Journal of Childrens Orthopaedics最新文献

{"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}

{"title":"Acute postoperative complications after spine deformity correction in patients with Down syndrome.","authors":"Claire W Bonnyman, Lydia N Klinkerman, Brandon A Ramo, Megan E Johnson","doi":"10.1177/18632521241277031","DOIUrl":"10.1177/18632521241277031","url":null,"abstract":"<p><strong>Introduction: </strong>Down syndrome, or trisomy 21, is the most diagnosed chromosomal abnormality and is associated with multiple orthopedic concerns, including scoliosis. We sought to examine the surgical treatment of scoliosis associated with Down syndrome with an emphasis on specific complications in this population.</p><p><strong>Methods: </strong>A retrospective review of 13 patients with Down syndrome who underwent surgical intervention for spinal deformity between 2000 and 2018 were identified. Postoperative complications were classified using the modified Clavien-Dindo-Sink system. Perioperative and final follow-up radiographic data were analyzed.</p><p><strong>Results: </strong>The mean age at surgery was 14.2 years (11-19) with a mean follow-up of 3.6 years (0.4-6.2) at the time of data collection. Seven (54%) patients had postoperative complications, all related to wound healing. Three patients (23%) had major complications (Clavien-Dindo-Sink grade ≥3). These included one deep surgical site infection, one hematoma, and one seroma, all requiring surgical drainage. Four additional patients (31%) had minor complications (Clavien-Dindo-Sink grade ≤2).</p><p><strong>Discussion: </strong>Surgical intervention for scoliosis in patients with Down syndrome is associated with high complication rates despite the use of more modern surgical techniques and implant types. Complications in this cohort primarily involved wound healing, whereas previous studies described high rates of postoperative implant failure, pseudoarthrosis, and significant curve progression, which were not experienced by the patients in this study. Although the etiology of wound-related complications is unknown, awareness of this risk may help surgeons optimize surgical technique, postoperative monitoring, and preoperative counseling of families.</p><p><strong>Level of evidence: </strong>IV-single-institution retrospective case series.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"495-501"},"PeriodicalIF":1.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402113","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":"Odontoid fractures in the pediatric population: a systematic review and management algorithm.","authors":"Anjali M Prabhat, David S Liu, Lara Cohen, Daniel Gabriel, Kristen E Hines, Grant D Hogue","doi":"10.1177/18632521241283232","DOIUrl":"10.1177/18632521241283232","url":null,"abstract":"<p><strong>Purpose: </strong>The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm.</p><p><strong>Methods: </strong>A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated.</p><p><strong>Results: </strong>In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach.</p><p><strong>Conclusions: </strong>Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"486-494"},"PeriodicalIF":1.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402115","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":"Allograft-prosthesis composite after proximal femur bone tumor resection in pediatric age: Is it effective in preserving bone stock?","authors":"Domenico Andrea Campanacci, Roberto Scanferla, Francesco Muratori, Federico Scolari, Guido Scoccianti, Angela Tamburini, Giovanni Beltrami","doi":"10.1177/18632521241269338","DOIUrl":"https://doi.org/10.1177/18632521241269338","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to answer the following questions. What was functional results of pediatric patients receiving a short stem allograft-prosthesis composite of the proximal femur? What was complication rate and revision-free implant survival? Was it possible to preserve the bone stock of the proximal femur in pediatric patients?</p><p><strong>Methods: </strong>We reviewed 10 pediatric patients treated with proximal femur resection for a primary bone tumor and reconstruction with short stem allograft-prosthesis composite, with at least 24 months follow-up. The median age was 9 years (4-13) at surgery. The mean resection length was 15 cm (6-29). In six cases, fixation was performed with a short plate positioned under the great trochanter while in four cases a long plate extended over the great trochanter was employed.</p><p><strong>Results: </strong>Nine complications that required surgical revision were assessed in six patients (one wound dehiscence, two nonunions, two fractures, one acetabular wear, three hypometria), while allograft-prosthesis composite removal was required in three patients. The revision-free survival was 57% (95% confidence interval 33%-100%) at 5 and 10 years. The graft removal-free survival was 75% (95% confidence interval 50%-100%) at 5 and 10 years. The mean Musculo-Skeletal Tumor Society Score was 28 (20-30).</p><p><strong>Conclusions: </strong>Allograft-prosthesis composites with short stem and compression plate represents an effective reconstructive option after proximal femur resection for primary bone tumors in growing patients, preserving bone stock. The use of a compression plate extended over the greater trochanter seemed to reduce failure rate.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"531-539"},"PeriodicalIF":1.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481739","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":"Femoral neck-shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy.","authors":"Luiz Carlos Almeida da Silva, Yusuke Hori, Burak Kaymaz, Kenneth J Rogers, Arianna Trionfo, James Richard Bowen, Jason J Howard, Michael Wade Shrader, Freeman Miller","doi":"10.1177/18632521241277023","DOIUrl":"10.1177/18632521241277023","url":null,"abstract":"<p><strong>Introduction: </strong>The neck-shaft angle and head-shaft angle in children with varying levels of neurological disability were evaluated to define change over different ages.</p><p><strong>Methods: </strong>Children aged 1-12 years with spastic cerebral palsy, spinal muscular atrophy types 1 and 2, or typical development were reviewed to evaluate the neck-shaft angle and head-shaft angle. Patients were divided into five groups: Gross Motor Function Classification System levels I and II, Gross Motor Function Classification System level III, Gross Motor Function Classification System levels IV and V, spinal muscular atrophy types 1 and 2, and typical development. A linear mixed model was utilized to evaluate neck-shaft angle and head-shaft angle.</p><p><strong>Results: </strong>Data from 196 children (mean age 4.8 ± 4.5 years) were included. Gross Motor Function Classification System levels I and II: 22 children, 130 hip radiographs measured, neck-shaft angle 143.7 ± 7.4, and head-shaft angle 160.0 ± 7.1. Gross Motor Function Classification System level III: 8 children, 33 hips evaluated, neck-shaft angle 153.1 ± 4.3, and head-shaft angle 163.4 ± 4.2. Gross Motor Function Classification System levels IV and V: 30 children, 137 hip radiographs measured, neck-shaft angle 156.4 ± 5.6, and head-shaft angle 167.9 ± 6.8. Spinal muscular atrophy types 1 and 2: 32 children, 83 hip radiographs measured, neck-shaft angle 161.9 ± 9.7, and head-shaft angle 173.4 ± 7.4. Typical development: 104 children, 222 hip radiographs measured, neck-shaft angle 138.6 ± 7.0, and head-shaft angle 156.4 ± 5.9. There were significant statistical differences when comparing neck-shaft angle and head-shaft angle.</p><p><strong>Conclusion: </strong>As children grow, neck-shaft angle and head-shaft angle tend to decrease in typical development and Gross Motor Function Classification System levels I and II groups. However, in low-tone (spinal muscular atrophy types 1 and 2) and high-tone groups (Gross Motor Function Classification System levels IV and V), neck-shaft angle and head-shaft angle tend to increase with age. In both low-tone and high-tone groups, coxa valga is observed. When evaluating the effect of proximal femur-guided growth, these defined normal growth patterns should be considered.</p><p><strong>Level of evidence: </strong>Level III Retrospective comparative study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"523-530"},"PeriodicalIF":1.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570605","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}