Journal of Pediatric Orthopaedics最新文献

{"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}

{"title":"Neonatal Physeal Fracture: What Treatment?","authors":"Jade Burnouf, Lys Budiartha, Xavier du Cluzel de Remaurin, Edouard Haumont, Nicolas Vinit, Stephanie Pannier, Eric Desailly, Alina Badina","doi":"10.1097/BPO.0000000000003024","DOIUrl":"10.1097/BPO.0000000000003024","url":null,"abstract":"<p><strong>Background: </strong>The management of diaphyseal fractures in newborns is well established as conservative, involving immobilization without reduction. Newborn physeal fractures (NPF) are rarer lesions, and their management is poorly codified. In the literature, treatment varies from simple monitoring to surgical reduction and osteosynthesis. The aim of this study was to describe the long-term evolution of NPFs according to their location and initial management, and to establish treatment guidelines.</p><p><strong>Methods: </strong>The first part of the study involved a systematic review of the literature according to PRISMA criteria. For the selected articles, patients were analyzed individually. For each patient, fracture location, time to treatment, type of treatment, and complications were recorded. Complications were classified as \"minor\" and \"major.\" The second part of the study involved the collection of patients with NPF managed in our department. The same data were recorded.</p><p><strong>Results: </strong>A total of 28 studies were selected. A total of 108 fractures (including 17 from our series) were analyzed. The most frequent locations were distal humerus (46%), proximal femur (27%), distal femur (13%), and proximal humerus (9%). Treatment was surgical for 17% of fractures. Considering the entire series, we found no significant relationship between the type of treatment and the complication rate. The most complication-prone site was the distal femur. However, these complications were primarily radiologic, with minimal clinical impact. They corrected progressively with growth. No patient required a long-term surgical procedure. No epiphysiodesis was reported.</p><p><strong>Conclusion: </strong>NPF has a favorable long-term outcome, irrespective of the type of treatment. We recommend that simple immobilization be the preferred treatment option. However, for distal femur fractures, reduction and possibly osteosynthesis should be considered due to the very slow correction of femoral deformities associated with orthopaedic treatment.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e804-e809"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199451","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":"Disparities Research in Pediatric Orthopaedic Surgery: Is the Needle Moving?","authors":"Amin Alayleh, Abdullah Arif, Eric Durudogan, Peter C Shen, Jasmin S Vargas, Neeraj M Patel","doi":"10.1097/BPO.0000000000003002","DOIUrl":"10.1097/BPO.0000000000003002","url":null,"abstract":"<p><strong>Background: </strong>Disparities in health care are well documented and may have major medical and socioeconomic implications in populations that are already marginalized. While research identifying disparities is important, community partnerships and interventions to address inequities are critical to establish long-term infrastructure and lasting impact. The purpose of this study is to investigate trends and characteristics of disparities research in pediatric orthopaedics, with attention to study design, intervention implementation, and federal funding.</p><p><strong>Methods: </strong>The Web of Science platform was queried for English-language articles in the Orthopedics or Sports Sciences categories between 2013 and 2022 with the following keywords: \"disparities\", \"disparity\", \"inequity\", \"inequities\", \"diversity\", \"socioeconomic\", \"sex\", \"gender\", \"insurance\", \"race\", and \"neighborhood\". Book chapters, meeting abstracts, proceedings papers, and retracted publications were excluded. Abstracts were reviewed manually to determine study inclusion. Descriptive statistics were calculated to report study characteristics, federal funding, and the evaluation of interventions to address disparities.</p><p><strong>Results: </strong>The initial query yielded 7274 articles, of which 69 addressed disparities or diversity topics in pediatric orthopaedics. Fifty (72.4%) were published between 2019 and 2022, and 32 (46.4%) were published in 2021 and 2022. The vast majority of studies (73.9%) had a retrospective design. No studies primarily utilized qualitative methods or a community-engaged approach. Most articles either analyzed multiple determinants (40.6%) or only focused on insurance (21.7%) or sex/gender (17.4%). No publications designed an original intervention and empirically studied its impact. No studies were directly funded by the National Institutes of Health.</p><p><strong>Conclusions: </strong>There is an increasing volume of disparities research in pediatric orthopaedics, with most articles published in 2019 or later. Most studies are retrospective, unfunded, and describe a disparity rather than implement an intervention. Future efforts should be dedicated to prospective and qualitative methodology, community engagement, increased federal funding, and interventions to reduce inequities.</p><p><strong>Level of evidence: </strong>N/A (bibliometric study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"566-571"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001267","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":"Response to the Comment on \"Similar Return-to-Sports After Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair in Skeletally Immature Patients: A Prospective, Comparative Cohort Study\".","authors":"Győző Lehoczky, Clara Flumian, Jérôme Sales de Gauzy, Franck Accadbled","doi":"10.1097/BPO.0000000000003026","DOIUrl":"10.1097/BPO.0000000000003026","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e886-e887"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649808","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":"Effect of Radioulnar Derotational Osteotomy on Hand Function in Patients With Brachial Plexus Injury: A Case Series Study.","authors":"Ramin Zargarbashi, Ali Nami Damirchi, Sina Esmaeili, Monir Najafi Pirasteh","doi":"10.1097/BPO.0000000000003039","DOIUrl":"10.1097/BPO.0000000000003039","url":null,"abstract":"<p><strong>Background: </strong>Childhood brachial plexus injury (BPI) is a severe nerve injury leading to significant functional impairments, including supination deformities that restrict hand function and complicate daily activities. This study aimed to evaluate the effect of radioulnar derotational osteotomy (RUDO) on hand function in children with BPI and supination deformity.</p><p><strong>Methods: </strong>A case series of 16 BPI patients (mean age: 7.44 ± 1.26 y) undergoing RUDO at a tertiary care center from 2019 to 2023 was analyzed. Inclusion criteria encompassed supination deformity with a minimum 12-month follow-up and functional wrist motion. Hand function was assessed preoperatively and postoperatively using the Functional Grasp Scale (FGS) and Activities of Daily Living (ADL) scores. Statistical analysis was conducted to compare outcomes.</p><p><strong>Results: </strong>RUDO significantly improved functional outcomes. The mean FGS score rose from 2.81 ± 4.17 preoperatively to 6.13 ± 2.99 postoperatively ( P < 0.001). Similarly, the mean ADL score increased from 1.50 ± 0.99 to 8.69 ± 1.65 ( P < 0.001). Subdomains of ADL, including domestic activities and physical self-maintenance, showed significant enhancements. No group-specific differences were observed in functional improvement, indicating consistent benefits across varying preoperative finger function statuses.</p><p><strong>Conclusions: </strong>RUDO is a minimally invasive, effective procedure that significantly enhances hand function and daily living capabilities in children with BPI and supination deformity. This technique offers reliable functional improvements. Further longitudinal studies are needed to confirm sustained benefits.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e876-e880"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626615","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 Open Distal Tibia Fractures More Severe Injuries Than Open Tibial Shaft Fractures in Children?","authors":"Taylor K Zak, Ivy Nguyen, Christine A Ho","doi":"10.1097/BPO.0000000000003013","DOIUrl":"10.1097/BPO.0000000000003013","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to compare a cohort of pediatric open distal tibia fractures to open tibial shaft fractures regarding demographics and treatment outcomes.</p><p><strong>Methods: </strong>This is a retrospective review of 39 open distal tibia fractures (D group) and 55 open tibia shaft fractures (S group), treated from January 2007 to May 2017 at a single level 1 pediatric trauma center. Mann-Whitney test was used to compare means between groups.</p><p><strong>Results: </strong>There was no statistically significant difference between the 2 groups regarding demographics, injury mechanism, or injury severity scores. While the D group had nearly 4x times the rate of open reduction internal fixation (ORIF) compared with the S group [15% (6/39) vs. 4% (2/54)] and twice the rate of external fixation [15% (6/39) vs. 7% (4/54)], these were not statistically significant ( P >0.05). D group had more Gustilo-Anderson type III open fractures compared with S group [46% (18/39) vs. 26% (14/54), P =0.04], longer mean operative times (2.5 vs. 2.1 h, P =0.04), longer hospitalization (8.7 vs. 6.5 d, P =0.01), and longer time to full weight-bearing (11.4 vs. 7.2 wk, P =0.03). Postoperative complications (delayed union, limb length discrepancy, infection) were similar between the 2 groups, although D group had nearly twice the rate of return to the operating room after index surgery [49% (19/39) vs. 26% (14/54), P =0.03]. Although over twice as many fractures in D group required a free flap compared with S group [18% (7/39) vs. 7% (4/54)], this did not reach statistical significance ( P >0.05). Two patients in each group eventually underwent amputation; all patients had Gustilo-Anderson IIIB or IIIC fractures. Radiographic angulation at final follow-up was similar between the 2 groups ( P >0.05).</p><p><strong>Conclusions: </strong>This study highlights the challenges in treating open distal tibia fractures compared with open tibial shaft fractures. Families should be counselled on a possibly prolonged treatment course, both inpatient and postoperatively, when patients sustain an open distal tibia fracture.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e789-e796"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Verbal Status on Postoperative Outcomes Following Proximal Femur Varus Derotational Osteotomy in Children With Cerebral Palsy.","authors":"Michaela Juels, Charlotte Wahle, Mathangi Sridharan, Aura Elias, Amith Umesh, Alexander Rueda, Nakul Talathi, Rachel Thompson","doi":"10.1097/BPO.0000000000003031","DOIUrl":"10.1097/BPO.0000000000003031","url":null,"abstract":"<p><strong>Background: </strong>In addition to physical disabilities, children with cerebral palsy (CP) often have concomitant nonphysical disabilities and associated medical comorbidities. Verbal disabilities are common and can affect both independence and communication, particularly in hospital settings, potentially impacting surgical outcomes. This study evaluates how verbal status affects postoperative outcomes of proximal femur varus derotational osteotomy (VDRO).</p><p><strong>Methods: </strong>A retrospective review of pediatric patients with CP who underwent VDRO for hip subluxation/dislocation between 2017 and 2021 at a single tertiary care institution was completed. Demographic data, including age, weight, height, BMI, sex, race/ethnicity, insurance status, Gross Motor Function Classification System (GMFCS), and verbal status was recorded. Outcome variables included acute complications occurring within 90 days after surgery and delayed complications occurring >90 days postoperatively. Acute complications included emergency department (ED) visits, readmissions, reoperations, deep surgical-site infections, and medical complications such as pneumonia, atelectasis, and gastrointestinal bleeds. Delayed complications included delayed union, re-subluxation/dislocation, nonunion, painful hardware, and superficial surgical-site infection. Descriptive statistics, 2-sample t tests, and multiple regression analyses were performed.</p><p><strong>Results: </strong>Seventy-two patients were included for analysis, 26 (35.1%) of whom were verbal and 46 (63.9%) nonverbal. In unadjusted analysis, nonverbal status was associated with higher rates of acute complications [OR=14.29, 95% CI (3.26, 64.83), P <0.0001] and increased ED visits [OR=7.86, 95% CI (1.17, 87.78), P =0.05] compared with verbal patients. However, after adjusting for GMFCS, these associations were no longer statistically significant. Conversely, after controlling for GMFCS, nonverbal patients were at significantly lower risk of experiencing delayed complications [OR=0.07, 95% CI (0.01, 0.36), P =0.0010] and painful hardware [OR=0.07, 95% CI (0.01, 0.33), P =0.0010] compared with verbal patients.</p><p><strong>Conclusion: </strong>Verbal status plays a significant role in postoperative outcomes for children with CP undergoing VDRO. Nonverbal patients are at higher risk for acute complications, while verbal patients are more likely to present for delayed complications. These findings reinforce the need for enhanced communication strategies and vigilant postoperative monitoring in this particularly vulnerable population.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e769-e774"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285036","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":"Treatment Trends in Symbrachydactyly: Surgical Management in Milder Cases and Nonoperative Treatment in Severe Ones.","authors":"Sergio Martínez-Álvarez, María Galán-Olleros, Sarah Toledo-García, Jaime Garcia-Fernandez, Isabel Vara-Patudo, Ángel Palazón-Quevedo","doi":"10.1097/BPO.0000000000003029","DOIUrl":"10.1097/BPO.0000000000003029","url":null,"abstract":"<p><strong>Introduction: </strong>Symbrachydactyly is a unilateral hand abnormality characterized by incomplete finger formation and rudimentary nubbins containing nail plate, bone, and cartilage. Surgical intervention typically targets web space contractures, digit instability, and pincer dysfunction. This study examines the relationship between the severity of symbrachydactyly and the choice of operative or nonoperative approaches.</p><p><strong>Methods: </strong>A retrospective comparative analysis was conducted on patients diagnosed with symbrachydactyly at a pediatric referral center from 2005 to 2024. Collected data included demographics (age, sex, laterality), familial factors (congenital malformations, miscarriage history), medical history (associated syndromes, pregnancy complications), clinical and radiologic details of hand abnormalities (side, Blauth and Foucher classifications), and treatment modalities. Descriptive, comparative, and correlation analyses were performed across treatment groups.</p><p><strong>Results: </strong>A total of 80 patients were analyzed (median age: 5.32 y, IQR: 1.8 to 8.8), including 47 males (58.8%) and 52 patients (65.0%) with left-sided involvement. Nonoperative treatment was provided to 61 patients (76.3%), while 19 (23.8%) underwent surgical interventions. Among the nonoperatively treated patients, 9 (14.8%) received prostheses. Prosthesis use was significantly associated with higher severity in the Blauth and Foucher classifications ( P <0.001). No significant differences in the Blauth ( P =0.14) and Foucher ( P =0.22) classifications were observed between nonoperative and surgical groups. The Blauth and Foucher classifications showed no significant associations with syndromic involvement, pregnancy complications, miscarriage history, or in vitro fertilization ( P >0.05). A correlation analysis showed that more severe involvement in both classifications was statistically associated with a higher likelihood of nonoperative management: Blauth (r=-0.253, P =0.031) and Foucher (r=-0.243, P =0.038).</p><p><strong>Conclusions: </strong>This study demonstrates that surgical interventions benefit patients with milder forms of symbrachydactyly, while patients with more severe manifestations typically receive nonoperative management, including prosthetic solutions.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e856-e864"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285037","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":"Osteochondral Allograft Transplantation for Large Osteochondral Lesions of the Femoral Head in Young Patients.","authors":"Omid Jalali, Jordan K Penn, James D Bomar, Julie C McCauley, Lei Zhao, Patrick W Whitlock, Andrew T Pennock, William D Bugbee, Vidyadhar V Upasani","doi":"10.1097/BPO.0000000000003020","DOIUrl":"10.1097/BPO.0000000000003020","url":null,"abstract":"<p><strong>Introduction: </strong>Osteochondral lesions of the femoral head in young patients are a rare but challenging clinical problem. Fresh osteochondral allograft (OCA) transplantation has been proposed as one potential treatment option that may improve function and delay hip arthroplasty. However, there is a paucity of published data. The purpose of this study was to assess allograft survivorship and patient-reported outcomes in patients undergoing OCA transplantation for osteochondral lesions of the femoral head.</p><p><strong>Methods: </strong>Sixteen patients (16 hips) who underwent femoral head OCA transplantation for the treatment of avascular necrosis between 1985 and 2021 were included. Mean age was 21.0±10.1 years (range: 11.6 to 43.5 y) and 56% were male. Mean allograft diameter was 26.9±4.2 mm (range: 20 to 35 mm) and mean thickness was 10.2±3.2 mm (range: 5 to 15 mm). We evaluated the frequency and type of further surgery, Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and UCLA function score. Clinical failure was defined as conversion to total hip arthroplasty.</p><p><strong>Results: </strong>Six of 16 hips (38%) experienced clinical failure (5 total hip arthroplasties and 1 resurfacing arthroplasty), with a mean time to failure of 3.6±2.6 years (range: 1.0 to 8.5 y). Allograft survivorship for patients under age 18 was 85.7% at 3 years and 42.9% at 5 years compared with patients over age 18 years who experienced a survivorship of 66.7% at 3 and 5 years ( P =0.911). Of the remaining 10 hips, the mean follow-up duration was 4.1 years (range: 1.9 to 7.4 y). At the latest follow-up, mean HOOS was 74.5±20.2 (range: 48.6 to 100), mean WOMAC was 79.9±18.2 (range: 56.1 to 100), mean mHHS was 74.9±20.9 (range: 41 to 100.1), and mean UCLA score was 7.0±2.7 (range: 4 to 10).</p><p><strong>Conclusions: </strong>Young patients with large chondral lesions of the femoral head may benefit from fresh OCA transplantation, but failure rates remain quite high for this challenging patient population. OCA can be considered as a useful treatment option that preserves function and delays the need for arthroplasty in young individuals with osteochondral lesions of the femoral head.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e826-e831"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150838","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}