Journal of Childrens Orthopaedics最新文献

Purpose: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians-especially where pediatric orthopedic expertise is limited, but their reliability across typical and discordant presentations is uncertain. This scenario-based validation study evaluated the accuracy of ChatGPT-5.0's management recommendations for DDH using 30 structured clinical cases and compared these outputs against AAOS (2022) and AAP (2016) guidelines.

Methods: Scenario-based validation using 30 unique cases: 20 concordant (aligned clinical and imaging findings) spanning Graf and acetabular index-based ages, and 10 mismatch scenarios with correct examinations but intentionally erroneous radiology. The primary outcome was guideline-concordant accuracy, categorized as correct, partially correct, undertreatment, overtreatment, or incorrect. Secondary outcomes included the effect of error-aware prompts and multilingual consistency.

Results: In concordant scenarios, guided ChatGPT achieved 100% correct, while non-logged-in ChatGPT achieved 95% with one overtreatment. In mismatch scenarios, guided ChatGPT frequently tends toward overtreatment and failing to recommend repeat ultrasound or urgent pediatric orthopedic consultation. Non-logged-in ChatGPT performed better in mismatch cases but similarly under-emphasized remeasurement/consultation. Error-aware prompts did not materially alter recommendations in either environment. Swahili queries produced outputs clinically identical to English responses.

Conclusions: ChatGPT-5.0 provides reliable, guideline-concordant guidance for DDH when clinical and radiologic data are concordant, supporting potential use as a decision aid in settings without immediate pediatric orthopedic access. Safe clinical implementation requires human oversight and integration of guideline-based safety checks to prevent mismanagement in ambiguous cases.

Purpose: Pediatric femoral neck fractures (PFNFs) are rare (≈1% of pediatric fractures), and avascular necrosis (AVN) is a devastating complication without a universally accepted management. High-degree posterior rotational osteotomy (HDPRO) with three-dimensional (3D) navigation is a novel joint-preserving technique with the potential to improve outcomes.

Methods: A retrospective case series was conducted with three pediatric patients (2 boys, 1 girl; aged 9-15 years at injury) diagnosed with AVN secondary to PFNF. All underwent HDPRO using Stryker OrthoMap 3D navigation to reposition the viable anteromedial femoral head. Preoperative and postoperative outcomes were assessed using radiographic analysis, functional scoring (Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ)), and sports participation. Follow-up ranged from 24 to 36 months.

Results: All patients showed pain relief, functional improvement, stable femoral head morphology, and revascularization. JHEQ improved to 79-84 points; hip motion normalized without impingement. All patients returned to sports (track, volleyball, cycling).

Conclusions: HDPRO with 3D navigation is a promising joint-preserving option for AVN following PFNF. Preliminary results are favorable; however, the small cohort and limited follow-up warrant larger studies.

Significance of study: To the best of our knowledge, this is the first report demonstrating that navigation-guided HDPRO reliably relocates the viable anteromedial head to the load-bearing zone.

Level of evidence: Level IV.

Purpose: To compare the effects of postoperative splint immobilization versus early mobilization on 1-year radiological and functional outcomes in pediatric diaphyseal both-bone forearm fractures treated with elastic stable intramedullary nailing (ESIN).

Methods: A retrospective analysis was performed on 124 children (6-14 years) who underwent ESIN for closed mid-diaphyseal radius-ulna fractures between January 2018 and December 2023. Patients were divided into splint (n = 64) and non-splint (n = 60) groups according to postoperative protocol. Radiological healing was evaluated using the Lane-Sandhu score at 1, 3, 6, and 12 months, and functional outcomes using the Price classification at 3, 6, and 12 months.

Results: Baseline characteristics were comparable. At the third month, radiological scores were slightly higher in the splint group, while functional results favored early mobilization, though differences were not statistically significant. By the 6th and 12th months, complete union and excellent functional recovery were achieved in all patients, with no significant intergroup differences (p > 0.05).

Conclusions: Early mobilization following ESIN is feasible and does not delay bone healing or impair function. Routine splinting may be unnecessary, and postoperative care can be tailored to the patient and fracture characteristics. Moreover, our findings demonstrate that when ESIN principles are properly applied, splint use in appropriately selected patients does not lead to any long-term functional deficit, and excellent outcomes can still be expected.

Purpose: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into Dutch and evaluate its psychometric properties.

Methods: The HWI was translated using a standardized forward-backward translation process. Psychometric evaluation followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and included assessments of readability, interpretability, responsiveness, reliability and content validity. Parents of infants aged 3-13 months diagnosed with DDH and managed with active surveillance or abduction bracing with a Pavlik harness were included.

Results: The Dutch version of the HWI was completed by 59 parents prior to treatment and by 50 of them during treatment. In addition, 56 parents completed the questionnaire twice around their child's first birthday. The Dutch HWI demonstrated good readability (Flesch Reading Ease Score = 84.1) and adequate interpretability (mean score 21.53, standard deviation 6.11). Responsiveness was supported by confirmation of 89% of the predefined hypotheses. Internal consistency was good (Cronbach's α = 0.77-0.79) and test-retest reliability was excellent (Intraclass Correlation Coefficient = 0.95; 95% Confidence interval 0.91-0.97). Content validity assessment identified concerns regarding the relevance of items 3-6 for non-brace treatment, the sequencing of items, the use of negatively worded items and the absence of items addressing practical and informational needs.

Conclusions: The Dutch HWI is a promising instrument for assessing parental concerns related to DDH in early infancy. However, limitations in content validity highlight the need for refinement, incorporating input from parents, caregivers and healthcare professionals to enhance content validity and clinical applicability.

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.

Purpose: The risk of implant-associated infection (IAI) is occasionally cited as an indication for routine removal of orthopaedic implants in children, but evidence is lacking. This study aimed at exploring the frequency of microbial colonization of paediatric orthopaedic implants by sonication, a gold standard for diagnosing IAI.

Methods: Data of all patients aged <18 years at index implantation who underwent implant removal over a 34-month period at a single institution were retrospectively reviewed. Sonication culture results were classified according to microbial growth as negative (no/non-significant growth) or positive (significant growth/colonization). Descriptive statistics were performed, correlations were analysed via crosstabs and univariate ANOVA (p < 0.05).

Results: One hundred and twenty-nine sonicated devices from 63 patients were included. Mean patient age at implantation was 9.8 years (standard deviation (SD) 3.4; range 3.0-15.6), mean implant in situ time was 2.2 years (SD 1.5; range 0.6-8.8). In all, 63 tension band plates, 35 locking screw plates, 26 cannulated screws, 3 intramedullary nails and 2 K-wires were evaluated. In total, 128/129 (99%) of implant sites were asymptomatic. Sonication fluid cultures of 24/128 (19%) implants from 21 asymptomatic patients showed non-significant growth of pathogens mainly related to the human skin microbiome, suggesting contamination.

Conclusions: Sonication of implants removed from asymptomatic implant sites showed no significant microbial growth. Thus, the risk of IAI should be irrelevant for scheduling implant removal in children without signs and symptoms of infection.

Significance of study: This study investigates for the first time the role of sonication in non-spinal paediatric orthopaedics and provides important insights into the question of routine implant removal in children, providing a foundation for future research.

Background: The goal of treatment in early onset scoliosis patients is to control the deformity while allowing chest and spinal growth. However, management, either conservative or surgical, remains controversial and require further clinical evidence. The aim of this study was to determine best practice guidelines for the management of early onset scoliosis patients in Europe.

Methods: A Delphi approach was used among European experts to determine consensus in: (1) identification of progression risk factors, (2) clinical and radiographic evaluation, (3) conservative treatment, and (4) surgical management. Idiopathic and non-idiopathic groups were analyzed separately. Statements were only included in the final agreed consensus if at least 80% of respondents agreed with the statement.

Results: A total of 22 pediatric orthopedic surgeons completed the first and second surveys, and 21 the third. Out of open-ended questions included in the initial Delphi, 75 statements for 59 multiple-choice questions in the idiopathic group and 47 statements for the 44 multiple-choice questions for the non-idiopathic group were formed for the second round. Of the total 122 statements, 50 (40.9%) reached consensus, and 72 did not. Among the 72 statements re-evaluated in Round 3, consensus was reached on 69 (96%).

Conclusion: Early onset scoliosis represents a rare, heterogeneous, but life-threatening condition often associated with insufficient relevant evidence. Consensus is difficult to achieve (39.3% of the 122 statements), especially in the non-idiopathic group. However, 48 guidelines (33 for idiopathic and 15 for non-idiopathic) were provided by European experts to improve early onset scoliosis management.

Level of evidence: IV.