Journal of Childrens Orthopaedics最新文献

{"title":"Osteochondral lesions of the talus in the pediatric population: A practical narrative review.","authors":"Marco Turati, Simone Daniel Gatti, Monika Thüsing, Matteo Guelfi, Marco Crippa, Jaakko Sinikumpu, Marco Bigoni","doi":"10.1177/18632521261497486","DOIUrl":"https://doi.org/10.1177/18632521261497486","url":null,"abstract":"<p><p>Osteochondral lesions of the talus (OLTs) in children and adolescents are a clinically important cause of persistent ankle pain after trauma and may also be present without a clear inciting event. Because plain radiographs may fail to detect OLTs or may underestimate their severity, modern pediatric pathways rely on magnetic resonance imaging (MRI) for characterization. However, conventional MRI may be inconclusive regarding osteochondral fragment stability in selected cases. In this setting, magnetic resonance arthrography may provide additional information, although pediatric-specific evidence is limited and its routine use is not supported. Nonoperative management is commonly used as first-line treatment for stable lesions in skeletally immature patients, but reported success is variable and often modest, prompting increasing interest in standardized conservative protocols and prospective comparisons. When surgery is required, selection among retrograde drilling, bone marrow stimulation, and fragment fixation is primarily driven by osteochondral fragment stability, cartilage integrity, fragment viability, and the extent of subchondral bone involvement. Assessment should also include ankle stability because clinically relevant concomitant ligamentous instability may influence treatment selection and outcomes. When ligament stabilization is indicated, minimally invasive arthroscopic techniques may be considered. Cartilage restoration and graft-based techniques may be indicated for large or cystic lesions, high-stage lesions, or revision cases, though pediatric-specific long-term evidence remains limited. This review summarizes contemporary assessment, imaging, treatment options, rehabilitation principles, and long-term considerations to support evidence-informed clinical decision-making.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261497486"},"PeriodicalIF":1.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171960","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":"Health-related quality of life after calcaneus fractures in childhood and adolescence.","authors":"Milan Milosevic, Carmen Müller, Timo Bullmann, Tobias Krause, Kai Ziebarth","doi":"10.1177/18632521261490258","DOIUrl":"https://doi.org/10.1177/18632521261490258","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the mid-term Health-Related Quality of Life after treatment of calcaneus fractures in childhood and adolescence.</p><p><strong>Methods: </strong>We conducted a retrospective review of data from 19 Patients who were treated for calcaneus fractures at our institution between 2004 and 2019. Radiological assessment was done according to the classification of Schmidt and Weiner. Patients completed a questionnaires with help of there parents when needed, that included the Foot and Ankle Ability Measure (FAAM) and the Pediatric Quality of Life Inventory (Peds-QL).</p><p><strong>Results: </strong>Out of 19 patients with calcaneus fractures, 9 patients had unilateral fractures with a mean age of 9.5 years. There were ten patients with bilateral fractures, with a mean age of 8.9 years. The most common type of fracture was the joint depression type 56%, followed by avulsion fracture 17%. In 65 % non-operative treatment was conducted. At a mean follow-up of 6.3 years, the average FAAM score was 98.8. The mean PedsQL-PF (Pediatric Quality of Life Inventory-Physical function) was 97.9 and the mean PedsQL-PS (Pediatric Quality of Life Inventory-Psychosocial function) was 88.9. Joint depression type fractures were associated with inferior outcomes with a mean PedsQL-PF of 95.9 and mean PedsQL-PS of 84.8.</p><p><strong>Conclusions: </strong>HRQoL, as measured by FAAM and PedsQL, was high overall in children and adolescents with calcaneal fractures. Lower scores were observed primarily in patients with joint depression type fractures.</p><p><strong>Significance of study: </strong>This study provides the first assessment of mid-term health-related quality of life after pediatric calcaneal fractures, demonstrating excellent outcomes that contrast sharply with those reported in adults.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261490258"},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170356","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":"Modified radiographic classification for postaxial polydactyly of the foot: An analysis of 121 digits in 98 children.","authors":"JianPing Wu, ChenYang Li, XiaoLin Luo, ZhiRui Hua, JianWei Hu, JinKao Li, XiaoFei Ding, ShiJie Liao, HongWen Xu","doi":"10.1177/18632521261490291","DOIUrl":"10.1177/18632521261490291","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the imaging features of congenital postaxial polydactyly (CPP) and introduce a modified radiographic classification based on radiographic pathoanatomy of CPP.</p><p><strong>Method: </strong>We retrospectively analyzed the data of 98 cases (121 digits) of CPP treated in our hospital from August 2014 to April 2023. Watanabe et al. classified polydactyly of the foot into fifth-ray duplication and sixth-ray duplication, further categorizing them by their anatomical origin into distal phalangeal, middle phalangeal, proximal phalangeal, and tarsal types. Lee subsequently refined the Watanabe classification into middle phalangeal, medial proximal phalangeal, lateral proximal phalangeal, proximal phalangeal head, floating, fourth metatarsal, and fifth metatarsal types. The modified classification is classified into four groups based on the pathoanatomy of the polydactyly: A (joint), B (epiphysis), C (bone) and D (soft tissues). Each group includes 4 subtypes according to the level of the CPP, with subtypes 1 through 4 extending from the distal phalanx to metatarsal or inter-phalangeal to tarso-metatarsal joints. The combined subtypes complete the modified classification. The modified classification includes specific subtypes from the Watanabe classification and the Lee classification.</p><p><strong>Result: </strong>A total of 98 cases (121 digits) were included in the study. Among them, 13 (10.74%) and 8 (6.61%) CPPs could not be classified according to the Watanabe and Lee system. Only 3 digits (2.48%) could not be classified according to the modified classification. According to the modified classification, the most common types of CPP were C4 (44/121; 36.4%), D2 (19/121; 15.7%) and A3 (15/121; 12.4%). Additionally, 6 digits (4.96%) were classified as combine type, including B3+D3 and B3+D4 types. The modified classification showed excellent intra- (0.875) and interrater reliability (0.851) relative to the Watanabe (0.863 and 0.820) and Lee (0.793 and 0.822).</p><p><strong>Conclusion: </strong>The modified classification with excellent inter- and intra-rater reliability is more comprehensive and practical compared to the Watanabe and Lee classification and convenient for clinical communication and guiding treatment choices.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261490291"},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139650","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":"Current concepts review: Low-vs high-tone neuromuscular spinal deformities: An evolving distinction with clinical implications.","authors":"Riza M Cetik, Daniel Studer, Muharrem Yazici","doi":"10.1177/18632521261492971","DOIUrl":"10.1177/18632521261492971","url":null,"abstract":"<p><strong>Background: </strong>Neuromuscular scoliosis (NMS) was historically classified into two groups as neuropathic and myopathic, which offers limited benefit beyond describing the underlying pathology. More recently, NMS is being classified according to changes in muscle tone, which more accurately characterizes presenting features, and also helps emphasize the critical differences in management.</p><p><strong>Clinical presentation: </strong>High-tone NMS, with cerebral palsy (CP) as a typical example, is characterized by spasticity, rigidity, and often reduced flexibility. Low-tone NMS, as in spinal muscular atrophy (SMA) and muscular dystrophy presents with hypotonia and truncal weakness, leading to more flexible, long curves often with significant kyphosis. High burden of medical comorbidities is common in both groups, while low-tone patients carry a higher risk of respiratory failure secondary to severe muscle weakness and cardiac involvement in myopathies and muscular dystrophies.</p><p><strong>Management: </strong>Successful management depends on careful evaluation of muscle tone, and tailoring the treatment accordingly. Multidisciplinary care is essential, and preoperatively all patients should be evaluated for possible respiratory problems and nutritional optimization. Muscular dystrophies and myopathic conditions require careful cardiac evaluation. Principles of surgical treatment may be similar for both low-tone and high-tone patients, but characteristics of the underlying disease can affect the details of treatment.</p><p><strong>Conclusion: </strong>Surgery can be performed safely and provide significant improvements in quality of life in NMS. Recent evidence suggests that surgery may also decrease mortality and help preserve pulmonary function. Distinguishing low-from high-tone NMS provides a clinically meaningful framework.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261492971"},"PeriodicalIF":1.8,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076841","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":"Management of chronic monteggia fractures with ulnar osteotomy, external fixation and gradual closed reduction of radial head.","authors":"Siyuan Liu, Jian Zhu, Zengfeng Xin","doi":"10.1177/18632521261492479","DOIUrl":"10.1177/18632521261492479","url":null,"abstract":"<p><strong>Purpose: </strong>At present, there is no standardized surgical protocol for chronic Monteggia fractures, particularly in patients who are older than 10, have missed radial head dislocation for over 1 year, or have developed radial head deformities. Current surgical approaches remain suboptimal and are often associated with poor clinical outcomes.</p><p><strong>Methods: </strong>This study retrospectively analyzed 14 patients with chronic Monteggia fractures who had been managed with ulnar osteotomy, external fixation and gradual closed reduction of radial head at our institution between January 2022 and November 2025. By analyzing clinical and radiographic outcome, we systematically assessed the therapeutic effectiveness and short-term outcomes of this treatment.</p><p><strong>Results: </strong>During the latest follow-up period (range: 6-42 months; median: 21.6 months), none of the 14 patients developed recurrent radial head dislocation. Five patients developed pin tract infections and two patients had mild limitation of elbow flexion and supination, but neither affected daily activities. Of note, radiographic outcome of one patient at the 3-year follow-up revealed degenerative changes in the radial head, but this patient maintained full range of motion of the elbow without experiencing pain or mobility restrictions. The remaining patients showed no significant abnormalities in both clinical and radiographic outcomes.</p><p><strong>Conclusions: </strong>We recommend ulnar osteotomy, external fixation and gradual closed reduction of radial head for patients with chronic Monteggia fractures who are older than 10, have missed radial head dislocation for over 1 year, or have developed radial head deformities. This treatment ensures anatomical reduction while significantly improving surgical success rates and short-term outcomes.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261492479"},"PeriodicalIF":1.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065963","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":"Perspectives of patients and families impacted by developmental dysplasia of the hip.","authors":"Duneesha De Silva, Bryn O Zomar, Delaney R Webber, Kishore Mulpuri, Emily K Schaeffer","doi":"10.1177/18632521261489001","DOIUrl":"10.1177/18632521261489001","url":null,"abstract":"<p><strong>Purpose: </strong>Knowledge translation (KT) ensures that the appropriate stakeholders, including patients and care providers are aware of and utilize research evidence to inform health decision-making. This is significant for those affected by developmental dysplasia of the hip (DDH), as patient experiences vary depending on the severity of their condition. To effectively improve health outcomes and quality of life for families impacted, we must first be aware of their lived experiences; therefore, we conducted focus groups with patients and caregivers of patients impacted by DDH.</p><p><strong>Methods: </strong>Patients with DDH and their caregivers were recruited to participate in semi-structured interviews to learn about their diverse lived experiences. Thematic content analysis was performed on deidentified transcripts of the focus groups using NVIVO software.</p><p><strong>Results: </strong>Key patient themes included anxiety and negative emotions associated with hospital/doctor visits, self-limiting activities, long-term effects of DDH, lack of agency in decision-making, and access to support services. Caregiver discussions underscored common themes including awareness level of DDH, road to diagnosis, treatment options, sufficiency of information presented, sources of support, need for more resources, and burden.</p><p><strong>Conclusion: </strong>Focus groups provided a more comprehensive understanding of patient and caregiver experiences across the care trajectory and identified priorities for future investigation. With the knowledge gathered, we have formed a patient and family advisory group to co-develop research priorities in DDH that are relevant to patients and families.</p><p><strong>Significance of study: </strong>This study offers deeper insight into patient and caregiver experiences, informing more responsive and patient-centered approach to DDH research and care.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261489001"},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042237","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":"Assessment and management of torsional malalignment in paediatric patients with patellofemoral joint instability.","authors":"Franck Accadbled, Tim Cheok, Vincent Martinel, Jaideep Rawat","doi":"10.1177/18632521261491569","DOIUrl":"10.1177/18632521261491569","url":null,"abstract":"<p><strong>Purpose: </strong>Torsional malalignment is an important but frequently underrecognized contributor to patellofemoral instability (PFI) in children and adolescents. This review aimed to provide a clinically focused overview of the development, assessment, imaging evaluation, and contemporary management of femoral and tibial torsional abnormalities associated with PFI.</p><p><strong>Methods: </strong>A literature search of PubMed and Embase was performed from database inception, using the terms ((patella) OR (patellofemoral)) AND ((rotation) OR (torsion)). Titles and abstracts were screened by two authors, followed by full-text review and synthesis of relevant literature. Evidence concerning developmental changes, clinical and dynamic assessment, imaging modalities, associations with PFI, and surgical management was evaluated.</p><p><strong>Results: </strong>Femoral anteversion decreases and tibial external torsion increases during childhood, although substantial physiological variability limits the use of universal normative thresholds. Clinical assessment, including hip rotation, thigh-foot angle, gait, and patellar tracking, is essential but demonstrates inter- and intraobserver variability. CT remains a reference standard for torsional measurement, whereas MRI and EOS imaging provide radiation-sparing alternatives. Increased femoral anteversion, tibial torsion, and tibiofemoral rotation are associated with PFI and may contribute to failure of isolated soft-tissue procedures. In selected symptomatic patients, derotational osteotomy, frequently combined with MPFL reconstruction or other procedures addressing concomitant risk factors, can provide favorable clinical outcomes.</p><p><strong>Conclusions: </strong>Evaluation of pediatric PFI should incorporate torsional. Treatment should be individualized according to symptoms, skeletal maturity, clinical findings, dynamic function, and anatomical contributors rather than imaging values alone. Recognition and correction of clinically significant torsional malalignment may improve stability and reduce treatment failure.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261491569"},"PeriodicalIF":1.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019008","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":"Acute, chronic, and non-fracture-related compartment syndrome in children. A current concepts review.","authors":"Francesco Candusso, Sara De Salvo, Camilla Cabrioli, Loris James Bari, Roberto Facchi, Emanuela Lanari, Marco Natale, Federico Canavese","doi":"10.1177/18632521261485657","DOIUrl":"10.1177/18632521261485657","url":null,"abstract":"<p><strong>Background: </strong>Pediatric acute compartment syndrome (PACS) is a rare limb-threatening emergency. Diagnosis is complicated by pediatric developmental physiology and communication barriers. Although traumatic fractures are the primary cause, non-fracture etiologies present unique diagnostic challenges. This review summarizes the latest evidence on the changing epidemiology, pathophysiology and diagnostic approaches to acute, chronic, and non-fracture compartment syndromes in children.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across the PubMed/MEDLINE, Embase, and the Cochrane Library databases. The review included English-language, peer-reviewed articles published between January 1966 and May 2026, utilizing Medical Subject Headings and keywords such as \"compartment syndrome,\" \"pediatric,\" \"children,\" and \"fasciotomy\".</p><p><strong>Results: </strong>The diagnostic approach to PACS has shifted from the unreliable \"5 Ps\" at late stages to the early \"3 As\": increased anxiety, agitation, and analgesic requirements. Children naturally have higher baseline compartment pressures than adults, so pediatric-specific interpretations of pressure monitoring are required. While fracture-related PACS generally has an excellent prognosis if recognised and treated promptly, non-fracture acute compartment syndrome frequently suffers from critical diagnostic delays, leading to high rates of myonecrosis. The definitive standard of care remains an emergent decompressive fasciotomy. However, pediatric tissue demonstrates robust regenerative capacity, enabling conservative initial muscle debridement and achieving high success rates with delayed primary wound closure.</p><p><strong>Conclusions: </strong>Although pediatric patients have remarkable healing potential, even following delayed surgical interventions, early recognition is essential to preventing permanent disability. The ability to safeguard limbs depends entirely on clinician's ability to prioritize the behavioral \"3 As\" over late-stage neurovascular changes.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261485657"},"PeriodicalIF":1.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898444","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":"Benefits and complications: A systematic review and meta-analysis of serial casting in early onset scoliosis.","authors":"Suhani Sharma, Arun Ramnarine, Karim Fouad, Ally Cheung, Vedika Khurana, Shreya Sankar, Michael O'Connor, George-Paul O'Byrne, Oliver Boughton, Patrick Kiely","doi":"10.1177/18632521261484309","DOIUrl":"10.1177/18632521261484309","url":null,"abstract":"<p><strong>Purpose: </strong>Early-onset scoliosis (EOS) presents a unique therapeutic challenge, requiring interventions that achieve deformity correction while preserving spinal and thoracic growth. This systematic review and meta-analysis aimed to synthesise current evidence on serial casting outcomes in EOS, with a primary focus on treatment-related complications and secondary evaluation of radiographic, pulmonary, and quality-of-life outcomes.</p><p><strong>Methods: </strong>Comprehensive searches were performed in MEDLINE, Embase, Cochrane Library and CINAHL without date restrictions to identify eligible studies. The primary outcome was treatment-related complications; secondary outcomes included Cobb angle correction, thoracic height progression, pulmonary function, and patient-reported quality of life. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were conducted using random-effects models, and narrative synthesis was applied where quantitative pooling was not feasible.</p><p><strong>Results: </strong>From 578 records, 23 studies met inclusion criteria. Sixteen studies were rated as low risk of bias, six moderate, and one high. The pooled complication rate from the single-arm meta-analysis was 17% (95% CI 9-24%), with moderate heterogeneity. Dermatological complications predominated (skin irritation, ulceration), while gastrointestinal and transient respiratory symptoms were infrequent. Comparative studies demonstrated lower complication rates with casting compared to growth rods (1/27 vs 12/27), with outcomes comparable or superior to bracing. Mean annual thoracic growth ranged from 0.8 to 3.8 cm. Cobb angle correction was generally greater in non-congenital compared to congenital scoliosis. Pulmonary function may transiently decline during casting but improves following cast removal, while long-term outcomes remained acceptable when early surgery was avoided. Quality-of-life analysis demonstrated inverse associations between residual curvature and domains including daily living, pain, and emotional wellbeing.</p><p><strong>Conclusion: </strong>Serial casting remains an effective, low-risk, and growth-preserving intervention for managing early-onset scoliosis. The predominance of minor, reversible complications underscores its safety, while radiographic and functional outcomes affirm its therapeutic value. Future research should prioritise prospective evaluation of pulmonary and psychosocial outcomes to optimise patient selection and refine treatment protocols.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261484309"},"PeriodicalIF":1.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857660","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":"Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study.","authors":"Anne Tabard-Fougère, Alice Bonnefoy-Mazure, Sophie Louis, Stephane Armand, Geraldo De Coulon, Oscar Vazquez","doi":"10.1177/18632521261475145","DOIUrl":"https://doi.org/10.1177/18632521261475145","url":null,"abstract":"<p><strong>Purpose: </strong>To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone.</p><p><strong>Method: </strong>This retrospective cohort study included children aged 5-12 years at baseline with ≥2 Assisting Hand Assessment (AHA) evaluations over ≥3 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination).</p><p><strong>Results: </strong>Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (Δ = -3.6 ± 2.7), versus improvements in 5/6 PT patients (Δ = +9.0 ± 6.4). Wrist extension declined in all BoNT-A+PT patients (Δ = -53° ± 19°) versus 1/5 PT patients (Δ = -4° ± 8°). Supination deteriorated in 4/5 cases of BoNT-A+PT patients (Δ = -30° ± 7°) but remained stable in all PT patients (Δ = +2° ± 9°).</p><p><strong>Conclusion: </strong>Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function.</p><p><strong>Significance of study: </strong>These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy.</p><p><strong>Level of evidence: </strong>III (retrospective cohort study).</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261475145"},"PeriodicalIF":1.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765740","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}