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

{"title":"Impact of the COVID-19 Pandemic on Buckle Fracture Treatment.","authors":"Mehmet E Kilinc, Evan P Sandefur, Mosufa Zainab, Nicholas J Peterman, Andrea A Yu-Shan, Peter J Apel","doi":"10.1016/j.jposna.2025.100162","DOIUrl":"10.1016/j.jposna.2025.100162","url":null,"abstract":"<p><strong>Background: </strong>Based on the existing consensus in the literature, we have coined a term at our institution to describe optimal treatment for distal radius buckle fractures: Buckle Evidence-based Strategic Treatment (BEST). BEST includes a single provider visit, education, a removable wrist brace/bandage, no additional follow-up visits, and no additional X-rays. During the COVID-19 pandemic, many providers were pressured to reduce the number of in-person visits, promote physical distancing, and minimize in-person interaction with the healthcare system. It is unknown if a secondary effect of the COVID-19 pandemic was increased use of BEST practices and if there was a sustained effect. This investigation analyzed the adherence to BEST practices for treating distal radius buckle fractures in the pre-COVID-19 and COVID-19 era.</p><p><strong>Methods: </strong>A retrospective cohort study of buckle fracture care was conducted across 2018-2019 (pre-COVID-19) and 2020-2022 (COVID-19 era). Subset analysis was also conducted for 2020 (peak COVID-19 era) and 2021-2022 (post-peak COVID-19 era). Adherence to BEST practices was assessed by chart review. The provider type was documented and subclassified into fellowship-trained pediatric orthopaedic surgeons, non-pediatric fellowship-trained orthopaedic surgeons, and non-physicians. Analyses were performed using chi-squared testing.</p><p><strong>Results: </strong>A total of 602 distal radius buckle fractures met inclusion, with an average patient age of 9.4 years. Pre-COVID-19 BEST practice adherence was 11.15%. During peak COVID-19 era, adherence rates improved significantly to 41.18% (<i>P</i> < .001). This effect was sustained for the post-peak COVID-19 era. There were significantly different rates of adherence depending on provider type (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with a significant increase in BEST practice utilization for buckle fracture management across all provider types. Adherence to BEST practices varied significantly based on provider type, with pediatric fellowship-trained orthopaedic surgeons having the highest level of adherence. This study demonstrates that external factors can impact treatment decisions for distal radius buckle fractures. Advocacy to change practice patterns for pediatric fracture care must first understand the factors that influence decision-making.</p><p><strong>Key concepts: </strong>(1)The COVID-19 pandemic was associated with an increase in the adoption of BEST practices for the management of buckle fractures across all provider groups.(2)Fellowship-trained pediatric orthopaedic surgeons have the highest level of BEST practice adherence compared to other provider types.(3)Initiatives aimed at altering clinical practice must prioritize an understanding of the decisional factors affecting healthcare providers.</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":"100162"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164742","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":"It's Just a Fingertip! Yet Controversy Exists: Standardizing a Treatment Pathway for Pediatric Fingertip Injuries.","authors":"Hilton P Gottschalk, Niamh D McMahon, Karen Piper, Karla Lawson, Andrea Bauer, Sonia Chaundhry, Julie Samora, Krister Freese, Christine A Ho","doi":"10.1016/j.jposna.2025.100163","DOIUrl":"10.1016/j.jposna.2025.100163","url":null,"abstract":"<p><strong>Background: </strong>Pediatric fingertip injuries are very common; however, treatment varies greatly depending on geographic location and surgeon. A paucity of data exists on how emergency department practitioners and hand surgeons should treat these injuries. We sought to develop consensus around treatment guidelines for these injuries.</p><p><strong>Methods: </strong>We conducted a Delphi survey of self-identified pediatric hand surgeons. Participants answered care delivery questions about 11 scenarios of fingertip injuries. These included minor (e.g., <50% subungual hematomas without fractures) to severe injuries (e.g., complete to near-complete partial tip amputations). Each question was answered on a 3-point Likert scale and included inquiry about antibiotic use, clinical consults, treatment methods, and need for hand surgeon follow-up. The second round of Delphi asked the participants to view round-one responses and reanswer questions that had moderate kappa values (kappa = 0.40-0.69) to attempt to reach consensus.</p><p><strong>Results: </strong>Thirty-four surgeons took the first round of Delphi survey. Questions in each scenario ranged from very high to very poor levels of agreement. All but one scenario contained at least one question with moderate agreement allowing for resurvey and consensus building. Thirty-three (97%) of the same surgeons completed the second round. In the 11 scenarios, there were 22 questions resurveyed. Of those 22 questions, 17 (77%) changed to higher levels of consensus with a kappa ≥0.70, allowing consensus of expert opinion to be reached on 45 treatments.</p><p><strong>Conclusions: </strong>The panel reached consensus on when to use intravenous (IV), oral (PO) or no antibiotics for various scenarios of pediatric fingertip injuries. Clarification was achieved on the standard treatment and follow-up practices for multiple clinical scenarios. Further work is required to achieve expert consensus for management of multiple clinical scenarios.</p><p><strong>Key concepts: </strong>(1)Fingertip traumas are commonly seen in pediatric emergency rooms with treatments varying widely depending on the region of care.(2)Oral (PO) antibiotics are recommended for a tuft fracture with nailbed displacement, a Seymour fracture, or during partial amputation without loss of vascularity, whereas IV and PO antibiotics are indicated for complete and near-complete amputation.(3)Hand surgeon consultation was recommended for Seymour fracture, partial amputation of the distal phalanx, and complete or near-complete amputation with loss of vascularity.(4)Further research needs to be done to achieve consensus on treatment of some traumas.</p><p><strong>Level of evidence: </strong>V, Expert Opinion.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100163"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164746","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":"Performance of Artificial Intelligence in Addressing Questions Regarding the Management of Pediatric Supracondylar Humerus Fractures.","authors":"John D Milner, Matthew S Quinn, Phillip Schmitt, Ashley Knebel, Jeffrey Henstenburg, Adam Nasreddine, Alexandre R Boulos, Jonathan R Schiller, Craig P Eberson, Aristides I Cruz","doi":"10.1016/j.jposna.2025.100164","DOIUrl":"10.1016/j.jposna.2025.100164","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The vast accessibility of artificial intelligence (AI) has enabled its utilization in medicine to improve patient education, augment patient-physician communications, support research efforts, and enhance medical student education. However, there is significant concern that these models may provide responses that are incorrect, biased, or lacking in the required nuance and complexity of best practice clinical decision-making. Currently, there is a paucity of literature comparing the quality and reliability of AI-generated responses. The purpose of this study was to assess the ability of ChatGPT and Gemini to generate reponses to the 2022 American Academy of Orthopaedic Surgeons' (AAOS) current practice guidlines on pediatric supracondylar humerus fractures. We hypothesized that both ChatGPT and Gemini would demonstrate high-quality, evidence-based responses with no significant difference between the models across evaluation criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The responses from ChatGPT and Gemini to responses based on the 14 AAOS guidelines were evaluated by seven fellowship-trained pediatric orthopaedic surgeons using a questionnaire to assess five key characteristics on a scale from 1 to 5. The prompts were categorized into nonoperative or preoperative management and diagnosis, surgical timing and technique, and rehabilitation and prevention. Statistical analysis included mean scoring, standard deviation, and two-sided t-tests to compare the performance between ChatGPT and Gemini. Scores were then evaluated for inter-rater reliability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;ChatGPT and Gemini demonstrated consistent performance across the criteria, with high mean scores across all criteria except for evidence-based responses. Mean scores were highest for clarity (ChatGPT: 3.745 ± 0.237, Gemini 4.388 ± 0.154) and lowest for evidence-based responses (ChatGPT: 1.816 ± 0.181, Gemini: 3.765 ± 0.229). There were notable statistically significant differences across all criteria, with Gemini having higher mean scores in each criterion (&lt;i&gt;P&lt;/i&gt; &lt; .001). Gemini achieved statistically higher ratings in the relevance (&lt;i&gt;P&lt;/i&gt; = .03) and evidence-based (&lt;i&gt;P&lt;/i&gt; &lt; .001) criteria. Both large language models (LLMs) performed comparably in the accuracy, clarity, and completeness criteria (&lt;i&gt;P&lt;/i&gt; &gt; .05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ChatGPT and Gemini produced responses aligned with the 2022 AAOS current guideline practices for pediatric supracondylar humerus fractures. Gemini outperformed ChatGPT across all criteria, with the greatest difference in scores seen in the evidence-based category. This study emphasizes the potential for LLMs, particularly Gemini, to provide pertinent clinical information for managing pediatric supracondylar humerus fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)The accessibility of artificial intelligence has enabled its utilization in medicine to improve patient education, support resea","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100164"},"PeriodicalIF":0.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164738","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-stage Combined Hip Arthroscopy and Periacetabular Osteotomy.","authors":"Morgan Hadley, Mihir M Thacker, Alvin W Su","doi":"10.1016/j.jposna.2025.100171","DOIUrl":"10.1016/j.jposna.2025.100171","url":null,"abstract":"<p><p>Intra-articular hip pathology is common in young patients with hip dysplasia. One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) allows for thorough treatment of both intra-articular pathology (labral tear and cartilage defects) and a dysplastic acetabulum in a single surgical setting. We describe our method for efficiently and effectively accomplishing both procedures in pediatric and adolescent patients, with emphasis on a streamlined set-up and transition.</p><p><strong>Key concepts: </strong>(1)One-stage combined hip arthroscopy and periacetabular osteotomy (PAO) addresses all relevant hip pathologies in a single, same-day surgery and facilitates patient recovery through one postoperative rehabilitation program.(2)A specialized surgical table attachment system and a dedicated, experienced surgical team optimize efficiency during the transition between the two procedures and minimize the need to move the patient to a second operating room (OR) table.(3)Hip arthroscopy may be performed using limited arthrotomy, and the capsule may not need to be closed. To enhance efficiency, hip joint capsule management can be deferred to the PAO portion, either for plication of the capsule or, in rare cases, for additional work on femoroplasty after correcting acetabular coverage.(4)Before concluding the PAO procedure, it can be helpful to use a \"checklist\" to confirm that the acetabulum has been appropriately corrected.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100171"},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164732","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":"Are Routine Post-Cast Removal Radiographs and a Second Follow-up Appointment Necessary in the Management of Nondisplaced or Minimally Displaced Distal Radius Fractures?","authors":"Brian Molokwu, Fareeda Eraky, Matthew Weintraub, Ian Briggs, Candice Legister, Katie Otero, Neil Kaushal, Alice Chu, Folorunsho Edobor-Osula","doi":"10.1016/j.jposna.2025.100170","DOIUrl":"10.1016/j.jposna.2025.100170","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of routine follow-up radiographs and appointments after cast removal when managing minimally displaced pediatric distal radius fractures has not been conclusively proven. This study aims to assess how often follow-up appointments and radiographs taken after cast removal alter management of patients with minimally displaced distal radius fractures.</p><p><strong>Methods: </strong>A single-center retrospective chart review was conducted on patients under 18 years of age with minimally displaced distal radius fractures between 2017 and 2023. Demographic information, fracture characteristics, time to follow-up, and each appointment outcome were recorded. A change in patient management following post-cast removal radiographs was defined as a need for closed reduction, operative intervention, or prolonged immobilization. The second follow-up appointment was considered to modify management if it necessitated a physical therapy referral or an additional office visit. Unscheduled appointments and any changes in fracture alignment during follow-up visits were also noted.</p><p><strong>Results: </strong>Ninety-three patients met the inclusion criteria; 1.1% (1 of 93) of patients had their management changed following their post-cast removal radiographs according to our criteria. One patient was indicated for prolonged immobilization for a visible fracture line; no patients were indicated for surgery or closed reduction. Thirty-eight patients who underwent cast removal attended their 2nd follow-up appointment; 2.6% (1 of 38) of patients had their management changed according to our criteria. One patient required an additional follow-up appointment for a physeal check; no patient required a physical therapy referral. Two patients had an unscheduled appointment after discharge of care, due to parental desire of recovery confirmation before returning to gym play. No changes in fracture alignment were observed during any follow-up radiographs.</p><p><strong>Conclusions: </strong>This study suggests that post-cast removal radiographs and second follow-up appointments rarely alter management of minimally displaced distal radius fractures. Limiting unnecessary visits and imaging could reduce costs and ease the burden on patients and families.</p><p><strong>Key concepts: </strong>1) Post-cast removal radiographs rarely altered management for minimally displaced pediatric distal radius fractures.2) Only 1.1% of patients required prolonged immobilization, with no cases needing surgery or closed reduction.3) Second follow-up appointments infrequently changed management, with only 2.6% of patients requiring an additional visit.4) Unscheduled visits were primarily driven by parental concerns rather than clinical necessity.5) No changes in fracture alignment were observed in any follow-up radiographs.</p><p><strong>Level of evidence: </strong>Level IV - case series.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100170"},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164478","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":"Characterization of Orthopaedic Indications Among Patients Undergoing Tethered Cord Release.","authors":"Katia E Valdez, Cameron M Arkin, Theresa Meyer, Jill E Larson, Vineeta T Swaroop","doi":"10.1016/j.jposna.2025.100168","DOIUrl":"10.1016/j.jposna.2025.100168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tethered cord syndrome (TCS) can present with neurologic, urologic, and/or orthopaedic symptoms, but little research has focused on the orthopaedic conditions that result in tethered cord release (TCR). This study aims to categorize orthopaedic findings associated with TCS and identify which conditions require further surgical intervention post TCR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study involved 247 patients from our tertiary referral center, all enrolled in the National Spina Bifida Patient Registry (NSBPR) and who underwent TCR between 2007 and 2017. Patients were grouped by tethered cord diagnosis: fatty filum (fatty filum, low-lying cord), lipoma [lipoma, meningocele, myelocystocele, diastematomyelia, meningocele manqué (MM)], and myelomeningocele (MMC). TCR indications were classified as orthopaedic or urologic \"yellow\" or \"red\" flags-yellow flags denoting the initial symptoms prompting a referral for tethered cord work-up and red flags representing physician-identified indicators for TCR. Red-flag surgical indicators were identified by an interdisciplinary team of orthopaedic surgeons, urologists, and neurosurgeons. Orthopaedic yellow and red flags included findings such as gait abnormalities or extremity deformities, while urologic flags included hydronephrosis or incontinence. Data on orthopaedic surgeries performed within 18 months post TCR were collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Orthopaedic-only symptoms were found in 41 patients (yellow flags) and 51 patients (red flags). Both urologic and orthopaedic symptoms led to TCR in 29 patients (yellow) and 54 patients (red). The number of orthopaedic indicators for TCR was strongly correlated with the total number of orthopaedic surgeries performed within 18 months after TCR (&lt;i&gt;P&lt;/i&gt; &lt; .00001). Additionally, the number of orthopaedic yellow flags was significantly correlated with the number of TCRs a patient underwent (&lt;i&gt;P&lt;/i&gt; = .002). Among those who went on to require orthopaedic intervention, the most common surgeries performed were foot, ankle, and knee contracture releases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Formal orthopaedic evaluation is an essential component of the multidisciplinary assessment and treatment of TCS. Nearly half (47%) of TCR patients presented with preoperative orthopaedic indicators, which varied by tethered cord diagnosis. Despite undergoing TCR, 16% of patients required further surgical intervention for definitive management of their orthopaedic conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Orthopaedic symptoms and sequelae are common among patients with tethered cord syndrome (TCS)-many will go on to require surgery.(2)Foot and ankle contractures are among the top presenting orthopaedic manifestations of TCS.(3)Formal orthopaedic evaluation is an essential component of the multidisciplinary assessment and treatment of TCS.(4)Our data suggest a relationship between orthopaedic presenting symp","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100168"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164499","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":"3D Mapping of Talocalcaneal Coalitions: An Aid to Surgical Approach and Excision.","authors":"Nathan Chaclas, Carter E Hall, Bernard D Horn, Richard S Davidson","doi":"10.1016/j.jposna.2025.100166","DOIUrl":"10.1016/j.jposna.2025.100166","url":null,"abstract":"<p><strong>Background: </strong>The traditional approach to talocalcaneal tarsal coalition (TCC) excision is medial through the deltoid ligament. Unfortunately, there are few anatomic markers to guide the surgeon. Preoperative planning includes radiographs and advanced imaging; these currently provide little help guiding the excision. Our method of mapping the coalition on advanced imaging accurately defines where to make osteotomies in the operating room.</p><p><strong>Methods: </strong>A retrospective review was conducted of TCC patients with preoperative computed tomography (CT) at a single institution from 2010 to 2022. Three independent raters reported sagittal TCC length relative to the talus. Raters further quantified TCC coronal depth and height across distal, middle, and proximal thirds of the TCC relative to the sustentaculum talus. This guidance directs two osteotomy cuts through the coalition directly into the normal lateral subtalar joint for complete and accurate excision of the coalition. CT measurement inter-rater reliability was determined using intra-class correlation.</p><p><strong>Results: </strong>Twenty-seven patients (16 male), average age 13.9 ± 2.4, met study criteria. TCCs were located on the right lower extremity in 10/27 cases. Sixteen/twenty-seven coalitions were horizontal, 10/27 was down sloping, and 1/27 was upsloping relative to the joint line. Substantial agreement was achieved between three raters (mean average measures intraclass correlation 0.781). The mean coalition length in the sagittal plane was 21.2 ± 6.0 mm, covering 49.6 ± 23.2% of the talar length.</p><p><strong>Conclusion: </strong>This study describes a 3D preoperative mapping technique with high reproducibility among the present raters to resect the TCC with direct vision of the normal subtalar joints. Alternative approaches, such as obtaining CT imaging intraoperatively, expose the patient to increased radiation and anesthesia, incurring higher financial and time costs. We report a concise, readily applicable, and systematic method to map TCCs on preoperative CT and provide direct vision of the normal subtalar (talar and calcaneal) joints, as well as close to normal subtalar motion.</p><p><strong>Key concepts: </strong>(1)To date, very little in the way of intraoperative planning for TCCs has been proposed in the literature, even though advanced imaging has been widely used preoperatively.(2)Our method of mapping coalitions on preoperative CT may assist with intraoperative resection. Additionally, this method demonstrates the three-dimensional variety that can be expected in surgical excision of these coalitions.(3)Neither the medial to lateral depth nor the distance proximal from the sustentaculum talus was uniform as the coalitions were thickest centrally and tapered both proximally and distally.</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":"100166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164477","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":"Do Open Tibial Shaft Fractures Portend a Worse Outcome in the Pediatric Population? A Pilot Study Utilizing a Matched Cohort.","authors":"Dylan R Rakowski, Brennan Roper, Sarah R Purtell, Patrick Carry, Julia S Sanders","doi":"10.1016/j.jposna.2025.100167","DOIUrl":"10.1016/j.jposna.2025.100167","url":null,"abstract":"<p><strong>Background: </strong>Tibia fractures are the third most common pediatric long bone fractures and are associated with numerous complications such as compartment syndrome, angular deformity, and nonunion. This study sought to determine if complication rates were higher in open tibia fractures than in closed tibia fractures in the pediatric population, with the hypothesis that there would be no difference.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study was performed at a quaternary care academic pediatric hospital identifying all open tibia fractures treated from March 1, 2016, to November 30, 2021. These patients were matched by sex, age, and injury pattern, with patients treated for closed tibia fractures during this same time period. Data collected included demographics, clinical and radiographic information, and complications.</p><p><strong>Results: </strong>Both fracture groups included 30 patients (24 males and 6 females). The average age at injury was 11.3 years in the open group, and 11.2 years in the closed group. The median follow-up duration was 7.7 months (1.2-67.8 months) and 9.3 months (1.4-62.9 months) for the open and closed groups, respectively, (<i>P</i> = .5749). One hundred percent of open fractures were treated operatively, versus 50% of the closed-group ones (<i>P</i> < .0001). There was no significant difference in any type of complications when comparing the open group to the closed tibia fracture group (odds ratio: 1.29, 95% confidence interval: 0.48 to 3.45, <i>P</i> = .6180). The most common complication was the development of a clinically significant angular deformity (26.7% in the open group and 10% in the closed group, <i>P</i> = .1806). There was a 10% rate of compartment syndrome in both groups and a nonunion rate of 6.7% for the open group and 3.3% for the closed group (<i>P</i> > .999).</p><p><strong>Conclusions: </strong>This pilot study utilizing a matched cohort found no significant difference in complication rates between open and closed pediatric tibia fractures, though complications were prevalent in both groups. These findings emphasize the importance of maintaining a high clinical suspicion for compartment syndrome and thoroughly counseling patients on the risks of angular deformity.</p><p><strong>Key concepts: </strong>(1) A matched cohort study demonstrates complication rates are similarly high in both open and closed pediatric tibial shaft fractures.(2) Angular deformity is the most common complication overall.(3) Treatment algorithms may differ in open versus closed tibial shaft fractures, with open fractures fixated with different constructs and immobilized for longer.</p><p><strong>Level of evidence: </strong>Level III, case control study.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100167"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164623","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":"Pain After Lower Extremity Fracture Surgery: What Is Normal and How Is It Impacted by Individual-specific and Caregiver-specific Psychosocial Factors?","authors":"Alex L Gornitzky, Zoe E Belardo, Bridget K Ellsworth, Sulagna Sarkar, Joseph L Yellin, Arianna Trionfo, Apurva S Shah","doi":"10.1016/j.jposna.2025.100165","DOIUrl":"10.1016/j.jposna.2025.100165","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This pilot study characterized normative pain and analgesic consumption following lower-extremity fracture surgery in children. Additionally, we sought to determine how various caregiver- and patient-specific psychosocial factors affect pain, opioid use, and health-related quality-of-life (HRQOL). We hypothesized that the majority of children following lower extremity fracture surgery would not need prolonged opioids, and that higher preoperative anxiety levels would translate into higher postoperative pain and analgesic needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prospective cohort study of children aged 5-17 years old undergoing operative fixation of an isolated lower extremity fracture at a single pediatric trauma center. Baseline surveys were administered preoperatively assessing anxiety, pain catastrophizing, and pain self-efficacy. Daily pain scores and analgesic consumption were collected on postoperative days (POD) 1-7, 10, 14, and 21. HRQOL was assessed via PROMIS Global Health, and functional recovery was assessed via PROMIS Mobility. Clinical data were abstracted from the medical record. Descriptive and bivariate statistics were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 63 patients with a mean age of 13.0 ± 2.6 years were included. The most common fracture locations were the ankle (49%), tibia (27%), and femur (17%). Mean daily pain scores peaked at 4.5/10 on POD1 and steadily decreased thereafter. By POD3, 62% of patients had mild pain or less (score ≤3/10), and 53% were no longer taking any opioids. The majority of caregivers (55%) and patients (61%) reported pain-related anxiety of ≥6/10 prior to surgery; 76% of caregivers and 50% of patients were at least moderately confident in their ability to adequately manage pain. Neither caregiver nor patient pain-related anxiety or self-efficacy was significantly related to postoperative pain scores, satisfaction with pain management, or opioid consumption. Caregiver pain catastrophizing and generalized anxiety also did not affect patient outcomes. One week after surgery, anxious children had lower average pain scores (1.2 vs 2.7; &lt;i&gt;P&lt;/i&gt; = .005) and were less likely to still be using nonopioid analgesics (47% vs 88%, &lt;i&gt;P&lt;/i&gt; = .013).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This pilot study contributes preliminary data for postoperative pain, analgesic consumption, and functional recovery following operative treatment of lower extremity fractures that can be used to guide prescribing practices and preoperative expectation management/family education. More work is needed to validate and build upon these findings before they can be safely extrapolated to other clinical scenarios and age groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)In this cohort of children following lower extremity fracture surgery of all types, mean daily pain scores peaked at 4.5 on postoperative day one and steadily decreased thereafter.(2)By POD3, most patients had mild p","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164734","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 Availability and Readability of Multilingual Online Patient Materials for Legg-Calve-Perthes Disease.","authors":"Rafael Verduzco Guillen, Emma Danielle Grellinger, Ishaan Swarup","doi":"10.1016/j.jposna.2025.100169","DOIUrl":"10.1016/j.jposna.2025.100169","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients newly diagnosed with Legg-Calve-Perthes disease (LCPD) often use the internet to learn about their disease. The American Medical Association (AMA) and the National Institutes of Health (NIH) recommend writing patient education resources at sixth- to eigth-grade reading levels. The purpose of this study was to determine the availability of online patient education resources for LCPD, assess the availability of translation to other languages, and analyze the readability of English-language resources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional analysis was conducted to determine the availability and readability of online, written patient education materials for LCPD. The top 50 pediatric orthopaedic hospitals, as reported by the &lt;i&gt;U.S. News and World Report&lt;/i&gt;, major professional societies (the American Academy of Orthopaedic Surgeons [AAOS], the American Academy of Pediatrics [AAP], and the Pediatric Orthopaedic Society of North America [POSNA]), and international societies (POSNA \"Alliance Societies\") were included. The number of translations to other languages was determined among the institutions with English resources. Three different readability measures were used on resources written in English. Statistical analysis was performed using descriptive, univariate, and correlation analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy-four percent (37/50) of hospitals, 67% (2/3) of U.S.-based professional societies, and 16% (5/31) of international societies provided LCPD education resources. Of the hospitals and societies that provided English resources, 36% (14/39) provided translation to other languages. The most common language available was Spanish. Resources written in English had an average Flesch Reading Ease score of 60.5, Fry Graph grade level of 9.6, and Simple Measure of Gobbledygook (SMOG) grade level of 11.4. There was no significant relationship between hospital rank and availability (&lt;i&gt;P&lt;/i&gt; &gt; .05) or reading level (&lt;i&gt;P&lt;/i&gt; &gt; .05) of resources and no significant relationship between a state's percentage of Spanish speakers and availability of Spanish translations (&lt;i&gt;P&lt;/i&gt; &gt; .05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Most selected hospitals and U.S.-based professional societies provided information about LCPD; however, many did not provide translation to other languages. There is a discrepancy between the reading level of the resources queried and national reading level recommendations. There is a need for translated LCPD resources from hospitals and societies domestically and abroad to provide adequate patient education, particularly for individuals with lower reading levels or non-English speakers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Online patient educational materials across United States hospitals and major pediatric orthopaedic societies for Legg-Calve-Perthes disease (LCPD) were written above the recommended English reading levels.(2)There is a limited availability of patient ","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100169"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164751","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}