Journal of Pediatric Orthopaedics-Part B最新文献

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.

All-terrain vehicle (ATV) accidents frequently cause orthopedic injuries. Previous studies have reported the frequency of fractures in ATV injuries. No studies have provided detailed assessments of fracture patterns, types of operative intervention, or risks for multiple surgeries. A total of 489 patients with ATV-related injuries were treated at one tertiary Level 1 pediatric hospital from January 2011 to December 2016. Medical records were retrospectively reviewed to define orthopedic injuries and treatment. Data were organized to identify fracture patterns, surgeries, and complications. Three age groups were utilized (0-6, 7-12, and ≥13 years). A total of 270 pelvic and extremity fractures occurred in 215 patients (44%); 136 patients (63%) required surgical intervention; 47 patients (22%) required multiple trips to the operating room; 16% of fractures (43/270) were open, and seven developed deep infections. Three patients required amputations, and one death was recorded. No significant differences were found between age and fracture frequency or need for surgery. Surgical rates of supracondylar humerus (97%) and tibial shaft fractures (87%) were higher than historical norms (16-24% and 5-74%, respectively). To date, this is one of the largest single-institution cohorts of ATV-related pediatric orthopedic injuries. Nearly half of ATV-related pediatric trauma patients sustained orthopedic injuries. The majority required surgical treatment, and nearly 1/4 of patients required multiple surgeries. Younger patients were as likely to require surgery as older patients. Supracondylar humerus fractures and tibial shaft fractures from ATVs required surgery at a higher rate than historical norms. The surgical morbidity of pediatric ATV fractures is substantial and should influence safety and prevention education.

Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration (P = 0.04), fewer intraoperative fluoroscopy times (P < 0.01), earlier partial weight-bearing time (P < 0.01), and full weight-bearing time (P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group (P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.

Treatment for neuromuscular hip dysplasia (NMHD) typically involves osteotomies of the proximal femur and/or pelvis, and the potential for significant volume blood loss is high. Tranexamic acid (TXA) functions as an antifibinolytic and has been shown to reduce bleeding in many operative settings. Retrospective evidence for the use of TXA in children undergoing NMHD reconstruction is inconclusive, and to our knowledge, prospective evaluation has never been performed. The purpose of this study was to examine the effectiveness of TXA use on intra- and postoperative outcomes during bony reconstruction for NMHD. In this matched comparative study, a prospective cohort of patients undergoing bony reconstruction for NMHD who were given TXA was enrolled and then matched to a retrospective cohort who previously underwent the same surgery without administration of TXA. The primary outcome variable was a change in perioperative hemoglobin values from preoperative to 1 day postoperatively. Secondary objectives were percent loss of estimated blood volume, postoperative transfusion requirements, and length of hospital stay. Forty-eight patients, 24 in each cohort, were included in the analyses. Mean age at surgery was 7.09 years (±2.5). Fifty percent of each cohort underwent bilateral varus derotational osteotomy with pelvic acetabuloplasty. No statistical differences were found in postoperative hemoglobin differences (P = 0.18), length of hospital stay (P = 0.45), or blood transfusion requirements (P = 0.56) between cohorts. Intraoperative administration of TXA to patients undergoing bony reconstruction for NMHD was not found to reduce postoperative blood loss or requirement for blood transfusion. Future studies should employ a larger, prospective randomized controlled trial to verify these findings.

The objective of this study was to analyze the treatment of recurrent valgus knee in fibular hemimelia patients with hemiepiphysiodesis and define associated variables for deformity relapse. Sixteen consecutive patients with fibular hemimelia treated with hemiepiphysiodesis (57 physis) were compared to 21 physis of idiopathic cases, in terms of magnitude, speed, and time of correction. Correction of valgus deformity was successfully achieved in all cases. In the fibular hemimelia group, children 4 years and younger had a bigger magnitude of correction than older ones (11° versus 6.9°) and greater speed (1° versus 0.6°), with statistical significance (P = 0.018 and P = 0.009, respectively), while time for correction was similar among these groups (11.6 months versus 12.3 months). Femoral distal physis corrected faster than proximal tibial physis (10.8 months versus 16.8 months), with statistical significance (P = 0.032). Thirty-three physis (57.9%) were isolated and 24 (42.1%) were tibia and femur. We found no statistical difference between the two groups regarding time for correction, magnitude, or speed (P = 0.526, P = 0.910, P = 0.803, respectively). Relapse was observed in 49 physis (86%) of the fibular hemimelia patients. These had a mean age of 5.5 years versus 3.9 years for those without a relapse, with statistical significance (P = 0.204). Relapse occurred after 2 years of the first procedure. Recurrent valgus deformity in fibular hemimelia can be successfully treated with single or multiple hemiepiphysiodesis with tension band plates in skeletally immature patients in an effective and gradual manner. Level of Evidence: Level III, therapeutic study.