Journal of Pediatric Orthopaedics最新文献

{"title":"An International Consensus on Evaluation and Management of Idiopathic Genu Valgum: A Modified Delphi Survey.","authors":"Ashish S Ranade, Gauri A Oka, Mohan V Belthur, Hitesh Shah, Martin J Herman, James A Fernandes, Reggie Hamdy, Yasmin D Hailer, Federico Canavese, Fergal Monsell, Yael Gelfer, Deborah M Eastwood, Aaron Huser, Jennifer Laine, James McCarthy, Alaric Aroojis, Anthony Cooper, Alejandro Barr, Pieter Herman Mare, Gamal A Hosny, Shyam Kishan, Salih Marangoz, Patricia Moreno Grangeiro, Bjarne Møller-Madsen, Timothy Nunn, Maulin Shah","doi":"10.1097/BPO.0000000000002908","DOIUrl":"10.1097/BPO.0000000000002908","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic genu valgum beyond physiological limits may require treatment, which is based on age, growth remaining, and the magnitude of the deformity. There is no consensus on clinical, or radiologic evaluation, indications, and management of idiopathic genu valgum, which can range from observation to surgical treatment using various modalities. If available, such guidelines will help surgeons offer optimal treatment to their patients. The aim of our study was to establish an expert consensus on the evaluation and treatment of idiopathic genu valgum.</p><p><strong>Methods: </strong>An international panel of 29 pediatric orthopaedic surgeons from 17 countries with clinical and research experience in the management of limb deformity participated in a modified Delphi survey. Surgeons were provided with patient and deformity characteristics and voted on 46 statements on history, clinical examination, radiographic evaluation, and treatment options for idiopathic genu valgum in round 1. Consensus was defined as when statements received ≥70% votes. Statements that were important but received <70% votes were reworded for clarity in round 2 (n=13).</p><p><strong>Results: </strong>Consensus was achieved for 28/46 statements and included obtaining a full-length standing radiograph of the lower extremities and measuring joint orientation angles. Participants did not agree to offer surgical treatment based only on the intermalleolar distance. They recommended surgical treatment if the mechanical axis falls in zone 2 or beyond on the lateral side and using guided growth by tension-band plating when the growth remaining is at least 2 years. The panel agreed on performing common peroneal nerve decompression for specific indications such as acute, opening wedge osteotomy of >20 degrees, but not for gradual correction. Consensus was not reached for indications and methods of bone age assessment, treatment when growth remaining is <1 year, indications for implant removal after guided growth in younger children, and the type of osteotomy for acute deformity correction.</p><p><strong>Conclusions: </strong>We have generated consensus statements to guide the management of idiopathic genu valgum. Statements that lack consensus are areas for future multicenter research.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"274-280"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122939","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 Open Reduction in Children With Developmental Hip Dislocation: A Multicenter Experience Over a Decade: Erratum.","authors":"","doi":"10.1097/BPO.0000000000002994","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002994","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 5","pages":"e499"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811563","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":"Can Surgery Be Proposed to Adolescent Idiopathic Scoliosis Patients With Structural Lumbar Curves Associated With Nonreducible Iliolumbar Angle?","authors":"Laurentiu-Cosmin Focsa, Anne-Laure Simon, Mikael Finoco, Thomas Krausse, Louise Ponchelet, Brice Ilharreborde","doi":"10.1097/BPO.0000000000002905","DOIUrl":"10.1097/BPO.0000000000002905","url":null,"abstract":"<p><strong>Background: </strong>Lower instrumented vertebra (LIV) selection for adolescent idiopathic scoliosis (AIS) with structural lumbar curves (Lenke 3, 5, and 6) remains debated. The iliolumbar angle (ILA) measurement is useful for assessing the lumbosacral junction flexibility. If it is nonreducible, surgeons need to make a difficult choice between a potential \"imperfect\" L4, associated with a residual lumbosacral curve, or a more distal fusion performed later in life due to poorer functional outcomes. The goal of this study was, therefore, to evaluate the postoperative radiographic and functional outcomes of AIS patients with nonreducible ILA.</p><p><strong>Methods: </strong>All consecutive AIS patients (2017 to 2022) with a structural lumbar curve and a posterior fusion ending on L4 were retrospectively included. Radiographic and functional outcomes (SRS-30 score) were reported with a minimum 2-year follow-up. Standing low dose stereoradiographs in both erect and maximum lateral bending positions were performed in all patients, and 2 groups of subjects were compared based on preoperative ILA flexibility [reducible group (R) or nonreducible group (NR)].</p><p><strong>Results: </strong>A total of 122 patients were included (30% NR and 71% R). At a mean follow-up of 2.3±0.1 years, surgery was efficient in correcting the major curve (77% reduction rate in the R group and 76% in the NR group, P <10 -5 ), and significantly improved coronal balance (R, P <10 -5 and NR, P =0.03) as well as the ILA [mean ILA gain 14 degrees (R group), P <10 -5 and 16 degrees (NR group), P <10 -5 ]. The proportion of excellent results was higher in the R group, but 97% of outcomes were either excellent or acceptable in the NR group, and only 1 case of poor result (residual ILA >10 degrees) was reported in each group. No significant difference was found in SRS 30 scores between groups, but scores were significantly improved in the NR group for the excellent outcomes' subgroup [self-image ( P =0.04) and satisfaction ( P =0.02) domains].</p><p><strong>Conclusions: </strong>The current study confirms that posterior fusion ending on L4 can still be proposed to young AIS patients with structural lumbar curves, even if the lumbosacral flexibility is limited.</p><p><strong>Level of evidence: </strong>Level III-comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e449-e456"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059610","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 Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?","authors":"Michael D Eckhoff, Daryn R Strub, Thomas J Utset-Ward, Matthew E Wells, Thomas J Scharschmidt","doi":"10.1097/BPO.0000000000002889","DOIUrl":"10.1097/BPO.0000000000002889","url":null,"abstract":"<p><strong>Background: </strong>Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection.</p><p><strong>Methods: </strong>Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately.</p><p><strong>Results: </strong>A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods.</p><p><strong>Conclusion: </strong>This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors.</p><p><strong>Level of evidence: </strong>Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e486-e491"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978916","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":"Factors Associated With Premature Physeal Closure After Distal Femur Physeal Fracture.","authors":"Molly A Hulbert, Liane Chun, Tracey P Bryan, Christopher D Souder, Andrew T Pennock","doi":"10.1097/BPO.0000000000002911","DOIUrl":"10.1097/BPO.0000000000002911","url":null,"abstract":"<p><strong>Background: </strong>Premature physeal closure (PPC) after distal femur fractures is a recognized complication. To date, risk factors for PPC have not been well identified. This study's purpose is to identify risk factors for this challenging problem and start the discussion for changing practice guidelines in high-risk patients.</p><p><strong>Methods: </strong>A retrospective review of displaced distal femur physeal fractures undergoing surgical stabilization at a single, level I pediatric hospital were identified between 2011 and 2022. Patient charts were reviewed and injury, radiographic, and surgical data were recorded. Univariable statistical analysis was performed to identify factors associated with PPC. Odds ratios were calculated and binary logistic regression was utilized to determine the odds of PPC based on risk factors present.</p><p><strong>Results: </strong>Fifty-four patients were identified with a mean chronologic age of 13±3 years, a mean bone age of 14±3 years, and the majority were male (67%). Twenty-eight percent of the cohort presented with severe fracture displacement. The interposed periosteum was removed in 37% of patients. The overall rate of PPC was 48% (N=26) and 77% of these underwent subsequent surgical intervention. When the PPC was identified at the 6-month postinjury visit (n=26), 50% had already developed a leg length discrepancy (LLD) of at least 1 cm. Three nonmodifiable factors were significantly associated with PPC: bone age, Salter-Harris (SH) type, and fracture displacement. The risks of PPC based on the number of factors present compared with zero factors were: 1 factor odds ratio (OR)=4.4 (95% CI: 0.4-45, P =0.22), 2 factors OR=39 (95% CI: 3.8-399, P =0.002), and 3 factors OR=96 (95% CI: 5.2-1767, P =0.002). Patients with 2 and 3 risk factors had a 77% and 89% rate of closing early.</p><p><strong>Conclusion: </strong>Premature physeal closure frequently occurs after distal femur physeal fractures and risk factors include younger bone age, SH I and II fractures, and fractures with greater initial displacement. When multiple risk factors are present, the odds of PPC are high, and intervention before 6 months could be considered to avoid a resultant LLD ≥1 cm or angular deformity. A larger study is warranted to create a predictive model and to enhance the precision of the risk factor analysis.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e413-e417"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523816","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":"Thickness of Subcutaneous Fat as a Proxy for BMI in Non-ambulatory Patients With Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion.","authors":"Hamdi Sukkarieh, Chibuzo Akalonu, Steele Liles, William Hunter Gillon, Drew Melancon, Isaac Spears, Priyanka Nehete, Jaysson Brooks","doi":"10.1097/BPO.0000000000002891","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002891","url":null,"abstract":"<p><strong>Background: </strong>Posterior spinal fusion in neuromuscular scoliosis patients carries a significant risk of postoperative surgical site infection (SSI). Body mass index has been associated with increased risk of surgical site infections, but it is difficult to obtain an accurate height of non-ambulatory children with severe neuromuscular scoliosis. Subcutaneous fat thickness has been associated with increased rates of surgical site infections in other surgeries; however, current literature has not elucidated a relationship between subcutaneous fat thickness and surgical site infections in this patient population.</p><p><strong>Methods: </strong>A retrospective chart review analyzed non-ambulatory patients with neuromuscular scoliosis who underwent posterior spinal fusion. Patients were stratified into 3 groups (underweight, normal weight, and overweight/obese) based on BMI-for-age percentiles. Subcutaneous fat thickness was measured in both the sagittal and coronal planes at 24 landmarks. Comparisons of categorical data were analyzed using χ2 tests. Logistic regression analysis was used to isolate independent factors associated with surgical site infections.</p><p><strong>Results: </strong>A total of 109 patients were analyzed. Thirty-four patients were underweight, 55 patients were normal weight, and 20 were overweight/obese. Twelve patients developed surgical site infections, with only 1 of them requiring an unplanned return to the operating room. Patients in the overweight/obese category had an increased risk of surgical site infection when compared with those in the normal weight and underweight categories (P=0.027). Of the 24 measurements taken, subcutaneous fat thickness to total distance from skin ratios at L2 spinous process (P=0.031), L3 spinous process (P=0.42), and averages of L2, L3, and L4 ratios (P=0.028) were all found to be associated with increased risk of surgical site infection.</p><p><strong>Conclusion: </strong>In this study population of patients with neuromuscular scoliosis who underwent posterior spinal fusion, increased BMI was associated with increased risk of SSI. Furthermore, 3 radiographic measurements of subcutaneous fat thickness associated with a higher risk of surgical site infections were identified. This knowledge could contribute to devising preoperative strategies to mitigate surgical risk and postoperative complications.</p><p><strong>Level of evidence: </strong>Level III-a retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 5","pages":"e480-e485"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811572","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 Radiologic and Clinical Results of Pediatric-adolescent Lisfranc Injuries.","authors":"Ersin Sensoz, Husnu Yilmaz, Tolga Onay","doi":"10.1097/BPO.0000000000002921","DOIUrl":"10.1097/BPO.0000000000002921","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of Lisfranc injury in pediatric-adolescent children is lower compared with adults. There is limited research on adolescent patients in this age group, with only a few case reports of pediatric patients. Furthermore, studies with adequate follow-up are lacking in the literature. This study aims to provide insights into the causes and types of fractures and evaluate mid-term clinical and radiologic outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric-adolescent patients diagnosed with a Lisfranc injury who underwent surgical treatment between June 2015 and January 2022. Patients underwent open reduction and internal fixation using Kirschner wires and/or screws, had satisfactory imaging, and were followed up for at least 2 years. Radiologic measurements included intermetatarsal distance, meary angle, and calcaneal height angle, done while the patient was standing. Assessments were made using the AOFAS midfoot score, the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), Visual Analog Scale (VAS) scores, and physical activities.</p><p><strong>Results: </strong>The study included 14 surgically treated patients with a minimum 2-year follow-up. The average patient age was 12.6 years, with a mean follow-up of 52.4 months. In pediatric cases, crush injury was the predominant trauma type ( P = 0.009). There were no significant differences in calcaneal pitch angle or meary angle between healthy and injured feet ( P = 0.2 and 0.1), but a greater intermetatarsal distance was observed on the injured side ( P = 0.02). The mean Visual Analog Scale (VAS) score was 1.5, the AOFAS midfoot score averaged 91.5, and the OxAFQ-C score averaged 86.3%.</p><p><strong>Conclusions: </strong>The mid-term outcomes for this age group were promising compared with adults. The use of Kirschner wires for fixation is more common in younger patients. Crush injuries and complications like compartment syndrome are more prevalent in the pediatric age group.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e405-e412"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391216","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":"Risk Factors for Developing Perthes Disease: A Comprehensive National Analysis Spanning 2 Decades.","authors":"Tanya Boghosian, David Momtaz, Jad Lawand, Jacob Jahn, Blaire Peterson, Abdullah Ghali, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002914","DOIUrl":"10.1097/BPO.0000000000002914","url":null,"abstract":"<p><strong>Background: </strong>Perthes disease is an uncommon pediatric condition affecting the hip joint, causing varying degrees of femoral head necrosis. The underlying cause of Perthes remains unknown, thus it is crucial to identify risk factors associated with its development to aid in early diagnosis and intervention. This study aimed to analyze risk factors associated with Perthes in a large cohort.</p><p><strong>Methods: </strong>A case-control study was conducted using data from a U.S. national database from 2003 to 2023. Patients diagnosed with Perthes were compared with those without the disease. Variables potentially associated with Perthes were analyzed using multivariable logit models, and adjusted odds ratios (AOR) with 95% CI were calculated. Statistical significance was determined, and a P -value <0.05 was considered significant.</p><p><strong>Results: </strong>The study included 4034 patients with Perthes and 3,483,745 age-matched controls. The mean age of patients with Perthes was 8.38 years, compared with 8.35 years in the control group ( P =0.27). Significant risk factors identified included male sex (AOR: 3.14, P <0.001), white race (AOR: 2.16, P <0.001), and obesity (AOR: 2.21, P <0.001). Conversely, Black (AOR: 0.26, P <0.001), Hispanic (AOR: 0.53, P <0.001), and Asian (AOR: 0.55, P <0.001) races were associated with lower odds of developing Perthes. Additional significant risk factors included tobacco exposure (AOR: 1.25, P =0.02), hypertension (AOR: 1.64, P <0.001), and thrombophilia (AOR: 9.17, P <0.001).</p><p><strong>Conclusions: </strong>This study is the largest study on Perthes disease in literature, identifying several independent risk factors, including male sex, white race, obesity, tobacco exposure, hypertension, obesity, and thrombophilia. Among children with Perthes, thrombophilia exhibited the highest adjusted odds ratio, despite its rarity. These findings offer valuable insights for further research aimed at elucidating the underlying etiology of Perthes disease, particularly with regards to the roles of vascular and metabolic pathways.</p><p><strong>Level of evidence: </strong>Level III-prognostic case-control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e443-e448"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573149","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.0000000000002887","DOIUrl":"10.1097/BPO.0000000000002887","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e496-e497"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978908","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":"Radiation Exposure in Operatively Treated Pediatric Femur Fracture Patients.","authors":"Nickelas Huffman, Ajay Nair, Summer M Drees, Trevor Bouck, David Yatsonsky, Kerry Krugh, Sara Seegert, Benjamin H Russell, Adrian Lewis, Aaron Buerk, Gregory M Georgiadis","doi":"10.1097/BPO.0000000000002907","DOIUrl":"10.1097/BPO.0000000000002907","url":null,"abstract":"<p><strong>Background: </strong>Children who sustain femur fractures are exposed to medical radiation as part of their treatment. In addition to standard radiographs and fluoroscopy, computerized tomography (CT) is a major source of ionizing radiation (IR). These patients frequently undergo CT scans during their treatment. The aim of the current study was to quantify the factors associated with greater IR exposure in children with operatively treated femur fractures and compare radiation exposure among those who received CT scans versus those who did not.</p><p><strong>Methods: </strong>Thirty-eight patients below 18 years old with operatively treated traumatic femur fractures were included in the study. They fell into one of 2 groups: 1 received 1 or more CT scans (CT group), and the other did not receive a CT scan (non-CT scan). The 2 groups were then compared by total quantitative radiation exposure, age, BMI, location of the femur fracture, open versus closed fracture, and the presence versus absence of fracture displacement.</p><p><strong>Results: </strong>The effective dose of IR exposure that occurred within the operating room (OR) made up 75.7%±27.4% of the total IR exposure among all patients. Patients in the CT group had over a 5-fold greater quantitative cumulative IR exposure compared with the non-CT group ( P <0.0001). Furthermore, patients in the CT group were significantly older than ( P =0.004) and had a greater BMI ( P =0.045) than the non-CT group.</p><p><strong>Conclusion: </strong>Children with pediatric femur fractures often exceed what is considered a low level of radiation. There is a significant difference in radiation exposure between pediatric femur fracture patients who receive 1 or more CT scans compared with those who do not receive a CT scan.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"264-268"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122879","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}