Rothman Orthopaedics

Team physicians may be called upon to treat adolescent athletes, defined in this document as those in the range of 12-18 yr of age. Many are involved in school-based, intramural, or specialized sports participation and/or training, potentially resulting in injury and/or illness. Specialized treatments may be necessary due to growth and development of the adolescent. Additionally, psychological factors in this age group may play an important role in sports participation, emotional well-being, and injury rehabilitation. While many children younger than 12 yr of age are active in sports participation, their medical and musculoskeletal concerns are not included in the scope of this consensus statement. The healthcare team must stay educated and knowledgeable regarding potential challenges to individuals participating safely in sport. All healthcare professionals should provide quality care, free from discrimination and specific to the needs of every unique individual. Ensuring access to care, fostering welcoming sporting environments, and recognizing the distinct challenges faced by underrepresented populations will reduce healthcare disparities and improve safe participation across all sports.

Parsonage-Turner syndrome (PTS) is an underdiagnosed condition that presents with debilitating symptoms in affected patients, with reported incidence rates varying between 1.64 and 3 per 100,000 individuals. Clinical presentation often includes acute shoulder pain associated with neurological deficits that do not follow a regular diagnostic pattern. The cause of this disease is not fully understood, but it is generally triggered by an upper respiratory infection a few weeks prior to presentation. Other associated risk factors include genetic predisposition, vaccines, and surgical intervention. Diagnosis often relies on clinical investigation, holistic physical exam, and appropriate diagnostic studies. Treatment is often conservative, in the form of physical rehabilitation and pain management to avoid muscular atrophy. The condition generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases. However, recurrences are noted, especially in patients with a genetic predisposition to the condition (75% in the hereditary form vs. 26% in the general form). Future research should explore the pathophysiological processes behind this disease to extrapolate strategies that can achieve an earlier diagnosis and more effective treatment.

Study DesignRetrospective cohort study.ObjectiveTo compare in-hospital mortality, complications, and resource utilization among patients undergoing fusion, decompression/discectomy, or instrumentation for spine trauma at Level I vs Level II trauma centers.MethodsThe National Trauma Data Bank was queried for adult patients with isolated spine trauma who underwent fusion, decompression/discectomy, or instrumentation at a Level I or Level II center. Multivariable logistic and linear regression models were used to adjust for patient demographics, injury severity, comorbidities, and hospital characteristics, comparing in-hospital mortality, complications, and length of stay (LOS).ResultsWe identified 10295 patients (6588 at Level I; 3707 at Level II). Level I patients were younger, had more severe spinal injuries, and had a higher incidence of spinal cord injury, particularly involving the cervical spine. Unadjusted outcomes showed similar mortality, but longer hospital and ICU LOS at Level I centers. After risk adjustment, treatment at a Level I center was associated with a 34% lower adjusted odds of in-hospital mortality (OR 0.66; 95% CI 0.46-0.96; P = .030). There were no significant differences in adjusted odds of any in-hospital complication or in adjusted hospital and ICU LOS.ConclusionTreatment at a Level I trauma center was associated with a significant survival benefit for patients undergoing operative management for spinal trauma. This mortality advantage was achieved without increasing complications or LOS. Given the retrospective design, causality cannot be inferred. Nevertheless, these findings suggest that Level I centers are associated with a distinct survival advantage for this high-acuity patient population.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the prognostic utility of preoperative laboratory values (PLVs) in predicting 30-day postoperative outcomes among patients undergoing single-level vertebral fracture fixation.MethodsThe ACS-NSQIP database (2015-2020) was queried to identify adults who underwent single-level vertebral fracture fusion. Patients were stratified by PLV categories using clinically relevant hypo- and hyper-thresholds. Outcomes included 30-day mortality, major complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Multivariate logistic regression adjusted for demographics and comorbidities was used to assess associations between PLVs and adverse outcomes.ResultsA total of 4005 patients were identified. Hypoalbuminemia emerged as the strongest independent predictor of poor outcomes, including mortality (OR 4.05, 95% CI 2.14-7.69, P < 0.001), major complications (OR 1.94, 95% CI 1.46-2.57, P < 0.01), and NHD (OR 1.72, 95% CI 1.37-2.17, P < 0.001). Elevated creatinine and leukocytosis were significantly associated with increased mortality (P = 0.047) and Clavien-Dindo IV complications (P < 0.001), while preoperative anemia predicted prolonged hospitalization (P < 0.01).ConclusionsAmong patients undergoing single-level vertebral fixation for fracture, hypoalbuminemia is the most consistent predictor of adverse 30-day outcomes. Elevated creatinine, leukocytosis, and anemia also confer independent risks for specific complications. Incorporating PLVs into preoperative risk stratification may enhance patient counseling, optimize perioperative planning, and identify candidates for targeted prehabilitation.

Abstract When recalling past episodes, different features of an experience, such as conceptual meaning and perceptual detail, are reconstructed and reinstated across distributed cortical regions. However, current models of human memory remain unclear how these feature-specific reinstatements unfold over time, and whether they interact hierarchically during memory retrieval. Using magnetoencephalography (MEG) and time-resolved encoding-retrieval cross-phase classification analysis, we compared the time course of conceptual and perceptual reinstatement during cued visual recall. Conceptual information decoding in the ventromedial prefrontal cortex (vmPFC) preceded perceptual information decoding in the ventral visual cortex (VVC), and the two were expressed in distinct frequency bands: theta (4–8 Hz) for conceptual and gamma (30–40 Hz) for perceptual information. Cross-correlation and spectral Granger causality analyses revealed that during reinstatement conceptual information in vmPFC predicted and directed perceptual information in VVC, with theta-band information flow predominantly from vmPFC to VVC. In addition, bottom-up connectivity from VVC to vmPFC was expressed in the alpha band. These findings suggest that memory retrieval proceeds from abstract conceptual reconstruction to the reinstatement of perceptual details, mediated by theta oscillatory communication between prefrontal and sensory areas. We propose a hierarchical interactive model in which vmPFC initiates conceptual activation through theta-band top-down signals, while VVC provides alpha-band feedback for evaluating reconstructed perceptual details.

Study DesignRetrospective cohort study.ObjectiveDialysis dependent patients have been found to have greater healthcare utilization, rates of postoperative complications, and mortality after cervical spine surgery. However, there is a gap in the literature investigating the impact of dialysis dependency on outcomes after posterior cervical decompression and fusion (PCDF) specifically. To compare perioperative outcomes in dialysis-dependent and non-dialysis-dependent patients after PCDF from 2016 to 2022 using the National Inpatient Sample (NIS) database.MethodsThe NIS was queried for adult patients who were dialysis dependent and underwent PCDF between 2016 and 2022. Data regarding demographics, comorbidities, cost, discharge disposition, hospital characteristics, adverse events, and mortality were collected. Survey-weighted chi-square tests and t-tests were used to compare groups. A multivariable regression was performed to determine whether dialysis dependency was independently predictive of complications, discharge disposition, and inpatient mortality.ResultsOf the 167,995 weighted PCDF admissions identified, 1080 (0.64%) were dialysis dependent. Dialysis patients were more frequently male (66.2% vs 53.0%; P < 0.001), Black (44.4% vs 12.8%; P < 0.001), and from distressed communities. Dialysis dependency was independently associated with increased odds of cardiovascular complications (OR 2.52, 95% CI 1.87-3.41, P < 0.001), sepsis (OR 2.68, 95% CI 1.17-6.15, P = 0.020, and non-routine discharge (OR 1.45, 95% CI 1.05-1.99, P = 0.022). Inpatient mortality was greater in our dialysis dependent cohort (1.9% vs 0.3% P < 0.001).ConclusionDialysis dependency causes increased morbidity, healthcare utilization, and mortality in patients undergoing PCDF. These findings highlight a need for more judicial surgical selection and perioperative management in patients with this comorbidity.Level of EvidenceIII.