Journal of Pediatric Orthopaedics-Part B最新文献

To evaluate whether preoperative conversion from a gastrostomy tube (G-tube) to a gastrojejunostomy tube (GJ-tube) decreases short-term postoperative aspiration pneumonia and gastrointestinal complications in children with neuromuscular scoliosis. We conducted a retrospective chart review from January 2006 to October 2021 of pediatric patients who had neuromuscular scoliosis and were fed with a G-tube before spinal fusion. Eligible patients were divided into two groups based on whether they were converted to a GJ-tube preoperatively. Preoperative characteristics and 30-day postoperative outcomes were compared between groups using Chi-square tests. Of 261 eligible patients, 205 were converted to a GJ-tube, while 56 underwent spinal fusion with a G-tube. Common complications following G-tube to GJ-tube conversion were feeding intolerance (25.2%), GJ-tube malfunction (17.7%), and at least one episode of vomiting (17.4%). Within 30 days of discharge, 12.5% of GJ-tube patients and 11.5% of G-tube patients experienced aspiration pneumonia ( P  = 0.85). The GJ-tube group received postoperative tube feeds 7 hours earlier than the G-tube group on average (51.6 h vs. 44.5 h, P  = 0.02). Within 30 days of discharge, one (0.5%) patient from the GJ-tube group died of gastrointestinal complications unrelated to conversion and two (3.6%) patients in the G-tube group died from aspiration pneumonia ( P  = 0.12). Results suggest that there were no appreciable differences in outcomes between patients converted to a GJ-tube preoperatively compared to those who continued to use a G-tube. However, preoperative characteristics indicate that a higher number of complex patients were converted to a GJ-tube, indicating potential selection bias in this retrospective sample. Level of evidence: Level III.

The main objective of this study was to retrospectively evaluate and compare the outcomes and complications of displaced closed tibial fractures in children treated by CRC (closed reduction and casting), elastic stable intramedullary nailing (ESIN) or external fixation (EF). One hundred twenty-three consecutive children were treated for displaced closed tibia shaft fracture from July 2014 and January 2020 at two different institutions. Seventy-five of them met the inclusion criteria and were included in the study: 30 (40%) patients were treated with CRC, 33 (44%) with ESIN, and 12 with EF (16%). All clinical and radiographic outcomes and complications were registered and compared. The three groups did not differ with regard to gender, affected side, fracture site and associated fibula fracture. The age at the time of treatment in the CRC group was statistically lower than in ESIN and EF groups (8.43 ± 3.52 years vs. 10.39 ± 2.56 years vs. 11.08 ± 3.55 years, respectively). Immobilization time and time to partial and total weight bearing were significantly reduced in ESIN and EF groups compared to CRC group ( P  < 0.05). Overall, no statistically significant differences were found between the three groups regarding complication rate and clinical and radiographic outcomes between the three groups. However, in CRC group, 3 patients (10%) had secondary fracture displacement and underwent ESIN. Surgical treatment is not contraindicated in children with displaced tibia shaft fractures. EF and ESIN provide earlier mobilization and weight-bearing recovery than CRC. However, apart from that, nonoperative treatment was as efficacious as surgical treatment.

Neurofibromatosis type 1 (NF-1) scoliosis can be difficult to treat without early detection. Correcting deformities while considering long-term growth in early-onset scoliosis (EOS) treatment is important. This study was performed to establish the safety and effectiveness of halo gravity traction (HGT) with traditional growing rods (TGRs) in NF-1 EOS. We retrospectively reviewed a cohort of 15 children (7 boys and 8 girls; mean age, 5.61 years) diagnosed with NF-1 EOS from October 2016 to March 2021. All patients underwent HGT before growing rod implantation. The growing rods were lengthened every 9-12 months, with a follow-up of 2-7 years. Cobb angle, thoracic kyphosis (TK), trunk shift (TS), sagittal vertebral axis and T1-S1 height were measured before operation, after traction, after operation and at last follow-up. Complications were also recorded. Fifteen patients with NF-1 EOS were treated with an average traction weight of 10.00 kg. After 29.20 days of HGT, the Cobb angle improved from 99.10° to 62.60°, TK from 79.33° to 55.04°, TS from 31.05 to 17.71 mm, sagittal vertebral axis from 42.07 to 25.63 mm and T1-S1 height from 27.50 to 29.70 cm ( P  < 0.05 for all). Postoperatively, compared with post-traction, the Cobb angle was 52.40° ( P  = 0.002) and TK was 44.54° ( P  = 0.004). No complications occurred during traction. Growing rod dislocation occurred in one patient and growing rod breakage in one patient. HGT combined with TGRs was well-tolerated and effective for treating severe NF-1 EOS. It significantly corrected the Cobb angle and TK, restored trunk balance, and increased spinal height with few complications.

Osteofibrous dysplasia (OFD) is a rare disease that may lead to tibial lesions. Currently, no gold standard method exists for the treatment of OFD. Recurrence is the most severe complication in OFD. Autogenous iliac bone grafting may reduce postoperative recurrence rates in children with tibial OFD. We aimed to evaluate the clinical effects of subperiosteal hemicortical resection in patients with OFD. We included 21 patients who were diagnosed with OFD. Retrospective clinical data were analyzed from our hospital between November 2009 and October 2016. All the tibial lesions were removed with a subperiosteal hemicortical resection, and bone grafts were implanted. Patient age, sex, symptoms, lesion site, imaging, surgical methods, and histopathological data were analyzed. Local recurrence, postoperative recovery, and postoperative function were evaluated. The postoperative function was evaluated using the Musculoskeletal Tumor Society score (MSTS). OFD recurrence postsurgery occurred in eight patients; seven had no further recurrence after a second procedure, while one patient did not undergo another procedure. There were statistical differences in postoperative recurrence rates between the autogenous and other graft groups ( P  = 0.046). The median MSTS was 28 (27-30) and 30 (29.5-30) in the nonautologous ( n  = 15) and autologous graft groups ( n  = 6), respectively. The function of the nonautologous graft group was significantly worse than that of the autologous group ( P  = 0.029). We recommend that patients with tibial OFD undergo subperiosteal hemicortical resection plus autogenous iliac bone grafting. Our study findings showed that these patients experience reduced postoperative recurrence rates and improved prognostic function. Level of Evidence: IV.

Current best practice guidelines recommend a plastics-style multilayer wound closure for high-risk pediatric spine surgery. However, plastic surgery closure of spinal incisions remains controversial. This study investigates surgeon perceptions and practice patterns regarding plastic surgery multilayered closure (PMC) in pediatric spine surgery. All surgeons in an international pediatric spine study group received a 30-question survey assessing incisional closure practices, frequency of plastic surgery collaboration, and drain management. Relationship to practice size, setting, geographic region, and individual diagnoses were analyzed. 87/178 (49%) surgeons responded from 79% of participating sites. Plastics utilization rates differed by diagnosis: neuromuscular scoliosis 16.9%, early onset scoliosis 7.8%, adolescent idiopathic scoliosis 2.8% ( P  < 0.0001). Plastics were used more for early onset scoliosis [odds ratio (OR) 18.5, 95% confidence interval (CI): 8.5, 40.2; P  < 0.001] and neuromuscular scoliosis [OR 29.2 (12.2, 69.9); P  < 0.001] than adolescent idiopathic scoliosis. Plastics use was unrelated to practice size, setting, or geographic region ( P  ≥ 0.09). Respondents used plastics more often for spina bifida and underweight patients compared to all other indications ( P  < 0.001). Compared to orthopaedic management, drains were utilized more often by plastic surgery (85 vs. 21%, P  = 0.06) and for longer durations ( P  = 0.001). Eighty-nine percent of surgeons felt plastics increased operative time (58 ± 37 min), and 34% felt it increased length of hospitalization. Surgeons who routinely utilize plastics were more likely to believe PMC decreases wound complications ( P  = 0.007). The perceived benefit of plastic surgery varies, highlighting equipoise among pediatric spine surgeons. An evidence-based guideline is needed to optimize utilization of plastics in pediatric spine surgery.

To assess whether excessive body weight or obesity predisposes adolescents to tibial tubercle fractures from less energetic traumas, prolongs the period of rehabilitation from these injuries or leads to worse outcomes. A retrospective study of patients who underwent surgical treatment for fracture of the tibial tubercle in the period from March 2013 to March 2022. Patients were classified according to age, gender, fracture type, BMI, mechanism and energy levels of injury, time to complete painless range of motion was achieved and rate of complications. We have surgically treated 33 patients who have sustained 34 tibial tubercle fractures. Twenty of our patients had a BMI in the 'healthy weight' range while 13 were either overweight or obese. A significant difference in the distribution of injury types between the two groups has been statistically confirmed, whereby more severe injuries were recorded in the 'healthy weight' group of patients. A statistically significant higher proportion of patients who sustained a fracture after a blow to the knee or during light activity could have been confirmed in the 'overweight/obese' group while patients in the 'healthy weight' group more often sustained fractures after a powerful concentric or eccentric contraction of the quadriceps muscle. All of the patients achieved full painless range of motion and a radiologically confirmed osseous union. The healthy weight group had a significantly shorter period of rehabilitation. Two minor complications have been recorded. A higher BMI may lead to tibial tubercle fractures caused by less energetic injuries in adolescent patients. We may also conclude that blows to the knee or injuries sustained while running most often do not cause the most severe type of fractures. However, operative treatment provides a good outcome regardless of the type of injury or BMI.

Clubfoot is a common musculoskeletal congenital abnormality, with a prevalence of 5-20 cases per 10 000 live births in low to middle-income countries. If left untreated, clubfoot causes severe consequences for the child: gait disturbances, reduced quality of life, and limited work opportunities. Our objective was to characterize clubfoot and determine its prevalence and associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with clubfoot, while controls consisted of infants without congenital abnormalities, matched in terms of birth date and hospital. Prevalence was calculated considering a 95% confidence interval using Poisson distribution, and risk factors were assessed through adjusted odds ratios obtained by logistic regression model. Of 558 255 births, 861 cases of clubfoot were identified, 48.20% were postural clubfoot, and 15 cases were syndromic clubfoot. In Bogota, prevalence rate was 15.1 per 10 000 live births, whereas in Cali it was 17.29 per 10 000 live births. Family history of clubfoot within first-degree relatives was identified as a risk factor for clubfoot. Investigating risk factors for clubfoot holds significant importance in terms of preventing and reducing morbidity within this population. Helping to drive government and healthcare initiatives aimed at providing timely and effective treatment.

We studied the correlation between changes in the interscrew angle (screw divergence) and the correction achieved with tension band plates applied for valgus deformities of the knee region. Twenty-eight children with 68 operated physes were included in this retrospective review. The interscrew angle and screw trajectory angle were measured in the initial and follow-up radiographs. Additionally, changes in the mechanical lateral distal femoral angle and medial proximal tibial angle were calculated from the follow-up radiographs. The statistical calculations involved correlating the changes in the above-mentioned parameters and the magnitude of correction. The location of the implant was in the distal femur in 49 and the proximal tibia in 19 limbs. A mean correction of 12.1° was achieved at a follow-up of 12.1 months. The correction was calculated as 1.1°/month (SD = 0.6). The correlation of screw divergence (R = -0.01; P = 0.97) and changes in screw trajectory angle (R = -0.11; P = 0.36) to the angular correction achieved was statistically insignificant. The changes in the interscrew angle did not correlate with the angular correction following tension band plates.

Rett syndrome, a neurodevelopmental disorder primarily affecting females, presents unique challenges in managing associated scoliosis. This study aims to evaluate the efficacy and challenges of posterior spinal fusion (PSF) in Rett syndrome patients by analyzing postoperative complications. A retrospective cohort study was conducted using a large national database. We included Rett syndrome patients aged 10-18 years who underwent PSF between 2010 and 2020. Outcomes such as medical and surgical complications, emergency department visits, readmissions, mortality, and reoperation rates up to 5 years were compared with a matched neuromuscular scoliosis (NMS) group. The study identified 195 Rett syndrome patients and 973 NMS patients. Post-surgery, Rett syndrome patients showed a significantly higher incidence of pneumothorax (56.9%, P < 0.001), respiratory failure (24.6%, P = 0.013), and pneumonia (26.2%, P < 0.001). Additionally, ileus (7.2%, P = 0.041), acute kidney injury (14.9%, P = 0.029), and urinary tract infections (14.9%, P < 0.001) were also significantly more frequent in the Rett syndrome group. Rett syndrome group also had higher rates of transfusion (11.3%, P = 0.004). Interestingly, the incidence of pseudarthrosis, implant complications, junctional failures, and the necessity for reoperation did not significantly differ at postoperative year 2. Mid-term follow-up showed that the reoperation rates over a 5-year period did not significantly differ between the Rett syndrome and NMS groups. Rett syndrome is associated with increased immediate postoperative complications, necessitating tailored preoperative planning, and intensive postoperative care. Despite these challenges, the mid-term surgical outcomes are comparable to those in NMS patients.