Faculty Bibliography

BACKGROUND:The common practice of performing concurrent or overlapping operations has been intensely scrutinized by lay media and academic press to investigate its safety and cost-effectiveness. However, there is little information about its use within the pediatric population. Even less is known about parents' expectations about the surgeon's role on the day of operation and how they align with those of pediatric surgeons and surgical trainees, despite the potential for significant discrepancies in expectations to erode trust and damage the physician-family relationship. STUDY DESIGN/METHODS:A 5-point Likert-style survey was designed to characterize expectations about the degree of involvement by pediatric attending surgeons throughout a surgical case (1 = strongly disagree, 3 = neutral, 5 = strongly agree). The survey was administered to parents of pediatric patients undergoing elective operations during a 3-month interval at a single academic institution. The survey was also administered to surgeons and surgical residents at the same institution. Multivariate multiplicity-adjusted t-tests were used to identify significant differences between responders. RESULTS:One hundred and ten parents and 84 pediatric surgeons and trainees completed the survey. Parents' responses to the survey ranged from 4.15 to 4.89, compared with 2.75 to 4.86 from surgeons. The differences achieved statistical significance (p < 0.05) for 8 of 9 statements. Statistically significant differences were fewer, but still present, between attending surgeons and surgical trainees, as well as between surgeons with and without children. CONCLUSIONS:There is a significant mismatch between parents' expectations and those of pediatric surgeons about the role of the surgeon on the day of operation, with parents consistently expecting more direct involvement by the attending surgeon. These discrepancies can have implications for both parent/patient satisfaction and medical education.

Firearm injuries are a major cause of morbidity and mortality among children and adolescents in the United States and take financial and emotional tolls on the affected children, their families, and society as a whole. Musculoskeletal injuries resulting from firearms are common and may involve bones, joints, and neurovascular structures and other soft tissues. Child-specific factors that must be considered in the setting of gunshot injuries include physeal arrest and lead toxicity. Understanding the ballistics associated with various types of weaponry is useful for guiding orthopaedic surgical treatment. Various strategies for preventing these injuries range from educational programs to the enactment of legislation focused on regulating guns and gun ownership. Several prominent medical societies whose members routinely care for children and adolescents with firearm-related injuries, including the American Academy of Pediatrics and the American Pediatric Surgical Association, have issued policy statements aimed at mitigating gun-related injuries and deaths in children. Healthcare providers for young patients with firearm-related musculoskeletal injuries must appreciate the full scope of this important public health issue.

BACKGROUND:Despite increasing numbers of female orthopaedic surgeons, we hypothesized that women were not actively participating at national and international meetings in numbers proportional to their membership. METHODS:A retrospective review of the 2009-2013 POSNA Annual Meeting Final Programs was performed. The following information was recorded for all members: name, sex, membership level, years of membership, and if the individual was an author on at least 1 abstract. To compare proportion of abstract authorship between sexes across years, while controlling for years of membership, general estimating equations with a binomial model and logit link were used. The study population was limited to candidate and active POSNA members only, as this group represents the most active practicing pediatric orthopaedic surgeons. RESULTS:Over the 5-year period studied, females comprised 16.6% (204/1227) of the total POSNA membership and 20.9% (184/880) of members at candidate and active status. The percentage of females with candidate or active member status in POSNA who had at least 1 abstract presentation during the 5 years was 37% and this was significantly lower (P=0.003) than the percentage of men (49%) who presented at least 1 abstract. Analysis across the 5 years showed a consistent difference between the sexes with no trend of convergence in abstract rates (P=0.65). Controlling for years membership, female members still presented abstracts at lower rates than their male colleagues (P=0.002). CONCLUSIONS:Female members of POSNA, in the most active part of their careers, participated at significantly lower rates than their male peers as accepted abstract authors for the 2009-2013 POSNA meetings than would be expected for their proportional size of total membership.

Femoroacetabular impingement (FAI), a recently described hip condition in adolescents and young adults, typically manifests as activity-related hip pain. Characteristic physical findings include limited passive internal rotation of the affected hip and a positive impingement sign. Diagnostic imaging may reveal cam and/or pincer lesions, and associated intra-articular pathology (eg, labral tear, chondral damage) is common. When nonoperative treatment fails to adequately alleviate symptoms, surgery may be warranted. Both open and arthroscopic techniques have been effective. As our understanding of FAI continues to evolve, sex-based differences in incidence, presentation, and outcomes for patients with FAI have become apparent. Understanding the different ways in which males and females may present with FAI and then changing clinical practice patterns to accommodate these sexual dimorphisms will likely result in improved outcomes for each patient with symptomatic FAI.

BACKGROUND:Although it has been postulated that injury to the proximal femoral physis results in the formation of a cam lesion, a clear causal association has not been established. PURPOSE/OBJECTIVE:The purpose of this study was to investigate the relationship between the physis and the cam lesion. Our hypotheses were that (1) the location of the cam lesion would coincide with the growth plate and (2) the distance between the cam lesion and the physis would vary as a function of skeletal maturity. METHODS:A retrospective review of the charts and magnetic resonance images of adolescent patients with femoroacetabular impingement (FAI) was performed. Data collected included the alpha angle, the distance between the cam lesion and physis, and physeal status. Linear mixed models were used to describe the association between the distance to the cam lesion and physeal status. RESULTS:Twenty-four hips in 17 patients were included. The average alpha angles were 50.7, 63.2, 64.4, and 63.9 degrees for the anterior, anterosuperior, superoanterior, and superior radial magnetic resonance imaging sections. The average distance from the cam lesion to the physis was 0.07 cm. There was a significant association between physeal status and the distance of the cam lesion to the physis. CONCLUSIONS:The location of the cam lesion occurs at the level of the physis. In skeletally mature adolescents, the cam lesion is located further from the physis than it is in patients whose growth plates remain widely open. This suggests a possible causal relationship between physeal injury and the development of the cam deformity in patients with femoroacetabular impingement. LEVEL OF EVIDENCE/METHODS:Level IV-retrospective case series.