Does An Osteotomy Performed in Congenital Pseudarthrosis of the Tibia Heal?
Conclusions:
Contrary to much of the established practice, osteotomies may be safely performed in CPT for various indications. All osteotomies healed with only 1 osteotomy requiring secondary bone grafting. Although time to healing of the osteotomy was generally prolonged, this study suggests, somewhat surprisingly, that preconsolidation can occur frequently in lengthening procedures.
Level of Evidence:
Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Pseudoarthrosis of the Tibia Source Type: research
Combination Treatment by Cross-Union of the Tibia and Fibula, Autogenic Iliac Bone Grafting, Reliable Fixation and Bone Morphogenetic Proteins for the Treatment of Refractory Congenital Pseudarthrosis of the Tibia
Conclusions:
Cross-union of the tibia and fibula is a promising complementary procedure for treating refractory CPT patients.
Level of Evidence:
Level IV—case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Pseudoarthrosis of the Tibia Source Type: research
Two-stage Bone Lengthening With Reuse of a Single Intramedullary Telescopic Nail in Patients With Achondroplasia
Conclusions:
This study analyzes lower-limb lengthening in a series of achondroplastic patients using TIMN with the novelty of nail reuse to relengthen the bone. The complication rate found is acceptable, among which, potential damage to the internal lengthening mechanism must be considered, though this complication can usually be easily resolved. Overall, nail reuse seems advisable in cases where bone elongation is indicated, and the size and design of the nail limits the extent of lengthening.
Level of Evidence:
Level III, retrospective comparative study, before and after intervention. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Limb Lengthening Source Type: research
The Utility of the Modified Fels Knee Skeletal Maturity System in Limb Length Prediction
Background:
Predicting ultimate lower extremity length is important in the treatment of lower limb length discrepancy (LLD), congenital limb deficiency, and other etiologies. Utilizing skeletal age over chronological age improves the prediction of ultimate lower extremity length. The recently described modified Fels knee skeletal maturity system allows for skeletal age estimation via imaging always available in LLD patients. We sought to compare the accuracy of the modified Fels knee skeletal maturity system versus chronological age in ultimate limb length prediction of a modern adolescent clinical population.
Metho...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Limb Lengthening Source Type: research
Weight-Bearing Computed Tomography of the Foot and Ankle in the Pediatric Population
Background:
Newer cone-beam computed tomography (CT) technology has grown in popularity for evaluation of foot and ankle pathology in the weight-bearing (WB) position. Many studies have demonstrated its benefits within the adult population, but there is a paucity of its use within the pediatric literature. The purpose of this study was to describe the indications and clinical findings of WBCT within a pediatric population.
Methods:
A retrospective cohort of 68 patients (86 extremities) who underwent WBCT for a variety of conditions were compared with 48 patients (59 extremities) who underwent traditional supine ...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Foot and Ankle Source Type: research
Talocalcaneal Tarsal Coalition Size: Evaluation and Reproducibility of MRI Measurements
Conclusions:
Measurements of coalition size using novel MRI guidelines were reproducible with good to excellent inter-rater reliability. These guidelines allow for determination of TCC size using coronal PD MRI.
Level of Evidence:
Level II—diagnostic reproducibility study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Foot and Ankle Source Type: research
A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center
Conclusion:
Documented cervical spine clearance protocols are effective for detection of significant injury in pediatric trauma patients. This study suggests these protocols minimize risk of missed injury and may prevent unnecessary radiation exposure, delayed clearance, prolonged hospitalization, or unnecessary specialist referral.
Clinical Relevance:
Utilization of a standard written protocol for cervical spine clearance likely prevents missed injury and helps to minimize radiation exposure in pediatric populations. Further research is needed on evaluation and management of pediatric cervical spine trauma. (So...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Trauma Source Type: research
Gartland Type IIa Supracondylar Humerus Fractures: Outcomes of Attempted Nonoperative Management
We report the results of a series of patients with type IIa fractures who underwent closed reduction and immobilization using conscious sedation in the emergency department. Our goal was to identify variables associated with fractures that were successfully managed nonoperatively.
Methods:
This was a retrospective cohort study of pediatric patients who underwent closed reduction of Gartland type IIa supracondylar humerus fractures with the use of conscious sedation in the emergency department. Prereduction and postreduction radiographs were reviewed to determine the degree of fracture extension, anterior humeral lin...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Trauma Source Type: research
Outcomes and Cost of Reduction of Overriding Pediatric Distal Radius Fractures
This study compared radiographic outcomes of pediatric patients undergoing closed reduction of 100% displaced distal radius fractures to a historical, published cohort treated with casting alone. We also examined the expense associated with sedated reduction.
Methods:
Single-center, retrospective cohort study examining radiographic outcomes following reduction of 100% translated distal radius fractures in 50 consecutive pediatric patients. Radiographic outcomes were compared with a historical cohort published by Crawford and colleagues. Charges associated with emergency department (ED) and clinic visits were compare...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Trauma Source Type: research
Nonaccidental Trauma in Pediatric Elbow Fractures: When You Should Be Worried
Conclusions:
The vast majority of pediatric elbow fractures (99.6%) are accidental. However, certain factors, namely age below 1 year and transphyseal fractures increase the likelihood that these fractures may be a result of NAT.
Level of Evidence:
Level IV: retrospective case series. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Trauma Source Type: research
Modified Velpeau Sling Application for the Treatment of Fractures Around Shoulder in Infants
Conclusions:
The modified Velpeau method is an effective way of treating fractures around the shoulder region in infants without underlying pathology. Several advantages such as accessibility of sling material, easy application, inexpensive material, and absence of skin-related complications make this an effective treatment.
Level of Evidence:
Level IV—therapeutic study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Trauma Source Type: research
Tendon Healing in a Mouse Model of Loeys-Dietz Syndrome: Controlled Study Using a Patellar Tendon Transection Model
Conclusion:
We present the first mechanistic insight into the effect of LDS on tendons and tendon healing. The morphologic differences between LDS and WT tendons at baseline may help explain the increased risk of tendon/ligament dysfunction in patients with LDS, and the differential healing response to injury in LDS may account for the delayed healing and weaker repair tissue.
Level of Evidence:
Level V. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Neuromuscular Source Type: research
Proximal Femoral Screw Hemiepiphysiodesis in Children With Cerebral Palsy Improves the Radiographic Measures of Hip Subluxation
Conclusion:
PFSH effectively alters proximal femoral growth and can improve hip subluxation in children with CP. Screws often need to be exchanged and hips should be carefully monitored.
Level of Evidence:
Level III—retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Neuromuscular Source Type: research
Can Over-containment Prevent Recurrence in Children With Cerebral Palsy and Hip Dysplasia Undergoing Hip Reconstruction?
Conclusions:
Over-containment at the time of hip reconstruction can positively affect radiographic outcomes and failure rates in children with CP. Over-containment should be considered in hips at high risk of failure, especially non ambulatory children with significant hip subluxation at an early age.
Level of Evidence:
Level III—retrospective comparative study. (Source: Journal of Pediatric Orthopaedics)
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Neuromuscular Source Type: research
Development and Validation of SCFE Percutaneous Pinning Surgical Simulation
Background:
In situ screw fixation with a single percutaneously placed femoral screw remains widely accepted for femoral head fixation in adolescent patients with slipped capital femoral epiphysis (SCFE). Given the potential risks involved with this procedure, a simulation whereby surgical skills could be refined before entering the operating room may be of benefit to orthopaedic trainees.
Methods:
We developed a synthetic model for the simulated treatment of SCFE. Five orthopaedic attendings and twenty trainees were recorded performing an in situ percutaneous fixation on the SCFE model. Time, radiation exposure...
Source: Journal of Pediatric Orthopaedics - June 7, 2022 Category: Orthopaedics Tags: Hip Source Type: research
