Journal of Childrens Orthopaedics最新文献

{"title":"Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg-Calvé-Perthes disease.","authors":"Kenichi Mishima,&nbsp;Yasunari Kamiya,&nbsp;Masaki Matsushita,&nbsp;Shiro Imagama","doi":"10.1177/18632521231164985","DOIUrl":"https://doi.org/10.1177/18632521231164985","url":null,"abstract":"<p><strong>Purpose: </strong>To examine whether differences in bone resorption patterns in the anterior portion of the femoral head correlate with the prognosis of Legg-Calvé-Perthes disease.</p><p><strong>Methods: </strong>Seventy-eight patients with unilateral Legg-Calvé-Perthes disease, who were diagnosed after 6.0 years of age, underwent the Salter innominate osteotomy from 1987 to 2013, and were followed up to skeletal maturity. The anterior bone resorption pattern of the femoral head was evaluated from a frog-leg lateral hip radiograph made in the middle of the fragmentation period, and classified into two types, an epiphysis-preserved type (P) and a physis-disrupted type (D). The correlation between the type of bone resorption and the Stulberg outcome was analyzed.</p><p><strong>Results: </strong>The Stulberg outcomes were grade I for 9 patients, grade II for 31, grade III for 35, and grade IV for 3, with a mean follow-up period of 8.3 ± 2.7 years. Fifty-one patients demonstrated the type P hips and 27 did the type D hip. In a subset analysis of patients with the modified lateral pillar group-B hips in the younger group (6.0-8.9 years of age at diagnosis), the percentages of the favorable and unfavorable outcomes significantly differed between the two types (<i>p</i> = 0.013). Anteroposterior enlargement of the affected femoral head was significantly greater in the type D hips than the type P hips (<i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>Unfavorable hip morphology at skeletal maturity can be predicted in patients with the lateral pillar group-B hips by focusing on bone resorption patterns of the anterior portion of the femoral head.</p><p><strong>Level of evidence: </strong>Level III, prognostic study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"197-204"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/72/10.1177_18632521231164985.PMC10242379.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment.","authors":"Ismat Ghanem,&nbsp;Geoffrey Karam,&nbsp;Diane Ghanem,&nbsp;Ibrahim Saliba","doi":"10.1177/18632521231172986","DOIUrl":"https://doi.org/10.1177/18632521231172986","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded.</p><p><strong>Results: </strong>In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness.</p><p><strong>Conclusion: </strong>Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"205-211"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/61/10.1177_18632521231172986.PMC10242367.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972161","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 humeral corrective osteotomy for treatment of supracondylar fracture malunions in children.","authors":"Mohammed M Tarabishi,&nbsp;Ahmed K Almigdad,&nbsp;Rudolf Ganger,&nbsp;Sebastian Farr","doi":"10.1177/18632521231156942","DOIUrl":"https://doi.org/10.1177/18632521231156942","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann's angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes.</p><p><strong>Results: </strong>The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann's angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered.</p><p><strong>Conclusions: </strong>Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance.</p><p><strong>Level of evidence: </strong>level IV: Retrospective therapeutic study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"232-238"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/d8/10.1177_18632521231156942.PMC10242378.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10646364","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":"Below- versus above-elbow cast treatment of displaced distal forearm fractures in children: A systematic review and meta-analysis of randomized controlled trials.","authors":"Osama Z Alzobi,&nbsp;Ashraf T Hantouly,&nbsp;Mohamed Kenawey,&nbsp;Talal Ibrahim","doi":"10.1177/18632521231162621","DOIUrl":"https://doi.org/10.1177/18632521231162621","url":null,"abstract":"<p><strong>Objectives: </strong>Distal forearm fractures are the most common pediatric fractures. This study aimed to investigate the effectiveness of below-elbow cast treatment for displaced distal forearm fractures in children compared to above-elbow cast through meta-analysis of randomized controlled trials.</p><p><strong>Methods: </strong>Several databases from January 1, 2000 until October 1, 2021 were searched for randomized controlled trials that assessed below versus above-elbow cast treatment of displaced distal forearm fractures in pediatric patients. The main meta-analysis comparison was based on the relative risk of loss of fracture reduction between children undergoing below versus above-elbow cast treatment. Other outcome measures including re-manipulation and cast-related complications were also investigated.</p><p><strong>Results: </strong>Nine studies were eligible of the 156 articles identified, with a total of 1049 children. Analysis was undertaken for all included studies with a sensitivity analysis conducted for studies with high quality. In the sensitivity analysis, the relative risks of loss of fracture reduction (relative risk = 0.6, 95% confidence interval = 0.38, 0.96) and re-manipulation (relative risk = 0.3, 95% confidence interval = 0.19, 0.48) between the below and above-elbow cast groups were in favor of below-elbow cast and statistically significant. Cast-related complications were in favor of below-elbow cast but did not attain statistical significance (relative risk = 0.45, 95% confidence interval = 0.05, 3.99). Loss of fracture reduction was noted in 28.9% of patients treated with above-elbow cast and 21.5% in below-elbow cast. Re-manipulation was attempted in 48.1% versus 53.8% of children who lost fracture reduction in the below-elbow cast and above-elbow cast groups, respectively.</p><p><strong>Conclusion: </strong>Below-elbow cast treatment was favored, with statistical significance, in terms of loss of fracture reduction and re-manipulation, and was not associated with a higher risk of cast-related complications. The accumulative evidence currently does not support above-elbow cast treatment and below-elbow cast treatment should be the mainstay for displaced distal forearm fractures in children.</p><p><strong>Level of evidence: </strong>Level I, meta-analysis of therapeutic level I studies.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"249-258"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10242373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350949","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":"Guided growth for FKFD: Historical perspective and insights.","authors":"Peter M Stevens","doi":"10.1177/18632521231172994","DOIUrl":"https://doi.org/10.1177/18632521231172994","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"291"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/84/10.1177_18632521231172994.PMC10242374.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972155","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":"Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review.","authors":"Benjamin J Shore,&nbsp;James McCarthy,&nbsp;M Wade Shrader,&nbsp;Kerr Graham,&nbsp;K Matthew Veerkamp,&nbsp;Erich Rutz,&nbsp;Hank Chambers,&nbsp;Jon R Davids,&nbsp;Unni Narayanan,&nbsp;Tom F Novacheck,&nbsp;Kristan Pierz,&nbsp;Thomas Dreher,&nbsp;Jason Rhodes,&nbsp;Jeffery Shilt,&nbsp;Tim Theologis,&nbsp;Anja Van Campenhout,&nbsp;Robert M Kay","doi":"10.1177/18632521231172993","DOIUrl":"https://doi.org/10.1177/18632521231172993","url":null,"abstract":"NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/18632521231172993 Journal of Children’s Orthopaedics 2023, Vol. 17(3) 292 –294 © The Author(s) 2023 DOI: 10.1 77/186325 1231 729 journals.sagepub.com/home/cho JOURNAL OF CHILDREN’S ORTHOPAEDICS Response to Letter to the Editor","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"292-294"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/61/10.1177_18632521231172993.PMC10242377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972159","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":"A salvage procedure: Radial head excision in children and adolescents-short-to-midterm outcomes and overview of the literature.","authors":"Christiane Kruppa,&nbsp;Alexis Brinkemper,&nbsp;Jana Cibura,&nbsp;Matthias Königshausen,&nbsp;Charlotte Cibura,&nbsp;Thomas A Schildhauer,&nbsp;Marcel Dudda","doi":"10.1177/18632521231167395","DOIUrl":"https://doi.org/10.1177/18632521231167395","url":null,"abstract":"<p><strong>Purpose: </strong>Purpose of the study was to report the outcomes after radial head excision in children and adolescents in addition with a review of the current literature.</p><p><strong>Methods: </strong>We report a series of five children and adolescents, who had undergone a post-traumatic radial head excision. Clinical outcomes were evaluated in terms of elbow/wrist range of motion, stability, deformity and discomforts or restrictions at two follow-up points. Radiographic changes were evaluated.</p><p><strong>Results: </strong>Patient's age at time of the radial head excision averaged 14.6 (13-16) years. Mean time from the injury to the radial head excision was 3.6 (0-9) years. Follow-up I averaged 4.4 (1-8) years and follow-up II 8.5 (7-10) years. At follow-up I, patients showed an average elbow range of motion of 0-10-120° Ext/Flex and 90-0-80° Pro/Sup. Two patients reported discomfort or pain at the elbow. Four (80%) patients had a symptomatic wrist with pain or crepitation at the distal radio ulnar joint. In three (60%) of them, an ulna plus at the wrist was present. Two patients required ulna shortening and autograft stabilization of the interosseous membrane. At final follow-up, all patients reported full functioning with daily activities. Restrictions were present with sport activities.</p><p><strong>Conclusion: </strong>Functional results at the elbow joint might be improved and pain syndromes lessen due to the radial head excision. Problems at the wrist are likely secondary to the procedure. A critical analysis of other options should be performed ahead of the procedure and a careless application should be avoided by all means.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"239-248"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/54/10.1177_18632521231167395.PMC10242372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599253","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":"Readability assessment of patient educational materials for pediatric spinal conditions from top academic orthopedic institutions.","authors":"Christopher Michel,&nbsp;Christopher Dijanic,&nbsp;George Abdelmalek,&nbsp;Suleiman Sudah,&nbsp;Daniel Kerrigan,&nbsp;George Gorgy,&nbsp;Praveen Yalamanchili","doi":"10.1177/18632521231156435","DOIUrl":"https://doi.org/10.1177/18632521231156435","url":null,"abstract":"<p><strong>Background: </strong>The Internet has become a popular source of health information for patients and their families. Healthcare experts recommend that the readability of online education materials be at or below a sixth grade reading level. This translates to a standardized Flesch Reading Ease Score between 81 and 90, which is equivalent to conversational English. However, previous studies have demonstrated that the readability of online education materials of various orthopedic topics is too advanced for the average patient. To date, the readability of online education materials for pediatric spinal conditions has not been analyzed. The objective of this study was to assess the readability of online educational materials of top pediatric orthopedic hospital websites for pediatric spinal conditions.</p><p><strong>Methods: </strong>Online patient education materials from the top 25 pediatric orthopedic institutions, as ranked by the U.S. News and World Report hospitals for pediatric orthopedics, were assessed utilizing multiple readability assessment metrics including Flesch-Kincaid, Flesch Reading Ease, Gunning Fog Index, and others. Correlations between academic institutional ranking, geographic location, and the use of concomitant multimedia modalities with Flesch-Kincaid scores were evaluated using a Spearman regression.</p><p><strong>Results: </strong>Only 32% (8 of 25) of top pediatric orthopedic hospitals provided online health information at or below a sixth grade reading level. The mean Flesch-Kincaid score was 9.3 ± 2.5, Flesch Reading Ease 48.3 ± 16.2, Gunning Fog Score 10.7 ± 3.0, Coleman-Liau Index 12.1 ± 2.8, Simple Measure of the Gobbledygook Index 11.7 ± 2.1, Automated Readability Index 9.0 ± 2.7, FORCAST 11.3 ± 1.2, and Dale-Chall Readability Index 6.7 ± 1.4. There was no significant correlation between institutional ranking, geographic location, or use of video material with Flesch-Kincaid scores (p = 0.1042, p = 0.7776, p = 0.3275, respectively).</p><p><strong>Conclusion: </strong>Online educational material for pediatric spinal conditions from top pediatric orthopedic institutional websites is associated with excessively complex language which may limit comprehension for the majority of the US population.</p><p><strong>Type of study/level of evidence: </strong>Economic and Decision Analysis/level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"284-290"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/1a/10.1177_18632521231156435.PMC10242376.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of percutaneous femoral derotational osteotomy in pediatric patients.","authors":"Adam D Geffner,&nbsp;Bridget K Ellsworth,&nbsp;Michael Greenstein,&nbsp;Austin T Fragomen,&nbsp;S Robert Rozbruch","doi":"10.1177/18632521231159426","DOIUrl":"https://doi.org/10.1177/18632521231159426","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous femoral derotational osteotomies are performed in both adult and pediatric patients. There is little published on the outcomes after femoral derotational osteotomy in pediatric patients.</p><p><strong>Methods: </strong>A retrospective cohort study of pediatric patients treated with percutaneous femoral derotational osteotomy by one of two surgeons between 2016 and 2022 was performed. Data collected included patient demographics; surgical indications; femoral version; tibial torsion; magnitude of rotational correction; complications; time to hardware removal; pre-operative and post-operative patient-reported outcome scores, including Limb Deformity-Scoliosis Research Society and Patient-Reported Outcomes Measurement Information System; and time to consolidation. Descriptive statistics were used to summarize the data and t tests used to compare means.</p><p><strong>Results: </strong>Thirty-one femoral derotational osteotomies in 19 patients were included with an average age of 14.7 (9-17) years. The average rotational correction was 21.5° ± 6.4° (10°-40°). The average length of follow-up was 17.9 ± 6.7 months. There were no instances of nonunion, joint stiffness, or nerve injury. No patients returned to the operating room for additional surgeries other than routine hardware removal. There were no cases of avascular necrosis of the femoral head. Of the 19 patients, 8 completed both a pre-operative and post-operative survey set. There were significant improvements in the Limb Deformity-Scoliosis Research Society Self-Image/Appearance sub-category and the Patient-Reported Outcomes Measurement Information System Physical Function sub-category.</p><p><strong>Conclusion: </strong>Femoral derotational osteotomy using a percutaneous drill hole technique with antegrade trochanteric entry femoral nail is safe in the pediatric population and improves self-image in patients with symptomatic femoral version abnormalities.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"276-283"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/5c/10.1177_18632521231159426.PMC10242370.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972156","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":"A four-year clinical and sonographic longitudinal follow-up of clubfeet treated according to Ponseti with normal references.","authors":"G Arne Johansson,&nbsp;Ylva B Aurell,&nbsp;Bertil H Romanus","doi":"10.1177/18632521231172548","DOIUrl":"https://doi.org/10.1177/18632521231172548","url":null,"abstract":"<p><strong>Purpose: </strong>To follow children with a clubfoot by ultrasonography during the entire treatment period up to 4 years and compare with controls.</p><p><strong>Method: </strong>Thirty clubfeet in 20 children treated using the Ponseti method and 29 controls were followed by repeated ultrasonography investigations from neonates to the age of 4 years. The previously established coronal medial and lateral, sagittal dorsal and posterior projections were used. Changes over time, correlations to the Diméglio score, and the course of treatment were studied.</p><p><strong>Results: </strong>The medial malleolus-navicular distance was shorter, while the talar tangent-navicular distance and the talo-navicular angle were larger in clubfeet than in controls even after the initial correction. The healthy feet in unilateral cases did not differ significantly from the controls. The range of motion in the talo-navicular joint was approximately 20° less in clubfeet than in controls during the first four years of life. The medial malleolus-navicular distance (<i>r</i> = -0.58) and the talo-navicular angle (<i>r</i> = 0.66) at the first ultrasonography showed the highest correlation to the number of casts needed to correct the deformities.</p><p><strong>Conclusion: </strong>Ultrasonography can be used to evaluate the initial degree of deformities in clubfeet and to follow the progress of the treatment and growth. Ultrasonography showed a clear difference between clubfeet and controls during the first four years of life. Although it was not possible to define specific limit values as benchmarks in the treatment, dynamic ultrasonography can provide valuable support in the decision-making process when complementary treatment may be needed.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 3","pages":"212-223"},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10242368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10646366","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}