Journal of Pediatric Orthopaedics-Part B最新文献

{"title":"Paediatric T-condylar fracture of distal humerus: a systematic review and meta-analysis.","authors":"Sushil Prajapati, Omprakash Meena, Mohit Kumar Patralekh, Vibhu Krishnan Viswanathan, Deepak Kumar, Vijay Kumar Jain","doi":"10.1097/BPB.0000000000001268","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001268","url":null,"abstract":"<p><p>T-condylar fractures of the distal humerus are rare pediatric injuries. There is no consensus regarding ideal management and clinical outcomes for these injuries. The current review was planned to comprehensively review existing evidence regarding these rare pediatric fractures. A literature search was performed to identify the articles on pediatric T-condylar distal humerus fractures (1950-2024). Patient data was categorized under two groups: groups A (≤8 years old) and B (9-18 years). Finally, 32 articles were reviewed. Groups A and B included 25 and 148 patients, respectively. A majority of patients were males (72.3%) in both groups. 100% and 95.3% (141) of patients in groups A and B, respectively, were managed surgically [closed/open reduction and internal fixation (CR/ORIF)]. IF was predominantly done using Kirschner wire (K-wire) in group A. In group B, IF was performed using plate/screw/K-wire. There was no significant difference in complication rates between the groups [3/10 and 39/62 complications were observed in groups A and B, respectively; Mantel-Haenszel odds ratio:0.33 (95% confidence interval (CI): 0.09-1.14; Z = 1.75, P = 0.08; Chi-square = 3.23, P = 0.66; I2 = 0%)]. 87.5% in group A and 91.8% in group B had excellent; and good to excellent outcomes, respectively. The final elbow range of motion was significantly higher in group A (vs. group B; mean difference:13.91°; 95% CI: 6.93°-20.89°; test of overall effect: z = 3.91, P < 0.0001). Surgical management (i.e. ORIF) is the preferred intervention in pediatric T-condylar fractures. K-wire fixation is the most common operative technique. Overall complication rate is 58.3% (irrespective of age and treatment). Postinjury stiffness is more common in older children (>8 years).</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545859","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}

{"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}

{"title":"Management of postinfective pathological hip dislocation with absent capital femoral epiphysis in young children: a long-term follow-up study.","authors":"Rajesh Kumar Kanojia, Sumit Gupta, Durgesh Sharma, Ajay Kumar","doi":"10.1097/BPB.0000000000001259","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001259","url":null,"abstract":"<p><strong>Level of evidence: </strong>Level IV - therapeutic study.</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":"144112620","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":"Factors associated with radiographic correction of the foot after medialising calcaneal osteotomy in children with symptomatic flexible flatfoot.","authors":"Phatcharapa Osateerakun, Pathit Sirichuchnin, Prajak Jiratummarat, Noppachart Limpaphayom","doi":"10.1097/BPB.0000000000001262","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001262","url":null,"abstract":"<p><strong>Level of evidence: </strong>Level IV - prognostic, retrospective case series.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112619","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":"Implants removal in children: results of a survey among Italian orthopaedic surgeons.","authors":"Nunzio Catena, Chiara Arrigoni, Antonio Andreacchio, Renato Toniolo, Fabio Verdoni, Pasquale Guida","doi":"10.1097/BPB.0000000000001187","DOIUrl":"10.1097/BPB.0000000000001187","url":null,"abstract":"<p><p>In the treatment of paediatric limb disorders, the use of metal implants has been increasing over the last decades. Recent studies have addressed the decision of orthopaedic surgeons regarding the removal of implants after the treatment of fracture, and there is a growing consensus within the scientific community supporting the choice of not removing implants in children. This survey aimed to investigate the rationale behind the Italian orthopaedic community's decision regarding metal implant removal in paediatric patients. An electronic questionnaire was sent to all members of the Italian Paediatric Orthopaedic and Traumatology Society, Italian Orthopaedic and Traumatology Society, Italian Club of Osteosynthesis, and South Italy Society of Orthopaedic and Traumatology. The survey comprised 34 questions about hardware removal after the treatment of long bone fractures, epiphyseal growth plate injuries, slipped capital femoral epiphysis (SCFE), and flat foot. Of the 3500 orthopaedic surgeons who received the questionnaire, 5.5% responded. The leading indications for implant removal were the patient's intolerance, pain, ROM limitations, and hardware breakage. Removal of elastic nails for long bone fractures, cannulated screws for growth plate injuries, and SCFE and screws for arthroereisis for flat foot correction were analysed in detail. The consensus among Italian Orthopaedic Surgeons is to remove elastic nails and cannulated screws in cases of pain, intolerance, or breakage and to reduce further risks during patient growth. An increasing number of physicians, however, are endorsing and advocating the growing trend in the literature of not routinely removing the hardware.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"236-239"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248782","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":"Rigid intramedullary nailing of lower limb segments in children and adolescents with metabolic bone disease.","authors":"Charlene K Chin See, Saeed Al-Naser, Nicolas Nicolaou, Stephen N Giles, James A Fernandes","doi":"10.1097/BPB.0000000000001215","DOIUrl":"10.1097/BPB.0000000000001215","url":null,"abstract":"<p><p>Children and adolescents with metabolic bone disease present to the orthopedic surgeon with pain, fractures (which may be impending), and deformity. Different modalities of orthopedic management are available. Scant literature exists on the use of rigid intramedullary nailing in this population. This study sought to evaluate the utilization of this treatment modality in the pediatric cohort, focusing on indications, techniques, and outcomes of the procedures. A retrospective review was performed over an 11-year period at a single tertiary pediatric institution in the UK. Medical records and radiographs were reviewed. Preoperative surgical and medical management, time to bony union, and complications were specifically ascertained. Twenty-seven patients (63 lower limb segments) had rigid intramedullary nailing over the specified period. The majority of patients had an underlying diagnosis of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright Syndrome). Surgical indications included acute fractures, prophylactic stabilization, previous nonunion and malunions, deformity correction, and limb lengthening. All fractures healed and deformity correction was successful. In one patient, delayed union occurred after deformity correction and was successfully treated with dynamization. Fractures healed faster than corrective osteotomies. Complications included implant prominence, cortical penetrance, and screw loosening. Nonunion occurred with limb lengthening in one patient. Rigid intramedullary nailing is a safe and effective method of treatment for lower limb fractures and deformities in children and adolescents. This technique is, therefore, recommended for patients with metabolic bone disease. However, care must be taken in preoperative surgical planning and a multidisciplinary approach should be utilized.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"264-270"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606301","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}