Journal of Pediatric Orthopaedics最新文献

{"title":"LongTerm Outcomes of Suspected Transient Synovitis of the Hip in NonAspirated Patients.","authors":"Zina Smadi, James Burnett, Joshua Varghese, Shragvi Balaji, Scott Rosenfeld","doi":"10.1097/BPO.0000000000003494","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003494","url":null,"abstract":"<p><strong>Background: </strong>Transient synovitis is a common cause of pediatric hip pain that must be distinguished from septic arthritis. Although the literature includes outcome data for aspirated hips, long-term outcomes in patients managed presumptively without aspiration remain limited. This study aimed to characterize the long-term clinical outcomes of children with presumed transient synovitis managed without hip aspiration.</p><p><strong>Methods: </strong>A retrospective study of pediatric patients diagnosed with transient synovitis and managed presumptively without aspiration. Collected variables included demographics, clinical presentation, laboratory values, and longitudinal outcomes. Outcomes assessed included residual symptoms, recurrence of symptoms or transient synovitis, admission, and rheumatologic or sequelae diagnoses at 4 weeks, 6 months, 1 year, and 5 years, as well as across overall follow-up. Time to recurrence was determined using documented free-text data and by the first follow-up interval with recurrence. Analyses were descriptive.</p><p><strong>Results: </strong>A total of 220 patients with transient synovitis were included. The mean age at diagnosis was 5.96±3.39 years, and 68.9% were male. Fever was present in 13.2% of patients, and the mean weightbearing score at presentation was 1.04±0.81. The mean WBC, ESR, and CRP were 9.56±3.54, 18.53±15.71, and 3.00±13.15, respectively. Mean follow-up was 9.41±4.26 years. Residual symptoms were observed in 4.3% of patients and recurrence in 2.6% across available follow-up. A rheumatologic or sequelae diagnosis was identified in 3.2% of patients, including juvenile idiopathic arthritis, Legg-Calvé-Perthes disease, and chronic arthralgia. No patients were later diagnosed with an infectious etiology or required a change in management.</p><p><strong>Conclusion: </strong>Pediatric transient synovitis managed without hip aspiration was associated with favorable long-term outcomes, including no missed diagnosis of septic arthritis, and low rates of persistent symptoms and recurrence. However, a small proportion of patients were later diagnosed with rheumatologic disease or other sequelae, supporting the need for continued clinical follow-up in cases with atypical, prolonged, or recurrent symptoms.</p><p><strong>Level of evidence: </strong>Level III-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111456","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":"Missing the Deadline: Predictors of Surgical Delay Beyond 18 Hours in Pediatric Supracondylar Humerus Fractures.","authors":"Quinn J Johnson, Emil Varas-Rodríguez, Mikaela H Sullivan, Brian D Wahlig, Samuel E Broida, Anthony Stans, Emmanouil Grigoriou, A Noelle Larson, Todd A Milbrandt","doi":"10.1097/BPO.0000000000003495","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003495","url":null,"abstract":"<p><strong>Introduction: </strong>A common national pediatric hospital ranking program utilizes treatment of supracondylar humerus fractures (SCHFx) within 18 hours of presentation as a quality metric when evaluating institutions. However, prior investigations have demonstrated that an arbitrary cutoff of <18 hours has no impact on patient outcomes. The present study aimed to identify clinical and systemic predictors of surgical delay beyond 18 hours following presentation to the emergency department (ED). We hypothesized that evening presentation to the ED and increased injury severity would delay patient care.</p><p><strong>Methods: </strong>We identified 450 patients who underwent surgical treatment for SCHFx between 2013 and 2024. The primary outcome of this study was defined as time to the operating room (OR) following presentation to the ED. Descriptive statistics were obtained for demographic variables and injury specifics. Variables that were normally distributed were compared utilizing Student t tests, while non-normally distributed variables were compared using the Mann-Whitney U test. All categorical variables were compared using χ2 or Fisher exact test. A multivariate logistic regression model was utilized to identify predictors of treatment delays.</p><p><strong>Results: </strong>The average age of patients was 6.0±2.4 years, and 51.8% (n=233) were male. Most patients were injured following a fall (n=319, 70.9%), had no vascular injury (n=437, 97.1%), no neurological injury (n=390, 86.7%), and no open injury (n=444, 98.7%). Most patients were referred to our institution (n=311, 69.1%) and arrived at the ED via private transportation (n=324, 72.0%), most commonly in the evening (n=256, 56.9%). Only 72 patients (16.0%) experienced surgical delay beyond 18 hours, while the average time to the OR was 12.2±5 hours. On multivariate analysis, evening ED arrival (OR=3.44, 95% CI: 1.87-6.34, P<0.001) and high Gartland severity (OR=2.39, 95% CI: 1.21-4.74, P=0.013) were independent predictors of surgical delay.</p><p><strong>Discussion: </strong>The present study showed that surgical delays for SCHFx repair are driven by predictable system issues and clinical findings. High Gartland severity and evening ED arrival were predictors of delay. Higher-severity cases were more likely to exceed the proposed time to treatment threshold, likely secondary to interfacility transfers and the need for postoperative admission. National quality metrics for pediatric supracondylar humerus fractures should be grounded in clinical outcomes, which are more reflective of the quality of care delivered.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111471","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":"Intravenous Dexamethasone Prolongs Opioid-Free Analgesia After Pediatric Hand Surgery: A Randomized Triple-Blind Trial.","authors":"Justyna Marszałek-Buko, Tomasz Reysner, Anna Perek, Paweł Pietraszek, Jowita Rosada-Kurasińska, Alicja Batkowska-Śniatkowska, Katarzyna Wieczorowska-Tobis, Przemysław Daroszewki, Ewa Grelowska, Malgorzata Reysner","doi":"10.1097/BPO.0000000000003482","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003482","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain control after pediatric hand surgery remains challenging despite the increasing use of regional anesthesia. This randomized triple-blind trial evaluated whether adjunctive intravenous dexamethasone prolongs postoperative opioid-free analgesia after pediatric supraclavicular brachial plexus block.</p><p><strong>Methods: </strong>Ninety children undergoing elective hand or wrist surgery were randomized to receive intravenous placebo, dexamethasone 0.1 mg/kg, or dexamethasone 0.2 mg/kg before ultrasound-guided supraclavicular brachial plexus block (30 patients/group). The primary outcome was time to first postoperative opioid administration within 48 hours. Secondary outcomes included opioid consumption, postoperative pain scores, time to first documented spontaneous finger movement, and adverse events.</p><p><strong>Results: </strong>Intravenous dexamethasone significantly prolonged postoperative opioid-free analgesia compared with placebo. Median time to first rescue opioid administration was 8.9 hours in the placebo group, 14.3 hours in the dexamethasone 0.1 mg/kg group, and 17.3 hours in the dexamethasone 0.2 mg/kg group (P<0.0001). Patients receiving dexamethasone also demonstrated lower postoperative opioid consumption and lower pain scores during the 48-hour follow-up period. The time to first documented spontaneous finger movement was delayed in dexamethasone-treated patients. No serious adverse events were observed.</p><p><strong>Conclusions: </strong>Adjunctive intravenous dexamethasone prolonged opioid-free analgesia and reduced postoperative opioid requirements after pediatric hand surgery. Although analgesic outcomes improved in a dose-dependent manner, higher dexamethasone doses were associated with longer time to first documented spontaneous finger movement.</p><p><strong>Level of evidence: </strong>Level I-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111445","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 Surgical Interventions in Children With Fibrous Dysplasia/McCune-Albright Syndrome.","authors":"Oana Ofelia Bulaicon, Jenna van der Kruk, Sjoerd Joustra, Michiel van de Sande, Natasha Mireille Appelman-Dijkstra, Pieter Bas de Witte","doi":"10.1097/BPO.0000000000003477","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003477","url":null,"abstract":"<p><strong>Background: </strong>Fibrous dysplasia/McCune-Albright (FD/MAS) is a rare bone disorder with an increased risk of skeletal deformities and fractures. Data on surgical indications, techniques, outcomes, and complications remain limited.</p><p><strong>Methods: </strong>An observational retrospective cohort study was conducted on children with FD/MAS who underwent FD-related orthopaedic surgery before the age of 18 years. Time-to-event analyses were performed, with the event defined as (re)fracture or second surgery after the first surgery.</p><p><strong>Results: </strong>A total of 45 children with FD/MAS were included (57.8% boys), with a median age of 10 years at diagnosis and 13 years at first surgery. In total, 64 surgical sites were included, and the median follow-up was 10 years (range 0.8 to 25.3). Surgery was performed for (impending) fractures in most cases (n=45, 70.3%), involving the proximal femur in 50.0%. Most frequently performed were osteosynthesis with hardware/implants (56.3%), followed by cortical strut grafting (21.9%). (Re)Fractures were the most common complication, often adjacent to the surgical site of the previous surgery. The probability of remaining free from an event was 70.3% at 1 year and 41.9% at 5 years. Increased risk of an event was associated with female sex (HR 2.2, 95% CI: 1.1-4.5, P=0.02) and lower age at index surgery (HR 0.93 per year increase, 95% CI: 0.86-0.99, P=0.04).</p><p><strong>Conclusion: </strong>In this largest series of children with orthopaedic surgery for FD/MAS, the proximal femur was the most common surgical site, typically for (impending) fractures. Risk of an event ((re)fracture or second surgery) was higher in females and those operated at a younger age.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109905","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 Comparison of Continuous Epidural, Spinal Opioid, and Patient-Controlled Analgesia for Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Multicenter, International Database Study.","authors":"Lloyd M Halpern, De-An Zhang, Clark J Kogan, Kirk A Ryan, Zackary Correll, William Bronson","doi":"10.1097/BPO.0000000000003272","DOIUrl":"10.1097/BPO.0000000000003272","url":null,"abstract":"<p><strong>Background: </strong>There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay.</p><p><strong>Methods: </strong>This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay.</p><p><strong>Results: </strong>A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P <0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay.</p><p><strong>Conclusions: </strong>Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"549-555"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512960","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":"Single-row vs. Double-row Anterior Vertebral Body Tethering: Which Offers Better Clinical and Radiographic Outcomes for AIS Patients?","authors":"Samuel Ezeonu, Nicholas Vollano, Juan Rodriguez-Rivera, Alyssa Capasso, Stéfan Parent, Firoz Miyanji, Kenneth Cheung, Ron El-Hawary, Tenner Guillaume, Walter Truong, Juan Carlos Rodriguez-Olaverri","doi":"10.1097/BPO.0000000000003226","DOIUrl":"10.1097/BPO.0000000000003226","url":null,"abstract":"<p><strong>Background: </strong>Vertebral body tethering (VBT) is a growth-modulating technique in treatment of AIS. While the use of a double row of screws for anchoring of the tether in the apex has been proposed to reduce the risk of tether breakage and improve correction, there is limited evidence supporting this.</p><p><strong>Methods: </strong>Patients ≤16 years of age with AIS who underwent anterior VBT with 2-year minimum follow-up were included in the study. We performed 3 separate analyses comparing main thoracic only (T), thoracolumbar only (TL), and combined thoracic/thoracolumbar (T/TL) tether constructs used in either single-row (SRVBT) or double-row VBT (DRVBT). Independent sample t tests and χ 2 analyses were performed for comparison of characteristics and main outcomes, including percent surgical correction, rates of tether breakage, and rates of revision.</p><p><strong>Results: </strong>A total of 227 patients were enrolled in the study (190 SRVBT: 37 DRVBT). Across T, TL, and T/TL cohorts, DRVBT patients were more skeletally mature based on differences in mean Rissers (2.9 vs. 0.7, P <0.05). In our TL cohorts, patients with DRVBT had significantly greater percent correction at early post-op (75% vs. 51%, P =0.003) and better correction at 2 years (DRVBT 50% vs. SRVBT 33%, P =0.279). SRVBT experienced higher rates of revision (39% vs. 7%, P =0.077) and had a higher conversion to fusion rate (23% vs. 0%, P =0.098) compared with DRVBT in the setting of a thoracolumbar tether. In our T analysis, though DRVBT had greater correction at post-op and 2 years, this was not statistically significant ( P >0.05). In addition, no significant differences were found in tether breakage (SRVBT 53% vs. DRVBT 50%, P =1.000) or revision (SRVBT 7% vs. DRVBT 0%, P =1.000). In patients with T/TL constructs, 2-year outcomes for correction, tether breakage (DRVBT 85% vs. SRVBT 79%, P =1.000), and revision (DRVBT 15% vs. SRVBT 0%, P =0.206) were statistically nondifferent between groups.</p><p><strong>Conclusions: </strong>While results of tether breakage were not statistically different between the SRVBT and DRVBT, DRVBT had greater initial and long-term correction for TL curves along with lower revision and fusion rates.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e859-e866"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271356","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":"Atlantoaxial Instability in Mucopolysaccharidoses: Surgical Indications and Recommendations.","authors":"Bryan Menapace, William Mackenzie, Colleen Ditro, Kenneth Rogers, Jeffery Campbell, William G Stuart Mackenzie","doi":"10.1097/BPO.0000000000003273","DOIUrl":"10.1097/BPO.0000000000003273","url":null,"abstract":"<p><strong>Background: </strong>Cervical spine atlantoaxial instability (AAI) is frequently encountered in patients with mucopolysaccharidoses (MPS). The value of clinical examination, radiographic measurements, and MRI findings in determining the management of MPS AAI is unknown. The goal of this study is to compare these tools and report the utility and significance of each in surgical decision-making.</p><p><strong>Methods: </strong>Retrospective case-control series from a single center's skeletal dysplasia (SD) division, 2007-2023, included MPS patients who had documented history, examination, and flexion-extension (F-E) cervical spine radiographs and MRI. Radiographic measurements included dens morphology, anterior atlanto-dens interval (AADI), and posterior atlanto-dens interval (PADI). MRI measurements included cervical stenosis, C1 SAC, and the presence of myelomalacia. Factors important were quantified by sensitivity, specificity, and odds ratio (OR). Criteria cutoffs were defined by receiver operating characteristic (ROC) curve analysis, and a scoring rubric was generated by internal validation.</p><p><strong>Results: </strong>Of all SD patients, 35 had MPS and met all inclusion criteria. The most common diagnosis was Morquio syndrome (77%, 27/35). Patients were majority 54% female and 80% white. About half (18, 51%) underwent surgery at an average age of 10.6-years-old. Measurement analysis followed by ROC evaluation defined 7 surgical cutoffs as follows: (1) paresthesias in the history, (2 and 3) weakness and/or positive Babinski on exam, (4) os or aplastic odontoid morphology, (5) ≥3 mm AADI instability, (6) myelomalacia on MRI, and (7) ≥115% C1-C2 stenosis. Stenosis and myelomalacia were the most impactful by OR. Os/aplastic odontoid morphology and positive Babinski were both 100% specific. Validation found that 100% of patients with 0 criteria were able to be managed nonoperatively. Conversely, patients with 3 or more criteria present were overwhelmingly indicated for surgery in 93% of cases.</p><p><strong>Discussion: </strong>This is the largest case series describing AAI in MPS patients. This study identified the above 7 criteria utilizing MPS-specific thresholds. These thresholds allow for the qualification of pathologic findings against other MPS patients, weight factor importance, and provide guidance for how many factors should be present to indicate MPS AAI for surgical intervention.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e900-e906"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592738","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":"Lower-Lying Flexor Hallucis Longus Is Associated With Advancing to Surgery in Pediatric and Adolescent Os Trigonum Syndrome.","authors":"Morgan E Swanson, Brendon Mitchell, Nathan Chaclas, Angie Kuang, Kaitlyn O'Malley, Sulagna Sarkar, Jie C Nguyen, Naomi J Brown, Kathleen J Maguire","doi":"10.1097/BPO.0000000000003237","DOIUrl":"10.1097/BPO.0000000000003237","url":null,"abstract":"<p><strong>Background: </strong>The os trigonum (OT), or Stieda process, is an accessory bone or osseous elongation at the posterolateral process of the talus. OT is one of the sources of posterior ankle impingement and pain (os trigonum syndrome), often in conjunction with the adjacent flexor hallucis longus (FHL) muscle belly. Local anesthetic injection and surgical excision are common treatments for this pathology.</p><p><strong>Hypothesis/purpose: </strong>We describe early pain relief among pediatric patients at a single university-affiliated hospital undergoing OT injection. We also evaluate risk factors for progression to surgery and the role that OT injection plays in that decision-making.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>A retrospective review of patients treated for OT syndrome over a 10-year period at a single, tertiary care pediatric hospital was performed. We collected demographics, magnetic resonance imaging (MRI) details, relative FHL location on MRI, treatment details, and symptom relief following injection. Bivariate statistical analysis using Wilcoxon Mann-Whitney, Kruskal-Wallis, ANOVA, χ 2 , Fisher, and T tests was performed, along with univariate logistic regression.</p><p><strong>Results: </strong>Sixty patients (49 female, mean age 14.7±2.4 y) yielded 65 ankles included for analysis. All patients underwent a trial of conservative management. 31/65 (47.7%) did not complain of further symptoms, while the remaining 34/65 (52.3%) progressed to injection and/or surgical intervention. 25/65 (38.5%) underwent lidocaine injection, and 21/65 (32.3%) underwent surgical excision of OT. Early patient-reported postinjection symptom relief (median, IQR: 80.0%, 65.0% to 100.0%) was not associated with patient age, sex, performance athlete status, FHL location or size, OT location or size, nor whether steroid was injected with the lidocaine ( P >0.05). Progression to surgery was unrelated to early relief from injection ( P >0.05). Odds of progression to surgery were increased with FHL musculotendinous junction distance ( P =0.005, OR=1.19) and relative musculotendinous junction distance ( P =0.012, OR=10.48).</p><p><strong>Conclusion: </strong>The relative location and distal extension of the FHL muscle belly may be a risk factor for failure of nonoperative management and progression to surgical intervention in the pediatric and adolescent patient.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e893-e899"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633774","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":"Is Two Better Than One? Pelvic Fixation Strategies in Neuromuscular and Early-onset Scoliosis: A Comparative Analysis of S1S2-iliac and S2-iliac Screws.","authors":"Tarek Obeid, Ramin Espandar, Anna Rambo, Kaushal Upadhyay, Caroline Epstein, Jospeh Larwa, Ketrick Lacoste, Mona Doshi, Kevin M Neal","doi":"10.1097/BPO.0000000000003257","DOIUrl":"10.1097/BPO.0000000000003257","url":null,"abstract":"<p><strong>Background: </strong>In patients with neuromuscular (NM) and early-onset scoliosis (EOS), spinal instrumentation and fusion treatments present significant challenges, particularly in achieving stable pelvic fixation and correcting pelvic obliquity (PO). This study aimed to evaluate whether dual sacroiliac (S1-iliac and S2-iliac) screw constructs improve PO correction and reduce complications compared with S2-iliac screws alone in patients with NM and EOS.</p><p><strong>Methods: </strong>A retrospective review of 77 patients with NM or EOS requiring pelvic fixation was conducted. Patients were divided into 2 groups: (1) bilateral S1-iliac and S2-iliac screws (S1-S2 group, n=22) and (2) bilateral S2-iliac screws alone (S2 group, n=55). Preoperative and postoperative major curves and PO were assessed, along with complication rates, including implant prominence, screw pullout, breakage, infection, and revision surgery.</p><p><strong>Results: </strong>Both groups achieved similar main curve corrections at final follow-up (S2=53%, S1-S2=64%, P =0.121). The mean preoperative major curve for the S2 and S1-S2 groups was 63.7 degrees (range 20 to 106 degrees) and 68.9 degrees (range 39 to 135 degrees), respectively. At final follow-up, the mean curve measured 29.4 degrees (range 3 to 82 degrees) and 23.4 degrees (range 7 to 48 degrees), corresponding to 54% and 66% correction, respectively. Preoperative PO averaged to 11.1 degrees (range 0 to 36 degrees) and 17.5 degrees (range 2 to 36 degrees) in S2 and S1-S2 groups, respectively. At final follow-up, PO measured 4.5 degrees (range -3 to 23 degrees) and 6.3 degrees (range 0 to 15 degrees), respectively. In all, 18% (4/22) of patients in the S1S2 group and 23% (13/55) of patients in the S2 group showed complications. Implant breakage occurred in 1 patient in the S1S2 group and 7 in the S2 group ( P =0.427). Revision surgery was required in 5 patients in the S2 group and 1 in the S1S2 group ( P =0.668).</p><p><strong>Conclusions: </strong>Bilateral S1S2-iliac screws were successfully placed and provided early improvements in PO correction compared with S2-iliac screws alone. However, differences in PO correction and complication rates were statistically insignificant at final follow-up. Further prospective studies with larger cohorts and longer follow-up are needed to assess potential long-term biomechanical advantages of dual fixation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e853-e858"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348727","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":"Author Response: Considerations and Challenges in Open Reduction With Ligamentum Teres Reconstruction for Pediatric Developmental Dysplasia of the Hip.","authors":"Kevin Klingele, Daryn Strub","doi":"10.1097/BPO.0000000000003430","DOIUrl":"10.1097/BPO.0000000000003430","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e907-e908"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604329","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}