Journal of Pediatric Orthopaedics-Part B最新文献

A retrospective study compared the anterior cubital approach to the triceps-sparing approach for treating T-condylar humerus fractures in 19 children and adolescents from January 2008 to May 2023. Patients were divided into group A (seven patients, mean age 10.7 years, triceps-sparing) and group B (12 patients, mean age 11.32 years, anterior cubital). Outcomes included surgical duration, incision length, scarring [Vancouver Scar Scale (VSS)], neurovascular complications, and functional results [Mayo Elbow Performance Score (MEPS) and Flynn's criteria]. Group A had a mean incision length of 8.60 cm, surgery duration of 68.29 min, and VSS scores averaging 3.71, with five excellent and two good MEPS results, and five excellent, one good, and one fair Flynn's outcomes. Two patients had radial nerve palsy. Group B showed a shorter mean incision length of 4.63 cm, surgery duration of 51.42 min, and VSS scores averaging 1.33, with 10 excellent and two good results for both MEPS and Flynn's criteria. One patient developed cubitus varus, with one case each of radial and median nerve palsy. Significant differences were found in surgery duration, incision length, and scarring, but functional outcomes were comparable. Multivariable regression, adjusted for confounders, validated significant associations of the anterior cubital approach with reduced surgery duration, shorter incision length, and lower VSS scores, with no significant difference in functional outcomes. The anterior cubital approach is minimally invasive, safe, and effective, offering shorter surgeries, smaller incisions, less scarring, and better neurovascular exploration, with similar functional recovery.

Randomized-controlled trials (RCTs) investigating nonoperative interventions for idiopathic toe walking (ITW) are limited. High-quality, parallel-group RCTs comparing treatment with no treatment are needed. This study aimed to assess the effects of serial casting and exercise interventions on ITW, compared with a control group. Children with ITW aged 3-10 years were randomized into the serial casting ( n  = 10), the exercise ( n  = 9), and the wait-list control ( n  = 10) groups. Primary outcomes were ankle dorsiflexion range of motion (ROM) and the Toe Walking Severity Scale (TWSS). The secondary outcomes included pediatric outcomes data collection instrument (PODCI), tandem walk test, and satisfaction from treatment. The patients were assessed before treatment, posttreatment, 1-month posttreatment (MPT), 3 MPT, and 6 MPT. The control group was followed up until the 1 MPT assessment. This trial is registered with Clinicaltrials.gov under the number NCT06010485. No differences were found between the treatment groups in ankle ROM and TWSS at any follow-up points. The control group showed less improvement in the TWSS compared with the intervention groups. Both intervention groups demonstrated significant intragroup improvements over time. All groups improved in ankle ROM, TWSS, and the Tandem Walk Scale, but only the intervention groups showed improvements in PODCI scores. Treatment satisfaction was similar among the intervention groups. Both interventions had comparable rates of side effects and adherence. Both treatment groups demonstrated greater effectiveness than the control group, with no significant differences observed between the treatment groups.

Hereditary multiple exostoses is an autosomal dominant genetic condition primarily affecting long bones. Forearm deformities, including wrist ulnar deviation, ulnar shortening, radial or ulnar bowing, and radial head dislocation, are common manifestations. Gradual ulnar lengthening is suggested as a viable treatment option for managing these deformities. This retrospective single-center study included 15 forearms treated with gradual ulnar lengthening using a monolateral external fixator by a single surgeon. Clinical and radiological characteristics were recorded preoperatively and during follow-ups. The Wilcoxon signed-rank test compared preoperative and postoperative radiological and clinical parameters, while McNemar's test assessed changes in radial head dislocation or subluxation. Significant radiological improvements were observed post-treatment. Proportional ulnar length increased from a mean of 0.85 ± 0.10 preoperatively to 1.11 ± 0.03 at the last follow-up ( P  < 0.001). Ulnar variance decreased from a mean of 17.6 ± 5.58 mm preoperatively to 0.13 ± 1.81 mm at the last follow-up ( P  < 0.001), while radial bowing decreased from a mean of 0.06 ± 0.02 to 0.05 ± 0.01 at the last follow-up ( P  < 0.001). In addition, the radioarticular angle decreased significantly from a mean of 29.93 ± 7.34 to 20.20 ± 5.71° ( P  < 0.001). The incidence of radial head dislocation or subluxation decreased significantly, from 11 patients preoperatively to only one at the last follow-up. These findings demonstrate the effectiveness of gradual ulnar lengthening with a monolateral external fixator in correcting forearm deformities and reducing the incidence of radial head dislocation or subluxation.

The objective of this inclusive literature review is to identify surgeries performed for Freiberg's disease (FD) and their outcomes and to perform the first population-based study to establish its incidence. We reviewed all retrievable publications linked to FD listed in PubMed and publications quoted within these publications going back to 1914. Patients with FD and the number of livebirths born in our maternity hospital between 2000 and 2023 were identified from our hospital database. We identified 208 publications of which we managed to review 163 (1121 patients, 1169 feet, of which 939 feet underwent surgery, 116 had no surgery, and for 114, it was unknown if surgery was performed. Patient age: 194 × <18 years, 516 × ≥18 years, 411 × age unknown). The most frequently performed surgeries were intra-articular closing wedge metatarsal osteotomies through the defect (IDCWMO) (284 feet), extra-articular dorsal closing wedge metatarsal osteotomies (EDCWMO) (118 feet), osteochondral autologous transplantation (OAT) (64 feet), and modified Weil osteotomies with intra-articular dorsal closing wedge osteotomies (52 feet). Outcome scores were used in 39 publications, with the American Orthopaedic Foot and Ankle Society score having been used most frequently (28 studies, 462 patients, 482 feet). The mean scores were excellent for OATs and EDCWMOs and good for IDCWMOs and modified Weil osteotomies. We identified 124 644 livebirths and 44 patients with FD. In conclusion, multiple procedures achieved a high rate of excellent and good outcomes where nonoperative management failed. FDis rare, with an extrapolated incidence of 1 in 2833 livebirths.

Level of evidence: Level IV - prognostic, retrospective case series.

Supracondylar humerus fractures comprise of a major part in pediatric trauma cases. They result from a fall on an outstretched hand. The rotational components of Gartland type III fractures if not corrected appropriately can lead to cubitus varus (gun stock deformity). The surgeon's aim while fixing this fracture is to achieve reduction and stable fixation without a residual deformity. The rotational component is difficult to correct owing to factors like severe swelling, obesity, entrapment of soft tissue, and pull of muscles. This study aimed to demonstrate the use of a proximal fragment Kirschner wire as a joystick to correct the rotational displacement in Gartland type III pediatric supracondylar humerus fractures. We proposed a method of using a lateral 3 mm. Kirschner wire as a joystick by inserting 1-1.5 cm proximal to the fracture and correct the rotational malalignment. The children were followed up for 1 year after surgery and evaluated with Flynn criteria. Amongst 18 type III supracondylar fractures, the average flexion was 146.8° in the 24-week follow-up period. The Flynn criteria showed 14 (77.78%) had excellent outcomes, three (16.66%) had good outcomes, and one (5.56%) had fair outcomes. Patients having obesity, severe edema, rotatory displacement, difficult or inadequate reduction by traction, and manipulation alone using a Kirschner wire in the proximal fragment as a joystick to reduce the fracture is a time-saving, cost-effective, simple, and reproducible technique with an excellent cosmetic and functional outcome without significant complications.

The proximal humerus is a common site for pediatric malignant bone tumors, often necessitating complex surgical approaches when the tumor extends into the glenohumeral joint. Limb-salvage techniques like clavicula pro humero (CPH) reconstruction aim to balance limb function with oncological safety. However, nonunion and functional limitations remain significant challenges. This study evaluates whether adding a vascularized fibular graft (VFG) reduces nonunion in CPH reconstructions following proximal humeral tumor resection. A retrospective review of six pediatric patients (mean age 12 years) treated between 2006 and 2021 for malignant bone tumors in the proximal humerus was performed. All underwent CPH reconstruction combined with a VFG. Primary outcomes included nonunion rates, time to bone healing, and complications like infections and fractures. Secondary outcomes assessed morbidity related to fibular graft harvesting, including lower limb alignment and peroneal nerve injury. Of the six patients, four (66%) experienced proximal nonunion, all requiring revision surgery. The average time to proximal union (21 months) was significantly longer than distal union (11.5 months; P  < 0.05). Fibular graft complications included transient common peroneal nerve deficiency in two cases (33%). No infections or local tumor recurrences were observed during follow-up. VFG improves distal junction consolidation, but provides limited benefit for proximal union. This may be influenced by factors such as the length of the harvested clavicle or the vascularization quality of the clavicular graft.

This study aimed to emphasize the effectiveness of using intraoperative neuromonitoring (IONM) in preventing possible nerve damage in Sprengel's deformity surgery. Eighteen patients who underwent Woodward surgery accompanied by neuromonitoring due to Sprengel's deformity were included in the study. Demographic information of the patients and their clinical and cosmetic results before and after surgery were recorded. Complications that occurred during and after the surgery were recorded. Of the 18 patients who underwent surgery, 12 were female and 6 were male. The mean age of the patients was 4.4 (2-8). The mean shoulder abduction angle of the patients was 84.4 (65-105) degrees before the surgery and 151.1 (125-175) degrees in the first year after the surgery. The mean Cavendish score of the patients was 3.6 (3-4) before the surgery and 1.1 (1-2) in the first year after the surgery. In one patient, there was a decrease in IONM motor-evoked potency signals during the reduction of the intraoperative scapula. Considering some loss of correction in the deformity, the scapula was detected at the point where there was no loss of signals. No patients developed wound problems or infections. In this study, it was determined that the use of neuromonitoring was effective in preventing brachial plexus damage, even if this complication was minimal in patients operated on due to Sprengel's deformity.

T-condylar fractures of the distal humerus are rare pediatric injuries. There is no consensus regarding ideal management and clinical outcomes for these injuries. The current review was planned to comprehensively review existing evidence regarding these rare pediatric fractures. A literature search was performed to identify the articles on pediatric T-condylar distal humerus fractures (1950-2024). Patient data was categorized under two groups: groups A (≤8 years old) and B (9-18 years). Finally, 32 articles were reviewed. Groups A and B included 25 and 148 patients, respectively. A majority of patients were males (72.3%) in both groups. 100% and 95.3% (141) of patients in groups A and B, respectively, were managed surgically [closed/open reduction and internal fixation (CR/ORIF)]. IF was predominantly done using Kirschner wire (K-wire) in group A. In group B, IF was performed using plate/screw/K-wire. There was no significant difference in complication rates between the groups [3/10 and 39/62 complications were observed in groups A and B, respectively; Mantel-Haenszel odds ratio:0.33 (95% confidence interval (CI): 0.09-1.14; Z = 1.75, P = 0.08; Chi-square = 3.23, P = 0.66; I2 = 0%)]. 87.5% in group A and 91.8% in group B had excellent; and good to excellent outcomes, respectively. The final elbow range of motion was significantly higher in group A (vs. group B; mean difference:13.91°; 95% CI: 6.93°-20.89°; test of overall effect: z = 3.91, P < 0.0001). Surgical management (i.e. ORIF) is the preferred intervention in pediatric T-condylar fractures. K-wire fixation is the most common operative technique. Overall complication rate is 58.3% (irrespective of age and treatment). Postinjury stiffness is more common in older children (>8 years).