We present a case of an 8-year-old girl with a high grade osteogenic sarcoma of the proximal humerus treated with wide resection and vascularized proximal humerus treated with wide resection and vascularized proximal fibular epiphyseal transfer. At 5 years after reconstruction, the patient is tumor free and had a Musculoskeletal Tumor Score of 26/30 or 86.7%. The functional outcomes in terms of shoulder range of motion and pain were good. Complications include transient peroneal nerve palsy and mild valgus instability of the knee.

Human ; Female ; Child ; Shoulder ; Peroneal Nerve ; Range Of Motion, Articular ; Fibula ; Humerus ; Knee Joint ; Pain ; Osteosarcoma

Background: The goal of preoperative fasting is to prevent pulmonary aspiration during general anesthesia. Fasting times are often prolonged leading to patient discomfort and risk for adverse events. This retrospective quality improvement survey evaluated effective nil-per-os (NPO) times and causes for prolonged NPO times with the aim to suggest improvement strategies by a newly founded fasting task force. Methods: Data from all electronic anesthesia records from 2019 at our institution were reviewed for fasting times. Our NPO instructions follow American Society of Anesthesiology guidelines and are calculated based on the patient’s arrival time (90 min before OR time). Primary outcome was the effective NPO time for clear liquids, secondary outcomes were incidence of delays and the parental compliance with the NPO instructions. Data are presented as median (interquartile range). Results: 9,625 cases were included in the analysis. NPO time was documented in 72.1% with a median effective NPO time of 7:13 h (7:36). OR in room times were documented in 72.8%, 2,075 (29.5%; median time 0:10 h [0:21]) were earlier and 4,939 (70.5%; median time 0:29 h [0:54]) were later than scheduled. Parental NPO compliance showed a median deviation for clear liquid intake of 0:55 h (8:30). Conclusions This study revealed that effective NPO times were longer than current ASA guidelines. Contributing causes include case delays and parental non-compliance to NPO instructions. Thus, task force recommendations include change NPO instruction calculations to scheduled OR time versus arrival time, and encourage parents to give their child clear liquids at the instructed time.