Journal Of Children's Orthopaedics[JOURNAL]
Sun
200 papers
Evolution of discrepancies in limb asymmetry in Beckwith-Wiedemann spectrum.
Lopez RD, Hall CE, Sussman JH … +5 more , George AM, Phillips CA, Gerace C, Davidson RS, Kalish JM
J Child Orthop · 2025 Dec · PMID 41111602 · Full text
BACKGROUND: Beckwith-Wiedemann spectrum is a genetic disorder characterized by lateralized overgrowth, often presenting as limb bulk discrepancy. While limb-length discrepancies are documented in Beckwith-Wiedemann spect...
BACKGROUND: Beckwith-Wiedemann spectrum is a genetic disorder characterized by lateralized overgrowth, often presenting as limb bulk discrepancy. While limb-length discrepancies are documented in Beckwith-Wiedemann spectrum, the natural history of limb bulk discrepancy and hand/foot asymmetry progression remains less studied. This research examines limb bulk discrepancy progression in children with Beckwith-Wiedemann spectrum and identifies factors influencing its severity. METHODS: A retrospective, single-institution study analyzed 142 children with molecularly confirmed Beckwith-Wiedemann spectrum (imprinting center 2 loss of methylation, imprinting center 1 gain of methylation, and paternal uniparental isodisomy at chromosome 11). Limb measurements (upper arm, forearm, thigh, calf, palm, finger, and foot) were recorded during clinic visits. Linear mixed-effects models assessed relationships between genotype, age, limb bulk discrepancy progression, body mass index, and sex. RESULTS: The cohort included 90 imprinting center 2 loss of methylation, 41 paternal uniparental isodisomy at chromosome 11, and 11 imprinting center 1 gain of methylation patients. In the imprinting center 2 loss of methylation group, significant limb bulk discrepancy progression occurred in the upper arm (0.47 mm/year), calf (0.53 mm/year), and foot anterior-posterior dimension (0.40 mm/year; all < 0.01). The paternal uniparental isodisomy at chromosome 11 genotype showed greater asymmetry in most regions compared to others ( < 0.01), except the middle finger. Asymmetry progression rates were similar across genotypes. Body mass index positively correlated with increased limb bulk discrepancy in the upper arm and calf. CONCLUSIONS: Limb asymmetry in Beckwith-Wiedemann spectrum progresses slowly in specific regions, with genotype and body mass index influencing baseline severity. Patients with paternal uniparental isodisomy at chromosome 11 exhibit greater baseline limb bulk discrepancy, but progression rates are consistent across genotypes, highlighting the need for further research into lateralized overgrowth mechanisms and clinical implications. LEVEL OF EVIDENCE: 3-Retrospective cohort study.
Reliability of Radiographic Union Score and correlation of clinical outcomes in children operated for supracondylar humerus fracture: A prospective study.
Yüzügüldü U, Yeşil M, Özcan Ö … +2 more , Maralcan G, Konya MN
J Child Orthop · 2025 Dec · PMID 41080704 · Full text
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Scoliosis in adolescents with autism spectrum disorder: A retrospective case series.
Torres-Gonzalez L, Morgan SJ, Truong WH … +3 more , Palmer C, Nouraee C, Harding DC
J Child Orthop · 2025 Dec · PMID 41030770 · Full text
PURPOSE: To describe the curve patterns and behaviors, clinical presentation, treatment modalities, and complications for adolescents with both scoliosis and autism spectrum disorders, but no additional concomitant diagn...
PURPOSE: To describe the curve patterns and behaviors, clinical presentation, treatment modalities, and complications for adolescents with both scoliosis and autism spectrum disorders, but no additional concomitant diagnoses. METHODS: A single-center, retrospective review of adolescents with scoliosis and autism spectrum disorder treated between 2001 and 2021. Patient demographics, clinical characteristics, and radiographic assessments were described across the scoliosis treatment plans (i.e. observation, bracing, and surgery). RESULTS: Forty patients with scoliosis and autism spectrum disorder (80% male, mean age at 13.2 ± 1.7) met eligibility criteria. Twenty-one patients were managed with observation initially. Of these patients, 55% ( = 11) didn't require further treatment and had an average change in curvature of 5° ± 6°. Twenty-one total patients were managed with bracing. In this group, 76% ( = 16) did not receive further treatments and had an average increase in curvature of 15° ± 11°. Five patients (24%) proceeded to surgery following brace treatment. Thirteen patients (33%) in total required surgery, with = 5 requiring surgery as their initial treatment. The initial curve magnitude for this group was 55° ± 7° and had an average correction of 47% following posterior spinal fusion. CONCLUSIONS: Although curves in adolescents with scoliosis and autism spectrum disorder had a similar presentation to adolescents with just scoliosis, the current cohort did have an increase in curve progression when managed with bracing, with an unclear explanation. Further study is warranted in this unique population, and families should be counseled that the prognosis may not be the same as adolescents with scoliosis alone. LEVELS OF EVIDENCE: Level IV.
Lower Child Opportunity Index and public insurance are associated with decreased prenatal orthopedic evaluation and minor treatment delays for idiopathic clubfoot.
Bram JT, Nian PP, Williams CJ … +5 more , Tracey OC, Scher DM, Blanco JS, Dodwell ER, Doyle SM
J Child Orthop · 2025 Dec · PMID 41024828 · Full text
BACKGROUND: Idiopathic clubfoot is a congenital disorder necessitating time-sensitive treatment. Delayed application of the Ponseti method may result in poorer outcomes. Adverse social determinants of health, as measured...
BACKGROUND: Idiopathic clubfoot is a congenital disorder necessitating time-sensitive treatment. Delayed application of the Ponseti method may result in poorer outcomes. Adverse social determinants of health, as measured with the Childhood Opportunity Index version 3.0, hinder access to care. This study aimed to determine the association between Childhood Opportunity Index, insurance status, and treatment disparities for patients with idiopathic clubfoot. METHODS: This retrospective cohort study included patients with idiopathic clubfoot who underwent Ponseti treatment at an urban tertiary care orthopedic hospital between October 2004 and September 2022. Patients presenting for care before 6 months of age and with a minimum 2-year follow-up were included. A threshold Childhood Opportunity Index value of 60.0 categorized patients into low (<60.0) and high (≥60.0) cohorts. Clinical and treatment/outcome variables were compared. RESULTS: A total of 156 patients (mean follow-up 5.1 ± 2.5 years) merited inclusion: 31 (20%) with Childhood Opportunity Index <60 and 125 (80%) with Childhood Opportunity Index ≥60. Patients with low Childhood Opportunity Index presented at older ages (18 ± 23 versus 11 ± 10 days, = 0.03) and had fewer prenatal orthopedic evaluations (42% versus 64%, = 0.03). Recurrence and necessity for further treatment were similar ( > 0.05). Patients with public insurance presented at older ages (28 ± 31 versus 10 ± 9 days, < 0.01) and were less likely to undergo prenatal consultation (13% versus 65%, < 0.01). Black/Hispanic patients were more likely to experience a recurrence (odds ratio 6.4, 95% confidence interval 1.2-35.4, = 0.03), whereas patients who had a prenatal orthopedic evaluation were less likely to experience a recurrence (odds ratio 0.3, 95% confidence interval 0.1-0.9, = 0.03). CONCLUSIONS: Patients with idiopathic clubfoot and low Childhood Opportunity Index/public insurance experienced delayed presentation to care and fewer prenatal orthopedic consultations. However, low Childhood Opportunity Index and public insurance status were not associated with adverse treatment outcomes. Clubfoot specialists remain a critical component of the multidisciplinary prenatal team, as orthopedic consultations served as a protective factor against recurrence. These findings contribute to the existing literature by highlighting discrepancies in the care for patients with adverse social determinants of health. LEVEL OF EVIDENCE: Level III.
The importance of collecting and sharing scientific publications in pediatric orthopedic surgery from China.
Canavese F, Hefti F, Wientroub S
J Child Orthop · 2025 Oct · PMID 40980205 · Full text
The has compiled a special collection of scientific publications from Chinese centers accepted for publication in the journal. Through this collection, the demonstrates its commitment to promoting global knowledge shar...
The has compiled a special collection of scientific publications from Chinese centers accepted for publication in the journal. Through this collection, the demonstrates its commitment to promoting global knowledge sharing and collaboration in pediatric orthopedic surgery. The articles in the collection undergo the same rigorous peer review process as other articles. Once a publication is assigned to an issue, it is automatically added to the Special Chinese Collection on the website, where it can be easily downloaded. The Special Chinese Collection's open access policy increases the visibility and global reach of articles, promoting accelerated citations and collaborations. The is an ideal platform for collecting and disseminating high-quality, relevant scientific publications in pediatric orthopedic surgery from China. The Special Chinese Collection showcases innovative research, encourages knowledge sharing, and fosters cultural exchange, promoting the development of a global community of researchers and clinicians dedicated to advancing the field of pediatric orthopedic surgery and improving children's lives worldwide.
Assessment of postoperative range of motion in pediatric patients undergoing surgical reduction and fixation of lateral condyle fractures.
Rogie G, Borden T, Crawford L … +4 more , Mundluru S, Roper B, Vanodia RM, Younas S
J Child Orthop · 2025 Dec · PMID 40980204 · Full text
PURPOSE: The objective of this study was to evaluate the outcomes of various methods of fixation for pediatric lateral condyle fractures. The null hypothesis was that there would be no difference between the three treatm...
PURPOSE: The objective of this study was to evaluate the outcomes of various methods of fixation for pediatric lateral condyle fractures. The null hypothesis was that there would be no difference between the three treatment groups and time of return to the full range of motion. METHOD: There were three fixation groups-Algemeinshaft fur osteosynthesegragen (AO) cannulated screws ( = 11), buried Steinmann pins ( = 13), and unburied Steinmann pins ( = 36). Variables evaluated were time to return to full range of motion of the elbow, whether therapy was required, average number of follow-up visits, fracture classification (Milch), time to operating room, duration of immobilization, degree of initial fracture displacement, time to radiographic healing, complications, and if manipulation under anesthesia was done, whether this was planned or not. RESULTS: Average return to full range of motion for Algemeinshaft fur osteosynthesegragen cannulated screw, buried Steinmann pins, and unburied Steinmann pins were 113, 82.7, and 94 days, respectively. A one-way ANOVA revealed a -value of 0.11711. -Values were also insignificant for the average number of follow-up visits, time to operating room, and time of immobilization. The -value for time to radiographic healing was <0.00001, with times for Algemeinshaft fur osteosynthesegragen cannulated screw, buried Steinmann pins, and unburied Steinmann pins being 75, 35, and 34.9 days, respectively. Notably, the Algemeinshaft fur osteosynthesegragen screw group averaged 9 years old, more than twice the Steinmann pin groups' 4 years. CONCLUSION: Data from this sample suggest that there is no difference in return to full range of motion when comparing the three fixation methods. There was a difference in time to radiographic healing with Algemeinshaft fur osteosynthesegragen screws taking the longest, potentially due to age differences.
Kinematic characterization of residual deformities in idiopathic clubfoot initially treated with the Ponseti method: Gait analysis using the Heidelberg Foot Model.
Chen Q, Salami F, Putz C … +1 more , Wolf SI
J Child Orthop · 2025 Oct · PMID 40908960 · Full text
PURPOSE: This study aimed to investigate foot kinematics during gait in individuals with idiopathic clubfoot initially treated with the Ponseti method, focusing on clubfoot-specific deformities, to improve the understand...
PURPOSE: This study aimed to investigate foot kinematics during gait in individuals with idiopathic clubfoot initially treated with the Ponseti method, focusing on clubfoot-specific deformities, to improve the understanding of posttreatment functional impairments. METHODS: In this prospective cohort study, 23 patients with treated idiopathic clubfoot (34 feet) were compared with 15 age-matched healthy controls (30 feet). Gait analysis was performed using the Heidelberg Foot Model. To characterize residual clubfoot deformities, selected kinematic parameters included medial arch and subtalar angles, as well as intersegmental angles between hindfoot-shank and forefoot-hindfoot, based on more functional joint centers. Within the patient group, potential influence of additional surgical interventions was explored. RESULTS: Compared with controls, treated idiopathic clubfoot exhibited significant reductions in hindfoot sagittal and transverse range of motion, forefoot sagittal range of motion, and medial arch mobility. Equinus deformity was not present posttreatment, as dorsiflexion metrics during stance did not differ significantly. However, plantarflexion range of motion during the transition to swing was reduced. In addition, treated idiopathic clubfoot showed persistent subtalar inversion and hindfoot varus, increased mid-stance adductus in both hindfoot and forefoot, and pronounced arch stiffness during transition to swing. Within the patient group, ankle and subtalar capsulotomy was associated with increased medial arch cavus. CONCLUSION: Patients with treated idiopathic clubfoot exhibit a functionally stiffer foot with altered alignment during gait, contributing to impaired limb advancement. The results expand the understanding of residual clubfoot deformities and highlight the importance of detailed functional assessment posttreatment, providing a foundation for future research. LEVEL OF EVIDENCE: Level II, prognostic study.
Bracing for scoliosis in children with cerebral palsy-a systematic review.
Merkelbach N, Pauw A, Van Campenhout A
J Child Orthop · 2025 Oct · PMID 40896527 · Full text
PURPOSE: Scoliosis is a prevalent condition among individuals with cerebral palsy, characterized by an inability to maintain spinal alignment due to diminished muscle tone. This progressive curvature becomes structural o...
PURPOSE: Scoliosis is a prevalent condition among individuals with cerebral palsy, characterized by an inability to maintain spinal alignment due to diminished muscle tone. This progressive curvature becomes structural over time, resulting in physical impairment and challenges in daily activities. Consequently, therapeutic intervention is essential. Historically, brace therapy has been extensively utilized, but its efficacy remains uncertain. METHODS: A systematic review was conducted across four databases to compile all relevant studies and reviews pertaining to brace therapy in cerebral palsy patients. Each article was independently assessed by two researchers and evaluated using the SIGN tool. RESULTS: Eight studies were included, comprising six retrospective and two prospective studies, all rated as "acceptable" or "high quality." Brace therapy demonstrated a temporary positive effect, with improved Cobb angles observed during brace usage, particularly in patients under 15 years of age, due to incomplete spinal maturation. However, this improvement is transient, as Cobb angles tend to increase once the brace is removed, diminishing its effectiveness. In addition, brace therapy positively impacts quality of life by enhancing posture and reducing pain, although these benefits also diminish over time, potentially leading to a decline in quality of life. CONCLUSIONS: Brace therapy offers temporary relief for physical and daily life challenges associated with cerebral palsy. However, its effects are not sustained, necessitating operative techniques for long-term management. This was a systematic review of Level-II studies or Level-I studies with inconsistent results.
Treatment choices for recurrent patellar instability in children and adolescents.
Sinikumpu J, Nicolaou N
J Child Orthop · 2025 Oct · PMID 40896526 · Full text
Chronic patellofemoral instability is common in children and adolescents. While it may follow a single traumatic injury to an otherwise healthy and anatomically normal knee, several predisposing anatomical risk factors a...
Chronic patellofemoral instability is common in children and adolescents. While it may follow a single traumatic injury to an otherwise healthy and anatomically normal knee, several predisposing anatomical risk factors are often present. This review assesses the treatment of recurrent patellar dislocation in children and adolescents. A literature review was performed, accompanied by the authors' current suggested practice. Surgical interventions are often required, and the available procedures depend on the stage of skeletal maturity. Soft-tissue procedures aim to restore medial patellar constraints, with medial patellofemoral ligament reconstruction being the most important treatment across all age groups. Reconstruction of the medial patellotibial ligament and medial quadriceps tendon femoral ligament is a developing technique to enhance medial stability. In skeletally immature children, patella alta may be addressed with tendon shortening, and an increased tibial tuberosity versus trochlear groove distance may warrant medialization procedures such as the Grammont technique. Valgus knee is managed with growth modulation. After physeal closure, treatment options include tibial tuberosity osteotomy with distalization and medialization, as well as femoral varus or rotational osteotomy in severe cases. Trochleoplasty is also an option for adolescents after growth plate fusion. Thorough clinical and imaging evaluation is essential in cases of recurrent lateral patellar dislocation. Treatment is selected based on the likelihood of success with isolated medial patellofemoral ligament reconstruction, success underpinned by the presence of underlying anatomical risk factors and the stage of skeletal maturity for each patient. : Level III.
Reliability of Radiographic Union Score and correlation of clinical outcomes in children operated for supracondylar humerus fracture: A prospective study.
Rehm A, Granger L, Worley RJ … +3 more , Morriss F, McMahon E, Ashby E
J Child Orthop · 2025 Dec · PMID 40880862 · Full text
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Healing smarter: A systematic review and meta-analysis of bioresorbable implants for paediatric forearm fractures.
Eastwood F, Raheman F, Al-Dairy G … +4 more , Popescu M, Henney C, Hunwick L, Buddhdev P
J Child Orthop · 2025 Oct · PMID 40852198 · Full text
PURPOSE: Paediatric forearm fractures are among the most common childhood injuries, with diaphyseal fractures often requiring surgical management due to their instability and poorer remodelling potential. Traditional met...
PURPOSE: Paediatric forearm fractures are among the most common childhood injuries, with diaphyseal fractures often requiring surgical management due to their instability and poorer remodelling potential. Traditional methods, such as elastic stable intramedullary nailing, are effective but require secondary procedures for implant removal, increasing healthcare burdens. Bioabsorbable intramedullary nails offer an alternative, eliminating the need for implant removal. This systematic review and meta-analysis evaluates the efficacy and safety of bioabsorbable intramedullary nails compared to conventional methods. METHODS: Five studies, including 255 paediatric patients with 399 forearm fractures, were included. Of these, 159 were treated with bioabsorbable intramedullary nails. Meta-analyses assessed outcomes, including fracture healing time, complications, functional results and reoperation rates. RESULTS: Bioabsorbable intramedullary nails demonstrated fracture healing times comparable to elastic stable intramedullary nailing (10.67 weeks; 95% CI: 8.92-11.42) with no significant differences. Complication rates were similar, with nine re-fractures in the bioabsorbable intramedullary nail group and 10 in the elastic stable intramedullary nailing group. Secondary displacement occurred in 3.1% of bioabsorbable intramedullary nail patients versus 4.7% for elastic stable intramedullary nailing. Functional outcomes showed improved pronation (78.5° versus 72.7°, = 0.030) and elbow flexion (153.8° versus 144.8°, = 0.001) for bioabsorbable intramedullary nails. Pain scores were comparable, with fewer bioabsorbable intramedullary nail patients reporting postoperative pain. CONCLUSIONS: Bioabsorbable intramedullary nails are a safe and effective alternative to elastic stable intramedullary nailing, offering equivalent clinical outcomes while eliminating the need for implant removal. Larger, long-term studies are needed to confirm these findings and evaluate the cost-effectiveness of bioabsorbable intramedullary nails in paediatric fracture management.
Ultrasonographic hip morphology in mucopolysaccharidosis type I Hurler after hematopoietic stem cell gene therapy.
De Pellegrin M, Filisetti C, Cossutta M … +5 more , Colombo M, Consiglieri G, Tucci F, Aiuti A, Bernardo ME
J Child Orthop · 2025 Oct · PMID 40809356 · Full text
PURPOSE: To assess ultrasonographic features of hip morphology in mucopolysaccharidosis type I Hurler. METHODS: Acetabular bony rim, acetabular cartilaginous roof, alpha and beta angles, echogenicity, and hip coverage we...
PURPOSE: To assess ultrasonographic features of hip morphology in mucopolysaccharidosis type I Hurler. METHODS: Acetabular bony rim, acetabular cartilaginous roof, alpha and beta angles, echogenicity, and hip coverage were analyzed in eight mucopolysaccharidosis type I Hurler syndrome children before and after hematopoietic stem cell gene therapy. RESULTS: Sixteen hips at baseline, 10 at +12 months, and 10 at + 24 months after hematopoietic stem cell gene therapy were evaluated. The median age was 22, 35, and 45 months at baseline evaluation, +12, and +24 months, respectively. Acetabular bony rim at baseline was angular in 2/16, rounded in 10/16, notched in 2/16, and flattened in 2/16; at +12 months, angular in 2/10, rounded in 5/10, notched in 3/10; at +24 months, angular in 2/10, rounded in 3/10, irregular in 1/10, and notched in 4/10. Acetabular cartilaginous roof at baseline was normal in 4/16, enlarged in 12/16; at +12 months, enlarged in 10/10 and at +24 months, enlarged in 8/10 and normal in 2/10. Echogenicity of the joint capsule at baseline was normal in 10/16, increased in 6/16; at +12 months, normal in 8/10, increased in 2/10; at +24 months, normal in 6/10, increased in 4/10. The mean femoral head coverage was 60% at baseline (16/16), 62% at +12 months (10/10), and 52% at +24 months (2/10). The mean alpha angle was 60° at baseline (16/16), 64° at +12 months (10/10), and 60° (2/10) at +24 months. The mean beta angle was 67° at baseline (16/16), 65° at +12 months (10/10), and 49° at +24 months (8/10). CONCLUSIONS: Hip morphology of children with mucopolysaccharidosis type I Hurler syndrome before and after hematopoietic stem cell gene therapy can be evaluated by available ultrasound techniques until a median age of 45 months.
European Paediatric Orthopaedic Society consensus study to identify research priorities in paediatric orthopaedic surgery.
Carpenter CV, Wong C, Perry DC … +1 more , Rölfing JD
J Child Orthop · 2025 Oct · PMID 40778284 · Full text
BACKGROUND: Paediatric orthopaedic surgery is rarely supported by high-quality evidence, with treatment decisions generally informed by experience or case series. The European Paediatric Orthopaedic Society recognises th...
BACKGROUND: Paediatric orthopaedic surgery is rarely supported by high-quality evidence, with treatment decisions generally informed by experience or case series. The European Paediatric Orthopaedic Society recognises the need to establish research priorities in the field. This study builds on previous UK research priorities to discover the most important unanswered clinical effectiveness research questions in elective and trauma care and basic science, amongst Paediatric Orthopaedic surgeons across Europe. METHODS: A modified Delphi technique, including an initial scoping survey and a two-round Delphi process conducted amongst paediatric orthopaedic surgeons in Europe. RESULTS: An average of 113 surgeon responses were received in each round, scoring questions from 1 (low priority) to 5 (high priority). The mean score for importance was 3.59 in elective questions, 3.13 in trauma and 3.54 in basic science. The top questions in each group were identified. The top five research priorities for elective care related to the care of - Perthes Disease, Slipped Upper Femoral Epiphysis and Developmental Dysplasia of the Hip. Those in trauma related to the treatment of fractures around the elbow, forearm and femur Basic science priorities related to pharmaceuticals in the management of paediatric orthopaedic conditions and the pathology of Perthes' Disease and Developmental Dysplasia of the Hip. CONCLUSIONS: The results will help guide clinicians, researchers and funding bodies to focus research towards important topics and improve the evidence for practice in paediatric orthopaedic surgery. We hope that this study will encourage the development of collaborative international studies to improve care in paediatric orthopaedics. LEVEL OF EVIDENCE: Level V - decision analysis.
All-inside physeal bar resection for partial physeal arrest of the distal radius with the aid of an arthroscope and patient-specific instrument.
Xiao H, Xiao B, Tan X … +7 more , Tan Q, Ye W, Wu J, Li R, Mei H, Zhu G, Yan A
J Child Orthop · 2025 Aug · PMID 40735358 · Full text
PURPOSE: The premature closure of the epiphysis of the distal radius is an infrequent condition in pediatric patients, often resulting in distal radius deformity. Currently, there is limited literature on its treatment,...
PURPOSE: The premature closure of the epiphysis of the distal radius is an infrequent condition in pediatric patients, often resulting in distal radius deformity. Currently, there is limited literature on its treatment, and controversy exists. This study aimed to evaluate the clinical efficacy of all-inside physeal bar resection with the aid of an arthroscope and patient-specific instrument. METHODS: We retrospectively reviewed the patients who sustained distal radius physeal bar resection under all-inside visualization of the arthroscope with the aid of a patient-specific instrument during 2016-2022. Follow-up was performed for a minimum of 2 years, during which pre-operative and post-operative clinical and radiological parameters were compared. RESULTS: There were six boys and two girls enrolled in this study. Six patients got satisfied results, while two patients didn't benefit from the surgery. The mean pre-operative RAA of the affected side was -11.4° ± 13°, while the post-operative radial articular angle was 3.4° ± 11°. There was a significant difference between them. The mean pre-operative ulnar variance was 7.6 mm ± 6 mm, while the post-operative UV was 3.3 cm ± 8 mm. There was no significant difference between them. The pre-operative modified Mayo Wrist Score was 92 ± 5, while that for post-operative was 96 ± 7. CONCLUSION: All-inside physeal bar resection for partial physeal arrest of the distal radius with the aid of an arthroscopy and patient-specific instrument is minimally invasive, accurate, and safe. It should be the one option treatment for the premature closure of the distal radius epiphysis.
Using the simple locking intramedullary (SLIM) system for bone deformity stabilization: A retrospective cohort study.
Mounsef PJ, Addab S, Alfaisali S … +2 more , Bernstein M, Hamdy R
J Child Orthop · 2025 Oct · PMID 40735357 · Full text
BACKGROUND: Osteogenesis imperfecta (OI) is characterized by bone fragility and deformities. Treating long bone fractures and deformities in OI patients typically involves intramedullary (IM) rods. The Simple Locking Int...
BACKGROUND: Osteogenesis imperfecta (OI) is characterized by bone fragility and deformities. Treating long bone fractures and deformities in OI patients typically involves intramedullary (IM) rods. The Simple Locking Intramedullary (SLIM) nail is a novel surgical device developed to address challenges in patients with narrow medullary canals, which are unsuitable for larger telescoping rods. This study aims to evaluate the outcomes and complications associated with SLIM nail use in pediatric patients with OI. METHODS: A retrospective chart review was conducted at our institution, analyzing 23 patients (41 limbs) who underwent surgery using the SLIM nail between April 2016 and March 2022. Data on patient demographics, surgical intervention, post-operative outcomes, and complications were collected. Radiological evaluations were performed from the immediate post-operative period up to the most recent follow-up. RESULTS: The SLIM nail demonstrated a 2-year survival rate of 82.8% and a 4-year survival rate of 77.1% in tibial applications. The most common complication was angular deformity in the distal tibia, occurring in 19 patients. Other complications included anterior cortical penetration, nail bending, and one case of nail breakage. CONCLUSIONS: The SLIM nail is a viable option for patients with narrow intramedullary canals, particularly in cases where telescoping rods are not feasible. While the SLIM nail provides adequate stabilization and reduces the need for multiple surgeries, careful monitoring is essential to manage complications such as distal angular deformity. Early revision to a larger rod, when possible, is recommended to prevent further complications as the patient grows. LEVEL OF EVIDENCE: Level IV.
Comparing the effectiveness of generative AI technology in commonly asked scoliosis questions.
Suresh A, Siahaan J, Marco RA … +7 more , Klineberg E, Borden T, Vanodia R, Crawford L, Dodwad SN, Younas S, Mundluru S
J Child Orthop · 2025 Oct · PMID 40735356 · Full text
PURPOSE: In recent years, generative artificial intelligence systems have transformed the landscape of patient's access to medical information and education. As increases in general and subspeciality physician shortages...
PURPOSE: In recent years, generative artificial intelligence systems have transformed the landscape of patient's access to medical information and education. As increases in general and subspeciality physician shortages lead to longer lead times for patients to get access to physicians, we aim to understand how effectively different AI platforms can respond to questions asked by parents about both operative and nonoperative scoliosis. METHODS: A survey comprised of 31 questions, among the most commonly asked, regarding scoliosis with responses from ChatGPT, Google Gemini, and Microsoft Copilot was administered to board-certified Orthopedic surgeons, fellowship trained in either pediatric or spine surgery. (four reviewers). They evaluated each output from Likert Scale of 1-5 with 5 meaning an excellent response was given and 1 meaning a poor response was given. Pairwise comparisons were used for analysis. RESULTS: All three generative AI technologies performed well with an overall mean rating of 3.4 which is between good and very good on the Likert Scale provided. ChatGPT performed the best out of the three, with a mean rating of 4.0, Google Gemini was second best with a mean rating of 3.1, and Copilot was third best with a mean rating of 3.1. ChatGPT compared with Gemini and Copilot revealed statistically significant differences with a p-value <0.001, with no statistical difference between Gemini and Copilot. CONCLUSION: In response to common scoliosis questions asked by parents, ChatGPT, Microsoft Copilot, and Google Gemini, were scored highly by our Spine team and has important indications for use in the future.
Surgical treatment of monostotic fibrous dysplasia of the proximal femur in children and adolescents: Observational European Paediatric Orthopaedic Society multicenter study.
van Geloven TP, de Witte PB, Laitinen MK … +16 more , Campanacci DA, Döring K, Dammerer D, Mesregah MK, Appelman-Dijkstra NM, Haara M, Beltrami G, Hobusch GM, Kraus T, Farr S, Soto-Montoya C, Medellin Rincon MR, Saeed J, Funovics PT, van der Heijden L, van de Sande MA
J Child Orthop · 2025 Jul · PMID 40726900 · Full text
PURPOSE: Monostotic fibrous dysplasia is a rare benign fibro-osseous disorder. Proximal femoral monostotic fibrous dysplasia is especially vulnerable to pathological fracture and deformation, requiring specific treatment...
PURPOSE: Monostotic fibrous dysplasia is a rare benign fibro-osseous disorder. Proximal femoral monostotic fibrous dysplasia is especially vulnerable to pathological fracture and deformation, requiring specific treatment strategies. Literature on pediatric proximal femoral monostotic fibrous dysplasias is sparse and without consensus. We present the largest observational cohort study on various treatment methods of pediatric proximal femoral monostotic fibrous dysplasia. METHODS: Pediatric patients with proximal femoral monostotic fibrous dysplasia were included, from 10 academic hospitals for oncological orthopedics (2000-2021). Baseline characteristics, treatment strategies, and complications were assessed. Primary outcomes were failure rates, failure-free survival, and risk factors for failure. Failure was defined as fracture, progressive deformity, or surgical (re-)intervention after the start of treatment. RESULTS: Forty-one pediatric patients with proximal femoral monostotic fibrous dysplasia were included (median age = 11 years (range = 6-16), = 21 (51%) male). Median follow-up was 5.1 years (range = 0.8-18.6). Index procedure was watchful waiting ( = 9), percutaneous procedure ( = 4), open procedure ( = 15), or internal fixation ( = 13). Failure rates were 11%, 50%, 40%, and 31%, respectively ( = 0.41). Overall, 2- and 5-year failure-free survival was stable at 87.5% (95% confidence interval = 64.6-110.4). Risk factors associated with failure were fracture at diagnosis (hazard ratio = 3.7, 95% confidence interval = 1.2-11.5), calcar involvement (hazard ratio = 2.6, 95% confidence interval = 0.7-9.4), and male sex (hazard ratio = 2.1, 95% confidence interval = 0.6-7.8). CONCLUSION: In cases with low fracture and deformity risk, watchful waiting can be a viable management option for proximal femoral monostotic fibrous dysplasia. When intervention is necessary, internal fixation is advised to prevent fractures and deformity. Curettage with grafting or bone substitute injections should be used with hesitance. Currently, there is no clearly superior treatment for pediatric proximal femoral monostotic fibrous dysplasia, leaving treatment choices to be based on individual characteristics.
Response to the article titled "Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases".
Song B, Zhang H, Zhang X
J Child Orthop · 2025 Aug · PMID 40704164 · Full text
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Forearm fractures treated with elastic stable intramedullary nailing: Is casting still necessary?
Herdea A, Dragomirescu MC, Tiron M … +1 more , Ulici A
J Child Orthop · 2025 Aug · PMID 40692964 · Full text
INTRODUCTION: Elastic stable intramedullary nailing is widely recognized for treating pediatric forearm fractures due to its stable fixation and minimal impact on soft tissue. Traditionally, casting has followed elastic...
INTRODUCTION: Elastic stable intramedullary nailing is widely recognized for treating pediatric forearm fractures due to its stable fixation and minimal impact on soft tissue. Traditionally, casting has followed elastic stable intramedullary nailing; however, recent studies question its necessity. This study evaluates the outcomes of omitting casts post-elastic stable intramedullary nailing, examining healing speed and quality of life compared to cases where casting was applied. MATERIALS AND METHODS: A prospective study was conducted from 2022 to 2024 in an urban hospital, where children with both-bone midshaft forearm fracture were randomized to receive or not receive casting after elastic stable intramedullary nailing. Age- and sex-matched patients were selected to allow for accurate comparison. The study included patients aged 5 to 14 years. Outcomes were measured using radiographic scores and quality-of-life assessments. RESULTS: From a total of 355 patients, 136 cases were included in the assessment. Analysis indicated faster healing in patients without postoperative casting, as evidenced by higher REBORNE scores at 3 weeks and 2 months. Quality of life, measured by the Pediatric Quality of Life Inventory, was also significantly improved in the no-cast group at 6 weeks. DISCUSSION: Our findings suggest that elastic stable intramedullary nailing provides sufficient stability for both-bone midshaft forearm fracture, making additional casting unnecessary. Early mobilization led to better functional outcomes without increasing complications. Although some minor early discomfort was reported, the cast-free approach proved effective and safe. CONCLUSION: Elastic stable intramedullary nailing remains the gold standard for treating pediatric forearm fractures. Our preliminary results indicate that for both-bone midshaft forearm fracture, elastic stable intramedullary nailing can be safely performed without postoperative casting, promoting faster healing and better patient satisfaction.
Arthroscopic management of discoid lateral meniscus in children: 5-Year minimum follow-up clinical outcome.
Bonny Obro R, Rassi J, Flumian C … +2 more , Sales de Gauzy J, Accadbled F
J Child Orthop · 2025 Aug · PMID 40692963 · Full text
PURPOSE: We investigated the medium-term clinical results and revision rate of arthroscopic rim-preserving saucerization for symptomatic lateral discoid meniscus in children. METHODS: A single-centre, retrospective study...
PURPOSE: We investigated the medium-term clinical results and revision rate of arthroscopic rim-preserving saucerization for symptomatic lateral discoid meniscus in children. METHODS: A single-centre, retrospective study was conducted on patients treated with arthroscopy for symptomatic discoid lateral meniscus between December 2005 and May 2019. Eligibility criteria were patients <16 years at the time of surgery and a minimum follow-up of 5 years. Preoperative data (age, sex, symptoms and physical examination), arthroscopic findings (Watanabe and Ahn classifications, meniscal instability and the presence of meniscal tear), treatment (saucerization ± stabilization ± meniscal repair), patient-reported outcome measurements (Lysholm, Tegner and Ikeuchi scores) and arthroscopic revision rate were recorded. RESULTS: In all, 47 (72%) of the 65 eligible patients replied to the questionnaires and were therefore included (9 bilateral cases). The mean age at the time of surgery was 8.6 ± 3.3 years. Patient-reported scores were all improved after a mean follow-up of 10.5 years (5-15.9): Ikeuchi (64.2% excellent-good versus 3.6%), Lysholm (90.5 versus 72.9) and Tegner (5 versus 4.3). Two patients developed osteochondritis dissecans of the lateral femoral condyle which healed following non-operative measures. There was no other complication. An arthroscopic revision was performed in 10 patients (17.9%) after a mean follow-up of 2.7 years. CONCLUSION: The medium-term results of rim-preserving arthroscopic saucerization are favourable, yet with a substantial arthroscopic revision rate. Risk factors for failure and revision should be further investigated.
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