Journal Of Children's Orthopaedics[JOURNAL]
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200 papers
Telescopic rods vs. non-telescopic rods in the treatment of osteogenesis imperfecta: A systematic review.
Yoshida R, Sombra MP, Cardoso MO … +1 more , Nogueira MP
J Child Orthop · 2026 Jun · PMID 42375789 · Full text
PURPOSE: To compare revision and complication rates between telescopic and non-telescopic intramedullary rods in children with osteogenesis imperfecta (OI). METHODS: A systematic review was conducted according to Preferr...
PURPOSE: To compare revision and complication rates between telescopic and non-telescopic intramedullary rods in children with osteogenesis imperfecta (OI). METHODS: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the PROSPERO database (CRD42021287054). Databases were searched up to December 2025. Studies reporting surgical outcomes of intramedullary fixation in OI were included. Meta-analysis was performed using random-effects models. RESULTS: Thirty-six studies including 1711 patients and 2459 treated bones were analyzed. Telescopic rods were associated with significantly lower revision rates compared to non-telescopic rods. No significant difference in overall complication rates was observed. CONCLUSION: Telescopic rods provide improved implant survival and reduce the need for reoperation in growing children with osteogenesis imperfecta, supporting their preferential use in clinical practice.
Proximal ulnar osteochondroma as a potential risk factor for radial head dislocation: A retrospective analysis.
Xiao H, Li M, Tan X … +7 more , Tan Q, Ye W, Wu J, Liu K, Mei H, Zhu G, Yan A
J Child Orthop · 2026 Jun · PMID 42326055 · Full text
BACKGROUND: Hereditary multiple osteochondromas (HMO) affecting the proximal radius and ulna represent a rare condition with limited documentation in the clinical literature. This study aims to describe a rare presentati...
BACKGROUND: Hereditary multiple osteochondromas (HMO) affecting the proximal radius and ulna represent a rare condition with limited documentation in the clinical literature. This study aims to describe a rare presentation of HMO involving the proximal forearm and discusses potential implications for management. METHODS: We retrospectively reviewed patients with HMO treated at our center between 2010 and 2021. Radiographic measurements included the presence or absence of osteochondromas in the entire forearm, radial head status, degree of ulnar bow, and ulnar length percentage. Radiographic measurements were compared using a Brown-Forsythe and Welch test with Tamhane's T2 post hoc analysis. RESULTS: A total of 12 patients with 14 forearms were included in the study. At the final follow-up, all patients with proximal ulnar tumors who did not undergo resection developed subluxation or dislocation. In contrast, all patients with proximal tumors limited in the radius remained free of subluxation or dislocation of the radial head throughout the follow-up period. The mean ulna length percentage in the Located group was 1.07 ± 0.05, while 1.09 ± 0.03 in the Subluxation group and 0.98 ± 0.09 in the Dislocated group. The mean ulna bow in Located group was 12° ± 7°, while 9° ± 6° in Subluxation group and 15° ± 8° in Dislocated group. No significant differences were observed. CONCLUSIONS: Proximal osteochondromas from the lateral side of the ulna may be a high-risk factor leading to radial head dislocation. Therefore, surgical excision of the proximal ulnar tumor could serve as a potential intervention to reduce the risk of radial head dislocation in affected patients.
Guided growth: Current concepts and novel techniques for harnessing a child's growth potential.
Roelen MCR, van Bergen CJA, Siemensma MF … +3 more , Eastwood DM, Sanpera I, Tolk JJ
J Child Orthop · 2026 Jun · PMID 42299327 · Full text
The principle of guided growth is grounded in the observations of Hueter and Volkmann, who proposed that longitudinal bone growth is stimulated by tension and inhibited by compression. The importance of guided growth lie...
The principle of guided growth is grounded in the observations of Hueter and Volkmann, who proposed that longitudinal bone growth is stimulated by tension and inhibited by compression. The importance of guided growth lies in its ability to address limb malalignment in a more physiological and less invasive manner compared to traditional osteotomies. By modulating growth at the physis, guided growth allows for gradual correction of deformities, minimizing the disruption to the child's developing musculoskeletal system and harnessing the child's own growth potential. Guided growth has been most frequently applied for coronal plane angular deformities around the knee, but is increasingly used for deformities in other locations throughout the growing skeleton. A wide range of deformities with underlying idiopathic and non-idiopathic etiologies are amendable to guided growth procedures. Understanding the influence of the underlying etiology, type, and severity of deformity, the growth rate of the treated physis, and skeletal age is essential for treatment success. This review explores current concepts and novel applications of guided growth and highlights areas that warrant further investigation. The focus is on the clinical aspects of guided growth to correct angular or rotational deformities in both the upper and lower extremities.
Factors associated with open reduction of pediatric type III supracondylar humerus fractures.
Najd Mazhar F, Zareie B, Shariatzadeh H … +4 more , Hasan A, Jafari Kafiabadi M, Akhlaghi N, Mahmoudi Nasab O
J Child Orthop · 2026 Jun · PMID 42261464 · Full text
PURPOSE: Supracondylar fractures of the humerus are the most common elbow fractures in children. Surgical fixation is necessary in cases with complete displacement (Gartland type III), with closed reduction and pin fixat...
PURPOSE: Supracondylar fractures of the humerus are the most common elbow fractures in children. Surgical fixation is necessary in cases with complete displacement (Gartland type III), with closed reduction and pin fixation being preferred. It is sometimes impossible. This study examined radiological and clinical factors that influence the selection of open reduction methods for these fractures. METHODS: A retrospective study was designed to investigate children aged 3-13 years with Gartland type III supracondylar humeral fractures (OTA/AO 13-M/3.1 III) treated with closed and open reduction techniques. We enrolled 140 patients in the closed reduction group (mean age 6.27) and 90 in the open reduction group (mean age 6.86). The main outcomes were achieving adequate closed reduction or switching to open reduction. We used univariate analysis and multivariate logistic regression to find independent risk factors and odds ratios for open reduction and internal fixation. RESULTS: Older children were significantly more likely to have flexion-type fractures ( = 0.001). The final univariate analysis showed that older age (odds ratios (95% confidence interval): 1.1 (1, 1.3)), flexion-type fractures (odds ratios (95% confidence interval): 3.2 (1.4, 7.4)), low-level (below isthmus) fractures (odds ratios (95% confidence interval): 2.2 (1.3, 3.9)), and Pucker sign (odds ratios (95% confidence interval): 2 (1, 4)) were factors that significantly increased the chance of open reduction and internal fixation. The influence of older age and low-level fracture was also strongly demonstrated in multivariate analysis. CONCLUSIONS: As age increases, the chance of a flexion-type fracture rises, and thus the chance of needing open reduction. Low-level fractures reduce the possibility of achieving a stable closed reduction by creating a smaller, more cartilaginous distal fragment. TYPE OF STUDY/LEVEL OF EVIDENCE: .
Irreducible extremity fractures in pediatric and adolescent rodeo-related trauma: A retrospective case series.
Arnold TE, Nolte JA, Krinock DJ … +4 more , Branton HR, Rabenhorst BM, Wyrick DL, Schoenleber SJ
J Child Orthop · 2026 May · PMID 42221064 · Full text
PURPOSE: Although most pediatric extremity fractures can be managed with closed reduction, even when operative fixation is required, youth rodeo exposes participants to high-energy livestock-related trauma that may produ...
PURPOSE: Although most pediatric extremity fractures can be managed with closed reduction, even when operative fixation is required, youth rodeo exposes participants to high-energy livestock-related trauma that may produce fracture patterns associated with failed closed reduction. This study described operative management and fracture irreducibility in pediatric and adolescent extremity injuries sustained during organized rodeo participation. METHODS: A retrospective case series was performed at a Level I pediatric trauma center. Patients aged ≤18 years who sustained injuries during organized rodeo participation between November 2017 and December 2023 were identified through trauma registry review. Demographics, injury characteristics, operative management, and intraoperative findings were recorded. Fractures were classified as irreducible when documented closed reduction attempts failed, and open reduction was required to obtain satisfactory alignment. RESULTS: Forty-one patients with rodeo-related injuries were identified. Orthopedic injuries occurred in 21 patients (51.2%), including 18 extremity fractures (43.9%). Thirteen of eighteen extremity fractures (72.2%) were managed operatively. Open reduction after unsuccessful closed reduction attempts was required in 5 of 13 operatively treated fractures (38.5%), representing 27.8% of all extremity fractures. Irreducible injuries included femoral shaft fractures, elbow fracture-dislocations, Monteggia injuries, proximal humerus fractures, and both-bone forearm fractures. CONCLUSION: Pediatric and adolescent rodeo-related extremity fractures were frequently managed operatively, and open reduction was required in a substantial proportion of surgically treated cases. These findings should be interpreted descriptively because no matched comparison cohort was available. SIGNIFICANCE OF STUDY: This single-center series suggests that failed closed reduction may occur in several pediatric and adolescent rodeo-related extremity fracture patterns. LEVEL OF EVIDENCE: IV (Therapeutic Case Series).
Late-developing acetabular dysplasia following normal infant hip ultrasound in breech and family-history cohorts: A systematic review.
Lakdawala HAR, Verma Y, Galán-Olleros M … +4 more , Bradley CS, Mulpuri K, Gardner R, Bavan L
J Child Orthop · 2026 May · PMID 42131730 · Full text
PURPOSE: This systematic review evaluates the reported incidence of late-developing acetabular dysplasia in infants with breech presentation or a positive family history of developmental dysplasia of the hip following no...
PURPOSE: This systematic review evaluates the reported incidence of late-developing acetabular dysplasia in infants with breech presentation or a positive family history of developmental dysplasia of the hip following normal early ultrasound. METHODS: MEDLINE, Embase, and the Cochrane Library were searched for studies of breech or positive family-history cohorts who underwent early ultrasound and subsequent radiographic follow-up for late-developing acetabular dysplasia. Two reviewers independently screened studies, extracted data, and assessed methodological quality. RESULTS: Ten studies met inclusion criteria. Across these studies, radiographic follow-up after normal infant ultrasound was incomplete and variably reported, with several cohorts demonstrating substantial attrition. Among infants with a positive family history who underwent radiographic assessment ( = 520), no cases of late-developing acetabular dysplasia were reported. In breech cohorts with available follow-up ( = 727), reported late-developing acetabular dysplasia rates ranged from 0% to 29%, with higher estimates generally observed in studies with earlier follow-up or more permissive diagnostic thresholds. Management was predominantly observational, and operative treatment was described in one case only. CONCLUSIONS: Persistent acetabular dysplasia after a normal screening ultrasound was not identified in the included family-history cohorts with post-screening imaging. In breech cohorts, reported rates of late-developing acetabular dysplasia vary widely and appear to be influenced by timing of assessment and diagnostic criteria. Methodological heterogeneity and incomplete cohort ascertainment limit interpretation, underscoring the need for prospective studies with standardised definitions and child-level incidence reporting. SIGNIFICANCE OF STUDY: This review highlights critical gaps in the evidence informing management of developemental dysplaisa of the hip following screening and provides a framework for designing definitive prospective studies to guide surveillance practices. LEVEL OF EVIDENCE: Level III.
Quality, reliability, and educational value of YouTube™ videos on Pavlik harness treatment for developmental dysplasia of the hip.
Unat B, Karabulut Ç, Bilgin MA … +3 more , Erol R, Rızvanoğlu İH, Gönder N
J Child Orthop · 2026 May · PMID 42110209 · Full text
BACKGROUND: Pavlik harness is a widely accepted first-line treatment for Developmental dysplasia of the hip in infants. Given the increasing use of online video platforms by caregivers seeking medical information, this s...
BACKGROUND: Pavlik harness is a widely accepted first-line treatment for Developmental dysplasia of the hip in infants. Given the increasing use of online video platforms by caregivers seeking medical information, this study aimed to evaluate the content, quality, and reliability of the most-viewed YouTube™ videos related to the Pavlik harness. METHODS: A YouTube™ search was conducted using the terms "Pavlik harness," "Pavlik harness treatment," "Pavlik harness overview," "Pavlik harness how to apply," "Pavlik harness application," and "Pavlik harness tips." 48 videos were included for analysis. Data collected included upload source, video length, date of upload, number of views, likes, dislikes, comments, and the interaction index. Video quality and reliability were evaluated using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) benchmark criteria, and DISCERN instrument. RESULTS: Of the 48 videos analyzed, 26 (54.2%) were classified as high quality, 10 (20.8%) as intermediate, and 12 (25%) as low quality. Videos uploaded by healthcare professionals and academic institutions had significantly higher GQS, JAMA, and DISCERN scores compared to those uploaded by non-medical sources( < 0.001). High-quality videos also had a higher number of likes per day and views per day ( = 0.001 and = 0.001, respectively). CONCLUSION: Nearly half of the most-viewed YouTube™ videos on this topic were of intermediate or low quality. Pediatric orthopedic specialists and professional societies should be encouraged to contribute high-quality, evidence-based videos to guide caregivers appropriately. Parents should be advised to rely on videos uploaded by reputable academic sources to ensure accurate and safe application of the Pavlik harness.
Outcomes of hemiepiphysiodesis on lower limb deformities due to rickets: A systematic review.
Ivansyah MD, Kurniawan A, Wibowo A
J Child Orthop · 2026 Apr · PMID 42078113 · Full text
PURPOSE: Rickets is a condition characterized by a defective mineralization on the epiphyseal plate, either in the form of nutritional or congenital hypophosphatemic rickets, which could lead to progressive bone deformit...
PURPOSE: Rickets is a condition characterized by a defective mineralization on the epiphyseal plate, either in the form of nutritional or congenital hypophosphatemic rickets, which could lead to progressive bone deformity. One of said deformities is angular growth of the knee which can cause permanent disfigurement. Hemiepiphysiodesis is a surgical option to correct the deformity, yet the studies evaluating its results are rare. This review aimed to map the literature pertaining to this topic. METHODS: A comprehensive search was performed across five databases: Pubmed, Cochrane, ProQuest, Embase, and Science Direct to identify studies involving children with rickets treated with hemiepiphysiodesis. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool, and the outcome data were compiled. RESULTS: Six studies fulfilled the inclusion and exclusion criteria of this study with highly varied groupings and outcomes. However, the risk of bias of all studies was low to moderate. Hemiepiphysiodesis showed good outcome in function, radiological parameter, and correction rate with lower complication rate compared to osteotomy. The average time required to achieve full deformity correction was within 10.8-22.7 months. However, hemiepiphysiodesis has a risk of overshooting the correction or paradoxically rebounding to the prior condition, therefore, requiring routine follow-up. CONCLUSION: Hemiepiphysiodesis is beneficial for the correction of angular deformities in the knee due to rickets. SIGNIFICANT OF STUDIES: This review provides a crucial evidence base for clinicians by establishing hemiepiphysiodesis as a viable, less invasive alternative to osteotomy.
What's new in pediatric bone sarcomas and benign bone tumors.
von der Weid N, Baumhoer D, Krieg AH
J Child Orthop · 2026 Apr · PMID 42064237 · Full text
Significant progress has been made in the diagnosis and treatment of pediatric bone tumors in recent years. For malignant bone tumors, a better understanding of the molecular pathogenesis has been achieved, providing new...
Significant progress has been made in the diagnosis and treatment of pediatric bone tumors in recent years. For malignant bone tumors, a better understanding of the molecular pathogenesis has been achieved, providing new directions for targeted approaches and immunotherapy. Advances in imaging techniques, such as whole-body magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography/computed tomography, have improved the accuracy of staging, treatment response evaluation, and recurrence monitoring. In surgical treatment, 3D printing technology, computer navigation, and minimally invasive techniques have shifted the paradigm from resection to functional reconstruction. Technologies, including modular and expandable implants, along with bio-integrated prostheses, support long-term functional recovery in pediatric patients. For benign bone tumors, the use of targeted drugs like denosumab and the refinement of minimally invasive techniques such as cryotherapy and radiofrequency ablation have achieved a better balance between disease control and functional preservation. The ongoing development of multidisciplinary collaboration further optimizes personalized treatment strategies. Looking ahead, continuous progress in precision medicine will steer the diagnosis and treatment of pediatric bone tumors toward minimally invasive, individualized, and innovative approaches.
Clinical decision-making in rare bone diseases - A survey among members of the European Paediatric Orthopaedic Society (EPOS) and the European Reference Network on Rare Bone Diseases (ERN BOND).
Gamage TH, Coutinho S, Leardini A … +10 more , Alves I, Großmann N, Sakkers R, Marcucci G, Masi L, Brandi ML, Zillikens MC, Trisolino G, Wekre LL, Horn J
J Child Orthop · 2026 Apr · PMID 42028272 · Full text
PURPOSE: Clinical management of rare bone diseases (RBDs) is challenged by low prevalence, delayed diagnosis, and complex multidisciplinary needs. This survey aimed to map current clinical practices in RBDs, identify unm...
PURPOSE: Clinical management of rare bone diseases (RBDs) is challenged by low prevalence, delayed diagnosis, and complex multidisciplinary needs. This survey aimed to map current clinical practices in RBDs, identify unmet needs, and generate foundational data to guide the development of minimum standards for patient assessment. METHODS: An anonymous online survey was distributed to members of the European Paediatric Orthopaedic Society (EPOS) and the European Reference Network on Rare Bone Diseases (ERN BOND) in September 2025. Questions addressed diagnostic work-up, interdisciplinary care, transition practices, and future perspectives. Quantitative data were analysed descriptively, and free-text responses thematically. RESULTS: A total of 119 respondents (35 countries), mostly orthopaedic surgeons (74%), completed the survey. Almost all (118/119) provided direct care, and 63% had >10 years' experience treating RBDs. Over 80% routinely used anthropometric, posture, and alignment measures, whereas the use of advanced tools varied. Interdisciplinary care is widely applied at varying frequencies, with a high consideration for shared decision-making and quality of life. Most lacked registry access (>80%) and formal transition protocols (~70%). Respondents prioritised clinical frameworks over technological advances and anticipated increasing future relevance for technological innovations. CONCLUSIONS: This survey highlights considerable variability in clinical decision-making for RBDs. The findings underscore the importance and need of standardised interdisciplinary care, registry data, and structured protocols and frameworks. STUDY SIGNIFICANCE: This is the first systematic survey of clinical practice and decision-making process in RBD care among EPOS and ERN BOND members. The findings may guide future recommendations and standards, supporting more harmonised care for individuals with RBDs, especially ultra-rare conditions.
Complications of treatment in paediatric forearm fractures: A 30-year review of compensation claims.
Dikert C, Nietosvaara Y, Grahn P
J Child Orthop · 2026 Apr · PMID 42016378 · Full text
PURPOSE: The study aimed to evaluate the risk and contributing factors leading to compensation claims and permanent disability following complications of treatment in the management of paediatric forearm fractures. METHO...
PURPOSE: The study aimed to evaluate the risk and contributing factors leading to compensation claims and permanent disability following complications of treatment in the management of paediatric forearm fractures. METHODS: Data were gathered from the Finnish Patient Insurance Centre (PIC), which reviews all claims regarding potential treatment complications in Finland. PIC grants monetary compensation based on excess pain or permanent cosmetic and/or functional disability. We evaluated all claims concerning paediatric forearm fracture management in children under 16 years of age between 1990 and 2019. RESULTS: One hundred and forty-four (58 distal forearm, 55 forearm shaft and 31 proximal forearm) of 226 claims were compensated for a total of 156 separate treatment complications. The overall calculated risk for sustaining a compensated treatment complication was 0.1%. Unsatisfactory standard of surgery was the reason for the compensation in 29/55 children with forearm shaft fractures and delayed diagnosis in 20/31 children with proximal forearm fractures, respectively. Compensation was granted for permanent functional disability to 35 children and for permanent cosmetic disability to 62 children. Permanent functional disability was compensated in 6/58 children with distal, 19/55 with shaft and 10/31 with proximal forearm fractures. CONCLUSIONS: The risk of sustaining a compensated complication of treatment after a paediatric forearm fracture is low. Forearm shaft and proximal forearm fractures are associated with a clearly higher risk of iatrogenic injuries with permanent disability than distal forearm fractures. STUDY SIGNIFICANCE: This paper is significant due to the lack of previous publications on this topic and can contribute to minimizing treatment complications in the future.
Letter to the editor: "Forearm fractures treated with elastic stable intramedullary nailing: Is casting still necessary?".
Bašković M, Čolić T, Pešorda D
J Child Orthop · 2026 Apr · PMID 42003998 · Full text
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Distal metaphyseal horizontal tibial fractures in children.
Kara H, Jääskelä M, Laaksonen T … +3 more , Grahn P, Helenius I, Ahonen MM
J Child Orthop · 2026 Apr · PMID 41982254 · Full text
BACKGROUND: Pediatric horizontal distal metaphyseal tibial fractures are relatively uncommon injuries. While nonoperative treatment remains the standard of care for most cases, certain fracture patterns may carry a highe...
BACKGROUND: Pediatric horizontal distal metaphyseal tibial fractures are relatively uncommon injuries. While nonoperative treatment remains the standard of care for most cases, certain fracture patterns may carry a higher risk of treatment failure, and optimal treatment strategies are still unclear. The aim of this study was to investigate the frequency, anatomical location of these fractures within the metaphysis, and risk factors associated with treatment failure in nonoperative management. METHODS: A retrospective, registry-based cohort study was conducted to evaluate treatment success in 86 consecutive pediatric patients with distal metaphyseal horizontal tibial fractures between 2014 and 2023. Demographic, clinical, and radiographic data were analyzed. Logistic regression analysis was performed to identify independent predictors of nonoperative treatment failure. Nonoperative treatment failure was defined as the requirement for cast wedging, re-reduction, or surgical intervention due to loss of reduction or coronal angulation greater than 10° observed on final follow-up radiographs. RESULTS: Of the 86 patients included, 70 (81%) were initially treated non-operatively, while 16 (19%) underwent primary surgical fixation. The overall failure rate in the nonoperative group was 35.3% (25/70). Multivariable logistic regression identified 3 independent predictors of treatment failure: age >11 years (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 1.3-81.7; = 0.030), the presence of a complete fibular fracture (adjusted OR, 6.1; 95% CI, 1.2-30.1; = 0.027), and initial coronal angulation >10° (adjusted OR, 4.9; 95% CI, 1.1-23.0; = 0.042). The complication rate was significantly higher in the operative group compared to the nonoperative group (18.3% vs. 4.3%; relative risk, 4.4; 95%CI 1.0-19.7, = 0.042). CONCLUSIONS: Nonoperative treatment remains an effective approach for the majority of pediatric horizontal distal metaphyseal tibial fractures. However, patients with older age, concomitant complete fibular fractures, or marked initial angulation may benefit from early surgical intervention to mitigate the risk of treatment failure. LEVEL OF EVIDENCE: .
Lateral malleolus reconstruction for fibular hemimelia as a prevention of foot deformity recurrence following tibial lengthening-A long-term analysis.
Shadi M, Janusz P, Kortus E … +1 more , Kotwicki T
J Child Orthop · 2026 Apr · PMID 41943811 · Full text
PURPOSE: Management of ankle deformity and instability remains a challenge in patients with severe fibular hemimelia (FH). This study aims to evaluate the long-term effectiveness of lateral malleus reconstruction using t...
PURPOSE: Management of ankle deformity and instability remains a challenge in patients with severe fibular hemimelia (FH). This study aims to evaluate the long-term effectiveness of lateral malleus reconstruction using the fibular anlage in correcting ankle malalignment and preventing the recurrence of deformity following leg lengthening. METHODS: Ten patients (age: 3.3 years, 0.8-7.7) with a severe FH, equino-valgus foot deformity, ankle instability, and tibial bowing underwent tibia and ankle realignment and lateral malleolus reconstruction. Afterward, all patients underwent tibial lengthening, and the mean lengthening was 9.9 cm (5.0-16.5). Foot and ankle alignment was evaluated clinically and radiographically before surgery, postoperatively, and at a follow-up (10.0 years, 9.2-11.7). Recurrences, additional procedures, and complications were analyzed. Quality of life was assessed using the Limb Deformity-Scoliosis Research Society (LD-SRS) questionnaire. RESULTS: At the last follow-up, all patients present neutral heel position or slight valgus (three patients 5° and one patient 10°). No additional procedures were performed except medial malleus temporary epiphysiodesis in two patients. The foot was plantigrade in six patients, presented equinus 10° in two and 20° in two, due to equinus, supra-malleolar osteotomy was performed in three patients. Significant improvement of radiological alignment was found and maintained in all parameters. The mean LD-SRS score was 3.78 at follow-up. CONCLUSION: Lateral malleolus reconstruction provided good clinical, radiological, and functional outcomes. Due to the tendency for recurrence, additional procedures may be necessary. LEVEL OF EVIDENCE: IV.
Response to letter: 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 · 2026 Jun · PMID 41918868 · Full text
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Open supracondylar humerus fractures in children: Associated injuries and clinical outcomes.
Emet A, Armet G, Luck C … +3 more , Aksoy T, Mendelson SA, Dede O
J Child Orthop · 2026 Jun · PMID 41918867 · Full text
PURPOSE: Supracondylar humerus (SCH) fractures are common, but they rarely present as open fractures. This study aimed to evaluate the incidence, associated injuries, and postoperative outcomes of open SCH fracture manag...
PURPOSE: Supracondylar humerus (SCH) fractures are common, but they rarely present as open fractures. This study aimed to evaluate the incidence, associated injuries, and postoperative outcomes of open SCH fracture management in the pediatric population. METHODS: Children with open SCH fractures treated at a single institution between January 2005 and January 2025 were included in this study. Electronic medical records were reviewed to collect demographic data, fracture characteristics, surgical details, and postoperative outcomes. All patients underwent wound irrigation and debridement, open-assisted reduction, and K-wire fixation under general anesthesia. Postoperative care included immobilization, follow-up for fracture healing and range of motion (ROM), and selective physical therapy. Data were analyzed using standard statistical methods, with significance set at < 0.05. RESULTS: Among 3053 SCH fractures, 1.1% were open fractures (15 males, 19 females), with a mean age of 7.7 ± 2.4 years. The nondominant left arm was affected in 82.4% of cases, and the most common mechanism of injury was a fall from height (64.7%). Extension-type modified Gartland type III fractures were observed in 91.2% of patients, and Gustilo-Anderson type II was the most frequent open fracture classification (44.1%). Associated nerve injuries occurred in 20.6% of patients, and vascular repair was required in 5.9%. The mean time to pin removal was 4.7 ± 1 weeks. Overall, 26.5% of patients underwent reoperation, 26.5% experienced ≥10° reduction in flexion-extension ROM. CONCLUSION: Open SCH fractures are rare yet serious injuries, causing peripheral nerve and vascular damage that require surgical repair.
Comparison of bone age between both limbs in patients with congenital hemihyperplasia or hemihypoplasia: A retrospective study.
Lee W, Ko JM, Song KI … +4 more , Yu SY, Song MH, Cho TJ, Shin CH
J Child Orthop · 2026 Mar · PMID 41913935 · Full text
PURPOSE: Side-to-side differences in bone age may exist due to somatic mosaicism in congenital hemihyperplasia or hemihypoplasia. We aimed to assess bone age differences between limbs in these conditions. METHODS: We ret...
PURPOSE: Side-to-side differences in bone age may exist due to somatic mosaicism in congenital hemihyperplasia or hemihypoplasia. We aimed to assess bone age differences between limbs in these conditions. METHODS: We retrospectively identified 118 children who underwent molecular testing for congenital hemihyperplasia or hemihypoplasia. Diagnoses included Beckwith-Wiedemann syndrome (BWS) ( = 34), Silver-Russell syndrome ( = 14), PIK3CA-related overgrowth spectrum (n = 14), and idiopathic isolated hemihyperplasia or hemihypoplasia ( = 56). Hand and knee bone ages were compared between the right and left limbs and between the longer and shorter limbs. RESULTS: In the overall cohort or each disease group, there was no difference in hand or knee bone age between the right and left limbs. However, the hand bone age of the longer limb was 1.2 ± 2.6 months older than that of the shorter limb ( = 0.005). In subgroup analysis, patients with BWS showed older knee (7.1 ± 9.9 months, = 0.031) and hand (3.2 ± 2.5 months, = 0.026) bone ages in the longer limb compared to the shorter limb. No significant differences were observed in the other disease groups. CONCLUSIONS: Pediatric patients with congenital hemihyperplasia or hemihypoplasia generally show minimal bone age differences between limbs. However, in BWS, the longer limb may have a bone age several months older than the shorter limb. SIGNIFICANCE OF STUDY: Surgeons need to consider potential side-to-side differences in bone age when estimating remaining growth and determining the timing for epiphysiodesis in these patients. LEVEL OF EVIDENCE: III-Study of nonconsecutive patients.
Brachial plexus birth injury in children and adolescents: A current concepts review.
Shackleford T, Little KJ
J Child Orthop · 2026 Jun · PMID 41907836 · Full text
Brachial plexus birth injuries (BPBI), although rare, have a significant impact on patients and the healthcare system. While these conditions tend to be treated at specialty centers around the world that are well equippe...
Brachial plexus birth injuries (BPBI), although rare, have a significant impact on patients and the healthcare system. While these conditions tend to be treated at specialty centers around the world that are well equipped to handle the complex needs of these patients, an understanding of the natural history, prognosis, and treatment options for this population is important for all pediatric orthopedic providers. This review aims to detail current concepts of the treatment of BPBI with a focus on clinical examination, operative indications, early surgical interventions, and long-term musculoskeletal sequelae.
Primary displacement predicts complications and poorer outcomes after pediatric proximal radius fractures: A retrospective study of 140 fractures.
Zilliacus K, Nietosvaara Y, Helenius I … +3 more , Kivisaari R, Kämppä N, Grahn P
J Child Orthop · 2026 Jun · PMID 41907835 · Full text
PURPOSE: Pediatric proximal radius fractures frequently lead to complications and unsatisfactory results, yet the medium- to long-term outcomes of these injuries remain insufficiently studied. METHODS: We treated 140 pro...
PURPOSE: Pediatric proximal radius fractures frequently lead to complications and unsatisfactory results, yet the medium- to long-term outcomes of these injuries remain insufficiently studied. METHODS: We treated 140 proximal radius fractures in 138 children (median age 10, range 1-16 years) between 2014 and 2019. Fracture characteristics, treatment, complications, patient-reported, and functional outcomes were assessed at a median follow-up of 6.8 years (range 5-10 years) through clinical assessment or telephone interview in 110 patients (80%). RESULTS: Less severe fractures (Judet types I-II) were most common (84/140), while 40% were Judet types III-IV. Most fractures (66%) were treated nonoperatively. Complications occurred in 25% of cases and were mainly associated with displacement ≥3 mm (Odds ratio (OR) 6.7, 95% confidence interval (CI) 2.7-19.1), physeal involvement (OR 5.1, 95% CI 2.0-15.7), and higher Judet classification (OR 4.2, 95% CI 1.9-9.7). Unfavorable functional outcomes occurred in 16% (11/67) and were more frequent after surgical treatment (OR 5.0, 95% CI 1.3-19.6) and in patients with complications (OR 9.2, 95% CI 1.8-47.0). CONCLUSION: In pediatric proximal radius fractures, primary displacement ≥3 mm, higher Judet's class, and physeal involvement increased the risk of complications and unfavorable long-term outcomes. LEVEL OF EVIDENCE: Prognostic study, Level III.
Variation in assessment, diagnosis and outcome measurement in Perthes disease: a scoping review.
Ball S, Thomas R, Davies LM … +4 more , Gray K, Williams N, Munns CF, Pacey V
J Child Orthop · 2026 Jun · PMID 41907834 · Full text
PURPOSE: Perthes disease is a rare self-limiting avascular necrosis of the developing proximal capital femoral epiphysis. Identifying methods used to assess, diagnose and determine outcomes is essential to improve consis...
PURPOSE: Perthes disease is a rare self-limiting avascular necrosis of the developing proximal capital femoral epiphysis. Identifying methods used to assess, diagnose and determine outcomes is essential to improve consistency in research and clinical care for this patient population. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews was used. Four electronic databases (Scopus, MEDLINE, CINAHL and Embase) were searched with articles included if clinical and radiological assessments were conducted on more than 10 participants, aged 0 to <18 years with Legg-Calvé-Perthes disease post 2004. RESULTS: From 9145 records, 32 studies were included, identifying 16 clinical assessments, 23 radiological assessments, 10 diagnostic classifications and 22 outcome measures. Overall, 64% of outcome measures identified are not currently validated for children and adolescents. CONCLUSIONS: Substantial variability in the methods used to assess, diagnose and determine outcomes in children and adolescents with Perthes disease was identified. When coupled with limited use of validated paediatric measures, this inconsistency complicates clinical decision-making, reduces consistency in patient care and prevents comparability across studies. Establishing expert consensus to determine the most appropriate, accurate and child-specific measures is needed to enhance consistency in patient care, enable more robust outcome reporting and strengthen future research in Perthes disease. SIGNIFICANCE OF STUDY: Significant variation in diagnostic, assessment and outcome measures for Perthes disease underscores the need for validated, child-specific tools to improve clinical decision-making, facilitate comparability across studies and strengthen future research. LEVEL OF EVIDENCE: Level III, scoping review.
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