An Analysis of the Evidence Underpinning the American Academy Orthopaedic Surgery Pediatrics Clinical Practice Guidelines
Conclusions:
Our results suggest that CONSORT adherence within RCTs used as evidence in AAOS Pediatric CPGs is substandard—relying on evidence that, in some cases, is>20 years old. Many of the RCTs cited as supporting evidence have a “high” risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopaedic surgery. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Selected Topics Source Type: research
Radial Head Prosthetic Replacement in Adolescents: A Report of 5 Cases
Conclusion:
RHA was successful in improving pain and axial forearm stability in this very small series of adolescent patients. Concerns regarding long-term longevity and complications still exist. Considering the lack of other reliable treatment options, RHA may be indicated in this challenging patient population.
Level of Evidence:
Level IV: therapeutic study—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Selected Topics Source Type: research
Novel Uses of Traditional Algorithms for Septic Arthritis
Conclusion:
Based on the findings of this study, it is clinically reasonable to apply the Caird algorithm to pediatric patients presenting with monoarticular joint pain of medium and large joints such as the knee, ankle, shoulder, elbow, and wrist, in addition to the hip.
Level of Evidence:
Level III—retrospective study of novel applications of SA algorithms. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Infection Source Type: research
Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections
Conclusions:
Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis.
Level of Evidence:
This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Infection Source Type: research
Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening
Conclusions:
The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy.
Level of Evidence:
Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Cerbral Palsy Source Type: research
No Difference in the Rates of Unplanned Return to the Operating Room Between Magnetically Controlled Growing Rods and Traditional Growth Friendly Surgery for Children With Cerebral Palsy
Conclusion:
For patients with EOS secondary to CP, there was no difference in the risk of UPROR within the first 2 years postoperatively whether treated with TGF surgery or with MCGRs (23% TGF, 21% MCGR).
Level of Evidence:
Level III—retrospective cohort, therapeutic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Cerbral Palsy Source Type: research
Fascia Iliaca Pain Block Results in Lower Overall Opioid Usage and Shorter Hospital Stays than Epidural Anesthesia After Hip Reconstruction in Children With Cerebral Palsy
Introduction and Objective:
Epidural anesthesia (EA) is often used for pain control in children with cerebral palsy (CP) who undergo hip reconstructions. The purpose of this study is to determine if preoperative fascia iliaca (FI) pain blocks would improve pain scores, decrease opioid use, and result in shorter hospital stays in comparison to the use of EA.
Methods:
This is a nonrandomized retrospective cohort study examining 60 consecutive patients with CP who underwent hip reconstruction utilizing either a fascia iliac compartment nerve block (FICNB) (N=37) or continuous lumbar epidural (N=22) from January 201...
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Cerbral Palsy Source Type: research
Limb Lengthening With Precice Intramedullary Lengthening Nails in Children and Adolescents
Conclusions:
The Precice nail facilitated reliable and safe bone lengthening and was associated with a low complication rate. Correction of additional malalignment was possible by applying intraoperative acute correction or guided growth.
Level of Evidence:
Level IV—therapeutic study investigating the results of treatment. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Limb Lengthening Source Type: research
Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery
Conclusion:
There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD.
Level of Evidence:
Level III. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Limb Lengthening Source Type: research
Age-related Outcomes and Complications of Osteodistraction in the Pediatric Upper Extremity: A Large Retrospective Single-center Study of 61 Cases
Conclusions:
Despite the occurrence of numerous complications, high patient satisfaction and good daily life functionality of the treated limb was observed. An age of more than 14 years at the beginning of therapy had a negative prognostic effect on bone healing during distraction. Thus, osteodistraction in the upper extremity may preferably be performed less than 10 years of age because of enhanced bone regeneration.
Level of Evidence:
Level IV—retrospective case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Limb Lengthening Source Type: research
Treatment of Hip Instability in Children With Down Syndrome: Keys to Managing a Challenging Problem
Discussion:
Surgical management of hip instability in children with Down syndrome remains challenging. The treating surgeon must have a thorough understanding of the pathoanatomy and design the surgical treatment to meet all of the underlying sources of instability. Combined femoral and acetabular osteotomies plus capsulorrhaphy are often required along with postoperative hip spica immobilization. Although complication and revision surgery rates are high, hip stability and good functional outcomes can be achieved. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Hip Source Type: research
Radiologic Outcomes of Bilateral and Unilateral Perthes Disease: A Comparative Cohort Study
This study was undertaken to compare the radiologic outcomes of bilateral and unilateral Perthes disease and also to evaluate the outcome of synchronous and metachronous bilateral Perthes disease.
Methods:
Of 353 children with Perthes disease followed up from presentation to healing during the last 10 years, 37 had bilateral involvement (11 synchronous and 26 metachronous onset). The radiologic outcomes of each hip of children with bilateral disease were compared with outcomes of 148 children with unilateral disease who were matched for age, sex, and treatment. Children with unilateral or bilateral diseases were tre...
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Hip Source Type: research
Does the Deformity Index Reliably Predict the Shape of the Femoral Head at Healing of Legg-Calvé-Perthes Disease?
Background:
Treatment of Legg-Calvé-Perthes disease (LCPD) aims to preserve the spherical shape of the femoral head. The deformity index (DI) (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Hip Source Type: research
Novel Minimally-Invasive Triple Pelvic Osteotomy: JiShuiTan Minimally-Invasive Approach
Conclusion:
This approach can simplify the TPO, making the complex operation safer, more effective, and capable of achieving satisfactory correction. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Hip Source Type: research
A Virtual Clinic for DDH Pavlik Harness Monitoring
Conclusions:
This study demonstrates adequate evidence that children requiring routine follow-up appointments involving PH adjustment, skincare, and identification of clinical anomalies, can be treated and followed up safely using virtual clinics. Clinical triage of suitable patients for virtual clinic provision must always be made by experienced clinicians. Children presenting with Graf IIa, IIb, IIc, IId, as well as those with stable and improving Graf III at initial diagnoses, had successful treatment with virtual clinic follow-up appointments in this study.
Level of Evidence:
Level IV. (Source: Journal of Pe...
Source: Journal of Pediatric Orthopaedics - January 16, 2022 Category: Orthopaedics Tags: Hip Source Type: research
