Journal of Pediatric Orthopaedics最新文献

{"title":"Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection.","authors":"Sarah Hunter","doi":"10.1097/BPO.0000000000003014","DOIUrl":"10.1097/BPO.0000000000003014","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e752-e753"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Do Venous Thromboembolism Rates in Adolescents and Adults Compare After Arthroscopic Knee Surgery? A Propensity-Matched Study.","authors":"Mehul M Mittal, Krishna Chandra, Harshavardhan Bollepalli, Katalina V Acevedo, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002986","DOIUrl":"10.1097/BPO.0000000000002986","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic knee procedures such as meniscus and ACL repairs are cornerstone interventions in pediatric and sports orthopaedics. While venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare yet devastating complication in major joint surgeries, its association with minimally invasive procedures remains relatively unexplored. Emerging evidence shows rates of VTE in adolescent orthopaedic patients approaching that of adults, highlighting the need to further characterize the unique risk profile of this population. Therefore, this study aims to compare VTE rates, risk factors, and chemoprophylaxis use in adolescents versus adults undergoing arthroscopic knee procedures.</p><p><strong>Methods: </strong>A retrospective cohort study using the TriNetX Research Network identified 301,585 patients who underwent knee arthroscopy from January 2003 to January 2023, including 29,984 adolescents (aged 14 to 17) and 271,601 adults (aged 18 years or older). Propensity score matching based on sex and relevant comorbidities, including diabetes mellitus, tobacco use, oral contraceptive (OCP) use, and obesity yielded balanced cohorts of 29,984 each. Univariate logistic regression analysis was performed for preliminary assessment of the risk factors associated with VTE. P <0.01 was considered significant.</p><p><strong>Results: </strong>Adults had a higher 90-day incidence of DVT (1.3% vs. 0.8%) and PE (0.3% vs. 0.2%) than adolescents. Combined DVT/PE incidence was 1.5% in adults and 0.8% in adolescents (RR: 1.782). Univariate analysis showed OCP use (OR: 3.167), obesity (OR: 3.445), tobacco use (OR: 23.975), and diabetes (OR: 34.064) were significant VTE risk factors in adolescents; sex was not. Adults more frequently received postoperative chemoprophylaxis (24% vs. 20%, P <0.001), with aspirin being the most common agent (23% in adults vs. 19% in adolescents, P <0.001).</p><p><strong>Conclusion: </strong>Adolescents undergoing knee arthroscopy have a lower risk of VTE compared with adults, with an incidence below 1%. Routine VTE prophylaxis may not be necessary for all adolescents but should be considered for those with significant risk factors, including diabetes, tobacco use, and obesity. Further research is warranted to refine prophylaxis guidelines in this population.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e680-e686"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010269","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":"Psychometric Validation and Responsiveness of the Cross-culturally Adapted Traditional Chinese Version of the Early-onset Scoliosis Self-report Questionnaire (EOSQ-SELF).","authors":"Prudence Wing Hang Cheung, Victoria Yuk Ting Hui, Verona Ming Hei Fu, Alex Hao Yeung Suen, Jason Pui Yin Cheung","doi":"10.1097/BPO.0000000000002999","DOIUrl":"10.1097/BPO.0000000000002999","url":null,"abstract":"<p><strong>Background: </strong>Patients with early-onset scoliosis (EOS) can experience compromised health-related quality of life (HRQoL). EOSQ-SELF was developed to assess HRQoL directly from patients, yet its responsiveness remains unclear. We aimed to evaluate the psychometric properties and responsiveness of the cross-culturally adapted traditional Chinese version of EOSQ-SELF.</p><p><strong>Methods: </strong>Patients were consecutively recruited at an orthopaedic specialist clinic. Included patients must be diagnosed with EOS, aged 8 to 18 years at recruitment, and could read traditional Chinese. EOSQ-SELF underwent double-forward single-backward translations. At recruitment and at 6-month follow-up, patients completed the traditional Chinese EOSQ-SELF, refined Scoliosis Research Society-22 item (SRS-22r) questionnaire, and EuroQol-5-dimension 5-level. Psychometric properties of the EOSQ-SELF were assessed, with sensitivity analysis via known group comparison. Responsiveness was evaluated through an anchor-based approach using a global rating of change (GRC) scale.</p><p><strong>Results: </strong>A total of 139 patients were recruited, with 132 (92.4% responsiveness) included for analyses. Traditional Chinese EOSQ-SELF has good internal consistency, test-retest reliability, convergent, and construct validity. The EOSQ-SELF total score showed no ceiling/floor effects, correlated with SRS-22r total score ( rs : 0.788, P <0.001), EQ index score ( rs : 0.680, P <0.001), and EQ VAS ( rs : 0.527, P <0.001). Discriminative validity was demonstrated: syndromic EOS had a lower transfer domain score (vs. idiopathic and congenital), and a lower EOSQ-SELF total score (median: 71.3 vs. idiopathic 81.1, P =0.023). On the basis of the GRC, 7.4%, 46.7%, and 45.9% of patients had worsened, unchanged, and improved overall health, respectively. The improvement group showed significantly higher EOSQ-SELF total score at 6 months (median: 83.4 vs. baseline 78.7, P =0.015), and none had total scores decrease reaching MCID.</p><p><strong>Conclusions: </strong>Traditional Chinese EOSQ-SELF is a reliable instrument for assessing HRQoL and its changes reported by older patients (aged 8 years or above). It is sensitive in differentiating patients with improved overall health from those who are stable/worsened. EOSQ-SELF can enhance clinical care and monitoring of EOS patients through assessing their HRQoL and detecting changes effectively.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"499-507"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable Risk Factors for Complications Following Surgical Treatment of Tibial Tubercle Fracture.","authors":"Emily L Niu, Evan D Sheppard, Md Sohel Rana, Anthony Dure, Syed I Ahmed","doi":"10.1097/BPO.0000000000002992","DOIUrl":"10.1097/BPO.0000000000002992","url":null,"abstract":"<p><strong>Background: </strong>Tibial tubercle fractures (TTF) commonly occur in an athletic adolescent population and typically require operative reduction and fixation. Surgical techniques and postoperative restrictions are varied, with limited knowledge on factors that may affect outcome. We hypothesize that surgical technique and postoperative rehabilitation protocol can affect risk of postoperative complications following surgical treatment of TTF.</p><p><strong>Methods: </strong>Retrospective review was conducted including all consecutive surgically treated TTF at a single level 1 pediatric trauma center between January 2010 and December 2022. Patients were excluded for skeletal dysplasia, <10 weeks of follow-up, or periosteal avulsion only. They were classified into \"accelerated\" (postoperative weight-bearing and motion allowed within 21 d) or \"conservative\" (did not meet accelerated criteria) groups. Postoperative complications were recorded and graded by the modified Clavien-Dindo (C-D) classification. Univariate and multivariate logistic regression analysis were used to investigate factors associated with C-D grade II and III complications.</p><p><strong>Results: </strong>Totally, 183 knees (177 patients) met criteria for analysis. Median follow-up was 27.3 weeks. Fifty-three knees (29%) qualified for the \"accelerated\" group and 129 knees (71%) were \"conservative.\" Initial postoperative casting was performed in 38% of the conservative group compared with 1.9% in the accelerated group ( P <0.001). Overall complication rate was 44.3% (81/183), with 33.3% (61/183) being a grade II or III complication. The most common complication was symptomatic implant (19.7%). There were 4 cases of fracture displacement and 1 case of implant displacement, all occurring in the conservative group. In multivariate analysis female sex (OR: 4.9), initial postoperative casting (OR: 2.6), and lower BMI percentile (OR: 1.02) were independently associated with higher grade II and III complication rate, while distal repair of the avulsed periosteum was associated with lower rate (OR: 0.26).</p><p><strong>Conclusion: </strong>Postoperative casting and repair of the distal periosteal avulsion are modifiable treatment decisions impacting risk of complications following surgical treatment of TTF. Decreasing variability in care, including implementing an accelerated rehabilitation protocol, may improve outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"466-473"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031552","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":"Lateral Ankle Avulsion Fracture Versus Subfibular Ossicles in Pediatric Lateral Ankle Sprain: A Novel Dynamic Ultrasonographic Technique.","authors":"Xiong-Tao Li, Xian-Tao Shen, Zhi-Guo Zhou, Xi-Jun Meng","doi":"10.1097/BPO.0000000000003094","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003094","url":null,"abstract":"<p><strong>Background: </strong>Differentiating lateral ankle avulsion fractures from subfibular ossicles in pediatric ankle sprains remains diagnostically challenging with conventional radiography. This study evaluates a novel dynamic ultrasonography technique for reliable differentiation, offering clinicians a rapid, accurate diagnostic tool.</p><p><strong>Methods: </strong>We collected radiographic and dynamic ultrasound imaging data from 95 children with lateral ankle sprains, all of whom underwent examination using the novel dynamic ultrasonographic technique. Four observers with varying levels of clinical experience evaluated the images. Each observer made diagnoses based on radiographs alone and then in combination with dynamic ultrasound images. Interobserver reliability was assessed using the multirater free-marginal kappa, while intraobserver reliability was evaluated using the linear weighted kappa. The changes in diagnoses of the observers after the addition of dynamic ultrasound images were collected and analyzed.</p><p><strong>Results: </strong>The study of 95 cases identified 5% (5/95) subfibular ossicles, 16% (15/95) distal fibular avulsion fractures, 4% (4/95) lateral process talus fractures, and 75% (71/95) radiographically negative cases. Among the 24 radiographically positive cases, initial interobserver agreement for distinguishing subfibular ossicles from avulsion fractures was slight (κ=0.33) using radiographs alone, which improved to excellent (κ=0.89) with dynamic ultrasound images. Ultrasound prompted diagnostic changes in 26% of cases (6.25 cases) from subfibular ossicles to avulsion fractures, and 6% (1.5 cases) from avulsion fractures to subfibular ossicles.</p><p><strong>Conclusion: </strong>The dynamic ultrasonographic technique accurately differentiates between lateral ankle avulsion fractures and subfibular ossicles in pediatric lateral ankle sprains. This dynamic ultrasound technology can also be used to assess the stability of lateral ankle bone fragments, providing valuable information for treatment planning.</p><p><strong>Level of evidence: </strong>Level III-diagnostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957915","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 Deficiency and Secondary Hyperparathyroidism as Potential Causes of Idiopathic Knee Angular Deformity: A Prospective Cross-Sectional Comparative Study.","authors":"Sang Roc Han, Won Ik Lee, Su Yeon Yu, Mi Hyun Song, Tae-Joon Cho, Chang Ho Shin","doi":"10.1097/BPO.0000000000003093","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003093","url":null,"abstract":"<p><strong>Background: </strong>Genu valgum and genu varum have various causes; however, the cause in some children remains unknown, leading to a diagnosis of idiopathic angular deformity. In this study, we investigated whether vitamin D deficiency could lead to idiopathic knee angular deformity in the absence of typical radiographic findings of rickets by examining serum markers in affected children and controls.</p><p><strong>Methods: </strong>In this prospective cross-sectional comparative study, we evaluated 38 children aged 7 to 14 years with genu valgum or varum without medical conditions or radiographic findings affecting lower limb alignment and 29 controls. Laboratory parameters and the prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level <20 ng/mL) or hyperparathyroidism [serum parathyroid hormone (PTH) level >60 pg/mL] were compared between the 2 groups. The prevalence of angular deformities was compared among the groups based on the presence of vitamin D deficiency and hyperparathyroidism. Binary logistic regression analysis was used to calculate the odds ratios (ORs) for angular deformities based on vitamin D deficiency and hyperparathyroidism.</p><p><strong>Results: </strong>The mean serum 25-hydroxyvitamin D levels did not significantly differ between the angular deformity (16.7±6.1 ng/mL) and control groups (19.9±7.1 ng/mL) (P=0.055). However, vitamin D deficiency was more prevalent in the angular deformity group than in the control group (79% vs. 48%, P=0.009). Angular deformities were more prevalent in children with both vitamin D deficiency and hyperparathyroidism than in those without these conditions [11/13 (85%) vs. 5/18 (28%), P=0.012]. The logistic regression analysis-adjusted for age, sex, and weight-showed a higher risk of angular deformity in children with both vitamin D deficiency and hyperparathyroidism (OR: 9.86, 95% CI: 1.36-71.47, P=0.024), but not in children with vitamin D deficiency alone.</p><p><strong>Conclusions: </strong>Isolated vitamin D deficiency without other laboratory abnormalities or radiographic findings of rickets did not lead to knee angular deformity. However, in cases in which vitamin D deficiency elevates PTH levels, idiopathic genu valgum or genu varum might be observed.</p><p><strong>Level of evidence: </strong>Level III-prognostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958220","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":"Comparative Outcomes of 8.5 mm Intramedullary Nails Versus Extramedullary Constructs for Femoral Lengthening in Pediatric Patients.","authors":"Akram Al Ramlawi, Bhagat Dhamala, Daniel J Over, Shawn C Standard, John E Herzenberg, Philip K McClure","doi":"10.1097/BPO.0000000000003079","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003079","url":null,"abstract":"<p><strong>Introduction: </strong>Limb-length discrepancies (LLDs) have traditionally been treated with external fixators, but magnetically driven intramedullary nails (MILNs) are increasingly favored for improved comfort and reduced infection risk. This study compared intramedullary (IM) versus extramedullary (EM) lengthening nails in pediatric patients with narrow femoral canals to evaluate mechanical axis deviation, nail bending, tourniquet time, and complications.</p><p><strong>Methods: </strong>A retrospective, single-center review was conducted of 75 pediatric patients who underwent femoral lengthening between 2015 and 2022, each with at least two years of follow-up. Patients received either an 8.5 mm IM nail or a 10.7/12.5 mm EM nail, combined with a solid, threaded IM nail for stability. Outcomes included preoperative and postoperative limb alignment (MAD, mLDFA, and mPDFA), IM nail bending, operative details (tourniquet time and blood loss), consolidation times, and complication rates classified according to the Cherkashin system.</p><p><strong>Results: </strong>Forty-two patients were treated with EM nails and 33 with IM nails. Both groups achieved similar distraction amounts (4.7 ± 1.1 cm) and consolidation intervals (7 to 8 mo). However, the EM group demonstrated significantly greater postoperative MAD (12.9 ± 9.5 mm vs.  8.7 ± 7.3 mm, P <0.05), higher nail bending (2 vs.  1.2 degrees, P<0.05), and longer tourniquet use. Overall complication rates were 69% (EM) and 60% (IM), with delayed union and soft tissue infection being the most frequent issues. Unplanned reoperations occurred in 21% of patients overall.</p><p><strong>Conclusion: </strong>Both nail types correct limb‑length discrepancy, but extramedullary nails demand longer tourniquet times and have higher bending (of the IM component of the EM construct) and complication rates. Implant choice must suit patient factors and further comparative studies are warranted.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcome of Idiopathic Increased Femoral Anteversion in 58 Untreated Individuals at a Mean Age of 46.2 Years.","authors":"Anders Grønseth, Joachim Horn, Suki Liyanarachi, Ragnhild Beate Gunderson, Terje Terjesen","doi":"10.1097/BPO.0000000000003074","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003074","url":null,"abstract":"<p><strong>Background: </strong>Increased femoral anteversion is a common problem in children, but the condition usually normalizes spontaneously over time. There is limited knowledge of the long-term consequences of persistently increased anteversion. The purpose of this study was to analyse the long-term functional complaints of untreated adults with idiopathic increased anteversion compared with a control group.</p><p><strong>Methods: </strong>Study participants were recruited from our institutional register of increased femoral anteversion during the period 1975 to 2008. Inclusion criteria were anteversion angle ≥30 degrees and no other disorders affecting the lower limbs. Outcome measures were the HAGOS and KOOS questionnaires, radiographic signs of osteoarthritis, and clinical examination. A control group of 24 healthy individuals was examined with the same methods.</p><p><strong>Results: </strong>Fifty-eight patients (46 females) with a mean age of 46.2 years were included in the AV group. The mean anteversion angle was of 40.2 degrees in the anteversion group and 20.6 degrees in the controls. The mean external foot progression angle was 0.5 degrees in the anteversion group and 4.6 degrees in the controls (P <0.001). The anteversion group scored significantly worse than the control group in 5 out of 6 HAGOS subscales: Pain (P=0.032), Symptoms (P=0.041), Sport/Rec (P=0.001), PA (P=0.036), and QOL (P=0.001). The KOOS subscale Symptoms was the only subscale with a worse score in the AV group (P=0.006). Only 1 patient in the anteversion group had hip osteoarthritis.</p><p><strong>Conclusions: </strong>Untreated adults with idiopathic increased femoral AV at a mean age of 46 years experienced more hip pain and limitations in participation in physical activities and sports compared with healthy individuals, but the limitations were mostly small to moderate and would hardly influence the present strict indications for surgical correction in children.</p><p><strong>Level of evidence: </strong>Level II-prospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957970","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":"Risk of DVT, ICU Admission, and Mortality in Pediatric Lower Extremity Musculoskeletal Infections: Impact of MRSA and Elevated CRP.","authors":"Blaire Peterson, David Momtaz, Jad Lawand, Jacob Jahn, Hallie B Remer, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000003089","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003089","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal infections (MSKIs), including osteomyelitis and pyogenic arthritis, present significant health risks in pediatric populations. This study evaluates the risks of septic deep vein thrombosis (DVT), intensive care unit (ICU) admission, and mortality in children diagnosed with lower extremity MSKIs, with a focus on methicillin-resistant Staphylococcus aureus (MRSA) infections.</p><p><strong>Methods: </strong>This retrospective cohort study from a multi-institutional database included 38,023 pediatric patients diagnosed with lower extremity MSKIs. Incidence and risk factors for DVT, ICU admission, and mortality were collected. Comparisons were made between age groups and MRSA versus non-MRSA infections. The association between CRP levels and outcomes was also examined. Multivariable logistic regression models were utilized.</p><p><strong>Results: </strong>The mean age of the cohort was 8.49 years. Overall, 1.52% of patients developed septic DVT, 0.49% required ICU admission, and 0.48% died. Patients with MRSA had significantly higher risks of DVT (RR 4.89, P<0.001) and mortality (RR 3.57, P<0.001) compared with those without MRSA. CRP levels were also markedly higher in MRSA patients (P<0.001). When comparing age groups, those <12 years had a higher risk of ICU admission (RR 2.03, P<0.001), whereas the 12 to 18 age group had a higher risk of DVT (RR 0.71, P<0.001). Among patients with DVT, the mortality risk was significantly increased (RR 5.18, P<0.001). MRSA patients with DVT had the highest mortality risk (RR 5.38, P<0.001) and elevated CRP levels (P<0.001).</p><p><strong>Conclusions: </strong>Reporting the largest series of children with lower extremity MSKI, our study found increased risk of DVT, ICU admission, and mortality in pediatric patients with MRSA. MRSA patients with septic DVT had significantly higher level of CRP than those without DVT (100.95 mg/L vs. 61.59 mg/L, P<0.001). MRSA infections with septic DVT had the highest rate of mortality (7.24%). Clinicians should consider proactive screening and aggressive management strategies for septic DVT in the at-risk population, especially in patients with high CRP.</p><p><strong>Level of evidence: </strong>Prognostic level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958193","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":"Health Disparities in Adolescent Idiopathic Scoliosis: Utilizing COI and ICE as Predictors of Initial Curve Magnitude and Risk for Progression 1 Year Later.","authors":"Rohit Siddabattula, George Thomas, Esther Varghese, Rithika Ginjupalli, John T Anderson, Richard M Schwend","doi":"10.1097/BPO.0000000000003088","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003088","url":null,"abstract":"<p><strong>Background: </strong>Adolescent idiopathic scoliosis (AIS) is a common pediatric spinal deformity, with disparities in care often linked to socioeconomic status (SES). The Childhood Opportunity Index (COI) and Index of Concentration at the Extremes (ICE) are SES markers that have been used to evaluate health disparities in orthopaedic care. The utility of these SES markers in identifying differences in AIS presentation remains unclear.</p><p><strong>Methods: </strong>Medical records between 2017 and 2020 were reviewed for patients newly diagnosed with AIS from our city-center institution with around 600,000 patient encounters annually from all communities. Patient home addresses were used to assign nationally available COI 2.0 and ICE scores. COI, which ranges from 0.0 to 100.0, was categorized into quintiles: very low (<20.0), low (20.0 to 39.9), moderate (40.0 to 59.9), high (60.0 to 79.9), and very high (>80.0). ICE was divided into ICE White versus Black income (ICEwbinc) and ICE White, Black, and Hispanic income (ICEwnhinc), with scores ranging from -1 to 1. SES markers were evaluated for associations with major curve angle magnitude at presentation and at 1-year follow-up.</p><p><strong>Results: </strong>Of 486 eligible patients, 330 (67.9%) were female. The mean major curve angle at presentation was 26 degrees. Average COI was significantly higher in White patients (73.6) compared with Hispanic patients (30.4; P<0.001). ICEwbinc (0.4 vs. 0.0; P<0.001) and ICEwnhinc (0.33 vs. -0.1; P<0.001) were highest in White patients and lowest in Hispanic patients. Very low COI was associated with the highest average body mass index (23.4) compared with the very high COI group (20.5; P<0.001). SES markers were not associated with major curve angle at presentation and 1-year follow-up.</p><p><strong>Conclusions: </strong>SES markers were not associated with AIS presentation or progression. These findings contribute to the growing literature showing that equitable access to AIS care is increasing across the nation. Future studies should focus on the role of early clinical detection contributing to equal access to AIS care.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957886","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}