Journal of Childrens Orthopaedics最新文献

The use of external fixators is part of the cultural background of orthopedic surgeons in treating numerous clinical conditions. Over the years, fixator design and biomechanical knowledge have led to different solutions and techniques, and bone lengthening and its better understanding come together with the development of external fixators and the application of the biological principle of distraction osteogenesis. The authors conducted a literature review about using external fixators and lengthening systems in pediatric upper limbs. Despite the applications of external fixators in upper limbs remaining much more limited than those of the lower limbs, there are indications of traumatic, congenital, tumor, and infectious etiologies. However, despite the spread of new systems of plate and screws and intramedullary lengthening nails, the problems about when to use external fixation remain unsolved. Another debated point is about using monolateral or circular frames for humeral lengthening and the correction of forearm deformities in multiple hereditary exostoses disease (MHE) or radial longitudinal deficiency sequelae. Monoaxial fixators retain a prominent role for skeletal lengthening in all the districts examined, although their role could be outclassed by the motorized intramedullary nails, especially for humeral lengthening. Hexapod systems are likely to represent the future for the correction of multiplanar forearm deformities; however, multicenter studies on larger series will be necessary to better validate their applications and advantages.

Preoperative planning is crucial for successful surgical outcomes. 3D printing technology has revolutionized surgical planning by enabling the creation and manufacturing of patient-specific models and instruments. This review explores the applications of 3D printing in pediatric orthopedics, focusing on image acquisition, segmentation, 3D model creation, and printing techniques within specific applications, including pediatric limb deformities, pediatric orthopedic oncology, and pediatric spinal deformities. 3D printing simultaneously enhances surgical precision while reducing operative time, reduces complications, and improves patient outcomes in various pediatric orthopedic conditions. 3D printing is a transformative technology in pediatric orthopedics, offering significant advantages in preoperative planning, surgical execution, and postoperative care.

Purpose: A flexed knee gait is a common gait in children with unilateral cerebral palsy. In children without knee contracture, hamstring spasticity is commonly considered a major contributor to a flexed knee gait. We hypothesized that the popliteal angle would not correlate to a flexed knee gait.

Methods: This retrospective study included 109 children with unilateral cerebral palsy who had undergone complete 3D gait analysis. Children who had previous surgery or knee flexion contracture were excluded. Children were divided into three groups based on knee position during stance as determined by 3D gait analysis: flexion (FK, 47), hyperextension (HK, 42), and normal (NK, 20).

Results: There were no significant correlations between popliteal angle and dynamic peak knee extension in stance or at initial contact. Similarly, peak dorsiflexion during the stance phase did not correlate with dynamic peak knee extension in stance (all p > 0.05). Significant differences were observed in foot position during stance between FK and HK groups, as well as in quick stretch dorsiflexion with the knee extended between HK and NK groups.

Conclusion: A flexed knee gait in children with unilateral cerebral palsy does not always correlate with the popliteal angle or dynamic ankle position in gait. These factors may contribute but are insufficient to explain all observed differences. A flexed knee gait likely involves a complex interplay of motor control, strength, spasticity, and lever arm dynamics, indicating that interventions at a single level may not fully improve dynamic knee extension.

The field of pediatric musculoskeletal imaging is undergoing significant advancements due to technological innovations and a growing emphasis on safety and patient-centered care. This review explores recent developments in imaging modalities such as advanced magnetic resonance imaging, ultrasound innovations, and artificial intelligence applications. Highlights include radiation dose-reduction techniques in radiography and computed tomography, enhanced diagnostic tools like contrast-enhanced ultrasound and ultra-high-frequency imaging, and the integration of artificial intelligence for pathology detection and workflow optimization. The adoption of advanced methods like whole-body magnetic resonance imaging and computed tomography-like magnetic resonance imaging sequences has improved diagnostic accuracy, minimized radiation exposure, and expanded the capabilities of noninvasive imaging. Emerging technologies, including photon-counting detector computed tomography and deep learning-based reconstructions, are transforming clinical practices by balancing precision and safety. Artificial intelligence applications are reshaping diagnostic approaches, automating complex assessments, and improving efficiency, although challenges such as external validation and limited scope persist. Functional imaging advancements, such as diffusion-weighted imaging and positron emission tomography-magnetic resonance imaging integration, are enhancing disease characterization and treatment planning. This review underscores the clinical impact of these innovations, emphasizing the need for standardized protocols, interdisciplinary collaboration, and continued research to address unmet needs in radiation safety and artificial intelligence integration. It aims to equip healthcare professionals with the knowledge to leverage these advancements for improved outcomes in pediatric musculoskeletal care.

Purpose: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips.

Methods: Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12-36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot.

Results: All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up (P < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 (P < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head.

Conclusion: Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory.

Level of evidence: Level 4, Case Series.

Background: Synthetic calcium sulfate-calcium phosphate bioceramic composite has been developed as a material for bone grafting; however, the literature is limited on outcomes of benign bone tumors treated with bone grafting. This study aims to investigate the outcomes of benign pediatric bone tumors treated with a calcium sulfate-calcium phosphate composite bone graft.

Methods: A retrospective review at a tertiary pediatric hospital with benign bone tumors treated with curettage and bone grafting with a calcium sulfate-calcium phosphate synthetic bone graft from 2008-2018 was included. Minimum follow-up was 6 months.

Results: Twenty-seven patients met inclusion criteria with a mean age of 10.3 ± 4.5 years and follow-up was 37.2 ± 22.3 months. Diagnoses were unicameral bone cysts (n = 16) and aneurysmal bone cysts (n = 11). Pathologic fracture was present in 48% (13/27) of patients on admission. All patients were treated using synthetic bone grafts and 37% (10/27) with internal fixation. Following index treatment, 96% (26/27) had resolution of pain and returned to full activity at 13.4 ± 10.7 weeks. Complications occurred in 33% (9/27) of patients; one developed chronic hip pain resulting in decreased physical activity, seven had a tumor recurrence without fracture, and one had tumor recurrence with pathologic fracture. Revision surgery was required in 26% (7/27) of cases. Per the modified Neer outcomes rating system, 52% of patients had a healed bone lesion, 4% had a healing lesion with a bone defect, and 44% had a persistent/recurrent cyst.

Conclusions: Children with benign bone tumors treated with curettage and bone grafting using a calcium sulfate-calcium phosphate composite had a high incidence of complications and revision surgery.

Level of evidence: IV.

Purpose: We aimed to analyze frequently searched questions through Google's "People Also Ask" feature related to four common treatments for developmental dysplasia of the hip (DDH): the Pavlik harness, rhino brace, closed reduction surgery and open reduction surgery.

Methods: Search terms for each treatment were entered into Google Web Search using a clean-install Google Chrome browser. The top frequently asked questions and associated websites were extracted. Questions were categorized using the Rothwell classification model. Websites were evaluated using the JAMA Benchmark Criteria. Chi-square tests were performed.

Results: The initial search yielded 828 questions. Of 479 included questions, the most popular topics were specific activities that patients with DDH can/cannot do (32.8%), technical details about treatments (30.9%) and indications for treatments (18.2%). Websites were commonly academic (59.3%), commercial (40.5%) and governmental (12.3%). There were statistically significant more specific activity questions about Pavlik harnesses than about rhino braces (χ ² = 7.1, p = 0.008), closed reduction (χ ² = 56.5, p < 0.001) and open reduction (χ ² = 14.7, p < 0.001). There were statistically significant more technical details questions about Pavlik harnesses than about closed reduction (χ ² = 4.1, p = 0.04).

Conclusions: This study provides insights into common concerns that parents have about their children's DDH treatment, enabling orthopaedic surgeons to provide more effective and targeted consultations. This is particularly important for DDH because affected patients are often diagnosed within the first few months of life, leaving parents overwhelmed by caring for a newborn child and simultaneously coping with this diagnosis.

Purpose: Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact on HRQL using the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire (CPCHILD) as the primary outcome measure.

Methods: In this prospective study, we analyzed 31 nonambulatory patients with spastic or mixed CP (GMFCS levels IV-V) who underwent hip reconstructive surgery between 2015 and 2021. The surgical procedures included one-sided varus derotation osteotomy of the femur with Dega transiliac osteotomy and, on the opposite side, varus derotation osteotomy (VDRO) of the femur with shortening and, as needed, Dega pelvic osteotomy.

Results: The study demonstrated significant improvement in the hip joint motion range, as assessed by the Thomas test, in hip abduction and rotational movements of the hip, as well as reduction of spasticity. The procedures also resulted in significant radiographic improvement of the femoral head coverage. The assessment of symptoms and problems associated with the hip revealed a positive influence of the surgery on pain, contractures, toileting/perineal hygiene, dressing, seating, transferring, and position changes. The mean improvement at a follow-up visit was significant in all domains of the CPCHILD, except for communication and social interaction.

Conclusion: Hip reconstruction with VDRO and Dega pelvic osteotomy can enhance the HRQL of children with CP. These surgical interventions can help to achieve the correct hip position and to reduce pain, which positively affects the patient QL, although proactive treatment results in less invasive procedures.

Level of evidence: IV case series.