Journal of Childrens Orthopaedics最新文献

Purpose: Open reduction internal fixation of paediatric medial epicondyle (ME) fractures can be technically challenging. The pull of the common flexor origin, ulnar nerve proximity, narrow ideal screw trajectory and sometimes fragmented epicondyle piece can make reduction difficult and lead to complications. Concern for tenuous fixation can lead to longer immobilization, placing the elbow at risk of stiffness. We describe a modified technique for screw fixation of ME fractures, with the goal of reducing complications and improving the stability of fixation.

Methods: The modified technique includes insertion of a guidewire and pre-drilling for the screw prior to any fracture reduction, suture-assisted mobilization and control of the ME fragment, and conversion of the suture into a transosseous tension band to augment the screw fixation. A Retrospective chart review of 13 patients treated with this technique was undertaken to report early clinical and radiographic outcomes.

Results: The average age at surgery was 12 years (range: 6-15). The mean follow-up was 8 months (range: 1-17). There was 100% fracture union with an average time to union of 7 weeks (range: 4-13). All patients obtained a functional range of motion with median flexion of 140° and median extension of 0°. Five patients had screw removal during follow-up. One patient had symptomatic ulnar nerve instability that was addressed at screw removal. There were no other complications.

Conclusion: This technique improves ease of reduction and increases stability of fixation allowing earlier range of motion. This technique has provided reliable early results in our series of 13 patients.

Purpose: Patients with cerebral palsy commonly exhibit flexed knee gait. Hamstring lengthening is a common intervention, and the popliteal angle test (PAT) is widely used to assess hamstring tightness and guide surgical planning. This systematic review evaluated the role of the popliteal angle test in relation to surgical hamstring lengthening.

Methods: PubMed, Scopus, Web of Science, Embase, and Cochrane Library were searched from inception to January 29, 2025 for articles involving cerebral palsy, popliteal angle test, and hamstring lengthening.

Results: Thirty-one articles met the inclusion criteria. Outcomes were reported per patient or per limb, with Gross Motor Function Classification System level specified in 19 studies. Nineteen studies (61.3%) incorporated the popliteal angle test in preoperative assessments, 6 (19.4%) used it as the sole surgical determinant, and 4 (12.9%) applied it intraoperatively to guide additional hamstring lengthening. Twenty-seven studies reported pre- and postoperative popliteal angle test values; among the 21 providing statistical analyses, all showed significant postoperative improvement, although repeat procedures and longer follow-up failed to demonstrate sustained benefit. Kinematic data were reported in 20 studies, but analyses were mostly limited to sagittal knee flexion/extension during stance. Follow-up was reported in 24 studies, but durations rarely exceeded 2 years.

Conclusions: The popliteal angle test remains widely used in the surgical assessment of flexed knee gait in cerebral palsy, but methodological heterogeneity limits comparability across studies. While postoperative improvements are common, they cannot be reliably correlated with gait outcomes. The main limitation lies in its use as the sole surgical or intraoperative determinant. Standardized protocols, integration with gait analysis, and long-term follow-up are needed to clarify its prognostic value.

Purpose: Compare functional, oncologic, and complication outcomes of distal femoral reconstruction after malignant tumor resection in children <12 years, in whom adult implants are unsuitable.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review and meta-analysis of PubMed, Embase, Scopus, Web of Science, and Cochrane (inception-January 1, 2025). Eligible studies reported outcomes for expandable or non-expandable prostheses, osteoarticular allograft, allograft-prosthetic composite, epiphyseal-preserving reconstruction, rotationplasty, arthrodesis, spacers, or amputation. Random-effects models pooled means/proportions; risk of bias was assessed using the Newcastle-Ottawa Scale; and certainty was assessed using GRADE.

Results: Forty-one studies (n = 1186) met criteria. Pooled mean Musculoskeletal Tumor Society was 24.9/30 (95% confidence interval, 23.9-25.9; I ² = 97%). Biological joint-preserving methods and rotationplasty tended to yield the highest function; arthrodesis and amputation were lower. Local recurrence was 5.2% (95% confidence interval, 3.3-7.1) without differences between techniques. Five-year overall survival was 81.6% (76.6-86.6); epiphyseal-preserving reached 93.3%, expandable prostheses 79.0% (contextual, not causal). Complications differed: expandable prostheses had reoperation rates of 57.2% and mechanical failure of 42.3%; osteoarticular allograft had a fracture rate of 27.4% and failure rate of 37.5%; allograft-prosthetic composite had a failure rate of 24.4% and nonunion rate of 13.5%; and arthrodesis had the fewest complications. Deep infection was 6.7%. GRADE certainty was as follows: high for local recurrence; moderate for 5-year survival and infection; and low for function and reoperation/failure (heterogeneity, retrospective design).

Conclusions: Reconstruction should be individualized, prioritizing function and complication risk; oncologic outcomes appear driven by tumor biology/systemic therapy. Heterogeneity and inconsistent failure definitions limited cross-technique comparisons and precluded pooled implant survival.

Significance of study: Our pooled estimates offer practical reference points for counseling families about function and complications across reconstruction options in children aged <12 years while highlighting priorities for standardized reporting and coordinated prospective research.

Purpose: X-linked hypophosphatemia is characterized by skeletal abnormalities, particularly lower limb angular deformities. Although burosumab has demonstrated short-term clinical improvements, its mid- to long-term effects on skeletal alignment remain underexplored. This study evaluated skeletal outcomes of burosumab therapy over 2 years, focusing on lower limb deformities.

Methods: We retrospectively analyzed 20 pediatric X-linked hypophosphatemia patients (10 boys and 10 girls) who initiated burosumab at a mean age of 7.5 ± 2.4 years. Rickets severity score, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, and standing height were assessed at baseline, 12 months, and 24 months. Outcomes were analyzed using age-standardized z-scores.

Results: Rickets severity improved from the first year, with Rickets Severity Score decreasing from 3.5 ± 1.2 to 0.6 ± 0.5 at 24 months (mean change 2.9; 95% confidence interval 2.4-3.4). Lower limb alignment also improved: |z|-mechanical axis deviation decreased from 2.3 ± 1.6 to 1.0 ± 1.0 (change 1.3; 95% confidence interval 0.9-1.7), showing progressive correction from the first year. |z|-mechanical lateral distal femoral angle improved mainly at 24 months, decreasing from 2.7 ± 2.1 to 1.3 ± 1.2 (change 1.4; 95% confidence interval 0.8-2.0). |z|-medial proximal tibial angle and |z|-lateral distal tibial angle showed smaller overall changes (0.8 and 0.9, respectively), indicating modest tibial correction. Standing-height z-scores remained stable (-1.5 ± 0.8 to -1.3 ± 0.7), with no measurable change in growth over 2 years.

Conclusions: Burosumab therapy may improve skeletal deformities in pediatric X-linked hypophosphatemia. Early improvements in rickets severity were followed by gains in alignment, particularly mechanical axis deviation and mechanical lateral distal femoral angle, though standing height remained unaffected. Longer-term follow-up is required to confirm sustained skeletal benefits.

Level of evidence: Level IV.

Objectives: To identify lifestyle-related risk factors for growing pains to advance the clinical prevention and management strategies.

Methods: A case-control study was conducted from September 2023 to December 2024, enrolling 290 children clinically diagnosed with growing pains (case group) and 467 age-matched healthy controls. All participants underwent detailed medical history reviews, physical examinations, imaging examination, and laboratory tests. The main data were collected through structured questionnaires administered to both groups.

Results: The results of univariate analysis showed that factors related to growing pains included maternal exposure to smoking environments, child exposure to smoking environments, preference for vegetables, grains, tubers, legumes, and fruits, sports preference, extreme fatigue after exercise, sleeping with parents at night, fear of sleeping alone, sleep latency between 15 and 30 min, sleep latency between 30 and 60 min, and average waking up twice per night (p < 0.050). Multivariate analysis indicated that maternal near-daily exposure to smoking during pregnancy (p = 0.042, odds ratio = 1.926), sleep latency between 30 and 60 min (p < 0.001, odds ratio = 3.696), and extreme fatigue after exercise (p = 0.015, odds ratio = 15.554) were independent risk factors for the occurrence of growth pain. On the other hand, legume preference (p = 0.001, odds ratio = 0.442) and sports preference (p = 0.009, odds ratio = 0.486) were protective factors against the occurrence of growth pains.

Conclusions: Frequent maternal smoking exposure during pregnancy, prolonged sleep latency (30-60 min), and post-exercise exhaustion are independently associated with a higher prevalence of growing pains. And the preference for legumes and participation in sports were associated with a lower prevalence of growing pains.

Significance of study: The preference for legumes and participation in sports were associated with a lower prevalence of growing pains.

Purpose: Non-surgical treatment is indicated in children with severe developmental dysplasia of the hip. Immobilisation may affect motor development. This study assessed motor outcomes in children treated with closed reduction, cast and brace or closed reduction and brace.

Methods: We conducted a retrospective study on 35 children (mean age 2.1 ± 1.4 months) and a prospective study on 17 children (mean age 1.4 ± 0.9 months), involving 68 hips (22 type D, 31 type III and 15 type IV). Treatment duration averaged 4.7 ± 2.2 months in retrospective study and 3.5 ± 1.9 months in prospective study. Multivariate regression analysed predictors of walking age, including treatment type, age at treatment start, developmental dysplasia of the hip severity, family history and breech presentation. A mixed-effects linear model compared treatment duration across studies. p values of z-score tests on regression coefficients are reported.

Results: Mean walking age was 14.6 ± 2.6 months in retrospective study and 14.7 ± 2.4 months in prospective study. Dysplasia severity (p < 0.05) and later treatment start (p < 0.001) predicted delayed walking age. Treatment type showed no overall effect; however, in type III, casts significantly delayed walking (p < 0.05). Severity had no impact when treatment began before 2 months, whereas later treatment led to significant differences based on severity (p < 0.01). At the last follow-up of prospective study, at 16 months, no parents reported persistent motor impairments compared with peers.

Conclusion: Treatment initiated within 2 months mitigates the effect of developmental dysplasia of the hip severity on motor development, resulting in similar walking outcomes across severities. These results underscore the importance of early treatment in severe developmental dysplasia of the hip.

Level of evidence: II.