Journal of Pediatric Orthopaedics-Part B最新文献

{"title":"Dandy-Walker malformations with other complex congenital deformities associated with scoliosis: a case series.","authors":"Masayoshi Machida, Masafumi Machida, Katsuaki Taira, Naho Nemoto, Noboru Oikawa, Hirofumi Ohashi, Kazuyoshi Nakanishi","doi":"10.1097/BPB.0000000000001213","DOIUrl":"10.1097/BPB.0000000000001213","url":null,"abstract":"<p><p>Dandy-Walker malformations (DWM) is a rare condition with an estimated prevalence of 1 in 30 000 cases. Although DWM often complicates scoliosis, its prevalence and the time of onset are unknown because only a few reports have described the association between scoliosis and DWM. This case series describes spinal deformity associated with DWM. The clinical records and spinal radiographs of 23 consecutive patients with DWM at a single centre were reviewed. DWM was clinically diagnosed if patients met the following three conditions: (1) posterior fossa enlargement, (2) cerebellar hypoplasia and (3) cystic dilation of the fourth ventricle on MRI. Radiological assessment records for the presence, prevalence and time of onset of DWM were studied. Twelve of 23 patients (52%) demonstrated a scoliotic deformity, with 3 (13%) having severe deformities exceeding 60°. The average age at diagnosis was 3.6 ± 2.9 years (range: 0.7-9.7) and at radiographic examination during the final follow-up was 8.7 years (range 1.0-22.0). Only two patients were skeletally mature. The coronal angular deformity at the final follow-up was 34.2 ± 32.3° (range: 10.1-125.1°). One patient with moderate deformity >25° died before bracing. In addition, of three patients with severe deformities, only one had undergone posterior spinal fusion. The prevalence of scoliosis in DWM was 52%, and all patients who developed scoliosis reported early-onset scoliosis under 10 years of age. Early diagnosis and screening of spine deformity are required for patients with DWM to prevent disease progression. Evidence level: 4.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"396-399"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of intraoperative C-arm flat-detector computed tomography following closed reduction and spica cast application in the treatment of children with developmental dysplasia and hip dislocation.","authors":"Michael Zaidman, Naum Simanovsky, Vladimir Goldman, Eden Weisstub","doi":"10.1097/BPB.0000000000001254","DOIUrl":"10.1097/BPB.0000000000001254","url":null,"abstract":"<p><strong>Level of evidence: </strong>Level IV - case series.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"357-361"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the increase in the use of perinatal hip sonography really reduce the number of developmental hip dislocations needing closed/open reduction? The experience of a large Italian pediatric hospital.","authors":"Enrico Micciulli, Andrea Magistrelli, Davide Lardo, Fernando De Maio, Ernesto Ippolito","doi":"10.1097/BPB.0000000000001256","DOIUrl":"10.1097/BPB.0000000000001256","url":null,"abstract":"<p><p>Perinatal hip sonography (PHS) is not mandatory in Italy, but during the last years, it has been performed increasingly more even in babies with negative Ortolani maneuver. We aimed to investigate whether the increased use of PHS decreased the number of Graf's type IV hips needing closed/open reduction (COR) at the Bambino Gesù Hospital of Rome, Palidoro (BGHRP). We consulted the BGHRP database from 2012 to 2022 to determine the number of patients with Graf's type IV hips who had COR; the COR patients who had PHS done inside and outside the hospital; the patients who had brace treatment after PHS with a diagnosis of DDH. The hospital's sonographers were ascertained to be experts in Graf's method because they had attended several instructional courses, while the sonographers operating in other centers had not received this training. Sixty-three patients with Graf's type IV hips had COR from 2012 to 2016 while 31, from 2017 to 2022. The difference was significant ( P  = 0.009). The 67 patients with COR who came to BGHRP for follow-up were divided into two groups. Group 1 included 61 patients who had PHS done outside the hospital. In those patients, several DDH had a wrong diagnosis and none had brace treatment. Group 2 included six patients out of the 277 with DDH who had PHS done at BGHRP and who received brace treatment. The difference between the two groups was significant ( P  < 0.001). To decrease the number of dislocated hips needing COR, an increased use of PHS is not sufficient but it is also necessary that sonographers must be experts in Graf's method and aware of DDH treatment.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"351-356"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nationwide survey on the information preferences of parents of children with developmental dysplasia of the hip compared with pediatric orthopedic surgeons' perspectives.","authors":"Wesley W E S Theunissen, Jaap J Tolk, Merel R Van Veen, Christiaan J A Van Bergen, Stijn E W Geraets, Adriaan K Mostert, Arnold T Besselaar, Florens Q M P Van Douveren, Maria C Van der Steen","doi":"10.1097/BPB.0000000000001251","DOIUrl":"10.1097/BPB.0000000000001251","url":null,"abstract":"<p><p>The diagnosis and treatment of developmental dysplasia of the hip (DDH) can be stressful for parents, often worsened by inadequate information. The primary aim of this study is to assess whether the information preferences of parents of children with DDH, identified in a prior single-center study, are generalizable across the Netherlands. A secondary aim is to compare these preferences with the perspectives of pediatric orthopedic surgeons. An online survey was conducted between September and November 2023 among parents of children with DDH and pediatric orthopedic surgeons in the Netherlands. Based on prior qualitative research, the survey included closed- and open-ended questions regarding the content, timing, and format of information delivery. A total of 177 parents and 20 pediatric orthopedic surgeons completed the survey. Median response scores were ≥7 across all questions, suggesting that previously identified parental preferences are applicable nationwide. Both parents and pediatric orthopedic surgeons emphasized the importance of accessible and understandable information to people at all levels of society. Parents strongly preferred reliable DDH-related information before diagnosis and valued resources they could revisit at home, such as websites or printed materials. However, parents showed minimal interest in a smartphone application, a preference that contrasted with pediatric orthopedic surgeons' perspectives. This nationwide study provides a comprehensive overview of the information preferences of parents in DDH care. Comparing these findings with the perspectives of pediatric orthopedic surgeons offers valuable insights for optimizing information delivery. This can help refine information delivery strategies, ultimately enhancing disease understanding, parental satisfaction, and treatment adherence.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"327-336"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Casting, elastic intramedullary nailing or external fixation in pediatric tibial shaft fractures: which is the most appropriate treatment? A multicenter study: comment on study by Marengo et al.","authors":"Siddharth Jain, Sourabh Kumar Sinha, Prateek Behera, John A Santoshi, Sonal Mishra","doi":"10.1097/BPB.0000000000001255","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001255","url":null,"abstract":"","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":"34 4","pages":"410"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dispelling the Dogma: upper-instrumented vertebrae of T5-T6 can achieve similar correction and shoulder balance with less blood loss than T2-T4 in select patients.","authors":"Matthew E LaBarge, William H Waddell, Hani Chanbour, Byron F Stephens, Jeffrey E Martus, Gregory A Mencio, Craig R Louer","doi":"10.1097/BPB.0000000000001245","DOIUrl":"10.1097/BPB.0000000000001245","url":null,"abstract":"<p><p>The choice of upper-instrumented vertebrae (UIV) for posterior spinal fusion (PSF) constructs is influenced by guidelines where UIV is T4 or more cephalad. In a cohort of patients with adolescent idiopathic scoliosis (AIS) with thoracic curves, we sought to (a) compare postoperative shoulder balance for patients with UIV of T5-T6 versus T2-T4 and (b) evaluate curve and operative characteristics that lead to balance with a more caudal UIV. A single-institution AIS registry was queried for patients undergoing PSF from 2000 to 2017. Included were patients undergoing PSF for AIS, with Lenke 1 and 2 curves, and minimum 2-year follow-up. Shoulder balance was defined as: T1 tilt = 0 ± 5°, coracoid height difference (CHD) = 0 ± 1 cm. A total of 161 patients were included, mean follow-up was 47 months. Curves fused to T2-T4 had larger, stiffer preoperative proximal thoracic curves and were more likely to be classified as Lenke 2. Following PSF, there was no difference in final T1 tilt ( P  = 0.062) or final CHD ( P  = 0.176) between groups. Patients with a UIV of T5-T6 had shorter operative times ( P  < 0.001), less operative blood loss ( P  = 0.009), and similar complication rates ( P  = 0.344). In the T5-T6 cohort, 70.3% of patients achieved shoulder balance at the final follow-up. For thoracic AIS undergoing PSF, selecting a UIV of T5 or T6 can result in comparable postoperative shoulder balance in properly selected patients.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"375-382"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 hamstring lengthening on stance knee flexion at skeletal maturity in ambulatory cerebral palsy.","authors":"Bidzina Kanashvili, Timothy A Niiler, Chris Church, Nancy Lennon, M Wade Shrader, Jason J Howard, Freeman Miller","doi":"10.1097/BPB.0000000000001174","DOIUrl":"10.1097/BPB.0000000000001174","url":null,"abstract":"<p><p>This study reports the long-term outcomes of hamstring lengthening to treat flexed knee gait in children with ambulatory cerebral palsy (CP) after skeletal maturity. This retrospective longitudinal observational study used instrumented gait analysis (GA) <8 and >15 years old in children with bilateral CP. The primary variable was knee flexion in stance phase. Eighty children (160 limbs) were included; 49% were male, 51% female. Mean age at first GA was 6.0 (SD: 1.2) years and 19.6 (SD: 4.5) years at final GA. Mean follow-up was 13.7 (SD: 4.7) years. Children were classified as Gross Motor Function Classification System I-8, II-46 and III-26. Average Gross Motor Function Measure Dimension D was 72% (SD: 20%). Hamstring lengthenings occurred once in 82, twice in 54 and three times in 10 limbs. From initial to final GA, average knee flexion in stance was unchanged, 27.8° (SD: 14.8°) to final 27.0° (SD: 11.2°; P  = 0.54). Knee flexion at foot contact was 39.6° (SD: 13.0°), improving to final GA of 30.7° (SD: 10.6°; P  < 0.001). Initial gait deviation index was 65.8 (SD: 31.9), improving to final 78.9 (SD: 28.2; P  < 0.001). Older age, males and concomitant plantar flexor lengthening predicted change toward more flexed knee gait. Hamstring lengthening did not lead to back-kneeing gait at maturity while maintaining childhood stance phase knee flexion. A subgroup still developed significant flexed knee gait posture and may have benefited from more aggressive treatment options. This outcome may also be impacted by diverse functional levels, etiologies and treatments of flexed knee gait.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"320-326"},"PeriodicalIF":0.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional biomechanical analysis of flexible intramedullary nailing constructs in length-unstable pediatric femur fractures.","authors":"Emmanouil Grigoriou, Emil Varas-Rodriguez, M Bryant Transtrum, Ameya H Deshpande, Jeremy P Doak, Mark T Ehrensberger","doi":"10.1097/BPB.0000000000001267","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001267","url":null,"abstract":"<p><p>Flexible intramedullary nail fixation of pediatric femoral shaft fractures offers advantages such as shorter hospital stays, faster return to function, and less associated costs when compared with traction and casting. This study compared the biomechanical performance of three configurations: 2CS, 2CL, and 3CL. Thirty synthetic femur models with identical, length-unstable, spiral fractures were tested using a three-dimensional camera system to assess real-time micromotion. Three groups were analyzed: (a) 2CS - two 3.5 mm C- and S-shaped nails inserted anterograde, (b) 2CL - one 'C' and one 'S' shaped 3.5 mm titanium nail-inserted retrograde from a single lateral entry, (c) 3CL - two 'C' shaped 3.5 mm titanium nails inserted medially and laterally with a third 'C' shaped 2.5 mm nail placed retrograde from an anterolateral site. Torsional loading, cyclical loading, and load-to-failure tests were conducted. The 3CL configuration demonstrated superior biomechanical performance. It exhibited the highest torsional stiffness [0.67 ± 0.06 Nm/° for external rotation (ER), 0.404 = ± 0.06 Nm/° for internal rotation (IR); P = 0.002], least displacement (0.05 ± 0.02 vs. 0.30 ± 0.02 mm for 2CL and 0.57 ± 0.05 mm for 2CS; P = 0.012), and required the highest load-to-failure (162 ± 83 vs. 1064 ± 75 N for 2CL and 790 ± 34 N for 2CS; P = 0.016).The 3CL configuration provided superior strength and stability across all tests, supporting its role in the fixation of length-unstable pediatric femoral fractures.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The alpha-defensin can rule out septic arthritis in pediatric cases: a first case series study.","authors":"Masayoshi Machida, Katsuaki Taira, Noboru Oikawa, Naho Nemoto, Brett Rocos, Shutaro Aiba, Kazuyoshi Nakanishi","doi":"10.1097/BPB.0000000000001266","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001266","url":null,"abstract":"<p><p>Achieving a rapid diagnosis in suspected septic arthritis is challenging as a pathogen is only isolated in 50% of cases, and the necessary investigation takes time and delays treatment. The alpha-defensin lateral flow test (Synovasure) has been shown to effectively and rapidly diagnose prosthetic joint infection, with the benefit of early initiation of treatment. This study tests the hypothesis that the alpha-defensin can diagnose pediatric septic arthritis and differ nonseptic arthritis (NSA) in native joints. A retrospective cohort study analysis was carried out for patients presenting with joint pain and fever with a differential that included septic arthritis. The Synovasure alpha-defensin lateral flow test kit was used to detect alpha-defensin in synovial fluid aspirated from the symptomatic joint. Septic arthritis was defined as present when a causative bacteria was identified in either blood or synovial fluid culture, whereas NSA was recognized when a causative bacteria was not identified, drainage or antibiotic treatment was not implemented, and symptoms improved without joint destruction. Demographic data and culture results were compared between septic arthritis and NSA. Eighteen eligible cases were identified. Of these, six were defined as septic arthritis and 12 as NSA. There were no significant differences in age, body temperature, serum white blood cell count, and C-reactive protein. All cases with confirmed septic arthritis showed a positive alpha-defensin lateral flow test, whereas all of the NSA group showed a negative result. The Synovasure alpha-defensin lateral flow test may be a reliable investigation for rapidly distinguishing septic arthritis from NSA in children.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study of gait compensation for limb-length discrepancy in children and adolescents: threshold values and compensatory strategies in the sagittal plane.","authors":"An Seong Chang, Hae-Ryong Song, Mi Hyun Song","doi":"10.1097/BPB.0000000000001265","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001265","url":null,"abstract":"<p><p>The critical threshold of limb-length discrepancy (LLD) at which compensation strategies are initiated in pediatric patients is unclear. We used spatiotemporal parameters to determine the LLD threshold at which compensatory gait is induced in skeletally immature patients and analyzed these compensatory patterns in terms of kinematics and kinetics. The findings for 20 children who experienced LLD-associated gait discomfort and underwent three-dimensional gait analysis between 2016 and 2019 were reviewed. Using spatiotemporal parameters, the LLD threshold that causes gait asymmetry was determined by receiver operating characteristic (ROC) analysis. Patients were grouped into those with an LLD greater than the cutoff value and those without. The kinematics and kinetics of the two groups were compared. The ROC curve showed that step length was a critical indicator of gait compensation. The area under the curve was 0.882 for both absolute LLD and LLD ratio, with threshold values of 14.06 mm and 1.85%, respectively. The group with LLDs above the threshold showed significant interlimb differences in the hip flexion angle, ankle dorsiflexion angle, and hip joint moment in the sagittal plane (P = 0.005, P = 0.015, and P = 0.047, respectively). Compensatory strategies for LLD began when the absolute LLD was 14.06 mm or the LLD ratio was 1.85%. These strategies included hip joint flexion, increased hip joint moment of the longer limb, and ankle joint plantar flexion of the shorter limb. Thus, even with LLD less than 2 cm, asymmetries may exist in joint kinematics and kinetics.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}