Journal of Pediatric Orthopaedics最新文献

{"title":"Treatment Trends in Symbrachydactyly: Surgical Management in Milder Cases and Nonoperative Treatment in Severe Ones.","authors":"Sergio Martínez-Álvarez, María Galán-Olleros, Sarah Toledo-García, Jaime Garcia-Fernandez, Isabel Vara-Patudo, Ángel Palazón-Quevedo","doi":"10.1097/BPO.0000000000003029","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003029","url":null,"abstract":"<p><strong>Introduction: </strong>Symbrachydactyly is a unilateral hand abnormality characterized by incomplete finger formation and rudimentary nubbins containing nail plate, bone, and cartilage. Surgical intervention typically targets web space contractures, digit instability, and pincer dysfunction. This study examines the relationship between the severity of symbrachydactyly and the choice of operative or nonoperative approaches.</p><p><strong>Methods: </strong>A retrospective comparative analysis was conducted on patients diagnosed with symbrachydactyly at a pediatric referral center from 2005 to 2024. Collected data included demographics (age, sex, laterality), familial factors (congenital malformations, miscarriage history), medical history (associated syndromes, pregnancy complications), clinical and radiologic details of hand abnormalities (side, Blauth and Foucher classifications), and treatment modalities. Descriptive, comparative, and correlation analyses were performed across treatment groups.</p><p><strong>Results: </strong>A total of 80 patients were analyzed (median age: 5.32 y, IQR: 1.8 to 8.8), including 47 males (58.8%) and 52 patients (65.0%) with left-sided involvement. Nonoperative treatment was provided to 61 patients (76.3%), while 19 (23.8%) underwent surgical interventions. Among the nonoperatively treated patients, 9 (14.8%) received prostheses. Prosthesis use was significantly associated with higher severity in the Blauth and Foucher classifications (P<0.001). No significant differences in the Blauth (P=0.14) and Foucher (P=0.22) classifications were observed between nonoperative and surgical groups. The Blauth and Foucher classifications showed no significant associations with syndromic involvement, pregnancy complications, miscarriage history, or in vitro fertilization (P>0.05). A correlation analysis showed that more severe involvement in both classifications was statistically associated with a higher likelihood of nonoperative management: Blauth (r=-0.253, P=0.031) and Foucher (r=-0.243, P=0.038).</p><p><strong>Conclusions: </strong>This study demonstrates that surgical interventions benefit patients with milder forms of symbrachydactyly, while patients with more severe manifestations typically receive nonoperative management, including prosthetic solutions.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285037","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 Impact of Verbal Status on Postoperative Outcomes Following Proximal Femur Varus Derotational Osteotomy in Children With Cerebral Palsy.","authors":"Michaela Juels, Charlotte Wahle, Mathangi Sridharan, Aura Elias, Amith Umesh, Alexander Rueda, Nakul Talathi, Rachel Thompson","doi":"10.1097/BPO.0000000000003031","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003031","url":null,"abstract":"<p><strong>Background: </strong>In addition to physical disabilities, children with cerebral palsy (CP) often have concomitant nonphysical disabilities and associated medical comorbidities. Verbal disabilities are common and can affect both independence and communication, particularly in hospital settings, potentially impacting surgical outcomes. This study evaluates how verbal status affects postoperative outcomes of proximal femur varus derotational osteotomy (VDRO).</p><p><strong>Methods: </strong>A retrospective review of pediatric patients with CP who underwent VDRO for hip subluxation/dislocation between 2017 and 2021 at a single tertiary care institution was completed. Demographic data, including age, weight, height, BMI, sex, race/ethnicity, insurance status, Gross Motor Function Classification System (GMFCS), and verbal status was recorded. Outcome variables included acute complications occurring within 90 days after surgery and delayed complications occurring >90 days postoperatively. Acute complications included emergency department (ED) visits, readmissions, reoperations, deep surgical-site infections, and medical complications such as pneumonia, atelectasis, and gastrointestinal bleeds. Delayed complications included delayed union, re-subluxation/dislocation, nonunion, painful hardware, and superficial surgical-site infection. Descriptive statistics, 2-sample t tests, and multiple regression analyses were performed.</p><p><strong>Results: </strong>Seventy-two patients were included for analysis, 26 (35.1%) of whom were verbal and 46 (63.9%) nonverbal. In unadjusted analysis, nonverbal status was associated with higher rates of acute complications [OR=14.29, 95% CI (3.26, 64.83), P<0.0001] and increased ED visits [OR=7.86, 95% CI (1.17, 87.78), P=0.05] compared with verbal patients. However, after adjusting for GMFCS, these associations were no longer statistically significant. Conversely, after controlling for GMFCS, nonverbal patients were at significantly lower risk of experiencing delayed complications [OR=0.07, 95% CI (0.01, 0.36), P=0.0010] and painful hardware [OR=0.07, 95% CI (0.01, 0.33), P=0.0010] compared with verbal patients.</p><p><strong>Conclusion: </strong>Verbal status plays a significant role in postoperative outcomes for children with CP undergoing VDRO. Nonverbal patients are at higher risk for acute complications, while verbal patients are more likely to present for delayed complications. These findings reinforce the need for enhanced communication strategies and vigilant postoperative monitoring in this particularly vulnerable population.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285036","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":"Do Social Determinants of Health Impact the Initial Evaluation and Management of Pediatric Patients With First-Time Patellofemoral Dislocation?","authors":"Casey C Kuka, David M Kell, Caroline L Kim, Kevin J Orellana, Brendon C Mitchell, Elliot M Greenberg, Sulagna Sarkar, Neeraj M Patel, Brendan A Williams","doi":"10.1097/BPO.0000000000003025","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003025","url":null,"abstract":"<p><strong>Background: </strong>Under-resourced communities face greater barriers to care. However, this relationship is not well-defined in the management of patellofemoral instability. We hypothesized that pediatric patients from under-resourced neighborhoods and those with public insurance would experience delays in care for first-time patellofemoral dislocation.</p><p><strong>Methods: </strong>A retrospective cohort study was performed of patients younger than or equal to 18 years evaluated at a single institution after a first-time patellofemoral dislocation between 2011 and 2022. Demographic, clinical, and radiographic characteristics were collected. Neighborhood conditions were categorized using the Child Opportunity Index (COI). Time from injury to presentation, magnetic resonance imaging (MRI), and physical therapy (PT) initiation were compared across COI categories and insurance types.</p><p><strong>Results: </strong>Three hundred seventy-five patients with first-time patellofemoral dislocation met inclusion criteria. Injuries occurred at a mean age of 14.2±2.1 years, with a majority occurring in female patients (55%). Time to evaluation by orthopaedic provider was longer in patients with very low COI (8.4 vs. 5.6 d for very high COI patients, P<0.001) and those with public insurance (7.4 vs. 6.1 d in those with private insurance, P=0.001). Time to MRI was also longer in patients with very low COI (mean 18.6 vs. 11.2 d in the very high group, P<0.001) and those with public insurance (mean 17.4 d vs. 12.5 d in those with private insurance, P<0.001). Time to initial PT evaluation was longer in patients of very low COI (67.0 d vs 39.4 in the very high group, P=0.02) and in patients with public insurance (49.5 vs 47.5 d in those with private insurance, P=0.03).</p><p><strong>Conclusion: </strong>Neighborhood resources and insurance are associated with statistically significant delays across multiple phases of care for pediatric patients with first-time patellar dislocation. The specific mechanisms underlying these disparities and the clinical significance of these delays require further evaluation. Efforts should be made to develop interventions that address these barriers and providers should be aware of these inequities.</p><p><strong>Levels of evidence: </strong>Level III (retrospective comparative study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248461","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":"Tumors and Tumor-like Lesions of the Pediatric Hand and Wrist: Clinical Presentation and Risk Factors for Malignancy.","authors":"Akbar N Syed, David Kell, Alexandre Arkader, Sulagna Sarkar, Pille-Riin Värk, Apurva S Shah","doi":"10.1097/BPO.0000000000003017","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003017","url":null,"abstract":"<p><strong>Background: </strong>Malignant tumors of the pediatric hand and wrist are rare. We hypothesize that pain, large size, and palm/wrist location are risk factors for malignancy in children.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients younger than 18.9 years of age presenting to our institution with hand and wrist tumors or tumor-like lesions over a 15-year period. Patients with skin lesions, commonly encountered subcutaneous masses (lipomas, ganglion cysts, and sebaceous cysts), multiple hereditary exostoses, and Ollier disease were excluded. Data collection included demographics, clinical presentation, imaging features, and surgical management. Risk factors for malignancy were determined using receiver operating characteristic and descriptive statistical analysis.</p><p><strong>Results: </strong>Three hundred twenty-seven tumors and tumor-like lesions were identified in 312 patients, with a mean age of 10.1 ± 4.6 years. Three hundred fifteen (96.3%) lesions were benign, and 12 (3.7%) lesions were malignant. The most common benign bone tumors were osteochondromas (75/160, 46.9%) and enchondromas (50/160, 31.3%), while the most common benign soft-tissue masses were vascular malformations (39/155, 25.2%) and giant cell tumors of the tendon sheath (30/155, 19.3%). The most common location was the digit. All malignant tumors (3 bone, 9 soft tissue) were in either the palm or wrist. Epithelioid sarcoma (4/9) and synovial sarcoma (2/9) were the most common soft-tissue malignancies, and osteosarcoma (3/3) was the only identified malignant bone tumor. Overall, the most common presenting complaints were swelling (63%) and pain (19.9%). Bivariate analysis found size >11.4 mm and palm/wrist location as risk factors for malignancy. Based on ROC analysis, age and pain ratings were poor predictors of malignancy. Among bone tumors, an aggressive zone of transition, periosteal reaction, and cortical destruction were significant radiographic risk factors for malignancy.</p><p><strong>Conclusions: </strong>The most common tumors and tumor-like conditions of the pediatric hand and wrist include osteochondromas, enchondromas, vascular malformations, and giant cell tumors of the tendon sheath. Larger tumors (>11.4 mm) and lesions found in the palm/wrist are more likely to represent malignancies and should be approached with caution.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248462","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":"Do Rib-Based Anchors Impair Chest Wall Motion in Early Onset Scoliosis? - A Novel Investigation via Dynamic MRI.","authors":"Yubing Tong, Jayaram K Udupa, Joseph M McDonough, Lipeng Xie, Caiyun Wu, Yusuf Akhtar, Mahdie Hosseini, Mostafa Alnoury, Shiva Shaghaghi, Samantha Gogel, David M Biko, Oscar H Mayer, Drew A Torigian, Patrick J Cahill, Jason B Anari","doi":"10.1097/BPO.0000000000003015","DOIUrl":"10.1097/BPO.0000000000003015","url":null,"abstract":"<p><strong>Background: </strong>There is a concern in pediatric spine surgical practice that rib-based fixation may limit chest wall motion in early onset scoliosis (EOS). The purpose of this study is to assess the contribution of chest wall excursion to respiration before and after growth-friendly surgery.</p><p><strong>Methods: </strong>Quantitative dynamic magnetic resonance imaging (QdMRI) is performed on 49 EOS patients (before and after surgery) and 191 normal children in this retrospective study. QdMRI is an image-based approach and allows for free-breathing image acquisition. Tidal volume parameters for chest walls (CWtv) and hemidiaphragms (Dtv) were analyzed on the concave and convex sides of the spinal deformity. EOS patients (1 to 14 y) and normal children (5 to 18 y) were enrolled, with an average interval of 2 years for dMRI acquisition before and after surgery.</p><p><strong>Results: </strong>CWtv significantly increased after surgery in all EOS patients (P<0.05) by 51% for left CWtv and 41% for right CWtv without age correction, and 17% for LCWtv and 25% for right CWtv with age correction, respectively. For main thoracic curve (MTC) EOS patients, CWtv significantly improved after surgery by 50% (concave side) and 35% (convex side) after age correction (P<0.05). The average ratio of Dtv to CWtv on the convex side in MTC EOS patients was not significantly different from that in normal children (P=0.78). However, the concave side showed the difference to be significant (P=0.019).</p><p><strong>Conclusion: </strong>Chest wall component tidal volumes in EOS patients measured through QdMRI did not decrease after rib-based surgery, suggesting that rib-based fixation does not impair chest wall motion in pediatric patients with EOS. The proposed QdMRI method can be used to quantify the motion of the individual 3D chest wall and diaphragm before and after surgery, to assess deviations from normality, and to quantify alterations due to corrective surgery in EOS.</p><p><strong>Level of evidence: </strong>Level III evidence-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248460","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 Mini-invasive Medial Approach is Safe for Cross-pinning in Pediatric Supracondylar Humerus Fractures When Performed by Resident Surgeons-A Retrospective Cohort Study.","authors":"Dan Sandbæk, Leonore Wünsche, Vera Halvorsen, Jan Erik Madsen, Jan Egil Brattgjerd","doi":"10.1097/BPO.0000000000003011","DOIUrl":"10.1097/BPO.0000000000003011","url":null,"abstract":"<p><strong>Background and purpose: </strong>In the treatment of pediatric supracondylar humerus fractures (SCHF), cross-pinning increases the risk of ulnar nerve injuries due to a misplaced medial pin. However, the extent to which the use of a mini-invasive approach medially may lead to safe cross-pinning remains unclear. Accordingly, we evaluated the safety of a mini-invasive medial approach in the hands of resident surgeons, who most commonly perform surgery on these patients.</p><p><strong>Methods: </strong>We retrospectively analyzed iatrogenic injury rate to the ulnar nerve in children operated between 2017 and 2021. Patient, fracture, and treatment details were collected from medical records and followed a predefined protocol. 211 children with an extension-type SCHF, who were treated with an open or closed reduction before pinning, were identified. Patients with preoperative nerve injuries, concurrently operated fracture in the same arm, pin configurations other than 2 or 3 crossed pins, or surgeries conducted by an attending surgeon, were excluded. Our institutional practice of cross-pinning with a mini-invasive medial approach to a semiflexed elbow was performed by residents in orthopaedic surgery in 167 patients.</p><p><strong>Results: </strong>No iatrogenic ulnar nerve motor injuries were found. Three out of 167 patients experienced transient sensory changes to the ulnar nerve, all resolving within the first week. In every procedure, the lead surgeon was a resident.</p><p><strong>Conclusion: </strong>Our results indicate that the mini-invasive medial approach is safe in the hands of resident surgeons for cross-pinning in pediatric SCHF. This finding suggests that iatrogenic ulnar nerve injuries may be prevented by performing mini-invasive medial pinning in a semiflexed elbow.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150839","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":"Neonatal Physeal Fracture​​​​​: What Treatment?","authors":"Jade Burnouf, Lys Budiartha, Xavier du Cluzel de Remaurin, Edouard Haumont, Nicolas Vinit, Stephanie Pannier, Eric Desailly, Alina Badina","doi":"10.1097/BPO.0000000000003024","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003024","url":null,"abstract":"<p><strong>Background: </strong>The management of diaphyseal fractures in newborns is well established as conservative, involving immobilization without reduction. Newborn physeal fractures (NPF) are rarer lesions, and their management is poorly codified. In the literature, treatment varies from simple monitoring to surgical reduction and osteosynthesis. The aim of this study was to describe the long-term evolution of NPFs according to their location and initial management, and to establish treatment guidelines.</p><p><strong>Methods: </strong>The first part of the study involved a systematic review of the literature according to PRISMA criteria. For the selected articles, patients were analyzed individually. For each patient, fracture location, time to treatment, type of treatment, and complications were recorded. Complications were classified as \"minor\" and \"major.\" The second part of the study involved the collection of patients with NPF managed in our department. The same data were recorded.</p><p><strong>Results: </strong>A total of 28 studies were selected. A total of 108 fractures (including 17 from our series) were analyzed. The most frequent locations were distal humerus (46%), proximal femur (27%), distal femur (13%), and proximal humerus (9%). Treatment was surgical for 17% of fractures. Considering the entire series, we found no significant relationship between the type of treatment and the complication rate. The most complication-prone site was the distal femur. However, these complications were primarily radiologic, with minimal clinical impact. They corrected progressively with growth. No patient required a long-term surgical procedure. No epiphysiodesis was reported.</p><p><strong>Conclusion: </strong>NPF has a favorable long-term outcome, irrespective of the type of treatment. We recommend that simple immobilization be the preferred treatment option. However, for distal femur fractures, reduction and possibly osteosynthesis should be considered due to the very slow correction of femoral deformities associated with orthopaedic treatment.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199451","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":"Opioid Prescription Patterns 30 Days After Pediatric Supracondylar Humerus Fracture Closed Reduction and Percutaneous Pinning: 2010 to 2021.","authors":"Jack M Haglin, David G Deckey, Tony Gaidici, Daniel R Gaines, Judson W Karlen, Jessica D Burns","doi":"10.1097/BPO.0000000000002993","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002993","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus fractures (SCH) are the most common type of elbow fracture in children, with many cases requiring surgery. Treatment of postoperative pain for SCH has high variability, but can often be treated effectively with minimal or no opioids. Furthermore, there is significant morbidity related to pediatric opioid consumption. The goal of this study was to characterize prescription patterns in the United States following closed reduction and percutaneous pinning (CRPP) of SCH.</p><p><strong>Methods: </strong>All patients aged 10 or younger years who underwent CRPP of SCH from January 2010 to December 2021 were identified in the PearlDiver Mariner Claims Database. The primary outcome was postoperative pain medication prescriptions in the 30 days following SCH CRPP. Patient demographics, prescription duration, and morphine milligram equivalents (MME) were analyzed. Multivariable-log-binomial mixed regression models were constructed to assess factors associated with increased opioid prescription.</p><p><strong>Results: </strong>In total, 43,611 SCH CRPP cases in patients aged 10 or younger were identified from 2010 to 2021. Throughout the study period, 48.6% of patients (21,191/43,611) received and filled a narcotic pain prescription. The percentage of patients receiving opioid medication decreased from 54.7% in 2010 to 27.4% in 2021. Opioid prescriptions totaled a mean of 6.1±2.1 days of narcotics with a mean of 79.2 MME prescribed per patient. Increased patient age, increased Elixhauser comorbidity index, and Medicaid insurance were all associated with increased opioid prescription (P<0.001). Living in the Northeast, increased family income, and commercial insurance were associated with decreased opioid prescriptions (P<0.001).</p><p><strong>Conclusions: </strong>Nearly half of the patients over the past decade treated with CRPP for SCH received a narcotic prescription. However, there has been a steady decline in the proportion of patients being prescribed opioids, with only 27.4% receiving opioids in 2021. Further, patients with increased comorbidities or those insured by Medicaid with lower mean family income may be at risk for increased opioid prescription. While efforts have been made to reduce opioid overprescribing, there continues to be room for further reduction in opioid utilization after CRPP for SCH moving forward.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199452","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 \"Similar Return-to-Sports After Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair in Skeletally Immature Patients\".","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1097/BPO.0000000000003006","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003006","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199450","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":"Strength Recovery from Nonsurgical Treatment of Apophyseal Avulsions of the Pelvis.","authors":"Terrul Ratcliff, Patrick O Ojeaga, Nolan D Hawkins, Alex Loewen, Robert L Van Pelt, Jeffrey Nepple, Philip L Wilson, Henry B Ellis","doi":"10.1097/BPO.0000000000003023","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003023","url":null,"abstract":"<p><strong>Background: </strong>Strength deficits, strength recovery, and return to sports timing following nonoperative apophyseal avulsion fractures are relatively unknown, as is the effect of displacement of the avulsed fragment. This study aims to assess strength recovery following a pelvic apophyseal avulsion and determine whether a relationship between radiographic characteristics and strength exists.</p><p><strong>Methods: </strong>Twenty-eight patients from a prospective pelvic apophyseal avulsion study database, were treated nonoperatively with physical therapy, and a minimum 3-month follow-up was included. Patients were categorized by location of injury and fracture displacement (greater or less than 15 millimeters). Strength measurements obtained at a minimum of 3 months postinjury were used to quantify overall hip and knee strength across several strength measurements. Limb symmetry index (LSI) was calculated as a percentage of the affected limb strength compared with the unaffected limb. Affected and unaffected sides were compared with t tests. Spearman correlation coefficients were calculated to assess radiographic characteristics and affected limb strength correlations.</p><p><strong>Results: </strong>Twenty-three (82.1%) patients were male, with an average age of 14.7±1.1 years. The mean fracture displacement was 10.87±10.24 mm. The most common location of injury was the anterior inferior iliac spine (35.7%, n=10). Among all patients, no strength deficits were observed on the affected limb compared with the unaffected limb, and affected knee extension (KE) strength was greater than unaffected (LSI 110.94%, P=0.013). In fractures displaced <15 millimeters, the affected limb KE strength was stronger than the unaffected limb (LSI 110.92±15.52, P=0.022). Increasing fracture displacement positively correlated with hip flexion (P=0.008), hip extension (P=0.049), hip abduction strength (P=0.040), and KE strength (P=0.011).</p><p><strong>Conclusion: </strong>No strength deficits were identified in the affected limbs following pelvic avulsion injuries compared with the unaffected limb. Affected limb knee extension strength was greater compared with the uninjured side following physical therapy. A majority of apophyseal avulsion fractures have near complete recovery of strength at 3 months with conservative management.</p><p><strong>Level of evidence: </strong>Level II-prospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199453","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}