Journal of Pediatric Orthopaedics最新文献

{"title":"Mitigating Risk of Acute Kidney Injury Among Children With Methicillin-resistant Staphylococcus aureus Osteomyelitis.","authors":"Lasya Challa, Mary C Villani, Ahmad A Hachem, Yuhan Ma, Chanhee Jo, Karisma Patel, Sarah Firmani, Lawson A Copley","doi":"10.1097/BPO.0000000000002808","DOIUrl":"10.1097/BPO.0000000000002808","url":null,"abstract":"<p><strong>Objective: </strong>Children with acute hematogenous osteomyelitis (AHO) from methicillin-resistant Staphylococcus aureus (MRSA) are treated with vancomycin despite the risk of acute kidney injury (AKI). This study evaluates the rate of AKI and resource utilization for children with or without AKI when vancomycin is used in this setting.</p><p><strong>Methods: </strong>Children with MRSA AHO treated with vancomycin were retrospectively studied. AKI was assessed by clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cohorts of children with or without AKI were compared for differences in treatment, resource utilization, and outcomes. Multivariate logistic regression analysis assessed factors associated with risk for AKI. Cost analysis was performed using the Pediatric Health Information System and Healthcare Cost and Utilization Project databases.</p><p><strong>Results: </strong>Among 85 children studied, 14 (16.5%) had chart-diagnosed AKI and 24 (28.2%) met KDIGO criteria. Children with AKI had more febrile days and higher thrombosis rates. They had longer vancomycin treatment (8 vs 5 d), higher troughs (27.8 vs 17.5 mg/L), and prolonged hospitalization (19.9 vs 11.1 d). Multivariate analysis found a maximum vancomycin trough level (odds ratio: 1.05, P = 0.003) with a cutoff of 21.7 mg/L predicted AKI.Only 2 of 20 (10%) children who had MRSA isolates with a minimum inhibitory concentration of 2 achieved therapeutic vancomycin levels. Pediatric Health Information System data of 3133 children with AHO treated with vancomycin identified 75 (2.4%) with AKI who had significantly longer lengths of stay (13 vs 7 d) and higher billed charges ($117K vs $51K) than children without AKI.</p><p><strong>Conclusions: </strong>Chart documentation of AKI (16.5%) grossly underestimated KDIGO-defined occurrence (28.2%). This study showed that vancomycin-associated AKI required substantially greater resource utilization and higher health care costs. Lowering the targeted trough range, shortening the duration of vancomycin therapy, and considering alternative antibiotics when minimum inhibitory concentration ≥2 will reduce the risk and cost of AKI among children with MRSA AHO.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e172-e178"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348946","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":"Removal of the Metaphyseal Screw From Tension Band Constructs After Hemiepiphysiodesis: High Rates of Physeal Tethering and Subsequent Implant Removal.","authors":"Timothy W Torrez, Michael Amick, Ndidi Njoku, Emily Zhang, Senah E Stephens, Christopher A Makarewich","doi":"10.1097/BPO.0000000000002843","DOIUrl":"10.1097/BPO.0000000000002843","url":null,"abstract":"<p><strong>Background: </strong>Removal of the metaphyseal screw from tension band plate constructs after correction of angular deformity in patients treated with hemiepiphysiodesis has been suggested as an alternative to removing the plate and both screws. While this has the potential benefit of easier implant removal and reinsertion in the event of rebound, there is debate in the literature regarding the benefits and risks of leaving the epiphyseal screw and plate in place.</p><p><strong>Methods: </strong>Patients treated with hemiepiphysiodesis at the distal femur and/or proximal tibia with tension band plates and screws who underwent subsequent removal of the metaphyseal screw after correction were included. Charts and radiographs were reviewed for the need for metaphyseal screw reinsertion, subsequent removal of deep implants, and evidence of physeal tethering. Tethering was defined as progressive overcorrection in the treated bone segment after removal of the metaphyseal screw with the mechanical axis moving one full mechanical axis zone or more. Patients with tethering were compared with those without.</p><p><strong>Results: </strong>A total of 215 patients with 387 limbs treated met inclusion criteria. Of those, 175 patients were treated for idiopathic genu valgum, while 40 were treated for other conditions. Fifty-nine individuals (27%) underwent replacement of the metaphyseal screw for repeat angular correction. Fifty-one percent of patients underwent secondary procedures for reasons other than metaphyseal screw reinsertion (74 symptomatic implant removal, 7 elective implant removal, 29 due to tethering). There were 44 cases of tethering in 36 patients (17%). In cases of tethering, 7 patients were treated with observation, 11 with implant removal only, 16 with hemiepiphysiodesis on the opposite side, and 2 with osteotomy. Patients with tethering were significantly younger, more likely to be male, and more likely to have had the metaphyseal screw removed more than once ( P < 0.05).</p><p><strong>Conclusion: </strong>Removal of only the metaphyseal screw after hemiepiphysiodesis has high rates of tethering and further surgery for iatrogenic deformity correction and implant removal. This technique is not recommended.</p><p><strong>Level of evidence: </strong>Therapeutic Level III, case-control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"100-106"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391373","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 Predictability of Clinical Findings and Radiographs for Detecting Tarsal Coalition.","authors":"Kianna D Nunally, Manon Pigeolet, Patricia E Miller, Jodie E Shea, Collin May, Benjamin J Shore","doi":"10.1097/BPO.0000000000002830","DOIUrl":"10.1097/BPO.0000000000002830","url":null,"abstract":"<p><strong>Introduction: </strong>Tarsal coalition is a disorder of the foot characterized by the abnormal union between 2 or more of the tarsal bones. A minority of patients will develop pain and limited motion when reaching adolescence, for whom surgical resection of the coalition may be necessary. The diagnostic value of clinical and radiologic signs remains unclear. The aim of this study is to assess the predictive value of clinical symptoms and plain x-rays to diagnose tarsal coalition in symptomatic patients.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients with clinical suspicion of tarsal coalition between January 2011 and November 2019. Patient demographic data; clinical data on pain, limited motion, peroneal spasm, recurrent, or previous trauma; and radiologic data on the presence and type of coalition were collected. Multivariable general estimating equations analysis was used to assess associations between demographic and clinical characteristics and the likelihood of a positive coalition diagnosis.</p><p><strong>Results: </strong>The study cohort was 336 patients (672 feet) with a mean age of 13 years and a 1:1 sex distribution. Thirt-eight percent of feet were diagnosed with a coalition of which 53% were talocalcaneal and 41% were calcaneonavicular. Coalitions were significantly more common in younger patients, males (OR 1.66, P =0.04), patients with lower BMI (OR 0.96, P =0.045), and patients who presented with painful feet (OR 1.59, P =0.04) or feet with limited motion (OR 7.49, P <0.001). Diagnostic utility of plain x-ray compared with CT diagnosis yielded a sensitivity of 76% and a specificity of 94%, with higher sensitivity (90%) in calcaneonavicular coalitions than in talocalcaneal (66%).</p><p><strong>Discussion: </strong>Our study shows that limited subtalar movement, male sex, and low BMI have a high predictive value for tarsal coalition in symptomatic patients. Classic clinical findings that were not predictive of coalition in our cohort of symptomatic patients included peroneal spasm, recurrent ankle sprains, and recent trauma. Plain x-rays offer a reliable alternative to CT for diagnosis, especially for calcaneonavicular coalitions.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"93-99"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468317","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":"Assessment of Adolescent and Parent Willingness to Participate in a Comparative Study of Scoliosis Braces.","authors":"Sara J Morgan, Zelphia C Brown, Mohamed M Ahmed, Jennifer M Bauer, Joshua S Murphy, Benjamin D Roye, Walter H Truong","doi":"10.1097/BPO.0000000000002840","DOIUrl":"10.1097/BPO.0000000000002840","url":null,"abstract":"<p><strong>Objective: </strong>Adolescents with idiopathic scoliosis (IS) are often prescribed an orthosis to prevent curve progression and avoid surgery. Standard-of-care scoliosis orthoses are designed for full-time (FT) wear, which can be burdensome for some patients. Nighttime (NT) hypercorrective scoliosis orthoses are another option that has a lower impact on daily life, however, additional research is needed to guide the prescription of NT orthoses. The aim of this study was to assess the willingness of patients with IS and their parents/guardians to enroll in a randomized controlled study on bracing in scoliosis.</p><p><strong>Methods: </strong>A cross-sectional study was conducted to survey adolescents with IS and their parents/guardians. Eligibility criteria for adolescent participants included: (1) diagnosis of IS, (2) no previous orthosis use, (3) currently seeing a provider for their scoliosis, and (4) able to communicate in English. Parent/guardian participants were the parent or guardian of an adolescent participant and were able to communicate in English. Separate online surveys were designed for adolescents and their parents/guardians. Surveys provided information about a hypothetical study and queried respondents about whether they would participate in the study, their willingness to randomize brace treatment, and their preferences for NT or FT bracing. Descriptive statistics were used to summarize survey data.</p><p><strong>Results: </strong>One hundred four adolescent/parent dyads completed the survey (104 adolescents and 103 parents). Most participants (adolescents: 55.8%, parents: 55.3%) indicated an interest in study participation, and approximately one-third of participants (adolescents: 31.8%, parents: 30.1%) reported that they would be willing to randomize to brace type. Most participants (adolescent: 77.0%, parent: 81.6%) preferred the NT brace if they needed brace treatment.</p><p><strong>Conclusions: </strong>High-quality evidence is needed to inform the use of FT and NT scoliosis orthoses. Approximately a third of respondents would enroll in a randomized trial, indicating that multiple collaborative sites will be needed to recruit a sufficient sample into a randomized study on scoliosis bracing. Study findings also demonstrate support from adolescents and their parents/guardians for research on scoliosis bracing.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"75-80"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502605","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 Epidemiology of Pediatric Shoulder Dislocations in the United States.","authors":"Stefano DiCenso, Ronald Justin Mistovich, David C Kaelber","doi":"10.1097/BPO.0000000000002841","DOIUrl":"10.1097/BPO.0000000000002841","url":null,"abstract":"<p><strong>Background: </strong>Shoulder dislocations are the most common of all major joint dislocations and are a frequent cause of emergency department (ED) presentations. While the epidemiology of shoulder dislocations has been characterized in adults, it has not yet been done for children in the United States. The primary goal of this study was to calculate the incidence rate of pediatric shoulder dislocations in the United States. Secondary goals were to characterize the demographic information of children with shoulder dislocations as well as trends in management.</p><p><strong>Methods: </strong>The US Collaborative Network in TriNetX, a network of clinical data repositories containing patient data from over 100,000,000 unique individuals within the United States, was queried for patients younger than 18 years old diagnosed with shoulder dislocation from 2014 to 2024 using ICD codes. The demographic details were then extracted from the data set, and treatment approaches were determined by CPT coding.</p><p><strong>Results: </strong>Over the past 10 years, there were 16,460 pediatric and adolescent patients diagnosed with a first-time shoulder dislocation in either an ED or ambulatory clinic. The overall incidence rate was 60.31 per 100,000 patients, while the incidence rate was 116.61 per 100,000 patients presenting in the ED and 33.95 per 100,000 patients presenting in ambulatory clinics that were under the age of 18 years. Most patients were male (73%), White (59%), and came from the southeastern region of the United States (36%). The most common treatment was a closed reduction (25%), followed by arthroscopic surgery (17%). The number of annual shoulder dislocations has increased over the past decade without an increase in the number of patients undergoing surgical treatment.</p><p><strong>Conclusions: </strong>There remains a high incidence rate of shoulder dislocations in the pediatric population of the United States. Despite evidence that early surgical treatment of shoulder dislocations offers improved outcomes, nonoperative treatment continues to be the most common modality without any increase in the percentage of patients undergoing surgical treatment.</p><p><strong>Level of evidence: </strong>Level IV-descriptive epidemiological analysis.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e101-e105"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.","authors":"Jay Moran, Michael S Lee, Scott Fong, Christopher LaPrade, Kyle N Kunze, Peter D Fabricant, Jorge Chahla, Andrew E Jimenez, Robert F LaPrade","doi":"10.1097/BPO.0000000000002900","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002900","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients undergoing ACLR. The purpose of this study was to perform a systematic review and meta-analysis to determine the pooled prevalence of and risk factors for MMRLs in pediatric patients with ACL injuries.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried in December 2023 for studies reporting on MMRLs in pediatric patients (≤21 y old) undergoing ACLR. Articles were only included if they reported on the prevalence and/or risk factors for arthroscopically diagnosed MMRLs. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MMRLs by generating effect estimates in the form of odds ratios (OR) with 95% CI.</p><p><strong>Results: </strong>Seven studies were identified, which included 1362 pediatric patients (mean±SD age, 15.3±1.4 y old) that underwent ACLR. The pooled MMRL prevalence was 16.4% (range, 13.2% to 28%) calculated across 6 studies. Of the 7 studies identified, 5 qualified for the risk factor analysis, which included a total of 536 ACLR patients. Twenty risk factors were identified, of which 8 were amenable to being explored quantitatively. Anterolateral ligament (ALL) injuries on magnetic resonance imaging (MRI) [odds ratio (OR), 4.16; 95% CI, 1.40-12.34; P=0.01], MMRLs on preoperative MRI (OR, 4.09; 95% CI, 2.52-6.64; P<0.00010), posteromedial tibial plateau bone marrow edema (OR, 2.11; 95% CI, 1.16-3.83; P=0.01), and concomitant lateral meniscus tears (OR, 1.70; 95% CI, 1.04-2.76; P=0.03) were important risk factors for pediatric MMRLs. Skeletal maturity (physes open or closed), male sex, or collateral ligament injury was not associated with the presence of pediatric MMRLs.</p><p><strong>Conclusion: </strong>The overall pooled prevalence of MMRLs was 16.4% in pediatric patients undergoing ACLR. Significant risk factors for pediatric MMRLs included the presence of concomitant ALL injuries on MRI, identification of MMRLs on MRI, posteromedial tibia plateau bone marrow edema, and concomitant lateral meniscus tears at the time of surgery. Skeletal maturity, male sex, or collateral ligament injury were not associated with MMRLs in pediatric ACL tears.</p><p><strong>Level of evidence: </strong>Systematic review and meta-analysis; level of evidence: IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Tibial Tubercle Fracture With and Without Combined Patellar Tendon Avulsion: Early Outcomes, Complications, and Reoperations.","authors":"Rebecca J Schultz, Jason Z Amaral, Matthew J Parham, Tiffany M Lee, Raymond L Kitziger, Scott D McKay, Basel M Touban","doi":"10.1097/BPO.0000000000002894","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002894","url":null,"abstract":"<p><strong>Background: </strong>Tibial tubercle fractures (TTF) are uncommon injuries, comprising <3% of proximal tibial fractures. Rarely, they occur in conjunction with patellar tendon avulsion (PTA). We aimed to compare reoperation rates and short-term postoperative outcomes in patients with TTF versus combined injuries.</p><p><strong>Methods: </strong>A retrospective review of patients presenting to a single tertiary pediatric hospital with a TTF who underwent open treatment and fixation of tibial tuberosity fractures was performed. Demographics, operative details, injury patterns, complications, and postoperative milestones were analyzed. Operative reports were reviewed to identify concomitant PTA. Outcomes analyzed included reoperation rates, weeks to full weight-bearing (FWB), full range of motion (FROM), and return to sport (RTS). Patients with <4 months of clinical follow-up were excluded from the analysis.</p><p><strong>Results: </strong>We identified 117 fractures in 111 patients (mean age: 13.75 ± 1.27, 5% female). One-hundred and one fractures were isolated TTF and 16 were combined TTF with PTA. There was no significant difference in secondary surgery (P=0.13) or complication rates (P=0.20). The duration in the hinged knee brace was significantly higher in the combined injury group (12.95 wk) than in the isolated injury group (9.77 wk) (P=0.0024). There was no significant difference in time to FWB (P=0.25), FROM (P=0.86) or time to RTS (P=0.40).</p><p><strong>Conclusion: </strong>No current postoperative guidelines exist for combined TTF and PTA. Our data suggest that combined injury can be largely managed similarly to isolated TTF. However, combined injuries may require a longer bracing period.</p><p><strong>Level of evidence: </strong>Level II prognostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Joint Articulotrochanteric Distance Measurements in Children: Articulotrochanteric Distance in Children Aged 5 to 14 Years Does Not Increase With Age.","authors":"Di Yang, Ouyang Haiping, Zhongliang Wang","doi":"10.1097/BPO.0000000000002904","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002904","url":null,"abstract":"<p><strong>Background: </strong>The articulotrochanteric distance (ATD) has universally been utilized to assess greater trochanter overgrowth in pediatric orthopaedic diseases. However, its overgrowth cannot be detected in a timely manner due to the absence of a normal ATD value. This study is to determine the ATD normal value in hip radiographs of children under the age of 14 and to establish the threshold for overgrowth of the greater trochanter.</p><p><strong>Methods: </strong>A retrospective analysis of 1787 hip radiographs was conducted, measuring ATD, trochanter-to-trochanter distance (TTD), lesser trochanter-to-articular surface distance (LTA), epiphysis height (EH), and femoral head epiphyseal plate-to-lesser trochanter distance (ELD). The differences in TTD and ELD between adjacent age groups were denoted as ΔTTD and ΔELD, respectively. Data with normal distribution were analyzed using independent sample (tow-tailed student t test) t tests and One-way ANOVA, while data with non-normal distribution were analyzed through nonparametric tests. The range defined by the 95% measurement values (mean±2SD) was considered the normal range.</p><p><strong>Results: </strong>Among 5-14 year-olds, the mean ATD (mean±2SD) was 23.5±10.0 mm for males and 21.2±9.6 mm (mean±2SD) for females, statistically significant differences in the ATD were observed between sexes (P<0.05), whereas no significant differences were noted among age subgroups within the same sex (P>0.05). The normal range for males was 13.5 to 33.5 mm, while for females it was 11.6 to 30.8 mm. In addition, no significant distinction (P>0.05) was noted in the EH between males and females within this age range. Furthermore, the analysis revealed no significant difference (P>0.05) between the changes in ΔTTD and ΔELD among the hips.</p><p><strong>Conclusions: </strong>Our findings revealed that in hip radiographs, ATD values of children aged 5 to 14 years differ significantly between males and females, although within each sex group, there was no notable variation across different age groups. We proposed that ATD <13.5 mm in males and <11.6 mm in females might indicate an overgrowth of the greater trochanter, and in such patients, prophylactic greater trochanteric epiphysiodesis may be beneficial. In addition, we believed that the growth rates of the femoral neck and greater trochanter were approximately similar.</p><p><strong>Level of evidence: </strong>Level IV-diagnostic studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors for Leg Length Discrepancy in Children With Idiopathic Clubfoot Treated With Ponseti Method.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Rohit Siddabattula, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002895","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002895","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is at times associated with other lower extremity abnormalities, such as leg length discrepancy (LLD). Initial studies in patients treated with extensive soft tissue release (STR) have estimated that LLD is prevalent in 9% to 11% of children with idiopathic clubfoot. However, Ponseti-style serial casting has since replaced STR as the preferred clubfoot treatment method. This study aimed to assess the prevalence of LLD, risk factors for LLD, and the required treatment in children with clubfoot deformity after Ponseti casting.</p><p><strong>Methods: </strong>A retrospective review of medical records from children ages 0 to 18 treated for clubfoot at a single institution from 2002 to 2023 was conducted. Included patients were initially treated with Ponseti casting and had minimum follow-up until age 3. Patients with nonidiopathic clubfoot or who had LLD noted on physical examination but did not have available radiographs were excluded. LLD was defined as a minimum discrepancy of 0.5 cm on bilateral lower extremity radiographs.</p><p><strong>Results: </strong>Two hundred seventy-eight patients (434 feet) met criteria; 73% (203) were male. Forty of the 49 patients with available radiographs had LLD. The prevalence of LLD was 14.4%, with an average discrepancy of 1.1±0.8 cm. The prevalence was significantly higher in patients with unilateral than bilateral cases, 27% (33) versus 4.5% (7), P=<0.001. LLD was present in 21.5% (32) of patients with recurrence and 6.2% (8) of patients without recurrence, P=<0.001. Twenty percent (8) of patients with LLD had an epiphysiodesis at an average age of 11.5±1.4 years.</p><p><strong>Conclusion: </strong>This study reported a prevalence of LLD in 14.4% of children with idiopathic clubfoot treated with Ponseti casting. LLD prevalence was higher in children with unilateral and recurrent clubfoot. Up to 20% of children with LLD may require an epiphysiodesis. We recommend that care providers regularly screen children with clubfoot for LLD, particularly those with unilateral and recurrent deformities, and consider obtaining bilateral lower extremity radiographs in patients with clinical LLD.</p><p><strong>Level of evidence: </strong>Level III. Therapeutic studies-investigating the results of treatment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Sheep to Sling: Pediatric Injuries Due to Rodeo Mutton Bustin'.","authors":"Rebecca J Schultz, Jason Z Amaral, Tristen N Taylor, Rioke M Diejomaoh, Valeria C De Las Casas, Jon C Wall, Scott B Rosenfeld","doi":"10.1097/BPO.0000000000002892","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002892","url":null,"abstract":"<p><strong>Background: </strong>Mutton Bustin' was developed as a safer alternative to rough stock rodeo events such as bull riding to allow kids to participate in the rodeo. Children hold on to the bareback of a running sheep until they fall, competing to see who can ride the longest. While reports of injuries due to other rodeo events are well described in the literature, there are no reports of Mutton Bustin'-associated injuries. We present a case series describing the injury patterns in Mutton Busters who presented to our institution.</p><p><strong>Methods: </strong>Pediatric patients presenting to a single tertiary pediatric hospital system from April 2011 to April 2023 with injuries related to participation in Mutton Bustin' were identified for retrospective review. Review of the medical record was performed to identify patients and collect demographic information (sex, age at injury, race, BMI), injury characteristics, mechanism of injury, and treatment patterns.</p><p><strong>Results: </strong>We identified 20 patients (mean age 5.5±1.2 y, 55% female) presenting to our institution with Mutton Bustin' injuries. The most common injury pattern was upper extremity fracture occurring in 18/20 (90%) cases. Three (15%) of patients required surgical intervention. No patients had complications related to their injuries.</p><p><strong>Conclusions: </strong>Our series demonstrates upper extremity fractures to be the most common injuries obtained while Mutton Bustin' outlines patient education strategies to prevent future rodeo-related injuries.</p><p><strong>Level of evidence: </strong>Level IV-prognostic case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}