Flowerslyng1225

f the general population. LEVEL OF EVIDENCE III, retrospective cohort study. PURPOSE To date, surgically treated multifragmentary patellar fractures are still associated with high rates of complications, such as i.e. secondary fracture displacement. Osteosynthesis is most frequently performed with screws and cerclages. To increase primary stability, locking plates have been introduced. However, there is still a lack of biomechanical data supporting the superiority of plate fixation compared to screw fixation with cerclages in these cases. The goal of the present study was to conduct biomechanical comparison of these two techniques under dynamic loading conditions. METHODS A standardized 34-C3 fracture was created in eight pairs of human cadaveric knee joints. Following a randomization protocol, they were fixed with a 3.5 mm anterior locking plate (LP) or cannulated screws with anterior tension band wiring (hybrid osteosynthesis, HO).Subsequently, all constructs were tested for 100 cycles from 90° of knee-flexion to full extension by applying a pulling force to the quadriceps tendon. Outcome parameters were fracture displacement after one cycle, after 100 cycles and implant loosening. Failure was defined as fracture displacement > 2 mm. RESULTS Biomechanical testing showed significantly less fracture displacement following LP compared to HO both after the first (p = 0.042) and after 100 cycles (p = 0.025). The difference in loosening was significant as well (p = 0.017). Following HO, 5/8 constructs failed during cyclic loading. There was no failure in the LP group. In the HO group, loosening correlated with bone mineral density (R = - 0.857) which was not observed in the LP group (R = - 0.429). CONCLUSION Anterior locking plate osteosynthesis of comminuted patellar fractures biomechanically provides better primary stability compared to cannulated screws with anterior tension band wiring. PURPOSE Pectus excavatum is a common chest wall deformity amenable to surgical correction, most commonly by a technique known as the Nuss Procedure. The surgery is associated with significant postoperative pain and lengthy hospital stays. We hypothesized that a standardized enhanced recovery after surgery (ERAS) pathway would result in significantly reduced length of stay (LOS) and reduced levels of postoperative pain without an increase in readmissions or emergency department (ED) visits. METHODS We instituted a pectus excavatum ERAS program at a high-volume academic center. Our ERAS protocol standardized perioperative exercise and pharmacologic regimens, pre- and post-operative education, and early return to activity. We conducted a retrospective review of all patients undergoing the Nuss procedure from 2015 to 2018. ERAS was implemented at the mid-point of the study period, and pre- and post-protocol patients were compared in our analysis. The primary outcome measure was LOS. The secondary outcomes included pain scores, incidence of urinary retention, and readmissions or ED visits. RESULTS One hundred nine patients were included in this study (51 patients pre-ERAS and 58 post-ERAS). The average length of hospitalization prior to implementation of ERAS was 3.49 and after the implementation 2.90 (p = 0.0007). The implementation of ERAS showed a trend of decreasing readmissions and emergency department visits, but this did not reach statistical significance. There was a statistically significant decrease in both requirement for urinary catheter placement and pain scores on postoperative day 0. CONCLUSIONS Implementation of ERAS for the Nuss procedure leads to a significant reduction in LOS, early pain scores, and urinary catheter usage, without an increase in post-operative ED visits and hospital readmissions. An ERAS protocol should be utilized in this patient population. TYPE OF STUDY Retrospective comparative study. TYPE OF EVIDENCE Level III. BACKGROUND Pediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to identify factors associated with applicant success in the match. METHODS After IRB approval, all applications to a single accredited pediatric surgery fellowship program were reviewed for match years 2014-2018. Matched and unmatched applicants were compared in an unadjusted and adjusted analysis. RESULTS This training program received 414 of 425 total applications (97%). Match results were available for 388 (94%). Matched applicants were more likely to train in programs with pediatric surgery fellowships (64% vs. Nedisertib purchase 28%) and to have dedicated research time (55% vs. 21%; all p  less then  0.01). Matched applicants had more total publications (median 12 vs. 7, p  less then  0.01) and higher ABSITE scores (median 64th vs. 59th percentile, p  less then  0.01). Training in multiple programs negatively impacted the chance to match (p  less then  0.01). The median number of publications per applicant increased over the study time period from 7 to 11 (p  less then  0.01). CONCLUSIONS The likelihood of matching into a pediatric surgery fellowship was related to the type of residency attended, dedicated research time, ABSITE scores, and number of publications. Overall, the total number of publications reported by all applicants increased. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE Level III. BACKGROUND Per-oral endoscopic myotomy (POEM), a modern treatment for achalasia, has only recently emerged as an option for pediatric patients. Here we describe and characterize the success of POEM in children with achalasia. METHODS A single-institution prospective cohort study was performed of patients less then 18 years old who underwent POEM from 2014 to 2019. Main outcomes were success at one year (Eckardt ≤3), procedure duration, complications, reintervention. RESULTS The median age of patients (n = 21) was 13 years (range 2-17). Median procedure duration was 92 min (range 52-259) with case duration plateau of 87.4 min and learning rate of 15.5 cases. Intraoperative complications included capnoperitoneum requiring needle decompression and mucosotomy requiring additional clips. One patient experienced chest pain with small capnoperitoneum seen on chest radiography, and three patients had extraluminal carbon dioxide found incidentally on routine radiography. All were managed with observation. Pre- versus 1-month postprocedure Eckardt scores were significantly improved (7 ± 2 versus 1 ± 2, p  less then  0.