Journal of Pediatric Orthopaedics最新文献

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Anterior Distal Femoral Hemiepiphysiodesis Using Coronally Oriented 8-plates for the Correction of Fixed Knee Flexion Deformities in Children-Preliminary Results. 使用冠状定向 8 号钢板进行股骨远端前半截骨切除术矫正儿童固定性膝关节屈曲畸形--初步结果。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-06 DOI: 10.1097/BPO.0000000000002746
Mohamed Y Hassanein, Mohamed Khaled, Mahmoud Yahya Hassanein, Nariman Abol Oyoun
{"title":"Anterior Distal Femoral Hemiepiphysiodesis Using Coronally Oriented 8-plates for the Correction of Fixed Knee Flexion Deformities in Children-Preliminary Results.","authors":"Mohamed Y Hassanein, Mohamed Khaled, Mahmoud Yahya Hassanein, Nariman Abol Oyoun","doi":"10.1097/BPO.0000000000002746","DOIUrl":"10.1097/BPO.0000000000002746","url":null,"abstract":"<p><strong>Introduction: </strong>The original technique for guided growth of the distal femur for correction of pediatric fixed knee flexion deformities (FKFDs) involves the utilization of two 8-plates inserted on either side of the trochlear groove, a technique that has been frequently linked to the development of persistent postoperative knee pain and crepitus. The present study aimed to assess the preliminary results of a novel technique where the two 8-plates are fixed in the coronal plane, one on each of the medial and lateral surfaces, so that they occupy the anterior part of the distal femur.</p><p><strong>Methods: </strong>Our study was a prospective case series that included cases with FKFD of >10 degrees in children with at least 12 months of predicted growth remaining. The preoperative knee flexion contracture angle was documented. The surgical procedure entailed the insertion of 2 coronally oriented 8-plates on the medial and lateral surfaces of the distal femur as anterior as possible to the axis of the femur without encroachment on the trochlear groove. The duration of time required to attain full knee extension and any complications encountered were recorded. Wilcoxon signed-rank was used to compare the preoperative and final contracture angles. The level of statistical significance was set at P <0.05.</p><p><strong>Results: </strong>Thirteen knees in 8 patients (6 boys and 2 girls) were included. The median age was 11 years (6 to 14). There was a significant improvement in the FKFD for the whole cohort from 25 degrees (14 to 42) to 0 degrees (-9 to 8), P <0.05. The median rate of correction was 2.0 degrees/month (0.9 to 5.8). The time till full correction was 14 months (4 to 25). Postoperative knee pain and metalware-related complications were not reported by any patient during follow-up.</p><p><strong>Conclusions: </strong>Guided growth of the distal femur using coronally oriented 8-plates is an effective procedure for the treatment of FKFDs in children. This modified technique may achieve faster correction while minimizing the risk of postoperative knee pain compared with the conventional technique.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261662","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}
引用次数: 0
Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic. 美国小儿枪伤流行病学:2019年冠状病毒疾病大流行期间枪伤率的变化。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-10 DOI: 10.1097/BPO.0000000000002742
Arakua Welbeck, Beltran Torres-Izquierdo, Mehul M Mittal, David Momtaz, Rishi Gonuguntla, Ndéye Guisse, Jesse Hu, Daniel E Pereira, Pooya Hosseinzadeh
{"title":"Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic.","authors":"Arakua Welbeck, Beltran Torres-Izquierdo, Mehul M Mittal, David Momtaz, Rishi Gonuguntla, Ndéye Guisse, Jesse Hu, Daniel E Pereira, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002742","DOIUrl":"10.1097/BPO.0000000000002742","url":null,"abstract":"<p><strong>Objectives: </strong>Ballistic injuries among pediatric populations have become a public health crisis in the United States. The surge in firearm injuries among children has outpaced other causes of death. This study aims to assess the trend in pediatric gunshot injuries (GSIs) over the last decade and investigate the impact, if any, of the pandemic on GSIs statistics.</p><p><strong>Methods: </strong>A comprehensive retrospective analysis was conducted using a federated, real-time national database. A total of 15,267,921 children without GSIs and 6261 children with GSIs between 2017 and 2023 were identified. The study evaluated the incidence and annual proportions of GSIs among different demographics. In addition, the incidence proportions per 100,000 for accidental, nonaccidental, fracture-related, and fatal GSIs were analyzed.</p><p><strong>Results: </strong>The incidence proportions per 100,000 for GSIs, accidental GSIs, nonaccidental GSIs, fatal GSIs, wheelchair-bound cases, and fracture-related GSIs increased significantly from 2017 to 2023, going from 9.7 to 22.8 (Relative Risk: 2.342, 95% CI: 2.041, 2.687 , P < 0.001). The overall increase was mostly a result of accidental GSI when compared with nonaccidental (incidence proportion 25.8 vs 2.1; P < 0.001) in 2021 at the height of the pandemic. In patients with an accidental GSI, the incidence proportion per 100k between 2017 and 2023 increased from 8.81 to 21.11 (Relative Risk: 2.397, 95% CI: 2.076, 2.768, P < 0.001).</p><p><strong>Conclusion: </strong>The study supports the shift in the leading cause of death among children from motor vehicle accidents to GSIs, with the continued rise in rates despite the coronavirus disease 2019 pandemic. Accidental injuries constituted the majority of GSIs, indicating the need for enhanced gun safety measures, including requirements for gun storage, keeping firearms locked and unloaded, requiring child supervision in homes with guns, and enforcing stricter punishments as penalties. Comprehensive efforts are required to address this public health crisis. Pediatricians play a vital role in counseling and educating families on firearm safety.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296235","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}
引用次数: 0
Tibial Tubercle Osteotomy With and Without Medial Patellofemoral Ligament Reconstruction in Adolescent Patients Leads to Decrease in Patellar Height and Patella Tendon Length. 青少年患者胫骨结节截骨术与髌股内侧韧带重建术导致髌骨高度和髌腱长度下降。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-21 DOI: 10.1097/BPO.0000000000002753
Natalya E McNamara, Elaine Z Shing, Ameen Z Khalil, Erin M Tabish, Joseph T Featherall, Reece M Rosenthal, Travis G Maak, Stephen K Aoki, Justin J Ernat
{"title":"Tibial Tubercle Osteotomy With and Without Medial Patellofemoral Ligament Reconstruction in Adolescent Patients Leads to Decrease in Patellar Height and Patella Tendon Length.","authors":"Natalya E McNamara, Elaine Z Shing, Ameen Z Khalil, Erin M Tabish, Joseph T Featherall, Reece M Rosenthal, Travis G Maak, Stephen K Aoki, Justin J Ernat","doi":"10.1097/BPO.0000000000002753","DOIUrl":"10.1097/BPO.0000000000002753","url":null,"abstract":"<p><strong>Objective: </strong>Patellar height changes after tibial tubercle osteotomy (TTO) have not yet been described. We aimed to evaluate whether TTO ± medial patellofemoral ligament reconstruction (MPFL-R) influences patellar height and tendon length, hypothesizing that TTO would decrease patellar height and tendon length.</p><p><strong>Methods: </strong>A retrospective review was performed of skeletally mature adolescents (<18 y) receiving primary anteromedialization or medialization TTO ± MPFL-R. Patients with at least 6 months of radiographic follow-up were included in the study. Pre and postoperative patellar heights were assessed on lateral, weight-bearing, and flexion (30 to 70 degrees) radiographs using the Blackburne-Peel Index (BPI), Caton-Deschamps Index (CDI), and Insall-Salvati Ratio (ISR). Subgroup analyses were performed to compare patellar height changes in patients with preoperative patella alta, norma, and baja, as well as between patients undergoing medialization and anteromedialization TTO. Data were analyzed for normality using a Shapiro-Wilk test, and paired-sample t tests were performed.</p><p><strong>Results: </strong>Forty-nine knees were included (mean age: 15 y; range: 12 to 17). A significant decrease in mean patellar height after TTO ± MPFL-R was observed across all measures: BPI (0.12, P = 0.000783), CDI (0.08, P = 0.01062), and ISR (0.15, P = 0.00000075). Patellar tendon length decreased by 2.26 mm ( P = 0.001272). Subgroup analyses demonstrated a decrease in mean patellar height across all 3 measurements ( P < 0.001; BPI, CDI, and ISR) for patients with preoperative patella alta but not patella norma or baja. Additional subgroup analysis showed a patellar height decrease using BPI (0.15, P = 0.004583) and ISR (0.14, P = 0.0002806) for patients receiving medialization TTO but not anteromedialization. The anteromedialization cohort did not demonstrate patellar height change using BPI and CDI; ISR demonstrated a decrease (0.10, P = 0.00917).</p><p><strong>Conclusions: </strong>Mean patellar height and tendon length decreases after TTO ± MPFL-R in skeletally mature, adolescent patients. Subgroup analyses suggest these changes occur in patients with preoperative patella alta and/or patients who undergo medialization TTO. These data suggest that some distalization in patellar positioning may be achieved without formal distalization osteotomy.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440549","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}
引用次数: 0
Scoliosis Development in Spinal Muscular Atrophy: The Influences of Genetic Severity, Functional Level, and Disease-Modifying Treatments. 脊髓肌肉萎缩症脊柱侧弯的发展:遗传严重程度、功能水平和疾病改变治疗的影响。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1097/BPO.0000000000002759
Sadettin Ciftci, Armagan C Ulusaloglu, M Wade Shrader, Mena T Scavina, William G Mackenzie, Robert Heinle, Kevin M Neal, Alec Stall, Jason J Howard
{"title":"Scoliosis Development in Spinal Muscular Atrophy: The Influences of Genetic Severity, Functional Level, and Disease-Modifying Treatments.","authors":"Sadettin Ciftci, Armagan C Ulusaloglu, M Wade Shrader, Mena T Scavina, William G Mackenzie, Robert Heinle, Kevin M Neal, Alec Stall, Jason J Howard","doi":"10.1097/BPO.0000000000002759","DOIUrl":"10.1097/BPO.0000000000002759","url":null,"abstract":"<p><strong>Background: </strong>Spinal muscular atrophy (SMA) is caused by abnormalities of the survival motor neuron (SMN) 1 gene, leading to deficiency in SMN protein and loss of spinal cord alpha motor neurons. Newer disease-modifying agents (DMA) targeting the involved genes, including nusinersen and gene replacement therapies, have improved gross motor and respiratory function, but their impact on scoliosis development has not been established. This study aimed to determine risk factors for scoliosis development in SMA, specifically genetic severity and DMA use.</p><p><strong>Methods: </strong>In this retrospective cohort study, children with SMA and minimum 2-year follow-up were included. The primary outcome was the prevalence of clinically relevant scoliosis. Secondary outcomes included SMA type, SMN2 copy number, Hammersmith Functional Motor Scale (HFMS), ambulatory status [functional mobility scale at 50m (FMS 50 )], DMA use, and hip displacement as risk factors. Univariate/multivariate logistic regression analyses were performed to identify dependent/independent risk factors.</p><p><strong>Results: </strong>One hundred sixty-five patients (51% female) with SMA types I-III met the inclusion criteria, with total follow-up of 9.8 years. The prevalence of scoliosis was 79%; age of onset 7.9 years. The major curve angle for the entire cohort at first assessment and final follow-up was 37 degrees (SD: 27 degrees) and 62 degrees (SD: 31 degrees) ( P <0.0001), respectively. Significant risk factors for scoliosis by univariate analysis were SMA type (I/II, P =0.02), HFMS (>23, P <0.001), nonambulatory status (FMS 50 =1, P <0.0001), DMA treatment ( P =0.02), and hip displacement ( P <0.0001). Multivariate analysis revealed that HFMS >23 ( P =0.02) and DMA ( P =0.05) treatment were independent (protective) risk factors.</p><p><strong>Conclusions: </strong>The development of scoliosis in SMA is high, with risk factors associated with proxy measures of disease severity, including SMA type, nonambulatory status, hip displacement, and most notably, gross motor function (by HFMS). DMA use and HFMS >23 were associated with a decreased risk of scoliosis development. Identified risk factors can be used in the development of surveillance programs for early detection of scoliosis in SMA.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446450","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}
引用次数: 0
Is a keystone Bone Anomaly the Main Cause of Flatfoot (Pes Planus)? 关键骨异常是导致扁平足(Pes Planus)的主要原因吗?
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-26 DOI: 10.1097/BPO.0000000000002760
Ahmet Payas, Sabri Batin
{"title":"Is a keystone Bone Anomaly the Main Cause of Flatfoot (Pes Planus)?","authors":"Ahmet Payas, Sabri Batin","doi":"10.1097/BPO.0000000000002760","DOIUrl":"10.1097/BPO.0000000000002760","url":null,"abstract":"<p><strong>Background: </strong>Flatfoot (pes planus) is a decrease or loss of longitudinal medial arch height. The cause of symptomatic flatfoot occurring in adolescents is still unclear. In this study, the relationship between adolescent pes planus and foot bone shape was investigated. For this purpose, the volume and superficial area data of the foot bones of adolescent individuals with flatfoot deformity and individuals without any foot deformity were compared.</p><p><strong>Methods: </strong>Between September 2022 and June 2023, 30 individuals with adolescent pes planus with a medial arch angle greater than 145 degrees and 30 individuals without any foot deformity were included in the study. Computed tomography (CT) images of the participants' feet were obtained with a General Electric brand IQ model 32 detector CT device with a section thickness of 0.625 mm in accordance with the bone protocol. Using the 3D Slicer program on CT images, foot bones were segmented and the volume and surface area ratios of each foot bone were determined.</p><p><strong>Results: </strong>Cuneiforme mediale and cuneiforme intermediale volume ratios in individuals with flatfoot deformity decreased by 14% and 24%, respectively, compared with the control group ( P <0.05). Cuneiforme mediale and cuneiforme intermediale superficial area ratios were found to be 10% and 30% lower in the flatfoot group compared with the control group, respectively ( P <0.05). There was no difference in the volume and superficial area ratios of other foot bones between the groups ( P >0.05).</p><p><strong>Conclusions: </strong>The study results suggest that symptomatic adolescent flatfoot deformity may be associated with developmental anomalies of the os cuneiforme mediale and os cuneiforme intermedium.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450770","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}
引用次数: 0
Lateral Open Wedge Osteotomy and Lateral Condyle Fusion In Situ for Children With Condyle Nonunion and Cubitus Valgus Deformity. 为患有髁骨不连和拇指外翻畸形的儿童实施外侧开放式楔形截骨术和外侧髁骨原位融合术。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-09-24 DOI: 10.1097/BPO.0000000000002829
Yunan Lu, Yuchen Pan, Federico Canavese, Ran Lin, Jinglin Lai, Shunyou Chen
{"title":"Lateral Open Wedge Osteotomy and Lateral Condyle Fusion In Situ for Children With Condyle Nonunion and Cubitus Valgus Deformity.","authors":"Yunan Lu, Yuchen Pan, Federico Canavese, Ran Lin, Jinglin Lai, Shunyou Chen","doi":"10.1097/BPO.0000000000002829","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002829","url":null,"abstract":"<p><strong>Purpose: </strong>Long-term nonunion of the lateral humeral condyle (LHC) can result in progressive cubitus valgus, elbow pain, instability, and delayed ulnar nerve palsy. Various techniques have been proposed for correction, each with its own advantages and disadvantages. The purpose of this study was to introduce a lateral open wedge osteotomy (LOWO) procedure combined with in situ osteosynthesis of nonunited LHC for the treatment of long-term LHC nonunion with cubitus valgus deformity.</p><p><strong>Methods: </strong>We evaluated 18 pediatric patients who had a cubitus valgus deformity greater than 10 degrees after nonunion of the LHC for more than 2 years. The LHC was fixed in situ with 1 or 2 cancellous screws, and the LOWO was fixed with a locking plate. All patients underwent clinical and radiologic evaluation, and the pre- and postoperative carrying angle (CA), range of motion (ROM), and Mayo elbow performance score (MEPS) were analyzed.</p><p><strong>Results: </strong>Eighteen patients, with a mean age of 9.9 ± 3.9 years, underwent treatment for LHC nonunion and cubitus valgus deformity after a mean interval of 61.6 ± 24.1 months from the initial injury. The mean follow-up period was 57.6 ± 22.8 months. Union of the LHC and LOWO was achieved in all patients. The mean CA decreased significantly from 31.6 ± 4.8 degrees before surgery to 10.4 ± 2.2 degrees after surgery (P<0.001). Surgery did not decrease elbow range of motion (P=0.202). The mean MEPS increased significantly from a preoperative value of 55 ± 4.9 to a postoperative value of 91.1 ± 5.6 (P<0.001). No significant complications were observed.</p><p><strong>Conclusions: </strong>LOWO combined with in situ fixation of nonunited LHC is an effective approach for treating long-term LHC nonunion associated with cubitus valgus deformity.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307992","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}
引用次数: 0
Letter to Editor Regarding "Shoulder Motion Overestimated by Mallet Scores" by Lovette et al. 致编辑的信,内容涉及 Lovette 等人撰写的 "用槌击评分高估了肩关节运动"。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-09-23 DOI: 10.1097/BPO.0000000000002822
Merve Sariipek, Tüzün Firat
{"title":"Letter to Editor Regarding \"Shoulder Motion Overestimated by Mallet Scores\" by Lovette et al.","authors":"Merve Sariipek, Tüzün Firat","doi":"10.1097/BPO.0000000000002822","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002822","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289702","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}
引用次数: 0
When to Radiate and When to Stop? Timing Radiographic Surveillance During Nonoperative Treatment of Pediatric Diaphyseal Clavicle Fractures. 何时放射,何时停止?小儿锁骨骨骺骨折非手术治疗期间的放射监测时机。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-09-23 DOI: 10.1097/BPO.0000000000002815
Robert W Gomez, David Jessen, Morgan Storino, Zachary J Lamb, Nigel K Wang, Neil Jain, Dustin A Greenhill
{"title":"When to Radiate and When to Stop? Timing Radiographic Surveillance During Nonoperative Treatment of Pediatric Diaphyseal Clavicle Fractures.","authors":"Robert W Gomez, David Jessen, Morgan Storino, Zachary J Lamb, Nigel K Wang, Neil Jain, Dustin A Greenhill","doi":"10.1097/BPO.0000000000002815","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002815","url":null,"abstract":"<p><strong>Introduction: </strong>Conservative management of most pediatric clavicle fractures is standard. Despite a predictable nonoperative course, evidence about the timeliness of healing is lacking. The goal of this study was to identify when radiographic signs of healing should be expected during routine conservative management of closed pediatric diaphyseal clavicle fractures.</p><p><strong>Methods: </strong>Patients 18 years or younger with an acute diaphyseal clavicle fracture treated at a large academic multispecialty orthopaedic practice over 5 years were retrospectively reviewed. Patients who completed nonoperative management until radiographic and clinical evidence of union were included and categorized into 3 age groups: infants and toddlers (0 to 2 y old), school-aged children (3 to 9 y old), and adolescents (10 to 18 y old). Radiographic healing was analyzed within each 2- to 4-week interval.</p><p><strong>Results: </strong>Among 390 patients, 303 met inclusion criteria. Overall shortening and displacement averaged 0.3±0.6 centimeters and 42.6%±43.0%, respectively. Follow-up averaged 50±24 days with an orthopaedic physician and 16.3±14.8 months for a well-child check. No clinically relevant or statistically significant improvements in the number of cortices bridged were observed in infants/toddlers after 4 weeks (average 20.4±4.3 d from injury), in school-aged children after 8 weeks (average 39.7±7.9 d from injury), or in adolescents after 12 weeks (average 66.4±8.1 d from injury).</p><p><strong>Conclusions: </strong>This study provides an age-dependent timeline during which adequate radiographic healing should be expected in nonoperatively managed pediatric diaphyseal clavicle fractures. Radiographic protocols can be purposefully timed to visualize sufficient healing in infants and toddlers by 4 weeks, school-aged children by 8 weeks, and adolescents by 12 weeks.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289707","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}
引用次数: 0
Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection. 儿童骨与关节感染高级成像的最佳时机。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-09-23 DOI: 10.1097/BPO.0000000000002819
Sarah Hunter, Elsie Brown, Haemish Crawford, Cameron Grant
{"title":"Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection.","authors":"Sarah Hunter, Elsie Brown, Haemish Crawford, Cameron Grant","doi":"10.1097/BPO.0000000000002819","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002819","url":null,"abstract":"<p><strong>Objective: </strong>Advanced imaging in the management of childhood bone and joint infection (BJI) has the potential to improve disease outcomes. Knowledge about the optimal timing for magnetic resonance imaging (MRI) in relation to both surgically and nonsurgically managed BJI is limited. This study examines the impact of MRI timing on number of surgeries, length of stay (LOS), hospitalization cost, and disease recurrence in childhood BJI.</p><p><strong>Methods: </strong>This is a retrospective review of patients younger than 16 years with acute hematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018 to 2023. Cases undergoing MRI as part of diagnostic workup were included. Treatment, hours between admission and MRI, LOS, hospitalization cost, and infection recurrence were assessed.</p><p><strong>Results: </strong>There were 563 cases of BJI, of which 390 met the inclusion criteria. Cases were primarily AHO (85%). The percentage of cases having MRI increased over time from 54% (2018) to 80% (2023). Locally disseminated infections such as subperiosteal abscess or adjacent septic arthritis occurred in 48%. Children with preoperative (n = 145) versus postoperative MRI (n = 60) had a lower reoperation rate (33% vs 77%, P = 0.001) and shorter LOS (14.1 vs 22.4 d, P = 0.002). Hospitalization costs appeared lower but did not differ statistically ($59,419 vs $159,353, P = 0.12). In nonoperative cases, LOS was shorter if an MRI occurred within 48 hours of admission (7.3 vs 10 d, P = 0.03). Disease recurrence was not associated with MRI timing.</p><p><strong>Conclusion: </strong>Overall, children with BJI who underwent MRI scans before surgery had lower reoperation rates. Children receiving MRIs within 48 hours of admission had shorter LOS.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289705","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}
引用次数: 0
Letter to the Editor Regarding "Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-blinded, Controlled Trial". 致编辑的信,内容涉及 "小儿特发性脊柱侧凸手术中双侧和双水平棘突平面阻滞的有效性:随机、双盲、对照试验"。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2024-09-18 DOI: 10.1097/BPO.0000000000002821
Vishwajeet Singh
{"title":"Letter to the Editor Regarding \"Effectiveness of the Bilateral and Bilevel Erector Spinae Plane Block in Pediatric Idiopathic Scoliosis Surgery: A Randomized, Double-blinded, Controlled Trial\".","authors":"Vishwajeet Singh","doi":"10.1097/BPO.0000000000002821","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002821","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289703","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}
引用次数: 0
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