Journal of Pediatric Orthopaedics最新文献

{"title":"The Role of Closed Reduction in the Treatment of Pediatric Monteggia Fractures.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Jesse Hu, Sabrina Madrigal, Lindley Wall, Charles Goldfarb, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002958","DOIUrl":"10.1097/BPO.0000000000002958","url":null,"abstract":"<p><strong>Introduction: </strong>Previous ulnar-based treatment algorithms for pediatric Monteggia fractures advocate for treating incomplete ulnar fractures with closed reduction and casting (CRC) while treating complete fractures surgically. However, recent evidence has suggested that these algorithms may result in overtreatment. This study aimed to evaluate the outcomes of CRC treatment across all ulnar fracture patterns and identify factors associated with CRC failure.</p><p><strong>Methods: </strong>A retrospective study was conducted of patients treated for Monteggia fractures at a single institution from 2002 to 2022. Inclusion criteria were patients younger than 18 at the time of injury, with complete radiographic follow-up from preintervention until the time of bony union. Patients treated surgically without a trial of CRC due to an open fracture or delayed presentation for treatment were excluded. Patient demographics, radiographs, and relevant surgical records were analyzed.</p><p><strong>Results: </strong>Eighty patients, 34 (42.5%) males, were included. Sixty-seven (83.8%) had complete ulnar fractures. The average age at injury was 5.7 years (range: 2 to 17), and the average follow-up was 5.6 months (range: 1 to 71). Fifty-eight (72.5%) patients were successfully treated with CRC. Of the 22 (27.5%) failures, all but 1 required surgery. Older age at injury was a risk factor for CRC failure ( P =0.002). Failure occurred in 50% of patients older than 6 and 17.9% of patients ages 6 or younger ( P =0.003). Other ulna-related criteria, including Bado classification, fracture pattern, and ulnar displacement, were not significant risk factors.</p><p><strong>Conclusion: </strong>This study's results support an emerging body of evidence suggesting that ulnar-based algorithms may overpredict CRC failure in pediatric Monteggia fractures. A trial of CRC in these fractures, regardless of ulnar fracture pattern, may prevent unnecessary surgical intervention. In this study, 26.3% of patients ultimately required surgery following an initial trial of CRC, whereas previous algorithms would have recommended surgery in 83.8% of patients. However, patients older than 6 may be less likely to retain reduction with CRC, as our study showed that 50% required surgical treatment.</p><p><strong>Level of evidence: </strong>Level III-Therapeutic studies-investigating the results of treatment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"384-389"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700668","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":"Response to the Letter to the Editor: Pediatric Lateral Condyle Fractures With Elbow Dislocation: Revisiting the Song Classification of the Most Severe Injuries.","authors":"Jonathan G Schoenecker, Leigh Campbell, Courtney E Baker, Andrew B Rees, Samuel R Johnson, Jacob D Schultz, Lucas C Wollenman, Katherine D Sborov, Alexander A Hysong, Craig Louer, Stephanie N Moore-Lotridge, Nathaniel L Lempert","doi":"10.1097/BPO.0000000000003033","DOIUrl":"10.1097/BPO.0000000000003033","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e654-e655"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497393","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 Functional and Radiographic Outcomes of Untreated Tarsal Coalitions: A Community-Based Observational Study.","authors":"Alysa Nash, Carolina Alvarez, Jordan B Renner, James Sanders, Yvonne M Golightly, Craig Louer","doi":"10.1097/BPO.0000000000002965","DOIUrl":"10.1097/BPO.0000000000002965","url":null,"abstract":"<p><strong>Background: </strong>The natural history of untreated tarsal coalitions is largely unknown. It is thought atypical biomechanics of limited hindfoot motion may contribute to early degeneration and foot pain or dysfunction. Consequently, there is no data on long-term outcomes of nonoperatively managed asymptomatic tarsal coalitions. This study sought to define the frequency of radiographically apparent tarsal coalitions among a cross-section of a population not seeking care for foot symptoms. Ultimately, we aimed to observe the natural history of these coalitions by comparing multiple functional scores and radiographic foot osteoarthritis between participants with and without radiographic coalition to see if coalition presence is associated with worsened scores and or radiographic osteoarthritis.</p><p><strong>Methods: </strong>Utilizing existing data from a community-based study, radiographs were reviewed for findings of calcaneonavicular (CN) and talocalcaneal (TC) coalitions. Patient and foot-specific outcome scores [patient-reported outcomes measurement information system (PROMIS), foot and ankle outcome score (FAOS)] and radiographic foot osteoarthritis scoring were compared between \"Coalition present\"(C) and \"No Coalition\" (NC) groups.</p><p><strong>Results: </strong>Among 299 participants (592 feet) in this study (mean age: 72 y, 34% male, 41% Black), radiographic coalitions were found in 9.3% of feet, with 6.4% CN and 3.0% TC. PROMIS and FAOS were not significantly different between the NC and C groups. There was no statistically significant association between radiographic osteoarthritis and coalition presence. An unadjusted subanalysis of the coalition subtype found a modest association between CN coalitions and talonavicular osteoarthritis. TC coalitions had marginally worse FAOS symptoms, pain, sports and rec, and QOL subscores, though most TC participants had minimal dysfunction, with >60% reporting mild or no symptoms.</p><p><strong>Conclusions: </strong>We found few observable relationships between subclinical coalitions and osteoarthritis or clinically significant foot dysfunction. Individuals with TC coalitions may have slightly lower functional scores than participants with no coalition over a lifetime. These data can be used to counsel participants with tarsal coalitions regarding their long-term outcomes. We recommend continued non-operative management of asymptomatic tarsal coalitions.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"396-402"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780325","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 Arterial Supply to the Foot and its Correlation With Return of Capillary Filling Post-Achilles Tenotomy in Congenital Clubfoot.","authors":"Khaled L El-Adwar, Tamer M Shehata, Karim M ElSharkawi, Mena M Mosa","doi":"10.1097/BPO.0000000000002970","DOIUrl":"10.1097/BPO.0000000000002970","url":null,"abstract":"<p><strong>Background: </strong>Congenital clubfoot is a common idiopathic foot abnormality that manifests in newborns. Vascular deficiencies have been suggested as one of the underlying etiologies of clubfoot. The question in hand was: \"Is the return of capillary filling to the foot post-Achilles tenotomy correlated with both the arterial supply to the foot and degree of ankle equinus\"?</p><p><strong>Methods: </strong>This clinical study included 30 unilateral idiopathic clubfeet. All patients were assessed clinically using the Pirani score, then manipulation using the Ponseti technique, followed by examination of the infragenicular arterial system using Doppler ultrasound in both the affected and the normal control limbs. After Achilles tenotomy and reaching dorsiflexion of 10 to 20 degrees, the time-lapse till complete return of capillary filling to the foot was recorded. Both the radiologist and the surgeon were blinded to each other's assessment.</p><p><strong>Results: </strong>The mean postoperative time-lapse to complete return of capillary filling after the maintenance of dorsiflexion at the start of cast application was 3.53±5.56 minutes (range: 0 to 26.59). The anterior tibial artery (ATA) on the affected side was found to be completely attenuated distally in 24 out of 30 feet (80%), while the mean caliber of the posterior tibial artery (PTA) (1.09±0.18 mm) on the affected side was found to be increased compared with the normal side (0.99±0.20 mm) ( P =0.042). Also, cases with hypoplastic PTAs needed more time for the return of capillary filling (mean: 8.71±8.88 min) compared with those with normal PTAs (mean: 1.95±2.83 min), ( P =0.007). Also, there was a direct positive correlation between postoperative complete return of capillary filling and preoperative degree of equinus ( P< 0.001).</p><p><strong>Conclusion: </strong>Delay of the postoperative complete return of capillary filling to the foot after maximum dorsiflexion post Achilles tenotomy is related to both the degree of preoperative equinus and insufficiency/hypoplasia of the posterior tibial artery. This expected delay should not rush the surgeons to remove the cast before the lapse of 30 minutes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"410-415"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753202","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":"Pinning and Arthroscopic Trimming for Mild Slipped Capital Femoral Epiphysis: Comparative Study With Traditional In Situ Pinning and Modified Dunn Procedure.","authors":"Alessandro Aprato, Andrea Audisio, Beatrice Cambursano, Matteo Giachino, Stefano Artiaco, Federico Fusini, Alessandro Massè","doi":"10.1097/BPO.0000000000002960","DOIUrl":"10.1097/BPO.0000000000002960","url":null,"abstract":"<p><strong>Introduction: </strong>Mild slipped capital femoral epiphysis (SCFE) was traditionally treated with in situ pinning (ISP), a technique that stabilizes the physis but does not restore the anterior-superior femoral head offset. This residual deformity can lead to femoroacetabular impingement and early joint degeneration. Therefore, immediate arthroscopic trimming was associated to in situ pinning (ISPAT). The primary goal is to assess the clinical and radiologic outcomes of patients treated with ISPAT. Secondarily, outcomes were compared with traditional in situ pinning (ISP) and modified Dunn's procedure (MDP).</p><p><strong>Methods: </strong>Patients with Southwick 1 SCFE were included. Patients were divided in 3 groups according to surgical treatment: (1) pinning in situ associated to arthroscopic trimming (ISPAT), (2) pinning in situ (ISP), and (3) modified Dunn procedure (MDP). Outcomes were assessed with clinical parameters (range of motion (ROM), impingement test, mHHS and UCLA activity score) and radiologic parameters (Southwick angle, alpha angle). Early and late complications were recorded. Comparative analysis was performed.</p><p><strong>Results: </strong>A total of 47 patients (59 hips) were included in the study (ISPAT: 12, ISP: 34, MDP: 13). Preoperative Southwick slip angle (SA) was higher in the ISPAT and MDP groups compared with the ISP group (ISPAT vs. MDP, P =0.85; ISPAT vs. ISP, P <0.001; MDP vs. ISP, P <0.001)​. Surgical time differed between groups (ISPAT 69.9±17.7; ISP 37.0±21; MDP 140.0±26.5 min; P <0.001). The ISPAT group had a higher postoperative internal rotation (23.4±7.9 deg) compared with ISP (15.0±7.1 deg, P <0.001) but similar to MDP (28.2±6.4 deg; P =0.099). No differences were found in mHHS scores across groups (ISPAT 90.7±0.9, ISP 86.8±10.0, MDP 90.6±1.2, P =0.18)​. Postoperatively, the alpha angle of the ISPAT group demonstrated significant improvement postoperatively (preoperative 81.5±7.7 vs. postoperative 47.7±8.3 deg, P <0.001), with results comparable to MDP (postoperative 45.1±11.3 deg, P =0.45)​. In ISPAT no major complications were recorded. In ISP 4 patients developed osteoarthritis (OA) (2 required total hip arthroplasty). In MDP 1 patient developed OA, but no further surgery was performed.</p><p><strong>Conclusions: </strong>ISPAT is a safe and effective option for managing mild SCFE, providing immediate intervention to address FAI. However, its long-term impact on hip function and osteoarthritis prevention requires further investigation.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e606-e613"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710399","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":"Response to the Letter to the Editor: Comparison of Surgical and Conservative Treatments for Gartland Type II Supracondylar Humerus Fractures: Evaluation of the Need for Surgical Treatment.","authors":"Zirvecan Güneş, Ataberk Beydemir, Esra Kutsal Mergen, Halil Gökhan Demirkiran, Güney Yilmaz, Mehmet Cemalettin Aksoy, Ahmet Mazhar Tokgözoğlu, Muharrem Yazici, Saygin Kamaci","doi":"10.1097/BPO.0000000000002974","DOIUrl":"10.1097/BPO.0000000000002974","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e651-e653"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005970","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":"How Does the Vertical Expandable Prosthetic Titanium Rib Lengthening Intervals Affect the Clinical Outcome in Early Onset Scoliosis Patients? A Five-Year Follow-Up Study.","authors":"Norman Ramirez, José I Acosta Julbe, John Smith, John Emans, Amer Samdani, Mark Erickson, John Flynn, Norberto J Torres Lugo, Alexandra M Claudio-Marcano, Gerardo Olivella","doi":"10.1097/BPO.0000000000002971","DOIUrl":"10.1097/BPO.0000000000002971","url":null,"abstract":"<p><strong>Background: </strong>Untreated early-onset scoliosis (EOS) is often complicated by decreased thoracic expansion growth and pulmonary complications. Various fusion-less techniques have been developed to address these complications, including growing rods and vertical expandable prosthetic titanium rib (VEPTR) devices. To achieve adequate spinal growth, optimal lengthening timing is required. Yet, there are no evidence-based guidelines for these intervals. We aimed to evaluate the clinical outcomes concerning the distraction intervals of surgically untreated EOS patients who underwent VEPTR treatment with a minimum 5-year follow-up.</p><p><strong>Methods: </strong>We conducted a multicentered retrospective review of EOS patients managed with VEPTR and grouped them as those patients who underwent lengthening procedures in intervals of ≤8 months throughout 5 years (ie, group 1) and those who were lengthened in intervals >8 months during the same time frame (ie, group 2). The 8-month average interval cutoff was chosen following the findings of Yang and colleagues. We compared demographic variables, radiographic parameters, pulmonary function tests, 24-item Early Onset Scoliosis Questionnaire (EOSQ) findings, and complication rates between both groups.</p><p><strong>Results: </strong>Our study included 447 patients (158 in group 1 and 289 in group 2) with similar preoperative baseline characteristics. Postoperatively, no statistically significant differences were observed between groups regarding the coronal and sagittal major curve magnitudes, spine height gains (ie, T1-T12, L1-S1, and T1-S1), and the 24-EOSQ results. However, group 1 had a higher postoperative complication rate ( P =0.034) than group 2.</p><p><strong>Conclusions: </strong>More frequent lengthening intervals were associated with a higher rate of postoperative complications. Further studies are needed to clarify the optimal timing of these intervals among patients with EOS and their association with the outcomes.</p><p><strong>Level of evidence: </strong>Level III-therapeutic retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"370-375"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970638","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":"Evaluation of Foot Osteotomies for Treating Residual Clubfoot Deformities in Ambulatory Children With Arthrogryposis.","authors":"Sadettin Ciftci, Anuj Gupta, Chris Church, John Henley, Maureen Donohoe, Freeman Miller, L Reid Nichols","doi":"10.1097/BPO.0000000000002956","DOIUrl":"10.1097/BPO.0000000000002956","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is the most common deformity seen in children with arthrogryposis. The primary method of treatment for this deformity is serial casting, which has a greater frequency of incomplete correction and recurrence than in idiopathic clubfoot. For both primary and recurring cases, surgical treatments vary from soft-tissue releases to talectomy. This research aimed to evaluate the effectiveness of bony surgical procedures in correcting clubfoot in ambulatory children with arthrogryposis.</p><p><strong>Methods: </strong>The study retrospectively examined ambulatory children with arthrogryposis, all of whom had at least 1 osteotomy procedure on their clubfoot. The treatment's effectiveness was assessed using passive range of motion (PROM), dynamic foot pressure, and the pediatric outcomes data collection instrument (PODCI) utilizing paired t tests. The frequency of subsequent bone surgeries following the initial operation was documented.</p><p><strong>Results: </strong>The study reviewed 20 children who had 49 surgical procedures performed on 24 feet at age 15.1±4.5 years. PROM revealed enhanced ankle dorsiflexion and forefoot abduction ( P <0.05). In addition, evaluating dynamic foot pressure, coronal plane pressure index (CPPI), and the timing of heel rise demonstrated significant improvement ( P <0.05). PODCI demonstrated improvement in transfer basic mobility (from 80.57±17.31 to 86.50±13.46) and global function (from 69.64±15.03 to 74.50±13.91) ( P <0.05). Pain (from 69.58±25.39 to 79.21±26.57; P =0.067) and happiness (from 70.68±27.66 to 79.32±20.02; P =0.052) also improved and approached statistical significance. Moreover, a CPPI of <-94 was found to be predictive for suggesting the necessity of external fixator use according to the receiver operating characteristic analysis done based on our findings (area under the curve: 0.79, P= 0.0007). Two children required an additional procedure at 26-months and 37-months postindex surgery because of residual equinus deformity and insufficient correction of forefoot adduction, respectively.</p><p><strong>Conclusion: </strong>This research highlights the substantial role surgical procedures can play in improving ankle PROM, hindfoot-forefoot alignment, dynamic foot position, and functional mobility in children with clubfoot secondary to arthrogryposis. It establishes a basis for future inquiries to delve into the longevity of these benefits and the overall outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"403-409"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700661","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":"Retrospective Analysis and Characterization of Avascular Necrosis By Bone Location in Pediatric Leukemia/Lymphoma Patients.","authors":"Amin Alayleh, Hiba Naz, Vanessa Taylor, Taylor R Johnson, Saima Farook, Grady Hofmann, Chiamaka Obilo, Nicole S Pham, Kathryn Harbacheck, Tara Laureano, Stephanie M Smith, Karen Chao, Stuart B Goodman, Kevin G Shea","doi":"10.1097/BPO.0000000000002963","DOIUrl":"10.1097/BPO.0000000000002963","url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis (AVN) is a serious complication of high-dose steroid therapy for pediatric patients with leukemia/lymphoma. AVN affects multiple bones and joints, leading to significant pain in different bone regions, early-onset osteoarthritis, and early joint replacement. Early detection and intervention for AVN may prevent pain and progressive joint collapse. The purpose of this study is to evaluate and characterize the specific AVN locations in a cohort of pediatric and adolescent patients with leukemia/lymphoma using the newly developed Bone Location for AVN from STeroids (BLAST) classification system that considers epiphyseal, metaphyseal, and diaphyseal locations in long bones.</p><p><strong>Methods: </strong>An imaging database was queried for patients 25 years old and younger with a diagnosis of AVN and leukemia/lymphoma who required steroid treatment. Patient MRIs were reviewed, and AVN sites were classified using the BLAST system. AVN locations were described using descriptive statistics. Multivariable logistic regression analysis was used to assess the odds of AVN bilaterality based on location.</p><p><strong>Results: </strong>A total of 84 patients (49/35 males/females) with acute lymphoblastic leukemia (ALL) (B-cell 74%, T-cell 21%) or acute myeloid leukemia (5%) were included in this cohort. The median age was 14.8 years at leukemia diagnosis and 16.5 years at AVN diagnosis. Most AVN locations include the femur (87%), tibia (68%), and humerus (25%). On the basis of the BLAST classification, the most common sites of AVN overall include the proximal tibial metaphysis (61%), distal femoral metaphysis (60%) and epiphysis (60%), and femoral head epiphysis (50%). The most common sites of AVN in the tibia, humerus, and femur are proximal tibial metaphysis (89%), humeral head epiphysis (86%), and distal femoral metaphysis (68%) and epiphysis (68%), respectively.</p><p><strong>Conclusions: </strong>This analysis demonstrates that AVN in leukemia/lymphoma patients on steroid therapy has a clear predilection for specific locations in long bones. Using the BLAST classification, practitioners are better equipped to characterize the location of AVN, monitor high-risk locations for joint collapse, and track early outcomes of preventative treatment. The development of prospective multicenter AVN study groups and screening protocols for early detection will be critical to improve functional outcomes and joint preservation for leukemia/lymphoma survivors and all other patients taking high-dose steroids.</p><p><strong>Level of evidence: </strong>Level II-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e641-e647"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027582","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":"Does Vertebral Body Tethering Cause Coronal Hypermobility at Adjacent Noninstrumented Levels? A Preliminary Study.","authors":"Hans K Nugraha, Todd A Milbrandt, A Noelle Larson","doi":"10.1097/BPO.0000000000002959","DOIUrl":"10.1097/BPO.0000000000002959","url":null,"abstract":"<p><strong>Background: </strong>Fusion into the lumbar spine with lower instrumented vertebra (LIV) of L2 and below can result in increased mobility or hypermobility of the unfused segments, potentially contributing to early disk and joint wear and subsequent degenerative arthritis. Vertebral body tethering (VBT) is a motion-preserving surgery for scoliosis, but no data is available about its effect on disk motion for the uninstrumented segments distal to the LIV. We hypothesize that VBT preserves the coronal arc of motion distal to the LIV in AIS patients without the development of hypermobility which has been observed following fusion surgery.</p><p><strong>Methods: </strong>A single-center retrospective review was completed of adolescent idiopathic scoliosis patients who underwent VBT. Standing bending films were collected as standard of care preoperatively and at 1-year postoperatively with maximum effort on side bending according to an institutional protocol. To evaluate the coronal arc of motion, radiographic measurement of the intervertebral angles was measured at each level from the disk directly distal to LIV-S1, as described in previous literature.</p><p><strong>Results: </strong>A total of 95 patients had clinical preoperative and postoperative bending radiographs and were included in the study. In total, there were 2086 segments measured. Sixteen patients had bilateral tether procedures and were analyzed separately. Compared with preoperative values over the same levels, paired t test showed no significant difference in the coronal arc of motion for the distal uninstrumented segments.</p><p><strong>Conclusions: </strong>Normal segmental motion on lateral bend was preserved on the noninstrumented segments following VBT. In contrast to fusion, there was no evidence of lumbar hypermobility following VBT in scoliosis patients. This provides early evidence for preserved normal motion which could be protective against adjacent segment disease and early arthritis reported with long fusions.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"376-383"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326033","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}