Journal of Pediatric Orthopaedics最新文献

{"title":"Increasing the Knee Arc of Motion in Patients With Arthrogryposis: Minimum 2-year Follow-up.","authors":"Aaron J Huser, Michael W Brown, Hans K Nugraha, David S Feldman","doi":"10.1097/BPO.0000000000002826","DOIUrl":"10.1097/BPO.0000000000002826","url":null,"abstract":"<p><strong>Background: </strong>Surgery for knee flexion contractures in patients with arthrogryposis multiplex congenital (AMC) have achieved extension to redirect the arc of motion and improve ambulation but has not demonstrated maintained increases in total range of motion (ROM). This study aimed to review the clinical outcomes of combined posterior knee release, proximal femoral shortening, and nerve decompression in patients with arthrogryposis.</p><p><strong>Methods: </strong>A retrospective chart and radiographic review were performed on patients with AMC who underwent treatment for knee flexion deformities ≥30 degrees. ROM, ambulation status, and orthotic use were reviewed and analyzed. Complications were recorded.</p><p><strong>Results: </strong>Twenty-nine patients with 51 knees and a mean age of 5.7 years were included. The mean follow-up was 36.9 months. The mean ROM increased from 49 to 80 degrees between pre-op and latest follow-up ( P <0.0001). The mean final follow-up flexion deformity was 10 degrees ( P <0.0001). Preoperative ROM was moderately correlated with final ROM (r s =0.51). The percentage of ambulatory patients improved from 39% to 93%. Five limbs experienced a fracture either intraoperatively or postoperatively, and 5 limbs required a return trip to the operating room.</p><p><strong>Conclusions: </strong>Improved ambulation and knee ROM can be maintained in patients with AMC at a minimum 2-year follow-up. Prospective investigation and longer follow-up are required to validate these findings.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e179-e185"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502608","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":"Medial Patellofemoral Ligament Reconstruction Improves Patella Alta.","authors":"Daniel Z Yang, Kevin Orellana, Nathan V Houlihan, Julianna Lee, Michael V Carter, Theodore J Ganley, J Todd R Lawrence, Brendan A Williams, Kathleen J Maguire","doi":"10.1097/BPO.0000000000002816","DOIUrl":"10.1097/BPO.0000000000002816","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability (PFI) is a common problem with various anatomic risk factors identified, including patella alta as one of the most powerful predictors. Given that the medial patellofemoral ligament (MPFL) is the primary soft tissue stabilizer of the patella, a common procedure to treat recurrent patellar instability is MPFL reconstruction. The aim of this study is to examine the relationship between MPFL reconstruction and patellar height. We hypothesize that after reconstruction, patellar instability patients would have demonstrable reduction in patella height and patella alta correction.</p><p><strong>Methods: </strong>Patient records were queried for patients who underwent MPFL reconstruction for recurrent patellar instability. Patient and operative demographics were collected. We measured Insall-Salvati ratio (ISR), Caton Deschamps index (CDI), and Blackburne-Peel ratio (BPR) in all patients at various time points. The height indices were compared across the preoperative, immediately postoperative, and 6-month time points in a pairwise fashion using paired-sample t -tests. Further subgroup analysis of patients (n=27) with elevated preoperative Caton Deschamps Index (defined as >1.3) was completed.</p><p><strong>Results: </strong>The final cohort was 103 patients. There was a significant difference between pre- and postoperative ISR ( P <0.001) and at 6-month follow up ( P <0.001), between preoperative CDI and the 6-month follow-up ( P <0.0010), and between the postoperative and preoperative CDI ( P <0.001). There was also a difference between preoperative and postoperative BPR ( P <0.001), as well as between the preoperative and 6-month follow-up BPR ( P =0.002). Twenty-seven patients had an initial CDI greater than 1.3. Differences were observed between pre- and postoperative mean CDI ( P =0.001) and at 6-month follow-up ( P =0.006), between both postoperative and 6-month ISR (both P <0.001), and preoperative mean BPR and the postoperative ( P =0.004) and 6-month mean BPR ( P =0.027).</p><p><strong>Conclusions: </strong>Patients with pre-existing patella alta and recurrent patella dislocations who undergo isolated MPFL reconstruction have decreased patella alta at their 6-month follow-up as measured by ISR, CDI, and BPR. Patients without patella alta do not demonstrate statistically significant differences after their MPFL reconstruction.</p><p><strong>Level of evidence: </strong>III (retrospective comparative study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e106-e111"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289704","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":"A Neglected Fracture: Treatment and Infection of Seymour Fractures of the Hallux in the Pediatric Population.","authors":"Morgan G Batley, Arielle Krakow, Nicolas Pascual-Leone, Sydney Lee, Carter E Hall, Sulagna Sarkar, Divya Talwar, Richard S Davidson","doi":"10.1097/BPO.0000000000002820","DOIUrl":"10.1097/BPO.0000000000002820","url":null,"abstract":"<p><strong>Introduction: </strong>Seymour physeal fractures of the distal phalanx of the Hallux in children are common but rarely described in the literature. There is limited literature investigating how these fractures should be specifically treated. Generally, good results are reported when open fractures are treated with debridement and antibiotics. This large retrospective review evaluates incidence of infection and compares outcomes of various treatments for Seymour physeal fractures of the distal phalanx of the Hallux in children.</p><p><strong>Methods: </strong>This study included patients ≤18 years of age treated for Seymour fractures of the Hallux between January 1, 2007, and November 20, 2018, at a single tertiary-care urban children's hospital. Demographic, injury, and treatment data were obtained via a retrospective review of electronic medical records, including closed versus open fracture status, time to treatment, and whether antibiotics were prescribed and taken. Initial radiographic imaging was examined by a single attending surgeon for angulation (degrees) and widening (mm). Outcome variables included the development of infection and the rate and success of healing.</p><p><strong>Results: </strong>One hundred thirty-eight patients were included in our analysis. Most (84/138, 61%) fractures were closed and treated successfully without antibiotics. Treatment for open fractures varied greatly, with many of these fractures undergoing an incision and drainage procedure (I&D) (33/54, 61%) and antibiotic prescription (43/54, 76%). Most (47/54, 87%) open fractures did not develop infection. However, 7/54 open fractures presented with an active infection. Four out of seven (29%) of these fractures did not receive any treatment before infection presentation. Two others who presented with infection both had delayed antibiotics and neither underwent I&D. Fractures that either presented with or developed an infection presented significantly later than those fractures that did not develop infection ( P <0.001). Neither angulation nor displacement correlated to the time of healing or development of infection.</p><p><strong>Conclusions: </strong>In our large cohort, the majority of open Seymour fractures of the Hallux treated in a timely manner did not develop infection, regardless of treatment. However, open fractures that presented multiple days after injury had an increased incidence of infection. Thus, for open fractures, we recommend timely antibiotics and I&D. Closed fractures may be treated conservatively, with no indication for reduction or use of antibiotics.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e125-e130"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468413","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":"Magnetic Resonance Imaging Can Predict Hamstring or Quadriceps Tendon Autograft Diameter in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction: A Systematic Review.","authors":"Prushoth Vivekanantha, Bryan Sun, Naveen Parasu, Darren de Sa","doi":"10.1097/BPO.0000000000002846","DOIUrl":"10.1097/BPO.0000000000002846","url":null,"abstract":"<p><strong>Objective: </strong>Insufficient graft diameter is an important factor that contributes to failure rates after anterior cruciate ligament reconstruction (ACLR). Although modalities, such as magnetic resonance imaging (MRI), have been well investigated in the adult population to predict graft diameter preoperatively, it is unclear whether similar strategies can be used in the pediatric population. This review aims to evaluate the utility of MRI in the preoperative estimation of autograft parameters in pediatric or adolescent patients undergoing ACLR.</p><p><strong>Methods: </strong>Three databases were searched on January 31, 2024. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Revised Assessment of Multiple Systematic Reviews guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, graft characteristics, MRI imaging techniques, and statistical analyses correlating MRI parameters with graft length or diameter were recorded.</p><p><strong>Results: </strong>Five studies consisting of 450 patients were included in this review (48.4% females). The mean (SD) age at ACLR was 14.7 (6.8) years. Three studies using hamstring tendon (HT) autografts found that combined semitendinosus and gracilis tendon cross-sectional area (ST+GT CSA) were able to predict graft diameter. One study reported an ST+GT CSA cutoff of 31.2 mm 2 to have an 80% and 74% sensitivity and specificity, respectively, in predicting HT autograft diameter above 8 mm. Two studies using quadriceps tendon (QT) autografts found that tendon thickness on sagittal MRI view was able to predict graft diameter. One study reported a QT cutoff of 6.7 mm to have 97.5% and 46.6% sensitivity and specificity, respectively, in predicting the diameter of the QT graft to be above 8 mm. Associations between MRI parameters and graft length were not reported.</p><p><strong>Conclusion: </strong>Although there is limited evidence, ST+GT CSA and QT thickness on sagittal view on MRI can be used to predict intraoperative HT and QT autograft diameter, respectively, in pediatric or adolescent ACLR. Future investigations should investigate correlations between imaging parameters and graft length, especially when using QT autografts in the pediatric population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e112-e118"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468414","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":"Perioperative Management of Tibial Spine Fractures in Pediatric Patients: A Delphi Study to Identify Principles of Treatment.","authors":"Madison Brenner, Benjamin Johnson, Kevin Shea, Theodore Ganley, Philip L Wilson, Henry B Ellis","doi":"10.1097/BPO.0000000000002844","DOIUrl":"10.1097/BPO.0000000000002844","url":null,"abstract":"<p><strong>Background: </strong>The Delphi technique is a structured, iterative group survey method utilized to reach a consensus among experts in a field regarding topics with evidence-based equipoise. Currently, there are few studies at the highest levels of evidence published on the perioperative tibial spine management, making it an ideal subject to utilize expert opinion to reach consensus decision.</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to utilize a Delphi-method survey to achieve consensus statements regarding the perioperative management of tibial spine fractures.</p><p><strong>Methods: </strong>Before study initiation, 3 rounds of surveys were agreed upon, maintaining the traditional Delphi principles. Consensus was defined as 75% agreement or disagreement on a Likert scale. An anonymous survey consisting of 50 statements describing the management of tibial spine fractures preoperative and postoperative in varying scenarios was distributed to a group of 44 pediatric sports medicine orthopaedic surgeons utilizing an electronic survey software system.</p><p><strong>Results: </strong>Of 44 surgeons invited to participate, 24 responded to round 1, 28 responded to round 2, and 25 responded to round 3. Consensus was achieved for the following: use of x-ray to determine initial treatment; casting for a minimum of 3 weeks for nonoperative management, but <3 weeks if treated with surgical fixation; advanced imaging to avoid missing concomitant injury; the necessity of physical therapy, but not continuous passive motion (CPM); and for arthroscopic surgical intervention. It was also agreed that functional testing is important in return-to-play (RTP) decision-making, though the specific timelines and clearance criteria could not be agreed upon. There were statements that displayed continued disagreement, including the role of aspiration, preoperative range of motion management, and the timing of surgical scheduling.</p><p><strong>Conclusions: </strong>Utilizing a Delphi methodology with experienced surgeons on tibial spine treatment, consensus in the management of tibial spine fracture was achieved for definitive management strategies. Further study will be important to optimize our management of this youthful population with tibial spine fractures.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"57-63"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502611","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":"Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection.","authors":"Sarah Hunter, Elsie Brown, Haemish Crawford, Cameron Grant","doi":"10.1097/BPO.0000000000002819","DOIUrl":"10.1097/BPO.0000000000002819","url":null,"abstract":"<p><strong>Objective: </strong>Advanced imaging in the management of childhood bone and joint infection (BJI) has the potential to improve disease outcomes. Knowledge about the optimal timing for magnetic resonance imaging (MRI) in relation to both surgically and nonsurgically managed BJI is limited. This study examines the impact of MRI timing on number of surgeries, length of stay (LOS), hospitalization cost, and disease recurrence in childhood BJI.</p><p><strong>Methods: </strong>This is a retrospective review of patients younger than 16 years with acute hematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018 to 2023. Cases undergoing MRI as part of diagnostic workup were included. Treatment, hours between admission and MRI, LOS, hospitalization cost, and infection recurrence were assessed.</p><p><strong>Results: </strong>There were 563 cases of BJI, of which 390 met the inclusion criteria. Cases were primarily AHO (85%). The percentage of cases having MRI increased over time from 54% (2018) to 80% (2023). Locally disseminated infections such as subperiosteal abscess or adjacent septic arthritis occurred in 48%. Children with preoperative (n = 145) versus postoperative MRI (n = 60) had a lower reoperation rate (33% vs 77%, P = 0.001) and shorter LOS (14.1 vs 22.4 d, P = 0.002). Hospitalization costs appeared lower but did not differ statistically ($59,419 vs $159,353, P = 0.12). In nonoperative cases, LOS was shorter if an MRI occurred within 48 hours of admission (7.3 vs 10 d, P = 0.03). Disease recurrence was not associated with MRI timing.</p><p><strong>Conclusion: </strong>Overall, children with BJI who underwent MRI scans before surgery had lower reoperation rates. Children receiving MRIs within 48 hours of admission had shorter LOS.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e166-e171"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289705","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":"Predicting Blood Loss in Aneurysmal Bone Cyst Surgery.","authors":"Akbar N Syed, Divya Talwar, David Kell, Alexandre Arkader","doi":"10.1097/BPO.0000000000002831","DOIUrl":"10.1097/BPO.0000000000002831","url":null,"abstract":"<p><strong>Background: </strong>Preoperative estimation of intraoperative blood loss is essential for its management and literature is lacking with respect to factors influencing blood loss in aneurysmal bone cysts (ABC) surgery. The purpose of this study is to identify risk factors and predictors for blood loss in ABC surgery.</p><p><strong>Methods: </strong>An IRB-approved retrospective review was performed from 2011 to 2021 at a pediatric tertiary care center. A database identified pediatric patients (<18y old) undergoing surgical curettage and bone grafting for ABC. Lesions in the skull and ribs were excluded. Data collected included demographic data (age, sex), Enneking stage, Capanna type for limb lesions, lesion location, lesion volume (calculated as Transverse × Craniocaudal × Anteroposterior), and history of pathologic fracture before surgical management. Blood loss was recorded as (1) absolute blood loss during surgery and (2) relative loss of total blood volume for individual patients based on their weight and age. Statistical testing was performed using bivariate statistics (Mann-Whitney, Kruskal-Wallis) and multivariate regression analysis.</p><p><strong>Results: </strong>We identified a total of 102 lesions in 101 patients with a mean age of 11.5 years at the time of surgery (range 1.0 to 18.2). Absolute blood loss and relative blood loss increased significantly (P<0.001 for both) with respect to lesion volume. Risk factors for absolute and relative blood loss were identified as type 3 Enneking lesions and those located at the spine/pelvis for all lesions (P<0.05), while for lesions in the limbs, those located in the shoulder/hip were identified as a risk factor for both absolute and relative blood loss. In multivariate analysis, age, lesion location, and lesional volume were predictive of absolute blood loss (P<0.05). While multivariate analysis for relative blood loss identified lesion location and lesional volume of >100 mm3 (P=0.004) as predictors.</p><p><strong>Conclusion: </strong>Our study enhances the understanding of intraoperative blood loss in ABC surgery. Findings from this study help identify patients at risk of increased blood loss. Age and lesion volume are factors to consider before estimating blood loss in ABC surgery. Surgeons should be cautious of bleeding risk associated with enneking type 3 lesions, spine/pelvic lesions, and locations precluding the use of a tourniquet.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 2","pages":"107-111"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950384","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":"Reliability and Validity of the Turkish Version of Early-Onset Scoliosis Self-Report Questionnaire.","authors":"Barlas Goker, Ataberk Beydemir, Yasemin Yavuz, Gizem Irem Kinikli, Rafik Ramazanov, Kayla Erin Anderson, Zeynep Deniz Olgun, Halil Gokhan Demirkiran, Muharrem Yazici","doi":"10.1097/BPO.0000000000002828","DOIUrl":"10.1097/BPO.0000000000002828","url":null,"abstract":"<p><strong>Objective: </strong>Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF) is a recently developed self-reported questionnaire based on the widely adopted Early-Onset Scoliosis Questionnaire and evaluates health-related quality of life in children with early-onset scoliosis over 8 years of age. To date, the questionnaire does not have a validated version in Turkish. The aim of this study was to translate EOSQ-SELF into Turkish and evaluate its reliability and validity.</p><p><strong>Methods: </strong>Content validity was assessed through the item (I-CVI) and scale (S-CVI) content validity indices. The distribution of survey responses was analyzed and ceiling and floor effects were calculated with descriptive statistics. Internal consistency was measured with the Cronbach alpha coefficient. Construct validity was evaluated by comparing the responses between EOSQ-SELF and Scoliosis Research Society questionnaire-22 revised.</p><p><strong>Results: </strong>Eighty-five patients (30 males and 55 females) diagnosed with early-onset scoliosis completed the EOSQ-SELF questionnaire. The I-CVI for the relevance of 30 questions was found to be 0.875 for 3 questions and 1.0 for the remaining questions, whereas the S-CVI was 0.9875. The I-CVI for the clarity of 30 questions was found 0.500 for 1 question, 0.875 for 3 questions, and 1.0 for the remaining questions. The S-CVI value for clarity was 0.97083. The Cronbach alpha coefficient for the total score of the Turkish EOSQ-SELF was recorded at 0.942. Common domains were significantly correlated with the Scoliosis Research Society questionnaire-22 revised.</p><p><strong>Conclusions: </strong>We found excellent internal consistency in our study and were able to demonstrate the reliability as well as the validity of EOSQ-SELF in Turkish.</p><p><strong>Level of evidence: </strong>Level I-diagnostic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 2","pages":"81-86"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950477","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":"Social Disadvantage and Transportation Insecurity in Clubfoot Clinic.","authors":"Melissa A Bent, Michelle Jhun, Veronica Beltran, Barbara Fimbres, Tishya A L Wren","doi":"10.1097/BPO.0000000000002823","DOIUrl":"10.1097/BPO.0000000000002823","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the child opportunity index (COI).</p><p><strong>Methods: </strong>An 11-question survey was administered to caregivers of patients with clubfoot seen at a single pediatric tertiary hospital between August 2020 and September 2023. A chart review was conducted to obtain zip codes used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics.</p><p><strong>Results: </strong>The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 180). Most participants reported use of a personal car (108/128, 83%), and 72% took time off work to attend the appointment. Those with lower COI had longer travel time ( P =0.02) and were less likely to use personal cars ( P =0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle ( P =0.01) and those with annual income under $30,000 ( P =0.02).</p><p><strong>Conclusions: </strong>Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e143-e147"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468316","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":"Hip Instability in Children With Spinal Muscular Atrophy: A Retrospective Study.","authors":"Kellen T Krajewski, Wade Coomer, Alexis Gerk, Scott C Miller, Cosmo Kwok, Zhaoxing Pan, Joyce L Oleszek, Anne T Stratton, Frank Chang, Sayan De","doi":"10.1097/BPO.0000000000002827","DOIUrl":"10.1097/BPO.0000000000002827","url":null,"abstract":"<p><strong>Purpose: </strong>Hip subluxation and dislocation are known problems for children with spinal muscular atrophy (SMA). Medical complexity of these children typically results in absence of monitoring and intervention for pathologic hips. Patterns of hip migration and acetabular morphology in SMA have not been described. This study examines the natural progression of hip instability across all types of SMA in a pediatric population.</p><p><strong>Methods: </strong>Following institutional review board approval, a retrospective chart review of all children with SMA at our institution was performed. All x-rays taken before the age of 18 years containing adequate projections of the pelvis were measured for Reimer migration index (MI), acetabular depth ratio (ADR), and acetabular index (AI). Demographics and clinical data were collected including use of nusinersen, ambulatory status, contractures, and hip pain. Linear mixed effects model was fit to serial MI measures of individual hips with fixed effects consisting of SMA type, age at x-ray, and their interaction. ADR and AI measures were similarly modeled following conversion of raw values to z-scores based on the model developed by Novais et al Slope indicated rate of measure change as a function of age.</p><p><strong>Results: </strong>Forty-five children (22 males) with SMA types 1 to 3 were included in this retrospective study. Six children were classified as type 1, 25 were type 2, and 14 were type 3. The interaction of age by SMA type was statistically significant ( P =0.01), indicating a difference in the rate of hip subluxation between the 3 SMA types as measured by MI. By age 4, MI values were different from one another across all 3 groups ( P <0.01). ADR decreased with age across all SMA types. The slopes of ADR regression lines were negative and statistically significant between the 3 groups ( P =0.002). AI values were higher for all types of SMA, which is the opposite of expected in normal hips.</p><p><strong>Conclusions: </strong>Hip subluxation occurs across all SMA types, most rapidly in SMA type 1. Regression lines of ADR and AI compared with those seen in unaffected populations suggest hips in children with SMA demonstrate a difference in morphology of the acetabulum and do not follow normal adaptive remodeling. As treatments advance and the population of SMA patients becomes more mobile, there is an increased need to monitor hip instability in children with SMA, thus making orthopaedic management an important consideration.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e131-e137"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289701","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}