Alternative and Adjunct Treatments for Scoliosis: A Google Trends Analysis of Public Popularity Compared With Scientific Literature.

Purpose As Google searches have often been found to provide inaccurate information regarding various treatments for orthopedic conditions, it becomes important to analyze search trends to understand what treatments are most popularly considered and the quality of information available. We sought to compare the public interest in popular adjunct/alternative scoliosis treatments to the published literature on these topics and assess any temporal trends in the public interest in these treatments. Methods The study authors compiled the most common adjunct/alternative treatments for scoliosis on PubMed. Chiropractic manipulation, Schroth exercises, physical therapy, pilates, and yoga, along with "scoliosis," were each entered into Google Trends, collected from 2004 to 2021. A linear regression analysis of covariance (ANCOVA) was done to determine whether there was a linear relationship between Google Trends' popularity and PubMed publication data. The seasonal popularity of the terms was assessed using locally estimated scatterplot smoothing (LOESS) regression. Results Google Trends and publication frequency linear regression curves were different for chiropractic manipulation (p < 0.001), Schroth exercises (p < 0.001), physical therapy (p < 0.001), and pilates (p = 0.003). Chiropractic manipulation (p < 0.001), Schroth exercises (p = 0.003), and physical therapy (p < 0.001) had positive trends, and yoga (p < 0.001) had a negative trend. Chiropractic manipulation and yoga were more popular in the summer and winter months. Conclusion Google Trends can provide orthopedic surgeons and other healthcare professionals with valuable information on which treatments are gaining popularity with the public, so physicians may specifically inform themselves prior to patient encounters, leading to more productive shared decision-making.

Socioeconomic Factors Correlation With Idiopathic Scoliosis Curve Type and Cobb Angle Severity.

INTRODUCTION: Race and socioeconomic status correlate with disease outcomes and treatment in patients with idiopathic scoliosis (IS) to varying degrees, although there is no clear association with Cobb angle and curve type. The purpose of this study was to assess socioeconomic factors and their association with Cobb angles in patients with IS. METHODS: A retrospective chart review was completed with the radiographic analysis of 89 patients diagnosed with IS and spinal curves >10° between the ages of six and 18. Associations between the Cobb angles and socioeconomic categorical variables were analyzed using a nonparametric Kruskal-Wallis test and continuous variables using a Spearman Rank correlation.  Results: There were no significant associations between proximal thoracic, main thoracic, or thoracolumbar/lumbar Cobb angles and sex, insurance type, race, access to healthy food, financial difficulty, or income. BMI and proximal thoracic Cobb angle (ρ = 0.2375, p=0.0268) had a significant positive correlation, and BMI and income (ρ = -0.2468, p=0.0228) shared a significant negative correlation. CONCLUSIONS: The severity of IS proximal thoracic Cobb angles was positively associated with BMI and income. Other socioeconomic factors such as age, race, sex, access to food, insurance, and financial difficulties related to scoliosis treatment were not correlated with Cobb angle severity. The data presented suggest that patients with IS have varying degrees of curve type and severity that overall do not correlate with various socioeconomic factors. Validating which factors are predictive of curve severity could lead to early intervention preventing further morbidity of IS.

Medial Proximal Tibia Physeal Overuse Injury of an Athlete.

Overuse injuries are well described for both upper and lower extremities among skeletally immature athletes. To our knowledge, there is no description in the literature of an overuse injury affecting the medial tibial physis that is different from the typical Osgood-Schlatter disease or tibial tubercle apophysitis. In this article we present a 13-year-old athlete with medial proximal tibial widening or epiphysiolysis from overuse playing soccer. We need to be aware that with increased early sports specialization we may see injuries we have not seen before. [Orthopedics. 2022;46(6):e345-e347.].

Pediatric Tibial Shaft Fractures.

Tibial shaft fractures are one of the most common pediatric fractures. They require appropriate diagnosis and treatment to minimize complications and optimize outcomes. Diagnosis is clinical and radiological, which can be difficult in a young child or with minimal clinical findings. In addition to acute fracture, Toddler's and stress fractures are important entities. Child abuse must always be considered in a nonambulatory child presenting with an inconsistent history or suspicious concomitant injuries. Treatment is predominantly nonoperative with closed reduction and casting, requiring close clinical and radiological followup until union. Although there is potential for remodeling, this may not be adequate with more significant deformities, thus requiring remanipulation or rarely, operative intervention. This includes flexible intramedullary nailing, Kirschner wire fixation, external fixation, locked intramedullary nailing, and plating. Complications are uncommon but include deformity, growth arrest, nonunion, and compartment syndrome.

A retrospective comparison of intraoperative CT and fluoroscopy evaluating radiation exposure in posterior spinal fusions for scoliosis.

BACKGROUND: Radiation exposure is a concern in the field of medicine. Deformity spine surgeons depend on modalities that have high exposure through scoliosis x-rays or computed tomography. The use of fluoroscopy has increased with the increased use of pedicle screws. Recently other 3-D imaging devices with navigation have also been brought onto the market to improve accuracy of screw placement. There is concern that because of the use of CT, the radiation dose to the patient is increased, however there is little literature that directly compares the amount of radiation using the 3-D devices to traditional fluoroscopy. Although we know intraoperative CT decreases the amount of radiation to the surgeon and operating room staff, there is limited comparison data for exposure to patients. Our study focused on a comparison of radiation exposure data for pediatric scoliosis patients receiving posterior spinal fusions using traditional fluoroscopy and the Medtronic O-arm in an effort to determine the method most likely to decrease radiation exposure in the pediatric population. METHODS: Retrospective review of data in patient charts from two pediatric surgeons practicing in both a University and private hospital setting. Data collected included age, weight, height, diagnosis, Cobb angle, fusion levels, number of screws, and number of hooks, O-arm spins, fluoro doses and O-arm doses. Effective dose was calculated using output measures and radiation doses were compared along a continuum that took into account the amount of correction as indicated by Cobb angle. RESULTS: A total of 57 patients, 25 using the O-arm and 32 using traditional fluoroscopy, were analyzed. Effective dose was calculated and then compared as a factor correlated to curve severity. At lower angles of correction we found no statistically significant difference between methods in terms of effective radiation dose. There was no statistically significant divergence until a Cobb angle correction of greater than 74 degrees, where the Oarm dose was shown to be lower by comparison. CONCLUSION: We found that regardless of the methods used there is still a significant radiation dose that is utilized in scoliosis procedures. The two methods analyzed did not display statistically significant differences in effective dose for the average case. Safely managing radiation exposure for pediatric patients is of the utmost priority. Healthcare professionals, however, face repeated exposure to radiation over the course of a long career. In our data set the O-Arm system does not increase overall exposure for patients and decreases radiation doses for providers and thereby provides a safe alternative to traditional fluoroscopy without compromising accuracy of implant placement or patient care.Level of Evidence: III.

The usefulness of MRI in atypical pulled/nursemaid's elbow: a case report.

BACKGROUND: A nursemaid's elbow most frequently occurs with transient longitudinal traction of the pronated forearm and extended elbow, which can be reduced by manipulation without sedation. There are circumstances in which the history is atypical and reduction of the elbow is unsuccessful. Imaging may be helpful in these cases. METHODS: A 33-month-old child was injured in a fall from a tire swing and sustained what was thought to be a nursemaid's elbow. Typical reduction maneuvers were unsuccessful. The patient underwent magnetic resonance imaging (MRI) with conscious sedation, which demonstrated the entrapment of the annular ligament in the radicapitellar joint. A presumed successful reduction was performed with confirmed reduction of the annular ligament by immediate MRI. CONCLUSIONS: To our knowledge, this is the first case report on MRI being used to diagnose and confirm treatment of an atypical nursemaid's elbow. LEVEL OF EVIDENCE: IV.

Peri-implant fracture of the femur in an 11-year-old: a case report.

Fracture of the femur in the area of a pre-existing implant is not common in an adolescent. We report the case of a fracture, in the area of a pre-existing implant in an 11-year-old boy, after a fall from a bike. We are not aware of any similar reports in the literature.

Reliability and necessity of computerized tomography in distal tibial physeal injuries.

OBJECTIVE: Complex distal tibial physeal fractures can be difficult to characterize on plain radiographs. The role of computed tomography (CT) scans in the evaluation and treatment decision of these injuries is unclear. We aimed to determine whether or not the addition of CT would improve the reliability of fracture classification and treatment decision. METHODS: Five independent observers evaluated 50 distal tibial physeal fractures on 2 separate occasions for Salter Harris (SH) classification and treatment decision (surgical/nonsurgical) using plain radiographs (round 1) and combination of radiographs and CT (round 2). During round 1, observers were asked if they would order a CT, and during round 2, they were asked if the CT was useful. These rounds were repeated at 2 to 4 weeks to assess intraobserver reliability. Statistical analyses were performed to assess inter and intraobserver reliability using Kappa coefficient (κ). RESULTS: Intraobserver reliability for SH classification showed substantial agreement, κ=0.76 and κ=0.80, respectively, during round 1 and 2. Interobserver agreement on the SH class was lower during round 1 and 2 (κ=0.67 and κ=0.57, respectively). There also was almost perfect intraobserver and interobserver agreement in the measurement of displacement at the fracture site during both rounds 1 and 2. Intraobserver reliability for treatment decision was substantial, κ=0.74 and κ=0.80, respectively, during round 1 and 2. However, interobserver agreement for treatment decision was moderate (κ=0.48) and fair (κ=0.36), respectively, during round 1 and 2. Surgeons indicated that they would like to order CT scans for 66% of the time in round 1, but the interobserver agreement as to who would best benefit from the CT was only fair (κ=-0.23). The main purpose of ordering the CT was to delineate fracture anatomy (55% of the time) and the observers felt CT would add to their treatment decision only 26% of the time. During round 2, 75% of time surgeons felt that CT scan was useful. CT was thought to be most useful in guiding screw placement (56% of the time) and not as useful (28% of time) for treatment decision making. CONCLUSIONS: Addition of CT in complex distal tibial physeal fractures did not increase interobserver reliability to classify the fracture or the treatment decision. Surgeons reported that the CT was most useful to plan screw placement and changed their treatment decision in about a fifth of the cases.

Effect of pressure applied during casting on temperatures beneath casts.

BACKGROUND: Burns and pressure sores are common injuries during cast application. Various factors such as water temperature, padding, and cast material layers may play a role in these injuries; however, the effect of cast molding on temperatures and pressures has not been investigated. This raises the following questions, does the application of molding during cast application: (1) alter skin level temperatures in a variety of cast materials? and (2) risk inducing either thermal injury or pressure necrosis? METHODS: An upper extremity model was created to measure pressure and temperature underneath casting materials. Cast padding, water bath temperature, and cast thickness were standardized. A 3-point mold was simulated using 3 casting materials-Fiberglass only, Plaster Only splint, and Plaster splint overwrapped with Fiberglass-while pressure and temperature were recorded. RESULTS: : Pressure application led to a statistically significant (P<0.0001) increase in temperature at the sites where the mold was applied although absolute temperature did not reach the theoretical burn threshold of 49 to 50°C for the casting materials studied. With pressure applied, the Plaster/Fiberglass combination reached an average peak temperature of 47.9°C, which was maintained for up to 6 minutes. Neither Fiberglass nor Plaster Only reached peak temperatures of this magnitude (average of 42.7 and 43.6°C, respectively). Peak (369 mm Hg) and highest residual (21 mm Hg) pressures were below harmful levels. CONCLUSIONS: Pressure application during casting is a risk factor for burn injuries. Care should be taken when molding a plaster splint overwrapped in fiberglass by waiting until the plaster has fully cooled. CLINICAL RELEVANCE: Combined with other known risk factors, the pressure from molding a cast could increase the likelihood of causing cutaneous burns.

Can a bone marrow-based graft replacement result in similar fusion rates as rib autograft in anterior interbody fusion procedures for adolescent thoracolumbar scoliosis?

STUDY DESIGN: Nonrandomized consecutive case series comparing interbody spine fusion with autograft versus bone marrow-based graft replacement (BGR). OBJECTIVES: Effectiveness of bone marrow-based graft versus rib autograft in achieving anterior interbody fusion of the thoracolumbar/lumbar spine. SUMMARY OF BACKGROUND DATA: The use of bone marrow (BM) with graft materials was shown in a prior study to aid with bone regeneration. Limited clinical data are currently available to demonstrate the effectiveness of BM for spinal applications. Engineered matrices of collagen type I coated with hydroxyapatite and combined with BM have been safely used in both spinal and long bone applications. METHODS: Nineteen consecutive patients from 2003 to 2006 underwent anterior interbody fusion through an anterior approach with dual-rod instrumentation and structural interbody support for thoracolumbar scoliosis. Within 19 patients, there were 42 disc levels treated with graft replacement material combined with BM (BGR+BM) and 25 disc levels with rib autograft. The mean follow-up time was 17 months with a minimum of 6 months. Clinical and radiographic data included Scoliosis Research Society (SRS)-22 questionnaires and pain and fusion assessments of posterior-anterior and lateral radiographs, collected preoperatively and at 6, 12, and 24 months, postoperatively. RESULTS: At 6 months, 72% of BGR+BM segments versus 44% of autograft segments were defined as fused. All BGR+BM segments were fused by 12 months, and all autograft segments were fused by 24 months. There was no pseudoarthrosis or instrumentation failure, and interbody fusion rate was 100%. The average correction was 73.5+/-13.5%. The overall loss of correction from the immediate alignment to postoperative follow-up was less than 4%. There was no loss of sagittal plane alignment or measured kyphosis. No morbidity was observed at the BM aspiration site. CONCLUSIONS: Anterior spinal fusion using bone marrow-based graft substitutes for thoracolumbar adolescent idiopathic scoliosis demonstrated equivalent results to rib autograft when used with dual-rod instrumentation and structural support. In this patient series, the rate of fusion was faster in the bone marrow-treated segments. These results suggest that for patients as described in this cohort, bone marrow-based graft replacements can thus be used as an alternative, or adjunct, to autograft to achieve interbody fusion in scoliosis surgery.