Journal of Pediatric Orthopaedics最新文献

{"title":"Does Pelvic Tilt Change After Periacetabular Osteotomy for Hip Dysplasia?","authors":"Andrew J Curley, Connor L Luck, Wasim Shihab, Ethan R Ruh, Ashley E Disantis, Michael P McClincy","doi":"10.1097/BPO.0000000000002870","DOIUrl":"10.1097/BPO.0000000000002870","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to (1) evaluate preoperative pelvic tilt utilizing the sacro-femoral-pubic (SFP) angle on standing pelvic x-rays, and (2) determine if the SFP angle changes after a unilateral or bilateral PAO.</p><p><strong>Methods: </strong>A retrospective review was conducted of PAOs performed by a single hip preservation surgeon from November 2018 to November 2023. Standing x-rays were reviewed at 4 time points: preoperative, subacute postoperative, 6-month follow-up, and 12-month follow-up. Data collected included demographics, lateral center-edge angle (LCEA), Tönnis angle, and sacro-femoral-pubic (SFP) angle (a surrogate metric for pelvic tilt). Linear mixed models and Wilcoxon signed-rank tests were used to evaluate preoperative to postoperative differences in pelvic tilt for the unilateral and bilateral PAO groups, respectively.</p><p><strong>Results: </strong>Seventy-four patients met inclusion criteria, consisting of 53 unilateral and 21 bilateral PAO patients (18.5±4.1 vs. 21.3±5.1 y, 90.6% vs. 95.2% female, LCEA 17.5 deg±6.5 deg vs. 18.0 deg±5.5 deg and 18.0 deg±6.3 deg, respectively). The Average preoperative pelvic tilt, calculated from the SFP angle, for the unilateral and bilateral PAO patients were 9.1 degrees±5.5 degrees and 8.1 degrees±5.6 degrees, respectively. These values increased postoperatively at average 7-week (-0.3 deg±3.4 deg and 1.3 deg±3.7 deg), 6-month (1.1 deg±3.8 deg and 2.7 deg±3.4 deg), and 12-month (1.0 deg±4.1 deg and 2.7 deg±3.0 deg) follow-up. Significant differences in pelvic tilt were observed from preoperative x-rays to 6 months ( P =0.002) and 12 months ( P =0.001) for the bilateral PAO patients, whereas the unilateral group demonstrated similar pelvic tilt at all time points ( P =0.09).</p><p><strong>Conclusion: </strong>Patients undergoing bilateral PAO demonstrated an average increase in pelvic tilt of 2.7 degrees as measured by SFP angle at 6 months and 12 months postoperatively, suggesting a compensatory adaptation after surgery that may have implications in rehabilitation regimens and planned surgical corrections.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e318-e323"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785613","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 and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.","authors":"Jay Moran, Michael S Lee, Scott Fong, Christopher LaPrade, Kyle N Kunze, Peter D Fabricant, Jorge Chahla, Andrew E Jimenez, Robert F LaPrade","doi":"10.1097/BPO.0000000000002900","DOIUrl":"10.1097/BPO.0000000000002900","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients undergoing ACLR. The purpose of this study was to perform a systematic review and meta-analysis to determine the pooled prevalence of and risk factors for MMRLs in pediatric patients with ACL injuries.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried in December 2023 for studies reporting on MMRLs in pediatric patients (≤21 y old) undergoing ACLR. Articles were only included if they reported on the prevalence and/or risk factors for arthroscopically diagnosed MMRLs. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MMRLs by generating effect estimates in the form of odds ratios (OR) with 95% CI.</p><p><strong>Results: </strong>Seven studies were identified, which included 1362 pediatric patients (mean±SD age, 15.3±1.4 y old) that underwent ACLR. The pooled MMRL prevalence was 16.4% (range, 13.2% to 28%) calculated across 6 studies. Of the 7 studies identified, 5 qualified for the risk factor analysis, which included a total of 536 ACLR patients. Twenty risk factors were identified, of which 8 were amenable to being explored quantitatively. Anterolateral ligament (ALL) injuries on magnetic resonance imaging (MRI) [odds ratio (OR), 4.16; 95% CI, 1.40-12.34; P =0.01], MMRLs on preoperative MRI (OR, 4.09; 95% CI, 2.52-6.64; P <0.00010), posteromedial tibial plateau bone marrow edema (OR, 2.11; 95% CI, 1.16-3.83; P =0.01), and concomitant lateral meniscus tears (OR, 1.70; 95% CI, 1.04-2.76; P =0.03) were important risk factors for pediatric MMRLs. Skeletal maturity (physes open or closed), male sex, or collateral ligament injury was not associated with the presence of pediatric MMRLs.</p><p><strong>Conclusion: </strong>The overall pooled prevalence of MMRLs was 16.4% in pediatric patients undergoing ACLR. Significant risk factors for pediatric MMRLs included the presence of concomitant ALL injuries on MRI, identification of MMRLs on MRI, posteromedial tibia plateau bone marrow edema, and concomitant lateral meniscus tears at the time of surgery. Skeletal maturity, male sex, or collateral ligament injury were not associated with MMRLs in pediatric ACL tears.</p><p><strong>Level of evidence: </strong>Systematic review and meta-analysis; level of evidence: IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"183-193"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007210","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 Perioperative Complication Rates in Congenital Scoliosis Patients With and Without Tethered Spinal Cord.","authors":"Andrea M Muñoz, Leila M Alvandi, Edina Gjonbalaj, Allyn Morris, Paul Sponseller, Richard C E Anderson, Jaime A Gomez","doi":"10.1097/BPO.0000000000002883","DOIUrl":"10.1097/BPO.0000000000002883","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Congenital early onset scoliosis (C-EOS) often co-occurs with tethered spinal cord syndrome (TSCS), necessitating surgical intervention to address both conditions to prevent worsening neuromuscular function. Detethering can be done concurrently with spinal deformity correction (SDC), before SDC, or not done at all. This study explores perioperative complications in C-EOS patients with and without TSCS who underwent SDC with growing instrumentation or fusion. We hypothesize that C-EOS patients with a history of TSCS who underwent SDC with either growing instrumentation or fusion experienced higher rates of perioperative complications compared with those without TSCS. Among patients with a history of TSCS, we hypothesize that those who were detethered had fewer perioperative complications than those who were not detethered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 751 C-EOS patients from an international spine registry were reviewed. After applying inclusion and exclusion criteria, 477 patients were divided into groups: those with TSCS (n=90) and those without (n=387). Among TSCS patients, the majority underwent detethering (n=54), whereas 36 did not. Demographics, magnetic resonance imaging (MRI) findings, treatment history, and surgical complications were assessed. Statistical analyses were conducted to compare demographic and clinical parameters, including complication rates, using appropriate tests. Postoperative complications were further categorized according to the modified Clavien-Dindo-Sink (mCDS) classification system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Comparing C-EOS patients with and without TSCS revealed no significant differences in age at first MRI ( P =0.52), pre-index major coronal curve ( P =0.43), pre-index maximum sagittal kyphosis ( P =0.113), the number of growth-friendly procedures ( P =1.00), resection ( P =0.071), osteotomy ( P =0.081), intraoperative complications ( P =0.088), postoperative complications ( P =0.41), hardware failure ( P =0.78), infections ( P =0.26), and neurological complications ( P =0.42). Postoperative complications further categorized using the mCDS demonstrated no significant differences between the groups ( P =0.144). No significant differences were found in age at first MRI ( P =0.60), pre-index major coronal curve ( P =0.90), pre-index maximum sagittal kyphosis ( P =0.50), resection ( P =0.20), or osteotomy ( P =0.47) between the detethered and not detethered cohorts. However, a higher percentage of TSCS patients without detethering underwent a growth-friendly procedure ( P =0.003). In addition, TSCS patients without detethering experienced higher rates of postoperative complications ( P =0.009), hardware failure ( P =0.005), and infections ( P =0.031) compared with those who underwent detethering. No differences were noted for intraoperative ( P =0.059) or neurological ( P =0.190) complications based on detethering status. Similarly, postoperative complications usin","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e352-e357"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882319","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":"Epidemiology of Pediatric Fractures and Effect of Socioeconomic Status on Fracture Incidence in Türkiye: A Nationwide Analysis of 2 Million Fractures.","authors":"Saygin Kamaci, Engin Turkay Yilmaz, Barlas Goker, Ebru Dumlupinar, Naim Ata, Mehmet Mahir Ulgu, Suayip Birinci, Izzet Bingol, Muharrem Yazici, Onder Kalenderer","doi":"10.1097/BPO.0000000000002881","DOIUrl":"10.1097/BPO.0000000000002881","url":null,"abstract":"<p><strong>Background: </strong>Childhood fractures are an important public health issue worldwide as they potentially lead to long-term complications. This is the first study reporting a nationwide data pool of 2 million children. We aimed to investigate the epidemiology of pediatric fractures by sex, age, geographical region, and socioeconomic status (SES).</p><p><strong>Methods: </strong>Medical records of children diagnosed with fractures between 2016 and 2022 were collected from Türkiye's e-health database. Fractures were divided into 16 anatomic locations. Age was evaluated in four categories: <5, 5-9, 9-14, and 15-19 years. Regional rankings were stratified based on SES.</p><p><strong>Results: </strong>A total of 1,989,212 pediatric fractures were analyzed (1,371,398 boys, 617,814 girls). The overall fracture incidence was 1117/100,000 person-years, being higher for boys (n=1501) compared with girls (n=713) ( P <0.001). The mean fracture incidence between 0 and 19 years of age was 21.2% (boys: 28.5%; girls: 13.5%). The overall fracture incidence increased with age, peaking at 10 to 14 years for all children and decreasing thereafter. The 4 most common fracture locations were in the upper extremities. Wrist fractures accounted for 28.9% (575,192) of all pediatric fractures. Provinces with higher SES had significantly increased fracture risks.</p><p><strong>Conclusions: </strong>This study provides the most accurate epidemiological analysis of childhood fractures in the Turkish population with landmark nationwide analysis for the pediatric literature. One fifth of children experienced fractures before maturity. The results highlight the influence of SES on fracture rates, as children in more urbanized and developed areas had an elevated risk of fractures.</p><p><strong>Level of evidence: </strong>Level III-diagnostic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e331-e337"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785716","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 and Risk Factors for Leg Length Discrepancy in Children With Idiopathic Clubfoot Treated With Ponseti Method.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Rohit Siddabattula, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002895","DOIUrl":"10.1097/BPO.0000000000002895","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is at times associated with other lower extremity abnormalities, such as leg length discrepancy (LLD). Initial studies in patients treated with extensive soft tissue release (STR) have estimated that LLD is prevalent in 9% to 11% of children with idiopathic clubfoot. However, Ponseti-style serial casting has since replaced STR as the preferred clubfoot treatment method. This study aimed to assess the prevalence of LLD, risk factors for LLD, and the required treatment in children with clubfoot deformity after Ponseti casting.</p><p><strong>Methods: </strong>A retrospective review of medical records from children ages 0 to 18 treated for clubfoot at a single institution from 2002 to 2023 was conducted. Included patients were initially treated with Ponseti casting and had minimum follow-up until age 3. Patients with nonidiopathic clubfoot or who had LLD noted on physical examination but did not have available radiographs were excluded. LLD was defined as a minimum discrepancy of 0.5 cm on bilateral lower extremity radiographs.</p><p><strong>Results: </strong>Two hundred seventy-eight patients (434 feet) met criteria; 73% (203) were male. Forty of the 49 patients with available radiographs had LLD. The prevalence of LLD was 14.4%, with an average discrepancy of 1.1±0.8 cm. The prevalence was significantly higher in patients with unilateral than bilateral cases, 27% (33) versus 4.5% (7), P =<0.001. LLD was present in 21.5% (32) of patients with recurrence and 6.2% (8) of patients without recurrence, P =<0.001. Twenty percent (8) of patients with LLD had an epiphysiodesis at an average age of 11.5±1.4 years.</p><p><strong>Conclusion: </strong>This study reported a prevalence of LLD in 14.4% of children with idiopathic clubfoot treated with Ponseti casting. LLD prevalence was higher in children with unilateral and recurrent clubfoot. Up to 20% of children with LLD may require an epiphysiodesis. We recommend that care providers regularly screen children with clubfoot for LLD, particularly those with unilateral and recurrent deformities, and consider obtaining bilateral lower extremity radiographs in patients with clinical LLD.</p><p><strong>Level of evidence: </strong>Level III. Therapeutic studies-investigating the results of treatment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"234-238"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007206","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":"Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block (ESPB) in Pediatric Hip Surgery: A Randomized, Double-Blinded, Controlled Trial.","authors":"Malgorzata Reysner, Tomasz Reysner, Piotr Janusz, Grzegorz Kowalski, Milud Shadi, Przemysław Daroszewski, Katarzyna Wieczorowska-Tobis, Tomasz Kotwicki","doi":"10.1097/BPO.0000000000002882","DOIUrl":"10.1097/BPO.0000000000002882","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of the pericapsular nerve group (PENG) block and lumbar erector spinae plane block (ESPB) in pediatric hip surgeries is limited mainly to case reports. This study assessed the efficacy of ultrasound-guided PENG block versus lumbar ESPB under spinal anesthesia.</p><p><strong>Methods: </strong>Ninety patients aged 2 to 7 years, ASA I-III scheduled for hip surgery were randomly assigned to 3 equal groups, each receiving the PENG block group (n=30), the ESPB group (n=30), or the control group (n=30). After the spinal anesthesia, the block was performed with 0.5 kg/mL of 0.2% ropivacaine. The primary outcome was the pain scores (FLACC) 48 hours after surgery. The secondary outcomes included postoperative FLACC pain scores, neutrophile-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total opioid consumption.</p><p><strong>Results: </strong>The FLACC score was significantly lower in the lumbar ESPB and PENG groups compared with the control group ( P <0.0001) at all time points. The NLR and PLR levels were substantially lower in the PENG and lumbar ESPB groups ( P <0.0001) compared with the control group. The NLR and PLR levels were significantly lower in the PENG and lumbar ESPB groups compared with the control group ( P <0.0001). The total opioid consumption was significantly lower in the PENG and lumbar ESPB groups compared with the control group ( P <0.0001). Forty-three percent of children in the PENG group and 50% of children in the lumbar ESPB group did not require opioids postoperatively.</p><p><strong>Conclusions: </strong>The PENG block and the lumbar ESPB provide efficient postoperative analgesia in children undergoing hip surgery. The PENG block and lumbar ESPB lower cumulative opioid consumption and the stress response to surgery, expressed by NLR and PLR levels.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e324-e330"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846846","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":"Who is the PROM King? Patient-reported Outcome Measures in Pediatric Musculoskeletal Oncology: A Systematic Review.","authors":"Soroush Baghdadi, David Van Eenenaam, Divya Talwar, Alexandre Arkader","doi":"10.1097/BPO.0000000000002874","DOIUrl":"10.1097/BPO.0000000000002874","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are important companions to traditional, physician-reported measures. The purpose of this study was to systematically review and identify PROMs used in pediatric musculoskeletal oncology and evaluate these instruments.</p><p><strong>Methods: </strong>A systematic literature review was conducted for studies pertaining to pediatric musculoskeletal tumors from 2010 to 2024. Two experts selected eligible papers for inclusion through a systematic approach. PROMs used in the eligible papers were cataloged, and the top 10 most frequently used instruments were evaluated with Evaluating Measures of Patient-Reported Outcomes (EMPRO), which is a standardized evaluation tool for PROs.</p><p><strong>Results: </strong>A total of 316 publications were included in the final analysis, reporting a total of 82 unique PROMs. Of the papers, 24% reported no PROMs, whereas 67% of the instruments were only reported once. Nine out of the 10 top PROMs scored over 50 on EMPRO, meeting the minimum acceptable criteria. Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, Disabilities of the Arm, Shoulder, and Hand (DASH), and Quick DASH were disease-specific instruments scoring high on EMPRO. Short Form-36, Pediatric Quality of Life Questionnaire, Quality of Life Questionnaire-30, BSI-18, and TNO AZL Child Quality Of Life met the requirements in the general instruments. Short Form-12 was the lowest-scored PROM.</p><p><strong>Conclusions: </strong>Our results show minimal consensus on the ideal PROM in pediatric musculoskeletal oncology. We recommend using instruments that are already in widespread use instead of obscure PROMs, which defy the purpose of reporting outcomes from a patient perspective. All 4 disease-specific instruments scored highly and are already widely used, including Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, DASH, and Quick DASH. However, we found no consensus on general instruments. With the development and increasing popularity of Patient-Reported Outcomes Measurement Information System, it may replace other general instruments that are proprietary, unreliable, or not developed with pediatric patients in mind.</p><p><strong>Level of evidence: </strong>Level IV-systematic review of level II to IV studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e378-e384"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794782","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":"Respiratory and Postoperative Outcomes in Early-onset Scoliosis Patients Treated With Vertical Expandable Prosthetic Titanium Rib: Single-center Experience of 20 Years.","authors":"Norman Ramírez, Elyette Lugo, Lyanne Camacho, Mary K Ibañéz, Nicole Ramírez, Jailene I Quiñones-Rodríguez, Gerardo Olivella","doi":"10.1097/BPO.0000000000002898","DOIUrl":"10.1097/BPO.0000000000002898","url":null,"abstract":"<p><strong>Background: </strong>This study examines the long-term effectiveness and safety of the vertical expandable prosthetic titanium rib (VEPTR) device, developed in 1989 to treat early-onset scoliosis (EOS) and thoracic insufficiency syndrome (TIS). Specifically, it assesses VEPTR outcomes over 20 years in a single center, focusing on spine deformity correction, pulmonary function, weight percentile changes, and complication rates.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 36 patients from the EOS clinic who underwent VEPTR implantation without prior spine surgery, with at least 2 years of follow-up. Data collected included age, sex, weight, height, BMI, weight percentiles, comorbidities, radiographic parameters, pulmonary function tests, and complications. Weight percentile (WP) was calculated as preoperative WP and last follow-up WP. Coronal and sagittal deformities were measured preoperatively, immediately postimplantation, and at the last follow-up. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) and were correlated with weight percentile changes. Complications were classified using established criteria.</p><p><strong>Results: </strong>The mean age at VEPTR implantation was 86±34 months, with most cases attributed to neuromuscular scoliosis (56%). The initial coronal Cobb angle improved from 59±18 to 32±14 degrees postimplantation but increased to 60±25 at the final follow-up. Sagittal angles showed similar trends. Pulmonary function tests indicated a decline in FVC and FEV1 over time. There was no correlation between weight percentile changes and pulmonary function changes. Complication rates were high, affecting 63% of patients, which included hardware prominence, device migration, and infections as the most common.</p><p><strong>Conclusions: </strong>Although VEPTR devices initially corrected spinal deformities, their long-term benefits are limited as the correction becomes less pronounced over time. Expected improvement in pulmonary function is not observed. A different approach to treating EOS and TIS is necessary, as the significant complication rates challenge the implants' effectiveness.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"220-225"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189456","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":"Defining Successful Radiographic Physeal Arrest: A Comparison Between Ulnar Epiphysiodesis With and Without a Sliding Bone Autograft.","authors":"Tanner R Campbell, C Douglas Wallace, Patrick F Curran, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000002897","DOIUrl":"10.1097/BPO.0000000000002897","url":null,"abstract":"<p><strong>Background: </strong>Distal radius physeal injuries can result in growth arrest and progressive deformity in children. Ulnar epiphysiodesis may be used to prevent deformity in the skeletally immature child; however, predicting success may be challenging. The purpose of this study was to (1) develop a method to predict successful ulnar epiphysiodesis, and (2) determine the utility of adding a sliding bone autograft as an adjunct to achieving successful epiphysiodesis.</p><p><strong>Methods: </strong>A radiographic assessment of children who underwent isolated ulnar epiphysiodesis for premature radial physeal closure at a single institution was performed, evaluating ulnar variance measurements pre-op, immediate post-op, time of physeal arrest, and final ulnar variance. Surgical technique, including ulnar epiphysiodesis with and without adjunctive sliding bone autograft, was recorded to develop two cohorts to compare the duration of successful physeal closure based on the methodology developed.</p><p><strong>Results: </strong>Eighty-seven wrists met the criteria (age 14.1±1.3 y) with an overall radiographic success of 99% with a mean radiographic follow-up of 6.6±5.9 months. Fifty-four wrists had repeat radiographs after defined radiographic physeal closure to confirm that when >50% of the ulnar physis demonstrated bridging bone formation, there was a longitudinal cessation of growth in 100% of these patients. Forty-five children had ulnar epiphysiodesis without bone graft, and 42 had ulnar epiphysiodesis with adjunct sliding bone autograft. Time to radiographic physeal arrest in the sliding bone autograft cohort was 1.3±0.7 (0.6 to 3.7) months compared with those without a bone graft of 2.9±2.2 (0.7 to 8.3) months; P <0.001.</p><p><strong>Conclusions: </strong>Greater than 50% of opacity across the ulnar physis reliably indicates a successful arrest following ulnar epiphysiodesis. Although the adjunct of a sliding bone autograft did not significantly change the ability to achieve an arrest, it did reduce the duration of time to achieve the arrest. The metric of 50% opacity as a marker for successful cessation of growth can be adapted to limit additional follow-up radiographs. Ulna epiphysiodesis with adjunct sliding bone autograft can be employed when faster cessation is needed.</p><p><strong>Level of evidence: </strong>Level III-comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"239-244"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978906","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":"From Sheep to Sling: Pediatric Injuries Due to Rodeo Mutton Bustin'.","authors":"Rebecca J Schultz, Jason Z Amaral, Tristen N Taylor, Rioke M Diejomaoh, Valeria C De Las Casas, Jon C Wall, Scott B Rosenfeld","doi":"10.1097/BPO.0000000000002892","DOIUrl":"10.1097/BPO.0000000000002892","url":null,"abstract":"<p><strong>Background: </strong>Mutton Bustin' was developed as a safer alternative to rough stock rodeo events such as bull riding to allow kids to participate in the rodeo. Children hold on to the bareback of a running sheep until they fall, competing to see who can ride the longest. While reports of injuries due to other rodeo events are well described in the literature, there are no reports of Mutton Bustin'-associated injuries. We present a case series describing the injury patterns in Mutton Busters who presented to our institution.</p><p><strong>Methods: </strong>Pediatric patients presenting to a single tertiary pediatric hospital system from April 2011 to April 2023 with injuries related to participation in Mutton Bustin' were identified for retrospective review. Review of the medical record was performed to identify patients and collect demographic information (sex, age at injury, race, BMI), injury characteristics, mechanism of injury, and treatment patterns.</p><p><strong>Results: </strong>We identified 20 patients (mean age 5.5±1.2 y, 55% female) presenting to our institution with Mutton Bustin' injuries. The most common injury pattern was upper extremity fracture occurring in 18/20 (90%) cases. Three (15%) of patients required surgical intervention. No patients had complications related to their injuries.</p><p><strong>Conclusions: </strong>Our series demonstrates upper extremity fractures to be the most common injuries obtained while Mutton Bustin' outlines patient education strategies to prevent future rodeo-related injuries.</p><p><strong>Level of evidence: </strong>Level IV-prognostic case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"208-211"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007331","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}