Pediatric Orthopedic Surgery Research

The Division of Orthopaedic Surgery and Sports Medicine is engaged in many research studies to improve the bone health of children.

Joseph Janicki, MD, and colleagues performed a retrospective analysis of percutaneous radiofrequency ablation (RFA) for treatment of osteoid osteoma, and determined that in the population studied, RFA is safe and effective but may carry a risk for complications. Janicki contributed to a study of cotransplantation with spina bifida bone marrow stem/progenitor cells. The group, with first author Arun Sharma, PhD, of the Division of Urology, determined that this technique could enhance urinary bladder regeneration.

Featured Studies

“Fractures in Childhood and Adolescence: a Risk Factor for Decreased Peak Bone Mass?”

Principle Investigator: Joseph Janicki, MD

Scientific Aims/Questions

  1. Collect a cohort of children with reduced bone density and fracture developing pilot data to base a prospective, multicenter longitudinal study to evaluate children with fractures who are a risk for decreased peak bone density.
  2. Determine if reduced bone density by forearm ultrasound contralateral to the fracture correlates with central DXA readings. A sensitivity and specificity of forearm ultrasound will be determined using central DXA readings as gold standard.
  3. Collect a cohort of children from an orthopaedic fracture clinic and compare their bone densities to a group of non-fracture patients.
  4. Determine subsequent change in bone mass in a fracture cohort by both DXA and ultrasound.

“Bone Health in Children: Results of a Survey of Risk Factors for Low Bone Density”

Principle Investigator: Joseph Janicki, MD

Purpose: Low bone density has been linked to numerous risk factors including family history, gender, diet, weight, exercise, and history of previous fractures. It has been hypothesized that adult osteoporosis has its origins during the pediatric period. The purpose of this study was to collect cross sectional data from a cohort of healthy children in the Chicago area to determine the baseline rate of risk factors for low bone density and to determine which are most associated with a history of fractures in these children.

Surveys were distributed to children ages 5 to 18 and their parents in community outpatient pediatric clinics in Chicago, Chicago suburbs, and in the Lurie Children’s Orthopaedics subspecialty clinic. The questions asked for “yes/no” responses regarding the following poor bone health risk factors: previous fractures, family history of osteoporosis, calcium (Ca)/dairy intake, low physical activity, being overweight, sunlight exposure and chronic disease.

“Risk Factors for Late Presentation of Developmental Hip Dislocation and Risk Factors for Failure of Pavlik Harness Use”

Principle Investigator: Joseph Janicki, MD

A retrospective review of patients presenting developmental hip dislocation will be completed. Specifically, we will be examining patient and family factors such as primary language and insurance status to determine if there is increased risk for late presentation associated with certain social and economic groups. A retrospective review of hospital charts and surgical records will be completed to identify patients from January 1, 2004 through October 20, 2010 treated for developmental hip dysplasia. Late presentation will be defined as 6 months of age or older as this has been previously described in the literature. We will compare these patients to those who presented prior to 6 months of age to help determine risk factors.

This is also a typical time at which patients can no longer be treated with nonoperative management and may need operative treatment such as closed reduction and spica casting, open hip reduction or possibly pelvic osteotomy to establish and maintain a concentric, reduced hip joint and prevent future pain and disability.

“Pain Management in Children Undergoing Supracondylar Humerus Fracture Repair: Can a Local Supraclavicular Block Improve Their Postoperative Outcome?”

Collaborative study with the Anesthesia Department
Principle Investigator: Joseph Janicki, MD

Post-operative pain is commonly under treated in children. A prospective, randomized clinical trial will compare supraclavicular blocks to intravenous morphine administration for the management of pain after closed reduction and pinning of a pediatric supracondylar humerus fracture. Outcomes evaluated include the use of rescue medication, pain scores, home pain medicine use, and the eventual need for physical therapy.

“Prospective Pediatric Scoliosis Study: A Prospective Multi-Center Study” (PPSS)

Principle Investigator: Joseph Janicki, MD

The main purpose of this study is to 1) develop a prospective comprehensive radiographic and clinical database on consecutively treated pediatric scoliosis (PS) surgical cases to assess outcome measures in pediatric patients with operative idiopathic scoliosis being treated with current surgical techniques. To reflect current operative techniques, consecutive patients with PS treated surgically will be collected from spinal deformity centers with appropriate case volume, research capabilities, and study commitment. Additionally, this prospective study will be able to: 2) Classify PS curves among different scoliosis surgeons; 3) Develop and utilize a detailed radiographic process measure scoring system that accurately portrays the radiographic deformity before and after surgery; 4) Develop and utilize a reliable cosmetic scoring system for PS that accurately portrays the trunk deformity before and after surgery; 5) Utilize and evaluate clinical outcome measures and patient satisfaction following surgery.

A secondary objective of this study is to obtain data on currently available surgical approaches to treat idiopathic PS in the thoracic, thoracolumbar, and lumbar spine. The investigation will attempt to answer the following questions: 1) Are levels saved using current anterior versus posterior techniques? 2) Which technique(s) provides the best correction, balance, cosmesis, and patient satisfaction? 3) Is there one technique associated with increased morbidity over others? 4) What are the cost profiles for current surgical techniques? 5) How does sagittal plane alignment influence the clinical results? Many other inquires will undoubtedly arise with data acquisition/analysis.

“Prospective Pediatric Kyphosis Study: A Prospective Multi-Center Study”(PPKS)

Principle Investigator: Joseph Janicki, MD

The main objective of this study is to assess outcome measures in patients with pediatric kyphosis (defined as a global sagittal plane angle of greater than 60° when measuring from T2-T12 on a standing lateral full-length radiograph in Scheuermann’s kyphosis or the maximum measured kyphosis, or a junctional kyphosis defined as any sagittal plane deformity which is considered to be ³ 20 degrees on appropriate end vertebra to end vertebra over 3 spinal segments) being treated non-operatively or operatively with current surgical techniques. To reflect these operative techniques, consecutive patients with Pediatric Kyphosis meeting these criteria, treated surgically will be collected from spinal deformity centers with appropriate case volume, research capabilities, and study commitment. This prospective study will help develop a model to determine the most successful treatment. Crossover between groups will be permitted (non-operative crossing over to operative).

A secondary objective of this study is to obtain data on currently available surgical approaches to treat pediatric kyphosis in the thoracic spine. The investigation will attempt to answer the following questions: 1) How are distal fusion levels saved by current techniques (rod and screw) compared to older techniques (hook and wire)? Historically, it was thought best to instrument to at least the first lordotic disc (in the lumbar spine). Is it best treated with anterior, posterior, or a combined fusion? 2) Which technique(s) provides the best sagittal correction, balance, cosmesis and patient satisfaction? Best is defined as: adjusting the patient surgically in such a way as to make the patient more aligned in the sagittal plane (lateral plane or view from the side of the patient).

The definition of pediatric kyphosis in this protocol is inclusive of juvenile and adolescent pediatric kyphosis (normal is generally accepted as between 20-50°), since onset of pediatric kyphosis does not spontaneously happen it often starts at a young age and is not diagnosed until adolescence.14,16,20,21 Therefore, an arbitrary age deadline for this study would not be inclusive of adolescent or juvenile pediatric kyphosis, but a combination of the two. At the conclusion of this study, we (the participating sites) will present a model that shows the best treatment option(s) for pediatric kyphosis.

“Evaluation the Necessity of Operative Irrigation and Debridement: Pediatric Randomized trial of type One Open Fractures (PROOF)”

Principle Investigator: Joseph Janicki, MD

Question: Do patients with type one open fractures treated in the emergency department with irrigation have a similar rate of infections compared to those treated in the operating room with formal irrigation and debridement?

Hypothesis: Minor open fractures in children can be safely treated in the emergency room with irrigation, closed reduction and home antibiotics without an increased risk of infection or an increased time to healing.

Significance: Fractures in which bone has been exposed to the outside world through an associated skin injury, known as open fractures, are frequently encountered in orthopaedics. An open fracture usually calls for a formal, operative treatment in which the bone is exposed, foreign tissue is removed and the wound is washed out. Centers are reporting that less aggressive operative management may result in comparable results without the time and expense of the operative theater.

The advantages of nonoperative treatment include shorter hospital stays, avoiding the risk of general anesthesia, lower costs and lack of a larger incision. In order to compare these two different treatments, a prospective randomized non-inferiority trial is necessary and warranted. Either patients are going to the operating room when emergency room treatment will be adequate or they are receiving inadequate care when they avoid operating room management.