Update This article was updated on December 31, 2020, because of a previous error. On page 1460, in the “Results” section of the Abstract, the sentence that had read “The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; function scores were significantly lower in the healthy control group compared with the surgical treatment group (p < 0.001).” now reads “The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; however, function scores were significantly lower among patients in the surgical treatment group (p < 0.001).” An erratum has been published: J Bone Joint Surg Am. 2021 Feb 3;103(3):e13. Background: Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group. Methods: Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls. Results: The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; however, function scores were significantly lower among patients in the surgical treatment group (p < 0.001). Conclusions: Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sex steroids are required for a normal pubertal growth spurt and fusion of the human epiphyseal growth plate. However, the localization of sex steroid receptors in the human pubertal growth plate remains controversial. We have investigated the expression of estrogen receptor (ER) , ER and androgen receptor (AR) in biopsies of proximal tibial growth plates obtained during epiphyseal surgery in 16 boys and eight girls. All pubertal stages were represented (Tanner stages 1-5). ER , ER and AR were visualized with immunohistochemistry and the number of receptor-positive cells was counted using an image analysis system. Percent receptor-positive chondrocytes were assessed in the resting, proliferative and hypertrophic zones and evaluated for sex differences and pubertal trends. Both ER -and ER -positive cells were detected at a greater frequency in the resting and proliferative zones than in the hypertrophic zone (64 2%, 64 2% compared with 38 3% for ER , and 63 3%, 66 3% compared with 53 3% for ER ), whereas AR was more abundant in the resting (65 3%) and hypertrophic zones (58 3%) than in the proliferative zone (41 3%). No sex difference in the patterns of expression was detected. For ER and AR, the percentage of receptor-positive cells was similar at all Tanner pubertal stages, whereas ER showed a slight decrease in the proliferative zone during pubertal development (P<0·05). In summary, our findings suggest that ER , ER and AR are expressed in the human growth plate throughout pubertal development, with no difference between the sexes.

43 children between the ages of 7 and 15 years with clinical symptoms of acute appendicitis were randomised to an open appendectomy (OA) or a laparoscopic appendectomy (LA). There were 15 acute cases of appendicitis and 5 perforated appendices in the OA group and 17 acute appendicitis, 3 cases of perforated appendices and 3 other diagnoses in the LA group. The operative time was a little shorter in the OA group. There were no differences in hospital stay or the postoperative course of the patients. In the LA group, there were two minor complications, no other complications were seen. When comparing the two surgical methods in the consistent group of patients with non-perforated acute appendicitis no statistical differences were seen in the operative time, hospital stay or in the recovery of the patients between the OA and the LA groups.We conclude that LA has no significant benefit over OA in routine use. In paediatric patients we recommend an open approach for clinically typical acute appendicitis, but there should be no hesitation to choose laparoscopic approach when the clinical diagnosis is unclear.

Background: unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing.Aim: Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (ten) in a pediatric cohort.Material and Methods: this retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at tampere university hospital during the time period from January 2001 to december 2005. All the fractures were classified according to otA. thirty-five children (mean age 12.3 years) were treated by ten-nailing. twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. in all but one patient both forearm bones were fractured. twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. in 29 cases both bones were fixed with ten-nail. in the four patients with re-fracture in both ulna and radius only the radius was ten-nailed. in one case radius was fixed with ten-nail and ulna with K-wire and in another case radius was fixed with ten-nail and ulna with plate. fracture pattern, mode of reduction, surgical approach, short-and long-term complications and outcome were recorded.Results: twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. twelve patients with postoperative complication were followed up 31-74 (median of 54) months. eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a volkmann's ischemic contracture. five of complicated patients had more than one problem. immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures.Discussion: despite various minor complications, ten-nailing is considered suitable treatment for unstable forearm shaft fractures. most of the problems were related to poor technical performance in nailing.