Journal Of Children's Orthopaedics[JOURNAL]
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200 papers
Assessment of postoperative range of motion in paediatric patients undergoing surgical reduction and fixation of lateral condyle fractures.
Rehm A, Liew I, Welsh K … +3 more , Barwell J, Stohlner V, Ashby E
J Child Orthop · 2026 Jun · PMID 41907833 · Full text
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Tranexamic acid reduces blood loss and transfusion in single-stage bilateral combined surgery for developmental dysplasia of the hip: A retrospective study.
Li S, Tang X, Yang X
J Child Orthop · 2026 Jun · PMID 41867395 · Full text
OBJECTIVE: To determine whether tranexamic acid (TXA) reduces blood loss and transfusion rate in single-stage bilateral combined surgery for developmental dysplasia of the hip (DDH) in children. METHODS: A retrospective...
OBJECTIVE: To determine whether tranexamic acid (TXA) reduces blood loss and transfusion rate in single-stage bilateral combined surgery for developmental dysplasia of the hip (DDH) in children. METHODS: A retrospective study was conducted on 148 children with bilateral DDH who underwent single-stage bilateral combined surgery between March 2021 and May 2025. Patients were categorized into a TXA group ( = 71) and a control group ( = 77) based on TXA administration. The TXA group received a single intravenous bolus of TXA 15 mg/kg preoperatively, while the control group received no intervention. Complete blood count tests were obtained preoperatively and at 24 h postoperatively. Estimated blood loss (EBL), transfusion rate, operative duration, and complications were compared. RESULTS: The TXA group exhibited significantly lower EBL compared with the control group (117.5 ± 7.7 mL vs. 171.4 ± 11.3 mL; < 0.001). The total transfusion rate was also lower in the TXA group (5.6 % vs. 16.9 %; = 0.03), as well as the intraoperative transfusion rate (1.4% vs. 11.7%; = 0.03). The median surgical duration was 2.3 h in both groups, with no significant difference ( = 0.29). One postoperative infection occurred in each group (1.4 % vs. 1.3 %; = 1), and no cases of seizures or deep vein thrombosis were observed. CONCLUSIONS: TXA significantly reduces EBL and both total and intraoperative transfusion rates in children undergoing single-stage bilateral combined surgery for DDH, without affecting the risk of complications.
Patient-reported outcome using EFAS score in skeletally mature clubfoot patients treated at birth with Ponseti's technique.
Donzelli A, Voute J, Bregou A … +2 more , Kocher F, Zambelli PY
J Child Orthop · 2026 Jun · PMID 41867394 · Full text
INTRODUCTION: Idiopathic clubfoot is a frequent congenital deformity treated worldwide using the Ponseti method, which has become the gold standard due to its safety, reproducibility, and excellent short-term outcomes. H...
INTRODUCTION: Idiopathic clubfoot is a frequent congenital deformity treated worldwide using the Ponseti method, which has become the gold standard due to its safety, reproducibility, and excellent short-term outcomes. However, long-term patient-reported outcomes in adolescents and young adults treated in infancy remain insufficiently documented. This study evaluates foot health perception in skeletally mature patients who underwent Ponseti treatment during early infancy, using the European Foot and Ankle Society (EFAS) score and the first two questions of the World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaire. METHODS: A retrospective study was conducted on patients older than 14 years who received complete Ponseti treatment for idiopathic clubfoot at a single pediatric university hospital. Clinical and demographic data were collected, and both EFAS and WHOQOL-BREF questionnaires were administered anonymously at follow-up. RESULTS: A total of 28 patients completed the questionnaires. Most reported high satisfaction with overall foot health; 78.5% achieved excellent or good EFAS scores for daily activities, while 89.2% demonstrated excellent sports-related scores. Persistent pain or major functional limitations were uncommon, though a subset reported reduced endurance in common walking activity (21%) and altered gait perception (25%). The majority rated their overall quality of life as good or acceptable according to WHOQOL-BREF responses. CONCLUSION: Ponseti treatment, combined with long-term follow-up and occasional minor procedures, offers satisfactory long-term outcomes in young adults with idiopathic clubfoot. Although some report reduced walking endurance or gait differences, overall foot health and quality-of-life perception remain high. Further studies are needed to evaluate outcomes later in adulthood.
Temporal patterns of redisplacement risk following nonoperative treatment of pediatric supracondylar humeral fractures: A retrospective cohort study.
Zhang J, Li C, Zhao Y
J Child Orthop · 2026 Jun · PMID 41852654 · Full text
BACKGROUND: Although risk factors for redisplacement after nonoperative treatment of pediatric supracondylar humeral fractures (SCHFs) are well described, the temporal distribution of this risk remains poorly understood....
BACKGROUND: Although risk factors for redisplacement after nonoperative treatment of pediatric supracondylar humeral fractures (SCHFs) are well described, the temporal distribution of this risk remains poorly understood. This study investigated temporal patterns of redisplacement and identified independent predictors using time-to-event analysis. METHODS: This retrospective cohort study included 218 children (aged 3-14 years) with Gartland type II ( = 142) and selectively treated type III ( = 76) SCHFs managed with closed reduction and custom-molded triplanar splinting between September 2020 and August 2023. Type III fractures were included only when fluoroscopic stress testing confirmed post-reduction stability. Redisplacement was assessed radiographically and analyzed using Kaplan-Meier and Cox regression methods. RESULTS: Redisplacement occurred in 39 patients (17.9%). Cumulative incidence demonstrated a nonlinear temporal pattern, with most events occurring early after reduction: 87% within the first 14 days, with apparent peaks at days 3-4 and 7-14. In multivariable analysis, initial lateral displacement percentage >85% (hazard ratio [HR] 3.52, 95% confidence interval (CI): 1.82-6.83) and severe soft-tissue swelling (HR 3.08, 95% CI: 1.61-5.89) were independently associated with redisplacement, whereas Gartland classification was not. CONCLUSIONS: Redisplacement risk after nonoperative management of pediatric SCHFs appears concentrated in early post-reduction periods. Displacement magnitude and severity of soft-tissue swelling may provide more clinically relevant prognostic information than fracture classification alone. The observed temporal pattern may be influenced by discrete follow-up intervals and requires prospective validation.
Manu: His hands, his friends! An educational short movie to prevent children's hand injuries.
Alonso E, Saghbiny E, Nguyen-Khac V … +4 more , Touati N, Fitoussi F, Vialle R, Bachy-Razzouk M
J Child Orthop · 2026 Jun · PMID 41847556 · Full text
INTRODUCTION: Hand injuries are a major public health issue and are very common in pediatrics, explained by children's world discovery. The aim of this study was to produce a short, animated video to raise awareness and...
INTRODUCTION: Hand injuries are a major public health issue and are very common in pediatrics, explained by children's world discovery. The aim of this study was to produce a short, animated video to raise awareness and educate children and their parents, by proxy, about common hand injuries, and to assess its effect. MATERIAL AND METHODS: The video was shown to children at school. They were asked to complete an anonymous questionnaire before the projection and 21 days after, to analyze its impact and its spreading. RESULTS: Eight hundred and thirty five children, with an average age of 9.57 years old, filled the pre-projection questionnaire. Upon those children, 88% have already hurt their hands, 86% knew someone who had hurt their hands and 30% did not know the dangerous situations for the hands. Out of the 565 children who filled the post-projection form, 97% answered that they understood the dangerous situations for the hands, with a significative difference compared to the pre-projection answers. 45% watched the video with their parents, 33% advised their families to watch it and 57% thought they would change their habits. CONCLUSION: Hand injuries should be a priority, to reduce their incidence and consequences. This short video sets out the various possible accidents and risk situations, targeting children between 6 and 12 years old, and indirectly adults. Even if this study has encouraging results, spreading must be improved and association with incidence of hand injuries followed to evaluate its impact and benefits.
Barriers to conducting prospective multicentre studies in paediatric orthopaedics in Europe: Insights from the EPOS Discoid Meniscus (DiMe) project.
Turati M, Crippa M, Nicolaou N … +16 more , Tassistro E, Thüsing M, Sinikumpu J, Courvoisier A, Cabral JJ, Duart J, Tschopp B, Tercier S, Lehoczky G, Vandergugten S, Maxim AV, Davies N, Montanari L, Galimberti S, Bigoni M, Accadbled F
J Child Orthop · 2026 Jun · PMID 41769156 · Full text
PURPOSE: Prospective multicentre studies represent a cornerstone of evidence-based advancement. However, within orthopaedics, and particularly in the European context of paediatric orthopaedics, such rigorous investigati...
PURPOSE: Prospective multicentre studies represent a cornerstone of evidence-based advancement. However, within orthopaedics, and particularly in the European context of paediatric orthopaedics, such rigorous investigations are notably scarce. This study aims to explore the organizational, regulatory, and resource-related barriers hindering initiation of these crucial studies, using the setup phase of the ''. METHODS: A cross-sectional survey was conducted from 19 centres initially recruited for the European Paediatric Orthopaedic Society DiMe Project (NCT05580315) cohort study. Delays and perceived obstacles encountered during initiation phases: contract negotiation, ethics committee approval, and patient enrolment were assessed. A descriptive analysis was performed to characterize the data. Twelve responding centres (63.2%) were still in the contract negotiation phase, while 36.8% ( = 7) had progressed to the patient enrolment stage. RESULTS: Median duration for contract negotiation was 12 months (Q1-Q3: 7-22), matching ethical approval (Q1-Q3: 3-12). Sixty-three point two percent ( = 12) of responding centres were still in the contract negotiation phase, while 36.8% ( = 7) had progressed to patient enrolment, with 41 patients enrolled across these sites. Formal ethics committee submission was required in 84.2% ( = 16) of responding centres. Major challenges identified included bureaucratic delays, lack of institutional support, absence of dedicated research staff, and prolonged administrative processes. CONCLUSION: The initiation of European multicentre studies in paediatric orthopaedics is hindered by institutional and regulatory barriers. Streamlining administrative and ethical processes and allocation of resources and personnel are needed to improve efficiency and facilitate successful collaborations. LEVEL OF EVIDENCE: V - Expert opinion / Cross-sectional survey.
Virtual reality as a distraction technique in pediatric patients undergoing orthopedic procedures: A systematic review and meta-analysis of randomized controlled trials.
Alharran AM, AlAyyaf AE, Addar A … +2 more , Hamdy R, Marwan Y
J Child Orthop · 2026 Jun · PMID 41769155 · Full text
INTRODUCTION: Pain and anxiety are common in pediatric orthopedic procedures such as cast or pin removal, often leading to distress and physiological stress responses. Virtual reality (VR) offers immersive distraction an...
INTRODUCTION: Pain and anxiety are common in pediatric orthopedic procedures such as cast or pin removal, often leading to distress and physiological stress responses. Virtual reality (VR) offers immersive distraction and has shown promise in pediatric procedural care; however, evidence in orthopedic procedures remains limited. This meta-analysis aimed to evaluate the effectiveness of VR compared with standard care in reducing pain, anxiety, and heart rate in children undergoing orthopedic procedures. METHODS: A systematic search was conducted in PubMed, Scopus, and Cochrane Library from inception to 20 October 2025 for randomized controlled trials (RCTs) comparing VR distraction and standard care in pediatric patients undergoing orthopedic procedures. Outcomes of interest included pain, anxiety, and heart rate. Statistical analysis was performed with R 4.3.1. Standardized mean differences (SMD) using the Inverse-Variance method and the random-effects method. RESULTS: A total of four RCTs were included in the final meta-analysis, comprising 624 patients, of whom 315 (50%) were distracted with VR during clinical orthopedic procedures (mean age 9.84 years, mean 40% females). In the pooled analysis, VR distraction significantly reduced anxiety (SMD = -0.55, 95% confidence intervals (CI) [-0.76, -0.34]; < 0.01; = 0%), pain (SMD = -0.43; 95% CI [-0.68, -0.19]; < 0.01; I = 44%), and heart rate (SMD = -0.34; 95% CI [-0.60, -0.07]; = 0.01; I = 53%). CONCLUSION: In this meta-analysis of four RCTs including 624 pediatric patients, VR distraction reduced procedural anxiety and, in pooled analyses, was associated with modest but statistically significant reductions in pain and heart rate compared with standard care during predominantly cast-related orthopedic clinic procedures. The integration of this child-friendly, nonpharmacological approach provides enhanced procedural comfort and effective anxiety management.
The prevalence of clinically significant proximal femoral growth disturbance following open versus closed reduction in dysplastic hips performed after 6 months: A systematic review and meta-analysis of 150 studies.
Cheok T, Boppana A, Christiansen J … +5 more , Beveridge A, Jordan W, Martin R, Van Hout Z, Rawat J
J Child Orthop · 2026 Jun · PMID 41743592 · Full text
BACKGROUND: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures. ME...
BACKGROUND: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures. METHODS: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above. RESULTS: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction ( = 0.022). CONCLUSION: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity ( ), but acceptable absolute heterogeneity ( ), and pooled prevalence estimates should be interpreted with caution. Further studies exploring the influence of disease severity and age on treatment method is required to allow reliable comparisons between open and closed reduction. PROSPERO REGISTRATION NO: CRD420251015622.
Let them move: Early range of motion and rehabilitation after fixation of medial epicondyle fractures in adolescent athletes.
Le B, Troutman T, Perez-Chaumont A … +2 more , Savoie FH, Skalak T
J Child Orthop · 2026 Apr · PMID 41726092 · Full text
BACKGROUND: Medial epicondyle fractures account for 11%-20% of pediatric elbow fractures. While nonoperative treatment is effective, surgery is often recommended for overhead athletes to enhance union rates, valgus stabi...
BACKGROUND: Medial epicondyle fractures account for 11%-20% of pediatric elbow fractures. While nonoperative treatment is effective, surgery is often recommended for overhead athletes to enhance union rates, valgus stability, and expedited return to sporting activities. Postoperative recovery protocols vary, with traditionally up to 2 weeks of strict immobilization and rehabilitation lasting 6-12 months. This study evaluates the early range of motion (ROM) and accelerated rehabilitation in high-performing youth athletes undergoing surgical fixation. METHODS: A retrospective review included patients aged 12-17 who underwent medial epicondyle fracture fixation (2015-2023). Those with concomitant injuries were excluded. Recovery was assessed by unrestricted Return to Sports (RTS). RESULTS: 18 patients (mean age 14) were included. Postoperatively, all wore a hinged elbow orthosis locked at 90° flexion. At 1 week, extension was allowed to -30°, with flexion as tolerated. Physical therapy was initiated, focusing on gentle stretching to full ROM out of the brace. Patients remained in a hinged elbow brace for an average of 4.47 weeks before transitioning to a hinged sleeve or discontinuing brace use. After 4-6 weeks, physical therapy increased with emphasis on strengthening and terminal extension. For the 16 baseball players included, progressive return to throw and hit programs began at an average of 8.6 weeks. All patients returned to sports without restriction at an average of 13.4 weeks. CONCLUSION: Early mobilization and accelerated rehabilitation following medial epicondyle fracture fixation facilitate a faster RTS in high-demand youth athletes. LEVELS OF EVIDENCE IV: Case series.
Prevalence of posttraumatic stress disorder in paediatric patients following orthopaedic trauma: A systematic review.
Punski-Hoogervorst JL, Hoogervorst LA, Schoones JW … +2 more , Avital A, de Witte PB
J Child Orthop · 2026 Apr · PMID 41726091 · Full text
PURPOSE: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop after exposure to severe psychological threats. It is characterized by debilitating symptoms such as re-experiencing and negative c...
PURPOSE: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may develop after exposure to severe psychological threats. It is characterized by debilitating symptoms such as re-experiencing and negative changes in mood and cognitions which are associated with comorbidity, functional impairment and increased mortality. Although orthopaedic trauma may be classified as a traumatic experience causing PTSD, the prevalence of PTSD in paediatric patients following orthopaedic trauma is currently unknown. METHODS: This systematic review aimed to obtain insight into the prevalence of PTSD in paediatric patients after orthopaedic trauma (with or without surgical intervention). Seven medical literature databases were searched to identify studies reporting on the occurrence of PTSD in paediatric patients following orthopaedic trauma. RESULTS: Ten studies were included for analysis. Overall, the pooled prevalence of PTSD was 15% (95% confidence interval: -5.1%, 34.2%), with significant heterogeneity between studies regarding patient population (e.g. age, gender and type of orthopaedic injury) as well as tools used to diagnose PTSD - all influencing the occurrence of PTSD. CONCLUSIONS: As PTSD appears to be a relatively common psychological comorbidity after orthopaedic paediatric trauma, we emphasize that both clinicians and parents should be aware of PTSD symptoms in children to allow early treatment of PTSD. SIGNIFICANCE OF STUDY: Approximately one in seven children may develop PTSD following orthopaedic trauma, highlighting the importance of systematic screening and monitoring of PTSD symptoms in paediatric patients recovering from orthopaedic injuries. LEVEL OF EVIDENCE: Level II (systematic review of level-II studies).
Sociodemographic variables are rarely reported in randomized controlled trials investigating posterior spinal fusion for adolescent idiopathic scoliosis: A systematic review.
Brown EL, Nguyen KT, Koppala BR … +3 more , Dhunna DP, Kuzma A, Baksh N
J Child Orthop · 2026 Apr · PMID 41726090 · Full text
BACKGROUND: Adolescent idiopathic scoliosis (AIS) develops between the ages of 10 and skeletal maturity and can lead to physical, psychosocial, and medical complications if untreated. Posterior spinal fusion (PSF) is the...
BACKGROUND: Adolescent idiopathic scoliosis (AIS) develops between the ages of 10 and skeletal maturity and can lead to physical, psychosocial, and medical complications if untreated. Posterior spinal fusion (PSF) is the primary surgical intervention when bracing fails. Although sociodemographic factors affect access to care, surgical candidacy, perioperative risk, and recovery, these variables are rarely reported in randomized controlled trials (RCTs), limiting assessment of equity and generalizability in AIS outcomes. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Scopus were searched on 9 April 2024, using "posterior spinal fusion," "randomized controlled trial," and "adolescent idiopathic scoliosis." Inclusion criteria were full-text RCTs on PSF in AIS; exclusions were non-English publications, cadaver studies, and technique articles. Two authors independently screened studies, with disagreements resolved by a third. Extracted variables included demographics and social factors. Analyses used descriptive statistics, chi-squared tests, and Fisher's exact test ( < 0.05). RESULTS: Of 148 studies, 44 met the inclusion criteria. Age (97.7%) and sex (95.5%) were reported more frequently than race (6.8%) or ethnicity (9.1%) ( < 0.001). No studies reported household income, insurance status, housing, employment, or education. Reporting did not differ by journal (Fisher's exact test, = 0.999) or publication year (chi-squared test, = 0.185), although reporting increased slightly after 2017. CONCLUSIONS: RCTs on PSF for AIS rarely report sociodemographic variables beyond age and sex. This gap limits understanding of whether outcomes are consistent across populations or if disparities exist in treatment response or recovery. Improved sociodemographic reporting is essential for transparency, external validity, and equity in AIS care. LEVEL OF EVIDENCE: Systematic review of Level II.
Evolution and outcomes of telescoping intramedullary rods in pediatric bone fragility disorders: A systematic review.
Mounsef PJ, Legler J, Patel D … +1 more , Hamdy R
J Child Orthop · 2026 Apr · PMID 41717534 · Full text
PURPOSE: Telescoping intramedullary rods have transformed the management of long bone deformity and fragility fractures in children, yet complications and revision surgery remain common. This systematic review synthesize...
PURPOSE: Telescoping intramedullary rods have transformed the management of long bone deformity and fragility fractures in children, yet complications and revision surgery remain common. This systematic review synthesizes outcomes across telescoping systems to evaluate complication and revision rates, telescoping success, and design evolution to guide implant selection and surgical decision-making in pediatric orthopedics. METHODS: A search was conducted through July 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting outcomes of telescoping rods in pediatric patients were included. Due to heterogeneity, results were synthesized descriptively and presented as weighted means per operated bone. RESULTS: Thirty-three studies (861 patients; 2054 rods) were included. Weighted mean complication and revision rates were 49.6% and 25.7% for Bailey-Dubow rods, 61.1% and 24.5% for Sheffield rods, 37.1% and 30.5% for Fassier-Duval rods, 14.9% and 9.0% for corkscrew-locking rods, and 46.7% and 6.7% for distal-female rods. Telescoping success was 48% for Bailey-Dubow, 74% for Fassier-Duval, 94% for corkscrew, and 100% for distal-female designs. Variation in follow-up duration and definitions of complications contributed to differences in reported rates. CONCLUSIONS: Modern telescoping rods have reduced migration and mechanical failure compared with earlier designs, yet complication and revision rates remain substantial. Newer systems show encouraging early results but require longer follow-up for validation. Differences in bone anatomy and biomechanics strongly influence implant performance, underscoring the need to tailor rod selection to individual bones. SIGNIFICANCE: This review consolidates published complication and revision rates across telescoping rod designs, establishing a foundation for comparison as newer implants are introduced and long-term outcome data become available. LEVEL OF EVIDENCE: III.
The long-term effect of femoral leg lengthening on muscle strength - A 10-year follow-up.
Speth BM, Barlow KA, Schmid M … +3 more , Nüesch C, Ismailidis P, Krieg AH
J Child Orthop · 2026 Apr · PMID 41696356 · Full text
INTRODUCTION: Callus distraction during leg lengthening procedures often leads to a reduction in muscle strength. This study explores whether this decline is temporary or if it persists long-term, with a follow-up period...
INTRODUCTION: Callus distraction during leg lengthening procedures often leads to a reduction in muscle strength. This study explores whether this decline is temporary or if it persists long-term, with a follow-up period of 10 years. MATERIALS AND METHODS: A cohort of nine patients underwent femoral lengthening with a motorized intramedullary device. We measured the maximum isokinetic concentric torque of the knee extensors and flexors preoperatively, at 2 years and at 10 years postsurgery. For this analysis, we included all patients with a full dataset and a minimum follow-up of 10 years ( = 9). We analyzed the differences between preoperative and postoperative maximal isokinetic torques and compared them with a control group of 10 healthy individuals. RESULTS: Before surgery, the median maximal isokinetic torque of the extensor group was higher in the unaffected leg compared to the shorter leg. After leg lengthening, the difference in extension torque between the unaffected and the lengthened legs increased at the 2-year follow-up and even more after 10 years. In contrast, no change was observed in the knee flexor group and there was no significant loss of maximal isokinetic torque in the lengthened leg. In the control group, the comparison between the dominant and nondominant leg showed a difference in knee extension torque of 2.9% and in knee flexion torque of 1.7% in favor of the dominant leg. CONCLUSION: Distraction of the muscle appears to have a higher long-term impact on the muscle properties than previously thought.
Guided growth for the correction of angular lower limb deformity: Correction rates for idiopathic and non-idiopathic aetiologies.
Tolk JJ, Keßling LM, Yeo A … +4 more , Gargent S, Menazirsha M, Wickremasinghe B, Eastwood DM
J Child Orthop · 2026 Apr · PMID 41696355 · Full text
INTRODUCTION: Coronal plane knee deformities are frequent in children and may arise from idiopathic or nonidiopathic causes, leading to cosmetic, functional, or early degenerative issues. Guided growth using tension band...
INTRODUCTION: Coronal plane knee deformities are frequent in children and may arise from idiopathic or nonidiopathic causes, leading to cosmetic, functional, or early degenerative issues. Guided growth using tension band plates is an established corrective method, but its predictability - especially in nonidiopathic cases - needs further evaluation. This study analyzed correction rates (CR) and treatment outcomes in different etiologies. METHODS: A retrospective review included patients treated for coronal plane deformities with tension band plates from 2009 to 2021. Patients were classified according to etiology. Radiographic measurements (mechanical axis deviation, mLDFA, and mMPTA) were compared between baseline and end of correction. Analyses regarding treatment success, CR and predictors for CR and success were performed. RESULTS: The analysis included 654 growth modulations in 313 children; distal femur (55.4%), proximal tibia (44.6%), both (42.2%. The average CR for mLDFA was 0.67 (+/-0.55)°/month and for mMPTA 0.43 (+/-0.38)°/month. CR significantly varied by etiology ( < 0.001), with older age at surgery and varus deformity predicting lower CRs. Neutral mechanical axis was achieved in 68.7% of patients. Significant differences between etiologies were seen, and complete correction was achieved significantly more often in patients with idiopathic etiology compared to nonidiopathic etiologies; 78.2% vs. 66.3% respectively, = 0.02. CONCLUSION: Hemi-epiphysiodesis is effective for correcting coronal plane deformities in children, but CR differs by etiology and incomplete correction is not uncommon. These factors should inform treatment planning and follow-up. LEVEL OF EVIDENCE: Level IV, case-series.
Osteosynthesis with allograft screws in pediatric orthopedics.
Gutierrez-Pereira J, Paulos F, Gutierrez-Carbonell P … +1 more , Garcia-Lopez A
J Child Orthop · 2026 Apr · PMID 41696354 · Full text
PURPOSE: A significant percentage of patients develop complications related to the use of implants made of stainless steel or titanium. The purpose of our study is to retrospectively analyze the clinical and radiological...
PURPOSE: A significant percentage of patients develop complications related to the use of implants made of stainless steel or titanium. The purpose of our study is to retrospectively analyze the clinical and radiological outcomes of allograft screws implanted in the Pediatric Orthopedic unit of our center. METHODS: A retrospective analysis was conducted, including 30 patients (16 females and 14 males) with lower limb pathologies who received 50 human cortical bone allograft screws. The study period covered 48 months, from 1 January 2020, to 1 January 2023. The average age was 12 years 7 months (range 3, 15 years). The mean follow-up was 44 months (range 24-66). RESULTS: After an average follow-up of 44 months, no patients developed minor or major complications, delayed union, or infections. Three patients reported discomfort due to implant prominence, and two of them (7%) required reoperation for screw head remodeling. The average resorption time was 9 months (range 5, 15 months). The postoperative American Orthopaedic Foot & Ankle Society score increased by 38.28 points compared to the preoperative score. CONCLUSIONS: This is the first reported series assessing cortical bone allograft screws in the pediatric population. Our findings suggest that these implants may reduce the need for hardware removal and associated morbidity. It is important to avoid implant prominences that may cause discomfort to the patient and potentially require reoperation. LEVEL OF EVIDENCE: IV, Therapeutic.
Risk factors for subsequent debridement in pediatric patients with septic arthritis of the knee: A case control study.
Niknam K, Bach K, O'Donnell J … +1 more , Swarup I
J Child Orthop · 2026 Apr · PMID 41696353 · Full text
BACKGROUND: Septic knee arthritis in pediatric patients is rare; however, timely diagnosis and treatment is key in preventing damage to articular cartilage and other structures in the joint. Risk and prognostic factors a...
BACKGROUND: Septic knee arthritis in pediatric patients is rare; however, timely diagnosis and treatment is key in preventing damage to articular cartilage and other structures in the joint. Risk and prognostic factors associated with treatment failure have not yet been studied in this patient population. In this study, we aim to assess how various lab and clinical findings at time of initial presentation associate with need for subsequent debridement among pediatric septic knee patients. METHODS: This is a retrospective, single-center, case-control study comparing patients who did and did not receive subsequent irrigation and debridement for septic arthritis of the knee. Risk factors were assessed through univariate comparisons, utilizing chi-squared tests, -tests, and Fisher-exact tests, as appropriate. Multivariate logistic regression and area under the receiver operating characteristic (AUROC) analysis was used to assess discriminatory ability of identified risk factors. Significance was defined as < 0.05. RESULTS: A total of 41 patients were included in this study, of which 18 underwent subsequent debridement. Patients requiring subsequent debridement had higher rates of positive blood culture (43.8% vs. 6.7%, = 0.04), positive synovial cultures (66.7% vs. 26.1%, = 0.01), and synovial white blood cell counts (WBC) > 100,000 cells/L (53.3% vs. 20.0%, = 0.04). When these three variables were placed in a logistic model, an AUROC of 0.82 was observed (95% confidence interval: 0.64-0.99). CONCLUSIONS: Positive blood and synovial cultures, and synovial WBC > 100,000 cells/L, were identified as significant prognostic factors for subsequent septic knee surgery. Clinicians should consider these factors when counseling patients and caregivers about risk for subsequent debridement. LEVEL OF EVIDENCE: III; Retrospective Case-Control Study.
3D-guided high-degree posterior rotational osteotomy for avascular necrosis in pediatric femoral neck fractures: A three-case study.
Watanabe M, Kagaya S, Kuzushima D … +1 more , Kachi I
J Child Orthop · 2026 Apr · PMID 41630959 · Full text
PURPOSE: Pediatric femoral neck fractures (PFNFs) are rare (≈1% of pediatric fractures), and avascular necrosis (AVN) is a devastating complication without a universally accepted management. High-degree posterior rotatio...
PURPOSE: Pediatric femoral neck fractures (PFNFs) are rare (≈1% of pediatric fractures), and avascular necrosis (AVN) is a devastating complication without a universally accepted management. High-degree posterior rotational osteotomy (HDPRO) with three-dimensional (3D) navigation is a novel joint-preserving technique with the potential to improve outcomes. METHODS: A retrospective case series was conducted with three pediatric patients (2 boys, 1 girl; aged 9-15 years at injury) diagnosed with AVN secondary to PFNF. All underwent HDPRO using Stryker OrthoMap 3D navigation to reposition the viable anteromedial femoral head. Preoperative and postoperative outcomes were assessed using radiographic analysis, functional scoring (Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ)), and sports participation. Follow-up ranged from 24 to 36 months. RESULTS: All patients showed pain relief, functional improvement, stable femoral head morphology, and revascularization. JHEQ improved to 79-84 points; hip motion normalized without impingement. All patients returned to sports (track, volleyball, cycling). CONCLUSIONS: HDPRO with 3D navigation is a promising joint-preserving option for AVN following PFNF. Preliminary results are favorable; however, the small cohort and limited follow-up warrant larger studies. SIGNIFICANCE OF STUDY: To the best of our knowledge, this is the first report demonstrating that navigation-guided HDPRO reliably relocates the viable anteromedial head to the load-bearing zone. LEVEL OF EVIDENCE: Level IV.
Postoperative immobilization versus early mobilization following titanium elastic nailing in pediatric diaphyseal both-bone forearm fractures: A retrospective comparative study.
Kozlu S, Ocak B, Görgün B … +2 more , Öner SK, Kuyubaşı SN
J Child Orthop · 2026 Apr · PMID 41630958 · Full text
PURPOSE: To compare the effects of postoperative splint immobilization versus early mobilization on 1-year radiological and functional outcomes in pediatric diaphyseal both-bone forearm fractures treated with elastic sta...
PURPOSE: To compare the effects of postoperative splint immobilization versus early mobilization on 1-year radiological and functional outcomes in pediatric diaphyseal both-bone forearm fractures treated with elastic stable intramedullary nailing (ESIN). METHODS: A retrospective analysis was performed on 124 children (6-14 years) who underwent ESIN for closed mid-diaphyseal radius-ulna fractures between January 2018 and December 2023. Patients were divided into splint ( = 64) and non-splint ( = 60) groups according to postoperative protocol. Radiological healing was evaluated using the Lane-Sandhu score at 1, 3, 6, and 12 months, and functional outcomes using the Price classification at 3, 6, and 12 months. RESULTS: Baseline characteristics were comparable. At the third month, radiological scores were slightly higher in the splint group, while functional results favored early mobilization, though differences were not statistically significant. By the 6th and 12th months, complete union and excellent functional recovery were achieved in all patients, with no significant intergroup differences ( > 0.05). CONCLUSIONS: Early mobilization following ESIN is feasible and does not delay bone healing or impair function. Routine splinting may be unnecessary, and postoperative care can be tailored to the patient and fracture characteristics. Moreover, our findings demonstrate that when ESIN principles are properly applied, splint use in appropriately selected patients does not lead to any long-term functional deficit, and excellent outcomes can still be expected.
Evaluating ChatGPT-5.0 in developmental dysplasia of the hip: A scenario-based validation study against AAOS and AAP guidelines.
Kozlu S, Görgün B, Öner SK
J Child Orthop · 2026 Apr · PMID 41630957 · Full text
PURPOSE: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians-especially where pediatric orthopedic expertise is limi...
PURPOSE: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians-especially where pediatric orthopedic expertise is limited, but their reliability across typical and discordant presentations is uncertain. This scenario-based validation study evaluated the accuracy of ChatGPT-5.0's management recommendations for DDH using 30 structured clinical cases and compared these outputs against AAOS (2022) and AAP (2016) guidelines. METHODS: Scenario-based validation using 30 unique cases: 20 concordant (aligned clinical and imaging findings) spanning Graf and acetabular index-based ages, and 10 mismatch scenarios with correct examinations but intentionally erroneous radiology. The primary outcome was guideline-concordant accuracy, categorized as correct, partially correct, undertreatment, overtreatment, or incorrect. Secondary outcomes included the effect of error-aware prompts and multilingual consistency. RESULTS: In concordant scenarios, guided ChatGPT achieved 100% correct, while non-logged-in ChatGPT achieved 95% with one overtreatment. In mismatch scenarios, guided ChatGPT frequently tends toward overtreatment and failing to recommend repeat ultrasound or urgent pediatric orthopedic consultation. Non-logged-in ChatGPT performed better in mismatch cases but similarly under-emphasized remeasurement/consultation. Error-aware prompts did not materially alter recommendations in either environment. Swahili queries produced outputs clinically identical to English responses. CONCLUSIONS: ChatGPT-5.0 provides reliable, guideline-concordant guidance for DDH when clinical and radiologic data are concordant, supporting potential use as a decision aid in settings without immediate pediatric orthopedic access. Safe clinical implementation requires human oversight and integration of guideline-based safety checks to prevent mismanagement in ambiguous cases.
Assessing parental concerns in developmental dysplasia of the hip in early infancy: Validation of the Dutch Hip Worries Inventory.
Theunissen WWES, Tolk JJ, Ito AB … +5 more , Dörssers BJMH, Oldenkamp HA, Van Heeswijk E, Van Douveren FQMP, Van der Steen MC
J Child Orthop · 2026 Apr · PMID 41589266 · Full text
PURPOSE: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into...
PURPOSE: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into Dutch and evaluate its psychometric properties. METHODS: The HWI was translated using a standardized forward-backward translation process. Psychometric evaluation followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and included assessments of readability, interpretability, responsiveness, reliability and content validity. Parents of infants aged 3-13 months diagnosed with DDH and managed with active surveillance or abduction bracing with a Pavlik harness were included. RESULTS: The Dutch version of the HWI was completed by 59 parents prior to treatment and by 50 of them during treatment. In addition, 56 parents completed the questionnaire twice around their child's first birthday. The Dutch HWI demonstrated good readability (Flesch Reading Ease Score = 84.1) and adequate interpretability (mean score 21.53, standard deviation 6.11). Responsiveness was supported by confirmation of 89% of the predefined hypotheses. Internal consistency was good (Cronbach's α = 0.77-0.79) and test-retest reliability was excellent (Intraclass Correlation Coefficient = 0.95; 95% Confidence interval 0.91-0.97). Content validity assessment identified concerns regarding the relevance of items 3-6 for non-brace treatment, the sequencing of items, the use of negatively worded items and the absence of items addressing practical and informational needs. CONCLUSIONS: The Dutch HWI is a promising instrument for assessing parental concerns related to DDH in early infancy. However, limitations in content validity highlight the need for refinement, incorporating input from parents, caregivers and healthcare professionals to enhance content validity and clinical applicability.
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