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

{"title":"Prenatal Counseling for Congenital Clubfoot.","authors":"Akshitha Adhiyaman, Olivia C Tracey, Amith Umesh, Patrick P Nian, Michele K Silverstein, Shevaun M Doyle, David M Scher","doi":"10.1016/j.jposna.2024.100130","DOIUrl":"10.1016/j.jposna.2024.100130","url":null,"abstract":"<p><p>Congenital clubfoot is a common deformity that affects 1 in 1000 newborns and is frequently detected prenatally during routine prenatal care. A wide variety of detection methods and testing are used to identify clubfoot and other congenital anomalies in the fetus, including complete ultrasonography, amniocentesis, chorionic villus sampling, or cell-free DNA. Newer studies have associated certain genome sequences to clubfoot specifically. It is important for orthopaedic surgeons to understand the implications of the various tests to provide the appropriate prenatal counseling. Early prenatal detection of clubfoot can help parents prepare for the demands of caring for a child with clubfoot and build trust between families and clinicians, ultimately leading to better, patient-centered care for their children.</p><p><strong>Key concepts: </strong>(1)Prompt recognition and treatment of congenital clubfoot is imperative to facilitate optimal treatment.(2)Prenatal diagnosis usually consists of sonography of the plantar surface of both feet at 13-16 weeks' gestation.(3)Additional post-natal testing may be indicated in patients with neurological impairment or syndromic features.(4)Genetic markers such as PITX1, RBM10, HOX, and CASP (among others) have been identified as involved in clubfoot development and have implications on prenatal testing and counseling.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100130"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164553","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":"Pediatric Halo Use: Indications, Application, and Potential Complications.","authors":"Jennifer M Bauer, Scott Yang, Burt Yaszay, W G Stuart Mackenzie","doi":"10.1016/j.jposna.2024.100129","DOIUrl":"10.1016/j.jposna.2024.100129","url":null,"abstract":"<p><p>A halo has many applications for the treatment of pediatric spine pathology. It is most commonly used with gravity traction for the correction of severe thoracolumbar deformity over the course of several weeks before a staged fusion or growing implant placement. It is also used for preoperative optimization, secure positioning of small skulls for prone spine approach, cervical deformities such as basilar invagination, trauma treatment, or postoperative immobilization with a halo vest. Application of a halo is generally straightforward, but surgeons must be vigilant about complications and risks.</p><p><strong>Key concepts: </strong>(1)Halo placement must be done with an understanding of safe corridors for pin placement and pin torque specific to a patient's bony anatomy, quality, and age.(2)In severe thoracolumbar spinal deformity, halo-gravity traction (HGT) allows for elongation of the spine, correction of deformity, and chest elongation before the second-stage placement of implants.(3)In the cervical spine; HGT can be used to reduce basilar invagination before occipitocervical fusion, C1-2 rotatory subluxation before C1-2 fusion. A halo vest orthosis can be a definitive treatment for atlanto-occipital dislocation without neurologic injury.(4)Complications such as pin site infections and nerve palsies are frequent but most resolve quickly with appropriate management and vigilant monitoring.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100129"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164374","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":"Evaluation of Radiolucent Lesions in Cortices of Long Bones in Osteogenesis Imperfecta Patients.","authors":"Carolyn Cook, Lydia Turk, Alicia January, Teresa Cappello, Peter Smith","doi":"10.1016/j.jposna.2024.100128","DOIUrl":"10.1016/j.jposna.2024.100128","url":null,"abstract":"<p><strong>Background: </strong>Osteogenesis imperfecta (OI), a rare genetic disorder of collagen synthesis and metabolism, is characterized by cortical bone thinning and decreased trabecular bone. We have noted individuals with OI develop radiolucent lesions in the cortices of the long bones and these have not been previously described. The prevalence of these lesions in the long bones of children and the significance of their appearance in relation to subsequent fractures is unknown.</p><p><strong>Methods: </strong>In a retrospective study, upper and lower extremity radiographs of 328 pediatric patients with OI were examined to determine the occurrence and clinical course of these lesions in patients with various subtypes of OI.</p><p><strong>Results: </strong>Lesions were present in 55 (17%) of the 328 patients. A total of 89 lesions were identified in these 55 patients, with 138 positive radiographs across the OI subtypes. Of the 138 positive radiographs, lesions were present in 90/138 (65%) tibiae, 10/138 (7%) fibulae, 24/138 (17%) femora, 4/138 (3%) ulnae, 1/138 (1%) radius, and 9/138 (7%) humeri. In affected patients, there was an average of 1.62 lesions per patient. In 99% (136/138) of the radiographs, the lesion was present on the diaphysis of the long bone, and in 86% (119/138) of the x-rays, the lesion was located on the tension side. 64% (57/89) of the lesions developed after a previous fracture, and in 24% (21/89) of lesions, a fracture subsequently occurred through the area of the lesion.</p><p><strong>Conclusions: </strong>We present that radiolucent lesions of long bone diaphyses are a characteristic finding in OI and often presage fractures.</p><p><strong>Key concepts: </strong>(1)Radiolucent lesions are a characteristic finding of OI and have not been yet described in literature.(2)These lesions may represent a probable failure of ossification and lack of remodeling in the area of the lesion.(3)There is no clear etiology of this finding, although many arise in areas of prior fracture or osteotomy.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100128"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164735","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":"Erratum Acknowledging Co-authors in Previously Published Articles.","authors":"","doi":"10.1016/j.jposna.2024.100121","DOIUrl":"https://doi.org/10.1016/j.jposna.2024.100121","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.jposna.2024.100077.].</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100121"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164731","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":"Alternative Methods of Fixation for Anterior Tibialis Transfer in Residual Clubfoot Deformity.","authors":"Spencer Wilson, Laura L Bellaire, Kenneth J Noonan","doi":"10.1016/j.jposna.2024.100126","DOIUrl":"10.1016/j.jposna.2024.100126","url":null,"abstract":"<p><p>The preferred treatment for congenital clubfoot is the Ponseti method, which involves weekly manipulation and casting followed by tendoachilles tenotomy and abduction bracing. Depending on patient age and deformity location, 5%-35% of patients experience recurrent deformities and require additional treatment, including casting or surgery. Dynamic supination during the swing phase of gait represents a common sequela; it can be managed with anterior tibialis transfer to the lateral foot. Variations in this technique include how much tendon is transferred, the use of 2 or 3 incisions, the recipient location of the transferred tendon, and fixation methods. Ponseti preferred the transfer of the entire anterior tibialis tendon into the ossified 3rd cuneiform and securing the transferred tendon with absorbable stitches tied over a plantar button and sterile felt. With this method, the senior author has had soft tissue complications, namely skin maceration and, on one occasion, full-thickness necrosis down to the plantar fascia. As a result, variations on this technique have evolved with resultant mitigation of these complications. These methods are described here.</p><p><strong>Key concepts: </strong>(1)Anterior tibialis transfer (ATT) is a commonly utilized method of addressing residual deformity following the Ponseti method(2)The classic fixation method includes using an absorbable suture tied over felt and a plantar button under the cast. While uncommon, this method can lead to significant pressure sores.(3)For patients who undergo isolated ATT, we now tie the button on the outside of the cast to avoid a pressure sore.(4)In patients who undergo ATT with additional treatment of posterior contracture, one can secure the anterior tibialis into the recipient site by tying it to a K-wire used to maintain the hindfoot correction.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100126"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164744","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":"Postoperative Opioid Prescription Practices at Discharge for Pediatric Orthopaedic Patients: A Systematic Review.","authors":"Jiwoo Park, Uma Balachandran, Brittany Sacks, Katrina Nietsch, Erin Abbott, Taylor Mustapich, Kyle Rako, Sheena C Ranade","doi":"10.1016/j.jposna.2024.100123","DOIUrl":"10.1016/j.jposna.2024.100123","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The overprescription of opioids for pediatric orthopaedic surgery patients is a concerning issue due to the risks of misuse, diversion, and prolonged use. Despite this, evidence-based guidelines for opioid prescribing in this population are lacking. This systematic review aimed to characterize current opioid prescription practices and utilization following pediatric orthopaedic procedures. We conducted a systematic literature search in October 2023 using PubMed, MEDLINE, Embase, and additional sources to identify studies reporting on opioid prescriptions at discharge for pediatric orthopaedic patients. Included studies were from the United States describing the quantity prescribed and/or utilized. Mean prescription quantities and utilization rates were extracted, with opioid dosages converted to morphine milligram equivalents when possible. The search identified 14 eligible studies encompassing a range of orthopaedic procedures including spinal fusion, fracture repairs, and arthroscopy. Substantial variation existed in mean prescription quantities both across and within procedure types. Mean prescriptions ranged from no opioids for certain closed reductions to 61 pills for posterior spinal fusion. However, opioid utilization rates were generally low, with under 60% of prescribed pills taken in most studies. The highest utilization was 90.2% following spinal fusion, while the lowest was 7% for forearm fracture reductions when prescribed. Overall, lower prescription quantities and utilization rates were seen for less invasive procedures. This review describes current postoperative opioid prescription patterns and utilization rates for a range of pediatric orthopaedic surgeries. Our results suggest variability in opioid prescriptions and the potential for overprescription across many pediatric orthopaedic procedures, highlighting a need for standardized, procedure-specific prescribing recommendations. Prescribing lower opioid quantities aligned with anticipated medication requirements may reduce risks of misuse and diversion. Incorporating nonopioid analgesics and providing education on proper opioid use and disposal could further mitigate hazards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)There was considerable variation in opioid prescription quantities across different pediatric orthopaedic procedures, ranging from no opioids prescribed for some minor procedures to over 60 pills for more invasive surgeries like spinal fusion.(2)Despite often receiving substantial opioid prescriptions, the reported utilization rates were generally low, with most studies showing less than 60% of prescribed opioid pills actually being taken by patients.(3)This discrepancy between prescribed amounts and actual utilization points toward potential overprescription of opioids for many pediatric orthopaedic procedures.(4)The findings highlight the need for standardized, procedure-specific opioid prescribing guidelines in pediatric orthopaedics to align prescriptions ","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100123"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164387","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":"Reducing Postoperative Opioids in Pediatric Orthopaedics: An Updated Tiered Prescription Guideline with a \"Tier 0\".","authors":"Mikaela H Sullivan, Courtney E Baker, Daniel S Ubl, Elizabeth B Habermann, A Noelle Larson, Todd A Milbrandt","doi":"10.1016/j.jposna.2024.100124","DOIUrl":"10.1016/j.jposna.2024.100124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is growing data on strategies to reduce opioid prescriptions in pediatric orthopaedics. Our institution implemented tiered guidelines for opioid discharge prescriptions in 2018 to standardize prescribing patterns across our entire pediatric orthopaedics practice. In 2022, we updated the tiered system with a goal to further minimize the quantity of opioids prescribed and eliminate opioids altogether for certain procedures. The aim of this project was to evaluate the effects of the updated tiered guidelines for discharge opioid prescribing following common pediatric orthopaedic procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A quality improvement project was conducted at a single academic institution. Guidelines for discharge opioid prescriptions were updated in January 2022 and established 5 tiers of increasing invasiveness for 28 procedures. The updated guidelines included a \"Tier 0\" which provided no opioids, reorganized surgical tiers based on prior data, and decreased the doses recommended for tiers. Opioid prescriptions were reported as oral morphine equivalents (OMEs). Univariate tests were performed to assess statistically significant differences before and after implementation of updated guideline eras, comparing 2020-2021 and 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 747 patients (2020-2021, &lt;i&gt;n&lt;/i&gt; ​= ​500; 2022, &lt;i&gt;n&lt;/i&gt; ​= ​247) were included. The proportion of patients receiving discharge opioid prescriptions decreased from 89.8% to 80.6% (&lt;i&gt;P&lt;/i&gt; ​&lt; ​0.05), between 2020 and 2021 and 2022. This resulted in decreased overall OME prescribed (median 75 vs 45, &lt;i&gt;P&lt;/i&gt; ​&lt; ​0.05) and OME prescribed in those &gt;10 years (135 vs 113, &lt;i&gt;P&lt;/i&gt; ​&lt; ​0.05) while 30-day refill rates (9.4% vs 6.1%), and OME per kilogram in those &lt;11 years of age (median 0.9 vs 0.8) remained unchanged (both &lt;i&gt;P&lt;/i&gt; ​&gt; ​0.05). Discharge prescriptions falling within overall guidelines increased after guideline implementation (83.3% vs 85.4%), though this was not statistically significant and guideline adherence was low among Tier 0 ​at 31%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Including \"Tier 0\" of procedures receiving no opioid prescriptions, reorganizing procedures within tiers, and decreasing the recommended doses to an already strict tiered guideline for discharge opioid prescriptions significantly decreased the quantity of opioids prescribed. We noted continued excellent overall adherence and, importantly, no overall increase in refills, with areas for improvement in Tier 0. Quality improvement projects can continue to reduce the amount of opioids prescribed following pediatric orthopaedic procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Updated tiered guidelines, including a \"Tier 0\" for discharge opioid prescriptions following pediatric orthopaedic procedures were effective in reducing the quantity of opioids provided at discharge.(2)A continued high adherence rate was observed with the updated guidelines, though areas","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100124"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164496","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":"To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures.","authors":"Matthew J Folkman, Neeraj M Patel, Alexandra C Stevens, Aristides I Cruz, R Jay Lee, Indranil Kushare, Theodore J Ganley, Henry Ellis, Peter Fabricant, Daniel Green, Benjamin Johnson, Scott Mckay, Gregory Schmale, Yi-Meng Yen, R Justin Mistovich","doi":"10.1016/j.jposna.2024.100122","DOIUrl":"10.1016/j.jposna.2024.100122","url":null,"abstract":"<p><strong>Background: </strong>Knee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for nonoperative management, while others prefer manipulation under anesthesia with a possible arthroscopic lysis of adhesions, if indicated. To better understand indications and outcomes from these treatment modalities for arthrofibrosis, we examined patients treated by both approaches.</p><p><strong>Methods: </strong>We performed a multicenter retrospective case series of patients with arthrofibrosis after tibial spine fracture surgery. Arthrofibrosis was defined as loss of knee extension ≥10.0° and/or knee flexion ≥25.0° compared to the contralateral, uninjured knee at three months following index surgery. Patients were organized into 2 cohorts: nonoperative and operative treatment. Data were collected for demographics, fracture classification, concomitant injuries, treatment timeline, and knee range of motion.</p><p><strong>Results: </strong>There were 16 patients in the operative group and 10 patients in the nonoperative group. At the time of diagnosis, the operative group had a mean 10° larger flexion deficit compared to the nonoperative group. Both treatment modalities resulted in similar ranges of motion at terminal evaluation. Final flexion was recorded as 130° in the operative group and 127° in the nonoperative group. Final extension deficits were 3° in both cohorts.</p><p><strong>Conclusions: </strong>Operative and nonoperative treatment modalities can be effective in management of knee arthrofibrosis after fixation of tibial spine fractures. Nonoperative treatment may be more suitable for milder range of motion deficits, but further research is necessary to guide clinical practice.</p><p><strong>Key concepts: </strong>(1)Cohorts were similar in demographics, fracture classification, and concomitant injuries.(2)Patients who received a second operation presented with a greater flexion deficit.(3)The mean time between initial surgery and reoperation was 85 days.(4)Operative and nonoperative treatment of arthrofibrosis resulted in similar outcomes.</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":"9 ","pages":"100122"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164594","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":"Weight Percentile Is Maintained During Spica Casting: A Retrospective Cohort Study of Patients Treated with Closed or Open Reduction for Developmental Dysplasia of the Hip.","authors":"Olivia C Tracey, Kiranpreet Nagra, Keza Levine, Akshitha Adhiyaman, Paige McBoyle, Erikson Nichols, Melanie Prior, Ernest L Sink, David Scher, Shevaun M Doyle, Emily Dodwell","doi":"10.1016/j.jposna.2024.100125","DOIUrl":"10.1016/j.jposna.2024.100125","url":null,"abstract":"<p><strong>Background: </strong>Weight changes during spica casting previously have not been reported. The primary aim of this study was to determine weight percentile change from cast initiation to cast removal. Secondary aims were to assess weight percentile changes from initiation to mid-term follow-up visits after cast removal and to assess the mean weight change from cast initiation to cast removal.</p><p><strong>Methods: </strong>Patients with developmental dysplasia of the hip (DDH) treated with closed or open reduction (± ​femoral/pelvic osteotomy) and spica cast were retrospectively reviewed from 2/2016-6/2023. Patients aged <4 years treated for ≥6 weeks in spica cast were included. Patients lacking weight measurements within the 4 weeks prior to cast initiation or within 2 weeks following cast removal were excluded. Demographics, weight, and weight percentiles at cast initiation, cast removal, and at follow-ups were collected. Mean weights and mean weight percentiles were compared across visits with dependent sample <i>t</i>-tests and one-way analysis of variance tests based on normality, with a significance threshold of <i>P</i> ​≤ ​.05.</p><p><strong>Results: </strong>Thirty-six hips in 31 infants (median age: 10.4 [interquartile range {IQR}: 9, 16.3] months, 86% female) were included. The median duration of casting was 9.2 [IQR: 7.9, 12.6] weeks; 2 hips had midpoint cast change. The mean weight was 9.8 ​± ​2.3 ​kg at cast initiation and 10.1 ​± ​1.9 ​kg at final cast removal, with a mean change of 0.3 ​± ​0.4 ​kg (<i>P</i> ​= ​.527). Mean weight percentiles did not differ during or after treatment (range: 55-61st percentile, <i>P</i> ​= ​.974).</p><p><strong>Conclusion: </strong>Weight percentiles were maintained during spica casting in the patients examined in this study, which should be reassuring to the family and treatment team; our study did not find that spica casting stunts weight gain. For surgeons who may consider maintaining the original spica cast throughout treatment, without cast change, a mean weight gain of 0.3 ​kg for a mean casting length of 9 weeks in infants of median age 10.4 months should be reassuring; many infants/toddlers may not require a cast change due to growth.</p><p><strong>Key concepts: </strong>(1)Spica casting does not appear to stunt weight gain.(2)The weight percentile did not change during spica casting following open or closed reduction for developmental dysplasia of the hip.(3)The mean weight gain during typical spica casting is 0.3 ​kg, which was not statistically significant.</p><p><strong>Level of evidence: </strong>III, retrospective cohort.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100125"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164614","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":"Proximal Tibia Hemiarthroplasty Reconstruction Following Resection of Malignant Bone Tumors in Skeletally Immature Patients.","authors":"Tyler Kelly, Lee J Morse, Rosanna Wustrack, Melissa Zimel","doi":"10.1016/j.jposna.2024.100118","DOIUrl":"10.1016/j.jposna.2024.100118","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of the proximal tibia following resection of malignant bone tumors in pediatric patients is traditionally limited to osteoarticular allografts or endoprostheses. Endoprostheses typically require resection or disruption of the distal femoral physis, which can lead to a leg length discrepancy (LLD). We introduce a novel form of proximal tibia limb reconstruction using a Compress® tibia hemiarthroplasty, which spares the distal femoral physis.</p><p><strong>Methods: </strong>We retrospectively reviewed 5 patients who underwent proximal tibia osteosarcoma resection and reconstruction with a custom Compress® proximal tibia hemiarthroplasty. Data on function, survival, LLD, complications, and patient-reported outcomes were collected.</p><p><strong>Results: </strong>Mean age at resection was 10.4 years [range: 8.8-12.9 years]. Mean implant survival was 59 months [range: 34-83 months]. One patient developed a deep infection, and two patients required implant lengthening. Both were later converted to a rotating hinged total knee arthroplasty (RHTKA) ​> ​58 months after index surgery. At the last follow-up, all living patients had knee range of motion from 0 to 110°, walked unassisted, and had no LLD or knee instability. Mean Toronto Extremity Salvage Score was 90 [range: 80-97].</p><p><strong>Conclusions: </strong>Proximal tibia hemiarthroplasty reconstruction after tumor resection in skeletally immature patients preserves the distal femoral physis and may potentially reduce LLD and delay conversion to an RHTKA until after skeletal maturity.</p><p><strong>Key concepts: </strong>(1)Osteosarcoma is the most common primary malignant bone tumor in children, arising most frequently around the knee.(2)Complete resection often requires excising the adjacent growth plate, creating a challenge for reconstruction in growing children to maintain function and avoid significant limb length inequality.(3)The custom expandable tibia hemiarthroplasty is a novel reconstruction option for skeletally immature patients requiring resection of the proximal tibia.(4)Although future research is needed, results of this study suggest that tibia hemiarthroplasty is a reasonable reconstruction option in growing children requiring oncologic resection of a primary bone tumor from the proximal tibia.</p><p><strong>Level of evidence: </strong>Case series, Level IV.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"9 ","pages":"100118"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164479","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}