Journal of Childrens Orthopaedics最新文献

{"title":"Complications of treatment in paediatric forearm fractures: A 30-year review of compensation claims.","authors":"Caroline Dikert, Yrjänä Nietosvaara, Petra Grahn","doi":"10.1177/18632521261438638","DOIUrl":"10.1177/18632521261438638","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to evaluate the risk and contributing factors leading to compensation claims and permanent disability following complications of treatment in the management of paediatric forearm fractures.</p><p><strong>Methods: </strong>Data were gathered from the Finnish Patient Insurance Centre (PIC), which reviews all claims regarding potential treatment complications in Finland. PIC grants monetary compensation based on excess pain or permanent cosmetic and/or functional disability. We evaluated all claims concerning paediatric forearm fracture management in children under 16 years of age between 1990 and 2019.</p><p><strong>Results: </strong>One hundred and forty-four (58 distal forearm, 55 forearm shaft and 31 proximal forearm) of 226 claims were compensated for a total of 156 separate treatment complications. The overall calculated risk for sustaining a compensated treatment complication was 0.1%. Unsatisfactory standard of surgery was the reason for the compensation in 29/55 children with forearm shaft fractures and delayed diagnosis in 20/31 children with proximal forearm fractures, respectively. Compensation was granted for permanent functional disability to 35 children and for permanent cosmetic disability to 62 children. Permanent functional disability was compensated in 6/58 children with distal, 19/55 with shaft and 10/31 with proximal forearm fractures.</p><p><strong>Conclusions: </strong>The risk of sustaining a compensated complication of treatment after a paediatric forearm fracture is low. Forearm shaft and proximal forearm fractures are associated with a clearly higher risk of iatrogenic injuries with permanent disability than distal forearm fractures.</p><p><strong>Study significance: </strong>This paper is significant due to the lack of previous publications on this topic and can contribute to minimizing treatment complications in the future.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"379-386"},"PeriodicalIF":1.8,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790006","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":"Letter to the editor: \"Forearm fractures treated with elastic stable intramedullary nailing: Is casting still necessary?\"","authors":"Marko Bašković, Tonko Čolić, Domagoj Pešorda","doi":"10.1177/18632521261444252","DOIUrl":"10.1177/18632521261444252","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"440-442"},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724730","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":"Distal metaphyseal horizontal tibial fractures in children.","authors":"Halil Kara, Maija Jääskelä, Topi Laaksonen, Petra Grahn, Ilkka Helenius, Matti Mikael Ahonen","doi":"10.1177/18632521261436703","DOIUrl":"10.1177/18632521261436703","url":null,"abstract":"<p><strong>Background: </strong>Pediatric horizontal distal metaphyseal tibial fractures are relatively uncommon injuries. While nonoperative treatment remains the standard of care for most cases, certain fracture patterns may carry a higher risk of treatment failure, and optimal treatment strategies are still unclear. The aim of this study was to investigate the frequency, anatomical location of these fractures within the metaphysis, and risk factors associated with treatment failure in nonoperative management.</p><p><strong>Methods: </strong>A retrospective, registry-based cohort study was conducted to evaluate treatment success in 86 consecutive pediatric patients with distal metaphyseal horizontal tibial fractures between 2014 and 2023. Demographic, clinical, and radiographic data were analyzed. Logistic regression analysis was performed to identify independent predictors of nonoperative treatment failure. Nonoperative treatment failure was defined as the requirement for cast wedging, re-reduction, or surgical intervention due to loss of reduction or coronal angulation greater than 10° observed on final follow-up radiographs.</p><p><strong>Results: </strong>Of the 86 patients included, 70 (81%) were initially treated non-operatively, while 16 (19%) underwent primary surgical fixation. The overall failure rate in the nonoperative group was 35.3% (25/70). Multivariable logistic regression identified 3 independent predictors of treatment failure: age >11 years (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 1.3-81.7; <i>p</i> = 0.030), the presence of a complete fibular fracture (adjusted OR, 6.1; 95% CI, 1.2-30.1; <i>p</i> = 0.027), and initial coronal angulation >10° (adjusted OR, 4.9; 95% CI, 1.1-23.0; <i>p</i> = 0.042). The complication rate was significantly higher in the operative group compared to the nonoperative group (18.3% vs. 4.3%; relative risk, 4.4; 95%CI 1.0-19.7, <i>p</i> = 0.042).</p><p><strong>Conclusions: </strong>Nonoperative treatment remains an effective approach for the majority of pediatric horizontal distal metaphyseal tibial fractures. However, patients with older age, concomitant complete fibular fractures, or marked initial angulation may benefit from early surgical intervention to mitigate the risk of treatment failure.</p><p><strong>Level of evidence: </strong><b>IV</b>.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"402-410"},"PeriodicalIF":1.8,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693541","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":"Lateral malleolus reconstruction for fibular hemimelia as a prevention of foot deformity recurrence following tibial lengthening-A long-term analysis.","authors":"Milud Shadi, Piotr Janusz, Eliza Kortus, Tomasz Kotwicki","doi":"10.1177/18632521261432859","DOIUrl":"10.1177/18632521261432859","url":null,"abstract":"<p><strong>Purpose: </strong>Management of ankle deformity and instability remains a challenge in patients with severe fibular hemimelia (FH). This study aims to evaluate the long-term effectiveness of lateral malleus reconstruction using the fibular anlage in correcting ankle malalignment and preventing the recurrence of deformity following leg lengthening.</p><p><strong>Methods: </strong>Ten patients (age: 3.3 years, 0.8-7.7) with a severe FH, equino-valgus foot deformity, ankle instability, and tibial bowing underwent tibia and ankle realignment and lateral malleolus reconstruction. Afterward, all patients underwent tibial lengthening, and the mean lengthening was 9.9 cm (5.0-16.5). Foot and ankle alignment was evaluated clinically and radiographically before surgery, postoperatively, and at a follow-up (10.0 years, 9.2-11.7). Recurrences, additional procedures, and complications were analyzed. Quality of life was assessed using the Limb Deformity-Scoliosis Research Society (LD-SRS) questionnaire.</p><p><strong>Results: </strong>At the last follow-up, all patients present neutral heel position or slight valgus (three patients 5° and one patient 10°). No additional procedures were performed except medial malleus temporary epiphysiodesis in two patients. The foot was plantigrade in six patients, presented equinus 10° in two and 20° in two, due to equinus, supra-malleolar osteotomy was performed in three patients. Significant improvement of radiological alignment was found and maintained in all parameters. The mean LD-SRS score was 3.78 at follow-up.</p><p><strong>Conclusion: </strong>Lateral malleolus reconstruction provided good clinical, radiological, and functional outcomes. Due to the tendency for recurrence, additional procedures may be necessary.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"349-358"},"PeriodicalIF":1.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter: Assessment of postoperative range of motion in pediatric patients undergoing surgical reduction and fixation of lateral condyle fractures.","authors":"Gabrielle Rogie, Timothy Borden, Lindsay Crawford, Surya Mundluru, Brennan Roper, Rohini Mahajan Vanodia, Shiraz Younas","doi":"10.1177/18632521261436242","DOIUrl":"10.1177/18632521261436242","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"309-310"},"PeriodicalIF":1.8,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596554","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":"Open supracondylar humerus fractures in children: Associated injuries and clinical outcomes.","authors":"Abdulsamet Emet, Grace Armet, Connor Luck, Taha Aksoy, Stephen A Mendelson, Ozgur Dede","doi":"10.1177/18632521261435431","DOIUrl":"10.1177/18632521261435431","url":null,"abstract":"<p><strong>Purpose: </strong>Supracondylar humerus (SCH) fractures are common, but they rarely present as open fractures. This study aimed to evaluate the incidence, associated injuries, and postoperative outcomes of open SCH fracture management in the pediatric population.</p><p><strong>Methods: </strong>Children with open SCH fractures treated at a single institution between January 2005 and January 2025 were included in this study. Electronic medical records were reviewed to collect demographic data, fracture characteristics, surgical details, and postoperative outcomes. All patients underwent wound irrigation and debridement, open-assisted reduction, and K-wire fixation under general anesthesia. Postoperative care included immobilization, follow-up for fracture healing and range of motion (ROM), and selective physical therapy. Data were analyzed using standard statistical methods, with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among 3053 SCH fractures, 1.1% were open fractures (15 males, 19 females), with a mean age of 7.7 ± 2.4 years. The nondominant left arm was affected in 82.4% of cases, and the most common mechanism of injury was a fall from height (64.7%). Extension-type modified Gartland type III fractures were observed in 91.2% of patients, and Gustilo-Anderson type II was the most frequent open fracture classification (44.1%). Associated nerve injuries occurred in 20.6% of patients, and vascular repair was required in 5.9%. The mean time to pin removal was 4.7 ± 1 weeks. Overall, 26.5% of patients underwent reoperation, 26.5% experienced ≥10° reduction in flexion-extension ROM.</p><p><strong>Conclusion: </strong>Open SCH fractures are rare yet serious injuries, causing peripheral nerve and vascular damage that require surgical repair.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"277-284"},"PeriodicalIF":1.8,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596545","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":"Comparison of bone age between both limbs in patients with congenital hemihyperplasia or hemihypoplasia: A retrospective study.","authors":"Wonik Lee, Jung Min Ko, Ki Ill Song, Su Yeon Yu, Mi Hyun Song, Tae-Joon Cho, Chang Ho Shin","doi":"10.1177/18632521261434091","DOIUrl":"10.1177/18632521261434091","url":null,"abstract":"<p><strong>Purpose: </strong>Side-to-side differences in bone age may exist due to somatic mosaicism in congenital hemihyperplasia or hemihypoplasia. We aimed to assess bone age differences between limbs in these conditions.</p><p><strong>Methods: </strong>We retrospectively identified 118 children who underwent molecular testing for congenital hemihyperplasia or hemihypoplasia. Diagnoses included Beckwith-Wiedemann syndrome (BWS) (<i>n</i> = 34), Silver-Russell syndrome (<i>n</i> = 14), PIK3CA-related overgrowth spectrum (n = 14), and idiopathic isolated hemihyperplasia or hemihypoplasia (<i>n</i> = 56). Hand and knee bone ages were compared between the right and left limbs and between the longer and shorter limbs.</p><p><strong>Results: </strong>In the overall cohort or each disease group, there was no difference in hand or knee bone age between the right and left limbs. However, the hand bone age of the longer limb was 1.2 ± 2.6 months older than that of the shorter limb (<i>p</i> = 0.005). In subgroup analysis, patients with BWS showed older knee (7.1 ± 9.9 months, <i>p</i> = 0.031) and hand (3.2 ± 2.5 months, <i>p</i> = 0.026) bone ages in the longer limb compared to the shorter limb. No significant differences were observed in the other disease groups.</p><p><strong>Conclusions: </strong>Pediatric patients with congenital hemihyperplasia or hemihypoplasia generally show minimal bone age differences between limbs. However, in BWS, the longer limb may have a bone age several months older than the shorter limb.</p><p><strong>Significance of study: </strong>Surgeons need to consider potential side-to-side differences in bone age when estimating remaining growth and determining the timing for epiphysiodesis in these patients.</p><p><strong>Level of evidence: </strong>III-Study of nonconsecutive patients.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"337-348"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583096","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":"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":"307-308"},"PeriodicalIF":1.8,"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":"266-276"},"PeriodicalIF":1.8,"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":"247-255"},"PeriodicalIF":1.8,"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}