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Newly minted pediatric orthopaedic surgeons face a variety of challenges when building a practice. No matter how skilled a surgeon is, he/she will be unsuccessful by any metrics if they lack patients to take care of. This manuscript will review principles and practical techniques that pediatric orthopaedic surgeons can utilize to build a renewable referral base to fuel their practice.

Adolescent idiopathic scoliosis represents a complex, three-dimensional deformity of the spine. Posterior spinal fusion is commonly performed in severe cases to avoid the long-term adverse sequelae associated with progressive spinal deformity. The goals of spinal fusion include halting the progression of deformity, optimizing spinal balance, and minimizing complications. Recent advances in short-segment spinal fixation have allowed for improved three-dimensional deformity correction. Preoperative planning and assessment of spinal flexibility is essential for successful deformity correction and optimization of long-term outcomes. Judicious use of releases and/or spinal osteotomies may allow for increased mobility of the spine but are associated with increased surgical time, blood loss, and risk of complications. Appreciation of implant design and material properties is critical for safe application of correction techniques. Although multiple reduction techniques have been described, no single technique is optimal for every patient.

Study design Randomized controlled trial. Objective To assess whether monitoring increases brace-wearing compliance in patients with adolescent idiopathic scoliosis (AIS). Summary of background data Noncompliance is a barrier to brace treatment of AIS. Studies have demonstrated that monitoring improves medication compliance; however, this has not been investigated in spinal braces. Methods Twenty-one patients (mean age = 12.4 ± 2.0 years) with AIS were prescribed treatment with a custom-made Thoraco-Lumbo-Sacral-Orthosis for 18 hours a day using a standardized script. Before beginning treatment, 10 patients were randomized to be informed that their compliance was monitored, whereas 11 patients were unaware. Compliance was measured via a temperature probe embedded within the Thoraco-Lumbo-Sacral-Orthosis hidden from view. Results Patients who were notified that they had a monitor in their brace demonstrated significantly increased compliance during the first 14 weeks of treatment compared with those who were uninformed (85.7% vs. 56.5%, P = 0.029), corresponding to a mean difference of 5.24 hours of daily brace wear. Conclusion Electronic monitoring can improve compliance with orthoses in patients with spinal deformity during a short observation period.

Introduction: In one-third of patients discharged with stroke or TIA the etiology of the event remains undetermined. Occult paroxysmal atrial fibrillation (PAF) was reported as a potential etiology. The factors predicting PAF in these patients have not been defined. Hypothesis: 1) A high rate of PAF can be detected during 21 days of mobile cardiac outpatient telemetry (MCOT). 2) There will be a set of risk factors which can predict the detection of PAF with MCOT. Methods: We performed a retrospective analysis on patients evaluated by MCOT monitoring within 6 months of a cryptogenic stroke or TIA. The ECG data were analyzed with an algorithm verified against the MIT-BIH arrhythmia database. Multivariate analysis with survival regression analysis was performed using demographic, clinical, neuroimaging and cardiac imaging characteristics to determine predictive risk factors for detection of PAF on MCOT. Kaplan-Meier estimates were computed for the 21-day PAF rates. Results: We analyzed 156 records; 97% of patients were not on anticoagulation. PAF occurred in 27 of 156 (17.3%) patients during MCOT monitoring of up to 30 days. The rate of PAF detection significantly increased from 3.9% in the initial 48hrs, to 9.2% at 7 days, to 15.1% at 14 days, and to 19.5% by 21 days (pfigure ). Multivariate analysis defined several independent predictors of PAF detection ( table ). Premature atrial complex (PAC) on baseline ECG held the strongest correlation with PAF (HR 13.65, p=0.001). Conclusion: MCOT is a robust diagnostic tool for the identification of PAF in patients with cryptogenic stroke and TIA. Length of monitoring is strongly associated with the likelihood of detection of PAF. Female gender, PAC on ECG, increased left atrial diameter (LAD), reduced left ventricular ejection fraction (LV EF) and greater NIHSS increase the likelihood of PAF detection.