Pediatric navicular dorsal osteochondroma: a rare case of navicular–cuneiform impingement
We present an exceptionally rare case of tarsal navicular dorsal osteochondroma diagnosed in an 11-year-old female child affected by chronic foot pain. Radiographs, MRI, and computed tomography scan revealed bony excrescences extending outward from the navicular bone. After conservative treatment failed, the navicular dorsal exostosis was excised in open surgery with complete resolution of symptoms. Navicular–cuneiform impingement was diagnosed by instrumental and intraoperative techniques. Histological analysis confirmed the diagnosis of navicular dorsal osteochondroma. This case report illustrates the necessity of ...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Can polyaryletherketone cage be used to achieve union and maintain correction in anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot?
A structural graft is often used to maintain correction and achieve union after anterior calcaneal lengthening osteotomy for treatment of flexible flatfoot. Autograft, the current gold standard, is limited in availability and configuration and is associated with donor site morbidity in as much as 48%, whereas the alternative allograft carries risks of disease transmission and collapse. Polyaryletherketone cage, with a healing rate similar to that of autograft, high stability, and no donor-site morbidity, has been used in spine surgery. However, its use has not been documented in foot and ankle surgery. We reviewed 15 patie...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Analysis of three-dimensional computed tomography talar morphology in relation to pediatric pes planovalgus deformity
This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also a...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

One-stage release by double surgical approach for neglected congenital vertical talus: results in a series of walking children in Tanzania
This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Simultaneous lateral column shortening along with differential distraction by Joshi’s external stabilization system for rigid neglected clubfoot correction
Correction of rigid clubfoot in an older child by gradual differential distraction using the Ilizarov’s device or Joshi’s external stabilization system (JESS) is a time-consuming procedure. We simultaneously combined the lateral column shortening by cuboid wedge resection along with the differential distraction by application of JESS fixator for the treatment of severe, rigid, neglected, or relapsed congenital talipes equinovarus (CTEV) foot deformity in 30 feet in 18 children with mean age of 5.3 years and mean follow-up of 27.6 months. The mean pretreatment Pirani score was 5.3 which improved to mean Pirani s...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Incidence and risk factors for iatrogenic distal tibia/fibula fracture during Ponseti technique of clubfoot treatment
The incidence and risk factors of distal tibia/fibula fracture, an uncommon complication during Ponseti manipulation, are unknown. We evaluated 222 virgin clubfeet of patients aged less than 3 years for fractures of distal tibia/fibula. Incidence rate was found to be 1.3% per year. Associated risk factors were identified as neglected, syndromic clubfeet, feet requiring greater than 10 casts, post-tenotomy dorsiflexion less than 10° and casting by physician with less than 3 years of casting experience, with odds ratios of 14, 28, 4.9, 3.7 and 3.4, respectively. Most of these fractures healed without consequences; howeve...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Effect of bar length on foot abduction and ankle dorsiflexion in Steenbeek foot abduction brace
We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (−2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abd...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Brachial artery pseudoaneurysm after fixation of supracondylar fracture in a 9-year-old child
The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Hoverboard injuries in children and adolescents: results of a multicenter study
We report the results of a multi-center study regarding hoverboard injuries in children and adolescents. who presented with extremity fractures while riding hoverboards to 12 paediatric orthopaedic centers during a 2-month period were included in the study. Circumstances of the injury, location, severity, associated injuries, and the required treatment were recorded and analysed using descriptive analysis to report the most common injuries. Between-group differences in injury location were examined using chi-squared statistics among (1) children versus adolescents and (2) males versus females. Seventy-eight patients (M/F r...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Do wrist buckle fractures in children need follow-up? Buckle fractures’ follow-up
Buckle or torus fractures in the distal forearm are characterized by a bulging of the cortical bone. They are a frequent reason for consultation in pediatric emergencies. The treatment and follow-up of this type of fractures varies from soft immobilizations to a plaster cast. The purpose of this study is to assess the stability of buckle fractures of the distal radius. We reviewed 106 pediatric patients with buckle fractures and analyzed the radiographs at the time of initial consultation and at the last follow-up. None of these fractures displaced further, regardless of the treatment given. Buckle or torus fractures do no...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Clinical and radiographic comparison of single-sugar-tong splint to long-arm cast immobilization for pediatric forearm fractures
The purpose of this study was to compare the efficacy of a single-sugar-tong splint (SSTS) to a long-arm cast (LAC) in maintaining reduction of pediatric forearm fractures, while avoiding secondary intervention. One hundred patients age 3–15 with a forearm fracture requiring a reduction and immobilization were evaluated (50 LAC and 50 SSTS). Medical records and radiographs were reviewed at injury, postreduction, and at 1, 2, and 4 weeks postinjury. Sagittal and coronal angular deformities were recorded. Any secondary intervention due to loss of reduction was documented. The groups were matched by age (P = 0.19), sex ...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Telehealth: a novel approach for the treatment of nondisplaced pediatric elbow fractures
Telehealth has seldom been used in the field of pediatric orthopaedics. The purpose of this study is to assess the efficacy of telehealth as a tool for the follow-up of children with nondisplaced elbow fractures. We hypothesize that patients treated via telehealth will have comparable clinical outcomes as those treated at our institution, with increased patient satisfaction. We conducted a randomized trial, which included 52 children with type I supracondylar humeral fractures, or occult elbow injuries, divided in two groups, based on the type of care provided during the fourth-week follow-up appointment: cast removal at o...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Is a radiograph needed one week after internal fixation of a supracondylar humeral fracture?
We examined patient and fracture characteristics and postoperative complications. LOR was defined as a change of 5° or more in measurement of Bauman’s angle or the lateral capitellohumeral angle. After applying exclusion criteria, the study group consisted of 131 patients; 87 (66.4%) were male; the left limb was involved in 76 patients (58%); 98 were classified as Gartland type 3 (74.8%); 118 patients had extension type fractures (90%); complications included nerve injury in 32 patients (24.4%), mostly involving the ulnar nerve (17, 13%). Pin-tract infection occurred in four patients (3%). LOR was found in five p...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Surgical management of Gartland type III supracondylar humerus fractures in older children: a retrospective study
The aim of this study was to analyse the management of Gartland type III supracondylar humerus fractures in children older than 10 years at our paediatric orthopaedics and to determine the clinical and radiographic long-term effects following open reduction by the small medial approach and cross-fixation with three kirschner wires. Eighty-three cases of Gartland type III supracondylar humerus fractures in children older than 10 years were treated by open reduction by the small medial approach and cross-fixation with three kirschner wires from January 2010 to December 2015. All patients were followed up from 12 to 15 months...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Washers do not affect the rate of implant removal or elbow motion in medial epicondyle fractures
The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

No difference in outcomes in a matched cohort of operative versus nonoperatively treated displaced medial epicondyle fractures
The purpose of our study was to compare the treatment outcomes and complications between operatively and nonoperatively treated displaced medial epicondyle fractures. Pediatric patients treated for an acute, displaced medial epicondyle fracture between 2005 and 2015 were retrospectively reviewed. A total of 22 operative participants were matched to 22 nonoperative participants, with an average displacement of 9.7 mm in both groups. There was no statistical difference in average length of immobilization, median time to full pronation/supination and flexion/extension, proportion of patients needing physical therapy, and comp...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

Is open reduction necessary for pediatric T-condylar fractures of the humerus?
The aim of this study was to investigate the outcomes of closed reduction and percutaneous pinning (Kirschner wire fixation) as a less invasive method for the treatment of pediatric T-condylar fractures of the humerus compared with open reduction and pinning. Among pediatric patients who were diagnosed with T-condylar fractures of the humerus between 2010 and 2017, those who underwent closed reduction and percutaneous pinning were retrospectively evaluated. The surgical technique used was to restore joint alignment through closed reduction and then to insert a pin parallel to the joint surface to stabilize the intercondyla...
Source: Journal of Pediatric Orthopaedics B - September 25, 2019 Category: Orthopaedics Tags: Trauma Source Type: research

High rate of inappropriate referrals to pediatric orthopedics in an egalitarian healthcare system
Previous studies have shown relatively high rates of inappropriate referrals to pediatric orthopedic surgery. The purpose of this study was to determine the rate of inappropriate referrals in an egalitarian healthcare system. We reviewed all 400 referrals to our pediatric orthopedic surgery practice over a 2-year period and assessed the appropriateness of each based on the American Academy of Pediatrics guidelines. A total 206 (52%) referrals were deemed appropriate. There is a high rate of inappropriate referral to pediatric orthopedic surgery even within a closed, egalitarian healthcare system. Targeted education of prim...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: MISCELLANEOUS Source Type: research

Personalized surgery approach in severe form of osteogenesis imperfecta type III: point of view
Osteogenesis imperfecta (OI) is a genetic disorder characterized by fragile bones. It is our aim to illustrate variability in clinical presentation of severe form of OI. As an example of personalized surgery approach we present an 11-year-old girl with OI type III. Prior to referral to our hospital, she was treated with 18 cycles of bisphosphonates as well as with several different surgical procedures. Due to no improvement in her mobility status she underwent two additional surgeries at our hospital with a 5-month interval between them. Prior to the surgery, molecular genetic analysis was performed and the clinical diagno...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: MISCELLANEOUS Source Type: research

Relevant advances in bone lengthening research: a bibliometric analysis of the 100 most-cited articles published from 2001 to 2017
This study aimed to assess the scientific production of bone lengthening research by identifying the most-cited papers. All articles including the term ‘bone lengthening’ published between 2001 and 2017 were retrieved through the Web of Science database. The 100 most-cited articles on bone lengthening included a total of 4244 citations, with 414 (9.7%) citations in 2017. There was an average of 249.6 citations per year. The articles predominantly addressed biomechanics and bone formation (38). Different surgical techniques, including intramedullary nail (14), Ilizarov (nine), intramedullary skeletal kinetic dis...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: MISCELLANEOUS Source Type: research

Simultaneous bilateral neck of femur fractures in an adolescent secondary to hypocalcaemic seizure
We present a rare case of a previously healthy 16-year-old boy who sustained simultaneous bilateral femoral neck fractures after a single first-time seizure episode. He was diagnosed to have severe vitamin D deficiency and secondary hyperparathyroidism. Symptomatic hypocalcemia was the cause of seizures. Both fractures were treated surgically and united at 3 months. Bilateral femoral neck fractures after seizures are very rare, especially in children. Severe vitamin D deficiency may cause seizures and also weakening of bone, predisposing to fractures without significant trauma. We recommend that paediatric cases of femoral...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Management of early-onset hip osteoarthritis in an adolescent patient with osteopetrosis tarda: a case report
Osteopetrosis (OP) is a group of rare sclerosing bone dysplasia characterized by increased bone density. The benign autosomal dominant form is the most common type. It typically carries a full life expectancy, despite increased propensity for fractures and other musculoskeletal problems, particularly hip osteoarthritis. In the current literature, the youngest OP patient having hip osteoarthritis is 16 years of age and treated with total hip arthroplasty. Within the present study, a 16-year-old female patient with early-onset hip osteoarthritis treated with hip joint debridement and femoral head reshaping is presented. The ...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Anatomic, diagnostic and management challenges in paediatric pelvic injuries: a review
Pelvic injuries have an incidence of 1: 100 000 children per year in the UK, of which 10% are unstable. A literature review was conducted. Clinical examination alone in a stable patient precludes the need for imaging. Imaging options in the acute pelvic injury are critically reviewed. Where appropriate Judet views or limited exposure computed tomography scan remain of diagnostic benefit. Displacement greater than 1 cm should be reduced and held with an appropriate method. Closed reduction and external fixation for rotationally unstable fractures, and closed or open reduction with internal fixation of two columns should be ...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

A nationwide analysis of failed irrigation and debridement for pediatric septic arthritis of the hip
Irrigation and debridement (I&D) is the gold standard for treatment of pediatric septic arthritis of the hip. If the index surgery fails, subsequent surgery may be required to eradicate the infection, resulting in substantial increases in morbidity, healthcare costs, and psychosocial burden. The purpose of this study was to identify the incidence of failed I&D for pediatric septic arthritis of the hip, defined by the need for at least one subsequent surgical intervention, and potential risk factors for failed initial I&D. The Kids’ Inpatient Database was used to extract data for pediatric patients diagnos...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

The effect of femoral orientation on the measurement of the head shaft angle: an ex-vivo study
This laboratory study evaluates head shaft angle (HSA) reliability using ranges of simulated femoral orientation often seen in children with cerebral palsy. A dry femur was mounted in a jig that enabled the bone to be positioned in a range of internal and external rotation (−40° to + 40°) and flexion (0°–60°), alone or in combination. A metal wire was placed as a surrogate physis to give two HSA angles of 140° and 160°. Radiographs were taken of the femur in differing combinations of rotation, flexion and the two HSA angles. The HSA was measured by four independent observers on two separ...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

The unstable slipped capital femoral epiphysis: does the rate of osteonecrosis really depend on the timing of surgery and surgical technique?
The aim of this study was to investigate whether the timing of surgery and surgical technique affect the rate of osteonecrosis in unstable slipped capital femoral epiphysis (SCFE). This is a retrospective review of all unstable slips that were treated at our institution over 8.5 years with a minimum follow-up period of 12 months. Patients with stable slips were excluded from this analysis. Demographic data, time to surgery, and surgical technique were analyzed. Twenty-three unstable slips were included for study after excluding 40 stable slips. There were 17 males and six females, with an average age of 11.9 years; 13 pati...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

The outcome of in-situ fixation of unstable slipped capital femoral epiphysis
There is limited information regarding the outcome of in-situ fixation of unstable slipped capital femoral epiphysis (U-SCFE). We aimed to report the outcome of a cohort of patients with U-SCFE that were treated with in-situ fixation, by comparing it to the outcome of patients with stable slipped capital femoral epiphysis (S-SCFE). After Institutional Review Board approval, a retrospective analysis of patients with SCFE that were treated with in-situ fixation at a single institution between 2005 and 2016 was performed. Preoperative and postoperative clinical and radiographic data was collected. The rate of complications, i...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Developmental dysplasia of the hip and clubfoot treated by Pavlik and Ponseti methods
Children having both typical developmental dysplasia of the hip (DDH) and clubfoot are rare, and early treatments of both conditions are recommended. The aim of this study was to evaluate the effects of the Ponseti method of clubfoot treatment on hips with DDH. After institutional review board approval, we identified children treated by the Ponseti and Pavlik methods between 2003 and 2016. During the Ponseti method treatment, the duration of manipulations, number of casts, tenotomies performed, and days in clubfoot orthosis were recorded. During DDH treatment, we registered duration for Pavlik and hip brace usage. Hips had...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Oligohydramnios: should it be considered a risk factor for developmental dysplasia of the hip?
Breech, family history, first born and female sex are the main risk factors described for developmental dysplasia of the hip (DDH). Foot abnormalities and oligohydramnios have also been listed. Recent studies have discredited torticollis, multiple gestation pregnancy, mode of delivery and prematurity as risk factors. Definition of oligohydramnios in the literature is inconsistent. Our aim was to investigate the term oligohydramnios and evaluate whether it should be considered a risk factor for DDH. All live births in our institution between 2001 and 2014 were included. We identified all pregnancies classed as reduced amnio...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Traction does not decrease failure of reduction and femoral head avascular necrosis in patients aged 6–24 months with developmental dysplasia of the hip treated by closed reduction: a review of 385 patients and meta-analysis
In conclusion, preliminary traction does not decrease the failure of reduction and the incidence of AVN in developmental dysplasia of the hip treated by closed reduction between 6 and 24 months of age. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

MRI reveals unrecognized treatment failures after application of Fettweis plaster in children with unstable hip joints
We examined 19 type D, 55 type III, and 58 type IV. Mean age at diagnosis was 84.5 days (SD: ± 55.4). Treatment period was 63.2 days (SD: ± 22.2). In 13 cases, the MRI showed a poor reduction. After repetition of this treatment, all 13 showed a concentric reduction. The use of MRI detects 9.8% of treatment failures. We recommend an MRI examination after each closed reduction to ensure the success of the therapy. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Spica MRI predictors for epiphyseal osteonecrosis after closed reduction treatment of dysplasia of the hip
The objective of our study was to evaluate spica MRI predictors for epiphyseal osteonecrosis after closed reduction. This was a retrospective study of all patients undergoing closed reduction for DDH followed by gadolinium-enhanced spica MRI between July 2011 and November 2014. Patient demographics and clinical follow-up through 2017, including the development of epiphyseal osteonecrosis and need for reintervention after the initial reduction, were recorded. MRI data included hip abduction angles and quantifying the percentage of femoral head enhancement. Twenty-five hips in 21 patients (16 girls, five boys, mean age: 0.99...
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Bone maturation of MRI residual developmental dysplasia of the hip with discrepancy between osseous and cartilaginous acetabular index
This study shows that, in one-third of cases, divergent dysplasia leads to a spontaneous recovery. MRI should be used early to accurately diagnose and follow-up DDH cases and allow surgeons to justify the required surgical treatment. Level of Evidence: IV. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2019 Category: Orthopaedics Tags: PELVIS & HIP Source Type: research

Response to ‘Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents: is the rationale of antibiotics use appropriate?’ by Rajnish: et al: .
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: LETTERS TO THE EDITOR Source Type: research

Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents: is the rationale of antibiotics use appropriate?
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: LETTERS TO THE EDITOR Source Type: research

Arthrography of the hip should be performed before incision in developmental dysplasia of the hip
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: LETTERS TO THE EDITOR Source Type: research

Complete remodelling of a displaced odontoid synchondrosis fracture managed conservatively: a case report
In this report, we present the long-term functional and radiological outcomes following nonoperative treatment of such a fracture in a 5-year-old female. The patient was referred to our tertiary centre with radiological progression of angulation from 10° to 35° within 5 weeks of the injury, despite wearing a rigid collar. She had no neurological compromise. Although we examined the fracture under general anaesthetic, and subsequently applied halo traction, there was no effect on alignment. The halo device was removed after 11 days and a rigid collar was fitted again. The patient had no pain or neurological symptoms...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Occipitocervical or C1–C2 fusion using allograft bone in pediatric patients with Down syndrome 8 years of age or younger
In this study, we used freeze-dried allograft as a bone graft substitute, and we were able to detect bony trabeculae at the graft–recipient interface on lateral cervical radiographs and on reconstructed sagittal computed tomographic images in all patients. These results suggest that use of allograft is effective for treatment of upper cervical spine abnormalities in pediatric patients with Down syndrome. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Back pain and school bag weight – a study on Indian children and review of literature
Back pain in children is a complex phenomenon, which has been shown to be associated with physical and psychosocial factors. None of the studies on Indian children have investigated the possible association between back pain and psychosocial factors. We decided to determine the prevalence of back pain in students and association with both physical and psychosocial factors. A cross-sectional study was conducted on 163 students from two city schools. Physical factors were evaluated using a structured questionnaire. Strengths and difficulties questionnaire was used to assess psychosocial factors. The studied sample consisted ...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Scoliosis and spinal muscular atrophy in the new world of medical therapy: providing lumbar access for intrathecal treatment in patients previously treated or undergoing spinal instrumentation and fusion
This study describes a new procedure for a safer and easier access for the intrathecal injection of the recently approved nusinersen therapy in spinal muscular atrophy. This therapy changed the natural history of the disease, but, to date, scoliosis surgery was an excluding criteria for nusinersen therapy. The bone mass, due to the posterior spinal fusion of the scoliosis surgery, prevents the needle for the nusinersen administration from intervertebral access. This is a single-center, single-surgeon case series descriptive study. A laminotomy at the L3–L4 level was performed to provide safer access for the intrathec...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

The modified Kostuik transilial bar technique has acceptable results in neuromuscular spinal deformity correction
The aim of this study is to evaluate the results of the modified Kostuik transilial bar technique for neuromuscular scoliosis (NS). We reviewed the records of 21 patients treated for NS with this instrumentation. There were 14 females and seven males, with an average age of 15.6 years (range: 9–21 years). We determined patients’ demographics, correction ratio of both curve and pelvic obliquity, loss of correction, screw loosening at first sacral vertebra, and clinical outcomes. Mean follow-up was 56 months (range: 34–96 months). There were no reoperations, no screw breakage, and no significant loss of cor...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Incidence of complete spinal instrumentation removal following surgery for spinal deformity: a 22-year single institution study
The aim of this study was to define the incidence of complete implant removal following surgical correction of spinal deformity in pediatric patients over a 22-year period and identify possible risk factors. A retrospective review of our Pediatric Orthopedic Spine Database between 1992 and 2016 was performed. We included patients undergoing complete implant removal following scoliosis correction surgery with a minimum of 2-year follow-up. Medical charts were reviewed to determine initial patient diagnosis and the indication for implant removal. Statistical analysis was carried out to determine the associations between sex ...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis
This study assessed the rate of adverse wound events in individuals with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and sought to determine if obesity was related to the rate of adverse wound events. A retrospective review of patients with adolescent idiopathic scoliosis that underwent posterior spinal fusion between 2001 and 2013 was performed. Preoperative, perioperative, and postoperative data, including wound adverse events, were obtained through medical record review. Using the Center for Disease Control BMI criteria, participants were grouped into overweight/obese (BMI%≥85 percentile) ...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Do postoperative drain volumes correlate with intraoperative blood loss and postoperative transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis?
Most studies have excluded postoperative drain volumes in analyzing blood loss associated with scoliosis surgery. We sought to analyze patient and surgical factors that influenced postoperative drain outputs. A retrospective review was conducted on 50 consecutive patients who had undergone posterior spinal fusion with pedicle screw instrumentation and subfascial drain placement over a 6-year period at a single institution for adolescent idiopathic scoliosis. Postoperative drain volumes were correlated to patient factors, surgical variables, and change in postoperative hemoglobin values. The association between drain output...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Assessment of fatty infiltration of the multifidus muscle in patients with adolescent idiopathic scoliosis through evaluation by magnetic resonance imaging compared with histological analysis: a diagnostic accuracy study
To evaluate fat infiltration in the multifidus muscle close to the scoliotic curve as seen in MRI compared with the histological evaluation in patients with adolescent idiopathic scoliosis (AIS). The evaluation of fatty infiltration in the multifidus muscle of patients with AIS by MRI was compared with biopsy. Fatty infiltration was greater in concave side than in the convex side in both MRI (P=0.005) and biopsy evaluation (P=0.026). There was no correlation between the fatty infiltration findings evaluated through MRI and biopsy. The MRI measurements do not express accurately the tissue changes observed in the biopsy. (So...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Noncontact sports participation in adolescent idiopathic scoliosis: effects on parent-reported and patient-reported outcomes
The objective of this study was to determine if sports participation had an impact on pain, function, mental status, and self-perception of deformity in patients and their parents. Patients had full spine radiographs and completed baseline surveys of demographics, socioeconomics, and patient-reported outcomes (PRO): Scoliosis Research Society (SRS)-30, Body Image Disturbance Questionnaire, and Spinal Appearance Questionnaire (SAQ: Children and Parent). Patients were grouped by their participation (sports) or nonparticipation (no-sports) in noncontact sports. Demographics, radiographic parameters, and PRO were compared usin...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: SPINE Source Type: research

Concept and treatment outcomes of dynamic spinal brace for scoliosis in cerebral palsy
We developed a novel device, dynamic spinal brace (DSB), with the basic concept of automatic correction by maximizing posture control. Herein, we report the structure of the DSB and preliminary treatment outcomes for scoliosis in patients with cerebral palsy. The study cohort comprised 219 patients with cerebral palsy treated for scoliosis with Cobb angle of at least 20° and follow-up of more than 3 years under the DSB. Cobb angle, trunk shift, and pelvic obliquity were assessed by semi-sitting radiography, and a questionnaire on daily lifestyle was collected. The immediate correction of these parameters by wearing DSB...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

Long-term outcome of knee hyperextension in children with cerebral palsy
This study evaluated knee hyperextension course in children with cerebral palsy over a 5-year follow-up. Knee hyperextension was identified in 308 knees, of which 97 had follow-up greater than 5 years. Between the tests, 40% of limbs had plantar flexor lengthening (PFL). Overall, knee flexion and ankle dorsiflexion in stance increased (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

Hamstring lengthening in females with cerebral palsy have greater effect than in males
The objective of this retrospective study was to determine if the surgical response to medial and lateral hamstring lengthenings is different between males and females. Preoperative and postoperative kinematic data of 109 (71 males and 38 females) patients with cerebral palsy were evaluated. Females demonstrated larger decreases in popliteal angle, larger decreases in mid-stance knee flexion, and higher incidences of knee hyperextension postoperatively. Results indicate that females have larger responses to hamstring lengthenings than males. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

The popliteal angle tests in patients with cerebral palsy
The aims were to determine during the popliteal angle (PA) tests whether particular knee muscles are activated and whether the position of pelvis affects the level of muscles activation. Twenty-two patients with cerebral palsy were recruited (age: 14±4.94 years). Knee muscle activities and range of motion were measured during PA. Knee flexors were active during tests, with fivefold increase of activation of ipsilateral hamstring. Higher and more frequent activation of muscles only in the contralateral limb was seen. Muscles activation should be considered as a confounding factor during tests. PA should not be relied...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research