Pub Date : 2023-08-23eCollection Date: 2023-10-01DOI: 10.1177/18632521231193711
Joseph L Yellin, Robert G Tysklind, Zaamin B Hussain, Evan T Zheng, Benton E Heyworth, Mininder S Kocher
Purpose: This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease.
Methods: Records of patients ≤18 years old from 2003 to 2016 with a diagnosis of osteochondritis dissecans of the knee and strictly unilateral knee pain were identified. Contralateral (asymptomatic) knee imaging within 1 year of initial presentation was required. Lesion characteristics were evaluated by assessing size, location, and Hefti staging. Both surgical and nonoperative treatments were recorded. Patients with unilateral osteochondritis dissecans were compared to those with bilateral disease.
Results: Eighty patients, 63 males (79%) and 17 females (21%), with an average age of 13.1 years old, were included. Twenty (25%) of the presenting/symptomatic lesions were deemed stable on magnetic resonance imaging. A positive correlation between lesion size and Hefti classification was appreciated. Twelve patients (15%) were found to have bilateral osteochondritis dissecans on contralateral imaging. There was no significant difference in skeletal maturity between patients with bilateral versus unilateral disease. Fifty-two patients (77%) with unilateral disease underwent surgical intervention, while 9 (75%) of those with bilateral disease underwent surgery on either knee. In patients with an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee.
Conclusions: In patients presenting with unilateral osteochondritis dissecans symptoms, there was a 15% prevalence of bilateral disease, with no difference in age, sex, physeal status, or lesion characteristics between patients with unilateral vs bilateral osteochondritis dissecans lesions. Given the prevalence of asymptomatic contralateral lesions and the required intervention, this study supports early bilateral radiologic knee evaluation.
{"title":"Bilateral osteochondritis dissecans of the knee in pediatric and adolescent patients presenting with unilateral symptoms: An epidemiological and radiographic analysis.","authors":"Joseph L Yellin, Robert G Tysklind, Zaamin B Hussain, Evan T Zheng, Benton E Heyworth, Mininder S Kocher","doi":"10.1177/18632521231193711","DOIUrl":"10.1177/18632521231193711","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease.</p><p><strong>Methods: </strong>Records of patients ≤18 years old from 2003 to 2016 with a diagnosis of osteochondritis dissecans of the knee and strictly unilateral knee pain were identified. Contralateral (asymptomatic) knee imaging within 1 year of initial presentation was required. Lesion characteristics were evaluated by assessing size, location, and Hefti staging. Both surgical and nonoperative treatments were recorded. Patients with unilateral osteochondritis dissecans were compared to those with bilateral disease.</p><p><strong>Results: </strong>Eighty patients, 63 males (79%) and 17 females (21%), with an average age of 13.1 years old, were included. Twenty (25%) of the presenting/symptomatic lesions were deemed stable on magnetic resonance imaging. A positive correlation between lesion size and Hefti classification was appreciated. Twelve patients (15%) were found to have bilateral osteochondritis dissecans on contralateral imaging. There was no significant difference in skeletal maturity between patients with bilateral versus unilateral disease. Fifty-two patients (77%) with unilateral disease underwent surgical intervention, while 9 (75%) of those with bilateral disease underwent surgery on either knee. In patients with an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee.</p><p><strong>Conclusions: </strong>In patients presenting with unilateral osteochondritis dissecans symptoms, there was a 15% prevalence of bilateral disease, with no difference in age, sex, physeal status, or lesion characteristics between patients with unilateral vs bilateral osteochondritis dissecans lesions. Given the prevalence of asymptomatic contralateral lesions and the required intervention, this study supports early bilateral radiologic knee evaluation.</p><p><strong>Level of evidence: </strong>IV, Retrospective Case series.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 5","pages":"481-488"},"PeriodicalIF":1.4,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/5c/10.1177_18632521231193711.PMC10549690.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is "3-point support and fixation," and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail. This study aims to present a novel tool for pre-bending the elastic stable intramedullary nails and the results of using this tool by surgeons.
Methods: A designed case of femoral shaft fracture was provided to the participants. All participants were divided into three groups according to their experience with the elastic stable intramedullary nail technique: resident, fellow, and attending groups. The time of completing the pre-bending and coronal plane deviation of the nails after pre-bending was recorded. Statistical analysis compared the data in a conventional way and with the new tools in each group.
Results: A total of 30 physicians were recruited in this study. The pre-bending duration with the new tool was significantly shorter than that of the conventional method for all physicians (p< 0.001). The coronal plane deviation of nails after pre-bending by the new tool was significantly smaller than that of the conventional method for all physicians (p< 0.001).
Conclusion: This novel tool for elastic stable intramedullary nail pre-bending was convenient and easy to use in achieving the principal role of the elastic stable intramedullary nail technique. Physicians could reduce the coronal plane deviation when pre-bending elastic stable intramedullary nails, especially for physicians with less experience with the elastic stable intramedullary nail technique.
{"title":"A novel pre-bending tool for elastic stable intramedullary nailing: An efficient and accurate study.","authors":"Wen Shu, LongJun Yu, Theddy Slongo, Saroj Rai, Haobo Zhong, Xin Tang","doi":"10.1177/18632521231193713","DOIUrl":"10.1177/18632521231193713","url":null,"abstract":"<p><strong>Purpose: </strong>The elastic stable intramedullary nail has been recognized as an accepted technique for treating pediatric long bone fractures. The principle of the technique is \"3-point support and fixation,\" and it should be followed to achieve the optimum outcome without implant failure and complications. However, tools have yet to be reported for pre-bending of the elastic stable intramedullary nail. This study aims to present a novel tool for pre-bending the elastic stable intramedullary nails and the results of using this tool by surgeons.</p><p><strong>Methods: </strong>A designed case of femoral shaft fracture was provided to the participants. All participants were divided into three groups according to their experience with the elastic stable intramedullary nail technique: resident, fellow, and attending groups. The time of completing the pre-bending and coronal plane deviation of the nails after pre-bending was recorded. Statistical analysis compared the data in a conventional way and with the new tools in each group.</p><p><strong>Results: </strong>A total of 30 physicians were recruited in this study. The pre-bending duration with the new tool was significantly shorter than that of the conventional method for all physicians (<i>p</i> <b><</b> 0.001). The coronal plane deviation of nails after pre-bending by the new tool was significantly smaller than that of the conventional method for all physicians (<i>p</i> <b><</b> 0.001).</p><p><strong>Conclusion: </strong>This novel tool for elastic stable intramedullary nail pre-bending was convenient and easy to use in achieving the principal role of the elastic stable intramedullary nail technique. Physicians could reduce the coronal plane deviation when pre-bending elastic stable intramedullary nails, especially for physicians with less experience with the elastic stable intramedullary nail technique.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 5","pages":"453-458"},"PeriodicalIF":1.4,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/d8/10.1177_18632521231193713.PMC10549693.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231182430
Jiahao Jiao, Dong Guo, Jun Cao, Xuejun Zhang, Ziming Yao
Purpose: To explore scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and internal fixation.
Methods: We retrospectively analyzed 56 children with dysplastic spondylolisthesis who underwent surgical reduction and internal fixation. Patients were grouped according to presence of scoliosis before surgery. Radiographic parameters measured before surgery included pelvic incidence, pelvic tilt, sacral slope, coronal Cobb angle, slip percentage, Dubousset's lumbosacral angle, lumbar lordosis, sagittal vertical axis, and Spinal Deformity Study Group index. Groups were compared using logistic regression. Receiver operating characteristic analysis was performed to determine the optimal Spinal Deformity Study Group index cut-off value. All patients were followed up for at least 2 years.
Results: The scoliosis group comprises 36 patients (mean age: 9.6 ± 2.7 years), while the no scoliosis group comprises 20 (mean age: 9.1 ± 2.4 years). Slip percentage and Spinal Deformity Study Group index were significantly higher in the scoliosis group (p < 0.01). Sacral slope and pelvic incidence were lower in the scoliosis group (p < 0.05). Univariate logistic regression analysis showed that slip percentage, Spinal Deformity Study Group index, pelvic incidence, and sacral slope were significantly associated with scoliosis. In the multivariate logistic regression analysis, only Spinal Deformity Study Group index was an independent risk factor for scoliosis. The optimal cut-off value for Spinal Deformity Study Group index was 0.288. Mean Cobb angle decreased from 20.3° ± 8.8° before surgery to 8.5° ± 8.9° at last follow-up; the mean scoliosis correction rate was 59.3%.
Conclusion: Severe S1 dysplasia and high slip percentage may be risk factors for developing scoliosis in patients with dysplastic spondylolisthesis. Scoliosis resolved spontaneously after spondylolisthesis reduction and fixation in most patients.
{"title":"Scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and fixation.","authors":"Jiahao Jiao, Dong Guo, Jun Cao, Xuejun Zhang, Ziming Yao","doi":"10.1177/18632521231182430","DOIUrl":"https://doi.org/10.1177/18632521231182430","url":null,"abstract":"<p><strong>Purpose: </strong>To explore scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and internal fixation.</p><p><strong>Methods: </strong>We retrospectively analyzed 56 children with dysplastic spondylolisthesis who underwent surgical reduction and internal fixation. Patients were grouped according to presence of scoliosis before surgery. Radiographic parameters measured before surgery included pelvic incidence, pelvic tilt, sacral slope, coronal Cobb angle, slip percentage, Dubousset's lumbosacral angle, lumbar lordosis, sagittal vertical axis, and Spinal Deformity Study Group index. Groups were compared using logistic regression. Receiver operating characteristic analysis was performed to determine the optimal Spinal Deformity Study Group index cut-off value. All patients were followed up for at least 2 years.</p><p><strong>Results: </strong>The scoliosis group comprises 36 patients (mean age: 9.6 ± 2.7 years), while the no scoliosis group comprises 20 (mean age: 9.1 ± 2.4 years). Slip percentage and Spinal Deformity Study Group index were significantly higher in the scoliosis group (p < 0.01). Sacral slope and pelvic incidence were lower in the scoliosis group (p < 0.05). Univariate logistic regression analysis showed that slip percentage, Spinal Deformity Study Group index, pelvic incidence, and sacral slope were significantly associated with scoliosis. In the multivariate logistic regression analysis, only Spinal Deformity Study Group index was an independent risk factor for scoliosis. The optimal cut-off value for Spinal Deformity Study Group index was 0.288. Mean Cobb angle decreased from 20.3° ± 8.8° before surgery to 8.5° ± 8.9° at last follow-up; the mean scoliosis correction rate was 59.3%.</p><p><strong>Conclusion: </strong>Severe S1 dysplasia and high slip percentage may be risk factors for developing scoliosis in patients with dysplastic spondylolisthesis. Scoliosis resolved spontaneously after spondylolisthesis reduction and fixation in most patients.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"360-366"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/0f/10.1177_18632521231182430.PMC10411372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231191687
Shlomo Wientroub, Fritz Hefti
{"title":"Introducing <i>Journal of Children's Orthopaedics</i>' ChatGPT and generative AI policy.","authors":"Shlomo Wientroub, Fritz Hefti","doi":"10.1177/18632521231191687","DOIUrl":"https://doi.org/10.1177/18632521231191687","url":null,"abstract":"","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"297-298"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/5f/10.1177_18632521231191687.PMC10411371.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10327507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231185294
Nai Kuang Wang, Shih Hsien Shen, Brian Po Jung Chen, Chia Hsieh Chang, Ken N Kuo
Purpose: The acetabulum interacts with the femoral head in daily activities and may exhibit structural changes in the presence of hip disorders. This study aims to redefine hip disorders in children with cerebral palsy by structural characteristics of the acetabulum in relation to the degree of the migration percentage.
Methods: The clinical and radiographic data of 70 patients (36 males, 34 females; mean age 8.2 years) with spastic cerebral palsy were retrospectively analyzed. The acetabular structure was measured by the acetabular index on reconstructed three-dimensional computerized tomography for precision of measurement. Any significant change in acetabular index measured on the reconstructive computerized tomography related to every 10% increment of migration percentage was regarded as clinically significant in hip disorders.
Results: The acetabular index measured on the reconstructive computerized tomography showed an increasing trend with the increment of migration percentage. The most significant acetabular index measured on the reconstructive computerized tomography change occurred between the 20%-29% and 30%-39% migration percentage groups (p < 0.001), suggesting that a migration percentage of 30% is the starting point of hip disorder. A significant increase in the posterolateral acetabular index measured on the reconstructive computerized tomography occurred in migration percentages >50%, indicating posterolateral acetabular dysplasia. Hips with migration percentages from 80% to 100% had consistent acetabular indexes measured on the reconstructive computerized tomography values, suggesting complete dislocation and no more contact and interaction between the femoral head and acetabular fossa.
Conclusion: Structural characteristics in the acetabulum reflect hip dysfunction and potentially classify hip disorders. Results suggest the migration percentage 30% as a starting point of hip disorder and 80% as a turning point of hip dislocation in children with cerebral palsy.
{"title":"Definition of hip displacement and dislocation by acetabular dysplasia in children with cerebral palsy.","authors":"Nai Kuang Wang, Shih Hsien Shen, Brian Po Jung Chen, Chia Hsieh Chang, Ken N Kuo","doi":"10.1177/18632521231185294","DOIUrl":"https://doi.org/10.1177/18632521231185294","url":null,"abstract":"<p><strong>Purpose: </strong>The acetabulum interacts with the femoral head in daily activities and may exhibit structural changes in the presence of hip disorders. This study aims to redefine hip disorders in children with cerebral palsy by structural characteristics of the acetabulum in relation to the degree of the migration percentage.</p><p><strong>Methods: </strong>The clinical and radiographic data of 70 patients (36 males, 34 females; mean age 8.2 years) with spastic cerebral palsy were retrospectively analyzed. The acetabular structure was measured by the acetabular index on reconstructed three-dimensional computerized tomography for precision of measurement. Any significant change in acetabular index measured on the reconstructive computerized tomography related to every 10% increment of migration percentage was regarded as clinically significant in hip disorders.</p><p><strong>Results: </strong>The acetabular index measured on the reconstructive computerized tomography showed an increasing trend with the increment of migration percentage. The most significant acetabular index measured on the reconstructive computerized tomography change occurred between the 20%-29% and 30%-39% migration percentage groups (p < 0.001), suggesting that a migration percentage of 30% is the starting point of hip disorder. A significant increase in the posterolateral acetabular index measured on the reconstructive computerized tomography occurred in migration percentages >50%, indicating posterolateral acetabular dysplasia. Hips with migration percentages from 80% to 100% had consistent acetabular indexes measured on the reconstructive computerized tomography values, suggesting complete dislocation and no more contact and interaction between the femoral head and acetabular fossa.</p><p><strong>Conclusion: </strong>Structural characteristics in the acetabulum reflect hip dysfunction and potentially classify hip disorders. Results suggest the migration percentage 30% as a starting point of hip disorder and 80% as a turning point of hip dislocation in children with cerebral palsy.</p><p><strong>Level of evidence: </strong>level IV, diagnostic study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"315-321"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/d6/10.1177_18632521231185294.PMC10411378.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side.
Methods: In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children.
Results: In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age.
Conclusions: The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances.
{"title":"A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips.","authors":"Doğaç Karagüven, Pervin Demir, Selcen Yüksel, Hakan Ömeroğlu","doi":"10.1177/18632521231177272","DOIUrl":"https://doi.org/10.1177/18632521231177272","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side.</p><p><strong>Methods: </strong>In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children.</p><p><strong>Results: </strong>In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age.</p><p><strong>Conclusions: </strong>The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances.</p><p><strong>Level of evidence: </strong>level V.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"299-305"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/00/10.1177_18632521231177272.PMC10411377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231182422
Yunan Lu, Federico Canavese, Yongjie Xia, Ran Lin, Dianhua Huang, Tianlai Chen, Shunyou Chen
Purpose: The simultaneous and ipsilateral occurrence of medial epicondylar and radial neck fractures is rare. This study evaluated the clinical and radiological outcomes of medial to lateral diagonal injury of the elbow (MELAINE).
Methods: Six males and 6 females were diagnosed with MELAINE (left: 10, 83.3%; right: 2, 16.7%). Medial epicondylar and radial neck fractures were classified according to Papavasiliou's classification (seven type II, two type III, three type IV) and Judet's classification (three type I, four type II and five type III), respectively. All patients underwent surgery. The carrying angle, range of motion, and Kim et al. Elbow Performance Score were used to evaluate clinical and functional outcomes; related complications were recorded.
Results: Mean age at injury and mean follow-up were 11.1 ± 2.5 (range, 6-14) and 40 ± 25.6 months (range, 13-90), respectively. All fractures consolidated in 6.3 ± 1.2 weeks on average (4-9). Outcomes were good (n = 1; 8.3%) to excellent (n = 11; 91.7%). The carrying angle of the injured and uninjured side was 15.5°± 2.6° and 14.7°± 2°, respectively (p = 0.218). The range of motion of elbow flexion-extension and forearm pronation-supination of the injured side was 144.2°± 10.4°, 4.6°± 5.4°, 76.7°± 9.1°, 80.4°± 9.2°, respectively, with no significant differences from the healthy side (p > 0.05). The Elbow Performance Score of the injured and uninjured side was 96.3 ± 5.3 and 98.8 ± 2.3, respectively (p = 0.139). No cases of infection, cubitus valgus, stiffness, or instability were recorded.
Conclusion: Although uncommon, MELAINE should not be neglected. Surgery aims to stabilize the elbow and avoid valgus deformity. If diagnosed and treated, clinical and radiological results are excellent in most cases.
{"title":"Diagnosis and treatment of \"medial to lateral diagonal injury of the elbow\" in children: Concomitant medial epicondylar and radial neck fractures.","authors":"Yunan Lu, Federico Canavese, Yongjie Xia, Ran Lin, Dianhua Huang, Tianlai Chen, Shunyou Chen","doi":"10.1177/18632521231182422","DOIUrl":"https://doi.org/10.1177/18632521231182422","url":null,"abstract":"<p><strong>Purpose: </strong>The simultaneous and ipsilateral occurrence of medial epicondylar and radial neck fractures is rare. This study evaluated the clinical and radiological outcomes of medial to lateral diagonal injury of the elbow (MELAINE).</p><p><strong>Methods: </strong>Six males and 6 females were diagnosed with MELAINE (left: 10, 83.3%; right: 2, 16.7%). Medial epicondylar and radial neck fractures were classified according to Papavasiliou's classification (seven type II, two type III, three type IV) and Judet's classification (three type I, four type II and five type III), respectively. All patients underwent surgery. The carrying angle, range of motion, and Kim et al. Elbow Performance Score were used to evaluate clinical and functional outcomes; related complications were recorded.</p><p><strong>Results: </strong>Mean age at injury and mean follow-up were 11.1 ± 2.5 (range, 6-14) and 40 ± 25.6 months (range, 13-90), respectively. All fractures consolidated in 6.3 ± 1.2 weeks on average (4-9). Outcomes were good (n = 1; 8.3%) to excellent (n = 11; 91.7%). The carrying angle of the injured and uninjured side was 15.5°± 2.6° and 14.7°± 2°, respectively (p = 0.218). The range of motion of elbow flexion-extension and forearm pronation-supination of the injured side was 144.2°± 10.4°, 4.6°± 5.4°, 76.7°± 9.1°, 80.4°± 9.2°, respectively, with no significant differences from the healthy side (p > 0.05). The Elbow Performance Score of the injured and uninjured side was 96.3 ± 5.3 and 98.8 ± 2.3, respectively (p = 0.139). No cases of infection, cubitus valgus, stiffness, or instability were recorded.</p><p><strong>Conclusion: </strong>Although uncommon, MELAINE should not be neglected. Surgery aims to stabilize the elbow and avoid valgus deformity. If diagnosed and treated, clinical and radiological results are excellent in most cases.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"339-347"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/a5/10.1177_18632521231182422.PMC10411373.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10667049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231182420
Nakul S Talathi, Brendan Shi, Jeremy Policht, Bailey Mooney, Kevin Y Chen, Mauricio Silva, Rachel M Thompson
Introduction: Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction.
Methods: We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups.
Results: A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis.
Conclusion: Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population.
Level of evidence: level III Case Control Study.
第三前臂远端骨折是儿童常见的骨折。虽然结果通常很好,但一些患者最初的非手术治疗失败,需要干预。本研究的目的是确定与闭合复位失败相关的独立危险因素。方法:我们对儿童第三前臂远端骨折采用闭合复位铸造治疗的病例进行回顾性分析。患者被分为两组,一组成功闭合复位,另一组失败的初始非手术治疗。统计学特征、铸造类型、铸造指数、x线骨折、软组织特征和复位质量进行分析。结果:共有207例儿童前臂远端第三骨折纳入分析。共有190例(91.8%)患儿保持了下降,17例(8.2%)患儿首次非手术治疗失败。单变量分析显示,与复位损失相关的可变危险因素包括使用长臂石膏(p = 0.003)、复位后移位增加(p = 0.02)和复位后角度畸形增加(p = 0.01)。不可改变的危险因素包括体重指数增加(p = 0.02),骨折移位增加(p = 0.002),骨折部位软组织包膜宽度增加(p = 0.0001)。在多因素分析后,使用长臂石膏(13% vs 2%,优势比= 6.44)和软组织宽度(60.6 vs 50.4 mm,优势比= 1.1)仍然是减少损失的重要危险因素。结论:在儿童人群中,骨折部位较大的软组织包膜和长臂石膏固定与第3前臂远端骨折初始闭合复位失败的风险增加独立相关。证据等级:III级病例对照研究。
{"title":"Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?","authors":"Nakul S Talathi, Brendan Shi, Jeremy Policht, Bailey Mooney, Kevin Y Chen, Mauricio Silva, Rachel M Thompson","doi":"10.1177/18632521231182420","DOIUrl":"https://doi.org/10.1177/18632521231182420","url":null,"abstract":"<p><strong>Introduction: </strong>Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction.</p><p><strong>Methods: </strong>We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups.</p><p><strong>Results: </strong>A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis.</p><p><strong>Conclusion: </strong>Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population.</p><p><strong>Level of evidence: </strong>level III Case Control Study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"332-338"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231182423
Yuchan Li, Zhigang Wang, Mingyuan Miao, Yunlan Xu, Jing Shi
Purpose: To evaluate the residual acetabular dysplasia in Graf type II hips after Pavlik harness treatment with a radiographic follow-up at 2 years of age.
Methods: We retrospectively reviewed the developmental dysplasia of the hip patients who were treated with the Pavlik harness between March 2018 and February 2022. Patients with Graf type II hip dysplasia who had at least one radiographic follow-up after 2 years of age were included. The following information, sex, laterality, affected side, age at harness initiation, treatment duration, α angle, and the morphology of bony roof, was collected and studied. We evaluated the radiographic acetabular index at the last follow-up and defined the value of greater than 2 standard deviations as residual acetabular dysplasia.
Results: A total of 33 patients (53 hips) met the criteria. The mean initial α angle was 53.4°; the mean age at Pavlik harness initiation was 10.9 weeks. The mean treatment duration was 10 weeks. The mean α angle at the last ultrasound follow-up was 64.9°. The mean age of the last radiographic follow-up was 2.6 years, and 26 hips had a residual acetabular dysplasia with acetabular indexes greater than 2 standard deviations above the mean. The morphology of the acetabular bony rim (odds ratio = 4.333, P = 0.029) and age of initial treatment <12 weeks (odds ratio = 7.113, P = 0.014) were seen as significant predictors for a higher acetabular index more than 2 years of age.
Conclusions: A notable incidence of residual acetabular dysplasia after Pavlik harness treatment in Graf type II hips, wherein the acetabular bony roof with a blunt rim at the end of treatment and initial age after 12 weeks were independent predictors associated with residual acetabular dysplasia.
{"title":"Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips.","authors":"Yuchan Li, Zhigang Wang, Mingyuan Miao, Yunlan Xu, Jing Shi","doi":"10.1177/18632521231182423","DOIUrl":"https://doi.org/10.1177/18632521231182423","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the residual acetabular dysplasia in Graf type II hips after Pavlik harness treatment with a radiographic follow-up at 2 years of age.</p><p><strong>Methods: </strong>We retrospectively reviewed the developmental dysplasia of the hip patients who were treated with the Pavlik harness between March 2018 and February 2022. Patients with Graf type II hip dysplasia who had at least one radiographic follow-up after 2 years of age were included. The following information, sex, laterality, affected side, age at harness initiation, treatment duration, α angle, and the morphology of bony roof, was collected and studied. We evaluated the radiographic acetabular index at the last follow-up and defined the value of greater than 2 standard deviations as residual acetabular dysplasia.</p><p><strong>Results: </strong>A total of 33 patients (53 hips) met the criteria. The mean initial α angle was 53.4°; the mean age at Pavlik harness initiation was 10.9 weeks. The mean treatment duration was 10 weeks. The mean α angle at the last ultrasound follow-up was 64.9°. The mean age of the last radiographic follow-up was 2.6 years, and 26 hips had a residual acetabular dysplasia with acetabular indexes greater than 2 standard deviations above the mean. The morphology of the acetabular bony rim (odds ratio = 4.333, P = 0.029) and age of initial treatment <12 weeks (odds ratio = 7.113, P = 0.014) were seen as significant predictors for a higher acetabular index more than 2 years of age.</p><p><strong>Conclusions: </strong>A notable incidence of residual acetabular dysplasia after Pavlik harness treatment in Graf type II hips, wherein the acetabular bony roof with a blunt rim at the end of treatment and initial age after 12 weeks were independent predictors associated with residual acetabular dysplasia.</p><p><strong>Levels of evidence: </strong>Therapeutic studies, IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"306-314"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/30/10.1177_18632521231182423.PMC10411375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10332196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.1177/18632521231177273
Dane J Brodke, Katherine Makaroff, Enda G Kelly, Mauricio Silva, Rachel M Thompson
Purpose: Structured visual gait assessment is essential for the evaluation of pediatric patients with neuromuscular conditions. The purpose of this study was to evaluate the benefit of slow-motion video recorded on a standard smartphone to augment visual gait assessment.
Methods: Coronal and sagittal plane videos of the gait of five pediatric subjects were recorded on a smartphone, including four subjects with ambulatory cerebral palsy and one subject without gait pathology. Twenty-one video scorers were recruited and randomized to evaluate slow-motion or normal-speed videos utilizing the Edinburgh Visual Gait Score. The slow-motion group (N = 11) evaluated the videos at one-eighth speed, and the normal-speed group (N = 10) evaluated the same videos at normal speed. Interrater reliabilities were determined by calculating intraclass correlation coefficients for each group as a whole, for each Edinburgh Visual Gait Score item, and after stratification by evaluator experience level.
Results: The slow-motion group exhibited an intraclass correlation coefficient of 0.65 (95% confidence interval: 0.58-0.73), whereas the normal-speed group exhibited an intraclass correlation coefficient of 0.57 (95% confidence interval: 0.49-0.65). For less-experienced scorers, intraclass correlation coefficients of 0.62 (95% confidence interval: 0.53-0.71) and 0.50 (95% confidence interval: 0.40-0.59) were calculated for slow motion and normal speed, respectively. For more-experienced scorers, intraclass correlation coefficients of 0.69 (95% confidence interval: 0.61-0.76) and 0.67 (95% confidence interval: 0.58-0.75) were calculated for slow motion and normal speed, respectively.
Conclusions: Visual gait assessment is enhanced by the use of slow-motion smartphone video, a tool widely available throughout the world with no marginal cost.
{"title":"Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy.","authors":"Dane J Brodke, Katherine Makaroff, Enda G Kelly, Mauricio Silva, Rachel M Thompson","doi":"10.1177/18632521231177273","DOIUrl":"https://doi.org/10.1177/18632521231177273","url":null,"abstract":"<p><strong>Purpose: </strong>Structured visual gait assessment is essential for the evaluation of pediatric patients with neuromuscular conditions. The purpose of this study was to evaluate the benefit of slow-motion video recorded on a standard smartphone to augment visual gait assessment.</p><p><strong>Methods: </strong>Coronal and sagittal plane videos of the gait of five pediatric subjects were recorded on a smartphone, including four subjects with ambulatory cerebral palsy and one subject without gait pathology. Twenty-one video scorers were recruited and randomized to evaluate slow-motion or normal-speed videos utilizing the Edinburgh Visual Gait Score. The slow-motion group (N = 11) evaluated the videos at one-eighth speed, and the normal-speed group (N = 10) evaluated the same videos at normal speed. Interrater reliabilities were determined by calculating intraclass correlation coefficients for each group as a whole, for each Edinburgh Visual Gait Score item, and after stratification by evaluator experience level.</p><p><strong>Results: </strong>The slow-motion group exhibited an intraclass correlation coefficient of 0.65 (95% confidence interval: 0.58-0.73), whereas the normal-speed group exhibited an intraclass correlation coefficient of 0.57 (95% confidence interval: 0.49-0.65). For less-experienced scorers, intraclass correlation coefficients of 0.62 (95% confidence interval: 0.53-0.71) and 0.50 (95% confidence interval: 0.40-0.59) were calculated for slow motion and normal speed, respectively. For more-experienced scorers, intraclass correlation coefficients of 0.69 (95% confidence interval: 0.61-0.76) and 0.67 (95% confidence interval: 0.58-0.75) were calculated for slow motion and normal speed, respectively.</p><p><strong>Conclusions: </strong>Visual gait assessment is enhanced by the use of slow-motion smartphone video, a tool widely available throughout the world with no marginal cost.</p><p><strong>Level of evidence: </strong>level I, randomized study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":"17 4","pages":"376-381"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/af/10.1177_18632521231177273.PMC10411369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10332199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}