Journal of Childrens Orthopaedics最新文献

{"title":"Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation.","authors":"Xinwu Wu, Linkun Wu, Federico Canavese, Dianhua Huang, Shunyou Chen","doi":"10.1177/18632521241246142","DOIUrl":"10.1177/18632521241246142","url":null,"abstract":"<p><strong>Background: </strong>Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to evaluate outcomes in the management of fracture separation of the distal humeral epiphysis treated seven or more days post-initial injury.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients diagnosed with fracture separation of the distal humeral epiphysis between November 2016 and October 2023. Inclusion criteria encompassed patients with delayed presentation of fracture separation of the distal humeral epiphysis who underwent surgical intervention seven or more days following the initial injury. Demographic data were collected, and fractures were categorized using the modified DeLee classification. Plain radiographs facilitated the assessment of the carrying angle and postoperative Baumann angle. Clinical outcomes were evaluated using the Flynn criteria.</p><p><strong>Results: </strong>The study included 12 patients who met the inclusion criteria. The average age at the time of injury was 1.59 years. According to the modified DeLee system, fracture classification identified one type I fracture, eight type II fractures, and three type III fractures. The average duration from injury to surgery was 11.8 days. The mean surgical duration was 21.5 min. The average follow-up period was 40.7 months. One patient exhibited cubitus varus development. Based on the Flynn criteria, outcomes were as follows: seven patients had excellent outcomes, four had good outcomes, and one had a poor outcome.</p><p><strong>Conclusion: </strong>Closed reduction with percutaneous K-wire fixation represents a minimally invasive approach suitable for children diagnosed with fracture separation of the distal humeral epiphysis seven or more days post-initial injury. Most of these patients experienced favorable outcomes.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"642-651"},"PeriodicalIF":1.3,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670018","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":"Single procedure tibialis anterior tendon shortening in combination with Achilles tendon lengthening in unilateral cerebral palsy improves swing phase dorsiflexion in gait.","authors":"Michèle Widmer, Monica Staganello, Morgan Sangeux, Marco Odorizzi, Reinald Brunner, Elke Viehweger","doi":"10.1177/18632521241244624","DOIUrl":"10.1177/18632521241244624","url":null,"abstract":"<p><strong>Purpose: </strong>Tibialis anterior tendon shortening combined with tendon Achilles lengthening showed satisfactory short- and long-term outcomes for pes equinus treatment. This retrospective study aimed to evaluate the effectiveness of a single tibialis anterior tendon shortening-tendon Achilles lengthening procedure for treating pes equinus, in a homogeneous unilateral cerebral palsy patient group.</p><p><strong>Methods: </strong>Gait analysis was conducted on 22 unilateral cerebral palsy patients (mean age at surgery = 13.3 years, standard deviation = 3 years) before and within 2.5 years (standard deviation = 0.61 years) after the tibialis anterior tendon shortening-tendon Achilles lengthening procedure. Primary outcome measures included foot drop occurrence in swing, foot dorsiflexion and the first ankle rocker presence compared to healthy reference data. Movement analysis profile and gait profile score were also calculated for the entire gait cycle. The clinical exam and the A2 peak ankle power were analyzed. Statistical analysis used the paired Wilcoxon's sign rank test (p < 0.05).</p><p><strong>Results: </strong>Post-operatively, significant improvements were observed in ankle dorsiflexion during swing (p = 0.0006) and reduced foot drop in swing (p = 0.0107). The occurrence of a first ankle rocker did not significantly change (p = 0.1489). Significant improvements in gait profile score and movement analysis profile for all joints and planes indicate overall gait quality improvement. The foot progression changed significantly (p = 0.0285), with a greater external orientation. Nineteen out of 22 patients were able to quit wearing their ankle foot orthoses.</p><p><strong>Conclusion: </strong>Tibialis anterior tendon shortening and tendon Achilles lengthening combination yielded positive outcomes, showing increased foot dorsiflexion, first ankle rocker presence, and overall improved gait quality. These findings support the effectiveness of this surgical approach for treating pes equinus in children with unilateral spastic cerebral palsy.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 4","pages":"441-449"},"PeriodicalIF":1.3,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891125","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":"Nusinersen therapy changed the natural course of spinal muscular atrophy type 1: What about spine and hip?","authors":"Niyazi Erdem Yasar, Guzelali Ozdemir, Elif Uzun Ata, Mustafa Okan Ayvali, Naim Ata, Mahir Ulgu, Ebru Dumlupınar, Suayip Birinci, Izzet Bingol, Senol Bekmez","doi":"10.1177/18632521241235028","DOIUrl":"10.1177/18632521241235028","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal muscular atrophy type 1 has a devastating natural course and presents a severe course marked by scoliosis and hip subluxation in nonambulatory patients. Nusinersen, Food and Drug Administration-approved spinal muscular atrophy therapy, extends survival and enhances motor function. However, its influence on spinal and hip deformities remains unclear.</p><p><strong>Methods: </strong>In a retrospective study, 29 spinal muscular atrophy type 1 patients born between 2017 and 2021, confirmed by genetic testing, treated with intrathecal nusinersen, and had registered to the national electronic health database were included. Demographics, age at the first nusinersen dose, total administrations, and Children's of Philadelphia Infant Test of Neuromuscular Disorders scores were collected. Radiological assessments included parasol rib deformity, scoliosis, pelvic obliquity, and hip subluxation.</p><p><strong>Results: </strong>Mean age was 3.7 ± 1.1 (range, 2-6), and average number of intrathecal nusinersen administration was 8.9 ± 2.9 (range, 4-19). There was a significant correlation between Children's of Philadelphia Infant Test of Neuromuscular Disorders score and the number of nusinersen administration (<i>r</i> = 0.539, <i>p</i> = 0.05). The correlation between Children's of Philadelphia Infant Test of Neuromuscular Disorders score and patient age (<i>r</i> = 0.361) or the time of first nusinersen dose (<i>r</i> = 0.39) was not significant (<i>p</i> = 0.076 and <i>p</i> = 0.054, respectively). While 93.1% had scoliosis, 69% had pelvic obliquity, and 60.7% had hip subluxation, these conditions showed no significant association with patient age, total nusinersen administrations, age at the first dose, or Children's of Philadelphia Infant Test of Neuromuscular Disorders scores.</p><p><strong>Conclusion: </strong>Disease-modifying therapy provides significant improvements in overall survival and motor function in spinal muscular atrophy type 1. However, progressive spine deformity and hip subluxation still remain significant problems in the majority of cases which would potentially need to be addressed.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"18 3","pages":"322-330"},"PeriodicalIF":1.4,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238723","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":"Acknowledgement to Reviewers 2023.","authors":"","doi":"10.1177/18632521231219615","DOIUrl":"https://doi.org/10.1177/18632521231219615","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"630-631"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483566","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":"Clinical examination and imaging resources in children and adolescent back pain.","authors":"Ana León-Domínguez, Rocío Cansino-Román, Jose M Martínez-Salas, David M Farrington","doi":"10.1177/18632521231215860","DOIUrl":"10.1177/18632521231215860","url":null,"abstract":"<p><p>Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often \"non-specific.\" The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"512-526"},"PeriodicalIF":1.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483568","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 scoliosis a source of pain?","authors":"Brice Ilharreborde, Anne-Laure Simon, Milud Shadi, Tomasz Kotwicki","doi":"10.1177/18632521231215861","DOIUrl":"10.1177/18632521231215861","url":null,"abstract":"<p><strong>Purpose: </strong>Pain in scoliosis is definitely a hot topic with growing popularity. The literature remains very controversial, with a pain prevalence ranging from 23% to 90%, but this can be explained by the great heterogeneity of the numerous series. The aim of this review was to report results from the literature regarding pain in relation to scoliosis regardless of the etiology.</p><p><strong>Methods: </strong>A bibliographic search in Medline and Google database from 2003 to March 2023 was performed. Relevant literature was analyzed, summarized, and discussed based on authors' experience. A 1-year prospective series of adolescent idiopathic scoliosis patients was also included to compare with the existing literature.</p><p><strong>Results: </strong>A total of 126 adolescent idiopathic scoliosis patients were included, with a mean preoperative Cobb angle of 64.5° (range, 45°-112°). Reported pain prevalence was 34.1%. Pain and no-pain groups were very different in their self-reported experience, with a very low mean visual analogue scale score of 0.5 (± 0.6) in the no pain group, while visual analogue scale averaged 5.6 (± 1.2) in the pain group (p < 0.001). No significant difference was found between groups regarding the most relevant demographic and radiological parameters.</p><p><strong>Conclusion: </strong>Evidence-based literature on \"scoliosis as a source of pain\" remains ambiguous. There seems to be a consensus on the lack of direct relationship between deformity magnitude and back pain intensity. A comprehensive evaluation of the patient is therefore necessary before any treatment, including medical history, clinical examination, and relevant imaging for any child with scoliosis and back pain.</p><p><strong>Level of evidence: </strong>Level VI.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"527-534"},"PeriodicalIF":1.4,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483571","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":"How back pain influences daily activities and quality of life: Incidence of back pain related to age.","authors":"Tomasz Potaczek, Barbara Jasiewicz","doi":"10.1177/18632521231215855","DOIUrl":"10.1177/18632521231215855","url":null,"abstract":"<p><p>Low back pain is a prevalent global musculoskeletal issue, with a lifetime prevalence ranging from 49% to 70% in adults. Traditionally associated with adults, recent field surveys indicate comparable prevalence rates in children and adolescents, challenging earlier assumptions. Non-specific low back pain, where the source cannot be identified through diagnostic imaging, accounts for about 80%-90% of cases. Studies have shown that over 80% of adolescents with low back pain exhibit no underlying pathology. The prevalence of low back pain in younger populations varies widely, influenced by study methodology, age, and pain types. Research suggests that back pain prevalence in adolescents increases with age, with a shift in attitudes considering it is not necessarily indicative of specific issues. <b>Level of evidence:</b> level V.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"505-511"},"PeriodicalIF":1.4,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483569","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 low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann's disease.","authors":"Riza Mert Cetik, Michał Latalski, Muharrem Yazici","doi":"10.1177/18632521231215873","DOIUrl":"10.1177/18632521231215873","url":null,"abstract":"<p><strong>Background: </strong>Low back pain in childhood was underappreciated for a long time, but recent studies report higher prevalences, up to 70%. Two of the common causes are spondylolyis/spondylolisthesis and Scheuermann's disease. These disorders are relevant in a way they both cause significant back pain, and may disrupt the sagittal spinal balance.</p><p><strong>Purpose: </strong>To present the current evidence on the diagnosis, natural history and treatment of these disorders with a special focus on sagittal spinal alignment.</p><p><strong>Methods: </strong>This study is conducted as a literature review.</p><p><strong>Results and conclusions: </strong>Spondylolysis and low-grade spondylolisthesis have a benign course and are typically treated conservatively. When pars repair is indicated, pedicle screw-based techniques achieve more than 90% fusion with acceptable complication rates. High-grade spondylolisthesis, however, is frequently progressive. Surgical treatment involves fusion, which can be done in situ or after reduction. Reduction is useful for \"unbalanced\" patients to acquire sagittal spinopelvic balance, and it is important to distinguish these patients. Despite lowering the risk for pseudoarthrosis, reduction brings a risk for neurologic complications. With re-operation rates as high as 40%, these patients definitely require careful preoperative planning. Scheuermann's disease generally causes back pain in addition to cosmetic discomfort during adolescence. If the kyphosis is lower than 60°, symptoms typically resolve into adulthood with conservative measures only. However, it must be kept in mind that these patients may experience problems with physical performance and have a lower quality of life even when the problem seems to have \"resolved\". Severe kyphosis and intractable back pain are the most frequently referred surgical indications, and surgery typically involves fusion. Proper utilization of osteotomies and proper selection of the upper and lower fusion levels are of utmost importance to prevent complications in these patients.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"535-547"},"PeriodicalIF":1.4,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483574","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":"Tumors and infections of the growing spine.","authors":"Barbara Jasiewicz, Ilkka Helenius","doi":"10.1177/18632521231215857","DOIUrl":"10.1177/18632521231215857","url":null,"abstract":"<p><p>The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. <b>Level of evidence:</b> level 4.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"556-572"},"PeriodicalIF":1.4,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483507","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 sagittal spinopelvic alignment a cause of low back pain in pediatric spine pathologies? A review.","authors":"Czubak-Wrzosek Maria, Wrzosek Patryk, Żebrowski Mateusz, Tyrakowski Marcin","doi":"10.1177/18632521231215853","DOIUrl":"10.1177/18632521231215853","url":null,"abstract":"<p><strong>Purpose: </strong>Altered spinopelvic morphology is observed in many spine pathologies occurring during growth. The aim of the study is to better understand the sagittal compensatory mechanisms and their possible influence on the occurrence of pain in selected pediatric spine pathologies.</p><p><strong>Methods: </strong>A bibliographic search in the PubMed database included articles published between September 1965 and July 2023. The keywords contained in the search were \"spondylolysis,\" \"spondylolisthesis,\" \"scoliosis,\" \"kypho,\" \"sagittal,\" \"pediatric,\" \"child,\" \"adolescent,\" \"grow,\" \"development,\" and \"pain.\"</p><p><strong>Results: </strong>The largest diversity in sagittal alignment patterns was reported in idiopathic scoliosis, with global flattening of the spine being the most common. Kyphotic deformations occurring during growth are characterized by structural thoracic or thoracolumbar kyphosis compensated by lumbar hyperlordosis and lower pelvic incidence. Whereas in spondylolisthesis, altered morphology of the spinopelvic junction with high values of pelvic incidence is observed. Pain does not seem to be related to sagittal alignment in idiopathic scoliosis. In Scheuermann disease, it is localized at the apex of the deformity and is associated with the curve pattern, whereas in spondylolisthesis, sagittal alignment correlates with pain scores only in high-grade slips.</p><p><strong>Conclusion: </strong>Most of the patients with spine disorders that occurred during growth present a clinically balanced posture in the sagittal plane. It suggests that compensatory mechanisms before achieving skeletal maturity are really significant. A comprehension of sagittal alignment in spine deformities and its relationship to pain is essential for the proper assessment and treatment of these disorders.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 6","pages":"548-555"},"PeriodicalIF":1.4,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483570","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}