Acute distal biceps rupture in an adolescent weightlifter on chronic steroid suppression: a case report
We present a case of a 17-year-old male on chronic corticosteroid suppression who underwent a successful distal biceps tendon repair after an acute rupture following weightlifting. At the 1-year follow-up, the patient reports full range of motion and strength, and is able to return to his preinjury activity level with sports and weightlifting. Acute distal biceps ruptures are uncommon injuries in the pediatric population, but may occur in conjunction with chronic corticosteroid use. Anatomic repair, when possible, can restore function and strength. Level of Evidence: level IV, case report (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications
This study aims to describe the epidemiology of pediatric diaphyseal forearm fractures in an urban population and the complications of titanium elastic nailing. The medical records of 456 consecutive fractures were reviewed. The annual incidence was 0.7/1000 children. Eighty-six (19%) fractures in 83 children were titanium elastic nailed. The complication rate was 24%. Dorsal entry to the radius was associated with extensor pollicis longus rupture and radial entry was associated with sensory nerve deficit in three cases each. Seventy-eight (94%) of the operated patients recovered completely. Titanium elastic nailing is eff...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Acute traumatic posterior fracture dislocation of the elbow in pediatric patients: impact of surgery time and associated fractures on outcome
This study assessed the effect of the time interval from initial injury to surgery and the presence of associated fracture on functional outcomes after acute posterior elbow fracture dislocation. Twenty-six pediatric patients were evaluated with respect to operation time point (within 24 h vs. later) and associated fracture retrospectively. The Mayo Elbow Performance Index (MEPI) score was used to assess functional results. The MEPI score was 91 (80–100) in patients with one associated fracture and 83 (75–95) (P=0.02) in patients with more than one associated fracture. The MEPI score in patients treated ...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Humeral lateral condyle fractures in children: redefining the criteria for displacement
The aim of this study is to define paediatric lateral humeral condyle fractures prone to later displacement. The authors reviewed 106 children who were treated surgically for this fracture. There were 74 boys and 32 girls with an age range of 3–10 years. The study included 27 minimally displaced and 79 displaced fractures. The average follow-up was 50 months. Binary logistic regression model indicated that 6–8-year-old children with minimally displaced fractures and who underwent immediate surgery have a better chance for satisfactory results. The authors concluded that routine use of 2 mm displacement f...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Modified step-cut osteotomy for correction of post-traumatic cubitus varus deformity: a report of 19 cases
We reviewed the outcomes of post-traumatic varus deformity treated with modified step-cut osteotomy in 19 patients (average age, 7.4 years; range, 4.3–16.8 years at time of surgery). The average follow-up period was 29.6 months. The mean range of motion was 15.0°/124.7° (extension/flexion) before surgery and 6.8°/132.6° at final follow-up. The humerus–elbow–wrist angle was −21.1° before surgery and 4.2° at final follow-up, with a loss of 4.4° from the value of the humerus–elbow–wrist angle after the surgery. Osteotomy was fixed with Kirschner wires, and, in fi...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Do additional full-length radiographs of the humerus and forearm improve the decision making in children with supracondylar humerus fractures?
We sought to determine the diagnostic utility of additional full-length radiographs of the forearm and humerus for pediatric supracondylar humerus fractures. A pediatric orthopedic surgeon and a senior orthopedic resident individually reviewed the initial humerus, forearm, and elbow radiographs of 55 children with a supracondylar humerus fracture and recommended definitive treatment (operative vs. nonoperative) on the basis of the modified Gartland classification. Interobserver agreements for classification and the recommended treatment were highest for the elbow radiographs (weighted κ=0.92). All disagreements in th...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Treatment of flexion-type supracondylar fractures in children: the ‘push–pull’ method for closed reduction and percutaneous K-wire fixation
We describe the surgical technique for the ‘push–pull’ method and report radiographic outcomes of a case series of children with flexion-type supracondylar fractures treated using this technique. A retrospective review of medical records and radiographs of all children who underwent operative treatment of a flexion-type supracondylar humeral fracture using the ‘push–pull’ method in a tertiary-level children’s hospital between January 2009 and January 2014 was carried out. Radiographic outcomes were reported using descriptive statistics. There were a total of nine patients (five fem...
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Posterolaterally displaced and flexion-type supracondylar fractures are associated with a higher risk of open reduction
To identify factors predictive of the risk of conversion from closed to open reduction. International Classification of Disease-9 codes were used to identify completely displaced pediatric supracondylar humerus fractures that were subjected to planned closed reduction and percutaneous pinning. Clinical and radiographic variables were retrospectively collected. Compared with posterior extension fractures, flexion (risk ratio: 34.1, 95% confidence interval: 8.1–143.6, P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated by elastic stable intramedullary nailing: preliminary results
This study reports good functional outcomes in children with displaced humeral shaft fractures surgically treated with ESIN, even in the presence of residual deformity. ESIN enables stable reduction, good rotational control, and good functional outcome. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 30, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Stepwise surgical approach to equinocavovarus in patients with cerebral palsy: Erratum
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Erratum Source Type: research

Operative management of bilateral Salter–Harris type III fractures of the proximal phalanges of the great toes of a 10-year-old female ballet dancer: a case report
Differentiation between the normal variant cleft epiphysis and Salter–Harris type III fracture of the first proximal phalanges of the foot in children might be challenging. The authors describe a case of a 10-year-old ballet dancer girl with bilateral epiphyseal segmentation of the first proximal phalanges of the foot, unresponsive to conservative treatment. Considered a nonhealing stress-induced fracture, operative treatment with closed reduction and Herbert screw insertion was chosen on both sides. Complete union was achieved, with significant reduction of pain. The presented case suggests that internal fixation ca...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Trauma Source Type: research

The normal and fractured physis: an anatomic and physiologic overview
The growth plate (physis) is responsible for enabling and regulating longitudinal growth of upper and lower limbs. This regulation occurs through interaction of the cells in the growth plate with systemic and locally produced factors. This complex interaction leads to precisely controlled changes in chondrocyte size, receptors, and matrix, which ultimately result in endochondral bone formation. With advances in cellular and molecular biology, our knowledge about these complex interactions has increased significantly over the past decade. Deficiency of any of the regulating factors or physeal injury during childhood can alt...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Trauma Source Type: research

Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture
A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient’s unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skele...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Trauma Source Type: research

The use of percutaneous joystick reduction and limited open reduction techniques in pediatric femoral shaft fractures: a study of 63 cases
Our study aimed to compare the effectiveness and clinical outcomes of percutaneous joystick reduction and limited open reduction for flexible intramedullary nailing in the treatment of pediatric femoral shaft fractures. A total of 63 pediatric femoral shaft fractures were studied: 35 fractures were treated with percutaneous fixation using the K-wire pin as a joystick (group A), whereas 28 fractures were treated with limited open reduction (group B). Clinical and radiographic data at the final follow-up were compared between the surgical groups. Their duration of X-ray exposure, postoperative weight-bearing time, healing ti...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Trauma Source Type: research

Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study
The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4–17 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (N=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and ...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Trauma Source Type: research

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery
Deep wound infection is a common complication in early-onset scoliosis (EOS) surgery. Soft tissue technique has received less attention as a means to reduce infection. A retrospective review of 1170 EOS surgeries (single surgeon, institution) investigated the impact of offset layered closure (OLC) and soft tissue awareness. The introduction of OLC reduced deep infection from 3.0% in 99 surgeries to 0.37% in 1071. Logistic regression confirmed that OLC led to significantly lower odds of infection (P=0.007). This deep infection rate (0.37%) is more typical of elective surgery, providing a more optimistic view of infection in...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Treatment dilemma in multiple metatarsal fractures: when to operate?
Fractures of multiple metatarsals in the pediatric population are uncommon; however, indications for surgical treatment have not been delineated. The aim of this study was to review multiple metatarsal fractures to help refine surgical indications. A total of 98 patients had multiple metatarsal fractures; displacement greater than 10% shaft width (displaced) was encountered in 33 (34.0%) patients. Fifteen patients had displacement of more than 75% shaft width of one metatarsal. Patients older than 14 years of age were more likely to have surgery for their injury (52.6%) than those younger than 14 years of age (3.7%) (P (So...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Effects of surgical intervention on trochlear remodeling in pediatric patients with recurrent patella dislocation cases
Patella instability is often encountered among physically active pediatric athletes, and surgical intervention is useful in cases with recurrent patella dislocations, chronic instability, and abnormal alignment. Several surgical procedures have been used for patella-realignment and stabilization, but the effects of surgical intervention on bony trochlear remodeling in skeletally immature patients have not been well studied. We thus present two cases of pediatric recurrent patella dislocations that showed trochlear remodeling following patella-realignment surgery. The first case describes an 11-year-old female treated with ...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Meniscus transplantation in skeletally immature patients
This study focuses on the surgical technique and short-term outcomes of meniscus transplantation in skeletally immature patients. We reviewed our clinical database for skeletally immature patients who had undergone meniscus transplantation with a minimum of 2 years of follow-up. Patients were contacted, invited for a physical exam, and asked to complete a Pedi-IKDC, Lysholm, and Tegner outcomes questionnaire. The study protocol was approved by the responsible institutional review board. Three patients (two females/one male) were eligible for the study, each of whom responded to our invitation indicating availability for ph...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes
The objective of this study was to compare the postural stability of pediatric and adolescent athletes without anterior cruciate ligament injury with those who underwent anterior cruciate reconstruction (ACLR). Postural stability ratings derived from a video-force plate system during the three stances of the modified Balance Error Scoring System were collected from pediatric and adolescent athletes who underwent ACLR (N=24; mean 1.2 years after surgery) and from uninjured controls (N=479). The postural control rating was calculated as the mean of the displacement and variance of the torso and center of pressure data, norma...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Treatment outcomes after insufficiency femoral diaphyseal fractures in nonambulatory children
We retrospectively reviewed the treatment and outcomes of diaphyseal femur fractures in a cohort of nonambulatory children. There were 30 patients (38 fractures) reviewed [average age of 10.1 years (range: 1.8–17.8)]. Fractures were treated with locked plate/screw fixation (n=18), with a complication rate of 24% (9/38). Patients with elastic stable intramedullary nailing experienced the highest complication rate (5/7, 71%) compared with plate/screw fixation (2/18, 11%) (P=0.01) and underwent greater subsequent procedures (n=5, 63%). Surgeons should consider locked plate and screw fixation as their first treatment cho...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Acetabular and femoral remodeling after varus derotational osteotomy in cerebral palsy: the effect of age and Gross Motor Function Classification Level
This study investigated the degree of acetabular and femoral remodeling after isolated varus derotation osteotomy (VDRO) in children with cerebral palsy. This retrospective review investigated 56 children (103 hips) who underwent VDROs for spastic hip displacement between 1994 and 2007. The average age of the patients at surgery was 7.7 years and the follow-up duration was 7.8 years (range 5–11 years). The acetabular index showed a significant linear decrease (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Sex and growth effect on pediatric hip injuries presenting to sports medicine clinic
To compare sports-related hip injuries on the basis of sex and age in a cohort of young athletes. A 5% random probability sample of all new patients’ charts over a 10-year time period was selected for investigation. The most common hip injury diagnoses, sport at time of injury, mechanism (acute/traumatic vs. overuse), and types (bony vs. soft tissue) were compared by sex and age (preadolescent vs. adolescent). Descriptive and χ2-analyses were carried out. The interaction of sex and age with respect to hip injury over time was examined by two-way (sex, age) analysis of variance. A total of 2133 charts were reviewe...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Normative values for a video-force plate assessment of postural control in athletic children
The objective of this study was to provide normative data for young athletes during the three stances of the modified Balance Error Scoring System (mBESS) using an objective video-force plate system. Postural control was measured in 398 athletes between 8 and 18 years of age during the three stances of the mBESS using a video-force plate rating system. Girls exhibited better postural control than boys during each stance of the mBESS. Age was not significantly associated with postural control. We provide normative data for a video-force plate assessment of postural stability in pediatric athletes during the three stances of...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Trends in the volume of operative treatment of midshaft clavicle fractures in children and adolescents: a retrospective, 12-year, single-institution analysis
The purpose of this study was to examine institutional trends in the volume of clavicle fractures in children and adolescents. Medical records were retrospectively reviewed to identify patients aged 10–18 years treated for a clavicle fracture between 1999 and 2011 at a single tertiary-care pediatric hospital. There were significant increases in the number of clavicle fractures seen annually, of midshaft clavicle fractures, and of midshaft clavicle fractures treated operatively. The percentage of midshaft clavicle fractures treated with fixation also increased significantly. The volumes of clavicle fractures and midsh...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Boston Children’s Hospital approach to brachial plexus birth palsy
The treatment of infants with brachial plexus birth palsy (BPBP) continues to be a focus at Boston Children’s Hospital. Over the last 15 years, there have been many developments in the treatment of infants with BPBP. Some of the greatest changes have emerged through technical advances such as the advent of distal nerve transfers to allow targeted reinnervation as well as through research to understand the pathoanatomical changes that lead to glenohumeral dysplasia and how this dysplasia can be remodeled. This review will discuss our current practice of evaluation of the infant with BPBP, techniques for microsurgical ...
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Pediatric orthopedic surgical simulation at Boston Children’s Hospital
Orthopedic surgical simulation has become an increasing valuable means for optimizing patient care, promoting patient safety, improving education, and fostering clinical research. The purpose of this review was to discuss the rationale for simulation training, describe current simulation efforts within the Department of Orthopaedic Surgery at Boston Children’s Hospital, and provide an example of how these simulation efforts touch both patient care and clinical research. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Boston Children’s Hospital orthopedic surgery program
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 2, 2016 Category: Orthopaedics Tags: Boston Children's Hospital Special Issue Source Type: research

Development of pediatric orthopedic training and practice in China: administrative, socioeconomic, and cultural impacts
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Review Source Type: research

Sacral fatigue fractures in children with sacral spina bifida occulta
In this report, we present two cases of 9-year-old children with spina bifida occulta (SBO) of the sacrum, who were diagnosed with sacral fatigue fractures. In both patients, MRI showed a linear signal void and high signal in sacral ala on the short tau inversion recovery sequence. Sacral SBO at the same level of the sacral fracture was observed in each patient on computed tomography images. These lesions healed with rest. This is the first literature reporting cases with sacral stress fractures who had SBO at the same level of fracture. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Lumbar spine duplication: a case report
Duplication of the spine is a rare malformation. A neurologically intact pediatric patient with this malformation is described here. A 6-year-old girl presented to our institution for evaluation of an asymptomatic kyphotic deformity. She denied weakness, sensory changes, and bowel or bladder complaints. Physical examination revealed mild kyphosis at the thoracolumbar junction with normal gait and neurologic function. Radiographs demonstrated duplication of the lumbar spine and sacrum. Computed tomography, MRI, and abdominal ultrasound results are reported. As she is neurologically normal, we will continue to observe this p...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Hysterical conversion paralysis in an adolescent boy with lumbar spondylolysis
We describe a case of recurrent hysterical paralysis triggered by low back pain because of lumbar spondylolysis. A 16-year-old male soccer player was referred to our institution with five previous episodes of acute paralysis triggered by severe low back pain. We performed direct surgical repair of the terminal-stage bilateral spondylolysis at L4 using a hook-rod system. His chronic low back pain was completely resolved, and no further episodes of hysterical paralysis have occurred after surgery. Spine surgeons should be aware of possible hysterical conversion paralysis when there is discrepancy between radiological and neu...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Cervical cord compression in pediatrics with hereditary multiple exostoses: a report of two cases and review of the literature
We report two cases of children with HME who have myelopathy because of cervical spine involvement and then review the literature to clarify the clinical characteristics of spinal cord HME involvement in young children. In our cases and previously reported cases, neurological deficits remained in cases with acute onset, but other cases with slow onset showed almost complete recovery after surgery. This suggests that the assessment of spinal lesions before trauma is very important. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Effect of growing rod on sagittal and spinopelvic parameters in early-onset scoliosis patients
In this study, 21 EOS patients treated by growing rod were evaluated retrospectively and thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI) , sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA) were measured. Preoperatively, the mean TK, LL, PI, PT, SS, and SVA were 27.4°, 35.2°, 43.8°, 7.5°, 33.8°, and 47.7 mm respectively. After the last lengthening, TK, LL, PI, PT, SS, and SVA were 28.3°, 28.06°, 41.4°, 7°, 5.2°, and 42.6 mm, respectively. The sagittal plane parameters in our EOS patients were not significantly altered during the le...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Predictors of variability in the length of surgery of posterior instrumented arthrodesis in patients with adolescent idiopathic scoliosis
The most common corrective surgery for adolescent idiopathic scoliosis (AIS) is posterior instrumented spinal fusion, which is a relatively lengthy procedure. Longer procedures are known to have higher rates of negative outcomes and higher economic costs across the surgical specialties. The purpose of this study is to identify the factors that influence the length of this operation in AIS patients. This was an institutional review board-approved, retrospective cohort study. All primary posterior instrumented arthrodesis procedures in 2011–2013 performed by three surgeons on AIS patients at a tertiary care hospital we...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Spine Source Type: research

Mid-term results of Ponseti management for an idiopathic congenital clubfoot at a single center in Vietnam
This study presents a scale to evaluate the relapse and identify the factors correlated with the relapse and latest follow-up mid-term results. A total of 101 children (newborn to 12 months), 142 idiopathic congenital clubfeet, were recruited for this study following treatment with the Ponseti method at the Hospital for Traumatology and Orthopaedics (Ho Chi Minh City, Vietnam) with a follow-up period of a minimum of 2 years. The clubfeet were then classified and evaluated during casting, for initial correction, and for relapse according to Diméglio’s score. Next, the latest follow-up results were evaluated acc...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Foot Source Type: research

Multifocal tuberculosis of long bones in an immunocompetent child
We report a case of multifocal TB of long bones in an immunocompetent child. We describe the radiological and diagnostic features of TB osteomyelitis and outline its therapy and prognosis. To the best of the authors’ knowledge, such a case with multiple long bone involvement without articular sequel and visceral involvement/constitutional symptoms has not been reported previously in the literature. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Treatment of an open book pelvic fracture and bilateral femoral fractures with an external fixator in a 14-month-old: a case report
A 14-month-old girl was involved in a road traffic accident that resulted in an open book pelvic fracture and bilateral femoral fractures. Acute treatment involved a novel collar and the cuff pelvic closure technique to tamponade the pelvis and reduce bleeding. The patient was treated surgically with an external fixator, which provided good reduction of the pelvic and femoral fractures. A literature search found no previous information on open book pelvic fractures in infants younger than 2 years. The success of this surgery led us to suggest that the use of an external fixator is a potential treatment method for open book...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Distal femoral aspect ratios throughout childhood: an MRI study of normative data and sex comparisons
In this study, the distal femoral dimensions and physeal development of 345 participants younger than 21 years of age were evaluated by MRI. Regression analysis indicated a significant increase in the AP/ML ratio with increasing age for both sexes. In girls, the ratio increased from 0.63 at ages 0–5 years to 0.76 at 15–20 years. In boys, the ratio increased from 0.61 to 0.73 over the same age groups. Female distal femur dimensions are narrower than that of males from birth. Throughout childhood, both sexes show gradual increases in AP/ML ratios. After closure of the physes, the AP/ML ratio in children approache...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Key role of magnetic resonance imaging in the diagnosis of infections around the hip and pelvic girdle mimicking septic arthritis of the hip in children
Infections around the hip and the pelvic girdle mimicking septic hip arthritis are rare conditions in the pediatric population requiring urgent treatment. They are not readily diagnosed because of rarity, resemblance to septic hip, and unclear pathophysiology, which often results in misdiagnosis, delayed diagnosis, and delayed treatment. The aim of this study was to prove the key role of magnetic resonance imaging (MRI) as the first-line modality in making a early definite diagnosis of an uncommon perihip infection in children. We retrospectively reviewed 20 children with a provisional diagnosis of unilateral septic hip wh...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Early prediction of outcomes in hip fractures: initial fracture displacement
We retrospectively analyzed the surgical treatment of 28 pediatric hip fractures. The majority of cases were Delbet type 2 (57%) and type 3 (29%). The average age of the patients was 10.8 years (range: 2–16 years). The mean follow-up period was 91 months. Displaced fractures were found in 18 cases (64%). The major factor in the development of avascular necrosis was the degree of displacement at the time of initial presentation (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Satisfaction and pain levels after proximal femoral valgus osteotomy according to Schanz in patients with cerebral palsy and hip dislocation
Outcome after Schanz osteotomy in the treatment of chronic hip dislocation in children with cerebral palsy was evaluated. Medical charts and questionnaires were used to assess pain, functional outcome and satisfaction. A total of 24 children, with a mean age of 13.8 years (±8.9), were included in the study, out of which 11 were classified with Gross Motor Function Classification System (GMFCS) level IV and 13 with GMFCS level V. Current pain was comparable to patients without chronic hip dislocation, and satisfaction was intermediate. Functional outcome improved in several domains. Longer postoperative time was asso...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy
The aim of this study was to assess whether hip pain was associated with radiographic hip displacement (migration percentage, MP) in a population-based cohort of children with cerebral palsy. Seventy-seven children, mean age 9.5 (SD 1.6) years and Gross Motor Function Classification System level III–V, were assessed. Caregivers responded to the Child Health Questionnaire pain questions and located recurrent pain on a body map. Hip pain was reported in 22 children (29%) and 27 hips (18%). Hip pain was significantly more frequent in hips with MP more than or equal to 50%, in children with spastic quadriplegia, and in t...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

The fate of lateral femoral cutaneous nerve after surgical reduction of developmental dysplasia of the hip: preliminary results
This study aimed to determine the fate of the lateral femoral cutaneous nerve (LFCN) after anterior reduction of the hip with or without pelvic or proximal femoral osteotomy for acetabular dysplasia. Using the antidromic technique, recording the response using standard electromyography equipment, evaluation was made of the LFCN in 36 hips of 24 patients (18 female and six male). The response was absent in six patients (25%) and nine patients (37.5%) had a somatosensory evoked potential latency greater than 40 ms. There was no relationship between somatosensory evoked potential latency or absent response with the typ...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

A new predictive indicator by arthrography for future acetabular growth following conservative treatment of developmental dysplasia of the hip
In conclusion, CEALA is a more reliable and accurate predictive indicator for acetabular development than center-edge angle or acetabular index. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Prophylactic pinning for slipped capital femoral epiphysis: does it affect proximal femoral morphology?
This study was designed to determine whether prophylactic pinning of the unaffected hip in unilateral slipped capital femoral epiphysis affects the proximal femoral morphology. Twenty-four hips prophylactically pinned were compared with 26 cases observed. The articulotrochanteric distance (ATD) and the trochanteric–trochanteric distance (TTD) were measured. Postoperative radiographs were compared with final follow-up radiographs. The final TTD : ATD ratio was higher (P=0.048) in the pinned group, suggesting relative coxa vara/breva. There was a smaller difference between the two hips in the prophylactic...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Significantly lower femoral neck growth in screw fixation of the asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis
There is an ongoing debate on which fixation technique should be preferred for the prophylactic fixation of the asymptomatic contralateral hip in slipped capital femoral epiphysis (SCFE). In the case of Kirschner-wire (K-wire) fixation, there is a possibility of secondary loss of fixation because of longitudinal growth of the physis, whereas in screw fixation, physeal growth of the femoral neck might be impaired. The aim of this matched-pair study was to compare the longitudinal growth of the femoral neck in screw fixation versus K-wire fixation of the asymptomatic contralateral hip in SCFE. All 18 patients (female ...
Source: Journal of Pediatric Orthopaedics B - April 1, 2016 Category: Orthopaedics Tags: Hip Source Type: research

Post-traumatic cyst-like lesion in children: case report and the literature review
Reports of post-traumatic cyst-like lesions in children are rare. These lesions occur between 1.5 and 3 months after a fracture. They are more frequent after a distal radius greenstick fracture. Conventional radiographs show a metaphyseal radiolucent lesion inside the most recent subperiosteal bone, adjacent to the initial fracture line. Post-traumatic cyst-like lesions are benign, asymptomatic, nonexpansive, and regress spontaneously. Two typical cases are described in the following report with a literature review of the etiology and main features of these lesions. Level of evidence: Level V, case report. (Source: Journal...
Source: Journal of Pediatric Orthopaedics B - January 27, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist
Paediatric wrist-buckle fractures are common distal radius fractures with inherent stability. Traditional management with complete plaster-cast immobilization necessitates follow-up visits, time off school/work and hospital treatment costs. Treatment with alternative splinting, negating the need for follow-up visits and saving time and money, has been proposed. However, concerns with regard to complications, primarily pain, have been raised; hence, the topic remains controversial. A systematic review was performed with eight randomized-controlled trials analysed. Alternative splinting was superior to casting in terms of fu...
Source: Journal of Pediatric Orthopaedics B - January 27, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research

Long-term results of Galeazzi-equivalent injuries in adolescents – open reduction and internal fixation of the ulna
This study included 10 Galeazzi-equivalent injuries (seven patients requiring open reduction and three requiring closed reduction for ulnar lesions) seen since 2004. The periosteum was entrapped around the fractured physis in five patients and the extensor carpi ulnaris to the periosteum was interposed in two patients. Among the seven patients, ulnar lengthening was performed in only three patients. Ulnar variances at the time of the lengthening were −6, −6, and −5 mm. Gradual lengthening was performed. Radiologic abnormalities, including the ulnar variances, were investigated at the end of growth....
Source: Journal of Pediatric Orthopaedics B - January 27, 2016 Category: Orthopaedics Tags: Trauma Upper Limb Source Type: research