In genu valgum, the patella seeks an abnormal mechanical axis, resulting in patellar instability. By correcting the mechanical axis with hemiepiphyseodesis, patellar instability symptoms improve and patients return to sports. Complications are rare. Selective hemiepiphyseodesis is recommended when treating patellar instability with associated genu valgum.

This article reports a case of solid variant aneurysmal bone cyst (S-ABC) in the cervical spine of a child [1]. Aneurysmal bone cyst (ABC) of the vertebral column occurs infrequently and, as the article points out, the solid variant is exceedingly rare in the spine. While MRI can be very helpful in formulating a differential diagnosis and differentiating S-ABC from more typical cystic ABC, imaging studies cannot always differentiate S-ABC from other benign bone lesions. Performing an incisional biopsy with intra-operative frozen section is an important first step in our approach to treatment of this and other forms of ABC.Traditional treatment of ABC with intralesional curettage and bone grafting produced recurrence rates of 10-60 % [2]. To limit recurrence, we recommend a four-step approach to treatment of ABC, including the solid variant form. This includes (1) intralesional curettage, (2) cauterization of the osseous cyst wall, (3) extended curettage with a high-speed diamond burr, and (4) dilute (5 %) phenol application [3]. Titanium instrumentation may be necessary after removal to reestablish spinal stability. As in this case, arterial embolization can be used as an adjunct to surgical excision.

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Background: Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy. Purpose: To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score–Sports (HOS-S) subscale. Results: All servicemembers’ final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months–4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [ P < .001]; HOS-ADL, 63 to 74 [ P < .001]; HOS-S, 44 to 57 [ P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [ P = .71]; Group PSY, 36 to 44 [ P = .22]; Group Both 43 to 45 [ P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics. Conclusion: Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.

Pediatric fracture reductions can create anxiety for the child and parent. While cross-cultural evidence supports parental presence during some pediatric procedures, no study addresses parental presence during fracture reductions. This study investigates parent experiences during their child’s reduction and provides guidance regarding parental attendance during fracture reductions. Sixty consecutive parents were retrospectively surveyed about their experience during their child’s fracture reduction. Parents were grouped according to presence or absence during the reduction and were compared. Forty parents attended the reduction and 20 parents were absent. All parents attending the reduction were satisfied with their experience. Thirty-nine parents (98%) believed their presence was helpful for their child and 36 (90%) believed it was personally helpful. Of the 20 absent parents, four (20%) were dissatisfied with their experience, five (25%) believed it was personally harmful, and two (10%) thought it was harmful to their child. All parents reporting negative experiences were prohibited from attending the reduction. When deciding about parental presence during reductions, 55 (92%) parents wanted to be included in this process. Overall, 47 parents (78%) wanted to attend the reduction and 52 (87%) would prefer to attend a future reduction. Most parents prefer to attend their child’s fracture reduction and believe their presence is helpful personally and for their child. Parents in attendance report a positive experience, while parents prohibited from attending report dissatisfaction with the experience and believe their absence is harmful to themselves and their children. It is recommended that healthcare workers consider parental attendance during pediatric reductions.