Journal of Pediatric Orthopaedics最新文献

{"title":"The Incomplete Picture: A Call for More Robust Arthroereisis Outcome Data.","authors":"Julio Javier Masquijo","doi":"10.1097/BPO.0000000000003098","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003098","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274998","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":"Novel Unipolar Shilla Technique for Complex EOS Provides Lasting Correction and Controlled Growth.","authors":"Omar Taha, Matthew Weintraub, Thomas M Zervos, Edwin S Kulubya, Ritt Givens, Mehdi M Elfilali, Fthimnir M Hassan, Nikki Bainton, Amber Mizerik, Benjamin D Roye, Lawrence G Lenke, Michael G Vitale","doi":"10.1097/BPO.0000000000003139","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003139","url":null,"abstract":"<p><strong>Background: </strong>The Shilla technique offers direct apical control and allows continuous cranial and caudal guided growth in early-onset scoliosis (EOS), eliminating the need for repeated surgeries. For cases where bipolar growth is not feasible, we developed a modified \"unipolar\" Shilla technique, allowing for asymmetric growth modulation with fusion at the opposite end. This study examines the feasibility and effectiveness of this approach in a complex EOS population.</p><p><strong>Methods: </strong>We conducted a retrospective review of all Shilla cases performed by 3 surgeons over 11 years at a single institution. We identified patients treated with the unipolar Shilla technique and collected socio-clinical variables, radiographic parameters, and growth metrics. \"Rod slide\" was measured to determine intra-Shilla construct growth.</p><p><strong>Results: </strong>Thirteen patients treated with unipolar Shilla were identified. The mean major coronal curve decreased from 69 degrees preoperatively to 19 degrees postoperatively. Thoracic height (T1 to T12) increased from 17.5 to 21.9 cm, and T1 to S1 height from 26.8 to 34.0 cm. Rod slide in those with complete follow-up averaged 9.6 mm, and all patients had more than 5 mm of Shilla growth. Overall, there was one unplanned return to OR due to discomfort from a prominent rod, which was trimmed.</p><p><strong>Conclusions: </strong>The unipolar Shilla technique provided excellent correction of severe spinal deformities with minimal complications. Although growth was modest in most cases, this technique is potentially beneficial for patients requiring definitive apical control with limited growth potential or those who may have difficulty with follow-up.</p><p><strong>Level of evidence: </strong>Level IV-retrospective case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258185","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":"Cervicothoracic Kyphosis and Spinal Cord Compression in Hurler Syndrome.","authors":"Saral Patel, Rajul Gupta, Alvin Jones, Peter Sturm, Viral Jain","doi":"10.1097/BPO.0000000000003125","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003125","url":null,"abstract":"<p><strong>Introduction: </strong>Hurler syndrome is characterized by significant spinal abnormalities, including cervical instability, odontoid dysplasia, and spinal cord compression. Spinal compression and kyphosis at the cervicothoracic (C-T) junction are also observed but less commonly reported. The present study was conducted to determine the prevalence of C-T kyphosis and spinal cord compression at the C-T junction in patients with Hurler syndrome. In addition, we aimed to evaluate the significance of C-T kyphosis and spinal cord compression in these patients in terms of clinical symptoms or neuromonitoring changes in nonspine surgery.</p><p><strong>Method: </strong>This retrospective case series examines patients with Hurler syndrome at a single pediatric institution from 2009 to 2023, with 47 included based on available spinal MRIs. Radiographic assessments included the C6-T4 kyphosis, maximal C-T kyphosis, and spinal cord compression using Kang grading for stenosis. Follow-up MRIs tracked changes in C-T kyphosis and new spinal cord compression. The value of C-T kyphosis associated with spinal cord compression (Kang grades 2 and 3) was determined using receiver operating characteristic (ROC) analysis. IONM data, including SSEP and TcMEP, were reviewed for significant changes during surgeries unrelated to the spine.</p><p><strong>Results: </strong>This study involved 47 patients with an average age of 5 years and 57% male. Initial MRI showed a mean C-T kyphosis of 17 degrees, primarily affecting C7-T3. Follow-up MRIs revealed progressive C-T kyphosis and spinal cord compression. A C-T kyphosis >20 degrees was associated with Kang grade 2 spinal cord compression. IONM during nonspine surgeries identified significant changes in 3 patients. One patient developed postoperative paraplegia following hip surgery performed without IONM. A retrospective review of a prior airway MRI showed a C-T kyphosis of 49 degrees along with spinal canal stenosis.</p><p><strong>Conclusions: </strong>The manuscript sheds light on the intricate nature of C-T kyphosis in individuals with Hurler syndrome. While the clinical significance and optimal management of this condition are still under discussion, the study underscores the importance of evaluating C-T kyphosis to guide surgical planning and reduce the risk of spinal cord injury in affected patients.</p><p><strong>Level of evidence: </strong>Case series, Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258246","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":"Reply to Letter to the Editor Regarding the Article: \"Treatment Outcomes at Skeletal Maturity After Physeal-Sparing Procedures for Early-Onset Slipped Capital Femoral Epiphysis Using a Long Screw With a Short-Threaded Tip\".","authors":"Mi Hyun Song","doi":"10.1097/BPO.0000000000003120","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003120","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251556","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 Letter to the Editor.","authors":"Susan T Mahan, Manon Pigeolet","doi":"10.1097/BPO.0000000000003129","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003129","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251539","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":"Timing of ACL Reconstruction and Spontaneous Meniscal Healing in Adolescent Patients With Concomitant Injuries.","authors":"Nadav Graif, Gil Rachevski, Ron Qual, Ram Cohen, Moshe Yaniv, Roy Gigi","doi":"10.1097/BPO.0000000000003133","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003133","url":null,"abstract":"<p><strong>Background: </strong>Meniscal injuries frequently accompany acute anterior cruciate ligament (ACL) tears, creating clinical dilemmas regarding optimal surgical timing. While delayed reconstruction increases risks of progressive meniscal damage, early intervention may interrupt natural healing capacity in the adolescent population. This study examines relationships between surgical timing, detailed tear characteristics, and meniscal healing patterns in adolescent ACL injuries.</p><p><strong>Methods: </strong>A retrospective cohort analysis of 55 adolescent patients (mean age: 14.9±1.9 y, range: 11.9 to 18; 63.6% male) undergoing arthroscopic ACL reconstruction (2015 to 2024) compared preoperative MRI findings with intraoperative meniscal evaluations. Individual meniscal tears (n=64) were characterized by anatomic location and morphologic configuration. Meniscal healing (absence of arthroscopically visible tears previously seen on MRI) was the primary outcome. Secondary analyses examined healing rates by location and surgical timing as a continuous variable. Multivariate logistic regression identified independent predictors.</p><p><strong>Results: </strong>Among 64 individual tears, 29 (45.3%) demonstrated spontaneous healing. Continuous timing analysis revealed healed tears averaged earlier surgery at 169.8±78.4 days versus persistent tears at 203.4±89.2 days (difference: 33.6 d, P=0.021). Medial meniscal tears showed significantly higher healing rates than lateral tears (60.0% vs. 27.6%, P=0.006). Multivariate analysis identified 3 independent predictors: medial location (OR: 3.9, 95% CI: 1.5-10.1, P=0.005), earlier surgical timing per day (OR: 0.994, 95% CI: 0.989-0.999, P=0.021), and posterior horn location (OR: 2.8, 95% CI: 1.1-7.2, P=0.031). Six new tears were identified at surgery (10.9% rate), with 5 occurring in patients with delayed surgery (>120 d from injury).</p><p><strong>Conclusion: </strong>This analysis demonstrates significant associations between surgical timing and meniscal healing in adolescent ACL injuries, with each day of delay associated with a 0.6% reduction in healing odds. These preliminary findings require validation in larger prospective studies before influencing treatment decisions but may inform patient counseling regarding expected outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251531","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":"Art and Pediatric Orthopaedics: Dürer and the Forbidden Fruit.","authors":"Gleeson Rebello, Hitesh Shah, Benjamin Joseph","doi":"10.1097/BPO.0000000000003100","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003100","url":null,"abstract":"<p><p>One of the greatest German Renaissance artists, Albrecht Dürer, noted for his realistic works of art, painted and engraved the Christ child and Eve with characteristic postures of the upper limb resembling the sequel of Erb palsy. However, there is no Biblical evidence to suggest that the Christ child or Eve had paralysis of the upper limb. It appears conjectural as to why Dürer chose to depict the limbs of his subjects in this manner.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251500","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":"Differential Effects of Lower Extremity Length Discrepancy on Functional and Structural Scoliosis: Coronal and Sagittal Plane Analysis.","authors":"Yifan Huang, Yi Zhang, Jie Chang, Feng Han, Xiangshui Sun","doi":"10.1097/BPO.0000000000003130","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003130","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity length discrepancy (LELD) is closely associated with spinal imbalances such as pelvic tilt and functional scoliosis. While existing studies have focused on LELD-induced coronal compensations, its impact on sagittal spinal balance remains poorly understood. The aim of the current study was to investigate the differential effects of LELD on coronal and sagittal spinal balance in adolescents with functional versus structural scoliosis.</p><p><strong>Methods: </strong>A retrospective analysis of 211 patients was conducted. Participants were stratified into functional (n=165) or structural scoliosis (n=46) groups based on pelvic and lumbar correction with limb elevation. Radiographic parameters included coronal and sagittal measures. Statistical analyses compared groups and assessed correlations.</p><p><strong>Results: </strong>Structural scoliosis exhibited significantly worse coronal imbalance (higher sacral obliquity, lumbar Cobb angle, and coronal balance distance; P<0.001) and greater sagittal vertical axis (SVA; P<0.05). LELD correlated with coronal parameters in functional scoliosis (P<0.05) but not structural cases. Sagittal balance parameters (pelvic tilt, sacral slope) showed no LELD association, though SVA correlated with coronal imbalance only in functional scoliosis (P<0.05). Roussouly's sagittal classification did not differ between groups.</p><p><strong>Conclusions: </strong>LELD primarily drives compensatory coronal changes, with minimal sagittal impact. Structural scoliosis demonstrates worse coronal imbalance and elevated SVA, suggesting distinct compensatory mechanisms. Functional cases may benefit from LELD correction, while structural scoliosis requires sagittal evaluation during surgical planning. These findings highlight the importance of prioritizing coronal alignment in LELD-related scoliosis management.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238978","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":"Infection Risk Following Orthopaedic Sports Knee Surgery is Greater in Pediatric Patients With Allergic Disease History.","authors":"Anagh Astavans, Kyung J Park, Sudarsan Murali, Rushyuan Jay Lee","doi":"10.1097/BPO.0000000000003126","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003126","url":null,"abstract":"<p><strong>Background: </strong>Allergic diseases are common in children and are risk factors for infections following orthopaedic surgery. However, their association with infection risk following knee surgery in pediatric populations is unknown. This study compared the risks of postoperative infection in children with and without a history of allergic disease (eczema [atopic dermatitis] or asthma) who underwent common orthopaedic sports knee surgeries.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX database. Patients aged 10 to 18 who underwent anterior cruciate ligament (ACL) reconstruction (ACLR) or meniscal surgery, including meniscectomy, meniscal repair, and meniscal transplant, were organized into separate cohorts based on prior history of asthma or eczema and matched based on demographics and comorbidities. Outcomes were 90-day postoperative superficial soft tissue infection (SSTI), deep soft tissue infection (DSTI), sepsis, wound complication, pneumonia, urinary tract infection (UTI), and emergency department (ED) visit risks. Tests of significance (alpha=0.05) were performed, and risk ratios (RRs) with 95% confidence intervals were calculated.</p><p><strong>Results: </strong>Patients with allergic diseases were more likely to be African American and obese. The risks of SSTI (1.3% vs. 0.4%; RR=3.182; P=0.0004) and sepsis (0.4% vs. 0%; P=0.002) in ACLR patients, and risks of SSTI (1.0% vs. 0.3%; RR=3.2; P=0.0007) and pneumonia (0.4% vs. 0%; P=0.0005) in meniscus surgery patients, were higher in patients with a history of eczema than without. Asthma was associated with a greater likelihood of SSTI (1.1% vs. 0.5%; RR=2.067; P=0.02) and sepsis (0.4% vs. 0%; P=0.002) in patients undergoing ACLR but not meniscus surgery. Prior diagnosis of either disease was associated with increased risk for ED visits following both ACLR and meniscus surgery. No significant differences in risk rates were noted between cohorts for DSTI, wound complications, and UTI.</p><p><strong>Conclusions: </strong>Although overall risks were low, there were significantly greater risks of SSTI and ED visits following common knee sports surgeries in pediatric patients with a history of allergic disease than in those without.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239001","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":"First Assistant Training Level Does Not Impact Postoperative Outcomes and Complications Following Varus Derotational Osteotomy in Patients With Cerebral Palsy.","authors":"Amith Umesh, Mathangi Sridharan, Gabrielle Noullet, Aura M Elias, Charlotte F Wahle, Michaela L Juels, Nakul Talathi, Rachel M Thompson","doi":"10.1097/BPO.0000000000003119","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003119","url":null,"abstract":"<p><strong>Introduction: </strong>The influence of the first assistant's training level on outcomes of orthopaedic surgery in children with cerebral palsy (CP) remains unknown. As such, this study aims to evaluate the effects of first assistant training level (resident vs. fellow) on perioperative and postoperative outcomes following proximal femoral varus derotational osteotomy (VDRO) in children with CP.</p><p><strong>Methods: </strong>Pediatric patients (age <18 y) with CP who underwent VDRO by a single fellowship-trained pediatric orthopaedic surgeon between 2017 and 2021 were retrospectively reviewed. Patients with a minimum of 2-year follow-up were included. Demographic data, training level of first assistant, and perioperative surgical characteristics (operative time, operating room time, estimated blood loss, length of stay, and peri- and postoperative complications) were recorded. Acute complications (≤ 90 d postoperatively) included medical complications, surgical site infection (SSI), peri-prosthetic fractures, emergency department visits, hospital readmission, and revision surgery. Long-term complications (>90 d postoperatively) included delayed/nonunion, re-subluxation, SSI, symptomatic hardware, and revision surgery. Preoperative and minimum 1-year postoperative migration percentages (MPs) were collected. t tests, χ2 test, and Fisher exact test were used to detect differences between complication rates and outcomes between resident-assisted (group A) and fellow-assisted (group B) cases.</p><p><strong>Results: </strong>Sixty-nine patients were included for analysis (group A: 27; group B: 42). Demographic data, medical comorbidities, and surgical complexity were comparable between groups. Perioperative surgical characteristics, acute complications, and long-term complications were equivalent between groups (P>0.05). Minimum 1-year postoperative MPs were lower in group A than group B (1% vs. 7.5%, P<0.001). No patients had MP≥40% at 1-year postoperatively in either group.</p><p><strong>Conclusion: </strong>Despite the high surgical and medical complexity of osseous hip reconstructions for children with CP, postoperative outcomes are not impacted by the first assistant's training level. While postoperative MPs were slightly lower for patients in the resident-assisted group, these differences were not clinically significant, and 1-year radiographic outcomes were comparable. Resident surgeons should be encouraged to participate in VDRO cases, and families should be reassured that resident participation will not negatively affect outcomes.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232852","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}