Journal of Pediatric Orthopaedics最新文献

{"title":"Thermal Risk During Bivalving of Fiberglass Casts Following Orthopaedic Reduction: A Comparative Analysis of 2 Commercially Available Cast Padding Products.","authors":"Claire A Donnelley, Aiden Reuter, James E Donnelley, Peter C Noback, Steven Tommasini, Xuan Luo","doi":"10.1097/BPO.0000000000003442","DOIUrl":"10.1097/BPO.0000000000003442","url":null,"abstract":"<p><strong>Background: </strong>Cast saw burns (CSBs) are a preventable, iatrogenic complication that may occur during bivalving or removal of fiberglass casts. Children undergoing fracture reduction with the use of procedural sedation, typically in the emergency department (ED), are at heightened risk for CSBs because they cannot provide real-time pain feedback during cast saw use. While prior investigations have examined the effects of cast material, cast thickness, and water dip temperature, the comparative thermal performance of commercially available cast padding products during cast bivalving has not been systematically evaluated. This study used thermal probes to compare measured temperatures beneath 2 widely used cast padding products, Webril (Kendall/Cardinal Health) and Specialist (BSN Medical), during a standardized cast application, molding, and bivalving protocol.</p><p><strong>Methods: </strong>A custom upper-extremity model was instrumented with 2 calibrated thermocouples (labeled \"near\" and \"far\"). Twenty experimental runs were performed, 10 each per padding product, with bivalving performed separately for near and far probes (N=40 total). Temperatures were recorded at 3 time points: baseline (before the application of any materials), prebivalve (immediately after fiberglass application ), and at maximum temperature during bivalving with an oscillating cast saw. The primary outcome was the change in temperature from prebivalve to maximum bivalve temperature (ΔT) measured by near and far probes. Secondary outcome included maximum temperatures relative to established burn injury thresholds.</p><p><strong>Results: </strong>The mean ΔT during bivalving was 13.2±13.0°C for Specialist padding and 13.0±6.9°C for Webril padding ( P =0.95). The mean absolute maximum temperature was 40.8±13.2°C for Specialist and 39.5±6.8°C for Webril. In the Specialist group, 6/10 runs exceeded the 44°C adult burn threshold on at least one probe, compared with 4/10 runs in the Webril group. Linear mixed-effects analysis with Kenward-Roger degrees of freedom revealed a significant material×probe interaction during bivalving ( P =0.020): at the near probe, Specialist peak temperatures averaged 8.5°C higher than Webril ( P =0.041), whereas the 2 materials did not differ significantly at the far probe ( P =0.146).</p><p><strong>Conclusion: </strong>Maximum temperatures exceeded clinically relevant burn thresholds in both cast padding groups, supporting the high-risk thermal environment at cast mold sites during bivalving. While Webril had some protective effect, neither commercially available cast-padding product provided consistently sufficient or statistically superior thermal protection.</p><p><strong>Levels of evidence: </strong>Not applicable (biomechanical study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e997-e1003"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764149","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":"Strengthening Evidence on Anxiety‑Associated Opioid Use After Paediatric Lower‑Extremity Fracture Surgery.","authors":"Xianwen Sun, Jun Fei","doi":"10.1097/BPO.0000000000003065","DOIUrl":"10.1097/BPO.0000000000003065","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1099"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675063","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":"Regarding: \"Intraoperative Duplex Ultrasonography in the Pink Pulseless Hand: A Useful Adjunct, But Not Yet a Decision-Making Standard Authors\".","authors":"Vivek Singh, Rahul Mishra","doi":"10.1097/BPO.0000000000003394","DOIUrl":"10.1097/BPO.0000000000003394","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1100-e1101"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295558","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":"Single Versus Double Pin Fixation of the Calcaneocuboid Joint During Calcaneal Lengthening Osteotomy for Pediatric Idiopathic Flatfoot.","authors":"Kunhyung Bae, Yoon Hae Kwak, Michael Seungcheol Kang, Soorack Ryu, Amber McCranie, Ji Hoon Ahn, Soo-Sung Park","doi":"10.1097/BPO.0000000000003413","DOIUrl":"10.1097/BPO.0000000000003413","url":null,"abstract":"<p><strong>Background: </strong>Calcaneocuboid (CC) joint subluxation is a recognized complication after calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot, and temporary pin fixation is often performed to prevent it. This study compared postoperative radiologic outcomes at 2 years of single- and double-pin fixation of the CC joint.</p><p><strong>Methods: </strong>We retrospectively reviewed 50 feet from 30 patients aged 9 to 15 years who underwent calcaneal lengthening osteotomy for idiopathic flexible flatfoot with a follow-up of at least 2 years. Fourteen feet (28%) underwent single-pin fixation, and 36 (72%) double-pin fixation. Five radiographic angles were measured, and the CC joint subluxation index was calculated preoperatively and at 3 months, 1 year, and 2 years postoperatively.</p><p><strong>Results: </strong>The mean age at surgery was 11.1±1.4 years, and there were no significant differences between the single-pin and double-pin groups. At postoperative 2 years, the calcaneal pitch angle was significantly higher in the double-pin group compared with the single-pin group (16.1±3.8 degrees vs. 19.3±4.4 degrees, P =0.019), whereas no significant differences were observed in the remaining radiographic angles or in the CC joint subluxation index ( P >0.05). Number of pins, preoperative anteroposterior and lateral talo-1 st metatarsal angles, and patient age were independently associated with calcaneal pitch angle after 2 years.</p><p><strong>Conclusions: </strong>Although the number of pins did not affect the CC joint subluxation index, double-pin fixation was associated with better maintenance of the calcaneal pitch angle at 2 years after calcaneal lengthening osteotomy for pediatric idiopathic flexible flatfoot. Considering the 3-dimensional anatomy of the CC joint and the characteristics of the calcaneal pitch angle, double-pin fixation may better maintain midfoot-hindfoot alignment after calcaneal lengthening osteotomy.</p><p><strong>Levels of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"668-674"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430642","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":"Three-Year Outcomes Following Hip Reconstruction in Cerebral Palsy: A Population-Based Analysis.","authors":"Autreen Golzar, Christopher D Hamad, Joshua Wiener, Timothy Liu, Al-Hassan J Dajani, David C Kaelber, Nicholas M Bernthal, William L Sheppard, Mauricio Silva, Soroush Baghdadi","doi":"10.1097/BPO.0000000000003435","DOIUrl":"10.1097/BPO.0000000000003435","url":null,"abstract":"<p><strong>Background: </strong>Pelvic reconstruction is commonly performed to manage hip displacement in patients with cerebral palsy (CP), yet population-based outcome data remain limited. Most existing studies are from single centers and have limited generalizability. Here, we present a national descriptive study outlining outcomes of hip reconstruction in patients with CP.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX Research Network, a federated database of 163 million patients across 117 US healthcare organizations. Patients aged 1 to 25 years with CP who underwent hip reconstruction between 2015 and 2022 were included. Outcomes assessed included hardware removal, hip dislocation, infection, and mortality, which were analyzed using the Kaplan-Meier method from 6 months to 3 years postoperatively.</p><p><strong>Results: </strong>Among 1037 patients, 3-year cumulative incidence was 38.6% (95% CI: 35.6-41.7) for hardware removal, 38.5% (95% CI: 35.5-41.6) for hip dislocation, 3.6% (95% CI: 2.5-5.3) for infection, and 2.6% (95% CI: 1.8-3.9) for mortality. Temporal analysis revealed that hip dislocation occurred early, with 61% of events in year 1, whereas hardware removal was late-predominant, with 70% of events in years 2 to 3. Notably, 83% of infections presented after the first postoperative year (0.60% at 1 y vs. 3.6% at 3 y).</p><p><strong>Conclusions: </strong>This large-scale, population-based analysis of hip reconstruction outcomes in CP demonstrates high rates of hardware removal and hip dislocation, and that 83% of hardware-associated infections present after the first postoperative year. These findings suggest that long-term hip surveillance may be warranted after reconstruction. Prospective studies are needed to validate these findings and inform targeted prevention strategies.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1059-e1064"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679050","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":"Are We Getting What We Ask For: Few Patients Meet Mean Arterial Pressure (MAP) Goals After Intraoperative Neuromonitoring (IONM) Changes During Pediatric Spine Surgery.","authors":"Michaela J O'Connor, Michael W Brown, Mehdi M Elfilali, Alexander M Park, Miles J Bomback, Erik D Williams, Joshua Choi, Josephine R Coury, Lawrence G Lenke, Benjamin D Roye, Michael G Vitale","doi":"10.1097/BPO.0000000000003295","DOIUrl":"10.1097/BPO.0000000000003295","url":null,"abstract":"<p><strong>Background: </strong>Hypotension is a critical, modifiable risk factor for neurological deficit in spine surgery. Patients with intraoperative neurophysiological monitoring (IONM) changes are particularly vulnerable, as their spinal cord has already demonstrated sensitivity to correction, and hypotension may exacerbate areas of inadequate perfusion. These patients are admitted postoperatively to the ICU for close neurological and hemodynamic monitoring. This study evaluated adherence to patient-specific mean arterial pressure (MAP) goals in the first 24 hours following IONM changes.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing spinal surgery with IONM changes between 2023 and 2025 at a single institution was conducted. Demographic and radiographic data were documented. Individual 24-hour postoperative \"Target MAP\" goals were established. Arterial line MAP values were collected. Hypotension was defined as MAP <5th percentile for age-based norms.</p><p><strong>Results: </strong>Twenty-one patients [12 female, 9 male; mean age 14.3±2.6 y (range: 7.7 to 19.0)] with IONM changes during pediatric deformity surgery were included. Etiologies included 8 idiopathic, 6 neuromuscular, 5 congenital, and 2 syndromic patients. Of those with major coronal deformities (n=19), mean preoperative and postoperative major curves were 79±22 degrees (range: 40 to 120 degrees) and 38±16 degrees (range: 18 to 75 degrees), respectively, with an average correction of 56%±11% (range: 41% to 71%) in completed cases. Four surgeries were aborted. Six patients (29%) had persistent neurological deficits beyond the first postoperative day. The median MAP goal was >80 mm Hg (range: >60 to >100). Twenty patients (95%) did not continuously meet their MAP goal, defined as ≥1 instance of MAP beneath target. Seven patients' (33%) 24-hour average MAPs were below target. On average, patients spent 27% of the time (6.4 h) beneath their target MAP. Four patients (19%) had a documented period of hypotension.</p><p><strong>Conclusions: </strong>Despite ICU-level care and established MAP goals in critical patients with prior IONM loss or within warning criteria, postoperative blood pressure management often failed to meet MAP goals. This is the first study to highlight this crucial gap between management goals and postoperative hemodynamic adherence.</p><p><strong>Levels of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"631-637"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645533","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 Quality Initiative for Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis (AIS): Liposomal Bupivacaine With Dexamethasone Use Results in Substantial Reduction in Inpatient Opioid Use.","authors":"Anne Stuedemann, Michon Huston, Nicolette Saddler, John Anderson, Michael Benvenuti, Ashley K Sherman, K Aaron Shaw","doi":"10.1097/BPO.0000000000003408","DOIUrl":"10.1097/BPO.0000000000003408","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) pathways have improved postoperative outcomes for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal instrumented fusion (PSF). Liposomal bupivacaine (LB) intramuscular infiltration has emerged as a potential adjunct for opioid-sparing analgesia. This quality initiative evaluates the impact of incorporating LB with intravenous dexamethasone and eliminating patient-controlled analgesia (PCA) within an ERAS pathway.</p><p><strong>Methods: </strong>A retrospective review was conducted of AIS patients aged 10 to 18 years who underwent PSF at a single pediatric tertiary-care center between 2019 and 2025. Three postoperative analgesia protocols were compared: (1) intrathecal morphine (ITM) with PCA, (2) intravenous methadone with PCA, and (3) LB infiltration with dexamethasone without PCA. The primary outcome included cumulative inpatient opioid consumption standardized to morphine milligram equivalents (MME/kg). Secondary outcomes included length of stay (LOS) and pain scores.</p><p><strong>Results: </strong>A total of 159 patients were analyzed (ITM: n=88; methadone: n=36; LB/Dex: n=35). The LB/Dex group demonstrated a substantial reduction in cumulative opioid use compared with ITM and methadone cohorts (0.56±1.43 vs. 4.13±0.90 and 5.32±1.41 MME/kg; P =0.04). LOS was significantly shorter in the LB/Dex group (2.11±0.15 d) compared with ITM (2.80±0.09) and methadone (3.06±0.14; P <0.001). Eighty percent of LB/Dex patients were discharged on postoperative day 2 versus 42% (ITM) and 27.8% (methadone). Pain scores were comparable across groups, with no clinically significant differences despite the absence of PCA in the LB/Dex cohort.</p><p><strong>Conclusions: </strong>Incorporating LB with dexamethasone and removing PCA within an AIS ERAS pathway significantly reduces opioid use and shortens LOS without compromising pain control following PSF. These findings support LB/Dex as an effective opioid-sparing strategy for AIS patients undergoing PSF and highlight the value of multimodal analgesia in optimizing recovery and promoting opioid stewardship.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e967-e973"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430702","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":"An Assessment of the Preoperative Vitamin D Levels in Patients Undergoing Limb Lengthening Surgery.","authors":"Ali Yalcinkaya, Bicheng Yong, Danielle Hatfield, Anirejuoritse Bafor, Christopher Iobst","doi":"10.1097/BPO.0000000000003415","DOIUrl":"10.1097/BPO.0000000000003415","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D is important for skeletal health and may influence bone regeneration during distraction osteogenesis. Although vitamin D insufficiency and deficiency are common in patients undergoing limb reconstruction, the relationship between baseline vitamin D status and regenerate healing remains unclear, particularly within clinical pathways where vitamin D testing is performed perioperatively and supplementation is initiated after surgery for low levels. This study determined the prevalence of perioperative vitamin D deficiency in pediatric patients undergoing limb reconstruction for deformity correction or limb length discrepancy and evaluated the association between baseline vitamin D status, bone-healing outcomes, and postoperative complications within this real-world testing and supplementation pathway.</p><p><strong>Methods: </strong>We performed a retrospective review of pediatric patients treated from January 2017 to December 2021 for lower-extremity limb-length discrepancy using an internal lengthening nail. Serum vitamin D levels were obtained perioperatively, typically on the day of surgery, and were not used to determine surgical eligibility or timing. Patients were categorized by preoperative serum vitamin D level as deficient, insufficient, or sufficient. Patients with vitamin D insufficiency or deficiency were routinely started on postoperative supplementation. Bone healing was assessed using the Bone Healing Index (BHI), and complication rates were compared across groups.</p><p><strong>Results: </strong>Seventy-five patients were included. Twenty-two patients (29%) were vitamin D deficient, 30 (40.0%) were vitamin D insufficient, and 23 (31%) were vitamin D sufficient. Demographic characteristics were similar among groups. Complications occurred in 3 of 22 deficient patients (14%), 2 of 30 insufficient patients (7%), and 2 of 23 sufficient patients (9%), with no difference among groups ( P =0.79). Baseline vitamin D level was not significantly correlated with BHI. Sensitivity analyses excluding tibial cases and grouping patients as sufficient versus insufficient/deficient produced findings consistent with the primary analysis.</p><p><strong>Conclusions: </strong>Vitamin D insufficiency and deficiency were common in this pediatric limb-lengthening cohort. Within a perioperative vitamin D testing and postoperative supplementation pathway for insufficiency or deficiency, low baseline vitamin D status was not associated with lower BHI or increased postoperative complications.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"675-680"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520581","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":"Subaxial Cervical Spine Injuries in Children: Do Adult Classification Systems Help With Surgical Decision-Making?","authors":"Ambika E Paulson, Alex La Poche, Austin Montgomery, Tyler Metcalf, Kelly Vittetoe, Teresa Benvenuti, Michael Benvenuti, Kirsten Ross, Jeffrey E Martus, Gregory A Mencio, Jonathan G Schoenecker, Stephanie N Moore-Lotridge, Craig R Louer","doi":"10.1097/BPO.0000000000003437","DOIUrl":"10.1097/BPO.0000000000003437","url":null,"abstract":"<p><strong>Background: </strong>There is no validated system for classifying and treating traumatic subaxial cervical spine injuries in children. The subaxial cervical spine injury classification (SLIC) system is widely used in adults, but its applicability in children is uncertain. This study evaluated the validity of the SLIC system in predicting operative versus non-operative treatment in pediatric patients with traumatic subaxial cervical spine injuries.</p><p><strong>Methods: </strong>Patients younger than 18 years with acute, traumatic, subaxial cervical spine injuries (without concomitant occipitocervical injury) were identified at a single pediatric level I trauma center from 2006 to 2020. Classification scores were determined from initial imaging and neurological examinations. Patients were grouped according to adult SLIC thresholds (<4 nonoperative, =4 indeterminate, >4 operative), and recommended treatment was compared with the treatment received. Validity was assessed using sensitivity, specificity, positive and negative predictive values, receiver-operating-characteristic area under the curve, and F1 score. Subgroup analyses were performed for children younger than 10 years and those 10 years or older.</p><p><strong>Results: </strong>Forty-seven patients met the inclusion criteria (7 operative, 40 nonoperative). No patient with SLIC<4 (recommended nonoperative treatment) required surgery. All patients with SLIC=4 (indeterminate) were successfully treated without surgery, as were 4/11 patients with SLIC>4 (recommended surgery). Overall area under the curve and F1 scores were 0.968 and 0.78, respectively. Performance decreased in children younger than 10 years, but was excellent in older children.</p><p><strong>Conclusions: </strong>The subaxial cervical spine injury classification system can be helpful in pediatric patients, though this study identifies key differences from its performance in adults. SLIC remains highly sensitive at identifying severe injury; however, it recommended surgery for multiple patients who were ultimately treated non-operatively in this cohort. All patients with SLIC >4 (recommended operative treatment) who were treated without surgery were younger than 10 years. While SLIC demonstrates modest validity in children, our findings suggest that younger patients may be recommended for unnecessary surgery. These results support the selective use of SLIC in pediatric patients, though larger studies are imperative for further age-specific validation.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e974-e982"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829563","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":"Establishing Normative Cartilaginous Acetabular Index Values in North American Children for Evaluation of Developmental Dysplasia of the Hip.","authors":"Jillian H Neuner, Nicholas Kelly, Katherine E Bach, Sara N Kiani, Bamidele F Kammen, Ishaan Swarup","doi":"10.1097/BPO.0000000000003292","DOIUrl":"10.1097/BPO.0000000000003292","url":null,"abstract":"<p><strong>Background: </strong>Cartilaginous acetabular index (CAI) factors in the cartilaginous component of acetabular morphology and may enhance evaluation of developmental dysplasia of the hip (DDH). No studies have established normal CAI values in North American children to date. The purpose of this study was to describe CAI in young patients and to determine the inter- and intrarater reliability of this measurement.</p><p><strong>Methods: </strong>Patients aged 6 months to 5 years who underwent pelvic MRI between 2010 and 2025 were included. We excluded patients with bilateral DDH, prior hip surgery, neurological disease, or other congenital abnormalities. Measurements were performed by 6 observers of varying clinical experience and backgrounds. Age-specific CAI values were compared with previously established age-specific acetabular index (AI) values on X-ray in the same cohort using Pearson correlation.</p><p><strong>Results: </strong>Forty-eight normal hips (24 girls and 24 boys; 4 of each sex per age group) were analyzed. The mean CAI decreased from 17.3 degrees (±2.6 degrees) at 6 months of age to 9.4 degrees (±1.4 degrees) at 5 years of age. Intrarater reliability was fair to excellent across raters, and inter-rater reliability was good. There was a strong, positive correlation between AI and CAI across age groups ( r =0.90, 95% CI: 0.34-0.99, P =0.014).</p><p><strong>Conclusions: </strong>In this single-institution study, we provide preliminary age-specific reference CAI values for North Americans aged 6 months to 5 years. This measurement demonstrated fair to good to excellent intra- and inter-rater reliability, and there is a strong, positive correlation between CAI on MRI and AI on X-ray. These findings support the use of CAI as a reliable measurement in the assessment of DDH and suggest its potential role as an adjunct to existing radiographic parameters.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"644-649"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674363","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}