Journal of Pediatric Orthopaedics最新文献

{"title":"Trampoline Fractures in Children.","authors":"Roope Parviainen, Topi Laaksonen, Petra Grahn, Juha-Jaakko Sinikumpu, Ilkka Helenius, Matti Ahonen","doi":"10.1097/BPO.0000000000003410","DOIUrl":"10.1097/BPO.0000000000003410","url":null,"abstract":"<p><strong>Background: </strong>Trampoline use has become increasingly common among children and adolescents, paralleled by a rise in trampoline-related injuries. Nevertheless, current age-based recommendations for trampoline use are supported by limited evidence. This study aimed to determine whether the frequency and severity of trampoline-related fractures differ among specific pediatric age groups.</p><p><strong>Methods: </strong>We identified all pediatric trampoline-related fractures treated in the Helsinki area, Finland, between 2014 and 2022. Cases were extracted from the institutional fracture registry, the KIDS Fracture Tool, which contained 18,279 fractures as of December 2022. The distribution, fracture severity, and frequency of surgical treatment were compared with the other sports-related fractures recorded in the registry. Trampoline-related fractures were analyzed across 3 age groups: 0 to 5 years, 6 to 10 years, and 11 to 15 years.</p><p><strong>Results: </strong>A total of 1153 trampoline-related fractures were identified (592 in girls and 561 in boys), representing 6.3% of all pediatric fractures. The annual incidence of trampoline-related fractures was 9.3 per 10,000 children. In the youngest age group, the lower leg was the most commonly fractured site, whereas forearm fractures predominated in the older groups. Well-aligned fracture was the most frequent fracture pattern in younger children, while more severe fracture types increased in prevalence with age. The proportion of open fractures was higher in the trampoline cohort than in the overall sport-related fracture cohort (relative risk, 2.02; 95% CI: 1.22-3.34).</p><p><strong>Conclusions: </strong>Trampoline-related fractures show age-dependent variation, with younger children sustaining predominantly low-energy injuries and older children experiencing more severe fracture patterns. Trampoline injuries were associated with a higher risk of displaced fractures requiring internal fixation and open fractures. Due to the lack of exposure data, definitive conclusions cannot be made regarding age-specific injury risk or age-based restrictions.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"619-624"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456146","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":"A 14% Rate of Surgery in Modern Rigo Chêneau Bracing for Adolescent Idiopathic Scoliosis: In-Brace Correction and Brace Wear Contribute to Treatment Success.","authors":"Michael W Brown, Alexander M Park, Mehdi M Elfilali, David C Gorman, Ying Yu, Benjamin D Roye, Michael G Vitale","doi":"10.1097/BPO.0000000000003443","DOIUrl":"10.1097/BPO.0000000000003443","url":null,"abstract":"<p><strong>Purpose: </strong>Rigo Chêneau-style orthoses (RCSOs) have gained popularity for treating adolescent idiopathic scoliosis (AIS) due to their emphasis on 3-dimensional correction. However, previous studies lack objective measures of brace wear compliance and have not described in-brace correction (IBC) thresholds associated with treatment success. This study evaluated the relationship between IBC, brace wear, and treatment outcomes in AIS patients treated with RCSOs.</p><p><strong>Methods: </strong>A retrospective review at a single academic institution included skeletally immature patients aged 10 to 18 years with AIS and a major curve of 20 to 40 degrees, who underwent full-time RCSO treatment with thermal wear-time sensors. Patients were followed until skeletal maturity or progression to surgery. Treatment success was defined as a change of ≤5 degrees in the major curve at the latest follow-up. Multivariable logistic regression identified predictors of treatment success.</p><p><strong>Results: </strong>Fifty patients (45 females, 90%) were included, with 36 (72%) classified as Sanders stage 3 and a mean age at brace initiation of 12.4±1.2 years (range: 10.1 to 15.5). The mean baseline major curve was 31±5 degrees with an IBC of 55±20%. The mean brace wear was 11.7±3.6 hours per day. At a mean follow-up of 3.0±0.9 years (range: 1.1 to 5.3), 43 patients (86%) avoided surgery and 36 (72%) met criteria for treatment success, with a mean major curve of 32±12 degrees. Greater IBC (60% vs. 40%, P <0.001) and brace wear (12.4 vs. 10.0 h, P =0.034) were associated with treatment success in univariate analysis, with IBC remaining an independent predictor in multivariable analysis ( P =0.013). An IBC ≥45% was associated with treatment success (AUC=0.79). Patients achieving ≥45% IBC (n=33) demonstrated significantly higher success rates (88% vs. 41%, P <0.001) and lower rates of progression to surgery (6% vs. 29%, P =0.037).</p><p><strong>Conclusions: </strong>In this study, which included objective compliance data, 3-dimensional RCSO bracing in AIS was associated with high rates of treatment success. Greater IBC and brace wear were associated with improved outcomes, with IBC emerging as the primary independent predictor of success. An IBC of 45% was associated with improved outcomes and may represent a clinically meaningful target in modern 3-dimensional bracing.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e950-e955"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724907","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":"Association Between Idiopathic Clubfoot and Developmental Dysplasia of the Hip: Do We Need Universal Screening for It?","authors":"Raphael Krespi, Roy Gigi, Yoram Hemo, Baruch Danino, Dror Ovadia","doi":"10.1097/BPO.0000000000003444","DOIUrl":"10.1097/BPO.0000000000003444","url":null,"abstract":"<p><strong>Background: </strong>The association between congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH) remains contested. Some guidelines consider idiopathic clubfoot a DDH risk factor warranting routine hip ultrasonography, while others do not. This study aimed to determine the prevalence of DDH in a large cohort of infants with idiopathic CTEV and assess whether routine screening is justified.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data was conducted at a single tertiary pediatric orthopaedic center. Children treated for idiopathic CTEV between July 2000 and November 2023 with a minimum 2-year follow-up were included. Teratologic and syndromic cases were excluded. All patients underwent routine hip ultrasonography at 6 weeks of age, classified by the Graf method. Hips graded Graf type 2B or higher received treatment.</p><p><strong>Results: </strong>A total of 515 patients (766 feet; 72% male) were included. Mean age at initiation of Ponseti casting was 14 days (SD: 14.2); mean follow-up was 7.3 years (SD: 4.1). DDH was identified in 4 patients (0.78%): 1 male (0.27%) and 3 females (2.05%). All 4 were classified as Graf type 2B or 2C; no frank dislocations were observed. DDH was successfully managed concurrently with CTEV treatment in all cases, with no recurrence.</p><p><strong>Conclusions: </strong>In this largest single-center series to date, the prevalence of DDH in idiopathic CTEV was comparable to population norms, indicating that idiopathic clubfoot is not an independent risk factor for DDH. These findings do not support routine hip ultrasound screening based on a clubfoot diagnosis alone in selective screening systems, though no change is warranted in universal screening systems. This may not apply to syndromic clubfoot, which was not evaluated here.</p><p><strong>Levels of evidence: </strong>Level III-retrospective review of a prospective cohort.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1040-e1044"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760293","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":"Femoral Nerve Palsy as a Complication of Pavlik Harness Treatment for Developmental Dysplasia of the Hip: Ten-Year Prospective Study.","authors":"Tahir Khan, Christine Douglas, Zahra Khan, Penina Edel","doi":"10.1097/BPO.0000000000003433","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003433","url":null,"abstract":"<p><strong>Background: </strong>Femoral nerve palsy (FNP) is a recognized complication of Pavlik harness (PH) treatment for developmental dysplasia of the hip (DDH), but its true incidence and clinical significance may be underestimated. This prospective study aims to determine the incidence, risk factors, and clinical course of FNP in infants undergoing PH treatment, and to evaluate whether FNP predicts treatment failure.</p><p><strong>Methods: </strong>A 10-year prospective study (2015 to 2025) was conducted on all infants treated with a PH for Graf II to IV DDH at a specialist center. Patients were reviewed weekly with clinical and ultrasound assessment during the initial phase of treatment. Parents received structured education to facilitate early identification of FNP. Data collected included demographics, Graf type, age, weight, onset and duration of FNP, parental detection, management strategies, and final treatment outcome.</p><p><strong>Results: </strong>Of 339 consecutive infants treated with a PH, 20 (5.89%) developed clinically evident FNP. Onset ranged from day 1 to 6 weeks, and 35% (n=7) were first identified by parents. All cases demonstrated full neurological recovery following harness adjustment or temporary cessation. PH treatment was successful in 65% of infants with FNP, compared with 93% in those without FNP. FNP occurred more frequently in older infants and in those with more severe DDH, with 16/20 cases involving at least 1 Graf III or IV hip. Traditional DDH risk factors showed no association. Treatment failure in the FNP cohort was confined to severe (Graf III/IV) dislocations.</p><p><strong>Conclusions: </strong>FNP is an important but reversible complication of PH treatment, with a prospective incidence of 5.89%. Older age at presentation, severe DDH (Graf III/IV), and possibly larger body habitus increase the risk of FNP. While FNP complicates management, it is not an independent predictor of PH failure; the primary determinant remains the severity of hip dysplasia. Early recognition, often by well-educated parents, and timely modification of PH settings allow most patients to continue successful nonoperative treatment. Individualized harness adjustment, rather than routine abandonment, is recommended to minimize nerve injury while preserving treatment success.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"46 10","pages":"650-653"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Intraoperative Duplex Ultrasonography in the Pink Pulseless Hand: A Useful Adjunct, But Not Yet a Decision-Making Standard\".","authors":"Tatsuhiko Muraoka, Takahiro Inui, Yoshinori Ueno, Sanshiro Inoue","doi":"10.1097/BPO.0000000000003402","DOIUrl":"10.1097/BPO.0000000000003402","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1101-e1102"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368891","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":"Outcomes From a Health-Related Social Needs Screening Initiative in Pediatric Orthopaedic Patients: A Prospective Study.","authors":"Devika A Shenoy, Evan Schrader, Kathryn Radulovacki, Andrew G LoPolito, Natalia Gonzalez, Anthony A Catanzano","doi":"10.1097/BPO.0000000000003382","DOIUrl":"10.1097/BPO.0000000000003382","url":null,"abstract":"<p><strong>Background: </strong>Health-related social needs (HRSN), which include unmet transportation, food, housing, financial, and utility needs, have been associated with poor outcomes in pediatric orthopaedic patients. This study aims to report outcomes from a prospective, quality improvement (QI) study that aimed to address this issue by screening for social risk factors and referring patients to resource management programs.</p><p><strong>Methods: </strong>This was a prospective QI study implemented at a tertiary care center's pediatric orthopaedic clinic. Patients (ie, their families/caregivers) were given an institutional social risk survey, which is derived from the Accountable Health Communities' HRSN Screening Tool. Data collected post-initiative over a 9-month period were compared with a 3-month period pre-initiative. We analyzed demographic characteristics, screening completion rates, the prevalence of specific social needs, and the rate of successful referral and enrollment in resource management services. Multivariable logistic regression was used to identify associations between patient factors and screening completion/referral status.</p><p><strong>Results: </strong>In total, 735 patients were evaluated (224 pre-initiative; 511 post-initiative). The initiative significantly increased screening rates from 38% pre-initiative to 65% post-initiative ( P <0.001). The highest rate increase was among fracture/dislocation patients (37% pre-initiative to 76% post-initiative, P =0.004). Among prospective respondents, 70 patients (21%) screened positive for at least one social need, with the highest rates of financial (13%) and food insecurity (11%). In regression analysis, female patients had higher odds of a completed screening (aOR: 1.53, P =0.03), and Medicaid insurance was associated with higher odds of social need (aOR: 3.56; 95% CI: 1.65-8.01; P =0.002). Post-initiative, 87% of patients with a social need received a referral, and 61% were successfully enrolled in services, a significant increase from the pre-initiative enrollment rate of 25% ( P =0.005).</p><p><strong>Conclusions: </strong>This study suggests that implementation of a systematic HRSN screening initiative in pediatric orthopaedics is feasible, and orthopaedic encounters may serve as a touch point to screen for unmet social needs and connect families with resource management programs.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1081-e1087"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308597","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":"Utility of the Modified Clavien-Dindo-Sink (mCDS) Grading System for Classifying Casting Complication Severity in Early Onset Scoliosis Patients.","authors":"Elinor Stern, Elizabeth Kappler, Makayla Hart, Jason B Anari, Sumeet Garg, Ying Li","doi":"10.1097/BPO.0000000000003438","DOIUrl":"10.1097/BPO.0000000000003438","url":null,"abstract":"<p><strong>Background: </strong>Serial casting can effectively treat early-onset scoliosis (EOS), thereby preventing or delaying the need for surgery. Reported complications range from pressure sores to cardiac arrest. The modified Clavien-Dindo-Sink (mCDS) system has high reliability for grading complications following EOS surgery, but has not previously been used to classify complications of casting. We aimed to assess the utility of the mCDS system for grading complications of EOS casting and hypothesized that, with modifications, it would be a valid system for assessing these complications.</p><p><strong>Methods: </strong>This was a multicenter retrospective study. Patients aged 10 years or younger who underwent ≥1 cast application for EOS treatment were included. Demographics, radiographic data, casting details, complications, and unplanned procedures were collected. Two authors (E.S. and M.H.) reviewed complications and assigned a mCDS grade to each.</p><p><strong>Results: </strong>One thousand twenty patients (5605 casts) were included. Two hundred forty-four casting-related complications in 159 patients were analyzed. 15.6% of patients (n=159) had a complication, and 47 patients (4.6%) had >1 complication. Fifteen complications were categorized as mCDS grade I (6.1%), 192 as grade II (78.7%), 5 as grade IIIa (2.0%), 28 as grade IIIb (11.5%), 4 as grade IVa (1.6%), and 0 as grade IVb or grade V (0%). The most common reason for a grade IIIb complication, which is an unplanned procedure, was early cast removal necessitating early cast re-application (25/28 patients).</p><p><strong>Conclusions: </strong>Most casting complications in our cohort were grades II and IIIb. The mCDS system, in its current state, may not accurately describe the complications of casting. Although a grade IIIb complication after casting results in an additional procedure requiring anesthesia, an unplanned return to the operating room after surgery is likely associated with greater morbidity than an unplanned cast re-application. Using the mCDS system to compare casting with surgery risks overstating the severity of casting complications and may inadequately represent outcomes. We propose modifying the mCDS system for casting.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e956-e960"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673932","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":"Pediatric Musculoskeletal Radiograph Interpretation Among Orthopaedic Surgery Postgraduate Trainees: A Competency-Based Education Intervention.","authors":"Carl A Starvaggi, Maryse Bouchard, Mark Camp, Sasha Carsen, Alexandra J Mortimer, Ryan Katchky, Ron El-Hawary, Lori A Archer, Neil Saran, Jennifer Stimec, Kai Ziebarth, Kristina Keitel, Kathy Boutis","doi":"10.1097/BPO.0000000000003446","DOIUrl":"10.1097/BPO.0000000000003446","url":null,"abstract":"<p><strong>Background: </strong>Pediatric musculoskeletal radiographs (pMSK) are the primary imaging modality for evaluating injured children, yet there is no widely adopted, standardized approach to teach and assess this specific skill among orthopaedic surgery postgraduate trainees (OS-PGT). We evaluated an online educational and assessment intervention using pMSK radiographs to improve fracture/dislocation detection and risk stratification among OS-PGT.</p><p><strong>Methods: </strong>We conducted a multicenter prospective cohort study using a web-based educational intervention, recruiting a convenience sample of OS-PGT. The intervention included 1609 pMSK radiograph cases organized into 6 body regions. OS-PGT judged whether a fracture/dislocation was present or absent, and when present, localized the abnormality and assigned a risk category. Participants received immediate feedback after every case, continuing until reaching a predefined 90% performance standard. Following the intervention period, participants were invited to complete a post-intervention survey.</p><p><strong>Results: </strong>A total of 64,489 unique case interpretations were generated by 115 OS-PGT. From initial to final 25 cases completed, diagnostic accuracy increased by 10.5% (95% CI: 9.4%, 11.6%), localization accuracy by 11.9% (95% CI: 10.7%, 13.0%), and risk stratification accuracy by 20.5% (95% CI: 18.9%, 22.1%), with the greatest gains observed for ankle/foot radiographs. Across 246 attempts to reach the performance standard, 192 (78.0%) were successful. The median number of cases required per body region was 141 (IQR: 96, 313), completed in a median of 34.9 minutes (IQR: 23.8, 77.6). Error rates were lower when participants were certain of their answers (7.8% incorrect \"definite\" interpretations vs. 23.7% \"probable\"). Forty-five (39.1%) participants completed the post-intervention survey, and 38 (84.6%) supported integrating the intervention into orthopaedic residency training.</p><p><strong>Conclusion: </strong>This study shows that a structured, web-based intervention combining performance-based assessment with case-based practice led to substantial and efficient learning gains in pMSK radiograph interpretation among OS-PGT and helped identify diagnostic challenges. These findings support the use of such educational interventions as a practical strategy to supplement orthopaedic residency training in targeted diagnostic skills.</p><p><strong>Levels of evidence: </strong>Level II-prospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e1088-e1098"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794848","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":"Functional Outcomes of Pediatrics and Adolescent Pelvic Fractures: A Systematic Review.","authors":"Vincent Buckman, Patrick Sun, Jeffrey Blibo, Nirav Pandya","doi":"10.1097/BPO.0000000000003439","DOIUrl":"10.1097/BPO.0000000000003439","url":null,"abstract":"<p><strong>Background: </strong>Pelvic fractures are rare injuries, representing 1% to 2% of fractures among pediatric and adolescent populations. Although uncommon, these injuries differ significantly from adult fractures due to skeletal immaturity and increased potential for bone remodeling. Currently, there is limited understanding of the long-term outcomes of pediatric pelvic fractures. This study aims to review the functional outcomes of pediatric and adolescent pelvic fractures.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic review was performed using PubMed, Embase, Scopus, and Google Scholar databases. Three independent authors screened all eligible studies, extracted the data, and assessed risk of bias. The types of studies included in the analysis were retrospective and prospective human cohort studies, as well as case series. The primary outcome of interest was functional outcomes by fracture stability and management. Secondary outcomes included radiologic and structural complications. Weighted pooled analyses were conducted where feasible.</p><p><strong>Results: </strong>Fourteen studies (n=731) were included in the review. Across reporting studies, more than 90% of patients regained independent ambulation and returned to activities of daily living regardless of management strategy and fracture stability. Pelvic asymmetry was the most frequently reported structural complication, occurring in 22 of 253 patients (8.7%). Other structural complications included limb length discrepancy (23/333; 6.9%), acetabular dysplasia (3/178; 1.7%), and nonunion (6/549; 1.1%).</p><p><strong>Conclusion: </strong>Pediatric and adolescent pelvic fractures demonstrate favorable functional outcomes when management strategies are appropriately aligned with fracture stability. However, operative fixation could be considered in selective patients with stable fractures who are hemodynamically stable and at low surgical risk to modify the risks of rare complications such as pelvic asymmetry, limb length discrepancy, and nonunion.</p><p><strong>Level of evidence: </strong>Level III-systematic review of level I to IV studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e939-e949"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794904","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":"Pediatric Flexion-Type Supracondylar Humerus Fractures: Predictive Factors for Open Reduction and Impact on the Outcome in a Single Center 10-Year Case Series.","authors":"Alberto Galeotti, Lorenzo Marcucci, Giuseppe Cucca, Salvatore Di Giacinto, Alessandro Zanardi, Maurizio De Pellegrin, Simone Lazzeri, Giovanni Beltrami","doi":"10.1097/BPO.0000000000003296","DOIUrl":"10.1097/BPO.0000000000003296","url":null,"abstract":"<p><strong>Background: </strong>Flexion-type supracondylar humerus fractures are rare, highly unstable, and often associated with technical challenges. Current literature is limited to small series, and no standardized diagnostic-therapeutic guidelines have been established.</p><p><strong>Methods: </strong>This retrospective study includes 47 patients with Gartland type II or III flexion-type supracondylar fractures surgically treated between September 2012 and October 2023. Demographic, clinical, radiographic, and functional data were collected to evaluate outcomes after closed or open reduction with percutaneous pinning. Univariate and multivariate model testing were used to analyze associations between fracture severity, surgical timing, rotational or translational deformities, and the need for open reduction and functional outcomes.</p><p><strong>Results: </strong>No major complications occurred. In the multivariate analysis, translational deformity emerged as the sole independent predictor of open reduction ( P =0.017). While the Gartland classification and rotational deformities correlated with the need for open surgery in univariate analysis, they were not significant in the final model. Surgical delay beyond 48 hours was not associated with open reduction ( P =0.751) or inferior functional outcomes ( P =0.327). Regarding functional results, although translational or rotational components were associated with higher QuickDASH scores in the univariate analysis ( P =0.036), this significance was not confirmed in the multivariate model. The requirement for open reduction itself was not associated with worse functional outcomes ( P =0.173).</p><p><strong>Conclusion: </strong>Translational deformity is the most significant predictor of the need for open reduction. However, complex fracture patterns do not independently result in inferior functional outcomes when appropriately managed. Our results suggest that open reduction is a safe option that does not negatively impact long-term function. It should be considered a valid alternative for unstable flexion-type fractures whenever closed reduction fails to restore anatomy.</p><p><strong>Levels of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"611-618"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674425","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}