The quality of pediatric orthopaedic information on the internet.

BACKGROUND: Many patients use the Internet for health information. However, there are few guarantees to the reliability and accuracy of this information. This study examined the quality and content of the Internet Web pages for 10 common pediatric orthopaedic diagnoses. METHODS: We identified 10 common diagnoses in pediatric orthopaedics: brachial plexus injury, cerebral palsy, clubfoot, developmental dysplasia of the hip, leg length discrepancy, osteochondroma, polydactyly, scoliosis, spina bifida, and syndactyly. We used 2 of the most popular search engines to identify the top 10 Web sites for each disease. We evaluated the Web sites utilizing both the quality-based Health On the Net (HON) Foundation criteria and our own content-based grading sheets. The custom grading sheets focused on essential information about disease summary, pathogenesis, diagnosis, treatment, and prognosis. RESULTS: Three orthopaedic surgeons graded 98 academic, commercial, nonprofit, and physicians' Web sites for 10 diseases. Academic Web sites scored the highest in content (mean, 60.8% ± 15.5%), whereas commercial Web sites scored the lowest (mean, 46.7% ± 22.2%). Among the diagnoses, osteochondroma Web sites had the highest content scores (mean, 75.8% ± 11.8%), whereas polydactyly Web sites had the lowest content scores (mean, 39.3% ± 15.7%). In contrast, Web sites about developmental dysplasia of the hip had the highest HON scores (65.0 ± 11.1), whereas those about brachial plexus birth palsy scored the lowest (42.6% ± 16.9%). Among the content subgroups, scores were generally higher for disease summary and diagnostics and lower for prognosis. CONCLUSIONS: The Internet Web sites reviewed demonstrated a wide range of content and information. We found that nonprofit and academic Web sites were the most reliable sources, whereas commercial and, surprisingly, physician-run Web sites were the least reliable. We advise physicians to talk to their patients about the information they get on the Internet and how it dictates their expectations. We hope this study, combined with further understanding of how our patients use this information, can help improve the Internet content. CLINICAL RELEVANCE: Physicians should know that their patients may be receiving misleading information from the Internet and be able to discuss this with their patients.

Comparison between rigid and flexible systems for drilling the femoral tunnel through an anteromedial portal in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to compare the differences in femoral tunnel length and distance to the lateral anatomic structures when using standard and flexible guide pins for anterior cruciate ligament (ACL) femoral tunnel drilling through a medial portal. METHODS: Using a medial arthroscopic portal in 10 cadaveric knees, we sequentially drilled straight and flexible guide pins into the center of the ACL femoral footprint using the same starting point. We recorded the interosseous length and distances to the peroneal nerve and the femoral origin of the lateral collateral ligament (LCL) for each pin. RESULTS: The mean interosseous length was 43.5 mm for the flexible pin and 37.1 mm for the straight pin (P = .01). The mean distance to the peroneal nerve was 42.3 mm for the flexible pin and 37.8 mm for the straight pin (P = .33). The mean distance to the femoral origin of the LCL was 26.1 mm for the flexible pin and 13.4 mm for the straight pin (P = .003). CONCLUSIONS: The use of commercially available flexible reamers and 42 degrees femoral guides results in longer femoral interosseous tunnel length than can be achieved with a straight guide pin. Femoral interosseous length consistently of 40 mm can be achieved with this technique and cannot be replicated with a rigid straight pin. This is advantageous for femoral tunnel drilling in an anatomic ACL reconstruction that uses suspensory fixation devices. There is minimal risk to the peroneal nerve and the femoral origin of the LCL unless lateral femoral wall blowout occurs. CLINICAL RELEVANCE: Flexible pins allow longer femoral tunnels and safer distances from the LCL by use of a medial portal technique.

A biomechanical comparison of trochanteric nail proximal screw configurations in a subtrochanteric fracture model.

OBJECTIVES: Historically, because of the magnitude of muscle forces exerted locally, as well as the commonly associated comminution, subtrochanteric fractures have been difficult to treat. Tencer et al found intramedullary nail fixation to be superior to lateral plate constructs in axial compression and combined bending. In addition, reconstruction-type intramedullary nails of more recent design have been shown to provide strength and stiffness superior to that supplied by the earlier antegrade intramedullary implants. A relatively new reconstruction nail, the DePuy VersaNail Troch Entry Nail (DePuy Orthopaedics, Inc., Warsaw, IN, USA), is unique in that it allows for two different proximal two-screw configurations: (1) the common parallel cephalomedullary arrangement and (2) a novel crossed-screw pattern. Our hypothesis was that the crossed-screw configuration would be as strong in axial loading as the cephalomedullary screw configuration. METHODS: Twenty composite femurs were instrumented using the DePuy VersaNail Troch Entry Nail in a subtrochanteric fracture model: 10 with the crossed proximal screw configuration and 10 with the traditional parallel screw configuration. These constructs were first loaded axially to calculate their stiffness and then axially loaded to failure. RESULTS: One specimen was rendered unusable for all calculations. Therefore, 19 constructs were evaluated: 9 parallel screw constructs, 10 crossed-screw constructs. The crossed-screw construct had a significantly higher stiffness than the parallel screw construct (347 +/- 73 N/mm and 261 +/- 42 N/mm, respectively; P = 0.01) and a significantly higher axial load to failure (2848 +/- 391 N vs. 2300 +/- 444 N; P = 0.01). CONCLUSIONS: This study shows that axial failure loads of the crossed-screw configuration were greater than those of the parallel screw configuration. Clinically, this provides the surgeon more options for stabilizing a subtrochanteric femur fracture. This decision may be made intra-operatively if necessary, facilitating fracture fixation and providing a stable construct.

Face tissue pressure in prone positioning: a comparison of three face pillows while in the prone position for spinal surgery.

STUDY DESIGN: This is a prospective, randomized study. OBJECTIVE: The purpose was to compare the tissue-pillow interface pressures at the forehead and chin in patients positioned in the prone fashion for spinal surgery on each of 3 facial positioners. SUMMARY OF BACKGROUND DATA: Facial pressure ulcers have been infrequently observed after spinal surgery requiring prone positioning. This requires the use of a specially designed head positioner to maintain spinal alignment and to allow space for the endotracheal tube. METHODS: We enrolled 66 consecutive elective thoracic and/or lumbar surgery patients from 18 to 65 years of age. Patients were randomized on entry into the study to 1 of 3 positioners. Facial tissue pressures were measured at the patient's forehead and chin at times 0, 5, 15, and 60 minutes of positioning. The integrity of the patient's skin was recorded and classified at the end of surgery. RESULTS: The pressures measured for the Dupaco positioner were lower at all time points at both the forehead and the chin in comparison with the other 2 positioners (P < 0.05). The ROHO and the OSI positioners created similar chin pressures at all time points (P > 0.05). The pressures at the forehead for the ROHO positioner were significantly less than those for the OSI positioner at all time points (P < 0.05). Ten patients on the OSI positioner had pressure ulcers at the end of the procedure. CONCLUSION: The Dupaco ProneView Protective Helmet System is superior to both the OSI and the ROHO positioners in decreasing forehead and chin tissue interface pressures during prone position surgery.