Journal of Childrens Orthopaedics最新文献

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.

Purpose: This study aimed to investigate foot kinematics during gait in individuals with idiopathic clubfoot initially treated with the Ponseti method, focusing on clubfoot-specific deformities, to improve the understanding of posttreatment functional impairments.

Methods: In this prospective cohort study, 23 patients with treated idiopathic clubfoot (34 feet) were compared with 15 age-matched healthy controls (30 feet). Gait analysis was performed using the Heidelberg Foot Model. To characterize residual clubfoot deformities, selected kinematic parameters included medial arch and subtalar angles, as well as intersegmental angles between hindfoot-shank and forefoot-hindfoot, based on more functional joint centers. Within the patient group, potential influence of additional surgical interventions was explored.

Results: Compared with controls, treated idiopathic clubfoot exhibited significant reductions in hindfoot sagittal and transverse range of motion, forefoot sagittal range of motion, and medial arch mobility. Equinus deformity was not present posttreatment, as dorsiflexion metrics during stance did not differ significantly. However, plantarflexion range of motion during the transition to swing was reduced. In addition, treated idiopathic clubfoot showed persistent subtalar inversion and hindfoot varus, increased mid-stance adductus in both hindfoot and forefoot, and pronounced arch stiffness during transition to swing. Within the patient group, ankle and subtalar capsulotomy was associated with increased medial arch cavus.

Conclusion: Patients with treated idiopathic clubfoot exhibit a functionally stiffer foot with altered alignment during gait, contributing to impaired limb advancement. The results expand the understanding of residual clubfoot deformities and highlight the importance of detailed functional assessment posttreatment, providing a foundation for future research.

Level of evidence: Level II, prognostic study.

Chronic patellofemoral instability is common in children and adolescents. While it may follow a single traumatic injury to an otherwise healthy and anatomically normal knee, several predisposing anatomical risk factors are often present. This review assesses the treatment of recurrent patellar dislocation in children and adolescents. A literature review was performed, accompanied by the authors' current suggested practice. Surgical interventions are often required, and the available procedures depend on the stage of skeletal maturity. Soft-tissue procedures aim to restore medial patellar constraints, with medial patellofemoral ligament reconstruction being the most important treatment across all age groups. Reconstruction of the medial patellotibial ligament and medial quadriceps tendon femoral ligament is a developing technique to enhance medial stability. In skeletally immature children, patella alta may be addressed with tendon shortening, and an increased tibial tuberosity versus trochlear groove distance may warrant medialization procedures such as the Grammont technique. Valgus knee is managed with growth modulation. After physeal closure, treatment options include tibial tuberosity osteotomy with distalization and medialization, as well as femoral varus or rotational osteotomy in severe cases. Trochleoplasty is also an option for adolescents after growth plate fusion. Thorough clinical and imaging evaluation is essential in cases of recurrent lateral patellar dislocation. Treatment is selected based on the likelihood of success with isolated medial patellofemoral ligament reconstruction, success underpinned by the presence of underlying anatomical risk factors and the stage of skeletal maturity for each patient. Level of evidence: Level III.

Purpose: Scoliosis is a prevalent condition among individuals with cerebral palsy, characterized by an inability to maintain spinal alignment due to diminished muscle tone. This progressive curvature becomes structural over time, resulting in physical impairment and challenges in daily activities. Consequently, therapeutic intervention is essential. Historically, brace therapy has been extensively utilized, but its efficacy remains uncertain.

Methods: A systematic review was conducted across four databases to compile all relevant studies and reviews pertaining to brace therapy in cerebral palsy patients. Each article was independently assessed by two researchers and evaluated using the SIGN tool.

Results: Eight studies were included, comprising six retrospective and two prospective studies, all rated as "acceptable" or "high quality." Brace therapy demonstrated a temporary positive effect, with improved Cobb angles observed during brace usage, particularly in patients under 15 years of age, due to incomplete spinal maturation. However, this improvement is transient, as Cobb angles tend to increase once the brace is removed, diminishing its effectiveness. In addition, brace therapy positively impacts quality of life by enhancing posture and reducing pain, although these benefits also diminish over time, potentially leading to a decline in quality of life.

Conclusions: Brace therapy offers temporary relief for physical and daily life challenges associated with cerebral palsy. However, its effects are not sustained, necessitating operative techniques for long-term management. This was a systematic review of Level-II studies or Level-I studies with inconsistent results.

Purpose: Paediatric forearm fractures are among the most common childhood injuries, with diaphyseal fractures often requiring surgical management due to their instability and poorer remodelling potential. Traditional methods, such as elastic stable intramedullary nailing, are effective but require secondary procedures for implant removal, increasing healthcare burdens. Bioabsorbable intramedullary nails offer an alternative, eliminating the need for implant removal. This systematic review and meta-analysis evaluates the efficacy and safety of bioabsorbable intramedullary nails compared to conventional methods.

Methods: Five studies, including 255 paediatric patients with 399 forearm fractures, were included. Of these, 159 were treated with bioabsorbable intramedullary nails. Meta-analyses assessed outcomes, including fracture healing time, complications, functional results and reoperation rates.

Results: Bioabsorbable intramedullary nails demonstrated fracture healing times comparable to elastic stable intramedullary nailing (10.67 weeks; 95% CI: 8.92-11.42) with no significant differences. Complication rates were similar, with nine re-fractures in the bioabsorbable intramedullary nail group and 10 in the elastic stable intramedullary nailing group. Secondary displacement occurred in 3.1% of bioabsorbable intramedullary nail patients versus 4.7% for elastic stable intramedullary nailing. Functional outcomes showed improved pronation (78.5° versus 72.7°, p = 0.030) and elbow flexion (153.8° versus 144.8°, p = 0.001) for bioabsorbable intramedullary nails. Pain scores were comparable, with fewer bioabsorbable intramedullary nail patients reporting postoperative pain.

Conclusions: Bioabsorbable intramedullary nails are a safe and effective alternative to elastic stable intramedullary nailing, offering equivalent clinical outcomes while eliminating the need for implant removal. Larger, long-term studies are needed to confirm these findings and evaluate the cost-effectiveness of bioabsorbable intramedullary nails in paediatric fracture management.

Purpose: To assess ultrasonographic features of hip morphology in mucopolysaccharidosis type I Hurler.

Methods: Acetabular bony rim, acetabular cartilaginous roof, alpha and beta angles, echogenicity, and hip coverage were analyzed in eight mucopolysaccharidosis type I Hurler syndrome children before and after hematopoietic stem cell gene therapy.

Results: Sixteen hips at baseline, 10 at +12 months, and 10 at + 24 months after hematopoietic stem cell gene therapy were evaluated. The median age was 22, 35, and 45 months at baseline evaluation, +12, and +24 months, respectively. Acetabular bony rim at baseline was angular in 2/16, rounded in 10/16, notched in 2/16, and flattened in 2/16; at +12 months, angular in 2/10, rounded in 5/10, notched in 3/10; at +24 months, angular in 2/10, rounded in 3/10, irregular in 1/10, and notched in 4/10. Acetabular cartilaginous roof at baseline was normal in 4/16, enlarged in 12/16; at +12 months, enlarged in 10/10 and at +24 months, enlarged in 8/10 and normal in 2/10. Echogenicity of the joint capsule at baseline was normal in 10/16, increased in 6/16; at +12 months, normal in 8/10, increased in 2/10; at +24 months, normal in 6/10, increased in 4/10. The mean femoral head coverage was 60% at baseline (16/16), 62% at +12 months (10/10), and 52% at +24 months (2/10). The mean alpha angle was 60° at baseline (16/16), 64° at +12 months (10/10), and 60° (2/10) at +24 months. The mean beta angle was 67° at baseline (16/16), 65° at +12 months (10/10), and 49° at +24 months (8/10).

Conclusions: Hip morphology of children with mucopolysaccharidosis type I Hurler syndrome before and after hematopoietic stem cell gene therapy can be evaluated by available ultrasound techniques until a median age of 45 months.