Journal of Pediatric Orthopaedics最新文献

{"title":"Longitudinal Improvement of Quality of Life in Children With Legg-Calve-Perthes Disease Treated With Proximal Femoral Varus Osteotomy.","authors":"Angel A Valencia, Dang-Huy Do, Chan-Hee Jo, Harry K W Kim","doi":"10.1097/BPO.0000000000002896","DOIUrl":"10.1097/BPO.0000000000002896","url":null,"abstract":"<p><strong>Background: </strong>Proximal femoral varus osteotomy (PFVO) is commonly performed to improve femoral head containment and decrease deformity in Legg-Calve-Perthes disease (LCPD). Little is known about how PFVO impacts the quality of life after surgery. The purpose of this study was to determine the longitudinal changes to patient-reported physical, mental, and social health measures after PFVO.</p><p><strong>Methods: </strong>This is a retrospective review of prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) data from 20 patients with unilateral LCPD treated with a PFVO. We collected seven PROMIS measures (mobility, anxiety, fatigue, depressive symptoms, pain interference, anger, and peer relationships) before and approximately 1, 3, 8, 12, and 18 months after surgery. We compared PROMIS scores across different time points using repeated measures ANOVA and multiple pairwise comparisons with Tukey adjustment. The relationship between presurgery and postsurgery mental health scores was analyzed using a Spearman correlation.</p><p><strong>Results: </strong>The mean age at PFVO was 8.2 ± 1.6 years. The mean length of follow-up was 17.0 ± 2.1 months. There was a significant improvement in the mobility score between preoperation and 12 months ( P =0.0031) and 18 months postoperation ( P <0.0001). Anxiety scores significantly improved from preoperation and 18 months postoperation ( P =0.0014). A significant reduction in the pain interference score between preoperation and 12 and 18 months postoperation ( P <0.0001) was observed. Peer relationships significantly improved from one month postoperatively to 18 months postoperation ( P =0.0355). Individual variations were also observed with some patients having elevated depressive symptoms and anxiety scores. Moderate correlations between preoperative and postoperative anxiety and depressive symptoms scores were observed.</p><p><strong>Conclusions: </strong>PROMIS mobility, anxiety, pain interference, and peer relationship scores improved significantly after PFVO. While the mean anxiety, depressive symptoms, peer relationships, and anger scores were in normal ranges at each visit, individual variations with elevated anxiety and depressive symptom scores were observed. This new longitudinal PROMIS data will better inform patients and families about the quality of life and recovery experience after PFVO.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"200-207"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983796","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 of Growth-Friendly Surgical Treatment of Early Onset Scoliosis in Children With Prune Belly Syndrome: A Preliminary Report.","authors":"Leta Ashebo, Paul Sponseller, Daniel Hedequist, Norman Ramirez, Matthew Oetgen, Ying Li","doi":"10.1097/BPO.0000000000002885","DOIUrl":"10.1097/BPO.0000000000002885","url":null,"abstract":"<p><strong>Background: </strong>Prune belly syndrome (PBS) is a rare condition characterized by absence of abdominal musculature, cryptorchidism, and obstructive uropathy. The most common orthopaedic problem is scoliosis, yet no reports on growth-friendly surgical treatment of early-onset scoliosis (EOS) exist. Our purpose was to evaluate outcomes of distraction-based implants in children with PBS.</p><p><strong>Methods: </strong>This was a multicenter retrospective review. Children with PBS treated with TGR, MCGR, or VEPTR with a minimum 2-year follow-up were identified. Demographics, radiographic/surgical data, complications, and unplanned returns to the operating room (UPROR) were collected. Quality of life was measured using EOSQ-24.</p><p><strong>Results: </strong>Seven patients (100% male) were identified. The mean age at index surgery was 5.6 years. The mean length of follow-up was 4 years (range: 2 to 11 y). Implant types included MCGR (4 patients), TGR (2 patients), and VEPTR (1 patient). Two patients had pelvic fixation. The mean major curve magnitude was 87 degrees preindex, 47 degrees postindex, and 53 degrees at the last follow-up. Mean kyphosis was 55 degrees preindex, 25 degrees postindex, and 42 degrees at the most recent follow-up. Mean T1-T12 and T1-S1 lengths increased 4.4 and 4.8 cm, respectively, between preindex and last follow-up.Complications occurred in 3 patients. One patient had 3 TGR breakages resulting in 3 UPRORs to revise the rods and 1 superficial wound infection treated with antibiotics. Another patient was readmitted for respiratory failure after TGR lengthening and a third patient had a superficial infection manifested by incisional swelling after MCGR insertion that resolved with antibiotics. Two patients have undergone definitive fusion and 1 patient has retained his TGR definitively. The other patients are still undergoing rod lengthening.</p><p><strong>Conclusions: </strong>Children with PBS can develop severe scoliosis at a young age. Distraction-based implants can successfully control scoliosis while allowing spinal growth. The complication rate is comparable to patients with idiopathic EOS treated with growth-friendly implants.</p><p><strong>Level of evidence: </strong>Therapeutic level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"212-219"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895577","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":"Morphologic Development of the Posterior Sloping Angle of the Proximal Femoral Epiphysis in Children: What Is the Peak Risk Age for Slipping?","authors":"Jingyu Wu, Federico Canavese, Lianyong Li","doi":"10.1097/BPO.0000000000002875","DOIUrl":"10.1097/BPO.0000000000002875","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to describe the developmental patterns of the posterior sloping angle (PSA) of the proximal femoral epiphyseal growth plate (PFEP) in a cohort of healthy Chinese children aged 5 to 14 years.</p><p><strong>Methods: </strong>Pelvic frog-leg lateral radiographs of 400 healthy children (n=800 hips) were retrospectively analyzed. The cohort included 215 males and 185 females with a mean age of 9.5 years (5 to 14). PSA measurements of the PFEP were obtained bilaterally from frog leg lateral radiographs. Subjects were equally divided into 10 subgroups of 40 patients each (80 hips per group) based on age, starting at 5 years of age; in addition, sex and lateral differences, as well as age-related developmental patterns were analyzed.</p><p><strong>Results: </strong>The PSA was -2.6±3.1 degrees at 5 years of age, indicating mild anterior inclination of the femoral epiphysis. It increased to 6.2±4.6 degrees at 11 years of age, decreased to 3.9±4.3 degrees at 12 years of age, and then stabilized until 14 years of age. Before 11 years of age, there was no significant sex difference in PSA values, whereas, after 11 years of age, males had a PSA of 5.8±4.3 degrees compared with 3.7±5.0 degrees in females ( P <0.001), with the former showing an average increase of ~2 to 3 degrees more. In addition, the left PSA was ~2 degrees greater than the right PSA in both men and women ( P <0.001).</p><p><strong>Conclusions: </strong>Before puberty, PSA gradually increased with age, peaking at 11 years of age, followed by a slight decline and then stabilization. After the age of 11 years, males had higher PSA levels than females, with the PSA of the left side being significantly higher than that of the right side. Understanding these developmental patterns may aid in the assessment and monitoring of adolescent PFEP disorders.</p><p><strong>Level of evidence: </strong>Level III-diagnostic studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e310-e317"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769925","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":"Does Pelvic Tilt Change After Periacetabular Osteotomy for Hip Dysplasia?","authors":"Andrew J Curley, Connor L Luck, Wasim Shihab, Ethan R Ruh, Ashley E Disantis, Michael P McClincy","doi":"10.1097/BPO.0000000000002870","DOIUrl":"10.1097/BPO.0000000000002870","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to (1) evaluate preoperative pelvic tilt utilizing the sacro-femoral-pubic (SFP) angle on standing pelvic x-rays, and (2) determine if the SFP angle changes after a unilateral or bilateral PAO.</p><p><strong>Methods: </strong>A retrospective review was conducted of PAOs performed by a single hip preservation surgeon from November 2018 to November 2023. Standing x-rays were reviewed at 4 time points: preoperative, subacute postoperative, 6-month follow-up, and 12-month follow-up. Data collected included demographics, lateral center-edge angle (LCEA), Tönnis angle, and sacro-femoral-pubic (SFP) angle (a surrogate metric for pelvic tilt). Linear mixed models and Wilcoxon signed-rank tests were used to evaluate preoperative to postoperative differences in pelvic tilt for the unilateral and bilateral PAO groups, respectively.</p><p><strong>Results: </strong>Seventy-four patients met inclusion criteria, consisting of 53 unilateral and 21 bilateral PAO patients (18.5±4.1 vs. 21.3±5.1 y, 90.6% vs. 95.2% female, LCEA 17.5 deg±6.5 deg vs. 18.0 deg±5.5 deg and 18.0 deg±6.3 deg, respectively). The Average preoperative pelvic tilt, calculated from the SFP angle, for the unilateral and bilateral PAO patients were 9.1 degrees±5.5 degrees and 8.1 degrees±5.6 degrees, respectively. These values increased postoperatively at average 7-week (-0.3 deg±3.4 deg and 1.3 deg±3.7 deg), 6-month (1.1 deg±3.8 deg and 2.7 deg±3.4 deg), and 12-month (1.0 deg±4.1 deg and 2.7 deg±3.0 deg) follow-up. Significant differences in pelvic tilt were observed from preoperative x-rays to 6 months ( P =0.002) and 12 months ( P =0.001) for the bilateral PAO patients, whereas the unilateral group demonstrated similar pelvic tilt at all time points ( P =0.09).</p><p><strong>Conclusion: </strong>Patients undergoing bilateral PAO demonstrated an average increase in pelvic tilt of 2.7 degrees as measured by SFP angle at 6 months and 12 months postoperatively, suggesting a compensatory adaptation after surgery that may have implications in rehabilitation regimens and planned surgical corrections.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e318-e323"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785613","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":"Prevalence and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.","authors":"Jay Moran, Michael S Lee, Scott Fong, Christopher LaPrade, Kyle N Kunze, Peter D Fabricant, Jorge Chahla, Andrew E Jimenez, Robert F LaPrade","doi":"10.1097/BPO.0000000000002900","DOIUrl":"10.1097/BPO.0000000000002900","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients undergoing ACLR. The purpose of this study was to perform a systematic review and meta-analysis to determine the pooled prevalence of and risk factors for MMRLs in pediatric patients with ACL injuries.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried in December 2023 for studies reporting on MMRLs in pediatric patients (≤21 y old) undergoing ACLR. Articles were only included if they reported on the prevalence and/or risk factors for arthroscopically diagnosed MMRLs. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MMRLs by generating effect estimates in the form of odds ratios (OR) with 95% CI.</p><p><strong>Results: </strong>Seven studies were identified, which included 1362 pediatric patients (mean±SD age, 15.3±1.4 y old) that underwent ACLR. The pooled MMRL prevalence was 16.4% (range, 13.2% to 28%) calculated across 6 studies. Of the 7 studies identified, 5 qualified for the risk factor analysis, which included a total of 536 ACLR patients. Twenty risk factors were identified, of which 8 were amenable to being explored quantitatively. Anterolateral ligament (ALL) injuries on magnetic resonance imaging (MRI) [odds ratio (OR), 4.16; 95% CI, 1.40-12.34; P =0.01], MMRLs on preoperative MRI (OR, 4.09; 95% CI, 2.52-6.64; P <0.00010), posteromedial tibial plateau bone marrow edema (OR, 2.11; 95% CI, 1.16-3.83; P =0.01), and concomitant lateral meniscus tears (OR, 1.70; 95% CI, 1.04-2.76; P =0.03) were important risk factors for pediatric MMRLs. Skeletal maturity (physes open or closed), male sex, or collateral ligament injury was not associated with the presence of pediatric MMRLs.</p><p><strong>Conclusion: </strong>The overall pooled prevalence of MMRLs was 16.4% in pediatric patients undergoing ACLR. Significant risk factors for pediatric MMRLs included the presence of concomitant ALL injuries on MRI, identification of MMRLs on MRI, posteromedial tibia plateau bone marrow edema, and concomitant lateral meniscus tears at the time of surgery. Skeletal maturity, male sex, or collateral ligament injury were not associated with MMRLs in pediatric ACL tears.</p><p><strong>Level of evidence: </strong>Systematic review and meta-analysis; level of evidence: IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"183-193"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007210","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":"Comparison of Perioperative Complication Rates in Congenital Scoliosis Patients With and Without Tethered Spinal Cord.","authors":"Andrea M Muñoz, Leila M Alvandi, Edina Gjonbalaj, Allyn Morris, Paul Sponseller, Richard C E Anderson, Jaime A Gomez","doi":"10.1097/BPO.0000000000002883","DOIUrl":"10.1097/BPO.0000000000002883","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Congenital early onset scoliosis (C-EOS) often co-occurs with tethered spinal cord syndrome (TSCS), necessitating surgical intervention to address both conditions to prevent worsening neuromuscular function. Detethering can be done concurrently with spinal deformity correction (SDC), before SDC, or not done at all. This study explores perioperative complications in C-EOS patients with and without TSCS who underwent SDC with growing instrumentation or fusion. We hypothesize that C-EOS patients with a history of TSCS who underwent SDC with either growing instrumentation or fusion experienced higher rates of perioperative complications compared with those without TSCS. Among patients with a history of TSCS, we hypothesize that those who were detethered had fewer perioperative complications than those who were not detethered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 751 C-EOS patients from an international spine registry were reviewed. After applying inclusion and exclusion criteria, 477 patients were divided into groups: those with TSCS (n=90) and those without (n=387). Among TSCS patients, the majority underwent detethering (n=54), whereas 36 did not. Demographics, magnetic resonance imaging (MRI) findings, treatment history, and surgical complications were assessed. Statistical analyses were conducted to compare demographic and clinical parameters, including complication rates, using appropriate tests. Postoperative complications were further categorized according to the modified Clavien-Dindo-Sink (mCDS) classification system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Comparing C-EOS patients with and without TSCS revealed no significant differences in age at first MRI ( P =0.52), pre-index major coronal curve ( P =0.43), pre-index maximum sagittal kyphosis ( P =0.113), the number of growth-friendly procedures ( P =1.00), resection ( P =0.071), osteotomy ( P =0.081), intraoperative complications ( P =0.088), postoperative complications ( P =0.41), hardware failure ( P =0.78), infections ( P =0.26), and neurological complications ( P =0.42). Postoperative complications further categorized using the mCDS demonstrated no significant differences between the groups ( P =0.144). No significant differences were found in age at first MRI ( P =0.60), pre-index major coronal curve ( P =0.90), pre-index maximum sagittal kyphosis ( P =0.50), resection ( P =0.20), or osteotomy ( P =0.47) between the detethered and not detethered cohorts. However, a higher percentage of TSCS patients without detethering underwent a growth-friendly procedure ( P =0.003). In addition, TSCS patients without detethering experienced higher rates of postoperative complications ( P =0.009), hardware failure ( P =0.005), and infections ( P =0.031) compared with those who underwent detethering. No differences were noted for intraoperative ( P =0.059) or neurological ( P =0.190) complications based on detethering status. Similarly, postoperative complications usin","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e352-e357"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882319","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":"Epidemiology of Pediatric Fractures and Effect of Socioeconomic Status on Fracture Incidence in Türkiye: A Nationwide Analysis of 2 Million Fractures.","authors":"Saygin Kamaci, Engin Turkay Yilmaz, Barlas Goker, Ebru Dumlupinar, Naim Ata, Mehmet Mahir Ulgu, Suayip Birinci, Izzet Bingol, Muharrem Yazici, Onder Kalenderer","doi":"10.1097/BPO.0000000000002881","DOIUrl":"10.1097/BPO.0000000000002881","url":null,"abstract":"<p><strong>Background: </strong>Childhood fractures are an important public health issue worldwide as they potentially lead to long-term complications. This is the first study reporting a nationwide data pool of 2 million children. We aimed to investigate the epidemiology of pediatric fractures by sex, age, geographical region, and socioeconomic status (SES).</p><p><strong>Methods: </strong>Medical records of children diagnosed with fractures between 2016 and 2022 were collected from Türkiye's e-health database. Fractures were divided into 16 anatomic locations. Age was evaluated in four categories: <5, 5-9, 9-14, and 15-19 years. Regional rankings were stratified based on SES.</p><p><strong>Results: </strong>A total of 1,989,212 pediatric fractures were analyzed (1,371,398 boys, 617,814 girls). The overall fracture incidence was 1117/100,000 person-years, being higher for boys (n=1501) compared with girls (n=713) ( P <0.001). The mean fracture incidence between 0 and 19 years of age was 21.2% (boys: 28.5%; girls: 13.5%). The overall fracture incidence increased with age, peaking at 10 to 14 years for all children and decreasing thereafter. The 4 most common fracture locations were in the upper extremities. Wrist fractures accounted for 28.9% (575,192) of all pediatric fractures. Provinces with higher SES had significantly increased fracture risks.</p><p><strong>Conclusions: </strong>This study provides the most accurate epidemiological analysis of childhood fractures in the Turkish population with landmark nationwide analysis for the pediatric literature. One fifth of children experienced fractures before maturity. The results highlight the influence of SES on fracture rates, as children in more urbanized and developed areas had an elevated risk of fractures.</p><p><strong>Level of evidence: </strong>Level III-diagnostic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e331-e337"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785716","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":"Prevalence and Risk Factors for Leg Length Discrepancy in Children With Idiopathic Clubfoot Treated With Ponseti Method.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Rohit Siddabattula, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002895","DOIUrl":"10.1097/BPO.0000000000002895","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is at times associated with other lower extremity abnormalities, such as leg length discrepancy (LLD). Initial studies in patients treated with extensive soft tissue release (STR) have estimated that LLD is prevalent in 9% to 11% of children with idiopathic clubfoot. However, Ponseti-style serial casting has since replaced STR as the preferred clubfoot treatment method. This study aimed to assess the prevalence of LLD, risk factors for LLD, and the required treatment in children with clubfoot deformity after Ponseti casting.</p><p><strong>Methods: </strong>A retrospective review of medical records from children ages 0 to 18 treated for clubfoot at a single institution from 2002 to 2023 was conducted. Included patients were initially treated with Ponseti casting and had minimum follow-up until age 3. Patients with nonidiopathic clubfoot or who had LLD noted on physical examination but did not have available radiographs were excluded. LLD was defined as a minimum discrepancy of 0.5 cm on bilateral lower extremity radiographs.</p><p><strong>Results: </strong>Two hundred seventy-eight patients (434 feet) met criteria; 73% (203) were male. Forty of the 49 patients with available radiographs had LLD. The prevalence of LLD was 14.4%, with an average discrepancy of 1.1±0.8 cm. The prevalence was significantly higher in patients with unilateral than bilateral cases, 27% (33) versus 4.5% (7), P =<0.001. LLD was present in 21.5% (32) of patients with recurrence and 6.2% (8) of patients without recurrence, P =<0.001. Twenty percent (8) of patients with LLD had an epiphysiodesis at an average age of 11.5±1.4 years.</p><p><strong>Conclusion: </strong>This study reported a prevalence of LLD in 14.4% of children with idiopathic clubfoot treated with Ponseti casting. LLD prevalence was higher in children with unilateral and recurrent clubfoot. Up to 20% of children with LLD may require an epiphysiodesis. We recommend that care providers regularly screen children with clubfoot for LLD, particularly those with unilateral and recurrent deformities, and consider obtaining bilateral lower extremity radiographs in patients with clinical LLD.</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":"234-238"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007206","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":"Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block (ESPB) in Pediatric Hip Surgery: A Randomized, Double-Blinded, Controlled Trial.","authors":"Malgorzata Reysner, Tomasz Reysner, Piotr Janusz, Grzegorz Kowalski, Milud Shadi, Przemysław Daroszewski, Katarzyna Wieczorowska-Tobis, Tomasz Kotwicki","doi":"10.1097/BPO.0000000000002882","DOIUrl":"10.1097/BPO.0000000000002882","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of the pericapsular nerve group (PENG) block and lumbar erector spinae plane block (ESPB) in pediatric hip surgeries is limited mainly to case reports. This study assessed the efficacy of ultrasound-guided PENG block versus lumbar ESPB under spinal anesthesia.</p><p><strong>Methods: </strong>Ninety patients aged 2 to 7 years, ASA I-III scheduled for hip surgery were randomly assigned to 3 equal groups, each receiving the PENG block group (n=30), the ESPB group (n=30), or the control group (n=30). After the spinal anesthesia, the block was performed with 0.5 kg/mL of 0.2% ropivacaine. The primary outcome was the pain scores (FLACC) 48 hours after surgery. The secondary outcomes included postoperative FLACC pain scores, neutrophile-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total opioid consumption.</p><p><strong>Results: </strong>The FLACC score was significantly lower in the lumbar ESPB and PENG groups compared with the control group ( P <0.0001) at all time points. The NLR and PLR levels were substantially lower in the PENG and lumbar ESPB groups ( P <0.0001) compared with the control group. The NLR and PLR levels were significantly lower in the PENG and lumbar ESPB groups compared with the control group ( P <0.0001). The total opioid consumption was significantly lower in the PENG and lumbar ESPB groups compared with the control group ( P <0.0001). Forty-three percent of children in the PENG group and 50% of children in the lumbar ESPB group did not require opioids postoperatively.</p><p><strong>Conclusions: </strong>The PENG block and the lumbar ESPB provide efficient postoperative analgesia in children undergoing hip surgery. The PENG block and lumbar ESPB lower cumulative opioid consumption and the stress response to surgery, expressed by NLR and PLR levels.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e324-e330"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846846","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":"Who is the PROM King? Patient-reported Outcome Measures in Pediatric Musculoskeletal Oncology: A Systematic Review.","authors":"Soroush Baghdadi, David Van Eenenaam, Divya Talwar, Alexandre Arkader","doi":"10.1097/BPO.0000000000002874","DOIUrl":"10.1097/BPO.0000000000002874","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are important companions to traditional, physician-reported measures. The purpose of this study was to systematically review and identify PROMs used in pediatric musculoskeletal oncology and evaluate these instruments.</p><p><strong>Methods: </strong>A systematic literature review was conducted for studies pertaining to pediatric musculoskeletal tumors from 2010 to 2024. Two experts selected eligible papers for inclusion through a systematic approach. PROMs used in the eligible papers were cataloged, and the top 10 most frequently used instruments were evaluated with Evaluating Measures of Patient-Reported Outcomes (EMPRO), which is a standardized evaluation tool for PROs.</p><p><strong>Results: </strong>A total of 316 publications were included in the final analysis, reporting a total of 82 unique PROMs. Of the papers, 24% reported no PROMs, whereas 67% of the instruments were only reported once. Nine out of the 10 top PROMs scored over 50 on EMPRO, meeting the minimum acceptable criteria. Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, Disabilities of the Arm, Shoulder, and Hand (DASH), and Quick DASH were disease-specific instruments scoring high on EMPRO. Short Form-36, Pediatric Quality of Life Questionnaire, Quality of Life Questionnaire-30, BSI-18, and TNO AZL Child Quality Of Life met the requirements in the general instruments. Short Form-12 was the lowest-scored PROM.</p><p><strong>Conclusions: </strong>Our results show minimal consensus on the ideal PROM in pediatric musculoskeletal oncology. We recommend using instruments that are already in widespread use instead of obscure PROMs, which defy the purpose of reporting outcomes from a patient perspective. All 4 disease-specific instruments scored highly and are already widely used, including Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, DASH, and Quick DASH. However, we found no consensus on general instruments. With the development and increasing popularity of Patient-Reported Outcomes Measurement Information System, it may replace other general instruments that are proprietary, unreliable, or not developed with pediatric patients in mind.</p><p><strong>Level of evidence: </strong>Level IV-systematic review of level II to IV studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e378-e384"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794782","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}