Journal of Pediatric Orthopaedics-Part B最新文献

{"title":"Bone healing and functional outcomes of utilizing contralateral free vascularized fibular graft following en bloc resection of adamantinoma and osteofibrous dysplasia-like adamantinoma.","authors":"Corentin Petitpas, Camille Girardin, Émilie Peltier, Jean-Marc Guillaume, Jean-Luc Jouve, Sébastien Pesenti, Franck Launay","doi":"10.1097/BPB.0000000000001384","DOIUrl":"https://doi.org/10.1097/BPB.0000000000001384","url":null,"abstract":"<p><p>Adamantinomas and osteofibrous dysplasia-like (OFD-like) adamantinomas are rare tibial bone tumors with variable presentations, making diagnosis and management challenging. While en bloc resection with wide margins is generally preferred, the optimal method for reconstruction remains debated. This study assesses clinical and functional outcomes following tibial reconstruction using an intercalary free vascularized fibular graft harvested from the contralateral limb. A retrospective single-center review included patients treated between 1998 and 2020 for tibial adamantinoma or OFD-like lesions, with at least 2 years of follow-up. Diagnosis was confirmed histologically. All patients underwent en bloc resection and reconstruction using an intercalary free vascularized fibular graft. Outcomes included bone healing and graft remodeling (De Boer and Wood coefficient), functional results (Musculoskeletal Tumor Society score), complications, and oncologic status. Ten patients (mean age: 12.6 years) were included, five with adamantinoma and five with OFD-like variants. All achieved bone union at a mean of 11.5 months; one required revision for nonunion. Graft remodeling averaged 94% at 2 years. The mean Musculoskeletal Tumor Society score at last follow-up (9.3 years) was 28. Reported complications included four graft fractures, one deep infection, and one transient peroneal nerve palsy. Two patients developed metastases; the remaining eight remained disease-free at a mean follow-up of 112 months. The contralateral free vascularized fibular graft provides effective tibial reconstruction after adamantinoma resection, yielding good oncologic control, bone consolidation, and functional outcomes. However, complications persist and warrant careful surgical planning and extended follow-up.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425928","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":"Risk stratification in conservatively treated pediatric lateral humeral condyle fractures: the prognostic value of articular gap and initial displacement - a retrospective cohort study.","authors":"Muhammed Furkan Darilmaz, Mustafa Bulut","doi":"10.1097/BPB.0000000000001379","DOIUrl":"10.1097/BPB.0000000000001379","url":null,"abstract":"<p><p>The optimal management of minimally displaced pediatric lateral humeral condyle fractures remains controversial because some fractures may displace or heal late despite apparently stable initial radiographs. This study aimed to identify radiographic predictors of instability and delayed union in conservatively treated fractures. We retrospectively reviewed 58 children with lateral humeral condyle fractures treated nonoperatively between 2019 and 2024 using a standardized radiographic protocol including anteroposterior, lateral, and internal oblique views. Serial displacement, time to radiographic union, and complications were analyzed. Predictors of displacement progression and delayed union were evaluated using multivariable analyses. Radiographic union was achieved in 57 of 58 fractures (98.3%). Clinically relevant displacement progression (≥1 mm) occurred in six patients (10.3%). The presence of a radiographic articular gap strongly predicted displacement progression (odds ratio = 12.0, 95% confidence interval = 1.80-80.05, P  = 0.019) and was associated with major complications ( P  < 0.001). Initial displacement greater than or equal to 2 mm was associated with longer time to union (29.7 ± 5.3 vs. 24.6 ± 4.2 days; P  = 0.001) and independently predicted delayed union (+4.75 days, P  = 0.008). All major complications occurred in fractures with initial displacement greater than or equal to 2 mm. Most minimally displaced lateral humeral condyle fractures treated conservatively achieve reliable union. However, fractures demonstrating an articular gap or displacement approaching 2 mm represent a higher-risk subgroup prone to displacement progression, delayed union, and complications. Incorporating these radiographic markers into initial assessment may help guide surveillance intensity and treatment decisions in pediatric patients.</p><p><strong>Level of evidence: </strong>Level III - retrospective cohort study.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370457","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":"Multidisciplinary team intervention enhances comprehensive recovery in adolescents aged 14-18 years with limb or pelvic fractures.","authors":"Xiao Wang, Zhiheng Tu, Dongdong Jiang, Gadisa Musa Wako, Junwei Yan, Bin Liang","doi":"10.1097/BPB.0000000000001292","DOIUrl":"10.1097/BPB.0000000000001292","url":null,"abstract":"<p><p>To evaluate the effects of multidisciplinary team (MDT) intervention on perioperative management, functional recovery, and psychological well-being in adolescents aged 14-18 years with limb or pelvic fractures. One hundred adolescents aged 14-18 years with limb or pelvic fractures, admitted between January 2018 and December 2023, were retrospectively divided into an MDT group ( n  = 50) and a control group ( n  = 50) according to whether they received MDT intervention. The MDT group received comprehensive perioperative management involving orthopedics, emergency, anesthesiology, rehabilitation, pediatrics, psychology, and surgical intensive care; the control group received standard perioperative management. Perioperative outcomes, pain scores, functional recovery, and psychological status were compared at predetermined time points. The MDT group had significantly shorter hospital stays and lower postoperative pain scores than the control group ( P  < 0.05). Functional recovery was assessed using the short musculoskeletal function assessment (SMFA) and the CORE-Kids simplified score (CKSS), a 0-9 binary scale developed with reference to the CORE-Kids core outcome set. At 3 and 6 months, the MDT group showed significantly better SMFA and CKSS scores ( P  < 0.05). At 12 months, no significant differences were observed. The MDT group also had significantly lower hospital anxiety and depression scale anxiety and depression scores on postoperative day 3 and at 12 months ( P  < 0.05). MDT intervention improves perioperative pain control, promotes functional recovery, and enhances psychological well-being in adolescents with limb or pelvic fractures and may facilitate earlier return to daily life and school.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"316-323"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071022","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":"Charleston vs. Providence: are all scoliosis bending braces created equal?","authors":"Connor A Nyborg, Laura Morales Leon, Ravi Rajendra, Michael R Cesarek, Claudia Leonardi, R Carter Clement","doi":"10.1097/BPB.0000000000001345","DOIUrl":"10.1097/BPB.0000000000001345","url":null,"abstract":"<p><strong>Level of evidence: </strong>III - retrospective comparative study.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"378-382"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500444","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":"Is MRI useful in the postoperative assessment of an open hip reduction in the presence of metal implants?","authors":"Lauren E Torrey, Eric R Siegel, Scott J Schoenleber, Brien M Rabenhorst","doi":"10.1097/BPB.0000000000001331","DOIUrl":"10.1097/BPB.0000000000001331","url":null,"abstract":"<p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"368-372"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214817","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":"Comparison of opioid-free versus traditional opioid-containing postoperative pain management pathways for idiopathic scoliosis.","authors":"Michael Schallmo, Katherine Drexelius, Elizabeth Benson, Ainsley Bloomer, Joseph Burger, Kayla Hietpas, Michael Paloski","doi":"10.1097/BPB.0000000000001351","DOIUrl":"10.1097/BPB.0000000000001351","url":null,"abstract":"<p><p>While opioid medications are commonly used to manage postoperative pain in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis, their use is associated with negative short and long-term effects. There is a paucity of data evaluating the feasibility and efficacy of opioid-free pain regimens in this population. The purpose of this study was to compare a multimodal opioid-free with a traditional opioid-containing protocol in pediatric patients undergoing instrumented PSF for idiopathic scoliosis. We hypothesized that the opioid-free pain management pathway would result in equivalent length of stay (LOS) and fewer opioids prescribed at discharge compared with an opioid-containing pathway. This was a prospective case-control study comparing opioid-free versus opioid-containing pathways. Eligible participants included patients aged 10-20 years at time of surgery with idiopathic scoliosis who underwent primary instrumented PSF by a single, fellowship-trained pediatric orthopedic surgeon during a 2-year period. Total opioid use was recorded. Statistical analysis included Wilcoxon, Chi-square, and Fisher's exact tests for group comparisons. Patients in the opioid-free group had a greater number of levels fused ( P  = 0.036), had a similar inpatient LOS postoperatively ( P  = 0.917), and required fewer opioid prescriptions at discharge [10/36 patients (27.8%) vs. 55/56 patients (98.2%), respectively; P  < 0.0001]. A comprehensive, multimodal, opioid-free pain management pathway following instrumented PSF for idiopathic scoliosis results in equivalent LOS and fewer opioids prescribed at discharge compared with an opioid-containing pathway. Establishing patient/family expectations beforehand is crucial to the successful engagement and implementation of this opioid-free protocol.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"394-402"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787667","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":"How reliable are radiographic measures of the pediatric elbow? Measurement and comparison of four parameters in healthy children's elbow.","authors":"Göker Utku Değer, Ece Davutluoğlu, Nuri Ayoğlu, Mahmut Kürşat Özşahin, Ali Şeker","doi":"10.1097/BPB.0000000000001349","DOIUrl":"10.1097/BPB.0000000000001349","url":null,"abstract":"<p><p>The reproducibility of radiographic parameters used to assess pediatric supracondylar fracture reduction, including Baumann angle, lateral capitellohumeral angle (LCHA), carrying angle, and anterior humeral line (AHL) crossing the capitellum, was evaluated. Two observers undertook a total of 2368 measures on 148 elbow radiographs from 107 patients aged 0-12 years. The observers, who were blinded to their own measurements and each other's measurements, performed the measurements twice with a 1-month interval using an electronic goniometer. The average value and reliability of the measurements were evaluated. Intraobserver and interobserver reliability were determined using intraclass correlation coefficients (ICCs). The mean LCHA of the 148 elbow population was 52.4° (range: 27-74°), the mean Baumann angle was 71.5° (range: 54-90°), and the mean carrying angle was 18° (range: 5-37°). 80% of the AHL was in the middle third of the capitellum. The ICCs for interobserver reliability were moderate to good for Baumann angle 0.71-0.78, for LCHA 0.72-0.72, for carrying angle 0.83-0.85, and for AHL 0.89-0.90. The ICCs for intraobserver reliability were moderate to excellent for Baumann angle 0.93-0.86, for LCHA 0.91-0.81, for carrying angle 0.71-0.92, and for AHL 0.94-0.90. This study demonstrated that Baumann angle, LCHA, carrying angle, and AHL are reliable measuring methods, with normal values reported in the Turkish population.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"311-315"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787712","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":"i-Factor bone graft compared with allograft in spinal fusion for adolescent idiopathic scoliosis: a preliminary comparative study.","authors":"Antti J Saarinen, Aron Frantzén, Matti Ahonen, Ilkka Helenius","doi":"10.1097/BPB.0000000000001336","DOIUrl":"10.1097/BPB.0000000000001336","url":null,"abstract":"<p><p>Bone graft extenders are widely used to supplement local autograft in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). P-15, a novel synthetic 15-amino-acid polypeptide, has shown promise in promoting bone healing. This study compares P-15 (i-Factor) as a bone graft extender to allograft in adolescents undergoing segmental pedicle screw instrumentation for AIS. We conducted a retrospective analysis of prospectively collected data on 60 adolescents with AIS who underwent segmental pedicle screw instrumentation with a minimum 2-year follow-up. In this preliminary study, 30 patients received P-15, and 30 received an allograft in addition to a local autograft. Operative time, radiographic outcomes, and health-related quality of life were assessed. Plain radiographs were used to evaluate nonunion. Operative time was significantly shorter in the P-15 group (2.7 vs. 3.4 h; P = 0.01). At 2-year follow-up, the mean major curve was 17° (SD: 6.2) in the P-15 group and 20° (SD: 5.2) in the allograft group ( P = 0.057). The mean loss of correction was similar between the groups (3.3 vs. 1.2°; P = 0.092). No cases of nonunion or deep surgical site infections were observed. Health-related quality of life scores were comparable between the groups. P-15 is, according to the current study, a safe and effective bone graft extender for posterior spinal fusion in adolescents with AIS, demonstrating similar radiographic and clinical outcomes compared to allograft while reducing operative time. Further research is warranted to assess the long-term results with P15 in adolescents undergoing pedicle screw instrumentation for idiopathic scoliosis.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"390-393"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198251","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":"Low-energy lower extremity long bone fractures are associated with lower vitamin D levels than high-energy fractures.","authors":"Saechin Kim, Samantha H Guzmán, Serafina F Zotter, Maggie Connolly, Charles J Culata, Amanda Schillinger","doi":"10.1097/BPB.0000000000001311","DOIUrl":"10.1097/BPB.0000000000001311","url":null,"abstract":"<p><p>Studies suggest that vitamin D may be protective against upper extremity low-energy (LEn) fractures. We hypothesized that there may be a similar effect in lower extremity long bone (LLB) fractures. We prospectively enrolled pediatric patients (ages 3 to 18) with LLB fractures. Exclusion criteria were pathologic, vertebral or pelvic fracture, or patients with metabolic and neuromuscular disorders. The 25-hydroxyvitamin D (25OH vit D) in the LEn group (18.3 ± 6.6 ng/ml, n  = 48) was significantly lower than that in the high-energy group (HEn) (23.5 ± 7.4 ng/ml, n = 22) ( P = 0.0086). As ankle fractures were predominantly in the higher 25OH vit D range, a subgroup analysis of 25OH vit D in LEn above ankle fracture group (LEnAA) (16.8 ± 5.5 ng/ml) was significantly lower than that in the HEn above ankle fracture group (HEnAA) (22.6 ± 6.3 ng/ml) ( P = 0.011). Defining vitamin D deficiency, insufficiency, and sufficiency as 25OH vit D < 20, 20-29, and ≥ 30 ng/ml respectively, the percentage of patients with vitamin D sufficiency in LEnAA (0%) was significantly less than that in HEnAA (19%); vitamin D deficiency in LEnAA (68%) was significantly greater than that in HEnAA (38%). A greater percentage of patients with vitamin D deficiency were treated operatively compared to those with vitamin D insufficiency and sufficiency ( P = 0.02). Our study found that LEn and LEnAA had significantly lower 25OH vit D compared to HEn and HEnAA and supported the hypothesis that vitamin D may be protective against LLB LEn fractures. Our recommendation is to obtain 25OH vit D in LLB LEn.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"341-345"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670574","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":"Pediatric proximal femoral locking plate features superior biomechanical properties compared to those of multiple screws in fixing unstable pediatric femoral neck fractures.","authors":"Yu-Meng Hsiao, Fa-Chuan Kuan, Chi-Hsiu Wang, Shu-Hsin Yao, Hao-Ming Chang, Chien-An Shih, Chih-Kai Hong","doi":"10.1097/BPB.0000000000001305","DOIUrl":"10.1097/BPB.0000000000001305","url":null,"abstract":"<p><p>Pediatric femoral neck fractures result primarily from high-energy trauma. Common treatment methods include screw fixation and the placement of a proximal femoral locking plate. However, there is limited biomechanical evidence favoring one method over another for the treatment of unstable fractures. This study aimed to evaluate the biomechanical properties of screws and proximal femoral locking plates for the treatment of unstable pediatric femoral neck fractures using a synthetic bone model. Fourteen synthetic composite femurs were divided into two groups that included screw fixation (S) and locking plates (P). All specimens were prepared using a vertically oriented osteotomy to simulate unstable Delbet type II femoral neck fractures. Fixation in Group S employed three 6.5 mm cannulated screws, while Group P utilized a proximal femoral locking plate with 5.0 mm screws. The axial stiffness, cyclic elongation, and ultimate failure load were assessed using a universal material testing machine under standardized loading conditions. Statistical analyses were performed to compare biomechanical properties between the groups. Group P exhibited significantly greater axial stiffness (763 ± 212 N/mm) compared to that of Group S (547 ± 93 N/mm, P  = 0.026). Following cyclic loading, elongation was significantly smaller in Group P (0.42 ± 0.2 mm) vs. Group S (0.88 ± 0.4 mm, P  = 0.002). The ultimate failure load was also higher in Group P (2511 ± 321 N) than it was in Group S (2036 ± 256 N, P  = 0.007). The failure modes differed, with Group S exhibiting screw bending and femoral neck collapse and Group P exhibiting subtrochanteric fractures. Proximal femoral locking plates offer superior biomechanical performance compared to that of screw fixation in unstable pediatric femoral neck fractures. These findings suggest that locking plates are a viable alternative to enhance stability and potentially reduce postoperative complications.</p>","PeriodicalId":50092,"journal":{"name":"Journal of Pediatric Orthopaedics-Part B","volume":" ","pages":"324-329"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439720","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}