Journal of Pediatric Orthopaedics-Part B最新文献

Achieving a rapid diagnosis in suspected septic arthritis is challenging as a pathogen is only isolated in 50% of cases, and the necessary investigation takes time and delays treatment. The alpha-defensin lateral flow test (Synovasure) has been shown to effectively and rapidly diagnose prosthetic joint infection, with the benefit of early initiation of treatment. This study tests the hypothesis that the alpha-defensin can diagnose pediatric septic arthritis and differ nonseptic arthritis (NSA) in native joints. A retrospective cohort study analysis was carried out for patients presenting with joint pain and fever with a differential that included septic arthritis. The Synovasure alpha-defensin lateral flow test kit was used to detect alpha-defensin in synovial fluid aspirated from the symptomatic joint. Septic arthritis was defined as present when a causative bacteria was identified in either blood or synovial fluid culture, whereas NSA was recognized when a causative bacteria was not identified, drainage or antibiotic treatment was not implemented, and symptoms improved without joint destruction. Demographic data and culture results were compared between septic arthritis and NSA. Eighteen eligible cases were identified. Of these, six were defined as septic arthritis and 12 as NSA. There were no significant differences in age, body temperature, serum white blood cell count, and C-reactive protein. All cases with confirmed septic arthritis showed a positive alpha-defensin lateral flow test, whereas all of the NSA group showed a negative result. The Synovasure alpha-defensin lateral flow test may be a reliable investigation for rapidly distinguishing septic arthritis from NSA in children.

Level of evidence: Level IV - therapeutic study.

This study was to identify some indicators that could be used to distinguish methicillin-resistant Staphylococcus aureus (MRSA) from methicillin-sensitive Staphylococcus aureus (MSSA) to more accurately guide empirical antibiotics. Data of 91 cases of acute osteomyelitis in children with Staphylococcus aureus infection (including 29 cases of MRSA and 62 cases of MSSA) from July 2017 to March 2024 were retrospectively analyzed. Age, sex, duration of onset, maximum body temperature at onset, and inflammatory indicators detected after admission were compared between the MRSA group and the MSSA group. According to the receiver operating characteristic (ROC) curve, the diagnostic efficiency of MRSA infection was evaluated. Logistic regression analysis was used to determine independent risk factors for MRSA infection. There were no significant differences in age, sex, duration of onset, maximum body temperature, white blood cell count, neutrophil count, and erythrocyte sedimentation rate between the MRSA group and the MSSA group ( P > 0.05). The median C-reactive protein in the MRSA group and the MSSA group was 97.93 and 58.10 mg/L, respectively, with statistical significance ( P < 0.05). The sensitivity, specificity, and area under the curve of C-reactive protein for detecting MRSA infection were 41.4, 90.3, and 0.646%, respectively. Logistic regression analysis showed that C-reactive protein greater than 116.46 mg/L (odds ratio = 6.588, 95% confidence interval: 2.149-20.197) was an independent risk factor for predicting MRSA infection ( P < 0.05). C-reactive protein greater than 116.46 mg/L can independently predict the likelihood of MRSA infection, and it is recommended to empirically select anti-MRSA treatment for such children.

The aim of this study was to investigate the early effectiveness of guided growth techniques for managing congenital anterolateral bowing of the tibia (ALBT) in children. A retrospective analysis was performed involving 18 patients with ALBT treated with the 'U'-shaped staple-guided growth technique between January 2020 and October 2022 at two centres. Anteroposterior and lateral radiographs of both lower limbs and the tibia as well as the fibula were collected before surgery, at the time of implant removal, or at the last follow-up. Changes in the coronal tibial diaphyseal angulation, sagittal tibial diaphyseal angulation, anatomical medial proximal tibial angle (aMPTA) and anatomical lateral distal tibial angle (aLDTA) were statistically analysed to evaluate the correction effect of the ALBT. All patients were followed up for an average of 23.36 months (range: 14.53-37.2 months). All 18 patients demonstrated an improvement in the coronal plane tibial shaft angle, with an average correction of 17.94° (range: 5.54°-33.52°). Fourteen patients displayed an improvement in the sagittal plane tibial shaft angle, with an average correction of 13.44° (range: 1.89°-32.6°). Both the aMPTA and aLDTA levels decreased after treatment. No tibial pseudarthrosis occurred in any of the 18 patients during the follow-up. The guided growth technique is effective in improving the ALBT, preventing further angular deformities of the tibia, and may delay or prevent tibial pseudarthrosis. Moreover, the guided growth technique is simple to perform, minimally invasive and associated with few complications.

Flexible intramedullary nail fixation of pediatric femoral shaft fractures offers advantages such as shorter hospital stays, faster return to function, and less associated costs when compared with traction and casting. This study compared the biomechanical performance of three configurations: 2CS, 2CL, and 3CL. Thirty synthetic femur models with identical, length-unstable, spiral fractures were tested using a three-dimensional camera system to assess real-time micromotion. Three groups were analyzed: (a) 2CS - two 3.5 mm C- and S-shaped nails inserted anterograde, (b) 2CL - one 'C' and one 'S' shaped 3.5 mm titanium nail-inserted retrograde from a single lateral entry, (c) 3CL - two 'C' shaped 3.5 mm titanium nails inserted medially and laterally with a third 'C' shaped 2.5 mm nail placed retrograde from an anterolateral site. Torsional loading, cyclical loading, and load-to-failure tests were conducted. The 3CL configuration demonstrated superior biomechanical performance. It exhibited the highest torsional stiffness [0.67 ± 0.06 Nm/° for external rotation (ER), 0.404 = ± 0.06 Nm/° for internal rotation (IR); P  = 0.002], least displacement (0.05  ± 0.02 vs. 0.30 ± 0.02 mm for 2CL and 0.57 ± 0.05 mm for 2CS; P  = 0.012), and required the highest load-to-failure (162 ± 83 vs. 106 4  ± 75 N for 2CL and 790 ± 34 N for 2CS; P  = 0.016).The 3CL configuration provided superior strength and stability across all tests, supporting its role in the fixation of length-unstable pediatric femoral fractures.

Pediatric pes planovalgus (flatfoot) is a prevalent musculoskeletal condition characterized by the flattening of the medial arch of the foot. Despite its common occurrence, there is a lack of standardized diagnostic and therapeutic protocols. This study aimed to conduct a comprehensive bibliometric analysis on the 100 most-cited papers on pediatric flatfoot to identify major research trends, including publication years, countries of origin, contributing institutions, prevalent keywords, common surgical treatments, and authorship patterns. This bibliometric analysis utilized the Web of Science Core Collection database by Clarivate Analytics to identify articles related to pediatric flatfoot using keywords. The 100 most-cited articles were manually selected and analyzed using the VOSviewer software to create network visualization maps. The 100 most-cited articles were published between 1951 and 2019, with the number of citations ranging from 26 to 299. The number of influential papers published increased in the 2000s, and the majority were published in the 2010s (57%). The USA was the most productive country (31 publications), the University of South Australia was the most productive institution (eight publications), and Evans AM was the most productive author (seven publications). Calcaneal osteotomy was the most studied procedure (14 publications, 782 citations), predominantly in North America. Subtalar arthroereisis was the focus of seven publications (462 citations), mostly coming from Europe. There was a notable expansion in research on pediatric flatfoot in recent years. There were major geographic differences in the approach to treatment for calcaneal osteotomy vs. subtalar arthroereisis.

Ataxia telangiectasia AT), an autosomal recessive disorder due to mutations in the ATM gene, results in progressive cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, pulmonary compromise, sensitivity to ionizing radiation, and increased risk of hematologic malignancies. Orthopedic manifestations such as scoliosis, hip displacement, gait abnormalities, and extremity contractures are common, but reports are scarce. This study aimed to evaluate and summarize the orthopedic manifestations associated with AT. A retrospective review was conducted of patients with AT. Reported outcomes included demographics, orthopedic manifestations and operative/nonoperative treatments, radiographic exposure, development of malignancy, and ambulatory status (using the Functional Mobility Scale at 50 m, FMS50). Twenty-four children were included [11 (45.8%) female] with a mean age at diagnosis of 5.5 (SD = 3.5) years. The most common reason for orthopedic consultation was ataxia; 12 (50%) were walkers (FMS50 = 4,5) and 12 nonwalkers (FMS50 = 1,2). Foot deformities were present in 10 (42%) including pes planovalgus (N = 6, 25%), Achilles tendon contracture (N = 1, 4%), hallux valgus (N = 1, 4%; underwent Akin osteotomy), equinovarus (N = 1.4%), and gastrocnemius contracture (N = 1, 4%). Six children (25%) developed scoliosis, and three underwent fusion. Other manifestations included hip flexion contracture (N = 2, 8%), hamstring contracture (N = 2, 8%), torticollis (N = 1, 4%), and osteomyelitis of the ischium (N = 1, 4). This report describes orthopedic manifestations associated with AT, most commonly foot deformities, followed by scoliosis. Since radiographic surveillance was not performed due to radiosensitivity, the frequency of hip displacement in AT could not be ascertained. Orthopedic surgical interventions, where required, were generally successful. Level of evidence: 3.

To evaluate the effects of multidisciplinary team (MDT) intervention on perioperative management, functional recovery, and psychological well-being in adolescents aged 14-18 years with limb or pelvic fractures. One hundred adolescents aged 14-18 years with limb or pelvic fractures, admitted between January 2018 and December 2023, were retrospectively divided into an MDT group (n = 50) and a control group (n = 50) according to whether they received MDT intervention. The MDT group received comprehensive perioperative management involving orthopedics, emergency, anesthesiology, rehabilitation, pediatrics, psychology, and surgical intensive care; the control group received standard perioperative management. Perioperative outcomes, pain scores, functional recovery, and psychological status were compared at predetermined time points. The MDT group had significantly shorter hospital stays and lower postoperative pain scores than the control group (P < 0.05). Functional recovery was assessed using the short musculoskeletal function assessment (SMFA) and the CORE-Kids simplified score (CKSS), a 0-9 binary scale developed with reference to the CORE-Kids core outcome set. At 3 and 6 months, the MDT group showed significantly better SMFA and CKSS scores (P < 0.05). At 12 months, no significant differences were observed. The MDT group also had significantly lower hospital anxiety and depression scale anxiety and depression scores on postoperative day 3 and at 12 months (P < 0.05). MDT intervention improves perioperative pain control, promotes functional recovery, and enhances psychological well-being in adolescents with limb or pelvic fractures and may facilitate earlier return to daily life and school.

Flatfoot is a common condition in children; surgical treatment should be reserved for severe and symptomatic cases. Calcaneal lengthening osteotomy (CLO) has been associated with good results; the original technique considers the use of allografts or autografts. This study aimed to evaluate advantages of a titanium trapezoidal wedge (TTW) in a pediatric population, compared with traditional grafts. At our knowledge, there are no studies in pediatric patients. This is a retrospective study of 11 patients (14 feet) with severe flatfoot treated with CLO and TTW and a control group of nine patients (13 feet) treated with CLO and traditional grafts. The mean age of TTW group was 13.4 years, and the mean follow-up was 15 months. The mean age in the control group was 13.7 years, and the mean follow-up was 36 months. Pre- and postoperative clinical and radiographic measures were evaluated, as well as operative time and radiation exposure. At follow-up, feet treated with TTW showed an improvement in all radiographic parameters measured on weight-bearing radiographs and also an improvement in the American Orthopedic Foot and Ankle Society Score, comparable to the control group. The use of TTW significantly reduced radiation exposure and operating time. No cases of graft fracture or migration were observed. All TTW appeared osteointegrated at the last follow-up. CLO using TTW is an effective procedure, allows correction to be maintained over time and reduces operative time and radiation exposure. Despite the promising results, our findings should be considered as a preliminary report; more data are needed to confirm our results.

Lateral condylar (LC) and olecranon (OC) fractures occurring concurrently on one side are rare phenomena with limited scientific literature. Our study aims to evaluate the radiologic, clinical, and functional consequences of lateral to medial injury of the elbow (LAMEINE) in pediatric patients, simultaneously comparing with lateral to medial diagonal injury of the elbow (MELAINE). Eighteen males and 10 females were diagnosed with LAMEINE. The average age at the time of injury was 3.8 ± 2.3 years (range, 1-9). Out of the 28 fractures, 19 (67.9%) occurred on the left side and nine (32.1%) on the right side. The OC fractures were classified according to the Weiss system, two being type I, 17 type II, and nine type III fractures. Based on the specific case characteristics, the OC fractures were further subdivided into five types corresponding to two types of AO classification: 24 (85.7%) cases of AO 21u-M/2. 1 incomplete fractures [3 type I (10.7%), 16 type II (57.1%), and five type III fractures (17.9%)], and four (14.3%) cases of AO 21u-M/3.1 complete simple fractures [2 type IV (7.1%) and two type V fractures (7.1%)]. All patients underwent surgical intervention. Their clinical and functional outcomes were evaluated using the carrying angle (CA) and elbow performance score (EPS). These results were then compared with those of our MELAINE patients. All patients were followed up for 42.9 ± 23.5 months (range, 15-88). Radiographs indicated that all fractures healed in 5.9 ± 1.4 weeks (range, 4-10). At the last follow-up, the CA and EPS of the injured side were 11.3° ± 2.8° and 97.7 ± 3.7, respectively. All patients had favorable outcomes: 27 patients (96.4%) had excellent EPS, and only one patient (3.6%) had good EPS. The LAMEINE group displayed lower age, displacement, incidence of elbow dislocation, and CA than the MELAINE group ( P  < 0.05). Although relatively rare, LAMEINE should not be neglected. Surgical treatment aims to stabilize the elbow and avoid varus deformity. With appropriate diagnosis and treatment, good clinical and radiographic outcomes can be achieved for both patterns of 'diagonal lesions' of the pediatric elbow. Level of evidence: III.