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

{"title":"Adaptive Sports Exposure Impacts Pediatric Orthopaedic Surgeon Comfort in Treating Patients With Disabilities.","authors":"Charlotte F Wahle, Nora A Galoustian, Nicole J Newman-Hung, Alexander Rueda, Christina Im, Eghosa Edogun, Charlotte Poplawski, Sharon L Hame, Rachel M Thompson","doi":"10.1016/j.jposna.2025.100209","DOIUrl":"10.1016/j.jposna.2025.100209","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients with physical disabilities often have difficulty accessing providers who are comfortable treating this unique patient population. The purpose of the study is to identify factors associated with increased pediatric orthopaedic surgeon familiarity in treating patients with disabilities and to assess whether involvement with adaptive sports (AS) improves their comfort level in treating these patients.</p><p><strong>Methods: </strong>An anonymous 36-question survey was administered from May to June 2024 to members of the Pediatric Orthopaedic Society of North America (POSNA). Demographic information and clinical practice details were collected. Survey questions assessed the comfort level of pediatric orthopaedic surgeons with treating and counseling patients with various types of disabilities, as well as their familiarity with AS. Data analysis was performed using chi-squared analysis, fisher exact test, and the Mann-Whitney U.</p><p><strong>Results: </strong>A total of 190 responses were recorded (13% of POSNA membership). Participants' ages ranged from 32 to 90; 93% of respondents completed fellowship training in pediatric orthopaedic surgery. Surgeon experience ranged from <5 to >20 years in practice. Surgeons with more experience had significantly higher comfort levels in treating patients with physical disabilities and counseling them regarding sports participation (<i>P</i> < .01, <i>P</i> < .001, respectively). Surgeons who treat a higher proportion of patients with physical disabilities were also significantly more likely to have attended an AS event (<i>P</i> = .02). Furthermore, there was a statistically significant association between AS event attendance and comfort counseling patients with physical disabilities on sports risks (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Pediatric orthopaedic surgeons with more practice experience and with greater exposure to patients with disabilities are more comfortable in treating and counseling these patients with disabilities. However, the data suggests that attending an AS event may improve pediatric orthopaedic surgeons' comfort and confidence in treating patients with disabilities regardless of practice experience. While AS have well-documented benefits for participants-including participation, community, and health benefits-these events may <i>also</i> provide an excellent opportunity for exposing pediatric orthopaedic surgeons to patients with disabilities early in their career, with significant impact on their ability to treat patients with disabilities.</p><p><strong>Key concepts: </strong>(1)Pediatric orthopaedic surgeons with more years in practice report significantly greater comfort treating and counseling patients with disabilities.(2)Surgeons who have attended adaptive sports (AS) events demonstrate significantly higher comfort levels in caring for patients with disabilities, regardless of years in practice.(3)Many physicians ","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100209"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777695","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":"Comparison of Three Surgical Options for Treatment of Diaphyseal Tibia Fractures in Pediatric Patients.","authors":"Sang Won Lee, Blair Stewig, Danielle Cook, Kristin Alves, Akossiwa Brynn Assignon, Daniel Hedequist, Mininder S Kocher, Benjamin J Shore, Susan T Mahan","doi":"10.1016/j.jposna.2025.100210","DOIUrl":"10.1016/j.jposna.2025.100210","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Most pediatric diaphyseal tibia fractures can be treated with reduction and casting. While surgical reduction and fixation are sometimes necessary, there is no clear consensus about the optimal implant. Plate osteosynthesis (PO), elastic intramedullary nailing (EIN), and multiplanar external fixation (MEF) are common surgical fixation methods in the skeletally immature patient after failing closed reduction. This study aims to compare the indications and outcomes of PO, EIN, and MEF techniques for the surgical treatment of the pediatric diaphyseal tibia fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Skeletally immature patients ages 4-16 years treated surgically by PO, EIN, or MEF for a diaphyseal tibia fracture at a single, tertiary pediatric hospital were included. Demographic, clinical, radiographic data, and complications were collected retrospectively. Complications were classified according to the Clavien-Dindo-Sink classification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 82 patients were included with a median age of 13.4 years (range, 5.69-15.94) and median follow-up of 46 weeks (range, 14-237), of whom 84% (69/82) were male. Most patients received EIN (61%; 50/82), while 23% (19/82) had MEF, and 16% (13/82) had PO. There were no differences across treatment groups for open (&lt;i&gt;P&lt;/i&gt; = .96) and comminuted (&lt;i&gt;P&lt;/i&gt; = .19) fractures. Location of fracture was significantly different by treatment method, with middle 1/3 fractures treated mostly by EIN (77%; 34/44) and distal 1/3 fractures treated across all three fixation methods (&lt;i&gt;P&lt;/i&gt; = .002). Patients treated with MEF (47%; 9/19) and PO (46%; 6/13) had higher complication rates compared with those treated with EIN (22%; 11/50). Patients treated with PO and MEF had 6.0 and 6.2 times the odds of having a severe complication, compared to patients who had EIN, controlling for age, weight, and fracture severity (&lt;i&gt;P&lt;/i&gt; = .01, &lt;i&gt;P&lt;/i&gt; = .02). There was no significant difference in other fracture characteristics and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;All three fixation types (PO, EIN, and MEF) show similar indications, although fracture location in the diaphysis may influence implant choice. EIN has a lower complication rate compared with PO and MEF and presents a strong option for operative treatment of the pediatric tibia shaft fracture.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)There is no clear consensus about optimal implant, including plate osteosynthesis (PO), elastic intramedullary nailing (EIN), and multiplanar external fixation (MEF), for the surgical treatment of skeletally immature tibial shaft fractures.(2)Among 82 patients with pediatric tibial diaphysis fractures, most patients received EIN (61%; 50/82), while 23% (19/82) had MEF, and 16% (13/82) had PO with no difference across treatment groups in terms of open (&lt;i&gt;P&lt;/i&gt; = .96) or comminuted (&lt;i&gt;P&lt;/i&gt; = .19) fractures.(3)Location of fracture was significantly different by treatment method","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100210"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777697","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":"Practice Pattern Preferences Among Pediatric Orthopaedic Surgeons in North America for the Treatment of Femoral Shaft Fractures.","authors":"Alyssa Barré, Andrew Kirk, Jonathan Grabau, Matthew Halsey, Gregory S Hawk, Vince W Prusick","doi":"10.1016/j.jposna.2025.100211","DOIUrl":"10.1016/j.jposna.2025.100211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The treatment of pediatric diaphyseal femur fractures varies based on many factors, and the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) are dependent on the quality and quantity of evidence in the literature. The purpose of this study is to assess current practice patterns in the treatment of femoral shaft fractures among pediatric orthopaedic surgeons to identify areas of variability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From October 2023 to January 2024, the Pediatric Orthopaedic Association of North America (POSNA) Trauma Quality, Safety, and Value Initiative Committee surveyed North American POSNA members on pediatric femoral shaft fracture treatment. Responses were analyzed based on surgeon age, practice location, and practice type. \"Usually\" and \"occasionally\" were considered positive responses; \"rarely\" and \"never\" were considered negative responses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1551 eligible members, 226 responded (14.6%), primarily aged 30-49 (56%) and in academic settings (77%). For infants (0-6 months), the Pavlik harness was most common, though usage declined with surgeon age (&lt;i&gt;P&lt;/i&gt; = .052), while spica casting increased (&lt;i&gt;P&lt;/i&gt; = .077). Regional differences were significant (&lt;i&gt;P&lt;/i&gt; = .021), with lower Pavlik harness use in the West. For children (6 months-5 years), spica casting was most common. Flexible intramedullary nails (FIN) was polarizing (42% positive, 58% negative). Regional differences were significant for traction with delayed spica (&lt;i&gt;P&lt;/i&gt; &lt; .0001) and submuscular plating (&lt;i&gt;P&lt;/i&gt; = .021). Surgeons aged 30-49 preferred single-leg spica over 1.5/2-leg spica (&lt;i&gt;P&lt;/i&gt; = .009). For length-stable fractures (5-11 years), FIN was preferred, followed by rigid intramedullary nailing. Older surgeons and nonacademic surgeons favored nonoperative treatment (&lt;i&gt;P&lt;/i&gt; &lt; .0001, &lt;i&gt;P&lt;/i&gt; = .005). For length-unstable fractures, operative treatment was predominant, though older surgeons more often considered nonoperative options (&lt;i&gt;P&lt;/i&gt; = .006). For adolescents (11-18 years), rigid intramedullary nailing was most common. Submuscular plating and FIN were increasingly preferred with surgeon age (&lt;i&gt;P&lt;/i&gt; = .010, &lt;i&gt;P&lt;/i&gt; = .002). Sixty-nine percent supported waterproof spica casting, with no significant differences by age, setting, or region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There are differences in practice patterns for the treatment of pediatric femoral shaft fractures based on surgeon age, practice location, and practice setting. This study identifies areas of variability in practice patterns where further studies are warranted to inform more evidence-based clinical practice guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Treatment preferences for diaphyseal femur fractures vary uniquely based on the treating surgeon's age, practice location, and practice type.(2)In general, older surgeons tend to choose from a broader array of treatment options w","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100211"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777707","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":"Artificial Intelligence-Based Large Language Models Can Facilitate Patient Education.","authors":"Xochitl Bryson, Marleni Albarran, Nicole Pham, Arianne Salunga, Taylor Johnson, Grant D Hogue, Jaysson T Brooks, Kali R Tileston, Craig R Louer, Ron El-Hawary, Meghan N Imrie, James F Policy, Daniel Bouton, Arun R Hariharan, Sara Van Nortwick, Vidyadhar V Upasani, Jennifer M Bauer, Andrew Tice, John S Vorhies","doi":"10.1016/j.jposna.2025.100196","DOIUrl":"10.1016/j.jposna.2025.100196","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) large language models (LLMs) are becoming increasingly popular, with patients and families more likely to utilize LLM when conducting internet-based research about scoliosis. For this reason, it is vital to understand the abilities and limitations of this technology in disseminating accurate medical information. We used an expert panel to compare LLM-generated and professional society-authored answers to frequently asked questions about pediatric scoliosis.</p><p><strong>Methods: </strong>We used three publicly available LLMs to generate answers to 15 frequently asked questions (FAQs) regarding pediatric scoliosis. The FAQs were derived from the Scoliosis Research Society, the American Academy of Orthopaedic Surgeons, and the Pediatric Spine Foundation. We gave minimal training to the LLM other than specifying the response length and requesting answers at a 5th-grade reading level. A 15-question survey was distributed to an expert panel composed of pediatric spine surgeons. To determine readability, responses were inputted into an open-source calculator. The panel members were presented with an AI and a physician-generated response to a FAQ and asked to select which they preferred. They were then asked to individually grade the accuracy of responses on a Likert scale.</p><p><strong>Results: </strong>The panel members had a mean of 8.9 years of experience post-fellowship (range: 3-23 years). The panel reported nearly equivalent agreement between AI-generated and physician-generated answers. The expert panel favored professional society-written responses for 40% of questions, AI for 40%, ranked responses equally good for 13%, and saw a tie between AI and \"equally good\" for 7%. For two professional society-generated and three AI-generated responses, the error bars of the expert panel mean score for accuracy and appropriateness fell below neutral, indicating a lack of consensus and mixed opinions with the response.</p><p><strong>Conclusions: </strong>Based on the expert panel review, AI delivered accurate and appropriate answers as frequently as professional society-authored FAQ answers from professional society websites. AI and professional society websites were equally likely to generate answers with which the expert panel disagreed.</p><p><strong>Key concepts: </strong>(1)Large language models (LLMs) are increasingly used for generating medical information online, necessitating an evaluation of their accuracy and effectiveness compared with traditional sources.(2)An expert panel of physicians compared artificial intelligence (AI)-generated answers with professional society-authored answers to pediatric scoliosis frequently asked questions, finding that both types of answers were equally favored in terms of accuracy and appropriateness.(3)The panel reported a similar rate of disagreement with AI-generated and professional society-generated answers, indicating that both had areas of contro","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100196"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824777","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":"Which Radiographic Measurements Best Predict Contralateral Slip in Patients Who Undergo Pinning for Unilateral Slipped Capital Femoral Epiphysis?","authors":"Eduardo N Novais, Timothy Borden, Thierry Pauyo, Mariana G Ferrer, Patricia Miller, Maranho Daniel","doi":"10.1016/j.jposna.2025.100204","DOIUrl":"10.1016/j.jposna.2025.100204","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Managing the contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) involves balancing the risks of prophylactic pinning against the potential for a subsequent slip. This study aimed to evaluate the role of radiographic methods in predicting contralateral slips in patients with unilateral SCFE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We assessed frog-leg radiographs from 312 patients with unilateral SCFE, measuring the Billings, Southwick, Posterior Sloping Angle (PSA), and tilt angles. Seventy patients (22%) experienced contralateral slips, with a median follow-up of 42 months (range, 18-70 months). Radiographs were evaluated independently by four raters at two separate time points. The radiographic parameters were compared between patients who developed contralateral slips and those who did not, and the diagnostic utility of each radiographic measure was assessed through receiver operating characteristic (ROC) curve analysis, with area under the ROC curve (AUC) values calculated for each method. Sensitivity, specificity, and predictive values were also determined using literature-based cutoffs for the angles (tilt angle &gt;10°, Billings &gt;12°, PSA &gt;14°, Southwick &gt;12°).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;ROC analysis showed discriminatory ability for all measures, with AUCs ranging from 0.61 to 0.66. The Tilt angle had the highest overall accuracy (77%; 95% CI = 72-82%) and specificity (93%) but the lowest sensitivity (21%). The Billings angle was the most sensitive (83%; 95% CI = 72-92%). All methods displayed good negative predictive values (NPV) between 80 and 90% and excellent interrater (ICC = 0.92-0.99) and intrarater (ICC = 0.84-0.98) reliability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Each radiographic method provides reliable predictive information regarding the risk of contralateral slip in unilateral SCFE. Surgeons who aim to minimize the risk of missing a contralateral slip should consider using the Billings angle with a cutoff of 12°, accepting that this may lead to some unnecessary pinning of hips that would not have slipped. Conversely, those who prioritize avoiding unnecessary surgery may prefer the tilt angle with a cutoff of 10°, understanding that this approach could result in missing some hips that will later develop a slip. These findings provide valuable guidance for decision-making regarding managing the contralateral hip in patients with unilateral SCFE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;1.Radiographic Predictive Measurements for Contralateral SCFE: The study evaluates the diagnostic utility of various radiographic angles (Epiphyseal Tilt, Billing's, Posterior Sloping, and Southwick angle) in predicting contralateral slips in unilateral SCFE cases, highlighting their sensitivity, specificity, and clinical implications.2.Interrater and Intrarater Reliability of radiographic measurements: The study demonstrates excellent interrater and intrarater reliability across all radi","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100204"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777714","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":"Molecular Basis of Fracture Pseudarthrosis Associated with Neurofibromatosis Type 1.","authors":"Aysha Khalid, Nandina Paria, Jonathan J Rios","doi":"10.1016/j.jposna.2025.100202","DOIUrl":"10.1016/j.jposna.2025.100202","url":null,"abstract":"<p><p>Neurofibromatosis Type 1 (NF1) is a tumor-predisposition syndrome caused by heterozygous mutations in the <i>NF1</i> gene. In addition to oncologic manifestations, individuals with NF1 face a heightened risk of developing secondary skeletal complications associated with somatic loss-of-heterozygosity. Long bone dysplasia and post-fracture pseudarthrosis are among the earliest skeletal manifestations observed in children with NF1. Most commonly occurring in the tibia, pseudarthroses are often treated with a combination of resection, fixation, bone grafting, and rhBMP2. Although rates of initial union are reported to be high, the risk of re-fracture and subsequent pseudarthrosis is similarly elevated, and some patients may ultimately require amputation. Basic science research related to NF1 pseudarthrosis is uncovering the cellular pathogenesis of the disease and unlocking new potential treatment paradigms. Here, we review the current understanding of the biological etiology of NF1 pseudarthrosis, informed by molecular studies of patient-derived tissue samples and mechanistic studies utilizing pre-clinical mouse models. Results from these studies are presented within the context of contemporary treatment paradigms. Finally, we introduce novel treatment paradigms currently under investigation in pre-clinical models and discuss how these may potentially translate to improve surgical outcomes in children with NF1 pseudarthrosis.</p><p><strong>Key concepts: </strong>(1)Fracture pseudarthrosis in patients with NF1 is caused by somatic mutations in the <i>NF1</i> gene.(2)Somatic <i>NF1</i> gene mutations hyperactivate the MAPK signaling pathway, disrupting cellular mechanisms necessary for proper fracture healing.(3)Emerging therapies aim to target hyperactive MAPK signaling to promote fracture healing by fostering osteogenic instead of fibrogenic pathways in skeletal progenitor cells.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777704","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":"Loss of Reduction in Pediatric Distal Radius Fractures: Risk Factors From a Prospective Multicenter Registry.","authors":"Apurva S Shah, Zoe E Belardo, Mark L Miller, Michael C Willey, Susan T Mahan, Divya Talwar, Donald S Bae","doi":"10.1016/j.jposna.2025.100206","DOIUrl":"10.1016/j.jposna.2025.100206","url":null,"abstract":"<p><strong>Objectives: </strong>Despite numerous single-center studies, uncertainty regarding the management of unstable pediatric distal radius fractures persists. The purpose of this investigation was to report patient factors and fracture characteristics that influence loss of reduction (LOR) or need for secondary procedures following closed reduction of pediatric distal radius fractures in a large, prospective multicenter cohort.</p><p><strong>Methods: </strong>Children aged 4-18 years old undergoing closed reduction for a displaced distal radius fracture were identified from the multicenter Pediatric Distal Radius Fracture (PDRF) Registry. Radiographic LOR was defined as a change in angulation ≥10° or an increase in translation of ≥2 out of 5 categories. Bivariate analysis and multivariate logistic regressions were performed.</p><p><strong>Results: </strong>In total, 616 children (69% male) with a mean age of 10.5 ± 3.4 years were included. The majority of subjects sustained bicortical metaphyseal distal radius fractures (68%), followed by Salter-Harris II physeal fractures (26%). The rate of radiographic LOR was 44% (271/616), and 11% (70/616) of fractures shifted ≥20°. On multivariate analysis, metaphyseal bicortical fracture pattern (OR = 2.3), prereduction translation of ≥51% (OR = 2.3), and nonanatomic closed reductions (OR = 1.9) independently increased the odds of LOR. Patient age, sex, and body mass index (BMI) were not significant predictors for LOR. Ultimately, 8% of children (47/616) underwent secondary procedures, including repeat closed reduction or operative treatment.</p><p><strong>Conclusions: </strong>Redisplacement of pediatric distal radius fractures after closed reduction is common (44%) and is greatly influenced by fracture characteristics. Roughly 11% of fractures will shift ≥20° after closed reduction and 8% undergo secondary procedures. Bicortical fracture pattern, prereduction fracture translation ≥51%, and nonanatomic closed reductions are independent risk factors for redisplacement. Dedicated effort should be made to minimize fracture translation at primary closed reduction, not because of remodeling potential, but to minimize the risk of angulation-driven LOR.</p><p><strong>Key concepts: </strong>(1)Approximately 4 out of 10 pediatric distal radius fractures experience re-displacement after closed reduction and 1 out of 10 will shift ≥20°.(2)Bicortical fracture patterns, prereduction fracture translation ≥51% of the radial shaft width, and nonanatomic closed reductions are independent risk factors for loss of reduction.(3)Any residual fracture translation at the time of closed reduction significantly increases the likelihood of redisplacement.</p><p><strong>Level of evidence: </strong>Level II: Prospective cohort study.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100206"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777703","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":"Outcomes of Suprapatellar Intramedullary Nail Fixation of Tibial Shaft Fractures in Skeletally Immature Patients.","authors":"Carlos D Pargas-Colina, Tori J Coble, Sara E Davis, David D Spence, Jonathan K Rowland, Derek M Kelly, Benjamin W Sheffer","doi":"10.1016/j.jposna.2025.100200","DOIUrl":"10.1016/j.jposna.2025.100200","url":null,"abstract":"<p><strong>Background: </strong>Tibial shaft fractures in children require individualized treatment approaches, including elastic nails, plates and screws, intramedullary rigid nails (IMN), and external fixators, with selection based on fracture characteristics and patient factors. IMN risks damaging the physis, but can provide enhanced stability and immediate weight bearing. While both infrapatellar and suprapatellar approaches exist for IMN placement, studies in adults have demonstrated that the suprapatellar approach offers higher patient satisfaction, less anterior knee pain, and lower radiation exposure. However, there is a lack of data on IMN for pediatric tibial fractures.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study analyzed patients aged 11-16 with open proximal tibia physis and tibial shaft fractures treated with IMN via the suprapatellar approach from January 2016 to October 2023. Demographic, fracture, and operative data were collected, and proximal tibial angles were measured. Follow-up radiographs were evaluated for tibial growth and alignment, with malunion defined as over 5 degrees of angular deformity.</p><p><strong>Results: </strong>Thirty-five patients aged 11 to 16 (mean 14.7 years, SD 1.1) met the inclusion criteria. Males comprised 60%; the average follow-up was 12.4 months. Most fractures (74%, 26/35) were closed. The most common (57%) fracture pattern was OA42A1-3. Fracture union occurred by 9 weeks in 79% of cases. The mechanical Medial Proximal Tibial Angle (mMPTA, range 85-90 degrees) and Posterior Proximal Tibial Angle (PPTA, range 77-84 degrees) were normal in all pre-operative patients; there were no statistically significant changes in mMPTA and PPTA over the follow-up period. The reported Visual Analog Scale pain scale averaged 1.87 at the final follow-up. Most patients reported return to full activities (87%), with the operative leg comparable to the contralateral leg in 78% of cases.</p><p><strong>Conclusions: </strong>Our findings demonstrated that suprapatellar IMN insertion leads to low pain scores and good function in short-term follow-up for adolescent patients treated for tibial shaft fractures. No proximal tibia growth disturbance was detected. Further prospective studies are warranted.</p><p><strong>Key concepts: </strong>(1)The suprapatellar approach appears to be safe for adolescent tibial nailing.(2)Growth disturbance was not encountered in this carefully selected patient group.(3)Radiographic tibial fracture union was achieved in call patients in this cohort.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100200"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777705","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":"Risk Factors for Corticosteroid-associated Osteonecrosis in Children: A National Database Study.","authors":"Gabriella B Smith, Nicole S Pham, Amin Alayleh, Stephanie Smith, Karen Chao, Stuart B Goodman, Kevin G Shea","doi":"10.1016/j.jposna.2025.100199","DOIUrl":"10.1016/j.jposna.2025.100199","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Corticosteroid-associated osteonecrosis presents a risk for severe pain and joint collapse. While the relationship between corticosteroid treatment and osteonecrosis in pediatric patients is well-documented, less is known about which patients are at greatest risk across medical conditions. The purpose of this study was to identify high-risk pediatric populations for developing osteonecrosis following corticosteroid treatment across autoimmune, inflammatory, and oncologic conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Merative MarketScan Research Databases (2007-2022) were queried to identify pediatric patients with an outpatient oral or intravenous corticosteroid prescription. Demographic, clinical, and prescription differences between osteonecrosis and non-osteonecrosis patients were analyzed using t-tests, Fisher's exact, and chi-square tests. Factors associated with time to osteonecrosis were assessed using a multivariable Cox proportional-hazards regression model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 5,606,781 pediatric patients who received corticosteroids, and 131 developed osteonecrosis. The mean time to osteonecrosis following corticosteroid administration was 7.1 months (SD = 5.2). Osteonecrosis patients were significantly older at the age of corticosteroid administration (12.1 [SD = 4.9] vs. 8.2 [5.6], &lt;i&gt;P&lt;/i&gt; &lt; .001) and were prescribed corticosteroids for more total days (136.6 [224.8] vs. 17.1 [89.2], &lt;i&gt;P&lt;/i&gt; &lt; .001) compared to patients who did not develop osteonecrosis. Adjusting for all other covariates, risk factors for osteonecrosis include acute lymphoblastic leukemia (HR = 575.82, 95% CI = [346.68, 956.40], &lt;i&gt;P&lt;/i&gt; &lt; .001), systemic lupus erythematosus (HR = 106.41, 95% CI = [44.65, 253.63], &lt;i&gt;P&lt;/i&gt; &lt; .001), Crohn's disease (HR = 6.67, 95% CI = [1.54, 28.86], &lt;i&gt;P&lt;/i&gt; = .011), juvenile idiopathic arthritis (HR = 4.62, 95% CI = [1.06, 20.08], &lt;i&gt;P&lt;/i&gt; = .041), solid organ transplant (HR = 4.24, 95% CI = [2.08, 8.65], &lt;i&gt;P&lt;/i&gt; &lt; .001), dexamethasone (HR = 2.59, 95% CI = [1.56, 4.28], &lt;i&gt;P&lt;/i&gt; &lt; .001), older age (hazard ratio [HR] = 1.11, 95% CI = [1.06, 1.16], &lt;i&gt;P&lt;/i&gt; &lt; .001), and greater total days prescribed (HR = 1.01, 95% CI = [1.00, 1.02], &lt;i&gt;P&lt;/i&gt; = .041).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our national database study highlights the need for targeted screening of pediatric patients treated with high-dose corticosteroids. This investigation may inform multidisciplinary studies and interventions in children treated with corticosteroids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Corticosteroid-associated osteonecrosis presents a risk for severe pain and joint collapse, yet little is known regarding which pediatric patients are at greatest risk across medical conditions.(2)Adjusting for other covariates, pediatric patients with acute lymphoblastic leukemia, systemic lupus erythematous, Crohn's disease, juvenile idiopathic arthritis, solid organ transplants, patients prescribed dexa","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100199"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777708","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":"Pearls to Address Challenges in Initial Casting Treatment for Idiopathic Clubfoot.","authors":"Christopher Williams, Patrick Nian, Ruth H Jones, Amith Umesh, David M Scher, Shevaun M Doyle","doi":"10.1016/j.jposna.2025.100198","DOIUrl":"10.1016/j.jposna.2025.100198","url":null,"abstract":"<p><p>Ponseti casting has established itself as the gold standard for the treatment of clubfoot over the past 30 years due to its outstanding short- and long-term outcomes. This method requires a nuanced technique throughout each phase of correction, involving gentle manipulation of the appropriate anatomic regions of the foot. Certain \"pearls\" should be considered to optimize this process, including minimizing infantile distress, deliberately choosing casting and padding material, and planning the casting timeline. Clubfoot providers should be aware of the \"pitfalls\" associated with inadequate execution of casting, including cast slippage, overcorrection, skin manifestations, and residual deformity.</p><p><strong>Key concepts: </strong>(1)Ponseti casting addresses all elements of clubfoot (midfoot cavus, forefoot and midfoot adduction, hindfoot varus, and equinus) in a systematic way that respects the natural kinematics of the foot.(2)Ponseti casting requires the use of gentle manipulation through the appropriate anatomical regions of the foot to ensure adequate correction, minimize residual deformity, and avoid iatrogenic deformity.(3)Efforts to minimize infantile distress will maximize the success of the Ponseti method. These include choosing appropriate cast and padding materials, providing a succinct casting plan, and optimizing brace tolerance.(4)Common undesirable consequences of casting include cast slippage, skin maceration, and iatrogenic deformities, such as tarsometatarsal abduction, hindfoot valgus, rocker bottom foot, and flat-top talus.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"12 ","pages":"100198"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777706","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}