Treatment of unilateral L5-S1 locked facet in a pediatric patient.

Background: Traumatic unilateral lumbosacral facet dislocations are rare injuries. The majority of cases are treated with open reduction and instrumented spinal fusions. Only less commonly can they be managed conservatively. Case Description: A 7-year-old unrestrained passenger was involved in a high-speed motor vehicle accident. X-ray/magnetic resonance/computed tomography imaging documented a unilateral L5-S1 facet dislocation and multiple lumbar/sacral fractures. The patient underwent open reduction and temporary L5-pelvic instrumentation without fusion; the instrumentation was removed 10 weeks later at which point follow-up imaging showed preserved lumbosacral stability. Conclusion: Open reduction with temporary instrumentation without fusion was successfully utilized to treat a unilateral L5-S1 facet dislocation in a 7-year-old child.

Dual Suture Button Fixation With Buttress Plate for Ankle Syndesmotic Injury.

SUMMARY: In this video, we present a unique approach to a purely ligamentous syndesmotic injury in a 16-year-old football player. Syndesmotic reduction was obtained using a large clamp and validated by matching fibular position to a fluoroscopic image of the contralateral ankle. Fixation was achieved using dual suture button devices in combination with a buttress plate. A small medial incision was used to protect the saphenous neurovascular bundle during button placement.

Elastomeric Pain Pumps for Scoliosis Surgery.

Objective  Postoperative pain management following scoliosis surgery has traditionally relied on intravenous opioids. The objective of this study was to evaluate the effect of elastomeric pain pumps. Methods A retrospective chart review of 81 adolescent patients who underwent scoliosis surgery in a seven-year period was performed. Patients were divided into three groups as the practice changed: (1) patient-controlled analgesia group (12 patients) who used intravenous (IV) opioids with oral opioids; (2) elastomeric pain pump group (28 patients) with the added use of bupivacaine; and (3) multimodal pain pump group (41 patients) with the added use of gabapentin and methocarbamol. Endpoints were analyzed for length of stay in the hospital, infection rate, and gastrointestinal retention. Results The length of stay in the elastomeric pain pump group was 3.1 days shorter than in the patient-controlled analgesia group (P = 0.004). The length of stay in the multimodal group was 3.9 days shorter than in the patient-controlled analgesia group (P = 0.001). The incidence of prolonged postoperative bowel retention decreased significantly from 25% to 18% to 2% (P = 0.03). Conclusions To our knowledge, this is the first study on the use of elastomeric pain pumps in conjunction with multimodal pain medication following scoliosis surgery. The use of elastomeric pain pumps was associated with clinically and statistically significant improvements in the postoperative course. The addition of methocarbamol and gabapentin was associated with a trend toward further improvements.

The relationship between repeat tympanostomy tube insertion and adenoidectomy.

OBJECTIVES: To examine the relationship between adenoidectomy and repeat tympanostomy tube placement in the treatment of otitis media, and the relationship between potential risk factors for otitis media and repeat tympanostomy tube placement. METHODS: Retrospective, cross-sectional analysis of consecutive patients undergoing tympanostomy tube placement at an academic/teaching hospital with 400+ beds. Utilizing an electronic billing database, patients less than 18 years of age undergoing tympanostomy tube placement between January 1, 2000 and December 31, 2007 were identified. Information regarding initial and repeat tympanostomy tube placement as well as potential risk factors for otitis media were extracted from medical records. RESULTS: 904 children were included in the study. Of the 780 children who initially underwent tympanostomy tube placement alone, 178 required additional tube placement; a repeat rate of 20%. Of the 90 children who initially underwent tympanostomy tube placement with adenoidectomy, only 6 required repeat tube placement, a statistically significant decrease in the incidence of repeat tympanostomy tube placement (95% CI, 0.056-0.334; p<0.0001). The presence of craniofacial anomalies and day care/school attendance were significantly associated with additional tube placement. Children between the ages of 4 and 10 showed a significant (p<0.0001) decrease in the risk of repeat tube placement when an adenoidectomy was performed at the initial tube placement. CONCLUSION: Adenoidectomy performed at the first tympanostomy tube for the treatment of otitis media may decrease the risk of repeat tube placement, especially for children >4-10 years of age.