Journal of Childrens Orthopaedics最新文献

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"title":"Effect of femoral derotational osteotomy in patients with idiopathic increased femoral anteversion on joint loading and muscular demands.","authors":"Nathalie Alexander, Johannes Cip, Reinald Gh Brunner, Enrico De Pieri","doi":"10.1177/18632521241269339","DOIUrl":"10.1177/18632521241269339","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyse the effect of the femoral derotational osteotomy (FDRO) on joint kinematics, kinetics, joint and muscle forces, and muscle moments in patients with idiopathic increased femoral anteversion compared with typically developing children (TDC).</p><p><strong>Methods: </strong>In this retrospective study, 17 patients (25 limbs, 13.2 ± 2.2 years, femoral anteversion = 49.0° ± 7.1°) were compared to nine TDC (9 limbs, 12.0 ± 3.0 years, femoral anteversion = 18.7° ± 4.1°). Gait analysis was performed 8.5 ± 7.2 months pre-surgery and 17.3 ± 5.5 months post-surgery. Joint angles, moments and forces as well as muscle forces and muscle contributions to joint moments were analysed using statistical parametric mapping.</p><p><strong>Results: </strong>Significant improvements in kinematics (hip rotation, foot progression, knee and hip flexion) were observed pre- to post-FDRO. Joint forces remained unaltered after surgery and did not differ from TDC. Gluteus minimus and deep external rotators muscle forces decreased in mid-stance, while adductor muscle forces increased during stance post-op compared to pre-op. Due to an improved knee extension postoperatively, the rectus femoris muscle force decreased to normal values during mid- and terminal stance. Postoperatively, only the deep external rotator muscle forces differed from TDC.</p><p><strong>Conclusions: </strong>This study showed that FDRO can restore muscle forces and muscle contributions to joint moments in addition to normal gait kinematics, while joint contact forces remain within normative ranges. This knowledge might also apply to other conditions in which pathological femoral anteversion is present.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 5","pages":"510-522"},"PeriodicalIF":1.3,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402114","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":"Management of pediatric distal humerus metaphyseal-diaphyseal junction fracture: A systematic review and meta-analysis.","authors":"Ahmad Saeed Aly, Ahmed Mohsen Mohamed, Mohamed Ahmed Al Kersh","doi":"10.1177/18632521241262169","DOIUrl":"10.1177/18632521241262169","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Fractures occurring at the metaphyseal-diaphyseal junction of the distal humerus in children are not commonly documented in the literature. Until this moment, there is no gold standard technique regarding its management and most surgeons treat it as a regular supracondylar humerus fracture by conventional pinning. This systematic review explores the relevant literature to assess the efficacy of different techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our literature search encompassed several online databases, including PUBMED/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar. Data from articles that met our general inclusion criteria were extracted and categorized into treatment method groupings. Functional and cosmetic outcomes, demographic characteristics, and complications were the main parameters used to analyze the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten retrospective studies met our inclusion criteria with a total of 178 participants of unilateral pediatric distal humerus metaphyseal-diaphyseal junction fractures. Most literature chose closed reduction and percutaneous pinning in seven articles, followed by elastic stable intramedullary nail technique used in three articles, then conservative treatment was chosen in two articles, while only one article used lateral miniplate and assisted K-wire and another article used combined closed reduction and percutaneous pinning and intramedullary K-wire. As regards the operation time; elastic stable intramedullary nails had the shortest time with a mean of 39.7 min (range: 37.5-41.9 min), while closed reduction and percutaneous pinning had the longest time with a mean of 75.47 min (range: 55.9-92.1 min). The shortest healing time was observed in miniplate with a mean of 7.2 weeks, while the most prolonged was in conservative management with a mean of 12 weeks and closed reduction and percutaneous pinning was a mean of 10 weeks. Regarding Flynn's criteria, all participants received excellent and good except in closed reduction and percutaneous pinning; 13 cases were fair and 2 cases were poor. Regarding complications, the most commonly observed complication after metaphyseal-diaphyseal junction fracture was cubitus varus, the highest incidence was in conservative management (33% of cases), followed by closed reduction and percutaneous pinning (10.9% of cases), the least incidence was observed in elastic stable intramedullary nails (3.77% of cases), and none of the cases treated with mini plate developed this complication. Other complications were observed only with closed reduction and percutaneous pinning; 8.5% of cases developed fixation loss, 6.2% of cases had a significantly reduced range of motion, and one case refractured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Pediatric distal humerus metaphyseal-diaphyseal junction fractures ","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 4","pages":"421-431"},"PeriodicalIF":1.3,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891124","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":"Is choice of approach associated with risk of avascular necrosis in pediatric septic hip?","authors":"Shrey Nihalani, Francis Cruz, Jacob K Hawkins, Branum Gage Griswold, Scott E Mabry, Gerald McGwin, Shawn R Gilbert, Michael J Conklin","doi":"10.1177/18632521241262167","DOIUrl":"10.1177/18632521241262167","url":null,"abstract":"<p><strong>Purpose: </strong>Septic arthritis of the hip in children and adolescents is a common condition requiring timely diagnosis and intervention. Surgical irrigation and debridement is typically performed through the anterior approach because of concerns about injury to the medial femoral circumflex artery leading to avascular necrosis. While there are multiple studies investigating the sequelae of anterior and medial approaches for reduction of developmental dislocation of the hip, none have compared these approaches for the pediatric septic hip. We hypothesize that there will be no significant difference in the rate of avascular necrosis when comparing the medial and anterior approaches to the septic hip in pediatric patients.</p><p><strong>Methods: </strong>A retrospective review was performed of pediatric septic hips treated with irrigation and debridement through either a medial or anterior approach at a single institution over an 18-year period of time. The primary outcome measure was the development of avascular necrosis.</p><p><strong>Results: </strong>Thirteen of 164 patients (7.9%) developed avascular necrosis. Avascular necrosis was noted in 9 of 101 patients who had anterior approach and 4 of 63 patients who underwent medial approach (p = 0.76). The average age for patients developing avascular necrosis was 10.0 years old versus 6.8 years old in patients who did not develop avascular necrosis (p = 0.01). The average follow-up was 3.3 years in patients with avascular necrosis versus 1.5 years for patients who did not develop avascular necrosis (p = 0.01).</p><p><strong>Conclusion: </strong>Medial approach to the pediatric septic hip does not increase the rate of avascular necrosis compared to the anterior approach.</p><p><strong>Level of evidence: </strong>Retrospective comparison study, Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 4","pages":"399-403"},"PeriodicalIF":1.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual reality use in pediatric patients for orthopedic clinical procedures: A randomized prospective trial of efficacy.","authors":"Bhumit Desai, Nicholas Newcomb, Brielle Plost, Sean Waldron, Korak Sarkar, Lawrence Haber","doi":"10.1177/18632521241254707","DOIUrl":"10.1177/18632521241254707","url":null,"abstract":"<p><strong>Background: </strong>Distraction therapy use such as virtual reality is novel in the pediatric orthopedic field. In this study, we use subjective and objective metrics to evaluate virtual reality efficacy to reduce anxiety and pain in a pediatric orthopedic cohort.</p><p><strong>Methods: </strong>A prospective randomized controlled trial included patients between age 5 and 17 years, presenting to a tertiary care pediatric orthopedic clinic. Parallel groups underwent orthopedic procedures in clinic, utilizing immersive and interactive virtual reality distraction therapies versus standard of care. Procedures included cast application, cast removal, bone pin removal, and fracture reduction. All preprocedure parameters were similar between the groups. Primary outcome was the difference between maximum procedural heart rate and baseline. Secondary outcomes included Wong Baker FACES Rating Scale (Wong & Baker, 1988, Oklahoma, USA) for pain and Visual Analog Scale scores for anxiety.</p><p><strong>Results: </strong>Ninety-five patients (66 M, 29 F) underwent 59 cast removals, 26 cast applications, 7 percutaneous pin removals, and 3 fracture reductions. Average patient age in the virtual reality and control cohorts was 10.1 (5-17) and 10.6 (5-17), respectively. Average change in maximum heart rate in the virtual reality and control groups was 10.6 ± 10.1 versus 18.4 ± 11.0 (p = 0.00048). The virtual reality group demonstrated trends toward lower perceived anxiety (1.7 ± 2.8 versus 2.9 ± 3.6, <i>p</i> = 0.0666) when compared to controls.</p><p><strong>Conclusions: </strong>This level 1 study is the first to utilize objective biometric measurements to evaluate use of interactive virtual reality during multiple types of pediatric orthopedic procedures in the clinical setting. The findings suggest that an interactive and immersive virtual reality experience can be effective in reducing pain and anxiety.</p><p><strong>Level of evidence: </strong>Level 1, Randomized Controlled Trial.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 4","pages":"414-420"},"PeriodicalIF":1.3,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891126","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}