Journal of Pediatric Orthopaedics最新文献

{"title":"Intermediate Duration Outcomes of Surgical Management for Chronic Exertional Compartment Syndrome in Adolescents and Young Adults: The Mubarak Fasciotome.","authors":"Katherine D Wilson, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000002924","DOIUrl":"10.1097/BPO.0000000000002924","url":null,"abstract":"<p><strong>Objective: </strong>Chronic exertional compartment syndrome (CECS) poses challenges in diagnosis and management, particularly in young athlete populations. Current surgical approaches have been successful after failed conservative management, but with only short-term follow-up detailed in the literature. This study aimed to evaluate intermediate outcomes (>2 y) of surgical management for CECS in adolescents and young adults using the Mubarak fasciotome, with attention to complications and patient-reported outcomes.</p><p><strong>Methods: </strong>A retrospective review of patients identified over a 13-year period who underwent lower extremity fasciotomy was performed. Those with CECS were included based on the history of lower extremity symptoms and elevated intracompartmental pressure readings meeting Pedowitz criteria. Fasciotomy was performed with the Mubarak fasciotome under general anesthesia. Single-incision approaches were used for anterior/lateral compartments, and/or a medial incision for posterior compartments. Patients received postoperative therapy and underwent patient-reported outcomes assessment, including MARX and SANE scores, and pain ratings at various time points and final follow-up. Descriptive statistics were calculated using SPSS.</p><p><strong>Results: </strong>We identified 6 patients (10 limbs) undergoing fasciotomy for CECS with a mean follow-up of 7.2 years (range: 2 to 12.5 years). Following surgery, patients reported significant improvements in pain, with mean scores decreasing from 7.7 to 1.5. MARX scores indicated a return to high physical activity, with a mean of 8.7. SANE scores for activities of daily living and athletics were high, indicating functional recovery. Yet only 66% of patients returned to their original sport or a comparable activity level. No major complications were noted.</p><p><strong>Conclusion: </strong>The Mubarak fasciotome for CECS surgery in adolescents and young adults resulted in favorable intermediate outcomes that persist throughout the athlete's career, including pain reduction, functional improvement, and high satisfaction. This minimally invasive technique offers a promising alternative to traditional fasciotomy when careful attention is placed on fasciotome placement to avoid nerve injury.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"287-293"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692409","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":"Letter to the Editor: Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures.","authors":"Siddharth Jain, Prateek Behera, Sourabh Kumar Sinha, John A Santoshi","doi":"10.1097/BPO.0000000000002869","DOIUrl":"10.1097/BPO.0000000000002869","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e496"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751057","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":"Knee Anterior Laxity and Graft Maturation After Transphyseal Anterior Cruciate Ligament Reconstruction.","authors":"Franck Accadbled, Timothé Lescot, Nicolas Nicolaou, Jeremy Doumerc, Etienne Cavaignac, Clara Flumian, Estelle Maupoint, Jérôme Sales de Gauzy","doi":"10.1097/BPO.0000000000002888","DOIUrl":"10.1097/BPO.0000000000002888","url":null,"abstract":"<p><strong>Background: </strong>The failure rate of anterior cruciate ligament (ACL) reconstruction in children and adolescents is a significant concern. Of the multitude of clinical factors that contribute to this risk, delayed maturation and graft laxity are potentially related and modifiable elements. The aim was to investigate knee anterior laxity and graft maturation in children and adolescents. The ligamentization of the graft may be correlated with the residual laxity.</p><p><strong>Methods: </strong>A single-center prospective study included skeletally immature patients treated with transphyseal ACL reconstruction using semitendinosus tendon autograft from 2017 to 2019. Participants were evaluated on 4 occasions: preoperatively, then at 6, 12, and 24 months with instrumented laximetry and MRI to analyze graft maturation according to the Signal-to-noise Quotient (SNQ) and Howell classification.</p><p><strong>Results: </strong>A total of 50 patients (33 boys and 17 girls), with a mean age of 13.2 years (range, 9 to 16) at the time of surgery, were included. Mean side-to-side knee anterior laxity decreased from 2.78 mm preoperatively to 1.59, 1.80, and 1.30 mm (at 6, 12, and 24 mo follow-up, respectively), P <0.05. No statistical difference was noted according to the follow-up or sex. SNQ was unchanged between 6 and 12 months, but a significant difference was demonstrated between 12 months and 24 months ( P =0.008). There was no statistical correlation between laximetry and graft maturation.</p><p><strong>Conclusions: </strong>ACL graft ligamentization is delayed in children and adolescents and only occurs between 12 and 24 months postoperatively. Residual laximetry and MRI signal of the graft may become one of the multiple elements upon which to base the decision to return to sport.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"281-286"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of the LLRS-AIM Index With LD-SRS and PROMIS in Pediatric Patients With Lower Limb Differences.","authors":"Luke Sang, Sarah Coufal, Ishaan Swarup, Sanjeev Sabharwal","doi":"10.1097/BPO.0000000000002916","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002916","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to assess the reliability of the Limb Lengthening and Reconstruction Society AIM (LLRS-AIM) index, a scale for grading the severity of lower limb deformities by the physician, and its concordance with 2 patient-reported outcome measures, the Limb Deformity-Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) tools in pediatric patients with lower limb differences.</p><p><strong>Methods: </strong>This was a retrospective review of patients 18 years old or younger who presented to our institution with lower limb differences for surgical reconstruction between 2019 and 2024. All patients received the LD-SRS and PROMIS for completion before surgery. The LLRS-AIM index for patients was assessed by 2 independent evaluators, with intraclass correlation coefficients (ICCs) calculated to determine inter-rater agreement. Spearman correlations were performed between the LLRS-AIM Index with all LD-SRS and PROMIS domains. The Benjamini-Hochberg procedure was conducted to reduce the false discovery rate.</p><p><strong>Results: </strong>A total of 81 patients were included in this study. The LLRS-AIM Index had good and near-perfect inter-rater reliability across different levels of medical training (ICC=0.9). Overall, there were no correlations between the LLRS-AIM Index with LD-SRS and PROMIS domains (LD-SRS function: P=-0.26, P=0.18; PROMIS pain interference: P=0.10, P=0.63). Mental health-related LD-SRS and PROMIS domains showed no correlations with the physician-reported LLRS-AIM index (LD-SRS self image: P=0.10, P=0.63; PROMIS depression: P=-0.05, P=0.63).</p><p><strong>Conclusions: </strong>There is a high level of reproducibility for the LLRS-AIM index to evaluate the complexity of lower limb differences in pediatric patients. However, there are no correlations between the LLRS-AIM index with LD-SRS and PROMIS across all relevant domains. Further modifications to the LLRS-AIM index criteria and scoring weights may allow it to better assess patient outcomes in the pediatric population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 5","pages":"e457-e463"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811561","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 Impact of Anxiety and Depression on Postoperative Pain Management and Emergency Room Visits in Pediatric Patients With Surgically Treated Lower Extremity Fractures: A Propensity-matched Cohort Analysis.","authors":"David Momtaz, Jacob Jahn, Jordan Eskenazi, Blaire Peterson, Jad Lawand, Abdullah Ghali, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002910","DOIUrl":"10.1097/BPO.0000000000002910","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and depression (AD) are prevalent comorbidities in pediatric patients and may influence postoperative outcomes. The impact of AD on postoperative pain medication use and emergency room (ER) visits in children with surgically treated lower extremity fractures has not been well-documented. This study aimed to evaluate the association between AD and outpatient postoperative pain medication requirements as well as ER visits in this population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using electronic medical records from 2000 to 2023 in a large national database of health care organizations across the United States. Pediatric patients (age below 18) with surgically treated lower extremity fractures were included. Patients were categorized into 2 groups: those with AD and those without (No-AD). Patients were further dichotomized into 2 groups based on fracture location: femur (femur) versus tibia or ankle (tibia/ankle). Outcomes of interest included the use of intravenous (IV) opiates within 3 days postoperatively, the number of outpatient oral (PO) opiate prescriptions, and the proportion of patients with at least one ER visit within 1 year postsurgery. Hazard ratios (HRs) were calculated using Cox proportional hazard models, adjusting for demographic and clinical characteristics.</p><p><strong>Results: </strong>A total of 25,658 patients with either femur or tibia/ankle fractures were included. After matching, 735 patients were included in the AD femur cohort, and 945 in the AD tibia/ankle cohort. Each cohort was matched 1:1 with their control counterparts. In the femur fracture cohort, 49.80% of AD patients and 46.53% of No-AD patients required IV opiates within the first 3 days after surgery (HR, 1.09; P =0.21). Outpatient PO opiate use was significantly higher in AD patients (55.78% vs. 38.50%, HR, 1.64; P <0.001). In addition, AD patients had a higher proportion of ER visits (20.3% vs. 11.7%, HR, 1.68; P <0.001). In the tibia/ankle fracture cohort, 55.2% of AD patients and 48.3% of No-AD patients required IV opiates within the first 3 days (HR, 1.18; P <0.001). Outpatient PO opiate use was also higher in AD patients (46.35% vs. 32.06%, HR, 1.55; P <0.001). ER visits were more frequent in AD patients (21.26% vs. 9.63%, HR, 2.08; P <0.001).</p><p><strong>Conclusions: </strong>Pediatric patients with AD undergoing surgery for lower extremity fractures have increased postoperative pain medication requirements and higher rates of ER visits compared with those without AD. These findings highlight the need for targeted interventions, such as the use of preoperative counseling or multimodal pain regimens, to manage postoperative pain and reduce ER visits in this vulnerable population.</p><p><strong>Level of evidence: </strong>Prognostic level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"251-257"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256095","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 Utility of the Radiocapitellar View in Pediatric Medial Epicondyle Fracture Evaluation.","authors":"Tucker C Callanan, John D Milner, Mary Y Lou, Joseph Moschella, Janine Molino, Alexandre R Boulos, Jonathan R Schiller, Craig P Eberson, Aristides I Cruz","doi":"10.1097/BPO.0000000000002902","DOIUrl":"10.1097/BPO.0000000000002902","url":null,"abstract":"<p><strong>Background: </strong>Anteroposterior (AP) and lateral radiographs often underestimate displacement in medial epicondyle fractures, further complicating the already debated operative indications. The radiocapitellar (RC) view is an alternative radiograph that allows for the separation of the humeroradial and humeroulnar joints. This study investigates the utility of the RC view in measuring displacement and identifying the need for operative intervention in pediatric medial epicondyle fractures.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric patients who presented to our institution with a medial epicondyle fracture treated operatively from 2015 to 2022 and received initial AP and RC radiographs. Fracture displacement was measured by 3 orthopaedic surgeons using the corresponding point measurement method and inter/intra-rater reliability was computed. A fracture >5 mm was considered to be within the threshold for recommendation of operative treatment. McNemar test was used to assess differences in sensitivity in detecting operative fractures between AP and RC radiographs, with a P -value of < 0.05 considered significant.</p><p><strong>Results: </strong>A total of 45 patients met the inclusion criteria. The RC view had significantly higher sensitivity in identifying fractures greater than the operative threshold of 5 mm compared with the AP view (93.3% vs. 68.9%, P =0.0127), and on average, measured 2.5 mm more displacement ( P <0.001) than the corresponding AP view. AP and RC radiographs both measured >5 mm of displacement in 62.2% (28/45) of fractures, with 6.7% (3/45) determined as >5 mm by AP view and ≤5 mm by RC view. 31.1% (14/45) of fractures were measured to be >5 mm by RC view and ≤5 mm by AP view.</p><p><strong>Conclusion: </strong>The RC view significantly increases sensitivity in detecting the 5 mm displacement threshold for operative treatment of pediatric medial epicondyle fractures due to improved visualization of fracture displacement.</p><p><strong>Level of evidence: </strong>Level III, diagnostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"258-263"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007225","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":"Vertical Video-based Gait Analysis for Assessment of Transverse Plane Motion: Reliability and Validity in a Neuromuscular Population.","authors":"Ramiro Olleac, Bernardo Centeno, Clara Duffy, Marcos Nuñez, Marcos Crespo, Lucas M Barrios, Jon R Davids, Vedant A Kulkarni","doi":"10.1097/BPO.0000000000002926","DOIUrl":"10.1097/BPO.0000000000002926","url":null,"abstract":"<p><strong>Background: </strong>In the absence of 3-dimensional gait analysis (3DGA), assessment of transverse plane motion of the lower extremity from sagittal and coronal video has a high degree of error. We propose a standardized method through vertical video-based gait analysis (VVGA) to assess the position of the pelvis and lower extremity in the transversal plane. This study aims to evaluate the reliability and accuracy of VVGA compared with 3DGA for transverse plane kinematics.</p><p><strong>Methods: </strong>VVGA and 3DGA were obtained simultaneously on subjects between the ages of 6 and 35 referred to a motion analysis center. Gait Deviation Index (GDI) and Gait Profile Score (GPS) were used to estimate overall gait deviation of the subjects. Three raters at different levels of experience performed VVGA on all patients utilizing a standardized technique. Inter-rater and intrarater reliability was calculated using interclass correlation coefficients (ICC). Mean absolute difference (MAD) between VVGA measurements and 3DGA data was calculated for each body-segment.</p><p><strong>Results: </strong>Twenty-six patients (median age: 12 y, 61.53% male) with neuromuscular disorders participated in the study, with the majority (65%) having cerebral palsy. The mean GDI of the subject group was 80.7 and the mean GPS was 1082, indicating a neuromuscular cohort with significant gait deviations. Inter-rater and intrarater reliabilities were excellent, with ICC ranging from 0.94 to 0.99. The overall MAD between VVGA analysis and 3DGA was 4.90 degrees, indicating a clinically acceptable overall error. Segment-specific errors were 4.63 degrees for pelvis rotation, 5.35 degrees for hip rotation, and 4.70 degrees for foot progression.</p><p><strong>Conclusions: </strong>VVGA is an accurate and reliable method for assessing the transverse plane position of the pelvis, hip, and foot when utilizing a standardized method of collection and data analysis. Further study is required to assess whether this technique can be used for surgical decision-making or outcome assessment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"294-299"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414460","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":"Pelvic Fractures and Associated Urogenital Injuries in Children: A Systematic Review.","authors":"Sazid Hasan, Jordan Kamen, Bassel Salka, Ameen Suhrawardy, Abdulmalik Saleem, Shivam Patel, Jaimo Ahn, Alexandria Chrumka, Amr Abdelgawad, Betina Hinckel, Ehab S Saleh","doi":"10.1097/BPO.0000000000002946","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002946","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Traumatic pelvic injuries are potentially life-threatening and disabling injuries that often result from high-energy impact. It is well established in the orthopaedic literature that adult pelvic fractures can result in urologic injury, especially posterior urethral injury. Pelvic trauma and associated injuries in children are less characterized than in adults and extrapolated from an older population although there are significant anatomic differences between the skeletally mature and immature pelvis. In this context, long-term urogenital sequelae of pelvic fractures, specifically in children, are not clearly and comprehensively represented in the literature. Therefore, we conducted this systematic review with 3 main objectives: (1) to identify characteristics of pediatric pelvic fractures and urogenital injuries, (2) to understand the relationship between pelvic fractures and associated urogenital injuries with their outcomes, and (3) to elucidate treatment modalities for orthopaedic pelvic injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive literature search of PubMed, Medline, SCOPUS, and Cochrane databases was conducted following the PRISMA guidelines with predefined criteria on September 1st, 2024, yielding 595 papers. The papers were screened using Rayyan QCRI and studies included for data analysis were confirmed by at least 2 reviewers. The final full manuscript review was conducted for 29 studies, encompassing a total of 838 pediatric patients with documented pelvic ring fractures and concurrent urogenital injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the papers reporting on the mechanism of injury, the most common mechanism was motor vehicle collision (325/562 patients, 58%), followed by motor vehicle versus pedestrian collision (215/562, 38%), and fall (22/562, 4%). Among 161 cases where the pelvic fracture was classified, 86 (53%) had rotational or segmental instability of the pelvis, correlating to Torode and Zieg type IV and Tile-type B and C classifications. Forty-eight (30%) patients had multisite pelvic fractures. The most commonly reported urogenital injuries included urethral injury (725/807, 90%), bladder/bladder neck injury (53/807, 6.6%), and vaginal/vulvar laceration (29/807, 3.6%). Among cases where the entire urologic management of the patient was described, nonoperative management was utilized in patients rarely, (38/683, 5.5%), early urethral realignment and repair was utilized (337/683, 49%) and was the most common form of post-traumatic intervention, followed by delayed urethroplasty [284/683 (42%)].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Many cases of pediatric pelvic fractures, ranging from 2.4% to 7.5%, present with concomitant urogenital injuries, particularly posterior urethral and bladder injuries. These urogenital injuries were more frequently reported in high-energy pelvic injuries characterized by rotational instability, multisite pelvic fractures, and pelvic ring disruptions.","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795420","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":"Peripheral Nerve Injury Following Tibial Osteotomy in Children. Is There a Role for Routine Prophylactic Common Peroneal Nerve Decompression?","authors":"Nisarg Mehta, Stewart Morrison, Chris Harris, Lucas Annabell, Leo Donnan","doi":"10.1097/BPO.0000000000002969","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002969","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the long-term clinical outcomes and risk factors for nerve injury in children undergoing tibial osteotomy for lengthening and/or deformity correction at a tertiary pediatric center, focusing on common peroneal and tibial nerve injuries.</p><p><strong>Methods: </strong>This retrospective study included all children under 18 years of age who underwent tibial osteotomy over a 7-year period, excluding those with neuromuscular conditions. The primary outcome was peripheral nerve injury, while secondary outcomes included early unplanned return to theatre and deformity parameters.</p><p><strong>Results: </strong>A total of 173 tibial osteotomies were performed on 135 children, 80 of which were for tibial lengthening. Peripheral nerve injuries occurred in 11 cases (6.3%), with 81% showing complete (45%) or partial recovery (36%). Among patients undergoing tibial lengthening, the prevalence of nerve injury was 3.5%. Significant risk factors for nerve injury included multiple osteotomies (P=0.02, RR: 1.30) and acute correction of valgus deformities (P=0.01, RR: 1.35).</p><p><strong>Conclusion: </strong>The overall prevalence of nerve injury was 6.3% for all osteotomies and 3.5% in those undergoing tibial lengthening, with an 81% recovery rate. The rate of early unplanned return to the theatre was low at 3.4%. Prophylactic decompression of the common peroneal nerve should be considered for double-level osteotomies and acute correction of valgus deformity but is not routinely required during standard tibial lengthening. The potential risk of nerve injury should be discussed with the families as part of shared decision-making.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795662","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":"Displaced Distal Tibia Physeal Fractures: Short Leg Versus Long Leg Casting-A Prospective Study.","authors":"Rajvarun S Grewal, Brock T Kitchen, James D Bomar, Emily O Cidambi, Macy J Dexter, Eric W Edmonds, Maya E Pring, Vidyadhar V Upasani, C Douglas Wallace, Andrew Pennock","doi":"10.1097/BPO.0000000000002961","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002961","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment of distal tibia physeal fractures in pediatric patients remains controversial. Traditionally, after a closed reduction is performed, a long leg cast (LLC) is used to provide rotational control and prevent loss of reduction. Recent retrospective data suggest that short leg casts (SLC) may be equally effective. This study compares outcomes of SLC versus LLC in treating these fractures in pediatric patients.</p><p><strong>Methods: </strong>This prospective study enrolled patients from a pediatric level I trauma center with displaced distal tibia physeal fractures requiring reduction. Ten surgeons declared their predetermined preference for either SLC (n=5) or LLC (n=5), and patients were treated based on the on-call surgeon's preference. Inclusion criteria included patients with open growth plates and distal tibia physeal fractures. Exclusion criteria included systemic bone disease, pathologic fractures, and open fractures. Patients underwent closed reduction and were immobilized in either SLC or LLC. Follow-up assessments included clinical evaluations, radiographs, and patient-reported outcomes.</p><p><strong>Results: </strong>Forty patients participated, with a mean age of 12.5 years (mean follow-up of 9.4 mo). 17/40 were female. Twenty-four patients were treated with SLC and 16 with LLC. None of the fractures lost reduction. At 1 week, there were no significant differences in pain scores or satisfaction (P>0.19). At cast removal, the LLC group reported significantly higher pain scores compared with the SLC group (P=0.033), though satisfaction scores remained similar (P=0.786). At the final follow-up, all outcomes of interest were comparable between the 2 groups (P>0.09). Thirty-eight percent (15/40) of our cohort developed a premature physeal closure (PPC), 3 of which (20%) required subsequent surgery. There was no significant difference in the proportion of PPC among the SLC and LLC groups (P=0.495).</p><p><strong>Conclusion: </strong>SLCs are effective in treating displaced distal tibia physeal fractures, with no increased risk of loss of reduction or premature physeal closure (PPC) compared with LLCs. Regardless of cast type, the risk of PPC is significant enough to require close follow-up.</p><p><strong>Level of evidence: </strong>Level II-prospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795243","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}