Journal of Childrens Orthopaedics最新文献

Purpose: To describe foot abnormalities in proximal femoral focal deficiency and their correlation to the severity.

Methods: Eighty-nine extremities in 87 patients were evaluated between 1996 and 2020 clinically and radiologically. Fibula length, ankle shape, tarsal coalitions, and the number of foot rays were recorded. Extremities with proximal femoral focal deficiency were classified according to Pappas and divided into severe (classes II and V), medium severe (classes III and IV), and mild groups (classes VII, VIII, and IX).

Results: The fibula was short in 89% and absent in 11% of cases. An absent fibula occurred mostly in severe class III and only in 4% of mild grades (statistically significant, p = 0.004). The valgus ankle joint prevailed in 82% of cases. Spherical ankle joints (18% of cases) were associated in all cases with a tarsal coalition. Tarsal coalitions occurred in 14.6% and were present in all classes except class IV. Five ray feet were found in 83% of cases, four ray feet were found in 16%, and three ray feet in one extremity. Reduction in the number of foot rays occurred more commonly in association with fibular aplasia (30%).

Conclusions: Abnormalities of the fibula and ankle joint represent a constant part of proximal femoral focal deficiency, whereas tarsal coalition and a reduction of foot rays do not. The severity of foot abnormalities does not correlate to the severity of proximal femoral focal deficiency but does with fibular aplasia.

Introduction: The field of pediatric spine surgery has encountered major changes and evolutions lately, with new treatment options available and the development of enabling technologies. This article aims to summarize the most relevant recent literature.

Materials and methods: The five most relevant topics were selected and assigned to one or two authors who performed a comprehensive Pubmed database search for articles published in the last 4 years (2021-2024). Only studies with a high level of evidence or clinical relevance were reported.

Results: Thirty-nine articles were selected and analyzed, covering the following subjects: treatment options in tweeners, the impact of new medical treatments in pediatric spine practice, the emergence of new surgical techniques, the development of enabling technologies in scoliosis surgery, and recent relevant randomized controlled trials.

Discussion: Many new surgical concepts and techniques have been developed lately, but their results need to be further assessed on specific subgroups of patients. Numerous significant medical improvements have been reported in the last 5 years, affecting positively the management of syndromic and neuromuscular patients.

Objective: In this study, we examined whether there was a change in the number of children who had been screened by hip ultrasound, the age of first diagnosis, and the number of invasive and conservative treatments applied due to developmental dysplasia of the hip between 2016 and 2022 among refugees who were in "Temporary Protection Status" in Türkiye?

Methods: The records were collected via the e-health database of the Turkish Ministry of Health. Over 1 month old were included in the study.

Results: The number of ultrasonography (USG) that was performed for developmental dysplasia of the hip survey had significantly increased over time. The incidence for 5 years was 6 cases per 100 babies. However, the incidence of developmental dysplasia of the hip needing intervention was 0.4 cases per 1000 babies. In 2016, the most used diagnosis method was X-ray. By contrast, the use of USG has increased from 2016 to 2022. The mean age at the time of diagnosis was significantly high in 2016, 2017, and 2020. The number of invasive treatment modalities including closed reduction under anesthesia, open reduction alone, or open reduction with pelvic and/or femoral osteotomies had significantly decreased from 2016 to 2022. However, the number of abduction orthosis used for treatment also increased significantly.

Conclusions: Free access to health services is effective in promoting families' compliance with screening programs for developmental dysplasia of the hip. But is not enough for initial periods of mass migrations. To increase sensitivity to screening programs for possible diseases, further efforts are needed to prevent low compliance in early cases of mass migrations.

Background: The newborn transphyseal fracture of the distal humerus is frequently misdiagnosed with an elbow dislocation due to the absence of the lateral condyle ossification node. No consensus has been reported either for the diagnosis or the management of these rare fractures. This study aimed to analyze a series of newborns with transphyseal distal humerus fractures.

Methods: All consecutive infants treated between 2005 and 2020 for a transphyseal fracture of the distal humerus before the age of 6 months were retrospectively included. All radiological examinations were analyzed (X-ray, ultrasound, and magnetic resonance imaging (MRI)) as well as the therapeutic management (orthopedic or surgical treatment). The patients were seen at outpatient clinic visits with a minimum of 2-year follow-up.

Results: Nine newborns were treated. The main cause was an obstetrical traumatism (n = 8). The diagnosis was made on physical examination and addressed by obstetric departments with standard biplanar radiographs in four cases. The fracture was suspected on physical examination in the remaining five cases and confirmed by complementary imaging (ultrasound (2), MRI (1), and both (3)). A total of six patients were treated conservatively and three surgically with an open reduction. At a mean follow-up of 79 months, two complications occurred: one axillary abscess due to the cast and one cubitus varus deformity. All children had a full functional recovery.

Conclusions: The transphyseal fracture of the distal humerus in newborns is a rare entity that should be managed conservatively. Additional imaging examinations are recommended to clarify the diagnosis.

Level of evidence: Level IV, cohort study.

Purpose: The purpose of this study is to retrospectively analyze children treated conservatively in our hospital to explore the clinical characteristics of children with traumatic atlantoaxial joint infra-anterior dislocation complicating odontoid fracture and the therapeutic effects of treatment.

Methods: Patients with atlantoaxial joint infra-anterior dislocation complicating odontoid fracture received conservative treatment, which comprised three steps: cervical traction (2 weeks), plaster fixation (2 months), and brace fixation (3 months).

Results: We treated three patients (boy:girl = 0:3, mean age = 2.5 years old) from 2017 to 2020, the diagnoses were all traumatic C1-2 infra-anterior dislocations associated with odontoid fracture (Anderson and D'Alonzo classification type II: three cases, Hosalkar type IB: two case and IC: one case), with or without cervical spinal cord injury. The C1-2 infra-anterior dislocations were all successfully reduced by gentle traction with the halo method (case 1) or occipital-jaw (cases 2 and 3) for a mean of 18.3 days (19, 15, 21 days), after which the Calot plaster vests (head-neck-chest plaster vests) were fitted and maintained for 2 months, without operation. Braces were maintained for 3 months after the Calot plaster vests were removed. All patients achieved fracture healing and recovered from the spinal injury.

Conclusion: In young children, atlantoaxial joint infra-anterior dislocation complicating odontoid fracture usually occurred at the odontoid synchondrosis and belonged to Anderson and D'Alonzo classification type II or Hosalkar type I. Conservative treatment achieved good results (dislocation reduction, bone healing, recovery of neurological symptoms).

Level of evidence: Level IV case series.

Purpose: Neuroblastoma (NB) is a common extracranial solid tumor in children, often requiring surgical resection. Post-resection NB near the spine can lead to spinal deformities, but treatment strategies are not well-documented.

Methods: We retrospectively reviewed our patients who developed spinal deformities after NB resection at our hospital from 2013 to 2021. Treatment included the traditional growing rod (TGR) technique for patients with growth potential, posterior spinal fusion (PSF) for skeletally mature patients, and intermittent cast therapy for infants.

Results: Five female patients underwent chemotherapy and surgical resection for NB, with no recurrence during follow-up. Single curves were seen in Cases 1, 2, 4, and 5, and Case 3 had double curves. NB tumors were on the convex side in Cases 1, 3, and 5, and on the concave side in Cases 2 and 4. TGR was used for Cases 1 and 2 due to growth potential and inadequate height. PSF was chosen for Cases 3 and 4, achieving satisfactory scoliosis and kyphosis correction. Case 5, diagnosed with scoliosis at 16 months, underwent intermittent cast therapy for 2 years, significantly correcting scoliosis and avoiding surgery. The average time from NB resection to scoliosis onset was 65.2 ± 49.3 months, with scoliosis treatment starting at 82.6 ± 58.1 months. The mean follow-up was 38.2 ± 12.1 months. All patients showed significant improvement in spinal deformities, with no significant correction loss at the last follow-up.

Conclusions: After NB resection, spinal deformities should be closely monitored, with intervention preferably within 6 months of discovery. TGR, PSF, and casting are effective interventions, with the treatment modality based on the patient's skeletal maturity and height.

Purpose: Paediatric musculoskeletal injuries in association with increased participation in sports activities continue to increase. Arthroscopy is recognized as a safe and effective procedure in children. This study aims to identify trends in European paediatric sports centres over 20 years.

Methods: A survey was performed across the European Paediatric Orthopaedic Society (EPOS) Sports Study Group focusing on 3 years (2000, 2009 and 2019). Centres were divided into two groups: Group 1 (n = 5, with data for 2000, 2009 and 2019) and Group 2 (n = 8, with data for 2009 and 2019). Data were analysed as the total annual number of cases and separately by anatomical region and patient demographics. A descriptive analysis was performed to characterize the trends.

Results: Data from eight centres across Europe showed an increase in total annual arthroscopy cases (G1 from 53 to 202 and G2 from 393 to 615, p-value < 0.001) and as a percentage of paediatric orthopaedic surgeries (G1 from 1.6% to 5.2%; G2 from 5.1% to 6.8%) in seven out of eight centres. The knee remained the most commonly treated joint (G1 from 79.2% to 83.3%; G2 from 78.9% to 84.4%), despite the rise of others such as the elbow (p-value = 0.020) and decline of the shoulder (p-value = 0.014). Cases involving paediatric patients over 11 years increased while there was no gender distinction among paediatric patients.

Conclusion: Paediatric arthroscopy procedures in Europe have increased in number over the past 3 decades. Technological advancements have allowed a surge in procedures and applications to new anatomical areas.

Level of evidence: IV - retrospective database review.

Purpose: Radial neck fractures in children are rare, representing less than 1% of all pediatric fractures. While conservative treatments are often sufficient, displaced fractures may require closed or open reduction. The Metaizeau technique is widely accepted for closed reduction and internal fixation. This study aims to assess the long-term functional and radiological outcomes of this technique and identify any complications that may arise.

Methods: This retrospective study analyzed 22 pediatric patients treated with the Metaizeau technique for proximal radius fractures between 2005 and 2018. Data on demographics, preoperative radiographs, and postoperative complications were reviewed. Outcomes were evaluated using radiographic and functional measures, including grip strength, the Mayo elbow performance score (MEPS), and the Tibone and Stolz classification.

Results: The mean age at the time of injury was 9.9 years, with a mean follow-up period of 139 months (range: 72-213 months). Patients were classified as Judet type 3 (n = 9), type 4a (n = 9), or type 4b (n = 4). The functional outcomes showed a mean MEPS score of 99 (range: 90-100), with 86% of patients achieving excellent results according to the Tibone and Stolz classification. Excellent outcomes were recorded in 100% of type 3, 77.7% of type 4a, and 75% of type 4b cases. Documented complications included one case of radioulnar synostosis and two cases of heterotopic ossification.

Conclusions: The Metaizeau technique represents an efficacious treatment option for pediatric radial neck fractures, offering favorable long-term functional and radiological outcomes with a low complication rate. Long-term follow-up data further support the reliability of this technique.

Types of studies: Level IV.

Purpose: To evaluate the effect of vitamin D on the speed and quality of pediatric fracture healing.

Methods: A 4-year prospective study of healthy children with shaft fractures of the forearm bones (treated with minimally invasive osteosynthesis) or femur (treated by traction or by minimally invasive osteosynthesis). All children had their vitamin D levels examined four times-at the time of the injury, 1, 3, and 5 months after the injury. Also, all children underwent radiograph follow-ups (same time as blood tests) to evaluate fracture healing. Children were, in the beginning, blindly divided into two similarly sized groups-one group was orally administered cholecalciferol throughout the follow-up, the second group was not, and we compared those groups.

Results: Altogether, 63 children were included in the study-36 supplemented and 27 non-supplemented. In supplemented children, the vitamin D levels increased statistically significantly during the follow-up period, in contrast to the non-supplemented group. The fracture healing on radiographs was also statistically significantly faster and better in the supplemented group. When we divided children according to fracture type, we observed statistically significantly better fracture healing in children with forearm fractures in the supplemented group for the whole study period. In children with femoral fractures, the healing in the supplemented group was statistically significantly better after 3 months; however, after 1 and 5 months, the difference was not statistically significant.

Conclusions: Based on our results, we recommend vitamin D testing and administration for children treated for forearm and femoral fractures.

Level of evidence: Level I.