Journal of Childrens Orthopaedics最新文献

Objective: To determine whether tranexamic acid (TXA) reduces blood loss and transfusion rate in single-stage bilateral combined surgery for developmental dysplasia of the hip (DDH) in children.

Methods: A retrospective study was conducted on 148 children with bilateral DDH who underwent single-stage bilateral combined surgery between March 2021 and May 2025. Patients were categorized into a TXA group (n = 71) and a control group (n = 77) based on TXA administration. The TXA group received a single intravenous bolus of TXA 15 mg/kg preoperatively, while the control group received no intervention. Complete blood count tests were obtained preoperatively and at 24 h postoperatively. Estimated blood loss (EBL), transfusion rate, operative duration, and complications were compared.

Results: The TXA group exhibited significantly lower EBL compared with the control group (117.5 ± 7.7 mL vs. 171.4 ± 11.3 mL; p < 0.001). The total transfusion rate was also lower in the TXA group (5.6 % vs. 16.9 %; p = 0.03), as well as the intraoperative transfusion rate (1.4% vs. 11.7%; p = 0.03). The median surgical duration was 2.3 h in both groups, with no significant difference (p = 0.29). One postoperative infection occurred in each group (1.4 % vs. 1.3 %; p = 1), and no cases of seizures or deep vein thrombosis were observed.

Conclusions: TXA significantly reduces EBL and both total and intraoperative transfusion rates in children undergoing single-stage bilateral combined surgery for DDH, without affecting the risk of complications.

Introduction: Idiopathic clubfoot is a frequent congenital deformity treated worldwide using the Ponseti method, which has become the gold standard due to its safety, reproducibility, and excellent short-term outcomes. However, long-term patient-reported outcomes in adolescents and young adults treated in infancy remain insufficiently documented. This study evaluates foot health perception in skeletally mature patients who underwent Ponseti treatment during early infancy, using the European Foot and Ankle Society (EFAS) score and the first two questions of the World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaire.

Methods: A retrospective study was conducted on patients older than 14 years who received complete Ponseti treatment for idiopathic clubfoot at a single pediatric university hospital. Clinical and demographic data were collected, and both EFAS and WHOQOL-BREF questionnaires were administered anonymously at follow-up.

Results: A total of 28 patients completed the questionnaires. Most reported high satisfaction with overall foot health; 78.5% achieved excellent or good EFAS scores for daily activities, while 89.2% demonstrated excellent sports-related scores. Persistent pain or major functional limitations were uncommon, though a subset reported reduced endurance in common walking activity (21%) and altered gait perception (25%). The majority rated their overall quality of life as good or acceptable according to WHOQOL-BREF responses.

Conclusion: Ponseti treatment, combined with long-term follow-up and occasional minor procedures, offers satisfactory long-term outcomes in young adults with idiopathic clubfoot. Although some report reduced walking endurance or gait differences, overall foot health and quality-of-life perception remain high. Further studies are needed to evaluate outcomes later in adulthood.

Introduction: Hand injuries are a major public health issue and are very common in pediatrics, explained by children's world discovery. The aim of this study was to produce a short, animated video to raise awareness and educate children and their parents, by proxy, about common hand injuries, and to assess its effect.

Material and methods: The video was shown to children at school. They were asked to complete an anonymous questionnaire before the projection and 21 days after, to analyze its impact and its spreading.

Results: Eight hundred and thirty five children, with an average age of 9.57 years old, filled the pre-projection questionnaire. Upon those children, 88% have already hurt their hands, 86% knew someone who had hurt their hands and 30% did not know the dangerous situations for the hands. Out of the 565 children who filled the post-projection form, 97% answered that they understood the dangerous situations for the hands, with a significative difference compared to the pre-projection answers. 45% watched the video with their parents, 33% advised their families to watch it and 57% thought they would change their habits.

Conclusion: Hand injuries should be a priority, to reduce their incidence and consequences. This short video sets out the various possible accidents and risk situations, targeting children between 6 and 12 years old, and indirectly adults. Even if this study has encouraging results, spreading must be improved and association with incidence of hand injuries followed to evaluate its impact and benefits.

Background: Although risk factors for redisplacement after nonoperative treatment of pediatric supracondylar humeral fractures (SCHFs) are well described, the temporal distribution of this risk remains poorly understood. This study investigated temporal patterns of redisplacement and identified independent predictors using time-to-event analysis.

Methods: This retrospective cohort study included 218 children (aged 3-14 years) with Gartland type II (n = 142) and selectively treated type III (n = 76) SCHFs managed with closed reduction and custom-molded triplanar splinting between September 2020 and August 2023. Type III fractures were included only when fluoroscopic stress testing confirmed post-reduction stability. Redisplacement was assessed radiographically and analyzed using Kaplan-Meier and Cox regression methods.

Results: Redisplacement occurred in 39 patients (17.9%). Cumulative incidence demonstrated a nonlinear temporal pattern, with most events occurring early after reduction: 87% within the first 14 days, with apparent peaks at days 3-4 and 7-14. In multivariable analysis, initial lateral displacement percentage >85% (hazard ratio [HR] 3.52, 95% confidence interval (CI): 1.82-6.83) and severe soft-tissue swelling (HR 3.08, 95% CI: 1.61-5.89) were independently associated with redisplacement, whereas Gartland classification was not.

Conclusions: Redisplacement risk after nonoperative management of pediatric SCHFs appears concentrated in early post-reduction periods. Displacement magnitude and severity of soft-tissue swelling may provide more clinically relevant prognostic information than fracture classification alone. The observed temporal pattern may be influenced by discrete follow-up intervals and requires prospective validation.

Purpose: Prospective multicentre studies represent a cornerstone of evidence-based advancement. However, within orthopaedics, and particularly in the European context of paediatric orthopaedics, such rigorous investigations are notably scarce. This study aims to explore the organizational, regulatory, and resource-related barriers hindering initiation of these crucial studies, using the setup phase of the 'EPOS Discoid Meniscus (DiMe) Project: a Prospective Multicentric Cohort Protocol'.

Methods: A cross-sectional survey was conducted from 19 centres initially recruited for the European Paediatric Orthopaedic Society DiMe Project (NCT05580315) cohort study. Delays and perceived obstacles encountered during initiation phases: contract negotiation, ethics committee approval, and patient enrolment were assessed. A descriptive analysis was performed to characterize the data. Twelve responding centres (63.2%) were still in the contract negotiation phase, while 36.8% (n = 7) had progressed to the patient enrolment stage.

Results: Median duration for contract negotiation was 12 months (Q1-Q3: 7-22), matching ethical approval (Q1-Q3: 3-12). Sixty-three point two percent (n = 12) of responding centres were still in the contract negotiation phase, while 36.8% (n = 7) had progressed to patient enrolment, with 41 patients enrolled across these sites. Formal ethics committee submission was required de novo in 84.2% (n = 16) of responding centres. Major challenges identified included bureaucratic delays, lack of institutional support, absence of dedicated research staff, and prolonged administrative processes.

Conclusion: The initiation of European multicentre studies in paediatric orthopaedics is hindered by institutional and regulatory barriers. Streamlining administrative and ethical processes and allocation of resources and personnel are needed to improve efficiency and facilitate successful collaborations.

Level of evidence: V - Expert opinion / Cross-sectional survey.

Introduction: Pain and anxiety are common in pediatric orthopedic procedures such as cast or pin removal, often leading to distress and physiological stress responses. Virtual reality (VR) offers immersive distraction and has shown promise in pediatric procedural care; however, evidence in orthopedic procedures remains limited. This meta-analysis aimed to evaluate the effectiveness of VR compared with standard care in reducing pain, anxiety, and heart rate in children undergoing orthopedic procedures.

Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane Library from inception to 20 October 2025 for randomized controlled trials (RCTs) comparing VR distraction and standard care in pediatric patients undergoing orthopedic procedures. Outcomes of interest included pain, anxiety, and heart rate. Statistical analysis was performed with R 4.3.1. Standardized mean differences (SMD) using the Inverse-Variance method and the random-effects method.

Results: A total of four RCTs were included in the final meta-analysis, comprising 624 patients, of whom 315 (50%) were distracted with VR during clinical orthopedic procedures (mean age 9.84 years, mean 40% females). In the pooled analysis, VR distraction significantly reduced anxiety (SMD = -0.55, 95% confidence intervals (CI) [-0.76, -0.34]; p < 0.01; I ² = 0%), pain (SMD = -0.43; 95% CI [-0.68, -0.19]; p < 0.01; I² = 44%), and heart rate (SMD = -0.34; 95% CI [-0.60, -0.07]; p = 0.01; I² = 53%).

Conclusion: In this meta-analysis of four RCTs including 624 pediatric patients, VR distraction reduced procedural anxiety and, in pooled analyses, was associated with modest but statistically significant reductions in pain and heart rate compared with standard care during predominantly cast-related orthopedic clinic procedures. The integration of this child-friendly, nonpharmacological approach provides enhanced procedural comfort and effective anxiety management.

Background: Late diagnosis of developmental hip dysplasia (DDH) may warrant either open or closed reduction of the hip. Proximal femoral growth disturbance (PFGD) is a possible complication following these procedures.

Methods: A systematic search of PubMed, Embase, Web of Science, The Cochrane Library and OrthoSearch from the date of inception of each database through to the 2 February 2025 was performed. The primary outcome of interest was the prevalence of clinically significant PFGD following open or closed reduction after 6 months of age. This was defined as Kalamchi-MacEwen or Bucholz-Ogden Type 2 or above.

Results: The prevalence of clinically significant PFGD in patients undergoing open reduction was 12.47% (95% Confidence interval (CI): 10.39-14.69), whereas the prevalence of clinically significant PFGD in patients undergoing closed reduction was 9.53% (95% CI: 6.91-12.46). Multivariate analysis suggested that mean age at time of reduction was associated with an increase in the prevalence of PFGD in patients undergoing closed reduction (p = 0.022).

Conclusion: We described the prevalence of clinically significant PFGD following closed reduction and open reduction. In both open and closed reduction groups, we observed a high relative heterogeneity (I ²), but acceptable absolute heterogeneity (τ ²), and pooled prevalence estimates should be interpreted with caution. Further studies exploring the influence of disease severity and age on treatment method is required to allow reliable comparisons between open and closed reduction.

Prospero registration no: CRD420251015622.

Purpose: To identify clinical and radiographic risk factors associated with hip redislocation in children with cerebral palsy (CP) who underwent surgical treatment for hip dislocation.

Methods: This multicenter retrospective study included children with CP who underwent reconstructive osteotomy for hip dislocation and were followed until triradiate cartilage closure. Demographic, clinical, and radiographic variables were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for redislocation. Additionally, a classification and regression tree (CART) model was developed to stratify redislocation risk.

Results: Hip redislocation occurred in 25 of 115 hips (21.7%). Redislocation was significantly more frequent in hips treated with femoral osteotomy alone (40%) compared to combined femoral and pelvic osteotomies (16.7%), (p = 0.026). Multivariate analysis identified younger age at surgery (Odds ratio (OR) = 0.981, p = 0.010), higher postoperative Sharp's angle (OR = 1.082, p = 0.034), and lower postoperative Mose hip ratio (MHR) (OR = 0.007, p = 0.033) as independent predictors of redislocation. Radiographic ratios, including medial joint space to cranial joint space (MJS/CJS) and MJS to maximum capital femoral epiphysis diameter (MJS/MCFED), were also significantly higher in redislocated hips. The CART model classified patients into high- and low-risk groups based on surgical age ≤76 months, postoperative Sharp's angle ≥48°, and MHR < 0.69.

Conclusions: Younger surgical age, insufficient correction as indicated by a higher postoperative Sharp angle and lower MHR were independently associated with hip redislocation in CP patients undergoing surgery. MJS/CJS and MJS/MCFED ratios were also associated with redislocation, indicating incomplete reduction.

Significance of study: This study presents a clinically applicable decision-tree model to predict redislocation risk after CP hip reconstruction using radiographic parameters.

Level of evidence: Level III, multicenter retrospective study.

Purpose: Clavicle injuries are among the most common pediatric injuries. This study aimed to identify the 50 most cited articles on pediatric and adolescent clavicle injuries, characterize their publication trends, and assess the correlation between citation metrics and study quality.

Methods: A bibliometric analysis was performed using Web of Science and Scopus databases, identifying the 50 most cited articles on pediatric and adolescent clavicle injuries. Data extracted included citation counts, citation density, study design, level of evidence, and publication characteristics. Methodological quality was assessed using the modified Coleman Methodology Score (mCMS) and Methodological Index for Non-Randomized Studies (MINORS), where applicable. Correlations between citation metrics and quality scores were evaluated using Spearman correlation.

Results: Among the 50 most cited articles published between 1984 and 2019, the majority (70%) were published in the last decade and in Journal of Pediatric Orthopaedics (38%). Most studies originated from the United States (74%). The mean citation count was 31.9 ± 19.7, with a citation density of 2.6 ± 1.4 citations/year. Level 4 evidence predominated (73%), with no level 1 studies identified. The average mCMS and MINORS scores were 40.1 and 13.1, respectively. No significant correlation was found between citation rank and methodological quality scores, although citation rank was significantly correlated with citation density (r _s = -0.66, p < 0.001).

Conclusions: The most cited studies on pediatric clavicle injuries are predominantly low-level evidence and retrospective in nature. Citation frequency was not associated with methodological quality, suggesting that article influence is often driven by historical context, novelty, or foundational relevance rather than study rigor.