Journal of Pediatric Orthopaedics最新文献

{"title":"Osteochondral Autograft Transplantation for Symptomatic Full-thickness Patellar Cartilage Defects in Adolescents.","authors":"Javier Masquijo, Miguel Carabajal Mattar, Alejandra Ron Marqués, Alberto Losa, Juan Cabello Blanco, Joaquín Nuñez de Armas, Maria J Tuca","doi":"10.1097/BPO.0000000000002850","DOIUrl":"10.1097/BPO.0000000000002850","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to review the clinical, radiographic, and magnetic resonance imaging (MRI) outcomes of osteochondral autograft transplantation applied to patellar cartilage lesions of patients under 18 years of age.</p><p><strong>Methods: </strong>Data from nine consecutive patients were retrospectively analyzed for indications, preoperative complications, and clinical-radiographic outcomes. Patients were clinically evaluated using the Pedi-IKDC and Lysholm scores. In addition, return to sports and knee pain were assessed. MRI evaluation included an analysis of osteochondral graft integration using the magnetic resonance observation of cartilage repair tissue 2.0 score and radiographic classification of osteoarthritis using the Kellgren-Lawrence system.</p><p><strong>Results: </strong>Nine patients (9 knees, 6 males) with a mean age of 14 years (SD: 1.7, range; 11 to 17 y) were analyzed. Lesions were located on the medial facet (N=5), lateral facet (N=3), and central ridge of the patella (N=1). One or 2 cylindrical osteochondral grafts were transplanted, with a median diameter of 9 mm (range: 8 to 10 mm). The average lesion size was 102.9 mm 2 . At a mean follow-up of 45.1 months (range: 23 to 117 mo), the mean Pedi-IKDC score was 89.2 (SD: 9.8), and the Lysholm score was 94.4 (SD: 4.8). Patients returned to sports in an average of 7.3 months (SD: 2, range: 6 to 12 mo). MRI of 8 patients showed osteochondral graft integration with a mean magnetic resonance observation of cartilage repair tissue 2.0 score of 86.9 (SD: 7, range: 80 to 100). Six knees showed Kellgren-Lawrence grade 0 joint space on radiographs, and 3 showed grade 1. Eight patients were asymptomatic at the last follow-up, and 1 reported occasional mild pain with intense physical activity. One patient developed arthrofibrosis, requiring arthroscopic lysis of adhesions and manipulation.</p><p><strong>Conclusion: </strong>Osteochondral autograft transplantation is a safe and effective technique for treating symptomatic patellar full-thickness chondral lesions in adolescents. Long-term follow-up studies will determine whether the affected area maintains structural and functional integrity over time.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"152-157"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502610","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":"Body Mass Index is Related to Femoral Anteversion, Hip Rotation During Gait, and Passive Hip Range of Motion in Children and Adolescents.","authors":"Florian Dobler, Laura Engler, Harald Lengnick, Johannes Cip, Nathalie Alexander","doi":"10.1097/BPO.0000000000002862","DOIUrl":"10.1097/BPO.0000000000002862","url":null,"abstract":"<p><strong>Background: </strong>Overweight and obesity are major global health issues, often linked to orthopaedic problems, skeletal malalignments, and altered gait biomechanics. However, skeletal and biomechanical adaptions in the transverse plane remain underexplored. Therefore, this study aimed to investigate the relationship between body mass index (BMI) and variables describing lower extremity torsional profiles, hip rotation mobility, and transverse plane gait characteristics in children and adolescents.</p><p><strong>Methods: </strong>Acetabular and femoral anteversion, tibial torsion (measured through computed tomography), hip and knee rotation, and foot progression angles during the stance phase of gait (measured by 3D gait analysis), as well as passive hip rotation range of motion (evaluated as the midpoint of hip rotation in clinical examination), were retrospectively analyzed in 122 children and adolescents. Correlations between all variables and logit-transformed BMI percentiles were calculated.</p><p><strong>Results: </strong>Moderate correlations were found between BMI percentile and hip rotation during the stance phase ( r =-0.68, P <0.001), the passive midpoint of hip rotation ( r =-0.51, P <0.001), and femoral anteversion ( r =-0.50, P <0.001). Small correlations were observed for acetabular anteversion ( r =-0.36, P <0.001), knee rotation during stance phase ( r =0.34, P <0.001), and foot progression angle during stance phase ( r =-0.31, P <0.001). Tibial torsion showed a nonsignificant negligible relationship with BMI percentile ( r =-0.26, P =0.004).</p><p><strong>Conclusion: </strong>BMI percentile was positively correlated with external hip rotation during the stance phase of gait and passive external hip rotation, and negatively correlated with femoral anteversion. These findings suggest abnormal body weight is associated with static and dynamic biomechanical alterations. Therefore, weight management should be considered in orthopaedic assessments and treatment planning for children and adolescents.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e242-e247"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558092","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 Medial Humeral Condyle Fractures: Classification, Treatment, and Outcomes.","authors":"Kevin J Orellana, Soroush Baghdadi, Eliza Buttrick, Pille-Riin Värk, Keith Baldwin, Apurva S Shah","doi":"10.1097/BPO.0000000000002879","DOIUrl":"10.1097/BPO.0000000000002879","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to develop and validate a classification system that describes the injury pattern of pediatric medial humeral condyle fractures and provide treatment guidelines.</p><p><strong>Methods: </strong>Patients less than 18 years old with medial humeral condyle fractures from 2012 to 2022 were identified. A classification system was developed based on fracture pattern and putative mechanism of injury. Type 1 fractures were characterized by a valgus/avulsion type injury while type 2 fractures were characterized by a vertical shear pattern. Each type was subdivided by amount of fragment displacement: (A) nondisplaced or minimally displaced (<2 mm) versus (B) displaced (>2 mm). Three attending orthopaedic surgeons evaluated and classified each patient's fracture. Intrarater and inter-rater reliability was calculated with Kappa statistics.</p><p><strong>Results: </strong>Twenty-seven patients (16 males) with an mean age of 10.5 years were included. There were 4 type 1A, 17 type 1B, and 6 type 2B fractures with substantial agreement in inter-rater (ĸ=0.62, CI=0.45-0.78), and intrarater (mean ĸ=0.79, range=0.70-0.93) reliability analysis. Surgical treatment was performed in 25/27 patients; 4 patients underwent closed reduction percutaneous pinning (CRPP) and 21 underwent open reduction and internal fixation (ORIF). Ten patients required advanced imaging to assist in surgical decision making. Both nonoperative patients had type 1A fractures. Nearly one-fourth of patients (6/27, 22%) had some functional loss of motion and poor outcomes based on Flynn's criteria, with a Fisher exact test revealing an increased risk of functional loss of motion in skeletally mature children ( P =0.02). Two patients had complications including 1 nonunion after initial nonoperative management (type 1B) and 1 patient (type 2B) required manipulation under anesthesia for postoperative stiffness.</p><p><strong>Conclusion: </strong>Moderate to strong inter-rater and intrarater reliability was demonstrated with the proposed classification system. Type 1A fractures are amenable to nonoperative treatment while types 1B and 2B require surgical management. Skeletally mature patients may be at greater risk of motion loss following injury.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"113-119"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769931","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 Lateral Condyle Fractures With Elbow Dislocation: Revisiting the Song Classification of the Most Severe Injuries.","authors":"Leigh Campbell, Courtney E Baker, Andrew B Rees, Samuel R Johnson, Jacob D Schultz, Lucas C Wollenman, Katherine D Sborov, Alexander A Hysong, Craig R Louer, Nathaniel L Lempert, Stephanie N Moore-Lotridge, Jonathan G Schoenecker","doi":"10.1097/BPO.0000000000002863","DOIUrl":"10.1097/BPO.0000000000002863","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral condyle fractures are the second most common pediatric elbow fracture and are at risk for malunion, nonunion or avascular necrosis. The Song or Jakob classification guides management and risk of complications. However, many lateral condyle fractures have accompanying bony or soft tissue injuries, including elbow dislocations, which are not represented in the current Song or Jakob classification systems. Little is known about the incidence and outcomes of these more complex injuries. The purpose of this study was to describe the largest known case series of these injuries and characterize the incidence and outcomes.</p><p><strong>Methods: </strong>Injury, presentation, treatment, and outcome data were retrospectively gathered on pediatric elbow fractures at a single center from November 2007 to October 2017.</p><p><strong>Results: </strong>Of 4607 pediatric elbow fractures, 492 were lateral condyle fractures, with 30 cases (6.1%) presenting with concomitant elbow dislocation. Predominantly affecting males (76.7%) with a median age of 6.9 years, these injuries often resulted from intermediate energy mechanisms. High rates of coincident neurovascular deficits (23%), skin tenting (13.3%), and polytrauma (13.3%) were observed. All cases were treated surgically, primarily within 24 hours, with no instances of AVN, nonunion, or fixation failure reported. Across the cohort, there were 2 (6.7%) pin tract infections, 2 cases required return to the operating room, and 12 (40.0)% patients requiring outpatient physical therapy for elbow stiffness.</p><p><strong>Conclusions: </strong>Lateral condyle fractures with concomitant ulnohumeral dislocation are distinct and unstable injuries requiring prompt inpatient treatment. Current classification systems do not adequately address this fracture-dislocation combination, risking underdiagnosis and potentially delayed reduction of a dislocated elbow. We propose adding a \"Song 6\" or \"Jakob 4\" category to existing classifications to ensure these injuries are properly identified and managed. This amendment will improve clinical awareness, facilitate timely intervention, and optimize outcomes for pediatric patients with these complex fractures.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 3","pages":"e201-e206"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189398","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":"Percutaneous Screw Fixation for the Management of Delayed Unions in Pediatric Lateral Humeral Condylar Fractures.","authors":"Eric Chang, Christopher Gajewski, Rachel M Thompson, Mauricio Silva","doi":"10.1097/BPO.0000000000002856","DOIUrl":"10.1097/BPO.0000000000002856","url":null,"abstract":"<p><strong>Background: </strong>The use of in situ screw fixation for the treatment of pediatric lateral humeral condyle (LCH) delayed unions has recently been reported. While attractive, the currently available literature consists of small retrospective studies with mixed results. As such, the present study aims to describe the outcome of a group of children with delayed unions of LCH fractures treated with in situ fixation using a single, percutaneously placed cannulated screw in compression.</p><p><strong>Methods: </strong>A retrospective review of all pediatric patients (below 18 y) with lateral condyle fractures of the humerus treated surgically for delayed union between 2013 and 2023 at a single, tertiary referral center was completed. Clinical and radiologic variables related to the initial injury and delayed union were abstracted from the medical record, as were surgical variables. Radiographs were evaluated for union postoperatively; time to union was determined by the senior authors. Descriptive statistics were used to summarize demographic and outcome variables.</p><p><strong>Results: </strong>A total of 12 consecutive patients met the inclusion criteria. The mean age at the time of initial injury was 5.6 years; subjects were followed for a mean of 3.0 years following initial presentation. All were treated with a single, percutaneously placed screw in compression at a mean of 10.5 months after the original injury. Radiographic union was achieved in 11 (91.7%) patients. At the latest follow-up, all patients were pain free and demonstrated a functional arc of motion without evidence of avascular necrosis. A total of 2 patients required revision for loss of fixation. In one patient, a persistent lucent line was observed, and 1 patient was found to have a cubitus valgus deformity, both of which were not clinically relevant.</p><p><strong>Conclusions: </strong>Our results suggest that with the use of proper technique (a 4.5 cannulated screw inserted through the metaphyseal portion of the lateral condyle fragment, engaging the most medial/distal aspect of the humeral shaft), radiographic union and clinical healing can be achieved in the majority of patients. Percutaneous screw fixation should be considered as an option for cases of noninfected pediatric lateral condyle delayed unions.</p><p><strong>Level of evidence: </strong>Level IV-evidence therapeutic studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"120-127"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622350","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":"The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study.","authors":"Stacey D Miller, Emma Lewis, Jonathan Lau, Maria Juricic, Vuong Nguyen, Paul Steinbok, Firoz Miyanji, Kishore Mulpuri","doi":"10.1097/BPO.0000000000002878","DOIUrl":"10.1097/BPO.0000000000002878","url":null,"abstract":"<p><strong>Background: </strong>Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.</p><p><strong>Methods: </strong>In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.</p><p><strong>Results: </strong>A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.</p><p><strong>Conclusions: </strong>The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"158-163"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poccetti's and Robbia's Recipe for Sound Sleep and Unsound Hips Painted and Sculpted in Ospedale Degli Innocenti.","authors":"Gleeson Rebello, Benjamin Joseph","doi":"10.1097/BPO.0000000000002884","DOIUrl":"10.1097/BPO.0000000000002884","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e288-e290"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846901","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":"Mid-term Results Following Surgical Hip Dislocation for Residual Pediatric Deformities.","authors":"Brian T Muffly, Zachary A Trotzky, Felix C Oettl, Ernest L Sink","doi":"10.1097/BPO.0000000000002818","DOIUrl":"10.1097/BPO.0000000000002818","url":null,"abstract":"<p><strong>Background: </strong>Mid-term results following surgical hip dislocation (SHD) for healed slipped capital femoral epiphysis (SCFE) and Perthes-related deformities are limited. This study aimed to characterize patient-reported outcome measures [including rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS)], report survivorship free from conversion to arthroplasty, and identify risk factors associated with composite failure.</p><p><strong>Methods: </strong>Twenty-seven patients (n=13 SCFE, n=14 Perthes) with minimum 2-year follow-up (mean 5.7 y) who underwent primary SHD from 2011 to 2021 were retrospectively reviewed. Modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) were collected preoperatively and at the latest follow-up. Composite failure was defined as not meeting any MCID/PASS threshold or conversion to arthroplasty. Continuous variables were analyzed using independent-sample t tests or the Wilcoxon Mann-Whitney test, where appropriate. Categorical variables were analyzed using χ 2 or Fisher exact test, as indicated. Kaplan-Meier survivorship was determined.</p><p><strong>Results: </strong>Mean mHHS improved from 56.2 to 77.2 ( P =0.003) and from 63.0 to 86.3 ( P <0.001), while iHOT-12 improved from 36.1 to 64.7 ( P =0.008) and 36.8 to 77.2 ( P <0.001) in SCFE and Perthes cohorts, respectively. MCID achievement for mHHS and iHOT-12 were 85.7% and 75.0% among SCFE, compared with 83.3% and 81.8% in Perthes. The proportion meeting PASS for mHHS and iHOT-12 was 30% for both in SCFE, compared with 61.5% and 83.3% in Perthes. 5- and 10-year survivorship free of conversion to arthroplasty was 100% and 80%, as well as 93% and 77% in the SCFE and Perthes cohorts, respectively.</p><p><strong>Conclusions: </strong>At mid-term follow-up, patients undergoing SHD for residual deformities related to chronic SCFE and Perthes demonstrated significant improvements in mHHS and iHOT-12, as well as relatively high rates of meeting MCID. SHD is an effective approach providing pain and functional benefit. Preoperative expectations, though, should be tempered in these cohorts, as some pre-existing damage limits the ability to completely normalize anatomy.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e236-e241"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854487","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":"Changes in Diaphragm Intrusion and Thoracic Dimensions After Posterior Spinal Fusion in Patients With Neuromuscular Scoliosis.","authors":"Gregory Benes, Peter G Gabos, Gregory J Redding, Joann Hunsberger, Patrick Cahill, Paul D Sponseller","doi":"10.1097/BPO.0000000000002832","DOIUrl":"10.1097/BPO.0000000000002832","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) can cause scoliosis with large thoracolumbar or lumbar curves. Such curves may impair pulmonary function by causing the abdomen and diaphragm to encroach on the thorax. Our purpose was to investigate changes in diaphragm position and other thoracic radiographic measurements at 2 years after posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>Retrospective review of data from 56 pediatric patients (Gross Motor Function Classification System >3) who underwent PSF for CP-related (neuromuscular) scoliosis at one US academic hospital from 2010 to 2018. In this study, we used radiographs taken preoperatively and 2 years after PSF to measure lung volume, diaphragm intrusion index (DII), diaphragm vertebral level (DVL), space available for the lung (SAL), and T1-S1 height.</p><p><strong>Results: </strong>Lung volume had increased by a mean 902 cm 3 (range, -735 to 2697 cm 3 ) at 2-year follow-up. DII improved from a mean (and SD) of 61%±12% to 71%±11% on the left side and 58%±14% to 68%±11% on the right ( P <0.001). DVL increased caudally by a mean 1.2 vertebral levels bilaterally, with a mean postoperative position between T8 and T9. Lung space became more symmetrical as the SAL increased from 0.76 to 0.91 ( P <0.001). T1-S1 height increased by a mean 7.5±4.3 cm.</p><p><strong>Conclusions: </strong>These findings suggest a new way to understand changes in thoracic volume and redistribution of thoracic and lumbar balance when correcting the collapsing spinal deformity in CP. A more caudal postoperative diaphragm position with less diaphragm intrusion into the thorax may reflect an improved length-tension configuration, which could in turn produce greater diaphragmatic strength and endurance.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e254-e260"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502606","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":"Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital.","authors":"Stephanie Chen, Jordan Ritchie, Jacob Hernandez, Nyma Khan, Vikki Nolan, Benjamin W Sheffer, Derek M Kelly","doi":"10.1097/BPO.0000000000002854","DOIUrl":"10.1097/BPO.0000000000002854","url":null,"abstract":"<p><strong>Background: </strong>In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital.</p><p><strong>Methods: </strong>A retrospective review identified pediatric patients with isolated, closed, and acute (below 3 wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs.</p><p><strong>Results: </strong>Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital.</p><p><strong>Conclusion: </strong>Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"139-143"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522219","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}