Journal of Pediatric Orthopaedics最新文献

{"title":"Outcomes of Spinal Deformity Treatment in Asphyxiating Thoracic Dystrophy.","authors":"Katerina M Kourpas, John W Stelzer, Jacob V Jordan, Blake K Montgomery, John M Flynn, Patrick J Cahill, Jason B Anari","doi":"10.1097/BPO.0000000000003414","DOIUrl":"10.1097/BPO.0000000000003414","url":null,"abstract":"<p><strong>Background: </strong>Asphyxiating thoracic dystrophy (ATD), or Jeune syndrome, is a rare skeletal dysplasia marked by a severe hypoplastic chest wall and restrictive lung disease, leading to an often-lethal thoracic insufficiency syndrome. Early-onset scoliosis (EOS) can complicate ATD, but details of operative management remain limited. This study aims to analyze the peri- and postoperative course of children with ATD who underwent posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>A retrospective review was conducted for all patients with ATD treated for EOS who underwent PSF at our institution. Preoperative spinal deformity at the time of definitive fusion and prior growth-friendly procedures were assessed. Intra- and postoperative data, including instrumentation levels, operative time, estimated blood loss, hospital and ICU stay, and complications, were collected and analyzed descriptively.</p><p><strong>Results: </strong>Six patients met inclusion criteria. Five had previous expansion thoracoplasties with VEPTR instrumentation; median age at first surgery was 9 months. Median age at scoliosis onset and PSF was 35 months and 14 years, respectively. Median preoperative major coronal curve was 60 degrees. The sagittal profile ranged from severe lordosis to hyperkyphotic. Three patients had VEPTR instrumentation at the time of PSF. The most common upper instrumented vertebra was T2, and the lowest instrumented level ranged from T12 to L4. Median estimated blood loss was 500 mL with 175 mL of autologous blood salvage. Two patients required intraoperative blood transfusions. Median intensive care unit and total hospitalization were 4 and 6 days, respectively. Using the modified Clavien-Dindo-Sink classification system, 1 patient had a grade 0, 1 had a grade I, and 1 had a grade IIIb complication due to an emergency bronchoscopy.</p><p><strong>Conclusions: </strong>ATD is well-known for resulting in thoracic insufficiency syndrome due to a volumetric decrease of the thoracic cage. This series indicates that ATD is not unlike other pediatric non-idiopathic scoliosis undergoing PSF. Despite the pulmonary complexity and history of multiple prior thoracic cage procedures, ATD patients can and should safely undergo spinal deformity correction if indicated.</p><p><strong>Levels of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"638-643"},"PeriodicalIF":1.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562360","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 Related to the Use of Standard-Standard versus Standard-Offset Magnetically Controlled Growing Rods.","authors":"Simon Blanchard, Thomas A Coleman, Jacob Jordan, Lorena Floccari, Joshua Pahys, Sulagna Sarkar, John W Stelzer, Paul Sponseller, Tenner Guillaume, Oheneba Boachie-Adjei, Michael Vitale, Peter Sturm, John M Flynn, Jason B Anari, Patrick J Cahill","doi":"10.1097/BPO.0000000000003513","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003513","url":null,"abstract":"<p><strong>Background: </strong>Magnetically controlled growing rods (MCGRs) are used to perform growth-friendly spinal deformity correction. A key variable that remains debated in determining the optimal use of MCGRs is the orientation of the rods: parallel to one another (standard-standard) versus antiparallel (standard-offset). This study aims to determine if the orientation of the rods has an impact on lengthening outcomes and complication rates.</p><p><strong>Methods: </strong>A retrospective analysis of an international multicenter prospective registry of early-onset scoliosis patients was conducted. Inclusion criteria were patients who underwent bilateral MCGR index surgery with available lengthening data for a minimum of 2 years. Lengthening analyses were discontinued following revision or exchange of the implants. Accumulated programmed and actual lengthening was recorded at the first visit, 2-year, and 5-year intervals following index surgery.</p><p><strong>Results: </strong>Six hundred sixty-eight patients met the inclusion criteria for the study, including 327 females (49%) and 341 males (51%) patients who were 8.0±1.9 years old at index surgery, with a mean major coronal curve of 74 degrees (18 to 134 degrees). Three hundred twenty-three (48%) patients received standard-standard and 345 (52%) patients received standard-offset MCGRs. Patients with standard-standard rods experienced complications at a similar rate to patients who received standard-offset rods [n=137 (42%) vs. n=128 (37%); P=0.161]. In terms of achieved lengthening, no differences were found across actuator orientations at the first lengthening, or in the achieved lengthening accumulated by patients who were still undergoing lengthening procedures at 2 or 5 years post-implantation.</p><p><strong>Conclusions: </strong>The lengthening achieved and complication risks are similar across rod orientations at 2 and 5 years. At 2 years post-index surgery, surgeons appear to be attempting to lengthen patients who receive standard-offset rods to a greater extent without any additional clinical benefit. Further investigation is needed to further elucidate the best practices of MCGR utilization and to determine which patients would benefit from one orientation compared with the other.</p><p><strong>Level of evidence: </strong>Level 3.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220487","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 Bone Age Estimation Using Capping Interval Index on MRI: Development and Validation of a Quantitative Method.","authors":"Wonik Lee, Ki Ill Song, Su Yeon Yu, Yoon Joo Cho, Mi Hyun Song, Tae-Joon Cho, Chang Ho Shin","doi":"10.1097/BPO.0000000000003501","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003501","url":null,"abstract":"<p><strong>Background: </strong>Knee bone age can differ from hand bone age and is more relevant to lower-extremity pediatric conditions. This study developed and validated a quantitative method for estimating skeletal maturity using knee MRI images.</p><p><strong>Methods: </strong>We identified 695 participants aged 18 years or younger without conditions affecting knee anatomy or maturation who underwent knee MRI. Participants were randomly allocated to the modeling (n=417) and validation (n=278) groups. Twenty-six maturation-related parameters were measured on coronal MRI, including the articular and peripheral cartilaginous thicknesses, physeal thicknesses, ossified epiphyseal width, and capping interval. The capping interval was defined as the distance from the medial or lateral metaphyseal end to the nearest ossified epiphysis. Each parameter was normalized to metaphyseal width and assessed by univariable linear regression against log-transformed chronological age. Top-ranked variables were entered into sex-specific multivariable models.</p><p><strong>Results: </strong>The sums of the medial and lateral capping intervals from the femur and tibia were the only parameters with R2>0.9 in both sexes and were defined as the femoral and tibial capping interval indices (CIIs), respectively. Final models were age=exp(-1.918[femoral CII]-1.797[tibial CII]+2.813) for males and age=exp(-2.056[femoral CII]-2.487[tibial CII]+2.738) for females. In the validation group, estimated knee bone age showed minimal difference from chronological age (0.1±1.1 y, P=0.534) and very strong correlation (rs=0.960).</p><p><strong>Conclusions: </strong>Knee bone age estimated from the femoral and tibial CII showed close agreement with chronological age in the independent validation cohort. This study introduces a novel, simple quantitative method that enables estimation of bone age on knee MRI using a minimal number of parameters.</p><p><strong>Level of evidence: </strong>Level III-diagnostic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220454","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":"Beyond the First Fix: Unraveling the Long-term Impact of Surgical Fixation for Early-onset Slipped Capital Femoral Epiphysis in Children Aged 10 and Younger.","authors":"David S Liu, Miles Batty, Lara Cohen, Mary Morcos, Nancy Wan, Shanika De Silva, Travis Matheney, Michael Millis, Young-Jo Kim, Yi-Meng Yen, Eduardo Novais","doi":"10.1097/BPO.0000000000003506","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003506","url":null,"abstract":"<p><strong>Background: </strong>Slipped capital femoral epiphysis (SCFE) is rare in children 10 years or younger, raising concerns about the development of proximal femoral deformity and contralateral SCFE, and indications for prophylactic pinning. This study examines the outcomes of SCFE in children 10 years or younger.</p><p><strong>Methods: </strong>This retrospective study included children who were 10 years or younger at the time of surgery for SCFE and had a minimum of 2 years of follow-up or until triradiate cartilage closure. We collected demographics, slip characteristics, surgical details, and subsequent procedures. We measured femoral neck length (FNL), articulotrochanteric distance (ATD), and α-angle. Radiographic outcomes were compared between affected and contralateral, prophylactically pinned hips using Wilcoxon rank-sum tests, and the mean cumulative function curve demonstrated reoperation events.</p><p><strong>Results: </strong>Eighty-two children (71% females, 27% obese) with SCFE presented at a median age of 10.2 years (range: 5.6 to 10.9). Five patients presented with bilateral SCFE. About 68% (n = 59) hips were chronic SCFE, and 68% (n = 59) were mild. Among 77 unilateral SCFEs, 23% (n = 18) underwent prophylactic pinning of the contralateral hip, and the remaining 59 patients were monitored. About 27% (n = 16) of monitored patients developed a subsequent SCFE, while 73% (n = 43) remained radiographically normal throughout follow-up. When compared with normal hips, SCFE hips showed shorter FNL (3.8 vs. 4.8 mm, P < 0.001), shorter ATD (1.8 vs. 2.6 mm, P < 0.001), and greater α-angle (66 vs. 53 degrees, P < 0.001). Prophylactically pinned hips showed a slight decrease in FNL (4.3 vs. 4.6 mm, P = 0.03) but similar ATD and α-angle compared with normal hips. 28% (n = 23) underwent at least one additional surgical procedure. About 17% (n = 3) of the 18 prophylactically pinned patients experienced an outgrown screw and required revision.</p><p><strong>Conclusions: </strong>SCFE in children 10 years or younger results in proximal femur deformity of shortened femoral neck and abnormal head-neck offset. Contralateral hip morphology was generally maintained, irrespective of prophylactic fixation or monitoring, suggesting that femoral neck growth is not entirely restricted by standard screw fixation. As 73% of monitored hips remained radiographically normal throughout follow-up, prophylactic surgery may not be necessary in this younger age group, and careful consideration with shared decision making is critical.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224372","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":"Open Reduction for Developmental Dysplasia of the Hip in the Newborn Hip Screening Era: Changing Patient Characteristics and Surgical Strategies Without Compromising Outcomes.","authors":"Senol Bekmez, Ali T Evren, Enis Erdem, Yalcin Turhan, Kenan Sen, Pervin Demir, Metin Dogan, Mehmet I S Kapicioglu","doi":"10.1097/BPO.0000000000003509","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003509","url":null,"abstract":"<p><strong>Introduction: </strong>Newborn hip ultrasound scan (USS) for developmental dysplasia of the hip (DDH) has significantly reduced the number of delayed cases. However, open reduction (OR) is still required when nonsurgical treatment fails in properly screened patients, as well as in neglected and late-presenting cases. The aim of this study is to compare the clinical and radiologic outcomes of OR for DDH between screened and neglected cases.</p><p><strong>Methods: </strong>Patients diagnosed with DDH and who underwent OR at a single center were included and categorized into 2 groups: Screened patients with an unsuccessful nonoperative treatment attempt (group 1), and neglected patients due to misdiagnosis or lack of USS (group 2). Comparisons were performed between groups for demographic parameters, surgical characteristics, pre- and postoperative radiographic analyses, radiologic and clinical outcome assessments, and complications.</p><p><strong>Results: </strong>One hundred thirteen patients (148 hips) were included (group 1=66 and group 2=82). Group 1 had younger median age at the time of OR (11 vs. 23.2 mo, P<0.001), less IHDI grade 3-4 ratio (74% vs. 90%, P<0.001) higher medial/anterior OR ratio (55% vs. 15%, P<0.001), lower rate of concomitant femoral (35% vs. 71%, P<0.001) and pelvic osteotomy (38% vs. 78%, P<0.001) as compared with group 2. PFGD (proximal femur growth disturbance) rates were similar between the 2 groups. No difference noted for Severin grade (good to excellent result 89% vs. 92%, P=0.42), McKay (excellent result 83% vs. 77%, P=0.21), revision (9.8% vs. 6.4%, P=0.33), reoperation for implant removal (14 vs. 20, P=0.23), and for pelvic osteotomy due to residual acetabular dysplasia (6 vs. 5, P=0.58).</p><p><strong>Conclusion: </strong>Early detection of DDH through USS not only reduced delayed presentations but also altered the demographic, clinical, and surgical characteristics of patients requiring OR. Despite failed initial conservative management, screened patients achieved comparable radiologic and clinical outcomes to those of unscreened patients, with similar rates of complications and residual acetabular dysplasia. These findings suggest that newborn hip USS enables less extensive surgical management without compromising outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224441","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":"Readability and Content Integrity of Discharge Documents for Common Pediatric Orthopaedic Procedures Before and After Artificial Intelligence Simplification.","authors":"Angel G A Prempeh, Rashid Saeed, Christina Hill, Lucas Kopp, Allison Tenfelde","doi":"10.1097/BPO.0000000000003508","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003508","url":null,"abstract":"<p><strong>Background: </strong>Caregivers of pediatric orthopaedic surgical patients routinely receive discharge documents written at reading levels exceeding established health literacy recommendations. This disparity creates a significant barrier to comprehension and adherence to postoperative instructions. While artificial intelligence (AI) language models offer a scalable solution for simplification of medical text, a systematic evaluation of the ability to preserve critical content in surgical discharge materials remains lacking.</p><p><strong>Methods: </strong>Publicly available caregiver-facing discharge documents for 3 common pediatric orthopaedic conditions, supracondylar humerus fractures (CRPP), pediatric forearm fractures (ORIF/CRPP), and slipped capital femoral epiphysis (SCFE pinning), were collected. All documents underwent AI simplification using a standardized prompt with ChatGPT (version 5.2; OpenAI). Readability was assessed using 6 validated indices for both original and simplified documents. A structured content integrity review was conducted on all simplified documents by 2 independent reviewers to assess for safety-critical errors, completeness gaps, and factual accuracy, with inter-rater reliability quantified by Cohen kappa.</p><p><strong>Results: </strong>Fifteen documents were obtained from institutions across 9 US states. After AI simplification, mean Flesch-Kincaid Grade Level (FKGL) decreased from 8.91 (SD: 1.38) to 4.97 (SD: 2.14), a mean reduction of 3.94 grade levels (95% CI: 2.65-5.23; P<0.001; Cohen d=1.69). All 6 readability indices improved across all documents. Eleven of 15 documents (73%) achieved the target readability threshold of FKGL 6 or below, compared with zero at baseline. Content integrity review identified 35 flags across 14 of 15 documents: 12 safety-critical errors, 16 completeness gaps, and 7 accuracy concerns. Cohen kappa was 0.87 for agreement on whether a change was clinically meaningful, 0.85 for severity classification, and 0.89 for flag category. Three documents had content omissions sufficient to require clinician revision before clinical use. Greater word-count reduction was associated with a higher burden of safety-critical flags (Spearman rho 0.63; P=0.012).</p><p><strong>Conclusions: </strong>While ChatGPT substantially reduced the reading complexity of pediatric orthopaedic discharge documents, it also introduced safety-critical alterations. AI-assisted simplification should be implemented only with structured clinician review. Larger word-count reductions were associated with more safety-critical alterations, so the magnitude of reduction may help prioritize which simplified documents receive the closest clinician review.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220465","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":"Principles or Resources? Best Management of Pediatric Femoral Neck Fractures.","authors":"Caroline L Kim, Sulagna Sarkar, Alberto Daniel Navarro Vergara, Alexandre Arkader","doi":"10.1097/BPO.0000000000003504","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003504","url":null,"abstract":"<p><strong>Background: </strong>Pediatric femoral neck fractures (PFNF) are rare but have a reported complication rate of >30%. To date, there remains a lack of consensus on the definitive risk factors for AVN following PFNF. By comparing the outcomes of PFNF treated at a major US metropolitan area tertiary-level 1 pediatric trauma center (group 1) to an equivalent trauma hospital in a major Latin American capital (group 2), we sought to weigh whether treatment principles or resources are more important for a favorable result.</p><p><strong>Methods: </strong>This was a retrospective review of all children (<18 years old) treated for PFNF in the past 10 years at each location. Demographics, treatment, and outcome variables were collected. Fractures were classified by Delbet criteria. Patients with incomplete fractures, pathologic fractures, and those with short follow-up (<3 months) were excluded. Univariate and bivariate statistics were applied.</p><p><strong>Results: </strong>In all, 74 fractures (73 children) were included, 39 from group 1 and 35 from group 2 (52% male, mean age 11.0±4.11). Patients from group 1 (12.5±3.95 years old) were significantly older compared with group 2 (9.35±3.72 years old, P<0.001). Group 2 had a significantly higher proportion of type 4 Delbet fractures (37% vs. 8%, P=0.01) while no other differences in fracture characteristics were observed between groups. Of the patients who underwent operative treatment for their fractures, the time to surgery was significantly shorter in group 1 (4.42 days) compared with group 2 (7.56 days, P<0.001). The preferred method of surgery was open reduction and internal fixation (ORIF) at group 1 and closed reduction and percutaneous pinning at group 2 (P=0.05). There were no differences in overall complication rates, including AVN (P>0.05).</p><p><strong>Conclusion: </strong>While these 2 institutions differ in resources, such as the ability to perform surgery urgently or hardware availability, and despite differences in fracture type, there were no significant differences in the outcome and incidence of complications, including AVN.</p><p><strong>Levels of evidence: </strong>Level 3, Retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224379","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 Effect of Metabolic Control of Rickets on Deformity Correction Following Hemiepiphysiodesis in Children With X-linked Hypophosphatemic Rickets.","authors":"Anna Ryabets-Lienhard, Ian Marpuri, My H Vu, Vivian X Yu, Irene Chen, Chelsey Grimbly, Oussama Abousamra","doi":"10.1097/BPO.0000000000003497","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003497","url":null,"abstract":"<p><strong>Background: </strong>X-linked hypophosphatemic rickets (XLH) is a genetic disorder of chronic hypophosphatemia leading to rickets and osteomalacia that often results in lower limb deformities requiring surgical correction. Hemiepiphysiodesis is commonly used to correct angular deformities in skeletally immature patients, but outcomes in XLH are variable, and the influence of metabolic control on surgical outcomes remains unclear. We evaluated the relationship between metabolic control of rickets, measured by serum alkaline phosphatase (ALP), and deformity correction after hemiepiphysiodesis in children with XLH.</p><p><strong>Methods: </strong>We retrospectively reviewed children with XLH from 2 tertiary centers between 2000 and 2021, who underwent hemiepiphysiodesis and had serial lower extremity radiographs from 6 months preoperatively to 2 years postoperatively or until implant removal. Angular correction was assessed using mechanical axis deviation (MAD, mm) and MAD rate of correction (mm/month); metabolic control was evaluated using serum ALP, expressed as percentage of the age-specific and sex-specific upper limit of normal (%ALP-ULN). Correction was defined as MAD=0 mm within 2 years of surgery. Associations between %ALP-ULN, MAD, and MAD rate of correction were analyzed using univariable and multivariable models adjusted for body mass index (BMI) Z-score.</p><p><strong>Results: </strong>Fourteen patients [26 affected limbs, 18/26 (69%) genu varum] who had both preoperative and postoperative radiographs were included. Correction was achieved in 20/26 (77%) limbs (71% of patients) by 2 years postoperatively. All non-corrected limbs (6/26, 23%) had varus deformity. %ALP-ULN at 1 year postoperatively correlated positively with greater residual MAD (R=0.83, P=0.0014) and negatively with MAD rate of correction (R=-0.70, P=0.017); which remained significant after controlling for BMI Z-score (MAD: β=0.96, 95% CI 0.23, 1.7, P=0.017; MAD rate of correction: β=-0.06, 95% CI -0.12, -0.01, P=0.036).</p><p><strong>Conclusions: </strong>Postoperative metabolic control of rickets, as assessed by lower ALP, was associated with greater and faster deformity correction after hemiepiphysiodesis in children with XLH, supporting the importance of metabolic optimization and medical management to improve surgical outcomes.</p><p><strong>Level of evidence: </strong>Level IV-Case Series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224402","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":"Reply to Letter to the Editor Regarding \"Infection Risk Following Orthopaedic Sports Knee Surgery Is Greater in Pediatric Patients With Allergic Disease History\".","authors":"Anagh Astavans, Kyung J Park, Sudarsan Murali, Rushyuan Jay Lee","doi":"10.1097/BPO.0000000000003462","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003462","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194600","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":"Trisomy 21 and Patellar Femoral Instability in a Pediatric Population: Results From 53,800 Patients.","authors":"Joseph A Magoline, R Garrett Yoder, Melanie A Morscher, Patrick M Riley, Kenneth T Bono, John D Polousky, David C Kaelber, R Gunnar Tysklind","doi":"10.1097/BPO.0000000000003499","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003499","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability (PFI) commonly occurs in pediatric patients with Trisomy 21 (T21). Reported prevalence ranges from 1.5% to over 20%. This study establishes incidence and prevalence among tens of thousands of T21 patients and compares rates of surgical intervention with a matched non-T21 cohort.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the TriNetX Research USA Minimal Date Shift network, which includes de-identified electronic health records from 59 healthcare organizations. Patients with T21 and PFI (ICD-10 code S83.00 or M22.1) diagnosed at or before age 19 were included. We evaluated rates of surgical intervention for PFI using CPT codes for patellofemoral reconstruction procedures in T21 patients and compared them to an age, sex, race, and ethnicity-matched non-T21 patients with PFI. The annual point prevalence of PFI in Down syndrome patients was also calculated in a separate cohort from 2017 to 2024.</p><p><strong>Results: </strong>Among 53,800 patients with T21, the annual prevalence of PFI increased from 0.54% in 2017 to 0.81% in 2024. Females exhibited a higher prevalence than males (0.97% vs. 0.67% in 2024). The mean age at initial PFI diagnosis among patients with T21 was 11.1±4.7 years. Following 1:1 propensity-score matching, 18.7% (65/347) of patients with T21 and PFI underwent surgical treatment compared with 10.7% (37/347) of matched patients without T21 (RR, 1.76; 95% CI, 1.21-2.56). Kaplan-Meier analysis demonstrated no statistically significant difference in time from PFI diagnosis to surgery between matched cohorts (log-rank P=0.054; HR, 1.49; 95% CI, 0.99-2.23).</p><p><strong>Conclusions: </strong>This is the first prevalence analysis of PFI in tens of thousands of children with T21. The findings reveal lower prevalence than previously reported, but a higher likelihood of surgical treatment compared with non-T21 peers. These results underscore the need to better understand how the current treatment strategies for PFI can affect this population and stress the importance of longitudinal monitoring of PFI in T21 patients.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167185","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}