Journal of Pediatric Orthopaedics-Part B最新文献

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.

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 evaluate the short-term effects of customized arch-support insoles on physical functional performance, physical function, and psychological well-being in asymptomatic, healthy children. In this randomized controlled trial, 45 healthy, asymptomatic children were assigned to a treatment group (customized arch-support insoles) or a control group (no insoles) for 12 weeks. Physical functional performance was assessed by walking speed, stair ascent and descent time, chair rise time, and the Timed Up and Go test. Physical function and psychological well-being were measured using the Pediatric Outcome Data Collection Instrument-Parent and the Child Health Questionnaire-Parent Form 28 (CHQ-PF28). Adverse events related to insole use were monitored. All 45 participants (25 boys and 20 girls; mean age: 5.6 ± 2.5 years) completed the study, and no adverse events were reported. Baseline characteristics were comparable between groups. At 12 weeks, significant between-group differences favored the treatment group for stair ascent (mean difference: 2.01; P = 0.007) and stair descent (mean difference: 2.23; P = 0.007). The treatment group also showed greater improvement in the Pediatric Outcome Data Collection Instrument-Sports and Physical Function subscale (mean difference: 4.5; P = 0.031). No significant between-group differences were observed for the Child Health Questionnaire-Parent Form 28 well-being scores. Customized arch-support insoles were associated with improvements limited to stair-climbing performance, with no measurable effects on overall physical function or psychological well-being over 12 weeks. Although no adverse effects were observed, the additional time and financial costs do not support routine use of customized arch-support insoles in healthy, asymptomatic children.

We examined how clinical experience relates to use of contralateral comparison radiographs in pediatric elbow/ankle trauma and quantified diagnostic change, additional-imaging requests, and observer agreement. In this multicenter, two-stage observer study, 12 anonymized pediatric trauma cases (six elbows and six ankles) were retrospectively selected (anteroposterior/lateral; mortise added for ankles) and reviewed by 120 orthopedic clinicians (residents, general orthopedic surgeons, and pediatric orthopedic specialists). Observers first assessed unilateral radiographs and later the same cases with bilateral comparison radiographs. Outcomes were comparison-radiograph requests, postcomparison diagnostic change, additional-imaging requests, and inter-/intra-observer agreement. Across 1440 assessments, comparison radiographs were requested in 47.2% overall - highest in junior residents (54.5%) and lowest in pediatric orthopedic specialists (33.0%; P = 0.003). Inter-observer agreement increased with experience (κ junior → pediatric: 0.44 → 0.82; P < 0.01); intra-observer stability likewise improved (junior κ = 0.32 vs. pediatric κ = 0.84; P < 0.001). Diagnostic change after comparison decreased with experience (P = 0.002). Additional-imaging requests peaked in senior residents and then declined across specialist levels (P < 0.001). Soft-tissue presentations and Salter-Harris I scenarios generated the highest additional-imaging demand. Increasing experience was associated with fewer comparison-radiograph requests, fewer diagnostic revisions, and higher agreement. Findings support selective comparison imaging and targeted training. The study evaluates practice patterns and reliability rather than diagnostic accuracy or outcomes.

Level of evidence: Level III, prognostic, case-control study.

As radiographic and clinical parameters have not been found to consistently correlate with pain and disability in adolescents with flexible flatfoot deformities, there is no consensus as to why some flexible flatfeet become bothersome and others do not. The purpose of this study was to assess pedobarographic differences between adolescents with symptomatic flexible flatfoot (SFF) and those with asymptomatic flatfeet (AFF) deformities. A retrospective review of a Foot and Ankle registry identified 59 adolescents (64 feet) with SFF who underwent plantar pressure analysis. Normalized contact area (CA%), contact time (CT%) and mean force (MF%) were assessed for the medial/lateral hindfoot, midfoot, and forefoot regions. In those with SFF, patient-reported outcomes were evaluated with the Oxford Ankle Foot Measure (OxAFM) questionnaire. From a control group, 13 feet with medial midfoot CA% greater than 1 SD comprised the AFF group. The SFF group differed from controls and the AFF group in all variables across the foot, with an emphasis in the medial midfoot. Ten symptomatic patients went on to surgery and 54 were managed nonoperatively. No pedobarographic differences were found between the operative and nonoperative groups; however, the operative group reported significantly lower OxAFM for school and play ( P  = 0.030) and emotional wellbeing ( P  = 0.023). There is a greater medial shift in CA%, MF%, and CT% within the SFF group when compared with the AFF. Pedobarographic differences were not found between symptomatic flatfeet undergoing surgical treatment and those managed conservatively. Level of evidence is therapeutic level 3.

Spinal muscular atrophy (SMA) is a severe childhood neuromuscular disorder caused by degeneration of lower motor neurons, leading to muscle atrophy. SMA type 1 (SMA1) is the most severe form and the leading genetic cause of infant mortality. While recent therapies such as nusinersen and onasemnogene abeparvovec have improved survival and ventilation-free time, affected children develop pelvic asymmetry and progressive spinal deformity, impairing the sitting position. Minimally invasive fusionless surgery (MIFS) using the Bipolar system has shown promising outcomes in SMA types 2 and 3, but evidence in SMA1 remains limited. This retrospective study reviewed medical records of SMA1 patients treated with MIFS using the Bipolar system between July 2023 and January 2025. Pre- and post-operative parameters were compared using paired Student's t -tests. Sixteen SMA1 patients (mean age: 8.1 ± 2.2 years; mean weight: 18.0 ± 3.2 kg) underwent MIFS with no surgical or anesthesiologic complications. Cobb angle improved from 71.8 ± 8.7 to 43.2 ± 9.2 ° ( P  < 0.001), pelvic obliquity from 12.7 ± 9.2 to 7.8 ± 6.1 ° ( P  = 0.0035), kyphosis from 62.9 ± 16.5 to 44.9 ± 14.1 ° ( P  < 0.001), and lordosis from 58.1 ± 15.3 to 43.5 ± 11.5 ° ( P  < 0.001). T1-S1 spinal length increased from 27.1 ± 1.8 to 30.9 ± 2.0 cm ( P  < 0.001), and thoracic width from 167.4 ± 12.0 to 181.5 ± 15.8 mm ( P  = 0.0017). The bipolar system appears to be a safe and effective surgical option for managing scoliosis in SMA type 1 patients, achieving significant correction of spinal and pelvic parameters without complications.