Latest journal articles on pediatric orthopaedics and conditions from Journal of Pediatric Orthopaedics, Journal of Children's Orthopaedics, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics
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Variations in AP and frog-leg pelvic radiographs in a pediatric population.
J Pediatr Orthop. 2013 Mar;33(2):212-5
Authors: Hudak KE, Faulkner ND, Guite K, Muchow R, Narotam V, Nemeth B, Halanski M, Noonan K
Abstract
INTRODUCTION: It is common for pediatric patients with a history of hip dysplasia to undergo anteroposterior (AP) and frog-leg (FL) lateral radiographs to monitor development of the hip. Because of sensitivity of pediatric tissues to ionizing radiation, we sought to document the relationship between AP and FL radiographs and to determine which image was better to assess acetabular dysplasia.
METHODS: An Institutional Review Board-approved, retrospective review was conducted on 33 patients screened for hip dysplasia at a single institution. We sought to determine whether either film was more likely to be qualitatively better in position and whether there were differences in acetabular measures between the 2 radiographs. Standard measurements on AP and FL radiographs were made by 5 observers on 2 different occasions to assess interobserver and intraobserver variability.
RESULTS: The mean age was 23+1 months, and 80% were female; none of the children had hip dysplasia. There was no statistical significance in the quotient of pelvic rotation (AP 1.2 + 0.1 degrees and FL 1.1 + 0.1 degrees; P = 0.84). There was a
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Correction in malrotation of the scapula and muscle transfer for the management of severe Sprengel deformity: static and dynamic evaluation using 3-dimensional computed tomography.
J Pediatr Orthop. 2013 Mar;33(2):205-11
Authors: Yamada K, Suenaga N, Iwasaki N, Oizumi N, Minami A, Funakoshi T
Abstract
BACKGROUND: The clinical results of surgical procedures for severe Sprengel deformity have been uncertain. To obtain improved elevation, we consider that it is necessary to realign the lateral border of the scapula for upward rotation. The purposes of the current study were to evaluate the clinical results and range of motion of the scapula after such realignment.
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Comparative study of 2 commissural dorsal flap techniques for the treatment of congenital syndactyly.
J Pediatr Orthop. 2013 Mar;33(2):197-204
Authors: Mallet C, Ilharreborde B, Jehanno P, Litzelmann E, Valenti P, Mazda K, Penneçot GF, Fitoussi F
Abstract
BACKGROUND: Many commissural reconstruction techniques have been described for the treatment of syndactyly. This study is the first to compare long-term results of 2 commissural dorsal flap procedures (T-flap and omega-flap).
METHODS: Fifty-nine web-spaces in 39 patients, operated on between 1991 and 2008, were retrospectively analyzed. Thirty-six T-flap and 23 omega-flap procedures were performed using full-thickness skin graft in every case for digital resurfacing. Factors that could affect the long-term outcome were collected, including development of web-creep, clinodactyly, and flexion contracture. Patients were reviewed with a mean follow-up of 5 years and 8 months.
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Radial polydactyly: proposal for a new classification system based on the 159 duplicated thumbs.
J Pediatr Orthop. 2013 Mar;33(2):190-6
Authors: Chung MS, Baek GH, Gong HS, Lee HJ, Kim J, Rhee SH
Abstract
BACKGROUND: Polydactyly is one of the most common congenital differences that affect the hand. It has various anatomic and morphologic features. Although the Wassel classification has been used widely for radial polydactyly, it is based on the anatomic level of duplication and has some limitations in describing the concrete morphology of the duplication. The authors devised a new classification system based on the anatomic pattern of duplication to facilitate surgical correction of the deformity and evaluated surgical outcomes.
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Proximal femoral geometry before and after varus rotational osteotomy in children with cerebral palsy and neuromuscular hip dysplasia.
J Pediatr Orthop. 2013 Mar;33(2):182-9
Authors: Davids JR, Gibson TW, Pugh LI, Hardin JW
Abstract
BACKGROUND: Surgical management of hip dysplasia in children with cerebral palsy (CP) usually includes varus rotational osteotomy (VRO) of the proximal femur. Several techniques of VRO (end-to-end, EE; end-to-side, ES) have been designed to maximize correction and minimize associated deformities. The goals of the current study were to establish the prevalence and contribution of caput valgum to coxa valga deformity in children with CP, compare the geometry of the proximal femur after EE and ES techniques of VRO, and document the response of the proximal femur to subsequent growth after VRO.
METHODS: The records of 75 children with CP (Gross Motor Function Classification System, levels IV and V) with 137 surgically treated hips were retrospectively reviewed. Outcomes were limited to the technical domain (eg, radiographic measurements and surgical complications). Measurements made for each hip (preoperative, operative, and follow-up) included the neck-shaft angle (NSA), head-shaft angle (HSA), and the medialization index.
RESULTS: The mean age at the time of surgery was 7 years. The mean
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Unilateral hip reconstruction in children with cerebral palsy: predictors for failure.
J Pediatr Orthop. 2013 Mar;33(2):175-81
Authors: Shukla PY, Mann S, Braun SV, Gholve PA
Abstract
BACKGROUND: Unilateral hip reconstruction in patients with cerebral palsy can be complicated by contralateral subluxation and ipsilateral failure. We sought to identify predictors for failure after unilateral reconstruction in patients with GMFCS IV-V CP with unilateral hip involvement.
METHODS: We performed an IRB-approved retrospective study on GMFCS IV-V CP patients with unilateral hip reconstruction at a minimum 2-year follow-up. Radiologic data included acetabular index, femoral migration index (FMI), lateral center edge angle (LCE), and pelvic obliquity. The effects of age, sex, pelvic obliquity, scoliosis surgery, and contralateral hip soft-tissue release at the index surgery were analyzed for ipsilateral hip failure and contralateral hip subluxation. Statistical analysis was performed using the χ and t tests.
RESULTS: There were 35 patients (M:F, 23:12) with mean age of 110 months (range, 45 to 215 mo) with mean follow-up of 60.5 months (range, 24 to 129 mo). The mean preoperative ipsilateral hip FMI was 60% (range, 40% to 100%) and the mean LCE was -16.7 degrees (range, -85 to 17.2 degrees). Contralateral soft-tissue release was
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Correction of spine deformity in patients with Melnick-needles syndrome: report of 2 cases and literature review.
J Pediatr Orthop. 2013 Mar;33(2):170-4
Authors: Lykissas MG, Crawford AH, Shufflebarger HL, Gaines S, Permal V
Abstract
BACKGROUND: Melnick-Needles syndrome (MNS) is a rare X-linked dominant disorder affecting the skeletal system and connective tissue. To date, < 70 cases with MNS have been documented. Although few reports in the literature have shown that these patients might develop kyphoscoliosis, there is no report regarding long-term follow-up of patients with MNS undergo spine surgery. The aim of this study is to describe 2 unique cases of MNS with long-term follow-up after instrumented posterior spinal fusion, multiple-level Ponte osteotomies, and pedicle subtraction osteotomies.
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Interobserver variability using a commercially available system of archived digital radiography with integrated computer-assisted measurements for scoliosis Cobb angles.
J Pediatr Orthop. 2013 Mar;33(2):163-9
Authors: Hardesty CK, Aronson J, Aronson EA, Ranade AS, McCracken CW, Nick TG, Cordell CL
Abstract
BACKGROUND: The purpose of this study was to determine if digital enhancements could improve upon published and interobserver variability for Cobb angle measurements of idiopathic scoliosis using a commercially available PACS system. The study also sought to determine if experience of the observer affected overall variability and to evaluate the time required to measure Cobb angles using 3 different techniques. As the decision for scoliosis treatment requires serial radiographic measurements by 1 or more observers at different times, precise landmark identification and curve measurement should decrease variability and improve accuracy.
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Prevalence of hypovitaminosis D among children with upper extremity fractures.
J Pediatr Orthop. 2013 Mar;33(2):159-62
Authors: James JR, Massey PA, Hollister AM, Greber EM
Abstract
BACKGROUND: Recent publications show a high rate of hypovitaminosis D among children in general as well as among children with fractures. 25-hydroxyvitamin D levels were analyzed from hospital records to determine the prevalence of hypovitaminosis D, with the goal of using that information in fracture management and nutritional counseling.
METHODS: We retrospectively reviewed the records of 213 children with upper extremity fractures that were treated during a 14-month period. For 181 of those patients, the 25-hydroxyvitamin D level was measured at the time of emergency department presentation or at the first clinic appointment within 2 weeks after the initial presentation. The following information was collected from the charts: fracture mechanism (high or low energy), age, sex, race, and body mass index. Vitamin D levels were categorized as normal (≥ 32 ng/mL), insufficient (20 to 32 ng/mL), or deficient (< 20 ng/mL). The levels were analyzed with respect to fracture pattern and race.
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Ultrasound in pediatric peripheral nerve injuries: can this affect our surgical decision making? A preliminary report.
J Pediatr Orthop. 2013 Mar;33(2):152-8
Authors: Lee J, Bidwell T, Metcalfe R
Abstract
BACKGROUND: The treatment of closed fractures with associated peripheral nerve palsy is controversial. Traditionally, the nerve palsy is managed with watchful waiting and subsequent neurophysiological studies if no improvement is seen within 4 months. This may not be necessary if nerve integrity can be imaged acutely with ultrasound scan. We present a case series of pediatric patients with closed upper limb injuries and associated peripheral nerve palsy who underwent ultrasound scanning to assess nerve integrity.
METHODS: A retrospective review of patients attending Starship Children's Hospital between May 2008 and April 2010 with closed upper limb injuries and associated peripheral nerve palsy was undertaken. Those patients up to and including the age of 14 years (skeletally immature) with complete clinical records available were included.
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