Journal of Pediatric Orthopaedics最新文献

{"title":"Changes in the Alignment of the Spine and Lower Limb in Children With Achondroplasia Treated With Vosoritide: A Single-center, 1-year Follow-up Prospective Study.","authors":"Kenta Sawamura, Hiroshi Kitoh, Yasunari Kamiya, Kenichi Mishima, Masaki Matsushita, Shiro Imagama","doi":"10.1097/BPO.0000000000002980","DOIUrl":"10.1097/BPO.0000000000002980","url":null,"abstract":"<p><strong>Background: </strong>Achondroplasia (ACH) is the most common skeletal dysplasia and is characterized by a short-limbed short stature, sagittal spinal malalignment, and genu varum. Vosoritide promotes longitudinal bone growth in children with ACH; however, its effects on various disease-specific complications, other than short stature, are unknown. This study aimed to investigate the therapeutic effects of vosoritide on spinal and lower limb malalignment in children with ACH.</p><p><strong>Methods: </strong>This single-center, open-label, prospective study included patients with ACH aged younger than or equal to 15 years who received vosoritide treatment and had a minimum follow-up period of 1 year. To evaluate alignment after vosoritide treatment, radiologic parameters were measured from sagittal radiographs of the spine and anteroposterior radiographs of the bilateral lower limbs before the administration of vosoritide and 12 months after treatment. Paired t tests were used to compare parameters before and after vosoritide treatment.</p><p><strong>Results: </strong>Seventeen patients (mean age, 7.6±2.7 y) were included. After 1-year treatment of vosoritide, the mean height increased by 5.4±1.3 cm. Changes in spinal alignment after 1 year of vosoritide treatment were 1.5 degrees for cervical lordosis, -1.3 degrees for thoracic kyphosis, -2.8 degrees for thoracolumbar kyphosis, -5.2 degrees for lumbar lordosis (LL), -2.2 degrees for pelvic tilt, -2.6 degrees for pelvic incidence, -0.4 degrees for sacral slope, and 2.6 mm for C7 sagittal vertical axis. Alignment changes in the lower limbs were -3.4 degrees for mechanical axis angle (MAA), 1.7 degrees for mechanical lateral proximal femoral angle (mLPFA), -2.8 degrees for mechanical lateral distal femoral angle (mLDFA), -0.2 degrees for medial proximal tibial angle, and -0.5 degrees for lateral distal tibial angle. The LL, MAA, mLPFA, and mLDFA levels showed statistically significant changes towards the normal range after treatment.</p><p><strong>Conclusions: </strong>One-year treatment of vosoritide decreased the exaggerated LL and improved genu varum deformity in children with ACH. Vosoritide therapy may not only increase longitudinal bone growth but also improve spinal and lower limb malalignment in children with ACH.</p><p><strong>Level of evidence: </strong>Level II: prospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"519-524"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001265","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":"Enhanced Recovery With Combined Epidural and General Anesthesia in Children With Cerebral Palsy Undergoing Hip Reconstructive Surgery: A National Cohort Study.","authors":"David Momtaz, Parker Mitchell, Jad Lawand, Blaire Peterson, Abdullah Ghali, Sean Tabaie, M Wade Shrader, Benjamin J Shore, Rachel Thompson, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002984","DOIUrl":"10.1097/BPO.0000000000002984","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients with cerebral palsy (CP) undergoing hip reconstruction face significant postoperative pain challenges. This study aimed to assess the efficacy and safety of epidural anesthesia combined with general anesthesia compared with general anesthesia alone in reducing postoperative opiate usage, postoperative complications, and length of hospital stay in this vulnerable population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, analyzing medical records of pediatric CP patients who underwent bilateral proximal femoral osteotomy between 2003 and 2023, using a large national US health care database. Patients were dichotomized into 2 groups based on anesthesia technique: general anesthesia only (General) and general anesthesia with adjunct epidural anesthesia (Epidural). The primary outcome measured was the use of IV opiates within the first 3 days postoperation. Secondary outcomes included the use of per os (PO) opiates, length of stay (LOS), and postoperative complications such as ICU admission, mortality, pneumonia, respiratory failure, urinary retention, and urinary tract infections within 90 days postoperatively. Patient characteristics, including age, BMI percentile, gastrostomy and tracheostomy status, as well as concomitant hamstring lengthening and pelvic osteotomy, were propensity matched between groups.</p><p><strong>Results: </strong>In total, 1303 CP patients were identified, including 502 patients with general plus epidural anesthesia and 801 patients with general anesthesia only. After matching, there remained 361 patients in each group (a total of 722 patients who were included for analysis). The Epidural group demonstrated a significantly lower proportion of IV opiate usage within the first 3 days postoperation. There were no significant differences in the rates of ICU admissions, mortality, pneumonia, respiratory failure, urinary retention, or urinary tract infections between groups. However, the general plus epidural anesthesia group demonstrated lower usage of PO opiates 90 days postoperatively compared with the general anesthesia only group. The epidural group further demonstrated a 1.3-days shorter LOS.</p><p><strong>Conclusions: </strong>The addition of epidural anesthesia to general anesthesia in pediatric CP patients undergoing proximal femoral osteotomy reduces hospital stay and IV opioid use postoperatively, without increasing complications. These findings support considering epidural anesthesia to enhance recovery and reduce opioid-related side effects in these patients.</p><p><strong>Level of evidence: </strong>Level III-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e738-e744"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023422","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":"Opioid Prescription Patterns 30 Days After Pediatric Supracondylar Humerus Fracture Closed Reduction and Percutaneous Pinning: 2010 to 2021.","authors":"Jack M Haglin, David G Deckey, Tony Gaidici, Daniel R Gaines, Judson W Karlen, Jessica D Burns","doi":"10.1097/BPO.0000000000002993","DOIUrl":"10.1097/BPO.0000000000002993","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus fractures (SCH) are the most common type of elbow fracture in children, with many cases requiring surgery. Treatment of postoperative pain for SCH has high variability, but can often be treated effectively with minimal or no opioids. Furthermore, there is significant morbidity related to pediatric opioid consumption. The goal of this study was to characterize prescription patterns in the United States following closed reduction and percutaneous pinning (CRPP) of SCH.</p><p><strong>Methods: </strong>All patients aged 10 or younger years who underwent CRPP of SCH from January 2010 to December 2021 were identified in the PearlDiver Mariner Claims Database. The primary outcome was postoperative pain medication prescriptions in the 30 days following SCH CRPP. Patient demographics, prescription duration, and morphine milligram equivalents (MME) were analyzed. Multivariable-log-binomial mixed regression models were constructed to assess factors associated with increased opioid prescription.</p><p><strong>Results: </strong>In total, 43,611 SCH CRPP cases in patients aged 10 or younger were identified from 2010 to 2021. Throughout the study period, 48.6% of patients (21,191/43,611) received and filled a narcotic pain prescription. The percentage of patients receiving opioid medication decreased from 54.7% in 2010 to 27.4% in 2021. Opioid prescriptions totaled a mean of 6.1±2.1 days of narcotics with a mean of 79.2 MME prescribed per patient. Increased patient age, increased Elixhauser comorbidity index, and Medicaid insurance were all associated with increased opioid prescription ( P <0.001). Living in the Northeast, increased family income, and commercial insurance were associated with decreased opioid prescriptions ( P <0.001).</p><p><strong>Conclusions: </strong>Nearly half of the patients over the past decade treated with CRPP for SCH received a narcotic prescription. However, there has been a steady decline in the proportion of patients being prescribed opioids, with only 27.4% receiving opioids in 2021. Further, patients with increased comorbidities or those insured by Medicaid with lower mean family income may be at risk for increased opioid prescription. While efforts have been made to reduce opioid overprescribing, there continues to be room for further reduction in opioid utilization after CRPP for SCH moving forward.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e687-e692"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199452","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":"Cast Art Analgesia: Investigating the Application of Cast Art as a Distraction Strategy to Mitigate Pain Following Supracondylar Humerus Fracture Surgery in Children.","authors":"Jackson Helms, Hayley Ditmars, Christine Ayoub, John Schlechter","doi":"10.1097/BPO.0000000000003097","DOIUrl":"https://doi.org/10.1097/BPO.0000000000003097","url":null,"abstract":"<p><strong>Background: </strong>Multiple distraction strategies to mitigate pain and distress during and after hospital procedures and surgery have become widely accepted and used in multimodal pain management in children. One such mode of nonpharmacological intervention and distraction is the application of cast art. There is a paucity of literature investigating the effect that cast art may have on a child's perception of pain. The purpose of this study was to investigate pain reporting and management trends in children undergoing supracondylar humerus fracture (SCHFx) surgery and immobilized postoperatively in a cast with applied custom illustrated cartoon art compared with a plain cast/no-art group.</p><p><strong>Methods: </strong>Children who underwent closed reduction with percutaneous pinning (CRPP) of SCHFx were identified through retrospective chart review. Children were divided into 2 cohorts: those who received cast art and those who did not. Postoperative Visual Analog Scale (VAS), Face, Legs, Activity, Cry, Consolability scale (FLACC), and pain medication administration were recorded. Data were compared using χ2, ANOVA, and Man-Whitney U tests to determine significance set as P<0.05.</p><p><strong>Results: </strong>Demographics and fracture type based on the Gartland fracture classification were similar between groups. The cast art group had significantly lower VAS (P=0.009) and FLACC (P=0.004) scores, required less acetaminophen (P=0.048), ibuprofen (P=0.014), and 4 times less children requiring postoperative narcotics (P=0.003) compared with the no art group. The average (+/- SD) surgery time differed between the art and no art groups (24.6+/-8.4 min vs. 20.1+/-5.6 min, P=0.012). Similarly, the average (+/- SD) anesthesia time differed between the art and no art groups (59.9+/-19.4 min vs. 49.9+/-9.9 min, P=0.01).</p><p><strong>Conclusion: </strong>Children undergoing CRPP for SCHFx fracture were found to have lower pain scores (VAS and FLACC) on the medical-surgical floor postoperatively and had decreased floor analgesic requirements lending evidence that cast art may be an adjunctive distraction strategy to mitigate pain and distress following SCHFx surgery in children.</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":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Lumbar Partial Microdiscectomy for Vertebral Ring Apophyseal Fractures in Adolescents on PROMIS Pain, Physical Function, and Mental Health Domains.","authors":"Read Streller, Brian A Kelly, Scott J Luhmann","doi":"10.1097/BPO.0000000000002982","DOIUrl":"10.1097/BPO.0000000000002982","url":null,"abstract":"<p><strong>Background: </strong>Lumbar partial microdiscectomy (LPM) in adolescents is an infrequently performed procedure, reserved for pain and neurological symptoms unresponsive to nonsurgical management. Most studies have focused on the interventional impact on pain outcomes creating a paucity of data on physical function and mental health outcomes. The study hypothesis is LPMs in adolescents will provide improvements in measured PROMIS domains (mental health, physical function, and pain) at 2 years postoperatively.</p><p><strong>Methods: </strong>This study is a retrospective analysis of patients under 21 years of age who underwent LPM surgery by 2 surgeons at a tertiary-care pediatric hospital. PROMIS scores [mobility (MOB), pain interference (PI), upper extremity (UE), physical functioning (PF), peer relationships (PR), anxiety, and depression] were obtained preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2+ years postoperative. The changes in PROMIS scores were then analyzed and compared at each time point using a mixed model analysis.</p><p><strong>Results: </strong>Thirty-six patients with a mean age of 16.6 years (range: 13 to 20 y) at surgery were included in the analysis (2015 to 2022). All patients underwent nonsurgical treatments, which varied according to symptom type and severity and included over-the-counter medications, pain management or physiatry consultations, physiotherapy, selective nerve root and epidural injections, and bracing for a minimum of 3 months. Preoperatively, 4 patients had motor weakness, 11 lower extremity numbness, and 35 lower extremity radicular pain. Postoperatively, there were improvements for MOB ( P ≤0.05) at each time point, with an estimated mean difference of +11.3 at 2 years ( P= 0.0027). In PI there was a significant decrease ( P ≤0.0001) immediately after surgery with sustained improvement (-8.6) at 2 years ( P= 0.0009). For UE and PR, there was a statistically significant improvement from the preoperative baseline scores to the 1-year postoperative visit for UE (+10.6; P =0.008) and PR (+8.0; P =0.01), but no difference at 2 years. PF, anxiety, and depression domains did not demonstrate any statistically significant changes.</p><p><strong>Conclusion: </strong>Using the PROMIS instrument, there were significant improvements postoperatively after LPM in adolescents in MOB, PI, UE, and PR up to 1 year postoperatively, and continued improvement in MOB and PI. These data demonstrate LPM can provide sustained improvement in PROMIS domains up to 2 years of follow-up after surgery.</p><p><strong>Level of evidence: </strong>Level III-retrospective, single cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e711-e717"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005004","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":"Meralgia Paresthetica in Children: Case Series and Surgical Technique.","authors":"Jeremy Bernhardt, William Roepke, David Y Chong","doi":"10.1097/BPO.0000000000003044","DOIUrl":"10.1097/BPO.0000000000003044","url":null,"abstract":"<p><strong>Background: </strong>Meralgia paresthetica is a painful compressive neuropathy of the lateral femoral cutaneous nerve, with minimal literature existing about the disorder in children. Easily overlooked, a misdiagnosis can lead to unnecessary imaging or surgical intervention. The purpose of this study was to increase provider awareness and compare patient-reported outcomes between surgical and nonsurgical management.</p><p><strong>Methods: </strong>We retrospectively reviewed records of pediatric patients treated for meralgia paresthetica by a single provider. Patients were initially treated with physical therapy, anti-inflammatories, and local injection to confirm the diagnosis. Individuals with persistent symptoms were offered surgical decompression. Patient-reported outcomes were assessed using the International Hip Outcome Tool 33 (iHOT-33) survey.</p><p><strong>Results: </strong>Twenty-four patients were treated. The mean age was 12.7 years (range: 9 to 17 y). Ninety-two percent were female, 63% had bilateral involvement, and 38% were referred with an alternate diagnosis. The average BMI was 20.96. Local injection provided immediate relief for all patients and lasted an average of 11 days. Seventy-one percent (17/24) had persistent symptoms in follow-up and underwent surgical decompression. All patients improved following initial decompression, but 4/17 (24%) had recurrence of symptoms requiring a second surgery. All recurrences had accessory nerves missed during the first surgery. Seventy-nine percent of patients (19/24) completed the iHOT-33 survey at an average of 33 months after intervention (injection or surgery). The average iHOT-33 score was higher in the operative group but was not statistically significant (7.88 vs. 6.72, P =0.250).</p><p><strong>Conclusions: </strong>Meralgia paresthetica can be readily diagnosed using physical examination and confirmed with a local injection, without the need for advanced imaging. In our cohort, it predominantly affected thin, adolescent females. Steroid injection provided definitive treatment for 29% of our patients. Persistent symptoms can be improved with surgical decompression, and we found a high rate of aberrant anatomy and accessory nerves in this population. Outcomes were not significantly different between local injection only and surgical management. More studies are needed to determine the role of ligation versus decompression.</p><p><strong>Level of evidence: </strong>Level IV-case series.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e656-e662"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626616","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":"Anterior Distal Femoral Hemiepiphysiodesis Procedure: A Comparison of Antegrade Versus Retrograde Insertion.","authors":"Kellen T Krajewski, Jessica L Stockhausen, Amanda L Vinson, Lucas Moore, Scott C Miller, James J Carollo, Mariano Garay, Radomir Dimovski, Jason T Rhodes, Sayan De","doi":"10.1097/BPO.0000000000002985","DOIUrl":"10.1097/BPO.0000000000002985","url":null,"abstract":"<p><strong>Background: </strong>Anterior distal femoral hemiepiphysiodesis (ADFH) is an effective surgery to correct knee flexion contractures. ADFH entails inserting 2 screws through the anterior third of the distal femoral physis, typically inserted in an antegrade fashion (proximal to distal across the physis). However, the screws must traverse significant soft tissue structures, thereby impeding simple insertion parallel to the mechanical axis of the femur. Our surgeons have developed a novel technique using a retrograde approach with a shorter path through soft tissue and an entry point with a broad surface for screw insertion. It is unknown how retrograde ADFH impacts surgical time, clinical outcomes, and complication rates. The purpose was to compare retrograde to antegrade ADFH on surgical times, maximum knee extension angles, and complications.</p><p><strong>Methods: </strong>Twenty-eight patients (53 knees) who underwent ADFH [12 antegrade (23 knees); 16 retrograde (30 knees)] were retrospectively reviewed. Surgical approach, time, pre and 2-year post-ADFH knee extension angles, and complications were retrieved. The effect of the approach on surgical time was analyzed through an independent t test. The differences between surgical approach on pre-ADFH and post-ADFH knee extension angles were analyzed using a mixed factor RMANOVA. χ 2 performed on complication frequencies. Alpha set to P ≤0.05.</p><p><strong>Results: </strong>No statistically significant difference was found between surgical insertion and removal times for antegrade ADFH (insertion: 85.2±30.2 min; removal: 118.0±106.0 min) compared with the retrograde ADFH (insertion: 61.7±29.4 min; removal: 56.2±22.8 min). A main effect of time was observed for knee extension angles ( P <0.001). Both groups improved knee extension at 2-year post ADFH (antegrade 5.9±7.3 degrees; retrograde 8.6±8.7 degrees). No differences were found between antegrade and retrograde ADFH on knee extension ( P >0.05). One complication was observed in each approach (retrograde: 1/16 patients, 2/30 knees; antegrade: 1/12 patients, 1/23 knees).</p><p><strong>Conclusions: </strong>Retrograde had comparable clinical effectiveness and complication rate as antegrade. An advantage of retrograde is the ease of hardware insertion and removal. Combined, these findings suggest retrograde insertion as a viable alternative approach to ADFH.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e745-e751"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978057","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":"Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy.","authors":"Joshua T Bram, Olivia C Tracey, Zachary Trotzky, Ruth H Jones, Olivia Jochl, Peter M Cirrincione, Erikson Nichols, Emily R Dodwell, David M Scher, Shevaun H Doyle, Ernest L Sink","doi":"10.1097/BPO.0000000000002976","DOIUrl":"10.1097/BPO.0000000000002976","url":null,"abstract":"<p><strong>Introduction: </strong>Breastfeeding is recommended exclusively until at least 6 months of age by the American Academy of Pediatrics. For mothers of children with hip dysplasia (DDH), Pavlik harness treatment may impact breastfeeding. The aim of this study was to assess how Pavlik harness treatment may impact breastfeeding by evaluating patient-reported outcomes (PRO) associated with breastfeeding.</p><p><strong>Methods: </strong>This was a prospective cohort study of mothers of patients treated in a Pavlik harness for DDH at <3 months of age. Controls were recruited from patients evaluated for DDH who had normal ultrasounds. Patients with neuromuscular/developmental conditions were excluded. The validated beginning breastfeeding survey-cumulative (BBS-C), breastfeeding self-efficacy scale-short form (BSES-SF), and patient health questionnaire-8 (PHQ8) were administered to mothers at the initial clinic appointment and 2, 4, 6 weeks postbaseline.</p><p><strong>Results: </strong>A total of 29 cases and 29 controls were enrolled. There were no differences in baseline demographics or socioeconomic/educational status between maternal cohorts. There were similarly no differences in demographics or birth characteristics between children except presenting age was lower in the DDH cohort (30.7±22.1 vs. 58.7±21.4 d, P <0.001). PROs were similar at enrollment. Six weeks after harness initiation, 76% of the DDH cohort were still breastfeeding (vs. 89% of controls, P =0.303), and 52% (vs. 77%, P =0.052) reported breastfeeding >80% of the time. Mothers of 13% of DDH patients reported that the Pavlik usually/always negatively impacted their breastfeeding ability at 6 weeks. The DDH cohort had lower BBS-C problem scores at 4 (17.6±6.4 vs. 20.8±3.7, P =0.045) and 6 weeks (17.2±6.2 vs. 20.2±3.3, P =0.029). BSES-SF scores were additionally lower among the DDH group at 2 (47.6±11.8 vs. 54.1±10.2, P =0.047) and 4 weeks (48.5±13.0 vs. 55.6±10.3, P =0.040). There were no differences in PHQ-8 scores.</p><p><strong>Conclusion: </strong>Pavlik harness treatment for DDH was associated with lower patient-reported breastfeeding efficacy PROs. Pavlik harness treatment did not lead to earlier breastfeeding cessation 6 weeks after harness initiation. Lower breastfeeding efficacy for these mothers may justify early education regarding effective breastfeeding methods in a harness.</p><p><strong>Level of evidence: </strong>Level II-prospective therapeutic cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e701-e705"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015062","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":"Comparative Analysis of Postoperative Rotational Malalignment in Pediatric Supracondylar Humerus Fractures: Cross Pinning Versus Lateral Para-olecranon Pinning.","authors":"Satoshi Muto, Satoshi Niwa, Yuki Fujihara, Hideyuki Ota, Hiroaki Kumagai","doi":"10.1097/BPO.0000000000003000","DOIUrl":"10.1097/BPO.0000000000003000","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humeral fractures are common in children, and are typically treated with percutaneous pinning. Cross pinning (CP) and lateral entry pinning (LP) are widely used methods. Although previous studies have focused on outcomes such as Baumann and carrying angles, research on rotational malalignment is limited. Furthermore, there have been few comparative studies on alternative surgical techniques. This study aimed to compare rotational malalignment and clinical outcomes between CP and the lateral para-olecranon pinning (LPOP) technique.</p><p><strong>Methods: </strong>This retrospective study initially identified 208 pediatric patients who underwent percutaneous pinning for supracondylar humeral fractures between 2005 and 2023. After applying the inclusion and exclusion criteria, 180 patients were included in the study and divided into 2 cohorts: LPOP (n=146) and CP (n=34). The primary outcome was corrective loss of rotation, measured radiographically at surgery and at 4 weeks postoperatively. Rotational malalignment was assessed using the formula described by Henderson and colleagues. Secondary outcomes included Baumann angle, carrying angle, tilting angle, range of motion, anesthesia, and operation times.</p><p><strong>Results: </strong>No significant difference was found in corrective loss of rotation between LPOP and CP (θ=0.079±0.24 for LPOP vs. 0.10±0.20 for CP, P =0.57). Secondary outcomes, including the Baumann angle, carrying angle, tilting angle, and range of motion, were similar in both groups. However, the anesthesia and operation times were significantly shorter in the LPOP cohort ( P <0.01): the LPOP cohort had a shorter duration of anesthesia (124.95±32.22 min) than the CP cohort (148.21±65.72 min) ( P =0.009) and had a shorter operation time (52.02±31.56 min) than the CP cohort (71.82±43.69 min) ( P =0.006). Complication rates, including reoperations and nerve injuries, were comparable between the cohorts.</p><p><strong>Conclusions: </strong>Both LPOP and CP resulted in similar rotational outcomes; however, LPOP offered shorter anesthesia and surgery times without increasing the risk of complications. LPOP might be a safe and more effective alternative technique, showing equivalent clinical results and lowering the incidence of iatrogenic nerve injuries.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"458-465"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016646","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":"Assessing Venous Thromboembolism Risk in Hip Arthroscopy: A Propensity-matched Comparison of Adolescents and Adults.","authors":"Mehul M Mittal, Katalina V Acevedo, Tiffany M Lee, Aaron Singh, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000002987","DOIUrl":"10.1097/BPO.0000000000002987","url":null,"abstract":"<p><strong>Background: </strong>Hip arthroscopy is a commonly performed procedure in adolescents with hip pathology. However, there is limited data on venous thromboembolism (VTE) events in this population, resulting in minimal guidance on appropriate VTE prophylaxis, with the bulk of current guidance extrapolated from the adult population. Therefore, this study aims to assess overall rates of VTE in the adolescent population as well as compare these rates to a matched cohort of adult patients undergoing hip arthroscopy.</p><p><strong>Methods: </strong>This retrospective cohort study drew data from the TriNetX platform between January 1, 2003 and March 1, 2024. Adolescent patients, ages 13 to 18, were matched to adult patients (19 and older) undergoing hip arthroscopy, accounting for sex, tobacco use, oral contraceptive use, diabetes mellitus, and overweight/obesity. Outcomes of interest were deep vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days after the procedure. Overall rates were calculated and compared between cohorts. Statistical significance was set at P <0.01.</p><p><strong>Results: </strong>A total of 3655 patients were successfully matched with a mean age of 16 in the adolescent cohort and 35 in the adult cohort. The overall rates of DVT were similar between cohorts, at 1% for adolescent patients and 0.9% for adults (RR: 0.892; 95% CI: 0.559-1.423; P =0.63). All VTE events (combined DVT and PE) were also similar at 1.1% for adolescent patients and 1.0% in adults (RR: 0.925; 95% CI: 0.593-1.443; P =0.73).</p><p><strong>Conclusion: </strong>This study found no significant difference in VTE between adolescent and adult patients undergoing hip arthroscopy. The overall rate of VTE was relatively high in adolescent patients, at 1.1%, suggesting additional attention to VTE and potential chemoprophylaxis may be warranted in select patients.</p><p><strong>Level of evidence: </strong>Level III-case-control study or retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e706-e710"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016253","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}