João Marques, Marcos Carvalho, Sérgio Martínez Alvarez, Maria Pia Monjardino, Pedro Cardoso, Tah Pu Ling, Cristina Alves
{"title":"Ray resection in pediatric population after trauma injuries.","authors":"João Marques, Marcos Carvalho, Sérgio Martínez Alvarez, Maria Pia Monjardino, Pedro Cardoso, Tah Pu Ling, Cristina Alves","doi":"10.1097/BPB.0000000000001172","DOIUrl":"10.1097/BPB.0000000000001172","url":null,"abstract":"<p><p>The aim of this study is to assess the functional, emotional, and social adaptation of pediatric patients submitted to a hand ray resection to treat a traumatic hand injury. Retrospective study of pediatric patients undergoing hand ray resection, in the period 2013-2022, performed in two hospital institutions. Inclusion criteria: age less than 18 years, primary/secondary resection due to traumatic etiology and follow-up time of more than 1 year. Data concerning demographic information, lesion location, traumatic mechanism and surgical description were collected. Functional outcomes (QuickDASH Score), social and emotional integration (PEDSQL) and satisfaction were evaluated. Seven patients were included, with male predominance ( n = 4) and the right side was the most affected ( n = 5). Median age at the time of surgery was 10 years (2-15). Primary ray resection, without previous revascularization, was performed in three patients. Secondary ray resection was performed in four patients. Three patients with an unsuccessful revascularization procedure attempt another patient with a sequela with severe deformity. All patients presented a good adaptation to daily living activities, with good pinch and grip function. The median follow-up was 4 years (min:1; max:9). The scores were collected on six out of seven patients. Median QuickDASH score of 14 (min:11; max:22), and PEDSQL[physical] of 95.31 (min:78.13; max:100) and PEDSQL[social] of 93.47 (min:66.3; max:100). Hand ray resection is a rare procedure in pediatric age and usually difficult for patients and parents to accept. However, it is a useful and safe technique that allows for an improvement in overall hand function and psychosocial readaptation in specific and selected cases. Level of evidence: Level of evidence IV - case series.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"240-248"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906781","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 we make out the coronal plane corrections of the knee region by studying the screw divergence in tension band plate induced growth modulations?","authors":"Anil Agarwal, Kishmita Sachdeva, Ankitha Kanchinadka Sripathy, Varun Garg","doi":"10.1097/BPB.0000000000001224","DOIUrl":"10.1097/BPB.0000000000001224","url":null,"abstract":"<p><p>We studied the correlation between changes in the interscrew angle (screw divergence) and the correction achieved with tension band plates applied for valgus deformities of the knee region. Twenty-eight children with 68 operated physes were included in this retrospective review. The interscrew angle and screw trajectory angle were measured in the initial and follow-up radiographs. Additionally, changes in the mechanical lateral distal femoral angle and medial proximal tibial angle were calculated from the follow-up radiographs. The statistical calculations involved correlating the changes in the above-mentioned parameters and the magnitude of correction. The location of the implant was in the distal femur in 49 and the proximal tibia in 19 limbs. A mean correction of 12.1° was achieved at a follow-up of 12.1 months. The correction was calculated as 1.1°/month (SD = 0.6). The correlation of screw divergence ( R = -0.01; P = 0.97) and changes in screw trajectory angle ( R = -0.11; P = 0.36) to the angular correction achieved was statistically insignificant. The changes in the interscrew angle did not correlate with the angular correction following tension band plates.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"271-274"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883368","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}
R Justin Mistovich, Robert J Burkhart, David A Kolin, Peter D Fabricant, Raymond W Liu
{"title":"Response to Rehm et al commentary: Less common than expected: late displacement after minimally displaced pediatric lateral condyle fractures of the elbow.","authors":"R Justin Mistovich, Robert J Burkhart, David A Kolin, Peter D Fabricant, Raymond W Liu","doi":"10.1097/BPB.0000000000001252","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001252","url":null,"abstract":"","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":"34 3","pages":"308"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722406","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":"Femoral shaft fractures in preschool children: external fixation and elastic intramedullary nail treatments in clinical practice.","authors":"Jiale Guo, Wei Feng, Baojian Song, Danjiang Zhu, Yuwei Wen, Qiang Wang","doi":"10.1097/BPB.0000000000001221","DOIUrl":"10.1097/BPB.0000000000001221","url":null,"abstract":"<p><p>Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration ( P = 0.04), fewer intraoperative fluoroscopy times ( P < 0.01), earlier partial weight-bearing time ( P < 0.01), and full weight-bearing time ( P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group ( P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"209-217"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803239","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}
Ana Gabriela Santana Cuoghi, Ana Maria Ferreira Paccola, Roger Frossard Pagotto, Douglas Manuel Carrapeiro Prina, Monica Paschoal Nogueira
{"title":"Treatment of relapse valgus knee deformity in fibular hemimelia with hemiepiphysiodesis.","authors":"Ana Gabriela Santana Cuoghi, Ana Maria Ferreira Paccola, Roger Frossard Pagotto, Douglas Manuel Carrapeiro Prina, Monica Paschoal Nogueira","doi":"10.1097/BPB.0000000000001217","DOIUrl":"10.1097/BPB.0000000000001217","url":null,"abstract":"<p><p>The objective of this study was to analyze the treatment of recurrent valgus knee in fibular hemimelia patients with hemiepiphysiodesis and define associated variables for deformity relapse. Sixteen consecutive patients with fibular hemimelia treated with hemiepiphysiodesis (57 physis) were compared to 21 physis of idiopathic cases, in terms of magnitude, speed, and time of correction. Correction of valgus deformity was successfully achieved in all cases. In the fibular hemimelia group, children 4 years and younger had a bigger magnitude of correction than older ones (11° versus 6.9°) and greater speed (1° versus 0.6°), with statistical significance ( P = 0.018 and P = 0.009, respectively), while time for correction was similar among these groups (11.6 months versus 12.3 months). Femoral distal physis corrected faster than proximal tibial physis (10.8 months versus 16.8 months), with statistical significance ( P = 0.032). Thirty-three physis (57.9%) were isolated and 24 (42.1%) were tibia and femur. We found no statistical difference between the two groups regarding time for correction, magnitude, or speed ( P = 0.526, P = 0.910, P = 0.803, respectively). Relapse was observed in 49 physis (86%) of the fibular hemimelia patients. These had a mean age of 5.5 years versus 3.9 years for those without a relapse, with statistical significance ( P = 0.204). Relapse occurred after 2 years of the first procedure. Recurrent valgus deformity in fibular hemimelia can be successfully treated with single or multiple hemiepiphysiodesis with tension band plates in skeletally immature patients in an effective and gradual manner. Level of Evidence: Level III, therapeutic study.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"275-281"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752124","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}
Heloisa Z Faggion, Javier Masquijo, Weverley R Valenza, Jamil F Soni, Gabriel J S Lange
{"title":"Intramalleolar triplane ankle fractures in adolescents.","authors":"Heloisa Z Faggion, Javier Masquijo, Weverley R Valenza, Jamil F Soni, Gabriel J S Lange","doi":"10.1097/BPB.0000000000001230","DOIUrl":"10.1097/BPB.0000000000001230","url":null,"abstract":"<p><p>This article aims to describe a multicenter cohort of atypical triplane ankle fractures with intramalleolar involvement of the epiphysis, providing insights into the affected population, treatment outcomes, and complications. In addition, we propose a treatment strategy for such fractures based on our findings. A retrospective analysis was conducted on adolescent patients diagnosed with triplane ankle fractures. Data from three participating centers in Brazil and Argentina were collected and analyzed. Treatment strategies, including surgical and nonsurgical approaches, were evaluated. Clinical outcomes such as pain levels, functional scores (AOFAS), and return to normal activities were assessed. Radiographic evaluations were performed to evaluate fracture healing and alignment. Data were collected from seven patients with an average age of 13 years. The sample consisted predominantly of male patients (6/7), with the left side affected (6/7) and Shin type 3 fractures. Two cases were treated conservatively, with consolidation within the expected period without subsequent displacements or negative functional repercussions (AOFAS score, 100). In surgical cases, starting fixation from the metaphysis made it possible to avoid fixation of the epiphyseal fragment in all cases, except one. All surgically treated cases had consolidation within the expected time, without subsequent deviations or complications. This multicenter evaluation offers valuable insights into the presentation of fractures, diverse treatment approaches employed, and their respective clinical and radiographic outcomes. However, further prospective studies with larger sample sizes are necessary to validate these findings and to establish evidence-based treatment guidelines for this specific fracture pattern in the adolescent population.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"224-230"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958071","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":"Surgical management of post-traumatic distal tibiofibular synostosis: a technical note.","authors":"Saral Patel, Ria S Parikh, Shital N Parikh","doi":"10.1097/BPB.0000000000001218","DOIUrl":"10.1097/BPB.0000000000001218","url":null,"abstract":"<p><p>Post-traumatic distal tibiofibular synostosis (DTFS) is a rare complication following distal tibiofibular fracture treatment in pediatric patients. Hence, there is a paucity of literature on the management of DTFS. DTFS can lead to ankle pain, ankle valgus, fibular shortening, and can alter the biomechanical function of the ankle joint. Two pediatric cases of DTFS are presented, highlighting the complication after a comminuted ankle fracture. Both underwent surgical excision of synostosis and interposition of a silastic sheet and fat graft between the tibia and fibula. At 1-year follow-up, there was complete resolution of symptoms and no recurrence of synostosis.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":"34 3","pages":"231-235"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722408","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}
Chad B Willis, Brien M Rabenhorst, Kirsten Johnston, David B Bumpass
{"title":"Pediatric orthopedic all-terrain vehicle injury patterns, surgeries, and complications: appreciating the true morbidity and impact.","authors":"Chad B Willis, Brien M Rabenhorst, Kirsten Johnston, David B Bumpass","doi":"10.1097/BPB.0000000000001222","DOIUrl":"10.1097/BPB.0000000000001222","url":null,"abstract":"<p><p>All-terrain vehicle (ATV) accidents frequently cause orthopedic injuries. Previous studies have reported the frequency of fractures in ATV injuries. No studies have provided detailed assessments of fracture patterns, types of operative intervention, or risks for multiple surgeries. A total of 489 patients with ATV-related injuries were treated at one tertiary Level 1 pediatric hospital from January 2011 to December 2016. Medical records were retrospectively reviewed to define orthopedic injuries and treatment. Data were organized to identify fracture patterns, surgeries, and complications. Three age groups were utilized (0-6, 7-12, and ≥13 years). A total of 270 pelvic and extremity fractures occurred in 215 patients (44%); 136 patients (63%) required surgical intervention; 47 patients (22%) required multiple trips to the operating room; 16% of fractures (43/270) were open, and seven developed deep infections. Three patients required amputations, and one death was recorded. No significant differences were found between age and fracture frequency or need for surgery. Surgical rates of supracondylar humerus (97%) and tibial shaft fractures (87%) were higher than historical norms (16-24% and 5-74%, respectively). To date, this is one of the largest single-institution cohorts of ATV-related pediatric orthopedic injuries. Nearly half of ATV-related pediatric trauma patients sustained orthopedic injuries. The majority required surgical treatment, and nearly 1/4 of patients required multiple surgeries. Younger patients were as likely to require surgery as older patients. Supracondylar humerus fractures and tibial shaft fractures from ATVs required surgery at a higher rate than historical norms. The surgical morbidity of pediatric ATV fractures is substantial and should influence safety and prevention education.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"218-223"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883377","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}
Monish S Lavu, Chloe Van Dorn, Lukas Bobak, Robert J Burkhart, David C Kaelber, R Justin Mistovich
{"title":"Does rickets carry an increased risk of osteomyelitis and septic arthritis? An aggregated electronic health record data study.","authors":"Monish S Lavu, Chloe Van Dorn, Lukas Bobak, Robert J Burkhart, David C Kaelber, R Justin Mistovich","doi":"10.1097/BPB.0000000000001168","DOIUrl":"10.1097/BPB.0000000000001168","url":null,"abstract":"<p><p>To investigate the prevalence of osteomyelitis and septic arthritis in pediatric patients with rickets, compared to the general population. A retrospective cohort study was conducted using the TriNetX analytics network, which aggregates deidentified electronic health record data from over 105 million US patients. We queried pediatric patients with rickets, based on ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) encounter diagnoses. Patients with any ICD-10-CM encounter diagnoses of osteomyelitis or septic arthritis were reported. We established a control cohort of pediatric patients without rickets. Of 7337 pediatric patients (≤18 years old) with a rickets diagnosis, 96 [1.31%, 95% confidence interval (CI): 1.05%-1.57%] had a diagnosis of osteomyelitis and 28 (0.38%, 95% CI: 0.24%-0.52%) had a diagnosis of septic arthritis. In comparison, of the 17 240 604 pediatric patients without a rickets diagnosis, 16 995 (0.10%, 95% CI: 0.10%-0.10%) had a diagnosis of osteomyelitis and 8521 (0.05%, 95% CI: 0.05%-0.05%) had a diagnosis of septic arthritis. The relative risk for an osteomyelitis diagnosis in pediatric patients with a rickets diagnosis was 13.27 (95% CI: 10.86-16.23), while the relative risk for a septic arthritis diagnosis was 7.72 (95% CI: 5.33-11.18). Pediatric patients with a diagnosis of rickets have over 10- and 5-times higher relative risks for having a diagnosis of osteomyelitis and septic arthritis, respectively, compared to those without a diagnosis of rickets. This is the first study to explore musculoskeletal infections in rickets patients, highlighting the importance of clinicians being vigilant about these conditions.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"288-293"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906778","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":"Prevalence, number of fractures, and hospital characteristics among the pediatric population with osteogenesis imperfecta: results from the nationwide registry of Türkiye.","authors":"Bariş Görgün, Niyazi Erdem Yaşar, İzzet Bingöl, Ebru Dumlupinar, Naim Ata, M Mahir Ülgü, Şuayip Birinci, Sinem Bayram, Güzelali Özdemir","doi":"10.1097/BPB.0000000000001192","DOIUrl":"10.1097/BPB.0000000000001192","url":null,"abstract":"<p><strong>Objective: </strong>Osteogenesis imperfecta is a rare connective tissue disorder with an estimated number of 4-20 cases per 100 000 inhabitants. Although the prevalence differs among regions, there are only a few number of national registry studies published previously. The aim of this study was to determine the prevalence of osteogenesis imperfecta among the pediatric age group in Türkiye, together with the patient and hospital characteristics.</p><p><strong>Methods: </strong>Via the e-health database of the Turkish Ministry of Health, we collected and retrospectively evaluated the medical records of the patients who were under 18 years of age with the diagnosis of osteogenesis imperfecta between 2016 and 2022. Total number of fractures, treatment modalities, and the hospital characteristics were also recorded. Two thousand seven hundred forty patients were extracted with a mean age of 9.77 ± 4.81 years.</p><p><strong>Results: </strong>The prevalence of osteogenesis imperfecta in Türkiye among the pediatric population was calculated as 11.6 per 100 000 individuals. The median annual incidence was 31.5 per 100 000 live births between 2016 and 2022. There were 17.4 hospital admissions per patient per year. The mean age at the time of in-hospital mortality was 4.08 ± 5.03 years. The fracture rate per patient per year was 0.56 and conservative treatment was the most commonly preferred modality for all ages.</p><p><strong>Conclusion: </strong>This is the first registry-based nationwide study of osteogenesis imperfecta patients in Türkiye, providing important characteristics of the disease. Together with the help of the ongoing development of national health database systems, precision in patient identification would yield substantial benefits in terms of management of osteogenesis imperfecta.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"249-256"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428136","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}