Background:The ability to estimate skeletal maturity using a hip radiograph does not yet exist, but may have utility in the treatment of scoliosis, slipped capital femoral epiphysis, and lower limb deformity. We sought to develop a fast, accurate, and reproducible method. Methods: Fourteen hip radiologic parameters were evaluated on serial anteroposterior hip radiographs from 3 years before to 2 years after the skeletal age associated with 90% of final height, a validated skeletal maturity definition which correlates with the timing of peak height velocity. The Greulich and Pyle (GP) left hand bone age was obtained for comparison. Stepwise linear regression and generalized estimating equation analyses were used to isolate key hip and demographic parameters, creating the "optimized Oxford" skeletal maturity system. The accuracy of the optimized Oxford system in predicting years from 90% of final height was evaluated and compared with systems of demographics only, the modified Oxford, demographics+modified Oxford, and demographics+GP. Results: A total of 284 hip radiographs from 41 girls (range: 7 to 15 y) and 38 boys (range: 9 to 17 y) were included. Following multivariate analyses, 5 of the original 14 hip radiographic parameters remained significant. The predictions made by the optimized Oxford model had greater accuracy and fewer outlier predictions (predictions > 1 y off from actual years from 90% of final height) than the demographics only and modified Oxford only models (P < 0.05 for all). The optimized Oxford model had greater prediction accuracy than the demographics+modified Oxford model, but similar rates of outlier predictions (P = 0.903). No differences in mean prediction accuracy or rate of outlier predictions were observed between the optimized Oxford and the demographics+GP model (P > 0.05). Conclusion: High precision in skeletal maturity estimation can be achieved by using chronological age, sex, and 5 hip radiographic parameters. Clinical Relevance: We have developed a skeletal maturity system that utilizes anteroposterior hip radiographs and performs as accurately as GP.

Abstract:PurposeProximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation.MethodsWe retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation.ResultsAverage patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation.ConclusionNo paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern.Level of EvidenceLevel III Diagnostic

Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS ( P = .03) and ASES score ( P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.