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A retrospective epidemiological cohort study of ankle fractures in children and teenagers. 儿童和青少年踝关节骨折的回顾性流行病学队列研究。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-08-01 DOI: 10.1177/18632521231182424
Christina Steiger, Giacomo De Marco, Céline Cuérel, Anne Tabard-Fougère, Moez Chargui, Romain Dayer, Dimitri Ceroni

Background: Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications.

Objective: This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old.

Methods: Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected.

Results: We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures).

Conclusion: Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis.

Level of evidence: Level III.

背景:踝关节骨折是最常见的儿童下肢骨折之一,可导致严重的并发症。目的:本研究旨在确定16岁以下儿童踝关节骨折的流行病学,确定骨折类型、治疗方法和并发症。方法:回顾性分析我院2004-2020年收治的所有踝关节骨折患者的病历。收集年龄、性别、损伤机制、骨折类型、治疗方式和并发症等数据。结果:我们检查了328名儿童331例踝关节骨折的记录,男女比例为1:2。年平均患病率为每10万名儿童24.3例。患者平均年龄11.2±4.2岁,10岁以上占75.3%。体育活动占骨折的最大比例(162例;49.4%),其次是下跌(67;20.4%)和道路交通事故(37%;11.3%)。骨骺骨折是最常见的病变类型(223例)。大多数踝关节骨折(60%)采用闭合复位和铸造治疗;对于其余40%的病例,在闭合或开放复位后进行骨折固定,以纠正关节脱节并确保身体的解剖恢复。踝关节骨折的主要并发症是过早生长停止(占所有骨骺骨折的12.1%)。结论:儿童踝关节骨折主要发生在10岁以上的儿童。这些骨折大多是由运动损伤或低能量创伤引起的。这些骨折大多数是骨骺骨折,胫骨远端骨骺骨折的发生率是腓骨远端骨骺骨折的10倍。证据等级:三级。
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引用次数: 0
Localized tenosynovial giant cell tumor in children. 儿童局限性腱滑膜巨细胞瘤。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-07-13 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231186795
Xifeng Du, Anning Xia, Junying Sun, Yinting Ye

Background: To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children.

Methods: The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis.

Results: The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations.

Conclusion: Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate.

Level of evidence: Level III.

背景:探讨儿童局限性腱滑膜巨细胞瘤的临床特点和手术疗效。方法:收集2011-2021年我院就诊的17例局限性腱滑膜巨细胞瘤患儿的临床资料、手术及随访结果进行统计分析。结果:患者的中位年龄为7岁 年和8 月,男女比例为1.43(10/7)。手足疾病的偏好相似,常见症状为肿块。一名患者术后复发,一名儿童术后功能受限。结论:四肢是儿童局限性腱滑膜巨细胞瘤的常见部位。完全手术切除有助于降低复发率。证据级别:三级。
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引用次数: 0
Isolating factors for the prediction of rebound after guided growth with tension band plating for the valgus deformity of the knee. 预测膝外翻畸形张力带钢板引导生长后反弹的隔离因素。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-07-11 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231182432
Alexander Eberle, Anika Stephan, Matthias P Tedeus, Hans M Manner, Hannes A Rüdiger, Vincent A Stadelmann

Purpose: The conditions leading to growth rebound after hemiepiphysiodesis are still poorly understood. This article analyzes the radiographical outcomes after guided growth with tension band plating, using plates in idiopathic genu valgum patients and attempts to generate a predictive model of growth rebound.

Methods: Patients with idiopathic genu valgum deformity who received tension band plating were selected for evaluation. We only analyzed coronal plane deformities. Only patients with a long-standing X-ray before tension band plating surgery, a long-standing X-ray at tension band plating removal, and a long-standing X-ray at the latest follow-up after tension band plating removal were considered for this study. The change of mechanical axis deviation between the tension band plating removal and the last follow-up was evaluated for rebound, and ordinal logistic regression was performed to determine the relevant variables for predictive modeling rebound growth.

Results: Overall, 100 patients (189 legs) were analyzed. The mean mechanical axis deviation at tension band plating removal was 8.4 mm in varus direction, and the mean mechanical axis deviation at the last follow-up was -3.4 mm (p ≤ 0.001). However, 111 legs (59%) showed rebound growth, 57 (30%) stayed stable, and 21 (11%) showed a continuous correction. Six significant factors significantly influencing rebound were isolated which are clinically relevant: sex, age, baseline mechanical axis deviation, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle, and mechanical axis deviation correction rate. Mechanical axis deviation correction rate had the highest odds ratios. The machine learning classification model for predicting rebound growth built from the study data showed a misclassification rate of 39%.

Conclusion: There was a high rate of rebound growth in this cohort, especially for patients at a young age at implantation. The highest risk factors for rebound growth were male sex, and high correction rates, such as found during peak growth spurt. The proposed classification model needs more data to improve its predictive power before it can be used in clinics.

Level of evidence: Level III.

目的:对导致半骨骺切除术后生长反弹的条件仍知之甚少。本文分析了在特发性膝外翻患者中使用张力带钢板引导生长后的放射学结果,并试图建立生长反弹的预测模型。方法:选择接受张力带钢板治疗的特发性膝外翻畸形患者进行评估。我们只分析了冠状面畸形。本研究仅考虑在张力带钢板手术前进行长期X光检查的患者、在移除张力带钢板时进行长期X射线检查的患者以及在移除张力带钢板后最新随访时进行长期X线检查的患者。评估张力带镀层去除和最后一次随访之间机械轴偏差的变化是否存在反弹,并进行有序逻辑回归以确定预测反弹生长建模的相关变量。结果:总共分析了100名患者(189条腿)。张力带镀层去除时的平均机械轴偏差为8.4 内翻方向的平均机械轴偏差为-3.4 毫米(p ≤ 0.001)。然而,111条腿(59%)出现反弹增长,57条腿(30%)保持稳定,21条腿(11%)出现持续矫正。分离出六个显著影响回弹的临床相关因素:性别、年龄、基线机械轴偏移、机械股骨远端外侧角和机械胫骨近端内侧角,以及机械轴偏移校正率。机械轴偏差校正率的比值比最高。根据研究数据建立的用于预测反弹增长的机器学习分类模型显示出39%的错误分类率。结论:该队列中的反弹增长率很高,尤其是对于植入时年龄较小的患者。反弹生长的最高风险因素是男性,校正率高,比如在生长高峰期。所提出的分类模型需要更多的数据来提高其预测能力,然后才能用于临床。证据级别:三级。
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引用次数: 0
Spontaneous improvement of olisthetic scoliosis in children following lumbosacral fusion for high-grade spondylolisthesis: A report of four new cases and systematic review of the literature. 腰骶部融合术治疗高位脊柱侧凸后,儿童畸形脊柱侧凸自发改善:四例新病例报告及文献系统回顾。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-07-05 eCollection Date: 2023-08-01 DOI: 10.1177/18632521231182427
Charles T Mehlman, Alvin H Crawford

Background: The study aim was to present four new well-documented cases of spontaneous improvement of olisthetic scoliosis and to analyze well-documented cases from the literature.

Methods: Surgical log search and systematic review were conducted. Inclusion criteria were (1) age less than 18 years, (2) symptomatic high-grade (≥50%) spondylolisthesis, (3) scoliosis ≥20o, (4) primary surgical treatment via lumbosacral fusion, (5) complete x-rays, and (6) minimum 1-year radiographic follow-up or until curve resolution.

Results: A total of 13 patients with average age of 13.9 years were included in the study, 4 from the authors' surgical logs and 9 from the literature. Slip percentage of L5-S1 ranged from 51% to 95%. Olisthetic curve magnitude averaged 34.6° (range: 20°-45°) with majority (8/13) demonstrating long thoracic curves with lateral trunk shift. All but one of these were apex right with rightward trunk shift. The remainder of the curves were isolated lumbar curves, with an apex left morphology without trunk shift. Eleven of the 13 patients showed curve improvement following isolated lumbosacral fusion. Three patients experienced a decrease in curve magnitude of 12°-28° and eight patients enjoyed complete resolution (≤10°) of their scoliosis.

Conclusion: The current study summarizes 13 well-documented cases of olisthetic scoliosis (4 new cases and 9 from the literature) that associated with symptomatic high-grade spondylolisthesis. All were treated via a primary posterior lumbosacral fusion strategy. Eleven of the 13 curves showed spontaneous improvement (8 complete resolution of scoliosis) following their lumbosacral surgery.

Level of evidence: Therapeutic level IV.

背景:本研究的目的是介绍四例有据可查的自发性脊柱侧凸改善病例,并分析文献中的有据可查病例:该研究旨在介绍四例有据可查的新的自发性脊柱侧凸改善病例,并对文献中的有据可查的病例进行分析:方法:进行外科日志检索和系统回顾。纳入标准为:(1) 年龄小于18岁;(2) 有症状的高位(≥50%)脊柱侧凸;(3) 脊柱侧凸≥20o;(4) 通过腰骶部融合术进行初次手术治疗;(5) 完整的X线片;(6) 至少1年的影像学随访或直至曲线消退:研究共纳入 13 名患者,平均年龄为 13.9 岁,其中 4 人来自作者的手术日志,9 人来自文献。L5-S1的滑动比例从51%到95%不等。胸廓曲线幅度平均为34.6°(范围:20°-45°),大多数患者(8/13)的胸廓曲线较长,躯干侧移。除一名患者外,其余患者均为先端右侧,躯干右移。其余曲线均为孤立的腰椎曲线,形态为顶点偏左,躯干无偏移。13 名患者中有 11 名在进行孤立的腰骶部融合术后曲线有所改善。三名患者的脊柱侧弯幅度减少了 12°-28°,八名患者的脊柱侧弯完全消除(≤10°):本研究总结了13例有充分证据证明的伴有症状的高位脊柱侧凸病例(4例为新病例,9例来自文献)。所有病例均采用腰骶部后路融合术进行治疗。腰骶部手术后,13 例脊柱侧弯患者中有 11 例的脊柱侧弯症状得到自发改善(8 例脊柱侧弯完全消失):证据级别:治疗级别 IV。
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引用次数: 0
Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic. COVID-19 大流行期间及之后的儿科创伤和骨折流行病学。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-06-19 eCollection Date: 2023-08-01 DOI: 10.1177/18632521231180161
Liam R Butler, Erin Abbott, Paulos Mengsteab, Calista L Dominy, Jashvant Poeran, Abigail K Allen, Sheena C Ranade

Purpose: Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.

Methods: Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.

Results: Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.

Conclusion: During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.

Level of evidence: Level III.

目的:以往的文献显示,在 COVID-19 爆发期间,小儿外伤病例有所减少,但很少有文献对大流行高峰期之后的情况进行分析。本研究评估了 COVID-19 大流行之前、期间和之后纽约市一家高流量教学医院的儿科创伤病例流行病学情况:提取了 2018 年 1 月 1 日至 2021 年 11 月 30 日期间儿科创伤骨科病例的机构数据。研究的时间范围如下:(1)2018 年和 2019 年 4 月 1 日至 6 月 22 日(大流行前);(2)2020 年 4 月 1 日至 6 月 22 日(大流行高峰期);(3)2021 年 4 月 1 日至 6 月 22 日(大流行高峰期后)。采用推断统计法比较患者和创伤特征:与大流行前队列(n = 6770)相比,大流行高峰期队列(n = 828)的骨折比例更高(p < 0.01),每周总体创伤率(p < 0.01)和每周骨折率(p < 0.01)显著下降。这种创伤率(p < 0.01)和骨折率(p < 0.01)的下降在大流行后的人群(n = 2509)中持续存在。空间分析发现,与大流行前相比,大流行高峰期纽约市急诊室就诊率较高的邮政编码集群与低收入社区一致:结论:在疫情高峰期,创伤和骨折的总体数量有所下降,流行伤害的类型发生了变化,不同经济资源的社区受到了不同程度的影响。这些趋势在大流行高峰期后的 12 个月内基本保持不变。这项纵向分析有助于为未来的长期重症护理和公共卫生资源分配提供信息并加以改进:证据等级:III 级。
{"title":"Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic.","authors":"Liam R Butler, Erin Abbott, Paulos Mengsteab, Calista L Dominy, Jashvant Poeran, Abigail K Allen, Sheena C Ranade","doi":"10.1177/18632521231180161","DOIUrl":"10.1177/18632521231180161","url":null,"abstract":"<p><strong>Purpose: </strong>Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.</p><p><strong>Results: </strong>Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.</p><p><strong>Conclusion: </strong>During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/c9/10.1177_18632521231180161.PMC10285363.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976240","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}
引用次数: 0
Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg-Calvé-Perthes disease. 股骨头前部骨吸收模式对legg - calv<s:1> - perthes病的预后价值。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1177/18632521231164985
Kenichi Mishima, Yasunari Kamiya, Masaki Matsushita, Shiro Imagama

Purpose: To examine whether differences in bone resorption patterns in the anterior portion of the femoral head correlate with the prognosis of Legg-Calvé-Perthes disease.

Methods: Seventy-eight patients with unilateral Legg-Calvé-Perthes disease, who were diagnosed after 6.0 years of age, underwent the Salter innominate osteotomy from 1987 to 2013, and were followed up to skeletal maturity. The anterior bone resorption pattern of the femoral head was evaluated from a frog-leg lateral hip radiograph made in the middle of the fragmentation period, and classified into two types, an epiphysis-preserved type (P) and a physis-disrupted type (D). The correlation between the type of bone resorption and the Stulberg outcome was analyzed.

Results: The Stulberg outcomes were grade I for 9 patients, grade II for 31, grade III for 35, and grade IV for 3, with a mean follow-up period of 8.3 ± 2.7 years. Fifty-one patients demonstrated the type P hips and 27 did the type D hip. In a subset analysis of patients with the modified lateral pillar group-B hips in the younger group (6.0-8.9 years of age at diagnosis), the percentages of the favorable and unfavorable outcomes significantly differed between the two types (p = 0.013). Anteroposterior enlargement of the affected femoral head was significantly greater in the type D hips than the type P hips (p = 0.014).

Conclusion: Unfavorable hip morphology at skeletal maturity can be predicted in patients with the lateral pillar group-B hips by focusing on bone resorption patterns of the anterior portion of the femoral head.

Level of evidence: Level III, prognostic study.

目的:探讨股骨头前部骨吸收模式的差异是否与legg - calv - perthes病的预后相关。方法:1987 ~ 2013年,78例6.0岁后确诊的单侧legg - calv - perthes病患者行Salter无名截骨术,随访至骨骼成熟。通过骨折期间拍摄的蛙腿侧位髋关节x线片评估股骨头前路骨吸收模式,并将其分为两种类型,骨骺保存型(P)和骨骺破坏型(D)。分析骨吸收类型与Stulberg结果之间的相关性。结果:Stulberg结果为I级9例,II级31例,III级35例,IV级3例,平均随访时间8.3±2.7年。51例为P型髋关节,27例为D型髋关节。在对年轻组(诊断时6.0-8.9岁)改良侧柱b组髋关节患者的亚组分析中,两种类型的有利和不利结果的百分比显着差异(p = 0.013)。D型髋的股骨头前后侧增大明显大于P型髋(P = 0.014)。结论:通过关注股骨头前部的骨吸收模式,可以预测侧柱b组髋关节患者骨骼成熟时的不良髋关节形态。证据等级:III级,预后研究。
{"title":"Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg-Calvé-Perthes disease.","authors":"Kenichi Mishima,&nbsp;Yasunari Kamiya,&nbsp;Masaki Matsushita,&nbsp;Shiro Imagama","doi":"10.1177/18632521231164985","DOIUrl":"https://doi.org/10.1177/18632521231164985","url":null,"abstract":"<p><strong>Purpose: </strong>To examine whether differences in bone resorption patterns in the anterior portion of the femoral head correlate with the prognosis of Legg-Calvé-Perthes disease.</p><p><strong>Methods: </strong>Seventy-eight patients with unilateral Legg-Calvé-Perthes disease, who were diagnosed after 6.0 years of age, underwent the Salter innominate osteotomy from 1987 to 2013, and were followed up to skeletal maturity. The anterior bone resorption pattern of the femoral head was evaluated from a frog-leg lateral hip radiograph made in the middle of the fragmentation period, and classified into two types, an epiphysis-preserved type (P) and a physis-disrupted type (D). The correlation between the type of bone resorption and the Stulberg outcome was analyzed.</p><p><strong>Results: </strong>The Stulberg outcomes were grade I for 9 patients, grade II for 31, grade III for 35, and grade IV for 3, with a mean follow-up period of 8.3 ± 2.7 years. Fifty-one patients demonstrated the type P hips and 27 did the type D hip. In a subset analysis of patients with the modified lateral pillar group-B hips in the younger group (6.0-8.9 years of age at diagnosis), the percentages of the favorable and unfavorable outcomes significantly differed between the two types (<i>p</i> = 0.013). Anteroposterior enlargement of the affected femoral head was significantly greater in the type D hips than the type P hips (<i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>Unfavorable hip morphology at skeletal maturity can be predicted in patients with the lateral pillar group-B hips by focusing on bone resorption patterns of the anterior portion of the femoral head.</p><p><strong>Level of evidence: </strong>Level III, prognostic study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/72/10.1177_18632521231164985.PMC10242379.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599255","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}
引用次数: 0
Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment. 在帕夫利克背带治疗发育不良的髋关节期间,股神经麻痹不是放弃背带的指征。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1177/18632521231172986
Ismat Ghanem, Geoffrey Karam, Diane Ghanem, Ibrahim Saliba

Objectives: The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release.

Methods: A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded.

Results: In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness.

Conclusion: Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation.

Level of evidence: Level III.

目的:本研究的目的是报道使用Pavlik背带治疗的发育性发育不良儿童股骨神经麻痹的发生率,确定任何可能的相关危险因素,并评估其结果,而无需任何特定的背带松解。方法:对连续接受帕夫利克托具治疗髋关节发育不良的所有儿童股骨神经麻痹病例进行回顾性分析。在单侧病例中,将髋关节发育不良与对侧进行比较。所有股骨神经麻痹的髋关节与该系列的其余髋关节进行比较,并记录任何可能导致瘫痪的危险因素。结果:在473例527髋的儿童中,共鉴定出53例不同程度的股神经麻痹,平均年龄为3.9个月。然而,93%发生在治疗的前2周。股骨神经麻痹多见于年龄较大、体型较大的儿童,且最严重的Tonnis型患儿,髋部屈曲角度大于90°(p)结论:股骨神经麻痹多见于较高的Tonnis型患儿和较高的髋部屈曲角度患儿,但其本身的存在并不能预示治疗失败。它在治疗完成前自行解决,不需要任何皮带释放或线束中止。证据等级:三级。
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引用次数: 0
Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children. 肱骨远端矫正截骨治疗儿童髁上骨折畸形愈合。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1177/18632521231156942
Mohammed M Tarabishi, Ahmed K Almigdad, Rudolf Ganger, Sebastian Farr

Purpose: This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center.

Methods: We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann's angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes.

Results: The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann's angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered.

Conclusions: Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance.

Level of evidence: level IV: Retrospective therapeutic study.

目的:本研究旨在确定矫正性肱骨远端截骨术治疗儿童髁上骨折畸形愈合后的功能和影像学结果。我们假设,在三级转诊中心的大型患者队列中,这种二次重建手术可以恢复合理且接近正常的功能。方法:我们回顾性分析了38例儿童创伤后髁上肱骨畸形愈合采用k针固定行矫正截骨术的临床和影像学记录。所有的临床数据在回顾病历后提取,包括年龄、性别、优势侧(无论何时)、随访时间、术前和最后一次就诊时肘关节活动度。术前、术后和复诊时评估影像学参数,包括鲍曼角、肱骨尺角、肱骨髁角和肘关节活动度,以确定手术矫正结果。结果:骨折患者的平均年龄为5.6(±2.7)岁,手术干预时的平均年龄为8.6(±2.6)岁。本系列的平均随访时间为28.2(±31.1)个月。Baumann角、肱骨尺角和肱骨髁角成功恢复到生理范围(分别为72.6°、5.4°和36.1°)。术后肘关节伸直从-22°(±5.7)改善至-2.7°(±7.2),屈曲从115°(±13.2)改善至128.2°(±11.1)。3例翻修手术(8%)。结论:肱骨远端矫形截骨联合k针固定是一种可靠的方法,能有效地矫正肱骨远端不同平面的畸形愈合,从而改善肘关节的活动范围和外观。证据等级:IV级:回顾性治疗性研究。
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引用次数: 1
Guided growth for FKFD: Historical perspective and insights. FKFD的指导性增长:历史视角与洞见。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1177/18632521231172994
Peter M Stevens
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引用次数: 0
Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review. 脑瘫患儿股骨前远端半骨骺成形术:采用改进的德尔菲法建立手术指征和技术并进行文献复习。
IF 1.4 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1177/18632521231172993
Benjamin J Shore, James McCarthy, M Wade Shrader, Kerr Graham, K Matthew Veerkamp, Erich Rutz, Hank Chambers, Jon R Davids, Unni Narayanan, Tom F Novacheck, Kristan Pierz, Thomas Dreher, Jason Rhodes, Jeffery Shilt, Tim Theologis, Anja Van Campenhout, Robert M Kay
NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). https://doi.org/10.1177/18632521231172993 Journal of Children’s Orthopaedics 2023, Vol. 17(3) 292 –294 © The Author(s) 2023 DOI: 10.1 77/186325 1231 729 journals.sagepub.com/home/cho JOURNAL OF CHILDREN’S ORTHOPAEDICS Response to Letter to the Editor
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Journal of Childrens Orthopaedics
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