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Journal of Pediatric Orthopedics. Part B

Oussama Abousamra, Justin Connor, Chris Church, Daveda Taylor, Nancy Lennon, Maria Del Pilar Duque Orozco, John Henley, Julieanne Sees, Freeman Miller
This study evaluated knee hyperextension course in children with cerebral palsy over a 5-year follow-up. Knee hyperextension was identified in 308 knees, of which 97 had follow-up greater than 5 years. Between the tests, 40% of limbs had plantar flexor lengthening (PFL). Overall, knee flexion and ankle dorsiflexion in stance increased (P<0.0001). Similar changes were noted between limbs that had PFL and those that did not. PFL is indicated in cases associated with equinus. However, the role of multilevel surgery in the treatment of knee hyperextension needs to be further determined...
January 14, 2019: Journal of Pediatric Orthopedics. Part B
Mingjing Li, Jian Xu, Tao Hu, Ming Zhang, Fan Li
The aim of this study was to analyse the management of Gartland type III supracondylar humerus fractures in children older than 10 years at our paediatric orthopaedics and to determine the clinical and radiographic long-term effects following open reduction by the small medial approach and cross-fixation with three kirschner wires. Eighty-three cases of Gartland type III supracondylar humerus fractures in children older than 10 years were treated by open reduction by the small medial approach and cross-fixation with three kirschner wires from January 2010 to December 2015...
January 4, 2019: Journal of Pediatric Orthopedics. Part B
Serkan Erkus, Ali Turgut, Ozkan Kose, Önder Kalenderer
Osteopetrosis (OP) is a group of rare sclerosing bone dysplasia characterized by increased bone density. The benign autosomal dominant form is the most common type. It typically carries a full life expectancy, despite increased propensity for fractures and other musculoskeletal problems, particularly hip osteoarthritis. In the current literature, the youngest OP patient having hip osteoarthritis is 16 years of age and treated with total hip arthroplasty. Within the present study, a 16-year-old female patient with early-onset hip osteoarthritis treated with hip joint debridement and femoral head reshaping is presented...
December 21, 2018: Journal of Pediatric Orthopedics. Part B
Yi-Qiang Li, Ming Li, Yue-Ming Guo, Xian-Tao Shen, Hai-Bo Mei, Shun-You Chen, Jing-Fan Shao, Sheng-Ping Tang, Federico Canavese, Hong-Wen Xu
This study aimed to investigate the effects of preliminary traction on the rate of failure of reduction and the incidence of femoral head avascular necrosis (AVN) in patients with late-detected developmental dysplasia of the hip treated by closed reduction. A total of 385 patients (440 hips) treated by closed reduction satisfied the inclusion criteria. Patients were divided in two groups according to treatment modality: a traction group (276 patients) and a no-traction group (109 patients). Tönnis grade, rate of failure reduction, AVN rate, acetabular index, center-edge angle of Wiberg, and Severin's radiographic grade were assessed on plain radiographs, and the results were compared between the two groups of patients...
December 21, 2018: Journal of Pediatric Orthopedics. Part B
Faustyna Manikowska, Brian Po-Jung Chen, Marek Jóźwiak, Maria K Lebiedowska
The aims were to determine during the popliteal angle (PA) tests whether particular knee muscles are activated and whether the position of pelvis affects the level of muscles activation. Twenty-two patients with cerebral palsy were recruited (age: 14±4.94 years). Knee muscle activities and range of motion were measured during PA. Knee flexors were active during tests, with fivefold increase of activation of ipsilateral hamstring. Higher and more frequent activation of muscles only in the contralateral limb was seen...
December 13, 2018: Journal of Pediatric Orthopedics. Part B
Paul Walbron, Florence Müller, Laurence Mainard-Simard, Amandine Luc, Pierre Journeau
Quality of spontaneous amelioration of residual developmental dysplasia of the hip (DDH) is nowadays not possible to predict. Normal age-related values of the osseous acetabular index (OAI), cartilaginous acetabular index and labral acetabular index have been established on MRI. In this study, MRI of dysplastic hips has been evaluated, and further osseous acetabular maturation was followed-up over time on pelvic radiography to find a correlation between MRI findings and radiological evolution. This is a retrospective single-centre study...
December 13, 2018: Journal of Pediatric Orthopedics. Part B
Marcelo Wajchenberg, Nelson Astur, Eloy A Fernandes, Edgar J Paredes-Gamero, Rafael P Luciano, Beny Schmidt, Acary S B Oliveira, Delio E Martins
To evaluate fat infiltration in the multifidus muscle close to the scoliotic curve as seen in MRI compared with the histological evaluation in patients with adolescent idiopathic scoliosis (AIS). The evaluation of fatty infiltration in the multifidus muscle of patients with AIS by MRI was compared with biopsy. Fatty infiltration was greater in concave side than in the convex side in both MRI (P=0.005) and biopsy evaluation (P=0.026). There was no correlation between the fatty infiltration findings evaluated through MRI and biopsy...
December 12, 2018: Journal of Pediatric Orthopedics. Part B
Ichiro Kajiura, Hidehiko Kawabata, Atsuko Okawa, Yukiyasu Minobe, Motoaki Matsuyama, Kiyoshi Yoshida, Tsunehiko Suzuki
We developed a novel device, dynamic spinal brace (DSB), with the basic concept of automatic correction by maximizing posture control. Herein, we report the structure of the DSB and preliminary treatment outcomes for scoliosis in patients with cerebral palsy. The study cohort comprised 219 patients with cerebral palsy treated for scoliosis with Cobb angle of at least 20° and follow-up of more than 3 years under the DSB. Cobb angle, trunk shift, and pelvic obliquity were assessed by semi-sitting radiography, and a questionnaire on daily lifestyle was collected...
December 12, 2018: Journal of Pediatric Orthopedics. Part B
Derek P Axibal, Brian Ketterman, Anne Skelton, Patrick Carry, Gaia Georgopoulos, Nancy Miller, Stephanie W Mayer
The purpose of our study was to compare the treatment outcomes and complications between operatively and nonoperatively treated displaced medial epicondyle fractures. Pediatric patients treated for an acute, displaced medial epicondyle fracture between 2005 and 2015 were retrospectively reviewed. A total of 22 operative participants were matched to 22 nonoperative participants, with an average displacement of 9.7 mm in both groups. There was no statistical difference in average length of immobilization, median time to full pronation/supination and flexion/extension, proportion of patients needing physical therapy, and complications...
December 11, 2018: Journal of Pediatric Orthopedics. Part B
Simone Riganti, Luigi A Nasto, Salvatore Mannino, Giorgio Marrè Brunenghi, Silvio Boero
The aim of this study was to compare clinical and radiographical results for treatment of lower limb multiaxial deformities±limb length discrepancy (LLD) of at least 2 cm with the Truelok hexapod fixator system (TL-HEX). All consecutive cases of lower limb multiaxial deformities were included. Patients were divided in two groups: group 1, lower limb angular deformity+LLD less than 2 cm, and group 2, lower limb angular deformity+LLD of at least 2 cm. Only patients with age younger than or equal to 20 years and follow-up of 6 months after removal of the external fixator were included...
December 8, 2018: Journal of Pediatric Orthopedics. Part B
Robert F Murphy, Leah Plumblee, Brian Sleasman, William Barfield, Matthew A Dow, James F Mooney
The purpose of this study was to compare the efficacy of a single-sugar-tong splint (SSTS) to a long-arm cast (LAC) in maintaining reduction of pediatric forearm fractures, while avoiding secondary intervention. One hundred patients age 3-15 with a forearm fracture requiring a reduction and immobilization were evaluated (50 LAC and 50 SSTS). Medical records and radiographs were reviewed at injury, postreduction, and at 1, 2, and 4 weeks postinjury. Sagittal and coronal angular deformities were recorded. Any secondary intervention due to loss of reduction was documented...
December 6, 2018: Journal of Pediatric Orthopedics. Part B
Mauro C de Morais Filho, Marcelo H Fujino, Cátia M Kawamura, Carlos A Dos Santos, José A F Lopes, Francesco C Blumetti, Rames Mattar
The aim of this study was to compare semitendinosus transfer to distal femur (STTX) to semitendinosus surgical lengthening (STL) regarding the increase of anterior pelvic tilt after flexed knee gait treatment. Thirty-nine patients were evaluated, and they were divided according surgical procedures at knees: STL group (22 patients/44 knees), which included patients who received medial hamstrings surgical lengthening as part of multilevel approach, and STTX group (17 patients/34 knees), which was represented by patients who underwent orthopedic surgery including a STTX instead of STL...
November 29, 2018: Journal of Pediatric Orthopedics. Part B
Frank A Segreto, James C Messina, James P Doran, Sarah E Walker, Alexandr Aylyarov, Neil V Shah, Patrick J Mixa, Natasha Ahmed, Karen Paltoo, Kwaku Opare-Sem, Harleen Kaur, Louis M Day, Qais Naziri, Carl B Paulino, Claude B Scott, Khalid Hesham, William P Urban, Bassel G Diebo
Comparing risks against benefits of adolescent idiopathic scoliosis (AIS) patients participating in sports represents a controversial topic in the literature. Previous studies have reported sports participation as a possible risk factor for AIS development, while others describe its functional benefits for AIS athletes. The objective of this study was to determine if sports participation had an impact on pain, function, mental status, and self-perception of deformity in patients and their parents. Patients had full spine radiographs and completed baseline surveys of demographics, socioeconomics, and patient-reported outcomes (PRO): Scoliosis Research Society (SRS)-30, Body Image Disturbance Questionnaire, and Spinal Appearance Questionnaire (SAQ: Children and Parent)...
November 26, 2018: Journal of Pediatric Orthopedics. Part B
Pasquale Farsetti, Roberto Caterini, Fernando De Maio, Vito Potenza, Kristian Efremov, Ernesto Ippolito
The authors reviewed 54 (58 hips) patients with acetabular dysplasia following developmental dislocation of the hip (DDH), treated by triple pelvic osteotomy according to the Tönnis technique. The aim of our study was to report the long-term clinical and radiographic results of the operation at a mean follow-up of 12 years (from 7 to 20). At diagnosis, all the hips were painful, the Wiberg angle measured less than 20°, and no radiographic signs of osteoarthritis were present. At follow-up, 82.7% of the operated hips showed either excellent or good results, according to Harris, and the Wiberg angle measured an average of 34° (from 26° to 45°)...
November 26, 2018: Journal of Pediatric Orthopedics. Part B
Khaled M Emara, Shady A Mahmoud, Ramy A Diab, Mahmoud A Elshobaky, Ahmed K Emara
The aim of this study was to assess the safety and efficacy of percutaneous low-energy osteotomy and casting in treatment of pathological coronal knee deformities in children equal or younger than 6 years. A prospective nonrandomized case series study was conducted. A total of 62 (109 limbs) patients with pathological coronal knee deformities were treated by percutaneous low-energy osteotomy and casting and observed over 3-10 years. The pathological nature was variable (rickets, Blount disease, dysplasia, after trauma, or after infection)...
November 21, 2018: Journal of Pediatric Orthopedics. Part B
Si Heng Sharon Tan, Keng Lin Wong, James Hoipo Hui
In a 12-year cohort study, all newborns with suspected developmental dysplasia of the hips (DDHs) were scheduled for hip ultrasound at the sixth week of life. Female sex is the only isolated risk factor with a positive likelihood ratio predictive of DDH [1.26; 95% confidence interval (CI): 1.04-1.54]. In combination, the presence of two or more risk factors was predictive of DDH (positive likelihood ratio 1.10; 95% CI: 1.00-1.20). The sensitivity and specificity of two or more risk factors for the prediction of DDH were 93...
November 19, 2018: Journal of Pediatric Orthopedics. Part B
Antonio Memeo, Fabio Verdoni, Caterina Ingraffia, Laura Rossi, Leopoldo Pedretti, Raffaele D D'Amato, Laura Peretto, Giuseppe V Mineo
Staged leg lengthening allows achondroplastic dwarfs to reach nearly normal height, but it takes long periods of external fixation and it can be burdened by delayed unions. Between 2009 and 2013, eight achondroplastic dwarfs showed delayed unions in the callus formation during femoral lengthening stages in our institute. We performed in-situ injections of bone marrow-derived stem cell concentrates. Patients underwent monthly clinical and radiographic assessment for determination of the healing rate. All eight patients showed an improvement in the regenerated bone, with an average healing index of 23...
November 15, 2018: Journal of Pediatric Orthopedics. Part B
Ashok Johari, Rashid Anjum
Focal fibrocartilaginous dysplasia (FFCD) is a rare developmental disorder frequently leading to angular deformities in young children. It most commonly affects the proximal tibia followed by distal femur. There are totally 22 reported cases of FFCD of femur. We report a case of FFCD of distal femur as a cause of varus deformity that was managed nonoperatively. The deformity resolved spontaneously over a period of 8 years. This is the second reported case of spontaneous resolution of angular deformity secondary to FFCD of distal femur...
November 15, 2018: Journal of Pediatric Orthopedics. Part B
Daniel E Choi, Michael J Vives, Harsh Shah, Caixia Zhao, Anuradha Patel, Sanjeev Sabharwal
Most studies have excluded postoperative drain volumes in analyzing blood loss associated with scoliosis surgery. We sought to analyze patient and surgical factors that influenced postoperative drain outputs. A retrospective review was conducted on 50 consecutive patients who had undergone posterior spinal fusion with pedicle screw instrumentation and subfascial drain placement over a 6-year period at a single institution for adolescent idiopathic scoliosis. Postoperative drain volumes were correlated to patient factors, surgical variables, and change in postoperative hemoglobin values...
November 13, 2018: Journal of Pediatric Orthopedics. Part B
Yu-Cheng Lai, Huey-Shyan Lin, Hui-Fen Pan, Wei-Ning Chang, Chien-Jen Hsu, Jenn-Huei Renn, Tsu-Jen Kuo
The aim of this study was to clarify the effects of general anesthesia (GA) on joint range of motion (ROM) in children with spastic cerebral palsy (SCP). Eighty-four SCP cases (mean age 8.4 years) admitted for first corrective surgery were retrospectively reviewed. Lower limb ROM were measured 1 day before operation and immediately after GA. Contracture of hip, knee, and ankle joints decreased significantly after GA, with +11.1° (39.5%) for the hip abduction angle, -3.7° (18.0%) for the Thomas test, -15.0° (19...
November 1, 2018: Journal of Pediatric Orthopedics. Part B
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