The treatment of scoliosis has been explored and debated in medicine since the first recorded texts. Scoliosis treatment has shifted over time from external modalities, such as traction and bracing, to internal stabilization techniques that leverage surgical advances. Surgical fixation constructs can generally be separated into two different modalities: dynamic vs. static constructs. For skeletally immature individuals with progressive deformities, surgical options range from traditional or magnetically controlled growing rods to vertebral body staples or tethering. For individuals who have reached skeletal maturity, many devices have been developed that provide static length constructs. Understanding the surgical options available is critical for the appropriate management of this varied patient population. With this article, we sought to provide a summary of past and present techniques and devices used in the treatment of scoliosis.

Purpose: Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns.Methods: The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location. Results: The study cohort consisted of 1,121 patients with a median RibScore of 2 (0–3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions.Conclusions: Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

The purpose of this study was to investigate proteomic alteration that occurs to whole blood when converted to activated serum (AS) using an autologous thrombin system. This study further sought to evaluate the functional in vitro effect of AS on tenocytes, chondrocytes, subacromial bursal cells, and osteoblasts. The peptide/protein composition of AS was analyzed by liquid chromatography–mass spectrophotometry (LC-MS). The cell lines were treated with AS, and cellular proliferation was quantified 48 h after treatment. Platelet-derived growth factor (PDGF), insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), interleukin-1 beta (IL-1β), and interleukin-1 receptor antagonist (IL-1Ra) were quantified utilizing enzyme-linked immunosorbent assays (ELISAs). LC-MS identified 357 proteins across the AS and whole blood. Fifty-four of the proteins identified had significant differences between the relative protein abundance of the AS samples compared to whole blood. Treatment with AS in all cell lines significantly increased proliferation compared to control cells at 48 h. Increased PDGF, VEGF, and IGF-1 in all cell lines exposed to AS compared to the control (p < 0.05) were observed. These findings suggest that treatment with AS increases in vitro cellular proliferation and the release of growth factors that may play a role in tissue repair.

Although transforaminal epidural steroid injections (TFESIs) have been very commonly used for symptomatic treatment in patients with lumbar spinal stenosis, there is a paucity of literature on their use in patients with stenosis associated with degenerative lumbar scoliosis. There have been various published studies on parameters affecting the outcome of TFESIs, however there are no studies focusing on the effects of anatomical parameters associated with lumbar scoliosis on the outcome of these injections. The primary goal of this study is to assess anatomical and structural factors affecting efficacy of TFESI in the treatment of patients with lumbar degenerative scoliosis. A secondary goal of this study is to assess whether positive response with TFESI could predict better outcomes of subsequent lumbar surgery. This is a retrospective cohort study involving patients who were treated at an academic medical center. The patient sample is made of 149 patients with degenerative lumbar scoliosis who underwent TFESI during the time period of 2018 to 2023 for symptoms of axial and radicular pain. 19 of these patients underwent subsequent lumbar surgery. Scoliosis was defined as having a Cobb’s angle of at least 20 degrees. The primary outcome measure is TFESI efficacy, assessed by the difference in pain on the numerical rating scale (NRS, score 0–10) for patients between score before TFESI and score at minimum 2 weeks after the injection. A minimal clinically important difference (MCID) was defined as net change in NRS ≥2.0 to identify the patients with a clinically significant reduction in pain level. A secondary outcome measure is subjective clinical improvement or lack thereof for patients after lumbar surgery. Variables analyzed to assess TFESI efficacy include laterality of injections with respect to the primary lumbar curve, distance of an injection to the apex of the primary lumbar curve, severity of Cobb’s angle, severity of stenosis, and degree of spinal lateral listhesis. Lumbar surgery success was compared between patients who had either previously achieved or had not achieved MCID with TFESI. Statistical analyses included Chi-Square tests, Fisher exact tests, and a linear regression. We found an improvement in TFESI efficacy for injections completed on the convex-side of the primary scoliosis curve over concave-side when patients had radicular pain at the L5-S1 spinal level (likelihood ratio with convex-side injection 0.21, likelihood with concave-side injection 0.80; p = .037). Trends were also observed for convex-side injections overall and for lower levels of lateral listhesis over higher levels to be associated with improved efficacy, and there was a 100% positive predictive value for prior successful TFESI to predict lumbar surgery success. No significant impact of severity of Cobb’s angle nor severity of stenosis were noted on the outcomes with the injections. This study, the first of its kind, suggests that for symptomatic treatment of axial and radicular pain in the treatment of degenerative lumbar scoliosis associated with stenosis, TFESIs performed on the convex side of the primary lumbar scoliosis curve provide more symptomatic relief than concave side injections in treating radicular pain in general including at the L5-S1 level and that a history of symptom relief from TFESI is a positive predictor of outcomes for future lumbar surgery.

Summary: This review describes intramedullary nailing of humeral shaft fractures through antegrade technique. The case involved a high-energy injury to the humerus in a patient with relevant comorbidities, and discusses the rationale for both surgery in general and nailing in specific. Indications for surgery, setup considerations unique to the lateral decubitus position, and intraoperative methods for avoiding complications are all discussed. A brief review of current relevant literature is included.