Slipped capital femoral epiphysis in children younger than 10 years old: clinical characteristics and efficacy of physeal-sparing procedures
We aimed to investigate the clinical characteristics of slipped capital femoral epiphysis (SCFE) in patients aged less than 10 years and identify the efficacy of physeal-sparing procedures in this age group. Demographic data of 18 SCFE patients aged less than 10 years were compared with those of 71 older patients to investigate the clinical characteristics. The efficacy of physeal-sparing procedures (n=5) was investigated compared with that of in-situ screw fixation (n=13). Obese children were noticeably more common among SCFE patients aged less than 10 years (P=0.034). The slip angle improved significantly more in the phy...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Radial head dislocation and malalignment in osteogenesis imperfecta type V: case report, pitfalls in the treatment, and review of the literature
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Letter to the Editor Source Type: research

Congenital insensitivity to pain in one family
We present case reports of two brothers with CIP with various orthopedic manifestations and methods of surgical treatment with 10 years of follow-up. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

The frequency of nonaccidental trauma in children under the age of 3 years with femur fractures: is there a better cutoff point for universal workups?
We examined rates of NAT in the less than or equal to 12-month, 13–24-month, 25–36-month, and 37–48-month age groups. χ2 was used to compare rates of NAT between these groups, and P less than 0.05 was considered to be significant. Over the indicated time period, there were 138 femur fractures in children aged 0–4 years, of which 30 were determined to be NAT. The rate of NAT in the less than or equal to 12-month age group was 74.1%, accounting for 20 of the 30 NAT femur fractures. A significant difference in rates of NAT was found between the less than or equal to 12-month age group and all other...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Comparison of two radiological methods in the determination of skeletal maturity in the Indian pediatric population
To determine a more precise and reliable method between Greulich–Pyle (GP) and MacKay’s (MK) method for the determination of skeletal age in an Indian pediatric population. We carried out a cross sectional study for the assessment of skeletal age on the basis of examination of hand and wrist radiographs of 106 patients (1–15 years of age) who presented with soft tissue injury to hand by the GP and the MK method. These radiographs were evaluated by a radiologist and an orthopedic surgeon independently. In girls, the mean age difference between chronological and skeletal age was 8 months by the GP method, w...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Variation in pediatric orthopedic case volume among residents: an assessment of Accreditation Council for Graduate Medical Education case logs
The aim of this investigation was to examine graduating orthopedic resident case logs to evaluate trends in performing pediatric orthopedic procedures and compare pediatric orthopedic case volume among residents in the 90th, 50th, and 10th percentiles (by case volume) to identify caseload variation. Accreditation Council for Graduate Medical Education orthopedic resident case logs were examined for graduating years 2007–2013. Linear regression analyses were carried out to assess temporal trends in pediatric orthopedic case volume. Subgroup analyses were carried out to assess trends in cases by anatomic location. Comp...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Titanium mesh cage as an alternative reconstruction method for epiphyseal sparing tumor resections in children
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Titanium mesh cage as an alternative reconstruction method for epiphyseal-sparing tumour resections in children
In this study, we introduced an alternative reconstruction option for epiphysis-sparing tumour resection in children. Eight patients with a malignant tumour in the diaphysis or metaphysis–diaphysis junction of a long bone underwent epiphysis-sparing intercalary resection. Reconstruction was performed using a titanium mesh cage filled with impacted cancellous bone allograft and autograft. A plate and screws were used to supplement the fixation. At the last follow-up, union was achieved in seven patients. Limb-length discrepancy occurred in three patients. Functional scores revealed a good functional outcome. This tech...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Intramedullary nailing with supplemental plate and screw fixation of long bones of patients with osteogenesis imperfecta: operative technique and preliminary results
We describe various options of this surgical technique and early results. Although further follow-up and investigation will provide further insight into long-term outcomes, supplemental plate and screw fixation is a valuable and versatile option for this challenging patient population. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Osteogenesis Imperfecta Source Type: research

Intraoperative bleeding in patients with osteogenesis imperfecta type III treated by Fassier–Duval femoral rodding: analysis of risk factors
The surgical treatment of osteogenesis imperfecta (OI) is negatively influenced by clinical features such as osteoporosis, limb deformities and bone changes caused by bisphosphonate therapy. Blood loss during femoral nailing surgeries in patients with OI is a serious problem. Platelet anomalies have been associated with an elevation of the serum pyrophosphate originating from the platelets during clotting, even if the causality with the platelet dysfunction has not yet been established. To identify predictive risk factors regarding intraoperative bleeding, a retrospective analysis was conducted on 23 patients aged between ...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Osteogenesis Imperfecta Source Type: research

Osteotomy as a treatment option in dysplasia epiphyseal hemimelica of the distal radius: a case report
We report the case of a 12-year-old patient with a distal epiphysis DEH on the left radius, treated by wedge osteotomy realignment at the level of the lesion with Kirschner wires. The clinical outcome of realignment osteotomy of the radial epiphysis has been the correction of the deformity with a normal and painless function of the wrist and hand. The case reported was an extremely rare location in the distal radial epiphysis of DEH. We are aware of only one case published previously with involvement of the distal radius in children. The surgical treatment of realignment osteotomy without complete removal of the lesion has...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Radius regeneration after open fracture and extrusion: a case report
This report represents a method of treatment for large bony defects in children if the periosteum is grossly intact, as opposed to more complex procedures. The intact periosteum can regenerate bony defects in the forearm if stabilized appropriately. Level of Evidence: Level 4; case report. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Lengthening of newly formed humerus after autologous fibula graft transplantation following intercalary tumor resection
We report on the lengthening of a humerus regenerate after fibula autograft transplantation into a humeral defect in a pediatric/young adolescent patient. Because of LLD, she underwent callus distraction of the humerus regenerate after transplantation of a fibula autograft using a unilateral external fixator device. An 18-year-old female patient with status postintercalary proliferating chondroma resection (at the age of 7 years) required treatment for correction of a 13 cm humerus shortening. She reported no pain, had no functional limitations, and had a full range of motion of the shoulder and elbow joint. She com...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Treatment of forearm deformity with radial head dislocation because of multiple osteochondromas: a series of three cases treated by simple axis correction and distraction osteogenesis of the ulna
Radial head dislocation in multiple osteochondroma leads to functional impairment and cosmetic problems, and surgical intervention has not been successful to date, with high rates of redislocation. Simple correction of the longitudinal axis and distraction oste8ogenesis of the ulna without corrective osteotomy of the radius were performed within 1 year of radial head dislocation. The mean age of the patients was 7.2 years and the postoperative follow-up duration was 63.6 months. In all cases, the dislocated radial head was repositioned without surgical invention involving the radius. All patients were pain free, with no im...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Surgical approach for elastic stable intramedullary nail in pediatric radius shaft fracture: a systematic review
When using elastic stable intramedullary nailing in children’s distal radius shaft fractures, the surgical approach can either be lateral or dorsal. The aim of this article was to carry out a systematic review of the literature comparing the two types of approaches in terms of complications. An electronic search of databases was performed. Titles of articles were screened, and abstracts and full text were read. Data were extracted in terms of demographics and complications. The dorsal approach had a 2.6% rate of extensor pollicis longus tendon rupture, whereas the lateral approach had a 2.9% rate of transient superfi...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Factors that predict instability in pediatric diaphyseal both-bone forearm fractures
The aim of this study was to determine the factors that may predict failure of closed reduction and casting of diaphyseal forearm fractures in children. Demographic and radiographic data of children with closed reduction and casting of these fractures in the emergency department were evaluated. Of 174 patients with adequate follow-up to union, 19 (11%) required a repeat procedure. Risk factors for repeat reduction included translation of 50% or more in any plane, age more than 9 years, complete fracture of the radius, and follow-up angulation of the radius more than 15° on lateral radiographs or of the ulna more than 1...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Functional outcome of displaced radial head fractures in children treated by elastic stable intramedullary nailing
The objectives of this study were to retrospectively investigate the clinical and radiological outcomes of displaced radial head fractures in children treated by elastic stable intramedullary nailing (ESIN) and evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). A total of 24 patients (nine males and 15 females) fulfilled the inclusion criteria. The mean age at the time of injury was 10.7±2.8 years (range: 9.5–16.33 years). Before surgery, the mean angulation was 53.8°±18.4° (range: 28°...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Radial head resection and hemi-interposition arthroplasty in patients with multiple hereditary exostoses: description of a new surgical technique
Multiple hereditary exostoses (MHE) are a rare disorder characterized by the growth of bony protrusions. Elbow involvement is found in a considerable number of patients and varies from the presence of a simple osteochondroma to severe forearm deformities and radial head dislocation. Patients encounter a variety of symptoms, for example, pain, functional impairment, and cosmetic concerns. Several types of surgical procedures, therefore, can be offered, ranging from excision of symptomatic osteochondromas to challenging reconstructions. In this paper, we will discuss the essential basics of visualizing, planning, and treatme...
Source: Journal of Pediatric Orthopaedics B - June 1, 2018 Category: Orthopaedics Tags: Upper Limb Source Type: research

Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report
This research focuses on femoral head wedge resection for the treatment of avascular necrosis (AVN) of the femoral head. A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident. After 8 months of internal fixation using cannulated screws for Delbet-type 2 fracture of the femoral neck, AVN of the femoral head developed in the patient. Even though valgus-derotation-extension intertrochanteric osteotomy was performed for the treatment of AVN, it progressed further and femoral head wedge resection was performed to recover the femoral head sphericity. After 3...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Asynchronous slipped capital femoral epiphysis in a patient with a seizure disorder: case report and review of the literature
Debate remains about the appropriate treatment of the asymptomatic side following treatment of a unilateral slipped capital femoral epiphysis (SCFE). A 12-year-old boy with a seizure disorder presented with an unstable SCFE on the left hip following a seizure. He underwent percutaneous pinning of the left only. At 8 months postoperatively, he returned with an unstable slip of the right hip, again following a seizure. No literature discussing the treatment of patients with risk of SCFE and seizure disorders was identified. Further study may identify an increased incidence of contralateral slip following an initial slip in t...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Bilateral avascular necrosis of the femoral head following asynchronous postictal femoral neck fractures: a case report and review of the literature
Bilateral avascular necrosis (AVN) following postictal bilateral fracture neck of the femur is a rare occurrence. Here, we report a case of bilateral AVN of the femoral head following an asynchronous bilateral postictal fracture neck of the femur. A 16-year-old autistic boy presented with left hip pain following an episode of seizures and radiographs showed Delbet type II fracture neck of the left femur. This was treated by closed reduction and cancellous screw fixation and skeletal traction for 6 weeks. At 3 months, follow-up radiograph showed union of the fracture, but he had developed segmental AVN with collapse of the ...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Developmental dysplasia of the hip: a history of innovation
Developmental dysplasia of the hip (DDH) is a relatively common malady that has profound consequences in the infant if left untreated. Effective and early treatment of DDH has been praised as one of the most successful ventures of modern pediatric orthopedics. Yet, before the modern management of DDH came into existence, there were extensive technological developments in the field of harnesses, casts, and traction methods. This paper aims to identify the centuries-old history of advancement in DDH treatment and the many important people involved. Their devices, thoughts, and ideas continue to have a profound impact on the ...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Incidence and risk factors of hardware-related complications after proximal femoral osteotomy in children and adolescents
Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femo...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip 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
The periacetabular quadruple osteotomy of the pelvis (QOP), with the osteotomy of ischial spine to release the sacrospinal ligament, is reserved for older children with low potential of remodeling. Different parameters were studied with computed tomography (CT) scan before (pre-OH) and after surgery (post-OH) and for nonoperated hip (NOH). The study determined an optimal method to avoid retroversion and excessive anterior coverage. Fifteen QOP were performed in 13 patients, ranging in age from 10 to 15 years. The morphology of pelvis was analyzed with a CT scan before the surgery and 2 years after. Pathologies were Legg&nd...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

The early radiological effects of Dega and Pemberton osteotomies on hip development in children aged 4–8 years with developmental dysplasia of the hip
We aimed to investigate the early radiological effects of Dega and Pemberton iliac osteotomies that were performed in patients aged 4–8 years with developmental dysplasia of the hip on development of hip joint. Dega osteotomy or Pemberton osteotomy was performed in 76 hips of 58 patients because of developmental dysplasia of the hip between September 2011 and June 2015 and were evaluated retrospectively. Of a total of 76 hips, Pemberton osteotomy was performed on 39 (19 unilateral) and Dega osteotomy was performed on 37 (21 unilateral). In all hips, the acetabular index, acetabular depth ratio, centre-edge angle of W...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Medial approach open reduction with ligamentum teres partial excision and plication for the management of congenital hip dislocation
In conclusion, this series of MAOR, in which ligamentum teres partial excision and plication was utilized, we found stable reduction in all hips. On the basis of these positive results, we recommend this method for children treated with MAOR. Level of evidence: Level IV: case series. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Values for bony acetabular roof angle and percentage femoral head cover in a selective ultrasound neonatal hip-screening programme: effect of age, sex and side
Published maturation curves for bony acetabular roof or α angle (AA) and percentage femoral head cover (FHC) with age are sparse. We aimed to determine typical values for AA and FHC in 2236 infants referred to a selective ultrasound screening programme. There was increase in the values of first measurement of AA and FHC related to the logarithm of age. Males had greater values than females (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Effects of long-term high-load exercise on the anatomy of the hip joints: a preliminary report
The aim of this study was to assess the impact of different sports on hip joint anatomic parameters in athletes. This was a cross-sectional study of eight male trampolinists, eight male weightlifters, and eight male volunteers enrolled in July 2014. Hip joint anatomic parameters were measured from plain radiographs taken at the level of the lesser trochanter center. Data were compared between groups using the χ2-test or one-way analysis of variance with the Bonferroni post-hoc test. There were no significant differences among groups in age, height, or weight. Compared with the controls, trampolinists showed higher pelv...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Hip Source Type: research

Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review
Hip dislocation is a common source of disability in cerebral palsy children. It has been remedied by various reconstructive procedures. This review aims at providing the best evidence for bony reconstructive procedures in cerebral palsy hip migration. The literature extraction process yielded 36 articles for inclusion in this review. There is fair evidence to indicate that the comparative effectiveness of femoral versus combined pelvifemoral reconstruction favours pelvifemoral reconstruction. All except one were retrospective articles with a significant degree of selection and performance bias and confounding variables tha...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

The effect of continuous intrathecal baclofen therapy on ambulatory children with cerebral palsy
The effect of a continuous intrathecal infusion of baclofen (CITB) was retrospectively studied in 19 ambulatory children with cerebral palsy (aged 12.4±4.9 years at CITB initiation). The mean clinical follow-up was 5.1±2.4 years and the mean follow-up gait analysis was 2.8±1.9 years. Spastic cerebral palsy diagnosis [14 (74%)] was most frequent. Most patients [11 (58%)] were Gross Motor Function Classification System level III. CITB significantly improved muscle tone and knee flexion at initial contact (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Undercorrection of planovalgus deformity after calcaneal lengthening in patients with cerebral palsy
Calcaneal lengthening (CL) is one of the treatment options for planovalgus deformity in patients with cerebral palsy (CP). However, its indication still needs to be clarified according to the functional status of CP. The aim of this study was to investigate the radiographic outcome after CL in patients with CP and to evaluate the risk factors causing undercorrection of planovalgus deformities. We included consecutive patients with CP who underwent CL for planovalgus deformity, were followed for more than 2 years, and had preoperative and postoperative weight-bearing anteroposterior (AP) and lateral foot radiographs. Six ra...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

The effect of plantar flexor lengthening on foot pressure in ambulatory children with cerebral palsy
This study aimed to assess the effects of plantar flexor lengthening (PFL) on dynamic foot pressures of children with cerebral palsy using pedobarographs. Of 97 enrolled, 13 children with 18 legs had PFL. Age at surgery was 4.7 (2.8–8.8) years. A significant increase in ankle dorsiflexion and heel impulse was achieved postoperatively and was maintained at 5 years. The coronal plane pressure index increased postoperatively, but reverted to preoperative levels at the 5-year follow-up. Children tend to have more valgus after PFL. In young children, there caution should be exercised to avoid over treating varus at the ti...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Changes in gait parameters after femoral derotational osteotomy in cerebral palsy patients with medial femoral torsion
Medial femoral torsion (MFT) is a common pathologic gait in cerebral palsy (CP) children that can be corrected by femoral derotational osteotomy (FDO). It is not clearly known as to how much various gait parameters change after FDO. The aim of this study was to quantify changes in gait parameters after FDO. The study group included 19 young CP patients (28 limbs, age (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Botulinum-A intramuscular injection in an orthopaedic paediatric patient cohort: service restructure analysis
Botulinum intramuscular injections are increasingly being used in the management of hypertonic musculature. Historically, injections were administered under general anaesthesia (GA), which has service and economic implications. Our delivery changed to outpatient conscious injections to improve service efficiency. A retrospective analysis of all patient injections from January 2010 to December 2015 analysed cost–benefit and efficiency of service remodelling. 472 patients were administered injections, 298 in theatre under GA and 174 without GA. In 2010, 97 of 102 cases were performed under GA (45 theatre-hours), decrea...
Source: Journal of Pediatric Orthopaedics B - March 27, 2018 Category: Orthopaedics Tags: Cerebral Palsy Source Type: research

Pelvic fracture of the sacroiliac joint region in a child – a case study and literature review
The aim of the paper is to present the case of a 3-year-old boy with an unaligned fracture of the sacroiliac joint region to propose a minimally invasive method of fracture fixation without using metal implants and to review the literature addressing this injury, which is uncommon in children. The patient was hit by a car; he suffered a fracture of the iliac ala with a complete traumatic damage to the L4–L5 nerve roots. The fracture was fixated by osteosuture and normal bone fusion was achieved. The follow-up period was 4 years. The boy manifested persistent flaccid paresis of the right foot and symptoms of a neuroge...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Congenital unilateral absence of the upper extremity may give rise to a specific kind of thoracolumbar curve
There is an increased incidence of scoliosis in patients with congenital malformations of the upper extremity even in the absence of overt vertebral abnormalities. In this case series, we summarize the curve characteristics of four patients presenting to two spine surgery clinics with unilateral amelia or phocomelia and a progressive scoliotic curve with the apex on the side of deficiency. All patients required orthopedic intervention for their curves. Amelia and phocomelia are severe congenital malformations of the upper limb affecting trunk balance and, conceivably, causing scoliosis with the absence of counterbalancing ...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study
Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surg...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Sagittal plane parameters in growing rod patients following final fusion
Almost half of growing rod (GR) patients that undergo final fusion (FF) have an extension of instrumented levels. The purpose of this study was to review sagittal plane radiographic parameters of patients with distal extension of instrumented levels at FF to those whose levels remained the same. Radiographs were assessed preoperatively, after GR insertion/first lengthening, following GR treatment before FFs, and after FF. Measurements included sagittal balance, lumbar lordosis, thoracic kyphosis, and distal junction angle (DJA). Twenty-one patients were included. There was no change in sagittal balance. There was a signifi...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Risk factors for pancreatitis after posterior spinal fusion in children with cerebral palsy
This study reports on the prevalence and risk factors of acute pancreatitis after posterior spinal fusion for cerebral palsy scoliosis. Pancreatitis diagnosis was based on elevated amylase or lipase above three times the upper normal limit. Perioperative data were compared between patients with and without pancreatitis. We included 300 patients; 55% developed acute pancreatitis. Gastrostomy dependence was more common in the pancreatitis group (P=0.048). Perioperative data were similar between groups. Patients with pancreatitis had longer duration of hospitalization (19 vs. 13 days, P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

A prevalence study of thoracic scoliosis in Chilean patients aged 10–20 years using chest radiographs as a screening tool
To determine the prevalence of thoracic scoliosis in patients 10–20 years old using radiographs as a screening tool, we studied 783 patients who obtained chest radiographs for nonspinal reasons. We measured thoracic curvature in coronal and sagittal planes; we determined whether age, sex, and sagittal curvature predicted the coronal curvature. The prevalence of scoliosis was 9.3%: 7.0% had curvatures 10°–20°; 1.0% had curvatures 20°–30°; and 1.3% had curvatures of at least 30°. Females (13%) presented larger prevalence of scoliosis than males (4.8%) (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Lack of joint hypermobility increases the risk of surgery in adolescent idiopathic scoliosis
Generalized joint hypermobility (GJH) is a risk factor for developing adolescent idiopathic scoliosis (AIS); however, it is not known whether joint hypermobility influences the risk of progression to surgery. Beighton joint hypermobility scores were assessed in 570 female AIS patients. Multivariate analysis was carried out to determine whether Beighton hypermobility scores were predictors of surgical intervention. In this female AIS cohort, 24.7% (141/570) had GJH (Beighton score ≥4). Multivariate analysis showed that GJH did not influence the risk of surgery, although having no joint hypermobility (Beighton score=0) in...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Scoliosis severity does not impact the risk of scoliosis in family members
Does scoliosis severity increase scoliosis risk or severity in relatives? In a cohort of 1257 severe idiopathic scoliosis patients, the percentage with at least one affected relative was compared across the categories of patient sex, major curve severity (Cobb angle), and treatment method. In total, 138 (11%) of 1257 patients had at least one affected first-degree relative and 59 (5%) had at least one affected second-degree relative. As expected, males were more likely to have affected first-degree relatives than females (18 vs. 10% with a risk difference of −0.0864) [95% confidence interval (CI): −0.14 to &min...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Spine Source Type: research

Delayed treatment of a neonatal type-I Monteggia fracture-dislocation: a case report
We report the case of a 14-month-old with a neonatal Monteggia type-I fracture-dislocation secondary to birth trauma, with anterior radial head dislocation and plastic deformation of the ulna. Uniplanar external fixation was used to restore ulnar length and correct angulation, with subsequent radiocapitellar joint closed reduction. Joint congruity was maintained at the 2-year follow-up, with articular remodeling shown on serial arthrogram. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Open reduction versus in-situ fixation of neglected lateral condyle fractures: a comparative study
The management of neglected fracture of the lateral condyle of the humerus is controversial. Careful neglect and conservative management with early ulnar nerve transposition and ostetomy, in-situ surgical fixation and accurate open reduction and internal fixation are all recommended as treatment options. However, an overgrowth of fractured condyle, highly distorted anatomy, contracted soft tissue and almost unrecognizable fracture ends make open reduction a challenging task. As the functional loss is not severe, in-situ fixation of the fragment provides a good alternative. There have been proponents of both surgeries with ...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Surgical treatment of displaced pediatric lateral condyle fractures of the humerus by the posterior approach
The surgical approach for open reduction and internal fixation of lateral condyle fractures in children is controversial. Some authors recommend the lateral approach to the elbow over the posterior approach because of theoretical concern for injury to the vascular supply of the distal humerus and potential avascular necrosis (AVN). The purpose of this retrospective case series study is to report the outcomes of open reduction and internal fixation of displaced lateral condyle fractures of the humerus by the posterior approach. Fifteen consecutive cases were reviewed and the posterior approach resulted in minimal postoperat...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Functional outcome of displaced intercondylar fractures of the humerus in children and adolescents
The main aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcome of displaced intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH), the hypothesis being that intercondylar fractures have poorer functional outcome than do other upper-limb fractures. The mean age at the time of injury was 11.9±2.5 years (range: 7.5–15.8 years). The male–female ratio was 3.5 : 1. Using the Toniolo & Wilk...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Distal humeral flexion osteotomy for the treatment of supracondylar extension-type malunions in children
Distal humeral extension-type malunions may occur as a complication following improper reduction of supracondylar humerus fractures. We evaluated results after distal humeral flexion osteotomies for sagittal realignment of the humeral condyle in children. Medical records and radiographs of all patients younger than 18 years of age, who underwent this procedure because of a clinically relevant lack of elbow flexion, were evaluated. In a cohort of 18 children with a mean age of 8 years at the time of surgery and a mean follow-up duration of 1 year, elbow flexion increased significantly from a mean of 101° preoperatively ...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Comparison of the lateral and posterior approaches in the treatment of pediatric supracondylar humeral fractures
This study explored the radiological, functional, and cosmetic results of treatment of supracondylar humeral fractures with open reduction and percutaneous pinning, comparing posterior triceps V-splitting (group I, n=22) and lateral (group II, n=25) approaches. The time to union, the functional and cosmetic results, and the flexor and extensor muscle strengths were measured and compared with the contralateral extremities. There were no statistical differences between the groups. The V-splitting posterior approach is as safe and effective as the lateral approach in the surgical treatment of pediatric supracondylar humeral f...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Pediatric supracondylar humerus fractures: is surgeon experience a surrogate for the need of open reduction?
Although there are many factors that are likely to influence the need for open reduction and percutaneous pinning (ORPF) in the treatment of pediatric supracondylar humerus fractures (SCHFs), the role of surgeon’s experience (as represented by the total number of surgically treated SCHFs) on the need for ORPF has seldom been investigated. We reviewed the data on all completely displaced, pediatric SCHFs that were treated surgically by a single, fellowship-trained, pediatric orthopedic surgeon over the first 10 years of the surgeon’s clinical practice. The incidence of ORPF was calculated as the percentage of op...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research

Treatment of proximal humerus fractures in children with a modified palm tree technique
Although most pediatric proximal humeral fractures can be successfully treated conservatively with satisfactory results, many operative techniques have been described for the treatment of displaced proximal humeral fractures. The aim of this study is to evaluate the efficacy of percutaneous fixation using a modified palm tree technique for proximal humerus fractures in children. Between March 2011 and May 2013, the modified palm tree technique was used for the management of 30 children (20 boys and 10 girls) with displaced proximal humeral fractures. The average age of the patients was 11.5 years (age range from 8 to 15 ye...
Source: Journal of Pediatric Orthopaedics B - February 2, 2018 Category: Orthopaedics Tags: Trauma Source Type: research