Journal of Pediatric Orthopaedics最新文献

{"title":"Management of Failed Multidirectional Shoulder Instability Surgery: To Revise or Not to Revise.","authors":"Michael A Silva, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000003102","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003102","url":null,"abstract":"<p><strong>Background: </strong>Multidirectional instability (MDI) of the shoulder is a complex condition with a high rate of recurrence after surgical intervention in the younger population. This study was undertaken to determine the best treatment strategy for adolescent patients who fail their index surgical capsulorrhaphy.</p><p><strong>Methods: </strong>Patients managed surgically over a 6-year period for MDI at a pediatric facility with 2 years minimum follow-up were evaluated via demographics, arthroscopic findings, and patient-reported outcomes (PROs): qDASH (short form Disabilities Arm, Shoulder, and Hand), PASS (Pediatric and Adolescent Shoulder Survey), and SANE (Single Assessment Numerical Evaluation). Treatment failure was defined as the need for a revision procedure, a PASS score less than 85, or a SANE score less than 75. Three cohorts were developed for comparison: successful, and unsuccessful (those electing a revision surgery, and those without a revision surgery).</p><p><strong>Results: </strong>A total of 27 patients (34 total shoulders) with a mean age 16.1±2.0 years (70% female) were identified who met criteria with a mean overall follow-up duration of 6.3±2.4 years. 50% (17/34) had a failed initial procedure with 5 electing to undergo revision surgery. The successful cohort mean qDASH 1.3±2.3, PASS 94.7±3.8, and SANE 92.8±6.7 scores were better than the unsuccessful cohorts (P<0.001), who had similar mean outcome scores (P>0.2) between revision and no revision cohorts, respectively: qDASH (12.4±5.9 vs. 13.6±11), PASS (74.7±12.0 vs. 71.8±23.8), and SANE (74.3±8.2 vs. 65.6±25.0). However, 1/5 (20%) of the revision cohort did achieve acceptable PROs after the revision surgery.</p><p><strong>Conclusions: </strong>A revision surgery following failed index MDI procedure does not appear to improve patient-reported outcome scores for all adolescents. Surgeons should counsel patients and families on the potential outcomes of the primary and/or revision surgery for this condition to improve the shared decision-making process. Future study into risk factors for failure, improved patient selection criteria, and even utilization of open techniques is warranted for adolescents with MDI and involuntary instability of their shoulders.</p><p><strong>Level of evidence: </strong>Level III-comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064836","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":"Early Definitive Fusion Versus Magnetic Growing Rods in \"Tweeners\": What Do Parents Prefer?","authors":"Sylvia Culpepper, Ravi Rajendra, Brett Lullo, Anthony A Catanzano, Tyler C McDonald, R Carter Clement","doi":"10.1097/BPO.0000000000003105","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003105","url":null,"abstract":"<p><strong>Introduction: </strong>In treating early-onset scoliosis (EOS), pediatric orthopaedic surgeons and families must often choose between growth-friendly interventions such as magnetically controlled growing rods (MCGR) and early definitive posterior spinal fusion (PSF). While each strategy has associated pros and cons, little is understood about the specific preferences of patients' families. Addressing potential nuances in these preferences is crucial for meaningful shared decision-making (SDM). To better understand the factors influencing family decisions, we conducted a choice-based conjoint (CBC) analysis to explore parents' preferences for PSF and MCGR as treatment options.</p><p><strong>Methods: </strong>A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) to gather demographic information and preferences on surgical scenarios via CBC analysis. Anonymous participants, recruited via the Prolific crowdsourcing platform, qualified if they were US residents over 18 years of age with children aged 8 to 9. Data analysis involved the Hierarchical Bayes (HB) method to determine the desirability of 5 surgical attributes: curve correction, increase in spinal height, total number of surgeries, duration of treatment, and chance of complications.</p><p><strong>Results: </strong>The study included 432 participants who prioritized the likelihood of complications (relative importance value of 37), followed by total number of surgeries (22), curve correction (21), spine height (12), and treatment duration (8). Female participants and those with daughters assigned significantly higher importance to the treatment's total number of surgeries (P<0.05). Simulator analysis showed that 86.6% of participants would hypothetically prefer PSF, while only 13.4% would opt for growing rods based on the modeled participant choices.</p><p><strong>Conclusions: </strong>This CBC analysis suggests that parents of children with EOS requiring surgical intervention would prioritize complication minimization, reduction in total surgical procedures, and effective curve correction, demonstrating a marked preference for PSF. Notably, the sex of both the child and the parent influenced attribute preferences. These findings exemplify the utility of CBC analysis in orthopaedic care, allowing for a deeper understanding of family preferences and enhancing SDM by providing the ability to align surgical recommendations with specific family priorities.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064823","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 Clinically Relevant Classification System for Pediatric Talocalcaneal Coalition.","authors":"Xiong-Tao Li, Xian-Tao Shen, Xing Wu, Zhi-Guo Zhou","doi":"10.1097/BPO.0000000000003103","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003103","url":null,"abstract":"<p><strong>Introduction: </strong>Talocalcaneal coalition (TCC) is one of the most common tarsal coalitions in children. However, current classifications of TCC are limited and focus on histologic or morphologic features without clinical correlation or therapeutic guidance. Moreover, no classification system specifically designed for pediatric populations. We hypothesize that the novel classification system will be clinically relevant, reliable, and easy to use for pediatric TCC management.</p><p><strong>Methods: </strong>A total of 43 patients (58 feet) with pediatric TCC confirmed by 3-dimensional CT scans were included in this study. All cases were classified according to the novel classification system: type I (middle facet TCC), type II (posterior facet TCC), and type III (extra-articular TCC). Three pediatric orthopaedic surgeons with varying levels of experience independently classified the 58 cases to assess interobserver agreement. For all patients, we documented the hindfoot alignment (valgus, varus, or neutral), presence of pain, peroneal muscle spasm, tarsal tunnel syndrome, treatment strategies, surgical duration, preoperative and postoperative AOFAS and VAS scores, and complications.</p><p><strong>Results: </strong>A total of 22 type I, 9 type II, and 27 type III TCC cases were identified, with a mean age of 10.9 years. The new classification system demonstrated almost perfect interobserver agreement (kappa=0.90). Type I showed the highest valgus prevalence (59%, 13/22; P=0.004), type II predominant varus (67%, 6/9; P<0.001), and type III neutral alignment (52%, 14/27; P=0.515). Medial displacement calcaneal osteotomy was performed in 14% (3/21) of type I cases, and lateral displacement osteotomy in 42% (5/12) of type II and III cases. All types achieved significant AOFAS/VAS improvement. Type III TCC had the shortest operative time (52 min; P <0.001) and no complications.</p><p><strong>Conclusion: </strong>We propose a novel classification system for pediatric TCC that is clinically relevant, reliable, and easy to use. Type I TCC is more often associated with hindfoot valgus, while type II TCC frequently presents with hindfoot varus. Types II and III TCC more commonly require lateral displacement calcaneal osteotomy for varus correction. Type III TCC showed the most favorable surgical outcomes, with the shortest operative times and lowest complication rates among all types.</p><p><strong>Level of evidence: </strong>Level III-diagnostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040491","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":"Torsional Malalignment Syndrome: The Hidden Role of Medial Tibial Slope in Knee Varus and the Potential of PETS Treatment for Correction.","authors":"Hui Taek Kim, Hak Sang Kim","doi":"10.1097/BPO.0000000000003087","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003087","url":null,"abstract":"<p><strong>Background: </strong>In torsional malalignment syndrome (TMS), knee varus is observed when feet are neutral but disappears with external foot rotation. The underlying cause of this phenomenon-whether it results from visual alterations from limb rotation or reflects an additional structural abnormality in the lower extremity-along with the potential for simpler treatment options beyond rotational osteotomy, has not been previously investigated.</p><p><strong>Methods: </strong>Eighteen subjects with TMS and ten control subjects had weight-bearing orthoroentgenograms and non-weight-bearing 3D CT scans of the lower limb. Mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured. Changes in the mechanical axis during femoral rotation were analyzed with 2D and 3D CT images processed with Adobe Photoshop and PowerPoint. Morphologies of the distal femur and proximal tibia were evaluated. Six subjects received guided growth with percutaneous epiphysiodesis transphyseal screws (PETS).</p><p><strong>Results: </strong>TMS subjects showed significantly greater mLDFA and knee varus on weight-bearing radiographs, but not on 3D CT, indicating that weight-bearing contributes to the varus appearance. Although external rotation on 3D CT caused medial axis shift and mLDFA reduction in both groups, the degree of change in TMS subjects was similar to controls and insufficient to explain the pronounced varus, implying an additional structural abnormality. While femoral contours appeared normal, TMS subjects exhibited a significantly steeper posterior slope of the medial tibial plateau-averaging 7.0 degrees more than the lateral slope and also significantly steeper than in controls. In patients treated with PETS, the mean mLDFA improved from 90.2 to 88.1 degrees, and all reported cosmetic satisfaction, with no deterioration in LEFS or TLKSS scores.</p><p><strong>Conclusions: </strong>A steeper posterior slope of the medial tibial plateau likely contributes to knee varus in TMS subjects when feet are neutral. Although PETS doesn't address the underlying rotational deformity, it improved coronal alignment and appearance in selected patients without functional compromise, offering a simple and cosmetically effective treatment alternative.</p><p><strong>Level of evidence: </strong>Level III-diagnostic studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033578","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":"Ultrasonography or Radiography for Suspected Pediatric Talocalcaneal Coalition.","authors":"Xiong-Tao Li, Xian-Tao Shen, Xing Wu","doi":"10.1097/BPO.0000000000003106","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003106","url":null,"abstract":"<p><strong>Background: </strong>Talocalcaneal coalition is a common tarsal coalition, but incomplete ossification in children often leads to underdiagnosis using traditional radiographic signs like the \"C sign\" and \"talar beak.\" Ultrasonography, which is radiation-free and detects unossified cartilage, has not been studied for pediatric talocalcaneal coalition. This study evaluates the accuracy and reliability of ultrasonography versus radiography in diagnosing suspected pediatric talocalcaneal coalition.</p><p><strong>Methods: </strong>Eighty-six suspected talocalcaneal coalitions underwent ultrasonography, radiography, and 3-dimensional CT scanning. Three pediatric orthopaedic surgeons assessed ultrasound results and radiographic signs (\"C sign\" and \"talar beak\") for interobserver and intraobserver reliability. Using CT as the diagnostic standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasonography and radiographic signs were evaluated.</p><p><strong>Results: </strong>In a cohort of 86 suspected pediatric talocalcaneal coalitions, the mean age was 12.3 years. The interobserver reliability for the \"C sign\" was moderate (κ=0.55), while the interobserver reliability for ultrasonography was almost perfect (κ=0.87). Using 3-dimensional CT scanning as the diagnostic standard, the specificity and sensitivity of the \"C sign\" for diagnosing talocalcaneal coalition in children were 86% and 54%, respectively. Ultrasonography demonstrated a sensitivity of 96% and a specificity of 98%. The \"talar beak\" had only 3 true positives and 25 false negatives, resulting in a sensitivity of 11%, which was statistically significant (P <0.001).</p><p><strong>Conclusions: </strong>The \"C sign\" is useful but less accurate than ultrasonography for diagnosing suspected pediatric talocalcaneal coalition, while the \"talar beak\" is unsuitable due to low sensitivity. Ultrasonography can accurately detect pediatric talocalcaneal coalition, even in unossified cases. Compared with radiography, ultrasonography is more suitable for diagnosing suspected pediatric talocalcaneal coalition.</p><p><strong>Level of evidence: </strong>Level III-diagnostic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033562","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":"Developmental Outcomes in Children With Clubfoot: A Twin Study Comparing Affected and Unaffected Siblings.","authors":"Peter Joller","doi":"10.1097/BPO.0000000000003109","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003109","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033529","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":"Effects of Growth Hormone Therapy in Children With Growth Hormone Deficiency and Legg-Calvé-Perthes Disease.","authors":"Ahan Mistry, Harry K W Kim","doi":"10.1097/BPO.0000000000003099","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003099","url":null,"abstract":"<p><strong>Background: </strong>Legg-Calvé-Perthes disease (LCPD) is a pediatric hip disorder characterized by idiopathic avascular necrosis of the femoral head. Although its etiology remains unclear, frequent observations of short stature and delayed skeletal maturation have suggested disturbance of systemic growth regulation, particularly involving the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis. This study evaluates the impact of GH deficiency (GHD) and timing of GH therapy (GHT) on radiographic progression and femoral head morphology in LCPD.</p><p><strong>Methods: </strong>We conducted a retrospective review of 10 patients (11 hips) with GHD and LCPD treated at a single institution. Patients were stratified into 2 cohorts: group A (n=5), diagnosed with GHD and initiated on GHT before LCPD onset, and group B (n=5, 6 hips), diagnosed and treated during LCPD. Each case was matched 1:2 to controls without GHD based on sex, age at diagnosis, stage, and treatment. Radiographic staging and outcomes were assessed using Waldenström and Stulberg classifications. Growth parameters and treatment-related complications were also recorded.</p><p><strong>Results: </strong>Group A exhibited disease stage duration and femoral head outcomes similar to matched controls. In contrast, group B experienced significantly prolonged fragmentation (1.8 vs. 0.8 y of matched controls, P=0.008) and reossification stages (5.8 vs. 3.9 y, P=0.006), along with worse femoral head sphericity (Stulberg I/II in 0% vs. 67%, P=0.013). Notably, all group B patients had growth deceleration (growth velocity <5 cm/y) before GHD diagnosis. GHT was well tolerated in all cases, with no orthopaedic complications.</p><p><strong>Conclusions: </strong>GHD diagnosed and treated during LCPD was associated with prolonged fragmentation and reossification stages and poorer femoral head morphology. In contrast, patients with GHD treated before LCPD onset demonstrated outcomes similar to matched controls. These findings underscore the potential relevance of the GH/IGF-1 axis in LCPD. Orthopaedic clinicians should maintain vigilance for endocrinopathies in LCPD patients with growth deceleration (growth velocity <5 cm/y) and delayed bone age, as early endocrine referral and treatment may improve outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030110","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":"Severe Cerebral Palsy and Short Stature Predict Absent Baseline IONM Signals in Pediatric Neuromuscular Scoliosis Surgery.","authors":"Pochih Shen, Alan Robert Bielsky, Thanh Nguyen, Carson Keeter, Susan Walczak, Tyler Sullivan, Nancy Hadley-Miller, Mark A Erickson","doi":"10.1097/BPO.0000000000003096","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003096","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative neurophysiological monitoring (IONM) is essential for detecting potential neurological injury during scoliosis surgery, but obtaining recordable baseline signals can be challenging in neuromuscular scoliosis (NMS) patients. Absent baseline IONM signals, characterized by unattainable initial IONM responses despite technical and anesthetic optimization, present significant challenges to intraoperative neurological assessment and surgical risk stratification. This study aims to identify predictive factors for absent baseline IONM signals in pediatric NMS patients and establish a clinically applicable risk prediction model.</p><p><strong>Methods: </strong>This retrospective study initially identified 118 nonambulatory NMS patients under 18 years old who underwent spinopelvic fusion between 2013 and 2022. All patients received standardized total intravenous anesthesia (TIVA) protocol to optimize signal acquisition. After excluding 3 patients with spinal cord injuries, 115 patients were analyzed. Multimodality IONM, including somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (TcMEPs) was attempted in all cases. Clinical data and radiographic measurements were analyzed to determine predictive factors for absent baseline IONM signal. ROC curve analysis and logistic regression were used to determine optimal thresholds and predictive factors for absent baseline IONM signals.</p><p><strong>Results: </strong>Thirty-eight (33%) had absent baseline lower extremity IONM signals. Cerebral palsy (CP) was the most significant predictive factor [odds ratio (OR): 9.615, P<0.001], with 53.1% of CP patients having absent baseline IONM signals. Within the CP cohort, Gross Motor Function Classification System (GMFCS) level V (OR: 11.501, P=0.028) and body height <128.5 cm (OR: 4.097, P=0.044) were significant risk factors. Three patients developed new-onset urinary incontinence postoperatively, though the relationship to IONM status remains undetermined.</p><p><strong>Conclusion: </strong>Severe CP and shorter stature significantly increase the risk of absent baseline IONM signals in pediatric NMS patients. These findings inform preoperative risk assessment, enhance patient-specific surgical planning, and suggest the need for alternative monitoring approaches in high-risk cases. Such early identification of monitoring challenges can improve surgical preparation, consent processes, and ultimately patient care in this vulnerable population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958235","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":"Continuity of Care Counts: Patient Satisfaction in Advanced Practice Clinician Fracture Clinics.","authors":"Emi Schwab, Shanika De Silva, Kristin Livingston","doi":"10.1097/BPO.0000000000003091","DOIUrl":"10.1097/BPO.0000000000003091","url":null,"abstract":"<p><strong>Background: </strong>Trauma centers may utilize fracture clinics primarily staffed by advanced practice clinicians (APC) for management of basic fractures that typically require few visits. It is unclear if provider continuity is important in these brief health care encounters. The purpose of this study was to determine the association between continuity of care and patient satisfaction scores in APC-run urgent/fracture clinics.</p><p><strong>Methods: </strong>This was a retrospective IRB-approved study at a pediatric tertiary-care Level-1 trauma hospital. We reviewed prospectively collected Press Ganey data from 2021 to 2023 for acute injury/fracture patients seen in a pediatric orthopaedic fracture clinic, which is APC-staffed and physician-supervised. Demographic and clinical data were collected along with the results of 4 Press Ganey patient satisfaction survey items (recommend provider, teamwork, recommend practice, overall rating). Univariate and multivariable models were conducted to determine independent predictors of patient satisfaction, including the effect of continuity of care.</p><p><strong>Results: </strong>A total of 230 follow-up encounters were reviewed. Median age was 11 years (range, 0 to 17). The majority of patients were male (59%), White (75%), with a very high child opportunity index (72%). Patients who saw the same provider at follow-up had a higher proportion of top-box ratings compared with those who saw a different provider for 3 of 4 outcomes: 88% versus 76% for staff teamwork (P=0.04), 94% versus 78% for recommend practice (P=0.003), and 93% versus 76% for overall rating of care (P=0.003). After adjusting for consistency of care, location, age, sex, child opportunity index, injury region, and geographical distance from clinic, the odds of receiving a top-box rating for recommend practice were 4.7 times higher (P=0.004) and 3.8 times higher for overall rating (P=0.002) for patients with continuity of care-provider.</p><p><strong>Conclusions: </strong>Continuity of APC care-provider has a positive impact on patient satisfaction in a pediatric fracture clinic, as patients who saw the same provider in successive follow-up visits. Demographic, geographic, and clinical factors had comparatively little effect on patient satisfaction. The provider remains a fundamental factor in patient experience.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958573","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":"Surgical Treatment of Infantile Shoulder Dislocation Following Brachial Plexus Birth Injury.","authors":"Tamara Al Muhtaseb, Stephanie Lamer, Allison Allgier, Melissa A Miller, Kevin J Little, Charles T Mehlman, Roger Cornwall","doi":"10.1097/BPO.0000000000002977","DOIUrl":"10.1097/BPO.0000000000002977","url":null,"abstract":"<p><strong>Background: </strong>Glenohumeral dysplasia following brachial plexus birth injury (BPBI) can present as dislocation of the glenohumeral joint in infancy. Multiple nonoperative treatment strategies have been reported for these early dislocations, yet none are universally successful; thus, surgical treatment may be required. However, reports of surgical treatment in infancy are scarce. The present study retrospectively reviews the outcomes of patients with BPBI treated surgically for glenohumeral dislocation under 1 year of age.</p><p><strong>Methods: </strong>Medical records were retrospectively reviewed for patients treated surgically for glenohumeral dislocation under 1 year of age. Dislocation was defined on magnetic resonance imaging (MRI) as a percentage of the humeral head anterior to the scapular line (PHHA) <10%, or on ultrasound, as the humeral head ossific nucleus entirely posterior to the posterior scapular line. The primary outcome was defined as the need for reoperation. Additional outcomes included Mallet scores for global shoulder function and PHHA and glenoid version measurements on follow-up MRI. Patients with <1 year follow-up were excluded.</p><p><strong>Results: </strong>Thirty-two patients underwent surgical intervention for shoulder dislocation at ages 5 months to <1 year with average follow-up of 4.6 years. Of these 32 patients, 25 underwent internal rotation contracture release and external rotation tendon transfer (ERTT), with 3 (12.0%) requiring revision surgery; 7 underwent release alone, with 6 (85.7%) requiring revision surgery. Across all groups, patients ultimately had improved passive and active external rotation (20.0 to 80.0 degrees, -90.0 to 30.0 degrees, respectively, P <0.0001) and global Mallet scores (14.5/30 to 19.5/30, P <0.001) without worsened internal rotation function. The indications for requiring further surgical intervention for the 9 patients were recurrent IR contracture, redislocation, persistent ER weakness, and weak abduction.</p><p><strong>Conclusions: </strong>Surgical treatment of infantile shoulder dislocation following BPBI can improve glenohumeral alignment and global shoulder function. The inclusion of external rotation tendon transfers at the index procedure lowers the risk of reoperation, whereas not sacrificing internal rotation function when combined with partial subscapularis release.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e724-e732"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000176","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}