Joshua Hyman | Columbia University (original) (raw)

Papers by Joshua Hyman

Research paper thumbnail of Gross Motor Function Classification System Specific Growth Charts—Utility as a Risk Stratification Tool for Surgical Site Infection Following Spine Surgery

Journal of Pediatric Orthopaedics, Apr 1, 2019

Research paper thumbnail of Paper 193: Mep/Ssep Monitoring in Spinal Deformity Surgery: Incidence and Factors Leading to Significant Electrophysiologic Events

Orthopaedic Proceedings, Mar 1, 2010

Purpose: Despite advances in surgical technique, neurological injury remains a potentially devast... more Purpose: Despite advances in surgical technique, neurological injury remains a potentially devastating complication of spinal deformity correction surgery. The purpose of the study is to describe surgical and patient factors associated with “electrophysiologic (EP) events” and neurogenic deficits. Method: A retrospective chart review, looking at “EP events” during surgery, was conducted on 162 patients who received surgical treatment of their pediatric spine deformity from 1999 to 2004. Results: Ninety three percent of cases (n=151) were successfully monitored by either somatosensory evoked potential (SEP) or motor evoked potential (MEP) monitoring. All three neurologic deficits that occurred in this study cases were successfully detected by EP monitoring (0.02%, p=.002). In those 151 cases that were successfully monitored, “EP events” were occured in twenty (13.2%) cases. The most common cause was systemic change (45%) and curve correction (40%). In those 20 cases, when corrective actions were made (n=15) “EP events” reversed to baseline values in all cases. When no corrective actions were taken (N=5) there was no reversals of “EP events” to baseline. Patients with kyphosis had a trend toward significantly higher rates of “EP events” (p=.174) and patients who had cardiopulmonary comorbidities had significantly higher rates of “EP events” (p=.007). Conclusion: Consistent with existing literature, the EP monitoring was successful in the vast majority of deformity surgeries. “EP events” were able to be reversed with corrective action and to predict neurologic deficits. Our study found that patients with kyphosis and/or cardiopulmonary comorbidities have higher risk of significant “EP events” during the surgeries.

Research paper thumbnail of Evaluation of assessment of caregiver experience with neuromuscular disease: reliability and responsiveness of a new caregiver-reported outcome measure in patients with cerebral palsy

Translational pediatrics, Aug 1, 2020

Research paper thumbnail of Effect of Preoperative Indications Conference on Procedural Planning for Treatment of Scoliosis

Research paper thumbnail of Efficacy of Preoperative Erythropoietin Administration in Pediatric Neuromuscular Scoliosis Patients

Research paper thumbnail of Paper 052: Femoral Valgus Osteotomy for Advanced Femoral Head Osteonecrosis and Perthes Disease in Children and Adolescents

Orthopaedic Proceedings, Mar 1, 2010

Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus os... more Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus osteotomy to treat osteonecrosis of the femoral head and Perthes disease in the pediatric and adolescent population. Owing to the severity of the pathology, a retrospective examination of the success of valgus osteotomies in treating avascular necrosis and Perthes disease in children and adolescents is warranted. Method: Twenty-four patients with diagnosis of osteo-necrosis of the femoral head or Perthes disease treated between 1995 and 2007 with a proximal femoral valgus osteotomy were identified. The causes of avascular necrosis were Perthes (N=14, 60.9%), slipped capital femoral epiphyses, (N=4, 17.4%), femoral neck fracture (N=2, 8.7%), hip septic arthritis (N=2, 8.7%) and developmental delays and idiopathic osteonecrosis (N=1, 4.3%). The average age of receiving a femoral valgus osteotomy was 10± 3.6 years. The average age at follow-up was 12.2± 4 years, mean time of follow-up from the initial valgus osteotomy to last assessment was 23± 15.3 months. Results: Postoperative pain improved significantly compared to preoperative pain (p=.002). Seventy five percent of patients (n=9) who had limitations in their daily activities preoperatively reported that they no longer experienced them after the treatment. External rotation (p=.005) and abduction (p=.003) improved significantly at follow up. Postoperative Ficat & Arlet classification was significantly better when compared to the classification before valgus osteotomy (p=0.007). Univariate analysis showed that sixty percent of patients (n=6) who had Perthes had improved in their Ficat & Arlet stage whereas one (14.3%) patient with a different diagnosis improved (p=.082). Complications from the surgery were reported in 5 of the 23 (21.7%) cases. Conclusion: The results of this study suggest that proximal femoral valgus osteotomy is a safe and effective treatment method for osteonecrosis of the femoral head in the pediatric population. Perthes patients improved their femoral head shape more than all other etiologies; there was a trend toward statistical significance in this change. Proximal femoral valgus osteotomy may improve pain and activity limitations in children with osteonecrosis of the femoral head. It is also effective at improving range of motion and femoral head x-ray appearance of the femoral head for these children.

Research paper thumbnail of Articulated Hip Distraction

Journal of Pediatric Orthopaedics, Mar 1, 2009

To describe the clinical outcomes of adolescent patients treated with articulated hip distraction... more To describe the clinical outcomes of adolescent patients treated with articulated hip distraction (AHD) for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness of and indications for performing hip arthrodiastasis in this patient population. : Retrospective review was performed on 31 hips with femoral head AVN treated with AHD. Mean age at treatment was 14.7 years. Preoperative and follow-up pain and physical limitations, as well as follow-up range of motion, were assessed. Follow-up assessment was obtained at 18.7 years. Time of follow-up was 57.4 months after distraction. The etiologies of AVN were the following: 10 slipped capital femoral epiphysis (SCFE), 5 idiopathic AVN, 3 with hip dysplasia, and 12 others. There was a significant difference in pain preoperatively and postoperatively (P<0.001), most patients (78.6%, n=22) had less pain after the treatment. Multivariate regression model demonstrated that patients with SCFE were likely to have less improvement in pain than patients with other etiologies (odds ratio, 22.7; P=0.035). All patients had activity limitations before the treatment; at the postoperative assessment, half of our patients (n=14) reported no limitations in their regular daily activities. Eight patients had minor complications with the fixator. At follow-up, 5 patients (17.2%) converted to total hip replacement or arthrodesis. Survival rates were 90.6% at 5 years, 77.7% at 10 years, and 38.8% at 15 years. Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities at a follow-up of 4.7 years. Arthrodiastasis is not the final solution to AVN. With longer follow-up, patient's symptoms increases. Patients with AVN secondary to SCFE do not seem to benefit from this procedure as much as other patients do. Articulated hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the…

Research paper thumbnail of Can parents rate their children's quality of life? Perspectives on pediatric orthopedic outcomes

Journal of Pediatric Orthopaedics B, May 1, 2011

The ultimate goal of treatment for children with orthopedic problems is to improve their health-r... more The ultimate goal of treatment for children with orthopedic problems is to improve their health-related quality of life. Because children may lack the abilities to effectively interpret and answer the questions used to assess a patient's health-related quality of life, parent proxies have been used in such pediatric cases. Unfortunately, previous studies exploring the efficacy of these parent proxies have been inconsistent. It is therefore important to determine the level of agreement between child-parent dyads and whether agreement is mediated by variables such as disease type, demographics, instrument, and the domain being assessed. The purpose of this study was to examine the degree of agreement between children and their parents' ratings in the Child Health Questionnaire (CHQ) and the Pediatric Orthopaedic Data Collection Instrument (PODCI), two instruments commonly used to assess health-related quality of life in children. The CHQ, PODCI, and standard demographic and clinical data were collected from parents and children between the ages of 5 and 18 years with a wide range of musculoskeletal problems. There was a strong level of agreement between child and parent responses for most of the domains in both instruments. Exceptions included Physical Functioning (PF), General Health (GH), and Mental Health (MH) in the CHQ, and Expectations in the PODCI. All four of these domains exhibited significant differences between the two respondent groups and had medium effect sizes. Children reported a higher level of PF and lower levels of both GH and MH than their parents. Additionally, parents reported significantly higher expectations for treatment than children did. None of the regressions yielded significant β values for child age, parent sex, match/no match between parent-child sex, and scoliosis/nonscoliosis diagnosis. These significant discrepancies were not driven by specific subsamples; therefore, we concluded that these discrepancies can be generalized to the pediatric orthopedic population. Our results also indicate that the CHQ is more sensitive than the PODCI to the rating differences between children and parents. The results of this study can serve clinicians in pediatric orthopedic surgery as a guide for not only selecting the most appropriate instruments for assessment but also for interpreting treatment outcomes most meaningfully. Level of Evidence is the Level II Prognostic Study.

Research paper thumbnail of Does ScoliScore Provide More Information Than Traditional Clinical Estimates of Curve Progression?

Research paper thumbnail of Depression in Pediatric Patients with Cerebral Palsy: Evaluating the Validity of a PROMIS Depressive Symptoms Domain and At-Risk Patient Identification

Research paper thumbnail of Gross Motor Function Classification System Specific Growth Charts - Utility as a Risk Stratification Tool for Surgical Site Infection Following Spine Surgery in Children with Cerebral Palsy

Research paper thumbnail of The incidence of congenital scoliosis in infants with tetralogy of Fallot based on chest radiographs

Journal of Pediatric Orthopaedics B, Jul 1, 2012

Early diagnosis is critical in patients with congenital scoliosis to identify vertebral defects t... more Early diagnosis is critical in patients with congenital scoliosis to identify vertebral defects that have a high risk for progression. A review of the medical records and chest radiographs for 562 patients who underwent corrective surgery for tetralogy of Fallot (TOF) at our institution between 1992 and 2007 was conducted. Of the 364 patients examined in the study, 12 patients (3.3%), six girls and six boys, had a positive diagnosis of congenital scoliosis confirmed by examination of radiographs. This incidence is significantly higher than both the incidence reported in prior studies (0-1.4%) and in the general population (0.05-0.10%). Given that patients with TOF routinely undergo chest radiograph, physicians examining chest radiographs of TOF patients should be aware of the potential for congenital scoliosis to provide early diagnosis and referral for orthopaedic evaluation and treatment.

Research paper thumbnail of Impact of Fractures on School Attendance

Journal of Pediatric Orthopaedics, Mar 1, 2011

Research paper thumbnail of Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

Journal of neurosurgery, Dec 1, 2013

Research paper thumbnail of Congenital Idiopathic Talipes Equinovarus

Pediatrics in Review, Apr 1, 2004

Research paper thumbnail of Effect of bracing on the quality of life of adolescents with idiopathic scoliosis*1

The Spine Journal, May 1, 2004

Research paper thumbnail of Paper 051: Articulated Hip Distraction Arthroplasty: A Treatment Option for Avascular Necrosis and Chondrolysis of the Child and Adolescent Femoral Head

Orthopaedic Proceedings, Mar 1, 2010

Purpose: To describe the clinical outcomes of adolescent patients, treated with hip distraction a... more Purpose: To describe the clinical outcomes of adolescent patients, treated with hip distraction arthroplasty for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness and indications of performing hip arthrodia-stasis in this patient population. Method: Retrospective review was performed on thirty-one hips with femoral head AVN treated with hip distraction arthroplasty. Mean age at treatment was 14.2 years. Preoperative and follow-up pain, and physical limitations, as well as follow-up range of motion (ROM) were assessed. Results: Follow up assessment was obtained at 18.3 years of age. Time of follow up was 55.3 months after distraction. The etiologies of AVN were: 11 Slipped Capital Femoral Epyphysis (SCFE); 5 Idiopathic AVN; 3 with hip dysplasia; and 12 others. There was a significant difference in pain preoperatively and postoperatively (p Conclusion: Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities, at a follow up of 4.6 years. Arthrodiastasis is not the final solution to AVN, with longer follow up patient’s symptomatology increases. Patients with AVN secondary to SCFE do not beneficiate of this procedure as much as other patients do. Hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the patient s quality of life.

Research paper thumbnail of 9:43210. Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation vs. traditional hook constructs: a single surgeon retrospective review

The Spine Journal, Jul 1, 2005

Research paper thumbnail of Risk Factors for School Absence After Acute Orthopaedic Injury in New York City

Journal of Pediatric Orthopaedics, Jun 1, 2007

The purpose of our study is to identify specific factors that affect a child&... more The purpose of our study is to identify specific factors that affect a child's ability to attend school after an acute orthopaedic injury. One hundred and sixty-four school-aged patients receiving treatment for an acute orthopaedic injury at the Division of Pediatric Orthopaedics were interviewed along with their parents. Most participants were Hispanic, which reflects the population of the Washington Heights section of Manhattan served by our hospital. Follow-up telephone interviews were conducted with those parents whose children were unable to return to school. The parents were asked of both the total number of school absences and whether the child received home instruction. A survey regarding official school attendance policy was mailed to the principals of all the schools attended by the children in our study. Forty-seven percent of the children were unable to return to school immediately after their injuries. Nearly 70% (n = 51) of the children who did not immediately return to school attributed their nonattendance to their school's attendance policy. Only half of the absentees received home instruction. A multivariate analysis showed that both the type of school (public vs private) and the use of crutches were statistically significant risk factors for school absence. The median household income also trended toward significance in predicting school attendance. The responses to our survey regarding official school attendance policy demonstrated considerable variability among the schools. This study indicates that pediatric orthopaedic injuries and their treatment impact the ability of school-aged patients to attend school. Our study shows that children's socioeconomic background influences their ability to attend school while injured.

Research paper thumbnail of Interobserver and Intraobserver Reliability of the Modified Waldenström Classification System for Staging of Legg-Calvé-Perthes Disease

Journal of Bone and Joint Surgery, American Volume, Apr 15, 2015

BACKGROUND The absence of a reliable classification system for Legg-Calvé-Perthes disease has con... more BACKGROUND The absence of a reliable classification system for Legg-Calvé-Perthes disease has contributed to difficulty in establishing consistent management strategies and in interpreting outcome studies. The purpose of this study was to assess interobserver and intraobserver reliability of the modified Waldenström classification system among a large and diverse group of pediatric orthopaedic surgeons. METHODS Twenty surgeons independently completed the first two rounds of staging: two assessments of forty deidentified radiographs of patients with Legg-Calvé-Perthes disease in various stages. Ten of the twenty surgeons completed another two rounds of staging after the addition of a second pair of radiographs in sequence. Kappa values were calculated within and between each of the rounds. RESULTS Interobserver kappa values for the classification for surveys 1, 2, 3, and 4 were 0.81, 0.82, 0.76, and 0.80, respectively (with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.0, nearly perfect agreement). Intraobserver agreement for the classification was an average of 0.88 (range, 0.77 to 0.96) between surveys 1 and 2 and an average of 0.87 (range, 0.81 to 0.94) between surveys 3 and 4. CONCLUSIONS The modified Waldenström classification system for staging of Legg-Calvé-Perthes disease demonstrated substantial to almost perfect agreement between and within observers across multiple rounds of study. In doing so, the results of this study provide a foundation for future validation studies, in which the classification stage will be associated with clinical outcomes.

Research paper thumbnail of Gross Motor Function Classification System Specific Growth Charts—Utility as a Risk Stratification Tool for Surgical Site Infection Following Spine Surgery

Journal of Pediatric Orthopaedics, Apr 1, 2019

Research paper thumbnail of Paper 193: Mep/Ssep Monitoring in Spinal Deformity Surgery: Incidence and Factors Leading to Significant Electrophysiologic Events

Orthopaedic Proceedings, Mar 1, 2010

Purpose: Despite advances in surgical technique, neurological injury remains a potentially devast... more Purpose: Despite advances in surgical technique, neurological injury remains a potentially devastating complication of spinal deformity correction surgery. The purpose of the study is to describe surgical and patient factors associated with “electrophysiologic (EP) events” and neurogenic deficits. Method: A retrospective chart review, looking at “EP events” during surgery, was conducted on 162 patients who received surgical treatment of their pediatric spine deformity from 1999 to 2004. Results: Ninety three percent of cases (n=151) were successfully monitored by either somatosensory evoked potential (SEP) or motor evoked potential (MEP) monitoring. All three neurologic deficits that occurred in this study cases were successfully detected by EP monitoring (0.02%, p=.002). In those 151 cases that were successfully monitored, “EP events” were occured in twenty (13.2%) cases. The most common cause was systemic change (45%) and curve correction (40%). In those 20 cases, when corrective actions were made (n=15) “EP events” reversed to baseline values in all cases. When no corrective actions were taken (N=5) there was no reversals of “EP events” to baseline. Patients with kyphosis had a trend toward significantly higher rates of “EP events” (p=.174) and patients who had cardiopulmonary comorbidities had significantly higher rates of “EP events” (p=.007). Conclusion: Consistent with existing literature, the EP monitoring was successful in the vast majority of deformity surgeries. “EP events” were able to be reversed with corrective action and to predict neurologic deficits. Our study found that patients with kyphosis and/or cardiopulmonary comorbidities have higher risk of significant “EP events” during the surgeries.

Research paper thumbnail of Evaluation of assessment of caregiver experience with neuromuscular disease: reliability and responsiveness of a new caregiver-reported outcome measure in patients with cerebral palsy

Translational pediatrics, Aug 1, 2020

Research paper thumbnail of Effect of Preoperative Indications Conference on Procedural Planning for Treatment of Scoliosis

Research paper thumbnail of Efficacy of Preoperative Erythropoietin Administration in Pediatric Neuromuscular Scoliosis Patients

Research paper thumbnail of Paper 052: Femoral Valgus Osteotomy for Advanced Femoral Head Osteonecrosis and Perthes Disease in Children and Adolescents

Orthopaedic Proceedings, Mar 1, 2010

Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus os... more Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus osteotomy to treat osteonecrosis of the femoral head and Perthes disease in the pediatric and adolescent population. Owing to the severity of the pathology, a retrospective examination of the success of valgus osteotomies in treating avascular necrosis and Perthes disease in children and adolescents is warranted. Method: Twenty-four patients with diagnosis of osteo-necrosis of the femoral head or Perthes disease treated between 1995 and 2007 with a proximal femoral valgus osteotomy were identified. The causes of avascular necrosis were Perthes (N=14, 60.9%), slipped capital femoral epiphyses, (N=4, 17.4%), femoral neck fracture (N=2, 8.7%), hip septic arthritis (N=2, 8.7%) and developmental delays and idiopathic osteonecrosis (N=1, 4.3%). The average age of receiving a femoral valgus osteotomy was 10± 3.6 years. The average age at follow-up was 12.2± 4 years, mean time of follow-up from the initial valgus osteotomy to last assessment was 23± 15.3 months. Results: Postoperative pain improved significantly compared to preoperative pain (p=.002). Seventy five percent of patients (n=9) who had limitations in their daily activities preoperatively reported that they no longer experienced them after the treatment. External rotation (p=.005) and abduction (p=.003) improved significantly at follow up. Postoperative Ficat & Arlet classification was significantly better when compared to the classification before valgus osteotomy (p=0.007). Univariate analysis showed that sixty percent of patients (n=6) who had Perthes had improved in their Ficat & Arlet stage whereas one (14.3%) patient with a different diagnosis improved (p=.082). Complications from the surgery were reported in 5 of the 23 (21.7%) cases. Conclusion: The results of this study suggest that proximal femoral valgus osteotomy is a safe and effective treatment method for osteonecrosis of the femoral head in the pediatric population. Perthes patients improved their femoral head shape more than all other etiologies; there was a trend toward statistical significance in this change. Proximal femoral valgus osteotomy may improve pain and activity limitations in children with osteonecrosis of the femoral head. It is also effective at improving range of motion and femoral head x-ray appearance of the femoral head for these children.

Research paper thumbnail of Articulated Hip Distraction

Journal of Pediatric Orthopaedics, Mar 1, 2009

To describe the clinical outcomes of adolescent patients treated with articulated hip distraction... more To describe the clinical outcomes of adolescent patients treated with articulated hip distraction (AHD) for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness of and indications for performing hip arthrodiastasis in this patient population. : Retrospective review was performed on 31 hips with femoral head AVN treated with AHD. Mean age at treatment was 14.7 years. Preoperative and follow-up pain and physical limitations, as well as follow-up range of motion, were assessed. Follow-up assessment was obtained at 18.7 years. Time of follow-up was 57.4 months after distraction. The etiologies of AVN were the following: 10 slipped capital femoral epiphysis (SCFE), 5 idiopathic AVN, 3 with hip dysplasia, and 12 others. There was a significant difference in pain preoperatively and postoperatively (P<0.001), most patients (78.6%, n=22) had less pain after the treatment. Multivariate regression model demonstrated that patients with SCFE were likely to have less improvement in pain than patients with other etiologies (odds ratio, 22.7; P=0.035). All patients had activity limitations before the treatment; at the postoperative assessment, half of our patients (n=14) reported no limitations in their regular daily activities. Eight patients had minor complications with the fixator. At follow-up, 5 patients (17.2%) converted to total hip replacement or arthrodesis. Survival rates were 90.6% at 5 years, 77.7% at 10 years, and 38.8% at 15 years. Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities at a follow-up of 4.7 years. Arthrodiastasis is not the final solution to AVN. With longer follow-up, patient's symptoms increases. Patients with AVN secondary to SCFE do not seem to benefit from this procedure as much as other patients do. Articulated hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the…

Research paper thumbnail of Can parents rate their children's quality of life? Perspectives on pediatric orthopedic outcomes

Journal of Pediatric Orthopaedics B, May 1, 2011

The ultimate goal of treatment for children with orthopedic problems is to improve their health-r... more The ultimate goal of treatment for children with orthopedic problems is to improve their health-related quality of life. Because children may lack the abilities to effectively interpret and answer the questions used to assess a patient's health-related quality of life, parent proxies have been used in such pediatric cases. Unfortunately, previous studies exploring the efficacy of these parent proxies have been inconsistent. It is therefore important to determine the level of agreement between child-parent dyads and whether agreement is mediated by variables such as disease type, demographics, instrument, and the domain being assessed. The purpose of this study was to examine the degree of agreement between children and their parents' ratings in the Child Health Questionnaire (CHQ) and the Pediatric Orthopaedic Data Collection Instrument (PODCI), two instruments commonly used to assess health-related quality of life in children. The CHQ, PODCI, and standard demographic and clinical data were collected from parents and children between the ages of 5 and 18 years with a wide range of musculoskeletal problems. There was a strong level of agreement between child and parent responses for most of the domains in both instruments. Exceptions included Physical Functioning (PF), General Health (GH), and Mental Health (MH) in the CHQ, and Expectations in the PODCI. All four of these domains exhibited significant differences between the two respondent groups and had medium effect sizes. Children reported a higher level of PF and lower levels of both GH and MH than their parents. Additionally, parents reported significantly higher expectations for treatment than children did. None of the regressions yielded significant β values for child age, parent sex, match/no match between parent-child sex, and scoliosis/nonscoliosis diagnosis. These significant discrepancies were not driven by specific subsamples; therefore, we concluded that these discrepancies can be generalized to the pediatric orthopedic population. Our results also indicate that the CHQ is more sensitive than the PODCI to the rating differences between children and parents. The results of this study can serve clinicians in pediatric orthopedic surgery as a guide for not only selecting the most appropriate instruments for assessment but also for interpreting treatment outcomes most meaningfully. Level of Evidence is the Level II Prognostic Study.

Research paper thumbnail of Does ScoliScore Provide More Information Than Traditional Clinical Estimates of Curve Progression?

Research paper thumbnail of Depression in Pediatric Patients with Cerebral Palsy: Evaluating the Validity of a PROMIS Depressive Symptoms Domain and At-Risk Patient Identification

Research paper thumbnail of Gross Motor Function Classification System Specific Growth Charts - Utility as a Risk Stratification Tool for Surgical Site Infection Following Spine Surgery in Children with Cerebral Palsy

Research paper thumbnail of The incidence of congenital scoliosis in infants with tetralogy of Fallot based on chest radiographs

Journal of Pediatric Orthopaedics B, Jul 1, 2012

Early diagnosis is critical in patients with congenital scoliosis to identify vertebral defects t... more Early diagnosis is critical in patients with congenital scoliosis to identify vertebral defects that have a high risk for progression. A review of the medical records and chest radiographs for 562 patients who underwent corrective surgery for tetralogy of Fallot (TOF) at our institution between 1992 and 2007 was conducted. Of the 364 patients examined in the study, 12 patients (3.3%), six girls and six boys, had a positive diagnosis of congenital scoliosis confirmed by examination of radiographs. This incidence is significantly higher than both the incidence reported in prior studies (0-1.4%) and in the general population (0.05-0.10%). Given that patients with TOF routinely undergo chest radiograph, physicians examining chest radiographs of TOF patients should be aware of the potential for congenital scoliosis to provide early diagnosis and referral for orthopaedic evaluation and treatment.

Research paper thumbnail of Impact of Fractures on School Attendance

Journal of Pediatric Orthopaedics, Mar 1, 2011

Research paper thumbnail of Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

Journal of neurosurgery, Dec 1, 2013

Research paper thumbnail of Congenital Idiopathic Talipes Equinovarus

Pediatrics in Review, Apr 1, 2004

Research paper thumbnail of Effect of bracing on the quality of life of adolescents with idiopathic scoliosis*1

The Spine Journal, May 1, 2004

Research paper thumbnail of Paper 051: Articulated Hip Distraction Arthroplasty: A Treatment Option for Avascular Necrosis and Chondrolysis of the Child and Adolescent Femoral Head

Orthopaedic Proceedings, Mar 1, 2010

Purpose: To describe the clinical outcomes of adolescent patients, treated with hip distraction a... more Purpose: To describe the clinical outcomes of adolescent patients, treated with hip distraction arthroplasty for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness and indications of performing hip arthrodia-stasis in this patient population. Method: Retrospective review was performed on thirty-one hips with femoral head AVN treated with hip distraction arthroplasty. Mean age at treatment was 14.2 years. Preoperative and follow-up pain, and physical limitations, as well as follow-up range of motion (ROM) were assessed. Results: Follow up assessment was obtained at 18.3 years of age. Time of follow up was 55.3 months after distraction. The etiologies of AVN were: 11 Slipped Capital Femoral Epyphysis (SCFE); 5 Idiopathic AVN; 3 with hip dysplasia; and 12 others. There was a significant difference in pain preoperatively and postoperatively (p Conclusion: Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities, at a follow up of 4.6 years. Arthrodiastasis is not the final solution to AVN, with longer follow up patient’s symptomatology increases. Patients with AVN secondary to SCFE do not beneficiate of this procedure as much as other patients do. Hip distraction is a safe and appropriate procedure to perform in these patients. The procedure might be able to delay definitive surgical procedures at an early age, restoring function and improving the patient s quality of life.

Research paper thumbnail of 9:43210. Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation vs. traditional hook constructs: a single surgeon retrospective review

The Spine Journal, Jul 1, 2005

Research paper thumbnail of Risk Factors for School Absence After Acute Orthopaedic Injury in New York City

Journal of Pediatric Orthopaedics, Jun 1, 2007

The purpose of our study is to identify specific factors that affect a child&... more The purpose of our study is to identify specific factors that affect a child's ability to attend school after an acute orthopaedic injury. One hundred and sixty-four school-aged patients receiving treatment for an acute orthopaedic injury at the Division of Pediatric Orthopaedics were interviewed along with their parents. Most participants were Hispanic, which reflects the population of the Washington Heights section of Manhattan served by our hospital. Follow-up telephone interviews were conducted with those parents whose children were unable to return to school. The parents were asked of both the total number of school absences and whether the child received home instruction. A survey regarding official school attendance policy was mailed to the principals of all the schools attended by the children in our study. Forty-seven percent of the children were unable to return to school immediately after their injuries. Nearly 70% (n = 51) of the children who did not immediately return to school attributed their nonattendance to their school's attendance policy. Only half of the absentees received home instruction. A multivariate analysis showed that both the type of school (public vs private) and the use of crutches were statistically significant risk factors for school absence. The median household income also trended toward significance in predicting school attendance. The responses to our survey regarding official school attendance policy demonstrated considerable variability among the schools. This study indicates that pediatric orthopaedic injuries and their treatment impact the ability of school-aged patients to attend school. Our study shows that children's socioeconomic background influences their ability to attend school while injured.

Research paper thumbnail of Interobserver and Intraobserver Reliability of the Modified Waldenström Classification System for Staging of Legg-Calvé-Perthes Disease

Journal of Bone and Joint Surgery, American Volume, Apr 15, 2015

BACKGROUND The absence of a reliable classification system for Legg-Calvé-Perthes disease has con... more BACKGROUND The absence of a reliable classification system for Legg-Calvé-Perthes disease has contributed to difficulty in establishing consistent management strategies and in interpreting outcome studies. The purpose of this study was to assess interobserver and intraobserver reliability of the modified Waldenström classification system among a large and diverse group of pediatric orthopaedic surgeons. METHODS Twenty surgeons independently completed the first two rounds of staging: two assessments of forty deidentified radiographs of patients with Legg-Calvé-Perthes disease in various stages. Ten of the twenty surgeons completed another two rounds of staging after the addition of a second pair of radiographs in sequence. Kappa values were calculated within and between each of the rounds. RESULTS Interobserver kappa values for the classification for surveys 1, 2, 3, and 4 were 0.81, 0.82, 0.76, and 0.80, respectively (with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.0, nearly perfect agreement). Intraobserver agreement for the classification was an average of 0.88 (range, 0.77 to 0.96) between surveys 1 and 2 and an average of 0.87 (range, 0.81 to 0.94) between surveys 3 and 4. CONCLUSIONS The modified Waldenström classification system for staging of Legg-Calvé-Perthes disease demonstrated substantial to almost perfect agreement between and within observers across multiple rounds of study. In doing so, the results of this study provide a foundation for future validation studies, in which the classification stage will be associated with clinical outcomes.