This was a retrospective study of data prospectively collected from 2012 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The objective was to evaluate the effect of pediatric fellowship training on 30-day perioperative morbidity and mortality following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Several pathways exist in North America by which physicians acquire the clinical and technical skills to manage AIS surgically. Previous work has noted that surgeons with pediatric fellowship training tend to perform the bulk of pediatric spine surgeries. However, no study has been performed that examines if pediatric fellowship training (PFT) has an impact on early postoperative outcomes. A total of 14,194 AIS surgical patients were identified from the ACS NSQIP database. A cohort receiving isolated PSF was abstracted from this group and separated into 3 groups according to surgeon training (1) ped+ (with PFT, n=4455); (2) ped-(without PFT, n=325); and (3) ped+match (patients selected from ped+ matched to ped- for age, sex, and fusion levels, n=325). The groups were compared for 30-day perioperative morbidity and mortality. No significant differences were noted for the 3 groups in terms of wound infections, length of hospital stay, readmissions, and unplanned returns to the operating room. Ped+match and ped- groups had no difference in neurologic injury rates. However, the ped+ and ped+match groups had significantly lower rates of blood transfusion and average volume of blood lost compared with the ped- group. Surgeons with pediatric fellowship training have a significantly lower average blood loss volume and blood transfusion rate in PSF for AIS than surgeons without such training. Understanding that different training pathways for surgeons may directly impact operative outcomes invites further examination of surgical education in North America to improve training consistency. [Orthopedics. 2020;43(5)e454-e459.].With the goal of safety and efficiency in health care delivery, enhanced recovery protocols (ERPs) continue to gain traction throughout various surgical disciplines, including in pediatric scoliosis surgery. The growing body of literature reporting decreased length of stay and cost with no change in readmissions or complications has brought these protocols to the forefront. The key components of ERPs include preoperative patient counseling, perioperative pain management, and early patient mobilization. In this review, the authors aim to describe the foundational history and major components of ERPs following pediatric spine deformity surgery. [Orthopedics. 2020;43(5)e338-e344.].This investigation assessed the availability and comprehensiveness of adult reconstruction fellowship websites. A list of adult reconstruction fellowship programs was compiled using 4 online directories American Association of Hip and Knee Surgeons, San Francisco Match, Fellowship and Residency Electronic Interactive Database Access, and American Academy of Orthopaedic Surgeons. These directories and Google (Alphabet Inc, Menlo Park, California) searches were used to assess for the presence and functionality of websites for each program. Each website was reviewed for the presence of 21 variables related to education and recruitment. The relationship between several program characteristics and presence of a website or website comprehensiveness was evaluated. In total, 81 programs were identified, of which 80.2% (65 of 81) had a functional website and 19.8% (16 of 81) did not. The mean±SD number of variables present on a website was 11.3±3.8 of 21 total variables, equating to mean comprehensiveness of 54.0%. Fellowships affiliated with an orthopedic residency were more likely to have a website than those that were not (91.8% vs 62.5%, P=.001). Fellowships that were accredited by the Accreditation Council for Graduate Medical Education were more likely to have a website than those that were not (100.0% vs 73.8%, P=.009). Website comprehensiveness was not associated with any program characteristics assessed. This study highlights deficits in online resources available for adult reconstruction fellowship program information and the gap that exists between the current means of information sharing. Efforts to encourage an online presence and optimize a program's online content may be of benefit to prospective applicants and the program itself. [Orthopedics. 2020;43(5)e447-e453.].There are conflicting reports regarding the outcome and effect of denosumab for distal radius giant cell tumor of bone (GCTB). The authors performed this study to evaluate the behavior of distal radius GCTB in relation to the type of treatment and the administration of denosumab. The files of 72 patients with distal radius GCTB treated from 1984 to 2018 were reviewed. Fourteen patients were administered denosumab. Surgical treatment consisted of curettage (25 patients) or resection (47 patients) and allograft or vascularized fibular head graft reconstruction. Median follow-up was 63.1 months (interquartile range [IQR], 35.5-107.1 months). The authors evaluated local recurrences, metastasis, function, and complications. The local recurrence rate was 30.6% at a median of 14.0 months (IQR, 10-19 months), with no difference between curettage and resection. The local recurrence rate was significantly higher in the patients who received denosumab. The metastasis rate was 9.7% at a median of 41.0 months (IQR, 15-114 months), with no difference regarding denosumab administration. Function was significantly better in patients after curettage. The complication rate was 25%; vascularized fibular graft reconstruction was associated with fewer complications. https://www.selleckchem.com/products/calpeptin.html This study found that denosumab increases the risk of local recurrence after curettage, function is better after curettage, and vascularized fibular graft is the optimal reconstruction after resection of distal radius GCTB. [Orthopedics. 2020;43(5)284-291.].The authors report the case of an atraumatic femoral component fracture 10 years after primary total knee arthroplasty (TKA) with a modern cemented fixed bearing system. The patient, a 70-year-old man, had the complication without inciting trauma, and he subsequently had severe pain and disability. This rare mode of TKA failure occurred at the superolateral aspect of the femoral component's anterior flange. At the time of revision, no femoral osteolysis was seen and the backside of the prosthesis fracture fragment was found to be free of cement. To the authors' knowledge, this is the first case of femoral component fracture in a Vanguard TKA (Biomet, Warsaw, Indiana), and the first case of fracture in a modern cobalt-chrome alloy femoral component associated with aseptic cement debonding. Femoral component stress fracture is a rare but serious complication of TKA. Reports of femoral component fracture in early designs were attributed to geometric design flaws, whereas modern TKA designs appear to fail when ingrowth failure, aseptic debonding, or osteolysis result in inadequate bony support of the prosthesis.