Journal of Childrens Orthopaedics最新文献

{"title":"Three radiographic parameters correlate with computed tomography displacement in transitional ankle fractures.","authors":"Luke Sang, Steven M Garcia, Alex Youn, Katherine Bach, Ishaan Swarup","doi":"10.1177/18632521251338537","DOIUrl":"10.1177/18632521251338537","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the ability of radiographic measures to predict displacement on computed tomography (CT) for transitional ankle fractures.</p><p><strong>Methods: </strong>This study is a retrospective review of pediatric patients who presented with Tillaux (Salter-Harris III) and triplane (Salter-Harris IV) fractures at a single institution. Radiographs and CT measurements were performed by three independent evaluators. Intraclass correlation coefficients (ICCs) were calculated to determine interrater reliability. Spearman correlations were performed to assess the correlations between each radiographic parameter and CT measurements.</p><p><strong>Results: </strong>A total of 61 patients were included in this study. The average age of patients was 12.3, and 65.6% of patients were male. There was an almost even split of triplane (55.7%) and Tillaux (44.3%) fractures. Overall, measurements showed at least good interobserver agreement (ICC >0.6). Radiographic anteroposterior view showed the least reliable measurements compared to the mortise and lateral views. There was significant correlation between CT displacement and the following measures on radiographs: tibiofibular clear space on the mortise view (ρ = 0.27, <i>p</i> < 0.05), articular displacement on the mortise view (ρ = 0.35, <i>p</i> < 0.01), articular displacement on the lateral view (ρ = 0.28, <i>p</i> < 0.05), and epiphyseal displacement on the lateral view (ρ = 0.55, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>There are several radiographic parameters that significantly correlate with increased displacement of transitional ankle fractures on CT. Increased articular displacement on the mortise and lateral view, as well as increased tibiofibular clear space on the mortise view, correlates with increased displacement. These radiographic parameters may be good indicators for the selective use of CT scans for transitional ankle fractures.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251338537"},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Test-retest reliability of clinical measurements of lower extremity joint motion and alignment in the pediatric population.","authors":"Thea Saabye, Thomas Colding-Rasmussen, Andreas Balslev-Clausen, Søren Bødtker, Christian Wong, Steen Harsted","doi":"10.1177/18632521251322639","DOIUrl":"10.1177/18632521251322639","url":null,"abstract":"<p><strong>Purpose: </strong>Manual anthropometric evaluations of pediatric lower extremities are essential in orthopedic pediatric practice due to their noninvasive and time-feasible nature. Therefore, this study aims to assess the test-retest reliability of clinical measurements obtained on children to examine measurement stability over time.</p><p><strong>Methods: </strong>In a test-retest design, data were collected from 50 Danish school children with 5-to 6 weeks between sessions. Measurements encompassed the joint range of motion (ROM), rotational profile, and angular alignment of lower extremities for a representative sample of school children. Reliability was assessed using intraclass correlations (ICC), and agreement was assessed using limits of agreement (LoA) and precision.</p><p><strong>Results: </strong>Reliability analysis revealed excellent results for foot length (ICC > 0.9), good results for foot width (ICC < 0.9), and poor to moderate results for all other measurements (ICC < 0.5, ICC < 0.75). Agreement results for hallux valgus were acceptable (within established reference) and the remaining variables were not acceptable (outside established reference).</p><p><strong>Conclusions: </strong>The majority of the manual assessment procedures were found to have poor reliability. This study highlights the need for reliable and time-efficient tools to assist clinicians in assessing manual clinical measurements and future research should explore this.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251322639"},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plates for the treatment of long bone metaphyseal and diaphyseal fracture and deformity in osteogenesis imperfecta: A scoping review.","authors":"Yacine Louni, Reggie Hamdy","doi":"10.1177/18632521251332498","DOIUrl":"https://doi.org/10.1177/18632521251332498","url":null,"abstract":"<p><strong>Purpose: </strong>Osteogenesis imperfecta is a rare disorder characterized by bone fragility. The current gold standard treatment for long bone fractures and deformities is telescopic intramedullary rods. Although the use of plates as a standalone implant has been discouraged, recent research has investigated their use as an adjunct to intramedullary fixation. This scoping review aims to assess the current literature on plates for the treatment of long bone metaphyseal and diaphyseal fractures and deformities in osteogenesis imperfecta.</p><p><strong>Methods: </strong>The MEDLINE, Embase, CENTRAL, and CDSR databases were searched via PubMed, Ovid, and Cochrane. Titles and abstracts of studies were screened, followed by full assessment of selected articles. Studies included were peer-reviewed, published in English in the last 20 years, and investigated plating alone or combined with other implants for the treatment of metaphyseal or diaphyseal long bone fractures and deformities in osteogenesis imperfecta.</p><p><strong>Results: </strong>Eleven articles were included: four investigated plating alone, two compared different implants, and five assessed plating as an adjunct to intramedullary fixation.</p><p><strong>Conclusions: </strong>Using plates alone is not recommended due to the high rate of complications, implant-related complications, and revision surgeries. However, they can be used when deemed appropriate by the surgeon or in narrow canals. Overall, the use of plates as an adjunct to intramedullary nails shows promising results, although further research is required to determine the indications for additional plating and the best timing of plate removal.</p><p><strong>Level of evidence: </strong>Level III (scoping review).</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251332498"},"PeriodicalIF":1.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General anesthesia versus locoregional anesthesia in pediatric forearm fractures.","authors":"Alessandro Aprato, Alessia Fierro, Chiara Arrigoni, Mattia Cravino, Nathalie Bini, Carlo Origo","doi":"10.1177/18632521251325066","DOIUrl":"https://doi.org/10.1177/18632521251325066","url":null,"abstract":"<p><strong>Aim of the study: </strong>Aim is to define whether the type of anesthesia during the reduction and fixation of a pediatric forearm fracture, can influence the fracture reduction technique.</p><p><strong>Materials and methods: </strong>All surgically treated forearm fractures were enrolled: patients underwent a different anesthesiology protocol depending on the on-call anesthesiologist: deep sedation in which the patient is still able to breathe with limited external support and nerve block (group A) and general anesthesia with curare (group B). Demographic data, type of fracture, surgical timing and technique, anesthesia type and timing, and clinical outcomes were recorded.</p><p><strong>Outcomes: </strong>Of the total 326 patients considered, 228 children were treated by closed reduction (70%), and 98 children were treated by open reduction (30%). Of the latter, 75% of the fractures reduced open were of group A and 25% were of group B. In more detail, in group A, of the 162 patients, 73 (45%) required an open reduction, while 89 (55%) did not. In group B, of the 164 patients, 25 (15%) required an open reduction, while 139 (85%) did not. This resulted in being statistically significant (<i>p</i> = 0.001). No statistically significant results emerged from the data related to complication and range of motion apart from the pronation movement (<i>p</i> = 0.153).</p><p><strong>Conclusion: </strong>According to our data, the use of curare, in a pediatric forearm fracture reduction and stabilization surgery, leads to a reduction in the number of open treatments. If deep sedation and nerve block are preferred to improve postoperative pain control, the technique and timing should be improved to facilitate reduction.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251325066"},"PeriodicalIF":1.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary assessment of large language models' performance in answering questions on developmental dysplasia of the hip.","authors":"Shiwei Li, Jun Jiang, Xiaodong Yang","doi":"10.1177/18632521251331772","DOIUrl":"https://doi.org/10.1177/18632521251331772","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of three large language models in answering questions regarding pediatric developmental dysplasia of the hip.</p><p><strong>Methods: </strong>We formulated 18 open-ended clinical questions in both Chinese and English and established a gold standard set of answers to benchmark the responses of the large language models. These questions were presented to ChatGPT-4o, Gemini, and Claude 3.5 Sonnet. The responses were evaluated by two independent reviewers using a 5-point scale. The average score, rounded to the nearest whole number, was taken as the final score. A final score of 4 or 5 indicated an accurate response, whereas a final score of 1, 2, or 3 indicated an inaccurate response.</p><p><strong>Results: </strong>The raters demonstrated a high level of agreement in scoring the answers, with weighted Kappa coefficients of 0.865 for Chinese responses (<i>p</i> < 0.001) and 0.875 for English responses (<i>p</i> < 0.001). No significant differences were observed among the three large language models in terms of accuracy when answering questions, with rates of 83.3%, 77.8%, and 77.8% for Claude 3.5 Sonnet, ChatGPT-4o, and Gemini in the Chinese responses (<i>p</i> = 1), and 83.3%, 83.3%, and 72.2% for ChatGPT-4o, Claude 3.5 Sonnet, and Gemini in the English responses (<i>p</i> = 0.761). In addition, there was no significant difference in the performance of the same large language model between the Chinese and English settings.</p><p><strong>Conclusions: </strong>Large language models demonstrate high accuracy in delivering information on dysplasia of the hip, maintaining consistent performance across both Chinese and English, which suggests their potential utility as medical support tools.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251331772"},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee surveillance for ambulant children with cerebral palsy.","authors":"Pam Thomason, Kerr Graham, Ken Ye, Annette O'Donnell, Vedant Kulkarni, Jon R Davids, Erich Rutz","doi":"10.1177/18632521251330448","DOIUrl":"https://doi.org/10.1177/18632521251330448","url":null,"abstract":"<p><strong>Purpose: </strong>A majority of ambulant children with cerebral palsy (CP) develop progressive musculoskeletal pathology (MSP) during growth. Fixed flexion deformity at the knee joint (FFDKn) contributes to flexed knee gait and is prone to relapse after index multi-level surgery. This perspective introduces the concept of \"knee surveillance\" (KS), defined as a repeated systematic assessment of gait and knee range of motion until skeletal maturity. KS aims to detect early FFDKn, allowing for early intervention with minimally invasive techniques such as anterior distal femur hemiepiphysiodesis (ADFH), and reduce the need for higher-risk surgery such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).</p><p><strong>Methods: </strong>Recent literature on the assessment of ambulant children with CP, consensus statements on indications for dose-based knee surgery, and the indications for ADFH have been reviewed and synthesized. These provide a preliminary evidence base for the concept of KS in ambulant children with CP.</p><p><strong>Conclusion: </strong>We propose the concept of KS for ambulant children with CP. The goals of KS are early detection of knee flexion deformity, early intervention, less invasive surgery, and better long-term outcomes. There is preliminary evidence to suggest that soft-tissue surgery, in combination with ADFH, can reduce, or perhaps replace, the need for more invasive surgery such as DFEO and PTS.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251330448"},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of radiographic union score and correlation of clinical outcomes in children operated for supracondylar humerus fracture: A prospective study.","authors":"Uğur Yüzügüldü, Murat Yeşil, Özal Özcan, Gökhan Maralcan, Mehmet Nuri Konya","doi":"10.1177/18632521251331773","DOIUrl":"https://doi.org/10.1177/18632521251331773","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus fractures are common in childhood, and postoperative follow-up planning for surgically treated fractures is still controversial. This study aims to investigate the interobserver and intraobserver reliability of the Radiographic Union Score for Tibial Fracture in the postoperative radiological follow-up of pediatric supracondylar humerus fractures and to evaluate the clinical results with the scores obtained during follow-up.</p><p><strong>Methods: </strong>In this prospective study, patients who were operated on for supracondylar humerus fractures were called for follow-up three times: postoperative splint removal, pin removal, and final control. A total of 58 patients, 34 boys and 24 girls, who provided regular follow-ups, were included in the study. During follow-ups, the Radiographic Union Score for Tibial Fracture was calculated by evaluating the patients' elbow anteroposterior and lateral radiographs, and the elbow joint range of motion was recorded with a goniometer. In two experiments, orthopedic surgeons evaluated intraobserver and interobserver reliability using the intraclass correlation coefficient at different times. The patients were evaluated at the last follow-up according to the Flynn criteria.</p><p><strong>Results: </strong>The first follow-up Radiographic Union Score for Tibial Fracture (median (range) was 8 (7-10), the second follow-up was 11 (9-12), and the third follow-up was 12 (11-12). Range of motion was 40° at the first follow-up, 90° at the second follow-up, and 120° at the third follow-up. Radiographic Union Score for Tibial Fracture and range of motion increased significantly as the weeks progressed (<i>p</i> < 0.001). Interobserver intraclass correlation coefficient at first follow-up was 0.80 (95% confidence interval 0.69-0.87), second follow-up was 0.85 (0.77-0.91), and third follow-up was 0.79 (0.67-0.87). Intraobserver intraclass correlation coefficient was 0.92 (0.88-0.95) at the first follow-up, 0.93 (0.98-0.96) at the second follow-up, and 1.00 (1.00-1.00) at the third follow-up. Flynn score results are functional; the cosmetic results were excellent in 46 patients, good in 4 patients, fair in 5 patients, poor in 3 patients, and cosmetic results were excellent in 54 patients and good in 4 patients.</p><p><strong>Conclusion: </strong>Our study determined that the radiographic union of fractures in pediatric supracondylar humerus fractures is reliably evaluated with the Radiographic Union Score for Tibial Fracture score. Radiographic Union Score for Tibial Fracture can be used to provide data-driven estimates of splint and pin removal.</p><p><strong>Level of evidence: </strong>Level II, prospective study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251331773"},"PeriodicalIF":1.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella.","authors":"Kristen E Hines, David S Liu, Amy E Steele, Daniel Gabriel, Anjali Prabhat, Yi-Meng Yen, Grant Douglas Hogue","doi":"10.1177/18632521251330829","DOIUrl":"10.1177/18632521251330829","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"174-175"},"PeriodicalIF":1.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases.","authors":"Mehmet Subasi","doi":"10.1177/18632521251330458","DOIUrl":"10.1177/18632521251330458","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251330458"},"PeriodicalIF":1.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella.","authors":"Murat Yuncu, Omer Faruk Egerci, Fırat Dogruoz","doi":"10.1177/18632521251330820","DOIUrl":"10.1177/18632521251330820","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"172-173"},"PeriodicalIF":1.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}