Journal of Pediatric Orthopaedics (J PEDIATR ORTHOPED )

Publisher: Pediatric Orthopaedic Society of North America; European Paediatric Orthopaedic Society


The Journal of Pediatric Orthopaedics publishes high-quality, peer-reviewed papers from around the world on the diagnosis and treatment of pediatric orthopaedic disorders. It cuts across disciplinary as well as national boundaries to provide the broadest possible coverage of the unique problems facing the pediatric orthopedist.

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    Journal of Pediatric Orthopaedics website
  • Other titles
    Journal of pediatric orthopedics, Journal of pediatric orthopaedics
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    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

  • Journal of Pediatric Orthopaedics 08/2014; 34(6).
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    ABSTRACT: Lower limb rotational anomalies in spastic diplegic children with cerebral palsy (CP) are common and difficult to identify through physical examination alone. The identification and treatment of the overall rotational disorders must be considered in order to restore physiological lever-arms lengths and lever-arms orientation. The aims of the study were to assess the prevalence of lower limb rotational malalignment and to describe the distribution of the different kinematic torsional profiles in children with spastic diplegia. Methods: Instrumented gait analysis data from one hundred and eighty-eight children with spastic diplegia were retrospectively reviewed. None of the patients had undergone surgery previously or received botulinum toxin treatment within six months prior to the review. Kinematic data, collected at the midstance phase, included: pelvic, hip and ankle rotation and foot progression angle. Results: The prevalence of kinematic rotational deviations was 98.4%. Sixty-one percent of the children walked with an internal foot progression angle and 21% exhibited external alignment. The pelvis was internally rotated in 41% of the cases and externally in another 27%. Hip rotation was internal in 29% and external in 27% of the cases. Ankle rotation was internal in 55% and external in 16% of the cases. Lower limb rotational anomalies involved more than one level in 77% of the limbs. A kinematic compensatory deviation was identified in at least one level in 48% of the limbs. Conclusions: Kinematic rotational anomalies were identified in nearly all the 188 children in the study. The multilevel involvement of lower limb malalignment was not systematically associated with compensatory mechanisms between the levels. Ankle rotational anomalies were the most frequent cause of lower limb torsional deviations followed by pelvic malalignment. Level of evidence: level IV
    Journal of Pediatric Orthopaedics 01/2014;
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    ABSTRACT: Background: Relapses following nonoperative treatment for clubfoot occur in 29% to 37% of feet after initial correction. One common gait abnormality is supination and inversion of the foot caused by an imbalance of the anterior tibialis tendon muscle. The purpose of this study was to determine if plantar pressures are normalized following an anterior tibialis tendon transfer (ATTT). Methods: Thirty children (37 clubfeet) who underwent an ATTT, were seen for plantar pressure testing preoperatively and postoperatively. Each foot was subdivided into 7 regions: medial/ lateral hindfoot and midfoot, and the forefoot (first, second, and third to fifth metatarsal heads). Variables included: contact time as a percentage of stance time (CT%), contact area as a percentage of the total foot (CA%), peak pressure (PP), hindfoot- forefoot angle (H-F), location of initial contact, and deviation of the center-of-pressure line (COP). Paired t tests were used for group comparisons, whereas multiple comparisons were assessed with ANOVA (a set to 0.05 with Bonferroni correction). Results: Significant changes were seen in preoperative to postoperative comparison. PP, CT%, and CA% had significant increases in the medial hindfoot, midfoot, and first metatarsal regions, whereas the involvement of the lateral midfoot and forefoot were reduced. Compared with controls, postoperative results following ATTT continue to show increased PP, CA%, and CT% in the lateral midfoot, increased CA% and CT% in the lateral forefoot, whereas CA% was decreased in the first metatarsal region. Compared with controls, the COP line continues to move laterally and the H-F angle continues to show forefoot adductus following ATTT. No differences were found between patients treated with an isolated ATTT and those treated with concomitant procedures. Conclusions: The changes seen in plantar pressures following ATTT would suggest that the foot is better aligned for a more even distribution of pressure throughout the foot, but is not fully normalized.
    Journal of Pediatric Orthopaedics 01/2014; 35(5):522-8.
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    ABSTRACT: Three patients with birth fractures and Werdnig-Hoffmann disease are presented. Two of the three were erroneously diagnosed as having osteogenesis imperfecta. The etiology of these fractures appears to be in utero osteoporosis secondary to decreased movement, leading to pathologic fracture during birth. Immobilization led to uneventful healing in all cases; no recurrent fractures were seen.
    Journal of Pediatric Orthopaedics 09/2013; 6(1):34-6.
  • Journal of Pediatric Orthopaedics 09/2013; 33(6):624-27.
  • Journal of Pediatric Orthopaedics 04/2013;
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Pediatric Orthopaedics 05/2011; 31(4):e36.
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    ABSTRACT: BACKGROUND: Rubber band syndrome is a rare condition seen in younger children in communities where rubber bands are worn around the wrist for decorative purposes. When the band is worn for a long duration, it burrows through the skin and soft tissues resulting in distal edema, loss of function, and even damage to the neurovascular structures. Recognition of this syndrome at the earliest can prevent catastrophic events. METHODS: We report 3 cases of rubber band syndrome. Three children presented with a discharging sinus at the wrist. There was a linear circumferential scar at the wrist in all cases. Plain radiographs showed a circumferential constriction in the soft tissue shadow in all the cases. There was a history of a band tied around the wrist, which had been forgotten by the parents and eventually became embedded in the soft tissues of the wrist. RESULTS: Surgical removal of the buried rubber band was successful in all the cases. Postoperative follow-up over a mean period of 13 months have shown a surprisingly good outcome of hand function in all our patients. CONCLUSIONS: The cardinal features of a linear constricting scar around the wrist in the presence of a discharging sinus should always alert the clinician to the possibility of a forgotten band around the wrist, which might have burrowed into the soft tissues over a period of time. A radiograph of the affected wrist shows a soft tissue constriction at the wrist. A high index of clinical suspicion and the uniformity of symptoms and clinico-radiologic signs enabled us to make a clinical diagnosis of a constriction band (rubber band syndrome), which was proved after a surgical exploration.
    Journal of Pediatric Orthopaedics 10/2010; Oct-Nov(30(7)):e1-4.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Pediatric Orthopaedics 09/2010; 30(7):631–632.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Pediatric Orthopaedics 03/2010; 30(3):305.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Journal of Pediatric Orthopaedics 03/2010; 30(3):306.
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    ABSTRACT: Anterior shoulder dislocation is the most common form of shoulder dislocation and is generally seen in adolescents participating in contact or collision sports among the pediatric age group. Age is the most important denominator for predicting the recurrence. In civilian/adult population, the treatment is generally conservative. However, there are emerging data to support stabilization surgery for the first-time traumatic anterior shoulder dislocation in the active adolescent patients. Traumatic posterior shoulder dislocations are rare, and can be easily missed on radiographs. Treatment is generally conservative. Multidirectional instability occurs in pediatric overhead athlete with generalized ligamentous laxity. A lengthy rehabilitation program involving shoulder girdle and periscapular strengthening is the mainstay of treatment.
    Journal of Pediatric Orthopaedics 02/2010; 30:S3-S6.
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    ABSTRACT: Embryogenesis of the upper limb occurs between 4 and 8 weeks after fertilization. Limb development is controlled by signaling centers that guide spatial axes formation and genes that encode limb arrangement. This article will discuss the signaling centers, genes, and molecular events that yield limb formation.
    Journal of Pediatric Orthopaedics 02/2010; 30:S31-S34.
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    ABSTRACT: In this manuscript the authors review essential and new information on compartment syndrome in children. The article stresses the three A's of pediatric compartment syndrome: agitation, anxiety and increasing analgesic requirement which precede the classic presentation by several hours. Non-invasive methods of assessing compartment syndrome are highlighted and the medical-legal implications of missed compartment syndrome are further reviewed.
    Journal of Pediatric Orthopaedics 02/2010; 30:S96-S101.
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    ABSTRACT: Acceptable alignment of forearm fractures in children is controversial. An initial attempt at closed reduction in the emergency department is appropriate for the majority of these injuries. Complex or unstable fractures and those that cannot be maintained in acceptable alignment are candidates for surgical intervention. As a general guideline, fractures with complete displacement will remodel satisfactorily. However, angulation may be more critical for preservation of forearm rotation. Up to 15 degrees angulation is recommended as maximum angulation for mid-shaft and distal-shaft fractures in children younger than 8 years old. But 10 degrees is recommended as the maximum acceptable angulation for older children and proximal shaft fractures. When malunion is greater than this, remodeling is unreliable but may occur for fractures with less than 20-30 degrees of angulation.
    Journal of Pediatric Orthopaedics 02/2010; 30:S82-S84.
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    ABSTRACT: Fractures of the distal radius account for 80 percent of pediatric forearm fractures. The rapid growth of the distal radial physis and the on-going transformation of the metaphysic explain the propensity for fractures in this location and the potential for fracture remodeling. Fractures of the distal ulna are less common and usually occur in conjunction with fractures of the distal radius. In general both injuries can be managed by closed treatment and casting. Indications for skeletal fixation and/or open reduction are discussed. Complications are infrequent but not insignificant and usually treatable with early recognition and appropriate intervention.
    Journal of Pediatric Orthopaedics 02/2010; 30:S85-S89.
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    ABSTRACT: Background: During the last century, there has been growing evidence that dislocation of the glenohumeral joint in children commonly occurs with brachial plexus birth palsy, often in the first year of life. Etiology: Permanent injuries to the brachial plexus in childhood create a muscle imbalance about the shoulder during the reinnervation process. This results in an internal rotation contracture, external rotation weakness, and subsequent glenoid retroversion, posterior deficiency, joint subluxation, and eventual dislocation. Evaluation: On physical examination with scapular stabilization, there is limited passive external rotation in adduction and abduction. Ultrasounds, arthrograms, and magnetic resonance imaging help in evaluating the deformity of glenohumeral deformity and dislocation. At present magnetic resonance imaging is the standard on which operative intervention is based. Treatment: Initial treatment is physical therapy with passive glenohumeral mobilization with scapular stabilization. Failure to regain or maintain passive external rotation and evidence of joint instability or dislocation on examination are indicators for for futher evaluation and intervention. Nonsurgical interventions such as Botox injections, or splinting or SPICA cast may be considered. Ultimately, contracture release, potential joint reduction, and extra-articular muscle transfer surgery has been the standard of care, though there is ongoing debate regarding whether release alone is sufficient. It is important not to overlengthen the subscapularis or over release the glenohumeral joint, which can cause loss of internal rotation power and development of external rotation contracture. Outcomes: Early operative intervention in the form of extra-articular rebalancing techniques has become the standard of care, providing the best opportunity for enhanced motion and function, and improved validated Mallet, Active Movement, and Pediatric Outcomes Data Collection Instrument scores. Long-term improvements in outcome may rest on joint remodeling by arthroscopic or open reduction, though further research is still required to evaluate remodeling of joints over the course of a lifetime.
    Journal of Pediatric Orthopaedics 02/2010; 30:S53-S56.
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    ABSTRACT: Carefully selected surgical procedures may reposition the elbow and wrist for better function in the child with arthrogryposis.
    Journal of Pediatric Orthopaedics 02/2010; 30:S57-S62.

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