Journal of Pediatric Orthopaedics-Part B最新文献

Blood cultures are routinely performed for microbiological diagnostic purposes in acute hematogenous osteomyelitis (AHO); however, the blood culture positivity rate is less than 50%. This retrospective study aimed to identify indicators to distinguish blood culture outcomes in children with AHO from July 2017 to 2024. Patients were stratified based on the results of blood cultures. The age, sex, duration of symptoms, duration of antibiotic therapy before blood culture, location of the lesion, maximum temperature, and inflammatory indexes from admission were reviewed. The efficacy of each index in diagnosing negative blood cultures was also determined according to the receiver operator curves. Logistic regression analysis was used to determine the independent risk factors for blood culture negativity. Among 75 patients, 47 had negative and 28 had positive cultures. No significant differences were found in age, sex, symptom duration, or leukocyte count. However, maximum temperature, duration of antibiotic therapy before culture, neutrophil count, C-reactive protein, and erythrocyte sedimentation rate (ESR) showed significant differences. Logistic regression identified antibiotic therapy duration >2.5 days (OR = 6.383, 95% CI: 1.720-23.680) and ESR <41.5 mm/h (OR = 12.377, 95% CI: 2.042-75.015) as independent risk factors for negative cultures. AHO patients with either of these factors are more likely to have negative blood cultures. For such children, early invasive procedures to obtain pus or tissue for culture should be considered.

Osteomyelitis of the scapula is a rare site of bone infection. Early diagnosis is difficult because of the rarity of localization, the rapid progression, and the misleading atypical manifestations. We systematically reviewed the current available evidence on osteomyelitis of the scapula to provide a synthesis on the epidemiology, clinical presentation, complications, and management of this infection. PubMed, Scopus, and Google Scholar databases were explored to identify studies, case series, and case reports with no time limits focused on children with scapular osteomyelitis. Thirteen articles were included in the final analysis, for a total of 17 patients (14 children and three newborns). The most frequently reported symptoms in children were pain (100%), limitation of shoulder movements (100%), and fever (79%). Several imaging tests were adopted (X-ray, ultrasound, computed tomography scan, and MRI) with pathological findings in most cases. Blood tests always showed a phlogistic state. The most frequent causative agent was methicillin-sensitive Staphylococcus aureus in children and group B Streptococcus in newborns. The mean total duration of antibiotic treatment was 51.5 days, with intravenous cephalosporins (43%), penicillins (36%), and aminoglycosides (29%) adopted as first-choice antibiotics in most cases. Full recovery was reported in most cases (79% in children). Osteomyelitis should be suspected in cases of osteomuscular symptoms even in the absence of fever or local signs. Inflammatory indices and white blood cell count can be only slightly elevated and normal X-rays cannot exclude the diagnosis, and in case of suspicion, MRI is mandatory.

Recent advancements in medical technology have introduced three-dimensional (3D) printing as a promising adjunct to conventional osteotomy. This review aims to evaluate the clinical, radiological outcomes and complications of patients who underwent conventional osteotomy compared to osteotomy with the adjunct use of 3D printing in paediatric deformity correction. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The current study searched from inception to April 2023. All studies that compared outcomes between conventional osteotomy and osteotomy with the adjunct use of 3D printing in paediatric deformity correction in both upper and lower limbs were included. A total of 13 publications with 482 patients were included in this review. In terms of intraoperative parameters, the 3D group had a shorter operative time by 21.3 min [95% confidence interval (CI): 15.92-26.85] and less radiation exposure of -3.42 times (95% CI: -4.57 to -2.28). For radiological outcomes, 3D group had a smaller mean osteotomy error of -2.03 degrees (95% CI: -3.84 to -0.22) and 1.94 times higher odds (95% CI: 1.08-3.48) of having better radiological outcomes. The conventional osteotomy group has possibly a 1.4 risk (95% CI: 0.32-1.59) of growth plate, articular or risk of avascular necrosis compared to 3D templated group. The findings of this meta-analysis support the use of 3D printing as an adjunct in paediatric deformity correction for better intraoperative outcomes, reduce radiation exposure and better radiological accuracy in both upper and lower limb surgery.

This study aims to describe the novel technique of intramedullary nailing of pediatric femoral fractures with a postless distraction technique and to report the technique's safety, complications, and early clinical outcomes. A retrospective review was performed of pediatric patients at a single urban level I trauma center who underwent femoral nailing using the postless distraction technique. The senior author performed all procedures. We collected the following data for patients meeting inclusion criteria: age, sex, height, weight, BMI, fracture classification, quality of fracture reduction, intraoperative time, length of follow-up, and postoperative complications. There were 17 patients in our study. On average, patients were 14 years old (range 11-17 years) with a BMI of 24.73 kg/m 2 (19.37-32.66 kg/m 2 ). The mean length of follow-up for all patients was 41 weeks (6-100 weeks). There were no immediate or early postoperative complications during the follow-up of all patients. The use of a postless system allows for accurate, reproducible, and safe management of femoral fractures in the pediatric population. This project demonstrates the safety and feasibility of this technique, even in a child of small stature. Furthermore, pediatric femoral nailing using a postless system has not been previously described in the literature. This is the first study to describe this surgical technique.

Social media is an accessible information source for patients and families but data on its educational veracity for pediatric musculoskeletal infections are limited. We aim to explore this gap by quantifying information quality on three social media platforms for two infections: acute hematogenous osteomyelitis and septic arthritis. Facebook, YouTube, and Instagram were searched using the keywords 'acute hematogenous osteomyelitis' and 'septic arthritis'. Four raters with medical backgrounds evaluated posts using the modified DISCERN 16-point scoring system to quantify educational value. The intraclass correlation coefficient measured the reviewers' agreement, group differences were analyzed using Kruskal-Wallis and Wilcox-rank sum tests, and predictors for DISCERN scoring were calculated with linear regression. Pairwise comparisons among septic arthritis posts showed higher scores with YouTube ( n  = 50, 45.41 ± 12.44) than for Facebook ( n  = 34, 32.70 ± 8.73) and Instagram ( n  = 100, 24.71 ± 4.68) ( P  < 0.001). For osteomyelitis, pairwise comparisons showed higher scores for YouTube ( n  = 50, 46.62 ± 6.29) versus Facebook ( n  = 19, 37.95 ± 9.69) and Instagram posts ( n  = 100, 36.14 ± 6.16) ( P  < 0.001). When aggregating infections, YouTube had the highest DISCERN score (46.01 ± 9.83) followed by Facebook (34.58 ± 9.35) and Instagram (30.42 ± 7.91); all pairwise comparisons were significantly different (all P  < 0.001). Across all posts, authorship from medical institutions was associated with higher DISCERN scoring ( P  < 0.001). Social media lacks educational veracity for pediatric musculoskeletal infections. Patients using social media as an information source for these diseases should preferentially gather information from medical institutions.

The critical threshold of limb-length discrepancy (LLD) at which compensation strategies are initiated in pediatric patients is unclear. We used spatiotemporal parameters to determine the LLD threshold at which compensatory gait is induced in skeletally immature patients and analyzed these compensatory patterns in terms of kinematics and kinetics. The findings for 20 children who experienced LLD-associated gait discomfort and underwent three-dimensional gait analysis between 2016 and 2019 were reviewed. Using spatiotemporal parameters, the LLD threshold that causes gait asymmetry was determined by receiver operating characteristic (ROC) analysis. Patients were grouped into those with an LLD greater than the cutoff value and those without. The kinematics and kinetics of the two groups were compared. The ROC curve showed that step length was a critical indicator of gait compensation. The area under the curve was 0.882 for both absolute LLD and LLD ratio, with threshold values of 14.06 mm and 1.85%, respectively. The group with LLDs above the threshold showed significant interlimb differences in the hip flexion angle, ankle dorsiflexion angle, and hip joint moment in the sagittal plane ( P  = 0.005, P  = 0.015, and P  = 0.047, respectively). Compensatory strategies for LLD began when the absolute LLD was 14.06 mm or the LLD ratio was 1.85%. These strategies included hip joint flexion, increased hip joint moment of the longer limb, and ankle joint plantar flexion of the shorter limb. Thus, even with LLD less than 2 cm, asymmetries may exist in joint kinematics and kinetics.

The optimal surgical timing for pediatric supracondylar humeral fractures has been deliberated. Although the recent trend is to postpone surgery until the daytime, the effect of after-hours surgery on outcomes requires further elucidation. Thus, we aimed to evaluate whether the timing of surgery for pediatric supracondylar humeral fractures affects the outcomes. The data of 135 pediatric patients who underwent surgery for Gartland type III supracondylar humeral fractures at a single trauma center were retrospectively analyzed. Depending on the time of admission to the operating room, the patients were divided into daytime and after-hours surgery cohorts. Nearest-neighbor propensity score matching was conducted, and outcomes were compared between the matched cohorts. The primary outcome was defined as reduction failure, including revision surgery. Secondary outcomes included the operative time, indication for open reduction, and complications. Each matched cohort consisted of 48 patients, with a mean age of 6.6 ± 2.6 years. The after-hours surgery resulted in more frequent reduction failures than the daytime surgery (21% vs. 4%, P  < 0.05). No significant differences were observed in the secondary outcomes. In the post hoc analysis, where the matched cohorts were stratified by the presence of supervising orthopedic trauma surgeons, reduction failure rates showed no statistically significant difference between daytime and after-hours surgery. This propensity score-adjusted retrospective study revealed that reduction failures occurred more frequently in after-hours surgeries than in daytime surgeries for pediatric supracondylar humeral fractures. The absence of supervising surgeons may have contributed to the poorer outcome of after-hours surgeries.