The routine use of intraoperative vancomycin powder to prevent postoperative wound infections has not been borne out in the literature in the pediatric spine population. The goal of this study is to determine the impact of vancomycin powder on postoperative wound infection rates and determine its potential impact on microbiology.

A retrospective analysis of the Harms Study Group database of 1269 adolescent idiopathic scoliosis patients was performed. Patients that underwent a posterior fusion from 2004-2018 were analyzed. A comparative analysis of postoperative infection rates was done between patients that received vancomycin powder to those who did not. Statistical significance was determined using Chi-squared test. Additionally, the microbiology of infected patients was examined.

In total, 765 patients in the vancomycin group (VG) were compared to 504 patients in the non-vancomycin group (NVG). NVG had a significantly higher rate of deep wound infection (p<0.0001) and associated reoperation rate compared to VG (p<0.0001). Both groups were compared for age, gender, race, weight, surgical time, blood loss, number of levels instrumented, and preop curve magnitude. There were significant differences between the groups for race (p<0.0001); surgical time (p=0.0033), and blood loss (p=0.0021). In terms of microbiology, VG grew p.acnes (n=2), and serratia (n=1), whereas NVG grew p.acnes (n=1) and gram positive bacilli (n=1). The remaining cultures were negative.

The use of intraoperative vancomycin powder in adolescent idiopathic scoliosis appears to contribute significantly to deep wound infection prevention and reduction of associated reoperations. Based on this study's limited culture data, Vancomycin does not seem to alter the microbiology of deep wound infections.

Closed reduction and percutaneous pinning has become the most common technique for the treatment of Type III displaced supracondylar humerus fractures in children. The purpose of this study was to evaluate whether the loss of reduction in lateral K wiring is non-inferior to crossed K wiring in this procedure.

A prospective randomised non-inferiority trial was conducted. Patients aged three to seven presenting to the Emergency Department with a diagnosis of Type III supracondylar humerus fracture were eligible for inclusion in the study. Consenting patients were block randomised into one of two groups based on wire configuration (lateral or crossed K wires). Surgical technique and post-operative management were standardised between the two groups. The primary outcome was loss of reduction, measured by the change in Baumann's angle immediately post –operation compared to that at the time of K wire removal at three weeks. Secondary outcome data collected included Flynn's elbow score, the humero-capitellar angle, and evidence of iatrogenic ulnar nerve injury. Data was analysed using a t-test for independent means.

A total of 52 patients were enrolled at baseline with 23 allocated to the lateral pinning group (44%) and 29 to the cross pinning group (56%). Six patients (5 crossed, 1 lateral) received a third wire and one patient (crossed) did not return for x-rays at pin removal and were therefore excluded from analysis. A total of 45 patients were subsequently analysed (22 lateral and 23 crossed). The mean change in Baumann's angle was 1.05 degrees, 95% CI [-0.29, 2.38] for the lateral group and 0.13 degrees, 95% CI [-1.30, 1.56] for the crossed group. There was no significant difference between the groups in change in Baumann's Angle at the time of pin removal (p = 0.18). Two patients in the crossed group developed post-operative iatrogenic ulnar nerve injuries, while none were reported in the lateral group.

Preliminary analysis shows that loss of reduction in Baumann's angle with lateral K wires is not inferior to crossed K wires in the management of Type III supracondylar humerus fractures in children. The results of this study suggest that orthopaedic surgeons who currently use crossed K wires could consider switching to lateral K wires in order to reduce the risk of iatrogenic ulnar nerve injuries without significantly compromising reduction.

Most long-term follow-up studies report retrospective data, the quality of which remains limited due to their inherent biases. Prospective databases may overcome these limitations, however, feasibility and costs limit their application. To date there exists a paucity of evidence-based literature on which recommendations can be made for the ideal length of follow-up for spinal deformity research. Therefore, our aim was to evaluate the added value of follow-up of patients beyond 2 years following surgery for AIS.

A database registry evaluating surgical outcomes for all consecutive AIS patients with post-op data-points of 6 months, 1 year, 2 year, and 5 year was analysed. Surgeon-reported complications, SRS-22 scores, and radiographic data were evaluated. Complications requiring surgical or medical intervention were compared between patients in whom complications developed within 2 years to those in which newly developed complications occurred between >2–5 years.

536 patients were analysed. SRS-22 scores significantly improved at 2 years post-op with no change at 5-year follow-up. Overall complication rate was 33.2% with majority occurring within 2 years (24.8%). The rate of complications occurring >2–5 years requiring intervention was significantly lower than those requiring intervention within 2 years of surgery (4.7% vs 9.7%, p=0.000), however was not negligible. The most common newly observed complication beyond 2 years was pain (1.9%), followed by surgical site infection (SSI) (1.3%) and implant issues (0.56%). There were no significant differences in the rates of crankshaft (p=0.48), implant issues (p=0.56), pseudarthrosis (p=0.19), and SSI (p=0.13) between the 2 time points.

Although majority of complications following AIS surgery occurs within 2 years, a non-negligible rate of newly observed complications occur at >2–5 years post-op. Specifically crankshaft, pseudarthrosis, implant issues, and SSI have similar rates of occurrence at these 2 time points.

Natural history of AIS >30° in skeletally mature patients is poorly defined. Studies reporting rates and risk factors for progression are predominantly of large curves in immature patients. Our aim was to determine the rate of curve progression in AIS following skeletal maturity, any associated changes in SRS-22 scores, and identify any potential predictors of curve progression.

Patients enrolled in a prospective, longitudinal, multicentre non-surgical AIS database were evaluated. All patients had minimum 2 year follow-up, idiopathic scoliosis >30°, and were skeletally mature. SRS-22 functional outcome scores and radiographic data were compared at baseline and 2-year follow-up. Patients were divided into 3 groups based on curve size: A=30°-39°, B=40°-49°, C= >50°. Curve progression was defined as any change in curve magnitude.

There were 80 patients, majority females (93.8%) with a mean age of 16.5+/−0.16. Mean BMI was 21+/−0.31 with 15.1% overweight. Mean major cobb at baseline was 38.3°+/−0.88°. At 2 year follow-up 46.3% of curves had progressed an average 3.4°+/−0.38°. Of curves that progressed, patients in group A had the largest mean rate of progression followed by group B. SRS-22 scores on average declined significantly over 2 years in this cohort (4.23 to 4.08; p=0.002). Patients who progressed had on average a more significant decline in SRS outcome scores compared to those that did not (p=0.018, p=0.041 respectively), with the most significant change noted in the Self-Image domain (p=0.03). There was no significant difference in the change in SRS scores over 2 years based on curve size. Univariate analysis did not identify any factors predictive of curve progression in this cohort.

Skeletally mature patients with AIS >30°may continue to have a risk of progression at a mean rate of 1.7°/yr and significant decline in SRS-22 outcome scores, in particular Pain and Self-Image, over time.