# Orthopedic and Chest Wall Conditions — GCMD Library living collection

Updated: n/a · 3 episodes · 51 cited statements

## Episodes
### Scoliosis
- [Vertebral body tethering for pediatric scoliosis: patient selection and surgical technique](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848) — podcast · 5:39 · [machine version](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848.md)

### Pectus Deformities
- [Literature Update: Bridge Fixation Superior for Pectus Bar Stabilization](https://library.globalcastmd.com/watch/literature-update-bridge-fixation-superior-for-pectus-bar-stabilization-16863) — podcast · 1:29 · [machine version](https://library.globalcastmd.com/watch/literature-update-bridge-fixation-superior-for-pectus-bar-stabilization-16863.md)

### Fracture Management
- [Most Common Pediatric Fractures and Prevention Strategies with Dr. Jill Larson](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867) — podcast · 19:54 · [machine version](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867.md)

## Chapters
- [0:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=1) Introduction and Clinical Scenario (Ep 1)
- [0:57](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=57) VBT Fundamentals and Mechanism (Ep 1)
- [2:08](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=128) Timing and Peak Growth Velocity (Ep 1)
- [2:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=160) Patient Selection Criteria (Ep 1)
- [2:57](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=177) Surgical Technique (Ep 1)
- [4:11](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=251) Postoperative Recovery and Outcomes Data (Ep 1)
- [5:06](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=306) Summary and Conclusions (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=0) Introduction and Seasonal Fracture Patterns (Ep 3)
- [0:56](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=56) Distal Radius Fractures: Classification and Non-Displaced Management (Ep 3)
- [3:11](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=191) Displaced Distal Radius Fractures and Physeal Injury Management (Ep 3)
- [5:07](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=307) Pediatric Ankle Fractures: Physeal and Triplane Injuries (Ep 3)
- [8:02](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=482) Tibial Shaft Fractures: Toddler's Fractures and Operative Indications (Ep 3)
- [9:43](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=583) Forearm Fractures: Greenstick and Both-Bone Injuries (Ep 3)
- [11:52](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=712) Supracondylar Humerus Fractures: Classification and Treatment (Ep 3)
- [13:03](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=783) Fracture Prevention: Obesity, Vitamin D, and Safety Guidelines (Ep 3)
- [18:35](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1115) Key Takeaways and Conclusion (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Fracture rates increase starting in March until peak in August, with a spike at Lurie Children's in October likely due to return to school with less supervision and increased athletic participation — Jill Larson (epidemiological) [Ep 3 · 0:32](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=32)
- The most common location for a pediatric fracture is the distal radius or wrist fracture — Jill Larson (epidemiological) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=60)
- Extraphyseal fractures have a low risk of physeal growth plate arrest or damage to longitudinal growth of the arm — Jill Larson (clinical) [Ep 3 · 1:36](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=96)
- The closer the fracture is to the physis, the increased potential for remodeling of any residual deformity — Jill Larson (clinical) [Ep 3 · 1:44](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=104)
- A buckle fracture that is non-displaced heals very reliably in approximately 3 to 4 weeks depending on age — Jill Larson (clinical) [Ep 3 · 2:31](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=151)
- Waterproof casting must get wet daily to prevent skin excoriation — Jill Larson (clinical) [Ep 3 · 2:53](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=173)
- In children greater than age 10, near anatomic reduction is imperative because of the remodeling potential left in the distal forearm — Jill Larson (clinical) [Ep 3 · 3:35](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=215)
- Due to physeal injury, a 6 month follow-up with an X-ray is recommended to assess for physeal growth arrest — Jill Larson (guideline) [Ep 3 · 4:39](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=279)
- The physis in children is often the weakest part of the bone, even weaker than the ligaments or tendons themselves — Jill Larson (clinical) [Ep 3 · 5:20](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=320)
- A toddler's fracture (non-displaced spiral fracture of the tibia shaft) is very common in children ages 9 months to 3 years old — Jill Larson (epidemiological) [Ep 3 · 8:07](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=487)
- At ages 9 months to 3 years, children have a robust periosteal sleeve around their bones so the fracture remains very stable and heals very reliably — Jill Larson (clinical) [Ep 3 · 8:16](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=496)
- In children with limited verbal skills, there is a high risk of heel ulceration when the leg is placed in temporary splints — Jill Larson (clinical) [Ep 3 · 8:30](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=510)
- Both bone forearm fractures are at a high risk to develop compartment syndrome due to swelling from the fracture and associated soft tissue trauma — Jill Larson (clinical) [Ep 3 · 10:01](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=601)
- Providers should have high suspicion for compartment syndrome if a pediatric patient has increasing agitation, anxiety, and analgesic requirements after closed reduction and casting — Jill Larson (clinical) [Ep 3 · 10:11](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=611)
- There is an increased risk of refracture of both bone forearm fractures within the first 6 months — Jill Larson (clinical) [Ep 3 · 11:00](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=660)
- Flexible nailing preserves the physis to prevent any early physeal closure — Jill Larson (clinical) [Ep 3 · 11:39](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=699)
- Flexible nails are typically removed 6 to 12 months after healing to avoid the high risk of refracturing within the first 6 months — Jill Larson (guideline) [Ep 3 · 11:43](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=703)
- Fall prone activities are recommended to be avoided for at least 8 weeks postoperatively after supracondylar fracture pinning — Jill Larson (guideline) [Ep 3 · 12:50](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=770)
- Studies have shown that obese or overweight children are at higher risk for fracture, primarily due to the increased stress on their bones, and secondarily due to inactivity or immobility — Jill Larson (epidemiological) [Ep 3 · 13:21](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=801)
- Obese children have increased complications of fracture management due to implant failures or fracture malunions — Jill Larson (clinical) [Ep 3 · 13:40](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=820)
- Cast immobilization may not be sufficient to stabilize broken bones in obese children due to increasing adipose tissue — Jill Larson (clinical) [Ep 3 · 13:48](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=828)
- The American Academy of Pediatrics recommends 1000 mg of calcium per day and 1000 international units of vitamin D daily for ages 4 to 8 years — Jill Larson (guideline) [Ep 3 · 14:51](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=891)
- Each year, 200,000 children injure themselves on playgrounds in the United States — Jill Larson (epidemiological) [Ep 3 · 15:15](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=915)
- 200,000 children get hurt on trampolines alone each year — Jill Larson (epidemiological) [Ep 3 · 15:21](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=921)
- More than 176,000 children ages 5 to 14 are treated each year in hospital emergency rooms for injuries related to skateboards, scooters, and skates — Jill Larson (epidemiological) [Ep 3 · 15:25](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=925)
- Most playground injuries are caused by a fall from the monkey bars onto an outstretched hand, which causes a forearm or an elbow fracture — Jill Larson (epidemiological) [Ep 3 · 16:07](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=967)
- The American Academy of Pediatrics recommends that children under 5 years old should not ride a skateboard — Jill Larson (guideline) [Ep 3 · 16:35](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=995)
- The American Academy of Pediatrics recommends that children younger than 8 years old should not use a formal two-wheeled scooter — Jill Larson (guideline) [Ep 3 · 16:49](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1009)
- Children should be at least 12 years of age or older before operating a push lawnmower, and 16 years or older to operate a riding lawnmower — Jill Larson (guideline) [Ep 3 · 17:26](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1046)
- The American Academy of Pediatrics guidelines state the safest course of action is to not buy or use a trampoline — Jill Larson (guideline) [Ep 3 · 18:06](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1086)
- VBT is definitely less invasive and more physiologic than standard spinal fusion. (opinion) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=70)
- VBT uses a polyethylene flexible band placed on the convex side of the spine. (clinical) [Ep 1 · 1:32](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=92)
- VBT requires a skeletally immature patient so that as they're growing, they're growing straighter. (clinical) [Ep 1 · 1:37](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=97)
- If VBT is done in a mature patient, it's probably not going to work. (clinical) [Ep 1 · 1:49](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=109)
- VBT cannot be used in adults; outcomes in adults are not very good. (clinical) [Ep 1 · 1:55](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=115)
- Everybody is moving towards only doing VBT in skeletally immature kids right around the time of peak growth velocity. (clinical) [Ep 1 · 2:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=121)
- The sweet spot for VBT is when we can actually modulate growth and change the shape of the disk space and the shape of the vertebrae as they grow. (clinical) [Ep 1 · 2:28](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=148)
- Current indications for VBT are immature, moderately severe curves, and flexible. (guideline) [Ep 1 · 2:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=160)
- Hybrid techniques can be used where if the thoracic curve doesn't meet criteria, the lumbar spine is where you need motion. (clinical) [Ep 1 · 2:47](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=167)
- You can usually get down to T12, L1 through the thoracoscopic approach and bluntly dissect the plane along the diaphragm to get to that level. (clinical) [Ep 1 · 3:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=181)
- L1 to L4 is accessed through an open incision. (clinical) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=191)
- Segmental vessels are typically ligated, but you certainly don't want to do that on both sides of the spine due to risk of a spinal infarct. (clinical) [Ep 1 · 3:15](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=195)
- Be really careful around the lumbosacral plexus; EMG neuromonitoring is used. (clinical) [Ep 1 · 3:44](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=224)
- You can bluntly retract the psoas off the vertebral body and dilate it up through tubes. (clinical) [Ep 1 · 3:50](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=230)
- The tether is threaded through each screw and a tensioning gun is used to place tension. (clinical) [Ep 1 · 4:05](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=245)
- VBT patients are mobilized immediately postoperatively. (clinical) [Ep 1 · 4:14](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=254)
- VBT patients return to sports within 6 weeks, while typical return to sports for a fusion would be 3 to 6 months. (clinical) [Ep 1 · 4:16](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=256)
- A Mayo study showed VBT success rate is only considered to be 75% at 2 years based on curve size and lack of revisions. (epidemiological) [Ep 1 · 4:26](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=266)
- The Mayo study showed VBT success declined to 63% at 3.8 years with a 20% revision rate. (epidemiological) [Ep 1 · 4:36](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=276)
- VBT started to be done mid 2000s at certain centers, and it has exploded in recent years. (epidemiological) [Ep 1 · 4:54](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=294)
- You have to be really careful about doing VBT in the right patient at the right time. (opinion) [Ep 1 · 5:01](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=301)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Intraphyseal fractures need to be closely monitored as there can be early closure or growth plate arrest during the healing process — The host summarizes what Dr. Jill Larson said [Ep 3 · 1:51](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=111)
- Recent studies have demonstrated that fracture healing rates are similar in a removable splint versus a cast — The host summarizes what Dr. Jill Larson said [Ep 3 · 2:41](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=161)
- A removable splint can be applied in an urgent care setting for buckle fractures, and follow-up with a pediatric orthopedic surgeon may not be needed — The host summarizes what Dr. Jill Larson said [Ep 3 · 2:46](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=166)
- Children greater than 10 years of age can have recurrence of displacement even with appropriate immobilization and should be seen within 3 to 5 days of casting — The host summarizes what Dr. Jill Larson said [Ep 3 · 3:41](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=221)
- If anatomic reduction of physeal fractures is not successfully achieved on the first attempt, then treatment in the OR for closed reduction is recommended to minimize additional trauma and physeal growth arrest — The host summarizes what Dr. Jill Larson said [Ep 3 · 4:22](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=262)
- Distal fibular physeal fractures should be non-weight bearing to prevent further injury to the physis — The host summarizes what Dr. Jill Larson said [Ep 3 · 5:31](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=331)
- In a very displaced fracture, it is critical to assess sensory and motor function of the foot and vascular status in a timely fashion — The host summarizes what Dr. Jill Larson said [Ep 3 · 6:14](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=374)
- It's important to do a reduction maneuver to take off pressure on the skin, as the bony spike can cause soft tissue or skin necrosis and ultimately lead to an open fracture — The host summarizes what Dr. Jill Larson said [Ep 3 · 6:28](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=388)
- If the displacement of the joint surface in triplane fractures is more than 2 millimeters, an open reduction in internal fixation of the articular surface with a positional screw is required — The host summarizes what Dr. Jill Larson said [Ep 3 · 7:23](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=443)
- Type 3 supracondylar fractures have complete disruption of the posterior cortex and are often widely displaced, which has an increased risk of neurovascular compromise — The host summarizes what Dr. Jill Larson said [Ep 3 · 12:15](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=735)
- Children with vitamin D insufficiency have a fracture risk that is 3 times greater than a vitamin D sufficient child — The host summarizes what Dr. Jill Larson said [Ep 3 · 14:26](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=866)
- In 2016, more than 4500 children in the United States were treated in emergency departments for injuries related to lawnmowers — The host summarizes what Dr. Jill Larson said [Ep 3 · 17:14](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1034)
- Talking on a phone accounted for 69% of injuries between 2004 and 2010, and texting for 9% of injuries during the same period — The host summarizes what Dr. Jill Larson said [Ep 3 · 17:48](https://library.globalcastmd.com/watch/most-common-pediatric-fractures-and-prevention-strategies-with-dr-jill-larson-16867?t=1068)
- Vertebral body tethering is an FDA approved minimally invasive non-fusion surgical treatment for growing patients with idiopathic scoliosis. — Jill Knepprath summarizing the discussion [Ep 1 · 1:18](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=78)
- The goal is to operate during peak growth velocity; if done too early, you overcorrect. — Jill Knepprath summarizing the discussion [Ep 1 · 2:08](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=128)
- Peak growth velocity occurs when kids are going through a period of significant skeletal growth around ages 8 to 15. — Jill Knepprath summarizing the discussion [Ep 1 · 2:14](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=134)
- If VBT is done too late, the tethering will eventually break and the spine will revert back to its initial shape. — Jill Knepprath summarizing the discussion [Ep 1 · 2:22](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=142)
- L1 can be accessed more easily thoracoscopically than by open surgery. — Jill Knepprath summarizing the discussion [Ep 1 · 3:23](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=203)
- L2 through L4 is better accessed by open approaches and removing one of the floating ribs. — Jill Knepprath summarizing the discussion [Ep 1 · 3:28](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=208)
- Lumbar exposure can be challenging, especially distally because of the iliac crest. — Jill Knepprath summarizing the discussion [Ep 1 · 3:40](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=220)
- The key is to bluntly retract the psoas off of the vertebral bodies during the open approach and make sure you are around the entire psoas muscle. — Jill Knepprath summarizing the discussion [Ep 1 · 3:56](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=236)
- The issues early on with VBT were due to poor patient selection. — Jill Knepprath summarizing the discussion [Ep 1 · 4:41](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=281)
- With more experience and better selection criteria, the data is now showing improved outcomes for VBT. — Jill Knepprath summarizing the discussion [Ep 1 · 4:46](https://library.globalcastmd.com/watch/vertebral-body-tethering-for-pediatric-scoliosis-patient-selection-and-surgical-16848?t=286)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai