Journal of Pediatric Orthopaedics-Part B最新文献

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.

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.