Journal of Pediatric Orthopaedics-Part B最新文献

More than 50% of Kawasaki disease patients exhibit cervical lymphadenopathy, which can lead to atlantoaxial rotatory fixation (AARF). Yet, the incidence and clinical features of AARF in Kawasaki disease (KD-AARF) have been poorly documented. This study explored the symptomatic incidence of AARF in patients with Kawasaki disease. Data were retrospectively collected from 1296 consecutive patients (740 male and 556 female) diagnosed with Kawasaki disease between April 2005 and March 2022 at a single academic institution. Fourteen (six males and eight females) of 1296 Kawasaki disease cases (1.08%) were diagnosed with AARF. The median and interquartile range (IQR) age (month) of KD-AARF was 60.0 months (IQR: 42.5-84.8 months), and the median age of Kawasaki disease without AARF was 28.0 months (IQR: 14.0-28.3 months) ( P  < 0.001). The average (range) symptomatic duration of torticollis was 16.0 (5-43) days. Moreover, seven cases were treated only with bed rest, one case with bed rest and analgesics, three with a cervical collar, and three using Glisson's traction. At the final follow-up (average: 35.5 months), none of the patients exhibited any residual symptoms. The average time from fever onset to torticollis onset was 2.9 (0-7) days, and that from fever resolution to torticollis resolution was 13.4 (4-41) days. The total treatment duration for KD-AARF was 16.4 ± 12.6 days. AARF incidence in Kawasaki disease cases was 1.08%. Patients with KD-AARF were older than those without.

Femoral neck-shaft angle (NSA) is a standard measurement for identifying hip pathology. Prior normative investigations relied on single radiographs from various children and lacked serial radiographs from the same individuals. Existing reference values do not explicitly differentiate by sex. In addition, they overlook the variability of this measurement in younger children. This study uses consecutive serial images to explore yearly changes and enhance our understanding of established patterns in femoral NSA adjustments. A total of 870 serial anteroposterior left hip radiographs from the Bolton-Brush collection were included in this study, representing 215 subjects ranging in age from 3 to 16 years. The NSA was measured as the angle between the femoral neck axis and the femoral shaft axis. A mixed model analysis revealed a significant negative association between NSA and age ( P  < 0.001), indicating that NSA decreases as children grow older. No significant correlation was observed between sex and NSA ( P  = 0.61). Pairwise comparisons of NSA between sequential ages did not show statistically significant differences after age 8 years.

To evaluate the safety and efficacy of a novel three-dimensional triangular external fixator (3D-TEF) in combination with proximal femoral derotational osteotomy (PFDO) for the treatment of symptomatic excessive femoral anteversion (EFA). A retrospective analysis was conducted on data from 12 patients (23 limbs) who underwent PFDO with 3D-TEF from July 2018 to 2024. The preoperative and postoperative femoral neck anteversion angle (FNA) was measured using computed tomography scans, quality of life was assessed using the Pediatric Outcomes Data Collection Instrument (PODCI), and complications and bone healing time were recorded. Twelve patients underwent surgery on a total of 23 limbs, with a mean age of 10.4 years (7.00-17.00). The mean follow-up duration was 23.25 months (5.00-44.00). The preoperative FNA was 42.58 ± 7.57°, which significantly decreased to 17.99 ± 2.14° postoperatively ( t  = 15.34, P  < 0.001). The mean femoral neck-shaft angle measured 136 .25° ± 4. 26° preoperatively and 136.80° ± 4.24° postoperatively (t = -0.77, P > 0.05), indicating no statistically significant change. Postoperative PODCI scores approached normative levels. All patients showed improvement in symptoms of tripping and falling, as well as in the degree of FNA. Two complications were observed: one superficial pin tract infection and one knee flexion contracture, neither of which impacted final outcomes. All osteotomies achieved union without evidence of nonunion, malunion, delayed union, hardware loosening, or avascular necrosis. PFDO stabilized with the 3D-TEF yielded satisfactory outcomes in correcting EFA. The 3D-TEF may present itself as a viable alternative for treating EFA, offering positive clinical outcomes.

Slipped capital femoral epiphysis (SCFE) has historically been associated with Black race, male gender, and Hispanic ethnicity, obesity, and adverse social determinants of health. The child opportunity index (COI) 2.0 is an aggregate measure by ZIP code of 29 features of communities that can impact the life outcomes of children. We aimed to investigate the relationship between the incidence of SCFE and residential ZIP code COI. We retrospectively queried the surgical database of a tertiary-referral children's hospital in a medium-sized metropolitan area. We identified subjects who underwent index surgical fixation of SCFE over a 12-year period and determined their composite COI. We calculated the incidence rate, stratified by COI, for our metropolitan area. We performed Chi-squared analysis to determine the associations of SCFE chronicity and stability with COI and obesity. We reviewed 426 hips in 389 unique subjects. In the metropolitan area of interest, we identified a total of 244 hips in 220 unique subjects for an annual incidence rate of 4.17 per 100 000 person-years. Communities in the lowest quintile of COI had higher incidence rates (7.1), while communities in the highest quintile of COI had lower incidence rates of SCFE (2.7, P  = 0.035), the relative risk of SCFE decreased by 11% (RR = 0.89, 95% confidence interval: 0.76-1.00). We identified a correlation between obesity and chronicity for our general analysis ( P  = 0.01163) and the metropolitan analysis ( P  = 0.005143). This study demonstrated an inverse relationship between SCFE incidence and COI at a pediatric tertiary referral center.

Level of evidence: Level III - case-control study.

Congenital dislocation of the knee (CDK) is a rare condition, often associated with syndromes and other limb anomalies. It is typically diagnosed and treated in early infancy. Neglected cases of CDK can present with significant deformities and loss of function. Their treatment is challenging and scarcely reported in the literature. The primary purpose of this study is to report on management of neglected CDK presenting in second decade of life. Four patients (eight knees) with severe, neglected, bilateral CDK who presented in their second decade of life were identified. Their preoperative radiographs were evaluated for presence of distal femoral dysplasia and compared to age-matched controls. Their clinical presentation, surgical treatment, and outcomes were analyzed at minimum 2 year follow-up. All four patients were 11-12 years old and had severe, bilateral, neglected CDK. Three patients had a quadrupedal gait. Preoperative radiographs showed significant distal femoral dysplasia when compared to controls. Surgical interventions included bilateral open reduction with quadricepsplasty in two patients and femoral flexion-shortening osteotomy (FSO) in two patients. At the latest follow-up, all patients had bipedal gait and improved quality of life. Postoperative radiographs showed improvement in distal femoral dysplasia in patients who underwent open reduction and quadricepsplasty. Patients with neglected CDK can present with quadrupedal gait. Compared to femoral FSO, open reduction and quadricepsplasty appears to be a better surgical treatment option as the latter can help restore joint articulation. Once the joint is reduced, distal femoral dysplasia can remodel to a certain extent. Level of evidence: Case series - Level 4.

Missed Monteggia fracture dislocations (MFDs) are rare injuries that are frequently associated with poor functional and cosmetic outcomes. A retrospective study was conducted on 12 patients with chronic MFDs who underwent annular ligament reconstruction using a palmaris longus autograft, combined with a novel Z-shaped ulnar osteotomy. The surgical intervention was performed, on average, 17 months after the initial trauma, with a mean follow-up period of 12 months. Following surgery, the average range of motion achieved was 128° in flexion, -1.65° in extension, and 140° in forearm pronation-supination. The overall complication rate was 16%, including ulnar nerve neuropraxia, persistent pain, and redislocation of the radiocapitellar joint. Annular ligament reconstruction using a palmaris longus autograft combined with a Z-shaped ulnar osteotomy is a reproducible and promising technique for the treatment of MFDs.

This study aimed to investigate whether distal radius torus fractures can be treated safely, effectively, and more cost-efficiently using a nonrigid immobilization method such as elastic bandages, instead of traditional rigid fixation like casting. A total of 366 patients aged between 4 and 15 years who presented to the orthopedics and traumatology clinic within 36 h of injury because of a distal radius torus fracture were included in the study. Patients were treated with either an elastic bandage or a short arm splint. They were followed up at scheduled clinical intervals. During follow-up, demographic data, Visual Analog Scale scores, HAND20 scores, wrist joint range of motion, fracture healing via radiographs, and treatment costs were recorded. A total of 366 patients were included, with 205 (56.1%) treated using a short arm splint and 161 (43.9%) with an elastic bandage. The mean age of the patients was 9.19 ± 2.59 years. A statistically significant difference was found between the two groups in terms of various clinical outcomes. Moreover, the material cost per patient in the splint group was found to be 10 times higher than that in the elastic bandage group. The treatment of distal radius torus fractures in children with elastic bandages is safe, effective, and cost-efficient. These fractures are inherently stable and have a low risk of complications. Therefore, nonrigid methods such as elastic bandages can be considered a viable alternative in the management of these injuries.

Studies suggest that vitamin D may be protective against upper extremity low-energy (LEn) fractures. We hypothesized that there may be a similar effect in lower extremity long bone (LLB) fractures. We prospectively enrolled pediatric patients (ages 3 to 18) with LLB fractures. Exclusion criteria were pathologic, vertebral or pelvic fracture, or patients with metabolic and neuromuscular disorders. The 25-hydroxyvitamin D (25OH vit D) in the LEn group (18.3 ± 6.6 ng/ml, n = 48) was significantly lower than that in the high-energy group (HEn) (23.5 ± 7.4 ng/ml, n = 22) (P = 0.0086). As ankle fractures were predominantly in the higher 25OH vit D range, a subgroup analysis of 25OH vit D in LEn above ankle fracture group (LEnAA) (16.8 ± 5.5 ng/ml) was significantly lower than that in the HEn above ankle fracture group (HEnAA) (22.6 ± 6.3 ng/ml) (P = 0.011). Defining vitamin D deficiency, insufficiency, and sufficiency as 25OH vit D < 20, 20-29, and ≥ 30 ng/ml respectively, the percentage of patients with vitamin D sufficiency in LEnAA (0%) was significantly less than that in HEnAA (19%); vitamin D deficiency in LEnAA (68%) was significantly greater than that in HEnAA (38%). A greater percentage of patients with vitamin D deficiency were treated operatively compared to those with vitamin D insufficiency and sufficiency (P = 0.02). Our study found that LEn and LEnAA had significantly lower 25OH vit D compared to HEn and HEnAA and supported the hypothesis that vitamin D may be protective against LLB LEn fractures. Our recommendation is to obtain 25OH vit D in LLB LEn.

In pediatric orthopedics, the physis functions as an ally, allowing for remodeling of fractures. However, when physeal bars occur, they can cause leg length discrepancy (LLD) and malalignment. 3D guided techniques can be used to guide the treatment of those physeal bars to achieve a precise resection while protecting the surrounding tissues, allowing growth to resume, and correcting angular deformity. The objective is to describe a 3D imaging-guided technique for excision of partial physeal bars and to report the results of a series of patients who have undergone this procedure. This is a retrospective chart review of five patients treated at a level 1 pediatric tertiary care center by a fellowship-trained pediatric orthopedic surgeon. Inclusion criteria were: (1) Pediatric patients aged 2-18 diagnosed with a partial physeal arrest with resulting deformity, (2) treatment with partial physeal excision using 3D imaging guidance between January 2008 and December 2022, and (3) appropriate radiographic follow-up of at least 6 months. Preoperative 3D imaging demonstrated physeal bar size and location for each patient and was utilized for operative planning. Descriptive statistics were used. The use of 3D imaging guidance for physeal bar excision resulted in improved radiographic angular deformities and LLD. Our cohort had an average physeal bar size of 6.7 ± 3.6% of the physis with no complications reported. A 3D guidance system can help achieve a precise and safe physeal bar resection and is a valuable tool to consider.