Journal of Pediatric Orthopaedics最新文献

{"title":"Management of Lateral Condyle Humeral Fracture Associated With Elbow Dislocation in Children: A Retrospective International Multicenter Cohort Study.","authors":"Xiongtao Li","doi":"10.1097/BPO.0000000000002927","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002927","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414458","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":"Vertical Video-based Gait Analysis for Assessment of Transverse Plane Motion: Reliability and Validity in a Neuromuscular Population.","authors":"Ramiro Olleac, Bernardo Centeno, Clara Duffy, Marcos Nuñez, Marcos Crespo, Lucas M Barrios, Jon R Davids, Vedant A Kulkarni","doi":"10.1097/BPO.0000000000002926","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002926","url":null,"abstract":"<p><strong>Background: </strong>In the absence of 3-dimensional gait analysis (3DGA), assessment of transverse plane motion of the lower extremity from sagittal and coronal video has a high degree of error. We propose a standardized method through vertical video-based gait analysis (VVGA) to assess the position of the pelvis and lower extremity in the transversal plane. This study aims to evaluate the reliability and accuracy of VVGA compared with 3DGA for transverse plane kinematics.</p><p><strong>Methods: </strong>VVGA and 3DGA were obtained simultaneously on subjects between the ages of 6 and 35 referred to a motion analysis center. Gait Deviation Index (GDI) and Gait Profile Score (GPS) were used to estimate overall gait deviation of the subjects. Three raters at different levels of experience performed VVGA on all patients utilizing a standardized technique. Inter-rater and intrarater reliability was calculated using interclass correlation coefficients (ICC). Mean absolute difference (MAD) between VVGA measurements and 3DGA data was calculated for each body-segment.</p><p><strong>Results: </strong>Twenty-six patients (median age: 12 y, 61.53% male) with neuromuscular disorders participated in the study, with the majority (65%) having cerebral palsy. The mean GDI of the subject group was 80.7 and the mean GPS was 1082, indicating a neuromuscular cohort with significant gait deviations. Inter-rater and intrarater reliabilities were excellent, with ICC ranging from 0.94 to 0.99. The overall MAD between VVGA analysis and 3DGA was 4.90 degrees, indicating a clinically acceptable overall error. Segment-specific errors were 4.63 degrees for pelvis rotation, 5.35 degrees for hip rotation, and 4.70 degrees for foot progression.</p><p><strong>Conclusions: </strong>VVGA is an accurate and reliable method for assessing the transverse plane position of the pelvis, hip, and foot when utilizing a standardized method of collection and data analysis. Further study is required to assess whether this technique can be used for surgical decision-making or outcome assessment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414460","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":"Comparison of Surgical and Conservative Treatments for Gartland Type II Supracondylar Humerus Fractures: Evaluation of the Need for Surgical Treatment.","authors":"Andreas Rehm, Rebecca J Worley, Hatem Osman, Ben Gompels, Helen E Chase, Elizabeth Ashby","doi":"10.1097/BPO.0000000000002930","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002930","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408758","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":"Examining Outcomes and Complications for Operative Versus Nonoperative Treatment of Pediatric Type II Supracondylar Humerus Fracture: A Systematic Review of Comparative Studies.","authors":"Andreas Rehm, Hatem Osman, Ayla C Newton, Pinelopi Linardatou Novak, Helen E Chase, Elizabeth Ashby","doi":"10.1097/BPO.0000000000002932","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002932","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408761","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":"Mid-term Radiologic and Clinical Results of Pediatric-adolescent Lisfranc Injuries.","authors":"Ersin Sensoz, Husnu Yilmaz, Eceviz Engin, Tolga Onay","doi":"10.1097/BPO.0000000000002921","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002921","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of Lisfranc injury in pediatric-adolescent children is lower compared with adults. There is limited research on adolescent patients in this age group, with only a few case reports of pediatric patients. Furthermore, studies with adequate follow-up are lacking in the literature. This study aims to provide insights into the causes and types of fractures and evaluate mid-term clinical and radiologic outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric-adolescent patients diagnosed with a Lisfranc injury who underwent surgical treatment between June 2015 and January 2022. Patients underwent open reduction and internal fixation using Kirschner wires and/or screws, had satisfactory imaging, and were followed up for at least 2 years. Radiologic measurements included intermetatarsal distance, meary angle, and calcaneal height angle, done while the patient was standing. Assessments were made using the AOFAS midfoot score, the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), Visual Analog Scale (VAS) scores, and physical activities.</p><p><strong>Results: </strong>The study included 14 surgically treated patients with a minimum 2-year follow-up. The average patient age was 12.6 years, with a mean follow-up of 52.4 months. In pediatric cases, crush injury was the predominant trauma type (P = 0.009). There were no significant differences in calcaneal pitch angle or meary angle between healthy and injured feet (P = 0.2 and 0.1), but a greater intermetatarsal distance was observed on the injured side (P = 0.02). The mean Visual Analog Scale (VAS) score was 1.5, the AOFAS midfoot score averaged 91.5, and the OxAFQ-C score averaged 86.3%.</p><p><strong>Conclusions: </strong>The mid-term outcomes for this age group were promising compared with adults. The use of Kirschner wires for fixation is more common in younger patients. Crush injuries and complications like compartment syndrome are more prevalent in the pediatric age group.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391216","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":"Effect of Vitamin D Deficiency on Development of Slipped Capital Femoral Epiphysis.","authors":"Beltran Torres-Izquierdo, Maria Galan-Olleros, David Momtaz, Mehul M Mittal, Rishi Gonuguntla, Abhishek Tippabhatla, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002915","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002915","url":null,"abstract":"<p><strong>Objective: </strong>Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders in adolescents, often linked to obesity. However, other factors, such as vitamin D deficiency, may also contribute to SCFE development. This study investigates the impact of vitamin D deficiency on SCFE development in a large cohort.</p><p><strong>Methods: </strong>We utilized the TriNetX national database to query pediatric patients with documented calcidiol levels. Patients with a recorded visit below the age of 9 and subsequent documented calcidiol levels were followed until SCFE occurrence or age 18. Patients were categorized into vitamin D adequate (≥ 30 ng/mL) and deficient (< 30 ng/mL) groups. Propensity score matching was performed using a multivariable logistic regression model to adjust for baseline characteristics, including age, sex, race, and body mass index percentile. Significance testing was conducted using the Fisher exact test and χ2 tests to compare SCFE risk between the cohorts, with a significance level set at P <0.05.</p><p><strong>Results: </strong>On preliminary analysis, 98,045 patients met the inclusion criteria. After matching, 34,552 individuals in both vitamin D deficient and adequate groups were included, with an average age of 8.4 years at the time of their first visit and 50% females. SCFE occurred in 136 (0.39%) and 48 (0.14%) patients in the vitamin D deficient and adequate groups, respectively (P < 0.0001). Vitamin D deficiency significantly increased SCFE risk, with a relative risk of 2.8 (95% CI: 2-3.9; P < 0.0001) and a hazard ratio of 1.6 (95% CI: 1.1-2.2; P < 0.0001).</p><p><strong>Conclusion: </strong>This study, one of the largest to date, establishes a significant association between vitamin D deficiency and SCFE development. After controlling for potential confounding variables, including body mass index, individuals with vitamin D deficiency were ∼2.83 times more likely to develop SCFE. The study findings highlight the need for further research to evaluate whether supplementation could mitigate this risk of developing SCFE.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382795","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":"Cast Wedging in Pediatric Forearm and Tibia Fractures-A Safe Way to Avoid Surgery.","authors":"Sachin Pathangey, Maria F Canizares, Michael Greenberg, Patricia E Miller, Colyn Watkins, Daniel Hedequist, Benjamin J Shore","doi":"10.1097/BPO.0000000000002918","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002918","url":null,"abstract":"<p><strong>Background: </strong>Cast wedging is an established technique used to improve the alignment of pediatric fractures. The purpose of this study was to review the effectiveness of cast wedging to treat malaligned pediatric fractures and report the incidence of complications and failure associated with cast wedging.</p><p><strong>Methods: </strong>A retrospective review of a level one pediatric trauma center was performed. Children aged 3 to 18 who underwent cast wedging following a forearm shaft, distal radius, or tibia shaft fracture (January 2005 to January 2021) were reviewed. A total of 294 patients were identified for analysis. Coronal and sagittal angles were measured throughout the course of fracture management. Improved radiologic correction was defined as at least a 50% correction of malalignment in the plane of maximum deformity. Complications associated with cast wedging were recorded, and wedging failure was defined as patients who underwent a secondary procedure. Multivariable logistic regression analysis was used to identify variables affecting outcomes and odds ratios (ORs) with 95% CIs were estimated for final model effects.</p><p><strong>Results: </strong>Cast wedging generated a median 56% correction in angulation, with 74% of the cohort (217/294) achieving at least 50% correction. Twenty-two patients (7%) failed wedging treatment, with half undergoing a repeat closed reduction (12/22, 55%). Eighteen patients (6%) experienced at least 1 complication. Nine patients (3%) sustained a refracture after wedging an average of 8.9 months from the initial injury. Multivariable analysis identified older patients and those who did not achieve 50% radiologic correction after wedging to have increased odds of repeat surgery (OR=1.17; P=0.04 and OR=11.1; P=0.001, respectively).</p><p><strong>Conclusions: </strong>Cast wedging is a safe and effective method to correct malaligned pediatric fractures with a low incidence of complications and refracture. Cast wedging remains an important skill for orthopaedic surgeons managing pediatric fractures.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382719","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":"Radial Inclination and Volar Tilt Following Ulnar Epiphysiodesis for Distal Radius Physeal Arrest.","authors":"Edmund P Mullin, Tanner R Campbell, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000002922","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002922","url":null,"abstract":"<p><strong>Objective: </strong>Physeal arrest of the distal radius is a known complication after pediatric distal radius fractures. When this occurs, ulnar epiphysiodesis has been shown to prevent further ulnar positive variance. The purpose of this study is to determine any difference in the radial inclination (RI) and volar tilt (VT) of the distal radius pre-ulnar and post-ulnar epiphysiodesis and whether the final distal radius radiographic measurements are associated with clinical outcomes.</p><p><strong>Methods: </strong>A review of children who underwent ulnar epiphysiodesis for premature radial physeal closure at a single institution was performed over a 12-year period. Exclusion criteria included patient-reported outcome measures (PROMs) <1 year. Preoperative and final follow-up radiographic measurements were obtained for RI and VT, with interobserver reliability recorded. Cutoffs for acceptable RI and VT were set at >10 degrees and between -10 degrees and 25 degrees, respectively. PROMs were recorded using the quick-disabilities of the arm, shoulder, and hand questionnaire-9 (quickDASH-9) and Single Assessment Numeric Evaluation (SANE) scores.</p><p><strong>Results: </strong>Forty-six wrists were included (age 13.9 ± 1.2 y) with a mean PROM duration of 5.2 ± 3.4 years (1.0 to 12.3 y). Neither RI (P = 0.123) nor VT (P = 0.305) changed significantly from preoperative to final follow-up. No significant correlation between distal radius measures and quickDASH-9 or SANE scores was observed: RI, P > 0.23, and VT, P > 0.28. Preoperatively, RI was unacceptable in 2 wrists, and VT was unacceptable in 5 wrists. While these 7 wrists became acceptable after ulnar epiphysiodesis, some acceptable wrists became unacceptable after the procedure.</p><p><strong>Conclusions: </strong>As predicted, distal radius radiographic parameters did not change after ulnar epiphysiodesis, and PROMs did not appear to correlate with acceptable RI or VT. The PROMs suggest that children do well with this procedure, but based on individual results, there appears to be room for improvement through future study and considerations for patient-specific treatment approaches.</p><p><strong>Level of evidence: </strong>Level IV-cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382798","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":"Assessing ChatGPT Responses to Frequently Asked Questions Regarding Pediatric Supracondylar Humerus Fractures.","authors":"Austin W Li, Jeremy M Adelstein, Lambert T Li, Margaret A Sinkler, R Justin Mistovich","doi":"10.1097/BPO.0000000000002923","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002923","url":null,"abstract":"<p><strong>Background: </strong>The internet and standard search engines are commonly used resources for patients seeking medical information online. With the advancement and increasing usage of artificial intelligence (AI) in health information, online AI chatbots such as ChatGPT may surpass traditional web search engines as the next go-to online resource for medical information. This study aims to assess the ability of ChatGPT to answer frequently asked questions regarding pediatric supracondylar humerus (SCH) fractures.</p><p><strong>Methods: </strong>Seven (7) frequently asked questions (FAQs) regarding SCH fractures were presented to ChatGPT. Initial responses were recorded and rated as either \"excellent requiring no clarification (0 items need clarification),\" \"satisfactory requiring minimal clarification (1 to 2 items need clarification),\" \"satisfactory requiring moderate clarification (3 to 4 items need clarification),\" or \"unsatisfactory requiring substantial clarification (>4 items need clarification or response contains false information).\"</p><p><strong>Results: </strong>While 4 responses met satisfactory ratings with either moderate (2 responses) or minimal (2 responses) clarification, 3 of the 7 FAQs yielded a response from ChatGPT that were unsatisfactory. There were no responses that required no further clarification.</p><p><strong>Conclusions: </strong>ChatGPT provided some satisfactory responses to FAQs regarding pediatric SCH fractures, but required substantial clarification about treatment algorithms, casting and return to sport timelines, and the utility of physical therapy. Therefore, ChatGPT is an unreliable resource for information on treating SCH fractures. Parents of children who experience SCH fractures should continue to communicate with their doctors for the most accurate medical information.</p><p><strong>Level of evidence: </strong>Level V-expert opinion on ChatGPT responses.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364472","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":"PETS (Percutaneous Epiphysiodesis Using Transphyseal Screws) in the Proximal Tibia: Deep Peroneal Nerve Proximity.","authors":"Myung-Jin Cha, John P Avendano, Brienna K Buchanan, Ryley K Zastrow, Shivani Ahlawat, Rushyuan J Lee","doi":"10.1097/BPO.0000000000002913","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002913","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous epiphysiodesis with transphyseal screws (PETS) is commonly used to treat limb-length discrepancy and angular knee deformity in children. PETS carries a small but serious risk of nerve injury from mechanical and/or thermal damage caused by instrumentation near the deep peroneal nerve (DPN). Our goals were to (1) characterize the location of the DPN to an ideally placed PETS screw in pediatric patients undergoing medial proximal tibia hemiepiphysiodesis; and (2) describe the optimal PETS screw trajectory in this location.</p><p><strong>Methods: </strong>This was a retrospective study of lower-extremity magnetic resonance imaging (MRI) of pediatric patients at our institution between January 2017 and July 2024. MRIs were excluded for incomplete visualization of the proximal tibia or the presence of tumors or fractures. Multiplanar reformations were generated to simulate the ideal medial proximal tibia PETS trajectory, defined as a screw crossing the medial 1/6 of the proximal tibia physis at a 55 degrees angle relative to the physis. Distances between the DPN and the ideal PETS trajectory were measured at the lateral cortical entry site on the proximal tibia, the point nearest the nerve, and the superficial fascia.</p><p><strong>Results: </strong>Of the 56 MRIs identified, 19 were included (mean patient age, 10.8 y, 68% female). Mean±SD distance from the DPN to the lateral cortical entry site of the tibia was 1.4±0.4 cm. The closest mean distance between the screw and DPN was 1.0±0.5 cm. Mean distance between the DPN and the superficial fascia was 2.4±0.7 cm. The screw trajectory was always anterior to the DPN.</p><p><strong>Conclusions: </strong>Given the proximity of transphyseal screws to the DPN during percutaneous epiphysiodesis of the medial proximal tibia, correct screw trajectory and a thorough understanding of the neurovascular anatomy in relation to bony landmarks is crucial to prevent nerve injury. In addition, biasing the screw path anteriorly can assist in maintaining a \"safe zone\" between the instrumentation and the DPN.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189469","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}