Journal of Childrens Orthopaedics最新文献

{"title":"Metal implants in children.","authors":"Peter John Cundy, Nicole Williams","doi":"10.1177/18632521241293954","DOIUrl":"10.1177/18632521241293954","url":null,"abstract":"<p><strong>Background: </strong>Metal implants are increasingly used in children for trauma and deformity correction. This review outlines the current knowledge on the types of metals used and explores reasons for removal and the potential for long-term health issues of metal implants.</p><p><strong>Methods: </strong>The literature pertaining to these aspects was studied and summarised in this review.</p><p><strong>Results: </strong>Types of metals used have evolved as well as the development of children-specific implants. Improvements in deformity correction are measurable with likely improved outcomes and reduced health costs. Indications for metal implant removal following successful treatment remain ill-defined; however, the risks of removal are known with a minimum 6% complication rate. Health costs could be reduced by around 6% by judicious decisions to leave metal in place. Implant removal should only be encouraged in the presence of infection, mechanical failure or symptoms that are truly attributable to the implant. In the domain of spinal implants, there is evidence of significant metal ion release, most notably titanium which remains elevated to many times baseline levels beyond 2 years. The detection of titanium at low levels requires special techniques. The long-term health effects on patients and/or their offspring are not well defined, although well described in animal models.</p><p><strong>Conclusion: </strong>The risks of metal removal are significant. Clinicians need to be aware of potential health risks in the use of metal implants and the potential for covert toxicity effects in children especially with their long life ahead. There is a need for greater awareness of metal alloy composition and implant design to minimise risks.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"557-568"},"PeriodicalIF":1.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633052","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":"Changes in diagnostics and treatment pathways for developmental dysplasia of the hip after the introduction of national guidelines: An updated questionnaire amongst paediatric orthopaedic surgeons in The Netherlands.","authors":"Mohamed Mai, Melinda Meh Witbreuk, Pieter Bas de Witte, Christiaan Ja van Bergen","doi":"10.1177/18632521241276367","DOIUrl":"10.1177/18632521241276367","url":null,"abstract":"<p><strong>Purpose: </strong>Diagnostics and treatment pathways for developmental dysplasia of the hip are highly variable in clinical practice. Recently, two national guidelines were developed in the Netherlands, providing a uniform protocol for the diagnosis and treatment of developmental dysplasia of the hip in children under the age of 1 year. The aim of this survey study was to assess whether diagnostic and treatment strategies have changed amongst paediatric orthopaedic surgeons in the Netherlands compared to a similar survey study in 2011, after the introduction of the guidelines.</p><p><strong>Methods: </strong>A web-based online questionnaire was developed and shared amongst the members of the Dutch Paediatric Orthopaedic Society. The questions concerned the diagnosis and treatment of developmental dysplasia of the hip, ranging from mildly dysplastic to dislocated hips, in children under the age of 1 year. We used a questionnaire similar to the previous study and evaluated the results.</p><p><strong>Results: </strong>Thirty-four participants completed the survey. Regarding diagnosis and follow-up, ultrasonography was generally applied for children younger than 6 months, while radiography was more frequently used for children aged 6-12 months. In 2011, radiography was more widely applied in all age groups. Initial treatment for dysplastic, stable hips was mostly active monitoring, while this was generally a rigid splint in 2011. For dislocated unstable hips, the first step in treatment was generally the Pavlik harness, as in 2011.</p><p><strong>Conclusion: </strong>The diagnostic and treatment pathways of developmental dysplasia of the hip in children under the age of 1 year seem to have partially changed amongst Dutch paediatric orthopaedic surgeons compared to 2011, after the publication of new guidelines.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"600-606"},"PeriodicalIF":1.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633039","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":"<i>In situ</i> pinning or modified Dunn procedure? Which one is superior in slipped capital femoral epiphysis surgery? A case-control study including only stable/moderate cases.","authors":"Ali Sisman, Caner Poyraz, Bilal Akbas, Mutlu Cobanoglu, Sevki Oner Savk, Emre Cullu","doi":"10.1177/18632521241295869","DOIUrl":"10.1177/18632521241295869","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to compare the clinical and radiologic results of <i>in situ</i> pinning and modified Dunn procedure methods in stable-moderate slipped capital femoral epiphyses surgery.</p><p><strong>Methods: </strong>Slipped capital femoral epiphyses cases between January 2000 and December 2022 were retrospectively analyzed. Stable and moderate cases treated with <i>in situ</i> pinning or modified Dunn procedure and those with a follow-up period longer than 1 year were included. Two groups were formed: the <i>in situ</i> pinning group and the modified Dunn procedure group. Radiologically, postoperative alpha angle, Southwick angle, avascular necrosis, and osteoarthritis rates were compared. Clinically, Harris Hip Score and Merle d'Aubigné score were compared. Total complications were evaluated.</p><p><strong>Results: </strong>The <i>in situ</i> pinning group consisted of 28 patients and the modified Dunn procedure group consisted of 17 patients. The groups were similar in terms of age, gender, affected side, body mass index, Fahey/O'Brien Classification, preoperative slip angles, and follow-up time. Operation time was shorter in the <i>in situ</i> pinning group (<i>p</i> < 0.001). Postoperative Southwick and alpha angle were lower in the modified Dunn procedure group (<i>p</i> < 0.001). In clinical outcomes, Merle d'Aubigné and Harris Hip Score were higher in the <i>in situ</i> pinning group (<i>p</i> = 0.013, <i>p</i> = 0.005, respectively). The rate of avascular necrosis was higher in the modified Dunn procedure group (<i>p</i> = 0.048). There was no difference between the groups in terms of total complications and osteoarthritis.</p><p><strong>Conclusions: </strong><i>In situ</i> pinning has an advantage over the modified Dunn procedure in the treatment of stable-moderate slipped capital femoral epiphyses due to shorter operative time, better clinical outcomes, and fewer avascular necrosis rates. Although Southwick and alpha angle measurements were found to be higher after <i>in situ</i> pinning compared to the modified Dunn procedure, this does not constitute a significant disadvantage in terms of osteoarthritis development in the mid-term.</p><p><strong>Level of evidence: </strong>Level III, case-control study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"607-614"},"PeriodicalIF":1.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633033","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":"The impact of neurological impairment and tone on hip joint development.","authors":"Sadettin Ciftci, Luiz Carlos Almeida da Silva, Jason J Howard, Michael Wade Shrader, Freeman Miller","doi":"10.1177/18632521241291768","DOIUrl":"10.1177/18632521241291768","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to define how different force environments by neuromuscular diagnosis (hypertonic versus hypotonic) impact the growth and morphology of the proximal femoral and acetabular regions relative to typically developing children.</p><p><strong>Methods: </strong>Children with cerebral palsy and spinal muscular atrophy were compared with typically developing children aged 6 months to 11 years. Routine pelvic radiographs were evaluated using measures of hip geometry for the proximal femur and acetabulum. The data were analyzed using general linear models to estimate the developmental patterns according to age and diagnosis.</p><p><strong>Results: </strong>One hundred eighty-four children met the inclusion criteria: 58 spastic cerebral palsy Gross Motor Function Classification System I-V (263 hips), 32 spinal muscular atrophy (79 hips)), and 94 typically developing (187 hips) were included with a mean age of 4.9 ± 3.1 years. Using spinal muscular atrophy as a reference, significant differences in proximal femoral development included long thin versus short neck (<i>p</i> < 0.01) and round versus flat epiphysis (<i>p</i> = 0.001). A thin neck-wide epiphysis was found in spinal muscular atrophy versus thick neck-small epiphysis for typically developing (<i>p</i> < 0.05). The ratio of acetabular width to proximal femoral epiphysis width differed significantly for typically developing (<i>p</i> = 0.001) compared with cerebral palsy and spinal muscular atrophy. There was a negative correlation between migration percentage and acetabular width to epiphysis width in children with cerebral palsy, but no correlation in children with spinal muscular atrophy.</p><p><strong>Conclusion: </strong>Hip geometry was impacted by the force environment experienced during growth. These findings emphasize the crucial roles of gross motor function, muscle tone, and strength differences in determining hip morphology.</p><p><strong>Level of evidence: </strong>III, retrospective case control.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"615-621"},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633065","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":"Core psychosocial insights, challenges, and opportunities in the orthopedic surgery care of children and adolescents.","authors":"Amber A Hamilton, Jidapa Wongcharoenwatana, Jason S Hoellwarth, Adam Geffner, Rena Mehta, B Sue Epstein, Peter D Fabricant, Austin T Fragomen, S Robert Rozbruch","doi":"10.1177/18632521241278159","DOIUrl":"10.1177/18632521241278159","url":null,"abstract":"<p><strong>Purpose: </strong>This is the second phase in an investigation of the psychosocial impact of orthopedic surgery on adolescents. What are the core psychosocial factors that shape the experience of adolescent patients aged 11-18 who are undergoing orthopedic surgery?</p><p><strong>Methods: </strong>Two 43-question surveys (preoperative and postoperative) were developed as modified versions of the survey used in phase 1. The preoperative survey was administered 2 weeks before surgery. The postoperative survey was administered 6 weeks later. Responses were collected from free-response and Likert-scale questions exploring patient-physician relationships, office visits/hospital stays, family, peers, academics, sports, and surgical expectations. The survey was administered prospectively to patients aged 11-18 undergoing limb lengthening/reconstruction, pediatric, spine, sports, or hand/upper extremity orthopedic surgery. In all, 135 patients were identified; 105 were enrolled and completed both surveys.</p><p><strong>Results: </strong>There were some statistically significant changes in responses to questions regarding office visits/hospital stays, patient-physician relationships, friends/community, academic performance, and expectations for surgical experience throughout the perioperative period. There were no statistically significant changes in responses to questions regarding the role of parent/family and sports. There was no statistically significant difference between the female and male genders or between age groups in any of the domains. Overall statistical significance in this study did not consistently correlate to clinical significance.</p><p><strong>Conclusion: </strong>Adolescents require psychosocial support from their surgeons, caregivers, and peers in addition to respect for their independence and personal needs.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"569-582"},"PeriodicalIF":1.3,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633045","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":"Effect of Pavlik harness on motor developmental milestones: Comment on a study by Ucpunar et al.","authors":"Sitanshu Barik, Vishal Kumar, Vikash Raj","doi":"10.1177/18632521241291770","DOIUrl":"10.1177/18632521241291770","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"652-653"},"PeriodicalIF":1.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633049","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":"Outcomes of open reduction for hip dislocations in children with connective tissue disorders.","authors":"Vineet M Desai, Christopher J DeFrancesco, Stefano Cardin, Carter E Hall, Wudbhav N Sankar","doi":"10.1177/18632521241287026","DOIUrl":"10.1177/18632521241287026","url":null,"abstract":"<p><strong>Purpose: </strong>While children with hypermobility and/or ligamentous laxity due to coexisting connective tissue disorders might be expected to have worse outcomes after open reduction for hip dislocations, there is minimal prior research on this topic.</p><p><strong>Methods: </strong>All open reduction surgeries for hip dislocations performed at a single urban, tertiary-care children's hospital from 2009 to 2023 were reviewed retrospectively. Those with connective tissue disorders secondary to a diagnosed syndrome or genetic disorder were included. Patients with <1 year of follow-up or hip instability in the setting of Trisomy 21 were excluded. Clinical and radiographic data was collected. Instances of re-dislocation, proximal femoral growth disturbance, residual acetabular dysplasia, and arthrofibrosis were recorded.</p><p><strong>Results: </strong>Twenty-three hips (15 patients) were included. Mean age at the time of surgery was 19.6 months (Range: 8.2-36.0 months), and mean follow-up was 4.3 years. The most common connective tissue disorder condition included was Ehlers-Danlos syndrome (13%). A majority of open reductions were performed via an anterior approach (96%). Seven hips (30%) underwent a concomitant pelvic osteotomy without femoral osteotomy and seven hips (30%) underwent both pelvic and femoral osteotomies. Twenty-two hips (96%) were International Hip Dysplasia Institute grade 1 at the final follow-up. Re-dislocation occurred in four hips (17%); eight hips (35%) demonstrated residual acetabular dysplasia, five hips (22%) demonstrated proximal femoral growth disturbance, and nine hips (39%) developed stiffness postoperatively.</p><p><strong>Conclusions: </strong>Patients with connective tissue disorders and ligamentous laxity have comparable rates of residual acetabular dysplasia, proximal femoral growth disturbance, and (surprisingly) stiffness as typical developmental dysplasia of the hip following open hip reduction surgery. Although the re-dislocation rate in the connective tissue disorders group was approximately 2-3 times higher, the difference did not reach statistical significance. Given that the study was limited by a low sample size, however, it is possible that the findings of no difference in residual acetabular dysplasia and proximal femoral growth disturbance were potentially due to a lack of power.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"583-589"},"PeriodicalIF":1.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633057","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":"Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?","authors":"Andreas Rehm, Matthew Seah, Silvester Kabwama, Victoria Dorrell, Sebastian Ho, Elizabeth Ashby","doi":"10.1177/18632521241283235","DOIUrl":"10.1177/18632521241283235","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"550-551"},"PeriodicalIF":1.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402017","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":"Pre-operative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?","authors":"Nicholas C Uren, Julia Judd, Edward A Lindisfarne, Kirsten G Elliott, Alexander Aarvold","doi":"10.1177/18632521241283249","DOIUrl":"10.1177/18632521241283249","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"552-553"},"PeriodicalIF":1.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513545","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":"One-bone forearm for the treatment of supination contractures secondary to neonatal brachial plexus injury.","authors":"Juliana Rojas-Neira, Camilo Chaves, Paula Díaz-Gallardo, Trong-Quynh Nguyen, Juan J Dominguez-Amador, Francisco Soldado","doi":"10.1177/18632521241276348","DOIUrl":"10.1177/18632521241276348","url":null,"abstract":"<p><strong>Background: </strong>The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°.</p><p><strong>Methods: </strong>In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique.</p><p><strong>Results: </strong>The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications.</p><p><strong>Conclusion: </strong>Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities.</p><p><strong>Case series level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"540-545"},"PeriodicalIF":1.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402016","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}