Journal of Childrens Orthopaedics最新文献

{"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}

{"title":"A bibliometric analysis of research on developmental dysplasia of the hip (2000-2025): Trends, leading contributors, impact, and collaboration patterns.","authors":"Murat Koçak, Feza Korkusuz, Mehmet İsmail Safa Kapıcıoğlu, Hakan Ömeroğlu","doi":"10.1177/18632521261479400","DOIUrl":"https://doi.org/10.1177/18632521261479400","url":null,"abstract":"<p><strong>Purpose: </strong>It was aimed to evaluate publication trends, scientific impact, and collaboration patterns in developmental dysplasia of the hip (DDH) research.</p><p><strong>Methods: </strong>DDH-related publications indexed in the Web of Science database between January 1, 2000, and December 31, 2025, were analyzed. Publication output, citation metrics, author and institutional collaboration networks, leading journals, and major research themes were assessed.</p><p><strong>Results: </strong>A total of 3462 articles were identified. Annual publication output increased substantially over the study period. The most cited article, by Steppacher et al., reported long-term outcomes of periacetabular osteotomy. Sankar WN (USA) was the most prolific author, while Clohisy JC (USA) had the highest citation impact and h-index. Shanghai Jiao Tong University (China) produced the greatest number of publications, whereas Western institutions achieved higher citation impact despite lower publication volumes. The USA led in publication output, while Switzerland demonstrated the highest citation impact. North American authors and institutions showed the strongest international collaboration rates, with the USA occupying the central position in the global collaboration network. The Journal of Pediatric Orthopaedics published the largest number of DDH-related articles. Research themes exhibited notable geographical variation.</p><p><strong>Conclusion: </strong>DDH research has grown rapidly over the past 25 years. North American and Western European researchers have played a leading role through strong international collaborations and publication in high-impact journals. Publication quality and global partnerships appear to be key determinants of scientific influence in the field.</p><p><strong>Significance of the study: </strong>This study provides novel bibliometric insights into the current landscape of DDH research for trainees, researchers, clinicians, and policymakers.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261479400"},"PeriodicalIF":1.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762813","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":"Comparing the outcome of pediatric femoral neck fracture between Ti-Robot surgery and traditional surgery.","authors":"Yuan Ma, Hao Yang, Yunfeng Xu, Fangyu Liu, Wenyu Liao, Zhen Bian, Lin Huang, Xieyuan Jiang, Zheng Yang, Xuemin Lyu","doi":"10.1177/18632521261475845","DOIUrl":"10.1177/18632521261475845","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of Ti-Robot system (Beijing TINAVI Medical Technology Company, China) compared with conventional surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 56 pediatric patients with femoral neck fractures. Patients ranged in age from 3.06 to 16.06 years. Twenty-six patients underwent Ti-Robot-assisted surgery, while thirty patients underwent freehand surgery. Baseline and intraoperative data were collected. During a follow-up period of at least 1 year, fracture healing and functional outcomes were assessed using radiographic evaluation and questionnaires.</p><p><strong>Results: </strong>All patients were successfully fixed with three screws. Baseline characteristics were similar between the two groups. Screw parallelism and femoral neck width coverage were better in the Ti-Robot group. Intraoperative fluoroscopy frequency, radiation dose, drilling frequency, and total screw implantation time were lower in the Ti-Robot group than in the conventional group. There were no significant differences in operative time, intraoperative blood loss, healing time, complication rate, Harris Hip Score, Non-Arthritic Hip Score, or Hip and Groin Outcome Score between the two groups.</p><p><strong>Conclusion: </strong>The Ti-Robot system is a feasible adjunctive approach for the treatment of pediatric femoral neck fractures. It improves screw placement accuracy and reduces radiation exposure, although its effect on long-term clinical outcomes requires further investigation.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261475845"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714666","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":"Postoperative displacement as a predictor of early elbow motion limitation following fixation of pediatric lateral condyle fractures.","authors":"Shin Woo Choi, Jae-Kwang Hwang, Sang Min Kang, Byong-Gon Park","doi":"10.1177/18632521261477225","DOIUrl":"10.1177/18632521261477225","url":null,"abstract":"<p><strong>Purpose: </strong>Recovery of elbow motion is a primary concern following fixation of pediatric lateral condyle fractures, yet the influence of postoperative displacement on early motion outcomes remains unclear. This study aimed to evaluate the association between postoperative displacement magnitude and early elbow motion limitation.</p><p><strong>Methods: </strong>We retrospectively reviewed 63 pediatric patients (mean age 5.4 years) who underwent surgical fixation for lateral condyle fractures between 2015 and 2025. Immediate postoperative displacement was measured on postoperative radiographs. Early elbow motion limitation was defined as ROM <140° within the first year. Multivariable logistic regression identified independent predictors, and ROC curve analysis determined the optimal displacement threshold.</p><p><strong>Results: </strong>Twelve of 63 patients (19.0%) demonstrated early elbow motion limitation. This group had significantly greater postoperative displacement (1.53 ± 0.72 mm vs. 0.79 ± 0.62 mm, p = 0.002) and older age (6.5 ± 2.1 vs. 5.2 ± 2.1 years, p = 0.038) than the normal ROM group. Multivariable regression identified postoperative displacement as the sole independent predictor (OR 5.95; 95% CI 1.44-24.56; p = 0.014). ROC analysis demonstrated moderate predictive ability (AUC = 0.782). Using a 1.0 mm cutoff, early motion limitation was significantly more frequent in patients with displacement ≥1.0 mm than <1.0 mm (32.3% vs. 6.3%, p = 0.011).</p><p><strong>Conclusions: </strong>Immediate postoperative displacement independently predicted early elbow motion limitation after lateral condyle fracture fixation. A threshold of approximately 1.0 mm may serve as a practical reference for anticipating early motion recovery. Minimizing residual displacement may be beneficial, though longer follow-up studies are warranted.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261477225"},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714752","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":"Proximal junctional kyphosis in distraction-based growth-friendly treatment: Definition, risk factors, and timeline.","authors":"Ataberk Beydemir, Rafik Ramazanov, Mehmet Berktas, Mehmet Ayvaz, Halil Gokhan Demirkiran, Muharrem Yazici","doi":"10.1177/18632521261475211","DOIUrl":"10.1177/18632521261475211","url":null,"abstract":"<p><strong>Purpose: </strong>To identify risk factors and characterize the timing and nature of proximal junctional kyphosis (PJK) following dual-rod distraction-based growth-friendly treatment (DB-GFT) in early-onset scoliosis (EOS).</p><p><strong>Methods: </strong>Ninety-five EOS patients (37 male, 58 female) treated with dual growing rod systems between 2004 and 2023, with ≥ 2 years of follow-up, were retrospectively reviewed at a single center. Radiographic parameters were assessed preoperatively, postoperatively, and at final follow-up. PJK was defined as a proximal junctional angle(PJA) ≥10° at final follow-up with an increase of ≥10° compared with preoperative measurement. Serial lateral radiographs were evaluated at 3 or 6 month intervals to determine occurrence and timing of PJK. Univariate and multivariate logistic regression analyses were performed to identify risk factors.</p><p><strong>Results: </strong>The mean age at index surgery was 6.8 years, with a mean follow-up of 5.8 years. PJK developed in 17 patients (17.9%): 3 immediately postoperatively(mechanical) and 14 gradually (biological), of whom 12 were diagnosed after the first year. Univariate analysis identified UIV at T3 or below and T5-T12 kyphosis correction ≥ 30° as significant risk factors. Each 1° increase in preoperative T5-T12 kyphosis increased PJK risk by 3%. Multivariate analysis confirmed preoperative T2-T12 kyphosis ≥45° and UIV at T3 or below as independent risk factors.</p><p><strong>Conclusions: </strong>While extensive kyphosis correction was identified as a significant risk factor on univariate analysis, preoperative T2-T12 kyphosis ≥45° and UIV at T3 or below emerged as independent predictors, underscoring the importance of both preoperative sagittal alignment and UIV selection in surgical planning. Segment-adjusted PJA values may better identify clinically significant cases at risk of progression to proximal junctional failure. As most PJK develops after 1 year, long-term follow-up is essential.</p><p><strong>The significance of study: </strong>Distal upper instrumented vertebra (T3 or below) and preoperative T2-12 thoracic kyphosis significantly increase the risk of proximal junctional kyphosis, which most commonly develops after the first postoperative year.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261475211"},"PeriodicalIF":1.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698340","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":"Percutaneous tendon lengthening and selective percutaneous myofascial lengthening in children with cerebral palsy: Establishing surgical indications using the Delphi method.","authors":"Michael Wade Shrader, Benjamin J Shore, Henry G Chambers, Tim Theologis, Robert M Kay, Erich Rutz, James J McCarthy, Kristan A Pierz, Kerr Graham","doi":"10.1177/18632521261466699","DOIUrl":"10.1177/18632521261466699","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous tendon lengthening (PTL), including selective percutaneous myofascial lengthening (SPML), is popular in cerebral palsy (CP) with advocates arguing that it is minimally invasive and may result in less pain and faster rehabilitation than open techniques, but supporting evidence is limited. The purpose of this study was to develop consensus for the surgical indications of PTL and SPML in CP.</p><p><strong>Methods: </strong>A 16-member panel, established experts with at least 10 years' experience in the surgical management of CP, was created to determine opinion consensus on orthopaedic surgical indications. The modified Delphi method was used, utilising a five-level Likert scale. Consensus was defined at 80% of responses being in the highest or lowest two of the five Likert ratings. General agreement was defined as 60%-79%.</p><p><strong>Results: </strong>Thirty-two statements were surveyed; consensus or general achievement was achieved for 22 questions (69%). The panel reached consensus that percutaneous methods for plantar flexor lengthening (PFL) for equinus in CP should be avoided due to the risk of overlengthening. There was disagreement on 10 questions (31%), primarily on the need for more evidence of differences between PTL and SPML.</p><p><strong>Conclusions: </strong>Expert consensus suggests more evidence is needed to establish the safety and efficacy of all types of percutaneous techniques across anatomical levels but confirmed that all percutaneous PFL in CP should be avoided due to the consequences of overlengthening.</p><p><strong>Significance of study: </strong>In the absence of prospective high-quality evidence, consensus opinion helps guide surgical decision-making for children with CP.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261466699"},"PeriodicalIF":1.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581276","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":"Retrospective cohort study assessing radiological outcomes and risk factors for progression of femoral head osteonecrosis in children with sickle cell disease, following bisphosphonate therapy, CD-BMAC and proximal femoral reorientation osteotomy.","authors":"Rasim Abid Elayedatt, Abhay Deodas Gahukamble, Arul Murugan A, Vikaas Ethanur Thuppale, Aby Abraham, Madhavi Kandagaddala, Thomas Palocaren","doi":"10.1177/18632521261436299","DOIUrl":"10.1177/18632521261436299","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the radiological outcomes of femoral head osteonecrosis (FHO) in children with sickle cell disease (SCD), comparing non-operative treatment (bisphosphonates) and head-preserving surgical interventions-core decompression with bone marrow aspirate concentrate (CD-BMAC) and proximal femur reorientation osteotomy (PFRO)-by analyzing changes in Steinberg stage before treatment to final follow-up.</p><p><strong>Methods: </strong>Retrospective review of 28 hips from 17 pediatric SCD patients treated between 2010 and 2024, analyzed patient demographics, disease stage, treatment modalities, disease progression, and follow-up duration; and compared pre-collapse and post-collapse stages.</p><p><strong>Results: </strong>Among 75 hips with FHO in 51 children, 61 (81%) were non-traumatic. Of the 28 hips (13 pre-collapse, 15 post-collapse) in 17 children (mean age 11.6 years; 58.8% male), the average interval from SCD diagnosis to FHO onset was 78.8 months (Standard deviation-36.6). Treatments included bisphosphonates (11 hips), CD-BMAC (5), and PFRO (6). After excluding salvage procedures and lost follow-up, 20 hips were available for the final outcome analysis. At final follow-up (mean 30.7 months), FHO improved or remained stable in 15 hips (75%), while it progressed by at least 1 Steinberg stage in 5 hips (25%). In pre-collapse hips, no further disease progression was seen. In post-collapse cases, progression was noted in three of five bisphosphonate-treated hips and two CD-BMAC-treated hips; PFRO-treated hips showed no progression. Two hips developed arthritis.</p><p><strong>Conclusion: </strong>Bisphosphonates, CD-BMAC, and PFRO prevent disease progression in pre-collapse hips. In post-collapse hips, PFRO showed no further progression, while CD-BMAC and bisphosphonates showed mixed results.</p><p><strong>Significance of study: </strong>Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261436299"},"PeriodicalIF":1.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474477","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":"Rock-paper-scissors-OK game for neurological examination in pediatric supracondylar humerus fractures: A prospective randomized controlled trial.","authors":"Tahsin Aydin, Fatih Inci, Muhammed Kilic, Nihat Yigit, Yakup Kahve, Erman Ceyhan","doi":"10.1177/18632521261466900","DOIUrl":"10.1177/18632521261466900","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric supracondylar humerus fractures frequently involve nerve injuries, which can be difficult to assess before and after surgery. This study evaluated a smartphone application that teaches nerve examination to children using a rock-paper-scissors-OK game, and assessed its effects on examination time and satisfaction.</p><p><strong>Methods: </strong>In this single-center, prospective randomized controlled study, 102 children aged 4-10 years who underwent surgical treatment were randomized into 2 groups. Group 1 learned nerve examination through the classical method taught by orthopedic residents and a specialist. Group 2 was taught using the smartphone application with the game. Pre- and postoperative nerve examination times were recorded. Child and parent satisfaction were measured with the Child HCAHPS questionnaire.</p><p><strong>Results: </strong>Mean preoperative examination time was shorter in group 1 (4.3 ± 1.3 min) (<i>p</i> = 0.036), while postoperative time was shorter in group 2 (12.2 ± 2.4 min; <i>p</i> = 0.041). Although the app-based method took longer preoperatively, children in group 2 adapted better, enabling faster postoperative assessments. Agitation, crying, and noncompliance were less frequent in the game-assisted group. Satisfaction scores were higher in group 2 for \"Communication with Doctors\" (<i>p</i> = 0.032) and \"Keeping You Informed\" (<i>p</i> = 0.041), with no differences in other domains. Temporary nerve deficits occurred at similar rates and resolved spontaneously in all cases.</p><p><strong>Conclusions: </strong>A smartphone-based rock-paper-scissors-OK game improves postoperative nerve examination efficiency and increases satisfaction, particularly regarding communication and information sharing.</p><p><strong>Level of evidence: </strong>Level II.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT07480798; retrospectively registered on 16 March 2026, after study initiation on 13 March 2024(Supplemental Material 1).</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261466900"},"PeriodicalIF":1.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431609","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":"Fracture morphology and multidirectional instability in failed closed reduction of pediatric supracondylar humerus fractures.","authors":"Muhammed Furkan Darilmaz, Mustafa Bulut","doi":"10.1177/18632521261466892","DOIUrl":"10.1177/18632521261466892","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical and fracture-related factors associated with failed closed reduction in high-risk pediatric supracondylar humerus fractures (SCHF), with emphasis on fracture morphology and intraoperative multidirectional instability.</p><p><strong>Methods: </strong>This retrospective cohort study included 318 consecutive children aged 2-12 years who underwent surgery for Gartland type III SCHF or intraoperatively confirmed Gartland type IV instability between 2015 and 2025. Fractures were classified as typical extension-type, medial oblique, lateral oblique, or flexion-type. Univariable and multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>Closed reduction was successful in 192 patients, whereas 126 required conversion to open reduction. Flexion-type fractures had the highest open reduction rate (80.0%; <i>p</i> < 0.001). In the full multivariable model, Gartland type IV instability was strongly associated with open reduction (odds ratio 5.21, 95% confidence interval 2.69 to 10.53; <i>p</i> < 0.001). Compared with flexion-type fractures, typical, medial oblique, and lateral oblique patterns had significantly lower adjusted odds. Older age and longer time from injury to surgery were also associated with open reduction.</p><p><strong>Conclusions: </strong>Flexion-type morphology and intraoperatively confirmed Gartland type IV instability were strongly associated with failed closed reduction. These findings may help surgeons anticipate reduction difficulty and plan operative resources in high-risk pediatric SCHF.</p><p><strong>Significance of study: </strong>Recognizing fracture morphology and intraoperative multidirectional instability may help surgeons anticipate failed closed reduction in high-risk pediatric SCHF.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261466892"},"PeriodicalIF":1.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431593","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}