Journal of Pediatric Orthopaedics最新文献

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Cross-Cultural Adaptation and Validation of the Spanish Version of the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). 西班牙版早发性脊柱侧凸自我报告问卷(EOSQ-SELF)的跨文化适应与验证。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-22 DOI: 10.1097/BPO.0000000000003110
Joseph Salem-Hernández, Cristian Cortés-Nieves, Hiroko Matsumoto, Pablo Marrero, Norman Ramirez
{"title":"Cross-Cultural Adaptation and Validation of the Spanish Version of the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF).","authors":"Joseph Salem-Hernández, Cristian Cortés-Nieves, Hiroko Matsumoto, Pablo Marrero, Norman Ramirez","doi":"10.1097/BPO.0000000000003110","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003110","url":null,"abstract":"<p><strong>Background: </strong>The Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF) is a recently developed tool designed to assess health-related quality of life (HRQoL) in children with early-onset scoliosis (EOS). It complements the existing EOSQ-24, which relies on parental proxy reporting. While the EOSQ-SELF has demonstrated reliability in English, Chinese, and Turkish populations, it has yet to be validated for Spanish-speaking patients. This study aimed to translate, culturally adapt, and validate the EOSQ-SELF for use in Spanish-speaking children with EOS.</p><p><strong>Methods: </strong>A multicenter, prospective validation study was conducted in Puerto Rico from August to November 2024. Participants aged 8 to 18 years with EOS were recruited during routine follow-up visits, regardless of treatment stage. The EOSQ-SELF underwent a rigorous translation and cultural adaptation process, including forward-backward translation and expert panel review. Reliability was evaluated using internal consistency metrics. Content and construct validity were assessed through expert and patient feedback, nonparametric tests, and multiple linear regression.</p><p><strong>Results: </strong>The final Spanish EOSQ-SELF showed no significant semantic or cultural issues following expert and patient feedback. A total of 42 patients (mean age 10.3±2.4 y; 64% female) were included. The instrument demonstrated excellent internal consistency (Cronbach's α=0.91), with item-total correlations ranging from 0.34 to 0.75. Discriminant validity was confirmed in 75% of domain comparisons, although overlap was observed between \"Transfer\" and \"Pain.\" Ceiling effects were most prominent in the \"Relationships\" domain (78%), while the lowest ceiling effect was found in \"Pain and Discomfort\" (30%).</p><p><strong>Conclusions: </strong>The Spanish EOSQ-SELF is a reliable and valid instrument for measuring self-reported HRQoL in Spanish-speaking children with EOS. Despite some ceiling effects in high-functioning domains, the tool remains clinically and scientifically useful for this population.</p><p><strong>Level of evidence: </strong>Level II-prognostic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113561","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}
引用次数: 0
Growth Modulation to Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease. 生长调节改善legg - calv<s:1> - perthes病股骨头球形度。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-19 DOI: 10.1097/BPO.0000000000003071
Juan C Abril, Manuel Fraga, Margarita Montero, Jaime García-Fernández
{"title":"Growth Modulation to Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease.","authors":"Juan C Abril, Manuel Fraga, Margarita Montero, Jaime García-Fernández","doi":"10.1097/BPO.0000000000003071","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003071","url":null,"abstract":"<p><strong>Introduction: </strong>Legg-Calvé-Perthes disease (LCPD) often causes residual deformities, typically manifesting as an ellipsoidal femoral head shape. This condition arises from initial bone collapse and necrosis, inhibiting growth at the anterosuperior femoral head and resulting in asymmetric growth. The aim of this study is to assess the effectiveness of selective hemiepiphysiodesis in improving femoral head sphericity in patients with LCPD with previous onset of ovalization.</p><p><strong>Methods: </strong>We compared 71 hips undergoing prophylactic selective hemiepiphysiodesis (surgical group) against 86 hips managed nonsurgically (control group). Radiographic evaluations were performed at 3 time points (3 y after disease onset, 5 y after disease onset, and skeletal maturity) to assess disease progression and intervention effects, measuring the ellipsoidal index (EI), the Reimer migration index (RMI), and the articulotrochanteric distance (ATD), with classifications according to the Herring scale and final sphericity assessments.</p><p><strong>Results: </strong>Both cohorts were initially comparable in terms of age at onset, sex, and degree of deformity, showing similar EI, Herring classifications, and RMI (P>0.05). At T2, significant improvements were observed in the EI, RMI, and ATD in the surgical group compared with the control group. At skeletal maturity, the surgical group demonstrated significantly improved sphericity across all 3 indices (P<0.05), confirming the effectiveness of selective hemiepiphysiodesis in halting and partially reversing the ovalization process. The sphericity deviation score was significantly lower in the operated group (28±12) compared with the control group (43±28), the EI improved to 1.68±0.25 in the operated group from 2.11±0.33 in the controls, and the RMI showed a marked improvement (24.0±8.1) compared with controls (32.4±7.3).</p><p><strong>Conclusions: </strong>Growth modulation by selective hemiepiphysiodesis effectively disrupts the progression of femoral head ovalization and enhances sphericity. This intervention presents a viable option for mitigating the ellipsoidal process in patients with LCPD, suggesting a significant potential to improve long-term outcomes by addressing early signs of deformity.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085218","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}
引用次数: 0
Improving Postoperative Pain Management in Pediatric Supracondylar Humerus Fractures With Local Anesthesia. 局部麻醉改善小儿肱骨髁上骨折术后疼痛处理。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-19 DOI: 10.1097/BPO.0000000000003043
Bhavana Gunda, Lisa M Tamburini, Malcolm N Hamilton-Hall, Andrew M Block, Adam Weaver, Sonia Chaudhry
{"title":"Improving Postoperative Pain Management in Pediatric Supracondylar Humerus Fractures With Local Anesthesia.","authors":"Bhavana Gunda, Lisa M Tamburini, Malcolm N Hamilton-Hall, Andrew M Block, Adam Weaver, Sonia Chaudhry","doi":"10.1097/BPO.0000000000003043","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003043","url":null,"abstract":"<p><strong>Background: </strong>With an annual incidence of 177 per 100,000 patients, supracondylar humerus fractures (SCHF) are the most common elbow fracture in the pediatric population.1,2 Pain control after closed reduction and percutaneous pinning (CRPP) of SCHF may be improved with the use of a local anesthetic. We aimed to assess the effects of local bupivacaine administration on immediate post-operative pain and opioid requirements.</p><p><strong>Methods: </strong>A retrospective chart review was performed for patients undergoing CRPP of SCHF from September 1, 2018 to September 30, 2022 at a single institution. Two groups (local vs. no local) were formed based on intraoperative administration of bupivacaine. Post-anesthesia care unit (PACU) records were reviewed for type and dose of pain medications administered and pain scores.</p><p><strong>Results: </strong>Three hundred thirty-five patients (114 local, 221 no local) were included in review. No differences were noted in demographic or injury characteristics. The local and no-local groups had average PACU pain scores of 2.2±3.2 and 3.3±3.5, respectively. There was no significant difference between groups in percentage of patients who received Tylenol, Motrin, and Toradol. There was a significant difference in the number of patients who received morphine with 42% of patients in the local group requiring morphine compared with 64% of patients in the no-local group. The average weight-based dose of morphine in the local group was 0.002 mg/kg±0.001 and 0.003 mg/kg±0.008 in the no-local group. No differences were noted in postoperative complications or unexpected follow-up.</p><p><strong>Conclusions: </strong>The use of local bupivacaine intraoperatively improved pain control as evidenced by fewer patients requiring morphine and lower pain scores in the local group. Local bupivacaine is a low-cost, low-risk intervention that can be used after CRPP of SCHF that may improve immediate postoperative pain and facilitate quicker transition to oral pain medications with decreased need for IV opioid medications.</p><p><strong>Level of evidence: </strong>Level IIIB-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085507","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}
引用次数: 0
To Splint or Not to Splint: Outcomes of Forearm Fracture Treatment With Elastic Intramedullary Nailing. 弹性髓内钉治疗前臂骨折的疗效。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-19 DOI: 10.1097/BPO.0000000000003104
Tomasz Schwarz, Ewa Kotwicka-Jurczyk, Pascal Sturz, Piotr Janusz
{"title":"To Splint or Not to Splint: Outcomes of Forearm Fracture Treatment With Elastic Intramedullary Nailing.","authors":"Tomasz Schwarz, Ewa Kotwicka-Jurczyk, Pascal Sturz, Piotr Janusz","doi":"10.1097/BPO.0000000000003104","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003104","url":null,"abstract":"<p><strong>Introduction: </strong>When surgical treatment is indicated, closed reduction with elastic stable intramedullary nailing (ESIN) is a widely accepted technique for managing both-bone forearm fractures in children. However, the optimal postoperative protocol-particularly the necessity and duration of immobilization-remains a matter of debate.</p><p><strong>Objective: </strong>This study aims to compare complication rates in patients with both-bone forearm fractures treated with ESIN, with or without postoperative splint immobilization.</p><p><strong>Methods: </strong>This retrospective study included 137 patients with displaced and unstable both-bone forearm shaft fractures who underwent surgical treatment with ESIN at our Department of Pediatric Surgery, Orthopedics, and Traumatology between January 2020 and August 2022. Postoperative immobilization was decided individually by the operating surgeon. Data collected included fracture etiology, healing time, complications, and final clinical outcomes.</p><p><strong>Results: </strong>Eighty-one patients were treated with postoperative splint immobilization, while 56 patients did not receive immobilization. There was no significant difference in bone healing time between the 2 groups. However, the complication rate was higher in the splinted group (16%) compared with the nonsplinted group (5.4%). In addition, open fractures and the need for open reduction were significantly associated with an increased risk of complications. No differences were observed between the groups in terms of QuickDASH scores.</p><p><strong>Conclusion: </strong>Postoperative splint immobilization does not appear to be necessary to achieve satisfactory outcomes following ESIN treatment of both-bone forearm fractures in pediatric patients. It does not influence bone healing time or functional recovery and may be associated with a higher risk of complications. Open fractures and the requirement for open reduction are additional factors associated with increased complication rates.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085878","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}
引用次数: 0
Enhancing X-Ray Orders by Utilizing Proper Physical Examination and Applying Clinical Guidelines. 通过适当的体格检查和应用临床指南来加强x光检查。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-18 DOI: 10.1097/BPO.0000000000003112
Samuel K Gerak, Charles T Mehlman
{"title":"Enhancing X-Ray Orders by Utilizing Proper Physical Examination and Applying Clinical Guidelines.","authors":"Samuel K Gerak, Charles T Mehlman","doi":"10.1097/BPO.0000000000003112","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003112","url":null,"abstract":"<p><strong>Background: </strong>Many pediatric injuries can be diagnosed with one radiograph. Because of health care costs and radiation risks, provider prudence while ordering radiographs is crucial. Although clinical guidelines like Ottawa Ankle Rules (OAR) and Ottawa Knee Rules (OKR) exist, the decision to order radiographs often bypasses clinical judgment. The purpose of this study was to conduct a review of the radiographic practices of providers.</p><p><strong>Methods: </strong>This was a retrospective cohort of 179 pediatric patients with an extremity injury. Detailed chart review was performed on patients regarding demographics, HPI, physical exam, radiographs, and follow-up. Primary outcomes included radiographs and their relationship to the physical examination. Specifically, knee, ankle, and foot complaints were examined in relation to OAR and OKR. Predictor variables included age, sex, ordering provider, and location of presentation.</p><p><strong>Results: </strong>At least one set of unnecessary radiographs was performed in 139 (86.3%) of 161 patients with documentation of physical examination. Decreased age was significantly associated with outcomes: unnecessary knee and foot radiographs per OAR and OKR, having completely negative radiographs, having unnecessary radiographs performed, and having zero radiographs indicated. Increased age was correlated with an increase in unnecessary radiographs ordered. Neither provider type nor location of triage showed significant outcomes.</p><p><strong>Conclusions: </strong>There is a significant number of patients that are not receiving a proper screening before radiographic orders. Providers should return to physical examination and the utilization of clinical guidelines to best serve their patients, while understanding some of the ways that age may negatively impact their habits.</p><p><strong>Level of evidence: </strong>Level III-retrospective diagnostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080933","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}
引用次数: 0
Factors Affecting Lateral Overgrowth in Operatively Treated Lateral Condyle Fractures in Children: Comment on Study By Bloodworth et al. 影响手术治疗的儿童外侧髁骨折外侧过度生长的因素:对Bloodworth等人研究的评论。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-17 DOI: 10.1097/BPO.0000000000003095
Siddharth Jain, Sourabh K Sinha, Prateek Behera, John A Santoshi, Sonal Mishra
{"title":"Factors Affecting Lateral Overgrowth in Operatively Treated Lateral Condyle Fractures in Children: Comment on Study By Bloodworth et al.","authors":"Siddharth Jain, Sourabh K Sinha, Prateek Behera, John A Santoshi, Sonal Mishra","doi":"10.1097/BPO.0000000000003095","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003095","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075649","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}
引用次数: 0
Bilateral Femur Fractures in Children: 14 Years of Experience at a Level I Pediatric Trauma Center. 儿童双侧股骨骨折:在一级儿科创伤中心14年的经验。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-16 DOI: 10.1097/BPO.0000000000003092
Jonathan Laredo, Matthew Bounds, Derek M Kelly, David D Spence, Benjamin W Sheffer
{"title":"Bilateral Femur Fractures in Children: 14 Years of Experience at a Level I Pediatric Trauma Center.","authors":"Jonathan Laredo, Matthew Bounds, Derek M Kelly, David D Spence, Benjamin W Sheffer","doi":"10.1097/BPO.0000000000003092","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003092","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous bilateral femur fractures (SBFFs) are an extremely rare type of injury, particularly among pediatric patients. Because of their infrequency, pediatric SBFFs are poorly characterized in the literature. Here, we review our center's experience with managing them. We hypothesized that such injuries were likely to be accompanied by additional traumatic injuries to other organ systems/parts of the body.</p><p><strong>Methods: </strong>This retrospective, observational cohort study was conducted on all patients who underwent treatment for SBFFs at a freestanding, level I pediatric hospital between May 2008 and September 2022. Patients were excluded from the study if they were over age 18 or had bilateral femur fractures that occurred on separate occasions. Demographic data and details related to the patient's presenting injuries, hospital stay, and orthopaedic interventions were collected through chart review. Injury Severity Scores (ISS) were obtained from the trauma registry.</p><p><strong>Results: </strong>A total of 17 patients were identified, most of whom were male, black, injured in a motor vehicle accident as unrestrained passengers, and had an associated injury to the head or neck at the time of presentation. Median age was 5.65 years (range: 0.93 to 16.84 y) while the median ISS was 14. Nearly half of the patients were admitted or transferred to the intensive care unit during hospitalization. One quarter of the patients required mechanical ventilation during the hospital stay, with 2 patients (12%) developing symptoms concerning for pulmonary fat embolism. No mortalities were observed following treatment of the femur fractures.</p><p><strong>Conclusion: </strong>To date, this is the largest cohort of pediatric patients with simultaneous bilateral femur fractures that has been examined. More research into this topic should be carried out with larger sample sizes to further characterize the complication profile and long-term outcomes of this injury pattern.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069856","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}
引用次数: 0
Comparing the Clinical Outcomes and Child Opportunity Index of Patients With Congenital Talipes Equinovarus After Early Treatment (<4 Wk Old) and Late Treatment (≥ 4 Wk Old). 先天性马蹄足内翻患者早期治疗(<4周)与晚期治疗(≥4周)的临床结局及儿童机会指数比较
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-16 DOI: 10.1097/BPO.0000000000003111
Jordan Giordano, Edina Gjonbalaj, Leila Mehraban Alvandi, Grace Yang, Alexandra Hoffman, Alexa J Karkenny, Melinda Sharkey, Jacob F Schulz
{"title":"Comparing the Clinical Outcomes and Child Opportunity Index of Patients With Congenital Talipes Equinovarus After Early Treatment (<4 Wk Old) and Late Treatment (≥ 4 Wk Old).","authors":"Jordan Giordano, Edina Gjonbalaj, Leila Mehraban Alvandi, Grace Yang, Alexandra Hoffman, Alexa J Karkenny, Melinda Sharkey, Jacob F Schulz","doi":"10.1097/BPO.0000000000003111","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003111","url":null,"abstract":"<p><strong>Background: </strong>Clubfoot is the most common congenital abnormality of the lower extremity. The widely accepted Ponseti casting method includes a series of manipulations and casts often followed by Achilles tenotomy then use of a foot abduction orthosis. Some evidence suggests initiation of casting within a week of age improves outcomes but access to care and socioeconomic factors can impact timing of casting initiation. This study evaluates differences in clinical outcomes, demographic variables, and Child Opportunity Index (COI) between patients who initiated treatment before and after 4 weeks of age.</p><p><strong>Methods: </strong>This was a retrospective study on patients with idiopathic clubfoot treated with the Ponseti method at a tertiary care center between 2011 and 2023. Patients were categorized into 2 groups by age at initial cast: early treatment (<4 wk) and late treatment (≥4 wk to 6 mo). Demographic and clinical data were collected, including treatment outcomes and bracing issues, and COI scores were recorded.</p><p><strong>Results: </strong>Seventy-eight patients were included: 60 in the early group (92 feet) and 18 in the late group (25 feet). Groups differed significantly by age at initiation of casting (P=<0.001). There were no significant differences in other demographic characteristics or insurance type. Patients in the late group were more likely to experience non-skin-related bracing issues (P=0.047). No significant differences were found in other clinical or bracing outcomes. Patients in the late group were more likely to have a low/very low total COI (P=0.008). There were no significant differences in domain-specific COI scores (health, socioeconomic, education).</p><p><strong>Conclusions: </strong>Clubfoot patients who initiated treatment ≥4 weeks had a lower total COI, indicating that socioeconomic factors may be associated with delayed treatment. Although patients in the late group experienced more non-skin-related bracing issues, there were no significant differences in other clinical outcomes when compared with those treated at <4 weeks of age. These findings may alleviate pressure to initiate treatment by the first week of life when there are barriers to accessing care that can be overcome within a month and highlight the need for providers to consider socioeconomic profiles in treatment planning.</p><p><strong>Level of evidence: </strong>This was a retrospective cohort study comparing 2 methods of treatment between 2 patient groups, making it a level III therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069847","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}
引用次数: 0
Femoral, Hip, and Pelvic Anomalies in Tibial Deficiency and Their Impact on Treatment. 胫骨缺陷的股骨、髋关节和骨盆异常及其对治疗的影响。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-16 DOI: 10.1097/BPO.0000000000003115
Alyssa Barré, Grace Markowski, David E Westberry, Kenneth P Powell, Janet L Walker
{"title":"Femoral, Hip, and Pelvic Anomalies in Tibial Deficiency and Their Impact on Treatment.","authors":"Alyssa Barré, Grace Markowski, David E Westberry, Kenneth P Powell, Janet L Walker","doi":"10.1097/BPO.0000000000003115","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003115","url":null,"abstract":"<p><strong>Background: </strong>Tibial deficiency (TD) is a rare congenital condition with an incidence of 5 to 21/million live births. While femoral and fibular deficiencies are more commonly recognized and frequently co-occur, associated femoral, hip, and pelvic (FHP) anomalies in TD remain under-characterized. Treatment options for TD include the use of orthotics, amputation with prosthetic management, and limb reconstruction. The presence of additional ipsilateral lower extremity anomalies and their impact on management are unknown. This study aims to characterize FHP anomalies in TD patients and assess their impact on treatment decisions.</p><p><strong>Methods: </strong>A retrospective review was conducted on TD patients seen at seven tertiary surgical facilities between 2004 and 2022. Demographic data, radiographic findings, anomalies, and treatment details were collected and analyzed. TD was classified using the Jones classification when possible.</p><p><strong>Results: </strong>A total of 492 patients with 650 tibial-deficient limbs were included. FHP anomalies were identified in 19% of limbs, with femoral anomalies most common (13%), followed by hip anomalies (8%) and pelvic anomalies (1%). The majority (72%) of FHP anomalies occurred with Jones type 1 TD. Treatment modifications for limbs with these anomalies were required in 50%, primarily additional procedures, treatment/surgery for the additional leg length loss, or a change in the level of prosthesis.</p><p><strong>Conclusions: </strong>FHP anomalies occur in 19% of limbs with TD. They necessitate additional treatment or a change in treatment plan for 9% of all TD limbs, and 50% of TD limbs with FHP anomalies. Further studies are needed to explore the functional outcomes for these patients with femoral, hip, and pelvic anomalies seen in conjunction with ipsilateral tibial deficiency and the impact on factors such as mobility and prosthesis selection.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069811","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}
引用次数: 0
Perfusion Magnetic Resonance Imaging is the Best Way to Predict the Occurrence of Avascular Necrosis in Slipped Capital Femoral Epiphysis. 灌注磁共振成像是预测股骨头骨骺滑动后发生缺血性坏死的最佳方法。
IF 1.5 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-09-16 DOI: 10.1097/BPO.0000000000003116
Akitoshi Sakuma, Jun Kakizaki, Yasuhiro Oikawa, Tomoya Inukai, Yuko Segawa, Yohei Tomaru, Takashi Saisu, Makoto Kamegaya
{"title":"Perfusion Magnetic Resonance Imaging is the Best Way to Predict the Occurrence of Avascular Necrosis in Slipped Capital Femoral Epiphysis.","authors":"Akitoshi Sakuma, Jun Kakizaki, Yasuhiro Oikawa, Tomoya Inukai, Yuko Segawa, Yohei Tomaru, Takashi Saisu, Makoto Kamegaya","doi":"10.1097/BPO.0000000000003116","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003116","url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis (AVN) is a known complication of slipped capital femoral epiphysis (SCFE) that can lead to poor long-term outcomes. Therefore, predicting the onset of AVN is crucial for effective management. While various preoperative methods have been proposed to predict AVN, none have demonstrated accurate prediction. This study aimed to assess the efficacy of preoperative perfusion magnetic resonance imaging (MRI) in accurately predicting the onset of AVN in patients with SCFE.</p><p><strong>Methods: </strong>This study included 17 cases (18 hips) treated for SCFE at a single institution between January 2017 and April 2021. Preoperative factors such as stability (stable, unstable), gradual onset (acute, chronic, acute on chronic), slip severity (mild, moderate, severe), superior translation, bone scintigraphy results (HOT, COLD), and perfusion MRI findings were compared with the incidence of AVN. Perfusion MRI involved sequential imaging of the contrast-enhanced femoral head to generate time intensity curves, categorized as type A (similar enhancement on both sides), type B (delayed but stronger enhancement on the affected side), and type C (no enhancement on the affected side).</p><p><strong>Results: </strong>AVN was observed in 4 out of 18 hips (22%). Among unstable hips, 4 out of 8 (50%) developed AVN, and superior translation averaged 20.8 ± 6.54 mm in 4 cases with AVN, and a statistically significant difference was observed in each factor. In terms of gradual onset, AVN occurred in 3 out of 7 acute cases (43%) and 1 out of 7 acute-on-chronic cases (14%). Regarding slip severity, AVN was found in 1 out of 7 moderate cases (14%) and 3 out of 9 severe cases (33%); there was no significant difference. AVN was observed in 4 out of 5 cases (80%) showing a COLD pattern on bone scintigraphy, and in all 4 cases (100%) classified as type C on perfusion MRI. Statistically significant differences were found for both imaging modalities.</p><p><strong>Conclusions: </strong>Stability, superior translation, bone scintigraphy, and perfusion MRI in cases of SCFE may serve as effective predictors of future AVN.</p><p><strong>Level of evidence: </strong>Level Ⅳ.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069799","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}
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