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Bilateral osteochondritis dissecans of the knee in pediatric and adolescent patients presenting with unilateral symptoms: An epidemiological and radiographic analysis. 有单侧症状的儿童和青少年双侧膝剥脱性骨软骨炎:流行病学和放射学分析。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-23 eCollection Date: 2023-10-01 DOI: 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.

Level of evidence: IV, Retrospective Case series.

目的:本研究旨在确定单侧症状患者双侧膝剥脱性骨软骨炎的患病率和特征,并将该队列与单侧疾病患者进行比较。方法:患者记录≤18 2003年至2016年,岁,诊断为剥脱性膝关节骨软骨炎和严格意义上的单侧膝关节疼痛。需要在初次出现后1年内进行对侧(无症状)膝关节成像。通过评估病变的大小、位置和Hefti分期来评估病变特征。记录了手术和非手术治疗。将单侧剥脱性骨软骨炎患者与双侧疾病患者进行比较。结果:80名患者,63名男性(79%),17名女性(21%),平均年龄13.1岁 年龄,包括在内。二十(25%)的表现/症状性病变在磁共振成像中被认为是稳定的。病变大小与Hefti分类呈正相关。12名患者(15%)在对侧影像学检查中发现双侧剥脱性骨软骨炎。双侧和单侧疾病患者的骨骼成熟度没有显著差异。52名单侧疾病患者(77%)接受了手术干预,而9名双侧疾病患者(75%)接受了膝关节手术。在对侧无症状病变的患者中,67%的患者最终接受了对侧膝关节的手术干预。结论:在表现为单侧剥脱性骨软骨炎症状的患者中,双侧疾病的患病率为15%,单侧和双侧剥脱性骨软骨炎病变患者在年龄、性别、身体状况或病变特征方面没有差异。考虑到对侧无症状病变的患病率和所需的干预措施,本研究支持早期双侧膝关节放射学评估。证据级别:四,回顾性病例系列。
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引用次数: 0
A novel pre-bending tool for elastic stable intramedullary nailing: An efficient and accurate study. 一种用于弹性稳定髓内钉的新型预弯曲工具:一项有效且准确的研究。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-18 eCollection Date: 2023-10-01 DOI: 10.1177/18632521231193713
Wen Shu, LongJun Yu, Theddy Slongo, Saroj Rai, Haobo Zhong, Xin Tang

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.

Level of evidence: IV.

目的:弹性稳定髓内钉已被公认为治疗儿童长骨骨折的一种公认技术。该技术的原理是“三点支撑和固定”,应遵循该技术以在没有植入失败和并发症的情况下获得最佳结果。然而,用于弹性稳定髓内钉预弯曲的工具尚未被报道。本研究旨在介绍一种用于预弯曲弹性稳定髓内钉的新型工具,以及外科医生使用该工具的结果。方法:为参与者提供一个设计的股骨干骨折病例。根据弹性稳定髓内钉技术的经验,所有参与者被分为三组:住院组、同事组和主治组。记录完成预弯曲的时间和预弯曲后指甲的冠状面偏差。统计分析以传统方式将数据与每组的新工具进行了比较。结果:本研究共招募了30名医生。对于所有医生来说,使用新工具的预弯曲持续时间明显短于传统方法(p  0.001)。对于所有医生来说,新工具预弯曲后指甲的冠状面偏差显著小于传统方法(p  0.001)。结论:这种新型的弹性稳定髓内钉预弯曲工具使用方便,易于实现弹性稳定髓外钉技术的主要作用。医生在预弯曲弹性稳定髓内钉时可以减少冠状面偏移,特别是对于对弹性稳定髓外钉技术经验较少的医生来说。证据级别:四。
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引用次数: 0
Scoliosis risk factors and outcomes in children with dysplastic spondylolisthesis undergoing surgical reduction and fixation. 脊柱滑脱发育不良儿童接受手术复位和固定的脊柱侧凸危险因素和预后。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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.

Level of evidence: 3.

目的:探讨发育不良的脊柱滑脱患儿接受手术复位和内固定后脊柱侧凸的危险因素和预后。方法:我们回顾性分析56例接受手术复位和内固定治疗的发育不良型脊柱滑脱患儿。根据术前是否存在脊柱侧凸进行分组。术前测量的影像学参数包括骨盆发生率、骨盆倾斜、骶骨斜度、冠状Cobb角、滑移率、Dubousset腰骶角、腰椎前凸、矢状垂直轴和脊柱畸形研究组指数。采用逻辑回归对各组进行比较。进行受试者工作特征分析以确定最佳脊柱畸形研究组指数临界值。所有患者均随访至少2年。结果:脊柱侧凸组36例,平均年龄9.6±2.7岁;无脊柱侧凸组20例,平均年龄9.1±2.4岁。结论:严重S1发育不良和高滑移率可能是发育不良腰椎滑脱患者发生脊柱侧凸的危险因素。大多数患者脊柱滑脱复位和固定后脊柱侧凸自行消退。证据等级:3。
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引用次数: 0
Introducing Journal of Children's Orthopaedics' ChatGPT and generative AI policy. 介绍《儿童骨科杂志》的ChatGPT和生成式AI策略。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1177/18632521231191687
Shlomo Wientroub, Fritz Hefti
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引用次数: 0
Definition of hip displacement and dislocation by acetabular dysplasia in children with cerebral palsy. 脑瘫患儿髋臼发育不良引起髋关节移位和脱位的定义。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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.

Level of evidence: level IV, diagnostic study.

目的:髋臼在日常活动中与股骨头相互作用,在出现髋关节疾病时可能表现出结构变化。本研究旨在通过髋臼的结构特征与移位百分率的关系来重新定义脑瘫儿童的髋关节疾病。方法:70例患者的临床及影像学资料(男36例,女34例;对痉挛型脑瘫患者的平均年龄8.2岁进行回顾性分析。采用重建三维计算机体层摄影的髋臼指数测量髋臼结构,以保证测量精度。髋臼指数在重建计算机断层扫描上每增加10%的移动百分比,就会有显著的变化,这被认为是髋关节疾病的临床意义。结果:重建ct测量的髋臼指数随迁移率的增加呈上升趋势。重建计算机断层扫描测量的最显著的髋臼指数变化发生在20%-29%和30%-39%迁移百分比组(p为50%),表明髋臼后外侧发育不良。在重建的计算机断层扫描值上,移动百分比从80%到100%的髋关节髋臼指数一致,表明完全脱位,股骨头和髋臼窝之间不再接触和相互作用。结论:髋臼的结构特征反映了髋关节功能障碍,并可能对髋关节疾病进行分类。结果表明,在脑瘫儿童中,30%的迁移率为髋关节疾病的起点,80%为髋关节脱位的转折点。证据等级:IV级,诊断性研究。
{"title":"Definition of hip displacement and dislocation by acetabular dysplasia in children with cerebral palsy.","authors":"Nai Kuang Wang,&nbsp;Shih Hsien Shen,&nbsp;Brian Po Jung Chen,&nbsp;Chia Hsieh Chang,&nbsp;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}
引用次数: 0
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. 一项德尔福共识研究治疗股骨骨骺滑动:在轻度和中度滑动中有相当多的共识,在严重滑动中有有限的共识。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 10.1177/18632521231177272
Doğaç Karagüven, Pervin Demir, Selcen Yüksel, Hakan Ömeroğlu

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.

Level of evidence: level V.

目的:本专家共识研究的目的是就不同类型股骨骨骺滑动的治疗和对侧未受影响侧预防性螺钉固定的使用达成共识。方法:本研究采用四轮德尔菲法。问卷包括所有可能的理论滑移情况,在线发送给14名参与者,他们在儿童骨科领域和儿童髋关节疾病的治疗方面经验丰富。结果:在所有类型的轻度滑移和中度、稳定滑移情况下,原位固定被认为是首选的治疗方法。在中度、不稳定和所有严重滑移情况下,不赞成进行原位固定。在中度至重度、不稳定的滑移情况下,使用温和的闭合或开放复位和内固定是一致的。对于严重、稳定滑移的最佳治疗方法尚无共识。对于同时存在内分泌紊乱和年龄较小的情况下,对侧预防性螺钉固定的使用也有共识。结论:即使在经验丰富的外科医生中,对所有类型的股骨头骨骺滑动的治疗方法建立共识似乎也是不可能的。滑移的严重程度和滑移的稳定性分别是外科医生治疗选择的主要和次要决定因素。原位固定仍然是几种滑移类型的首选治疗方案。在移位的、不稳定的卡瓦中,建议采用关闭或打开的方法进行温和的资本调整。对侧预防性螺钉固定在某些情况下是可行的。证据等级:V级。
{"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,&nbsp;Pervin Demir,&nbsp;Selcen Yüksel,&nbsp;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}
引用次数: 0
Diagnosis and treatment of "medial to lateral diagonal injury of the elbow" in children: Concomitant medial epicondylar and radial neck fractures. 儿童“肘关节内外侧对角线损伤”的诊断和治疗:并发内上髁和桡骨颈骨折。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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.

目的:肱骨内上髁及桡骨颈骨折同时及同侧发生实属罕见。本研究评估肘关节内外侧对角线损伤(MELAINE)的临床和影像学结果。方法:男性6例,女性6例(左:10例,占83.3%;右:2,16.7%)。内上髁和桡骨颈骨折分别按Papavasiliou分型(II型7例,III型2例,IV型3例)和Judet分型(I型3例,II型4例,III型5例)进行分类。所有患者均接受手术治疗。搬运角度,运动范围,以及Kim等。肘部功能评分用于评估临床和功能结果;记录相关并发症。结果:患者平均受伤年龄11.1±2.5个月(范围6 ~ 14),平均随访时间40±25.6个月(范围13 ~ 90)。所有骨折平均在6.3±1.2周内愈合(4-9)。结果良好(n = 1;8.3%)至优秀(n = 11;91.7%)。损伤侧和未损伤侧的携带角分别为15.5°±2.6°和14.7°±2°(p = 0.218)。损伤侧肘关节屈伸和前臂旋前活动范围分别为144.2°±10.4°、4.6°±5.4°、76.7°±9.1°、80.4°±9.2°,与健康侧比较差异无统计学意义(p > 0.05)。损伤侧与未损伤侧肘关节功能评分分别为96.3±5.3和98.8±2.3,差异有统计学意义(p = 0.139)。没有感染、肘外翻、僵硬或不稳定的病例记录。结论:美黑碱虽罕见,但不可忽视。手术的目的是稳定肘关节,避免外翻畸形。如果得到诊断和治疗,大多数病例的临床和放射学结果都很好。
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引用次数: 1
Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better? 儿童前臂骨折非手术治疗失败的可改变和不可改变的危险因素:我们在哪些方面可以做得更好?
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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,&nbsp;Brendan Shi,&nbsp;Jeremy Policht,&nbsp;Bailey Mooney,&nbsp;Kevin Y Chen,&nbsp;Mauricio Silva,&nbsp;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}
引用次数: 0
Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips. Graf II型髋关节Pavlik支架治疗后残留的髋臼发育不良。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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.

Levels of evidence: Therapeutic studies, IV.

目的:评价Graf II型髋关节在Pavlik支架治疗后残留的髋臼发育不良,并在2岁时进行影像学随访。方法:回顾性分析2018年3月至2022年2月期间使用Pavlik托具治疗的髋关节发育不良患者。Graf II型髋关节发育不良患者在2岁后至少进行了一次影像学随访。收集和研究了以下信息:性别、侧位、患侧、脊具起始年龄、治疗时间、α角和骨顶形态。我们在最后一次随访时评估髋臼指数,并将大于2个标准差的值定义为残余髋臼发育不良。结果:33例患者(53髋)符合标准。平均初始α角为53.4°;Pavlik马具开始时的平均年龄为10.9周。平均治疗时间为10周。末次超声随访时平均α角为64.9°。最后一次x线随访的平均年龄为2.6岁,26髋髋臼发育不良,髋臼指数高于平均值2个标准差以上。结论:在Graf II型髋中,Pavlik支架治疗后残留髋臼发育不良的发生率显著,其中治疗结束时髋臼骨顶钝缘和12周后的初始年龄是残留髋臼发育不良的独立预测因素。证据水平:治疗性研究,IV。
{"title":"Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips.","authors":"Yuchan Li,&nbsp;Zhigang Wang,&nbsp;Mingyuan Miao,&nbsp;Yunlan Xu,&nbsp;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}
引用次数: 0
Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy. 慢动作智能手机视频提高了动态脑瘫患者步态评估的观察者间可靠性。
IF 1.4 4区 医学 Q3 ORTHOPEDICS Pub Date : 2023-08-01 DOI: 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.

Level of evidence: level I, randomized study.

目的:结构化的视觉步态评估是评估小儿神经肌肉疾病患者的必要条件。本研究的目的是评估在标准智能手机上录制的慢动作视频对增强视觉步态评估的好处。方法:用智能手机记录5例小儿受试者的冠状面和矢状面步态视频,其中4例为动态脑瘫,1例为无步态病理。21名视频评分者被招募并随机使用爱丁堡视觉步态评分来评估慢动作或正常速度的视频。慢动作组(N = 11)以八分之一的速度观看视频,正常速度组(N = 10)以正常速度观看相同的视频。通过计算每组整体、每个爱丁堡视觉步态评分项目的类内相关系数,并按评估者经验水平分层,确定评估者间信度。结果:慢动作组组内相关系数为0.65(95%可信区间为0.58 ~ 0.73),匀速组组内相关系数为0.57(95%可信区间为0.49 ~ 0.65)。对于经验不足的评分者,慢动作和正常速度的组内相关系数分别为0.62(95%置信区间:0.53-0.71)和0.50(95%置信区间:0.40-0.59)。对于经验丰富的评分者,慢动作和正常速度的组内相关系数分别为0.69(95%置信区间:0.61-0.76)和0.67(95%置信区间:0.58-0.75)。结论:使用慢动作智能手机视频可以增强视觉步态评估,这是一种在世界范围内广泛使用的工具,没有边际成本。证据等级:I级,随机研究。
{"title":"Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy.","authors":"Dane J Brodke,&nbsp;Katherine Makaroff,&nbsp;Enda G Kelly,&nbsp;Mauricio Silva,&nbsp;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}
引用次数: 0
期刊
Journal of Childrens Orthopaedics
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