Pediatric Orthopedics Research Articles

Emerging Trends on the Growing Rods in Scoliosis in the Last 20 Years: A Bibliometric Analysis from 2003 to 2024.

Growing rods is a distraction-based, growth-friendly method that is commonly used in the treatment of scoliosis. Studies on growing rods in scoliosis published from 2003 to 2024 were retrieved from the Web of Science Core Collection. VOSviewer, Microsoft Excel, and CiteSpace were applied for data analysis. We identified 742 publications on growing rods in scoliosis. The annual number of publications grew steadily. The United States was the most prolific country. University of California, San Diego was the most productive institution. Behrooz A. Akbarnia ranked first among authors regarding the number of articles and citations. The Journal of Pediatric Orthopedics was the most prolific journal. The research topics can be divided into 3 clusters as follows. 1) Complications of growing rods and magnetically controlled rods in early onset scoliosis; 2) growing rods in congenital scoliosis, focusing on pulmonary function and thoracic insufficiency syndrome; and 3) scoliosis management. The frontier directions of current research included magnetically controlled growing rods and growing rods fusion. This study drew a knowledge map of growing rods in scoliosis over the past 2 decades. The changes in research hotspots and current research directions have been summarized. The high costs and limited access to growing rods methodology in less-developed regions highlight the economic and technical challenges of globalizing these advanced treatments.

Activity of Selected Bone Formation and Angiogenesis Markers During the Treatment of Limb Length Discrepancy in Children Using Distraction Osteogenesis with the Circular Hexapod External Fixator.

Background/Objectives: Limb lengthening and deformity correction techniques, particularly distraction osteogenesis, have significantly evolved in pediatric orthopedics. This study examines the temporal changes of key biochemical markers-vascular endothelial growth factor (VEGF), fibroblast growth factor 1 (FGF-1), and the propeptide of type I collagen (P1NP)-during the limb lengthening process. Methods: Twenty pediatric patients (aged 13-16) underwent distraction osteogenesis using the Circular Hexapod External Fixator. Peripheral blood samples were collected pre-treatment, three weeks after initiating distraction, and one month post-lengthening. Marker levels were measured using ELISA. Results: Serum VEGF concentrations significantly increased during treatment, peaking at T2 (T1 35.91 ± SD 5.54 vs. T2 293.47 ± SD 69.57, p < 0.0001), then declined at T3 (293.47 ± SD 69.57 vs. 40.86 ± SD 6.26, p < 0.0001). FGF-1 showed minor fluctuations initially but significantly increased by T3 (18.14 ± SD 4.57 vs. 41.56 ± SD 17.15, p < 0.01), about 2.3 times higher than baseline. P1NP concentrations exhibited a linear increase, with a significant rise from T2 to T3 (234.06 ± SD 36.57 vs. 280.68 ± SD 35.63, p < 0.05), while the T1 to T2 increase was not statistically significant, indicating ongoing osteoblastic activity and bone formation. Conclusions: This study highlights the dynamic changes in VEGF, FGF-1, and P1NP during distraction osteogenesis, emphasizing their roles as biomarkers of bone regeneration. These findings enhance the understanding of bone healing mechanisms and could inform future therapeutic strategies for pediatric limb lengthening. Further research is warranted to explore their clinical utility.

Floating-embedded stems reduce tibial stress shielding in total knee revision arthroplasty

BackgroundTotal knee arthroplasty (TKA) is one of the most common orthopaedic procedures and the number of patients which undergo TKA will continue to rise in the coming years. Consecutively, the number of necessary revision surgeries will increase. One of the main reasons for revision surgery is aseptic loosening because of a so-called stress-shielding effect. Typically, revision of a primary TKA is done from a bicondylar surface replacement to a stem-anchored prosthesis, which, due to higher stress-shielding, have a shorter survival time than non-stem-anchored systems. Similar to endoprosthetic treatment in pediatric tumor orthopedics, non-ingrown cementless stems can be used. The study aim was to investigate whether this concept can also be applied to reduce stress-shielding in the tibial metaphysis after revision TKA in adults.MethodsSix tibial biomechanical bone with stemmed tibial TKA components were implanted using surface cementing and a floating-embedded stem or classic full cementing. After implantation, axial force was applied in such a way that the same load was generated as during walking. Two high-resolution cameras and illumination spots were used to record changes on the bone surface circumferentially in three regions of interest and from three different views.ResultsWith regard to the fixation method, a significant difference could be demonstrated in the metaphyseal and in the middle region around the stem (p < 0.001). At the tip of the stems, the reduction of strain energy density showed a stress shielding reduction for the floating-stemmed models in two of three views (ventromedial p = 0.002, lateral p = 0.398, and dorsal: p = 0.027).ConclusionsIn revision surgery after TKA, the use of floating-embedded, uncemented stems without bony ingrowth shows significant reduction of metaphyseal stress-shielding within the proximal tibia. This technique could be a viable alternative to prevent early aseptic loosening and should be examined in future in-vivo studies.

Pediatric Supracondylar Humerus and Diaphyseal Femur Fractures: A Comparative Analysis of Chat Generative Pretrained Transformer and Google Gemini Recommendations Versus American Academy of Orthopaedic Surgeons Clinical Practice Guidelines.

Artificial intelligence (AI) chatbots, including chat generative pretrained transformer (ChatGPT) and Google Gemini, have significantly increased access to medical information. However, in pediatric orthopaedics, no study has evaluated the accuracy of AI chatbots compared with evidence-based recommendations, including the American Academy of Orthopaedic Surgeons clinical practice guidelines (AAOS CPGs). The aims of this study were to compare responses by ChatGPT-4.0, ChatGPT-3.5, and Google Gemini with AAOS CPG recommendations on pediatric supracondylar humerus and diaphyseal femur fractures regarding accuracy, supplementary and incomplete response patterns, and readability. ChatGPT-4.0, ChatGPT-3.5, and Google Gemini were prompted by questions created from 13 evidence-based recommendations (6 from the 2011 AAOS CPG on pediatric supracondylar humerus fractures; 7 from the 2020 AAOS CPG on pediatric diaphyseal femur fractures). Responses were anonymized and independently evaluated by 2 pediatric orthopaedic attending surgeons. Supplementary responses were, in addition, evaluated on whether no, some, or many modifications were necessary. Readability metrics (response length, Flesch-Kincaid reading level, Flesch Reading Ease, Gunning Fog Index) were compared. Cohen Kappa interrater reliability (κ) was calculated. χ2 analyses and single-factor analysis of variance were utilized to compare categorical and continuous variables, respectively. Statistical significance was set with P <0.05. ChatGPT-4.0, ChatGPT-3.5, and Google Gemini were accurate in 11/13, 9/13, and 11/13, supplementary in 13/13, 11/13, and 13/13, and incomplete in 3/13, 4/13, and 4/13 recommendations, respectively. Of 37 supplementary responses, 17 (45.9%), 19 (51.4%), and 1 (2.7%) required no, some, and many modifications, respectively. There were no significant differences in accuracy (P = 0.533), supplementary responses (P = 0.121), necessary modifications (P = 0.580), and incomplete responses (P = 0.881). Overall κ was moderate at 0.55. ChatGPT-3.5 provided shorter responses (P = 0.002), but Google Gemini was more readable in terms of Flesch-Kincaid Grade Level (P = 0.002), Flesch Reading Ease (P < 0.001), and Gunning Fog Index (P = 0.021). While AI chatbots provided responses with reasonable accuracy, most supplemental information required modification and had complex readability. Improvements are necessary before AI chatbots can be reliably used for patient education. Level IV.

Gait Analysis in Patients After Hemiepiphysiodesis Due to Valgus or Varus Knee Deformity.

Background: Developmental knee joint deformities are a common problem in pediatric orthopedics. Children with a valgus or varus deformity of the distal femur or the proximal tibia are commonly treated with hemiepiphysiodesis. Gait analysis in patients with lower limb deformities plays an important role in clinical practice. The purpose of our study was to assess gait parameters in patients who underwent hemiepiphysiodesis procedures of the distal femur or proximal tibia due to a knee deformity and to compare them with those in healthy controls. Methods: We prospectively evaluated 35 patients (14 females and 21 males) after hemiepiphysiodesis and compared the results with a healthy control group (26 participants). Gait was analyzed with a G-Sensor device (BTS Bioengineering Corp., Quincy, MA, USA). We assessed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, and step length. We assessed these gait parameters in a group of patients before and after treatment with hemiepiphysiodesis. We compared the patients' results before and after treatment to those of a healthy control group. The level of significance was set at p < 0.05. Results: The mean follow-up period was 13 months. There was no difference in the results of gait assessments in patients prior to and after treatment. The median step length was 47.09% in the treated limb after treatment and 54.01% in the intact limb (p = 0.018). There were no other differences in gait parameters in the treated limbs and the healthy, intact limbs in the patient group after treatment. There were no significant differences in the patients before and after treatment compared with those in the healthy control group in all gait parameters. Conclusions: Valgus or varus knee deformity correction with the use of hemiepiphysiodesis does not significantly improve preoperative gait parameters. The biomechanical outcomes of hemiepiphysiodesis in the treatment of valgus or varus knee deformity are good. We observed no differences in gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, gait velocity, cadence, or step length between the experimental and healthy control groups.

Limb Axis Disorder During Leg Length Discrepancy Treatment with Temporary Epiphysiodesis Using Eight-Plate Implants

Background: A common problem in pediatric orthopedics is leg length discrepancy (LLD). In adulthood, this may result in overload and degenerative changes in the lumbar spine, hip, and knee joints of the longer limb, and the fixed equinus position of the foot of the shorter limb. Surgical treatment using temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and patient-tolerated procedure in LLD. However, publications mainly describe the effects of treatment in the form of achieved equalization and there is little information about the occurrence of secondary deformations. Our study aimed to determine the effect of temporary growth plate blocking on the final axis after treatment. Methods: The study was based on an analysis of radiographs recorded from 2010 to 2019 and an assessment of parameters such as MAD (mechanical axis deviation), mMPTA (mechanical medial proximal tibial angle), and M/at (mechanical axis of the tibia). Results: Twenty-four girls and thirty-six boys treated with eight-plate implants were included in the investigation. The duration of the treatment was 18 months (group I), 30 months (group II), and 42 months (group III). Our study revealed that the most significant differences were observed in the MAD parameter. MAD changed in a statistically significant manner across all investigated groups, for both girls and boys, regardless of the treatment duration. Conclusions: The treatment of LLD with epiphysiodesis using eight-plate implants influences both the anatomical axis of the bones and the mechanical axis of the limb.

Work-Life Balance in Pediatric Orthopaedics: The role of the leaders.

Work-Life Balance in Pediatric Orthopaedics: The role of the leaders.

Unraveling molecular mechanisms in growth plate development advancing pediatric orthopedic interventions

Dynamic Growth Plate based on Molecular Profiling (DGMP) represents a pioneering approach to understanding the intricate molecular processes governing growth plate development, essential for advancing pediatric orthopedic treatments. Growth plates, located at the ends of long bones, are pivotal for bone elongation during childhood and adolescence, but disruptions in their molecular and cellular regulation can result in developmental abnormalities and orthopedic deformities. DGMP integrates genomic, transcriptomic, proteomic, and epigenomic analyses to uncover cell-specific expression patterns and regulatory elements critical to growth plate formation. By leveraging high-throughput sequencing, single-cell RNA (Ribonucleic Acid) sequencing, and spatial transcriptomics, DGMP facilitates the identification of diagnostic biomarkers and enables the development of targeted pharmacological therapies tailored to children with defective growth plates. Furthermore, in silico models simulating cellular differentiation and pathway interactions provide predictive insights into the long-term effects of interventions on bone development. This innovative framework not only enhances early and accurate detection of growth-related disorders but also supports the design of personalized treatments, ultimately improving clinical outcomes for affected children. As a precision medicine tool, DGMP has the potential to transform pediatric orthopedics by resolving challenges related to molecular data integration, spatiotemporal dynamics, and therapeutic application, thereby advancing the understanding and treatment of growth plate disorders.

Bridging the Gaps in Pediatric Orthopaedics: A Holistic Approach to Strengthening the Workforce

The pediatric orthopaedic workforce in the United States faces critical challenges as the demand for specialized services grows. Despite recent advancements, significant gaps remain in the availability and geographic distribution of pediatric orthopaedic surgeons, particularly in rural underserved areas. These disparities affect the quality of care pediatric and adolescent patients deserve. While efforts to improve disproportionality have shown some progress, overall gender and racial diversity remains low. Furthermore, the osteopathic approach, which emphasizes whole-person care and preventive strategies, offers valuable insights and interventions for addressing these workforce challenges. By integrating osteopathic principles, such as the interrelationship of structure and function and osteopathic manipulative treatment (OMT), into preoperative and postoperative care, pediatric orthopaedists can enhance patient outcomes and long-term recovery, benefitting both subspecialists and generalists. This article reviews the current state of the pediatric orthopaedic workforce, proposes recommendations to address existing gaps, and highlights the role of osteopathic distinctiveness in strengthening healthcare for pediatric patients.

Chronic recurrent multifocal osteomyelitis in pediatric patients: A Chinese single center observational study and literature review.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disorder that commonly poses diagnostic challenges due to its atypical symptomatology. This observational study aimed to investigate the clinical features, laboratory test results, imaging features, and treatment strategies for pediatric patients with CRMO. We retrospectively analyzed 7 pediatric patients with CRMO treated at the Department of Pediatric Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2018 and February 2022. This study aimed to enhance current understanding of CRMO by exploring in-depth clinical data. The study cohort comprised 5 males and 2 females, aged 3 to 13 years. All patients experienced symptoms for a median duration of 6 months prior to hospitalization, at which point they presented with recurrent pain and various accompanying signs including hypothermia (14.28%), swelling (42.85%), localized skin warmth (42.85%), and plantar pustules (14.28%). The femurs (71.42%) and tibia (71.42%) were frequently affected. Radiographic and computed tomography scans revealed osteosclerosis and osteolytic lesions, while magnetic resonance imaging revealed bone marrow edema. Histological examination of bone biopsies from 4 patients revealed fibrous tissue hyperplasia and lymphocytic and neutrophilic infiltration, despite negative bacterial cultures. Laboratory test results were either normal or slightly elevated. Symptomatic improvement was observed in 6 patients (85.72%) treated with nonsteroidal anti-inflammatory drugs, while 1 patient (14.28%) resistant to nonsteroidal anti-inflammatory drugs responded well to tumor necrosis factor inhibitors. The clinical presentation of CRMO lacks specificity, with unexplained bone pain being the most common symptom. Precise diagnosis and timely intervention depend on a thorough magnetic resonance imaging evaluation for lesion detection, which facilitates CRMO diagnosis. This study offers valuable insights into the clinical manifestations, laboratory findings, imaging features, and treatment strategies of CRMO in pediatric patients.

Relationship between hand and wrist bone age assessment method and application to male children

Objective: To explore the interrelationship among three simplified hand and wrist bone age assessment methods and to establish corresponding bone ages for each substage in male children. Methods: This retrospective case series study included 169 left hand and wrist X-rays from 152 male children who underwent bone age assessments at the Pediatric Orthopedics and Pediatrics Departments,Beijing Jishuitan Hospital,Capital Medical University from January 2019 to December 2023. The age at the time of X-ray was (13.7±2.0) years (range:9.1 to 17.9 years). Reasons for bone age assessment included evaluating the progress of adolescent idiopathic scoliosis in 36 cases, predicting limb length discrepancies in 28 cases, and predicting the height of healthy adolescents in 88 cases. Bone age was first graded using the Chinese hand-wrist bone age assessment method. Three simplified hand and wrist bone age assessment methods were then applied:Sanders simplified skeletal maturity staging system(Sanders stage), the distal radius and ulna classification (DRU), and e thumb ossification composite index (TOCI). Somers'delta correlation test was used to analyze the relationship among the results of the three simplified methods. The bone age and standard deviation for each sub-stage were calculated, and gender differences in bone age for the same sub-stage were compared with previous study. Results: The DRU, TOCI and Sanders stages showed a strong correlation when assessing bone age in male children, with Somers'delta correlation coefficients ranging from 0.881 to 0.876 (all P<0.01). The sub-stages with the smallest standard deviations (shorter duration) in each of the three classifications can serve as a quick reference for determining precise bone age, included proximal thumb epiphysis covered, without sesamoid (12.0 years);proximal thumb epiphysis covered with sesamoid or distal radial covered (13.0 years), early capping of the thumb epiphysis, radial epiphysis medial side capping(13.5 years), all phalangeal epiphyses capping (14.0 years), distal phalangeal physes beginning to close (14.5 years), all distal phalangeal physes closed (15.0 years), middle or proximal phalangeal physes beginning to close (15.5 years), all digital epiphyses closed (16.5 years), and nearly complete distal radius fusion with a notch (17.5 years). On average, the bone ages of males were 2 years behind those of females in the same substage. Conclusions: The DRU, TOCI, and Sanders stages can be applied to male children, and it is showed good correlation between them. The subtypes with shorter duration can be used as a quick assessment method to determine the bone age.

Artificial intelligence awareness and perceptions among pediatric orthopedic surgeons: A cross-sectional observational study.

Artificial intelligence (AI) is a branch of computer science that allows machines to analyze large datasets, learn from patterns, and perform tasks that would otherwise require human intelligence and supervision. It is an emerging tool in pediatric orthopedic surgery, with various promising applications. An evaluation of the current awareness and perceptions among pediatric orthopedic surgeons is necessary to facilitate AI utilization and highlight possible areas of concern. To assess the awareness and perceptions of AI among pediatric orthopedic surgeons. This cross-sectional observational study was conducted using a structured questionnaire designed using QuestionPro online survey software to collect quantitative and qualitative data. One hundred and twenty-eight pediatric orthopedic surgeons affiliated with two groups: Pediatric Orthopedic Chapter of Saudi Orthopedics Association and Middle East Pediatric Orthopedic Society in Gulf Cooperation Council Countries were surveyed. The pediatric orthopedic surgeons surveyed had a low level of familiarity with AI, with more than 60% of respondents rating themselves as being slightly familiar or not at all familiar. The most positively rated aspect of AI applications for pediatric orthopedic surgery was their ability to save time and enhance productivity, with 61.97% agreeing or strongly agreeing, and only 4.23% disagreeing or strongly disagreeing. Our participants also placed a high priority on patient privacy and data security, with over 90% rating them as quite important or highly important. Additional bivariate analyses suggested that physicians with a higher awareness of AI also have a more positive perception. Our study highlights a lack of familiarity among pediatric orthopedic surgeons towards AI, and suggests a need for enhanced education and regulatory frameworks to ensure the safe adoption of AI.

FUNCTIONAL OUTCOME OF FLEXIBLE TITANIUM NAILS IN PAEDIATRIC WITH FEMORAL SHAFT FRACTURES

Background: Femoral shaft fractures are among the most common long bone fractures in the pediatric population, with a higher incidence in boys and typically resulting from falls, accidents, or trauma. Effective treatment aims to maintain bone length and alignment while minimizing discomfort for the patient and inconvenience for the family. Flexible intramedullary nailing has emerged as a preferred method for pediatric femoral fractures due to its simplicity, favorable healing rates, and low complication risk. Objective: This study aimed to assess the functional outcomes of pediatric femoral shaft fractures treated with flexible titanium intramedullary nails. Methods: A descriptive case series was conducted in the Orthopaedic Surgery Unit-II at Jinnah Hospital, Lahore, Pakistan, over six months from September 16, 2021, to March 16, 2022. A total of 60 pediatric patients, aged 4-11 years with femoral shaft fractures, underwent retrograde intramedullary nailing using two nails of identical diameter under image guidance. Patients were monitored in three-week intervals until radiological union was confirmed. Data analysis was performed with SPSS 25.0, stratified by gender and age, with statistical significance determined by a Chi-square test at p ≤ 0.05. Results: The final sample included 46 male (76.7%) and 14 female (23.3%) patients, with a mean age of 7.18 years (SD ± 2.259). Based on Flynn’s criteria, 96.7% (58 patients) demonstrated satisfactory functional outcomes, with 60.0% (36 patients) rated as “excellent,” 30.0% (18 patients) as “good,” and 6.7% (4 patients) as “fair,” while only 3.3% (2 patients) had “poor” outcomes. Conclusion: Flexible intramedullary nailing is an effective method for treating simple pediatric femoral shaft fractures, providing strong functional outcomes with minimal complications, supporting its role as a reliable treatment option in pediatric orthopedics.

Changes in diagnostics and treatment pathways for developmental dysplasia of the hip after the introduction of national guidelines: An updated questionnaire amongst paediatric orthopaedic surgeons in The Netherlands.

Diagnostics and treatment pathways for developmental dysplasia of the hip are highly variable in clinical practice. Recently, two national guidelines were developed in the Netherlands, providing a uniform protocol for the diagnosis and treatment of developmental dysplasia of the hip in children under the age of 1 year. The aim of this survey study was to assess whether diagnostic and treatment strategies have changed amongst paediatric orthopaedic surgeons in the Netherlands compared to a similar survey study in 2011, after the introduction of the guidelines. A web-based online questionnaire was developed and shared amongst the members of the Dutch Paediatric Orthopaedic Society. The questions concerned the diagnosis and treatment of developmental dysplasia of the hip, ranging from mildly dysplastic to dislocated hips, in children under the age of 1 year. We used a questionnaire similar to the previous study and evaluated the results. Thirty-four participants completed the survey. Regarding diagnosis and follow-up, ultrasonography was generally applied for children younger than 6 months, while radiography was more frequently used for children aged 6-12 months. In 2011, radiography was more widely applied in all age groups. Initial treatment for dysplastic, stable hips was mostly active monitoring, while this was generally a rigid splint in 2011. For dislocated unstable hips, the first step in treatment was generally the Pavlik harness, as in 2011. The diagnostic and treatment pathways of developmental dysplasia of the hip in children under the age of 1 year seem to have partially changed amongst Dutch paediatric orthopaedic surgeons compared to 2011, after the publication of new guidelines.

Use of Artificial Intelligence in Cobb Angle Measurement for Scoliosis: Retrospective Reliability and Accuracy Study of a Mobile App.

Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation. We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis. A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers. Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5°, the 95% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were -4.7° to 4.9° and -4.9° to 4.9°, respectively. For the photography and upload methods, the 95% LoAs for measuring Cobb angles were -4.3° to 4.6° and -4.4° to 4.7°, respectively, in mild scoliosis patients; -4.9° to 5.2° and -5.1° to 5.1°, respectively, in moderate scoliosis patients; and -5.2° to 5.0° and -6.0° to 4.8°, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001). The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis.

Reichel Syndrome in Children: A Case Report.

Reichel syndrome or primary synovial chondromatosis (PSC) is an uncommon benign metaplastic condition that usually affects large joints. Though shoulder involvement was scarce, there are only a few cases in the pediatric population. A 14- year-old boy was admitted to the Pediatric Orthopedics department with right shoulder pain for 14 months. Imaging revealed multiple loose bodies distributed throughout the glenohumeral joint. Upon the arthroscopic approach, we remove all cartilaginous nodules within the glenohumeral space and abarticular tendon. Histopathologic examination confirmed the diagnosis of primary synovial chondromatosis. At follow-up, the patient remains free of symptoms, and shoulder radiographs showed no recurrence of calcification. The present case illustrates the clinical patterns, imaging features, histological findings, and therapeutic management of shoulder primary synovial chondromatosis in a pediatric patient.

Enhancing biomechanical outcomes in proximal femoral osteotomy through optimised blade plate sizing: A neuromusculoskeletal-informed finite element analysis

Proximal femoral osteotomy (PFO) is a frequently performed surgical procedure to correct hip deformities in the paediatric population. The optimal size of the blade plate implant in PFO is a critical but underexplored factor influencing biomechanical outcomes. This study introduces a novel approach to refine implant selection by integrating personalized neuromusculoskeletal modelling with finite element analysis. Using computed tomography scans and walking gait data from six paediatric patients with various pathologies and deformities, we assessed the impact of four distinct implant width-to-femoral neck diameter (W-D) ratios (30 %, 40 %, 50 %, and 60 %) on surgical outcomes. The results show that the risk of implant yield generally decreases with increasing W-D ratio, except for Patient P2, where the yield risk remained below 100 % across all ratios. The implant factor of safety (FoS) increased with larger W-D ratios, except for Patients P2 and P6, where the highest FoS was 2.60 (P2) and 0.49 (P6) at a 60 % W-D ratio. Bone-implant micromotion consistently remained below 40 µm at higher W-D ratios, with a 50 % W-D ratio striking the optimal balance for mechanical stability in all patients except P6. Although interfragmentary and principal femoral strains did not display consistent trends across all patients, they highlight the need for patient-specific approaches to ensure effective fracture healing. These findings highlight the importance of patient-specific considerations in implant selection, offering surgeons a more informed pathway to enhance patient outcomes and extend implant longevity. Additionally, the insights gained from this study provide valuable guidance for manufacturers in designing next-generation blade plates tailored to improve biomechanical performance in paediatric orthopaedics.

Reevaluating Pediatric Osteomyelitis with Osteoarticular Tuberculosis: Addressing Diagnostic Delays and Improving Treatment Outcomes.

Pediatric osteoarticular tuberculosis (TB) remains a significant global health challenge, particularly in resource-limited settings, where delayed diagnosis and treatment frequently lead to severe long-term complications. Despite advancements in TB control, skeletal TB in children is often misdiagnosed due to its non-specific clinical presentation, contributing to poor outcomes such as joint deformities, growth disturbances, and chronic pain. The complexity of diagnosing osteoarticular TB is further exacerbated by the limited sensitivity of conventional diagnostic tools and the overlap with other musculoskeletal conditions. This study seeks to evaluate the impact of early detection and multidisciplinary management on treatment outcomes in pediatric patients with osteoarticular TB. A retrospective review was conducted at the Pediatric Orthopedics Department of the "Grigore Alexandrescu" Children's Hospital in Romania from 2009 to 2023. Case data included clinical, imaging, and microbiological findings, and treatment outcomes in children aged 0-18 years diagnosed with tuberculous osteomyelitis. The study identified varied clinical presentations, with delayed diagnosis often linked to misinterpretation of symptoms as non-TB infections. Multimodal diagnostic approaches combining imaging, microbiological testing, and histopathology improved diagnostic accuracy. Early surgical intervention alongside anti-TB therapy proved effective in reducing long-term complications. Timely, accurate diagnosis and multidisciplinary treatment are critical to improving outcomes in pediatric osteoarticular TB. Vaccination status and comprehensive diagnostic tools significantly influence disease progression and treatment success. The study underscores the need for enhanced screening and diagnostic methods to prevent delays in treatment.

Factors that Influence Recovery From Concussion in Young Children and Preadolescents.

To examine differences in the presentation and management of concussion in younger children (aged 4-8 years) versus preadolescents (9-12 years) and identify factors that influence recovery time. Retrospective analysis of prospectively collected data. Pediatric sports medicine and orthopedics clinic. Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022. Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores. Days since injury (DSI) to initial visit, total number of visits, recovery time (days). Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery. Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.

Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises.

The COVID-19 pandemic has been recognized as an unprecedented global health crisis. Over 7 million mortalities have been documented with many paediatric fatalities. Trauma and orthopaedic care, much like other specialities, were marginalized due to resource allocation during the pandemic which affected paediatric care. This is the first systematic review to centralise and compile the recommended published guidelines from professional bodies in principally English speaking countries on managing paediatric trauma and orthopaedic care. These guidelines will be required to be implemented sooner and more effectively in case of future pandemics with similar impact. A search was conducted on PubMed/MedLine, Cochrane Library and Embase using terms including p(a)ediatric or child* and/or COVID* or coronavirus or SARS-CoV-2 and/or trauma and/or orthop(a)edic* with a simplified MeSH heading [mh] in order to make the search as comprehensive as possible. General terminology was utilized to make the search as exhaustive as possible for this systematic review. Another search was conducted on resources available in the public domain from professional bodies publishing on consensus statements and clinical practice guidelines in countries where English is the principal language managing pediatric trauma and orthopedics. The review adhered to PRISMA guidance. The search revealed a total of 62 results from both databases and professional bodies. Duplicates were removed. This was then reviewed to identify a total of 21 results which fit the inclusion criteria and included within the main analysis. The guidelines from professional bodies were outlined and categorized into aspects of clinical care. The impact of COVID-19 pandemic has compelled for changes in clinical practice and pediatric management. The systematic review highlights the relevant guidelines on service provision for pediatric patients including indications for urgent referrals, surgical prioritization, reasons for follow-up and trauma guidelines. The rationale for care during the unpredictable evolution of the COVID-19 pandemic may have the potential to be translated and replicated in future pandemics of similar significance.