Introduction: While bracing may improve the natural history of patients with adolescent idiopathic scoliosis with moderate curves, little attention has been paid to the potential impact of brace treatment on their quality of life. We hypothesized that bracing has a negative affect on the physical and psychosocial health of affected adolescents.

Methods: Quality of life (QOL) data was collected from patients with adolescent idiopathic scoliosis and a spinal curvature greater than 10 degrees at our institution. The Child Health Questionnaire (CHQ) and the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI) were administered to parents to measure their children’s QOL. Multivariate analyses were conducted to determine the effect of gender and treatment on QOL.

Results: Our cohort consisted of 214 patients, who were mostly female, with an average curve of 28 degrees and an average age of 13.7 years. One hundred thirty four patients were observed (average curve 25 degrees), while 80 patients were treated with bracing (average curve 34 degrees). There were no significant differences in QOL between these two treatment groups, using the Bonfer-roni multiple comparison test. There were no gender-related differences in QOL. Among 15 children with pre- and intra-bracing data, there were no significant differences in QOL between these two time points.

Discussion and conclusion: Our patients who were treated with spinal bracing did not seem to have significantly different health-related QOL, as compared with patients in the observation group. These findings are contrary to our initial hypotheses and merit further study.

Introduction: The surgical correction of idiopathic scoliosis is a technically complex procedure that requires significant surgical expertise and highly specialized support. The current study examines practice patterns for the surgical treatment of scoliosis over a 5-year period in the State of California, with particular attention to the effect of payer status on surgical outcomes. Given the significant disparity in reimbursement for scoliosis surgery between patients with different payment sources (i.e. Medicaid versus private insurance), the potential exists for different management of disease and patient outcomes.

Methods: Using the California Office of Statewide Health Planning and Development (OSHPD) hospital discharge database, data for all surgical discharges between 1993 and 1997 for children ages 10–18 years old with a primary diagnosis of idiopathic scoliosis were reviewed. 1614 children were discharged from 99 hospitals over this period, and form the basis for this report. Outcomes of interest included length of stay (LOS), readmission, death, and need for surgical reoperation. Results: The mean age at admission of patients was 13.97 years (SD=1.89). The mean LOS was 7.38 days (SD=5.63) and mean readmission rate was 4.5%. Death (n=2) and reoperation (n=4) were extremely uncommon, making it impossible to use these as primary endpoints. Patients insured by Medi-Cal did not have significantly higher readmission rates, but did have a significantly longer length of hospital stay than patients with other payment sources (p< 0.001) and had a greater proportion of cases of extreme severity (p< 0.05), according to DRG severity code. Patients insured by Medi-Cal also incurred significantly higher hospital charges than patients with other sources of payment (p< 0.001).

Discussion and conclusions: The current study highlights the significant disparity in reimbursement rates for scoliosis surgery for patient insured by Medicaid versus private insurance in California. While this study does not address the issue of “unmet need” among the underinsured segment of the population, review of administrative data suggests that patients with Medicaid are more likely to have a higher severity of illness when presenting for surgery, and perhaps as a result, a longer length of stay. Future investigations will seek to reanalyze this dataset in patients with neurogenic scoliosis, where higher mortality and morbidity may allow for a more sensitive analysis of predictors of outcome.

Introduction: The goal of surgical equalization of leg length discrepancy (LLD) is to improve the quality of life (QOL) of affected individuals by improving function and appearance. While many surgeons utilize a cut off point of 2cm as a treatment guide, little attention has been focused on the effect of LLD on QOL. The purpose is to determine the critical cut off size for the effect of LLD on QOL. Such information may help refine the surgical indications of leg length equalization in these patients.

Methods: QOL and scanogram data were collected from children diagnosed with LLD at our institution. QOL was assessed using the parent short-form of the Child Health Questionnaire (CHQ). QOL scores from this group were compared to normative data. Correlation analyses and independent t-tests were conducted to assess the relationship between size of LLD and QOL.

Results: Our cohort consists of 41 patients (50 observations) with an average LLD of 2.05cm. Compared to norms, LLD patients scored significantly lower on four CHQ domains. Correlation analyses revealed a negative relationship between size of LLD and several psychosocial domains. Independent t-test revealed that children with LLD greater than or equal to 2cm scored significantly (p< 0.05) higher in six domains than children with LLD> 2cm: General Health, Parental Impact-Emotional Scale, Parental Impact-Time Scale, Family Activities, Family Cohesion, Psychosocial Summary Score.

Discussion and conclusion: With increasing LLD, differences in psychosocial health become especially apparent. This study suggests that children with LLD> 2 cm experience perturbations in QOL, supporting the use of this cut off as a guideline for intervention.

Seventy-eight children, with 79 femoral fractures, treated with titanium elastic intramedullary nails were reviewed for complications.

Insertion site symptoms (41), malunion (8), refracture (2), transient neurological deficit (2), superficial wound infection (2), and reoperation prior to union (10).

Malunion/loss of reduction was increased with mismatched nails (p=0.02) and comminution (p=0.02). Insertion site symptoms were increased with nail ends that were bent (p=0.02), or > 10mm prominent (p=0.002). Nails remain implanted in 25 children without problems.

Nail ends should lie against the femur to avoid insertion site symptoms. Nails of different diameters should not be implanted. Comminuted fractures require close monitoring.