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

{"title":"Care for Pediatric Patellofemoral Instability Prior to Orthopaedic Referral.","authors":"Emily Qian, Ally A Yang, Halle Freiman, Corinna Franklin","doi":"10.1016/j.jposna.2025.100181","DOIUrl":"10.1016/j.jposna.2025.100181","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability is a common condition in the pediatric population with increasing incidence. Recent guidelines recommend radiographs and nonoperative treatment for simple first-time dislocations and surgical consideration after a repeated event. However, it is not known whether non-orthopaedic clinicians are initiating these treatments. We sought to characterize injury history, diagnostic evaluations and treatments pursued by referring clinicians prior to orthopaedic evaluation of patellofemoral instability events.</p><p><strong>Methods: </strong>We performed a retrospective review of pediatric patient records with a patellofemoral instability event referred for orthopaedic evaluation. Data collected include demographics, referral clinician specialty, previous injury, mechanism of injury, imaging performed and findings, treatments pursued, surgical timeline, and outcomes. Cases were grouped by their referring clinician specialty into emergency settings, primary care, and other settings.</p><p><strong>Results: </strong>Of the 100 cases, 44 were referred from emergency settings, 41 from primary care, and 15 from other settings. Thirty-one cases ultimately underwent surgical intervention. The primary care group was the least likely to have performed radiographs prior to referral (n = 21, 51.2%) compared with the emergency group (n = 43, 97.7%). The primary care group was also found to be more likely to have already had recurrent dislocations (n = 18, 43.9%). Lastly, of the 32 recurrent cases, only 12 cases had been recommended physical therapy.</p><p><strong>Conclusions: </strong>We found that radiographs and nonoperative treatments are inconsistently used prior to orthopaedic referral. This impacts the timeline of management, which can lead to further injury. Our study identified that there are upstream referral factors influencing patellofemoral instability outcomes. Future research may include methods to improve concordance with treatment guidelines.</p><p><strong>Key concepts: </strong>(1)Identifying clinician groups referring to orthopaedic practices for pediatric patellofemoral instability (PFI) events.(2)Describing evaluations and treatments pursued by clinicians for pediatric PFI events prior to orthopaedic referral.(3)Algorithm-based approaches are more adherent to current proposed pediatric PFI management guidelines.(4)Education of referring clinicians may help to improve surgical outcomes.</p><p><strong>Level of evidence: </strong>III, Retrospective Cohort Study.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100181"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164480","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":"Clinical and Functional Outcome of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot in a Limited Resource Country: A Three-year Retrospective Cohort Study.","authors":"Alazar M Haile, Birhanu Ayana, Wubegzier Mekonnen, Fentahun Bantigegn, Bizuayehu Amanu","doi":"10.1016/j.jposna.2025.100182","DOIUrl":"10.1016/j.jposna.2025.100182","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tibialis anterior tendon transfer (TATT) is a surgical procedure aimed at correcting dynamic supination in children with idiopathic clubfoot, typically performed between ages 2.5 and 5. There is limited literature discussing the factors that contribute to unfavorable outcomes. This study explores the clinical and functional outcomes of TATT and identifies factors that lead to poor functional results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study evaluated children with recurrent idiopathic clubfoot who underwent TATT from February 2021 to February 2024 in Tikur Anbessa Specialized Hospital, Ethiopia. A matched comparison group that did not undergo TATT was used, with a final sample of 42 TATT patients (56 feet) and 21 non-surgery patients (36 feet). For cases involving both feet, the outcome scores were averaged. Data were collected using the Oxford Foot Ankle Questionnaire and Pirani/Bohm/Sinclair scores via interviews and clinical evaluations, with analysis performed using the R package vcd (R Core Team, 2024).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-three cases (92 feet) were analyzed. The TATT group showed significantly better clinical (&lt;i&gt;P&lt;/i&gt; = .02) and functional scores (&lt;i&gt;P&lt;/i&gt; = .006). However, a low correlation was observed between clinical measures and patient-reported outcomes (τ = 0.22, &lt;i&gt;P&lt;/i&gt; = .018). Patients with poor brace compliance and structural deformities (varus/equinus) showed inferior patient-reported outcomes on the bivariate regression. A progressive decline in patient-reported outcomes was also noted with advancing patient age at the time of surgery. In multivariate analysis, structural deformities-namely varus (&lt;i&gt;P&lt;/i&gt; = .012) and equinus (&lt;i&gt;P&lt;/i&gt; &lt; .001)-were significantly related to poor functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The TATT group exhibited higher clinical (12.3%) and functional (11.8%) scores compared with the non-TATT group, indicating better outcomes. The low correlation between the two outcome scores (τ = 0.22, &lt;i&gt;P&lt;/i&gt; = .018) underscores the importance of a comprehensive patient evaluation prior to surgery. Furthermore, unaddressed concomitant structural deformities, such as varus (&lt;i&gt;P&lt;/i&gt; = .012) and equinus (&lt;i&gt;P&lt;/i&gt; &lt; .001), were linked to poorer functional outcomes when compared with cases that experienced a recurrence of dynamic supination after TATT (&lt;i&gt;P&lt;/i&gt; = .8).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)The Ponseti method, which involves serial manipulation and casting, is considered the gold standard for the initial management of idiopathic clubfoot.(2)Approximately one-third of clubfoot cases treated successfully experience a recurrence, often presenting as dynamic supination.(3)For children over the age of three, tibialis anterior tendon transfer is recommended to address dynamic supination.(4)Clinician assessment of the need for the procedure does not always correlate with patient perception of functional impairment.(","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100182"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164504","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":"Rate of Unexpected Findings in Adolescent Lumbar Magnetic Resonance Imagings Ordered by Orthopaedic Surgeons.","authors":"Bilal S Siddiq, Anna Rambo, Benjamin Sheffer, Vania Ejiofor, Abu M Naser, Trevor McGee, William C Warner, Derek M Kelly","doi":"10.1016/j.jposna.2025.100183","DOIUrl":"10.1016/j.jposna.2025.100183","url":null,"abstract":"<p><strong>Background: </strong>The use of advanced imaging in children is increasing and unexpected findings (UFs) are often detected. The present literature lacks studies investigating the rate of UFs in pediatric lumbar spine magnetic resonance imagings (MRIs) and the sequelae of these findings. This study aimed to determine the overall incidence of UFs in adolescent lumbar MRIs, characterize these findings, stratify UFs based on patient characteristics, and determine any influences on patient treatment plans.</p><p><strong>Methods: </strong>Medical records of 1409 patients aged 10 to 18.5 years old that had a lumbar MRI ordered by an orthopaedic surgeon from 2010 to 2020 were reviewed retrospectively. Demographics, insurance, reason for MRI, and change in treatment plans were noted. Unexpected findings were characterized as spinal cord, infra-peritoneal, retroperitoneal, peritoneal, or vascular-related. The relationship between patient characteristics and UFs was investigated using a <i>t</i> test and Chi-square test. The statistical relationships between UFs and treatment plan changes were evaluated using generalized linear models with a log link and a binomial error distribution.</p><p><strong>Results: </strong>The average age of the 1409 patients was 15.5 years (95% CI: 15.4, 15.6). Back pain (90.1%) was the most common reason for lumbar MRI. Thirty-five UFs were found in 33 patients (2.3%): 19 were spinal cord-related, 15 were peritoneal-related, and one was vascular. Eight peritoneal findings involved the kidneys: two atrophy, two hypoplasia, two renal cysts, one pelvic kidney, and one hydronephrosis. Five patients had a syrinx, and two had spine tumors. Out of 33 patients with UFs, 11 required a change in treatment plan (33.3%). Back pain was not associated with an increased risk of UF. Patients with an UF on MRI had 2.60 times higher odds of experiencing a change in treatment plan.</p><p><strong>Conclusions: </strong>The prevalence of UFs was 2.5% on lumbar MRIs and were mainly spinal cord or retroperitoneal-related. UFs were associated with an altered treatment plan 33% of the time and were unrelated to standard demographic characteristics or insurance type.</p><p><strong>Key concepts: </strong>(1)Overall, 33.3% of patients with an unexpected finding had a change in treatment plan.(2)Unexpected findings should be interpreted in the context of the patient's overall clinical picture, symptoms, and health to help elucidate the next steps in treatment.(3)The clinical significance of unexpected findings needs to be further studied.</p><p><strong>Level of evidence: </strong>Level III, Retrospective.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100183"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164748","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":"Surgical Management of Nerve Injuries Caused by Pediatric Upper Extremity Fractures.","authors":"Sonia Chaudhry, Hilton P Gottschalk, Krister Freese, Micah Sinclair, Carley Vuillermin","doi":"10.1016/j.jposna.2025.100179","DOIUrl":"10.1016/j.jposna.2025.100179","url":null,"abstract":"<p><p>While most nerve injuries associated with fractures resolve on their own, there is limited literature regarding the optimal management of persistent palsies. This review outlines nonoperative treatment strategies and provides guidance on the indications and management of cases when surgery is necessary for major upper extremity nerve injuries. It covers indications and techniques for surgical exploration, neurolysis, nerve repair, resection with grafting, and late reconstruction options. We synthesize the existing pediatric and adolescent literature and pertinent adult studies. Furthermore, we share the extensive clinical expertise of the authors, all of whom specialize in pediatric hand and upper extremity surgery.</p><p><strong>Key concepts: </strong>(1)Associated nerve injuries following pediatric upper extremity trauma are uncommon, yet optimal upper extremity function is dependent on prompt diagnosis and referral to a team of hand surgeons and therapists.(2)Understanding the potential mechanisms/locations of injury and the natural history will enable these teams to diagnose and prognosticate outcomes efficiently.(3)Physical examination, nerve conduction studies, radiographs, ultrasound, and advanced imaging (MRI) are often required.(4)Treatment of nerve deficits can include combinations of observation, neurolysis, nerve repair, nerve grafting, nerve transfer, and muscle transfer.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100179"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164750","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":"Congenital Muscular Torticollis: Clinical Risk Factors and Rates of Surgery.","authors":"Akshitha Adhiyaman, Emilie Lijesen, Olivia C Tracey, Ruth H Jones, Keza E Levine, Shevaun M Doyle","doi":"10.1016/j.jposna.2025.100173","DOIUrl":"10.1016/j.jposna.2025.100173","url":null,"abstract":"<p><strong>Background: </strong>Congenital muscular torticollis (CMT) is a rare shortening of the sternocleidomastoid muscle leading to lateral flexion and rotation of the cervical spine. Nonoperative treatment is most common; however, failure of contracture resolution may result in surgery. The aim of this study was to determine the clinical risk factors for CMT, exploring surgical correction rates, resolution rates, and cervical range of motion surrounding various treatment paths.</p><p><strong>Methods: </strong>This retrospective study reviewed all patients diagnosed with CMT at a single institution from January 1, 2016, to July 31, 2023. Patient demographics, risk factors, and clinical notes were collected. Two analyses were performed, separated by sufficiency of the clinical note.</p><p><strong>Results: </strong>A total of 171 patients were included in the final evaluation. Mean age was 5.0 ± 8.7 months at initial visit, 52% were female and 51.1% of patients had right-sided CMT. Of the 171 patients included in the initial analysis, 47.3% of patients had no other medical history prior to diagnosis of CMT, 12.3% had a history of developmental dysplasia of the hip (DDH), and 20.5% had plagiocephaly. Of all, 40.9% of patients were delivered via Cesarean section and 41.5% via normal spontaneous vaginal delivery. For the 110 patients included in treatment and range of motion (ROM) analysis, the mean follow-up time was 9.6 ± 13.0 months. Average lateral flexion improvement was 11.6 ± 20.4° (<i>P</i> < .0001). Average axial rotation improvement was 10.8 ± 23.1° (<i>P</i> < .0001). Eight patients underwent surgery; these patients' average length of physical therapy (PT) before surgery was 42.3 ± 14.3 months. By the last clinical visit, 87 patients had resolved CMT and 4 patients had resolving CMT.</p><p><strong>Conclusions: </strong>Most infants with CMT who are healthy otherwise will improve rapidly and not undergo surgery. Meanwhile, for patients with longer treatment and/or surgical intervention, this study demonstrates favorable outcomes.</p><p><strong>Key concepts: </strong>(1)History of developmental dysplasia of the hip and plagiocephaly were common in patients diagnosed with congenital muscular torticollis (CMT).(2)Rarely, infants with long treatment regimens for CMT will need surgical intervention, but, if indicated, the outcomes are favorable with no complications.(3)Overall, parents and caregivers can be reassured that most infants who have CMT are healthy children without significant risk factors that improve rapidly.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100173"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164619","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":"The Role of Suicide Risk Assessment Screening in the Pediatric Orthopaedic Clinic.","authors":"Cortney Matthews, Trayce Gray, Jordan Tanyi, Niamh McMahon, Hilton Gottschalk","doi":"10.1016/j.jposna.2025.100177","DOIUrl":"10.1016/j.jposna.2025.100177","url":null,"abstract":"<p><strong>Background: </strong>Suicide is the second leading cause of death for youth 12-18 years of age. Identification of adolescents with suicidal ideation can help facilitate early interventions. This study evaluates the use of a PSS-3 Suicide Risk Screener (SRA), given to patients presenting to a specialty pediatric orthopaedic clinic (SCC), to identify suicide risk and interventions performed for these patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of the 1920 patients that presented to the SCC in 2022. Every patient that entered the clinic was given a SRA to complete. We determined the frequency of positive screens, negative screens, and incomplete screens and the demographics of the patients in the positive group. We also determined the frequencies of the interventions performed for patients that did have a positive screen.</p><p><strong>Results: </strong>Of the 1920 patients that presented in the SCC in 2022, 319 patients had an incomplete screen and were excluded from the analysis. One patient was incorrectly coded to have a positive screen in the SCC clinic and was excluded. Of the 1600 patients that had a complete screen, 3% (48) had a positive SRA screen. Of the patients with a positive screen, the mean age was 13.6 years (1.27), 54.2% (26) female, and 89.8% (43) had public insurance. Of note, 23% (11) of those with a positive screen met with a social worker and were admitted to an inpatient facility.</p><p><strong>Conclusions: </strong>The addition of the PSS-3 Suicide Risk Screener in this pediatric orthopaedic clinic screened 83% of patients presenting to the clinic and found a 3% positivity rate for patients that completed the screen. In 2022, 1 in every 180 patients who visited the SCC were admitted to an inpatient facility for suicidality. The implementation of a suicide risk assessment helped us to identify a need for intervention in patients originally presenting for musculoskeletal complaints. There is a role for suicide risk screening in pediatric orthopaedic clinics.</p><p><strong>Key concepts: </strong>(1)Utility of suicide screening questionnaires in orthopaedic clinics is poorly understood.(2)This study sought to investigate the risk of suicidality in pediatric orthopaedic patients.(3)Suicide risk screening in pediatric populations can identify patients at risk.(4)Early intervention to address suicide risk in pediatric orthopaedic patients can significantly improve outcome.(5)Suicide risk screening in pediatric orthopaedic clinics has a strong role in better promoting overall health.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100177"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164752","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":"Posterior Interosseous Nerve Injury From Chronic Monteggia Fracture Dislocation Requiring Nerve Reconstruction.","authors":"John Bartoletta, Raymond Tse, Suzanne Steinman","doi":"10.1016/j.jposna.2025.100176","DOIUrl":"10.1016/j.jposna.2025.100176","url":null,"abstract":"<p><p>Monteggia fracture-dislocations are rare elbow injuries in the pediatric population. Multiple case reports have described posterior interosseous nerve (PIN) palsies in the setting of Monteggia fracture-dislocations, usually due to stretch neuropraxia. In this report of a Bado Type III Monteggia fracture-dislocations with delayed diagnosis of an entrapped PIN, we highlight the importance of timely diagnosis. Surgical reconstruction using a sural nerve autograft was required when the PIN was found to be entrapped in the radiocapitellar joint and encircling the radial neck.</p><p><strong>Key concepts: </strong>(1)Monteggia fracture-dislocations are rare elbow injuries in the pediatric population and can be missed.(2)The orthopaedic surgeon should have heightened suspicion for a posterior interosseous nerve palsy in Bado Type III Monteggia fracture-dislocations.(3)If a posterior interosseous nerve palsy is identified at the time of injury and reduction is difficult, we should consider nerve exploration as it may be entrapped in the joint.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100176"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164739","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":"Trends in Complications Following Pediatric Anterior Cruciate Ligament Reconstruction as Reported to the American Board of Orthopaedic Surgery Part II Oral Examination Database.","authors":"Dane R G Lind, Meagan J Sabatino, Virginia C Clark, Robert L Van Pelt, Curtis D Vandenberg, Jennifer J Beck, Andrew T Pennock, Aristides I Cruz, Theodore J Ganley, Kevin G Shea, Philip L Wilson, Henry B Ellis","doi":"10.1016/j.jposna.2025.100178","DOIUrl":"10.1016/j.jposna.2025.100178","url":null,"abstract":"<p><strong>Background: </strong>Pediatric anterior cruciate ligament reconstructions (ACLR) have increased dramatically in recent years. However, a comprehensive list of short-term complications related to this procedure has yet to be reported. This study aimed to report complication rates in pediatric ACLR using submissions to the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination. A secondary goal was to assess the relationship of complications with patient sex, geographic region of surgery, surgical volume, and surgeon fellowship training.</p><p><strong>Methods: </strong>A query was submitted to the ABOS Part II Oral Examination Case List Database for all ACLR performed in patients younger than 19 years between 2000 and 2021. Surgeon fellowship training, geographic region of surgery, and patient demographics were included, along with medical, surgical, and anesthetic complications, reoperation, and readmission. Statistic comparisons used chi-square tests for categorical variables with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Surgical complications were the most common type of complication, present in 10.1% of pediatric ACLR. Stiffness (3.6%) and infection (1.5%) were the most prevalent surgical complications. Females had higher rates of overall complications than males (11.9% vs. 10.4%, <i>P</i> = 0.010). Females also had higher rates of surgical complications (10.7%-9.5%, <i>P</i> = 0.019) -- specifically stiffness (5.0%-2.2%, <i>P</i> < 0.001). However, males had higher rates of infection (1.8% vs. 1.3%, <i>P</i> = 0.047). Geographic analyses showed higher infection rates in Hawaii and Alaska and lower surgical complication rates in the Northwest region. Procedures completed by surgeons with a fellowship training other than Sports Medicine and/or Pediatric Orthopaedics had lower rates of overall complications (8.9%, <i>P</i> < 0.001) and surgical complications (8.3%, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>This study establishes that female pediatric and adolescent patients are at an increased risk for complications following ACLR. Arthrofibrosis was more than twice as common in females than in males. Geographic region and fellowship training may be associated with complications in this population.</p><p><strong>Study design: </strong>Cross-Sectional Study.</p><p><strong>Key concepts: </strong>(1)Complications following ACL reconstruction may be associated with geographic region and fellowship training.(2)Females present with more short-term complications following ACL reconstruction.(3)There was a higher reported infection rate overall for surgeons in their board collection period than infection rates in the literature, with males having an overall higher infection rate than females.(4)Arthrofibrosis is more than twice as common in females than males following ACL reconstruction.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100178"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164753","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":"Minimally Invasive Surgery for Juvenile Hallux Valgus.","authors":"Sang W Lee, Daniel Gabriel, Dong W Lee, Winnie T H Lin, Collin May","doi":"10.1016/j.jposna.2025.100175","DOIUrl":"10.1016/j.jposna.2025.100175","url":null,"abstract":"<p><p>In adults, minimally invasive surgery for surgical treatment of hallux valgus has become increasingly popular, with a growing body of literature showing safety and effectiveness comparable to open surgery. Minimally invasive techniques for the treatment of juvenile hallux valgus include Bosch, Reverdin-Isham, Chevron, Endolog, distal soft tissue release, and hemiepiphysiodesis procedures. Data comparing minimally invasive and open surgery for the treatment of juvenile hallux valgus in children and adolescents are limited. In this review, we provide an overview of juvenile hallux valgus, discuss the minimally invasive techniques available for surgical treatment, and review the data on safety and effectiveness associated with each technique. There is a need for larger-scale studies comparing minimally invasive and open surgery for the treatment of juvenile hallux valgus, as well as the development of a standardized set of clinical and radiographic outcomes to guide evidence-based surgical management of juvenile hallux valgus.</p><p><strong>Key concepts: </strong>(1)Compared with data on managing hallux valgus in adults, information on the safety and effectiveness of minimally invasive surgery for treating juvenile hallux valgus is limited.(2)Minimally invasive techniques for treating juvenile hallux valgus include Bosch, Reverdin-Isham, Chevron, Endolog, distal soft tissue release, and hemiepiphysiodesis procedures.(3)In total, 10 studies have assessed outcomes, demonstrating varying degrees of radiographic and clinical improvement along with complication rates.(4)Future large-scale comparative studies and standardized outcomes are essential for informing evidence-based surgical management of juvenile hallux valgus.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100175"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164747","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":"Fosaprepitant Use as an Antiemetic to Prevent Postoperative Nausea and Vomiting in Pediatric Spinal Fusion Patients May Be Associated With More Rapid Transition to Oral Pain Medication and Reduced Length of Stay.","authors":"Jennifer Busse, Aaron Louie, Jennifer Crotty, Albert Lin, Zarema Muratova, Matan Malka, Ritt Givens, Benjamin Roye, Michael Vitale, William Schechter","doi":"10.1016/j.jposna.2025.100174","DOIUrl":"10.1016/j.jposna.2025.100174","url":null,"abstract":"<p><strong>Background: </strong>Significant postoperative nausea and vomiting (PONV) in pediatric patients undergoing posterior spinal fusion is common and limits recovery, prolonging hospital stay. Fosaprepitant is a long-acting antiemetic and works by blocking substance P binding to the neurokinin-1 (NK₁) receptor. There is evidence that its perioperative use substantially reduces PONV in adults, but there is a dearth of literature on its use in pediatric PONV. We seek to elucidate whether a postoperative dose of fosaprepitant in pediatric posterior instrumentation and fusion (PSIF) patients decreases PONV, thus improving recovery and decreasing the length of hospital stay.</p><p><strong>Methods: </strong>This is a retrospective chart review of 173 pediatric patients with idiopathic scoliosis undergoing PSIF. The anesthetic methodology was standardized among both groups. The cohort was divided into two groups according to the use of fosaprepitant intraoperatively (or within four hours postoperatively) or no use. We examined patient characteristics, fosaprepitant dose, incidence of PONV, time to transition from parenteral to oral opioids, and length of hospital stay.</p><p><strong>Results: </strong>78 (45%) patients received fosaprepitant and 95 (55%) did not. There were no statistically significant differences between groups based on demographics or intraoperative management. No significant difference was found in the incidence of PONV between the groups, but there was a reduction in the number of rescue antiemetics required and a quicker transition from parenteral to oral opioids in the fosaprepitant group. There was also a significantly decreased length of stay.</p><p><strong>Conclusions: </strong>While fosaprepitant did not significantly decrease PONV in pediatric PSIF patients, it was associated with decreased use of additional antiemetics. The patients also demonstrated a more rapid transition to oral from parenteral opioids and a shorter length of hospital stay. A larger study may show a statistically significant reduction in PONV in patients who received fosaprepitant. Future studies are needed to elucidate the optimal dose and timing needed to treat PONV in pediatrics.</p><p><strong>Key concepts: </strong>(1)Spinal fusion surgery patients are at risk of having significant postoperative nausea and vomiting.(2)Fosaprepitant is an effective agent to treat postoperative nausea and vomiting in adults, but has not been extensively studied in pediatrics for this purpose.</p><p><strong>Level of evidence: </strong>The level of evidence is a 3 as it is a cohort study looking at the relationship between an exposure and an outcome.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100174"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164627","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}