The increase of anterior pelvic tilt after semitendinosus transfer to distal femur in patients with spastic diplegic cerebral palsy
The aim of this study was to compare semitendinosus transfer to distal femur (STTX) to semitendinosus surgical lengthening (STL) regarding the increase of anterior pelvic tilt after flexed knee gait treatment. Thirty-nine patients were evaluated, and they were divided according surgical procedures at knees: STL group (22 patients/44 knees), which included patients who received medial hamstrings surgical lengthening as part of multilevel approach, and STTX group (17 patients/34 knees), which was represented by patients who underwent orthopedic surgery including a STTX instead of STL. In the present study, the mean anterior ...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

The long-term outcome of pelvic asymmetry during gait in children with cerebral palsy following unilateral femoral derotation osteotomy
In this retrospective study, children with cerebral palsy underwent a unilateral femoral derotation osteotomy and had a preoperative (PO), short-term postoperative (1–3 years), and a long-term postoperative (≥5 years) gait analysis. Patients were subdivided into groups by the PO pelvic presentation and Gross Motor Function Classification System level. In children with PO pelvic external rotation, femoral derotation osteotomy decreased the hip internal rotation and decreased the pelvic external rotation. These results could influence surgical planning to achieve long-term pelvic asymmetry. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

Outcomes of salvage hip surgery in children with cerebral palsy
This study compared the outcomes of four salvage procedures in treating painful dislocated hips in patients with cerebral palsy: Schanz osteotomy, Girdlestone, Castle, and McHale procedures. A retrospective review of cerebral palsy patients treated between 1990 and 2014 with minimum 6-month follow-up was carried out. Of 69 hips (62 patients), there were 36 McHales, 24 Castles, four Girdlestones, and five Schanz procedures at a mean age of 13.9 years. All four procedures provided pain relief. Proximal femoral migration was similar following the procedures, but heterotopic ossification was more common after the Castle proced...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

C-reactive protein: what to expect after bony hip surgery for nonambulatory children and adolescents with cerebral palsy
Bony hip reconstruction surgery in children with severe cerebral palsy is associated with high complication rates, usually postoperative chest and urinary tract infections. C-reactive protein (CRP) level is commonly used as an indication of infection; an understanding of its normal postoperative trends is crucial to allow early identification of abnormal levels and possible infection. Our aim was to describe the trends in CRP following bony hip surgery in children who had an uneventful postoperative course, on the basis that the children for whom CRP does not follow this course are likely to have a bacterial infection. A r...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

Outcome of hand surgery in children with spasticity – a 9-year follow-up study
The aim of this study was to evaluate whether short-term positive effects on bimanual function after surgery of the paretic arm in cerebral palsy are maintained long term. Assisting Hand Assessment (AHA) and active range of motion was tested before surgery and at 7 month and 9-year follow-up (n=18). AHA improved significantly from 50 to 52 U at 7 months, but was not different from before surgery at the 9-year follow-up, 49 U. Surgery of wrist and elbow flexors significantly improved active extension. Improvement in wrist and elbow extension was maintained at the 9-year follow-up, but usefulness of the hand me...
Source: Journal of Pediatric Orthopaedics B - May 29, 2019 Category: Orthopaedics Tags: CEREBRAL PALSY Source Type: research

Abstracts of the 9th International Clubfoot Congress, Montreal, Canada, 11th October 2018
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: ABSTRACTS: PDF Only Source Type: research

Treatment of early-onset scoliosis with growing rods in patients with neurofibromatosis-1
This study aimed at verifying the efficacy of growing rod treatment in patients affected by neurofibromatosis with early-onset scoliosis. The authors present a retrospective case study of seven children treated between 2001 and 2017. Mean age at initial surgery was 7.2 years. Mean Cobb angle was 82.7°. Lengthening was performed once a year. Mean Cobb angle at last follow-up was 50.1°. Mean spinal growth was 13.6 mm/year, with regular gain during lengthening procedures. Mean follow-up period was 7 years after the first surgery. Three patients underwent final fusion. Complications were one proximal junctional ...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory
Although several procedures for treating scoliosis have been developed, the most effective treatment is still based on early detection. For early diagnosis of idiopathic scoliosis, many authors have proposed methods of school screening; however, there is still no standardized screening program. The aim of this study was to evaluate a school screening method and the prevalence and distribution of scoliosis in Italian school children, aged 9–14 years, and to determine if the screening method can reduce morbidity in an Italian territory. The screening program consisted of three steps: the first step was a clinical exami...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Practices concerning management of Gartland type III supracondylar humeral fractures among Italian pediatric orthopedic surgeons
The purpose of this study was to investigate the current practice among Italian pediatric orthopedic surgeons concerning management of Gartland type III supracondylar humerus fractures (SHFs). A total of 17 Italian pediatric orthopedic surgeons were asked to complete a questionnaire about their attitudes and practices concerning Gartland type III SHF treatment in 2015. Overall, 67% of the fractures were treated in a delayed fashion (>6 h after patient presentation to the emergency department). Moreover, the method of fixation was lateral-only pinning (64% of the cases). Although the management of any child with a...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Complications during the treatment of missed Monteggia fractures with unilateral external fixation: a report on 20 patients in a 10-year period in a tertiary referral center
We describe our initial experience with ulnar osteotomy and progressive correction with unilateral external fixator in MM. We retrospectively evaluated 20 children undergoing ulnar osteotomy and progressive distraction angulation by unilateral external fixator to treat MM. Nine patients had closed reduction, whereas 11 patients had simultaneous open reduction, repair, or reconstruction of the annular ligament and K-wire stabilization of the radiocapitellar joint. Patients were followed for an average of 3 (1–11) years. Three children developed aseptic nonunion and one child had delayed union. A distal level of the os...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

An alternative to plaster cast treatment in a pediatric trauma center using the CAD/CAM technology to manufacture customized three-dimensional-printed orthoses in a totally hospital context: a feasibility study
We describe the manufacturing process of the 3D device in place of the plaster cast usually applied to a child 48/72 h after the access to the Trauma Center Traumatology Hub. This procedure had already been performed at Level II, Trauma Center, Campania Region, Orthopaedic Division of Santobono Children’s Hospital, Naples, Italy. The operative phase was performed by two 3D printers and a scanner in the bioengineering laboratory of the hospital’s outpatient area. The phase of software elaboration requires close cooperation among physicians and engineers. We decided to use a model with a double-shell desig...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Proposal of an innovative casting technique for correction of clubfoot according to Ponseti method: a pilot study
A total of 70 clubfeet were treated by a posterior above-knee cast (pressure points on the talus and on the first metatarsal) according to Ponseti method. At diagnosis, average Pirani score was 4.44, and mean time of treatment was 50.32 days. Overall, 27 (38.6%) clubfeet had only conservative treatment (5.29 casts) and 43 (61.4%) also had Achilles tenotomy (6.38 casts). At the end 61/70 feet (87.14%) had Pirani score 0; 10/70 feet (5.71%) had Pirani score 0.5. The Pirani score gain/cast was β=–0.432 (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Double hindfoot arthrodesis technique for the treatment of severe equino-plano-valgus foot deformity in cerebral palsy: long-term results and radiological evaluation
The aim of this study was to evaluate the clinical and radiological results of a double arthrodesis technique for the treatment of equino-plano-valgus foot deformity in pediatric patients affected by cerebral palsy. A retrospective evaluation was performed on 175 feet surgically treated with a talonavicular and calcaneocuboid joint fusion technique. The average age at surgery was 14.7 years (range: 12–20 years). Visual analogue scale for pain score, Gross Motor Function Classification System scale, talonavicular angle, Costa–Bertani angle, and Kite’s angle on standard weight bearing radiographs were evalu...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Effects of body weight on the clinical and radiological outcomes of children with flexible flatfeet managed with the ‘calcaneo-stop’ procedure
This study aimed to evaluate the clinical and radiological outcomes of normal, overweight, and obese children with symptomatic flexible flatfeet managed with the ‘calcaneo-stop’ procedure (CSP), and to determine whether any correlation exists between patient weight and outcome. One hundred and seventy-four symptomatic flexible flatfeet were managed with CSP during the study period. The patients were divided into three groups according to their BMI and weight Z-scores: normal, overweight, and obese. Their clinical and radiographic outcomes were assessed preoperatively, and at 1 and 5 years after the index proced...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Mesenchymal stem cells as adjuvant therapy for limb lengthening in achondroplasia
Staged leg lengthening allows achondroplastic dwarfs to reach nearly normal height, but it takes long periods of external fixation and it can be burdened by delayed unions. Between 2009 and 2013, eight achondroplastic dwarfs showed delayed unions in the callus formation during femoral lengthening stages in our institute. We performed in-situ injections of bone marrow-derived stem cell concentrates. Patients underwent monthly clinical and radiographic assessment for determination of the healing rate. All eight patients showed an improvement in the regenerated bone, with an average healing index of 23.1 days/cm (range: 18.7&...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Correction of complex lower limb angular deformities with or without length discrepancy in children using the TL-HEX hexapod system: comparison of clinical and radiographical results
The aim of this study was to compare clinical and radiographical results for treatment of lower limb multiaxial deformities±limb length discrepancy (LLD) of at least 2 cm with the Truelok hexapod fixator system (TL-HEX). All consecutive cases of lower limb multiaxial deformities were included. Patients were divided in two groups: group 1, lower limb angular deformity+LLD less than 2 cm, and group 2, lower limb angular deformity+LLD of at least 2 cm. Only patients with age younger than or equal to 20 years and follow-up of 6 months after removal of the external fixator were included. A total of 2...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Oblique pelvic osteotomy in the treatment of bladder exstrophy in neonates
Bladder exstrophy is a congenital and rare malformation of the lower abdominal wall with exposure of the bladder mucosa to the external environment, and it is related to pelvis abnormalities. Eighteen patients with bladder exstrophy were treated with bilateral oblique pelvic osteotomy in conjunction with urologic reconstruction after they were stabilized by cast. No failure of midline closure was observed (wound dehiscence or recurrence of bladder exstrophy). Follow-up showed no leg length discrepancy or problems in walking. Bilateral oblique pelvic osteotomy is a safe procedure to treat bladder exstrophy, and it results i...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Tönnis triple pelvic osteotomy for the management of late residual acetabular dysplasia: mid-term to long-term follow-up study of 54 patients
In conclusion, we believe that, although Bernese periacetabular osteotomy is nowadays considered the gold standard for the surgical treatment of the dysplastic hip following DDH, Tönnis osteotomy represents a good treatment option: it is technically easy, enables direct visualization of the three osteotomies, leads to few complications, and its learning curve is short. The absence of radiographic signs of osteoarthritis and hip congruency before surgery are the basic requirements to achieve a successful result. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Ultrasonographic changes of labrum morphology in patients with developmental dysplasia of the hip: a preliminary report on 74 dysplastic and unstable hips
The aim of the study was to verify the labrum’s morphological changes in unstable and dysplastic hips during treatment. Between January 2013 and April 2015, 74 dysplastic hips were divided into type D (n=12), type III (n=40), and type IV (n=22). The labrum was evaluated on ultrasonography (US) for echogenicity and dimensions with interobserver/intraobserver tests: test 1 (US at diagnosis and control group), test 2 (US at diagnosis and 6 weeks post-treatment), and test 3 (US at diagnosis and at end of treatment). Statistical analysis was performed. The labrum was less echogenic in test 1 and more echogenic in test 3, ...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents
The aim of this work was to evaluate the outcome and efficacy of treatment in a homogeneous group of skeletally immature patients with chronic osteomyelitis of the long bones managed by a combination of radical debridement and insertion of tobramycin-impregnated calcium sulfate pellets to fill the bone defect in a single-stage procedure. Between 2011 and 2016, 12 skeletally immature patients were treated surgically by the reported technique. Single-stage surgery using tobramycin-impregnated calcium sulfate pellets in association with systemic antibiotic therapy yields satisfactory outcomes in skeletally immature children p...
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

The Italian School of Pediatric Orthopedic Surgery: from the origins to present days
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 28, 2019 Category: Orthopaedics Tags: PEDIATRIC ORTHOPAEDICS IN ITALY: SPECIAL ISSUE Source Type: research

Periacetabular quadruple osteotomy of the pelvis in older children: computed tomography scan analysis of acetabular retroversion and anterior overcoverage of the hip, preventing femoral acetabular impingement: Erratum
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: ERRATUM Source Type: research

Treatment of tibial deformities with the Fassier–Duval telescopic nail and minimally invasive percutaneous osteotomies in patients with osteogenesis imperfecta type III
Osteogenesis imperfecta (OI) is a rare congenital osteodystrophy. Patients with OI present with osteoporosis, extreme bone fragility and severe deformities of the lower limbs, which predispose them to frequent fractures. The aim of our study is to describe the minimally invasive osteotomy technique to correct the tibial deformities in patients with OI type III, using the Fassier–Duval (FD) intramedullary nailing, which is considered the gold standard in this kind of surgery. We analyzed the results obtained from 14 patients with OI type III, treated for tibial deformities with the minimally invasive percutaneous oste...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: OSTEOGENESIS IMPERFECTA Source Type: research

Using a corkscrew-tipped telescopic nail in the treatment of osteogenesis imperfecta: a biomechanical study and preliminary results of 17 consecutive cases
High complication rates were reported with the telescopic nail technique systems. To overcome such technical difficulties, we designed a corkscrew-tipped telescopic nail (CTTN). We biomechanically compared its pullout strength with that of two other tip designs. We used CTTN in 17 patients with osteogenesis imperfecta and reported their preliminary results. Average patient age was 82.6 months, and mean follow-up was 32.0±6 months. Telescoping and osteotomy site healing were assessed using radiological studies. Successful telescoping with event-free osteotomy site healing was achieved in 94.1% of patients; limited te...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: OSTEOGENESIS IMPERFECTA Source Type: research

The top 100 most-cited articles on ‘Clubfoot’
Clubfoot is an important aspect of pediatric orthopedics and is a readily prevalent condition presenting to orthopedic clinics worldwide. To identify landmark articles and important contributions to this field, we sought to do a citation analysis of the top 100 most-cited articles on clubfoot. Using the Scopus database and the search strategy ‘Clubfoot’, ‘Clubfeet’ OR ‘Talipes Equinovarus’, we identified 5753 articles. After filtering for relevant articles, the top 100 cited articles on clubfoot were retrieved for descriptive and statistical analysis. The most cited paper was ‘Long...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: ANKLE & FOOT Source Type: research

The Ponseti method of clubfoot treatment in walking age children: is it effective? A study of 56 children from 1 to 10 years of age
The Ponseti method is well-established for the treatment of clubfoot in younger babies; however, its effectiveness in older children is still unclear. The aim of our study was to report our results of the ‘traditional’ Ponseti method in the management of clubfoot in children of walking age. A total of 56 (81 clubfeet) children with a mean age of 3.16±2.35 years (1–10 years) were divided into two groups: group I consisted of 12 (18 clubfeet) patients with a mean age of 3.36±2.7 years (range: 1–8.4 years) who presented with an untreated clubfoot whereas group II consisted of 44 (63 clubf...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: ANKLE & FOOT Source Type: research

Foot size asymmetry following Ponseti treatment versus comprehensive surgical releases for unilateral clubfeet
Using age and height matched cohorts with unilateral idiopathic clubfeet (n=40 each), we retrospectively reviewed pedobarographic studies to determine the impact of treatment, Ponseti versus comprehensive surgical releases (CSR), on the foot length, width, and contact area. The foot pressures were determined by self-selected walking across a force plate. Ponseti treatment results in more symmetrical foot lengths, widths, and total contact areas with an improvement of 1.3 shoe sizes difference compared with treatment with CSR. This suggests that there is improved growth in the clubfoot in those treated with Ponseti manageme...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: ANKLE & FOOT Source Type: research

Optimizing the use of fibula in type II tibial hemimelia: early results
We describe a technique for optimal use of fibula in reconstruction of type II tibial hemimelia. Six affected children with mean age of 1.4 years and treated over a 5-year period were reviewed. All underwent staged reconstruction by lowering the fibula to below knee level using Ilizarov soft tissue distraction, transfer of distal fibula under proximal tibia, and foot centralization. Mean follow-up period was 3.6 years (range: 1.6–6.05 years). Mean age at follow-up was 4.4 years, and increase in length was 4.08 cm. Tibiofibular union and foot centralization were universally achieved. Mild residual equinovarus d...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: KNEE & LEG Source Type: research

Femoral trochlea does not remodel after patellar stabilization in children older than 10 years of age
Trochlear dysplasia is a major risk factor for patellar instability. It has been sparsely reported that the trochlea can remodel when patellar stabilization is performed in skeletally immature patients before the age of 10 years. It is not known whether trochlea can remodel significantly after the age of 10 years. The purpose of the study was to evaluate trochlear remodeling in skeletally immature patients after patellar stabilization surgery, with a focus on children older than 10 years of age. In a retrospective study, knee MRI of 21 patients who had undergone patellar stabilization surgery, were evaluated. Twenty of the...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: KNEE & LEG Source Type: research

Simultaneous treatment for patellar instability and genu valgum in skeletally immature patients: a preliminary study
Genu valgum is a risk factor for patellar instability. The study purpose was to report on preliminary results of medial patellofemoral ligament (MPFL) reconstruction and simultaneous growth modulation, in patients with patellar instability and genu valgum. A total of seven patients (eight knees) with MPFL reconstruction and medial transphyseal screw insertion for genu valgum correction were assessed using full-length radiographs. Genu valgum corrected from 13.1° to 3.7° at mean 11.7 months, without compromising patellar stability. One patient each had 6° overcorrection and 5° rebound valgus. Guided growth u...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: KNEE & LEG Source Type: research

Spontaneous resolution of focal fibrocartilaginous dysplasia of femur on long-term follow-up: case report and review of literature
We report a case of FFCD of distal femur as a cause of varus deformity that was managed nonoperatively. The deformity resolved spontaneously over a period of 8 years. This is the second reported case of spontaneous resolution of angular deformity secondary to FFCD of distal femur. We strongly recommend to observe the behavior of deformity over a period of 24 months before any surgical intervention is planned. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Early versus late hip spica casting for paediatric femoral shaft fractures
The purpose of our study was to evaluate the effectiveness of treating paediatric femoral shaft fractures by early (48 h) hip spica casting. A retrospective review of 44 patients with 44 femoral shaft fractures treated by either early or late hip spica application with at least 9-month follow-up was undertaken. Both groups were treated on an inpatient basis. The late hip spica group had skin traction applied before the application of a hip spica. The outcome measures involved both clinical [Pediatric Outcomes Questionnaire (POQ) and Activities Scale for Kids (ASK)] and radiological outcomes. Complications were noted...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

The long-term outcomes of posteromedial limited surgery for developmental dysplasia of the hip: a mean 17.3-year follow-up
The objectives of this retrospective study were to evaluate long-term functional and radiological outcomes of 102 dislocated hips of 79 patients treated with the modified medial approach and to compare them with respect to both of our short-term and mid-term outcomes and also with the current literature. The mean age at operation was 11.3±4.3 months (range: 3–18 months), with a minimum follow-up of 15 years (range: 15–23 years). It was determined that 94.1% of mean hip scores were either good or excellent. Avascular necrosis, subluxation/redislocation, and secondary surgeries were 14.8, 6.9, and 7.8%, re...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Incorporating risk factors in the development of the screening programme for developmental dysplasia of the hips
In a 12-year cohort study, all newborns with suspected developmental dysplasia of the hips (DDHs) were scheduled for hip ultrasound at the sixth week of life. Female sex is the only isolated risk factor with a positive likelihood ratio predictive of DDH [1.26; 95% confidence interval (CI): 1.04–1.54]. In combination, the presence of two or more risk factors was predictive of DDH (positive likelihood ratio 1.10; 95% CI: 1.00–1.20). The sensitivity and specificity of two or more risk factors for the prediction of DDH were 93.6% (95% CI: 86.6–97.6) and 14.5% (95% CI: 8.70–22.2), respectively. The level...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Does gestational age affect ultrasonographic findings of the hip in preterm newborns? A sonographic study of the early neonatal period
There are only a few studies in the literature investigating the effects of gestational age on developmental dysplasia of the hip. The aim of this study was to investigate the effects of gestational age on hip ultrasound findings in the early neonatal period in preterm newborns born between 30th and 36th weeks of gestational age. Between January 2008 and December 2013, a total of 788 hips of 394 premature newborns with a gestational age of up to 36th weeks who underwent hip ultrasonography in the first week of their life were retrospectively examined. The distribution of roof angles and hip types in terms of sexes was comp...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Agreement of radiographic measurements and patient-reported outcome in 61 patients with Legg–Calvé–Perthes disease at mean follow-up of 28 years
It is unclear how patient-reported outcome in patients with Legg–Calvé–Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. At a mean follow-up of 28 years (15–42), 61 patients were investigated clinic...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Pediatric obesity is associated with short-term risks after pelvic osteotomy
The risk factors for increased perioperative morbidity following pediatric pelvic osteotomies are poorly understood. The purpose of this study was to characterize differences in adverse events, operative time, length of stay, and readmission following pelvic osteotomy for obese and nonobese patients. A retrospective cohort study was carried out using the National Surgical Quality Improvement Program Pediatric database to identify patients that underwent pelvic osteotomy with or without femoral osteotomy. Obesity was found to be an independent risk factor for blood transfusion (relative risk: 1.4, P=0.007) and readmission (...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Response to ‘Is the extensive anterolateral approach for the treatment of developmental dysplasia of the hip more favorable than conventional surgical methods?’ by Citlak and Baki
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: LETTER TO THE EDITOR Source Type: research

Surgical site infection following elective nonspinal paediatric orthopaedic surgery: a prospective review
The aim of this study was to determine the rate of surgical site infection (SSI) and the factors that predispose to it in children undergoing nonspinal orthopaedic surgery. Over a 6-month period, 326 children who underwent 334 nonspinal elective orthopaedic surgical procedures were prospectively reviewed for the development of surgical site infections. A total of 14 sites became infected, with an overall infection rate of 4.19%. All the infections were superficial, and the only causative organism detected was Staphylococcus aureus. Operating times longer than 1 h and surgical wounds greater than 10 cm in length were...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: INFECTION Source Type: research

Dupuytren’s disease in a child: a long-term evolution after surgery
We report the case of a 13-year-old girl who presented with a fibrous nodular lesion on the palm of her hand. After ultrasonographic examination, surgical resection of the skin (dermofasciectomy) was performed, and a nodular phase mass was recovered, characterized as fusocellular fibroblast proliferation in a dense collagenous stroma with a cell population consisting of parallel fascicles of densely packed fusiform cells of a fibroblast strain. No signs of encapsulation or malignant changes were observed, all of which was consistent with Dupuytren’s disease. This lesion is exceptional in childhood. Sixteen years late...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Missed proximal radioulnar joint translocation with ulnar nerve entrapment: an unusual injury in a child
We report an unusual case of a missed PRUJ translocation with ulnar nerve entrapment in a 10-year-old child. The key to diagnosing the translocation is the position of the proximal radius, which lies medial to the ulna. This was treated by open reduction and release of the entrapped nerve. The ulnar nerve palsy recovered fully at the 1-year follow-up. Although PRUJ translocation with ulnar nerve entrapment is a rare injury, a successful outcome is possible with timely open reduction and release of the ulnar nerve. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Buttress plating for volar Barton fractures in children: Salter–Harris II distal radius fractures in sagittal plane
We report the radiological and clinical outcomes after follow-up for at least 3 years. From March 2008 to September 2014, nine consecutive children were treated by buttress plating. Their mean age at the time of injury was 13.1 years. All of the fractures were metaphyseal fractures in the coronal plane and typical Salter–Harris II fractures in the sagittal plane. After accurate reduction of the fragment, a cortical screw was inserted in the proximal area until the maximum compressive force against the fragment was obtained. Then, one or two locking screws were added adjacent to the initial cortical screw. No screw wa...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Gradual ulnar lengthening by an Ilizarov ring fixator for correction of Masada IIb forearm deformity without tumor excision in hereditary multiple exostosis: preliminary results
Bony exostoses are benign osteocartilaginous growths that start close to growth plates. Approximately 30–60% of patients have forearm deformities. The commonly encountered forearm deformities in these patients are bowing of the radius, with or without ulnar drift of the carpus, radial head dislocation, shortening of the ulna, and radial head dislocation. The current study reported on the results of management of radial head dislocation for type IIb Masada and Oho classification of forearm deformities by Ilizarov ulnar lengthening and without tumor excision. A series of 12 patients with Masada type IIb deformity were ...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Severity of ulnar deficiency and its relationship with lower extremity deficiencies
To assess the characteristics of ulnar deficiency (UD) and their relationship to lower extremity deficiencies, we retrospectively classified 82 limbs with UD in 62 patients, 55% of whom had femoral, fibular, or combined deficiencies. In general, UD severity classification at one level (elbow, ulna, fingers, thumb/first web space) statistically correlated with similar severity at another. Ours is the first study to show that presence of a lower limb deficiency is associated with less severe UD on the basis of elbow, ulnar, and thumb/first web parameters. This is consistent with the embryological timing of proximal upper ext...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Normal value and range of the humerus–elbow–wrist angle in a sample of healthy children with even distributions of age, sex, and laterality
This study was performed to evaluate the normal value of the humerus–elbow–wrist angle (HEWA) in a sample of healthy children with even distributions of age, sex, and laterality. A total of 168 radiographs of the elbows of healthy children with even distributions of age, sex, and laterality were reviewed. The mean HEWA was 12.1° (range: 5°–20°). The value of HEWA was significantly associated with increasing age. Neither sex nor side showed significant differences for the HEWA. The data should be useful for postoperative radiographic assessment of cubitus varus or valgus deformities. (Source: J...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Comparison of three surgical treatment options for unicameral bone cysts in humerus
Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991–2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surg...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Nonoperative versus operative treatment for displaced midshaft clavicle fractures in adolescents: a comparative study
We aimed to compare the outcomes and complications of nonoperative and operative treatment for displaced midshaft clavicle fractures in adolescents. Radiological and functional evaluations and complications for 23 patients with nonoperative treatment were compared with those for 18 patients with operative treatment. No nonunion developed in either group. No significant intergroup differences were observed for occurrence of delayed union or time to union (P=0.851 and 0.887, respectively). Both groups showed excellent functional outcomes on the basis of Disabilities of the Arm, Shoulder and Hand scores and Constant Shoulder ...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Unexpected higher blood loss associated with higher dose ε-aminocaproic acid in pediatric scoliosis surgery
The purpose of this study was to determine if a higher dosing of ε-aminocaproic acid (EACA) is associated with less perioperative blood loss than a lower dose. A total of 74 patients having scoliosis surgery were analyzed. Of the 74 patients, 36 patients received EACA (10 mg/kg/h) and 38 patients received EACA (33 mg/kg/h). After controlling for key variables, an infusion of 33 mg/kg/h of EACA was associated with an increase in intraoperative blood loss of 8.1 ml/kg compared with an infusion of 10 mg/kg/h of EACA. A 33 mg/kg/h intraoperative infusion is associated with high...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Does fusion to T2 compared with T3/T4 lead to improved shoulder balance in adolescent idiopathic scoliosis with a double thoracic curve?
This study included 74 patients who underwent corrective surgery for Lenke-2 AIS with the right main thoracic and left proximal thoracic (PT) curve at a single center. Various radiological parameters were measured using whole-spine standing radiographs preoperatively and postoperatively. Patients were grouped by proximal fusion level: T2 (group F; fusion, N=15) or T3/T4 (group NF; nonfusion, N=59). Preoperative and postoperative radiological parameters were compared between the two groups. Group NF was divided on the basis of the existence of a postoperative shoulder imbalance (PSI;>15 mm) and a subgroup analysis...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery
Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. The Statewide Planning and Research Cooperative System database was used to identify patients with adolescent idiopathic scoliosis who underwent spinal fusion from 1 October 2007 to 30 September 2012 at high-volume institutions (>20 cases/year) in the state of New York. Reg...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research