Journal of Pediatric Orthopaedics-Part B最新文献

Clubfoot (CF) is one of the most common musculoskeletal congenital abnormalities. Despite having optimal methods for its treatment, factors associated with the recurrence of CF treatment continue to be a topic of interest. The aim of this study was to perform a scoping review of the existing literature on factors associated with the recurrence of CF following treatment with the Ponseti method in children under 5 years of age. A scoping literature review was conducted in March 2024 using PubMed and Embase databases, and a structured research strategy. Screening of articles was performed by independent reviewers to ensure the inclusion of all pertinent studies. Considering inclusion and exclusion criteria, a final of 18 articles were included which encompassed factors associated with the recurrence of CF after treatment with the Ponseti method. The Ponseti method has demonstrated a high success rate in achieving CF correction. Various factors come into play regarding favorable outcomes and recurrence cases. The identified factors were initial severity scores for CF, age at the beginning of treatment, correct identification of idiopathic CF and complex CF, neuromuscular imbalance, poor nutritional status, noncompliance for the brace use, and the availability of a specialized attention center that ensured proper Ponseti method application and treatment adherence. Our findings highlight the importance of identifying different factors associated with the recurrence of CF following treatment with the Ponseti method, where timely intervention could minimize the risk of recurrence and achieve favorable outcomes.

The frequency of multiple clubfoot recurrences following Ponseti casting and the effect on final outcomes have not been well studied. This study aims to evaluate the effect of early recurrence (during the first 2 years) on the timing and rate of subsequent recurrences. A retrospective review was conducted of children treated with Ponseti casting at a single institution from 2002 to 2023 with minimum follow-up until age 5. Patients who required comprehensive soft tissue surgery to obtain initial correction were excluded. Patient-Reported Outcomes Measurement Information System data were collected when available. A total of 86 patients were included; 69.8% (60) had idiopathic clubfoot. Average follow-up was 5.8 years. Early recurrence (recurrence before age 2) occurred in 26.7% (23). The rate of late recurrence (recurrence after age 2) was higher in the early recurrence group, 73.9% (17) vs. 39.7% (25), P  = 0.005. Survival analysis revealed that patients with early recurrence experience late recurrence at a younger age of 3.9 vs. 6.7 years, P ≤ 0.001. The early recurrence group experienced more frequent recurrences, with a median of 3 [interquartile range (IQR): 1-5] total recurrences vs. 0 (IQR: 0-1), P ≤ 0.001. Patients with early recurrence had lower final mobility scores, 40.83 ± 10.88 vs. 48.00 ± 10.60, P  = 0.029. In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.

Toddler's fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler's fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler's fracture.

This study aimed to compare outcomes of idiopathic clubfeet (IC) treated with a percutaneous heel cord tenotomy (PHCT) at the conclusion of Ponseti casting with those that were not. A retrospective review of patients enrolled in a single institution prospective clubfoot registry over 19 years was performed. Patients under the age of 3 months with untreated IC managed via the Ponseti method that had a minimum of 2 years follow-up were included. Dimeglio score, number of casts to achieve correction, bracing compliance, need for subsequent procedures, and outcomes using the Richards classification were compared between patients who underwent a PHCT as part of their initial treatment and those that did not. A total of 1184 clubfeet in 791 patients met inclusion criteria; and 863 feet (73%) underwent a PHCT in clinic as part of initial Ponseti treatment. A total of 23% (75/321) of feet that did not undergo initial PHCT ultimately required a later PHCT or tendo-Achilles lengthening for recurrent equinus. Multivariate analysis demonstrated that an initial PHCT decreased the likelihood of requiring any additional surgical procedure by 30% (odds ratio: 0.70, P  = 0.02). While an initial tenotomy was not predictive of clinical outcomes ( P  = 0.09), the rate of fair and poor outcomes is more than double from 13.6 to 30% when an initial tenotomy was not performed in feet with Dimeglio scores of 13 or greater ( P  = 0.02). Incorporation of a PHCT at the conclusion of Ponseti casting may reduce the need for subsequent and more invasive surgical interventions in IC patients, especially those with Dimeglio scores of 13 or greater. Level of evidence: therapeutic level III.

Pediatric hand traumas are common injuries in childhood. The incidence and type of injury vary with age. In our country, there are only two publications in which only crush is examined in etiology. In this study, we aimed to develop a strategy to prevent hand injuries by examining pediatric hand injuries according to the child's developmental stage and anatomical region. The data of 493 (315 boys, 178 girls) patients under the age of 18 between 2016 and 2020 were analyzed. Patients were categorized according to etiology and age. Males are more dominant in pediatric hand injuries (63.9%). The most common cause of hand injuries under the age of 4 years is scald burns. While distal phalanx fractures (79.7%) are more common under 7 years of age, little finger fractures (44.7%) are more common than other finger fractures over 7 years of age. The reason for the increase in fifth metacarpal (neck) fractures between the ages of 12 and 17 years is fighting and punching. Door/window jamming injuries (60.7%) are more common under the age of 7 years, while there is an increase in sports injuries (94.7%) over the age of 7 years. The findings of this study provided age-specific information about the anatomical site, objects, activities, mechanisms, diagnosis, and treatment associated with hand and finger injuries. While developing a strategy to prevent childhood hand and finger injuries in Turkey, it is necessary to focus on age.

Cannulated screws have significant advantages, including ease of insertion and increased accuracy, during fracture fixation. Unraveling of screw threads is an uncommon complication related to cannulated screws. This single-institution case series aims to highlight four cases of unraveling of cannulated screw threads during the fixation of medial epicondyle humerus fractures in adolescents. All four cases involved the use of 4.0 or 4.5 mm partially threaded cannulated screws from the same manufacturer. This phenomenon was replicated in two cadaveric humeri. The higher density of bone on the lateral aspect of the medial column of the distal humerus would likely contribute to this complication. Modifying the surgical technique to include predrilling prior to screw placement can potentially avoid this complication.

The post birth revelation of child with physical anomaly taxes maternal hopes of a healthy child. However, unlike many other congenital anomalies, the Ponseti method has enabled an early and effective treatment of the clubfoot deformity. Our study aimed to assess the quality of life (QoL) of mothers with child born with idiopathic clubfoot through various stages of its management compared to a healthy infant. The study was conducted on mothers of children born with untreated congenital idiopathic clubfoot presenting within first 3 months after birth and undergoing Ponseti treatment. The WHO Quality of Life Instrument (QoL), Short Form (WHOQOL-BREF) questionnaire was used to capture maternal responses at enrolment of the child at the clubfoot clinic, at percutaneous Achilles tenotomy, 3 weeks post tenotomy, and 1 month after prescription of foot abduction brace. Intertreatment comparison of QoL responses was performed. Baseline values for QoL domains were obtained for mothers born with healthy infants (controls). Responses from 29 affected mothers and 30 controls were available. The QoL responses from affected mothers were significantly lower than those born with healthy children. The domains most affected were psychological health and environment ( P  < 0.001). Subsequent responses through various stages of Ponseti management remained comparable. Although the affected mothers' QoL was lower than mothers of healthy child, they were pacified by the available treatment and the counseling for clubfoot. Physical health and social relationship domains were no longer areas of concern for them. Further, there was no change of QoL across sequential Ponseti management.