Background: Academic conferences such as the annual Pediatric Orthopaedic Society of North America (POSNA) meeting provide opportunities to present up-to-date scientific work that can influence clinical decision making. This study reviewed 4 years of abstracts presented at POSNA to assess trends in poster and podium presentation publication rates and associated metrics and the impact of academic presentations on the pediatric orthopaedic literature. Methods: All abstracts presented at POSNA annual meetings from 2013 to 2016 were analyzed for presentation type, subspeciality, level of evidence, study design, peer-reviewed publication within 4 years of presentation, 1-year publication rates, journal impact factors, number of authors, and citations of the final publication. χ 2 , analysis of variance, and t tests were conducted to measure independence of variables. Statistical significance was indicated at P < 0.05. Results: A total of 1135 abstracts were included with 676 published in peer-reviewed journals by August 2020 and 38 excluded because of publication before presentation. The number of accepted abstracts increased yearly. Total of 58.2% of POSNA abstracts were published and 42.5% had the same first author on the final manuscript. Average journal impact factor was 2.60 ± 1.30 with a mean 14.3 ± 16.0 citations. Podium presentations were significantly more likely to be published than poster presentations (63.1% vs. 51.2%, P < 0.001) and in higher-impact factor journals. Level I evidence abstracts were published in journals with an average 1.663 higher impact factor than level V evidence abstracts, with no significant difference between overall publication rate and study type (P = 0.69) or level of evidence (P = 0.95) for podium presentations. The Journal of Pediatric Orthopaedics accepted the most abstracts, 38.4% overall, with 64.1% of acceptances resulting from podium presentations and no difference in time to publication based on subspecialty. Conclusions:The overall publication rate for POSNA abstracts has increased 8.7% from prior analysis. Podium presentations are more likely than poster presentations to be published, overall and in higher-impact journals, and are cited more frequently. Level of Evidence: Level IV-descriptive retrospective epidemiological study.

BackgroundObstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature.MethodsThe National Inpatient Sample from 2010 to 2018 was utilized to identify adult AIS patients treated with MT. Those with and without OSA were compared for clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis and propensity score adjustment (PA) were employed to evaluate independent associations between OSA and clinical outcome.ResultsAmong 101 093 AIS patients treated with MT, 6412 (6%) had OSA. Those without OSA were older (68.5 vs 65.6 years old, p<0.001), female (50.5% vs 33.5%, p<0.001), and non-caucasian (29.7% vs 23.7%, p<0.001). The OSA group had significantly higher rates of obesity (41.4% vs 10.5%, p<0.001), atrial fibrillation (47.1% vs 42.2%, p=0.001), hypertension (87.4% vs 78.5%, p<0.001), and diabetes mellitus (41.2% vs 26.9%, p<0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs 21.8%, p=0.017), treatment of hydrocephalus (0.3% vs 1.1%, p=0.009), and in-hospital mortality (9.7% vs 13.5%, p<0.001). OSA was independently associated with lower rate of in-hospital mortality (aOR 0.76, 95% CI 0.69 to 0.83; p<0.001), intracranial hemorrhage (aOR 0.88, 95% CI 0.83 to 0.95; p<0.001), and hydrocephalus (aOR 0.51, 95% CI 0.37 to 0.71; p<0.001). Results were confirmed by PA.ConclusionsOur findings suggest that MT is a viable and safe treatment option for AIS patients with OSA.

Background: Radiographic markers of skeletal maturity are vital to the prediction and interpretation of skeletal growth patterns. Accurate predictions of skeletal maturity factor into the management of common musculoskeletal disorders. Bone age is conventionally measured using hand and wrist radiographs. The primary study objective was to optimize skeletal maturity estimates based on the morphology of markers at the hip, knee, and foot rather than conventional upper extremity radiographs. Methods: This was a retrospective analysis of children from the Bolton-Brush collection with anteroposterior radiographs of the hip and anteroposterior and lateral radiographs of the knee and foot, and heights recorded at the time of each radiograph. The percent growth achieved (%GA) was calculated as a function of final patient height. Poor quality radiographs were excluded, leaving 50 patients-32 females and 18 males-and 1068 radiographs for analysis. Skeletal maturity was evaluated using the Oxford bone, O'Connor knee, and calcaneal apophyseal scores. Interrater and intrarater reliability analyses were performed for hip and knee scores. Multiple linear regressions were conducted on these scores and chronologic age as predictors of %GA. Mean differences were calculated between actual and estimated %GAs. All analyses were performed in Prism 8.0. Results: Each lower extremity skeletal maturity score served as statistically significant, independent predictors of %GA, the accuracy and strength of which increased with the addition of chronologic age. The integration of all 3 systems and chronologic age yielded the most predictive, accurate model predictive of % GA, which can be used to determine percent growth remaining. However, this fully integrated system was not statistically superior to the combination of knee and foot scores and knee score and chronologic age, which yield similarly accurate %GA predictions. The hip and knee systems demonstrated good to excellent interrater and intrarater reliability. Conclusions: Integration of bone age scores across different regions of the lower extremity has the potential to facilitate orthopaedic decision-making using radiographs already obtained in the treatment of pediatric musculoskeletal conditions. Level of Evidence: Level IV.

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Patient: Female, 75-year-old Final Diagnosis: Healing fracture Symptoms: Deformity • pain Clinical Procedure: Open reduction and internal fixation of the right humerus • revision of open reduction and internal fixation of the right humerus Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Attainment of extremity immobilization in orthopedic trauma patients experiencing psychosis is often uniquely challenging. Many fractures, including those of the distal humerus, require a period of immobilization postoperatively to optimize fracture healing. Patients with Parkinson’s disease have also been shown to have lower rates of union after fracture compared to the general population. The combination of Parkinson’s disease and associated psychosis requires heightened attention to those parameters that may hinder fracture healing, such as inadequate immobilization of the fracture. Botulinum toxin has previously been described as a potential adjunctive therapy for fracture immobilization but has not yet been described in the setting of distal humerus fractures. Case Report: A 75-year-old woman with Parkinson’s disease-associated psychosis presented 2 weeks after open reduction and internal fixation of a distal third humeral shaft fracture due to failure of fixation and episodes of violent hallucinations. The patient underwent irrigation and debridement, and revision open reduction and internal fixation. Given her uncontrolled hallucinations, intramuscular botulinum toxin injections were given to the right triceps, biceps, and brachialis muscles to aid in the immobilization of the right extremity and protect the surgical site during the perioperative period. The patient subsequently followed up at the clinic 3 months postoperatively with ongoing fracture healing, evidenced by bridging callous and bone formation on radiographs, as well as a return of motion to the extremity. Conclusions: Botulinum toxin may be a safe and effective adjunct for fracture immobilization in patients who are difficult to immobilize and have high fixation failure risk.

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