Journal of Childrens Orthopaedics最新文献

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One-bone forearm for the treatment of supination contractures secondary to neonatal brachial plexus injury. 单骨前臂用于治疗新生儿臂丛神经损伤继发的上举挛缩。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-28 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241276348
Juliana Rojas-Neira, Camilo Chaves, Paula Díaz-Gallardo, Trong-Quynh Nguyen, Juan J Dominguez-Amador, Francisco Soldado
{"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}
引用次数: 0
Acute postoperative complications after spine deformity correction in patients with Down syndrome. 唐氏综合征患者脊柱畸形矫正术后的急性并发症。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-26 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241277031
Claire W Bonnyman, Lydia N Klinkerman, Brandon A Ramo, Megan E Johnson
{"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}
引用次数: 0
Odontoid fractures in the pediatric population: a systematic review and management algorithm. 小儿牙槽骨骨折:系统回顾和处理算法。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-19 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241283232
Anjali M Prabhat, David S Liu, Lara Cohen, Daniel Gabriel, Kristen E Hines, Grant D Hogue
{"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}
引用次数: 0
Allograft-prosthesis composite after proximal femur bone tumor resection in pediatric age: Is it effective in preserving bone stock? 儿童股骨近端骨肿瘤切除术后的异体移植-假体复合技术:它能有效保留骨量吗?
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-17 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241269338
Domenico Andrea Campanacci, Roberto Scanferla, Francesco Muratori, Federico Scolari, Guido Scoccianti, Angela Tamburini, Giovanni Beltrami
{"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}
引用次数: 0
Femoral neck-shaft angle changes based on the severity of neurologic impairment in children with cerebral palsy and spinal muscular atrophy. 根据脑瘫和脊髓性肌肉萎缩症患儿神经功能受损的严重程度确定股骨颈轴角的变化。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-10 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241277023
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
{"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}
引用次数: 0
Solitary medial proximal tibial osteochondromas cause pes anserinus syndrome in adolescents. 孤独性胫骨近端内侧骨软骨瘤导致青少年拇趾趾骨综合征。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-08 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241276323
Fevzi Saglam, Muhammed Fatih Serttas
{"title":"Solitary medial proximal tibial osteochondromas cause pes anserinus syndrome in adolescents.","authors":"Fevzi Saglam, Muhammed Fatih Serttas","doi":"10.1177/18632521241276323","DOIUrl":"10.1177/18632521241276323","url":null,"abstract":"<p><strong>Objective: </strong>Osteochondromas are common bone tumors with hyaline cartilage-covered heads, arising from cortical and medullary bone. Solitary medial proximal tibial osteochondromas (MPTOs) can cause pes anserinus syndrome via compression. However, the literature lacks comprehensive studies on MPTO-related pes anserinus syndrome and its surgical outcomes.</p><p><strong>Material and method: </strong>The study reviewed 227 patients diagnosed with osteochondroma between January 2018 and January 2022, with 21 patients meeting inclusion criteria: under 19 years, MPTO, surgical excision, histological diagnosis, ≥1-year follow-up. Cases with irregular follow-ups and multiple hereditary exostoses were excluded. Different surgical techniques were employed based on lesion characteristics. Postoperative weight bearing was allowed, and follow-ups involved postoperative complications assessment, clinical data collection, imaging, and functional evaluations using the International Knee Documentation Committee (IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale scoring systems.</p><p><strong>Results: </strong>The study involved 21 adolescents (15 ± 2 years). Lesion types were predominantly pedunculated (86%) and surgical interventions involved pes anserinus split (76%) or tenoplasty (24%). No significant correlations were observed between lesion dimensions and IKDC scores. Split intervention led to a significant improvement in IKDC scores (<i>p</i> < 0.01), while tenoplasty showed similar results (<i>p</i> < 0.05). Athlete status did not affect IKDC scores significantly, but both athletes and non-athletes demonstrated improvements (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The negative impact of MPTOs causing pes anserinus tendinitis on the patient's quality of life and activity can be completely corrected with surgical treatment. Complete pes anserinus tendon cutting and subsequent repair are recommended if they facilitate surgery. The study underscores the importance of surgical management for MPTO-related pes anserinus syndrome and provides insights into the effectiveness of different surgical techniques.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"477-485"},"PeriodicalIF":1.3,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402019","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}
引用次数: 0
Response to Letter to the Editor-Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the paediatric population: A systematic review and meta-analysis of the adverse outcomes (J Child Orthop 2023,17(5),442-452). 对致编辑的信的回复--在治疗儿科闭合性股骨干骨折时使用钢板固定与柔性髓内钉:不良结果的系统回顾和荟萃分析》(J Child Orthop 2023,17(5),442-452).
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-02 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241264133
Abhinav Singh, William Bierrum, Justin Wormald, Manoj Ramachandran, Gregory Firth, Deborah Eastwood
{"title":"Response to Letter to the Editor-Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the paediatric population: A systematic review and meta-analysis of the adverse outcomes (<i>J Child Orthop</i> 2023,17(5),442-452).","authors":"Abhinav Singh, William Bierrum, Justin Wormald, Manoj Ramachandran, Gregory Firth, Deborah Eastwood","doi":"10.1177/18632521241264133","DOIUrl":"10.1177/18632521241264133","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"548-549"},"PeriodicalIF":1.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402018","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}
引用次数: 0
Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the pediatric population: A systematic review and meta-analysis of the adverse outcomes. 在治疗儿科闭合性股骨干骨折时,钢板固定与柔性髓内钉的对比:不良后果的系统回顾和荟萃分析。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-09-02 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241264129
Andreas Rehm, Jehan Butt, Ramy Shehata, Katerina Hatzantoni, Nicholas Judkins
{"title":"Plate fixation versus flexible intramedullary nails for management of closed femoral shaft fractures in the pediatric population: A systematic review and meta-analysis of the adverse outcomes.","authors":"Andreas Rehm, Jehan Butt, Ramy Shehata, Katerina Hatzantoni, Nicholas Judkins","doi":"10.1177/18632521241264129","DOIUrl":"10.1177/18632521241264129","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"546-547"},"PeriodicalIF":1.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570606","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}
引用次数: 0
Achondroplasia current concept of orthopaedic management. 软骨发育不全症矫形治疗的当前概念。
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-08-27 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241269340
Gabriel T Mindler, Alexandra Stauffer, Catharina Chiari, Kiril Mladenov, Joachim Horn
{"title":"Achondroplasia current concept of orthopaedic management.","authors":"Gabriel T Mindler, Alexandra Stauffer, Catharina Chiari, Kiril Mladenov, Joachim Horn","doi":"10.1177/18632521241269340","DOIUrl":"10.1177/18632521241269340","url":null,"abstract":"<p><p>Achondroplasia, the most common form of inherited disproportionate short stature, is caused by mutations in the fibroblast growth factor receptor 3 gene. The typical clinical features of achondroplasia include short stature, rhizomelic disproportion, joint hyperlaxity, spinal deformity and deformity of the upper and lower limbs. The latter are among the challenges of state-of-the-art orthopaedic treatment plans and significantly contribute to the burden of the disease in individuals with achondroplasia. Multidisciplinary preoperative individual decision-making concerning surgical interventions should be considered. New medical treatments for achondroplasia have been developed and (some) have been approved for clinical use in several countries. While the number of research articles on achondroplasia is increasing rapidly, many unknown or controversial orthopaedic topics remain. Furthermore, in view of new medical developments with improvements in growth and potentially other effects, the timing and algorithms of orthopaedic treatments (e.g. guided growth, limb lengthening and deformity correction) need to be re-evaluated. While standing height is the primary research focus in medical therapy, it is crucial to comprehensively assess orthopaedic parameters in this multifactorial disease. The current treatment of patients with achondroplasia requires specialised multidisciplinary centres with transitional care and individual orthopaedic counselling.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"461-476"},"PeriodicalIF":1.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402112","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}
引用次数: 0
Initial management of pediatric Gustilo-Anderson type I upper limb open fractures: Are antibiotics enough? 小儿古斯蒂洛-安德森I型上肢开放性骨折的初期处理:抗生素就够了吗?
IF 1.3 4区 医学
Journal of Childrens Orthopaedics Pub Date : 2024-08-27 eCollection Date: 2024-10-01 DOI: 10.1177/18632521241262973
Olufemi Olatigbe, Sabba Hussain, Anna Bridgens, Shamim Umarji, Caroline Hing, Fergal Monsell, Yael Gelfer
{"title":"Initial management of pediatric Gustilo-Anderson type I upper limb open fractures: Are antibiotics enough?","authors":"Olufemi Olatigbe, Sabba Hussain, Anna Bridgens, Shamim Umarji, Caroline Hing, Fergal Monsell, Yael Gelfer","doi":"10.1177/18632521241262973","DOIUrl":"10.1177/18632521241262973","url":null,"abstract":"<p><strong>Purpose: </strong>The British Orthopaedic Association Standards for Trauma-4 includes pediatric Gustilo-Anderson type I upper limb open fractures and recommends surgical debridement as the preferred method of treatment. The reported incidence of fracture-related infection is low in patients with this injury pattern and the evidence supporting debridement is therefore weak. The aim of this systematic review is to compare infection rates between non-operative management and operative debridement in children with Gustilo I upper limb fractures who did not require surgical fixation.</p><p><strong>Methods: </strong>A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligibility criteria included patients <18 years with Gustilo-Anderson type I upper limb fractures managed with either antibiotics alone or with operative debridement. Patients in whom the fracture was stabilized were excluded, and the Risk Of Bias In Non-randomized Studies-of Interventions tool was used to evaluate bias.</p><p><strong>Results: </strong>Eleven, predominantly retrospective studies were identified, involving 537 patients with fractures including 466 forearm, 70 wrist, and one humerus. A non-operative management strategy was used in 293 patients with one superficial infection (0.3%). Operative debridement was used in 244 patients with one superficial infection (0.4%).</p><p><strong>Conclusion: </strong>The optimal management of Gustilo-Anderson type I pediatric upper limb fractures is unclear. Based on the current evidence base, surgical debridement does not appear to reduce the rate of infection. The decision to manage these injuries aggressively should therefore be individualized to consider patient age, mechanism, and clinical extent of injury.</p><p><strong>Level of evidence: </strong>level II.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"502-509"},"PeriodicalIF":1.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513544","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}
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