Journal Of Children's Orthopaedics[JOURNAL]
Sun
200 papers
Factors associated with flexed knee gait in unilateral cerebral palsy.
Do KP, Feng J, Bauer JP
J Child Orthop · 2025 Apr · PMID 40093031 · Full text
PURPOSE: A flexed knee gait is a common gait in children with unilateral cerebral palsy. In children without knee contracture, hamstring spasticity is commonly considered a major contributor to a flexed knee gait. We hyp...
PURPOSE: A flexed knee gait is a common gait in children with unilateral cerebral palsy. In children without knee contracture, hamstring spasticity is commonly considered a major contributor to a flexed knee gait. We hypothesized that the popliteal angle would not correlate to a flexed knee gait. METHODS: This retrospective study included 109 children with unilateral cerebral palsy who had undergone complete 3D gait analysis. Children who had previous surgery or knee flexion contracture were excluded. Children were divided into three groups based on knee position during stance as determined by 3D gait analysis: flexion (FK, 47), hyperextension (HK, 42), and normal (NK, 20). RESULTS: There were no significant correlations between popliteal angle and dynamic peak knee extension in stance or at initial contact. Similarly, peak dorsiflexion during the stance phase did not correlate with dynamic peak knee extension in stance (all > 0.05). Significant differences were observed in foot position during stance between FK and HK groups, as well as in quick stretch dorsiflexion with the knee extended between HK and NK groups. CONCLUSION: A flexed knee gait in children with unilateral cerebral palsy does not always correlate with the popliteal angle or dynamic ankle position in gait. These factors may contribute but are insufficient to explain all observed differences. A flexed knee gait likely involves a complex interplay of motor control, strength, spasticity, and lever arm dynamics, indicating that interventions at a single level may not fully improve dynamic knee extension.
What's new in pediatric musculoskeletal imaging.
Kraus M, Pertman L, Eshed I
J Child Orthop · 2025 Apr · PMID 40093030 · Full text
The field of pediatric musculoskeletal imaging is undergoing significant advancements due to technological innovations and a growing emphasis on safety and patient-centered care. This review explores recent developments...
The field of pediatric musculoskeletal imaging is undergoing significant advancements due to technological innovations and a growing emphasis on safety and patient-centered care. This review explores recent developments in imaging modalities such as advanced magnetic resonance imaging, ultrasound innovations, and artificial intelligence applications. Highlights include radiation dose-reduction techniques in radiography and computed tomography, enhanced diagnostic tools like contrast-enhanced ultrasound and ultra-high-frequency imaging, and the integration of artificial intelligence for pathology detection and workflow optimization. The adoption of advanced methods like whole-body magnetic resonance imaging and computed tomography-like magnetic resonance imaging sequences has improved diagnostic accuracy, minimized radiation exposure, and expanded the capabilities of noninvasive imaging. Emerging technologies, including photon-counting detector computed tomography and deep learning-based reconstructions, are transforming clinical practices by balancing precision and safety. Artificial intelligence applications are reshaping diagnostic approaches, automating complex assessments, and improving efficiency, although challenges such as external validation and limited scope persist. Functional imaging advancements, such as diffusion-weighted imaging and positron emission tomography-magnetic resonance imaging integration, are enhancing disease characterization and treatment planning. This review underscores the clinical impact of these innovations, emphasizing the need for standardized protocols, interdisciplinary collaboration, and continued research to address unmet needs in radiation safety and artificial intelligence integration. It aims to equip healthcare professionals with the knowledge to leverage these advancements for improved outcomes in pediatric musculoskeletal care.
Robot-assisted percutaneous cannulated screw fixation in the treatment of slipped capital femoral epiphysis.
Xu Y, Fu G, Feng C … +11 more , Huang L, Ma Y, Zhang Y, Zhou Y, Luo X, Lu M, Yang J, Wang Y, Lv X, Jiang X, Yang Z
J Child Orthop · 2025 Apr · PMID 39959673 · Full text
PURPOSE: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstab...
PURPOSE: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips. METHODS: Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12-36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot. RESULTS: All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up ( < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 ( < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head. CONCLUSION: Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory. LEVEL OF EVIDENCE: 4, Case Series.
Low rate of healing and high incidence of complications in benign pediatric bone tumors treated with synthetic calcium sulfate-calcium phosphate bone graft.
Siddiqui AA, Andras LM, Myers AY … +5 more , Fan BB, Bennett J, Illingworth KD, Skaggs DL, Tolo VT
J Child Orthop · 2025 Apr · PMID 39896934 · Full text
BACKGROUND: Synthetic calcium sulfate-calcium phosphate bioceramic composite has been developed as a material for bone grafting; however, the literature is limited on outcomes of benign bone tumors treated with bone graf...
BACKGROUND: Synthetic calcium sulfate-calcium phosphate bioceramic composite has been developed as a material for bone grafting; however, the literature is limited on outcomes of benign bone tumors treated with bone grafting. This study aims to investigate the outcomes of benign pediatric bone tumors treated with a calcium sulfate-calcium phosphate composite bone graft. METHODS: A retrospective review at a tertiary pediatric hospital with benign bone tumors treated with curettage and bone grafting with a calcium sulfate-calcium phosphate synthetic bone graft from 2008-2018 was included. Minimum follow-up was 6 months. RESULTS: Twenty-seven patients met inclusion criteria with a mean age of 10.3 ± 4.5 years and follow-up was 37.2 ± 22.3 months. Diagnoses were unicameral bone cysts ( = 16) and aneurysmal bone cysts ( = 11). Pathologic fracture was present in 48% (13/27) of patients on admission. All patients were treated using synthetic bone grafts and 37% (10/27) with internal fixation. Following index treatment, 96% (26/27) had resolution of pain and returned to full activity at 13.4 ± 10.7 weeks. Complications occurred in 33% (9/27) of patients; one developed chronic hip pain resulting in decreased physical activity, seven had a tumor recurrence without fracture, and one had tumor recurrence with pathologic fracture. Revision surgery was required in 26% (7/27) of cases. Per the modified Neer outcomes rating system, 52% of patients had a healed bone lesion, 4% had a healing lesion with a bone defect, and 44% had a persistent/recurrent cyst. CONCLUSIONS: Children with benign bone tumors treated with curettage and bone grafting using a calcium sulfate-calcium phosphate composite had a high incidence of complications and revision surgery. LEVEL OF EVIDENCE: IV.
Health-related quality of life after Dega pelvic osteotomy and varus derotation osteotomy due to spastic hip disease in children with cerebral palsy.
Kasprzyk M, Koch A, Jóźwiak M
J Child Orthop · 2025 Feb · PMID 39802483 · Full text
PURPOSE: Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact o...
PURPOSE: Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact on HRQL using the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire (CPCHILD) as the primary outcome measure. METHODS: In this prospective study, we analyzed 31 nonambulatory patients with spastic or mixed CP (GMFCS levels IV-V) who underwent hip reconstructive surgery between 2015 and 2021. The surgical procedures included one-sided varus derotation osteotomy of the femur with Dega transiliac osteotomy and, on the opposite side, varus derotation osteotomy (VDRO) of the femur with shortening and, as needed, Dega pelvic osteotomy. RESULTS: The study demonstrated significant improvement in the hip joint motion range, as assessed by the Thomas test, in hip abduction and rotational movements of the hip, as well as reduction of spasticity. The procedures also resulted in significant radiographic improvement of the femoral head coverage. The assessment of symptoms and problems associated with the hip revealed a positive influence of the surgery on pain, contractures, toileting/perineal hygiene, dressing, seating, transferring, and position changes. The mean improvement at a follow-up visit was significant in all domains of the CPCHILD, except for communication and social interaction. CONCLUSION: Hip reconstruction with VDRO and Dega pelvic osteotomy can enhance the HRQL of children with CP. These surgical interventions can help to achieve the correct hip position and to reduce pain, which positively affects the patient QL, although proactive treatment results in less invasive procedures. LEVEL OF EVIDENCE: IV case series.
What are patients asking and reading online? An analysis of online patient searches about treatments for developmental dysplasia of the hip.
Balachandran U, Ren R, Vicioso C … +5 more , Park J, Nietsch KS, Sacks B, Busigo Torres R, Ranade SC
J Child Orthop · 2025 Feb · PMID 39802482 · Full text
PURPOSE: We aimed to analyze frequently searched questions through Google's "People Also Ask" feature related to four common treatments for developmental dysplasia of the hip (DDH): the Pavlik harness, rhino brace, close...
PURPOSE: We aimed to analyze frequently searched questions through Google's "People Also Ask" feature related to four common treatments for developmental dysplasia of the hip (DDH): the Pavlik harness, rhino brace, closed reduction surgery and open reduction surgery. METHODS: Search terms for each treatment were entered into Google Web Search using a clean-install Google Chrome browser. The top frequently asked questions and associated websites were extracted. Questions were categorized using the Rothwell classification model. Websites were evaluated using the JAMA Benchmark Criteria. Chi-square tests were performed. RESULTS: The initial search yielded 828 questions. Of 479 included questions, the most popular topics were specific activities that patients with DDH can/cannot do (32.8%), technical details about treatments (30.9%) and indications for treatments (18.2%). Websites were commonly academic (59.3%), commercial (40.5%) and governmental (12.3%). There were statistically significant more specific activity questions about Pavlik harnesses than about rhino braces ( = 7.1, = 0.008), closed reduction ( = 56.5, < 0.001) and open reduction ( = 14.7, < 0.001). There were statistically significant more technical details questions about Pavlik harnesses than about closed reduction ( = 4.1, = 0.04). CONCLUSIONS: This study provides insights into common concerns that parents have about their children's DDH treatment, enabling orthopaedic surgeons to provide more effective and targeted consultations. This is particularly important for DDH because affected patients are often diagnosed within the first few months of life, leaving parents overwhelmed by caring for a newborn child and simultaneously coping with this diagnosis.
Diagnosis and management of septic arthritis: A current concepts review.
Sanpera I, Salom M, Alves C … +1 more , Eastwood D
J Child Orthop · 2025 Feb · PMID 39758603 · Full text
Correct diagnosis and treatment of septic arthritis (SA) are essential to achieve satisfactory results and avoid lifelong consequences. Diagnosing septic arthritis is not always easy, which is why new biomarkers have bee...
Correct diagnosis and treatment of septic arthritis (SA) are essential to achieve satisfactory results and avoid lifelong consequences. Diagnosing septic arthritis is not always easy, which is why new biomarkers have been sought. Another difficulty in diagnosis is the increase in septic arthritis due to Kingella Kingae, which does not show the same signs and symptoms as classic infections. Increasingly, magnetic resonance imaging plays a more fundamental role in diagnosing septic arthritis, and many studies are focused on this line, especially for the study of associated pathologies. Numerous studies have been published on less invasive treatments for septic arthritis, although the evidence suggests that the results should be taken cautiously. Although most of the published studies focus on the hip and knee, there have also been recent publications on SA in the upper limb, foot, and ankle. Finally, the literature also pays attention to SA in young children due to its different etiology and the greater difficulties in its diagnosis.
Treatment of symptomatic bipartite patella in patients <21 years of age: A systematic review and treatment algorithm.
Hines KE, Liu DS, Steele AE … +4 more , Gabriel D, Prabhat A, Yen YM, Hogue GD
J Child Orthop · 2025 Feb · PMID 39726688 · Full text
PURPOSE: The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published lite...
PURPOSE: The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published literature. METHODS: A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on PubMed and Embase, selecting for studies discussing the management of symptomatic bipartite patella. RESULTS: Five studies met criteria, involving 315 knees (314 patients, average age 15.8 years). All patients presented with symptomatic bipartite patella and underwent an initial trial of conservative management. Seventy-six percent (239 knees) achieved full resolution of symptoms after conservative management at a median of 1.9 months. The remaining 76 knees (24.12%) had persistent symptoms requiring operative intervention. Surgical techniques included surgical excision, screw fixation, synchondrosis drilling, lateral release, and both arthroscopic and open interventions (92.1%). Most patients (90.79%) who underwent surgical intervention had partial or complete resolution of their symptoms. Seven of 76 knees (9.21%) needed management postoperatively for pain due to trauma, residual symptomatic ossicles, and hardware complications. Of these, four patients required reoperations (average 2 years). The remaining three patients had satisfactory outcomes with an additional course of conservative management and oral analgesics. CONCLUSION: Management of symptomatic bipartite patella should begin with a trial of conservative management. With refractory symptoms lasting greater than 3 months, surgical intervention may be considered with positive outcomes of partial or complete resolution of symptoms. The proposed algorithm is provided to guide physician management of symptomatic BPP in pediatric or adolescent patients.
Ankle and foot deformities and malformations in proximal femoral focal deficiency.
Chomiak J, Frydrychova M, Ošťádal M … +1 more , Dungl P
J Child Orthop · 2025 Feb · PMID 39713180 · Full text
PURPOSE: To describe foot abnormalities in proximal femoral focal deficiency and their correlation to the severity. METHODS: Eighty-nine extremities in 87 patients were evaluated between 1996 and 2020 clinically and radi...
PURPOSE: To describe foot abnormalities in proximal femoral focal deficiency and their correlation to the severity. METHODS: Eighty-nine extremities in 87 patients were evaluated between 1996 and 2020 clinically and radiologically. Fibula length, ankle shape, tarsal coalitions, and the number of foot rays were recorded. Extremities with proximal femoral focal deficiency were classified according to Pappas and divided into severe (classes II and V), medium severe (classes III and IV), and mild groups (classes VII, VIII, and IX). RESULTS: The fibula was short in 89% and absent in 11% of cases. An absent fibula occurred mostly in severe class III and only in 4% of mild grades (statistically significant, = 0.004). The valgus ankle joint prevailed in 82% of cases. Spherical ankle joints (18% of cases) were associated in all cases with a tarsal coalition. Tarsal coalitions occurred in 14.6% and were present in all classes except class IV. Five ray feet were found in 83% of cases, four ray feet were found in 16%, and three ray feet in one extremity. Reduction in the number of foot rays occurred more commonly in association with fibular aplasia (30%). CONCLUSIONS: Abnormalities of the fibula and ankle joint represent a constant part of proximal femoral focal deficiency, whereas tarsal coalition and a reduction of foot rays do not. The severity of foot abnormalities does not correlate to the severity of proximal femoral focal deficiency but does with fibular aplasia.
What's new in the pediatric spine?
Ilharreborde B, Helenius I, Studer D … +8 more , Hasler C, Kruyt M, Mineiro J, Ovadia D, Farrington D, Pesenti S, Yazici M, EPOS Spine Study Group
J Child Orthop · 2025 Feb · PMID 39713179 · Full text
INTRODUCTION: The field of pediatric spine surgery has encountered major changes and evolutions lately, with new treatment options available and the development of enabling technologies. This article aims to summarize th...
INTRODUCTION: The field of pediatric spine surgery has encountered major changes and evolutions lately, with new treatment options available and the development of enabling technologies. This article aims to summarize the most relevant recent literature. MATERIALS AND METHODS: The five most relevant topics were selected and assigned to one or two authors who performed a comprehensive Pubmed database search for articles published in the last 4 years (2021-2024). Only studies with a high level of evidence or clinical relevance were reported. RESULTS: Thirty-nine articles were selected and analyzed, covering the following subjects: treatment options in tweeners, the impact of new medical treatments in pediatric spine practice, the emergence of new surgical techniques, the development of enabling technologies in scoliosis surgery, and recent relevant randomized controlled trials. DISCUSSION: Many new surgical concepts and techniques have been developed lately, but their results need to be further assessed on specific subgroups of patients. Numerous significant medical improvements have been reported in the last 5 years, affecting positively the management of syndromic and neuromuscular patients.
Exploring the impact of developmental dysplasia of the hip on refugees with temporary protected status in Türkiye.
Bingöl I, Taşcı M, Yaşar NE … +5 more , Ata N, Ülgü MM, Birinci Ş, Sağlam Y, Söylemez MS
J Child Orthop · 2025 Feb · PMID 39678014 · Full text
OBJECTIVE: In this study, we examined whether there was a change in the number of children who had been screened by hip ultrasound, the age of first diagnosis, and the number of invasive and conservative treatments appli...
OBJECTIVE: In this study, we examined whether there was a change in the number of children who had been screened by hip ultrasound, the age of first diagnosis, and the number of invasive and conservative treatments applied due to developmental dysplasia of the hip between 2016 and 2022 among refugees who were in "Temporary Protection Status" in Türkiye? METHODS: The records were collected via the e-health database of the Turkish Ministry of Health. Over 1 month old were included in the study. RESULTS: The number of ultrasonography (USG) that was performed for developmental dysplasia of the hip survey had significantly increased over time. The incidence for 5 years was 6 cases per 100 babies. However, the incidence of developmental dysplasia of the hip needing intervention was 0.4 cases per 1000 babies. In 2016, the most used diagnosis method was X-ray. By contrast, the use of USG has increased from 2016 to 2022. The mean age at the time of diagnosis was significantly high in 2016, 2017, and 2020. The number of invasive treatment modalities including closed reduction under anesthesia, open reduction alone, or open reduction with pelvic and/or femoral osteotomies had significantly decreased from 2016 to 2022. However, the number of abduction orthosis used for treatment also increased significantly. CONCLUSIONS: Free access to health services is effective in promoting families' compliance with screening programs for developmental dysplasia of the hip. But is not enough for initial periods of mass migrations. To increase sensitivity to screening programs for possible diseases, further efforts are needed to prevent low compliance in early cases of mass migrations.
Management of the supposed elbow dislocation in newborns.
Kruse F, Dizin F, Ilharreborde B … +3 more , Jehanno P, Simon AL, Mas V
J Child Orthop · 2025 Feb · PMID 39668997 · Full text
BACKGROUND: The newborn transphyseal fracture of the distal humerus is frequently misdiagnosed with an elbow dislocation due to the absence of the lateral condyle ossification node. No consensus has been reported either...
BACKGROUND: The newborn transphyseal fracture of the distal humerus is frequently misdiagnosed with an elbow dislocation due to the absence of the lateral condyle ossification node. No consensus has been reported either for the diagnosis or the management of these rare fractures. This study aimed to analyze a series of newborns with transphyseal distal humerus fractures. METHODS: All consecutive infants treated between 2005 and 2020 for a transphyseal fracture of the distal humerus before the age of 6 months were retrospectively included. All radiological examinations were analyzed (X-ray, ultrasound, and magnetic resonance imaging (MRI)) as well as the therapeutic management (orthopedic or surgical treatment). The patients were seen at outpatient clinic visits with a minimum of 2-year follow-up. RESULTS: Nine newborns were treated. The main cause was an obstetrical traumatism ( = 8). The diagnosis was made on physical examination and addressed by obstetric departments with standard biplanar radiographs in four cases. The fracture was suspected on physical examination in the remaining five cases and confirmed by complementary imaging (ultrasound (2), MRI (1), and both (3)). A total of six patients were treated conservatively and three surgically with an open reduction. At a mean follow-up of 79 months, two complications occurred: one axillary abscess due to the cast and one cubitus varus deformity. All children had a full functional recovery. CONCLUSIONS: The transphyseal fracture of the distal humerus in newborns is a rare entity that should be managed conservatively. Additional imaging examinations are recommended to clarify the diagnosis. LEVEL OF EVIDENCE: Level IV, cohort study.
Conservative treatment for traumatic atlantoaxial joint infra-anterior dislocation complicating odontoid fracture in young children: A case series.
Wu C, Zheng Y, Qian C … +3 more , Huang P, Ning B, Wang D
J Child Orthop · 2024 Dec · PMID 39619633 · Full text
PURPOSE: The purpose of this study is to retrospectively analyze children treated conservatively in our hospital to explore the clinical characteristics of children with traumatic atlantoaxial joint infra-anterior disloc...
PURPOSE: The purpose of this study is to retrospectively analyze children treated conservatively in our hospital to explore the clinical characteristics of children with traumatic atlantoaxial joint infra-anterior dislocation complicating odontoid fracture and the therapeutic effects of treatment. METHODS: Patients with atlantoaxial joint infra-anterior dislocation complicating odontoid fracture received conservative treatment, which comprised three steps: cervical traction (2 weeks), plaster fixation (2 months), and brace fixation (3 months). RESULTS: We treated three patients (boy:girl = 0:3, mean age = 2.5 years old) from 2017 to 2020, the diagnoses were all traumatic C1-2 infra-anterior dislocations associated with odontoid fracture (Anderson and D'Alonzo classification type II: three cases, Hosalkar type IB: two case and IC: one case), with or without cervical spinal cord injury. The C1-2 infra-anterior dislocations were all successfully reduced by gentle traction with the halo method (case 1) or occipital-jaw (cases 2 and 3) for a mean of 18.3 days (19, 15, 21 days), after which the Calot plaster vests (head-neck-chest plaster vests) were fitted and maintained for 2 months, without operation. Braces were maintained for 3 months after the Calot plaster vests were removed. All patients achieved fracture healing and recovered from the spinal injury. CONCLUSION: In young children, atlantoaxial joint infra-anterior dislocation complicating odontoid fracture usually occurred at the odontoid synchondrosis and belonged to Anderson and D'Alonzo classification type II or Hosalkar type I. Conservative treatment achieved good results (dislocation reduction, bone healing, recovery of neurological symptoms). LEVEL OF EVIDENCE: Level IV case series.
Treatment of scoliosis in children after resection of neuroblastoma-A report of five cases.
Xu J, Zou Y, Zhang H … +4 more , Chen J, Liu H, Guo D, Yao Z
J Child Orthop · 2024 Dec · PMID 39619632 · Full text
PURPOSE: Neuroblastoma (NB) is a common extracranial solid tumor in children, often requiring surgical resection. Post-resection NB near the spine can lead to spinal deformities, but treatment strategies are not well-doc...
PURPOSE: Neuroblastoma (NB) is a common extracranial solid tumor in children, often requiring surgical resection. Post-resection NB near the spine can lead to spinal deformities, but treatment strategies are not well-documented. METHODS: We retrospectively reviewed our patients who developed spinal deformities after NB resection at our hospital from 2013 to 2021. Treatment included the traditional growing rod (TGR) technique for patients with growth potential, posterior spinal fusion (PSF) for skeletally mature patients, and intermittent cast therapy for infants. RESULTS: Five female patients underwent chemotherapy and surgical resection for NB, with no recurrence during follow-up. Single curves were seen in Cases 1, 2, 4, and 5, and Case 3 had double curves. NB tumors were on the convex side in Cases 1, 3, and 5, and on the concave side in Cases 2 and 4. TGR was used for Cases 1 and 2 due to growth potential and inadequate height. PSF was chosen for Cases 3 and 4, achieving satisfactory scoliosis and kyphosis correction. Case 5, diagnosed with scoliosis at 16 months, underwent intermittent cast therapy for 2 years, significantly correcting scoliosis and avoiding surgery. The average time from NB resection to scoliosis onset was 65.2 ± 49.3 months, with scoliosis treatment starting at 82.6 ± 58.1 months. The mean follow-up was 38.2 ± 12.1 months. All patients showed significant improvement in spinal deformities, with no significant correction loss at the last follow-up. CONCLUSIONS: After NB resection, spinal deformities should be closely monitored, with intervention preferably within 6 months of discovery. TGR, PSF, and casting are effective interventions, with the treatment modality based on the patient's skeletal maturity and height.
An increase in paediatric arthroscopy in Europe: Experience of the EPOS Sport Study Group.
Turati M, Crippa M, Nicolaou N … +8 more , Tassistro E, Sinikumpu J, Courvoisier A, Mumme M, Duart J, Thüsing M, Bigoni M, Accadbled F
J Child Orthop · 2025 Feb · PMID 39619109 · Full text
PURPOSE: Paediatric musculoskeletal injuries in association with increased participation in sports activities continue to increase. Arthroscopy is recognized as a safe and effective procedure in children. This study aims...
PURPOSE: Paediatric musculoskeletal injuries in association with increased participation in sports activities continue to increase. Arthroscopy is recognized as a safe and effective procedure in children. This study aims to identify trends in European paediatric sports centres over 20 years. METHODS: A survey was performed across the European Paediatric Orthopaedic Society (EPOS) Sports Study Group focusing on 3 years (2000, 2009 and 2019). Centres were divided into two groups: Group 1 ( = 5, with data for 2000, 2009 and 2019) and Group 2 ( = 8, with data for 2009 and 2019). Data were analysed as the total annual number of cases and separately by anatomical region and patient demographics. A descriptive analysis was performed to characterize the trends. RESULTS: Data from eight centres across Europe showed an increase in total annual arthroscopy cases (G1 from 53 to 202 and G2 from 393 to 615, -value < 0.001) and as a percentage of paediatric orthopaedic surgeries (G1 from 1.6% to 5.2%; G2 from 5.1% to 6.8%) in seven out of eight centres. The knee remained the most commonly treated joint (G1 from 79.2% to 83.3%; G2 from 78.9% to 84.4%), despite the rise of others such as the elbow (-value = 0.020) and decline of the shoulder (-value = 0.014). Cases involving paediatric patients over 11 years increased while there was no gender distinction among paediatric patients. CONCLUSION: Paediatric arthroscopy procedures in Europe have increased in number over the past 3 decades. Technological advancements have allowed a surge in procedures and applications to new anatomical areas. LEVEL OF EVIDENCE: IV - retrospective database review.
The long-term results of treating radial neck fractures in children with the Metaizeau technique.
Kanar M, Sülek Y, Gök B … +3 more , Demirhan A, Samedov F, Balkanlı B
J Child Orthop · 2025 Feb · PMID 39575200 · Full text
PURPOSE: Radial neck fractures in children are rare, representing less than 1% of all pediatric fractures. While conservative treatments are often sufficient, displaced fractures may require closed or open reduction. The...
PURPOSE: Radial neck fractures in children are rare, representing less than 1% of all pediatric fractures. While conservative treatments are often sufficient, displaced fractures may require closed or open reduction. The Metaizeau technique is widely accepted for closed reduction and internal fixation. This study aims to assess the long-term functional and radiological outcomes of this technique and identify any complications that may arise. METHODS: This retrospective study analyzed 22 pediatric patients treated with the Metaizeau technique for proximal radius fractures between 2005 and 2018. Data on demographics, preoperative radiographs, and postoperative complications were reviewed. Outcomes were evaluated using radiographic and functional measures, including grip strength, the Mayo elbow performance score (MEPS), and the Tibone and Stolz classification. RESULTS: The mean age at the time of injury was 9.9 years, with a mean follow-up period of 139 months (range: 72-213 months). Patients were classified as Judet type 3 ( = 9), type 4a ( = 9), or type 4b ( = 4). The functional outcomes showed a mean MEPS score of 99 (range: 90-100), with 86% of patients achieving excellent results according to the Tibone and Stolz classification. Excellent outcomes were recorded in 100% of type 3, 77.7% of type 4a, and 75% of type 4b cases. Documented complications included one case of radioulnar synostosis and two cases of heterotopic ossification. CONCLUSIONS: The Metaizeau technique represents an efficacious treatment option for pediatric radial neck fractures, offering favorable long-term functional and radiological outcomes with a low complication rate. Long-term follow-up data further support the reliability of this technique. TYPES OF STUDIES: Level IV.
The effect of vitamin D on the speed and quality of pediatric fracture healing.
Hendrych J, Havránek P, Bayer M … +2 more , Čepelík M, Pešl T
J Child Orthop · 2025 Feb · PMID 39563984 · Full text
PURPOSE: To evaluate the effect of vitamin D on the speed and quality of pediatric fracture healing. METHODS: A 4-year prospective study of healthy children with shaft fractures of the forearm bones (treated with minimal...
PURPOSE: To evaluate the effect of vitamin D on the speed and quality of pediatric fracture healing. METHODS: A 4-year prospective study of healthy children with shaft fractures of the forearm bones (treated with minimally invasive osteosynthesis) or femur (treated by traction or by minimally invasive osteosynthesis). All children had their vitamin D levels examined four times-at the time of the injury, 1, 3, and 5 months after the injury. Also, all children underwent radiograph follow-ups (same time as blood tests) to evaluate fracture healing. Children were, in the beginning, blindly divided into two similarly sized groups-one group was orally administered cholecalciferol throughout the follow-up, the second group was not, and we compared those groups. RESULTS: Altogether, 63 children were included in the study-36 supplemented and 27 non-supplemented. In supplemented children, the vitamin D levels increased statistically significantly during the follow-up period, in contrast to the non-supplemented group. The fracture healing on radiographs was also statistically significantly faster and better in the supplemented group. When we divided children according to fracture type, we observed statistically significantly better fracture healing in children with forearm fractures in the supplemented group for the whole study period. In children with femoral fractures, the healing in the supplemented group was statistically significantly better after 3 months; however, after 1 and 5 months, the difference was not statistically significant. CONCLUSIONS: Based on our results, we recommend vitamin D testing and administration for children treated for forearm and femoral fractures. LEVEL OF EVIDENCE: Level I.
Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation.
Wu X, Wu L, Canavese F … +2 more , Huang D, Chen S
J Child Orthop · 2024 Dec · PMID 39559721 · Full text
BACKGROUND: Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to e...
BACKGROUND: Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to evaluate outcomes in the management of fracture separation of the distal humeral epiphysis treated seven or more days post-initial injury. METHODS: A retrospective analysis was conducted on patients diagnosed with fracture separation of the distal humeral epiphysis between November 2016 and October 2023. Inclusion criteria encompassed patients with delayed presentation of fracture separation of the distal humeral epiphysis who underwent surgical intervention seven or more days following the initial injury. Demographic data were collected, and fractures were categorized using the modified DeLee classification. Plain radiographs facilitated the assessment of the carrying angle and postoperative Baumann angle. Clinical outcomes were evaluated using the Flynn criteria. RESULTS: The study included 12 patients who met the inclusion criteria. The average age at the time of injury was 1.59 years. According to the modified DeLee system, fracture classification identified one type I fracture, eight type II fractures, and three type III fractures. The average duration from injury to surgery was 11.8 days. The mean surgical duration was 21.5 min. The average follow-up period was 40.7 months. One patient exhibited cubitus varus development. Based on the Flynn criteria, outcomes were as follows: seven patients had excellent outcomes, four had good outcomes, and one had a poor outcome. CONCLUSION: Closed reduction with percutaneous K-wire fixation represents a minimally invasive approach suitable for children diagnosed with fracture separation of the distal humeral epiphysis seven or more days post-initial injury. Most of these patients experienced favorable outcomes. LEVEL OF EVIDENCE: IV.
Comparative long-term outcomes of Petit-Morel versus overhead traction methods versus immediate closed reduction for late-detected developmental dysplasia of the hip: A systematic review.
Duan L, Canavese F, Zhou W … +2 more , Chen Y, Li L
J Child Orthop · 2024 Dec · PMID 39559720 · Full text
PURPOSE: This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the B...
PURPOSE: This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the Bryant overhead traction technique, and to compare the clinical and radiographic outcomes of these two traction techniques with immediate closed reduction. METHODS: A comprehensive systematic search of the MEDLINE/PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies. Studies on Petit-Morel and overhead traction techniques and immediate closed reduction were then screened, selected, and data collected; included studies were assessed using the Methodological Index for Non-Randomized Studies criteria. RESULTS: In total, 22 studies met the inclusion criteria. The Petit-Morel group had a successful reduction rate of 87% while the overhead traction group had a successful reduction rate of 67.1%, and the immediate closed reduction group had a successful reduction rate of 78.4% (Petit-Morel versus overhead traction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001, Petit-Morel versus immediate closed reduction, p = 0.021). The Petit-Morel group had an overall avascular necrosis rate of 2.7%, compared to 10.6% for overhead traction and 21.5% for immediate closed reduction (Petit-Morel versus overhead traction, p = 0.001; Petit-Morel versus immediate closed reduction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001). The Petit-Morel group achieved a satisfaction rate of 86.4% according to the Severin classification, as compared to 71.2% in the overhead traction group and 76.4% in the immediate closed reduction group (Petit-Morel versus overhead traction, p < 0.001; Petit-Morel versus immediate closed reduction, p = 0.018; overhead traction versus immediate closed reduction, p = 0.195). CONCLUSION: Petit-Morel and overhead traction techniques did not outperform immediate closed reduction in terms of redislocation rates, and radiological satisfaction, the Petit-Morel technique, has lower clinically significant avascular necrosis rates than overhead traction and immediate closed reduction. LEVEL OF EVIDENCE: Level III.
Metal implants in children.
Cundy PJ, Williams N
J Child Orthop · 2024 Dec · PMID 39539480 · Full text
BACKGROUND: Metal implants are increasingly used in children for trauma and deformity correction. This review outlines the current knowledge on the types of metals used and explores reasons for removal and the potential...
BACKGROUND: Metal implants are increasingly used in children for trauma and deformity correction. This review outlines the current knowledge on the types of metals used and explores reasons for removal and the potential for long-term health issues of metal implants. METHODS: The literature pertaining to these aspects was studied and summarised in this review. RESULTS: Types of metals used have evolved as well as the development of children-specific implants. Improvements in deformity correction are measurable with likely improved outcomes and reduced health costs. Indications for metal implant removal following successful treatment remain ill-defined; however, the risks of removal are known with a minimum 6% complication rate. Health costs could be reduced by around 6% by judicious decisions to leave metal in place. Implant removal should only be encouraged in the presence of infection, mechanical failure or symptoms that are truly attributable to the implant. In the domain of spinal implants, there is evidence of significant metal ion release, most notably titanium which remains elevated to many times baseline levels beyond 2 years. The detection of titanium at low levels requires special techniques. The long-term health effects on patients and/or their offspring are not well defined, although well described in animal models. CONCLUSION: The risks of metal removal are significant. Clinicians need to be aware of potential health risks in the use of metal implants and the potential for covert toxicity effects in children especially with their long life ahead. There is a need for greater awareness of metal alloy composition and implant design to minimise risks. LEVEL OF EVIDENCE: Level V.
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