Journal of Pediatric Orthopaedics最新文献

{"title":"Long-term Evaluation of Free Fibular Flap in Extremity Bony Reconstruction.","authors":"Justin Choy, David Podeszwa, Chris Stutz, Scott N Oishi","doi":"10.1097/BPO.0000000000003313","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003313","url":null,"abstract":"<p><strong>Background: </strong>Free fibular flaps (FFF) and pedicled fibular grafts (PFG) are established techniques for reconstructing pediatric long bone defects. While the FFF provides versatility through microvascular transfer, PFGs avoid anastomosis but are limited by anatomic constraints. Clinical questions remain regarding optimal fixation strategies, donor-site morbidity, and graft outcomes in children.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 22 pediatric patients undergoing FFF or PFG between 1994 and 2025. Outcomes included time to radiographic union, time to weight bearing, fibular regeneration, and donor-site complications. Subgroup analyses compared external fixation use, periosteal sleeve preservation, and graft type/location.</p><p><strong>Results: </strong>The average time to radiographic union was 41 weeks. External fixation was associated with shorter radiographic union time (30.1 vs. 86.4 wk) and earlier full weight bearing on the graft-receiving limb (52.0 vs. 127.2 d), though these findings should be interpreted as exploratory given the limited sample size and inconsistent significance across statistical tests. Younger patient age correlated with faster union (r = 0.60, P = 0.004). Preservation of a periosteal sleeve at the donor site significantly promoted fibular regeneration (P = 0.0004) and may hasten donor limb recovery. Ankle valgus deformity was associated with shorter residual distal fibula length (mean 5.6 cm, P = 0.0498). All grafts showed remodeling over time. Tibial graft location and use of PFG were significantly associated with need for refixation (P = 0.0001 and P = 0.0002, respectively).</p><p><strong>Conclusion: </strong>Pediatric FFF reconstruction demonstrates high union and remodeling rates with favorable functional outcomes. External fixation was found to be weakly associated with acceleration of union and weight bearing, while periosteal sleeve preservation supports fibular regeneration and potentially expedites return to weight bearing on the donor limb. PFGs may be effective in select tibial cases but showed higher reoperation rates. Preserving an adequate distal fibula segment may mitigate ankle valgus. These findings support tailored fixation strategies and highlight the importance of surgical planning to optimize outcomes and minimize donor-site morbidity in pediatric patients.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856603","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 Patient Reported Outcomes of Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle Fractures.","authors":"Andrew Monhollen, Nash Kolb, Ana C Belzarena, Sumit K Gupta","doi":"10.1097/BPO.0000000000003307","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003307","url":null,"abstract":"<p><strong>Background: </strong>Indications for surgical fixation of medial epicondyle fractures have been debated for over 4 decades, with no clear consensus supporting operative versus nonoperative management. Medial epicondyle fractures account for ∼11% to 20% of pediatric elbow fractures and are associated with posterior elbow dislocation in up to 60% of cases. The purpose of this study was to evaluate long-term outcomes of surgical versus nonsurgical management of medial epicondyle fractures with a minimum follow-up of 2 years.</p><p><strong>Methods: </strong>Pediatric patients evaluated for a medial epicondyle fracture at a tertiary academic health center over a 10-year period were eligible for inclusion. Treatment was determined by the treating surgeon. Operative indications during the study period included fragment incarceration, displacement >5 mm, and elbow valgus instability. Displacement was measured on the internal oblique radiographic view. Eligible patients or their guardians were contacted by telephone and invited to complete standardised patient-reported outcome measures, including the quick disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Score, to assess functional outcomes 2 to 10 years following treatment.</p><p><strong>Results: </strong>Nonparametric analysis demonstrated significant differences between groups in age at injury (P=0.001), injury occurrence during wrestling (P=0.002), and fracture displacement >5 mm (P<0.001). No significant differences were identified in QuickDASH scores (P=0.649), PROMIS scores (P=0.963), or range of motion between cohorts.</p><p><strong>Conclusions: </strong>In this unmatched cohort with long-term follow-up, no clinically meaningful differences in patient-reported outcomes were observed between groups. Surgically treated patients were older and had greater fracture displacement, reflecting indication-based treatment selection. These findings suggest that both operative and nonoperative strategies can result in comparable long-term outcomes when applied to appropriately selected patients.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856552","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":"Comparison of Lateral Shelf Acetabuloplasty in the Treatment of Legg-Calvé-Perthes Disease in Older Children.","authors":"Ying Jie Du, Jia Qi Yao, Xiang Ling Deng, Rui Jiang Xu, Li Liu, Wen Chao Li","doi":"10.1097/BPO.0000000000003318","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003318","url":null,"abstract":"<p><strong>Background: </strong>In older children with Perthes disease, where containment surgery is often indicated, the comparative effectiveness of the 2 principal shelf acetabuloplasty techniques, Staheli and Tectoplasty, remains unclear.</p><p><strong>Methods: </strong>A total of 26 children (23 males and 3 females; mean age at surgery, 8.55±0.95 y) underwent the Staheli technique, and 20 children (18 males and 2 females; mean age at surgery, 8.65±0.89 y) were treated with the Tectoplasty technique. Clinical data and radiographs were retrospectively reviewed. Radiographic parameters, including the center-edge angle, Sharp angle, femoral head subluxation ratio, femoral head size ratio, and final Stulberg classification, were assessed.</p><p><strong>Results: </strong>Femoral head containment improved significantly in both groups. The postoperative-to-preoperative CE angle ratio was greater in the Staheli group than in the Tectoplasty group (213.14±38.66% vs. 189.33±39.08%, P=0.04). The postoperative-to-preoperative Sharp angle ratio was comparable between groups (75.09±6.60% vs. 75.31±5.41%, P=0.90). The postoperative-to-preoperative subluxation ratio was lower in the Tectoplasty group than in the Staheli group (67.66±6.64% vs. 74.90±10.05%, P=0.008). The postoperative-to-preoperative femoral head size ratio was modestly greater in the Tectoplasty group than in the Staheli group (113.66±7.81% vs. 109.18±6.77%, P=0.04). No significant difference in the final Stulberg classification was found between groups (P=0.96).</p><p><strong>Conclusions: </strong>Both the Staheli and Tectoplasty techniques were associated with improved acetabular coverage and femoral head remodeling in older children with Legg-Calvé-Perthes disease. The Staheli technique showed a greater postoperative-to-preoperative CE angle ratio, whereas the Tectoplasty technique showed a lower postoperative-to-preoperative subluxation ratio. Sharp angle correction and final Stulberg classification were comparable between groups. These findings should be interpreted cautiously, given the retrospective Level III design and limited sample size. Further prospective studies are needed to confirm the comparative effectiveness and long-term outcomes of these 2 techniques.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856572","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":"Pediatric Femoral Neck Fractures: Unrecognized Association With Autism Spectrum and Neurodevelopmental Disorders.","authors":"Abdulsamet Emet, Grace Armet, Connor Luck, Taha Aksoy, Stephen Mendelson, Ozgur Dede","doi":"10.1097/BPO.0000000000003306","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003306","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify all pediatric femoral neck fractures and determine the prevalence of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDD) among these patients. In addition, it aimed to assess their impact on clinical and radiographic outcomes.</p><p><strong>Methods: </strong>A total of 289 pediatric patients with proximal femoral fractures were initially identified, of whom 140 met the inclusion criteria for femoral neck fractures after excluding pathologic fractures, polytrauma, and incomplete records. Demographic, clinical, and radiographic data, including the presence of ASD and other NDD conditions, were collected. Intraoperative and postoperative complications were recorded. Statistical analyses were performed using (IBM SPSS Statistics; IBM Corp., Armonk, NY) with associations between variables assessed using t tests and χ2 tests, and significance set at P<0.05.</p><p><strong>Results: </strong>Among 140 pediatric patients with femoral neck fractures, 39 (28%) were diagnosed with ASD or NDD. Compared with non-ASD patients, those with ASD exhibited more frequent additional neurological and gastrointestinal/endocrinologic comorbidities, higher prevalence of low preoperative vitamin D levels, and a greater incidence of home-related injuries (all P<0.05). Intraoperative and postoperative complications, including infection and avascular necrosis, were infrequent and did not differ significantly between groups. The mean time for return to daily activities was similar between ASD and non-ASD patients.</p><p><strong>Conclusion: </strong>A significant association was observed between pediatric femoral neck fractures and ASD or other NDD, including intellectual disabilities. Children with ASD or NDD demonstrated higher rates of medical comorbidities, low preoperative vitamin D levels, and home‑related injuries, suggesting unique risk profiles in this population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856595","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":"Are Routine 4-Week Radiographs After ESIN Osteosynthesis in Pediatric Forearm Fractures Necessary?: A Retrospective Analysis and Proposal of a Risk-Adapted Algorithm.","authors":"Roland Mojica Crespo, Clemens Memmel, Lino Hundhausen, Christian Wulbrand, Alexander Hanke","doi":"10.1097/BPO.0000000000003321","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003321","url":null,"abstract":"<p><strong>Background: </strong>Elastic stable intramedullary nailing (ESIN) is an established treatment for unstable pediatric forearm fractures. Although routine radiographic follow-up at 4 weeks is widely performed, its clinical benefit is unclear. This study aimed to evaluate the relevance of routine 4-week radiographs and to develop a risk-adapted follow-up protocol.</p><p><strong>Methods: </strong>We retrospectively analyzed all patients aged 0 to 18 years treated with ESIN for diaphyseal forearm fractures at a level I trauma center between 2014 and 2024. Clinical and radiologic findings at the scheduled 4-week follow-up visit were assessed retrospectively. Radiologic abnormalities were defined as secondary displacement, implant-related problems, or signs of infection. Therapeutic consequences were recorded. Statistical analyses included χ2 or Fisher exact tests, Mann-Whitney U tests, and logistic regression.</p><p><strong>Results: </strong>Of 610 patients screened, 553 were included (mean age: 8.0±3.5 y, 61.1% male). At the 4-week follow-up, 65.5% (362/553) were asymptomatic. Radiologic abnormalities were rare (1.3%, n=7). Importantly, none of the 362 asymptomatic patients showed relevant radiologic findings. Radiologic abnormalities were more frequent in children with clinical abnormalities (2.6% vs. 1.1%). In multivariable analysis, radiologic abnormalities remained the only independent predictor of therapeutic consequences (aOR: 11.9, 95% CI: 2.3-62.3; P=0.003).</p><p><strong>Conclusion: </strong>Routine 4-week radiographs after ESIN osteosynthesis in pediatric forearm fractures do not lead to therapeutic consequences in asymptomatic patients. An algorithm for risk-adapted x-ray is proposed, although further prospective evaluation is needed.</p><p><strong>Levels of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856419","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":"Socioeconomic and Racial Disparities in Surgical Management of Adolescent Idiopathic Scoliosis: Vertebral Body Tethering Versus Posterior Spinal Fusion.","authors":"Laurel E Wong, Ryan G Smolarsky, Yazan Alasadi, Helen Xie, Sheena Ranade","doi":"10.1097/BPO.0000000000003308","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003308","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) affects 2% to 3% of children aged 10 to 18, and progressive cases often require surgery. Posterior spinal fusion (PSF) remains the standard treatment but restricts mobility, while vertebral body tethering (VBT) offers a motion-preserving alternative. However, VBT is costly, concentrated in specialized centers, and inconsistently reimbursed, raising concerns that access is limited to higher socioeconomic status (SES) populations. This study examined patterns of VBT utilization compared with PSF across SES and hospital characteristics.</p><p><strong>Methods: </strong>A retrospective analysis of the 2022 Healthcare Cost and Utilization Project Kids' Inpatient Database identified patients aged ≤18 years diagnosed with AIS undergoing elective PSF or VBT. Race, insurance, and ZIP code income quartile served as SES proxies, while hospital characteristics represented institutional access. Weighted χ2 and t tests compared covariates. Multivariable logistic regression identified predictors of VBT utilization, reporting adjusted odds ratios (OR) and 95% confidence intervals (CI), with P<0.05 considered significant.</p><p><strong>Results: </strong>Among 6507 AIS patients, 259 (4.0%) underwent VBT and 6248 (96.0%) PSF. VBT patients were younger (13.2 vs. 14.3 y, P<0.001) and incurred higher hospital charges ($301,050 vs. 226,124, P<0.001). VBT utilization was higher among White (83.8% vs. 60.8%, P<0.001), privately insured patients (77.5% vs. 58.2%, P<0.001) residing in higher-income neighborhoods (42.1% vs. 27.1%, P<0.001), and at private (55.8% vs. 38.6%, P<0.001), urban hospitals (69.9% vs. 50.1%, P<0.001) in the Northeast (38.2% vs. 17.9%, P<0.001). Adjusted multivariable analysis showed significantly reduced odds of VBT among Black (OR 0.39, 95% CI 0.22-0.67) and Hispanic (OR 0.32, 95% CI 0.17-0.61) patients, those with Medicaid (OR 0.50, 95% CI 0.33-0.74), and those residing in the lowest-income neighborhoods (OR 0.51, 95% CI 0.31-0.87). Hospitals in the South (OR 0.16, 95% CI 0.10-0.24) and Midwest (OR 0.65, 95% CI 0.44-0.95) performed fewer VBTs.</p><p><strong>Conclusions: </strong>VBT was predominantly performed in White, privately insured, higher-income patients at metropolitan hospitals, while minority and lower-SES groups had significantly lower utilization. These findings reveal persistent inequities in access to advanced surgical options for AIS.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839326","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":"Ketorolac Administration During Admission Is Not Associated With Nonunion Following Treatment of Pediatric Femoral Shaft Fractures.","authors":"Ashley A Ellingwood, Daniel Woo, Richard E Campbell, Christopher D Souder, Patrick F Curran, James D Bomar, Rachel M Thompson","doi":"10.1097/BPO.0000000000003320","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003320","url":null,"abstract":"<p><strong>Background: </strong>Ketorolac is a common component of multimodal analgesia protocols; however, there are concerns that it may increase the risk of pediatric fracture nonunion, particularly in femoral shaft fractures. The purpose of this study was to determine whether perioperative ketorolac administration is associated with an increased risk of nonunion in operatively treated pediatric femoral shaft fractures.</p><p><strong>Methods: </strong>We conducted an IRB-approved retrospective review of all pediatric patients (age <18 y) who underwent operative management of femoral shaft fractures at a single institution between May 1, 2012, and December 31, 2024. Patients aged ≥18 years, those treated nonoperatively, with underlying bone pathology, inadequate follow-up, or nondiaphyseal fractures were excluded. The primary outcome was radiographic nonunion, determined by the Radiographic Union Scale for Tibia score and treating surgeon documentation. Secondary outcomes included postoperative opioid consumption, pain scores, and hospital length of stay.</p><p><strong>Results: </strong>Nonunion was rare in this cohort, occurring in 1/122 patients (0.8%) who received ketorolac and 1/21 patients (4.8%) who did not receive ketorolac (P=0.27). Patients who received ketorolac required fewer opioids, averaging 0.13±0.17 (95% CI 0.10-0.16) versus 0.23±0.28 (95% CI 0.10-0.35) MME/kg in the first 24 hours postoperatively (P=0.047) and 0.44±0.84 (95% CI 0.29-0.59) versus 3.98±6.57 (95% CI 0.99-6.97) MME/kg cumulatively throughout admission (P<0.001). Pain scores did not differ significantly between the ketorolac and no-ketorolac groups in the first 24 hours (P=0.30) or cumulatively (P=0.50).</p><p><strong>Conclusions: </strong>This comparative case series demonstrates that nonunion in operatively treated pediatric femoral fractures is rare regardless of ketorolac administration. In addition, ketorolac use appears to be associated with reduced opioid requirements without increasing pain scores.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839278","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":"Outcomes of Conservative Versus Surgical Treatment of Adolescent Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis.","authors":"Lindsey L Molina, Andrew M Block, Sasha Carsen, Allison E Crepeau, Tyler J Stavinoha, Michael M Chau, Jeffrey J Nepple","doi":"10.1097/BPO.0000000000003305","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003305","url":null,"abstract":"<p><strong>Background: </strong>Avulsion fractures of the pelvis and hip primarily affect active adolescents. Although most cases are successfully treated with nonoperative management, surgical intervention may be indicated as displacement and risk for nonunion increase. The literature remains heterogeneous and limited by small comparative cohorts. This study summarizes available evidence comparing outcomes after nonoperative and operative treatment, with particular attention to displacement.</p><p><strong>Methods: </strong>A literature search of Ovid Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov was completed in July 2024. Patient characteristics, type of activity at the time of injury, displacement distance, treatment modality, complications, and patient outcomes were recorded for specific fracture types, as available.</p><p><strong>Results: </strong>Twenty-four eligible studies were identified and contributed a total of 852 fractures in 849 patients (mean age 14.4±1.7 y, 79% male) for analysis. The most common fracture sites were the anterior superior iliac spine (ASIS, 33.1%) and anterior inferior iliac spine (AIIS, 30.4%), followed by the ischial tuberosity (ISCH, 15.5%), lesser trochanter (LT, 13.5%), and iliac crest (IC, 7.5%). Overall, 86.6% of fractures were managed nonoperatively, and 13.4% were managed surgically. In displacement-stratified cohorts, ISCH fractures with displacement >15 mm achieved high functional scores with both operative and nonoperative treatment, although pseudoarthrosis occurred in some nonoperatively treated cases with minimal functional limitation. ASIS fractures with displacement >15 mm showed similar transient complications before resolution to excellent outcomes in both treatment groups, but faster RTS with the operative management alone. Rates of persistent pain were highest in ISCH fractures (27.3% surgically, 10.9% nonoperatively) and AIIS fractures treated nonoperatively (13.8%). Return to sport was achieved in nearly all cases, with surgically treated ISCH fractures requiring the longest recovery periods (6 mo).</p><p><strong>Conclusion: </strong>Both nonoperative and operative management result in favorable outcomes for most adolescent pelvic avulsion fractures. Although displacement frequently influences surgical decision-making, current evidence does not establish a validated threshold at which outcomes reliably diverge. Before displacement can be considered a reliable surgical indication, higher-quality evidence demonstrating superior outcomes at clear displacement thresholds is needed.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839321","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":"Is the Bernese Periacetabular Osteotomy Safe for the Treatment of Acetabular Dysplasia When the Triradiate Cartilage is Still Open? A Preliminary Study.","authors":"Stephanie Y Pun, Stephanie T Kha, Meewon O Park, Ann E Richey, Nicole S Pham, Michael B Millis","doi":"10.1097/BPO.0000000000003275","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003275","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy (PAO) has historically been contraindicated in children with hip dysplasia and open triradiate cartilage because of concerns that osteotomy through the triradiate might disrupt acetabular development. This preliminary study reports early outcomes of PAO for hip dysplasia in patients approaching skeletal maturity (aged 8 to 12 y or younger) with open triradiate cartilage.</p><p><strong>Methods: </strong>We performed a retrospective review of patients with hip dysplasia and open triradiate cartilage who underwent PAO between 1994 and 2019. Primary outcomes included changes in lateral center edge angle (LCEA), anterior center edge angle (ACEA), and acetabular index (AI), discontinuity along Shenton's line, extrusion index, triradiate width, and Tonnis grade preoperatively, postoperatively, and at final follow-up. Secondary outcomes included comparisons of radiographic parameters between the operative hip and the contralateral nonoperative hip, preoperative and postoperative patient-reported outcomes, and complications, including intraoperative intra-articular fractures, osteotomy nonunion, and premature triradiate closure. Descriptive statistics characterized the study population. Linear mixed-effects regression models and Cochran Q tests compared clinical and radiographic outcomes preoperatively, postoperatively, and at final follow-up. Differences between operative hips and contralateral nonoperative hips were analyzed using paired t tests or Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>Thirteen patients were included. The mean age was 11.04 years (range: 8.05 to 12.82 y), and the mean follow-up was 3.79 years (range: 0.51 to 8.39 y). The mean LCEA increased 21.08 degrees immediately after PAO (preoperative 5.61±10.41 degrees; postoperative 26.69±8.82 degrees; P <0.01). This change was maintained at final follow-up (23.14±9.14 degrees; P <.01). Premature triradiate closure occurred in 5/13 patients (38.5%). No hips progressed in Tonnis Grade during the study period. Neither intra-articular fracture nor osteotomy nonunion was noted.</p><p><strong>Conclusions: </strong>This preliminary study demonstrates that PAO can safely treat hip dysplasia in young adolescents with open triradiate cartilage, with good short-term outcomes. Despite premature triradiate closure in 38%, immediate postoperative correction of acetabular dysplasia remained satisfactory at final follow-up. Further studies are warranted to determine long-term outcomes.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839262","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":"Daytime Versus After-hours Surgical Fixation of Pediatric Supracondylar Humeral Fractures: A Meta-analysis.","authors":"Marc Boutros, Guy Awad, Jean-Pierre Saad, Zina Smadi, Karim Masrouha","doi":"10.1097/BPO.0000000000003315","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003315","url":null,"abstract":"<p><strong>Background: </strong>Pediatric supracondylar humeral fractures (SCHFs) are among the most common elbow injuries in children and frequently require operative fixation. Although after-hours surgery is often unavoidable due to emergency presentation patterns, many centers now reserve nighttime intervention for urgent indications such as vascular compromise. Concerns nevertheless persist regarding the potential impact of after-hours surgery on surgical efficiency, technical decision-making, and postoperative outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 15, 2025. Comparative studies evaluating operative treatment of pediatric SCHFs performed during daytime working hours versus after-hours were included. Outcomes assessed comprised perioperative characteristics (operative time, time to surgery), intraoperative decision-making (medial pin fixation, open reduction), and postoperative complications (pin migration, alignment-related complications, infection, and iatrogenic postoperative nerve injury).</p><p><strong>Results: </strong>Seven studies encompassing 913 pediatric patients met the inclusion criteria. Operative time did not differ significantly between daytime and after-hours surgery ( P =0.11). Time to surgery was shorter in the after-hours group ( P <0.001). No significant differences were observed in rates of medial pin fixation ( P =0.70) or open reduction ( P =0.80). Postoperative complications, including pin migration, infection, and iatrogenic postoperative nerve injury, were comparable between groups, whereas alignment-related complications were more frequent in the after-hours group ( P =0.04).</p><p><strong>Conclusions: </strong>Operative fixation of pediatric SCHFs showed broadly comparable perioperative efficiency, technical outcomes, and complication rates when performed during daytime or after-hours, although alignment-related complications were more frequent in the after-hours group. These findings suggest that surgical timing alone may not be the primary determinant of outcome.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839344","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}