years after spinal instrumentation surgery. The authors analyzed the cases of three patients with adolescent idiopathic scoliosis who presented with delayed neurological symptoms (later than 12 months postoperatively) following spinal deformity surgery using Texas Scottish Rite Hospital (TSRH) hook-rod instrumentation. One case presented with conus medullaris syndrome while the last two were rare cases of posterior cord syndrome due to a dislodged laminar hook at the thoracolumbar transition. In all three cases, the neurological symptoms were due to direct laminar hook compression. Metallosis was observed extra-spinally around the hook-rod construct but not at the sublaminar site. The dislodged laminar hook responsible for the symptoms was situated at the concavity of the curve with the blade-tip pointing downwards. Symptomatic improvement was observed in all patients following complete hardware removal. Conscientious long-term follow-up of patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is important in order to recognize late neurological deficits directly related to instrumentation. Anamnesis and physical examination are key for initial assessment and diagnosis, while myelography and computed tomography (CT) images are of great help to confirm the site of spinal compression. Removal of the dislodged laminar hooks after PSF with TSRH instrumentation in AIS cases can potentially improve neurological symptoms.

Can Repeated Ponseti Management for Relapsed Clubfeet Produce the Outcome Comparable With the Case Without Relapse? A Clinical Study in Term of Gait Analysis.

The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P<0.05). No statistically significant difference was found in the kinematic parameters of total hip, knee, and ankle excursion, peak knee and ankle flexion and extension, and internal foot progression (P>0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. Level III-retrospective comparative study.

39th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 23–24, 2017

The Annual Carrell-Krusen Neuromuscular Symposium is a unique conference attended by more than 200 each year at the Texas Scottish Rite Hospital for Children. Its name honors Dr. Brandon Carrell who retired as physician-in-chief at Texas Scottish Rite Hospital in 1978 and Dr. Ed Krusen who organized the first Muscular Dystrophy Association clinic in Dallas. This Symposium began in 1978 under the leadership of Dr. Jay Cook as a Muscular Dystrophy Clinic Directors' meeting and is now jointly sponsored by the hospital, the Muscular Dystrophy Association, Childrens' Medical Center of Dallas, and the University of Texas Southwestern Medical Center. The Symposium has grown to be the most popular clinical meeting for neuromuscular specialists in the country. During the 2 day meeting, attendees participate in lively discussions while meeting interesting and challenging patients. Attendees are invited to contribute interesting electrodiagnostic and histopathologic cases to review with the group. The visiting professor, the recipient of the Carrell-Krusen Award, gives the keynote lecture. Currently, the Program Director is Dr. Susan T. Iannaccone and Co-Directors Dr. Jaya Trivedi and Dr. Diana Castro.

38th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 25–26, 2016

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School Scoliosis Screenings: Family Experiences and Potential Anxiety After Orthopaedic Referral.

Cross-sequential study design that used data from Texas Scottish Rite Hospital for Children (TSRHC). Examine anxiety symptoms and family experiences subsequent to school scoliosis screening (SSS) referrals. Use of SSS remains controversial. Prior research suggested that SSS programs may result in anxiety for both children and parents. Unfortunately, no study has examined the SSS referral processes and anxiety in families. Study consisted of 2 groups-patients/parents from TSRHC evaluated for Adolescent Idiopathic Scoliosis (AIS) (n = 27) and control participants/parents (n = 27) between ages 9 and 17. All participants completed the primary outcome measure (State-Trait Anxiety Inventory) before and after the scoliosis evaluation or controlled wait time. Parents also rated experience and satisfaction with SSS. Compared with the control group, children/parents in patient group experienced significantly elevated levels of state-anxiety at preappointment. Children/parents in the patient group not diagnosed with AIS experienced a significant decline in state-anxiety. Children/parents in the patient group diagnosed with AIS continued to report elevated levels of anxiety. The control group remained consistent, reporting of low levels of anxiety pre to post. More than half (55.5%) of families indicated they received no information from the school about scoliosis. A third of the families who received information indicated it did not adequately address their concerns. Nonetheless, most families reported overall satisfaction with SSS. This study suggested that children and parents referred through the SSS program experienced significantly elevated levels of state-anxiety. This supports the subjective concerns of anxiety experiences in families voiced by researchers previously. However, families deemed the costs of the SSS referral process as worth the benefits. Though challengers of SSS programs were accurate in observing anxiety in families, it may not constitute significant burden to eliminate SSS programs altogether. Improvements to the current system may be warranted. 3.

A glimpse into Texas Scottish Rite Hospital's educational, clinical care, and research development.

This article describes four areas of pediatric orthopaedic education, research, and clinical care undertaken at Texas Scottish Rite Hospital (TSRH) over the past 25 years. These areas include the weekly preoperative conferences, the evolution of the limb lengthening and deformity correction program, the development of the TSRH instrumentation system, and the evolution of the clubfoot treatment program.

37th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 19–20, 2015

37th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 19–20, 2015

BOOK REVIEW Tachdjian’s Pediatric Orthopaedics: from the Texas Scottish Rite Hospital for Children

BOOK REVIEW Tachdjian’s Pediatric Orthopaedics: from the Texas Scottish Rite Hospital for Children

Texas Scottish rite hospital special issue. Preface.

Children’s Orthopaedic Centre, Mumbai, India Correspondence to Ashok N. Johari, MS Orth, MCh Orth, DNB Orth, FCPS, FRCS, FAMS, Children’s Orthopaedic Centre, Bobby Apts, Lady Jamshedji Road, Mahim, Mumbai 400 016, India Tel: +91 22 24365050/24374040; fax: +91 22 24363030; e-mail: [email protected]