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":"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":"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":"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":"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":"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}

{"title":"C-reactive protein can be used to guide the empiric antimicrobial therapy of acute osteomyelitis in children.","authors":"Haiting Jia, Tao Liu","doi":"10.1097/BPB.0000000000001264","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001264","url":null,"abstract":"<p><p>This study was to identify some indicators that could be used to distinguish methicillin-resistant Staphylococcus aureus (MRSA) from methicillin-sensitive Staphylococcus aureus (MSSA) to more accurately guide empirical antibiotics. Data of 91 cases of acute osteomyelitis in children with Staphylococcus aureus infection (including 29 cases of MRSA and 62 cases of MSSA) from July 2017 to March 2024 were retrospectively analyzed. Age, sex, duration of onset, maximum body temperature at onset, and inflammatory indicators detected after admission were compared between the MRSA group and the MSSA group. According to the receiver operating characteristic (ROC) curve, the diagnostic efficiency of MRSA infection was evaluated. Logistic regression analysis was used to determine independent risk factors for MRSA infection. There were no significant differences in age, sex, duration of onset, maximum body temperature, white blood cell count, neutrophil count, and erythrocyte sedimentation rate between the MRSA group and the MSSA group (P > 0.05). The median C-reactive protein in the MRSA group and the MSSA group was 97.93 and 58.10 mg/L, respectively, with statistical significance (P < 0.05). The sensitivity, specificity, and area under the curve of C-reactive protein for detecting MRSA infection were 41.4, 90.3, and 0.646%, respectively. Logistic regression analysis showed that C-reactive protein greater than 116.46 mg/L (odds ratio = 6.588, 95% confidence interval: 2.149-20.197) was an independent risk factor for predicting MRSA infection (P < 0.05). C-reactive protein greater than 116.46 mg/L can independently predict the likelihood of MRSA infection, and it is recommended to empirically select anti-MRSA treatment for such children.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112618","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":"Diagnosis and treatment of lateral to medial diagonal injury of the elbow in children: concomitant lateral condyle and olecranon fractures.","authors":"Yunan Lu, Chentao Xue, Federico Canavese, Yongjie Xia, An Yan, Yuchen Pan, Hetu Yao, Shunyou Chen","doi":"10.1097/BPB.0000000000001263","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001263","url":null,"abstract":"<p><p>Lateral condylar (LC) and olecranon (OC) fractures occurring concurrently on one side are rare phenomena with limited scientific literature. Our study aims to evaluate the radiologic, clinical, and functional consequences of lateral to medial injury of the elbow (LAMEINE) in pediatric patients, simultaneously comparing with lateral to medial diagonal injury of the elbow (MELAINE). Eighteen males and 10 females were diagnosed with LAMEINE. The average age at the time of injury was 3.8 ± 2.3 years (range, 1-9). Out of the 28 fractures, 19 (67.9%) occurred on the left side and nine (32.1%) on the right side. The OC fractures were classified according to the Weiss system, two being type I, 17 type II, and nine type III fractures. Based on the specific case characteristics, the OC fractures were further subdivided into five types corresponding to two types of AO classification: 24 (85.7%) cases of AO 21u-M/2. 1 incomplete fractures [3 type I (10.7%), 16 type II (57.1%), and five type III fractures (17.9%)], and four (14.3%) cases of AO 21u-M/3.1 complete simple fractures [2 type IV (7.1%) and two type V fractures (7.1%)]. All patients underwent surgical intervention. Their clinical and functional outcomes were evaluated using the carrying angle (CA) and elbow performance score (EPS). These results were then compared with those of our MELAINE patients. All patients were followed up for 42.9 ± 23.5 months (range, 15-88). Radiographs indicated that all fractures healed in 5.9 ± 1.4 weeks (range, 4-10). At the last follow-up, the CA and EPS of the injured side were 11.3° ± 2.8° and 97.7 ± 3.7, respectively. All patients had favorable outcomes: 27 patients (96.4%) had excellent EPS, and only one patient (3.6%) had good EPS. The LAMEINE group displayed lower age, displacement, incidence of elbow dislocation, and CA than the MELAINE group (P < 0.05). Although relatively rare, LAMEINE should not be neglected. Surgical treatment aims to stabilize the elbow and avoid varus deformity. With appropriate diagnosis and treatment, good clinical and radiographic outcomes can be achieved for both patterns of 'diagonal lesions' of the pediatric elbow. Level of evidence: III.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095258","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}