Journal of Pediatric Orthopaedics最新文献

{"title":"Daytime Versus After-hours Surgical Fixation of Pediatric Supracondylar Humeral Fractures: A Meta-analysis.","authors":"Marc Boutros, Guy Awad, Jean-Pierre Saad, Zina Smadi, Karim Masrouha","doi":"10.1097/BPO.0000000000003315","DOIUrl":"10.1097/BPO.0000000000003315","url":null,"abstract":"<p><strong>Background: </strong>Pediatric supracondylar humeral fractures (SCHFs) are among the most common elbow injuries in children and frequently require operative fixation. Although after-hours surgery is often unavoidable due to emergency presentation patterns, many centers now reserve nighttime intervention for urgent indications such as vascular compromise. Concerns nevertheless persist regarding the potential impact of after-hours surgery on surgical efficiency, technical decision-making, and postoperative outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 15, 2025. Comparative studies evaluating operative treatment of pediatric SCHFs performed during daytime working hours versus after-hours were included. Outcomes assessed comprised perioperative characteristics (operative time, time to surgery), intraoperative decision-making (medial pin fixation, open reduction), and postoperative complications (pin migration, alignment-related complications, infection, and iatrogenic postoperative nerve injury).</p><p><strong>Results: </strong>Seven studies encompassing 913 pediatric patients met the inclusion criteria. Operative time did not differ significantly between daytime and after-hours surgery ( P =0.11). Time to surgery was shorter in the after-hours group ( P <0.001). No significant differences were observed in rates of medial pin fixation ( P =0.70) or open reduction ( P =0.80). Postoperative complications, including pin migration, infection, and iatrogenic postoperative nerve injury, were comparable between groups, whereas alignment-related complications were more frequent in the after-hours group ( P =0.04).</p><p><strong>Conclusions: </strong>Operative fixation of pediatric SCHFs showed broadly comparable perioperative efficiency, technical outcomes, and complication rates when performed during daytime or after-hours, although alignment-related complications were more frequent in the after-hours group. These findings suggest that surgical timing alone may not be the primary determinant of outcome.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"603-610"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839344","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":"Are Surgically Treated Long Bone Fractures in Adolescents Linked to Higher Rates of Substance Use Disorder? A Propensity-Matched Study.","authors":"Mehul M Mittal, Katalina V Acevedo, Sri Tummala, Daniel E Pereira, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000003405","DOIUrl":"10.1097/BPO.0000000000003405","url":null,"abstract":"<p><strong>Background: </strong>Adolescents recovering from operatively treated traumatic fractures face significant perioperative challenges, including pain, functional limitations, and psychological distress. Pain management often involves the use of opioids, which may contribute to the subsequent risk of developing substance use disorders (SUDs). This study explores the relationship between surgically treated upper and lower-extremity long-bone fractures and the subsequent risk of developing SUDs.</p><p><strong>Methods: </strong>This retrospective, propensity-matched cohort study used the TriNetX US Collaborative database, which encompasses over 115 million patient records. Adolescents aged 14 to 17 years or younger with surgically treated upper (n=24,249) or lower (n=16,507) extremity fractures were compared with matched controls without fractures (n=24,249 and 16,507, respectively). Patients with prior psychiatric, substance use, or insomnia disorders were excluded. Hazard ratios (HRs) for SUD diagnoses were estimated over a 2-year follow-up period using a Cox proportional hazards model.</p><p><strong>Results: </strong>Adolescents with surgically treated upper extremity fractures have a moderate but significant increase in SUD risk ( HR =1.3) compared with matched controls. In addition, those with surgically treated lower-extremity fractures have a significantly increased risk ( HR =1.7) of developing substance use disorders compared with matched controls.</p><p><strong>Conclusion: </strong>Adolescents with surgically treated long-bone fractures are at increased risk of developing SUDs, particularly following lower-extremity fractures. These findings highlight opportunities for opioid-sparing pain management and early identification of at-risk adolescents, which may warrant further investigation as strategies to mitigate this risk.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e925-e931"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535846","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":"Assessing Correlations Between PROMIS-25 and QuickDASH in Pediatric Patients With Upper Extremity Trauma.","authors":"Nicholas Kelly, Luke Sang, Sarah Coufal, Ishaan Swarup","doi":"10.1097/BPO.0000000000003403","DOIUrl":"10.1097/BPO.0000000000003403","url":null,"abstract":"<p><strong>Background: </strong>In pediatric upper extremity (UE) trauma, outcome tracking is essential to guide treatment decisions. QuickDASH is commonly used as a region-specific outcome measure but is limited in scope and comparability across populations. PROMIS-25 is a standardized multidomain tool assessing physical function, pain, fatigue, emotional health, and social relationships. Its relationship with QuickDASH in pediatric UE trauma remains unclear. This study aimed to assess correlations between PROMIS-25 domains and QuickDASH scores and explored variation across demographic subgroups and perioperative timing.</p><p><strong>Methods: </strong>This IRB-approved retrospective study was conducted at a single tertiary pediatric trauma center. Pediatric patients with UE injuries were included if they completed paired PROMIS-25 and QuickDASH questionnaires. A total of 591 paired survey instances were analyzed. Spearman correlation coefficients were utilized to assess the associations between PROMIS-25 domains and QuickDASH scores. Floor and ceiling effects were quantified. Rho-to-Z transformations were performed to assess differences in correlation strength across sex, age, race/ethnicity, and operative timing.</p><p><strong>Results: </strong>QuickDASH scores correlated strongly with PROMIS-25 functional mobility ( ρ =-0.84, P <0.01) and PROMIS Pediatric Upper Extremity Short Form ( ρ =-0.87, P <0.01) and showed a strong-moderate correlation with pain interference ( ρ =0.64, P <0.01). Fatigue ( ρ =0.54), depression ( ρ =0.51), and anxiety ( ρ =0.43) demonstrated moderate correlations, while peer relationships showed a weak association ( ρ =-0.15; all P <0.01). QuickDASH demonstrated a substantial floor effect (28.3%) with minimal ceiling effect, whereas PROMIS functional mobility and pediatric UE-SF showed notable ceiling effects (42.5% and 39.6%) with negligible floor effects. Correlations varied by sex, age, and operative status.</p><p><strong>Conclusion: </strong>PROMIS-25 demonstrates strong concurrent validity with QuickDASH in pediatric UE trauma, particularly for physical function and pain domains. Given the differing ceiling and floor effects observed across instruments, PROMIS-25 may be especially useful for postoperative assessment, while QuickDASH may provide complementary information in higher-functioning patients.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e932-e938"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447627","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":"Ulnar Epiphysiodesis for Distal Radius Physeal Arrest: Comparing Early Detection to Late Presentation Management.","authors":"Aidan O'Brien, Tanner R Campbell, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000003416","DOIUrl":"10.1097/BPO.0000000000003416","url":null,"abstract":"<p><strong>Background: </strong>Premature physeal arrest of the distal radius (PPAR) is a rare but serious complication following pediatric fractures that may result in ulnar impaction syndrome. The purpose of this study was to compare outcomes following distal ulnar epiphysiodesis between those identified without deformity (early cohort) and those identified with deformity (late cohort). The hypothesis was that treating children before deformity development would improve patient-reported outcomes (PROs).</p><p><strong>Methods: </strong>All patients younger than 18 years of age who underwent ulnar epiphysiodesis due to PPAR from 2011 to 2022 were identified through a query of the electronic medical record. Demographics were collected, final QuickDASH (Disabilities Arm, Shoulder, Hand) and SANE (Single Assessment Numerical Evaluation) scores, and final ulnar variance. Two cohorts were developed based on whether or not they required a concomitant corrective osteotomy: the early cohort, without meaningful deformity at surgery; and the late cohort, with meaningful deformity (angular deformities outside the normal range for articular position or abnormal ulnar variance). Patients with >1 year of radiographic follow-up were divided into ≥2.5 and <2.5 mm ulnar variance at final follow-up, and PROs were compared.</p><p><strong>Results: </strong>A total of 63 wrists (60 patients), 39 males and 40% Hispanic, were followed for a mean of 6.4±3.4 years (range: 2.0 to 12.3 y). The mean QuickDASH scores for the early (n=41 wrists) and late (n=22 wrists) cohorts were 6.7±12.1 and 5.7±9.0, and the mean SANE scores were 90.4±14.5 and 87.9±14.5, respectively. The ≥2.5 mm final ulnar variance cohort (n=7), and the <2.5 mm final ulnar variance cohort (n=12) were determined at a mean of 22.5±8.8 months (range: 12.4 to 50.5 mo) follow-up, with no difference in QuickDASH or SANE scores between these radiographic outcome cohorts.</p><p><strong>Conclusions: </strong>Both early-presenting (requiring no osteotomy) and late-presenting (osteotomy required) wrists with premature physeal arrest of the distal radius experienced similar functional outcomes at short-term duration of follow-up, suggesting that correction of the deformity and restoration/maintenance of radiographic parameters to the wrist are more important than timing of the ulnar epiphysiodesis.</p><p><strong>Level of evidence: </strong>Therapeutic, level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"654-660"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471061","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":"Examining Sex-Based Inequities in Pediatric Sports Medicine Research: A Systematic Review.","authors":"John H Sonnier, Neeraj M Patel, Samantha L Watson, Isabel Gippo, Lance Lew, Eric H Durudogan, Abigail Miller, Suna Paek, Sigrid F Wolf","doi":"10.1097/BPO.0000000000003436","DOIUrl":"10.1097/BPO.0000000000003436","url":null,"abstract":"<p><strong>Background: </strong>Inequalities in the inclusion of male and female athletes have been documented in the sports medicine literature. However, the extent to which this phenomenon exists in studies of pediatric athletes remains poorly defined. The purpose of this study is to characterize the inclusion of male versus female athletes in pediatric sports medicine.</p><p><strong>Methods: </strong>All articles published from 2020 to 2024 in 12 top interdisciplinary sports medicine journals were manually reviewed, and results were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocols. Inclusion criteria were: (1) full-text original research study, (2) isolated athletes, and (3) isolated a pediatric patient population. Exclusion criteria were: (1) editorial or review article, (2) case report with only one subject, and (3) cadaveric study. Data were collected to characterize study design, inclusion, and outcomes of interest. Statistical analysis was performed using the asymptotic χ 2 (Pearson) test as the default. To examine absolute inequality in the inclusion of male and female athletes, mean differences (MDs) were calculated from linear regression models for continuous outcomes.</p><p><strong>Results: </strong>Across 409 included studies, 30% enrolled only male athletes, 10% enrolled only female athletes, and 60% included both male and female athletes. The median inclusion was 61% male and 39% female (mean 64% and 36%, respectively). Among 234 studies that focused on a single sport, 48.7% included only males, 15.4% included only females, and 35.9% included both males and females ( P <0.001). Using MDs from linear regression, female athletes were shown to be underrepresented in study designs representing a higher level of evidence that analyzed variables such as patient-reported outcomes, injury, reinjury, or return to play. No difference in inclusion was seen in studies of mental health outcomes.</p><p><strong>Conclusion: </strong>Females are underrepresented in studies of youth athletes, particularly in single-sport studies and study designs with a higher level of evidence.</p><p><strong>Clinical relevance: </strong>Given that there are known differences in sex-related outcomes, future research should prioritize equity in the inclusion of male and female athletes.</p><p><strong>Levels of evidence: </strong>Level IV-systematic review.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e919-e924"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701566","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":"Is D-Dimer Associated With Disease Severity and Contralateral Slip Risk in Slipped Capital Femoral Epiphysis?","authors":"Muhammed B Kurk, Kutalmis Albayrak, Abdurrahman Aydin, Gorkem Kayis, Evren Akpinar","doi":"10.1097/BPO.0000000000003441","DOIUrl":"10.1097/BPO.0000000000003441","url":null,"abstract":"<p><strong>Background: </strong>To evaluate D-dimer levels in patients with slipped capital femoral epiphysis (SCFE), to investigate their association with disease severity and the development of contralateral slip, and to assess their contribution to existing predictive models.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 25 patients with unilateral SCFE diagnosed between January 2020 and April 2024 were included. The control group consisted of age- and sex-matched obese individuals and healthy subjects with normal body mass index (BMI). Clinical variables (age, sex, BMI, stability according to the Loder classification, and chronicity); laboratory parameters [complete blood count, neutrophil-to-lymphocyte ratio (NLR), inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer]; and radiographic measurements [Southwick angle, interhip angle difference, posterior sloping angle (PSA), and modified Oxford bone score (MOBS)] were analyzed. Subgroup analyses based on stability and chronicity were performed, and correlations between D-dimer levels and clinical, laboratory, and radiographic parameters were assessed. Multivariable logistic regression models were constructed to predict contralateral slip, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>D-dimer levels were significantly higher in the SCFE group compared with both obese and healthy control groups ( P <0.001). D-dimer showed positive correlations with CRP and NLR and negative correlations with the MOBS and the interhip Southwick angle difference. Higher D-dimer levels were observed in unstable and acute-on-chronic cases ( P <0.001). During a mean follow-up of 24 months, patients who developed contralateral slip had significantly higher D-dimer levels ( P =0.002). The addition of Southwick angle difference to a baseline model including age and MOBS increased the AUC from 0.73 to 0.80, while further inclusion of D-dimer improved the AUC to 0.87. However, the increase in AUC after addition of D-dimer was not statistically significant according to the paired DeLong test ( P =0.18).</p><p><strong>Conclusion: </strong>D-dimer levels are associated with disease severity and the risk of contralateral slip in SCFE. Incorporation of D-dimer into established clinical and radiographic parameters improved predictive model performance. These findings support the role of inflammatory and microvascular processes in the pathogenesis of SCFE and suggest that D-dimer may serve as a useful adjunct biomarker for risk stratification.</p><p><strong>Levels of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1018-e1024"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712718","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":"Early-Stage Perfusion MRI Correlates Significantly With Femoral Head Deformity in Children Under 6 Years of Age With Legg-Calvé-Perthes Disease: A Preliminary Multicenter Study.","authors":"Joonoh Lee, Ahan Mistry, Jessica Cao, Keinan Agonias, William Morris, Hitesh Shah, Mihir M Thacker, Harry K W Kim","doi":"10.1097/BPO.0000000000003407","DOIUrl":"10.1097/BPO.0000000000003407","url":null,"abstract":"<p><strong>Background: </strong>In general, the onset of Legg-Calvé-Perthes disease (LCPD) before age 6 is thought to be associated with a good radiographic outcome. Many of these patients, however, still develop a poor outcome with ovoid-to-flat femoral head deformity. Currently, no early-stage prognosticator of outcome exists for patients younger than 6 years at onset. This study investigated whether perfusion MRI (pMRI) obtained in early stages of LCPD correlates with deformity index (DI), epiphyseal index (EI), and sphericity deviation score (SDS). We hypothesized that early-stage femoral head hypoperfusion would correlate significantly with these radiographic outcomes and serve as an early prognosticator.</p><p><strong>Methods: </strong>This multicenter study reviewed demographic, pMRI, and radiographic data from patients with LCPD who had disease onset before age 6. Inclusion criteria were pMRI at Waldenström stage I to IIa. DI and EI were evaluated at 2-year follow-up, and SDS at the healed stage. Statistical analyses included Pearson correlation and ROC analysis, with a threshold predictive of SDS >20.</p><p><strong>Results: </strong>Forty-one femoral heads (37 patients; mean age at onset 5.0±0.9 years) were analyzed with a mean follow-up of 4.1±1.3 years. Mean hypoperfusion was 49±28%. Mean DI was 0.38±0.18, EI was 0.26±0.10, and SDS was 18.2±12.9. Increasing hypoperfusion (%) correlated significantly with greater femoral head deformity, including higher DI ( r =0.76), lower EI ( r =-0.62), and higher SDS ( r =0.64) (all P <0.001). ROC analysis identified 62% hypoperfusion as optimal for predicting SDS >20 (AUC: 0.80; sensitivity 75%; specificity 87%). Using a 60% cutoff point, outcomes were worse above the threshold: DI (0.31±0.16 vs. 0.52±0.14, P =0.002), EI (0.30±0.09 vs. 0.19±0.07, P <0.001), and SDS (11.7±6.1 vs. 26.8±14.6, P =0.001).</p><p><strong>Conclusions: </strong>Early-stage femoral head hypoperfusion correlated significantly with radiographic outcomes at 2-year follow-up and at the healed stage in patients with LCPD onset before age 6. A pMRI hypoperfusion threshold of 60% identified femoral heads at a higher risk for femoral head deformity, supporting pMRI as a potential early prognostic marker.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e989-e996"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447678","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":"Children With Synpolydactyly Type I Homozygous HOXD13 Mutations: Embryology and Surgical Correction of the \"Cupping\" of the Hands and Feet.","authors":"Samir O Alsayegh, Abdullah M Alghamdi, Mohammad M Al-Qattan","doi":"10.1097/BPO.0000000000003434","DOIUrl":"10.1097/BPO.0000000000003434","url":null,"abstract":"<p><strong>Purpose: </strong>Some patients with familial Synpolydactyly Type I have severe flexion deformities of the hands and feet at the metacarpophalangeal and the metatarsophalangeal joints, and the resulting deformity has been named \"cupping\" of the hands and feet. Severe \"cupping\" requiring surgical correction has not been previously reported. We explore the embryology and pathogenesis of the phenotype and present the surgical technique and results after the correction of the cupping deformity in a case series of 3 children.</p><p><strong>Patients and methods: </strong>Two children had severe deformity of the postaxial toes, and they were stepping on the dorsal aspect of these rays. Correction was done with dorsal wedge osteotomies of the metatarsals. One child required correction of 1 hand. He underwent syndactyly release, release of the tight volar skin at the metacarpophalangeal joints, and volar plate release of the metacarpophalangeal joints.</p><p><strong>Results: </strong>Partial correction of the deformity was achieved in all 3 children. All children were followed up for more than 5 years. The former 2 children were stepping on the plantar aspect of the toes, and the latter child was using his hand well in daily activities. All parents were satisfied with the results.</p><p><strong>Conclusion: </strong>Cupping of the hands and feet is severe enough to require surgery in some patients with familial Synpolydactyly Type I. Our surgical technique partially corrects the deformity, but it resulted in a good functional outcome.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1075-e1080"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663667","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":"Correlation Between Radiographic Parameters and Clinical Range of Motion in Slipped Capital Femoral Epiphysis.","authors":"Stone R Streeter, Olivia C Ullmann, Sulagna Sarkar, Wudbhav N Sankar","doi":"10.1097/BPO.0000000000003411","DOIUrl":"10.1097/BPO.0000000000003411","url":null,"abstract":"<p><strong>Background: </strong>Surgical procedures that improve motion for slipped capital femoral epiphysis (SCFE) deformity are typically guided by radiographic imaging. However, the specific aspects of the deformity that have the greatest impact on hip functional biomechanics remain unclear. This study investigated the relationship between radiographic parameters and clinical ROM measurements in patients with SCFE to better elucidate which elements of SCFE pathoanatomy have the greatest effect on joint mobility.</p><p><strong>Methods: </strong>Patients who underwent in situ pinning for stable SCFE at a single institution between 2013 and 2025 were retrospectively reviewed. Patients were excluded if they had unstable SCFE or underwent a modified Dunn osteotomy or simultaneous bilateral SCFE procedures. Demographics and clinical ROM measurements were obtained from the electronic health record. Radiographic parameters, including the Southwick slip angle (SSA), posterior sloping angle (PSA), percent epiphyseal displacement of Wilson (PED), and alpha angle, were measured on immediate postoperative radiographs. ROM deficits were calculated as the difference between affected and unaffected hips. The relationships between radiographic and clinical ROM variables were quantified using linear regressions.</p><p><strong>Results: </strong>Seventy-four hips in 69 patients (mean age 12.3±1.5 y, 50.7% male) were included. In 5 patients, ROM data were available for the contralateral, unaffected hip just before a subsequent slip and were used as control measurements for that hip. Overall, PED had the largest effect on ROM. For every 1% increase in displacement, patients lost an average of 2.18 degrees of flexion ( P <0.001) and 2.13 degrees of abduction ( P =0.001). SSA, PSA, and AP alpha angle had statistically significant effects on internal rotation in flexion (IRF)-a 1-degree increase in each led to a 0.78, 0.81, and 0.74-degree decrease in IRF, respectively ( P <0.001 for all). The lateral alpha angle had the smallest impact.</p><p><strong>Conclusions: </strong>In children with SCFE, radiographic deformity predicts clinical ROM. PED has the strongest negative association with flexion and abduction, while PSA, SSA, and AP alpha angle have negative associations with IRF. Reconstructive strategies should prioritize correction of these aspects of the SCFE deformity to maximize joint mobility.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1004-e1009"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447713","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":"Total Hip Arthroplasty in Patients With Open Triradiate Cartilage: 10-Year Follow-Up of an Expanded Cohort.","authors":"Nicolas A Selemon, Zachary C Reuter, Emil Varas-Rodríguez, Rafael J Sierra, Robert T Trousdale, Emmanouil Grigoriou","doi":"10.1097/BPO.0000000000003399","DOIUrl":"10.1097/BPO.0000000000003399","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) in patients with open triradiate cartilage remains controversial, with an open triradiate cartilage considered a challenge for acetabular component fixation. We previously reported excellent 5-year functional outcomes and implant survivorship in a series of patients undergoing THA with open triradiate cartilage. The current study expands this cohort to 10-year radiographic and functional outcomes.</p><p><strong>Methods: </strong>Our institutional Total Joint Registry was queried to identify 24 patients who underwent THA with an open triradiate cartilage between the years 2000 and 2024. Skeletal maturity was assessed utilizing the modified Oxford bone age, with only triradiate scores of 1 and 2 included. Demographic, implant, and radiographic data were collected. Functional outcomes were assessed through the Harris Hip score (HHS).</p><p><strong>Results: </strong>The previously analyzed cohort (11 patients, 12 THAs) had a mean age of 13 years, and a mean follow-up of 10 years (range: 5 to 15). The overall expanded cohort (24 THAs) had a mean age of 14 years, with a mean follow-up of 6 years (range: 1 to 15) and a mean modified Oxford bone age was 22. The most common indications for THA were avascular necrosis ( 67%), secondary arthritis (25%), and neoplasia (8%). Preoperatively, 54% of patients utilized gait aids; at final follow-up, all patients reported independent ambulation with a mean HHS of 92. Radiographically, 92% of implants showed stable osseointegration at the latest follow-up. Two patients required acetabular component revisions for aseptic loosening, one of whom required rerevision for instability.</p><p><strong>Conclusion: </strong>The present study expands on the largest series in the literature of THA in patients with open triradiate cartilage. Our results demonstrate excellent functional outcomes, 92% implant survivorship, and low complication rates at long-term 10-year follow-up. These findings suggest THA is safe and durable in patients with open triradiate cartilage without the need to delay arthroplasty for closure of the triradiate cartilage.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e983-e988"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447686","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}