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

{"title":"Reviewer Profile: Soroush Baghdadi, MD.","authors":"Soroush Baghdadi","doi":"10.1016/j.jposna.2025.100172","DOIUrl":"https://doi.org/10.1016/j.jposna.2025.100172","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"11 ","pages":"100172"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164749","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":"Work-Life Balance in Pediatric Orthopaedics: The Role of the Leaders.","authors":"Steven L Frick, Rebecca Glavin, Corinna Franklin, Peter M Waters","doi":"10.1016/j.jposna.2025.100158","DOIUrl":"10.1016/j.jposna.2025.100158","url":null,"abstract":"<p><p>This article describes the intersection of two POSNA initiatives, leadership development and professional well-being, highlighting the role of orthopaedic leaders in helping themselves (by deliberate actions and role modeling) and others (by mentoring, administrating, and promoting well-being programs) work to achieve work-life balance and physician well-being for themselves and those they lead.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100158"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164376","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":"Career Perspectives for Pediatric Orthopaedic Trainees and Early Practitioners: A Panel Discussion.","authors":"Jeffrey B Peck, William Cutchen, Lee Haruno, Dustin Greenhill, Karen Bovid, Brandon Ramo","doi":"10.1016/j.jposna.2024.100155","DOIUrl":"10.1016/j.jposna.2024.100155","url":null,"abstract":"<p><p>The life of a pediatric orthopaedic surgeon involves many more challenges than just those seen in our clinics and operating rooms. These begin during fellowship, when key decisions occur regarding training and the development of mentor and peer relationships. Then, selection of a surgeon's first job opportunity and ensuing practice development involve significant potential career turning points. Our panel of young surgeons offers thoughts and advice on these situations, hoping that current and future trainees will benefit from the knowledge gained through their experience in entering and beginning a successful career in pediatric orthopaedics.</p><p><strong>Key concepts: </strong>(1)When selecting a fellowship, it is valuable to understand one's learning style and to consider family needs.(2)After discovering what positions may be available, match each potential position's professional and personal opportunities with your needs.(3)Your initial practice will evolve to your ideal professional endpoint over years of effort and development.(4)The optimal work-life relationship is possible with good communication with your partner/family and with a good team of supporting healthcare staff around you.(5)Regular attendance at the POSNA annual meeting and involvement in committee work can be a resource and provide tremendous professional satisfaction.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100155"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164575","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":"Lean Slipped Capital Femoral Epiphysis Draping.","authors":"Laura Lins, Laura L Bellaire, T Peter Li","doi":"10.1016/j.jposna.2024.100156","DOIUrl":"10.1016/j.jposna.2024.100156","url":null,"abstract":"<p><p>In situ pinning of slipped capital femoral epiphysis (SCFE) is a standard procedure performed by pediatric orthopaedic surgeons. Different techniques and operative tables can be used to perform this procedure with similar outcomes. This paper aims to describe the specific technique utilized at our institution to decrease the waste of draping materials and time to provide the most efficient procedure, while potentially minimizing radiation exposure.</p><p><strong>Key concepts: </strong>(1)Providers and institutions should aim to decrease unnecessary surgical waste and improve surgical efficiency.(2)We describe a fast draping technique that decreases waste and can be used for stable or unstable SCFE on a radiolucent flattop or fracture table.(3)The draping technique on a radiolucent table can easily be adapted for bilateral procedures.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100156"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164647","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":"Percutaneous Screw Fixation of Slipped Capital Femoral Epiphysis Using Biplanar Fluoroscopy.","authors":"Emilio Feijoo, Michael J Conklin","doi":"10.1016/j.jposna.2024.100157","DOIUrl":"10.1016/j.jposna.2024.100157","url":null,"abstract":"<p><p>Percutaneous screw fixation for slipped capital femoral epiphysis (SCFE) is a standard surgical procedure. This can be performed on a radiolucent \"flattop\" table or a fracture table, which holds the leg stable and can help with the serendipitous reduction of unstable SCFE's. Pivotal to success is accurate screw placement in the center of the epiphysis, adequate threads crossing the physis, and avoidance of screw penetration into the joint. Adequate fluoroscopic visualization in all planes is essential. We have used simultaneous biplanar fluoroscopy for accurate screw placement on a fracture table. The indications, techniques, pearls, and pitfalls of this procedure are presented in this study.</p><p><strong>Key concepts: </strong>(1)Percutaneous screw fixation of SCFE is a mainstay of treatment.(2)Simultaneous biplanar fluoroscopy facilitates accurate screw placement.(3)Positioning on a fracture table can promote incidental reduction in cases where this is desirable.(4)Meticulous attention to room setup, patient positioning, and operative technique are necessary for success.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100157"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164702","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":"Modified Bohlman Method for High-grade Spondylolisthesis.","authors":"T Peter Li, Dominique L Petty, Laura Lins, Celestine Shih, Jeffrey Henstenburg, Kenneth J Noonan","doi":"10.1016/j.jposna.2024.100153","DOIUrl":"10.1016/j.jposna.2024.100153","url":null,"abstract":"<p><p>High-grade lumbosacral spondylolisthesis in children often requires surgery. Goals of surgery are to resolve back or radicular pain, relieve neurologic deficit, and achieve bony fusion in order to prevent progression. Surgical options range widely from in situ uninstrumented posterolateral fusion to reduction of deformity with instrumented circumferential fusion. This article reviews our preferred method of in situ instrumented posterolateral and interbody fusion.</p><p><strong>Key concepts: </strong>(1)The presented method modifies the Bohlman method in these salient aspects:•Using a single-strut cortical allograft and bone morphogenic protein (BMP) for interbody fusion instead of two dowels of fibular autograft to avoid donor site morbidity.•Leaving intact the posterior prominence of the first sacral vertebral body to provide cortical strength at the entry site of the strut allograft.•Adding two solid stainless steel 6.5 mm screws to back up an interbody strut allograft to lower the risk of graft fracture.(2)Advantages of this modified Bohlman method are the cost-effective implants and single-stage posterior approach.(3)Disadvantages are the lack of deformity reduction, unknown long-term effect on sagittal alignment, and patient-reported outcomes.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100153"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164648","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":"Orthopaedic Management in Duchenne Muscular Dystrophy.","authors":"Uma Balachandran, Taylor Mustapich, Sheena C Ranade","doi":"10.1016/j.jposna.2024.100154","DOIUrl":"10.1016/j.jposna.2024.100154","url":null,"abstract":"<p><p>Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy and occurs primarily in males, affecting 1 in 3600-6000 live male births. The natural course of DMD results in a profound, progressive decline in muscle strength, requiring the use of a wheelchair, typically by age 13, and ultimately leading to fatal respiratory and cardiac dysfunction by young adulthood. Musculoskeletal care for patients with DMD often centers around preventing and managing contractures, fractures, and scoliosis. Medical considerations that affect musculoskeletal care include osteopenia and osteoporosis, endocrinopathies, and pulmonary diseases, which often affect perioperative care. This study aims to provide a detailed and updated review of current treatment options for DMD, highlighting the role of novel treatment options (eg gene therapy) that are changing the landscape of care for the DMD population.</p><p><strong>Key concepts: </strong>(1)Orthopaedic management of patients with Duchenne muscular dystrophy centers primarily around mobility preservation and managing contractures, scoliosis, and fractures.(2)Perioperative considerations include cardiology (ie preoperative echocardiogram for assessing cardiomyopathy progression), pulmonology (ie sleep-related breathing disorders that may result in compromised respiratory function intraoperatively), endocrinology (ie chronic glucocorticoid use that should not be paused in the perioperative period to prevent adrenal crisis), and anesthesiology (ie avoidance of depolarizing muscle relaxants).(3)As new gene-modifying treatments become available, the orthopaedic management of patients with Duchenne muscular dystrophy will continue to evolve rapidly.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100154"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164650","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":"Scurvy as a Cause of Leg Pain and Limp in Pediatric and Adolescent Patients.","authors":"Christopher J DeFrancesco, David Kell, Sean Owens, Matt Grady, Naomi Brown","doi":"10.1016/j.jposna.2024.100150","DOIUrl":"10.1016/j.jposna.2024.100150","url":null,"abstract":"<p><p>Vitamin C deficiency (VCD) results in collagen dysfunction due to decreased lysyl and prolyl hydroxylase enzyme activity. The resulting disease, known as scurvy, can present with various findings, including gingival bleeding, bruising, other skin lesions, poor wound healing, and tooth and bone abnormalities. VCD is also an uncommon cause of musculoskeletal pain among children. This current concept review aims to summarize our institutional experience with scurvy in ten patients and compare it with existing literature. Astute history taking, critical review of imaging, thorough physical examination, and a high index of suspicion are essential to efficiently diagnose scurvy in the child presenting with nonspecific lower extremity pain or limping. In these patients, a simple question about diet when taking the history could help focus the differential diagnosis and prevent the need for unnecessary imaging, anesthetic events, invasive diagnostic procedures, and prolonged pain and symptoms.</p><p><strong>Key concepts: </strong>(1)Scurvy, the condition caused by vitamin C deficiency, is not a historical disease, with research suggesting that its incidence in the US is on the rise.(2)Scurvy can result in lower extremity pain and limping among children, who may present for orthopaedic evaluation.(3)An increased index of suspicion for vitamin C deficiency should be maintained for any child with a history of restrictive eating, especially those with a history of autism spectrum disorder.(4)Orthopaedic providers should know the specific MRI and x-ray findings characteristic of vitamin C deficiency.(5)Vitamin C levels can be repleted in weeks with proper supplementation, but children with scurvy due to restrictive eating generally require continued intervention from nutrition and/or feeding specialists.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100150"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164703","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 Measures Associated With Tibial Torsion in Ambulatory Children With Cerebral Palsy and Pes Valgus.","authors":"Eva Ciccodicola, Oussama Abousamra, Veronica Beltran, Susan A Rethlefsen, Tishya A L Wren","doi":"10.1016/j.jposna.2024.100151","DOIUrl":"10.1016/j.jposna.2024.100151","url":null,"abstract":"<p><strong>Background: </strong>Transverse plane alignment deviations in individuals with cerebral palsy (CP) contribute to lever arm dysfunction. The cause of this is often multifactorial. External tibial torsion and pes valgus are both possible causes. Tibial torsion could be missed without detailed clinical exam. The purpose of this study was to examine factors associated with external tibial torsion in patients with CP and pes valgus.</p><p><strong>Methods: </strong>We retrospectively examined patients with CP who had pes valgus. Participants underwent clinical examination, including transmalleolar axis angle (TMA). TMA >20° external was considered clinically significant external tibial torsion. The association of TMA and external tibial torsion to demographic and clinical examination data were examined.</p><p><strong>Results: </strong>Two hundred forty-seven patients were included with 422 valgus feet (175 bilateral). External tibial torsion was observed in 11.6% of limbs. Tibial torsion became more external with age (β ​= ​0.12, 95% CI ​= ​[0.02, 0.22], <i>P</i> ​= ​.02). TMA was correlated with dorsiflexion (β ​= ​-0.10, 95% CI ​= ​[-0.18, -0.02], <i>P</i> ​= ​.02) and hindfoot inversion range of motion (ROM) (β ​= ​0.19, 95% CI ​= ​[0.06, 0.31], <i>P</i> ​= ​.005). Tibial torsion was not correlated with gender, Gross Motor Function Classification System (GMFCS) level, plantarflexor spasticity, or knee extension ROM.</p><p><strong>Conclusions: </strong>External tibial torsion as a possible contributor to transverse plane malalignment needs to be considered in older patients with CP who have pes valgus with limited hindfoot inversion ROM. Our results highlight that external tibial torsion increases with age, increased dorsiflexion, and limited hindfoot inversion ROM. Overlooking external tibial torsion when correcting pes valgus could result in under correction of malalignment and continued functional limitations related to lever arm dysfunction.</p><p><strong>Key concepts: </strong>(1)The causes of external foot progression are often multifactorial, including both external tibial torsion and pes valgus.(2)External tibial torsion needs to be considered as a possible contributor to transverse plane malalignment in older patients with CP with pes valgus and limited hindfoot inversion ROM.(3)Failure to recognize external tibial torsion may lead to undercorrection of lever arm dysfunction for patients with CP.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100151"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164644","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":"Patellar Instability Events Requiring Emergency Department Management - A 20-year Analysis.","authors":"David Kell, Nathan Houlihan, Kevin Huang, Sulagna Sarkar, John Schlechter, Brendan A Williams","doi":"10.1016/j.jposna.2024.100152","DOIUrl":"10.1016/j.jposna.2024.100152","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability (PFI) is a common pediatric knee injury most prevalent among females in late adolescence. This study's purpose was to use a nationally representative database to examine epidemiologic trends in pediatric PFI events requiring management in emergency departments (ED).</p><p><strong>Methods: </strong>The National Electronic Injury Surveillance System (NEISS) was queried from 2001 to 2020 for cases of knee \"dislocation\" or \"fracture\" in patients aged 0-18 years. Case narratives were used to confirm episodes of patellar instability. National estimates were calculated. Seasonal and temporal patterns of injury were assessed overall and within demographic subgroups using bivariate and multivariate analysis.</p><p><strong>Results: </strong>Study criteria identified an estimated 208,673 cases of patellar instability presenting to United States EDs between 2001 and 2020. The mean annual frequency of injury was 10,434, with time series analysis estimating an increase of 256 dislocations per year (<i>P</i> ​< ​0.001) over the study period. Seasonal injury peaks occurred during the Spring (April-May) and Fall (September-October) months. Males accounted for the majority (59%) of injured patients, and patients aged 15-18 were the most frequently injured age group (48%). A generalized linear model demonstrated that males had a higher rate of dislocations prompting ED management than females and patients aged 10-14 saw a slight increase in the rate of dislocations compared to patients aged 15-18 (<i>P</i> ​< ​0.001). Seasonal variation in injuries was most evident among males and adolescents.</p><p><strong>Conclusions: </strong>Findings from this study suggest a rising overall frequency of pediatric PFI injuries presenting to the ED. Statistically significant seasonal injury patterns were observed that appeared driven by male adolescent injury. This study highlights novel epidemiologic patterns and improves our understanding of patellar instability events requiring management in the ED.</p><p><strong>Key concepts: </strong>(1)Temporal trends found a significant rise in the annual number of patellar dislocations requiring an emergent evaluation driven by increases during the Spring and Fall.(2)Seasonal trends were likely driven by an increase in sports participation during the fall and Spring months.(3)Despite patellofemoral instability being more common in females, males were more likely to seek an evaluation at the emergency department after a patellar dislocation.(4)Although both males and females saw an increase in patellar dislocations over the course of this study, males and patients aged 10-18 demonstrated a higher rate and increase of dislocations.</p><p><strong>Level of evidence: </strong>Level IV - Retrospective Case Series.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"10 ","pages":"100152"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164701","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}