Journal of Pediatric Orthopaedics最新文献

{"title":"Analysis of Serial Foot Radiographs to Determine Foot Height Multipliers.","authors":"Victoria J Nedder, Ansh P Shah, Kallie J Chen, John E Herzenberg, Raymond W Liu","doi":"10.1097/BPO.0000000000002859","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002859","url":null,"abstract":"<p><strong>Background: </strong>The multiplier method is an arithmetic calculation that estimates the amount of growth remaining until skeletal maturity. When predicting lower limb length discrepancy, differences in foot height are added to femur and tibia discrepancies. Foot height multipliers have not been calculated using radiographic measurements, so it is unclear whether foot height develops at the same pace as the femur and tibia. This study used serial images to calculate foot height multipliers and compared them to published lower limb and foot length multipliers.</p><p><strong>Methods: </strong>The Bolton Brush radiograph collection was used to measure foot height on the lateral foot view. Multipliers were calculated for ages with at least 10 serial study visits. 212 patients (2195 radiographs) were included in the study (102 female, 110 male patients). Foot height multipliers were calculated for ages 0 to 17 years (females) and 0 to 18 years (males).</p><p><strong>Results: </strong>Multipliers decreased with age, but qualitatively plateau at age 13 (females) and age 15 (males). Lower extremity multipliers have a more dramatic growth curve, indicating comparatively greater lower extremity growth after birth. However, when comparing the limb length discrepancy calculation using the lower extremity multiplier versus the foot height multiplier for the foot portion, the difference was negligible.</p><p><strong>Conclusions: </strong>This paper provides a database of foot height multipliers. Foot height seems to grow on a different trajectory than other lower limb components, confirming that one should consider separate multiplier values. The difference created by the foot height multiplier versus the lower extremity multiplier appears to be modest. Separate use of the foot height multiplier may only be necessary for young children with large foot height discrepancies, but further study to confirm the lack of impact of the foot height multiplier on limb length discrepancy calculations is needed. Our data were derived from normal children, so it is unknown if the presence of a talo-calcaneal coalition would affect foot height on the involved side.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity.","authors":"Jared M May, Emily L DeMaio, Jill E Larson","doi":"10.1097/BPO.0000000000002848","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002848","url":null,"abstract":"<p><strong>Background: </strong>Clubfoot occurs in up to 50% of patients with spina bifida (SB) and 90% with arthrogryposis (AR). Many of these patients with neuromuscular clubfoot deformity fail conservative casting and require surgery with posteromedial lateral release (PMLR). Limited data exist for the outcomes of PMLR in patients with SB and AR.</p><p><strong>Methods: </strong>Retrospective chart review was performed on PMLR in patients with SB and AR from January 2007 to June 2022, excluding those with follow-up <3 years or incomplete charts. Radiographic measurements were obtained pre-PMLR and post-PMLR when available.</p><p><strong>Results: </strong>In total, 51 patients with 79 cases of clubfeet treated with PMLR at a tertiary children's hospital were identified. Of those, 35 patients with 54 cases of clubfeet treated with PMLR were analyzed, including 22 patients (29 feet) with SB and 13 patients (25 feet) with AR. In the SB cohort, 41% of feet required reoperation at an average of 4.6 years, and 76% of AR feet required reoperation at an average of 4.7 years post-PMLR. In addition, 21% of SB feet and 8% of AR feet required 2 or more reoperations. Talectomy was required post-PMLR in 24% of SB feet and 40% of AR feet at an average of 4.9 and 5.9 years, respectively. Younger age at time of PMLR was associated with significantly increased reoperation rates in AR (P=0.01). Greater change in calcaneus-fifth metatarsal angle after PMLR was associated with a future need for reoperation (P=0.047). Greater talo-first metatarsal angle after PMLR was associated with a future need for reoperations of any kind (P=0.040) in SB.</p><p><strong>Conclusions: </strong>Although PMLR remains a safe and successful treatment in the short term, many neuromuscular clubfeet will require additional procedures. Younger age and greater preoperative versus postoperative changes in calcaneus-fifth metatarsal and postoperative talo-first metatarsal angles were associated with increased reoperation rate. These results help orthopaedic surgeons counsel families about the long-term prognosis of clubfoot treatment in SB and AR.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injuries Following COVID-19 Infection in Academy-level Male Youth Soccer Players.","authors":"Kyle Brougham, Jonathan R Warren, McKenna Noe, Brian R Lee, Shannon Margherio, James Roberson, Brian Harvey","doi":"10.1097/BPO.0000000000002845","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002845","url":null,"abstract":"<p><strong>Background: </strong>Injury epidemiology data are key to injury prevention strategy development. Most such data surrounding the COVID-19 pandemic compare team injury data during the pandemic to that before the pandemic; few investigate injuries by infection status and even less involve academy-level organizations. We hypothesized that in male youth developmental academy-level soccer players, the rate of injury would be higher following COVID-19 infection than in the uninfected.</p><p><strong>Methods: </strong>Retrospective cohort study involving 141 male youth athletes from a single midwestern US developmental soccer academy during the spring 2022 soccer season. Injury data was gathered prospectively and analyzed retrospectively. Injury rate (incidence per 1000 playing hours), type, location, severity, mechanism, and mode of play were compared between COVID-19-positive and -negative athletes.</p><p><strong>Results: </strong>Thirty-four (24.11%) of 141 athletes tested positive for COVID-19. Of those 34, 20 (58.8%) sustained at least 1 injury, totaling 30 injuries. Of the 107 (75.89%) uninfected athletes, 30 (28.04%) sustained at least 1 injury, totaling 37 injuries. COVID-19-positive athletes sustained injuries at higher rates (7.10, 95% CI: 4.79-10.14) than uninfected athletes (2.71, 95% CI: 1.91-3.74), with an infected to uninfected adjusted injury rate ratio of 2.08 (95% CI: 1.20-3.59, P=0.008). COVID-19 positive players were 2.78 times more likely to sustain an injury following their infection than uninfected players (95% CI: 1.14-6.96, P=0.026). There were no significant differences in injury type (P=0.515), location (P=0.319), severity (P=0.679), mechanism (P=0.225), or mode of play (P=0.557) between groups.</p><p><strong>Conclusions: </strong>Among academy-level youth soccer athletes, injury rate increased significantly after COVID-19 infection; injury patterns were similar.</p><p><strong>Level of evidence: </strong>II - Retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Spinal Deformity and Surgery on Health-Related Quality of Life in Cerebral Palsy: A Multicenter Prospective Controlled Trial.","authors":"Patrick J Cahill, Unni Narayanan, Margaret Bowen, Sulagna Sarkar, Joshua M Pahys, Firoz Miyanji, Burt Yaszay, Suken A Shah, Paul D Sponseller","doi":"10.1097/BPO.0000000000002774","DOIUrl":"10.1097/BPO.0000000000002774","url":null,"abstract":"<p><strong>Background: </strong>Spinal fusion for scoliosis associated with cerebral palsy (CP) is challenging to study because specialized outcome measures are needed. Therefore, evidence in favor of the benefits of surgery has not been firmly established. This study aimed to determine if corrective spinal fusion improves health-related quality of life (HRQoL) in children with CP scoliosis at 2 years.</p><p><strong>Methods: </strong>Children with CP and scoliosis who met the criteria for posterior spinal fusion were offered enrollment at 16 US and Canada centers. Participants' families selected either operative intervention (OP) or nonoperative treatment (NON) in discussion with their surgeon with no influence by the decision to participate in the research study. Demographic, clinical data (function level, magnitude of deformity, comorbidities), and HRQoL (CPCHILD Questionnaire) were collected at baseline and 2 years. Change (from baseline) in total CPCHIL scores was the primary outcome.</p><p><strong>Results: </strong>Three hundred one OP and 34 NON subjects had complete baseline and 2-year data. At baseline, both groups were comparable in function level, comorbid status, and CPCHILD scores (52.1 ±15.3 vs. 53.4 ±14.5; P =0.66). The OP group had a larger spinal deformity magnitude (84.5˚ ± 21.8˚ vs. 66.3˚ ± 18.1˚) ( P =0.001). The total CPCHILD score improved in the OP group by 6.6 points ( P <0.001). NON scores were unchanged (+1.2; P =0.65) during follow-up. There were also significant score increases in the OP group for 5 of 6 CPCHILD domains. The change in CPCHILD scores from enrollment to 2 years was more significant in the OP group ( P =0.05).</p><p><strong>Conclusion: </strong>For children with CP who undergo spinal fusion, HRQoL improved over preoperative levels and an unchanged nonoperative control group.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interfacility Transfer of Pediatric Supracondylar Elbow Fractures: Transfer by Ambulance Shows No Advantage in Speed of Transfer or Prevention of Complications.","authors":"Spencer M Richardson, Sarah T Levey, Joash R Suryavanshi, Amrit S Parihar, Curtis Vrabec, R Gunnar Tysklind, Robert J Bielski","doi":"10.1097/BPO.0000000000002788","DOIUrl":"10.1097/BPO.0000000000002788","url":null,"abstract":"<p><strong>Background: </strong>The treatment of supracondylar humerus (SCH) fractures is increasingly centralized in tertiary centers. Interfacility transfer from other facilities may occur by ground ambulance or privately owned vehicle (POV). The objective of this study was to determine if interfacility transfer by POV is equivalent in transfer time and perioperative complications compared with ground ambulance.</p><p><strong>Methods: </strong>This was a single-institution, retrospective study of SCH fractures with an intact pulse transferred by POV or ground ambulance. Transfer time points were collected to determine transfer time and speed. Associated injuries of ipsilateral fracture, skin at risk, and motor nerve palsy were recorded from orthopaedic documentation at the presentation. Insurance status and the Area Deprivation Index (ADI) were used as measures of socioeconomic disparity.</p><p><strong>Results: </strong>676 \"urgent\" Type III, IV, and flexion type SCH fractures and 167 \"nonurgent\" Type II SCH fractures were transferred by ambulance or POV. Open reduction was similar between urgent transfers transported by ambulance or POV (10% vs. 9%, P =0.344). There was no difference in transfer time ( P =0.391) or transfer speed ( P =0.416) between transfer groups. POV transfers were independently associated with no skin at risk (OR 2.1; 95% CI: 1.3-3.3, P =0.003), neurovascularly intact (OR 2.5; 95% CI: 1.4-4.4, P =0.001), and patients in the low (OR 1.9; 95% CI: 1.3-2.5, P =0.041) and moderate deprivation (OR 1.9; 95% CI: 1.1-3.5, P =0.034) compared with the high deprivation group. Medicaid insurance was associated with a lower odds ratio of private transport compared with commercial insurance (OR 0.54; 95% CI: 0.38-0.76, P =<0.001).</p><p><strong>Conclusions: </strong>Interfacility transfer of nonemergent SCH fractures by privately owned vehicles has a similar speed of transfer and perioperative complication rate to transfer by ground ambulance. Our findings allow the triaging of nonemergent SCH fractures for potential interfacility transfer by privately owned vehicles and bring attention to disparities in interfacility transfer methods.</p><p><strong>Level of evidence: </strong>Level III- Retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors for Stiffness Following Open Reduction for Developmental Dysplasia of the Hip.","authors":"Vineet M Desai, Carter E Hall, Stefano Cardin, Christopher J DeFrancesco, Sulagna Sarkar, Wudbhav N Sankar","doi":"10.1097/BPO.0000000000002769","DOIUrl":"10.1097/BPO.0000000000002769","url":null,"abstract":"<p><strong>Objective: </strong>Most prior investigations on adverse outcomes after open reduction (OR) for developmental dysplasia of the hip (DDH) have focused on avascular necrosis, redislocation, and residual dysplasia. To our knowledge, no previous study has investigated risk factors for stiffness, an underappreciated source of postoperative morbidity. The goals of this study were to define the entity more clearly and evaluate the prevalence and risk factors for arthrofibrosis after OR for DDH.</p><p><strong>Methods: </strong>A retrospective study was conducted, including all open hip reductions for DDH performed by a single surgeon from 2009 to 2022. Preoperative anteroposterior pelvic radiographs were used to calculate superior displacement, which was defined as the distance from the highest point of the proximal femoral metaphysis to the Hilgenreiner line, normalized by pelvic width. Cases treated with premature postoperative bracing cessation and/or referral to physical therapy with a resolution of stiffness within 6 months were categorized as mild arthrofibrosis. Cases that required >6 months of formal physical therapy for persistent range of motion concerns, manipulation under anesthesia, and/or inpatient rehabilitation admission were categorized as significant arthrofibrosis.</p><p><strong>Results: </strong>This study included 170 hips with a mean age of 21.6 months (range: 6.1 to 93.6 mo) and a mean follow-up of 46.8 months. 156 ORs (91.8%) were done through an anterior approach. Sixty-four patients (37.6%) had a concomitant isolated pelvic osteotomy, and 34 (20.0%) had both pelvic and femoral osteotomies. During the postoperative course, 109 patients (64.1%) had no arthrofibrosis, 38 (22.4%) had mild stiffness, and 23 (13.5%) had significant arthrofibrosis. On multivariable analysis, older age, superior displacement, and concomitant pelvic osteotomy were associated with any degree of arthrofibrosis ( P < 0.05). Children older than 18 months or with dislocations higher than 16% of pelvic width had a 4.7 and 2.7 times higher risk, respectively, of experiencing some degree of stiffness postoperatively.</p><p><strong>Conclusions: </strong>Older age, high dislocations, and concomitant pelvic osteotomy without femoral shortening are risk factors for stiffness after OR for DDH. Surgeons should counsel families about the risk of postoperative stiffness, which occurred to some degree in 36% of our patients.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures.","authors":"Ulas Can Kolac, Melih Oral, Mazlum Veysel Sili, Serkan Ibik, Hasan Samil Aydinoglu, Sancar Bakircioglu, Guney Yilmaz","doi":"10.1097/BPO.0000000000002784","DOIUrl":"10.1097/BPO.0000000000002784","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus fractures (SCHFs) are the most common injuires of the elbow in children, often categorized by the Gartland classification. While type 1 and 2 fractures commonly managed conservatively, type 3 and 4 fractures typically require surgical treatment. Although closed reduction and percutaneous pinning have shown success, open reduction may be required in cases where adequate reduction cannot be achieved. This study aims to identify radiological and clinical risk factors associated with transitioning from closed reduction to open reduction in Gartland type 3 and 4 SCHF in children.</p><p><strong>Study design and methods: </strong>We retrospectively analysed 159 patients operated on between 2014 and 2022 for Gartland type 3 and 4 SCHF. Parameters including age, gender, injury severity, time to surgery, neurovascular damage, medial spike angle, fracture-skin distance, medial-lateral deviation, rotation, fracture level, and Baumann angle were evaluated.</p><p><strong>Results: </strong>A total of 159 SCHF in children aged 3 to 12 years, classified as Gartland type 3 (106 patients, 66.6%) and type 4 (53 patients 33.4%), underwent surgical intervention. Notably, 46 patients (28.9%) initially managed with closed reduction exhibited failure, prompting the necessity for conversion to open reduction. Injury severity, lateral deviation, advanced age, low medial spike angle, and low fracture tip-to-skin distance were found to be factors that could potentially increase the need for open reduction ( P <0.05). Logistic regression analysis showed that the low medial spike angle, flexion type injury, and low fracture type increased the likelihood of open surgery ( P <0.05). Sex, side, duration to surgery, and Baumann angle showed no significant associations.</p><p><strong>Conclusions: </strong>SCHF commonly necessitate surgical intervention in children. Although the risk factors for failed closed reduction and the need for open surgery have been discussed in the literature, there is no consensus. Preoperative planning, particularly for patients with specific factors like lateral deviation, advanced age, low medial spike angle, low fracture-to-skin distance and high injury severity, should consider potential open surgery requirements.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Utilization and Impact of Advanced Imaging for Tibial Tubercle Fractures? An Analysis of 598 Patients From the Tibial Tubercle Study (TITUS) Group.","authors":"Peter C Shen, Brendan A Williams, O Folorunsho Edobor-Osula, John S Blanco, Lindsay M Crawford, Dustin A Greenhill, Alexander H Griffith, Neil K Kaushal, David M Kell, Abhi Rashiwala, John A Schlechter, Evelyn S Thomas, Haley N Tornberg, Neeraj M Patel","doi":"10.1097/BPO.0000000000002766","DOIUrl":"10.1097/BPO.0000000000002766","url":null,"abstract":"<p><strong>Background: </strong>Given the rare nature of tibial tubercle fractures, previous studies are mostly limited to small, single-center series. This results in practice variation. Previous research has shown poor surgeon agreement on utilization of advanced imaging, but improved evidence-based indications may help balance clinical utility with resource utilization. The purpose of this study is to quantify diagnostic practices for tibial tubercle fractures in a large, multicenter cohort, with attention to the usage and impact of advanced imaging.</p><p><strong>Methods: </strong>This is a retrospective series of pediatric tibial tubercle fractures from 7 centers between 2007 and 2022. Exclusion criteria were age above 18 years, missing demographic and pretreatment data, closed proximal tibial physis and tubercle apophysis, or a proximal tibia fracture not involving the tubercle. Demographic and injury data were collected. Fracture classifications were derived from radiographic evaluation. The utilization of advanced imaging was recorded as well as the presence of findings not identified on radiographs. Standard descriptive statistics were reported, and χ 2 tests were performed (means reported±SD).</p><p><strong>Results: </strong>A total of 598 patients satisfied the inclusion criteria, of which 88.6% (530/598) were male with a mean age of 13.8±1.9 years. Internal oblique x-rays were obtained in 267 patients (44.6%), computed tomography (CT) in 158 (26.4%), and magnetic resonance imaging (MRI) in 64 (10.7%). There were significant differences in the frequency at which CT (7.2% to 79.4%, P <0.001) and MRI were obtained (1.5% to 54.8%, P <0.001). CT was obtained most frequently for Ogden type IV fractures (50/99, 50.5%), and resulted in novel findings that were not visualized on radiographs in a total of 37/158 patients (23.4%). The most common finding on CT was intra-articular fracture extension (25/37). MRI was obtained most frequently for Ogden type V fractures (13/35, 37.1%), and resulted in novel findings in a total of 31/64 patients (48.4%). The most common finding was patellar tendon injury (11/64), but only 3 of these patients required tendon repair.</p><p><strong>Conclusions: </strong>Substantial variation exists in the diagnostic evaluation of tibial tubercle fractures. CT was most helpful in clarifying intra-articular involvement, while MRI can identify patellar tendon injury, periosteal sleeve avulsion, or a nondisplaced fracture. This study quantifies variation in diagnostic practices for tibial tubercle fractures, highlighting the need for evidence-based indications for advanced imaging.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder Motion Overestimated by Mallet Scores.","authors":"Madison Lovette, Ross S Chafetz, Stephanie A Russo, Scott H Kozin, Dan A Zlotolow","doi":"10.1097/BPO.0000000000002775","DOIUrl":"10.1097/BPO.0000000000002775","url":null,"abstract":"<p><strong>Background: </strong>Brachial plexus birth injuries (BPBI) occur in up 0.4 to 4.6 per 1000 live births. Weakness about the shoulder and development of glenohumeral joint contractures are common sequalae of BPBI. Shoulder function in children with BPBI is frequently assessed using the modified Mallet classification to evaluate upper extremity motion deficits. The purpose of this study was to assess the accuracy of the abduction, external rotation, and hand-to-mouth Mallet classification scores in children with BPBI using motion capture.</p><p><strong>Methods: </strong>A retrospective study of 107 children with BPBI who underwent motion capture assessment and Mallet scores on the same date were reviewed. Motion capture measurements were used to calculate humerothoracic elevation and external rotation joint angles in the abduction/hand-to-mouth and external rotation positions, respectively. The humerothoracic joint angles were converted to the corresponding Mallet scores. Discrepancies between the Mallet scores determined by clinicians and those determined by motion capture were assessed.</p><p><strong>Results: </strong>For abduction, 24.3% of Mallet scores were misclassified during clinical examination. Of the misclassified scores, 22 were overestimated by 1 point and 4 were underestimated by 1 point compared with motion capture. For external rotation, 72.9% of Mallet scores were misclassified during clinical examination. Only 5 patients had an HT elevation that was less than 40 degrees, with 4 of them (80%) having a Mallet hand-to-mouth score of 4. There were no differences in proportion of patients with HT elevation less than 40 degrees who had a Mallet score of 4 or a Mallet score less than 4.</p><p><strong>Conclusions: </strong>There was better agreement in global abduction Mallet scores compared with external rotation and hand-to-mouth Mallet scores. This difference was likely due to the complex compensatory strategies that patients employ while performing external rotation and hand-to-mouth positions. The inaccuracy of the clinically determined Mallet scores is alarming given that they are frequently utilized to assist with surgical indications and are commonly used as outcome measures.</p><p><strong>Level of evidence: </strong>Level IV Case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Displacement After Triradiate Closure in Ambulatory Cerebral Palsy: Who Needs Continued Surveillance?","authors":"Amelia M Lindgren, Ali Asma, Kenneth J Rogers, Freeman Miller, M Wade Shrader, Jason J Howard","doi":"10.1097/BPO.0000000000002783","DOIUrl":"10.1097/BPO.0000000000002783","url":null,"abstract":"<p><strong>Background: </strong>Hip surveillance in cerebral palsy (CP) is an accepted practice with evidence-based guidelines implemented. For the skeletally immature with open triradiate cartilage (TRC), recommendations for radiographic surveillance stemmed from population-based studies. For nonambulatory CP, progression of hip displacement after skeletal maturity has been reported; less is known for ambulatory CP. We aimed to determine the prevalence and risk factors associated with progressive hip displacement after TRC closure, a proxy for skeletal maturity, for ambulatory CP.</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients with ambulatory CP (Gross Motor Function Classification System I-III), with unilateral or bilateral involvement, hypertonic motor type, regular hip surveillance (≥3 radiographs after age 10 yr, 1 before TRC closure, ≥1 after age 16 yr), and 2-year follow-up post-TRC closure. The primary outcome was migration percentage (MP). Other variables included previous preventative/reconstructive surgery, topographic pattern, sex, scoliosis, epilepsy, and ventriculoperitoneal shunt. An \"unsuccessful hip\" was defined by MP ≥30%, MP progression ≥10%, and/or requiring reconstructive surgery after TRC closure. Statistical analyses included chi-square and multivariate Cox regression. Kaplan-Meier survivorship curves were also determined. Receiver operating characteristic analysis was used to determine the MP threshold for progression to an \"unsuccessful hip\" after TRC closure.</p><p><strong>Results: </strong>Seventy-six patients (39.5% female) met the inclusion criteria, mean follow-up 4.7±2.1 years after TRC closure. Sixteen (21.1%) patients had an unsuccessful hip outcome. By chi-square analysis, diplegia ( P =0.002) and epilepsy ( P =0.04) were risk factors for an unsuccessful hip. By multivariate analysis, only first MP after TRC closure ( P <0.001) was a significant risk factor for progression to an unsuccessful hip; MP ≥28% being the determined threshold (receiver operating characteristic curve analysis, area under curve: 0.845, P <0.02).</p><p><strong>Conclusions: </strong>The risk of MP progression after skeletal maturity is relatively high (21%), similar to nonambulatory CP. Annual hip surveillance radiographs after TRC closure should continue for Gross Motor Function Classification System I-III with an MP ≥28% after TRC closure, especially for bilateral CP and epilepsy.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}