Journal of the Pediatric Orthopaedic Society of North America最新文献

{"title":"Commentary on <i>JPOSNA®</i> Quality Improvement Case Series: Pediatric Limb Reconstruction Gone Wrong: Risks of Pursuing Treatment Without Thorough Psychological Evaluation.","authors":"Christopher Iobst, Jill C Flanagan, Kindell R Schoffner, Cara C Tomaso, David B Frumberg, Jessica Hoehn","doi":"10.1016/j.jposna.2025.100192","DOIUrl":"10.1016/j.jposna.2025.100192","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100192"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on <i>JPOSNA®</i> Quality Improvement Case Series: Isolated Lateral Extra-articular Tenodesis After Primary Anterior Cruciate Ligament Reconstruction.","authors":"Aristides I Cruz, Jennifer J Beck, Neeraj M Patel","doi":"10.1016/j.jposna.2025.100190","DOIUrl":"10.1016/j.jposna.2025.100190","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100190"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Master's Surgical Technique: One-stage Combined Hip Arthroscopy and Peri-acetabular Osteotomy.","authors":"Andrea M Spiker","doi":"10.1016/j.jposna.2025.100189","DOIUrl":"10.1016/j.jposna.2025.100189","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100189"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on <i>JPOSNA®</i> Quality Improvement Case Series: Posterior Interosseous Nerve Injury From Chronic Monteggia Fracture Dislocation Requiring Nerve Reconstruction.","authors":"Donald S Bae, Andrea H W Chan, Kevin J Little","doi":"10.1016/j.jposna.2025.100191","DOIUrl":"10.1016/j.jposna.2025.100191","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100191"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Surgeons and Surgical Leaders Manage Complications, Medical Errors, Malpractice, and Second Victim Syndrome.","authors":"Peter M Waters, David R DeMaso, James J Horgan, Steven L Frick","doi":"10.1016/j.jposna.2025.100186","DOIUrl":"10.1016/j.jposna.2025.100186","url":null,"abstract":"<p><p>Complications are inevitable for practicing surgeons, and when you lead surgeons, negative outcomes and consequences will result from some of their professional work. The implications of the undesired, unintended, or unexpected changes to a child's health due to surgical intervention can be either transient or permanent, ranging from minor to major, devastating, or even deadly adverse events. Just as surgeons strive to maximize their surgical knowledge and expertise before performing an operation, surgeons and their teams need to practice and learn how to improve their non-technical leadership and team performance skills. When an error occurs, surgeons and their teams need to resolve the complication as best as possible with their expertise, knowledge, and consultation(s) as needed. Leaders of surgeons and institutions need to support the patients, their families (first victims) and the surgeons and their care-giving teams (second victims) when a complication occurs. After a medical error, healthcare professionals should for their and the patient-parent(s) well-being: (1) acknowledge the error and its consequences; (2) take responsibility for the error; (3) express regret that the error occurred; (4) solve the problem as best as feasible with professional colleagues; and (5) strive to learn from this error and prevent such or related complication(s) from occurring to other patients in the future. There are partial and total apology (I'm sorry\") laws in 38 states protecting expressions of sympathy (partial) and admissions of fault (total) from admissibility in court. Institutional CANDOR/CANDOUR requirements do exist respectively in the US and UK. Malpractice or negligence litigation is a real risk when complications occur but interestingly occurs most often when patients and their families feel abandoned and deceived. Ultimately, all involved need to heal and this includes the surgeons who experience second victim syndrome. Providing individual and institutional support is imperative and essential for patients, their families, and the health care professionals involved in a serious surgical complication or medical error. Only then can we all cope and continue on as our best selves.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100186"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of a Graftless Salter Osteotomy in Developmental Dysplasia of the Hip.","authors":"Andrew G Kim, Carter E Hall, Sulagna Sarkar, Christopher J DeFrancesco, Wudbhav N Sankar","doi":"10.1016/j.jposna.2025.100188","DOIUrl":"10.1016/j.jposna.2025.100188","url":null,"abstract":"<p><strong>Background: </strong>Salter's innominate osteotomy is one of the most popular pediatric hip procedures for developmental dysplasia of the hip (DDH). Traditionally, Salter osteotomies require harvesting of autograft from the iliac crest, which can result in iliac wing deformities, pelvic asymmetry, and abductor dysfunction. A graftless variation of this procedure has been described in which the iliac osteotomy is fixed with threaded pins without an intervening graft, but literature surrounding this technique is sparse. The purpose of this study was to evaluate the efficacy of a graftless Salter osteotomy and compare the degree of correction to the traditional method.</p><p><strong>Methods: </strong>A retrospective review was performed of all Salter osteotomies performed at a single tertiary care children's hospital from 2009 to 2024. Demographic and clinical variables were extracted from electronic medical records. Acetabular indices (AIs) on preoperative and 3-month postoperative AP pelvic radiographs were compared to assess the degree of acetabular correction. Traditional and graftless procedures were propensity score matched 1:2 based on age, gender, and preoperative AI. Acetabular correction was compared between the two cohorts using the Wilcoxon Mann-Whitney test.</p><p><strong>Results: </strong>Forty-seven hips were identified (14 traditional, 33 graftless). Seventy-two percent of patients were female; the mean age at surgery was 29.9 months (range: 15-70). Thirty-eight hips (81%) underwent concomitant open reduction. Propensity score matched analysis demonstrated no significant difference in the degree of acetabular correction between the cohorts (traditional vs graftless: 11.9° ± 5.4 vs 12.7° ± 5.7, <i>P</i> = .69). All osteotomies healed by 3 months, and there were no cases of lost fixation with either technique.</p><p><strong>Conclusions: </strong>The graftless variation of Salter's osteotomy yields a comparable degree of acetabular correction to the traditional technique. There were no complications in either cohort from the osteotomy. The graftless Salter osteotomy is a safe and effective alternative to the traditional Salter osteotomy without the risk of iliac wing deformities and potential abductor dysfunction.</p><p><strong>Key concepts: </strong>(1)Graftless Salter osteotomy provides similar degrees of correction to the traditional technique.(2)No complications related to the osteotomy were observed in both the graftless and traditional cohort.(3)All Salter osteotomies demonstrated healing at the 3-month postoperative timepoint.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100188"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Year Results of the Randomized BiPOWR Trial Comparing the Spring Distraction System (SDS) and the One Way Self-Expanding Rod (OWSER) for the Correction of Neuromuscular and Syndromic Early Onset Scoliosis.","authors":"Justin V C Lemans, Casper S Tabeling, Agnita Stadhouder, Jeroen J M Renkens, E Pauline Scholten, Hilde W Stempels, Lotfi Miladi, René M Castelein, Moyo C Kruyt","doi":"10.1016/j.jposna.2025.100180","DOIUrl":"10.1016/j.jposna.2025.100180","url":null,"abstract":"<p><strong>Background: </strong>Current \"growth-friendly\" implants for treatment of Early Onset Scoliosis (EOS) have limitations that reduce their efficacy and cost-effectiveness. Recently, two systems have been developed that mitigate many of these limitations, the Spring Distraction System (SDS) and the One Way Self-Expanding Rod (OWSER). The purpose of the multicenter BiPOWR trial was to compare 1-year efficacy and -safety of both strategies in the treatment of neuromuscular or syndromic EOS.</p><p><strong>Methods: </strong>Non-ambulant, neuromuscular/syndromic EOS patients were included in three academic hospitals. They were randomized to treatment with SDS or OWSER and were blinded until after surgery. Outcomes were coronal curve, spinal growth and the occurrence of (serious) adverse events ((S)AEs). In addition, spinal growth and implant lengthening were calculated. Data were collected pre-operatively, immediately post-operatively, and at 1-, 3-, 6-, and 12-month follow-up.</p><p><strong>Results: </strong>Thirty patients were included. Two patients passed away during follow-up, and these patients were replaced. All collected data were used for analysis. Mean age at surgery was 9.0 years, and 20/30 patients were male. Mean coronal curve decreased from 74.9° pre-operatively, to 37.6° post-operatively, remaining stable at 37.7° at the 1-year follow-up, with no group differences. T1-T12 length increased by 18 mm/year for SDS and 9 mm/year for OWSER. For T1-S1 length, this was 26 mm/year (SDS) and 18 mm/year (OWSER). Five (S)AEs occurred in the SDS group and 11 (S)AEs in the OWSER group. Two SDS patients passed away, unrelated to the surgery or implant. One (S)AE in the SDS group and 6 (S)AEs in the OWSER group were implant-related.</p><p><strong>Conclusions: </strong>The SDS and the OWSER achieved coronal curve correction of 50%, which was maintained at 1-year follow-up. Spinal length increase was excellent for both systems. The (S)AE rate was 30%/patient/year for SDS and 78%/patient/year for OWSER.</p><p><strong>Key concepts: </strong>(1) The current study is the first RCT that compares two \"growth-friendly\" implants in a neuromuscular early onset scoliosis (EOS) population.(2) The Spring Distraction System (SDS) and the One Way Self-Expanding Rod (OWSER) both achieve around 50% curve correction which is maintained at 1 year follow-up.(3) Both systems achieve excellent T1-T12- and T1-S1 height increase, without the need for repetitive lengthenings.(4) The (S)AE rate of SDS was 30%/patient/year. For OWSER, the (S)AE rate was 78%/patient/year.</p><p><strong>Study design: </strong>RCT.</p><p><strong>Level of evidence: </strong>Level 1.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100180"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Chondrolysis of the Hip in Adolescents: Updated Evidence for Clinical Management.","authors":"Martha Kebeh, Carter Hall, Vrisha Madhuri, Wudbhav N Sankar","doi":"10.1016/j.jposna.2025.100187","DOIUrl":"10.1016/j.jposna.2025.100187","url":null,"abstract":"<p><p>Idiopathic chondrolysis of the hip (ICH) is a rare condition characterized by the acute and rapidly progressive destruction of cartilage. ICH typically presents in peri-pubescent females with acutely worsening hip pain, a deterioration in range of motion (ROM), and distinctive imaging and biopsy findings. Variability in outcomes, ranging from complete resolution of symptoms to a permanently ankylosed hip, has been observed in both conservatively and aggressively treated cases. The treatments described often consider patient factors and disease stage yet consist of inconsistent combinations of pharmacologic and surgical approaches. Consequently, it is challenging to compare outcomes across different treatment methods. Although recent literature has enhanced our understanding of the epidemiology and natural history of ICH, a consensus on optimal management is still lacking, highlighting the need to investigate the components and outcomes of evolving treatments. Since the last systematic review of imaging findings and treatment regimens for ICH, over 50 new cases have been documented in the literature. However, limited data still exist regarding patient-reported outcomes. Our aim is to review and contribute to the current evidence guiding the management of ICH by analyzing data on presentation, clinical and radiologic findings, and treatment outcomes.</p><p><strong>Key concepts: </strong>(1)ICH has an unknown etiology and predominantly affects female adolescent patients.(2)There is no standardized treatment regimen for ICH.(3)The authors' preferred approach combines medical and surgical treatment.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100187"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Limb Reconstruction Gone Wrong: Risks of Pursuing Treatment Without Thorough Psychological Evaluation.","authors":"Whitney M Herge, Mikhail Samchukov, Emily Elerson, Alexander Cherkashin, David Podeszwa","doi":"10.1016/j.jposna.2025.100185","DOIUrl":"10.1016/j.jposna.2025.100185","url":null,"abstract":"<p><p>A 12+9-year-old female-assigned at birth diagnosed with osteofibrous dysplasia of her right tibia underwent 15cm bone resection, ipsilateral pedicled fibular graft, and frame application without a thorough multidisciplinary preoperative evaluation. During her course of treatment, the patient's mood and ability to participate in her own care (e.g. showering, feeding herself on a regular and consistent basis, completing home exercises) declined precipitously, and she began to endorse symptoms of suicidal ideation and non-suicidal self-injury behavior. Eventually the patient had to be admitted to the team's pediatric orthopaedic institution and was later transferred to an intensive outpatient mental health program for safety and mood stabilization. Due to multiple absences, the patient was prematurely dismissed from the mental health program and subsequently refused to participate with any sort of mental health intervention. Simultaneously, she struggled to cope with the demands of her external fixation treatment.Broadly, this case highlights the critical importance of thorough psychological assessment prior to consideration of limb lengthening and/or reconstruction. Psychological assessment should first establish the patient's baseline mental health, identify any extant mental health symptoms, and connect the patient with appropriate intervention as needed. Second, psychological assessment should establish the family's baseline functioning, including caregiver availability and support as well as emotional and logistical resources available to support treatment. Third, psychological assessment should continue throughout the course of treatment, in order to identify real time possible changes in a patient's mental health and intervention needs.</p><p><strong>Key concepts: </strong>(1)Inadequate preoperative assessment of a patient and family being considered for limb lengthening and/or reconstruction may result in significant medical and psychological consequences for the patient during and after treatment.(2)Preoperative psychological assessment should establish a patient's baseline mental health and identify any pre-existing mental health concerns.(3)Preoperative psychological assessment should establish a family's baseline functioning, focusing on the cognitive, emotional, and logistical resources available to support treatment demands.(4)Psychological assessment should continue throughout treatment, in order to promptly identify any emotional concerns that arise throughout treatment.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100185"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Lateral Extra-articular Tenodesis After Prior Anterior Cruciate Ligament Reconstruction.","authors":"Rachel M Randall","doi":"10.1016/j.jposna.2025.100184","DOIUrl":"10.1016/j.jposna.2025.100184","url":null,"abstract":"<p><p>Lateral extra-articular tenodesis (LET), as an adjunct to anterior cruciate ligament (ACL) reconstruction, is gaining popularity among pediatric and sports medicine orthopaedic surgeons for the treatment of ACL injury, especially in the female, hyperflexible, and high-risk athlete population. The addition of LET or anterolateral ligament (ALL) reconstruction is typically recommended at the time of index ACL reconstruction surgery and is performed after the ACL graft is tensioned. Rotational instability has been described in cases where the ACL graft was malpositioned too vertically, and in those cases, ACL revision is indicated. In our case, ACL reconstruction was performed in isolation in a hyperflexible, high-risk (volleyball) female athlete, and she had persistent complaints of rotational instability despite an intact and well-positioned ACL graft on magnetic resonance imaging (MRI) scan. She demonstrated excessive internal rotation of the tibia in relation to the femur and exhibited symptomatic anterolateral instability on clinical examination, with a negative pivot shift but pain on internal rotation stress. She underwent a second surgery consisting of isolated modified Lemaire LET after examination under anesthesia (EUA) demonstrated negative Lachman and pivot shift. Second-look arthroscopy demonstrated an intact quadriceps autograft ACL graft. She recovered uneventfully, and her rotational instability problem was resolved. She returned to sports 12 months after the surgery and has been pleased with her result.</p><p><strong>Key concepts: </strong>(1)Lateral extra-articular tenodesis (LET) can be added to increased rotational stability in the setting of anterior cruciate ligament (ACL) reconstruction.(2)Although typically added during the index procedure, it can be successfully completed later if needed.(3)The ACL confers both anteroposterior and rotational stability to prevent excessive anterior translation and excessive internal rotation of the tibia with respect to the femur.(4)LET can augment the ACL graft in preventing rotational instability in the setting of an ACL-deficient knee.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100184"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}