Journal of Pediatric Orthopaedics-Part B最新文献

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.

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.

Pediatric open fractures present major challenges in wound management because of high infection risk and delayed healing. This study compared the clinical efficacy of vacuum sealing drainage (VSD) combined with moist exposed burn ointment (MEBO) versus VSD combined with hydrogel dressings in pediatric open fracture wounds. A retrospective analysis was performed in 222 pediatric patients with refractory fracture wounds, including 119 treated with VSD + MEBO and 103 treated with VSD + hydrogel dressings. Outcomes assessed included wound healing time, overall treatment efficacy, total treatment cost, pain intensity evaluated using the Visual Analogue Scale (VAS), serum inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and interleukin-6 (IL-6)], and complication rates. Compared with the VSD + hydrogel group, the VSD + MEBO group demonstrated significantly faster wound healing and lower total treatment costs (both P < 0.001). VAS scores on days 3 and 5 after dressing application were also significantly lower in the VSD + MEBO group (P < 0.001). Moreover, serum levels of hs-CRP, PCT, and IL-6 on day 7 were significantly reduced in the VSD + MEBO group compared with the VSD + hydrogel group (P < 0.001). No significant differences were observed between the two groups in overall treatment efficacy or complication rates (P > 0.05), indicating comparable safety. In conclusion, VSD combined with MEBO accelerates wound healing, reduces inflammation and pain, and lowers treatment costs in pediatric open fracture wounds, demonstrating potential clinical advantages.

Evaluation of vitamin D (D vit) levels in Scheuermann's kyphosis is important for a better understanding of environmental and metabolic factors that may contribute to the etiopathogenesis of the disease and for revising screening approaches. We aimed to evaluate the relationship between serum D vit, calcium, phosphorus, and alkaline phosphatase (ALP) levels between individuals with Scheuermann's kyphosis and an age- and sex-matched healthy control group. A total of 400 individuals (200 Scheuermann's kyphosis and 200 control), aged between 10 and 18 years, were included. Participants were considered eligible if they: were aged 10-18, in the kyphosis group, had a thoracic Cobb angle ≥ 45°, had available laboratory data for D vit, calcium, phosphorus, and ALP, and had not received D vit supplementation before evaluation. The Scheuermann's kyphosis group was found to have low levels of D vit (P < 0.05). Both groups had the highest levels of D vit in the summer months and the lowest levels in the winter months, which was statistically significant (P < 0.05). When we compared the groups across seasons, serum D vit levels in the kyphosis group were found to be low in all seasons (all P < 0.05). In the Scheuermann's kyphosis group, a significant positive correlation was found between serum D vit and serum calcium levels (r = 0.18, P = 0.01) and a significant negative correlation was found between D vit and thoracic Cobb angle (r = -0.16, P = 0.02). We found that D vit levels in patients with Scheuermann's kyphosis were lower than in healthy individuals.

To identify risk factors for forearm shaft refractures in paediatric patients treated with flexible nails in situ and explore effective management strategies. From January 2022 to April 2024, paediatric patients with diaphyseal radius and ulna fractures treated with flexible nails were retrospectively reviewed. Patients without refractures were assigned to group A, and those with refractures and flexible nails in situ to group B. Demographics, injury mechanisms, operative details, complications, and time to radiographic union were analyzed. Fifty-six paediatric patients with 105 forearm fractures were divided into group A (50 patients with 94 fractures that healed uneventfully) and group B (six patients with 11 fractures that sustained refracture while having flexible nails in-situ). Group B patients were significantly older (14.92 ± 0.72 vs. 12.09 ± 2.83 years; P = 0.019), and all had undersized nails occupying less than two-thirds of the canal diameter, compared with 40% in group A (P = 0.007). No significant differences in sex, injury mechanism, or reduction method were observed. Refractures occurred, on average, 3.22 ± 1.38 months postsurgery, mainly after early return to sports and low-energy trauma. Treatment included conservative management for undisplaced refractures and exchange nailing for displaced cases, with all achieving complete union and no complications during follow-up. The risk of refracture with flexible nails in-situ is greater in older children approaching skeletal maturity, particularly those who had undersized flexible nails and resumed sports and high-impact activities prematurely. These refractures can be effectively managed using casting, exchange nailing, or plating.