Patients who underwent repair of massive rotator cuff tears with interposition porcine acellular dermal matrix graft have good subjective function as assessed by the MASES score. Patients have significant improvement in pain, range of motion, and manual muscle strength. Postoperative ultrasound demonstrated that the repair was completely intact in 91.8% of patients, a vast improvement compared with results previously reported for primary repairs of massive rotator cuff tears.

Level IV.

Background Osteoarticular infections (OAI) are frequently encountered in children. Treatment may be guided by isolation of a pathogen; however, operative cultures are often negative. Metagenomic next-generation sequencing (mNGS) allows for broad and sensitive pathogen detection that is culture-independent. We sought to evaluate the diagnostic utility of mNGS in comparison to culture and usual care testing to detect pathogens in acute osteomyelitis and/or septic arthritis in children. Methods This was a single-site study to evaluate the use of mNGS in comparison to culture to detect pathogens in acute pediatric osteomyelitis and/or septic arthritis. Subjects admitted to a tertiary children’s hospital with suspected OAI were eligible for enrollment. We excluded subjects with bone or joint surgery within 30 days of admission or with chronic osteomyelitis. Operative samples were obtained at the surgeon’s discretion per standard care (fluid or tissue) and based on imagining and operative findings. We compared mNGS to culture and usual care testing (culture and PCR) from the same site. Results We recruited 42 subjects over the enrollment period. mNGS of the operative samples identified a pathogen in 26 subjects compared to 19 subjects in whom culture identified a pathogen. In four subjects, mNGS identified a pathogen where combined usual care testing (culture and PCR) was negative. Positive predictive agreement and negative predictive agreement both were 93.0% for mNGS. Conclusion In this single site prospective study of pediatric OAI, we demonstrated the diagnostic utility of mNGS testing in comparison to culture and usual care (culture and PCR) from operative specimens.

Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States. Study design Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported. Results 87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI.

Background: Screw fixation is the most commonly employed fixation strategy for displaced medial epicondyle fractures, but in younger patients with minimal ossification, the fracture fragment may not accommodate a screw. In these situations, Kirschner-wires (K-wire) or suture anchors may be utilized as alternatives. The purposes of this study were to examine the biomechanical properties of medial epicondyle fractures fixed with a screw, K-wires, or suture anchors, to evaluate clinical outcomes and complications of patients 10 years of age or younger treated with these approaches, and to perform a cost-analysis. Methods: Biomechanical assessment: Immature pig forelimbs underwent an osteotomy through the medial epicondyle apophysis, simulating a fracture. These were then fixed with a screw, K-wires or suture anchors. Cyclic elongation (mm), displacement (mm), load to failure (N), and stiffness (N/mm) were assessed. Clinical assessment: a retrospective review was performed of patients 10 years of age or younger with a medial epicondyle fracture fixed with these strategies. Radiographic outcomes, postoperative data and complications were compared. These data were used to perform a cost-analysis of each treatment approach. Results: Biomechanically, screws were stronger (P=0.047) and stiffer (P=0.01) than the other constructs. Clinically, 51 patients met inclusion criteria (screw=27, wires=11, anchor=13). Patients treated with K-wires were younger (P<0.05) and patients treated with screw fixation had a shorter casting duration (P=0.008). Irrespective of treatment strategy, all fractures healed (100%) and only 1 patient in the screw group lost reduction. Clinical outcomes and complications were similar between groups, but the suture anchor group was less likely to require a second surgery for implant removal (P<0.05). This lower reoperation rate led to a cost-saving of 10%. Conclusions: Biomechanically, all 3 approaches provided initial fixation exceeding the forces observed across the elbow joint with routine motion. The screw construct was the strongest and stiffest. Clinically, all 3 strategies were acceptable, with screw fixation offering a shorter casting duration, but greater implant removal need with higher associated costs.