Journal of Childrens Orthopaedics最新文献

{"title":"Assessment of postoperative range of motion in paediatric patients undergoing surgical reduction and fixation of lateral condyle fractures.","authors":"Andreas Rehm, Ignatius Liew, Kimberly Welsh, Jennifer Barwell, Victoria Stohlner, Elizabeth Ashby","doi":"10.1177/18632521261436244","DOIUrl":"10.1177/18632521261436244","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261436244"},"PeriodicalIF":1.6,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576700","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":"Primary displacement predicts complications and poorer outcomes after pediatric proximal radius fractures: A retrospective study of 140 fractures.","authors":"Kaj Zilliacus, Yrjänä Nietosvaara, Ilkka Helenius, Reetta Kivisaari, Niko Kämppä, Petra Grahn","doi":"10.1177/18632521261434093","DOIUrl":"10.1177/18632521261434093","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric proximal radius fractures frequently lead to complications and unsatisfactory results, yet the medium- to long-term outcomes of these injuries remain insufficiently studied.</p><p><strong>Methods: </strong>We treated 140 proximal radius fractures in 138 children (median age 10, range 1-16 years) between 2014 and 2019. Fracture characteristics, treatment, complications, patient-reported, and functional outcomes were assessed at a median follow-up of 6.8 years (range 5-10 years) through clinical assessment or telephone interview in 110 patients (80%).</p><p><strong>Results: </strong>Less severe fractures (Judet types I-II) were most common (84/140), while 40% were Judet types III-IV. Most fractures (66%) were treated nonoperatively. Complications occurred in 25% of cases and were mainly associated with displacement ≥3 mm (Odds ratio (OR) 6.7, 95% confidence interval (CI) 2.7-19.1), physeal involvement (OR 5.1, 95% CI 2.0-15.7), and higher Judet classification (OR 4.2, 95% CI 1.9-9.7). Unfavorable functional outcomes occurred in 16% (11/67) and were more frequent after surgical treatment (OR 5.0, 95% CI 1.3-19.6) and in patients with complications (OR 9.2, 95% CI 1.8-47.0).</p><p><strong>Conclusion: </strong>In pediatric proximal radius fractures, primary displacement ≥3 mm, higher Judet's class, and physeal involvement increased the risk of complications and unfavorable long-term outcomes.</p><p><strong>Level of evidence: </strong>Prognostic study, Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261434093"},"PeriodicalIF":1.6,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576733","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":"Variation in assessment, diagnosis and outcome measurement in Perthes disease: a scoping review.","authors":"Stephanie Ball, Rhianydd Thomas, Luke M Davies, Kelly Gray, Nicole Williams, Craig F Munns, Verity Pacey","doi":"10.1177/18632521261432861","DOIUrl":"10.1177/18632521261432861","url":null,"abstract":"<p><strong>Purpose: </strong>Perthes disease is a rare self-limiting avascular necrosis of the developing proximal capital femoral epiphysis. Identifying methods used to assess, diagnose and determine outcomes is essential to improve consistency in research and clinical care for this patient population.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews was used. Four electronic databases (Scopus, MEDLINE, CINAHL and Embase) were searched with articles included if clinical and radiological assessments were conducted on more than 10 participants, aged 0 to <18 years with Legg-Calvé-Perthes disease post 2004.</p><p><strong>Results: </strong>From 9145 records, 32 studies were included, identifying 16 clinical assessments, 23 radiological assessments, 10 diagnostic classifications and 22 outcome measures. Overall, 64% of outcome measures identified are not currently validated for children and adolescents.</p><p><strong>Conclusions: </strong>Substantial variability in the methods used to assess, diagnose and determine outcomes in children and adolescents with Perthes disease was identified. When coupled with limited use of validated paediatric measures, this inconsistency complicates clinical decision-making, reduces consistency in patient care and prevents comparability across studies. Establishing expert consensus to determine the most appropriate, accurate and child-specific measures is needed to enhance consistency in patient care, enable more robust outcome reporting and strengthen future research in Perthes disease.</p><p><strong>Significance of study: </strong>Significant variation in diagnostic, assessment and outcome measures for Perthes disease underscores the need for validated, child-specific tools to improve clinical decision-making, facilitate comparability across studies and strengthen future research.</p><p><strong>Level of evidence: </strong>Level III, scoping review.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261432861"},"PeriodicalIF":1.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576714","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":"Brachial plexus birth injury in children and adolescents: A current concepts review.","authors":"Taylor Shackleford, Kevin J Little","doi":"10.1177/18632521261420152","DOIUrl":"10.1177/18632521261420152","url":null,"abstract":"<p><p>Brachial plexus birth injuries (BPBI), although rare, have a significant impact on patients and the healthcare system. While these conditions tend to be treated at specialty centers around the world that are well equipped to handle the complex needs of these patients, an understanding of the natural history, prognosis, and treatment options for this population is important for all pediatric orthopedic providers. This review aims to detail current concepts of the treatment of BPBI with a focus on clinical examination, operative indications, early surgical interventions, and long-term musculoskeletal sequelae.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261420152"},"PeriodicalIF":1.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576738","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":"Tranexamic acid reduces blood loss and transfusion in single-stage bilateral combined surgery for developmental dysplasia of the hip: A retrospective study.","authors":"Shiwei Li, Xueyang Tang, Xiaodong Yang","doi":"10.1177/18632521261429003","DOIUrl":"https://doi.org/10.1177/18632521261429003","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether tranexamic acid (TXA) reduces blood loss and transfusion rate in single-stage bilateral combined surgery for developmental dysplasia of the hip (DDH) in children.</p><p><strong>Methods: </strong>A retrospective study was conducted on 148 children with bilateral DDH who underwent single-stage bilateral combined surgery between March 2021 and May 2025. Patients were categorized into a TXA group (<i>n</i> = 71) and a control group (<i>n</i> = 77) based on TXA administration. The TXA group received a single intravenous bolus of TXA 15 mg/kg preoperatively, while the control group received no intervention. Complete blood count tests were obtained preoperatively and at 24 h postoperatively. Estimated blood loss (EBL), transfusion rate, operative duration, and complications were compared.</p><p><strong>Results: </strong>The TXA group exhibited significantly lower EBL compared with the control group (117.5 ± 7.7 mL vs. 171.4 ± 11.3 mL; <i>p</i> < 0.001). The total transfusion rate was also lower in the TXA group (5.6 % vs. 16.9 %; <i>p</i> = 0.03), as well as the intraoperative transfusion rate (1.4% vs. 11.7%; <i>p</i> = 0.03). The median surgical duration was 2.3 h in both groups, with no significant difference (<i>p</i> = 0.29). One postoperative infection occurred in each group (1.4 % vs. 1.3 %; <i>p</i> = 1), and no cases of seizures or deep vein thrombosis were observed.</p><p><strong>Conclusions: </strong>TXA significantly reduces EBL and both total and intraoperative transfusion rates in children undergoing single-stage bilateral combined surgery for DDH, without affecting the risk of complications.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261429003"},"PeriodicalIF":1.6,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500910","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":"Patient-reported outcome using EFAS score in skeletally mature clubfoot patients treated at birth with Ponseti's technique.","authors":"Ambra Donzelli, Jeanne Voute, Aline Bregou, Franziska Kocher, Pierre-Yves Zambelli","doi":"10.1177/18632521261427193","DOIUrl":"https://doi.org/10.1177/18632521261427193","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic clubfoot is a frequent congenital deformity treated worldwide using the Ponseti method, which has become the gold standard due to its safety, reproducibility, and excellent short-term outcomes. However, long-term patient-reported outcomes in adolescents and young adults treated in infancy remain insufficiently documented. This study evaluates foot health perception in skeletally mature patients who underwent Ponseti treatment during early infancy, using the European Foot and Ankle Society (EFAS) score and the first two questions of the World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaire.</p><p><strong>Methods: </strong>A retrospective study was conducted on patients older than 14 years who received complete Ponseti treatment for idiopathic clubfoot at a single pediatric university hospital. Clinical and demographic data were collected, and both EFAS and WHOQOL-BREF questionnaires were administered anonymously at follow-up.</p><p><strong>Results: </strong>A total of 28 patients completed the questionnaires. Most reported high satisfaction with overall foot health; 78.5% achieved excellent or good EFAS scores for daily activities, while 89.2% demonstrated excellent sports-related scores. Persistent pain or major functional limitations were uncommon, though a subset reported reduced endurance in common walking activity (21%) and altered gait perception (25%). The majority rated their overall quality of life as good or acceptable according to WHOQOL-BREF responses.</p><p><strong>Conclusion: </strong>Ponseti treatment, combined with long-term follow-up and occasional minor procedures, offers satisfactory long-term outcomes in young adults with idiopathic clubfoot. Although some report reduced walking endurance or gait differences, overall foot health and quality-of-life perception remain high. Further studies are needed to evaluate outcomes later in adulthood.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261427193"},"PeriodicalIF":1.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13002476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500882","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":"Manu: His hands, his friends! An educational short movie to prevent children's hand injuries.","authors":"Estelle Alonso, Elie Saghbiny, Virginie Nguyen-Khac, Nizar Touati, Franck Fitoussi, Raphael Vialle, Manon Bachy-Razzouk","doi":"10.1177/18632521251411809","DOIUrl":"https://doi.org/10.1177/18632521251411809","url":null,"abstract":"<p><strong>Introduction: </strong>Hand injuries are a major public health issue and are very common in pediatrics, explained by children's world discovery. The aim of this study was to produce a short, animated video to raise awareness and educate children and their parents, by proxy, about common hand injuries, and to assess its effect.</p><p><strong>Material and methods: </strong>The video was shown to children at school. They were asked to complete an anonymous questionnaire before the projection and 21 days after, to analyze its impact and its spreading.</p><p><strong>Results: </strong>Eight hundred and thirty five children, with an average age of 9.57 years old, filled the pre-projection questionnaire. Upon those children, 88% have already hurt their hands, 86% knew someone who had hurt their hands and 30% did not know the dangerous situations for the hands. Out of the 565 children who filled the post-projection form, 97% answered that they understood the dangerous situations for the hands, with a significative difference compared to the pre-projection answers. 45% watched the video with their parents, 33% advised their families to watch it and 57% thought they would change their habits.</p><p><strong>Conclusion: </strong>Hand injuries should be a priority, to reduce their incidence and consequences. This short video sets out the various possible accidents and risk situations, targeting children between 6 and 12 years old, and indirectly adults. Even if this study has encouraging results, spreading must be improved and association with incidence of hand injuries followed to evaluate its impact and benefits.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251411809"},"PeriodicalIF":1.6,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476088","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":"Temporal patterns of redisplacement risk following nonoperative treatment of pediatric supracondylar humeral fractures: A retrospective cohort study.","authors":"Jie Zhang, Chaohua Li, Ying Zhao","doi":"10.1177/18632521261433873","DOIUrl":"https://doi.org/10.1177/18632521261433873","url":null,"abstract":"<p><strong>Background: </strong>Although risk factors for redisplacement after nonoperative treatment of pediatric supracondylar humeral fractures (SCHFs) are well described, the temporal distribution of this risk remains poorly understood. This study investigated temporal patterns of redisplacement and identified independent predictors using time-to-event analysis.</p><p><strong>Methods: </strong>This retrospective cohort study included 218 children (aged 3-14 years) with Gartland type II (<i>n</i> = 142) and selectively treated type III (<i>n</i> = 76) SCHFs managed with closed reduction and custom-molded triplanar splinting between September 2020 and August 2023. Type III fractures were included only when fluoroscopic stress testing confirmed post-reduction stability. Redisplacement was assessed radiographically and analyzed using Kaplan-Meier and Cox regression methods.</p><p><strong>Results: </strong>Redisplacement occurred in 39 patients (17.9%). Cumulative incidence demonstrated a nonlinear temporal pattern, with most events occurring early after reduction: 87% within the first 14 days, with apparent peaks at days 3-4 and 7-14. In multivariable analysis, initial lateral displacement percentage >85% (hazard ratio [HR] 3.52, 95% confidence interval (CI): 1.82-6.83) and severe soft-tissue swelling (HR 3.08, 95% CI: 1.61-5.89) were independently associated with redisplacement, whereas Gartland classification was not.</p><p><strong>Conclusions: </strong>Redisplacement risk after nonoperative management of pediatric SCHFs appears concentrated in early post-reduction periods. Displacement magnitude and severity of soft-tissue swelling may provide more clinically relevant prognostic information than fracture classification alone. The observed temporal pattern may be influenced by discrete follow-up intervals and requires prospective validation.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261433873"},"PeriodicalIF":1.6,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12992127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482396","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":"Barriers to conducting prospective multicentre studies in paediatric orthopaedics in Europe: Insights from the EPOS Discoid Meniscus (DiMe) project.","authors":"Marco Turati, Marco Crippa, Nicolas Nicolaou, Elena Tassistro, Monika Thüsing, Jaakko Sinikumpu, Aurélien Courvoisier, Joao Jose Cabral, Julio Duart, Benjamin Tschopp, Stéphane Tercier, Gyözö Lehoczky, Simon Vandergugten, Andrei-Vasile Maxim, Nev Davies, Lucrezia Montanari, Stefania Galimberti, Marco Bigoni, Franck Accadbled","doi":"10.1177/18632521261424747","DOIUrl":"https://doi.org/10.1177/18632521261424747","url":null,"abstract":"<p><strong>Purpose: </strong>Prospective multicentre studies represent a cornerstone of evidence-based advancement. However, within orthopaedics, and particularly in the European context of paediatric orthopaedics, such rigorous investigations are notably scarce. This study aims to explore the organizational, regulatory, and resource-related barriers hindering initiation of these crucial studies, using the setup phase of the '<i>EPOS Discoid Meniscus (DiMe) Project: a Prospective Multicentric Cohort Protocol</i>'.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted from 19 centres initially recruited for the European Paediatric Orthopaedic Society DiMe Project (NCT05580315) cohort study. Delays and perceived obstacles encountered during initiation phases: contract negotiation, ethics committee approval, and patient enrolment were assessed. A descriptive analysis was performed to characterize the data. Twelve responding centres (63.2%) were still in the contract negotiation phase, while 36.8% (<i>n</i> = 7) had progressed to the patient enrolment stage.</p><p><strong>Results: </strong>Median duration for contract negotiation was 12 months (Q1-Q3: 7-22), matching ethical approval (Q1-Q3: 3-12). Sixty-three point two percent (<i>n</i> = 12) of responding centres were still in the contract negotiation phase, while 36.8% (<i>n</i> = 7) had progressed to patient enrolment, with 41 patients enrolled across these sites. Formal ethics committee submission was required <i>de novo</i> in 84.2% (<i>n</i> = 16) of responding centres. Major challenges identified included bureaucratic delays, lack of institutional support, absence of dedicated research staff, and prolonged administrative processes.</p><p><strong>Conclusion: </strong>The initiation of European multicentre studies in paediatric orthopaedics is hindered by institutional and regulatory barriers. Streamlining administrative and ethical processes and allocation of resources and personnel are needed to improve efficiency and facilitate successful collaborations.</p><p><strong>Level of evidence: </strong>V - Expert opinion / Cross-sectional survey.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521261424747"},"PeriodicalIF":1.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328193","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":"Virtual reality as a distraction technique in pediatric patients undergoing orthopedic procedures: A systematic review and meta-analysis of randomized controlled trials.","authors":"Abdullah M Alharran, Abdulrahman Emad AlAyyaf, Abdullah Addar, Reggie Hamdy, Yousef Marwan","doi":"10.1177/18632521251414463","DOIUrl":"https://doi.org/10.1177/18632521251414463","url":null,"abstract":"<p><strong>Introduction: </strong>Pain and anxiety are common in pediatric orthopedic procedures such as cast or pin removal, often leading to distress and physiological stress responses. Virtual reality (VR) offers immersive distraction and has shown promise in pediatric procedural care; however, evidence in orthopedic procedures remains limited. This meta-analysis aimed to evaluate the effectiveness of VR compared with standard care in reducing pain, anxiety, and heart rate in children undergoing orthopedic procedures.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Scopus, and Cochrane Library from inception to 20 October 2025 for randomized controlled trials (RCTs) comparing VR distraction and standard care in pediatric patients undergoing orthopedic procedures. Outcomes of interest included pain, anxiety, and heart rate. Statistical analysis was performed with R 4.3.1. Standardized mean differences (SMD) using the Inverse-Variance method and the random-effects method.</p><p><strong>Results: </strong>A total of four RCTs were included in the final meta-analysis, comprising 624 patients, of whom 315 (50%) were distracted with VR during clinical orthopedic procedures (mean age 9.84 years, mean 40% females). In the pooled analysis, VR distraction significantly reduced anxiety (SMD = -0.55, 95% confidence intervals (CI) [-0.76, -0.34]; <i>p</i> < 0.01; <i>I</i> ² = 0%), pain (SMD = -0.43; 95% CI [-0.68, -0.19]; <i>p</i> < 0.01; I² = 44%), and heart rate (SMD = -0.34; 95% CI [-0.60, -0.07]; <i>p</i> = 0.01; I² = 53%).</p><p><strong>Conclusion: </strong>In this meta-analysis of four RCTs including 624 pediatric patients, VR distraction reduced procedural anxiety and, in pooled analyses, was associated with modest but statistically significant reductions in pain and heart rate compared with standard care during predominantly cast-related orthopedic clinic procedures. The integration of this child-friendly, nonpharmacological approach provides enhanced procedural comfort and effective anxiety management.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251414463"},"PeriodicalIF":1.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12935579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328235","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}