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At a mean follow-up of 20 months, the Trendelenburg sign was negative in 7 patients and the Trendelenburg gait had disappeared in 7 patients. There was an improvement in patient-reported outcome measures but not to a significant level except for the pain subscores. Two patients had a postoperative seroma that resulted in a visible bump on the lateral side. Seven of 10 repairs with MRI follow-up showed perfect ingrowth on MRI without signs of rerupture. Gluteus maximus transfer for abductor deficiency of the hip may be effective for pain relief and functional improvements. Most patients showed an improved quality of life but were not completely pain free. [Orthopedics. 2020;43(X)xx-xx.].The aim of the study was to investigate the utility of a simple office-based tool in predicting the need for secondary intervention to obtain union in patients with tibial fractures. All patients 18 years and older with isolated tibial shaft fractures (OTA 41A, 42A-C, and 43A) treated with intramedullary nailing from 2013 to 2017 were screened. Eighty-seven patients met enrollment criteria. Surgeon assessment of the following 3 clinical parameters was performed at routine office visits and scored as follows (1) pain (none/mild/decreased=1, no change/increased=0); (2) function (minimal limp/able to perform a single-leg stance=1, significant limp/unable to perform single-leg stance=0); and (3) examination (no/minimal pain with manipulation=1, pain with manipulation=0). Radiographic healing was assessed by the adjusted radiographic union scale in tibial fractures (aRUST). The tibial fracture healing score (TFHS) is the sum of 3 clinical scores (0 to 3) and aRUST score (1 to 3) at 3 months postoperatively. The overall nonunion rate was 11%. A RUST score of 5 or less and a sum of the 3 clinical scores of less than 2 at 3 months were found be predictive of nonunion. A TFHS of less than 3 at 3 months was more reliable in identifying patients requiring nonunion repair, especially for those with minimal radiographic healing (RUST score 6 or 7) at 3 months. The TFHS is a simple office-based clinical tool that may identify patients at high risk of nonunion (TFHS less then 3) following isolated tibial shaft fracture more effectively than clinical examination or radiographic assessment alone. [Orthopedics. 2020;43(x);xx-xx.].High school athletes sustaining a concussion require careful attention when determining return-to-sport (RTS) readiness. The purpose of this study was to determine epidemiological and RTS data of a large cohort of high school athletes who sustained 1 or more concussions. Records of 357 consecutive youth patients who sustained concussions and presented to a single health care system between September 2013 and December 2016 were reviewed. Demographic data, RTS, and concussion-related variables were obtained via chart review. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline and following concussions were performed by neuropsychologists. The average age at injury was 15.5 years (range, 14-18 years), 61.9% of patients were male, 6.7% reported a loss of consciousness, and 14.3% reported amnesia, requiring 30.4±23.3 days of recovery prior to RTS. The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion. this website A multivariate model demonstrated that females, players with a history of concussion, and those diagnosed in-clinic rather than in-game required increased time to RTS. Memory ImPACT scores were found to increase as players had recurrent concussions. Visual motor speed and reaction time scores decreased with recurrent concussions. [Orthopedics. 2020;43(x)xx-xx.].Indirect decompression using oblique lateral interbody fusion (OLIF) improves spinal canal dimensions by reducing spondylolisthesis and restoring intervertebral disk height in patients with degenerative lumbar diseases. However, the clinical significance of these radiological improvements has not been fully evaluated in the literature. To examine the relationship between the clinical and radiological outcomes following OLIF, the authors prospectively studied 41 patients who underwent single-level OLIF with percutaneous pedicle screw fixation for lumbar degenerative disease, including degenerative and spondylolytic spondylolisthesis and spinal stenosis with disk height loss. Clinical scores were obtained preoperatively and at 1 year postoperatively using multiple questionnaires. Radiological outcomes were evaluated using plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) at 1 year postoperatively. Following a single-level OLIF, all categories of clinical scores showed statistically significant improvement. Rate of cage subsidence was 14.6% and 31.7% at 1 week and 1 year postoperatively, respectively. Patients with subsidence had higher Oswestry Disability Index (P=.026) scores and lower physical composite summary scores on the Short Form-36 Health Survey (P=.007). On CT scan, 28 (68.3%) patients showed a complete interbody fusion and 13 (31.7%) had intermediate fusion. All parameters from the MRI, except for foraminal width, showed significant improvement at 1 year postoperatively. The improvement ratio of foraminal height was associated with the percent improvement of lower-extremity radiating pain (Pearson coefficient=0.384; P=.013) and the walking ability score of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (Pearson coefficient=0.319; P=.042) at 1 year postoperatively. Restoration of foraminal height while preserving the endplates is associated with favorable results following OLIF. [Orthopedics. 2020;43(x)xx-xx.].The characteristics and clinical consequences of pyogenic bone and joint infections in older children and adolescents have received little attention. This study evaluated the presentation and complications of musculoskeletal infections involving the pelvis and extremities in children older than 10 years. Thirty patients 10 to 17 years old (mean, 12.7 years old) were treated for musculoskeletal infections. Mean time to diagnosis was 9.2 days. Prior to correct diagnosis, 83% were assessed by at least 1 outpatient provider. At the time of admission, 55% were weight bearing and 93% were afebrile. Twenty-eight percent had a multifocal infection. More than one-third had serious medical complications or orthopedic sequelae; compared with patients without complications, this group had a significantly higher admission C-reactive protein and longer hospital stay. Symptoms of musculoskeletal infection common among young children may be absent in adolescents. Axial imaging is recommended to identify adjacent or multifocal disease.