Journal of Childrens Orthopaedics最新文献

Purpose: Objectives were to evaluate if gait was improved after multilevel surgery on the involved leg and simultaneously performed guided growth procedure on the uninvolved leg and whether simultaneously performed guided growth is efficient in limb length discrepancy management in hemiplegic children.

Methods: Gait pattern of 78 hemiplegic children (mean age 10.4 years) was evaluated using instrumented gait analysis before surgery and at 2 years. This study involved children with type 2a (Rodda and Graham classification) - 12, type 3 - 20, type 4 - 23, type 4s (undergone triceps lengthening at early age) - 23.

Results: The mean limb length discrepancy was 2.3 cm before surgery and 0.4 cm at final control. In all patients aged over 144 months, the residual length discrepancy was over 10 mm. The improvement in gait kinematics was observed on both the uninvolved and hemiplegic limbs. Finally, control on uninvolved leg kinematics presented values similar to reference values. On the involved leg, there were significant improvements in sagittal and transverse kinematics. Only patients of the 4s (patients undergone previous triceps lengthening surgery at an early age) group had no improvements in ankle flexion moment and power generation.

Conclusion: Multilevel surgery including simultaneous guided growth ensures improvements on both the uninvolved and hemiplegic limb gait kinematics. We suggest guided growth surgery before the age of 12 years for more exact equalization. Isolated triceps performed at an early age represent negative conditions for plantar flexion strength development in long term.

Introduction: Clubfoot is a congenital birth defect affecting musculoskeletal tissues of the affected lower legs, resulting in the typical appearance and changes in muscle-tendon properties. These properties change during development due to growth and activity, but how these properties differ across ages in clubfoot remains not fully understood. This study aimed to describe plantarflexor muscle-tendon volumes between affected and unaffected legs in unilateral clubfoot patients and explore the relationship between muscle volume and age.

Methods: A prospective cross-sectional study was performed on unilateral clubfoot patients treated with the Ponseti method. Muscle-tendon volumes of the medial and lateral gastrocnemius, soleus, and Achilles tendons in both affected and unaffected legs of clubfoot patients were assessed using ultrasound. Volumetric reconstructions were made using three-dimensional ultrasound (3DUS). Statistical analyses compared muscle-tendon volume between legs and their relationship with age.

Results: A total of 25 clubfoot patients with good clinical status aged between 2.0 and 11.8 years were analyzed. Smaller plantarflexor muscle and greater Achilles tendon volumes were found in the affected leg compared to the unaffected leg. Furthermore, age was not significantly related to absolute muscle volume difference between the legs.

Discussion and conclusions: The findings of this study indicate that changes in muscle and tendon volume are present in treated clubfoot patients of multiple ages, enhancing understanding of their muscle-tendon morphology. The clinical significance of muscle-tendon alterations and their adaptation to targeted interventions remains to be established. Further research should investigate the relationship between muscle-tendon morphology and clinical status of (relapsed) clubfoot patients.

Background: Beckwith-Wiedemann spectrum is a genetic disorder characterized by lateralized overgrowth, often presenting as limb bulk discrepancy. While limb-length discrepancies are documented in Beckwith-Wiedemann spectrum, the natural history of limb bulk discrepancy and hand/foot asymmetry progression remains less studied. This research examines limb bulk discrepancy progression in children with Beckwith-Wiedemann spectrum and identifies factors influencing its severity.

Methods: A retrospective, single-institution study analyzed 142 children with molecularly confirmed Beckwith-Wiedemann spectrum (imprinting center 2 loss of methylation, imprinting center 1 gain of methylation, and paternal uniparental isodisomy at chromosome 11). Limb measurements (upper arm, forearm, thigh, calf, palm, finger, and foot) were recorded during clinic visits. Linear mixed-effects models assessed relationships between genotype, age, limb bulk discrepancy progression, body mass index, and sex.

Results: The cohort included 90 imprinting center 2 loss of methylation, 41 paternal uniparental isodisomy at chromosome 11, and 11 imprinting center 1 gain of methylation patients. In the imprinting center 2 loss of methylation group, significant limb bulk discrepancy progression occurred in the upper arm (0.47 mm/year), calf (0.53 mm/year), and foot anterior-posterior dimension (0.40 mm/year; all p < 0.01). The paternal uniparental isodisomy at chromosome 11 genotype showed greater asymmetry in most regions compared to others (p < 0.01), except the middle finger. Asymmetry progression rates were similar across genotypes. Body mass index positively correlated with increased limb bulk discrepancy in the upper arm and calf.

Conclusions: Limb asymmetry in Beckwith-Wiedemann spectrum progresses slowly in specific regions, with genotype and body mass index influencing baseline severity. Patients with paternal uniparental isodisomy at chromosome 11 exhibit greater baseline limb bulk discrepancy, but progression rates are consistent across genotypes, highlighting the need for further research into lateralized overgrowth mechanisms and clinical implications.

Level of evidence: 3-Retrospective cohort study.

Purpose: To describe the curve patterns and behaviors, clinical presentation, treatment modalities, and complications for adolescents with both scoliosis and autism spectrum disorders, but no additional concomitant diagnoses.

Methods: A single-center, retrospective review of adolescents with scoliosis and autism spectrum disorder treated between 2001 and 2021. Patient demographics, clinical characteristics, and radiographic assessments were described across the scoliosis treatment plans (i.e. observation, bracing, and surgery).

Results: Forty patients with scoliosis and autism spectrum disorder (80% male, mean age at 13.2 ± 1.7) met eligibility criteria. Twenty-one patients were managed with observation initially. Of these patients, 55% (n = 11) didn't require further treatment and had an average change in curvature of 5° ± 6°. Twenty-one total patients were managed with bracing. In this group, 76% (n = 16) did not receive further treatments and had an average increase in curvature of 15° ± 11°. Five patients (24%) proceeded to surgery following brace treatment. Thirteen patients (33%) in total required surgery, with n = 5 requiring surgery as their initial treatment. The initial curve magnitude for this group was 55° ± 7° and had an average correction of 47% following posterior spinal fusion.

Conclusions: Although curves in adolescents with scoliosis and autism spectrum disorder had a similar presentation to adolescents with just scoliosis, the current cohort did have an increase in curve progression when managed with bracing, with an unclear explanation. Further study is warranted in this unique population, and families should be counseled that the prognosis may not be the same as adolescents with scoliosis alone.

Levels of evidence: Level IV.

Background: Idiopathic clubfoot is a congenital disorder necessitating time-sensitive treatment. Delayed application of the Ponseti method may result in poorer outcomes. Adverse social determinants of health, as measured with the Childhood Opportunity Index version 3.0, hinder access to care. This study aimed to determine the association between Childhood Opportunity Index, insurance status, and treatment disparities for patients with idiopathic clubfoot.

Methods: This retrospective cohort study included patients with idiopathic clubfoot who underwent Ponseti treatment at an urban tertiary care orthopedic hospital between October 2004 and September 2022. Patients presenting for care before 6 months of age and with a minimum 2-year follow-up were included. A threshold Childhood Opportunity Index value of 60.0 categorized patients into low (<60.0) and high (≥60.0) cohorts. Clinical and treatment/outcome variables were compared.

Results: A total of 156 patients (mean follow-up 5.1 ± 2.5 years) merited inclusion: 31 (20%) with Childhood Opportunity Index <60 and 125 (80%) with Childhood Opportunity Index ≥60. Patients with low Childhood Opportunity Index presented at older ages (18 ± 23 versus 11 ± 10 days, p = 0.03) and had fewer prenatal orthopedic evaluations (42% versus 64%, p = 0.03). Recurrence and necessity for further treatment were similar (p > 0.05). Patients with public insurance presented at older ages (28 ± 31 versus 10 ± 9 days, p < 0.01) and were less likely to undergo prenatal consultation (13% versus 65%, p < 0.01). Black/Hispanic patients were more likely to experience a recurrence (odds ratio 6.4, 95% confidence interval 1.2-35.4, p = 0.03), whereas patients who had a prenatal orthopedic evaluation were less likely to experience a recurrence (odds ratio 0.3, 95% confidence interval 0.1-0.9, p = 0.03).

Conclusions: Patients with idiopathic clubfoot and low Childhood Opportunity Index/public insurance experienced delayed presentation to care and fewer prenatal orthopedic consultations. However, low Childhood Opportunity Index and public insurance status were not associated with adverse treatment outcomes. Clubfoot specialists remain a critical component of the multidisciplinary prenatal team, as orthopedic consultations served as a protective factor against recurrence. These findings contribute to the existing literature by highlighting discrepancies in the care for patients with adverse social determinants of health.

Level of evidence: Level III.

The Journal of Children's Orthopedics has compiled a special collection of scientific publications from Chinese centers accepted for publication in the journal. Through this collection, the Journal of Children's Orthopedics demonstrates its commitment to promoting global knowledge sharing and collaboration in pediatric orthopedic surgery. The articles in the collection undergo the same rigorous peer review process as other articles. Once a publication is assigned to an issue, it is automatically added to the Special Chinese Collection on the Journal of Children's Orthopedics website, where it can be easily downloaded. The Special Chinese Collection's open access policy increases the visibility and global reach of Journal of Children's Orthopedics articles, promoting accelerated citations and collaborations. The Journal of Children's Orthopedics is an ideal platform for collecting and disseminating high-quality, relevant scientific publications in pediatric orthopedic surgery from China. The Special Chinese Collection showcases innovative research, encourages knowledge sharing, and fosters cultural exchange, promoting the development of a global community of researchers and clinicians dedicated to advancing the field of pediatric orthopedic surgery and improving children's lives worldwide.

Purpose: The objective of this study was to evaluate the outcomes of various methods of fixation for pediatric lateral condyle fractures. The null hypothesis was that there would be no difference between the three treatment groups and time of return to the full range of motion.

Method: There were three fixation groups-Algemeinshaft fur osteosynthesegragen (AO) cannulated screws (n = 11), buried Steinmann pins (n = 13), and unburied Steinmann pins (n = 36). Variables evaluated were time to return to full range of motion of the elbow, whether therapy was required, average number of follow-up visits, fracture classification (Milch), time to operating room, duration of immobilization, degree of initial fracture displacement, time to radiographic healing, complications, and if manipulation under anesthesia was done, whether this was planned or not.

Results: Average return to full range of motion for Algemeinshaft fur osteosynthesegragen cannulated screw, buried Steinmann pins, and unburied Steinmann pins were 113, 82.7, and 94 days, respectively. A one-way ANOVA revealed a p-value of 0.11711. p-Values were also insignificant for the average number of follow-up visits, time to operating room, and time of immobilization. The p-value for time to radiographic healing was <0.00001, with times for Algemeinshaft fur osteosynthesegragen cannulated screw, buried Steinmann pins, and unburied Steinmann pins being 75, 35, and 34.9 days, respectively. Notably, the Algemeinshaft fur osteosynthesegragen screw group averaged 9 years old, more than twice the Steinmann pin groups' 4 years.

Conclusion: Data from this sample suggest that there is no difference in return to full range of motion when comparing the three fixation methods. There was a difference in time to radiographic healing with Algemeinshaft fur osteosynthesegragen screws taking the longest, potentially due to age differences.