Journal of Pediatric Orthopaedics最新文献

{"title":"Popliteal Fossa Infection, Septic Arthritis of the Knee, Pyomyositis, and Deep Vein Thrombosis Risk in Children.","authors":"Piers D Mitchell, Jose Blanco, Mariusz Chomicki, Alastair Littlewood","doi":"10.1097/BPO.0000000000003123","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003123","url":null,"abstract":"<p><strong>Background: </strong>Our aim is to investigate the association between soft tissue infection in the popliteal fossa and hamstring muscles to determine the risk of DVT formation in children with infections in the knee and posterior thigh.</p><p><strong>Methods: </strong>This prospective cohort study (the Peterborough Paediatric Musculoskeletal Infection Study) has gathered data for 181 children aged 0 to 15 years with infection of their limbs or spine. Those with MRI evidence for infection of the popliteal fossa of the knee were identified, as well as those with thrombosis in the venous system.</p><p><strong>Results: </strong>Popliteal fossa infection was present in 15 children (8% of the 181 in the entire study). Most were associated with septic arthritis of the knee (80%), but some were due to pyomyositis of the hamstrings or calf (20%). Venous thrombosis was noted in 1.1% of the entire 181 study group, but 13% of those with popliteal fossa infection, a 12-fold difference (Fisher exact test statistic 0.0064, P<0.01). One of those with a DVT died from pulmonary embolism a few hours after their MRI scan had been performed.</p><p><strong>Conclusion: </strong>Thirteen percent of children with popliteal fossa infection had an associated DVT, so it may be an independent risk factor for thrombosis. To minimize the risk of DVT and its serious complications, we recommend that children presenting to the Emergency Department with pain in the knee, thigh or calf and raised inflammatory markers (CRP/ESR) suspicious for musculoskeletal infection should have their popliteal fossa examined, and if tender, an urgent Doppler ultrasound should be organised. On MRI, attention should be paid to the popliteal fossa on axial STIR images, and if oedema is present around the popliteal vessels, then prophylactic dose anticoagulation should be started, while those with a dilated popliteal vein on MRI should receive treatment dose anticoagulation.</p><p><strong>Level of evidence: </strong>Level II. A lesser quality prospective study with patients enrolled at different points in their disease.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232892","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 Event Multilevel Surgery (SEMLS) for Children With Cerebral Palsy (CP)-Does Adding a Second Surgeon Make a Difference?","authors":"Michelle Mo, Patricia Miller, Sachin Pathangey, Brian Snyder, Colyn Watkins, Benjamin Shore","doi":"10.1097/BPO.0000000000003108","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003108","url":null,"abstract":"<p><strong>Background: </strong>Single-event multilevel surgery (SEMLS) has been accepted as the standard of care for the surgical treatment of children with cerebral palsy (CP). However, little has been studied on the effect of dual-attending surgeons in SEMLS. The aim of this study was to compare the effect of single versus dual-attending surgeons on resource utilization and postoperative outcomes in children with CP undergoing SEMLS.</p><p><strong>Methods: </strong>A total of 70 patients with CP or CP-like conditions, who were <20 years old, and who underwent SEMLS at a single institution, were identified. Bivariate comparisons were conducted using Student's t tests, Mann-Whitney U tests, and chi-squared tests. Stratified analyses were conducted within patient characteristic subgroups to compare operative outcomes within groups. Multivariable regression analyses were used to assess differences across surgeon cohorts while controlling for potential confounding factors.</p><p><strong>Results: </strong>Patients were stratified into single versus dual surgeon cohorts (n=40 vs. n=30, respectively). No significant differences were noted with respect to age, sex, race, BMI, GMFCS level, or ASA level between groups. A higher proportion of patients with a seizure history (67% vs. 38%; P=0.03) and revision procedures (33% vs. 3%, respectively; P=0.001) were found in the dual surgeon cohort. Bivariate analysis demonstrated that operative times in the dual surgeon cohort were significantly decreased in GMFCS level IV/V patients (269.6 ± 46.7 vs. 356 ± 103.4 min; P=0.002) and patients undergoing hip reconstruction procedures (270.6 ± 53.2 vs. 337.4 ± 85.8 min; P=0.007). A significant decrease in total blood loss (20% in hip reconstruction patients, P=0.036, 25% in GMFCS IV/V patients, P=0.049) and OR costs (16% in GMFCS level IV/V patients, P=0.008) was also observed. Moreover, multivariable analysis found that dual surgeon procedures had a 50-minute average reduction in operative time (P=0.005); no differences were noted in complication rates, unplanned clinic visits, or re-operation rates.</p><p><strong>Conclusions: </strong>A 2-surgeon team for SEMLS can significantly decrease operative time, total blood loss, and OR costs-particularly for hip reconstruction and higher GMFCS level patients.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212995","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":"Polydactyly and Risk of Cancer.","authors":"Matthew V Abola, Logan M Good, Kira L Smith, Alexander N Berk, Robert J Burkhart, Raymond W Liu, Apurva S Shah, Samir K Trehan, Aaron Daluiski","doi":"10.1097/BPO.0000000000003124","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003124","url":null,"abstract":"<p><strong>Introduction: </strong>Syndromic polydactyly is often associated with an increased cancer risk. However, limited data exist regarding nonsyndromic polydactyly and its associated risk of subsequent malignancy. Therefore, our purpose was to investigate differences in rates of both malignant and benign neoplasms among pediatric patients diagnosed with nonsyndromic polydactyly compared with matched controls.</p><p><strong>Methods: </strong>The TriNetX US Collaborative Network database was queried using ICD-9 and ICD-10 codes to identify patients aged 10 and younger diagnosed with any form of polydactyly. Patients were then divided into 2 cohorts depending on their history of polydactyly. These cohorts were propensity-matched based on age, sex, race, ethnicity, and congenital malformation syndromes associated with both polydactyly and malignancy. Subsequent rates of cancer were compared between patients with and without polydactyly.</p><p><strong>Results: </strong>A total of 9,266,353 patients aged 10 and younger were identified, of which 16,478 (0.18%) were diagnosed with polydactyly. After 1:1 propensity matching, both cohorts included 14,361 patients. Mean follow-up was 73 months for the polydactyly cohort and 78 months for the control cohort. Overall, the polydactyly cohort had a significantly increased rate of any neoplasm (3.3% vs. 2.6%) and benign neoplasms (2.6% vs. 2.2%) compared with the control cohort. There was no significant difference between rates of malignant neoplasms between cohorts. In contrast, when analyzing site-specific cancer risk between cohorts, malignant neoplasms of bone or cartilage (0% vs. 0.1%) as well as breast (0% vs. 0.1%) were significantly higher in the control cohort compared with the polydactyly cohort. However, there were no significant differences between cohorts among rates of alternative site-specific cancers, including digestive, respiratory or intrathoracic, skin, mesothelial or soft tissue, urinary tract, central nervous system (CNS), thyroid or endocrine, neuroendocrine, lymphoid, and lip, oral cavity, or pharynx. Furthermore, after stratifying follow-up time periods, no significant differences were appreciated between polydactyly and control cohorts in rates of all neoplasms, malignant neoplasms, and benign neoplasms at follow-up <1 year, between 1 and 5 years, and >5 years.</p><p><strong>Conclusions: </strong>Nonsyndromic polydactyly seems to be associated with increased rates of neoplasms, particularly benign neoplasms. However, site-specific cancers of bone, cartilage, and breast were significantly decreased in polydactyly patients. Although our large study further investigates this complex relationship, further studies are needed to elucidate polydactyly and its cancer implications.</p><p><strong>Level of evidence: </strong>Retrospective cohort study, level of evidence III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213019","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":"Correction of Fixed Knee Flexion Deformity in Patients With Cerebral Palsy Using Suture Anchors for Anterior Distal Femur Hemi-epiphysiodesis.","authors":"Mathangi Sridharan, Thomas Olson, Vanessa J Pare, Amy Steele, Nakul Talathi, Daniel Weltsch, Enda Kelly, Nicholas J Jackson, Rachel Thompson","doi":"10.1097/BPO.0000000000003122","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003122","url":null,"abstract":"<p><strong>Background: </strong>Fixed knee flexion deformity in skeletally immature patients with cerebral palsy (CP) is a common contributor to mobility impairment. Established techniques for guided growth using metal implants are associated with symptomatic hardware. This study provides early results following anterior distal femur hemi-epiphysiodesis (ADFHE) with a novel technique utilizing suture anchor-based nonmetallic implants.</p><p><strong>Methods: </strong>We reviewed a consecutive series of skeletally immature patients with CP treated for fixed knee flexion contracture with ADFHE using this novel technique between April 2021 and March 2023 at a single tertiary care hospital. All surgeries were performed by a single board-certified pediatric orthopaedic surgeon. Age at surgery, ambulatory status, Gross Motor Function Classification System (GMFCS) level, concurrent lower extremity surgery, and preoperative and postoperative knee flexion contracture (degrees) were collected. Time to resolution of contracture (months) and correction rate (degrees/month) were calculated for each knee. All patients were followed for a minimum of 6 months postoperatively (or until full correction). Descriptive statistics and time-to-event analysis were performed.</p><p><strong>Results: </strong>Twenty-one patients were included, of whom 19 underwent bilateral correction (N=40 knees); 14 patients (26 knees) were ambulatory, and 7 patients (14 knees) were non-ambulatory. Six patients were classified as GMFCS level II (29%), 8 level III (38%), 6 level IV (29%), and 1 as level V (5%). In the ambulatory patients, preoperative knee flexion contracture measured 12.9±6.6°. Final postoperative contracture measured 1.69±4.16°. Correction occurred at a rate of 2.0°/month over 11.9±10.2 months. In the non-ambulatory patients, preoperative knee flexion contracture measured 24.6±17.4°. Final postoperative knee flexion contracture measured 13.2±12.3°. Correction occurred at a rate of 1.6°/month over 13.5±0.3 months. Correction rate (P=0.71) and time-to-resolution of contracture (P=0.91) did not differ significantly based on ambulatory status. There were no complications or symptomatic hardware necessitating removal.</p><p><strong>Conclusions: </strong>The use of suture anchor-based ADFHE technique for fixed knee flexion contracture is an effective technique in patients with CP, yielding results similar to those of historical techniques with a favorable complication profile.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213070","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":"Incidence of Autism Spectrum Disorder and Global Developmental Delay in Infants With Brachial Plexus Birth Injury: An Early Association With Birth Asphyxia.","authors":"Thomas J McQuillan, Daniel Gabriel, Patricia E Miller, Peter M Waters, Andrea S Bauer","doi":"10.1097/BPO.0000000000003035","DOIUrl":"10.1097/BPO.0000000000003035","url":null,"abstract":"<p><strong>Background: </strong>Autism spectrum disorder (ASD) and global developmental delay (GDD) are 2 common central nervous system (CNS) diagnoses in children. We hypothesized that the incidence of ASD and GDD is higher among patients with brachial plexus birth injury (BPBI), and that the subgroup of patients with BPBI and CNS diagnoses would have increased rates of maternal risk factors and birth-related complications.</p><p><strong>Methods: </strong>A single institution prospective cohort of 849 patients with BPBI was used. Demographics, perinatal history, maternal factors and treatment, and patient outcomes were recorded. Charts were reviewed for concomitant diagnoses of GDD and ASD. Cohorts were compared regarding demographics and treatment data, and then age and sex-matched to analyze for risk factors.</p><p><strong>Results: </strong>Of 834 unique patients seen for BPBI, 772 met inclusion criteria. Seventeen subjects had a diagnosis of GDD (13) or ASD (4) before the age of 5 years, an incidence of 2.2%, which is not different from the general population incidence of ASD and GDD. After age and sex-matching, a history of birth asphyxia (58% vs. 15%, P <0.05) was most associated with an increased likelihood of ASD or GDD diagnosis. Rates of shoulder dystocia and eventual surgical management did not differ between cohorts.</p><p><strong>Conclusions: </strong>Birth complications, especially birth asphyxia, are associated with GDD/ASD in patients with BPBI. Providers should consider that BPBI and GDD/ASD may coexist in children with a history of a complicated birth.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e871-e875"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497392","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":"Most Coronal Knee Deformities of Healed Nutritional Rickets Under 8 Years of Age Remodel Spontaneously: Building Evidence for Practice Change.","authors":"Mostafa M Baraka, Shady Samir, Shady Mahmoud, Tamer A El-Sobky","doi":"10.1097/BPO.0000000000003028","DOIUrl":"10.1097/BPO.0000000000003028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nutritional rickets remains a global health burden. The optimal management of coronal knee deformities in children/adolescents with healed nutritional rickets as to the indications of conservative treatment versus guided growth surgery remains unsettled. The objective was to report the natural history of disease regarding the remodeling potential of coronal knee deformities and isolate potential patient- and deformity-related factors that are predictors of favorable deformity remodeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We prospectively assessed 109 knees in 57 patients-mean age, 6.1 years (range, 2 to 12)-for spontaneous correction of their coronal knee deformities over a period of 1 year. Male/female:33/24, valgum/varum:34/23, bilateral/unilateral:52/5 patients. Outcome variables were, radiologic tibiofemoral angle and a questionnaire to assess parent satisfaction. They were correlated to independent patient- and deformity-related variables, including age, sex, deformity direction/severity, and laterality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of patients that achieved complete knee remodeling (4.9 y) was significantly lower compared with patients who experienced complete failure of remodeling (8.4 y), P =0.000, (95% CI, 4.3-5.4). In 109 knees, there was a highly significant negative Spearman correlation coefficient between age and degrees of coronal correction, patient satisfaction, and complete failure of remodeling R=-0.660, R=-0.475, R=-0.434, respectively, P &lt;0.001. The knees of patients &gt;8 years of age that failed to remodel (87.5%) was significantly higher compared with patients ≤8 years (29.9%), P =0.000, OR=16.4, (95% CI, 5.2-52.2). There were statistically significant correlations between deformity severity/tibiofemoral angle and the remodeling potential, with a cutoff angle of 16.5 degrees/13 degrees for valgum/varum above which deformities were less likely to remodel spontaneously, P =0.03, P =0.007. Complete knee remodeling in unilateral deformities was statistically but not clinically significant. Correlations of sex and deformity direction with remodeling outcomes were insignificant. The inter- and intrarater agreements were excellent for the radiologic tibiofemoral angle measurements (ICC=0.993, CI, 0.982-0.997, P  &lt;0.01) and (ICC=0.994, CI, 0.987-0.998, P &lt;0.01), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Children with coronal knee deformities of healed nutritional rickets under the age of 8 years should be given the full opportunity to remodel spontaneously for at least 1 year, particularly children with moderate deformities ≤16 degrees. This is irrespective of sex, deformity direction, and laterality. Most deformities remodel spontaneously. This suggests that these deformities may be overtreated. This could reduce unnecessary surgeries and potentiate cost-effectiveness of treatment and risk-benefit profile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;Level IV prognostic studies-invest","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e832-e840"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553847","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":"Do Cerebral Palsy Scoliosis Patients With Postoperative Complications Have Worse CPCHILD Scores 2 Years After Surgery?","authors":"Vineet M Desai, Thomas Coleman, John W Stelzer, Margaret Bowen, Jason B Anari, John M Flynn, Burt Yaszay, Paul Sponseller, Mark Abel, Patrick J Cahill","doi":"10.1097/BPO.0000000000003010","DOIUrl":"10.1097/BPO.0000000000003010","url":null,"abstract":"<p><strong>Background: </strong>Surgical intervention for scoliosis in the cerebral palsy (CP) population is associated with high rates of postoperative complications. Research regarding whether complications after spinal fusion for CP scoliosis patients affect long-term health-related quality of life (HRQOL) remains limited. The goal of this study was to determine if CP scoliosis patients with major postoperative complications have worse HRQOL 2 years after surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with nonambulatory CP treated with spinal fusion from 2008 to 2019 with at least 2 years of follow-up. HRQOL was measured through the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Complications included anything life-threatening, extended hospitalization, spinal cord/nerve injury, or reoperation. Complications were also classified as \"existing\" or \"resolved\" based on the 2-year postoperative visit. Patients with existing or unresolved complications at the 2-year postoperative visit were excluded.</p><p><strong>Results: </strong>There were 298 CP patients operated on during the study period (51% male, mean age: 14.3±3 y). Within this cohort, 208 patients (70.0%) were identified as GMFCS V. 76 patients (26%) experienced a postoperative complication. Seventy-one patients (93%) had a complication that resolved by 2 years postoperatively. Five patients (7%) had complications that did not resolve and required ongoing treatment. The most common complication was infection (13%). There was no difference in CPCHILD total, as well as domain HRQOL scores at 2 years postoperatively between patients without complications and patients with resolved complications ( P >0.05). Similarly, there was no difference in mean improvements in CPCHILD total and domain scores at 2 years postoperatively between the no complication and resolved complication cohorts ( P >0.05).</p><p><strong>Conclusion: </strong>Patients with CP scoliosis who experience postoperative complications that resolved by 2 years postoperatively have no significant difference in HRQOL in comparison to those without postoperative complications as measured through the CPCHILD questionnaire. Patients and surgeons can be reassured that despite a high complication rate in CP scoliosis surgery, the initial expectations of improved HRQOL are not diminished as long as the complication is appropriately identified and managed.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e775-e781"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208765","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":"Tumors and Tumor-like Lesions of the Pediatric Hand and Wrist: Clinical Presentation and Risk Factors for Malignancy.","authors":"Akbar N Syed, David Kell, Alexandre Arkader, Sulagna Sarkar, Pille-Riin Värk, Apurva S Shah","doi":"10.1097/BPO.0000000000003017","DOIUrl":"10.1097/BPO.0000000000003017","url":null,"abstract":"<p><strong>Background: </strong>Malignant tumors of the pediatric hand and wrist are rare. We hypothesize that pain, large size, and palm/wrist location are risk factors for malignancy in children.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients younger than 18.9 years of age presenting to our institution with hand and wrist tumors or tumor-like lesions over a 15-year period. Patients with skin lesions, commonly encountered subcutaneous masses (lipomas, ganglion cysts, and sebaceous cysts), multiple hereditary exostoses, and Ollier disease were excluded. Data collection included demographics, clinical presentation, imaging features, and surgical management. Risk factors for malignancy were determined using receiver operating characteristic and descriptive statistical analysis.</p><p><strong>Results: </strong>Three hundred twenty-seven tumors and tumor-like lesions were identified in 312 patients, with a mean age of 10.1 ± 4.6 years. Three hundred fifteen (96.3%) lesions were benign, and 12 (3.7%) lesions were malignant. The most common benign bone tumors were osteochondromas (75/160, 46.9%) and enchondromas (50/160, 31.3%), while the most common benign soft-tissue masses were vascular malformations (39/155, 25.2%) and giant cell tumors of the tendon sheath (30/155, 19.3%). The most common location was the digit. All malignant tumors (3 bone, 9 soft tissue) were in either the palm or wrist. Epithelioid sarcoma (4/9) and synovial sarcoma (2/9) were the most common soft-tissue malignancies, and osteosarcoma (3/3) was the only identified malignant bone tumor. Overall, the most common presenting complaints were swelling (63%) and pain (19.9%). Bivariate analysis found size >11.4 mm and palm/wrist location as risk factors for malignancy. Based on ROC analysis, age and pain ratings were poor predictors of malignancy. Among bone tumors, an aggressive zone of transition, periosteal reaction, and cortical destruction were significant radiographic risk factors for malignancy.</p><p><strong>Conclusions: </strong>The most common tumors and tumor-like conditions of the pediatric hand and wrist include osteochondromas, enchondromas, vascular malformations, and giant cell tumors of the tendon sheath. Larger tumors (>11.4 mm) and lesions found in the palm/wrist are more likely to represent malignancies and should be approached with caution.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e865-e870"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248462","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":"The 10-Year Functional Outcome of Ponseti Treatment of Idiopathic and Arthrogrypotic Clubfeet With an Age-Matched Control.","authors":"Chris Church, Nicole Wang, Stephanie Butler, Jose J Salazar-Torres, John Henley, Freeman Miller, Nancy Carlin, Maureen Donohoe, L Reid Nichols","doi":"10.1097/BPO.0000000000003007","DOIUrl":"10.1097/BPO.0000000000003007","url":null,"abstract":"<p><strong>Background: </strong>The Ponseti method is accepted as an effective primary conservative treatment for idiopathic clubfoot (IC) using serial casting, percutaneous Achilles tenotomy, and prolonged bracing. The outcomes of its use in treating rigid clubfoot in arthrogryposis are unclear. This study assesses the outcomes of the Ponseti method in children with IC and arthrogrypotic clubfoot at an average age of 10 years.</p><p><strong>Methods: </strong>Outcomes of the Ponseti method were retrospectively studied in ambulatory children ages 8.0 to 12.9 years in the gait lab between 2004 and 2024. Children were excluded due to the presence of nonidiopathic or nonarthrogryposis-related clubfoot and history of posteromedial release. The Ponseti treatment included serial casting and Achilles tenotomy in infancy, followed by night bracing until age 5 in both cohorts. Clubfoot groups were compared with typically developing children by analyses of foot pressure data, passive range of motion, Gross Motor Function Measure Dimension-D, and Pediatric Outcomes Data Collection Instrument. Surgical history was also recorded. A subsection of these children visited the gait lab at age 4.0 to 6.9 years (2003 to 2021) and data from their visits were abstracted for a longitudinal study.</p><p><strong>Results: </strong>One hundred seventy-seven children were reviewed (48 with clubfoot associated with arthrogryposis, 129 with IC) with an average age of 9.4±0.9 years. Repeat surgical intervention was used in 33% of IC feet and 44% of arthrogrypotic clubfeet. Residual equinovarus and limitations in range of motion were present in both clubfoot groups compared with typically developing feet ( P <0.05). The foot deformity and passive range of motion restrictions were more severe in children with arthrogrypotic clubfeet ( P <0.05). The arthrogrypotic clubfoot group additionally exhibited limited gross motor and global function ( P <0.001). In 5-year to 10-year comparisons, both subgroups showed more limitations in ankle motion but improvements in dynamic equinovarus deformity and function at age 10 years ( P <0.05).</p><p><strong>Conclusions: </strong>Despite residual deformity, children with idiopathic clubfoot achieve typical functional outcomes through Ponseti treatment. Children with arthrogrypotic clubfeet exhibit functional limitations, but the Ponseti method is effective in improving foot position while minimizing the need for surgical intervention.</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":"552-558"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110108","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":"Psychological Predictors of Pain Outcomes in Children With Cerebral Palsy Undergoing Orthopaedic Surgery.","authors":"Elizabeth R Boyer, Allison G Corlett, Kyle Nickodem, Frank J Symons, Tom F Novacheck, Chantel C Burkitt","doi":"10.1097/BPO.0000000000003005","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003005","url":null,"abstract":"<p><strong>Background: </strong>Many children with cerebral palsy (CP) undergo orthopaedic surgery. Prospective studies exploring patient or psychological factors predictive of pain recovery or chronicity have not been investigated in CP and orthopaedic surgery. In studies with other pediatric clinical samples, preoperative pain, anxiety, and catastrophizing were shown to be predictive of pain outcomes. The purpose of this exploratory study was to (a) quantify pain presence longitudinally before and after orthopaedic surgery in children with CP and (b) identify preoperative factors associated with postoperative pain intensity and interference.</p><p><strong>Methods: </strong>Parents of 36 children (mean age=12 y, range=4 to 17) completed online surveys at 1 week preoperative, and 1, 3, 6, and 12 months after spinal fusion (n=10), multilevel lower extremity surgery (n=20), or other orthopaedic surgery (n=6). Pain interference (Brief Pain Inventory-Pain Interference), pain intensity (Numerical Rating Scale 0 to 10), and chronic postsurgical pain (CPSP; new or worsening pain) were the outcome variables. Multilevel modeling was used to identify whether participant demographics (eg, age, sex, gross motor ability) and psychological factors (parent pain catastrophizing and grit) were associated with pain interference and intensity outcomes.</p><p><strong>Results: </strong>There was significant variability in pain experience between participants. Moderate to severe pain affected about one-third of participants at all time points, with about one-quarter of participants meeting the criteria for CPSP. Higher parent pain catastrophizing and lower grit were associated with greater pain intensity and interference. Participant age, sex, gross motor ability, and number of prior surgeries were not related to pain outcomes.</p><p><strong>Conclusions: </strong>Pain, including moderate to severe pain, was experienced by a substantial proportion of children with CP in this sample both before and after orthopaedic surgery. There is initial evidence that psychological factors may be viable predictors of postsurgical pain outcomes, highlighting opportunities for screening and intervention, though further research is needed.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 9","pages":"531-539"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030151","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}