Journal of Pediatric Orthopaedics最新文献

{"title":"The Relationship Between Boxer's Fracture and Aggression, Hyperactivity, and 2D:4D Finger Ratio in Children and Adolescents: A Prospective Case-Control Study.","authors":"Volkan Özel, Fatih Günaydin, Şahan Dağlar, Gökay Dursun, Murat Yilmaz","doi":"10.1097/BPO.0000000000003412","DOIUrl":"10.1097/BPO.0000000000003412","url":null,"abstract":"<p><strong>Background: </strong>Boxer's fracture (fifth metacarpal neck fracture associated with the fist mechanism) is a common outcome of aggression-related intentional injuries, particularly in children and adolescents. This study aimed to compare the second-to-fourth digit ratio (2D:4D), aggression level, and attention deficit hyperactivity disorder (ADHD) symptoms in children and adolescents with a boxer's fracture against a healthy control group, and to evaluate possible relationships among these variables.</p><p><strong>Method: </strong>In this prospective case-control study, 100 children and adolescents (mean age: 13 y; range: 6 to 17) with a fist-mechanism fifth metacarpal neck fracture (group 1) and 100 patients presenting with nonaggression-related trauma (group 2) were enrolled at 2 hospitals over a 1-year period. All variables were assessed at presentation; as the design involved a single assessment point, no follow-up period was applicable. The 2D:4D finger ratio was measured in all participants using conventional hand radiographs. Aggression was evaluated using the Buss-Perry Aggression Scale and the Violence Propensity Scale, while ADHD symptoms were evaluated using the Level 2 ADHD Assessment Scale based on DSM-5-TR. Intergroup comparisons, correlation analyses, and multivariate logistic regression analyses were performed.</p><p><strong>Results: </strong>The case and control groups were similar in terms of age, sex, and socioeconomic status (all P >0.05). The 2D:4D finger ratio was significantly lower in patients with a boxer's fracture compared with the control group (0.888 vs. 0.939, P <0.001). Physical aggression, anger, hostility, and total aggression scores were significantly higher in the case group (all P <0.001).A weak but significant negative correlation was found between the 2D:4D ratio and physical aggression ( r =-0.23, P =0.001) and total aggression score ( r =-0.23, P =0.001). In multivariate logistic regression analysis, a low 2D:4D ratio and a high total aggression score were independently associated with a boxer's fracture. ADHD subtypes (predominantly inattentive, predominantly hyperactive, and combined type) were strongly associated with a boxer's fracture in penalized logistic regression analysis.</p><p><strong>Conclusion: </strong>This study demonstrates that children and adolescents with a boxer's fracture exhibit a risk profile characterized by a lower 2D:4D finger ratio, increased aggression, and pronounced ADHD symptoms. The findings suggest that a boxer's fracture in childhood and adolescence may not only be an orthopaedic injury but also a clinical reflection of associated behavioral and neurodevelopmental risks. Therefore, multidisciplinary assessment and appropriate psychosocial screening approaches in children presenting with a boxer's fracture may contribute to clinical practice.</p><p><strong>Level of evidence: </strong>Level III: prospective case-control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"661-667"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471485","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":"Concordance and Discordance of Intraoperative Nerve Root Findings in Brachial Plexus Birth Injury.","authors":"Clark J Chen, Dan A Zlotolow, Christopher S Crowe, Eugene Park, Scott H Kozin","doi":"10.1097/BPO.0000000000003440","DOIUrl":"10.1097/BPO.0000000000003440","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative characterization of brachial plexus birth injury (BPBI) is important for counseling and surgical planning, but the prediction of root-level injury remains challenging. We evaluated the agreement between preoperative injury classification and intraoperative nerve root findings, patterns of discordance, and the influence of Horner syndrome (HS).</p><p><strong>Methods: </strong>A retrospective review identified 162 infants who underwent primary brachial plexus exploration and reconstruction at a single institution between 2004 and 2023. Preoperative injury classification was assigned from clinical examination and Active Movement Scale (AMS) scores using a root level classification (2025): Injury A (C5-6), B (C5-7), C (C5-8), and D (C5-T1). Intraoperative class was assigned from operative findings, including nerve stimulation and direct assessment of root integrity.</p><p><strong>Results: </strong>Preoperative and intraoperative classifications were concordant in 135 of 162 patients (83.3%) and discordant in 27 (16.7%), with substantial overall agreement (Cohen kappa=0.700). Concordance was highest for Injury D (C5-T1) and poorest for Injury C (C5-C8). Preoperative classification was least accurate for Injury C, with only 1 of 14 cases correctly identified. Among the 27 discordant cases, undercalls were more common than overcalls (19 [70.4%] vs. 8 [29.6%]), most frequently involving B-to-C and A-to-B misclassification. C7 and C8 were the roots most often misidentified. Concordance did not differ significantly before versus after adoption of differential nerve stimulation (86.9% vs. 81.2%, P =0.070). All undercalls occurred without HS. All 5 overcall events in which preoperative Injury D was downgraded intraoperatively to Injury B or C occurred in patients with HS, injuries of which had higher preoperative AMS scores than concordant D-D injuries.</p><p><strong>Conclusion: </strong>This intraoperative BPBI classification provides reliable broad categorization preoperatively with substantial agreement but is vulnerable at the C7-C8 transition. Focused assessment of the C8 nerve root is important because this injury pattern is commonly misidentified and may affect diagnosis and treatment. Viewing HS as a marker of severity rather than a standalone sign of global injury may improve preoperative assessment.</p><p><strong>Level of evidence: </strong>Level IV-retrospective case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1045-e1051"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982809","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":"Comfort and Ease of Care in Pediatric Hip Spica Casts: A Comparison of Fiberglass Versus Plaster of Paris.","authors":"McKinley-Pacheco Estefania, Laura Cecilia Ramirez-Schneider, Brandon Zaldivar, Nossa-Almanza Sergio, Maria Fernanda Garcia-Rueda","doi":"10.1097/BPO.0000000000003293","DOIUrl":"10.1097/BPO.0000000000003293","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients with femur fractures or those undergoing pelvic surgery for dysplasia or dislocation require immobilization with a spica cast to maintain reduction, protect the correction, and ensure adequate rehabilitation. Materials used for immobilization include plaster of Paris (POP) and fiberglass casts. The study objective is to compare fiberglass spica cast immobilization with plaster of Paris in terms of comfort and ease of care.</p><p><strong>Methods: </strong>A prospective cohort study comparing the comfort and ease of care of pediatric patients immobilized with a spica cast POP and fiberglass was conducted, encompassing patients treated between 2022 and 2025. Outcomes were assessed using an observer-rated outcome (ObsRO) questionnaire adapted from the one described by Inglis and colleagues, and the correlation between the ObsRO score and the constructs of comfort and ease of care was assessed using Pearson correlation coefficient. In addition, complication rates and cast modifications by spica material were reported.</p><p><strong>Results: </strong>The median ObsRO questionnaire score was higher for fiberglass than for POP ( P <0.001). The Pearson correlation matrix between this questionnaire and the constructs for validity yielded 0.59 and 0.63 for comfort and ease of care, respectively. There was no statistically significant difference in adverse events related to each material.</p><p><strong>Conclusions: </strong>The fiberglass pelvic spica cast is more comfortable and easier to care for than plaster of Paris in immobilized pediatric patients. There were no differences in complication rates between the 2 materials.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"625-630"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973216","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":"Anatomic Classifications and Functional Outcomes in Preaxial Polydactyly of the Hand.","authors":"Danilo González-Zapata, Sergio Martínez-Álvarez, María Galán-Olleros, Paula Arias-Martínez, Natalia Soriano Lorié, Isabel Vara-Patudo, Ángel Palazón-Quevedo","doi":"10.1097/BPO.0000000000003445","DOIUrl":"10.1097/BPO.0000000000003445","url":null,"abstract":"<p><strong>Background: </strong>Preaxial polydactyly is a common congenital hand anomaly with substantial anatomic variability. Although several classification systems exist, the relationship between anatomic subclassification and postoperative outcomes remains incompletely defined. This study evaluated clinical and radiographic outcomes after surgical reconstruction, compared associations of the Wassel-Flatt (WF) and JK classifications with outcomes, and assessed the Japanese Society for Surgery of the Hand (JSSH) and Rotterdam scoring systems.</p><p><strong>Methods: </strong>We retrospectively reviewed 58 patients (59 thumbs) treated surgically between 2012 and 2024. Thumbs were classified using the WF and JK systems. Final outcomes included range of motion, alignment, stability, JSSH and Rotterdam scores, and reoperation. Associations with classification subtype, surgical procedures, and temporary transarticular K-wire fixation were analyzed at the thumb level.</p><p><strong>Results: </strong>WF type IV and JK type IV were the most common categories. Total range of motion exceeded 70 degrees in 39 thumbs, and joint stability was preserved in 52. Fifty-three thumbs had good or excellent outcomes acoording to JSSH criteria; the mean Rotterdam score was 27.1±2.5. Eleven thumbs were classified differently by the 2 systems. Of 29 WF type IV thumbs, 26 remained JK type IV and 3 were reclassified as JK type VIIB; the latter had lower JSSH total and functional scores. Overall, the JK classification was associated with postoperative alignment and JSSH total score, although the small type VIIB subgroup limits interpretation. Temporary K-wire fixation was associated with lower interphalangeal joint and total range of motion and lower functional scores; however, confounding by deformity severity and reconstruction complexity cannot be excluded. No reoperations were required during the available follow-up period.</p><p><strong>Conclusions: </strong>Surgical reconstruction yielded favorable outcomes in most patients. The JK classification provided additional anatomic granularity, particularly by identifying a small type VIIB subgroup within heterogeneous WF categories, but its prognostic value requires validation in larger cohorts. Temporary K-wire fixation was associated with reduced postoperative motion without establishing causation. The JSSH and Rotterdam instruments provided complementary outcome assessment.</p><p><strong>Levels of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1025-e1033"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760686","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 Distal Radius Autograft in Adolescent Scaphoid Nonunion Repair.","authors":"Garrett E Rupp, Parker M Rea, Patrick F Curran, James D Bomar, Eric W Edmonds, Charles Douglas Wallace","doi":"10.1097/BPO.0000000000003409","DOIUrl":"10.1097/BPO.0000000000003409","url":null,"abstract":"<p><strong>Background: </strong>When treated early with cast immobilization, adolescent scaphoid fractures have excellent outcomes; however, nonunion may occur, particularly in patients with a delayed presentation. The purpose of this study is to evaluate the radiographic outcomes and to determine factors associated with time till union in adolescent scaphoid fracture nonunions treated with open reduction and internal fixation (ORIF) with distal radius cancellous autograft interposition.</p><p><strong>Methods: </strong>Children with scaphoid fracture nonunions treated at a single center were identified through an electronic database from 2010 to 2021, who underwent scaphoid nonunion repair through ORIF with a distal radius autograft were included. Exclusion criteria included a subject age of 19 years or older and a <6-month follow-up. Preoperative data included the interval between injury and surgery and initial x-ray and CT findings, including the presence of deformity, displacement, or avascular necrosis. Perioperative data included grafting, tourniquet time, and estimated blood loss. Pre- and postoperative carpal alignment were assessed. Postoperative data included immobilization time and time to union.</p><p><strong>Results: </strong>Thirty-five wrists in 35 patients met inclusion criteria (33 males, 2 females) with a mean age at presentation of 15.9±1.6 years (range 12.0 to 18.6 y) with a mean duration of radiographic follow-up of 11.1±4.9 months (range: 6.2 to 24.5 mo). Union was achieved in all wrists at a mean of 3.3±1.4 months (range: 1.3 to 7.7) postsurgery. Two wrists (6%) achieved union at ≥6 months post-op. Mean scapho-lunate angle decreased from preoperative (62.5±14.7 degrees) to postoperative (52.5±12.7 degrees), P <0.001. Mean radio-lunate angle decreased from preoperative (17.8±12.4 degrees) to postoperative (9.7±7.6 degrees), P <0.001. No intraoperative complications were noted. All but 3 subjects returned to activities at a mean of 9.6±4.4 months postsurgery.</p><p><strong>Conclusions: </strong>Adolescent patients with scaphoid nonunion treated with ORIF with distal radius autograft have good outcomes, including a high rate of union, improved radiographic wrist parameters, and return to sport. Although achieving this positive outcome may take more than a year postoperatively, success is seen in 94% of adolescents.</p><p><strong>Levels of evidence: </strong>Level IV-case control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1034-e1039"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430644","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":"Calcaneal Lengthening Osteotomy in Cerebral Palsy: Does Age at Intervention Influence Outcomes?","authors":"David E Westberry, Jacob M Bailey, Emily R Shull, Branum Bo Layton, Lauren C Hyer","doi":"10.1097/BPO.0000000000003422","DOIUrl":"10.1097/BPO.0000000000003422","url":null,"abstract":"<p><strong>Background: </strong>The optimal age for calcaneal lengthening osteotomy in children with cerebral palsy remains controversial. Younger age has been suggested as a risk factor for recurrence or overcorrection, but long-term clinical data are limited. The primary purpose of this study was to determine whether age at surgery influences long-term radiographic maintenance of correction and clinical outcomes.</p><p><strong>Methods: </strong>A retrospective review was performed of 102 patients (155 feet) with cerebral palsy who underwent lateral column lengthening as part of a foot reconstruction procedure between 1990 and 2020 with a minimum of 5 years of radiographic follow-up. Patients were divided into 2 cohorts based on age at surgery: younger than or equal to 8 years (55 patients, 85 feet) and older than 8 years (47 patients, 70 feet). Radiographic parameters were measured preoperatively and at the latest follow-up. Longitudinal changes were assessed using mixed-effects modeling. Secondary outcomes included revision surgery, persistent pain, and pedobarographic analysis in a subset of patients.</p><p><strong>Results: </strong>Both cohorts showed significant improvement in nearly all radiographic parameters postoperatively ( P <0.05), with no differences between groups at long-term follow-up. Mixed-effects modeling demonstrated gradual changes in several radiographic measures over time; however, rates of change were similar between cohorts. Revision surgery was performed in 11.8% of feet in the younger cohort and 7.1% in the older cohort ( P >0.05). Overcorrection requiring revision occurred in 2 feet, both in the younger cohort. Persistent pain was reported in ~10% of patients in both groups. Pedobarographic analysis demonstrated improvement in fore-aft loading and directionally more normalized loading in the medial-lateral distribution in both cohorts, although medial-lateral changes were not statistically significant.</p><p><strong>Conclusions: </strong>Foot reconstruction involving calcaneal lengthening osteotomy provides radiographic correction and acceptable clinical outcomes in children with cerebral palsy, regardless of whether surgery is performed before or after 8 years of age. Age at surgery was not associated with increased recurrence, revision, or persistent pain at long-term follow-up.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1065-e1074"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549471","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 Role of Caudal Screw Fixation in Outcomes of Posterior Dynamic Distracting Device for Adolescent Idiopathic Scoliosis.","authors":"Gabrielle A Rogie, Hilton Braithwaite Iv, Scott Luhmann","doi":"10.1097/BPO.0000000000003447","DOIUrl":"10.1097/BPO.0000000000003447","url":null,"abstract":"<p><strong>Background: </strong>Nonfusion techniques, such as the posterior dynamic distracting device (PDDD), for adolescent idiopathic scoliosis (AIS), aim to correct deformity and preserve motion. PDDD relies on 2 pedicle screws cranially but only a single caudal screw, a design that may predispose to implant complications. This study evaluated the role of caudal screw parameters-depth, trajectory, and diameter-on mechanical failure, revision surgery, and curve correction.</p><p><strong>Methods: </strong>A review of AIS patients from a multicenter registry who underwent PDDD with ≥2 years of follow-up was performed. Radiographic measures included caudal screw depth, rod-to-caudal screw angle, and caudal screw-to-upper endplate angle postoperatively and at final follow-up or before revision.</p><p><strong>Results: </strong>A total of 155 patients (mean age 14.4 y, range 10 to 19 y) were included with a mean f/u of 2.3 years. Initial coronal deformity was 46 degrees, which improved to 21 degrees at final f/u. Construct breakage occurred in 17% and overall mechanical failure in 27%. Revisions for mechanical failure occurred in 14%. Revisions, breakage, and mechanical failure were all correlated with more convergent, negative, initial screw-toupper endplate angle ( P =0.025, P =0.003, and P <0.001, respectively). Mechanical failure correlated with lower final caudal screw depth ( P =0.025), lower initial actuator-to-caudal screw angle ( P =0.010), and initial and final convergent screw-to-upper endplate angulation ( P <0.001 and P =0.010, respectively). Multivariable logistic regression identified initial caudal sagittal angle (OR: 0.893; P =0.003) and Lenke curve type (OR: 0.446; P =0.049) as independent predictors of mechanical failure, with the final model demonstrating strong predictive capacity (AUC=0.755).</p><p><strong>Conclusion: </strong>PDDD achieved meaningful curve correction, but with notable mechanical failure rates. Convergent caudal screw angulation, but not screw depth or diameter, was associated with construct breakage, mechanical failure, and revision surgery, emphasizing the importance of sagittal screw trajectory for optimal outcome. Furthermore, caution should be exercised with Lenke type 5 curves.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e961-e966"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794552","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":"Serial Casting and Hinged Elbow Bracing in the Treatment of Fixed Flexion Deformity of the Elbow Following Obstetric Brachial Plexus Palsy.","authors":"Ashley I Simpson, Iris Hy Kwok, Rémy Liechti, Marco Sinisi, Anna Panagiotidou, Michael Fox","doi":"10.1097/BPO.0000000000003406","DOIUrl":"10.1097/BPO.0000000000003406","url":null,"abstract":"<p><strong>Background: </strong>Fixed flexion deformity (FFD) of the elbow is a recognized sequela of obstetric brachial plexus palsy (OBPP). Physiotherapy, stretching, and extension splinting are commonly used, but established contractures may persist despite these measures. This study evaluated the outcomes and complications of serial casting and hinged elbow bracing for OBPP-related elbow FFD.</p><p><strong>Methods: </strong>A retrospective case series of 89 treatment courses in 73 patients with OBPP-related elbow FFD treated between 1996 and 2014 was performed. There were 80 serial casting courses, 8 hinged elbow brace courses, and 1 combined course. Outcomes were analyzed at the treatment-course level. The primary outcome was the change in active elbow FFD measured before and after treatment. Treatment duration, number of casts, complications, premature termination, and recurrence requiring repeat treatment were recorded.</p><p><strong>Results: </strong>The mean age at treatment was 12.2±4.9 years. Mean treatment duration was 6.2±3.7 weeks. Mean pretreatment active FFD was 45.8±19.9 degrees and improved to 20.7±15.1 degrees after treatment, giving a mean improvement of 25.2 degrees (95% CI: 21.6-28.8 degrees; P <0.001; Cohen dz =1.49). The recorded range of pretreatment FFD was 15 to 120 degrees. Fifty-eight treatment courses (65.2%) achieved a post-treatment FFD of 20 degrees or less. Eight treatment courses (9.0%) were terminated prematurely because of complications, discomfort, travel burden, or noncompliance. Sixty-two of 73 patients (84.9%) required only 1 treatment course. Recurrence requiring repeat treatment occurred in 11 patients (15.1%), who underwent 27 treatment courses in total.</p><p><strong>Conclusions: </strong>Serial casting and hinged elbow bracing produced clinically meaningful improvement in elbow extension in patients with OBPP-related elbow FFD, with a low rate of complications and premature termination. Most patients required only 1 treatment course. Recurrence occurred in a minority of patients, but repeat treatment remained effective, supporting these techniques as repeatable nonoperative options for selected patients.</p><p><strong>Level of evidence: </strong>Level IV, case series, retrospective.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1052-e1058"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430632","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 Hidden Injury: Behavioral Health's Role in Pediatric Orthopaedic Outcomes-A Systematic Review.","authors":"Jessica L Koshinski, Kristen N Reikersdorfer, Emily I Pluhar, Aristides I Cruz, Mark A Seeley","doi":"10.1097/BPO.0000000000003428","DOIUrl":"10.1097/BPO.0000000000003428","url":null,"abstract":"<p><strong>Background: </strong>The psychological toll of injuries in youth athletes is often overlooked, even while these injuries continue to increase in incidence. Research exploring the role that psychology plays in recovery from these injuries demonstrates that not addressing them can be detrimental to return-to-sport and postoperative outcomes. There are limited studies investigating these questions and the role that integrated care pathways can play in optimizing these outcomes in pediatric athletes undergoing orthopaedic surgeries.</p><p><strong>Methods: </strong>A systematic review of PubMed, Cochrane, and Ovid MEDLINE was done using the following search string: (pediatric OR child OR adolescent) AND (orthopedic OR orthopaedic OR musculoskeletal OR fracture OR injury OR surgery) AND (psychological OR \"mental health\" OR anxiety OR depression OR coping OR resilience) AND (recovery OR rehabilitation OR \"treatment outcome\" OR \"return to sport\" OR healing). Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were utilized to structure our search. Inclusion criteria included: articles published in English, articles of studies or reviews assessing the role of psychiatric and psychological factors in orthopaedic conditions. Exclusion criteria included: articles not published in English, concussion-related and traumatic brain injury-related articles, and other articles unrelated to the search criteria. Outcomes assessed included study type, condition studied, outcomes collected and relevant findings.</p><p><strong>Results: </strong>A total of 197 articles were included in the final analysis. Across clinical and experimental studies, commonly studied conditions were anterior cruciate ligament injuries, general athletic/sport injuries, and adolescent idiopathic scoliosis. Multiple articles addressed the emotional distress that occurs with injury and the potential negative implications that can occur if the psychological aspect of injury is not managed properly. Studied groups varied between pediatric, adolescent, adult and mixed populations, with variation in definitions of these terms.</p><p><strong>Conclusions: </strong>Behavioral health clinicians, including sports psychologists and sports psychiatrists, may be beneficial for high-risk athletes to improve outcomes. It is important to be able to discuss psychological aspects of sports injury with patients and their families, identify at-risk athletes, and offer timely interventions to optimize their care. Future directions to integrate psychological care into pediatric orthopaedic surgical care include the development of multidisciplinary clinics that have both orthopaedic and behavioral health care services available to patients, standardized behavioral health screenings, and increased awareness of the implications of untreated psychological distress in these patients.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e911-e918"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535931","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":"Temporary in Situ Pinning With Subsequent Modified Dunn is a Safe Alternative to Primary Modified Dunn in Moderate and Severe Slipped Capital Femoral Epiphysis.","authors":"Jordyn Adams, Brian Zalneraitis, Graham Whiting, Ryan Pahlau, Patrick Carry, Sayan De, Courtney Selberg","doi":"10.1097/BPO.0000000000003421","DOIUrl":"10.1097/BPO.0000000000003421","url":null,"abstract":"<p><strong>Background: </strong>Surgical hip dislocation with modified Dunn procedure (MD) is a viable treatment option for moderate to severe slipped capital femoral epiphysis (SCFE). In the acute setting, an experienced surgeon may not be immediately available for the MD. However, in situ pinning (ISP) is a well-accepted initial treatment and may be more familiar to the on-call orthopaedic surgeon. Our aim was to compare outcomes at short and midterm follow-up in patients with moderate/severe SCFE undergoing ISP with subsequent MD versus primary MD.</p><p><strong>Methods: </strong>Between June 2017 and July 2024, we treated 29 patients for SCFE. During this time, we generally indicated the modified Dunn procedure when the slip angle was ≥30 degrees. Radiographic morphologic parameters were measured before surgery and at a minimum follow-up of 8.5 months. Radiographs at final follow-up were also screened for signs of osteoarthritis by the senior hip surgeon. After adjusting for age and sex, we used multivariable linear regression to assess differences in continuous outcomes between the ISP+MD and MD-only groups, and logistic regression to evaluate differences in the odds of binary outcomes between groups. The Wilcoxon rank-sum test tested differences in the distribution of Merle d'Aubigné scores between groups.</p><p><strong>Results: </strong>Twelve patients underwent initial ISP with subsequent MD; 17 patients underwent primary MD. Median time between ISP and MD was 35 days (range: 5 to 137 d). There was no difference in complication rate between groups, including the incidence of AVN (17% in ISP+MD vs. 12% in MD; P ≥0.99). Merle d'Aubigné scores at final follow-up were 18 (interquartile range: 16 to 18) in the ISP+MD group versus 17 (interquartile range: 16 to 18) in the MD group ( P =0.36). There were no significant differences in radiographic outcomes between groups at final follow-up.</p><p><strong>Conclusion: </strong>In this series, a temporary ISP before modified Dunn in moderate and severe slips was a safe alternative to primary MD if an experienced hip surgeon was not immediately available. This allows for optimization regarding surgical timing with an experienced hip surgeon, preoperative patient and family education of surgical risks and benefits, and postoperative compliance with precautions after MD. A longer follow-up duration and results from other centers are warranted for this approach. This study contains a small patient cohort and may be underpowered to detect smaller differences that may be detectable with a higher-powered study.</p><p><strong>Level of evidence: </strong>Level II, prospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1010-e1017"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818802","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}