Purpose Isolated congenital clubfoot can be treated either operatively (posteromedial release) or conservatively (Ponseti method). This study retrospectively compared mid-term outcomes after surgical and Ponseti treatments to a normal sample and used multiple evaluation techniques, such as detailed gait analysis and foot kinematics. Methods Twenty-six children with clubfoot treated surgically and 22 children with clubfoot treated with the Ponseti technique were evaluated retrospectively and compared to 34 children with normal feet. Comprehensive evaluation included a full gait analysis with multi-segment and single-segment foot kinematics, pedobarograph, physical examination, validated outcome questionnaires, and radiographic measurements. Results The Ponseti group had significantly better plantarflexion and dorsiflexion range of motion during gait and had greater push-off power. Residual varus was present in both treatment groups, but more so in the operative group. Gait analysis also showed that the operative group had residual in-toeing, which appeared well corrected in the Ponseti group. Pedobarograph results showed that the operative group had significantly increased varus and significantly decreased medial foot pressure. The physical examination demonstrated significantly greater stiffness in the operative group in dorsiflexion, plantarflexion, ankle inversion, and midfoot abduction and adduction. Surveys showed that the Ponseti group had significantly more normal pediatric outcome data collection instrument results, disease-specific indices, and Dimeglio scores. The radiographic results suggested greater equinus and cavus and increased foot internal rotation profile in the operative group compared with the Ponseti group.

ObjectiveThe primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand.MethodsA retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. Demographics and delivery characteristics were collected in addition to pain scores and total ibuprofen, acetaminophen and oxycodone use at 24, 48 and 72 h postoperatively.ResultsThe scheduled dosing group was found to have a statistically significant decrease in pain scores at all time intervals. Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%.ConclusionScheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.

Background While several studies have evaluated the short-term effectiveness of conservative and surgical treatment of flexed-knee gait in children with cerebral palsy (CP), few have explored the long-term outcomes using gait analysis. The purpose of this study was to examine, through gait analysis, the 10-year outcomes of flexed-knee gait in children with CP.

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INTRODUCTION: Postpartum hemorrhage causes significant maternal morbidity and mortality. Coordinated care and adherence to standard protocol in these events may improve patient outcomes. Few studies of the obstetric population focus on appropriate transfusion of blood products. Studies in the trauma and anesthesia literature recommend a 1:1:1 transfusion protocol. Adherence to these recommendations among labor and delivery units nationwide remains unclear. METHODS: After IRB approval was obtained, we conducted a retrospective analysis examining all pregnant patients greater than 23 weeks gestation who delivered between 2011-2017 and received transfusion of at least 4 units of packed red blood cells (PRBCs) at our institution. Patients were identified by blood bank transfusion records. Data was collected regarding patient demographics, labor course, hemorrhage event and management, postpartum course, and associated complications. Each case was analyzed for adherence to a transfusion protocol. RESULTS: There were 23,964 deliveries during the study period. 90 (0.38%) patients who received at least four units PRBCs were identified. The median total EBL was 2800 ml (450ml-9,000ml). The median units transfused were: PRBCs 4.0 (4-22), fresh frozen plasma 2.0 (0-17), platelets 0 (0-7). None of the patients received a transfusion of products in a 1:1:1 ratio. Of the 90 studied patients, 24 (26.7%) required admission to the intensive care unit. CONCLUSION: Obstetrical hemorrhage is a rare but serious event. From review of the data, adherence to standardized use of a transfusion protocol at this institution is rare. In order to diminish maternal mortality, utilization of a hemorrhage protocol with a transfusion ratio should be encouraged.