Kali Tileston

All Publications

• Bedside Aspiration for Workup of the Pediatric Septic Hip: Avoid Trips to the OR and Expedited Time to Diagnosis. Journal of pediatric orthopedics Skaggs, K. F., Okoli, O., Naz, H., Pham, N. S., Vorhies, J. S., Tileston, K. R. 2025

  Abstract

  Septic arthritis of the hip is a pediatric orthopaedic emergency. Joint synovial fluid aspiration is a critical step of diagnosis, which may be delayed due to limited personnel or operating room (OR) availability. To expedite diagnosis, orthopaedic residents perform ultrasound-guided bedside arthrocentesis in the emergency department (ED). This study aims to evaluate the impact of this practice on time to diagnosis and definitive treatment of septic arthritis of the hip and minimizing trips to the operating room.This is a retrospective study of patients presenting to our pediatric orthopaedic tertiary care emergency room requiring a hip aspiration to rule out septic arthritis between 2003 and 2023. We identified all patients who had resulted hip synovial fluid nucleated cell count during the above time period. Chart review was performed to determine how synovial fluid was collected via interventional radiology (IR), in the OR with an orthopaedic surgeon, or via bedside aspiration with the on-call resident. Clinical outcomes were primarily defined as time points in clinical care. Patient demographics, Kocher criteria values, time to aspiration, and final treatment are presented. Kruskal-Wallis and Fisher exact tests were used to compare demographic and clinical differences in RStudio using a two-sided level of significance of 0.05.Hip aspiration was performed in the workup of septic arthritis in 57 patients (median age 5.1 y; 58% female). Aspiration occurred in the ED for 28 patients, interventional radiology (IR) for 11, and in the OR for 18 patients. Bedside aspiration avoided a trip to the OR for 15 patients (54%). Median time to obtaining joint fluid was significantly shorter for patients undergoing bedside or IR-guided aspiration compared with OR aspiration (7.4 vs. 5.3 vs. 15.7 h, respectively; bedside vs. OR P=0.007, IR vs. OR P=0.013). Time from presentation to OR for open surgical debridement, total operative time, and the percentage of patients requiring open surgical debridement did not significantly differ between groups.Bedside aspiration decreases the time to diagnosis of septic arthritis and can prevent ~50% of children from going to the OR. This is beneficial for the patient as it may allow for earlier antibiotic administration, provide pain relief, and avoid possible complications of general anesthesia.Level III-retrospective chart review.

  View details for DOI 10.1097/BPO.0000000000002996

  View details for PubMedID 40391565

• Smartphone-based surface topography app accurately detects clinically significant scoliosis. Spine deformity Rohde, M. S., Albarran, M., Catanzano, A. A., Sachs, E. J., Naz, H., Jobanputra, A., Ribet, J., Tileston, K., Vorhies, J. S. 2025

  Abstract

  The purpose of this study was twofold: (1) to validate the predictive capabilities of the Scoliosis Assessment App using ST technology against X-ray "ground truth" in patients being evaluated for clinically significant scoliosis; and (2) to compare the diagnostic accuracy of the App versus the commonly used scoliometer tool.A multicenter, prospective validation study was conducted among patients with known or suspected scoliosis. The App determined an Asymmetry Index to predict the likelihood of clinically significant disease (MCM ≥ 20°) as determined by X-ray. Outcomes included the sensitivity, specificity, and area under the receiver operating characteristic curve (ROC AUC) associated with the Apps prediction of clinically significant disease.Fifty-five patients were evaluated with a mean age of 13.6 ± 2.1 years. The App correctly classified 91% (50/55) of the patients compared to 69% (38/55) for the scoliometer. The sensitivity of the App was 96.4% (89.6-100% CI) versus 50% (28.1-71.9% CI) for the scoliometer (P < 0.05), while the specificity values were 85.2% (71.8-98.9% CI) and 88.9% (74.4-100% CI), respectively. ROC analysis indicated a statistically significant difference in accuracy (AUC) in favor of the App (95% versus 71%; P = 0.015).The Scoliosis Assessment App using ST technology offers an accurate, accessible, and non-ionizing method of detecting clinically significant scoliosis, suggesting that the App can be used for detection and monitoring as an alternative to radiography and as a replacement for scoliometer without diminishing the standard of care. Further studies are required to assess variations of sensitivity in a large cohort of patients and clinical utility as an alternative to radiographs.

  View details for DOI 10.1007/s43390-025-01062-7

  View details for PubMedID 40172834

  View details for PubMedCentralID 5759132

• Correction: Mobile device-based 3D scanning is superior to scoliometer in assessment of adolescent idiopathic scoliosis. Spine deformity Oquendo, Y., Hollyer, I., Maschhoff, C., Calderon, C., DeBaun, M., Langner, J., Javier, N., Bryson, X., Richey, A., Naz, H., Tileston, K., Gardner, M., Vorhies, J. S. 2025

  View details for DOI 10.1007/s43390-025-01046-7

  View details for PubMedID 39847213

• CORR Insights®: No Association Between Growth Hormone Therapy and Upper Extremity Physeal Tension Injuries: A Matched Case-control Study. Clinical orthopaedics and related research Tileston, K. 2024

  View details for DOI 10.1097/CORR.0000000000003345

  View details for PubMedID 39679626

• Mobile device-based 3D scanning is superior to scoliometer in assessment of adolescent idiopathic scoliosis. Spine deformity Oquendo, Y., Hollyer, I., Maschhoff, C., Calderon, C., DeBaun, M., Langner, J., Javier, N., Bryson, X., Richey, A., Naz, H., Tileston, K., Gardner, M., Vorhies, J. S. 2024

  Abstract

  Screening for adolescent idiopathic scoliosis (AIS) currently relies on clinical evaluations by trained practitioners, most commonly using a scoliometer. Modern structured light 3D scanning can generate high-quality 3D representations of surface anatomy using a mobile device. We hypothesized that a mobile-based 3D scanning system would provide accurate deformity assessments compared to a scoliometer.Between August 2020 and June 2022, patients 10-18 years being evaluated for AIS in our clinic with a scoliosis radiograph obtained within 30 days of clinic evaluation and no history of spinal surgery were enrolled. Patients had 3D scans taken in the upright and forward bend positions, and the largest angle of trunk rotation (ATR) was measured by a scoliometer. Image processing software was used to analyze trunk shift (TS), coronal balance (CB), and clavicle angle (CL) in the upright position and the largest ATR in the forward bend position. 3D and scoliometer measurements were correlated to major curve magnitude. Multiple logistic regression models were created based on 3D and scoliometer measurements, controlling for demographic covariates.Two hundred and fifty-eight patients were included in this study. Mean coronal major curve magnitude was 25.7° (range 0-100), and 59% had a thoracic major curve. There were good-to-excellent correlations between 3D and radiographic measures of TS, CB, and CL (r = 0.79, rs = 0.80, and r = 0.64, respectively, p < 0.001). Correlations between 3D and radiographic measures of largest lumbar and thoracic ATR also demonstrated good correlations (r = 0.64 for both, p < 0.001). Using Akaike's Information Criterion (AIC), a multivariable logistic regression model based on 3D scanning outperformed a scoliometer model.Mobile device-based 3D scanning of TS, CB, and TS identifies clinically relevant scoliotic deformity and is more predictive of radiographic curve magnitude than scoliometer in this population. This new modality may facilitate scoliosis screening by decreasing the need for trained personnel or dedicated equipment and clinical space to perform screening tests.II.

  View details for DOI 10.1007/s43390-024-01007-6

  View details for PubMedID 39663336

  View details for PubMedCentralID 3913566

• Impact of a Daily Huddle on Safety in Perioperative Services. Joint Commission journal on quality and patient safety Tuyishime, H., Claure, R., Balakrishnan, K., Chan, H., Lam, L., Randolph, M., Stroud, J., Traber, K., Tileston, K., Shea, K. 2024

  Abstract

  BACKGROUND: Communication failures contribute to quality gaps and may lead to serious safety events (SSEs) in the operating room (OR). Our perioperative services team experienced an increased rate of SSEs in 2020. Event analysis revealed clustered causes: communication failures and lack of timely information to prepare for cases. Consequently, the team implemented a daily morning OR safety huddle conducted before bringing patients into the OR to reduce quality gaps and improve communication.METHODS: The attending surgeon and anesthesiologist, circulating nurse, and scrub staff are required to be present. Cases are discussed using a standard format designed by the OR team with built-in time for questions and clarifications. The surgeon initiates the huddle; the circulating nurse leads and records the discussion. OR leadership initially performed daily audits but gradually reduced them when huddles became standard operating procedure (SOP). SSEs were recorded from December 2015 to September 2020 preintervention and October 2020 to July 2023 postintervention.RESULTS: Following the implementation of huddles, there were no SSEs for more than 900 days (2.0 SSEs/year preintervention vs. 0.0 SSEs/year postintervention). The first SSE during the postintervention period occurred in March 2023. Huddle compliance was consistently > 95%. No delays were observed in first-case on-time starts postintervention. The huddle is now SOP for all general OR teams and interventional radiology.CONCLUSION: Implementing the morning safety huddle contributed to a reduction in the rate of SSEs without introducing delays to first-case start-times.

  View details for DOI 10.1016/j.jcjq.2024.04.012

  View details for PubMedID 38845238

• Cannabidiol Use Patterns and Efficacy for Children Who Have Cerebral Palsy ORTHOPEDICS Seltzer, R. A., Langner, J. L., Javier, N. M., Kaur, J., Shafau, A., Ezeonu, T., Bryson, X., Hastings, K., Tileston, K., Vorhies, J. S. 2024; 47 (1): 52-+

  Abstract

  Cannabidiol (CBD)-containing supplements are used by children with cerebral palsy (CP), but the prevalence and efficacy of their use have not been studied. We sought to describe CBD use patterns and perceived efficacy in the pediatric population with CP, evaluating any association between CBD use and health-related quality of life. Patients with CP were prospectively enrolled, and caregivers were offered the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) Questionnaire and a survey assessing CBD use. Of 119 participants, 20 (16.8%) endorsed CBD use (CBD+) and 99 (83.2%) denied it (CBD-). Participants in the CBD+ group had worse functional status (85% Gross Motor Function Classification System level IV-V for CBD+ vs 37.4% for CBD-, P<.001) and lower health-related quality of life (mean CPCHILD score of 49.3 for CBD+ vs 62.2 for CBD-, P=.001). Spasticity was the rationale most cited for CBD use (29%), followed by pain and anxiety (both 22.6%). CBD was perceived to be most effective for improving emotional health, spasticity, and pain. Fifty percent of the patients in the CBD+ group underwent surgery in the previous 2 years and most endorsed a general benefit in the postoperative setting. The most common side effects noted were fatigue and increased appetite (both 12%). Most participants endorsed no side effects (60%). CBD may serve as a useful adjunct for some children with CP, especially those with worse disease severity. Caregivers perceive CBD as offering some benefits, particularly in the domains of emotional health, spasticity, and pain. We found no evidence of severe adverse events in our small cohort. [Orthopedics. 2024;47(1):52-56.].

  View details for DOI 10.3928/01477447-20230517-06

  View details for Web of Science ID 001152481700018

  View details for PubMedID 37216564

• Temporary Flexible Rods for Correction of Severe Pediatric Spinal Deformity ORTHOPEDICS Kwong, J. W., Tileston, K. R., Kaur, J., Segovia, N. A., Imrie, M. N., Rinsky, L. A., Vorhies, J. S. 2023; 46 (4): 234-+

  Abstract

  Surgical correction of large, rigid scoliotic and kyphotic curves carries an increased risk of perioperative complications, such as neurological injury and excessive blood loss, compared with correction of less severe curves. Titanium temporary flexible rods (TFRs), designed for pediatric long bone fracture fixation, may be helpful as adjuncts to achieve gradual, stepwise intraoperative correction of severe pediatric spinal deformities. A retrospective review was conducted of spinal fusion cases for pediatric scoliosis or kyphosis at our institution that used TFRs as a correction technique from 2007 to 2019. Patients underwent posterior spinal fusion with predominantly pedicle screw instrumentation. Intraoperatively, a non-contoured titanium elastic nail was temporarily positioned in the screws unilaterally to achieve partial correction while the contralateral side was instrumented. Then, the TFR was removed and replaced with a permanent rod. Thirty-four patients with severe spinal deformities underwent posterior spinal fusion. Seventeen had scoliosis (mean major Cobb angle, 89.3°) and 17 had kyphosis (mean T5-T12 kyphosis, 73.8°). Idiopathic deformity was the most common etiology; neuromuscular, syndromic, and postsurgical causes contributed to the remainder of cases. All patients had Ponte osteotomies. Four patients (11.8%) had neuromonitoring alerts, 1 of which was related to insertion of the TFR; all were reversible. For patients with scoliosis, the mean postoperative Cobb angle measured 40.2° (53.6% correction). For patients with kyphosis, the mean postoperative T5-T12 angle measured 43.3° (30.4° of correction). TFRs appear to be helpful adjuncts for correction of severe pediatric spinal deformities, facilitating gradual intraoperative correction in a single-stage operation. Neuromonitoring alerts are common but reversible. [Orthopedics. 2023;46(4):234-241.].

  View details for DOI 10.3928/01477447-20230207-03

  View details for Web of Science ID 001036949800013

  View details for PubMedID 36779740

• The Influence of Race, Income, and Sex on Treatment and Complications of Common Pediatric Fractures ORTHOPEDICS Montgomery, B. K., Joseph, G., Segovia, N., Koltsov, J., Thomas, T. L., Vorhies, J. S., Tileston, K. R. 2023; 46 (3): E156-+

  Abstract

  Despite best intentions, health care disparities exist and can consequently impact patient care. Few studies have examined the impact of disparities in pediatric orthopedic populations. The current study aimed to determine if the treatment type or complication rates of supracondylar, both-bone forearm, or femur fractures are associated with race, ethnicity, sex, or socioeconomic status. The New York Healthcare Cost and Utilization Project's database was used to identify all pediatric patients treated for supracondylar humerus fractures, both-bone forearm fractures, and femoral shaft fractures in 2016. Risk-adjusted relationships with race, ethnicity, sex, hospital location, and median income by zip code were assessed with multivariable logistic regression. Patients who were non-White, resided in the zip codes with the lowest median income (<$42,999 annually), and were treated in metropolitan areas were more likely to receive nonoperative treatments for supracondylar humerus fractures. Female patients with a femoral shaft fracture were less likely to be treated with open reduction and internal fixation vs intramedullary fixation. Finally, complications were not associated with patient race, sex, or socioeconomic statuses. These findings bring attention to health care disparities in the treatment of common pediatric orthopedic fractures. Further studies investigating the underlying etiology behind these disparities are warranted. [Orthopedics. 2023;46(3):e156-e160.].

  View details for DOI 10.3928/01477447-20230104-06

  View details for Web of Science ID 000995876400007

  View details for PubMedID 36623278

• QI/PI: POSNA Safe Surgery Program (PSSP)-First-Year Results Implementing Quality Metrics. Journal of the Pediatric Orthopaedic Society of North America Tileston, K., van Niekerk, M., Vitale, M., Cho, R., Brighton, B., Tippabhatla, A., Rohde, M., Shea, K. 2023; 5 (2): 544

  Abstract

  Background: Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics. These external organizations rarely consult pediatric orthopaedists themselves; therefore, POSNA members strongly supported the creation of a new performance evaluation. As a result, POSNA developed a member-driven process for driving quality improvements in pediatric orthopaedics: the POSNA Safe Surgery Program (PSSP). The PSSP aims to develop key quality metrics that members believe improve outcomes in pediatric orthopaedics. This paper aims to summarize the first year of implementing the PSSP quality metrics. Methods: The POSNA Quality, Safety, and Value Initiative (QSVI) Council developed 20 PSSP quality metrics for five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE). The quality metrics were integrated into five online surveys (one per domain) and distributed to POSNA member orthopaedic centers across North America. Results: Thirty-three POSNA member orthopaedic centers responded to at least one domain-specific survey. Spine had the highest response rate (88%), while hand/UE and hip/LE had the lowest (70% and 73%, respectively). Centers meeting each quality metric ranged from 65% to 92% in sports medicine, 62% to 100% in trauma, 79% to 100% in spine, 83% to 96% in hip/LE, and 83% to 100% in hand/UE. Large and very large centers, as well as specialized children's hospitals, provided more detailed protocols and procedures, likely due to greater resources and specialization. There was nearly 100% agreement between centers on protocols with well-known, easy-to-follow checklists for fulfilling a quality metric. Conclusions: The primary goal of the PSSP is to create internally developed, surgeon-driven quality metrics that determine high-quality care. By using these quality metrics and reports, we hope surgeons can gain institutional resources to drive improvements in their centers. In its first year, the PSSP demonstrated that these quality metrics can be successfully distributed and reviewed by POSNA members. Our future work will focus on expanding the PSSP to more pediatric orthopaedic centers, iteratively evaluating and modifying the metrics, and adding metrics for additional domains. Level of Evidence: Level IV Key Concepts•Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics which will have important clinical and financial implications.•Pediatric orthopaedists are rarely consulted in quality evaluations by external organizations; therefore, POSNA created a member-driven performance evaluation system-the POSNA Safe Surgery Program (PSSP)-to develop surgeon-driven quality metrics to improve high-quality care.•Twenty PSSP quality metrics were developed by the POSNA Quality, Safety, and Value Initiative (QSVI) Council across five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE).•Our first year distributing the PSSP quality metrics to POSNA member centers revealed (1) high engagement rates and (2) diverse ranges of quality metric fulfillment by centers.•In the future, we will expand the PSSP to more pediatric orthopaedic centers, iteratively evaluate and modify the PSSP quality metrics, and develop metrics for additional domains.

  View details for DOI 10.55275/JPOSNA-2023-544

  View details for PubMedID 40433530

  View details for PubMedCentralID PMC12088094

• CORR Insights: Interpersonal Interactions and Biases in Orthopaedic Surgery Residency: Do Experiences Differ Based on Gender? Clinical orthopaedics and related research Tileston, K. 2023; 481 (2): 379-381

  View details for DOI 10.1097/CORR.0000000000002512

  View details for PubMedID 36668701

• Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review World Journal of Pediatric Surgery van Niekerk, M., Richey, A., Vorhies, J., Wong, C., Tileston, K. 2023; 6 (e000513)

  View details for DOI 10.1136/wjps-2022-000513

• Innovative technique for early-onset scoliosis casting using Jackson table. Spine deformity Montgomery, B. K., Tileston, K., Kaur, J., Kym, D., Segovia, N. A., Imrie, M., Policy, J., Rinsky, L., Vorhies, J. 2022

  Abstract

  PURPOSE: Early-onset scoliosis (EOS) can have harmful effects on pulmonary function. Serial elongation, derotation, and flexion (EDF) casting can cure EOS or delay surgical intervention. Most described casting techniques call for specialized tables, which are not available at many institutions. We describe an innovative technique for EDF casting utilizing a modified Jackson table (MJ) and compare results to a Risser frame (RF).METHODS: All patients who underwent EDF casting at our institution between January 2015 and January 2019 were identified and retrospectively reviewed. Patients were stratified by type of table used and clinical and radiographic outcomes were compared. Standard descriptive statistics were calculated.RESULTS: We identified 25 patients who underwent 77 casting events, 11 on an MJ table and 14 on a RF. Mean follow-up was 32months (range 11-61months). 28% of patients had idiopathic scoliosis. There was no significant difference in age at initiation of casting (P=0.3), initial Cobb angle (equivalence, P=0.009), or rate of idiopathic scoliosis between the MJ and RF groups. There was no significant difference in initial coronal Cobb angle percent correction (equivalence, P=0.045) or percent correction at 1-year follow-up (equivalence, P=0.010) between the two groups. There was no difference in cast related complications. There was a significant difference in surgical time, with the MJ group 11min shorter than the RF (P=0.005).CONCLUSION: The MJ table is a safe and effective alternative for applying EDF casts under traction without the need for a specialized table.LEVEL OF EVIDENCE: III.

  View details for DOI 10.1007/s43390-022-00526-4

  View details for PubMedID 35776363

• What is New in Pediatric Orthopaedic Foot and Ankle. Journal of pediatric orthopedics Tileston, K., Baskar, D., Frick, S. L. 2022; 42 (5): e448-e452

  Abstract

  BACKGROUND: This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans.METHODS: The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021.RESULTS: A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies.CONCLUSIONS: Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices.LEVEL OF EVIDENCE: Level III.

  View details for DOI 10.1097/BPO.0000000000002134

  View details for PubMedID 35405728

• Letter to the editor: Improving Biopsychosocial Care for Adolescents with Scoliosis “A systematic scoping review and textual narrative synthesis of the qualitative evidence related to adolescent idiopathic scoliosis”   International Journal of Orthopaedic and Trauma Nursing van Niekerk, M., Tileston, K. 2022

  View details for DOI 10.1016/j.ijotn.2022.100961

• Mindset correlates with health-related quality of life assessment in patients with adolescent idiopathic scoliosis. Spine deformity Joseph, G. P., Segovia, N. A., Wright, R. C., Mueller, C., Tileston, K. R. 2020

  Abstract

  PURPOSE: Mindset theory describes two different belief systems regarding ability: "fixed", in which a particular personal characteristic is seen as unchangeable, and "growth", in which the characteristic is viewed as malleable and subject to improvement. The purpose of this study is to evaluate how that mindset toward one's health correlates with health-related quality of life assessments (HRQoL) in patients with adolescent idiopathic scoliosis (AIS).METHODS: Patients undergoing brace treatment for AIS were prospectively recruited for this study and completed both an SRS-30 andHealth Mindset Scale questionnaire. Inclusion criteria for patients are based on Scoliosis Research Society standardized criteria for bracing studies: diagnosis of AIS, a prescribed TLSO brace for full-time wear, skeletal immaturity at brace initiation (Risser 0-2), Cobb angles 25-50 degrees, no prior treatment, and, if female, no more than 1year post-menarchal at the time of brace initiation. Statistical analysis was performed utilizing Mann-Whitney U tests for skewed data and two-sample t tests for normally distributed data.Multivariable models were also used to evaluate the relationships of SRS-30 subscores with health mindset, adjusting for age, gender, and pre-treatment curve magnitudes.RESULTS: Among the 110 enrolled patients, a stronger growth mindset was associated with significantly higher SRS-30 scores overall (p=0.001), as well as in the appearance (p=0.003), and mental (p=0.001) subscores.CONCLUSION: We demonstrate that health mindset affects an AIS patients' HRQoL. Prior studies have demonstrated that mindset is malleable and can be altered. Further studies are required to determine whether changing health mindset from a fixed to a growth mindset can also improve HRQoL in patients with scoliosis.

  View details for DOI 10.1007/s43390-020-00243-w

  View details for PubMedID 33201496

• CORR Insights: What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They? Clinical orthopaedics and related research Tileston, K. 2020

  View details for DOI 10.1097/CORR.0000000000001110

  View details for PubMedID 32011381

• Day of the Week of Surgery Affects Time to Discharge for Patients With Adolescent Idiopathic Scoliosis ORTHOPEDICS Tileston, K. R., Uzosike, M., Segovia, N., Rinsky, L. A., Imrie, M. N. 2020; 43 (1): 8–12

  Abstract

  Unnecessary delays in discharge are extraordinarily common in the current US health care system. These delays are even more protracted for patients undergoing orthopedic procedures. A traditional hospital staffing model is heavily weighted toward increased resources on weekdays and minimal coverage on the weekend. This study examined the effect of this traditional staffing model on time to discharge for patients undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Patients undergoing surgery later in the week had a significantly longer hospital stay compared with patients undergoing surgery early in the week (5.5 days vs 4.9 days, respectively; P=.003). This discrepancy resulted in a mean cost increase of $7749.50 for patients undergoing surgery later in the week. A subsequent quality, safety, value initiative (QSVI) was undertaken to balance physical therapy resources alone. Following the QSVI, patients undergoing surgery later in the week had a decreased mean length of stay of 3.78 days (P=.002). Patients undergoing fusion early in the week also had a decreased mean length of stay of 3.66 days (P<.001). There was no longer a significant difference in length of stay between the "early" and the "late" groups (P=.84). This study demonstrates that simply having surgery later in the week in a hospital with a traditional staffing model adversely affects the timing of discharge, resulting in a significantly longer and more costly hospital course. By increasing physical therapy availability on the weekend, the length of stay and the cost of hospitalization decrease precipitously for these patients. [Orthopedics. 2020; 43(1);8-12.].

  View details for DOI 10.3928/01477447-20191001-06

  View details for Web of Science ID 000508434100012

  View details for PubMedID 31587077

• Team Approach: Complex Regional Pain Syndrome in Children and Adolescents. JBJS reviews Tileston, K. R., Griffin, A. n., Wagner, J. F., O'Day, M. N., Krane, E. J. 2020; 8 (4): e0174

  View details for DOI 10.2106/JBJS.RVW.19.00174

  View details for PubMedID 32304498

• Transepiphyseal (Type VII) Ankle Fracture Versus Os Subfibulare in Pediatric Ankle Injuries. Journal of pediatric orthopedics Sugi, M. T., Tileston, K., Krygier, J. E., Gamble, J. 2018

  Abstract

  BACKGROUND: Pediatric ankle injuries are common, giving rise to 17% of all physeal injuries. An os subfibulare in a child with an ankle sprain may be confused with a type VII transepiphyseal fracture. Here, we evaluate the clinical and radiographic features of type VII transepiphyseal fractures to those of os subfibulare presenting with acute ankle trauma with the hypothesis that radiographs are necessary for final diagnosis and neither clinical history nor examination would be diagnostic.METHODS: We performed an internal review board-approved, retrospective chart review of patients identified with a traumatic os subfibulare or type VII ankle fracture over an 18-month period. Charts were reviewed for demographics, mechanism, and clinical findings on initial presentation. Radiographic measurements of the distal fibular fragment as well as epiphysis were made on presenting ankle series radiographs.RESULTS: A total of 23 patients were identified. Eleven patients had a traumatic type VII ankle fracture and 12 had trauma associated with an os subfibulare on initial radiographs. The history and clinical presentations were similar and were nondiagnostic. The ratio of the width of the fibula at its largest point on the anterior posterior view to the width of the fibular fragment was significantly larger in the type VII ankle fractures (P=0.05). All os subfibulare were located within the inferior third of the epiphysis, whereas all type VII fractures were either at the equator or within the middle third of the fibular epiphysis.CONCLUSIONS: Radiographs, not clinical presentation, can differentiate an os subfibulare from a type VII transepiphyseal fracture. Children with type VII fractures have a long, irregular fracture line within the middle third of the distal fibular epiphysis. Those with an ankle sprain and os subfibulare have a smooth-edged ossicle of relatively short length located within the inferior pole of the epiphysis. Furthermore, the radiographic width of the fragment in the type VII fractures is significantly larger in width than the os subfibulare.LEVEL OF EVIDENCE: Level II.

  View details for PubMedID 30199459

• Proximal Tibial Fractures in the Pediatric Population. The journal of knee surgery Tileston, K., Frick, S. 2018

  Abstract

  Injuries about the proximal tibia are quite common in children. Understanding the mechanisms of injury and treatment strategies is imperative for practitioners caring for these patients. Similarly, appreciating the anatomy of the proximal tibia and the adjacent neurovascular structures can assist a practitioner in recognizing the potential associated risks following fracture. Patients with injuries about the proximal tibia require long-term follow-up, and knowledge of the natural history of these fractures is imperative.

  View details for DOI 10.1055/s-0038-1636911

  View details for PubMedID 29514377

• Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes? Journal of orthopaedic trauma Paci, G. M., Tileston, K. R., Vorhies, J. S., Bishop, J. A. 2018; 32 (6): e215–e220

  Abstract

  To compare the outcomes of pediatric supracondylar humerus fractures treated during daytime hours to those treated after-hours.Retrospective.Academic Level I trauma center.Two hundred ninety-eight pediatric patients treated with surgical reduction and fixation of closed supracondylar fractures were included.Seventy-seven patients underwent surgery during daytime hours (06:00-15:59 on weekdays). One hundred eighty-six patients underwent surgery after-hours (16:00-05:59 on weekdays and any surgery on weekends or holidays).Surgeon subspecialty, operative duration, and radiographic and clinical outcomes, including range of motion and carrying angle, were extracted from the patient medical records.There were no patient-related demographic differences between the daytime hours and after-hours groups. Daytime surgery was more likely to be performed by a pediatric orthopaedic surgeon than after-hours surgery. Fractures treated after-hours had more severe injury patterns. After-hours surgery was not independently associated with rate of open reduction, operative times, complications, achievement of functional range of motion, or radiographic alignment. A late-night surgery subgroup analysis demonstrated an increased rate of malunion in patients undergoing surgery between the hours of 23:00 and 05:59.There is no difference in the operative duration or outcomes after surgical treatment of pediatric supracondylar humerus fractures performed after-hours when compared with daytime surgery. However, late-night surgery performed between 23:00 and 05:59 may be associated with a higher rate of malunion. Surgeons can use these data to make better-informed decisions about the timing of surgery in this patient population.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  View details for PubMedID 29432316

• Local versus distal transplantation of human neural stem cells following chronic spinal cord injury SPINE JOURNAL Cheng, I., Githens, M., Smith, R. L., Johnston, T. R., Park, D. Y., Stauff, M. P., Salari, N., Tileston, K. R., Kharazi, A. I. 2016; 16 (6): 764-769

  Abstract

  Previous studies have demonstrated functional recovery of rats with spinal cord contusions after transplantation of neural stem cells adjacent to the site of acute injury.The purpose of the study was to determine if the local or distal injection of neural stem cells can cause functional difference in recovery after chronic spinal cord injury.Twenty-four adult female Long-Evans hooded rats were randomized into four groups, with six animals in each group: two experimental and two control groups. Functional assessment was measured after injury and then weekly for 6 weeks using the Basso, Beattie, and Bresnahan locomotor rating score. Data were analyzed using two-sample t test and linear mixed-effects model analysis.Posterior exposure and laminectomy at the T10 level was used. Moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor with 10-g weight dropped from a height of 25 mm. Experimental subjects received either a subdural injection of human neural stem cells (hNSCs) locally at the injury site or intrathecal injection of hNSCs through a separate distal laminotomy 4 weeks after injury. Controls received control media injection either locally or distally.A statistically significant functional improvement in subjects that received hNSCs injected distally to the site of injury was observed when compared with the control (p=.042). The difference between subjects that received hNSCs locally and the control did not reach statistical significance (p=.085).The transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected distally but not locally to the site of chronic spinal cord injury.

  View details for DOI 10.1016/j.spinee.2015.12.007

  View details for Web of Science ID 000378201100035

  View details for PubMedID 26698654

• The Inadequacy of Pediatric Fracture Care Information in Emergency Medicine and Pediatric Literature and Online Resources. Journal of pediatric orthopedics Tileston, K., Bishop, J. A. 2015; 35 (7): 769-773

  Abstract

  Emergency medicine and pediatric physicians often provide initial pediatric fracture care. Therefore, basic knowledge of the various treatment options is essential. The purpose of this study was to determine the accuracy of information commonly available to these physicians in textbooks and online regarding the management of pediatric supracondylar humerus and femoral shaft fractures.The American Academy of Orthopaedic Surgeons Clinical Practice Guidelines for pediatric supracondylar humerus and femoral shaft fractures were used to assess the content of top selling emergency medicine and pediatric textbooks as well as the top returned Web sites after a Google search. Only guidelines that addressed initial patient management were included. Information provided in the texts was graded as consistent, inconsistent, or omitted.Five emergency medicine textbooks, 4 pediatric textbooks, and 5 Web sites were assessed. Overall, these resources contained a mean 31.6% (SD=32.5) complete and correct information, whereas 3.6 % of the information was incorrect or inconsistent, and 64.8% was omitted. Emergency medicine textbooks had a mean of 34.3% (SD=28.3) correct and complete recommendations, 5.7% incorrect or incomplete recommendations, and 60% omissions. Pediatric textbooks were poor in addressing any of the American Academy of Orthopaedic Surgeons guidelines with an overall mean of 7.14% (SD=18.9) complete and correct recommendations, a single incorrect/incomplete recommendation, and 91.1% omissions. Online resources had a mean of 48.6% (SD=33.1) complete and correct recommendations, 5.72% incomplete or incorrect recommendations, and 45.7% omissions.This study highlights important deficiencies in resources available to pediatric and emergency medicine physicians seeking information on pediatric fracture management. Information in emergency medicine and pediatric textbooks as well as online is variable, with both inaccuracies and omissions being common. This lack of high-quality information could compromise patient care. Resources should be committed to ensuring accurate and complete information is readily available to all physicians providing pediatric fracture care. In addition, orthopaedic surgeons should take an active role to ensure that nonorthopaedic textbooks and online resources contain complete and accurate information.Level IV.

  View details for DOI 10.1097/BPO.0000000000000357

  View details for PubMedID 25393570

• Proximal femur shape differs between subjects with lateral and medial knee osteoarthritis and controls: the Osteoarthritis Initiative OSTEOARTHRITIS AND CARTILAGE Wise, B. L., Kritikos, L., Lynch, J. A., Liu, F., Parimi, N., Tileston, K. L., Nevitt, M. C., Lane, N. E. 2014; 22 (12): 2067-2073

  Abstract

  This study examined the association of proximal femur shape with ipsilateral medial and lateral compartment knee osteoarthritis (OA).Radiographs were obtained from the NIH-funded Osteoarthritis Initiative (OAI). Cases of isolated radiographic lateral compartment knee OA were defined on baseline radiographs as Kellgren/Lawrence (K/L) Grade ≥ 2 and joint space narrowing (JSN) > 0 in the lateral compartment and JSN = 0 in the medial compartment; isolated medial compartment knee OA had K/L ≥ 2 and JSN > 0 medially with JSN = 0 in the lateral compartment. Controls had K/L < 2 and JSN = 0 in both compartments. Controls were frequency matched to cases by sex and 10-year age intervals. We characterized the shape of the proximal femurs on radiographs using Active Shape Modeling (ASM) and determined the association of proximal femur shape with knee OA using logistic regression.There were 168 lateral compartment knee OA cases (mean body mass index (BMI) 29.72 ± 5.26), 169 medial compartment knee OA cases (mean BMI 29.68 ± 4.83) and 168 controls (mean BMI 26.87 ± 4.2). Thirteen modes were derived for femur shape which described 95.5% of the total variance in proximal femur shape in the population. Modes 6, 8 and 12 were associated with prevalent lateral compartment knee OA. Medial compartment knee OA was associated with proximal femur modes 1, 5, 8, and 12.Prevalent lateral and medial compartment knee OA are associated with different ipsilateral proximal femur shapes. Additional studies are needed to better define how the shape of the proximal femur influences compartment-specific knee OA.

  View details for DOI 10.1016/j.joca.2014.08.013

  View details for Web of Science ID 000345149100012

  View details for PubMedID 25194496

  View details for PubMedCentralID PMC4252863

• Functional task kinematics of the thumb carpometacarpal joint. Clinical orthopaedics and related research Luker, K. R., Aguinaldo, A., Kenney, D., Cahill-Rowley, K., Ladd, A. L. 2014; 472 (4): 1123-1129

  Abstract

  Abnormal biomechanical loading has been identified as an associated risk factor of osteoarthritis in the wrist and hand. Empirical data to date are insufficient to describe the role of altered biomechanics in thumb carpometacarpal (CMC) arthritis.This is a pilot study to evaluate motion analysis of the upper extremity while performing functional tasks. We wished to describe the in vivo kinematics of the thumb and hand in relation to the larger joints of the upper extremity in subjects without arthritis in functional positions at rest and while loading the CMC joint. If reproducible, we then planned to compare kinematics between these subjects and a subject with advanced thumb CMC arthritis.In vivo kinematics of the hand and upper extremity during the functional tasks of grasp, jar opening, and pinch with and without loading of the CMC joint were evaluated using cameras and a motion-capture system in four asymptomatic female subjects and one female subject with advanced radiographic (Eaton Stage IV) osteoarthritis.Kinematics of the hand and upper extremity can be reliably quantified. Loading of the CMC joint did not alter the hand and forearm kinematics in control subjects. In the subject with osteoarthritis, the adduction-extension deformity at the CMC joint resulted in kinematic alterations as compared with the four control subjects.This study represents preliminary steps in defining thumb CMC position, motion, and loading associated with activities of daily living. These findings enhance our understanding of motion at the CMC joint and how it differs in arthritic patients.Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  View details for DOI 10.1007/s11999-013-2964-0

  View details for PubMedID 23549712

  View details for PubMedCentralID PMC3940744

• Active Shape Modeling of the Hip in the Prediction of Incident Hip Fracture JOURNAL OF BONE AND MINERAL RESEARCH Baker-LePain, J. C., Luker, K. R., Lynch, J. A., Parimi, N., Nevitt, M. C., Lane, N. E. 2011; 26 (3): 468-474

  Abstract

  The objective of this study was to evaluate right proximal femur shape as a risk factor for incident hip fracture using active shape modeling (ASM). A nested case-control study of white women 65 years of age and older enrolled in the Study of Osteoporotic Fractures (SOF) was performed. Subjects (n = 168) were randomly selected from study participants who experienced hip fracture during the follow-up period (mean 8.3 years). Controls (n = 231) had no fracture during follow-up. Subjects with baseline radiographic hip osteoarthritis were excluded. ASM of digitized right hip radiographs generated 10 independent modes of variation in proximal femur shape that together accounted for 95% of the variance in proximal femur shape. The association of ASM modes with incident hip fracture was analyzed by logistic regression. Together, the 10 ASM modes demonstrated good discrimination of incident hip fracture. In models controlling for age and body mass index (BMI), the area under receiver operating characteristic (AUROC) curve for hip shape was 0.813, 95% confidence interval (CI) 0.771-0.854 compared with models containing femoral neck bone mineral density (AUROC = 0.675, 95% CI 0.620-0.730), intertrochanteric bone mineral density (AUROC = 0.645, 95% CI 0.589-0.701), femoral neck length (AUROC = 0.631, 95% CI 0.573-0.690), or femoral neck width (AUROC = 0.633, 95% CI 0.574-0.691). The accuracy of fracture discrimination was improved by combining ASM modes with femoral neck bone mineral density (AUROC = 0.835, 95% CI 0.795-0.875) or with intertrochanteric bone mineral density (AUROC = 0.834, 95% CI 0.794-0.875). Hips with positive standard deviations of ASM mode 4 had the highest risk of incident hip fracture (odds ratio = 2.48, 95% CI 1.68-3.31, p < .001). We conclude that variations in the relative size of the femoral head and neck are important determinants of incident hip fracture. The addition of hip shape to fracture-prediction tools may improve the risk assessment for osteoporotic hip fractures.

  View details for DOI 10.1002/jbmr.254

  View details for Web of Science ID 000287827600006

  View details for PubMedID 20878772

  View details for PubMedCentralID PMC3179295