Journal of Pediatric Orthopaedics最新文献

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The Risks and Benefits of Definitive Surgery in the Graduation of Idiopathic Early-Onset Scoliosis (I-EOS) Patients Whose Deformities Were Managed With Growing Rods: A Comparison With Matched Adolescent Idiopathic Scoliosis (AIS) Patients. 特发性早发性脊柱侧凸(I-EOS)患者用生长棒治疗畸形的最终手术的风险和收益:与匹配的青少年特发性脊柱侧凸(AIS)患者的比较
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-28 DOI: 10.1097/BPO.0000000000002966
Gokay Dursun, Rafik Ramazanov, Halil G Demirkiran, Mehmet Ayvaz, Muharrem Yazici
{"title":"The Risks and Benefits of Definitive Surgery in the Graduation of Idiopathic Early-Onset Scoliosis (I-EOS) Patients Whose Deformities Were Managed With Growing Rods: A Comparison With Matched Adolescent Idiopathic Scoliosis (AIS) Patients.","authors":"Gokay Dursun, Rafik Ramazanov, Halil G Demirkiran, Mehmet Ayvaz, Muharrem Yazici","doi":"10.1097/BPO.0000000000002966","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002966","url":null,"abstract":"<p><strong>Background: </strong>Growing rod treatment (GR) is one of the most popular methods for idiopathic EOS and is usually followed by posterior instrumented spinal fusion (PISF), which is also called graduation. Graduation surgery is technically demanding and complicated, leading to a tendency to avoid definitive fusion when there is an adequate improvement in scoliosis angle, no implant failure, and no need to change the instrumentation level. The aim of the present study was to compare the risks and benefits of PISF between patients with adolescent idiopathic scoliosis (AIS) treated with standard PISF against those with idiopathic EOS treated with GR and graduated with PISF.</p><p><strong>Methods: </strong>The study included patients with I-EOS who were treated with dual GR and PISF, and those with AIS who underwent standard PISF with AIS during the study period. The AIS and EOS groups were matched in terms of scoliosis curve magnitude, T2-T12 kyphosis, L1-S1 lordosis, sex, and age variables by propensity score matching.</p><p><strong>Results: </strong>Seven hundred seventy-six patients (24 EOS and 752 AIS) were included in the study. Seventy-two AIS patients were matched against 24 EOS patients. Statistically significant differences were found between the groups in terms of scoliosis correction percentage, surgical time, transfusion need, and number of instrumented segments. However, the percentage of T1-T12 length increase, percentage of T1-S1 length increase, instrumented spinal segment length increase, and the estimated blood loss were similar between the groups.</p><p><strong>Conclusion: </strong>Although the EOS group had longer surgical time (30 min longer), more bleeding (75 cc more), and less correction of the coronal deformity, trunk height gained by definitive surgery was the same as that in the AIS group. There was a difference in favor of AIS between the groups in terms of coronal deformity correction rates, but the final deformity size in the EOS patients was clinically insignificant (22±13 degrees). Definitive fusion in EOS with idiopathic etiology does not carry an excessive risk for complications, and the gains obtained by the patients after surgery are comparable to AIS patients who underwent PISF surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729917","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
Pinning and Arthroscopic Trimming for Mild Slipped Capital Femoral Epiphysis: Comparative Study With Traditional In Situ Pinning and Modified Dunn Procedure. 关节镜下钉钉和修剪治疗轻度股骨骨骺滑动:与传统原位钉钉和改良Dunn手术的比较研究。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-26 DOI: 10.1097/BPO.0000000000002960
Alessandro Aprato, Andrea Audisio, Beatrice Cambursano, Matteo Giachino, Stefano Artiaco, Federico Fusini, Alessandro Massè
{"title":"Pinning and Arthroscopic Trimming for Mild Slipped Capital Femoral Epiphysis: Comparative Study With Traditional In Situ Pinning and Modified Dunn Procedure.","authors":"Alessandro Aprato, Andrea Audisio, Beatrice Cambursano, Matteo Giachino, Stefano Artiaco, Federico Fusini, Alessandro Massè","doi":"10.1097/BPO.0000000000002960","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002960","url":null,"abstract":"<p><strong>Introduction: </strong>Mild slipped capital femoral epiphysis (SCFE) was traditionally treated with in situ pinning (ISP), a technique that stabilizes the physis but does not restore the anterior-superior femoral head offset. This residual deformity can lead to femoroacetabular impingement and early joint degeneration. Therefore, immediate arthroscopic trimming was associated to in situ pinning (ISPAT). The primary goal is to assess the clinical and radiologic outcomes of patients treated with ISPAT. Secondarily, outcomes were compared with traditional in situ pinning (ISP) and modified Dunn's procedure (MDP).</p><p><strong>Methods: </strong>Patients with Southwick 1 SCFE were included. Patients were divided in 3 groups according to surgical treatment: (1) pinning in situ associated to arthroscopic trimming (ISPAT), (2) pinning in situ (ISP), and (3) modified Dunn procedure (MDP). Outcomes were assessed with clinical parameters (range of motion (ROM), impingement test, mHHS and UCLA activity score) and radiologic parameters (Southwick angle, alpha angle). Early and late complications were recorded. Comparative analysis was performed.</p><p><strong>Results: </strong>A total of 47 patients (59 hips) were included in the study (ISPAT: 12, ISP: 34, MDP: 13). Preoperative Southwick slip angle (SA) was higher in the ISPAT and MDP groups compared with the ISP group (ISPAT vs. MDP, P=0.85; ISPAT vs. ISP, P<0.001; MDP vs. ISP, P<0.001)​. Surgical time differed between groups (ISPAT 69.9±17.7; ISP 37.0±21; MDP 140.0±26.5 min; P<0.001). The ISPAT group had a higher postoperative internal rotation (23.4±7.9 deg) compared with ISP (15.0±7.1 deg, P<0.001) but similar to MDP (28.2±6.4 deg; P=0.099). No differences were found in mHHS scores across groups (ISPAT 90.7±0.9, ISP 86.8±10.0, MDP 90.6±1.2, P=0.18)​. Postoperatively, the alpha angle of the ISPAT group demonstrated significant improvement postoperatively (preoperative 81.5±7.7 vs. postoperative 47.7±8.3 deg, P<0.001), with results comparable to MDP (postoperative 45.1±11.3 deg, P=0.45)​. In ISPAT no major complications were recorded. In ISP 4 patients developed osteoarthritis (OA) (2 required total hip arthroplasty). In MDP 1 patient developed OA, but no further surgery was performed.</p><p><strong>Conclusions: </strong>ISPAT is a safe and effective option for managing mild SCFE, providing immediate intervention to address FAI. However, its long-term impact on hip function and osteoarthritis prevention requires further investigation.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710399","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
The Role of Closed Reduction in the Treatment of Pediatric Monteggia Fractures. 闭合复位在小儿蒙氏骨折治疗中的作用。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-25 DOI: 10.1097/BPO.0000000000002958
Claire Schaibley, Beltran Torres-Izquierdo, Jesse Hu, Sabrina Madrigal, Lindley Wall, Charles Goldfarb, Pooya Hosseinzadeh
{"title":"The Role of Closed Reduction in the Treatment of Pediatric Monteggia Fractures.","authors":"Claire Schaibley, Beltran Torres-Izquierdo, Jesse Hu, Sabrina Madrigal, Lindley Wall, Charles Goldfarb, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002958","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002958","url":null,"abstract":"<p><strong>Introduction: </strong>Previous ulnar-based treatment algorithms for pediatric Monteggia fractures advocate for treating incomplete ulnar fractures with closed reduction and casting (CRC) while treating complete fractures surgically. However, recent evidence has suggested that these algorithms may result in overtreatment. This study aimed to evaluate the outcomes of CRC treatment across all ulnar fracture patterns and identify factors associated with CRC failure.</p><p><strong>Methods: </strong>A retrospective study was conducted of patients treated for Monteggia fractures at a single institution from 2002 to 2022. Inclusion criteria were patients younger than 18 at the time of injury, with complete radiographic follow-up from preintervention until the time of bony union. Patients treated surgically without a trial of CRC due to an open fracture or delayed presentation for treatment were excluded. Patient demographics, radiographs, and relevant surgical records were analyzed.</p><p><strong>Results: </strong>Eighty patients, 34 (42.5%) males, were included. Sixty-seven (83.8%) had complete ulnar fractures. The average age at injury was 5.7 years (range: 2 to 17), and the average follow-up was 5.6 months (range: 1 to 71). Fifty-eight (72.5%) patients were successfully treated with CRC. Of the 22 (27.5%) failures, all but 1 required surgery. Older age at injury was a risk factor for CRC failure (P=0.002). Failure occurred in 50% of patients older than 6 and 17.9% of patients ages 6 or younger (P=0.003). Other ulna-related criteria, including Bado classification, fracture pattern, and ulnar displacement, were not significant risk factors.</p><p><strong>Conclusion: </strong>This study's results support an emerging body of evidence suggesting that ulnar-based algorithms may overpredict CRC failure in pediatric Monteggia fractures. A trial of CRC in these fractures, regardless of ulnar fracture pattern, may prevent unnecessary surgical intervention. In this study, 26.3% of patients ultimately required surgery following an initial trial of CRC, whereas previous algorithms would have recommended surgery in 83.8% of patients. However, patients older than 6 may be less likely to retain reduction with CRC, as our study showed that 50% required surgical treatment.</p><p><strong>Level of evidence: </strong>Level III-Therapeutic studies-investigating the results of treatment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700668","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
Evaluation of Foot Osteotomies for Treating Residual Clubfoot Deformities in Ambulatory Children With Arthrogryposis. 足部截骨术治疗活动期儿童关节挛缩残足畸形的疗效评价。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-25 DOI: 10.1097/BPO.0000000000002956
Sadettin Ciftci, Anuj Gupta, Chris Church, John Henley, Maureen Donohoe, Freeman Miller, L Reid Nichols
{"title":"Evaluation of Foot Osteotomies for Treating Residual Clubfoot Deformities in Ambulatory Children With Arthrogryposis.","authors":"Sadettin Ciftci, Anuj Gupta, Chris Church, John Henley, Maureen Donohoe, Freeman Miller, L Reid Nichols","doi":"10.1097/BPO.0000000000002956","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002956","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is the most common deformity seen in children with arthrogryposis. The primary method of treatment for this deformity is serial casting, which has a greater frequency of incomplete correction and recurrence than in idiopathic clubfoot. For both primary and recurring cases, surgical treatments vary from soft-tissue releases to talectomy. This research aimed to evaluate the effectiveness of bony surgical procedures in correcting clubfoot in ambulatory children with arthrogryposis.</p><p><strong>Methods: </strong>The study retrospectively examined ambulatory children with arthrogryposis, all of whom had at least 1 osteotomy procedure on their clubfoot. The treatment's effectiveness was assessed using passive range of motion (PROM), dynamic foot pressure, and the pediatric outcomes data collection instrument (PODCI) utilizing paired t tests. The frequency of subsequent bone surgeries following the initial operation was documented.</p><p><strong>Results: </strong>The study reviewed 20 children who had 49 surgical procedures performed on 24 feet at age 15.1±4.5 years. PROM revealed enhanced ankle dorsiflexion and forefoot abduction (P<0.05). In addition, evaluating dynamic foot pressure, coronal plane pressure index (CPPI), and the timing of heel rise demonstrated significant improvement (P<0.05). PODCI demonstrated improvement in transfer basic mobility (from 80.57±17.31 to 86.50±13.46) and global function (from 69.64±15.03 to 74.50±13.91) (P<0.05). Pain (from 69.58±25.39 to 79.21±26.57; P=0.067) and happiness (from 70.68±27.66 to 79.32±20.02; P=0.052) also improved and approached statistical significance. Moreover, a CPPI of <-94 was found to be predictive for suggesting the necessity of external fixator use according to the receiver operating characteristic analysis done based on our findings (area under the curve: 0.79, P=0.0007). Two children required an additional procedure at 26-months and 37-months postindex surgery because of residual equinus deformity and insufficient correction of forefoot adduction, respectively.</p><p><strong>Conclusion: </strong>This research highlights the substantial role surgical procedures can play in improving ankle PROM, hindfoot-forefoot alignment, dynamic foot position, and functional mobility in children with clubfoot secondary to arthrogryposis. It establishes a basis for future inquiries to delve into the longevity of these benefits and the overall outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700661","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
Pathway for the Differential Diagnosis of Obstetrical Brachial Plexus Palsy. 产科臂丛神经麻痹的鉴别诊断途径。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-24 DOI: 10.1097/BPO.0000000000002957
Kyoko Okuno, Hidehiko Kawabata, Daisuke Tamura, Chikahisa Higuchi
{"title":"Pathway for the Differential Diagnosis of Obstetrical Brachial Plexus Palsy.","authors":"Kyoko Okuno, Hidehiko Kawabata, Daisuke Tamura, Chikahisa Higuchi","doi":"10.1097/BPO.0000000000002957","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002957","url":null,"abstract":"<p><strong>Background: </strong>Obstetrical brachial plexus palsy (OBPP) is a common birth injury, generally presenting as upper limb paralysis at birth. While diagnosis is straightforward when associated with known risk factors, misdiagnoses can nevertheless occur. This study aimed to elucidate the process of differential diagnosis for OBPP by analyzing cases of suspected OBPP, ultimately diagnosed with other conditions.</p><p><strong>Methods: </strong>We reviewed the electronic medical records of patients under 1 year of age presenting with suspected or previously diagnosed OBPP at 2 tertiary childrens' centers in Osaka between 1994 and 2021. Cases were divided into the OBPP and non-OBPP groups, according to the final diagnosis, for comparison of demographic data and physical findings, to determine the clinical course that could be used to differentiate non-OBPP from OBPP.</p><p><strong>Results: </strong>Of the 414 enrolled cases, 387 (93%) were confirmed as OBPP, while 27 (7%) were diagnosed with other conditions. Statistically significant differences were found in gestational age, birth weight, and age of first visit, between the 2 groups, although these were not clinically meaningful for differential diagnosis. Shoulder dystocia was observed in 54% of OBPP cases, but not in non-OBPP cases. The key characteristics of OBPP included paralysis from birth, paralysis following an anatomic distribution, and paralysis that gradually improved without worsening. Conversely, joint contracture immediately after birth was a key indicator for ruling out OBPP. Using these criteria, 24 of 27 suspected cases were excluded from OBPP diagnosis. Of the remaining 3 cases, spinal cord infarction was detected on MRI in 1 case. In the remaining 2 cases, although normal MRI and surgical findings could rule out OBPP, a definite diagnosis could not be made.</p><p><strong>Conclusions: </strong>This study highlights that accurate OBPP diagnosis requires careful verification of specific characteristics. If these characteristics are not met, OBPP becomes less likely, and diagnostic uncertainty persists. An MRI of the brachial plexus is needed in such cases.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692410","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
Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version. 建立一种准确、精确的术中测定股骨变形的替代技术。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-21 DOI: 10.1097/BPO.0000000000002920
Benjamin Yao, Don Li, Jonathan Cui, Kira L Smith, Vineet Tyagi, Joseph B Kahan, Allen Daniel Nicholson, Brian G Smith, Raymond Liu, Daniel Roy Cooperman
{"title":"Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version.","authors":"Benjamin Yao, Don Li, Jonathan Cui, Kira L Smith, Vineet Tyagi, Joseph B Kahan, Allen Daniel Nicholson, Brian G Smith, Raymond Liu, Daniel Roy Cooperman","doi":"10.1097/BPO.0000000000002920","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002920","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version.</p><p><strong>Methods: </strong>To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from -20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version.</p><p><strong>Results: </strong>In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique.</p><p><strong>Conclusions: </strong>Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique.</p><p><strong>Clinical relevance: </strong>The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700570","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
Stability of Idiopathic Lumbar Curves During Growth in Pediatric Patients After Instrumented Isolated Thoracic Fusion. 固定式孤立胸椎融合术后儿童生长过程中特发性腰椎弯曲的稳定性。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-17 DOI: 10.1097/BPO.0000000000002948
Jake H Goldfarb, Edward M Barksdale, Scott J Luhmann, Brian A Kelly, Kirsten Brouillet, Simon Y Tang, Blake K Montgomery
{"title":"Stability of Idiopathic Lumbar Curves During Growth in Pediatric Patients After Instrumented Isolated Thoracic Fusion.","authors":"Jake H Goldfarb, Edward M Barksdale, Scott J Luhmann, Brian A Kelly, Kirsten Brouillet, Simon Y Tang, Blake K Montgomery","doi":"10.1097/BPO.0000000000002948","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002948","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated thoracic fusion (ITF) for idiopathic scoliosis preserves lumbar segment motion but risks lumbar curve progression. This study examined if Lenke classification, residual disc wedging, or tilting at the lowest instrumented vertebrae (LIV) are associated with lumbar curve progression or adding-on after ITF.</p><p><strong>Methods: </strong>A retrospective analysis of idiopathic scoliosis patients aged 8 to 12 years treated with primary ITF was conducted. Inclusion criteria were a diagnosis of idiopathic scoliosis, LIV T10-L1, and ≥2 years of postoperative follow-up. Growth, Lenke classification, lumbar magnitude, angle of disc wedging below the LIV, and LIV tilt were assessed preoperatively, at 6 weeks postoperative, and at final follow-up. Standard descriptive statistics and repeated measures ANOVA were performed, with significance set at P<0.05.</p><p><strong>Results: </strong>Fifty-seven patients were included, with a mean follow-up of 4.6 years (2 to 12 y). At surgery, 67% (38 patients) were Risser 0. There was no significant lumbar curve increase from the first (24 degrees±12) to the final follow-up (22 degrees±14, P=0.21). Patients with a lumbar curve ≥30 degrees at first follow-up (n=16) also showed no increase in curve magnitude (40 degrees±8 at first follow-up vs. 37 degrees±17 at final follow-up, P=0.47). Disc wedging ≥5 degrees and LIV tilt ≥5 degrees were not associated with lumbar curve progression (29 degrees±14 at first follow-up vs. 28 degrees±17 at final follow-up for disc wedging, P=0.52; and 30 degrees±12 at first follow-up vs. 27 degrees±16 at final follow-up for LIV tilt, P=0.28) or adding-on. Lenke classification was not associated with lumbar curve progression. However, Lenke 3 and 4 patients had larger curves immediately after surgery and final lumbar curves ≥45 degrees. Of 9 Lenke 3 and 4 patients, 3 had lumbar curves ≥45 degrees at the final follow-up. No Lenke 1 or 2 patients (0 out of 41) had lumbar curves ≥45 degrees at the final follow-up (P<0.01).</p><p><strong>Conclusion: </strong>In pediatric ITF patients, disc wedging and LIV tilt were not associated with adding-on or lumbar curve progression.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649466","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
Incidence and Risk Factors for Steroid-associated Osteonecrosis in Children and Adolescents: A Systematic Review of the Literature. 儿童和青少年类固醇相关性骨坏死的发病率和危险因素:文献的系统回顾。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-13 DOI: 10.1097/BPO.0000000000002919
Taylor Johnson, Hiba Naz, Vanessa Taylor, Saima Farook, Grady Hofmann, Kathryn Harbacheck, Nicole S Pham, Stephanie M Smith, Karen Chao, Tzielan Lee, Stuart Goodman, Kevin Shea
{"title":"Incidence and Risk Factors for Steroid-associated Osteonecrosis in Children and Adolescents: A Systematic Review of the Literature.","authors":"Taylor Johnson, Hiba Naz, Vanessa Taylor, Saima Farook, Grady Hofmann, Kathryn Harbacheck, Nicole S Pham, Stephanie M Smith, Karen Chao, Tzielan Lee, Stuart Goodman, Kevin Shea","doi":"10.1097/BPO.0000000000002919","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002919","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Steroid-associated osteonecrosis in pediatric patients with inflammatory and oncologic disease is an uncommon yet debilitating condition causing significant functional disability. Pediatric orthopaedic surgeons encounter this population during stages in which surgical intervention may be necessary for joint preservation. Various risk factors for steroid-associated osteonecrosis have been suggested, but a comprehensive systematic review of the literature has not been performed. The purpose of this systematic review is to investigate incidence and risk factors for steroid-associated osteonecrosis in pediatric, adolescent, and young adult patients to help guide clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines. MEDLINE, Embase, PubMed databases, and the Cochrane Central Registry of Controlled Trials were used to search for studies assessing risk factors for osteonecrosis in patients 0 to 21 years of age with systemic corticosteroid exposure. Two reviewers independently screened titles, abstracts, and full texts of retrieved studies for inclusion. Quality assessment of retrospective and prospective nonrandomized case-control and cohort studies was completed using the MINORS criteria. Outcomes and variables of interest included reported incidence and demographic, clinical, radiographic, and genetic risk factors for steroid-associated osteonecrosis. Reported statistics were deemed significant if P &lt;0.05. Due to heterogeneous and limited reporting, data were not combined in a meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The literature search revealed 895 articles and 37 articles were included. Of the included studies, 47% were retrospective cohort studies, and 39% were prospective cohort studies. There were 3 randomized controlled trials included. of the included studies, 95% were conducted in patients with leukemia and/or lymphoma. The overall prevalence of steroid-associated osteonecrosis ranged from 1% to 39%. Osteonecrosis was diagnosed with a mean or median of 1 to 2 years after the start of steroid therapy, and the most frequently involved joints were knees, followed by hips. Age older than 10 years, female gender, greater body mass index, and white and non-Hispanic race were the most reported risk factors for steroid-associated osteonecrosis. Core decompression was a frequent operative treatment with variable improvement in outcomes. For pediatric leukemia patients, those stratified as High risk and Intermediate risk were at the greatest risk for steroid-associated osteonecrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This systematic review summarizes specific risk factors and demographics of steroid-associated osteonecrosis and helps lay the foundation for future studies to delineate the causal role of risk factors and guides clinical decision-making for current an","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615527","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
Validation of Parental Reports in Assessing Idiopathic Toe Walking Using Quantitative In-Shoe Device Measurements. 使用定量鞋内装置测量评估特发性脚趾行走的父母报告的验证。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-12 DOI: 10.1097/BPO.0000000000002950
Logan Morrison, Susan Sienko, Mark McMulkin, Bruce MacWilliams, Jon Davids, Paige Lemhouse, Jeremy Bauer
{"title":"Validation of Parental Reports in Assessing Idiopathic Toe Walking Using Quantitative In-Shoe Device Measurements.","authors":"Logan Morrison, Susan Sienko, Mark McMulkin, Bruce MacWilliams, Jon Davids, Paige Lemhouse, Jeremy Bauer","doi":"10.1097/BPO.0000000000002950","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002950","url":null,"abstract":"<p><strong>Background: </strong>Toe walking is prevalent among children, affecting 5% to 24% of the pediatric population. Clinicians rely on parental reports of frequency of toe walking to guide clinical decision making and outcomes assessment. However, recall accuracy and differing environments challenge the reliability of parental reports. This study aims to validate parental reports against quantitative in-shoe device measurements (NURVV/RUN).</p><p><strong>Methods: </strong>Twenty children with persistent idiopathic toe walking (ITWp) (mean age: 9.6y; 13 males, 7 females) from 8 pediatric orthopaedic specialty care sites participated in this multicenter study. Parents assessed toe walking frequency using a 6-point scale, while children wore NURVV/RUN insoles for 8 hours/day over 7 days. Insole sensors recorded foot strike patterns (rearfoot, midfoot, and forefoot), which were classified using the same severity scale. Agreement between parental reports and NURVV data was assessed using weighted Kappa statistics (P<0.05).</p><p><strong>Results: </strong>Before intervention, children with ITWp exhibited daily walking patterns: 61.7% forefoot, 15.3% midfoot, and 22.8% hindfoot contact. Agreement analysis showed substantial agreement (k=0.688, P<0.001) for combined forefoot and midfoot contacts and fair agreement (k=0.381, P<0.005) for isolated forefoot contact.</p><p><strong>Conclusion: </strong>Parental reports of toe walking prevalence in their children are relatively accurate, supporting their use in clinical management. However, quantitative in-shoe devices provide a more objective and quantitative understanding of ITWp frequency and have the potential to guide clinical decision-making and outcomes assessment children with ITWp.</p><p><strong>Level of evidence: </strong>Level II-diagnostic study. See instructions to authors for a complete description of levels of evidence.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615793","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
Anterior Hip Clearance in Residual Legg-Calvé-Perthes Disease. 残腿- calv<s:1> - perthes病的髋前清除率。
IF 1.4 3区 医学
Journal of Pediatric Orthopaedics Pub Date : 2025-03-10 DOI: 10.1097/BPO.0000000000002949
Luke G Johnson, Honglin Zhang, Benjamin Joseph, Emily K Schaeffer, Kishore Mulpuri, David R Wilson
{"title":"Anterior Hip Clearance in Residual Legg-Calvé-Perthes Disease.","authors":"Luke G Johnson, Honglin Zhang, Benjamin Joseph, Emily K Schaeffer, Kishore Mulpuri, David R Wilson","doi":"10.1097/BPO.0000000000002949","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002949","url":null,"abstract":"<p><strong>Background: </strong>The mechanical environment in the hip in people with residual Legg-Calvé-Perthes disease (LCPD) deformity is still poorly understood. Anterior impingement is thought to contribute to poor long-term outcomes such as early-onset osteoarthritis, but it has not been measured directly using imaging in high flexion. Our objective in this study was to determine the association between radiographic morphologic scores of LCPD deformity and reduced anterior hip clearance.</p><p><strong>Methods: </strong>We measured the anterior clearance (β-angle) of 20 LCPD-affected hips (17 patients) scanned in 4 functional postures using an upright open MRI scanner. Mixed effects models were used to describe the relationship between β, posture, and morphologic measures of deformity (Stulberg classification and Sphericity Deviation Score).</p><p><strong>Results: </strong>Hip β-angle was significantly associated with posture (P<0.001). Aspherical (Stulberg III to V) hips had lower β across all postures compared with spherical (Stulberg I to II) hips (difference in β = -39.1 degrees; 95% CI: -71.9 to -6.2 degrees; P=0.020). An increased SDS was strongly associated with reduced β in neutral hip postures (P=0.002, 0.005, respectively), but not with elevated adduction and internal rotation. Due to morphologic heterogeneity, 6 hips (out of 20 overall) did not fit the overall trend.</p><p><strong>Conclusions: </strong>Our results show an association between more severe radiographic deformity and a greater potential for anterior impingement, a known contributor to cartilage degradation. However, the large proportion of cases where morphologic deformity does not align with functional clearance suggests current radiographic measures of deformity may not be sufficient to predict long-term outcomes in every LCPD patient.</p><p><strong>Clinical relevance: </strong>(1) Hip joint asphericity in LCPD is associated with less anterior clearance and a greater potential for anterior impingement in high flexion postures. (2) Considering both morphologic and functional parameters may improve our understanding of the causes of pain and early-onset osteoarthritisin LCPD, as opposed to morphology alone.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586096","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
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