Journal of Pediatric Orthopaedics-Part B最新文献

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.

Level of evidence: IV.

Cast-related skin complications remain an under-recognised challenge during Ponseti casting for congenital talipes equinovarus (CTEV). These complications - ranging from erythema and skin peeling to deep sores - can prolong treatment, increase infection risk, and reduce caregiver compliance. This study aimed to determine the prevalence and predictors of skin complications during serial casting for idiopathic CTEV. An ambispective observational cohort study was conducted at a tertiary care centre between December 2023 and June 2025. Children with idiopathic CTEV undergoing Ponseti casting were included. Cast-related skin lesions were documented at removal and categorised as erythema, skin peeling, superficial sore, or deep sore. Variables across patient, procedural, hospital, and caregiver domains were analysed using univariate and multivariate logistic regression to identify independent risk factors. A total of 306 casting episodes were analysed. The overall incidence of skin complications was 13.1%. On univariate analysis, dorsum swelling after cast removal [odds ratio (OR): 17.06, P < 0.001], patient irritability (OR: 3.17, P < 0.001), cast staining (OR: 11.56, P = 0.010), and foul odour (OR: 23.29, P = 0.008) were significantly associated with skin lesions. Multivariate analysis identified dorsum swelling as the strongest predictor [adjusted OR: 30.96, 95% confidence interval (CI): 5.26-182.13, P < 0.001]. Bilateral casting was protective compared with unilateral casting (adjusted OR: 0.19, 95% CI: 0.05-0.66, P = 0.009). Cast-related skin complications occur in over one in eight CTEV casting episodes. Postcast swelling and unilateral involvement are significant predictors. Routine inspection for swelling and risk-stratified follow-up can reduce morbidity while maintaining high correction success with the Ponseti method.

The use of locking plates with intramedullary rodding in children with osteogenesis imperfecta reduces rotational and longitudinal instability. However, adjunctive locking plates do not allow early weight-bearing. We explored the outcomes of intramedullary rodding combined with external fixation or titanium threaded wires (ThW). The study included osteogenesis imperfecta children who underwent surgery with intramedullary telescopic rods and adjunctive fixation with external fixation or ThW. The timing of and reason for implant failure were primary outcome variables. Our cohort consisted of 62 limb segments in 24 patients. The mean external fixation duration was 40.2 days (femur) and 44.3 days (tibia). Patients with external fixation were verticalized with weight-bearing during the first postoperative week. Eleven rod revisions were performed (mean follow-up 50.9 months). We found no fractures after external fixation removal, no rotational displacement, or cortical gaps. We did not observe complications related to ThW. The use of external fixation as an adjunct to telescopic rodding appears feasible and reproducible method for managing deformities in osteogenesis imperfecta children. Use of titanium telescopic rods is associated with a similar revision rate compared to the most commonly used rods. Intramedullary rodding with adjunctive external fixation enables early weight-bearing. Rotational and longitudinal stability ensured by the combined fixation eliminates the risk of secondary rotational displacement, cortical gap, and nonunion. The combination with threaded wires did not show the inconveniences of locking plates used as an adjunct. Results should be interpreted as feasibility data from a retrospective case series.

Bone graft extenders are widely used to supplement local autograft in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). P-15, a novel synthetic 15-amino-acid polypeptide, has shown promise in promoting bone healing. This study compares P-15 (i-Factor) as a bone graft extender to allograft in adolescents undergoing segmental pedicle screw instrumentation for AIS. We conducted a retrospective analysis of prospectively collected data on 60 adolescents with AIS who underwent segmental pedicle screw instrumentation with a minimum 2-year follow-up. In this preliminary study, 30 patients received P-15, and 30 received an allograft in addition to a local autograft. Operative time, radiographic outcomes, and health-related quality of life were assessed. Plain radiographs were used to evaluate nonunion. Operative time was significantly shorter in the P-15 group (2.7 vs. 3.4 h; P = 0.01). At 2-year follow-up, the mean major curve was 17° (SD: 6.2) in the P-15 group and 20° (SD: 5.2) in the allograft group (P = 0.057). The mean loss of correction was similar between the groups (3.3 vs. 1.2°; P = 0.092). No cases of nonunion or deep surgical site infections were observed. Health-related quality of life scores were comparable between the groups. P-15 is, according to the current study, a safe and effective bone graft extender for posterior spinal fusion in adolescents with AIS, demonstrating similar radiographic and clinical outcomes compared to allograft while reducing operative time. Further research is warranted to assess the long-term results with P15 in adolescents undergoing pedicle screw instrumentation for idiopathic scoliosis.

This study systematically reviewed the literature on surgical management of arthrogryposis multiplex congenita (AMC) to identify trends in timing and outcomes of interventions across joints. A secondary objective was to provide practical recommendations and a clear research agenda to inform a forthcoming consensus process on timing and synchronization of care in AMC. A systematic review was conducted using MEDLINE, Embase, Web of Science, and Scopus databases from inception to June 2025. Studies reporting surgical management of AMC with data on age at intervention, recurrence, or functional outcomes were included. Forty-two studies encompassing 729 patients and 1088 joints were analyzed descriptively. The mean age at intervention ranged from infancy for foot and hip procedures to late childhood and adolescence for upper-extremity surgeries and spinal reconstructions. Soft-tissue releases and tendon procedures predominated in early life, while bony reconstructions were more common in older patients. Recurrence rates were highest after isolated soft-tissue procedures of the foot and knee (30-100%), and lowest after osteotomies, muscle transfers, and definitive fusions in the wrist, shoulder, and spine (<20%). Functional outcomes were generally favorable, with most studies reporting improved alignment, mobility, and quality of life, though long-term recurrence remains a persistent challenge across joints. This review highlights trends linking procedure type and patient age to recurrence and function but also reveals substantial heterogeneity and a lack of standardized protocols. The findings underscore the need for a multidisciplinary consensus study to define optimal timing, sequencing, and staged correction of joint deformities in AMC.