Evidence-Based Orthopedics

MOHIT BHANDARI, MD, PHD, FRCSC, is Professor of Surgery in the Division of Orthopedic Surgery at McMaster University, Ontario, Canada. He is a University Scholar, holds a Canada Research Chair in Evidence-Based Orthopedics, serves as Associate Chair-Research in the Department of Surgery, and was inducted as a member of the Order of Canada. Dr Bhandari has been acknowledged as one of the top 10 most cited orthopedic fracture surgeons in the world. He conducts major multinational, transformative randomized clinical trials, publishes actively in the top medical journals, lectures to thousands around the world, and edits several major textbooks. He is Editor-in-Chief of OrthoEvidence, an online source for high quality and timely evidence-based orthopedic summaries.

• Contributors xvForeword xxixPreface xxxiAbbreviations xxxiiiSection I Methodology of Evidence-Based Orthopedics1 Principles of Evidence-Based Orthopedics 3Niek Van Der Hoek MD and Paul Tornetta III MD2 Hierarchy of Evidence and Common Study Designs 7Annie George BHSc, Ydo V. Kleinlugtenbelt MD PhD, and Kim Madden PhD3 Systematic Reviews and Meta-Analyses 11Joseph T. Patterson MD and Saam Morshed MD PhD MPH4 Healthcare Recommendations: Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Approach 19Mark Phillips BSc PhD, Cand5 Outcomes and Their Interpretations 25Leah Gitajn MD6 Value-Based Orthopedics 31Nathan N. O’Hara MHA and Daniel Mwayafu MBChB MMedSection II Orthopedic Medicine7 Critical Issues in Osteoporosis Management 39Matthew Wong-Pack BHSc MD (Cand), Kyra Cummings, Arthur Lau MD FRCPC, and Jonathan D. Adachi MD FRCPC8 Venous Thromboembolic Events 51Ernest Kwek MBBS FRCS(Ed) and Richard E. Buckley MD FRCSC9 Blood Transfusion 55Seper Ekhtiari MD MSc, David W. Sanders MD FRCSC, and Jeffrey L. Carson MD10 Wound Infections 59Mark D. Hasenauer MD, Michael D. Hunter MD, Kyle J. Jeray MD, and Atul F. Kamath MD11 Smoking Cessation 65Paul E. Matuszewski MD, David Zuelzer MD, and Robert V. O’Toole MD12 Perioperative Medical Management 71Jennifer Muniak MD, Susan M. Friedman MD MPH, Joseph A. Nicholas MD MPH, and Daniel A. Mendelson MD MSc13 Orthobiologics 75John A. Buza III MD and Thomas A. Einhorn MD14 Intimate Partner Violence 83Sheila Sprague PhD, Taryn Scott MSW, Erika Arseneau MSc, Prism Schneider MD FRCSC, Andrew Furey MD FRCSC, Rudolf Poolman MD PhD, Emil Schemitsch MD, and Mohit Bhandari MD PhD15 Pain Management in Orthopedic Surgery 91Vishal Uppal MD FRCA and Harsha Shanthanna MD PhD16 Post-Traumatic Stress Disorder and Depression 99Basem Attum MD and William Obremsky17 Nutrition and Supplements in Orthopedic Care, 105Martí Bernaus MD, Brad Petrisor MD MSc, Sofia Bzovsky MSc, and Sheila Sprague PhDSection III Joint ReconstructionIII.I Hip and Knee18 Outpatient Total Joint Arthroplasty 113Michael Pollock BSc MSc and Brent Lanting MD19 Hip Preservation 117Ahmed El-Bakoury MBBS PhD, Asif A. H. Parkar MBBS, and James N. Powell MD20 The Direct Anterior Approach 123Thomas J. Wood MD and Brent Lanting MD MSc21 Computer Navigation in Total Hip Arthroplasty 129Aamer Malik MD PhD and Lawrence Dorr MD22 Highly Crosslinked Polyethylene in Total Hip Arthroplasty 135Glen Richardson MD MSc FRCSC and Michael J. Dunbar MD PhD FRCSC23 Hip Resurfacing 141Adam Hart MD MASc, Nikolaos Davarinos MD MSc, and John Antoniou MD PhD24 Metal-on-Metal Hip Arthroplasty 147Oliver Marin-Peña MD, Olga Pidgaiska MD, and Pedro Reis-Campos25 Ceramic in Total Hip Arthroplasty 153Peter M. Lewis MB BCh FRCS(Orth) and James P. Waddell MD FRCSC26 Cement in Total Hip Arthroplasty 161Jorge H. Nuñez MD, Tony Fraguas MD, Ernesto Guerra-Farfán MD, and Diego Collado MD27 Head Size in Total Hip Arthroplasty 167Francesc Angles MD, Jorge H. Nuñez MD, and Pablo Castillón MD28 Dual Mobility in Total Hip Arthroplasty 173Iñaki Mimendia MD, Maria Jurado MD, Ernesto Guerra-Farfán MD, and Victor BarroMDPhD29 Trunnionosis 179Christopher Del Balso MBBS MSc, Emil Schemitsch MD, and Brent Lanting MD MSc30 Periprosthetic Hip Fractures 185Lisa C. Howard MD, Bas A. Masri MD, Don S. Garbuz MD, and Clive P. Duncan MD31 The Infected Total Hip Arthroplasty 191Sebastián A. León MD, Xin Y. Mei MD, and Paul R. Kuzyk MD MASc32 The Painful Total Hip Arthroplasty 199Asif A. H. Parkar MBBS, Ahmed El-Bakoury MBBS PhD, and James N. Powell MD33 Revision of the Femoral Component 205Lisa C. Howard MD, Bas A. Masri MD, Don S. Garbuz MD, and Clive P. Duncan MD34 Revision of the Acetabular Component 213Nikolaos Davarinos MD MSc, Adam Hart MDCM MASc, and John Antoniou MD PhD35 Antibiotic Cement in Total Knee Arthroplasty 221Stephen M. Petis MD MSc FRCSC and Steven J. MacDonald MD FRCSC36 Unicompartmental Knee Arthroplasty and Patellofemoral Resurfacing Arthroplasty 225Waleed Albishi MBBS, Paul Jamieson MD, Ivan Kamikovski MD, and Geoffrey Dervin MD37 Cemented versus Uncemented Fixation in Total Knee Arthroplasty 231Thomas Turgeon MD FRCSC38 Cruciate Retaining versus Posterior Stabilized Total Knee Arthroplasty 237Michael G. Zywiel MD MSc FRCSC and Sarah Ward MD MLA FRCSC39 Patellar Resurfacing in Total Knee Arthroplasty 243Michael G. Zywiel MD MSc FRCSC, Rajiv Gandhi MD MSc FRCSC, and Nizar N. Mahomed MD ScD FRCSC40 Mechanical versus Kinematic Alignment in Total Knee Arthroplasty 249Pascal-André Vendittoli MD MSc, William Blakeney MBBS MSc MS FRACS, Charles Rivière, and Gene Dossett41 Ligament Balancing in Total Knee Arthroplasty 253Pascal-André Vendittoli MD MSc, Jihad Matta MD, Christophe Fornasieri MD, and William Blakeney MBBS MSc MS FRACS42 Robotics in Total Knee Arthroplasty 259Seper Ekhtiari MD MSc, Vickas Khanna MD, and Anthony Adili MD43 Patient-Specific Instrumentation in Total Knee Arthroplasty 265Seper Ekhtiari MD MSc, Luc Rubinger MD, Vickas Khanna MD, and Anthony Adili MD44 Metal Allergy in Total Knee Arthroplasty 269Evangelos Tyrpenou MD, Amit Atrey MD MSc FRCSC45 Perioperative Management in Total Knee Arthroplasty 275Sebastian M. Klim MD and Mathias Glehr MD46 Arthrofibrosis following Total Knee Arthroplasty 279Samuel T. Walters MBBS, Saket Tibrewal MBBS, and Jakob van Oldenrijk MD PhD47 High-Flexion Implants in Total Knee Arthroplasty 285Thomas J. Wood MD FRCSC and Douglas D. R. Naudie MD FRCSC48 Venous Thromboembolism in Total Knee Arthroplasty 289Harman Chaudhry MD MSc and Mitch Winemaker MDFRCSC49 Highly Cross-Linked Polyethylene in Total Knee Arthroplasty 295Pascal-André Vendittoli MD MSc, William Blakeney MBBS MSc MS FRACS, Ebru Oral, and Orhun Muratoglu50 Exposure and Implant Options in Revision Total Knee Arthroplasty 301Felipe Moreira MD, Maria Jurado MD, and Marcelo Casaccia MD51 The Painful Total Knee Arthroplasty 307Jason Werle MD FRCSC, Kelly Johnston MD FRCSC, Nicholas Desy MD FRCSC, and Stuart Goodman MDPhD FRCSC52 Diagnosing the Infected Total Knee Arthroplasty 315Mina Tohidi MD and John F. Rudan MD53 Management of the Infected Total Knee Arthroplasty 321Ewout S. Veltman MD and Dirk Jan F. Moojen MD PhD54 Management of the Unstable Total Knee Arthroplasty 325John Esposito MD FRCSC and James L. Howard MD MSc FRCSC55 Stem Choices in Revision Total Knee Arthroplasty 329Pablo A. I. Slullitel MD, Gerard M. J. March MD FRCSC, and Paul R. Kim MD FRCSC56 Periprosthetic Fractures: Knee 335Jesse Wolfstadt MD MSc FRCSC and Aaron Nauth MDMSc FRCSC57 Femoral Bone Defects in Revision Total Knee Arthroplasty 341Adam Katchky MD MSc FRCSC and David J. Backstein MEd MD FRCSC58 Management of Structural Defects in Revision Knee Arthroplasty: Tibial Side 349Sebastián León MD, Jennifer Leighton MD FRCSC, Xin Y. Mei MD, and Paul R. Kuzyk MD MASc FRCSC59 Patellar Options in Revision Total Knee Arthroplasty 355Jesse Wolfstadt MD MSc FRCSC and Paul Zalzal MASc MD FRCSCIII.II Shoulder60 Implant Design Options in the Treatment of Shoulder Osteoarthritis 361Chad Myeroff MD, Michael Knudsen MD, and Michael D.McKee MD FRCS(C)61 Cement in Shoulder Arthroplasty 369Midhat Patel MD and Niloofar Dehghan MD FRCSC62 Management of Glenoid Bone Loss 375Diego Soza MD, Montserrat García-Portabella MD, Lledó Batalla MD, and Josep Massons MD PhD63 Reverse Total Shoulder Arthroplasty 381Mitchel D. Armstrong MD BMSc FRCSC, Bandar M. Assiry MBBS SB-orth, and Ryan T. Bicknell MD MSc FRCSC64 Glenoid Components in Total Shoulder Arthroplasty 387Eric Benson MD, George Athwal MD, and Kenneth Faber MD65 Periprosthetic Joint Infection in Shoulder Arthroplasty 393Peter Lapner MD FRCSC, Jay Keener MD, and Thomas Duquin MDIII.III Foot and Ankle66 Ankle Osteoarthritis 401Rosa Busquets MD PhD and Andrea Sallent MD67 Osteoarthritis of the 1st Metatarsophalangeal Joint 407Seper Ekhtiari MD MSc and Waleed Kishta MD PhD68 Hallux Valgus 413Sebastián Drago Perez MD and Cristian Ortiz Mateluna MD69 Cavovarus Foot 419Sebastián Drago Perez MD and Cristian Ortiz Mateluna MDSection IV TraumaIV.I General Trauma70 Damage Control Orthopedics 425Sascha Halvachizadeh MD, Paolo Cinelli PhD, Florin Allemann MD, Philipp Kobbe MD MHBA, and Hans-Christoph Pap MD71 Open Fractures 431Michael D. Hunter MD, Mark D. Hasenauer MD, Atul F. Kamath MD, and Kyle J. Jeray MD72 The Mangled Extremity 437Tiffany Huynh MD and Ted V. Tufescu MD FRCSC73 Acute Compartment Syndrome 441Aurelia Bihari PhD, Christopher Del Balso MBBS MSc FRCSC, and Abdel-Rahman Lawend MDPhD FRCSC74 Noninvasive Technologies for Fracture Repair 447Natsumi Saka MD, Yoshinobu Watanabe MD PhD, and Takashi Matsushita MD DSc75 Calcium-Based Bone Substitutes 451Ross Leighton BSc MD FRCSC, Kelly Trask BEng MSc CCRP, Thomas A. Russell MD, Mohit Bhandari MD MSc, and Richard E. Buckley MD FRCSCIV.II Shoulder Girdle and Upper Extremity76 Scapula Fractures 457Peter A. Cole MD and Lisa K. Schroder BS MBA77 Sternoclavicular Joint 463Annie Weber MD and Raymond A. Pensy MD78 Clavicle Fractures 469Chad Myeroff MD and Michael D.McKee MD FRCS(C)79 Acromioclavicular Joint 475Chad Myeroff MD and Michael D. McKee MD FRCS (C)80 Proximal Humeral Fractures 481Benjamin Kopp MD and David Ring MD PhD81 Humeral Shaft Fractures 487David J. Hak MD MBA FACS and Cyril Mauffrey MD FRCS FACS82 Distal Humerus Fractures 491Brandon Girardi MD, Emil H. Schemitsch MD, and Aaron Nauth MD MSc83 Elbow Dislocations 499Lisa C. Howard MD and Jason W. Pollock MD84 Radial Head Fractures 505James D. Spearman Jr MD MBA, David Ring MD PhD, and Lee M. Reichel MD85 Olecranon Fractures 509Michael C. Daly MD and Jesse B. Jupiter MD86 Forearm Fractures 515Habeeb Khan CCPA and Rudolf W. Poolman MD PhD87 Distal Radius Fractures 521Boris A. Zelle MD and Riikkaa E. Nomides MD88 Carpal Dislocations 525Carl Nunziato MD, Geert A. Buijze MD PhD, and David Ring MD PhD89 Carpal Fractures 529Bert Perey MD FRCSC, Emanuelle Villemaire-Côté MD FRCSC, and Francesc A. Marcano-Fernández MDPhD90 Metacarpal Fractures 537Christina Ward MDIV.III Pelvis and Lower Extremity91 Pelvic Fractures 541G. Yves Laflamme MD FRCS(c), Jonah Hébert-Davies MDFRCS(c)c, and Dominique M.Rouleau MD MSc FRCS(c)92 Acetabular Fractures 547Juan Antonio Porcel Vázquez MD and Ernesto Guerra-Farfán93 Hip Dislocations 553Luis Felipe López MD, Carlos Prada MD MHSc, Brett D. Crist MD FACS, and Gregory J. Della Rocca MD PhD Facs94 Femoral Head Fractures 559Kevin D. Phelps MD, Joshua L. Gary MD, and Milton Lee “Chip” Routt Jr MD95 Femoral Neck Fractures in Younger Patients 565Malynda Wynn MD, Trevor Gulbrandsen MD, Michael Willey MD, and Matthew Hogue MD96 Femoral Neck Fractures in the Elderly 571Dylan McCreary BA, Brian P. Cunningham MD, and Marc Swiontkowski MD97 Extracapsular Hip Fractures 577Luke A. Lopas MD, Andrew F. Tyler MD PhD, and Samir Mehta MD98 Subtrochanteric Femur Fractures 583John Morellato BSc (Pharm) MBBS (Hons) FRCSC, Steven Papp BSc MSc MD FRCSC, Wade Gofton BSc MSc MD FRCSC, and Allan Liew BSc MD FRCSC99 Femoral Shaft Fractures 589Costas Papakostidis MD and Peter V. Giannoudis MDFacs Frcs100 Distal Femur Fractures 595Graeme Hoit MD, Amir Khoshbin MD, and Rudolf W. Poolman MD PhD101 Proximal Tibia Fractures 601Daniel Axelrod MD, Richard Jenkinson MD MSc FRCSC, and Hans Kreder MD MPH FRCSC102 Tibial Shaft Fractures 607Taylor Yong MD MS, Ilda Molloy MD MS, and Leah Gitajn MD103 Intra-Articular Distal Tibia (Pilon/Plafond) Fractures 613Luc Rubinger MD, Seper Ekhtiari MD MSc, and Peter J. O’Brien MD104 Malleolar Fractures 619Daniel Axelrod MD and David W. Sanders MD FRCSC105 Talus Fractures 625Pablo Mery MD and Carlos Prada MD MHSc106 Calcaneal Fractures 631Richard E. Buckley MD FRCSC107 Lisfranc Injuries 637Robin R. Elliot MA FRCS, Nicholas B. Jorgensen MBBS, and Terrence S. Saxby MBBS FRACS108 Fifth Metatarsal Fractures 643Robin R. Elliot MA FRCS, Nicholas B. Jorgensen MBBS, and Terrence S. Saxby MBBS FRACSSection V Spine109 Mechanical Neck Pain 651Kenneth Nwosu MD and Thomas Cha MD MBA110 Whiplash 655Eren O. Kuris MD and Alan H. Daniels MD111 Cervical Radiculopathy and Myelopathy 659Michael Fehlings MD PhD FACS FRCSC and Jetan Badhiwala MD112 Mechanical Low Back Pain: Operative Management 665Pranay Patel MD, Ian Buchanan MD, Zorica Buser PhD, and Jeffrey C. Wang MD113 Mechanical Low Back Pain: Nonoperative Management 671Kirkham Wood MD and Craig McMains MD114 Neurogenic Claudication 677Gregor Lønne MD PhD and Øystein Nygaard MD115 Lumbar Radiculopathy 683Daniel G. Tobert MD and James D. Kang MD116 Adolescent and Adult Spinal Deformity: Nonoperative Management 687Patrick Thornley MD and Colby Oitment MDFRCSC117 Adolescent and Adult Spinal Deformity: Operative Management 693Peter G. Passias MD, Frank A. Segreto MD, Samantha R. Horn BA, and Cole A. Bortz BA118 Metastatic/Myeloma Disease 699Marco Ferrone MD and Justin Bulcher MSc119 Spinal Infections 705Stuart D. Kinsella MD MTR, Lauren B. Barton BS, and Andrew J. Schoenfeld MD MScSection VI Sports MedicineVI.I General120 Ergogenic Aids 713Michael J. O’Brien MDVI.II Shoulder121 First Time Shoulder Dislocation 717Dane Swinehart MD, Jordan Meiss MD, and Charles Cox MD122 Recurrent Shoulder Instability 723Joost I. P. Willems MD, Amber von Gerhardt MD, W. Jaap Willems MD, and Arthur van Noort MD PhD123 Rotator Cuff Tears 729Alberto Blanco MD, Montserrat García-Portabella MD, Lledó Batalla MD, and Josep Massons MD124 Massive and Irreparable Rotator Cuff Tears 735Brandon J. Erickson MD and Joshua S. Dines MD125 Subacromial Pain Syndrome 739Egbert J. D. Veen MD and Ron L. Diercks MD126 Pathology of the Long Head of the Biceps 743Daniel Wang BA, David Ring MD PhD, and Matt Driscoll MD127 Superior Labral Tears and Throwing Shoulder Injuries 749Michael T. Freehill MD, Jacob M. Kirsch MD, Hiroyuki Sugaya MD, and Jon J. P. Warner MDVI.III Elbow128 Ulnar Collateral Ligament Injuries of the Elbow 755Frank G. J. Loeffen MD, Izaäk F. Kodde MD PhD, and Denise Eygendaal MD PhD129 Lateral Epicondylitis (Tennis Elbow) 761Neeru Jayanthi MD130 Osteochondritis Dissecans Lesions of the Elbow 769Matthew Smith MD and Mitchel Obey MDVI.IV Hip131 Labral Tears 775Chetan Gohal MD, Nolan S. Horner MD, and Marc R. Safran MD132 Femoroacetabular Impingement 779Marc J. Philippon MD, Ioanna K. Bolia MD, and Karen K. Briggs MPHVI.V Knee133 Initial Management of the Sports Injured Knee 783Marc Aguilar Garcia MD, Carla Carbonell Rosell MD, and Joan Pijoan Bueno MD134 Meniscal Tears 787Nicola Maffulli MD MS PhD FRCS (Orth), Domiziano Tarantino MD, and Rocco Aicale MD135 Anterior Cruciate Ligament Injuries 793Aaron Gazendam MD, Darren de SA MD, and Freddie Fu MD136 Posterior Cruciate Ligament Injuries 799Chetan Gohal MD, Nolan S. Horner MD, Jihad Abouali MD, and John Theodoropoulos MD MSc137 Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries 805Domiziano Tarantino MD, Rocco Aicale MD, and NicolaMaffulli MD MS PhD FRCS (Orth)138 Multiligamentous Knee Injuries 811James P. Stannard MD and Hee Young Lee MD139 Posterolateral Corner Injuries 815Nolan S. Horner MD, Chetan Gohal MD, Olufemi R. Ayeni MD PhD, and Daniel B. Whelan MD MSc140 Lateral Extra-Articular Tenodesis Procedures and the Anterolateral Ligament 819Felipe Moreira MD, Merce Reverté MD PhD, Enric Castellet MD, and Joan Minguell MD PhD141 Cartilage Lesions of the Knee 825Mario Hevesi MD, Aaron J. Krych MD, and Daniël B. F. Saris MD PhD142 Patellofemoral Pain Syndrome (Runner’s Knee) 831Carlos Prada MD MHSc and Sebastián Irarrázaval MD143 Osteotomy and Lower Extremity Realignment Procedures 837Jayson Lian BA, Darren de SA MD, João V. Novaretti MD, and Volker Musahl MDVI.VI Foot & Ankle144 Ankle Ligament Injuries 843Gwendolyn Vuurberg PhD, J. Nienke Altink BSc, Rover Krips MD PhD, and Gino M. M. J. Kerkhoffs MD PhD145 Achilles Tendinopathy 849Domiziano Tarantino MD, Rocco Aicale MD, and Nicola Maffulli MD MS PhD FRCS (Orth)Section VII Wrist146 Distal Radius Malunions 855Muhanned Ali MD, Roberto S. Rosales MD PhD, and Isam Atroshi MD PhD147 Distal Radial–Ulnar Joint 861Nina Suh MD148 Wrist Osteoarthritis 867Randy Bindra MD149 Rheumatoid Wrist Reconstruction 873Warren Hammert DDS MD150 Acute Scaphoid Fractures 877Joseph J. Dias MD (Research) FRCS MBBS151 Scaphoid Nonunions 883Anne Eva J. Bulstra MD, Job N. Doornberg MD PhD, Myriam C. Obdeijn MD PhD, and Geert A. Buijze MDPhD152 Carpal Instability 889Jessica B. Hawken MD and Aviram M. Giladi MD MS153 Kienböck’s Disease 895Simon B. M. MacLean and Gregory I. Bain154 Trapeziometacarpal Osteoarthritis 899Jeremiah D. Johnson MD, Jennifer M. Brewer BA, and Jennifer Moriatis Wolf MDSection VIII Hand155 Carpal Tunnel Syndrome: Nonoperative Management 907Thomas A. Miller MD FRCPC, Christopher Doherty MDMPH FRCSC, and Douglas C. Ross MD MEd FRCSC156 Carpal Tunnel Syndrome: Operative Management 913Douglas C. Ross MD MEd FRCSC, Christopher Doherty MD MPH FRCSC, and Thomas A. Miller MD FRCPC157 Carpal Tunnel Release: Minor Procedure Room or Operating Room? 917Kevin Cheung MD and Hannah St Denis-Katz MD158 Thumb Carpometacarpal Osteoarthritis 921Ryan Wolek MD, Steven McCabe MD MSc, and Matthew Furey MD MSc159 Flexor Tendon Injuries: Surgical Management 925Robert M. Szabo MD MPH and Shima Sokol MD160 Flexor Tendon Injuries: Rehabilitation 931Matthew McRae MD, Mark McRae MD, Daniel Waltho MD, and Jenny Santos MSc161 Extensor Tendon Injuries 935Noor Alolabi MD, Monica Alderson MSc, and Carolyn M. Levis MD MSc162 Dupuytren’s Disease 947Lauren Willoughby BMSc MD FRCSC, Daniel Waltho MD, Marta Karpinski BHSc, and Achilleas Thoma MDMSc163 Rheumatoid Hand Reconstruction 953Kevin C. Chung MD MS, Oluseyi Aliu MD, and Sandra V. Kotsis MPH164 Replantation 957Serge Goekjian MD FRCS (C), Lucas Gallo BHSc MD (c), and Achilleas Thoma MD MSc165 Ulnar Neuropathy 963Christopher Doherty MD MPH FRCSC, Thomas A. Miller MD FRCPC, and Douglas C. Ross MD MEd FRCSC166 Finger Fractures 969Claire Ryan MD and David Ring MD PhDSection IX Oncology167 Radiation Therapy in Soft Tissue Sarcoma 975Anthony Bozzo MD MSc, Aaron Gazendam MD, and Kurt R. Weiss MD168 Chemotherapy in Soft Tissue Sarcoma 981Robert J. Wilson ii MD, Jennifer L. Halpern MD, Jill Gilbert MD, Ginger E. Holt MD, Vicki L. Keedy MD, and Herbert S. Schwartz MD169 Surgical Margins in Soft Tissue Sarcoma 993Eugenia Schwarzkopf MD, Tomohiro Fujiwara MD, and John H. Healey MD170 Allograft versus Megaprosthesis 999Kelly C. Homlar MD, Robert J. Wilson ii MD, Jessica Rose Wilson MD MSCI, Jennifer L. Halpern MD, Herbert S. Schwartz MD, and Ginger E. Holt MD171 Biopsy of Soft Tissue Masses 1005Aaron Gazendam MD, Anthony Bozzo MD MSc, Casey Wang MD, and David Wilson MD MASc172 Denosumab in Giant Cell Tumors of Bone 1011Michael Parry MD and Robert Grimer MDSection X Pediatrics174 Cerebral Palsy 1029Vedant Kulkarni MD175 Pediatric Osteoarticular Infections 1035Brice Ilharreborde MD, Cindy Mallet MD, and Dimitri Ceroni MD176 Simple Bone Cysts 1041Cristina Alves MD FEBOT, Inês Balacó MD, Marta Salom Taverner MD PhD, Thomas Wirth MD PhD, and Michiel Van De Sande MD PhD177 Pediatric Clavicle Fractures 1047Benton E. Heyworth MD and Nirav Pandya MD178 Supracondylar Humerus Fractures 1053Ravi Brar MD MPH, David Skaggs MD MMM, and Sanjeev Sabharwal MD MPH179 Adolescent Spondylolisthesis 1061Matthew E. Oetgen MD MBA and M. Timothy Hresko MD180 Early Onset Scoliosis 1067Jason Pui Yin Cheung MBBS MMedSc MS FHKAM (orth) FRCS(orth) FHKCOS(Edin), Susan Nelson MDMPH, James O. Sanders MD, and Ron El-Hawary MDMSc FRCS (C)181 Developmental Dysplasia of the Hip 1075Emily K. Schaeffer PhD and Wudbhav N. Sankar MD182 Legg–Calvé–Perthes Disease 1081Benjamin Joseph MS Orth MCh Orth FRCS Ed and Hitesh Shah MS Orth183 Slipped Capital Femoral Epiphysis 1087Eduardo Novais MD and Randy Loder MD184 Pediatric Femoral Shaft Fractures 1093Matthew Winterton MD, Shital Parikh MD FACS, and Keith Baldwin MD MSPT MPH185 Infantile Blount Disease 1099Steven M. Rivero MD and Sanjeev Sabharwal MD MPH186 Pediatric Anterior Cruciate Ligament Injuries 1107Lindsay Schlichte MS, Colleen Wixted BS, and Daniel Green MD MS FACS187 Clubfoot 1113Anna D. Vergun MD and Peter Moskal MD188 Tarsal Coalitions 1119Joseph Fox MD and Maryse Bouchard MD MSc173 Outcomes in Pediatric Orthopedics 1019Unni G. Narayanan MBBS MSc FRCS(C)Index, 1125