Journal of Pediatric Orthopedics. Part B

The purpose of this study is to assess the utility of follow-up radiological imaging in the management of developmental dysplasia of the hip (DDH) in patients successfully treated with the Pavlik harness. A retrospective review was conducted on all children under 6 months diagnosed with DDH at a tertiary pediatric hospital between January 2004 and December 2018. Inclusion criteria included successful Pavlik harness treatment following a standardized protocol with complete radiological documentation at 2 years of age...

The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC...

Anterior approach to the hip joint is commonly used for paediatric hip disorders. Lateral femoral cutaneous nerve (LFCN) is always exposed and dissected in this approach before deep dissection is carried out. The course of this nerve has been described in adults but there is a lack of literature regarding this in the paediatric age group. This study aimed to find the surgical anatomy of LFCN in children during the anterior approach to the hip. A total of 51 paediatric hip surgeries were done in 45 children for various hip disorders...

Ultrasound is an imaging modality utilized for early detection and follow-up of developmental dysplasia of the hip (DDH) in infants. Traditionally, pediatric orthopedic surgeons have relied on radiologists to perform ultrasound examinations and interpret the imaging. Today, however, many orthopedic surgeons are performing and interpreting ultrasound themselves. The purpose of this paper was to evaluate the reliability of pediatric orthopedic surgeons in interpreting ultrasound imaging of infant hips. This was a prospective observational pilot study...

This study was a retrospective single surgeon case series approved by institutional review board and showed the efficacy of limited Ponte osteotomy at T6/7, 7/8 and 8/9 (limited-PO) in the sagittal plane for patients with Lenke type 1 and 2 adolescent idiopathic scoliosis (AIS). A total of 37 consecutive patients [7 males and 30 females; average age 16.0 ± 2.5 (range: 12-21)] over a 4-year period with posterior corrective fusion surgery were included. Initially, 18 patients were operated on without limited-PO [P(-)-group]...

The aim of this study is to evaluate the results of submuscular plating using nonlocking plates for extra-articular proximal femur fractures (EPFF) in children. From our hospital records, we retrieved data of 15 children treated with submuscular plating with nonlocking dynamic compression plates (DCP) for EPFF between January 2010 and September 2021. EPFF was defined as a proximal femur fracture within 10% of the femoral length below the lesser trochanter. Patients' demographics, as well as details of the duration of operation, type of DCP used, time to union, complications, and outcomes using Flynn criteria were noted...

Our investigation aimed to assess the reliability of the femoral head shape classification system devised by Rutz et al. and observe its application in patients with cerebral palsy (CP) at different skeletal maturity levels. Four independent observers assessed anteroposterior radiographs of the hips of 60 patients with hip dysplasia associated with non-ambulatory CP (Gross Motor Function Classification System levels IV and V) and recorded the femoral head shape radiological grading system as described by Rutz et al...

Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb...

Race can influence perioperative care and outcomes in adult and pediatric orthopedic surgery. However, no prior study has evaluated any associations between race and complications following upper extremity surgery in pediatric patients. Thus, the purpose of this study was to evaluate whether there are any differences in risks for complications, readmission, or mortality following upper extremity surgery between African American and Caucasian pediatric patients. Pediatric patients who had a primary upper extremity procedure from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database...

OBJECTIVE: The purpose of this study was to evaluate the healing index and complications of distraction osteogenesis through the physis in children with Congenital pseudarthrosis of the tibia (CPT) using Ilizarov external fixation device. METHODS: Nine children with CPT who underwent distraction osteogenesis through the physis surgery with an Ilizarov external fixation device between June 2018 and August 2020 were included in the study. The average follow-up time was 36...

Current literature on pin migration is inconsistent and its significance is not understood. We aimed to investigate the incidence, magnitude, predictors, and consequences of radiographic pin migration after pediatric supracondylar humeral fractures (SCHF). We retrospectively reviewed pediatric patients treated with reduction and pinning of SCHF at our institution. Baseline and clinical data were collected. Pin migration was assessed by measuring the change in distance between pin tip and humeral cortex on sequential radiographs...

The purpose of this study is to examine the epidemiologic trends of adolescent idiopathic scoliosis (AIS) detection and treatment in New York State (NYS), including disparities in access. The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent treatment for, or were diagnosed with, AIS from 2008 to 2016. Age determined adolescence; and the surgery date, 3-digit zip code, sex, race, insurance status, institution and surgeon license number were recorded to identify such trends...

Fractures around the elbow in children should be carefully evaluated because the main portion is cartilaginous, and radiographs are not completely reliable. This study aimed to assess the diagnostic imaging for pediatric elbow fractures that require special attention and consider the usefulness of ultrasonography with seven standard planes for the diagnosis. Patients diagnosed with elbow fractures wherein TRASH (The Radiographic Appearance Seemed Harmless) lesions were evaluated retrospectively. The diagnoses on initial radiographs, final diagnoses, additional imaging excluding radiographs, and the treatments were investigated...

The displaced flexion type supracondylar humeral fractures (SCHF) are inherently unstable and there is great intraoperative difficulty in obtaining and maintaining the fracture reduction by closed means. We introduced a technique for closed reduction and K-wires pinning of displaced flexion type SCHF. Fourteen patients with flexion-type SCHF (9 boys and 5 girls) underwent a reduction technique using a construct of three K-wires. The proximal wire was used for rotational control of the proximal fragment and the two distal wires were used for correction of the flexion and rotational deformity of the distal fragment...

Foot deformities in methyl-CpG binding protein 2 (MECP2) disorders are thought to be common, but reports are scant. The purpose of this study was to report the prevalence and type of foot deformities and surgical management for MECP2 disorders. In this retrospective, comparative study, all children presenting between June 2005 and July 2020, with a genetically confirmed MECP2-related disorder, were included. The primary outcome measure was the prevalence of surgery for foot deformities. Secondary outcomes included type and frequency of foot surgeries, age at surgery, ambulatory status, genetic severity, presence of scoliosis/hip displacement, seizures, and associated comorbidities...

Management of patellar instability is still a clinical challenge, especially in pediatric and adolescent athletes. The purpose of the study was to check the association between the positive apprehension test (which is a sign of patellar instability) and positive Ober's test [which is a sign of a tight iliotibial band (ITB)] and the lower degree of internal rotation of the tibia in young athletes determined by inertial sensors. The participants of this observational case-control study were 56 young athletes aged 10-15...

Intraarticular radial head (IARH) fractures are uncommon pediatric injuries with unpredictable yet poor outcomes. The aim of this study was to evaluate clinical outcomes of IARH fractures in pediatric and adolescent patients, by testing our hypothesis that surgically managed fractures would have less risk for an unplanned second surgery and better elbow range of motion at the final follow-up. A retrospective review of 53 IARH fractures was performed. Demographic and clinical data were recorded. Concomitant and associated injuries were documented...

A scoring system has recently been published that uses parameters within the first 4-5 days of hospitalization to determine the severity of illness (SOI) in children with acute hematogenous osteomyelitis (AHO). To our knowledge, no additional studies to date have examined the validity of the SOI score outside of the institution of origin. This study evaluates the performance of the SOI score in a retrospective cohort of cases at our institution. Patients admitted to our institution over the past 5 years with AHO who met inclusion and exclusion criteria were analyzed...

The objective is to document the rate of vitamin D deficiency and insufficiency among children with low-energy fractures and compare it to fracture-free control group. We included all children under 15 years presenting to the emergency department with low-energy fractures; controls were children without history of fractures from the outpatient department. Conventional X-ray and laboratory blood tests were performed. Vitamin D deficiency was defined as serum level ≤20 ng/ml, and the mean values were compared through two-sample t-tests...

While children undergo skeletal maturation, it is difficult to distinguish between normal variants and abnormalities of the epiphysis and acrophysis on radiological images. Abnormalities in the epiphysis and acrophysis of the toe phalanx have not been reported yet. Here, we describe a series of abnormalities in the epiphysis and acrophysis of the fourth and fifth toe phalanges, including an investigation of their pathogenesis. We evaluated patients suspected of having bone tumors at a local orthopedic clinic because of abnormal findings of the toe phalanx between the distal and middle phalanx on plain radiographs...