Journal of Pediatric Orthopaedics-Part B最新文献

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.

Pediatric femoral neck fractures result primarily from high-energy trauma. Common treatment methods include screw fixation and the placement of a proximal femoral locking plate. However, there is limited biomechanical evidence favoring one method over another for the treatment of unstable fractures. This study aimed to evaluate the biomechanical properties of screws and proximal femoral locking plates for the treatment of unstable pediatric femoral neck fractures using a synthetic bone model. Fourteen synthetic composite femurs were divided into two groups that included screw fixation (S) and locking plates (P). All specimens were prepared using a vertically oriented osteotomy to simulate unstable Delbet type II femoral neck fractures. Fixation in Group S employed three 6.5 mm cannulated screws, while Group P utilized a proximal femoral locking plate with 5.0 mm screws. The axial stiffness, cyclic elongation, and ultimate failure load were assessed using a universal material testing machine under standardized loading conditions. Statistical analyses were performed to compare biomechanical properties between the groups. Group P exhibited significantly greater axial stiffness (763 ± 212 N/mm) compared to that of Group S (547 ± 93 N/mm, P  = 0.026). Following cyclic loading, elongation was significantly smaller in Group P (0.42 ± 0.2 mm) vs. Group S (0.88 ± 0.4 mm, P  = 0.002). The ultimate failure load was also higher in Group P (2511 ± 321 N) than it was in Group S (2036 ± 256 N, P  = 0.007). The failure modes differed, with Group S exhibiting screw bending and femoral neck collapse and Group P exhibiting subtrochanteric fractures. Proximal femoral locking plates offer superior biomechanical performance compared to that of screw fixation in unstable pediatric femoral neck fractures. These findings suggest that locking plates are a viable alternative to enhance stability and potentially reduce postoperative complications.

Level of evidence: Level IV.

This study investigated the impact of preoperative vertebral rotation (VR) on the surgical outcomes in spinal muscular atrophy (SMA) scoliosis. A retrospective analysis of 27 SMA patients (mean age 13.4 ± 4.3 years) who underwent scoliosis surgery between 2015 and 2019 was conducted. Preoperative VR was measured using Aaro-Dahlborn's and Ho's methods on computed tomography images. Surgical outcome prediction was evaluated using the Pearson correlation coefficient, linear stepwise regression, receiver operating characteristic (ROC) curve, and logistic regression analyses. Ho's method yielded significantly higher VR measurements than Aaro-Dahlborn's ( P  < 0.001). Postoperative Cobb angles correlated positively with preoperative Cobb angles ( r ² = 0.425, P  = 0.0002), Ho's method VR ( r ² = 0.449, P  = 0.0001), and Aaro-Dahlborn's method VR ( r ² = 0.4352, P  = 0.0002). Stepwise regression identified preoperative Ho's method VR and Cobb angles as independent predictors of postoperative Cobb angles. Postoperative Cobb angles >30 ° indicated increased risk of deformity progression in SMA. ROC curve analysis showed preoperative Ho's method VR significantly predicted postoperative Cobb angles >30 ° (area under the curve: 0.813, P  = 0.006), with an optimal cutoff of 35 °. Logistic regression analysis revealed patients with preoperative Ho's method VR > 35 ° had a higher risk of postoperative Cobb angles >30 ° (odds ratio: 10.36, 95% confidence interval: 1.050-102.261, P  = 0.045). This study demonstrated that Ho's method better predicted surgical outcomes, with preoperative Ho's method VR > 35 ° at the apex associated with higher initial residual scoliosis curves after surgery. These findings could enhance surgical planning and improve outcome predictions in SMA scoliosis correction.

Reconstructive hip surgery is essential for managing hip displacement in nonambulatory children with cerebral palsy (CP); however, its impact on health-related quality of life (HRQoL) and caregiver burden remains unclear. This study evaluates postoperative changes in HRQoL and caregiver burden. This prospective observational study included 19 nonambulatory children with spastic CP classified as Gross Motor Function Classification System (GMFCS) levels III-V undergoing reconstructive hip surgery. HRQoL and caregiver burden were assessed using the Pediatric Quality of Life Inventory (PedsQL 4.0) and the Zarit Burden Interview (ZBI), respectively, at baseline and during a 12-month follow-up. Subgroup analyses were performed based on Reimers' migration index, GMFCS levels, and age. PedsQL scores showed a continuous improvement over 12 months, with a significant increase from baseline to 1 year ( P  < 0.001). Caregiver burden (ZBI) slightly increased at 3 months but progressively declined thereafter, with significant reductions at 9 months ( P  = 0.010) and 12 months ( P  = 0.002). Subgroup analyses by Reimers' migration index, GMFCS level, and age revealed no significant between-group differences in outcome scores ( P  > 0.05). Reconstructive hip surgery enhances HRQoL and reduces caregiver burden over time in nonambulatory children with CP. These findings highlight the long-term benefits of surgical intervention.

This article aims to introduce a novel growth-guidance technique for early onset scoliosis (EOS) surgery, utilizing closed multiaxial screws (CMAS) as an alternative to Shilla trolley screws. We report clinical and radiographic outcomes from five EOS patients treated between 2021 and 2024, who underwent active apex correction using CMAS. This method provided an effective alternative for anchoring in the cephalad and caudad regions. Our analysis shows a significant reduction in the major coronal Cobb angle from an average of 71.2 to 19.6° postoperatively, with a 22.8% increase in truncal height maintained at the final follow-up. Importantly, no neurological changes were observed, and patients were braced for the initial 3 months after surgery. In conclusion, CMAS offers a user-friendly and effective alternative for growth guidance in EOS treatment, demonstrating reliable outcomes.

We evaluated the imaging and clinical outcomes of posterior thoracic-pelvic corrective fixation (TP-PCF) for nonambulant neuromuscular scoliosis (NA-NMS), including the Caregiver Priorities and Child Health Index of Life with the Japanese version of the Disabilities Questionnaire (J-CPCHILD), and analyzed the J-CPCHILD and preoperative and postoperative radiographic parameters to determine whether sagittal and coronal alignment correlate with preoperative and postoperative quality of life (QoL) in NMS, respectively. Twenty-five patients (nine males and 16 females) with a mean age of 14.3 ± 2.0 years, who had TP-PCF and were followed up for >2 years postoperatively, were included. Sitting radiographs and the J-CPCHILD were evaluated preoperatively, at 1 year postoperatively, and at the final visit. Preoperative major curve and pelvic obliquity (PO) were 102.4 ± 22.2 ° and 21.5 ± 9.9 °, which significantly improved to 51.4 ± 18.8 ° and 10.9 ± 7.6 °, respectively, at the final visit. At the final visit, lumbar lordosis and sacral slope showed a significant increase of 46.6 ± 18.5 ° and 30.2 ± 17.5 ° compared with preoperative values of 25.8 ± 33.2 ° and 24.4 ± 31.0 °, respectively. Sagittal vertical axis showed a significant decrease of 2.2 ± 35.3 mm at the final visit compared with 37.1 ± 36.5 mm preoperatively. However, iliac screw (IS)-related implant failure was observed in four (16%) patients. Significant improvement from 37.1 ± 20.8 to 51.2 ± 25.2 points and from 49.6 ± 12.6 to 59.1 ± 14.9 points was observed in the positioning domain ( P  = 0.047) and total score ( P  = 0.032) of the J-CPCHILD, respectively, at 1 year postoperatively compared with preoperatively. However, no correlations were identified between the respective domains of the J-CPCHILD and the magnitude of the major curves, PO, or sagittal plane vertical axis, either preoperatively or postoperatively. According to caregivers, improvement in comprehensive trunk stability with better global balance, similar to that of the ambulant patient, contributed to overall QoL after TP-PCF for NA-NMS. However, IS-related implant failure occurred in approximately 16% of the patients.