Pediatric Orthopedics Research Articles

Association Among Complete Blood Count Parameters, Bone Mineral Density, and Cobb Angle in Cases of Adolescent Idiopathic Scoliosis.

BACKGROUND Improving the quality of life of scoliosis patients with appropriate preventive measures is critical. This study aimed to investigate the relationships among bone mass, Cobb angle, and complete blood count (CBC) parameters in patients with scoliosis. MATERIAL AND METHODS This joint study was conducted by the pediatric department and orthopedics clinics, which used the medical records of patients aged 10-18 years between 2018 and 2022. Patients were divided into 3 groups according to the Cobb angle. Patient blood count levels from medical records and bone mineral density (BMD) Z scores (g/cm²) were compared among groups. Notably, BMD Z scores were calculated using a (BMD) dataset from local Turkish children after adjusting for height and age. RESULTS A total of 184 individuals (120 females, 64 males) were included in the study. There were statistically significant differences among the groups in platelet-to-lymphocyte ratio (PLR). Significant differences in DXA Z scores among groups were found. There was a significantly strong and positive correlation between DXA Z scores and all CBC parameters in patients with severe scoliosis. CONCLUSIONS This study found that CBC parameters can predict BMD in adolescents. Furthermore, the association between vitamin D deficiency and low BMD may contribute to the follow-up of body adaptation in patients with scoliosis receiving conservative treatment.

Trends in ACGME Accreditation of Orthopedic Surgery Fellowship Training.

Currently, most surgeons pursue subspecialty fellowship training. This study answers the following questions: (1) How does the rate of fellowship training in orthopedic surgery compare with that in other surgical specialties? (2) To what extent did adoption of Accreditation Council for Graduate Medical Education (ACGME) accreditation change from 2013 to 2021? Orthopedic subspecialties were analyzed for total number of fellowship programs and positions in the 2013 and 2021 Match. Rates of ACGME accreditation were analyzed via chi-square tests. In 2021, orthopedic surgery had the highest rate of fellowship selection (94%) relative to general surgery (77%), ophthalmology (66%), plastic surgery (63%), and otolaryngology (55%). Across all orthopedic subspecialties, the percentage of ACGME accreditation decreased among fellowship programs (53% in 2013 to 48% in 2021, P=.166) and positions (58% in 2013 to 50% in 2021, P<.001). Orthopedic sports medicine had the highest adoption of ACGME accreditation (100%), followed by hand surgery (99%), musculoskeletal oncology (67%), and pediatric orthopedics (56%). Significant increases in the adoption of ACGME accreditation were noted for orthopedic sports medicine (93% in 2013 to 100% in 2021, P=.016) and hand surgery (81% in 2013 to 99% in 2021, P<.001). There was a significant decrease in ACGME accreditation for adult reconstructive orthopedics (40% in 2013 to 24% in 2021, P=.042), driven by the increase in unaccredited fellowship programs. Accreditation of orthopedic subspecialty fellowship training has decreased with respect to the proportion of accredited training positions. More research is needed to understand the benefits of ACGME accreditation for fellowship training in orthopedic surgery. [Orthopedics. 2024;47(1):57-63.].

QI/PI: POSNA Safe Surgery Program (PSSP)—First-Year Results Implementing Quality Metrics

Background: Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics. These external organizations rarely consult pediatric orthopaedists themselves; therefore, POSNA members strongly supported the creation of a new performance evaluation. As a result, POSNA developed a member-driven process for driving quality improvements in pediatric orthopaedics: the POSNA Safe Surgery Program (PSSP). The PSSP aims to develop key quality metrics that members believe improve outcomes in pediatric orthopaedics. This paper aims to summarize the first year of implementing the PSSP quality metrics.Methods: The POSNA Quality, Safety, and Value Initiative (QSVI) Council developed 20 PSSP quality metrics for five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE). The quality metrics were integrated into five online surveys (one per domain) and distributed to POSNA member orthopaedic centers across North America.Results: Thirty-three POSNA member orthopaedic centers responded to at least one domain-specific survey. Spine had the highest response rate (88%), while hand/UE and hip/LE had the lowest (70% and 73%, respectively). Centers meeting each quality metric ranged from 65% to 92% in sports medicine, 62% to 100% in trauma, 79% to 100% in spine, 83% to 96% in hip/LE, and 83% to 100% in hand/UE. Large and very large centers, as well as specialized children's hospitals, provided more detailed protocols and procedures, likely due to greater resources and specialization. There was nearly 100% agreement between centers on protocols with well-known, easy-to-follow checklists for fulfilling a quality metric.Conclusions: The primary goal of the PSSP is to create internally developed, surgeon-driven quality metrics that determine high-quality care. By using these quality metrics and reports, we hope surgeons can gain institutional resources to drive improvements in their centers. In its first year, the PSSP demonstrated that these quality metrics can be successfully distributed and reviewed by POSNA members. Our future work will focus on expanding the PSSP to more pediatric orthopaedic centers, iteratively evaluating and modifying the metrics, and adding metrics for additional domains.Level of Evidence: Level IVKey Concepts•Ranking of orthopaedic programs by external organizations is expanding to pediatric orthopaedics which will have important clinical and financial implications.•Pediatric orthopaedists are rarely consulted in quality evaluations by external organizations; therefore, POSNA created a member-driven performance evaluation system—the POSNA Safe Surgery Program (PSSP)—to develop surgeon-driven quality metrics to improve high-quality care.•Twenty PSSP quality metrics were developed by the POSNA Quality, Safety, and Value Initiative (QSVI) Council across five domains: sports medicine, trauma, spine, hip/lower extremity (LE), and hand/upper extremity (UE).•Our first year distributing the PSSP quality metrics to POSNA member centers revealed (1) high engagement rates and (2) diverse ranges of quality metric fulfillment by centers.•In the future, we will expand the PSSP to more pediatric orthopaedic centers, iteratively evaluate and modify the PSSP quality metrics, and develop metrics for additional domains.

Predictors of Patient-Related Cancellations and No-Shows for Pediatric Orthopaedics and Sports Medicine Appointments Are Condition Specific

Background: Visit cancellations have detrimental effects on patient health and reduce clinic productivity. We sought to understand the factors that influence cancellation rates across the major subspecialties in pediatric orthopaedics and sports medicine (OSM).Methods: In-person OSM visits from a high-volume multi-site academic pediatric hospital (01/01/2019-02/28/2020) were used to study the effect of patient demographics, distance to clinic, insurance type, visit type (new vs. follow-up) on visit cancellation (canceled by patient and no-shows). When available, chief complaint was used to categorize visits into major subspecialties: cerebral palsy, foot and ankle, hip, knee, other lower extremity, spine, and upper extremity. Logistic regression was used to identify contributors to the visit cancellations in a multivariate model.Results: 424,397 visits (15.9% canceled) were included in the analysis. Based on the multivariate analysis, being non-white (OR=1.139), Hispanic (OR=1.133), older age (OR=1.007), female (OR=1.046), living farther from clinic (OR=1.002), and having public insurance (OR=1.163) were associated with higher cancellations, whereas median household income (OR=0.994, per $10,000) and new visit (OR=0.969) were associated with lower cancellations (P<0.04). 241,305 visits were categorized into subspecialties. The effects of studied patient-related factors and visit types on cancellations were highly variable across subspecialties. When significant, having public insurance and living farther from the clinic were consistently associated with higher rates of cancellations, while being a non-English speaker and having a new visit were associated with lower rates of cancellation. The remaining factors showed variable effects.Conclusion: Disparities exist in patient-related visit cancellations in pediatric and young-adult OSM with different patterns across major OSM subspecialties. These findings highlight the importance of looking at these specific orthopedic conditions separately to develop more effective strategies to improve patient compliance and efficiently utilize healthcare resources.Level of Evidence: Level IIIKey Concepts•Across all pediatric and young-adult OSM visits, being non-white, Hispanic, female, living farther from clinic, and having public insurance were associated with higher odds of cancellation.•While disparities exist in patient-related visit OSM care, the factors that influence cancellation in specific subspecialties are varied and complex.•Further research that looks at specific orthopedic conditions separately will improve efficiency and effectiveness of care and increasing patient compliance.

Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment. Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors. Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed. Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons.

Male Versus Female Authorship in Flagship Pediatric Orthopaedic Journals From 2002 to 2021.

The evolution of female authorship in orthopaedic journals is reportedly rising, however, trends in pediatric orthopaedic publications have not been specifically studied, despite a higher proportion of female pediatric orthopaedic surgeons compared with orthopaedics at large. This study aimed to investigate trends in female first and senior authorship in 3 flagship pediatric orthopaedic journals over the past 20 years. All manuscripts from the "Journal of Pediatric Orthopaedics, Journal of Pediatric Orthopaedics Part B, and Journal of Children's Orthopaedics" from 2002 to 2021 were evaluated from Ovid MEDLINE, and the data were extracted. We utilized the sex "Application Program Interface" algorithm to determine the sex of the first and senior authors. χ 2 tests were used to analyze the demographics of the first and senior author cohorts. Fisher exact test was used to assess the trends in male and female authorship, controlling for year and journal. Of a total, 5499 individual first authors and 5794 senior authors were identified. Sex was determined for 83.5% of the authors. Female first authorship increased significantly from 2002 to 2021 (8.8% to 22.4%, P < 0.001), with women being more likely to publish as first authors in more recent years in each journal ( P < 0.001). Female senior authorship did not increase significantly over the same time period (10.8% to 12.8%, P = 0.238). There was significantly more male than female first and senior authors for all journals ( P <0.001 for both first and senior authors). While female first authorship in prominent pediatric orthopaedic journals has increased significantly from 2002 to 2021, senior authorship has remained stagnant. In addition, female pediatric orthopaedic surgeons publish at rates lower than their prevalence in the field. This study serves as a benchmark for future studies looking at sex and authorship in hopes of better understanding the underlying complex issues. Level III.

Analysis of the results of the surgical treatment of plano-valgus foot deformity in children and adolescent

Background: Plano-valgus deformity of the feet is a common reason for contacting an orthopedist. Pediatric orthopedics uses technologies, in particular, subtalar arthroeresis, that do not violate the physiological growth of the patient. Aim: to choose the optimal methods for the correction of foot deformity in children and adolescents. Analysis of the results of the surgical treatment. Methods: In the period from 2013 to 2022, 482 patients were operated on for flat-foot deformity. Subtalar arthroeresis surgery was performed in 405 cases in various combinations. Results: The 9-year-long observation of the patients after the surgical treatment showed that in most cases there was a persistent positive effect, namely: no complaints of pain syndrome, no clinical and radiological pictures of a plano-valgus foot, patients led an active lifestyle, including sports. On average, after 17.7 months, 66 cases (16.1%) required replacement of the subtalar implant due to the physiological growth of patients. In 125 cases (31.2%) the implant was removed on average 31.2 months after placement. Unsatisfactory results were noted in 14 patients (3.4%). Conclusions: The technique of subtalar arthroeresis, as a low-traumatic one, does not interfere with the physiological growth of the foot skeleton, does not limit physiological loads after the surgical treatment, and is actively used in the childhood and adolescence. The peculiarity of the subtalar arthroeresis in a patient with the physiological growth of the foot skeleton is a high probability of the subtalar implant replacement.

Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.&#x0D; AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.&#x0D; MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.&#x0D; RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.&#x0D; CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

Footprint analysis in flatfoot assessment

BACKGROUND: A flatfoot is the most common condition in the practice of a pediatric orthopedist. A flatfoot is primarily diagnosed based on the assessment of the degree of the foot flattening. Along with clinical examination, footprint analysis is often used in practice due to the safety of this study and convenience and ease of implementation.&#x0D; AIM: This study aimed to determine how much footprints can correlate with the clinical assessment of flatfoot in children and which footprint indices are the most valuable in flatfoot assessment.&#x0D; MATERIALS AND METHODS: The study included the survey results of 76 children aged 715 years of the St. Petersburg 49th school School of Health for 20212022. In this study, anthropometric data, clinical parameters (value of the heel valgus, arch angle, and Friedland index) and footprint indices and angles (Schwartz and Clarke angle, ChippauxSmirak index, Staheli index, Cavanagh and Rodgers index, and Irwin index) were analyzed. In the study, the average values were calculated, and correlation and regression analyses were performed.&#x0D; RESULTS: The footprint parameters did not have moderate and strong correlations with clinical parameters. Footprint parameters that assessed the area of the barefoot zone on the footprints (Irwin index and Cavanagh and Rodgers index) showed statistically significant moderate and strong correlations among plantographic parameters. Among linear and angular footprint parameters, the ChippauxSmirak index showed statistically significant moderate and strong correlations.&#x0D; CONCLUSIONS: The footprint criteria weakly correlated with the foot shape criteria in a clinical assessment, which does not allow us to interpolate the footprints data to the clinical evaluation data of the foot. The Cavanagh and Rodgers index, Irwin index, and ChippauxSmirak index had statistically significant moderate and strong correlations with other indices, which makes them more valuable in the assessment of feet according to the footprint analysis.

The articular and the craniocervical abnormalities are of confusing age of onset in patients with Maroteaux-Lamy disease (MPS VI).

Maroteaux-Lamy disease (MPS Type VI) is an autosomal recessive lysosomal storage disorder. Skeletal abnormalities are vast. Early recognition may facilitate timely diagnosis and intervention, leading to improved patient outcomes. The most challenging is when patients manifest a constellation of craniocervical and articular deformities with variable age of onset. We collected 15 patients with MPS VI (aged from 6 years-58 years). From within our practice in Pediatric Orthopedics, we present patients with MPS type VI who were found to manifest a diverse and confusing clinical presentation of hip deformities and cervical cord compression. Stem cell transplants were proposed as treatment tool and enzyme replacement therapy has been instituted in some patients. The spectrum of the clinical involvement in our group of patients was supported firstly via the clinical phenotype followed by assessment of the biochemical defect, which has been detected through the deficiency of N-acetylgalactosamine-4-sulfatase (arylsulphatase B) leading to increased excretion of dermatan sulphate. Secondly, through the molecular genetic results, which showed homozygous or compound heterozygous mutation in the ARSB gene on chromosome 5q14. Hip replacements and decompression operations have been performed to restore function and to alleviate pain in the former and life saving procedure in the latter. The efforts in searching for the etiological diagnosis in patients with skeletal dysplasia/MPSs has not been rewarding as many had anticipated. This emerged from several facts such as improper clinical documentation, missing diagnostic pointers in radiographic interpretations, limited knowledge in skeletal dysplasia and its variants, and the reliance on underpowered studies. Physicians and radiologists are required to appreciate and assess the diverse phenotypic and the radiographic variability of MPS VI. The importance of considering MPS in the differential diagnosis of other forms skeletal dysplasia is mandatory. Finally, we stress that the value of early diagnosis is to overcome dreadful complications.

MP49-07 THE UGANDAN BLADDER EXSTROPHY-EPISPADIAS COMPLEX INITIATIVE: A PROGRAM FOR TRANSFERENCE OF COMPLEX SURGICAL RECONSTRUCTIVE SKILLS

You have accessJournal of UrologyCME1 Apr 2023MP49-07 THE UGANDAN BLADDER EXSTROPHY-EPISPADIAS COMPLEX INITIATIVE: A PROGRAM FOR TRANSFERENCE OF COMPLEX SURGICAL RECONSTRUCTIVE SKILLS Anthony Schaeffer, Pamela Artigas, Amanya Colline, Marlo Eldridge, Janet Gibson, Emily Haddad, Martin Situma (Posthumous), Stephen Watya, and Ranjiv Mathews Anthony SchaefferAnthony Schaeffer More articles by this author , Pamela ArtigasPamela Artigas More articles by this author , Amanya CollineAmanya Colline More articles by this author , Marlo EldridgeMarlo Eldridge More articles by this author , Janet GibsonJanet Gibson More articles by this author , Emily HaddadEmily Haddad More articles by this author , Martin Situma (Posthumous)Martin Situma (Posthumous) More articles by this author , Stephen WatyaStephen Watya More articles by this author , and Ranjiv MathewsRanjiv Mathews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with the bladder exstrophy-epispadias (BE) complex in resource limited countries lack access to readily available state-of-the-art BE care. We aim to describe a collaboration between US-based BE experts and Ugandan care providers to address this unmet need. METHODS: Described below. RESULTS: Need: Despite 43 million citizens, Uganda has only 5 pediatric surgeons and 1 pediatric urologist. Ugandans have sparse access to BE surgical care, and if unable to obtain adequate BE care have limited educational and/or employment prospects. Advanced training in state-of-the-art BE operative and perioperative care for healthcare providers is also limited. Response: As the largest BE patient/parent support group, the Association for the Bladder Exstrophy Community (A-BE-C) has partnered with US-based BE experts, a Ugandan hospital, and local healthcare providers to address this gap. The mission of this 5-year program is to provide hands-on BE skills training to Ugandan surgeons, nurses, and social workers and facilitate BE knowledge transfer through an intensive didactic symposium. This is accomplished using the same care team each year. The goal is to develop a self-sustaining program to provide optimal, cost effective BE care in local facilities. This program also benefits urologists, nurses, and social workers who are members of the College of Surgeons of East Central and Southern Africa. Outcomes: An initial planning visit occurred in 2018. The first of 5 yearly, 7 day long symposia commenced in October 2019 when 18 patients received care (1 delayed closure w/ osteotomy, 1 epispadias repair, 16 cystoscopies for treatment planning). 2 females attained urinary continence with new catheterization regimens. Social workers, assigned to each individual patient, are absolutely critical to ensure ongoing patient communication, assist with travel and supply delivery, and liaise with BE providers in Kampala and the US. 7 talks were given to symposia attendees from many East African countries. Challenges: Challenges identified include: the need for pediatric orthopedists with BE experience; selection of the most suitable urinary continence operation; medical supply access/payment/delivery; program cancellations due to global (2020, 2021) and locoregional disease outbreaks (2022). CONCLUSIONS: Partnering with nonprofit organizations and identifying a supportive local facility committed to providing short- and long-term management has been a crucial step in starting to advance BE care in Uganda. Source of Funding: Schaeffer: NIH K08DK119535 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e680 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Schaeffer More articles by this author Pamela Artigas More articles by this author Amanya Colline More articles by this author Marlo Eldridge More articles by this author Janet Gibson More articles by this author Emily Haddad More articles by this author Martin Situma (Posthumous) More articles by this author Stephen Watya More articles by this author Ranjiv Mathews More articles by this author Expand All Advertisement PDF downloadLoading ...

Combined application of pulsed low-frequency electrostatic field and robotic mechanotherapy for damage to capsular ligamentous apparatus of the knee joint in children (Methodological recommendations, SAHI MSPC MRRSM MHD. 2022. - 19 p.).

Pathology of the knee joint in children is an urgent problem in pediatric traumatology, orthopedics and pediatrics. Features of the anatomical structure of the knee joint, its functioning, high static and dynamic loads determine the frequency of injuries of this localization (up to 25% among all injuries of the musculoskeletal system).

A Novel Heterozygous Missense Variant inParathyroid Hormone 1is Related to the Occurrence of Developmental Dysplasia of the Hip

Introduction: Developmental dysplasia of the hip (DDH) is one of the most common diseases in the pediatric orthopedics, with an incidence of 1-5%. Genetic factors are the bases of the pathogenesis of DDH, but the pathogenic variants and pathogenesis of DDH are still unknown. There are no key accurate diagnostic or prognostic molecular markers for DDH. The purpose of our study was to screen for genetic variant associated with DDH and explore its pathogenesis. Materials and Methods: The genetic variation of DDH was tested by variant NGS-based exome analyses, verified by the Sanger sequencing. Results: A four-generation family in which DDH was present in three generations was recruited. A novel heterozygous missense variant c.629C>T (p.(Ala210Val)) in exon 7/8 of the parathyroid hormone 1 receptor (PTH1R) gene was identified through screening of two affected and one unaffected family members. The candidate variant was validated in all available family members with all three affected members being positive for the PTH1R variant. Conclusion: Our results are highly supportive of PTH1R as a novel candidate gene for DDH and demonstrated that the combination of pedigree information and next-generation sequencing is an effective method for identifying pathogenic variants associated with DDH.

Diagnosis and Treatment Planning of Developmental Hip Dysplasia: Evaluation of Care Practices of the Members of the Turkish Pediatric Orthopedics Association.

Developmental dysplasia of the hip is one of the most important causes of childhood disabilities. Although there are accepted treatment algorithms for developmental dysplasia of the hip, diagnosis and treatment approaches can show variations in the management among physicians. This study aimed to develop a diagnosis and treatment algorithm for developmental dysplasia of the hip according to the preferences of members of the Turkish Pediatric Orthopedics Association. An interview by telephone call was made with 76 orthopedists (group 1: more experienced 39 physicians, group 2: less experienced 37 physicians) who are members of the Turkish Pediatric Orthopedics Association. Participants were q uesti onnai red ab out their demographic information, experiences, diagnostic criteria that they use for developmental dysplasia of the hip, and treatment approaches to patient scenarios of different ages. Most of the participants recommended universal screening at the age of 4 weeks. It was observed that the most significant physical examination finding was limited hip abduction, and the most frequently used radiographic evaluation on x-ray was acetabular index measurement. The most frequently used description for dysplasia was found as acetabular index >30°. Although there are some differences among orthopedists in the diagnosis, treatment, and follow-up approach of developmental dysplasia of the hip, there was no significant difference according to the experience-based grouping. The treatment algorithm, which was created with the most frequently given answers, was designed, which we think may be beneficial for pediatricians and orthopedists.

Racial disparities in readmission rates following surgical treatment of pediatric developmental dysplasia of the hip.

Across orthopedic subspecialties, significant racial disparities have been identified with regard to postoperative outcomes. Despite these findings among adult patients, the literature assessing these disparities within pediatric orthopedics is limited. The purpose of this study was to determine the independent predictors for unplanned readmission following surgical treatment of developmental dysplasia of the hip. Pediatric patients undergoing hip dysplasia surgery from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Two patient groups were defined: patients who had unplanned hospital readmission within 30days of surgery and patients who were not readmitted. Clinical characteristics assessed included gender, race, and American Society of Anesthesiologists (ASA) class. Risk factors for complications were assessed using bivariate and multivariate analysis. Of 6561 pediatric patients undergoing surgical treatment for hip dysplasia, 540 (8.2%) had unplanned readmission. On bivariate analysis, non-white race (Black, Asian, Hispanic, American Indian, and Native Hawaiian), an ASA class of III, IV, or V, pulmonary, renal, neurological, and gastrointestinal comorbidities, as well as immune disease, steroid use, and nutritional support were significantly associated with unplanned readmission (p < 0.05 for all). After controlling for confounding variables on multivariate analysis, non-white race (OR 1.46; p = 0.042) and ASA class of III-V (OR 2.21; p = 0.002) were found to be independent predictors for readmission. Clinicians should be advised of the increased readmission rates observed in non-white patients and those of higher ASA scores. Further work is needed to combat existing disparities within pediatric orthopedics.

Clubfoot from past to the present: A bibliometric analysis with global productivity and research trends.

Clubfoot, a common congenital abnormality, affects the lower extremities; however, the literature search revealed no bibliometric research on this subject. Thus, we aimed to holistically analyze scientific articles and reveal global productivity and trend issues. This study statistically analyzed 1417 published articles on clubfoot (1980-2021) from the Web of Science database. Bibliometric network visualization maps were created to reveal trend topics, citation analysis, and cross-country collaborations. The analysis was conducted using Spearman correlation analysis. An exponential smoothing estimator was used to predict article productivity. The United States of America (433, 30.5%), the United Kingdom (166, 11.7%), and India (107, 7.5%) are the top 3 countries contributing to the literature. The Journal of Pediatric Orthopedics (220 articles), the Journal of Pediatric Orthopedics-Part B (147 articles), and Clinical Orthopedics and Related Research (69 articles) are the top 3 most productive journals. Dobbs MB (34 articles) is the most active author, and Shriners Hospital Children (44 articles) is the most active institution. Bibliometric analysis revealed that recently studied trend topics included Pirani score, Dimeglio score, Ponseti method, Ponseti casting, tenotomy, recurrence, neglected, tendon transfer, bracing, gait, risk factors, pedobarography, complex clubfoot, and polymorphism. The most studied subjects included Ponseti technique, treatment/casting, recurrent/relapsed clubfoot, Pirani score, pediatrics/children, foot deformities, surgery, ultrasound, Achilles tendon/tenotomy, gait analysis, casting, outcomes, neglected clubfoot, and tenotomy. Research leadership was determined in the western and European countries and Canada in studies and scientific collaborations on clubfoot; its impact was remarkable in India, China, and Turkey.

Launching telemedicine in a tertiary ambulatory pediatric orthopedic clinic during the coronavirus disease-19 pandemic: a retrospective study.

Telemedicine services increased dramaticallyduring the coronavirus disease (COVID-19) pandemic, with limited studies on its implementation within pediatric orthopedics. The goal of this study was to examine patient satisfaction and the efficacy of pediatric orthopedic telemedicine visits. Two hundred and sixty-nine qualifying telehealth visits took place at a metropolitan area pediatric institute between 1 March and 30 May 2020. Patients were invited to complete an anonymous satisfaction survey on their telemedicine experience. Sixty-seven patients responded to the survey. A chart review was completed for all 269 telemedicine visits. Ninety-two percent (249/269) of telemedicine visits were with established patients, and 95% (256/269) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telemedicine visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5). Our analysis showed that telemedicine is a viable alternative to in-person visits for various pediatric orthopedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telemedicine visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients' perceived value of an in-person evaluation. Our study's findings should encourage the continued implementation of pediatric orthopedic telemedicine as an adjunct to in-person clinical practice.

DÖRT YAŞINDAN BÜYÜK GELİŞİMSEL KALÇA DİSPLAZİSİ OLAN HASTALARDA, TEK AŞAMALI AÇIK REDÜKSİYON, FEMORAL KISALMA VE SALTER OSTEOTOMİSİ’NİN RADYOLOJİK SONUÇLARINI, İLK AMELİYAT YAŞI NASIL ETKİLER ?

OBJECTIVE: One of the most controversial issues in pediatric orthopedics is Developmental dysplasia of the hip (DDH). The timing of diagnosis and treatment are is the main goal to treat this condition successfully. Neglected cases that may remain undiagnosed until advancing age are still seen especially in developing countries. Delayed diagnosis and treatment with advancing age leads to more extensive surgery and cause low satisfactory rates. The aim of this study is to evaluate the effect of patients’ age on the results of single-stage treatment of Developmental Dysplasia of the Hip.MATERIAL AND METHODS: 23 patients (34 hips) treated in our hospital between 2004 and 2010 were included in the study. Single-stage treatment including open reduction, femoral shortening, and Salter’s innominate osteotomy was applied to patients whose mean age of surgery was 7.5 years. Radiological results were evaluated in terms of improvement in the acetabular index, in the acetabular angle and according to Severin’s classification, and Bucholz and Ogden’s avascular necrosis (AVN) classification at the final follow-up.RESULTS: The average follow-up period was 60 (range: 24 - 84) months. While the acetabular index was 39.7°±1.4° (range: 25°- 52°) preoperatively, it was measured as 21.8°±1.8° postoperatively. The mean amount of improvement in the acetabular angle was 17.9°±0.8°. According to Bucholz and Ogden’s classification, one patient (2.9%) had Type 1 AVN and one patient (2.9%) had Type 3 AVN. Radiologically, the success rate (85.7%) was significantly higher in children aged 8 years and younger (p = 0.008).CONCLUSIONS: According to the improvement in the acetabular index and Severin's radiological classification, successful results are obtained after a single-step treatment of DDH, which is treated in the 4-8 age range. However, the radiological results of children older than 8 years are worse than those under 8 years old.

Ponseti Technique for CTEV: Our Experience at TMCH

Abstract Background and Objective: Congenital talipes equinovarus (CTEV) also known as clubfoot is one of the common congenital orthopedic foot deformities in children. It is a complex deformity that is hard to correct, and the management is arguable and continues to be one of the significant challenges in pediatric orthopedics. It is believed that the initial treatment should be nonsurgical, which is started soon after birth within the first 2 weeks of life. We aimed to assess the efficacy of Ponseti’s technique for the treatment of CTEV in our institute for 6 years. Materials and Methods: One hundred eighty patients between 2 weeks and 12 years of age who had attended the CTEV clinic of the Department of Orthopaedics of our medical college in the last 6 years, until December 2020, were taken for the study to correct idiopathic CTEV using the Ponseti technique. Children included in the study were assessed every week before cast placement for the severity of the deformity using the Pirani scoring system. Once a week, manipulation and serial casting of the CTEV foot were started by the technique described by Ponseti. Patients were followed up at weekly intervals until forefoot and midfoot deformities were corrected. Percutaneous Achilles tenotomy was done to prevent rocker-bottom deformity and for correcting Equinus deformity after correction of other deformities. All patients were maintained on foot abduction brace after correction until 4 years of age or more. Results: At 6-month follow-up, Ponseti’s technique gave us 84.8% excellent results, 13.1% good results, and 2.1% poor results. A total of 86.6% required percutaneous tenotomy, whereas 13.4% did not require tenotomy. Conclusion: The Ponseti technique is still a safe, economical, and convenient treatment modality for CTEV, which gives successful results, and thus radically decreases the need for extensive corrective surgery even in older children.

Комплекское лечение больных со сложными формами врожденной синдактилии кисти у детей

Complex forms of congenital syndactyly of the hand are one of the most difficult problems in pediatric orthopedics and bring significant functional and cosmetic disorders to patients.The article presents a description of the series of clinical cases of the complex form of hand syndactyly. We have established a high efficiency of the surgical treatment with a complex form of hand syndactyly in children. The choice of an adequate surgical method and its technically correct implementation using microsurgical methods and optical magnification will achieve the desired functional and aesthetic long-term results. Developed specific indications and optimized tactics of the surgical treatment of complex forms of hand syndactyly help to avoid repeated and multi-stage surgical interventions, which is of great socio-economic importance.Key words: hand syndactyly, case series description, microsurgical treatment.