Journal of Pediatric Orthopaedics最新文献

{"title":"The Use of Fresh Osteoarticular Allografts for Steroid-induced Osteonecrosis of the Femoral Condyle With Collapse in Childhood Cancer Patients: Single-institutional Experience.","authors":"Michael D Neel, Sandra W Murphy, Sue C Kaste, Brian M Defeo, Seth E Karol, Patrick B Klug, Mary B Houston, Kenneth S Weiss","doi":"10.1097/BPO.0000000000002873","DOIUrl":"10.1097/BPO.0000000000002873","url":null,"abstract":"<p><strong>Background: </strong>Despite success in treating childhood acute lymphoblastic leukemia and lymphoma (ALL), modern multiagent chemotherapy regimens containing high-dose corticosteroids can result in osteonecrosis afflicting survivors, frequently involving the knee. Thus, we describe the usage of fresh osteoarticular allograft (FOAG) to treat steroid-induced osteonecrosis of the femoral condyle in pediatric cancer survivors. We assessed the efficacy of FOAGs to heal necrotic bone, provide long-term pain relief, while retrospectively reviewing quality of life and functional status.</p><p><strong>Methods: </strong>We recorded patient demographics, pain, and functional scores preoperatively, postoperatively, and at the most recent follow-up, additional surgical procedures, and radiographic outcomes at each timepoint. Anatomic locations and sizes of the grafts were noted using operative reports and intraoperative photographs. Function and pain scores were collected by direct patient communication or through survey, with data scored using the KOOS (Knee Injury and Osteoarthritis Outcome Score), PROMIS (Patient-Reported Outcomes Measurement Information System), and CTCAE (Common Terminology Criteria for Adverse Events) scoring tools.</p><p><strong>Results: </strong>Eighteen patients, (12 females) over a period of 8 years, underwent the procedure. One patient was excluded due to death before 12 months follow-up. The average age at diagnosis of femoral condyle osteonecrosis was 14.5 years. The average age at the time of surgery was 18.5 years (range, 13 to 25 y). All patients had at least 16 months follow-up (average 60 mo; range 16 to 99 mo). Grafts ranged in size from 18 to 27.5 mm. All patients reported a return to normal function of the knees with KOOS scores approaching normal, PROMIS scores averaging 46, and CTCAE outcomes improving at an average of 34 months post-surgery. Two patients experienced a partial graft failure, which was repaired with new allografts.</p><p><strong>Conclusions: </strong>Although historical reviews indicated unsatisfactory results, our experience highlights the successful usage of FOAG for the management of patients treated for childhood leukemia who develop steroid-induced osteonecrosis of the femoral condyle. This procedure proved effective in managing pain and improving function and quality of life, with good bone ingrowth despite large necrotic lesions.</p><p><strong>Levels of evidence: </strong>Therapeutic Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 4","pages":"e358-e365"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557046","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":"Should Femoral Nerve Blocks and Adductor Canal Blocks Be Used in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction?: A Systematic Review.","authors":"Prushoth Vivekanantha, Bryan Sun, Sachin Tapasvi, Isabella Jaramillo, Yuichi Hoshino, Darren de Sa","doi":"10.1097/BPO.0000000000002886","DOIUrl":"10.1097/BPO.0000000000002886","url":null,"abstract":"<p><strong>Background: </strong>Achieving adequate pain control is vital for proper rehabilitation, satisfaction, and earlier discharge after anterior cruciate ligament reconstruction. Opioids have traditionally been used for this purpose, however, can be associated with various negative outcomes. As such, multimodal analgesia was introduced to reduce postoperative opioid use. Regional nerve blocks constitute one modality of multimodal analgesia, with femoral nerve blocks (FNBs) and adductor canal blocks (ACBs) being standard. This review sought to evaluate the utility and adverse effects of FNBs and ACBs relative to controls, alternative regional anesthesia options, and each other in pediatric or adolescent anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods: </strong>Three databases were searched on January 31, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The definition of pediatric was considered to be a mean age of 18 years or younger. Data on demographics, operative and anesthetic details, strength and functional outcomes, postoperative opioid consumption, revision rates and return to sport (RTS) rates, and Visual Analogue Scale (VAS) scores were extracted.</p><p><strong>Results: </strong>Eleven studies (1 level I, 10 level III) comprising 5453 patients were included in this review (54.1% female), with a mean age of 16.3 (range of means: 15.0 to 16.9) years. Two studies compared FNB with and without a sciatic-nerve block (SNB), finding lower opioid consumption ( P =0.007) and VAS scores ( P <0.0001) in the postanesthesia care unit (PACU) in the FNB + SNB group. Three studies compared FNB or ACB with controls, with no studies reporting a benefit in rates of RTS, isokinetic quadriceps or hamstrings strength, or functional test performance. There were minimal differences when comparing continuous and single nerve blocks and FNB with ACB.</p><p><strong>Conclusion: </strong>There is inconclusive evidence investigating the role of FNB and ACB in pediatric or adolescent ACLR. The addition of a SNB to FNB may result in improvements in opioid consumption and VAS scores in the early postoperative period. There was minimal evidence in support of continuous blocks over single-shot blocks. Future studies should compare the use of ACB, FNB, and no blocks for pediatric or adolescent ACLR, with primary endpoints of acute pain control, postoperative opioid use, and the presence of longer-term motor deficits.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e301-e309"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction of Ankle Malalignment in Severe Fibular Hemimelia.","authors":"Milud Shadi, Piotr Janusz, Tomasz Kotwicki","doi":"10.1097/BPO.0000000000002876","DOIUrl":"10.1097/BPO.0000000000002876","url":null,"abstract":"<p><strong>Background: </strong>Management of ankle joint deformity and instability are challenging issues in congenital fibular hemimelia (FH). This study aims to assess how much the SUPERankle procedure improves ankle alignment and provides durable ankle stability in patients with severe FH.</p><p><strong>Methods: </strong>Seventeen children aged 53.4±44.1 months with severe form of FH, equinovalgus foot deformation, ankle instability, and tibial curvature (Paley type IIIC), affecting 19 limbs, underwent the SUPERankle procedure. Foot and ankle position was evaluated clinically and radiologically before surgery, immediately after, and at follow-up of 63.0±19.7 months. Mechanical lateral distal tibial angle (mLDTA), tibiocalcaneal angle (mTCA), and tibiocalcaneal distance (mTCD) were measured on the AP radiograms, while the anterior distal tibial angle (mADTA) and lateral tibiocalcaneal angle (mLTCA) were measured on the lateral radiograms. Recurrences, additional procedures, and complications were documented based on medical records. Quality of life was evaluated with Limb Deformity-SRS questionnaire.</p><p><strong>Results: </strong>On clinical examination, the normal tibia and ankle alignment, along with a plantigrade foot were achieved in all limbs after the first surgery. In 11 limbs (58%) this result was maintained at follow-up. Due to recurrence, additional procedures were necessary to provide durable ankle alignment in 7 limbs (37%), while in 1 limb (5%) the ankle joint remained in equinus at the last follow-up. Significant improvement of radiologic alignment was found in all parameters (preoperative vs. postoperative vs. FU) as follows-mLDTA: 71.4±11.2 versus 88.7±5.6 versus 88.1±2.7 degrees, P =0.0001; mTCA: 41.4±14.9 versus 8.7±8.4 versus 11.6±8.9 degrees, P =0.0001; mTCD: 22.3±7.9 versus 4.0±3.6 versus 7.7±6.5 mm, P =0.0001; mADTA: 99.5±19.4 versus 82.3±4.2 versus 81.5±5.9 degrees, P =0.0002; mLTCA: 116.7±23.9 versus 95.8±11.7 versus 93.5±15.1 degrees, P =0.0002. The mean follow-up LD-SRS score was 4.03.</p><p><strong>Conclusion: </strong>In children with severe fibular hemimelia, the SUPERankle procedure provided clinically and radiologically fully corrected ankle joint and plantigrade foot, suitable for further lengthening procedure. The 40% rate of deformity recurrence was managed with additional surgical intervention to achieve a good clinical, radiologic, and functional outcome in 95% of children at 5-year follow-up.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e366-e377"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828772","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":"Comparison of Postoperative Strength Progression and Outcomes Following Primary Versus Secondary ACL Reconstruction in the Young Athlete.","authors":"Brian T Ford, Adam P Weaver, Annabelle Davey, Joel W Mayo, Matthew E Shuman, Benjamin C Mayo, Emil Coman, Allison E Crepeau","doi":"10.1097/BPO.0000000000002901","DOIUrl":"10.1097/BPO.0000000000002901","url":null,"abstract":"<p><strong>Background: </strong>Return to sport testing after ACL reconstruction (ACLR) is becoming increasingly popular. Anecdotally, some believe that patients who undergo a second ACL surgery on either the ipsilateral or contralateral leg progress through their rehabilitation goals faster the second time through. The purpose of this study was to evaluate the rate of strength progression in return to sport testing after primary and secondary ACLR surgeries in a young, active population.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent ACLR between September 2013 and December 2022 was performed. Patients were included if they underwent an ACLR and completed at least 2 postoperative strength tests. Strength testing was commonly performed at 3, 6, and 9 months. Exclusion criteria included age older than 30 and those who had a contralateral graft harvest. Structural equation modeling was performed for each strength assessment by the timepoint it was performed. A linear combination of parameters was performed to compare the path coefficients between the primary and secondary ACL groups for each strength test to assess statistical differences in the rate of change of each strength test over time.</p><p><strong>Results: </strong>Three hundred ninety-six patients in the primary ACLR group and 50 patients in the secondary ACLR group met the inclusion criteria. Patients who received secondary ACL surgery were older, had a higher percentage of BTB grafts, lateral augments, and internal brace augments. Months from surgery had a significant positive correlation with nearly all strength tests in both groups. There was no difference between primary and secondary surgery in the progression of any postoperative strength test. There was no difference in progression of IKDC or RSI scores between groups.</p><p><strong>Conclusion: </strong>This study suggests that patients who undergo a second ACL surgery do not progress their strength faster or slower than after primary ACLR. This implies that these patients do not require different return-to-play protocols from a strength perspective.</p><p><strong>Level of evidence: </strong>Retrospective study, level III evidence.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"177-182"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007329","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 Arterial Supply to the Foot and its Correlation With Return of Capillary Filling Post-Achilles Tenotomy in Congenital Clubfoot.","authors":"Khaled L El-Adwar, Tamer M Shehata, Karim M ElSharkawi, Mena M Mosa","doi":"10.1097/BPO.0000000000002970","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002970","url":null,"abstract":"<p><strong>Background: </strong>Congenital clubfoot is a common idiopathic foot abnormality that manifests in newborns. Vascular deficiencies have been suggested as one of the underlying etiologies of clubfoot. The question in hand was: \"Is the return of capillary filling to the foot post-Achilles tenotomy correlated with both the arterial supply to the foot and degree of ankle equinus\"?</p><p><strong>Methods: </strong>This clinical study included 30 unilateral idiopathic clubfeet. All patients were assessed clinically using the Pirani score, then manipulation using the Ponseti technique, followed by examination of the infragenicular arterial system using Doppler ultrasound in both the affected and the normal control limbs. After Achilles tenotomy and reaching dorsiflexion of 10 to 20 degrees, the time-lapse till complete return of capillary filling to the foot was recorded. Both the radiologist and the surgeon were blinded to each other's assessment.</p><p><strong>Results: </strong>The mean postoperative time-lapse to complete return of capillary filling after the maintenance of dorsiflexion at the start of cast application was 3.53±5.56 minutes (range: 0 to 26.59). The anterior tibial artery (ATA) on the affected side was found to be completely attenuated distally in 24 out of 30 feet (80%), while the mean caliber of the posterior tibial artery (PTA) (1.09±0.18 mm) on the affected side was found to be increased compared with the normal side (0.99±0.20 mm) (P=0.042). Also, cases with hypoplastic PTAs needed more time for the return of capillary filling (mean: 8.71±8.88 min) compared with those with normal PTAs (mean: 1.95±2.83 min), (P=0.007). Also, there was a direct positive correlation between postoperative complete return of capillary filling and preoperative degree of equinus (P<0.001).</p><p><strong>Conclusion: </strong>Delay of the postoperative complete return of capillary filling to the foot after maximum dorsiflexion post Achilles tenotomy is related to both the degree of preoperative equinus and insufficiency/hypoplasia of the posterior tibial artery. This expected delay should not rush the surgeons to remove the cast before the lapse of 30 minutes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753202","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":"Atlantoaxial Instability in Collagen Type 2 Skeletal Dysplasias: Surgical Indications and Recommendations.","authors":"Bryan Menapace, William Mackenzie, Colleen Ditro, Kenneth Rogers, Jeffery Campbell, William G Stuart Mackenzie","doi":"10.1097/BPO.0000000000002955","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002955","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spine atlantoaxial instability (AAI) is frequently encountered in skeletal dysplasias (SD), particularly in patients with collagen type 2 (COL2) mutations. The values of clinical examination, radiographic measurements, and magnetic resonance imaging (MRI) findings in determining when to intervene on COL2 AAI are unknown. The goal of this study is to compare these tools and report the utility and significance of each in surgical decision-making.</p><p><strong>Methods: </strong>A retrospective case-control series from a single center's skeletal dysplasia database, 2007 to 2023, included COL2 patients that had documented history, examination, and flexion-extension (F-E) cervical spine radiographs and MRI. Radiographic measurements included dens morphology, anterior atlanto-dens interval (AADI), and posterior atlanto-dens interval (PADI). MRI measurements included cervical stenosis, C1 space available for the cord (SAC), and presence of myelomalacia. Criteria cutoffs were defined by receiver operating characteristic analysis and a scoring rubric was generated by internal validation.</p><p><strong>Results: </strong>Of all SD patients, 78 of 547 (14%) had COL2 syndromes, and 53 (68%) met all inclusion criteria. The most common diagnosis was spondyloepiphyseal dysplasia (65%). Patients were majority 54% female and 80% white. Ten (19%) underwent surgery at an average age of 4.3 years. There were no differences in AAI clinical histories (P = 0.18). Physical examination revealed higher rates of hyperreflexia in the surgical group (P = 0.0002). On radiographs, surgical patients had more os odontoidea (P = 0.0001) and greater change in AADI and PADI (P = 0.01 and P < 0.0001). On MRI, surgical patients had myelomalacia more frequently (P < 0.0001), more severe stenosis (P = 0.02), and greater change in SAC (P = 0.01). receiver operating characteristic analysis defined 7 surgical cutoffs as follows: (1) presence of hyperreflexia, (2) radiographic os odontoid, (3 and 4) F-E radiographs with ≥5 mm change in AADI and/or PADI, (5) myelomalacia on MRI, (6) C1-C2 stenosis ≥80%, and (7) ≥1.5 mm of C1-C2 SAC change on F-E MRI. Applying those cutoffs, it was determined that 100% of patients with 0 to 1 criteria were able to be managed nonoperative. Conversely patients with 4 or more criteria present were indicated for surgery in 80% of cases.</p><p><strong>Conclusion: </strong>This is the largest case series on AAI in SD patients with COL2-associated conditions. This study identified 7 criteria that could be used to indicate surgical intervention. Patients who had ≤1 of these factors did not undergo surgery, while those with ≥4 had a high propensity to be recommended for surgical stabilization.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753190","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":"Follow-Up After Hemiepiphysiodesis: Can We Do Better?","authors":"Emilio Feijoo, Shrey Nihalani, Hamp Sisson, Ellie Starnes, Gerald McGwin, Kevin A Williams, Shawn R Gilbert, Michael J Conklin","doi":"10.1097/BPO.0000000000002962","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002962","url":null,"abstract":"<p><strong>Background: </strong>Hemiepiphysiodesis carries a risk of overcorrection, especially if the patient demonstrates poor follow-up. Few studies have evaluated patients treated with hemiepiphysiodesis for risk factors predictive of follow-up. The present study evaluates patients who underwent hemiepiphysiodesis at the knee and/or ankle for associations between late follow-up (LFU), lost to follow-up (LTFU), and sociodemographic factors, such as area deprivation index (ADI), race, ethnicity, insurance status, age, sex, and BMI.</p><p><strong>Methods: </strong>Skeletally immature patients undergoing hemiepiphysiodesis from 2018 to 2022 for coronal deformities of the knee and ankle were retrospectively studied through electronic medical record. Follow-up status was categorized as on-time follow-up (OTFU), LFU, or LTFU. Late presentation was defined as presentation over 6 months past the recommended follow-up date. The angle between the mechanical axis of the femur and the tibia and the lateral distal tibial angle were measured preoperatively and at final follow-up for coronal knee deformities and ankle valgus, respectively. Overcorrection was stratified by severity: 0° to 5° was considered acceptable, 5° to 10° mild, 10° to 15° moderate, and >15° severe. OTFU was used as a reference for statistical comparisons of follow-up status. Statistical comparisons were performed with multivariate analysis.</p><p><strong>Results: </strong>One hundred fifty-five patients were included, 91 male and 64 female. In all, 103 patients followed up on-time, 28 were LFU (mean 17.9 mo after recommended follow-up), and 24 (average 6.5 mo from surgery) were LTFU. Of the LFU, 4 underwent an additional procedure to correct new deformity. Of the LFU genu valgum limbs, 50.0% were severely overcorrected. Of the LFU genu varum limbs, 38.5% were severely overcorrected. ADI (national), male, black race, and uninsured status were significantly more likely to be LTFU. The predominant deformity in both the LFU and LTFU groups was genu varum and the predominant diagnosis was Blount disease.</p><p><strong>Conclusion: </strong>Poor follow-up after hemiepiphysiodesis can result in overcorrection necessitating additional procedures. Factors associated with LFU included a diagnosis of genu varum. Factors associated with LTFU included older age, high national ADI, increased weight for age percentile, male, black race, uninsured status, and genu varum. Quality improvement measures should be implemented to ensure follow-up in high-risk groups.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753197","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 Risks and Benefits of Definitive Surgery in the Graduation of Idiopathic Early-Onset Scoliosis (I-EOS) Patients Whose Deformities Were Managed With Growing Rods: A Comparison With Matched Adolescent Idiopathic Scoliosis (AIS) Patients.","authors":"Gokay Dursun, Rafik Ramazanov, Halil G Demirkiran, Mehmet Ayvaz, Muharrem Yazici","doi":"10.1097/BPO.0000000000002966","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002966","url":null,"abstract":"<p><strong>Background: </strong>Growing rod treatment (GR) is one of the most popular methods for idiopathic EOS and is usually followed by posterior instrumented spinal fusion (PISF), which is also called graduation. Graduation surgery is technically demanding and complicated, leading to a tendency to avoid definitive fusion when there is an adequate improvement in scoliosis angle, no implant failure, and no need to change the instrumentation level. The aim of the present study was to compare the risks and benefits of PISF between patients with adolescent idiopathic scoliosis (AIS) treated with standard PISF against those with idiopathic EOS treated with GR and graduated with PISF.</p><p><strong>Methods: </strong>The study included patients with I-EOS who were treated with dual GR and PISF, and those with AIS who underwent standard PISF with AIS during the study period. The AIS and EOS groups were matched in terms of scoliosis curve magnitude, T2-T12 kyphosis, L1-S1 lordosis, sex, and age variables by propensity score matching.</p><p><strong>Results: </strong>Seven hundred seventy-six patients (24 EOS and 752 AIS) were included in the study. Seventy-two AIS patients were matched against 24 EOS patients. Statistically significant differences were found between the groups in terms of scoliosis correction percentage, surgical time, transfusion need, and number of instrumented segments. However, the percentage of T1-T12 length increase, percentage of T1-S1 length increase, instrumented spinal segment length increase, and the estimated blood loss were similar between the groups.</p><p><strong>Conclusion: </strong>Although the EOS group had longer surgical time (30 min longer), more bleeding (75 cc more), and less correction of the coronal deformity, trunk height gained by definitive surgery was the same as that in the AIS group. There was a difference in favor of AIS between the groups in terms of coronal deformity correction rates, but the final deformity size in the EOS patients was clinically insignificant (22±13 degrees). Definitive fusion in EOS with idiopathic etiology does not carry an excessive risk for complications, and the gains obtained by the patients after surgery are comparable to AIS patients who underwent PISF surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729917","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":"Pinning and Arthroscopic Trimming for Mild Slipped Capital Femoral Epiphysis: Comparative Study With Traditional In Situ Pinning and Modified Dunn Procedure.","authors":"Alessandro Aprato, Andrea Audisio, Beatrice Cambursano, Matteo Giachino, Stefano Artiaco, Federico Fusini, Alessandro Massè","doi":"10.1097/BPO.0000000000002960","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002960","url":null,"abstract":"<p><strong>Introduction: </strong>Mild slipped capital femoral epiphysis (SCFE) was traditionally treated with in situ pinning (ISP), a technique that stabilizes the physis but does not restore the anterior-superior femoral head offset. This residual deformity can lead to femoroacetabular impingement and early joint degeneration. Therefore, immediate arthroscopic trimming was associated to in situ pinning (ISPAT). The primary goal is to assess the clinical and radiologic outcomes of patients treated with ISPAT. Secondarily, outcomes were compared with traditional in situ pinning (ISP) and modified Dunn's procedure (MDP).</p><p><strong>Methods: </strong>Patients with Southwick 1 SCFE were included. Patients were divided in 3 groups according to surgical treatment: (1) pinning in situ associated to arthroscopic trimming (ISPAT), (2) pinning in situ (ISP), and (3) modified Dunn procedure (MDP). Outcomes were assessed with clinical parameters (range of motion (ROM), impingement test, mHHS and UCLA activity score) and radiologic parameters (Southwick angle, alpha angle). Early and late complications were recorded. Comparative analysis was performed.</p><p><strong>Results: </strong>A total of 47 patients (59 hips) were included in the study (ISPAT: 12, ISP: 34, MDP: 13). Preoperative Southwick slip angle (SA) was higher in the ISPAT and MDP groups compared with the ISP group (ISPAT vs. MDP, P=0.85; ISPAT vs. ISP, P<0.001; MDP vs. ISP, P<0.001)​. Surgical time differed between groups (ISPAT 69.9±17.7; ISP 37.0±21; MDP 140.0±26.5 min; P<0.001). The ISPAT group had a higher postoperative internal rotation (23.4±7.9 deg) compared with ISP (15.0±7.1 deg, P<0.001) but similar to MDP (28.2±6.4 deg; P=0.099). No differences were found in mHHS scores across groups (ISPAT 90.7±0.9, ISP 86.8±10.0, MDP 90.6±1.2, P=0.18)​. Postoperatively, the alpha angle of the ISPAT group demonstrated significant improvement postoperatively (preoperative 81.5±7.7 vs. postoperative 47.7±8.3 deg, P<0.001), with results comparable to MDP (postoperative 45.1±11.3 deg, P=0.45)​. In ISPAT no major complications were recorded. In ISP 4 patients developed osteoarthritis (OA) (2 required total hip arthroplasty). In MDP 1 patient developed OA, but no further surgery was performed.</p><p><strong>Conclusions: </strong>ISPAT is a safe and effective option for managing mild SCFE, providing immediate intervention to address FAI. However, its long-term impact on hip function and osteoarthritis prevention requires further investigation.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710399","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 Role of Closed Reduction in the Treatment of Pediatric Monteggia Fractures.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Jesse Hu, Sabrina Madrigal, Lindley Wall, Charles Goldfarb, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002958","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002958","url":null,"abstract":"<p><strong>Introduction: </strong>Previous ulnar-based treatment algorithms for pediatric Monteggia fractures advocate for treating incomplete ulnar fractures with closed reduction and casting (CRC) while treating complete fractures surgically. However, recent evidence has suggested that these algorithms may result in overtreatment. This study aimed to evaluate the outcomes of CRC treatment across all ulnar fracture patterns and identify factors associated with CRC failure.</p><p><strong>Methods: </strong>A retrospective study was conducted of patients treated for Monteggia fractures at a single institution from 2002 to 2022. Inclusion criteria were patients younger than 18 at the time of injury, with complete radiographic follow-up from preintervention until the time of bony union. Patients treated surgically without a trial of CRC due to an open fracture or delayed presentation for treatment were excluded. Patient demographics, radiographs, and relevant surgical records were analyzed.</p><p><strong>Results: </strong>Eighty patients, 34 (42.5%) males, were included. Sixty-seven (83.8%) had complete ulnar fractures. The average age at injury was 5.7 years (range: 2 to 17), and the average follow-up was 5.6 months (range: 1 to 71). Fifty-eight (72.5%) patients were successfully treated with CRC. Of the 22 (27.5%) failures, all but 1 required surgery. Older age at injury was a risk factor for CRC failure (P=0.002). Failure occurred in 50% of patients older than 6 and 17.9% of patients ages 6 or younger (P=0.003). Other ulna-related criteria, including Bado classification, fracture pattern, and ulnar displacement, were not significant risk factors.</p><p><strong>Conclusion: </strong>This study's results support an emerging body of evidence suggesting that ulnar-based algorithms may overpredict CRC failure in pediatric Monteggia fractures. A trial of CRC in these fractures, regardless of ulnar fracture pattern, may prevent unnecessary surgical intervention. In this study, 26.3% of patients ultimately required surgery following an initial trial of CRC, whereas previous algorithms would have recommended surgery in 83.8% of patients. However, patients older than 6 may be less likely to retain reduction with CRC, as our study showed that 50% required surgical treatment.</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":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700668","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}