Journal of Pediatric Orthopaedics-Part B最新文献

Hip joint morphology varies by sex and age. Computed tomography (CT) provides excellent evaluation of acetabular morphology; however, a description of the normal range of CT measurements in healthy children is lacking. This study aimed to describe the acetabular morphology on CT in healthy children by sex and at specific ages. Children who underwent pelvic CT from February 2016 to 2022 were retrospectively studied. The anterior pelvic plane was the basis for measuring lateral center-edge angle (LCEA), acetabular angle, anterior center-edge angle (ACEA), acetabular version (AcetV), anterior acetabular sector angle (AASA), and posterior acetabular sector angle (PASA). This study included 55 females and 55 males. The mean age was 12.5 years (range: 1-18 years). Patients were grouped by age: 2-7 years ( n = 50 hips), 8-11 years ( n = 50 hips), and 12-18 years ( n = 120 hips). Mean AcetV was 16.5° (range: 5.8-29.5°), mean AASA was 58.38° (range: 40.0-69.4°), mean PASA was 90.6° (range: 68.8-111.00°), mean LCEA was 27.9° (range: 19.0-40.4°), mean acetabular angle was 45.1° (range: 33.6-55.9°), and mean ACEA was 47.6° (range: 23.0-64.4°). The AcetV, AASA, PASA, LCEA, and ACEA increased with age, while the acetabular angle decreased ( P < 0.001). AcetV and PASA were highest in females ( P < 0.001). Hip joint development varies by sex across specific ages. The measurements reported provide descriptive reference data that may be used as an assessment tool for early identification of pediatric hip deformities and aid surgical planning.

Level of evidence: Level IV.

This study reports preliminary outcomes in coronal and sagittal spinal alignment and complications following posterior dynamic distraction device (PDDD) implantation (ApiFix) in adolescent idiopathic scoliosis (AIS) patients. A retrospective review of 11 AIS patients treated with PDDD between 2020 and 2022 was conducted. Radiographic parameters [Cobb angle, kyphosis, lordosis, and sagittal vertical axis (SVA)], trunk rotation, operative data, and SRS-22r were assessed preoperatively, postoperatively, and at latest follow-up. Complications and revisions were recorded. Eleven patients (Lenke 1: n = 6; Lenke 5: n = 5) with a mean follow-up of 37.35 ± 10.31 months were reviewed. Significant scoliosis improvement was achieved postsurgery and maintained at follow-up for both Lenke groups, but no further correction occurred after the initial postoperative period. Distal sagittal malalignment developed in eight patients; distal junctional kyphosis in 5 Lenke 1 patients (83%) and distal junctional lordosis in 3 Lenke 5 patients (60%). Kyphosis and lordosis returned to baseline, with SVA unchanged. Two patients (18%) required PDDD removal for deep infection. One with chronic pain and another with implant prominence required or were scheduled for conversion to posterior spinal fusion (PSF). Postoperatively, trunk rotation improved in 75% of patients. Patient satisfaction with scoliosis management improved, but the device cannot be strongly recommended based on these preliminary results. In conclusion, PDDD achieves good initial coronal correction but has a high rate of sagittal malalignment compared to PSF. Beyond the need for patient counselling regarding risks and further surgery, the implant's uncertain safety profile warrants the authors discontinuing it in clinical practice.

Flatfoot is a common condition in children; surgical treatment should be reserved for severe and symptomatic cases. Calcaneal lengthening osteotomy (CLO) has been associated with good results; the original technique considers the use of allografts or autografts. This study aimed to evaluate advantages of a titanium trapezoidal wedge (TTW) in a pediatric population, compared with traditional grafts. At our knowledge, there are no studies in pediatric patients. This is a retrospective study of 11 patients (14 feet) with severe flatfoot treated with CLO and TTW and a control group of nine patients (13 feet) treated with CLO and traditional grafts. The mean age of TTW group was 13.4 years, and the mean follow-up was 15 months. The mean age in the control group was 13.7 years, and the mean follow-up was 36 months. Pre- and postoperative clinical and radiographic measures were evaluated, as well as operative time and radiation exposure. At follow-up, feet treated with TTW showed an improvement in all radiographic parameters measured on weight-bearing radiographs and also an improvement in the American Orthopedic Foot and Ankle Society Score, comparable to the control group. The use of TTW significantly reduced radiation exposure and operating time. No cases of graft fracture or migration were observed. All TTW appeared osteointegrated at the last follow-up. CLO using TTW is an effective procedure, allows correction to be maintained over time and reduces operative time and radiation exposure. Despite the promising results, our findings should be considered as a preliminary report; more data are needed to confirm our results.

Limited data exists on adolescent athletes' and their parents' expectations for return to sport (RTS) and outcomes following anterior cruciate ligament reconstruction (ACLR). This study evaluates and compares these preoperative expectations. Fifty patients (12-18 years) and their parents completed a preoperative questionnaire administered before consultation with a single sports medicine surgeon at a tertiary referral center between June 2019 and December 2021. This 12-question survey assessed knowledge and expectations regarding ACLR. Statistical analysis compared patient-parent responses. The study included 50 patients (44% female, mean age 15.2 ± 2.0 years) and parents (64% female, mean age 46.4 ± 6.5 years). Most participants were Caucasian (68% patients and 72% parents) with private insurance (68%). A total of 36% of consults were for a second opinion. Prior research on ACL injuries was reported by 58% of patients and 76% of parents. Patients were more likely to expect RTS within 6 months (32%) than parents (14%; P = 0.048), while more parents anticipated RTS at greater than or equal to 12 months (38 vs. 20%). Both groups had high expectations for RTS at or above preinjury level (88% patients and 94% parents; P = 0.604). Fear of reinjury was the leading reason for not returning or returning at a lower level (P = 0.733). There was no significant difference regarding perceived risk of contralateral ACL injury (P = 0.195). Adolescent patients anticipate earlier RTS post-ACLR than parents, both having high RTS performance expectations. Improved preoperative education may help align expectations.

Atlantoaxial instability (AAI) is a common but potentially severe complication in pediatric patients with Down syndrome, while its surgical characteristics and outcomes remain understudied compared with non-Down syndrome populations. To compare the clinical presentation, radiological features, surgical strategies, and postoperative outcomes of AAI between pediatric patients with Down syndrome and matched non-Down syndrome controls. A retrospective case-match study was conducted, including 15 patients with Down syndrome along with AAI who underwent surgical atlantoaxial arthrodesis between 2009 and 2022. Each case was matched with two non-Down syndrome controls by age, sex, and AAI severity. The patients were divided into two groups: the Down syndrome group (group DS) and the control group (group C). Data included clinical presentation, radiographic parameters [atlantodental interval (ADI) and space available for the spinal cord (SAC)], surgical approach, complications, and fusion rates were compared between the two groups. Patients with Down syndrome exhibited a higher incidence of neurological symptoms (12/15, 80%) compared with controls (5/30, 16.7%) (P < 0.05). Os odontoideum was more common in patients with Down syndrome (10/15, 66.7%), while rotatory dislocation was more common in patients with non-Down syndrome (9/30, 30%); nine (60%) in group DS and one (2.9%) in group C had a high-signal area on MRI. Preoperative ADI was larger for group DS compared with group C (9.0 vs. 7.4 mm; P < 0.01). The ADI and SAC were significantly corrected and were comparable at the last follow-up. Preoperative Japanese Orthopaedic Association scores were significantly smaller in group DS compared with group C (13.3 vs. 16.5; P < 0.01). Neurological symptoms were significantly improved in all patients at the last follow-up. All included patients underwent posterior atlantoaxial screw-rod fixation and fusion. Only two patients suffered superficial wound infection at the iliac bone area, and another patient in the neck (20%), and no complications occurred in group C. Solid fusion was shown in all patients by the time of the last follow-up. Pediatric patients with AAI often have os odontoideum and hypoplasia of the dental process. Posterior atlantoaxial screw-rod fixation can result in good fusion and neurological function recovery.

Plaster of Paris (POP) is traditional for Ponseti treatment of idiopathic congenital talipes equinovarus (CTEV), but semirigid fiberglass (SRF) is an alternative. This systematic review and meta-analysis compare POP and SRF outcomes. We searched PubMed, Scopus, Cochrane, and EMBASE up to 5th April 2025 for randomized controlled trials (RCTs) and quasi-RCTs comparing POP versus SRF for initial Ponseti treatment of idiopathic CTEV. Eligible studies reported on the number of casts, clinical scores (Dimeglio/Pirani), relapse or skin complications. Risk of bias was assessed using the Cochrane RoB tool. Data were pooled using random-effects meta-analysis [mean difference (MD) for continuous, risk ratio (RR) for binary outcomes]. Four studies (two RCTs, one prospective, one retrospective; 454 feet) met inclusion criteria. Study quality varied. No significant difference was found in the mean number of casts [MD: 0.34, 95% confidence interval (CI): -8.80 to 9.48; two studies, I ² = 70.6%], relapse rates (RR: 1.41, 95% CI: 0.04-50.93; two studies, I ² = 0.0%), or skin lesions (RR: 0.68, 95% CI: 0.31-1.50; two studies, I ² = NA). Evidence certainty was low due to heterogeneity and limited studies. Clinical score analysis was limited by differing scales and missing data; SRF consistently received higher parental satisfaction ratings. Based on limited, low-certainty evidence, no significant difference in clinical efficacy (casts, relapse, skin lesions) was found between POP and SRF. SRF offers advantages in parental satisfaction. Limitations include heterogeneity, few studies per outcome, and inconsistent reporting. While POP is cost-effective, SRF is a viable alternative. Further high-quality RCTs are needed.

We investigated to what extent the Ponseti technique is successful in radiologically aligning the deformed foot when the deformity was clinically corrected. This prospective study radiologically evaluated Ponseti-treated clubfoot children (Pirani score zero) at a minimum follow-up of 5 years. The radiographs obtained were foot anteroposterior and lateral views (standing views). The angles evaluated in the anteroposterior view were the talocalcaneal and the talus first metatarsal angle. In the lateral view, calcaneal fifth metatarsal, talocalcaneal, talus first metatarsal, tibiocalcaneal, and calcaneal pitch angles were measured. The measured radiological angles were statistically compared to the unaffected feet of the unilateral cases. The mean age of initial treatment for 91 enrolled children (unilateral 37; bilateral 54) was 4 months, and the mean follow-up was 7.2 years. The radiographs revealed similarities for the treated ( n  = 145) and unaffected feet ( n  = 37) for two angles (talocalcaneal and talus first metatarsal) evaluated in the anteroposterior view, indicating corrected hindfoot varus and midfoot adduction. Again, the calcaneal fifth metatarsal, talus first metatarsal, and calcaneal pitch angles matched for both feet, indicating a completely corrected cavus. There were, however, significantly lower talocalcaneal (mean 28.1 degrees vs. 32.9 degrees in the unaffected feet) and higher tibiocalcaneal angles (76.5 degrees vs. 72 degrees in the unaffected feet) in the lateral projection of the treated clubfeet, indicating the presence of residual hindfoot abnormalities. The radiological measures in the successfully treated clubfeet matched those of unaffected feet. The exceptions were abnormal lateral talocalcaneal and tibiocalcaneal angles. These might indicate the presence of a certain amount of subclinical hindfoot equinus in the treated children.

This study introduces and evaluates the unilateral convex sliding-growing rod (UCSGR) technique, a novel growth-guiding approach for early-onset scoliosis (EOS). The UCSGR aims to achieve deformity correction while preserving spinal growth and minimizing morbidity by using instrumentation solely on the convex side. A retrospective analysis was performed on EOS patients treated with UCSGR between 2018 and 2022 at a tertiary spine center. Eighteen patients were screened; 11 met inclusion criteria and completed greater than or equal to 24 months of follow-up. Clinical and radiographic outcomes-including Cobb angle, annual T1-S1 spinal growth, operative parameters, and complications-were analyzed. Curve flexibility and morphology were assessed on preoperative bending films. The cohort (mean age: 4.9 years, range: 3-7) included congenital (36.4%), spina-bifida-associated (27.3%), and juvenile idiopathic scoliosis (36.4%). Mean follow-up was 47.3 months. The average Cobb angle improved from 69.7° preoperatively to 26.4° postoperatively, yielding 63.5% correction ( P = 0.018). Annual spinal growth averaged 9.8 mm. Mean operative time was 203 min, and blood loss 225 ml. Two complications occurred-one rod fracture requiring revision and one superficial infection treated conservatively. No neurological deficits or spontaneous fusion were observed. The UCSGR technique provides substantial deformity correction with maintained spinal growth and a low complication rate. By leveraging convex-side biomechanics while preserving concave structures, it offers a promising alternative to bilateral growth-friendly constructs. Multicenter studies with longer follow-up are needed to confirm its long-term safety and efficacy.