Journal of Pediatric Orthopaedics-Part B最新文献

Intoeing is a common reason for pediatric orthopedic consultations. Families increasingly use YouTube for medical information, but the reliability and quality of this content are unclear, and no previous study has evaluated videos on intoeing. This study assessed the reliability, educational quality, and popularity of YouTube videos on intoeing using validated scoring systems and a novel disease-specific tool. YouTube was searched using the terms 'intoeing', 'pigeon toe', and 'toeing in'. After applying inclusion and exclusion criteria, 48 videos were analyzed. Video characteristics were recorded, and reliability and quality were evaluated using the Journal of the American Medical Association score, Global Quality Score, DISCERN instrument, and the Intoeing Specific Score (ISS) developed for this study. Popularity was measured using the Video Power Index. Interobserver and intraobserver reliability were calculated, and statistical analyses examined associations between scores, video sources, and content. Overall quality was low: 76.4% of videos scored less than or equal to 2 on the Journal of the American Medical Association score, and 54% were rated poor or very poor by DISCERN. According to the ISS, 43.8% were very poor. Academic and physician-generated videos had higher educational quality but lower popularity than nonprofessional sources. Videos from YouTube-verified uploaders scored significantly higher in all quality measures, yet popularity did not correlate with educational quality. YouTube videos on intoeing are generally low quality, revealing a gap between popularity and reliability. Although academic and physician-generated content is more accurate, it is less represented among popular videos. The ISS showed strong reliability and may be useful for future evaluations of disease-specific online content.

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.

This study aimed to evaluate the agreement between radiographic and pedobarographic measurement methods for classifying a normal foot type following calcaneal lengthening osteotomy in children with symptomatic pes planus. Thirty feet from patients (mean age: 15.1 years; range: 11-17 years) with idiopathic symptomatic hypermobile pes planus who had data and over 1 year of follow-up were evaluated. Radiographic assessments were categorized into measurements evaluating the medial longitudinal arch and those assessing calcaneal morphology. Medial longitudinal arch measurements included talocalcaneal, lateral talo-first metatarsal, talohorizontal, calcaneal pitch, talonavicular coverage, anteroposterior talo-first metatarsal, and Moreau-Costa-Bartani angles, while calcaneal measurements included calcaneal length, posterior facet height, Gissane angle, and Böhler angle. Pedobarographic measurements were performed using Arch Index, Footprint Index, and Clarke's angle, and clinical outcomes were assessed using the Oxford Ankle Foot Questionnaire for Children. Cohen's kappa coefficient was used to determine the agreement among the measurement methods in classifying the foot type as 'normal'. Postoperative findings revealed that changes in calcaneal length occurred without deformation of the articular surface. Arch Index exhibited 'almost perfect' agreement with the lateral talo-first metatarsal (k = 0.902) and talohorizontal angles (k = 0.814) and was the only pedobarographic measurement that correlated significantly with all domains of the Oxford Ankle Foot Questionnaire for Children. In contrast, Clarke's angle and Footprint Index did not show agreement with radiographic measurements. Following calcaneal lengthening osteotomy, among the pedobarographic measurement methods, only the Arch Index can be used as an alternative to radiographic measurement methods for classifying normal foot structure.

Syndactyly, a congenital hand deformity caused by failed phalangeal separation, often requires surgical correction to restore function and aesthetics. Traditional dorsal rectangular flap techniques involve skin grafting, increasing the risk of web creep and residual deformity. This study evaluates islanded perforator-based flaps, which offer better vascularization for improved outcomes. Preoperative Doppler ultrasound was used for vascular mapping to enhance surgical precision. This prospective observational study analyzed 31 webspaces in 26 patients undergoing syndactyly release. Doppler ultrasound was performed in 15 cases to guide flap selection. Islanded flaps were used when viable, while dorsal rectangular flaps were used otherwise. Data collection included demographics, preoperative evaluation, intraoperative details, and postoperative outcomes. Functional and aesthetic results were assessed using the Withey score, Visual Analog Scale (VAS) from the Patient Observer Scar Assessment Score Scale, and photographic analysis over follow-up. Syndactyly release was performed in 31 webspaces. Doppler mapping optimized flap design. Statistically significant findings showed improved VAS scores postsurgery, especially in younger patients (1-5 years, P = 0.0001 and 6-10 years, P = 0.0065) and males (P = 0.0000). Simple syndactyly had better outcomes than complex cases (P = 0.0004). Long-term VAS scores favored islanded flaps (1.9 ± 0.83) over dorsal flaps (2.60 ± 0.84). Scar quality improved significantly (P < 0.001 for 6+ months), with minimal complications in patients with islanded perforator flaps. Islanded perforator-based flaps present a promising alternative for syndactyly release, delivering superior functional and aesthetic results. The incorporation of Doppler mapping ensures vascular safety and reduces complications. Further research is needed to establish long-term outcomes.

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.