Glotzbecker, Michael P.

OBJECTIVESurgery for severe congenital defects, such as congenital diaphragmatic hernia, congenital heart defects, and tracheoesophageal disorders, are life-saving treatments for many infants. However, the incidence of scoliosis following thoracoabdominal surgery has been reported to range from 8% to 50%. Little is known about severe scoliosis that occurs after chest wall procedures in infants. The authors sought to determine the prevalence of thoracogenic scoliosis, disease severity, and need for scoliosis surgery in patients who underwent chest wall procedures in early childhood.METHODSA multicenter database of patients with early-onset scoliosis was queried to identify patients with a history of thoracogenic or acquired iatrogenic scoliosis. Patients with significant congenital spine deformities were excluded. Forty-one patients (1.6%) were noted to have thoracogenic scoliosis. Of these patients, 14 patients were observed; 10 received casts and/or braces; and 17 underwent treatment with rib-based distraction rods, Shilla procedures, or spine-based growing rod devices. Radiographs, complications, and patient characteristics were reviewed.RESULTSThe mean age at scoliosis diagnosis for the 41 patients was 6.0 years. The mean time to follow-up was 2.9 years (4.5 years in the 17 surgical patients). The mean preoperative coronal Cobb angle in the surgical group was 65° and improved to 47° postoperatively (p = 0.01). The mean Cobb angle for the nonoperative group was 31° initially and 32° at follow-up (p = 0.44). Among the 17 patients undergoing surgery for scoliosis, there were 13 complications in 7 patients, including a brachial plexus palsy following rib-based distraction rod placement. This resolved with revision of the rib hooks. There were no known complications in the nonoperative cohort.CONCLUSIONSSevere scoliosis can develop after thoracoabdominal surgeries during infancy. Further work is needed to understand the pathogenesis of scoliosis in this population so as to implement measures for prevention and early diagnosis and to guide appropriate treatment.

Introduction: A dramatic increase in the number of pediatric orthopaedic fellows being trained has led to concerns that there may be an oversupply of pediatric orthopaedists. The purpose of this study was to determine whether this perception is accurate and whether the practice expectations of recent pediatric fellowship graduates are being met by surveying recent pediatric fellowship graduates about their early practice experiences. Methods: A 36-question survey approved by the Pediatric Orthopaedic Society of North America (POSNA) leadership was electronically distributed to 120 recent graduates of pediatric orthopaedic fellowships; 81 responses were ultimately obtained (67.5% response rate). Results: Almost all (91%) of the respondents were very or extremely satisfied with their fellowship experience. Half of the respondents had at least 1 job offer before they entered their fellowships. After completion of fellowships, 35% received 1 job offer and 62.5% received ≥2 job offers; only 2.5% did not receive a job offer. Most reported a practice consisting almost entirely of pediatric orthopaedics, and 93.5% thought this was in line with their expectations; 87% indicated satisfaction with their current volume of pediatric orthopaedics, and 85% with the complexity of their pediatric orthopaedic cases. Despite the high employment percentages and satisfaction with practice profiles, nearly a third (28%) of respondents replied that too many pediatric orthopaedists are being trained. Conclusions: Positive messages from this survey include the satisfaction of graduates with their fellowship training, the high percentage of graduates who readily found employment, and the satisfaction of graduates with their current practice environments; this indicates that the pediatric orthopaedic job environment is not completely saturated and there are continued opportunities for graduating pediatric fellows despite the increased number of fellows being trained. Although not determined by this study, it may be that the stable demand for pediatric orthopaedic services is being driven by the expansion of the scope of practice as well as subspecialization within the practice of pediatric orthopaedics.