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

{"title":"A Prospective Study on Yoga for Anterior Knee Pain in Adolescents.","authors":"Stephanie Price, Robert Martin, Chand Shah, Matthew Ellington","doi":"10.1016/j.jposna.2025.100230","DOIUrl":"10.1016/j.jposna.2025.100230","url":null,"abstract":"<p><strong>Background: </strong>Anterior knee pain (AKP) is one of the most common musculoskeletal complaints in adolescents. Several causes have been attributed to this, with many aspects of the pathology being traced back to flawed biomechanics. Yoga has been used as an alternative therapy for many types of musculoskeletal ailments. Although studies have shown that yoga has positive effects on biomechanics, its impact on AKP in adolescents has not been investigated.</p><p><strong>Hypothesis: </strong>If pediatric patients with AKP were to complete an 8-week yoga protocol focusing on flexibility and strengthening, there would be improvements in both objective measures of flexibility and patient-reported outcomes in regard to their knee pain and function.</p><p><strong>Methods: </strong>A certified yoga instructor developed 2 separate videos for study participants to perform 3 to 4 times per week for a total of 8 weeks. The first 4 weeks, the participants completed a 20-minute video with an emphasis on flexibility. For the second 4 weeks, they completed a 16-minute video with an emphasis on strengthening. Popliteal angles and prone heel-to-buttock (HTB) distances were taken at the initial visit and at the 8-week follow-up. PROMIS PIS/PSS (Patient-Reported Outcome Measurement Information System - Pain Interference Survey/Perceived Stress Scale) and Pediatric International Knee Documentation Committee (Pedi-IKDC) scores were collected at the initial visit and again at the 8 weeks. Patient-reported adherence to the yoga protocol, as well as return to sport/activity data was also collected.</p><p><strong>Results: </strong>Baseline and 8-week follow-up data were collected on 24 patients (15 M, 9 F, avg age: 13.25 ys) who were diagnosed with a mixture of nonstructural causes for AKP. There was a 23.82-point increase in Pedi-IKDC scores (<i>P</i>-value <.01), 8.54 point decrease in PIS (<0.01), and 4.06 point decrease in PSS (<0.01). Popliteal angle measurements increased by 10.14° on the right side (<0.01) and 13.05° (<0.01) on the left side. HTB measures decreased by 1.48″ on the right side (<0.01) and 1.58″ on the left side (<0.01). Symmetry between popliteal angle and HTB measurements also improved after 8 weeks of yoga (<0.01).</p><p><strong>Conclusions: </strong>When compared to baseline measurements, all study measures showed statistically significant improvement at the 8-week mark. Targeted yoga has the potential to be a formidable adjunctive treatment option in the management of AKP in adolescents.</p><p><strong>Clinical trial registration number: </strong>UT Austin IRB Approved Submission ID: STUDY00004289-MOD01 Date approved 8/25/2023.</p><p><strong>Key concepts: </strong>(1)Whether a multiweek yoga program has beneficial effects in improving objective measures of thigh muscle flexibility, specifically popliteal angle and heel-to-buttock measurements.(2)Whether previously mentioned objective improvements also correlated with subjective improv","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100230"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824776","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":"Lower Extremity Splint Application.","authors":"Wasim Shihab, Jaime Denning","doi":"10.1016/j.jposna.2025.100248","DOIUrl":"10.1016/j.jposna.2025.100248","url":null,"abstract":"<p><p>In pediatric orthopaedic surgery, the choice between splinting and casting plays a crucial role in early fracture management, postoperative care, and soft tissue injury stabilization. Impeccable application technique ensures that the immobilization serves its purpose without causing additional injury.Splints provide crucial advantages over casts in acute situations, particularly in cases with significant swelling, evolving injuries, soft tissue damage, or the necessity for frequent reassessment. Unlike circumferential casts, which can heighten the risk of compartment syndrome or pressure-related complications, splints deliver stability while accommodating soft tissue expansion and preserving structural support. Their adjustable, removable, and reapplicable nature makes splints a preferred choice during the early stages of fracture healing and postoperative recovery, particularly for younger patients with high remodeling potential.The Bulky Jones dressing is an essential tool in orthopaedics, providing compression, controlling edema, and offering mild immobilization. This enhances patient comfort and promotes tissue healing.</p><p><strong>Key concepts: </strong>(1)Splints provide effective preoperative stabilization, definitive treatment of stable fractures, and management of soft tissue injuries while allowing for swelling accommodation and periodic reassessment.(2)Splinting minimizes complications associated with circumferential casting.(3)Proper technique and padding are essential for effective splint application.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100248"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839961","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":"Cast Wedging to Correct Fracture Angulation: Tips and Tricks.","authors":"Keith Orland, David Spence","doi":"10.1016/j.jposna.2025.100241","DOIUrl":"10.1016/j.jposna.2025.100241","url":null,"abstract":"<p><p>This chapter offers a guide to the principles, indications, and technical steps of cast wedging, along with tips for achieving a successful cast wedge to correct angular deformity within a cast. Cast wedging is a technique that facilitates the correction of angular deformities once a fracture has been immobilized in a cast but before the fracture has fully healed. It is commonly used early in fracture healing when there has been some displacement or loss of alignment within the cast. This technique is especially beneficial for pediatric patients, who develop early callus and possess robust periosteum, enabling the cast wedge to effectively correct deformity, prevent further deformity, and potentially eliminate the need for surgical intervention. With proper planning, patient selection, and technique, cast wedging proves to be a safe and effective method.</p><p><strong>Key concepts: </strong>(1)Cast wedging can be used to correct some angular deformities in the early phase of fracture healing.(2)Fractures that may benefit from cast wedging include forearm fractures, femoral shaft fractures, and tibial shaft fractures.(3)Careful planning prior to making cuts in the cast and placing a wedge can lead to a more successful correction.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100241"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839960","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":"Cast Removal.","authors":"Ryan Guilbault, Benjamin J Shore","doi":"10.1016/j.jposna.2025.100237","DOIUrl":"10.1016/j.jposna.2025.100237","url":null,"abstract":"<p><p>Cast removal is a routine yet critical procedure in pediatric orthopaedic care, requiring meticulous attention to safety and detail to prevent avoidable complications such as thermal injury, lacerations, and subsequent patient anxiety. This review provides a comprehensive overview of best practices as it relates to safe cast removal, highlighting techniques, equipment considerations, and common pitfalls. Cast saws remain the standard tool for cast removal; however, improper use can result in friction burns or skin lacerations, particularly in young patients with thinner soft-tissue envelopes. Strategies to mitigate these risks include regular cast saw blade maintenance, proper saw angulation, intermittent cutting techniques, cooling of the blade, and the use of protective padding. Emerging technologies such as cast spreaders, alternative cutting tools, and water-softenable casting materials may further improve safety profiles. Additionally, patient cooperation and comfort plays a crucial role in safe cast removal, creating a calming environment and using child-friendly communication is paramount. In rare cases, sedation can be considered to help safely remove a cast in a traumatized child. This review synthesizes current evidence on the biomechanics of cast saws, injury risk factors, and training recommendations to enhance safety during cast removal.</p><p><strong>Key concepts: </strong>(1)<b>Proper Cast Saw Technique</b> - Intermittent cast saw application with a perpendicular saw angle minimizes heat generation and reduces the risk of thermal injury and soft tissue damage.(2)<b>Adequate Padding Assessment</b> - Ensuring at least two layers of cast padding and a stockinette before cast removal decreases the likelihood of skin lacerations or pressure injuries.(3)<b>Patient Positioning and Cooperation</b> - Stabilizing the limb and maintaining patient comfort during cast removal reduces movement-related errors and improves safety.(4)<b>Use of Cast Spreaders</b> - After initial saw cuts, cast spreaders should be employed to avoid excessive blade contact and potential injury.(5) <b>Careful inspection of the cast saw prior to cast removal and regular blade replacement when dull helps prevent avoidable cast saw injuries</b>.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100237"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802492","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":"Upper Extremity Splint Application.","authors":"Jonathan D Grabau, Hannah T Hoopes, Christine Ho","doi":"10.1016/j.jposna.2025.100239","DOIUrl":"10.1016/j.jposna.2025.100239","url":null,"abstract":"<p><p>The purpose of this chapter is to provide a basic instructional reference for upper extremity splint application in the context of pediatric orthopaedic trauma. In addition to reviewing the steps necessary for successful splint application, this chapter will also discuss common pitfalls to avoid in order to optimize outcomes and prevent complications during and after splint immobilization for upper extremity injuries. Embedded throughout the chapter are figures and videos that highlight how to apply various splints to the upper extremity based on the injury location and the immobilization required for different clinical situations. Previous studies have indicated that many practitioners caring for pediatric trauma patients lack the proper training to apply splints safely and effectively. This chapter and its accompanying media should ideally serve as a primer for medical trainees, including orthopaedic residents, fellows, advanced practice providers, and other medical professionals learning to treat pediatric patients in clinical and emergency department settings. Generally, upper extremity splints are used as a method of temporary immobilization while awaiting definitive management, which may involve conversion to a cast once the swelling has resolved or following surgical intervention.</p><p><strong>Key concepts: </strong>(1)Splints should be considered for pediatric patients with upper extremity injuries when associated soft tissue injuries or anticipated swelling prevent the use of a cast.(2)Similar to casting, upper extremity splints should immobilize the injured area while minimizing the immobilization of uninjured joints. This approach allows for a continued range of motion and helps prevent iatrogenic stiffness.(3)Successful splint application depends on the proper use of cast padding and plaster to effectively immobilize injuries and prevent iatrogenic soft tissue complications like wounds or skin ulceration.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100239"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839963","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":"Lower Extremity Cast Application.","authors":"Wendy Ramalingam, Stéphanie Lamer","doi":"10.1016/j.jposna.2025.100236","DOIUrl":"10.1016/j.jposna.2025.100236","url":null,"abstract":"<p><p>This chapter will focus on lower extremity casting. Casting is widely recognized as the best treatment for many pediatric lower extremity fractures, unlike those in adults. Due to children's remodeling potential, the displacement threshold for surgery is often higher than that for skeletally mature patients, and immobilization in a cast with proper molding may be the only treatment needed.Lower extremity casts can be used to maintain the alignment of nondisplaced fractures. They are also utilized after closed reduction of a fracture, with appropriate molding to prevent any further displacement. Additionally, casts can provide protection and reinforcement following surgical fixation of lower extremity fractures.Proper casting technique is essential to prevent complications and ensure adequate fracture alignment. Cast treatment is not without risks and should not be considered benign. While it is less invasive than surgery, complications can arise after casting, some of which can be severe, such as compartment syndrome, burns, and significant pressure sores.In this chapter, 4 techniques for casting the lower extremities will be demonstrated: 1. Short leg cast 2. Long leg cast 3. Cylinder cast 4. Patellar tendon-bearing cast.</p><p><strong>Key concepts: </strong>(1)Mastering casting techniques is crucial to avoiding significant complications.(2)A short leg cast can be used for lower leg and foot fractures.(3)Long leg casts are used to control rotational instability and manage distal femur, patella, and proximal tibia fractures.(4)Any patient's complaint of increased pain with a cast should be taken seriously and investigated.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100236"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850375","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":"Common Cast Complications.","authors":"Jessica A McGraw-Heinrich, Jon C Wall, Scott B Rosenfeld","doi":"10.1016/j.jposna.2025.100244","DOIUrl":"10.1016/j.jposna.2025.100244","url":null,"abstract":"<p><p>Complications can arise from the application, wear, and removal of casts and splints. This text reviews common complications, risk factors, and prevention strategies while exploring the medical-legal implications of these complications. Being aware of common pitfalls can help reduce risk and promote optimal patient outcomes.</p><p><strong>Key concepts: </strong>(1)Proper and judicious casting and splinting techniques are critical to prevent complications.(2)Thermal injuries can occur due to excessive curing heat and cast saw burns.(3)Poor cast molding can lead to skin sores and loss of fracture reduction.(4)Patients should be comfortable in their cast, and uncontrolled pain warrants investigation.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100244"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824779","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 to Quality Improvement Case Series: Iatrogenic Physeal Fracture Sustained During Manipulation for Arthrofibrosis of the Knee.","authors":"Henry Bone Ellis, Molly C Meadows, R Justin Mistovich, Jennifer J Beck","doi":"10.1016/j.jposna.2025.100245","DOIUrl":"10.1016/j.jposna.2025.100245","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100245"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824778","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":"Upper Extremity Cast Application.","authors":"David S Liu, Andrea S Bauer","doi":"10.1016/j.jposna.2025.100240","DOIUrl":"10.1016/j.jposna.2025.100240","url":null,"abstract":"<p><p>This chapter aims to provide a comprehensive review of the techniques and challenges associated with applying upper extremity casts in pediatric patients. The chapter, along with its accompanying figures and video clips, serves as an introductory guide to pediatric orthopaedic cast application for trainees. Generally, casts are used to preserve appropriate alignment rather than to create improved alignment. In cases of nondisplaced fractures or those with acceptable alignment, the role of the cast is to maintain that alignment until healing occurs. For fractures with unacceptable alignment, reducing them to an acceptable position is necessary while the cast is utilized to maintain proper alignment. For challenging fractures that are difficult to keep aligned, have displaced intraarticular components, or are length-unstable, surgical intervention is recommended, followed by casting for immobilization after surgery. This chapter reviews the indications, application, techniques, and pitfalls of short arm, thumb spica, mitten, ulnar gutter, long arm, and hanging arm casts.</p><p><strong>Key concepts: </strong>(1)The cast index is a valuable measure that impacts the rates of loss of reduction in distal radius fractures.(2)Molds are important not only for maintaining fracture reduction but also for keeping the cast in position and preventing slippage.(3)Along with using a cast saw to split fiberglass casts, a cast splitter should be employed to ensure proper bivalving.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100240"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839962","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 Quality Improvement Case Series: Leukemic Arthritis Mimicking Septic Arthritis in a Pediatric Patient.","authors":"Alexandre Arkader, Mihir M Thacker, Karim Masrouha","doi":"10.1016/j.jposna.2025.100246","DOIUrl":"10.1016/j.jposna.2025.100246","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100246"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763085","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}