Journal of Pediatric Orthopaedics最新文献

{"title":"Pedicle Screw Placement in Pediatric and Adolescent Spinal Deformity Surgery: Does Tapping of the Pedicle Screw Tract Increase Safety?","authors":"Asha Tate, Kirsten Brouillet, Hilton C Braithwaite Iv, Scott J Luhmann","doi":"10.1097/BPO.0000000000002909","DOIUrl":"10.1097/BPO.0000000000002909","url":null,"abstract":"<p><strong>Introduction: </strong>Since the development of pedicle screw fixation in the spine, safe placement has remained a crucial component in maximizing patient outcomes and mitigating pedicle screw-related complications. The purpose of this study is to investigate the utility of pedicle tapping in identifying pedicle breaches.</p><p><strong>Methods: </strong>A pediatric spine surgery database was queried to identify a consecutive series of patients who underwent spinal deformity surgery utilizing pedicle screw fixation between May 2019 and October 2022. A \"breached pedicle\" was defined as a pedicle with intact walls after initial manual cannulation but found to have a breach upon probing after tapping 1 mm smaller than the planned screw diameter. The number of screws placed and breached was prospectively recorded, along with patient demographics and procedural data.</p><p><strong>Results: </strong>There were 288 patients (68% female) with a mean age of 14.3 years (range: 3.7 to 23.3). Diagnoses included idiopathic (129), neuromuscular (76), syndromic (38), congenital (23), kyphosis (9), spondylopathy (12), and trauma (1). The mean upper and lower instrumented vertebrae were T3 and L3, respectively, with an average of 1.4 posterior column osteotomies (PCOs) (range: 0 to 8). Posterior spinal fusion and segmental instrumentation (PSFSI) was the most common procedure (254 cases, 88%). Of 4796 attempted screw placements, 20 (0.4%) pedicles were breached: medial (17), lateral (1), inferior (1), and inferolateral (1). Fourteen screws were abandoned, 3 redirected, and 3 replaced by hooks. T1 (14.3%) and T6 (1.2%) had the highest breach rates. No associations were found between breached pedicles and age ( P =0.099), sex ( P =0.795), or PCOs ( P >0.05). Congenital scoliosis had the highest breach rate at 1.6%.</p><p><strong>Conclusion: </strong>A total of 4796 pedicle screws were placed, with 1 of every 250 (0.4%) of pedicle screw insertions (n=20) having \"breached pedicles\" identified only after tapping. The technical step of pedicle screw tapping potentially mitigated the chance of a misplaced pedicle screw. Surgeons need to assess the value of this information in their surgical workflow and risk assessment.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"269-273"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066386","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":"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 χ 2 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":"e422-e426"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","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":"Midterm Outcomes of Shoulder Dislocations in Brachial Plexus Birth Injuries Treated With Injection Botulinum Toxin A.","authors":"Maulin M Shah, Joyance J Mammen, Meet Jain, Godhasiri Ponugoti, Nischal Naik, Tejas Patel, Tashfin Rubaiath, Preksha Vijay","doi":"10.1097/BPO.0000000000002917","DOIUrl":"10.1097/BPO.0000000000002917","url":null,"abstract":"<p><strong>Background: </strong>Shoulder dislocation can be seen early in infancy and can be diagnosed by shoulder ultrasound. Botulinum toxin injection in the internal rotators of the shoulder can be used to as an adjunct to relieve the internal rotation contracture. The aim of this study was to evaluate the intermediate-term outcomes of shoulder dislocations treated with injection botulinum toxin and to identify the factors determining the outcomes of the procedure.</p><p><strong>Methods: </strong>Eighty-six children with ultrasound diagnosed shoulder dislocation underwent injection BTX-A between 2011 and 2022. Children who underwent nerve surgeries and the ones with inadequate follow-up were excluded. Sixty-two children were followed up for a mean duration of 36 months. Injection botulinum toxin A 2 U/kg body weight was injected each into the subscapularis and the pectoralis major. After manual stretching of contracted anterior soft tissue and shoulder capsule, a shoulder spica was applied for 3 weeks. Hospital for Sick Children Active Movement Scale (HSC-AMS) score and active and passive shoulder was recorded before and after the procedure and the requirement for further interventions was noted.</p><p><strong>Results: </strong>Outcomes were divided into 3 categories: group A-27 (44%) children who did not require any further surgery in our follow-up period; group B-27 (44%) needed further procedure for recurrence of IR contracture; and group C-8 (12%) developed external rotation contracture later. Children in group A had statistically significant higher preinjection HSC-AMS score for elbow flexion and shoulder abduction than the other groups. Children in group C had greater passive external rotation and weak elbow extension and wrist dorsiflexion as compared with the other 2 groups.</p><p><strong>Conclusions: </strong>Injection botulinum toxin A is effective in treating shoulder dislocations in children with early recruitment of C5 to 6 muscles, while children with involvement of C7 muscles may develop an external rotation contracture subsequently, hence this procedure should be avoided.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e492-e495"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079199","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":"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":"e397-e404"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","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":"Hip Joint Articulotrochanteric Distance Measurements in Children: Articulotrochanteric Distance in Children Aged 5 to 14 Years Does Not Increase With Age.","authors":"Di Yang, Ouyang Haiping, Zhongliang Wang","doi":"10.1097/BPO.0000000000002904","DOIUrl":"10.1097/BPO.0000000000002904","url":null,"abstract":"<p><strong>Background: </strong>The articulotrochanteric distance (ATD) has universally been utilized to assess greater trochanter overgrowth in pediatric orthopaedic diseases. However, its overgrowth cannot be detected in a timely manner due to the absence of a normal ATD value. This study is to determine the ATD normal value in hip radiographs of children under the age of 14 and to establish the threshold for overgrowth of the greater trochanter.</p><p><strong>Methods: </strong>A retrospective analysis of 1787 hip radiographs was conducted, measuring ATD, trochanter-to-trochanter distance (TTD), lesser trochanter-to-articular surface distance (LTA), epiphysis height (EH), and femoral head epiphyseal plate-to-lesser trochanter distance (ELD). The differences in TTD and ELD between adjacent age groups were denoted as ΔTTD and ΔELD, respectively. Data with normal distribution were analyzed using independent sample (tow-tailed student t test) t tests and One-way ANOVA, while data with non-normal distribution were analyzed through nonparametric tests. The range defined by the 95% measurement values (mean±2SD) was considered the normal range.</p><p><strong>Results: </strong>Among 5-14 year-olds, the mean ATD (mean±2SD) was 23.5±10.0 mm for males and 21.2±9.6 mm (mean±2SD) for females, statistically significant differences in the ATD were observed between sexes ( P <0.05), whereas no significant differences were noted among age subgroups within the same sex ( P >0.05). The normal range for males was 13.5 to 33.5 mm, while for females it was 11.6 to 30.8 mm. In addition, no significant distinction ( P >0.05) was noted in the EH between males and females within this age range. Furthermore, the analysis revealed no significant difference ( P >0.05) between the changes in ΔTTD and ΔELD among the hips.</p><p><strong>Conclusions: </strong>Our findings revealed that in hip radiographs, ATD values of children aged 5 to 14 years differ significantly between males and females, although within each sex group, there was no notable variation across different age groups. We proposed that ATD <13.5 mm in males and <11.6 mm in females might indicate an overgrowth of the greater trochanter, and in such patients, prophylactic greater trochanteric epiphysiodesis may be beneficial. In addition, we believed that the growth rates of the femoral neck and greater trochanter were approximately similar.</p><p><strong>Level of evidence: </strong>Level IV-diagnostic studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e436-e442"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006810","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":"Bone Scintigraphy Prediction of Postoperative Femoral Head Avascular Necrosis in Children With Hip Trauma and Slipped Capital Femoral Epiphysis.","authors":"Rajvarun S Grewal, Katharine F Hollnagel, Patrick F Curran, James D Bomar, Vidyadhar V Upasani","doi":"10.1097/BPO.0000000000002903","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002903","url":null,"abstract":"<p><strong>Background: </strong>Femoral head avascular necrosis (AVN) is a devastating complication that can occur in the setting of trauma to the pediatric hip. Bone scintigraphy (BoS) can be used to evaluate femoral head perfusion, but current evidence in support of its use in the pediatric population is lacking. The purpose of this study was to evaluate the sensitivity and specificity of BoS to diagnose femoral head AVN in children.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent BoS to assess femoral head perfusion following treatment of traumatic femoral neck fracture, hip dislocation, or SCFE at a single pediatric hospital. All patients had a minimum radiographic follow-up of 1 year. Assessment of intraoperative femoral head perfusion was also recorded if performed. Results of BoS and intra-op assessments were compared with RAVN (radiographic findings of AVN) at final follow-up.</p><p><strong>Results: </strong>Forty-eight hips were included, and 75% were male. The mean age at the time of surgery was 12.5±1.6 years. The mean age at BoS was 12.7±1.7 years. The mean follow-up was 23.3±13.1 months. RAVN developed in 15% (7/48) of hips. Nine hips had an abnormal BoS: 7 hips had absent perfusion and 2 hips had diminished perfusion. All 7 hips with absent perfusion on BoS went on to develop RAVN with collapse. Neither hip with diminished perfusion on BoS went on to femoral head collapse. No hip with normal BoS developed radiographic evidence of AVN at the final follow-up. BoS demonstrating absent perfusion had a sensitivity of 100% and a specificity of 95% in predicting RAVN. Evidence of femoral head perfusion at the time of surgery (drilling or IOP) had a sensitivity of 17% and a specificity of 80% in predicting RAVN.</p><p><strong>Conclusions: </strong>BoS demonstrates high sensitivity and specificity for predicting postoperative RAVN. Clinicians should have increased suspicion of impending femoral head collapse if there is absent perfusion on BoS at 6 to 12 weeks post-op, even with evidence of preserved femoral head perfusion at the time of surgery.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 5","pages":"e418-e421"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811354","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":"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":"e464-e467"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","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}

{"title":"Prevalence of Asymptomatic Acetabular Labrum Abnormalities in the Active Pediatric Population.","authors":"Hunter Jones, I-Yuan Joseph Chang, Diana Chen, Vivek Kalia, Hamza Alizai, Philip L Wilson, Henry B Ellis","doi":"10.1097/BPO.0000000000002906","DOIUrl":"10.1097/BPO.0000000000002906","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of labral tears in asymptomatic active adults has been reported, but the prevalence of labral tears and other incidental hip lesions in the asymptomatic active pediatric population remains unclear. The purpose of this study was to determine the prevalence of hip abnormalities detected on 3T MRI in an active pediatric population with no hip symptoms and to compare with hip abnormalities found in children and adolescents who underwent an MRI for a hip-related condition.</p><p><strong>Methods: </strong>After IRB approval, pediatric patients self-reporting as athletes and presenting with isolated, acute-onset knee pain requiring knee MRI were prospectively recruited to undergo 3T MRI of their asymptomatic contralateral hip (ASx). A comparison group of pediatric subjects who underwent an MRI for hip pain was enrolled retrospectively (Sx). All MRI scans were anonymized and randomized. Fifty subjects were enrolled for each cohort. Two fellowship-trained musculoskeletal radiologists independently evaluated MRIs for abnormal hip lesions, including labral tears. Inter-reader reliability was evaluated using Cohen Kappa. χ 2 or Fisher exact test was used to compare the prevalence of hip lesions between the 2 cohorts.</p><p><strong>Results: </strong>The average patient age was 14.9 years for both cohorts (range 9 to 18 y) and 48% were male. In the ASx group, incidental labral tears were found in 18%, labral/paralabral cysts 6%, cartilage lesion 0%, subchondral cyst 0%, ligamentum teres tear 0%, femoral fibrocystic change 0%, cam lesion 30%, acetabular bone edema 0%, acetabular rim fracture 0%. The prevalence of labral tears (30%, P -value 0.16) and cam lesion (36%, P -value 0.52) in the Sx group was not significantly different from the ASx cohort. No significant correlation was found between the presence of femoral neck osseous bump and labral tear, labral cyst, or paralabral cyst in either cohort.</p><p><strong>Conclusions: </strong>Labral tears were present on 3T MRIs of active pediatric patients with and without hip pain. Although MRI is essential to confirm the surgeon's suspicion and to detect unexpected pathology, clinical examination and history are crucial in pinpointing clinically relevant abnormal imaging findings.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e468-e472"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066390","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":"Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes?","authors":"Andreas Rehm, Ramy Shehata, Sherif Elerian, Rachael Clegg, Pinelopi Linardatou Novak","doi":"10.1097/BPO.0000000000002557","DOIUrl":"10.1097/BPO.0000000000002557","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e497-e498"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412696","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":"Similar Return-to-Sports After Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair in Skeletally Immature Patients: A Prospective, Comparative Cohort Study.","authors":"Győző Lehoczky, Clara Flumian, Jerome Sales de Gauzy, Franck Accadbled","doi":"10.1097/BPO.0000000000002912","DOIUrl":"10.1097/BPO.0000000000002912","url":null,"abstract":"<p><strong>Background: </strong>Pediatric anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients is still controversially debated, with several gaps in its literature. More information is needed about the role of concomitant meniscal injuries in postoperative outcomes and return to pre-injury sports level (RTS).</p><p><strong>Methods: </strong>Fifty skeletally immature patients who underwent ACLR were enrolled prospectively: 21 had meniscal injury additionally, and 29 did not. Patients were assessed with Tegner, Lysholm, Pedi-IKDC, and subjective knee value (SKV) scores presurgery and 6, 12, and 24 months postoperatively. The primary outcome was RTS at 24 months. Secondary outcomes were the 24-month clinical results and the mapping of prognostic factors to RTS in the meniscal injury group. Logistic regression model to estimate OR [95% CI], t test for parametric and Wilcoxon test for nonparametric variables (comparisons of 2 independent groups) were used, as well as t test or Wilcoxon test for paired data, according to the distribution of differences (postoperative-preoperative, paired groups) were used.</p><p><strong>Results: </strong>Out of 50 patients with a mean age of 13.2 years (range 9 to 16), the meniscal injury group had 67% RTS (12/18), and the isolated ACLR group had 75% RTS (18/24) after 24 months, which was not statistically significant, OR=0.67 [0.17 to 2.60], P =0.6. 24-month Lysholm scores were significantly higher in the isolated ACLR group (medians, 95.5 vs. 100.0, P =0.01). There was no significant difference between the groups of Tegner scores, Pedi-IKDC and SKV. No prognostic factors were found for worse RTS after meniscal injury.</p><p><strong>Conclusions: </strong>There is no difference in RTS 24 months after ACLR with or without meniscal injury in the skeletally immature patient.</p><p><strong>Level of evidence: </strong>Level of evidence I-prospective, comparative cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e473-e479"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597165","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}