Journal of Childrens Orthopaedics最新文献

{"title":"Ultrasonographic hip morphology in mucopolysaccharidosis type I Hurler after hematopoietic stem cell gene therapy.","authors":"Maurizio De Pellegrin, Chiara Filisetti, Matilde Cossutta, Michele Colombo, Giulia Consiglieri, Francesca Tucci, Alessandro Aiuti, Maria Ester Bernardo","doi":"10.1177/18632521251349438","DOIUrl":"10.1177/18632521251349438","url":null,"abstract":"<p><strong>Purpose: </strong>To assess ultrasonographic features of hip morphology in mucopolysaccharidosis type I Hurler.</p><p><strong>Methods: </strong>Acetabular bony rim, acetabular cartilaginous roof, alpha and beta angles, echogenicity, and hip coverage were analyzed in eight mucopolysaccharidosis type I Hurler syndrome children before and after hematopoietic stem cell gene therapy.</p><p><strong>Results: </strong>Sixteen hips at baseline, 10 at +12 months, and 10 at + 24 months after hematopoietic stem cell gene therapy were evaluated. The median age was 22, 35, and 45 months at baseline evaluation, +12, and +24 months, respectively. Acetabular bony rim at baseline was angular in 2/16, rounded in 10/16, notched in 2/16, and flattened in 2/16; at +12 months, angular in 2/10, rounded in 5/10, notched in 3/10; at +24 months, angular in 2/10, rounded in 3/10, irregular in 1/10, and notched in 4/10. Acetabular cartilaginous roof at baseline was normal in 4/16, enlarged in 12/16; at +12 months, enlarged in 10/10 and at +24 months, enlarged in 8/10 and normal in 2/10. Echogenicity of the joint capsule at baseline was normal in 10/16, increased in 6/16; at +12 months, normal in 8/10, increased in 2/10; at +24 months, normal in 6/10, increased in 4/10. The mean femoral head coverage was 60% at baseline (16/16), 62% at +12 months (10/10), and 52% at +24 months (2/10). The mean alpha angle was 60° at baseline (16/16), 64° at +12 months (10/10), and 60° (2/10) at +24 months. The mean beta angle was 67° at baseline (16/16), 65° at +12 months (10/10), and 49° at +24 months (8/10).</p><p><strong>Conclusions: </strong>Hip morphology of children with mucopolysaccharidosis type I Hurler syndrome before and after hematopoietic stem cell gene therapy can be evaluated by available ultrasound techniques until a median age of 45 months.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"377-385"},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849703","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":"European Paediatric Orthopaedic Society consensus study to identify research priorities in paediatric orthopaedic surgery.","authors":"Charlotte Ve Carpenter, Christian Wong, Daniel C Perry, Jan Duedal Rölfing","doi":"10.1177/18632521251333331","DOIUrl":"10.1177/18632521251333331","url":null,"abstract":"<p><strong>Background: </strong>Paediatric orthopaedic surgery is rarely supported by high-quality evidence, with treatment decisions generally informed by experience or case series. The European Paediatric Orthopaedic Society recognises the need to establish research priorities in the field. This study builds on previous UK research priorities to discover the most important unanswered clinical effectiveness research questions in elective and trauma care and basic science, amongst Paediatric Orthopaedic surgeons across Europe.</p><p><strong>Methods: </strong>A modified Delphi technique, including an initial scoping survey and a two-round Delphi process conducted amongst paediatric orthopaedic surgeons in Europe.</p><p><strong>Results: </strong>An average of 113 surgeon responses were received in each round, scoring questions from 1 (low priority) to 5 (high priority). The mean score for importance was 3.59 in elective questions, 3.13 in trauma and 3.54 in basic science. The top questions in each group were identified. The top five research priorities for elective care related to the care of - Perthes Disease, Slipped Upper Femoral Epiphysis and Developmental Dysplasia of the Hip. Those in trauma related to the treatment of fractures around the elbow, forearm and femur Basic science priorities related to pharmaceuticals in the management of paediatric orthopaedic conditions and the pathology of Perthes' Disease and Developmental Dysplasia of the Hip.</p><p><strong>Conclusions: </strong>The results will help guide clinicians, researchers and funding bodies to focus research towards important topics and improve the evidence for practice in paediatric orthopaedic surgery. We hope that this study will encourage the development of collaborative international studies to improve care in paediatric orthopaedics.</p><p><strong>Level of evidence: </strong>Level V - decision analysis.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"347-353"},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801012","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":"All-inside physeal bar resection for partial physeal arrest of the distal radius with the aid of an arthroscope and patient-specific instrument.","authors":"Han Xiao, Baohui Xiao, Xiaoqian Tan, Qian Tan, Weihua Ye, Jiangyan Wu, Renfei Li, Haibo Mei, Guanghui Zhu, An Yan","doi":"10.1177/18632521251358639","DOIUrl":"10.1177/18632521251358639","url":null,"abstract":"<p><strong>Purpose: </strong>The premature closure of the epiphysis of the distal radius is an infrequent condition in pediatric patients, often resulting in distal radius deformity. Currently, there is limited literature on its treatment, and controversy exists. This study aimed to evaluate the clinical efficacy of all-inside physeal bar resection with the aid of an arthroscope and patient-specific instrument.</p><p><strong>Methods: </strong>We retrospectively reviewed the patients who sustained distal radius physeal bar resection under all-inside visualization of the arthroscope with the aid of a patient-specific instrument during 2016-2022. Follow-up was performed for a minimum of 2 years, during which pre-operative and post-operative clinical and radiological parameters were compared.</p><p><strong>Results: </strong>There were six boys and two girls enrolled in this study. Six patients got satisfied results, while two patients didn't benefit from the surgery. The mean pre-operative RAA of the affected side was -11.4° ± 13°, while the post-operative radial articular angle was 3.4° ± 11°. There was a significant difference between them. The mean pre-operative ulnar variance was 7.6 mm ± 6 mm, while the post-operative UV was 3.3 cm ± 8 mm. There was no significant difference between them. The pre-operative modified Mayo Wrist Score was 92 ± 5, while that for post-operative was 96 ± 7.</p><p><strong>Conclusion: </strong>All-inside physeal bar resection for partial physeal arrest of the distal radius with the aid of an arthroscopy and patient-specific instrument is minimally invasive, accurate, and safe. It should be the one option treatment for the premature closure of the distal radius epiphysis.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"321-328"},"PeriodicalIF":1.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746125","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 effectiveness of generative AI technology in commonly asked scoliosis questions.","authors":"Adarsh Suresh, Jacob Siahaan, Rex Aw Marco, Eric Klineberg, Timothy Borden, Rohini Vanodia, Lindsay Crawford, Shah-Nawaz Dodwad, Shiraz Younas, Surya Mundluru","doi":"10.1177/18632521251359098","DOIUrl":"10.1177/18632521251359098","url":null,"abstract":"<p><strong>Purpose: </strong>In recent years, generative artificial intelligence systems have transformed the landscape of patient's access to medical information and education. As increases in general and subspeciality physician shortages lead to longer lead times for patients to get access to physicians, we aim to understand how effectively different AI platforms can respond to questions asked by parents about both operative and nonoperative scoliosis.</p><p><strong>Methods: </strong>A survey comprised of 31 questions, among the most commonly asked, regarding scoliosis with responses from ChatGPT, Google Gemini, and Microsoft Copilot was administered to board-certified Orthopedic surgeons, fellowship trained in either pediatric or spine surgery. (four reviewers). They evaluated each output from Likert Scale of 1-5 with 5 meaning an excellent response was given and 1 meaning a poor response was given. Pairwise comparisons were used for analysis.</p><p><strong>Results: </strong>All three generative AI technologies performed well with an overall mean rating of 3.4 which is between good and very good on the Likert Scale provided. ChatGPT performed the best out of the three, with a mean rating of 4.0, Google Gemini was second best with a mean rating of 3.1, and Copilot was third best with a mean rating of 3.1. ChatGPT compared with Gemini and Copilot revealed statistically significant differences with a p-value <0.001, with no statistical difference between Gemini and Copilot.</p><p><strong>Conclusion: </strong>In response to common scoliosis questions asked by parents, ChatGPT, Microsoft Copilot, and Google Gemini, were scored highly by our Spine team and has important indications for use in the future.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"416-421"},"PeriodicalIF":1.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746126","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":"Using the simple locking intramedullary (SLIM) system for bone deformity stabilization: A retrospective cohort study.","authors":"Peter Joseph Mounsef, Sofia Addab, Saleh Alfaisali, Mitchell Bernstein, Reggie Hamdy","doi":"10.1177/18632521251359105","DOIUrl":"10.1177/18632521251359105","url":null,"abstract":"<p><strong>Background: </strong>Osteogenesis imperfecta (OI) is characterized by bone fragility and deformities. Treating long bone fractures and deformities in OI patients typically involves intramedullary (IM) rods. The Simple Locking Intramedullary (SLIM) nail is a novel surgical device developed to address challenges in patients with narrow medullary canals, which are unsuitable for larger telescoping rods. This study aims to evaluate the outcomes and complications associated with SLIM nail use in pediatric patients with OI.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at our institution, analyzing 23 patients (41 limbs) who underwent surgery using the SLIM nail between April 2016 and March 2022. Data on patient demographics, surgical intervention, post-operative outcomes, and complications were collected. Radiological evaluations were performed from the immediate post-operative period up to the most recent follow-up.</p><p><strong>Results: </strong>The SLIM nail demonstrated a 2-year survival rate of 82.8% and a 4-year survival rate of 77.1% in tibial applications. The most common complication was angular deformity in the distal tibia, occurring in 19 patients. Other complications included anterior cortical penetration, nail bending, and one case of nail breakage.</p><p><strong>Conclusions: </strong>The SLIM nail is a viable option for patients with narrow intramedullary canals, particularly in cases where telescoping rods are not feasible. While the SLIM nail provides adequate stabilization and reduces the need for multiple surgeries, careful monitoring is essential to manage complications such as distal angular deformity. Early revision to a larger rod, when possible, is recommended to prevent further complications as the patient grows.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"386-394"},"PeriodicalIF":1.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746127","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":"Surgical treatment of monostotic fibrous dysplasia of the proximal femur in children and adolescents: Observational European Paediatric Orthopaedic Society multicenter study.","authors":"Thomas Pg van Geloven, Pieter Bas de Witte, Minna K Laitinen, Domenico A Campanacci, Kevin Döring, Dietmar Dammerer, Mohamed K Mesregah, Natasja M Appelman-Dijkstra, Mikko Haara, Giovanni Beltrami, Gerhard M Hobusch, Tanja Kraus, Sebastian Farr, Camilo Soto-Montoya, Manuel R Medellin Rincon, Javeria Saeed, Phillipp T Funovics, Lizz van der Heijden, Michiel Aj van de Sande","doi":"10.1177/18632521251355884","DOIUrl":"10.1177/18632521251355884","url":null,"abstract":"<p><strong>Purpose: </strong>Monostotic fibrous dysplasia is a rare benign fibro-osseous disorder. Proximal femoral monostotic fibrous dysplasia is especially vulnerable to pathological fracture and deformation, requiring specific treatment strategies. Literature on pediatric proximal femoral monostotic fibrous dysplasias is sparse and without consensus. We present the largest observational cohort study on various treatment methods of pediatric proximal femoral monostotic fibrous dysplasia.</p><p><strong>Methods: </strong>Pediatric patients with proximal femoral monostotic fibrous dysplasia were included, from 10 academic hospitals for oncological orthopedics (2000-2021). Baseline characteristics, treatment strategies, and complications were assessed. Primary outcomes were failure rates, failure-free survival, and risk factors for failure. Failure was defined as fracture, progressive deformity, or surgical (re-)intervention after the start of treatment.</p><p><strong>Results: </strong>Forty-one pediatric patients with proximal femoral monostotic fibrous dysplasia were included (median age = 11 years (range = 6-16), <i>n</i> = 21 (51%) male). Median follow-up was 5.1 years (range = 0.8-18.6). Index procedure was watchful waiting (<i>n</i> = 9), percutaneous procedure (<i>n</i> = 4), open procedure (<i>n</i> = 15), or internal fixation (<i>n</i> = 13). Failure rates were 11%, 50%, 40%, and 31%, respectively (<i>p</i> = 0.41). Overall, 2- and 5-year failure-free survival was stable at 87.5% (95% confidence interval = 64.6-110.4). Risk factors associated with failure were fracture at diagnosis (hazard ratio = 3.7, 95% confidence interval = 1.2-11.5), calcar involvement (hazard ratio = 2.6, 95% confidence interval = 0.7-9.4), and male sex (hazard ratio = 2.1, 95% confidence interval = 0.6-7.8).</p><p><strong>Conclusion: </strong>In cases with low fracture and deformity risk, watchful waiting can be a viable management option for proximal femoral monostotic fibrous dysplasia. When intervention is necessary, internal fixation is advised to prevent fractures and deformity. Curettage with grafting or bone substitute injections should be used with hesitance. Currently, there is no clearly superior treatment for pediatric proximal femoral monostotic fibrous dysplasia, leaving treatment choices to be based on individual characteristics.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251355884"},"PeriodicalIF":1.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735617","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 the article titled \"Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases\".","authors":"Baojian Song, Hanwen Zhang, Xuejun Zhang","doi":"10.1177/18632521251330454","DOIUrl":"10.1177/18632521251330454","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"341-342"},"PeriodicalIF":1.6,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700392","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":"Forearm fractures treated with elastic stable intramedullary nailing: Is casting still necessary?","authors":"Alexandru Herdea, Mihai-Codrut Dragomirescu, Mara Tiron, Alexandru Ulici","doi":"10.1177/18632521251352323","DOIUrl":"10.1177/18632521251352323","url":null,"abstract":"<p><strong>Introduction: </strong>Elastic stable intramedullary nailing is widely recognized for treating pediatric forearm fractures due to its stable fixation and minimal impact on soft tissue. Traditionally, casting has followed elastic stable intramedullary nailing; however, recent studies question its necessity. This study evaluates the outcomes of omitting casts post-elastic stable intramedullary nailing, examining healing speed and quality of life compared to cases where casting was applied.</p><p><strong>Materials and methods: </strong>A prospective study was conducted from 2022 to 2024 in an urban hospital, where children with both-bone midshaft forearm fracture were randomized to receive or not receive casting after elastic stable intramedullary nailing. Age- and sex-matched patients were selected to allow for accurate comparison. The study included patients aged 5 to 14 years. Outcomes were measured using radiographic scores and quality-of-life assessments.</p><p><strong>Results: </strong>From a total of 355 patients, 136 cases were included in the assessment. Analysis indicated faster healing in patients without postoperative casting, as evidenced by higher REBORNE scores at 3 weeks and 2 months. Quality of life, measured by the Pediatric Quality of Life Inventory, was also significantly improved in the no-cast group at 6 weeks.</p><p><strong>Discussion: </strong>Our findings suggest that elastic stable intramedullary nailing provides sufficient stability for both-bone midshaft forearm fracture, making additional casting unnecessary. Early mobilization led to better functional outcomes without increasing complications. Although some minor early discomfort was reported, the cast-free approach proved effective and safe.</p><p><strong>Conclusion: </strong>Elastic stable intramedullary nailing remains the gold standard for treating pediatric forearm fractures. Our preliminary results indicate that for both-bone midshaft forearm fracture, elastic stable intramedullary nailing can be safely performed without postoperative casting, promoting faster healing and better patient satisfaction.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"276-283"},"PeriodicalIF":1.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683603","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":"Arthroscopic management of discoid lateral meniscus in children: 5-Year minimum follow-up clinical outcome.","authors":"Rebecca Bonny Obro, Joe Rassi, Clara Flumian, Jérôme Sales de Gauzy, Franck Accadbled","doi":"10.1177/18632521251325030","DOIUrl":"10.1177/18632521251325030","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the medium-term clinical results and revision rate of arthroscopic rim-preserving saucerization for symptomatic lateral discoid meniscus in children.</p><p><strong>Methods: </strong>A single-centre, retrospective study was conducted on patients treated with arthroscopy for symptomatic discoid lateral meniscus between December 2005 and May 2019. Eligibility criteria were patients <16 years at the time of surgery and a minimum follow-up of 5 years. Preoperative data (age, sex, symptoms and physical examination), arthroscopic findings (Watanabe and Ahn classifications, meniscal instability and the presence of meniscal tear), treatment (saucerization ± stabilization ± meniscal repair), patient-reported outcome measurements (Lysholm, Tegner and Ikeuchi scores) and arthroscopic revision rate were recorded.</p><p><strong>Results: </strong>In all, 47 (72%) of the 65 eligible patients replied to the questionnaires and were therefore included (9 bilateral cases). The mean age at the time of surgery was 8.6 ± 3.3 years. Patient-reported scores were all improved after a mean follow-up of 10.5 years (5-15.9): Ikeuchi (64.2% excellent-good versus 3.6%), Lysholm (90.5 versus 72.9) and Tegner (5 versus 4.3). Two patients developed osteochondritis dissecans of the lateral femoral condyle which healed following non-operative measures. There was no other complication. An arthroscopic revision was performed in 10 patients (17.9%) after a mean follow-up of 2.7 years.</p><p><strong>Conclusion: </strong>The medium-term results of rim-preserving arthroscopic saucerization are favourable, yet with a substantial arthroscopic revision rate. Risk factors for failure and revision should be further investigated.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"295-300"},"PeriodicalIF":1.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683602","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":"Predictive value of post-reduction gadolinium-enhanced magnetic resonance imaging in detecting avascular necrosis after closed and open reduction for developmental dysplasia: A minimum 5-year follow-up study.","authors":"Eduardo N Novais, Katharine F Hollnagel, Sarah D Bixby, Mariana G Ferrer, David N Williams, Young-Jo Kim, Florian Schmaranzer","doi":"10.1177/18632521251350524","DOIUrl":"10.1177/18632521251350524","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate whether globally decreased enhancement on post-reduction gadolinium-enhanced magnetic resonance imaging can predict avascular necrosis after open or closed reduction for developmental dysplasia of the hip.</p><p><strong>Methods: </strong>We retrospectively analyzed 83 patients (94 hips) who underwent open or closed reduction, with a minimum 5-year follow-up. There were 79 females (84%) with a median age of 7.2 months (interquartile range, 4.8-12). Femoral head enhancement on post-reduction gadolinium-enhanced magnetic resonance imaging was evaluated, and the most recent radiographs were graded using the Kalamchi and MacEwen avascular necrosis classification. Logistic regression was employed to identify predictors of avascular necrosis, and diagnostic performance was calculated.</p><p><strong>Results: </strong>Of the 94 hips, 51 (54%) exhibited normal enhancement, 20 (21%) had asymmetric enhancement, 11 (12%) had focal decreased enhancement, and 12 (13%) showed global decreased enhancement. At the final follow-up, 63 hips (67%) had no avascular necrosis, and 31 (33%) developed avascular necrosis: 13 (14%) Grade 2, 7 (7%) Grade 3, and 11 (12%) Grade 4 severe avascular necrosis. Multivariate analysis revealed no significant association between globally decreased enhancement, age, type of reduction, or abduction angle with the development of any avascular necrosis or severe avascular necrosis. Sensitivity was low for hips with any avascular necrosis (13%) and severe avascular necrosis (36%), while specificity was 87% and 90%, respectively.</p><p><strong>Conclusions: </strong>Globally decreased enhancement on post-reduction gadolinium-enhanced magnetic resonance imaging does not necessarily indicate long-term avascular necrosis development following closed or open reduction for developmental dysplasia of the hip. Treatment decisions should not solely rely on this finding. Further research is needed to improve imaging accuracy and assess whether modifying treatment in response to enhancement patterns can reduce avascular necrosis risk.</p><p><strong>Level of evidence: </strong>Diagnostic, level 3 retrospective cohort.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"329-338"},"PeriodicalIF":1.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12230044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592940","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}