Journal of Pediatric Orthopaedics-Part B最新文献

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.

This study aimed to evaluate the outcomes of guided growth - temporary hemiepiphysiodesis - in patients with fibular hemimelia (FH) and proximal femoral focal deficiency (PFFD), with a focus on treatment effectiveness, success rates, complications, and rebound phenomena. A retrospective review was conducted using medical records and standing radiographs from a prospective database of all FH and PFFD patients treated with guided growth for genu valgum deformity between 2007 and 2017. Forty-two children (28 with FH and 14 with PFFD) comprising 55 operated physes were included. The mean duration of follow-up was 51.11 ± 27.56 months from the first surgical intervention. Thirty-two physes were treated for pathological mechanical lateral distal femoral angle abnormalities, achieving a mean angular correction of 6.24° in the FH group and 6° in the PFFD group, with corresponding time-to-correction intervals of 14.07 months and 11.56 months. Twenty-three physes were operated on for pathological mechanical medial proximal tibial angle deformities, with mean angular corrections of 4.43° (FH) and 6.22° (PFFD), and time-to-correction of 17.95 months and 20.35 months, respectively. Among the 30 children in whom implants were removed, 12 (40%) developed recurrent deformity - 7 of 21 in the FH group and 5 of 9 in the PFFD group. Patients with first-episode rebound required repeat hemiepiphysiodesis. A second recurrence occurred in 3 of 21 (14%) FH patients and 2 of 9 (22%) PFFD patients. Temporary hemiepiphysiodesis is an effective method for correcting angular deformities around the knee in this congenital cohort, with a low complication rate but a notable risk of rebound.

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.

This study evaluates Chat Generative Pre-Trained Transformer 4o's (ChatGPT-4o's) utility in clinical relevance and accuracy compared with Google for pediatric clubfoot treatment questions. Both were queried for the 15 most frequently asked questions related to pediatric clubfoot treatment, with Google as control. Questions were classified using the modified Rothwell criteria for online sources. Questions and answers were independently graded for clinical relevance (0 = not clinically relevance, 1 = some clinical relevance, 2 = very clinically relevant) and clinical accuracy (0 = inaccurate, 1 = somewhat accurate, 2 = accurate), respectively (D.E.P. and N.G.). Questions and answers were validated by an expert, board-certified pediatric orthopedic surgeon (P.H.), who also resolved any discrepancies in grading. Per modified Rothwell criteria, Google responses were most frequently classified as either 'notion' or 'indications/management' while ChatGPT-4o responses were most likely addressed as 'notion' or 'longevity'. Google sources were primarily from academic and government platforms, while ChatGPT-4o exclusively used academic sources. ChatGPT-4o questions scored higher for clinical relevance ( P  = 0.006); however, clinical accuracy of answers was equivalent ( P  = 0.570). ChatGPT-4o provides clinically relevant questions, more so than Google with regard to pediatric clubfoot treatment. Furthermore, ChatGPT-4o uses a greater proportion of academic sources compared with Google. While both sources provided clinically accurate answers, large language models appeared to provide information that was more relevant and scholarly to patients' concerns regarding clubfoot; however, further validation and extensive testing are required to prevent the unnecessary spread of misinformation and its utilization in a clinical setting.

Level of evidence: Level III, retrospective comparative study.

Pediatric pes planovalgus (flatfoot) is a prevalent musculoskeletal condition characterized by the flattening of the medial arch of the foot. Despite its common occurrence, there is a lack of standardized diagnostic and therapeutic protocols. This study aimed to conduct a comprehensive bibliometric analysis on the 100 most-cited papers on pediatric flatfoot to identify major research trends, including publication years, countries of origin, contributing institutions, prevalent keywords, common surgical treatments, and authorship patterns. This bibliometric analysis utilized the Web of Science Core Collection database by Clarivate Analytics to identify articles related to pediatric flatfoot using keywords. The 100 most-cited articles were manually selected and analyzed using the VOSviewer software to create network visualization maps. The 100 most-cited articles were published between 1951 and 2019, with the number of citations ranging from 26 to 299. The number of influential papers published increased in the 2000s, and the majority were published in the 2010s (57%). The USA was the most productive country (31 publications), the University of South Australia was the most productive institution (eight publications), and Evans AM was the most productive author (seven publications). Calcaneal osteotomy was the most studied procedure (14 publications, 782 citations), predominantly in North America. Subtalar arthroereisis was the focus of seven publications (462 citations), mostly coming from Europe. There was a notable expansion in research on pediatric flatfoot in recent years. There were major geographic differences in the approach to treatment for calcaneal osteotomy vs. subtalar arthroereisis.

The management of recurrent clubfoot (RCF) in children of walking age is challenging, especially when secondary anatomic changes such as talar flattening are present. The purpose of this study was to report our experience with the use of anterior distal tibial hemi-epiphysiodesis (ADTH) in children with RCF and fixed equinus, to evaluate clinical and radiographic outcomes, and to compare our results with the available literature. This is a retrospective review of 14 patients (20 distal tibiae) treated with ADTH at our pediatric orthopedics referral institution between September 2021 and November 2022. The mean age at surgery was 10.1 years, and the mean follow-up was 23.7 months. Preoperative anterior-posterior (AP) and lateral radiographs and annual postoperative AP and lateral weight-bearing radiographs were reviewed to assess anterior distal tibial angle (ADTA), screw spread angle (SSA), and the correlation between SSA and ADTA variation. Clinical assessment was performed by measuring maximum ankle dorsiflexion and using the AOFAS scale. Complications were also recorded. Preoperative mean dorsiflexion was -7.1 ± 7.5 ° with negative values indicating plantarflexion. At final follow-up, mean dorsiflexion was 1.8 ± 8.2 °, with a statistically significant mean correction rate of 8.9 ± 11.14 °. Final ADTA and SSA showed 12.8 ± 8.4 ° ( P < 0.001) and 20.8 ± 16.9 ° ( P < 0.005) of improvement, respectively. There was also a good correlation ( r = 0.642) between the change in SSA and the change in ADTA. Plate and screws were removed in 1/20 cases (5%). ADTH in patients with RCF and fixed equinus reduces pain, minimizes equinus, and improves SSA and ADTA with limited complications.

This study aimed to assess the determinants affecting parental satisfaction and trust in clinical care of children with clubfoot at a specialized clubfoot clinic in a tertiary care setting. In this cross-sectional study at Khyber Teaching Hospital, 306 attendants of children with clubfoot were recruited using consecutive sampling. Pirani score was used to evaluate the severity. Satisfaction levels were assessed using Short Assessment of Patient Satisfaction score. Data were analyzed using SPSS, with chi-square tests. The mean number of clinic visits was 8.52 ± 5.08; 55.6% of patients required more than eight clinical visits, and 82.7% underwent treatment for more than 8 weeks. Mean Short Assessment of Patient Satisfaction score was 23.37 ± 5.19; 82% of parents expressed satisfaction, whereas 18% showed variable levels of dissatisfaction. High dissatisfaction was correlated with greater than eight visits (P = 0.014), prolonged treatment duration (P = 0.008), Ponseti management with serial casting plus tenotomy versus serial casting only (very dissatisfied: 43.8% vs. 2.4%; P < 0.001), and unsatisfactory clinical outcome (P < 0.001). Significant concerns included lack of shared decision-making (19.3% dissatisfied), unclear explanations (10.2% dissatisfied), and overall dissatisfaction towards the health services (23.6% dissatisfied; 16.0% neutral). Even with high satisfaction and satisfactory outcomes with the Ponseti method, high frequency of visits, long treatment durations, inadequate parental participation and lack of effective communication compromise caregivers' trust. Enhancing patient-centered approach, proper counseling, and effective care delivery may influence follow-up and satisfaction in sustained pediatric orthopedic care and optimize compliance.