Journal of Pediatric Orthopaedics最新文献

{"title":"The Duration of Pavlik Harness Wear Following Successful Reduction of Dislocated Hips Does Not Play a Role in Determining Radiographic Dysplasia at 2 Years.","authors":"Rishi Sinha, Matthew Siebert, Hannah Worrall, Chan-Hee Jo, William Z Morris, Harry Kim, Laura Mayfield, Daniel J Sucato","doi":"10.1097/BPO.0000000000003425","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003425","url":null,"abstract":"<p><strong>Background: </strong>Though the Pavlik harness is often used to reduce dislocated hips in infants with developmental dysplasia of the hip (DDH), residual acetabular dysplasia may occur following reduction. It is unclear whether patient or treatment-related factors, including Pavlik wear duration, are associated with residual dysplasia. As a result, there is considerable variability in treatment practices using the harness. The purpose of this study was to determine whether the duration of Pavlik wear predicts radiographic success at 2-year follow-up for newborns with successfully reduced hips.</p><p><strong>Methods: </strong>Consecutive newborns referred to a single tertiary academic center for concerns of idiopathic DDH were prospectively enrolled between 2008 and 2019. Patients with an Ortolani-positive or fixed dislocated hip reduced with a Pavlik harness were included. Residual acetabular dysplasia was defined as an acetabular index (AI) at 2-year follow-up greater than or equal to the 90th percentile of the normative AI value for age. Associations were investigated between baseline clinical characteristics, including duration of Pavlik wear, and residual dysplasia.</p><p><strong>Results: </strong>Fifty-five patients (64 hips) were included. Forty-seven were female, 35 first-born, 21 born breech, and 8 with a family history of DDH. Age at initiation of harness was 3.8±4.8 weeks, with average duration of wear of 11.8±4.4 weeks. At 2-year follow-up, 7 patients (8 out of 64 hips) had residual dysplasia with an average AI of 30.0±3.0 degrees. There was no significant difference in duration of wear between hips that developed residual dysplasia and normal hips at 2-year follow-up (13.2±4.9 vs. 11.9±4.4 wk, P=0.45). None of the traditional risk factors for DDH (female sex, first-born, breech presentation, and family history of DDH) were found to be associated with residual dysplasia.</p><p><strong>Conclusions: </strong>In a cohort of primarily Ortolani-positive and fixed dislocated hips (n=5) reduced with a Pavlik harness, duration of Pavlik wear was not found to be associated with residual dysplasia at 2-year follow-up. A total of 12 weeks in the harness was associated with a relatively low rate of dysplasia. Traditional risk factors for DDH were not associated with residual dysplasia.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"46 9","pages":"556-561"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912589","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":"Safe, Satisfied, and Home Early: Patient-Reported Outcomes of Next-Day Discharge Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.","authors":"Alyssa Barré, Andrew Kirk, Vincent Prusick, Shelby White, Ryan Muchow","doi":"10.1097/BPO.0000000000003493","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003493","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery pathways have enabled shorter hospitalizations following posterior spinal instrumented fusion (PSIF) for adolescent idiopathic scoliosis (AIS), including next-day discharge (NDD). Although NDD has demonstrated favorable safety outcomes, its impact on patient-reported outcomes (PROs) remains unknown. This study compared postoperative PROs between patients discharged on postoperative day 1 and those with longer hospitalizations and secondarily evaluated whether preoperative PRO measures were associated with successful NDD.</p><p><strong>Methods: </strong>A retrospective secondary analysis was performed of a previously published cohort of AIS patients aged 10 to 18 years who underwent primary posterior-only PSIF between 2017 and 2022 with a standard intra- and postoperative care pathway. Prospectively collected preoperative and 6-month postoperative PROs included Scoliosis Research Society (SRS)-22r, Spinal Appearance Questionnaire (SAQ), and PRO Measurement Information System (PROMIS) domains. Patients were grouped by discharge status: NDD (postoperative day 1) and postoperative day >2 (POD>2). Group comparisons and Spearman correlation analyses were performed.</p><p><strong>Results: </strong>Of 111 eligible surgical patients, 91 had analyzable PRO data (32 NDD, 59 POD>2). Mean age was 14.3 years (range: 11 to 18), 77% (n=85) were female, and 35% (n=39) were discharged on POD1. No significant differences existed between groups in demographic, radiographic, or perioperative characteristics. Preoperative SRS-22r, SAQ, and PROMIS scores did not differ between groups, and no significant associations were identified between baseline PROs and length of stay. Postoperatively, there were no significant between-group differences in SAQ, SRS-22r function, pain, self-image, mental health, or PROMIS domains. Satisfaction scores were slightly higher in POD>2 patients (4.7 vs. 4.4, P=0.04); however, the magnitude of difference (0.3) was below established minimally clinically important difference thresholds. Both groups demonstrated significant postoperative improvement across PRO measures. Length of stay demonstrated a modest positive correlation with postoperative SRS-22r Function (rs=0.34, adjusted P=0.042).</p><p><strong>Conclusions: </strong>Patients discharged on POD1 following PSIF for AIS demonstrated short-term postoperative PROs comparable to patients with longer hospitalizations. Baseline SRS-22r, SAQ, and PROMIS measures were not associated with successful NDD. Accelerated discharge pathways may preserve patient-perceived recovery while maintaining previously demonstrated safety benefits.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075150","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":"Vitamin D Status, Supplementation and Radiographic Healing in Pediatric Both-Bone Forearm Fractures: A Prospective Controlled Study.","authors":"Emin C Balcı, Dilara Karakaş Balcı, Muhammed Uslu, Yiğit Önaloğlu, Anıl Şüküroğlu, Sait Küçükberber, Serdar Biber, Sidar Güneş, Oktay Adanır","doi":"10.1097/BPO.0000000000003492","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003492","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D plays an essential role in skeletal mineralization and fracture repair, yet its influence on fracture healing in children remains incompletely understood. The aim of this study was to evaluate the relationship between vitamin D status, fracture occurrence, radiographic healing progression, and different supplementation protocols in pediatric both-bone forearm fractures.</p><p><strong>Methods: </strong>This prospective controlled study included 151 children aged 5-12 years with conservatively treated both-bone forearm shaft fractures and 140 healthy age-matched controls. Baseline serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured in all participants. Fracture patients with suboptimal vitamin D levels (<30 ng/mL) received either standard-dose (1000 IU/d, n=109) or high-dose (2000 IU/d, n=33) oral cholecalciferol for 12 weeks. Fracture healing was assessed radiographically using serial modified Radiographic Union Score for Tibial fractures (mRUST) measurements obtained at 4, 6, and 12 weeks.</p><p><strong>Results: </strong>Mean baseline vitamin D levels were similar between fracture and control groups (13.96±7.85 vs. 15.46±6.91 ng/mL, P=0.086), although severe vitamin D deficiency was significantly more prevalent in fracture patients (25.2% vs. 8.6%, P<0.001). Patients with vitamin D levels <20 ng/mL demonstrated significantly lower 12-week union rates compared with patients with levels ≥20 ng/mL (48.9% vs. 80.3%, P<0.001). High-dose supplementation was associated with significantly higher union rates (78.8% vs. 57.8%, P=0.029) and higher final mRUST scores (13.82±1.41 vs. 12.96±1.87, P=0.016). Baseline vitamin D concentration independently predicted fracture union (OR=1.15, P<0.001).</p><p><strong>Conclusion: </strong>Vitamin D status appears to influence fracture healing progression in pediatric forearm fractures. Lower vitamin D levels were associated with delayed radiographic healing, while higher-dose supplementation was associated with more favorable healing outcomes. Early identification and correction of vitamin D deficiency may represent a potentially modifiable factor in optimizing pediatric fracture healing.</p><p><strong>Level of evidence: </strong>Level III, -prospective comparative therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069886","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":"Radiologic Sequelae of Pediatric Septic Arthritis of the Shoulder: A Retrospective Series and Proposed Classification.","authors":"Anil Agarwal, Md Zafar Iqbal, Shivank Khurana, Mannan Gupta, Sagarika Sahoo, Aakash Deep","doi":"10.1097/BPO.0000000000003483","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003483","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the long-term radiologic sequelae of pediatric septic arthritis of the shoulder and identify characteristic patterns of residual proximal humeral deformity.</p><p><strong>Methods: </strong>A retrospective review was performed of children treated for septic arthritis of the shoulder at a tertiary pediatric orthopaedic center between 2010 and 2024. Inclusion criteria were confirmed septic shoulder, complete radiographic records, and a minimum 2-year follow-up. Radiographs at final follow-up were analyzed for epiphyseal, physeal, and articular abnormalities, and sequelae were classified according to severity and anatomic involvement.</p><p><strong>Results: </strong>Twenty-three children were included, with a mean age at presentation of 31.7 months and a mean follow-up of 6.2 years. Twelve children presented during infancy, including 5 neonates. Multifocal musculoskeletal infection was present in 43.5%, and associated proximal humeral osteomyelitis in 52.2%. Methicillin-resistant Staphylococcus aureus was the most commonly isolated organism (39.1%). Radiologic sequelae were classified into 4 types: type I, complete recovery (17.4%); type II, epiphyseal irregularity/dysplasia (17.4%); type III, physeal arrest/bar formation (47.8%); and type IV, articular destruction/proximal humeral loss (17.3%). Neonates and children with multifocal infection more frequently developed severe type III/IV sequelae.</p><p><strong>Conclusion: </strong>Septic arthritis of the pediatric shoulder is associated with a high risk of permanent growth-related deformity, particularly in neonates and infants. Physeal injury is the most predominant long-term sequela. The proposed radiologic classification may aid prognostication, follow-up, and surgical planning in affected children.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069842","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":"Complications of Implant Removal of Pediatric Femoral Shaft Fractures.","authors":"Andreas Rehm, Jessica Treves, Ignatius Liew, John E Lawrence, Victoria Stohlner, Kenechukwu Igboebisi","doi":"10.1097/BPO.0000000000003496","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003496","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069835","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":"Reassessing the Kocher Criteria: A Prospective Evaluation of Diagnostic Performance in Pediatric Musculoskeletal Infection.","authors":"Gabrielle A Rogie, Edward M Barksdale, Hilton C Braithwaite, Michelle Mo, David Clever, Nichelle Enata, Kirsten Brouillet, Kim Quayle, Scott J Luhmann","doi":"10.1097/BPO.0000000000003481","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003481","url":null,"abstract":"<p><strong>Background: </strong>The Kocher criteria are widely used to differentiate septic arthritis (SA) from transient synovitis (TS) in children. However, diagnostic performance has since been proven to be inconsistent. Furthermore, the criteria were originally developed to distinguish SA from TS and have not been validated for differentiating osteomyelitis (OM), which frequently presents with overlapping clinical features. The purpose of this prospective study was to evaluate the diagnostic performance of the Kocher criteria and other clinical variables in differentiating SA from both TS and OM.</p><p><strong>Methods: </strong>A prospective cohort study of 102 pediatric patients (ages 0 to 18 y) presenting with suspected musculoskeletal infection was performed. Patients were categorized into 3 groups: TS (n=42), OM (n=30), and SA (n=30). Clinical variables, laboratory biomarkers (C-reactive protein, erythrocyte sedimentation rate, white blood cell count), and Kocher criteria were analyzed. Clinical, laboratory, and Kocher variables were compared across groups using appropriate univariate analyses and linear regression modeling, with P<0.05 being considered significant.</p><p><strong>Results: </strong>Patients with SA and OM demonstrated significantly elevated inflammatory markers compared with TS, including C-reactive protein and erythrocyte sedimentation rate (both P<0.001). White blood cell count demonstrated weaker discriminatory ability (P=0.041). Tenderness to palpation and erythema were significantly more common in SA and OM than in TS (both P<0.001). Among patients with SA and TS only, the probability of SA increased from 9.5% with 0 criteria to 65% with 2 criteria, then plateaued at 66.7% with 3 or 4 criteria. When OM was included in the analysis, substantial overlap in the Kocher score distribution was observed between SA and OM. Notably, among patients meeting two criteria, SA and OM each accounted for 39.4% of diagnoses. No significant difference in Kocher criteria burden was identified between SA and OM cohorts (P=0.874). Hip-specific subgroup analysis demonstrated improved discriminatory performance, with no cases of SA or OM identified among patients meeting zero criteria.</p><p><strong>Conclusions: </strong>The Kocher criteria demonstrated moderate utility in distinguishing SA from TS but poor specificity for differentiating SA from OM because of substantial overlap in clinical presentation and inflammatory markers. The historically reported predictive performance of the Kocher criteria was not reproducible in this prospective cohort. The identified diagnostic plateau at ≥2 criteria suggests these scores should serve as an indicator for advanced imaging (magnetic resonance imaging) rather than a definitive surgical algorithm.</p><p><strong>Level of evidence: </strong>Level III (prospective cohort study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069818","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":"Comment on 'Provision of Video Education Instead of an In-Person Visit for Pediatric Buckle Fractures: A Randomized Controlled Trial'.","authors":"Rohit K Yadav","doi":"10.1097/BPO.0000000000003489","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003489","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025203","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":"Comments on \"Is Susceptibility to Slipped Capital Femoral Epiphysis Linked to Obesity-associated Proximal Femoral Morphology?\"","authors":"Rohit Kumar Yadav","doi":"10.1097/BPO.0000000000003485","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003485","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025192","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":"Presentation of Limping Among Preschool Children in the Orthopaedic Clinic: Epidemiology and Risk Factors.","authors":"Orhun Çelik, Yunus Elmas","doi":"10.1097/BPO.0000000000003486","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003486","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025208","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":"Comments on 'Redefining Orthopaedic Expectations of Pediatric Fracture Reductions Performed in Hybrid Emergency Departments'.","authors":"Rohit K Yadav","doi":"10.1097/BPO.0000000000003487","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003487","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017159","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}