PURPOSE: The purpose of this study is to describe the efficacy and adverse events of neuraxial anesthesia for post-operative pain control in non-ambulatory children with cerebral palsy with pre-existing intrathecal baclofen (ITB) pumps undergoing hip reconstructive or palliative surgery. METHODS: Twelve children (mean age 11.25 years) were included in the study with the following neuraxial anesthesia methods: indwelling epidural catheter (8 patients), neuraxial opioids administered through the side port of the ITB pump (3 patients), and single injection spinal anesthetic (1 patient). Observational pain scores and opioid requirements were quantified for all patients. RESULTS: There were no ITB pump or surgical complications at a mean follow-up of 2.2 years. The average length of stay was 6 days. Patients had good post-operative pain control with a mean observational pain score of 0.7 and mean morphine equivalent use of 0.26mg/kg/day. Four patients required anti-emetics to control nausea and three patients had urinary retention requiring repeat catheterization, but all medical complications resolved prior to discharge. CONCLUSION: Neuraxial anesthesia can effectively control post-operative pain in children with a pre-existing ITB pump. Utilizing the side port of the ITB pump for administration of neuraxial opioids is an option when epidural or spinal anesthesia is not possible.

In settings where three dimensional gait analysis is not feasible, observational gait analysis can provide important information about gait pathology.  Among the validated scoring systems to organize the observations of gait, the Edinburgh Visual Gait Score (EVGS) is the most comprehensive and has the most favorable psychometrics.  Improvements in mobile videography have created opportunities to obtain high-quality slow-motion video in a clinic setting.  These videos can provide excellent documentation of gait pathology in the sagittal, coronal, and vertical planes.  Free and low-cost video analysis software is now available on all mobile device platforms, allowing for slow-motion video analysis of gait with increased accuracy.  By utilizing the appropriate technology with a validated scoring system, gait analysis outside the walls of a gait lab is possible.  Though limitations of the mobile enhanced observational gait analysis technique require further study, the technique can facilitate improved documentation of gait pathology and improved communication between providers.   In settings where three dimensional gait analysis is not feasible, observational gait analysis can provide important information about gait pathology.  Among the validated scoring systems to organize the o In settings where three dimensional gait analysis is not feasible, observational gait analysis can provide important information about gait pathology.  Among the validated scoring systems to organize the observations of gait, the Edinburgh Visual Gait Score (EVGS) is the most comprehensive and has the most favorable psychometrics.  Improvements in mobile videography have created opportunities to obtain high-quality slow-motion video in a clinic setting.  These videos can provide excellent documentation of gait pathology in the sagittal, coronal, and vertical planes.  Free and low-cost video analysis software is now available on all mobile device platforms, allowing for slow-motion video analysis of gait with increased accuracy.  By utilizing the appropriate technology with a validated scoring system, gait analysis outside the walls of a gait lab is possible.  Though limitations of the mobile enhanced observational gait analysis technique require further study, the technique can facilitate improved documentation of gait pathology and improved communication between providers.  bservations of gait, the Edinburgh Visual Gait Score (EVGS) is the most comprehensive and has the most favorable psychometrics.  Improvements in mobile videography have created opportunities to obtain high-quality slow-motion video in a clinic setting.  These videos can provide excellent documentation of gait pathology in the sagittal, coronal, and vertical planes.  Free and low-cost video analysis software is now available on all mobile device platforms, allowing for slow-motion video analysis of gait with increased accuracy.  By utilizing the appropriate technology with a validated scoring system, gait analysis outside the walls of a gait lab is possible.  Though limitations of the mobile enhanced observational gait analysis technique require further study, the technique can facilitate improved documentation of gait pathology and improved communication between providers.

Background: Our understanding of the biology of ankle arthrodesis is based largely on work in spine and long bone animal models. However, the local soft tissue and vascular anatomy of the foot and ankle is different from that of the spine. Accordingly, the objective of this study was to develop a small animal ankle arthrodesis model. Methods: A total of 12 Lewis rats successfully underwent ankle arthrodesis with stabilization consisting of a single Kirschner wire across the prepared tibiotalar joint. Based on high nonunion rates with this initial procedure, a modification was made consisting of a second pin crossing the joint. A total of 6 rats underwent the second procedure. Radiographs were taken postoperatively and in 2-week intervals up to 10 weeks. Micro computed tomography (µCT) and histological analysis was conducted at 10 weeks to assess the fusion mass. Osseous bridging of greater than 50% across the tibiotalar joint was deemed a successful fusion. Results: µCT analysis determined that 11 of the 12 rats in the single-pin cohort developed nonunions (8.3% fusion rate). In the dual-pin cohort, all 6 animals successfully fused (100% fusion rate). Histological analysis supported the radiographic imaging conclusions. Conclusion: While the initial procedure had a high nonunion rate, enhancing the stability of the fixation greatly increased the union rate. Clinical Relevance: The present work demonstrates the first reliable small animal ankle arthrodesis model. We believe that this model can be used in the development of novel therapies aimed at decreasing complications and increasing fusion rates.

knee progression angle (KPA) having among the highest mean errors (12.85° and 10.33°, respectively) (Table 1). Out of plane measurements substantially affected accuracy of the OGA method. If the FPA or KPA was greater than 20°, the accuracy of midstance ankle and knee position had substantially lower reliability and accuracy.

Category: Basic Sciences/Biologics Introduction/Purpose: Ankle arthrodesis is performed for a variety of ankle joint pathology with the most common being post traumatic arthritis. It is estimated that there are nearly twenty-five thousand ankle fusions performed annually in the United States. Reported complication rates vary between studies and patient population characteristics and comorbidities. Our understanding of the biology of ankle arthrodesis is based largely upon spine fusion and long bone animal models. However, bony healing and infection is greatly influenced by local soft tissue and vascular anatomy, therefore the application of data from these models may not be entirely accurate. There is currently no small animal ankle fusion model. Accordingly, the purpose of this study is to develop a reliable small animal ankle arthrodesis model. Methods: A total of twenty Lewis rats were included in this study. Ankle arthrodesis was performed on one extremity of fourteen rats with the other ankle serving as an internal control. An anterior approach was used to expose the tibiotalar joint. Careful technique was utilized to protect neurovascular structures. After adequate joint exposure, a power burr and sharp curette was used to remove joint cartilage. A .042 kirschner wire was then passed through the calcaneus and through the subtalar and tibiotalar joint. Six rats served as controls and their procedures did not involve any joint cartilage removal. Radiographs were taken immediately postoperatively and at 8 weeks. Bony healing was assessed in a blinded fashion by a board certified foot and ankle orthopaedic surgeon using a grading system based upon assessment of cortical bridging and joint space. Results: Sixteen rats – eleven fusions and five controls - underwent the procedure without any perioperative complications and were included in analysis. Four rats were excluded due to a perioperative complication and/or death. The most common postoperative complication encountered was a wound complication (n=3). Of the eleven rats in the fusion group, six (55%) were determined to be fused radiographically. Two of the five controls were radiographically fused (40%). Conclusion: This study demonstrates preliminary data from a novel small animal ankle arthrodesis model. Fifty-five percent of the rats in the fusion group fused based on radiographic evaluation at eight weeks postoperatively. Further work involves improving upon the surgical technique for fusion in this small animal model to help increase fusion rates, and using CT scans and biomechanical testing to further assess fusion. The development of a small animal ankle fusion model will enhance our understanding of the biology of ankle arthrodesis and allow for development of novel therapies aimed at increasing fusion rates and decreasing complications.