BACKGROUND:Surgical hip dislocation with modified Dunn procedure (MD) is a viable treatment option for moderate to severe slipped capital femoral epiphysis (SCFE). In the acute setting, an experienced surgeon may not be immediately available for the MD. However, in situ pinning (ISP) is a well-accepted initial treatment and may be more familiar to the on-call orthopaedic surgeon. Our aim was to compare outcomes at short and midterm follow-up in patients with moderate/severe SCFE undergoing ISP with subsequent MD versus primary MD. METHODS:Between June 2017 and July 2024, we treated 29 patients for SCFE. During this time, we generally indicated the modified Dunn procedure when the slip angle was ≥30 degrees. Radiographic morphologic parameters were measured before surgery and at a minimum follow-up of 8.5 months. Radiographs at final follow-up were also screened for signs of osteoarthritis by the senior hip surgeon. After adjusting for age and sex, we used multivariable linear regression to assess differences in continuous outcomes between the ISP+MD and MD-only groups, and logistic regression to evaluate differences in the odds of binary outcomes between groups. The Wilcoxon rank-sum test tested differences in the distribution of Merle d'Aubigné scores between groups. RESULTS:Twelve patients underwent initial ISP with subsequent MD; 17 patients underwent primary MD. Median time between ISP and MD was 35 days (range: 5 to 137 d). There was no difference in complication rate between groups, including the incidence of AVN (17% in ISP+MD vs. 12% in MD; P≥0.99). Merle d'Aubigné scores at final follow-up were 18 (interquartile range: 16 to 18) in the ISP+MD group versus 17 (interquartile range: 16 to 18) in the MD group (P=0.36). There were no significant differences in radiographic outcomes between groups at final follow-up. CONCLUSION:In this series, a temporary ISP before modified Dunn in moderate and severe slips was a safe alternative to primary MD if an experienced hip surgeon was not immediately available. This allows for optimization regarding surgical timing with an experienced hip surgeon, preoperative patient and family education of surgical risks and benefits, and postoperative compliance with precautions after MD. A longer follow-up duration and results from other centers are warranted for this approach. This study contains a small patient cohort and may be underpowered to detect smaller differences that may be detectable with a higher-powered study. LEVEL OF EVIDENCE:Level II, prospective comparative study.

CONTEXT:Clinical assessments of the cervical spine and vestibular/oculomotor systems may inform return-to-play (RTP) clearance time after concussion and inform individualized concussion prognosis. Our objective was to investigate whether cervical spine and vestibular/oculomotor clinical assessments were associated with RTP clearance time after concussion. DESIGN:Prospective cohort study. METHODS:Adolescents ages 13-18 years within 3 weeks of concussion completed assessments of symptom severity using the Post-Concussion Symptom Inventory, cervical spine proprioception (head repositioning accuracy [HRA]), and symptom provocation with vestibular/oculomotor testing (visio-vestibular exam [VVE]; assesses smooth pursuits, saccades, vestibulo-ocular reflex, and motion sensitivity). HRA was performed with eyes closed and involved patients relocating their head to a neutral starting position after right/left rotation and cervical spine flexion/extension. The mean distance (distance between center position and each self-reported center point) across 12 trials was used in analysis as the measure of HRA error. For VVE, we used the number of tests that provoked symptoms for analysis. We then monitored participants until they received RTP clearance from their physician. We used multivariable linear regression with RTP clearance time (days from concussion to RTP clearance) as the outcome, HRA error and number of positive VVE subtests as predictors, adjusting for covariates. RESULTS:We assessed 68 participants (age = 15.8 (1.4) y, 59% female, mean = 11.0 (3.8) d of postconcussion). After adjusting for age, sex, concussion history, initial symptom severity (Post-Concussion Symptom Inventory score), and days from concussion to assessment, neither HRA error (hazard ratio = 0.89; 95% confidence interval, 0.71-1.12; P = .34) or number of positive VVE subtests (hazard ratio = 1.06; 95% confidence interval, 0.91-1.24; P = .47) were associated with RTP clearance time. CONCLUSIONS:Cervical spine proprioception and vestibular/oculomotor symptom provocation evaluated within 3 weeks of injury were not associated with RTP clearance time, potentially reflecting the complexity and multifaceted nature of RTP decisions.

INTRODUCTION:In paediatric patients with concern for septic arthritis, arthrocentesis may be performed under anaesthesia with intraoperative cell count determining need for surgical intervention. Shorter turnaround time (TAT) between collection and result minimises anaesthesia exposure for the patient and surgical time for the treatment team. This study evaluated a quality improvement (QI) initiative to decrease TAT to <1 hour by improving interdisciplinary communication and placing visual reminders ('stat card') to indicate priority handling. METHODS:206 consecutive paediatric patients who underwent arthrocentesis for the diagnosis of septic arthritis were identified. Midway through the collection period, the QI intervention (stat card) was implemented. We collected the date and time of arthrocentesis and sample verification (TAT) and calculated the proportion of TAT <1 hour preintervention and postintervention. We collected variables related to the affected joint and whether the stat card was used. Operative time was calculated for those samples collected in the Operating Room (OR). RESULTS:The final study population included 109 patients preintervention and 88 patients postintervention. Postintervention, the stat card was used in only 44% (20/45) of eligible cases. Compliance was highest in aspirations of the hip (75%). After adjusting for the affected joint, the odds of TAT <1 hour were higher in the postintervention stat card group compared with the postintervention no stat card group (odds ratio 7.10, p=0.0147) and to the preintervention group (odds ratio 3.63, p=0.0810). There was no difference between the postintervention no stat card versus the preintervention groups (odds ratio 0.51, p=0.2524). TAT was significantly decreased when the stat card was used (42 min) compared with when it was not used (84 min) (mean difference -39.5%, p=0.0178). After adjusting for the affected joint, there was no difference in operative time across the three groups (p=0.2531). CONCLUSION:A multidisciplinary QI initiative for the intraoperative diagnosis of septic arthritis was effective in reducing cell count TAT but demonstrated poor compliance and failed to reduce operative time.

Background: Tibia fractures are the third most common pediatric long bone fractures and are associated with numerous complications such as compartment syndrome, angular deformity, and nonunion. This study sought to determine if complication rates were higher in open tibia fractures than in closed tibia fractures in the pediatric population, with the hypothesis that there would be no difference. Methods: A single-center, retrospective cohort study was performed at a quaternary care academic pediatric hospital identifying all open tibia fractures treated from March 1, 2016, to November 30, 2021. These patients were matched by sex, age, and injury pattern, with patients treated for closed tibia fractures during this same time period. Data collected included demographics, clinical and radiographic information, and complications. Results: Both fracture groups included 30 patients (24 males and 6 females). The average age at injury was 11.3 years in the open group, and 11.2 years in the closed group. The median follow-up duration was 7.7 months (1.2-67.8 months) and 9.3 months (1.4-62.9 months) for the open and closed groups, respectively, (P = .5749). One hundred percent of open fractures were treated operatively, versus 50% of the closed-group ones (P < .0001). There was no significant difference in any type of complications when comparing the open group to the closed tibia fracture group (odds ratio: 1.29, 95% confidence interval: 0.48 to 3.45, P = .6180). The most common complication was the development of a clinically significant angular deformity (26.7% in the open group and 10% in the closed group, P = .1806). There was a 10% rate of compartment syndrome in both groups and a nonunion rate of 6.7% for the open group and 3.3% for the closed group (P > .999). Conclusions: This pilot study utilizing a matched cohort found no significant difference in complication rates between open and closed pediatric tibia fractures, though complications were prevalent in both groups. These findings emphasize the importance of maintaining a high clinical suspicion for compartment syndrome and thoroughly counseling patients on the risks of angular deformity. Key Concepts: (1) A matched cohort study demonstrates complication rates are similarly high in both open and closed pediatric tibial shaft fractures. (2) Angular deformity is the most common complication overall. (3) Treatment algorithms may differ in open versus closed tibial shaft fractures, with open fractures fixated with different constructs and immobilized for longer. Level of Evidence: Level III, case control study

PURPOSE:This study aimed to examine associations between clinical measures (self-reported and clinician administered) and subsequent injury rates in the year after concussion return to play (RTP) among adolescent athletes. METHODS:We performed a prospective, longitudinal study of adolescents ages 13-18 yr. Each participant was initially assessed within 21 d of concussion and again within 5 d of receiving RTP clearance from their physician. Participants completed self-report measures: the Pittsburgh Sleep Quality Index and Tampa Scale of Kinesiophobia, and clinician-administered measures: single- and dual-task tandem gait and reaction time (RT; simple and clinical) assessments. They then completed monthly surveys for a year after RTP, which assessed exposure to injury (sport participation) and subsequent injuries (musculoskeletal or concussions) sustained. We used Poisson regression models to calculate injury rate ratios with the number of subsequent injuries sustained as the outcome, adjusted for RTP clearance time and competitive exposures for each measure. RESULTS:Forty-one participants were included (age = 15.5 ± 1.3 yr, 56% female, 9.6 ± 4.6 d postconcussion; 38.0 ± 31.5 d to RTP). A higher injury rate per athletic exposure was observed for simple RT ≥ 505 ms versus <505 ms (injury rate ratio = 2.96, 95% confidence interval = 1.41-6.60, P = 0.005). Injury rates did not significantly differ by Pittsburgh Sleep Quality Index or Tampa Scale of Kinesiophobia scores, single/dual-task tandem gait time, or clinical RT. CONCLUSIONS:Simple RT may be one risk factor that is associated with higher rates of subsequent injury after adolescent concussion. A simple RT measure incorporated into a comprehensive concussion RTP assessment may identify some individuals at higher risk of subsequent injury in the year after concussion, although further research is needed to better understand this relationship.

OBJECTIVE:Multiple studies have reported an inverse association between self-reported smoking during pregnancy and offspring type 1 diabetes (T1D) risk. We investigated the association between DNA methylation (DNAm) smoke exposure scores, parental self-reported smoking, and islet autoimmunity (IA) and T1D risk in children at high risk of T1D. RESEARCH DESIGN AND METHODS:We used longitudinal data from the Diabetes Autoimmunity Study in the Young cohort, including 205 IA case and 206 control participants (87 and 88 were T1D case and control participants, respectively), matched by age, race/ethnicity, and sample availability. DNAm profiles were obtained from cord or peripheral blood using the Infinium Human Methylation 450K or EPIC BeadChip. Three published DNAm smoking scores were calculated at every time point. To estimate in utero smoke exposure, participant-specific intercepts were derived from mixed-effects models of longitudinal DNAm scores. These intercepts strongly correlated with cord blood scores (r = 0.85-0.95; n = 179), indicating their utility as proxies for in utero smoke exposure. Associations with IA/T1D were evaluated using logistic regression, adjusting for HLA-DR3/4, first-degree relative status, and sex. RESULTS:Multivariable models showed both maternally reported smoking during pregnancy and higher DNAm smoking scores to be associated with lower risk of IA and T1D. Maternal smoking showed a strong inverse association with IA (odds ratio [OR] 0.24; 95% CI 0.10-0.54). Rauschert and McCartney DNAm scores showed consistent inverse associations with both outcomes (OR 0.65-0.83 for SD increase). CONCLUSIONS:Our study supports existing literature indicating in utero smoke exposure is associated with reduced IA and T1D risk. Further research is essential to uncover the underlying mechanisms.

ObjectiveTo investigate the association between concussion history and depressive symptoms after adjusting for physical activity, substance use, and illicit drug use.MethodsWe analysed data from the Adolescent Behaviour and Experiences Survey, a nationally representative survey of adolescents in the USA. Our independent variables were history of concussion in the 12 months preceding survey completion; self-reported weekly physical activity (days per week with >60 min of physical activity, 0–7 scale); substance use over the past 30 days (yes vs no) and illicit drug use throughout lifetime (yes vs no). Our dependent variable was participant-reported sadness/hopelessness over the past 12 months (yes vs no).ResultsAmong 7499 adolescents (9th–12th grade, 50.4% female), reporting one or more concussions over the past year was not associated with the odds of depressive symptoms (OR: 1.13, 95% CI: 0.93 to 1.37, p=0.21). Each additional day of physical activity per week was associated with a lower odds of depressive symptoms (OR: 0.91; 95% CI: 0.89 to 0.94; p<0.0001). Illicit drug use (OR ever vs never: 2.48; 95% CI: 1.96 to 3.13; p<0.0001) and substance use (OR yes vs no: 2.77; 95% CI: 2.34 to 3.29; p<0.001) were associated with a higher odds of depressive symptoms.ConclusionsAdjusting for physical activity, substance use and illicit drug use, concussion was not significantly associated with depressive symptoms. This novel discovery informs clinicians as they counsel adolescents with concussion; future research should examine physical activity and avoidance of substance/illicit drug use as postinjury recommendations in an effort to lower the risk of depressive symptoms.

BACKGROUND:Surgical treatment of a dislocated hip at walking age includes open reduction (OR) with or without osteotomies of the pelvis and/or femur. Three-dimensional imaging, such as computerized tomography (CT), can be utilized postoperatively to determine femoral head position following cast placement. Alternatively, intraoperative 3D imaging (O-arm) may be used for the same purpose. Disadvantages of CT include limited access to the patient's airway and high radiation dose. The current study aimed to determine the ability of O-arm imaging to visualize femoral head position following surgical treatment of a dislocated hip, and compare radiation dosage between CT and O-arm. METHODS:Thirteen patients (16 hips) with a dislocated hip at walking age who underwent OR with pelvic ± femoral osteotomies at a single institution were retrospectively reviewed. All patients underwent CT or O-arm evaluation following surgery and spica cast application. Total radiation dose per kilogram was compared between the CT (n=8 hips) and O-Arm 14 (n=8 hips) groups. Radiographic parameters and complication rates were analyzed. Image quality was blindly assessed by 3 fellowship-trained pediatric orthopedic surgeons with hip expertise. RESULTS:The mean age was 4.68 years (range: 3.1-7.8) in the CT group and 4.31 (range: 1.2-7.5) in the O-Arm group. The average radiation dose from the O-arm was lower than CT (4.51 19 mGy/kg vs. 6.12 mGy/kg, P =0.37). Five hips in the CT cohort were scanned post-extubation. All surgeons agreed that femoral head position was adequately visualized in all images from both groups. No patient in either group required a cast change post-scanning due to a malpositioned femoral head. CONCLUSION:The O-arm is a reasonable alternative to CT following surgical treatment of a dislocated hip. It may decrease radiation dose and provides adequate visual information to determine femoral head position following surgical intervention and casting. Utilization of the O-arm keeps the patient in the operating room during the study, allowing for immediate revision of the cast position or revision reduction if necessary, while maximizing access to the patient's airway and minimizing risk for adverse anesthetic events. LEVEL OF EVIDENCE:Level III, retrospective comparative study.

BackgroundType 1 diabetes (T1D) is preceded by a heterogenous pre-clinical phase, islet autoimmunity (IA). We aimed to identify pre vs. post-IA seroconversion (SV) changes in DNAm that differed across three IA progression phenotypes, those who lose autoantibodies (reverters), progress to clinical T1D (progressors), or maintain autoantibody levels (maintainers).MethodsThis epigenome-wide association study (EWAS) included longitudinal DNAm measurements in blood (Illumina 450K and EPIC) from participants in Diabetes Autoimmunity Study in the Young (DAISY) who developed IA, one or more islet autoantibodies on at least two consecutive visits. We compared reverters - individuals who sero-reverted, negative for all autoantibodies on at least two consecutive visits and did not develop T1D (n=41); maintainers - continued to test positive for autoantibodies but did not develop T1D (n=60); progressors - developed clinical T1D (n=42). DNAm data were measured before (pre-SV visit) and after IA (post-SV visit). Linear mixed models were used to test for differences in pre- vs post-SV changes in DNAm across the three groups. Linear mixed models were also used to test for group differences in average DNAm. Cell proportions, age, and sex were adjusted for in all models. Median follow-up across all participants was 15.5 yrs. (interquartile range (IQR): 10.8-18.7).ResultsThe median age at the pre-SV visit was 2.2 yrs. (IQR: 0.8-5.3) in progressors, compared to 6.0 yrs. (IQR: 1.3-8.4) in reverters, and 5.7 yrs. (IQR: 1.4-9.7) in maintainers. Median time between the visits was similar in reverters 1.4 yrs. (IQR: 1-1.9), maintainers 1.3 yrs. (IQR: 1.0-2.0), and progressors 1.8 yrs. (IQR: 1.0-2.0). Changes in DNAm, pre- vs post-SV, differed across the groups at one site (cg16066195) and 11 regions. Average DNAm (mean of pre- and post-SV) differed across 22 regions.ConclusionDifferentially changing DNAm regions were located in genomic areas related to beta cell function, immune cell differentiation, and immune cell function.

Background: Idiopathic scoliosis is a common structural spine curvature of unknown etiology. Scoliosis onset and progression are likely related to the interplay between genetics and the environment. Serum protein levels are influenced by both genetic and environmental factors and thus, are a promising methodology. Aims: We aimed to determine whether serum protein levels differed between idiopathic scoliosis cases and controls. In scoliosis cases, we also aimed to determine if protein levels were correlated with curve severity. Methods: In the discovery population, serum blood samples were obtained from 7 females with severe scoliosis and 11 unaffected female controls. Liquid chromatography-mass spectroscopy was used to quantify protein levels. Wilcoxon rank sum tests were used to test for differences between cases and controls. Within scoliosis cases, Spearman correlation coefficients were used to test the correlation between curve severity and age-adjusted protein levels. Candidate proteins were defined as proteins that significantly differed between cases and controls and were moderately or strongly correlated with curve severity (ρ>0.30). We validated candidate proteins using the SomaScan Discovery v4.1 proteomics platform with serum from 11 females with scoliosis. Results: In the discovery analysis, 10 proteins differed between cases and controls (p<0.05) and were correlated with protein levels (ρ=0.36-0.65). Of these candidate proteins, one protein, alpha 2-HS glycoprotein (AHSG), was significantly correlated with curve severity (p=0.0323) in the validation population. Fixed effects meta-analysis showed a strong inverse correlation between curve severity and decreasing alpha 2-HS glycoprotein levels (meta-combined ρ: -0.67, p=0.0052). Conclusion: Alpha 2-HS glycoprotein met our criteria for significance in both the discovery and validation populations. Developing a proteomic signature for idiopathic scoliosis has important clinical implications. This study supports the feasibility of untargeted proteomics and provides evidence for the potential role of alpha 2-HS glycoprotein levels in scoliosis etiology.

Objective: To investigate dizziness, vestibular/oculomotor symptoms, and cervical spine proprioception among adults with/without a concussion history. Methods: Adults ages 18-40 years with/without a concussion history completed: dizziness handicap inventory (DHI), visio-vestibular exam (VVE), and head repositioning accuracy (HRA, assesses cervical spine proprioception). Linear regression models were used to assess relationships between (1) concussion/no concussion history group and VVE, HRA, and DHI, and (2) DHI with HRA and VVE for the concussion history group. Results: We enrolled 42 participants with concussion history (age = 26.5 +/- 4.5 years, 79% female, mean = 1.4 +/- 0.8 years post-concussion) and 46 without (age = 27.0 +/- 3.8 years, 74% female). Concussion history was associated with worse HRA (8 = 1.23, 95% confidence interval [CI]: 0.77, 1.68; p < 0.001), more positive VVE subtests (beta = 3.01, 95%CI: 2.32, 3.70; p < 0.001), and higher DHI scores (beta = 9.79, 95%CI: 6.27, 13.32; p < 0.001) after covariate adjustment. For the concussion history group, number of positive VVE subtests was significantly associated with DHI score (beta = 3.78, 95%CI: 2.30, 5.26; p < 0.001) after covariate adjustment, while HRA error was not (beta = 1.10, 95%CI: -2.32, 4.51; p = 0.52). Conclusions: Vestibular/oculomotor symptom provocation and cervical spine proprioception impairments may persist chronically (i.e., 3 years) after concussion. Assessing dizziness, vestibular/oculomotor and cervical spine function after concussion may inform patient-specific treatments to address ongoing dysfunction.

Purpose Distal radius (DR) fracture fi xation with volar locked plating typically uses indirect fracture reduction without direct visualization of the articular surface in an attempt to preserve the volar radiocarpal ligaments and prevent iatrogenic radiocarpal instability. This study assessed the biomechanical stability after a volar radiocarpal arthrotomy for direct articular visualization for DR fracture repair compared to a standard trans- fl exor carpi radialis approach without arthrotomy in a cadaver model. Methods Ten fresh-frozen upper extremity matched -pair cadaveric specimens were tested. For each pair, one limb underwent trans-FCR approach with a volar arthrotomy that partially sectioned the long and short radiolunate ligaments to visualize the DR articular surface (Group 1). The contralateral limb underwent standard trans-FCR approach without arthrotomy (Group 2). Following capsular repair (Group 1), all specimens (Groups 1 and 2) underwent biomechanical testing, including axial loading (22.2 N, 44.5 N, 89.0 N, 177.9 N), volar translational, and dorsal translation loading (22.2 N, 44.5 N, 89.0 N) to assess carpal stability using both fl uoroscopy and motion capture. Ulnar carpal translation was assessed using the Gilula method, measuring radiographic lunate overhang from the ulnar edge of the lunate fossa relative to the full width of the lunate. Dorsal and volar translation were assessed by measuring lunate overhang with respect to the dorsal or volar radial cortex. To simulate fractures with dorsal radiocarpal ligament disruption, the dorsal capsule was sectioned, and the biomechanical comparisons were repeated. Results Ulnar translation of the lunate remained below 2 mm for both groups in all testing scenarios. No signi fi cant differences were identi fi ed in ulnar, volar, or dorsal translation with increasing loads between the groups. Conclusions This volar ligament -sparing radiocarpal arthrotomy did not cause biomechanical radiocarpal instability. Clinical relevance This arthrotomy may provide enhanced visualization of the DR articular surface during fracture fi xation without causing iatrogenic wrist instability. (J Hand Surg Am. 2024;49(6):613.e1 -e10. Copyright (c) 2024 by the American Society for Surgery of the Hand. All rights reserved.)

BACKGROUND:There is a lack of consensus on the optimal age for specific surgical interventions for developmental dysplasia of the hip. We compared radiographic and clinical outcomes among patients who were treated with closed reduction (CR), open reduction (OR), and open reduction with concomitant pelvic osteotomy (ORP) for the treatment of a dislocated hip. We sought to identify the optimal age at treatment within each of these groups. METHODS:We retrospectively reviewed 256 hips (n=195 patients) who underwent CR (n=96), OR (n=116), or an ORP (n=44) as their index procedure at a single institution between January 1, 2004 and September 23, 2020. Radiographic outcomes included acetabular index, The International Hip Dysplasia Institute classification, and acetabular depth ratio. The incidence of further corrective surgery (FCS), defined as the need for an additional femoral and/or pelvic osteotomy before skeletal maturity, and the optimal age cutoffs for index surgery within each surgical group were determined. RESULTS:After adjusting for age and sex, the incidence of FCS was 13.8% in the CR group, 29.2% in the OR group, and 9.2% in the ORP group. Earlier surgery was protective against FCS in the CR and OR groups. In contrast, patients in the ORP group who were older at index procedure were less likely to undergo FCS. Optimal age at surgery was 9.9 months (CR), 11.5 months (OR), and 21.4 months (ORP). Compared with older patients, younger patients were associated with a larger average decrease in the acetabular index and a larger average increase in acetabular width during the first 5 years post surgery. CONCLUSIONS:Age at index surgical procedure was correlated with both clinical and radiographic outcomes. Age at index procedure did impact the risk of subsequent FCS, particularly in the CR and ORP groups. Based on our analysis, CR should be considered before 9.9 months of age and OR considered before 11.5 months of age to minimize the risk of FCS during childhood. This work highlights the importance of considering age-related heterogeneity in developmental dysplasia of the hip treatment outcomes. LEVEL OF EVIDENCE:Level III-retrospective comparative study.

Background Secondary sequelae of sport-related concussion (SRC) among adolescents may include development of depression or suicidality. Prevention strategies for these secondary sequelae are poorly understood. Objective (1) Cross-sectionally investigate associations between recent (≤12-months) concussion and endorsement of sadness/hopelessness or suicidal ideation/attempt; (2) Identify relationships between regular physical activity (PA) and endorsement of sadness/hopelessness or suicidal ideation/attempt among adolescents with recent concussion. Design A nationwide survey, administered using a multi-stage cluster random sampling design, targeted all adolescents enrolled in public or private schools within one country. Setting Participants completed the survey via an online platform in early 2021. Participants 12–18-year-olds. Assessment of Risk Factors Self-reported concussions sustained during sports (none vs. ≥ one) and days per week of PA for more than 60 total minutes (≤3days/week vs. >3days/week) over the previous 12-months. Main Outcome Measures Self-reported sadness/hopelessness (yes/no), seriously considering suicide (yes/no), or attempting suicide (yes/no) over the previous 12-months. Results 7,692 participants (Table) completed the survey, of which 728 (10.1%) sustained SRC in the previous year. Participants with recent concussion had 1.29-times (95% Confidence Interval [CI]: 1.08–1.54; p=.007) greater odds of endorsing sadness/hopelessness, 1.64-times (CI: 1.27–2.11; p<.001) greater odds of considering suicide, and 2.93-times (CI: 2.06–4.17; p<.001) greater odds of attempting suicide compared to participants without recent concussion. Among the subset of individuals who sustained recent concussion (N=728), for those who reported PA >3days/week, the odds of endorsing sadness/hopelessness, suicidal ideation, or suicide attempt were 0.51-times (CI: 0.34–0.76; p=.001), 0.63-times (CI: 0.41–0.98; p=.04), and 0.90-times (CI: 0.69–1.39; p=.64) that of individuals with recent concussion who were not physically active (Figure). Conclusions Adolescents with recent concussion are more likely than peers to report sadness/hopelessness and suicidal ideation/attempt. Our nationally representative cross-sectional investigation suggests that regular PA may mediate the relationship between mental illness development and concussion.

Background: Magnetic controlled growth rods (MCGR) are the most common type of implant used for operative treatment of patients with early-onset scoliosis (EOS). Rods can have either a 7-cm actuator, allowing 2.8 cm of potential expansion, or a 9-cm actuator which allows 4.8 cm potential expansion. We hypothesized that the rate of unplanned return to the operating room (UPROR) will be increased when the 9-cm actuator is implanted in smaller patients. In addition, we aimed to identify a cutoff for spine length between planned upper and lower instrumented MCGR levels that best differentiated between patients having a high versus low risk of UPROR. Methods: We identified 167 patients from a prospectively collected registry of EOS patients who began MCGR treatment at 9 years of age or younger, with greater than 1 year of follow-up, and had adequate radiographs. Demographic, clinical, and surgical characteristics were analyzed for 7-cm and 9-cm actuator patients. Chi-square tests and Student t tests were used to test for differences between the 2 actuator rod groups. A predictive model for UPROR within 2 years was developed based on variables significantly predictive of UPROR. Results: The average follow-up was 2.6 years (range, 1 to 5 y) in both the 7 cm (n=74) and 9 cm (n=93) groups. Twenty-five complications in 14 patients led to UPROR within 2 years of MCGR insertion, 8% incidence (95% CI, 4%-13%). Device-related complications (n=15) were the most common reason for UPROR, followed by wound complications (n=4), pain-related complications (n=3), junctional kyphosis (n=2), and incarcerated umbilical hernia (n=1). After adjusting for age, spine height, number of spine anchors, sex, and diagnosis, there was no significant difference in UPROR rates between groups. Fewer proximal anchors, smaller T1-S1 height, and more caudal mid-point of primary coronal curvature were significantly associated with UPROR in the predictive model. Conclusion: MCGR actuator size is not a significant factor in predicted UPROR. Smaller height, fewer anchors, and caudal apex increased UPROR risk. Level of Evidence: This is a retrospective, multicenter comparative cohort study (Level III therapeutic).

The Periacetabular Osteotomy is a technically demanding procedure that requires precise intraoperative evaluation of pelvic anatomy. Fluoroscopic images pose a radiation risk to operating room staff, scrubbed personnel, and the patient. Most commonly, a Standard Fluoroscope with an Image Intensifier is used. Our institution recently implemented the novel Fluoroscope with a Flat Panel Detector. The purpose of this study was to compare radiation dosage and accuracy between the two fluoroscopes. A retrospective review of a consecutive series of patients who underwent Periacetabular Osteotomy for symptomatic hip dysplasia was completed. The total radiation exposure dose (mGy) was recorded and compared for each case from the standard fluoroscope (n = 27) and the flat panel detector (n = 26) cohorts. Lateral center edge angle was measured and compared intraoperatively and at the six-week postoperative visit. A total of 53 patients (96% female) with a mean age and BMI of 17.84 (± 6.84) years and 22.66 (± 4.49) kg/m2 (standard fluoroscope) and 18.23 (± 4.21) years and 21.99 (± 4.00) kg/m2 (flat panel detector) were included. The standard fluoroscope averaged total radiation exposure to be 410.61(± 193.02) mGy, while the flat panel detector averaged 91.12 (± 49.64) mGy (p < 0.0001). The average difference (bias) between intraoperative and 6-week postoperative lateral center edge angle measurement was 0.36° (limits of agreement: − 3.19 to 2.47°) for the standard fluoroscope and 0.27° (limits of agreement: − 2.05 to 2.59°) for the flat panel detector cohort. Use of fluoroscopy with flat panel detector technology decreased the total radiation dose exposure intraoperatively and produced an equivalent assessment of intraoperative lateral center edge angle. Decreasing radiation exposure to young patients is imperative to reduce the risk of future comorbidities.