Journal of Children s Orthopaedics Impact Factor & Information

Publisher: Springer Verlag

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Other titles SpringerLink
ISSN 1863-2521
OCLC 288981587
Material type Document, Periodical
Document type Journal / Magazine / Newspaper, Computer File

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Springer Verlag

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Publications in this journal

  • John A Schlechter, Michael Dempewolf
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    ABSTRACT: To determine the safety, utility, and efficacy of pin removal prior to radiographs during the postoperative care of surgically treated displaced pediatric supracondylar humerus fractures. Retrospective review of 532 children with supracondylar humerus fractures treated with closed reduction and pinning from 2007 to 2012. Group 1: children who had their splint/cast removed and radiographs prior to pin removal. Group 2: children with radiographs taken after removal. Data recorded and analyzed included: demographic and radiographic data at the time of surgery and at final follow-up, including the number of radiographs taken prior to pin removal and if pins were ever retained after radiographs were performed on the date of intended removal. There was no difference between the groups' demographics. The number of postoperative radiographs taken prior to pin removal ranged from zero to two. No statistically significant change in Baumann's (p = 0.79) or lateral humeral capitellar angles (p = 0.19) was noted between the groups. No children in group 1 (0/438) had their pins retained after radiographs were taken on the date of intended removal. Obtaining postoperative radiographs prior to pin removal, although commonplace, is not necessary. If fracture stability is noted intraoperatively, and there is an uneventful postoperative course, it is safe and effective to discontinue immobilization and remove pins prior to X-ray. This is safely done without change in alignment or clinical sequelae. Doing so can aid in clinic flow, may decrease child anxiety, and limit multiple cast room visits. Level III therapeutic study.
    Journal of Children s Orthopaedics 07/2015; DOI:10.1007/s11832-015-0673-9
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    ABSTRACT: Legg-Calvé-Perthes disease (LCPD) is uncommon in girls. The presentation of LCPD in female patients has been reported as later in onset and associated with certain high-impact activities. Our aim is to characterize the presentation of female LCPD at a large center, with particular attention to the clinical and radiographic features of late-onset disease (>ten years of age). We perceived an increasing burden of late-onset disease with adult-like radiographic features. All patients presenting to a single large urban children's hospital from 1990-2014 with a diagnosis of LCPD were reviewed. Demographic, clinical, and radiographic data for all female patients were examined and compared to historical norms. Four-hundred and fifty-one patients presented with LCPD in the study period, of which 82 (18.2 %) were female. The average age at presentation was 6.58 years in girls, which is similar to the classically reported mean age. Fourteen patients participated in high-impact repetitive activities or those with deep flexion and abduction, although few were late presenters. There were four female patients who presented for initial diagnosis >ten years of age. There was a paucity of late-onset LCPD in girls in the study population, and the females with LCPD had a very similar age and character to their presentation as did males. Although their presentation is infrequent, three of four older females with LCPD were engaged in high-level physical activity, and their disease may be attributed to high-impact, repetitive athletics. Case series, Level IV.
    Journal of Children s Orthopaedics 07/2015; DOI:10.1007/s11832-015-0671-y
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    ABSTRACT: To test the hypothesis that collecting material for culture from metaphyseal bone of the ilium and proximal femur at the time of a hip aspiration will increase the sensitivity to detect an infectious organism in patients with presumed septic arthritis of the hip. We retrospectively reviewed a series of 36 patients with presumed septic arthritis of the hip, based on clinical exam and serum inflammatory markers, who underwent aspirations of hip synovial fluid as well as blood from the ilium and proximal femur. Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection. The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included. The specificities were equivalent in both modalities (≥90 %). We conclude that obtaining aspirates of the ilium and proximal femur at the time of hip synovial fluid aspiration increases the likelihood that the procedure will return an infectious organism. Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment. The child with a septic hip or peri-articular hip infection and positive cultures is likely to receive more narrow-spectrum therapy, potentially decreasing the overuse of broad-spectrum antibiotics. DIAGNOSTIC STUDY LEVEL III: Development of diagnostic criteria on the basis of a series of non-consecutive patients (with universally applied reference "gold standard").
    Journal of Children s Orthopaedics 07/2015; DOI:10.1007/s11832-015-0669-5
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    ABSTRACT: Predictors of failure of the Pavlik harness in reducing and stabilizing an Ortolani-positive hip remain 'unclear'. The purpose of this study is to investigate the success of the Pavlik harness when treating Ortolani-positive hips, to look for predictors of failure of the harness and to analyze the arthrographic findings among these failures. The medical records of 39 consecutive patients with an Ortolani-positive hip treated initially with a Pavlik harness were reviewed. Data regarding birth order, problems during pregnancy, presentation at birth, delivery, family history of DDH, gender, side involved, bilaterality, onset of treatment, problems related to use of the harness, and time until the harness reduced and stabilized the hip or was abandoned because of a failure were recorded. The presence of plagiocephaly, torticollis or foot deformity was also noted. We looked for predictors of failure among these aspects and report the arthrographic findings of the failures. The mean age when the harness was started was 16.7 days. The mean time until success or failure of the harness in reducing and stabilize the hip was 18.5 days. There were 8 (20.5 %) failures. Multigravida (p = 0.026) and foot deformity (p = 0.023) were associated with failure of the harness. On the other hand, problems during pregnancy (p = 1), presentation at birth (p = 0.078), c-section (p = 0.394), family history of DDH (p = 1), gender (0.313), torticollis (p = 1), bilaterality (p = 1) and onset of treatment (p = 0.485) were not associated. Arthrographic abnormalities were found in all failures. The Pavlik harness failed to reduce and stabilize the hip in 20.5 % of the newborns with an Ortolani-positive hip. Multigravida and foot deformity were statistically associated with failure of the harness. An anatomical obstacle for reduction was found in all hips with a harness failure. A more teratological than mechanical hip dislocation could be the reason for failure of the Pavlik harness. IV, Retrospective case series.
    Journal of Children s Orthopaedics 07/2015; DOI:10.1007/s11832-015-0666-8
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    ABSTRACT: The aim of this investigation is the development of primarily healthy hips in children who have required orthoses/protheses over the long term due to ipsilateral distally located deformities of the leg. These children show ipsilateral in-toeing gait and Duchenne's limping followed by a coxa valga antetorta and facultative hip decentration. A practical question is whether these hips are in danger of decompensation. An additional theoretical question is how the external shape and internal architecture changes if a primarily healthy hip is underused. Ten children with healthy hips who are unilaterally long-term orthotics/prosthetics-dependent agreed to undergo an instrumental gait analysis. The results were analyzed and correlated with clinical findings, a common activity score and planimetric radiographic data. The intra-individual comparison revealed a number of significant changes in the hip of the deformed leg (p < 0.05). Clinically, the internal rotation was increased (15° ± 4.2°), while the external rotation was diminished (13° ± 1.3°). Radiologically, the projected caput-collum-diaphyseal angle, the lesser trochanter to articular surface distance and the head-shaft angle were increased by 11.1° ± 15.4°, 5.8 ± 4.2 mm and 11.9° ± 0.6°, respectively. Both the Sharp and acetabular angles were increased, the former by 3.6° ± 0.6° and the latter by 3.2° ± 0.6°. Kinetic gait analysis showed increased stride length (6.8 ± 3.7 cm), shortened stance phase (6.6 ± 1.6 %) and reduced forces transmitted to the ground (92.2 ± 34.3 N). The kinematic analysis showed increased hip abduction (14.0° ± 8.2°), while the pelvic obliquity was not significantly changed (0.01° ± 0.01°). Duchenne's limp and lack of weight-bearing stress are the decisive pathogenic factors of the underused coxa valga and acetabular dysplasia. These changes follow the mechanobiological concept of "function modifies design", which means function influences external shape and internal architecture of bones and joints. As a practical consequence we recommend that one pelvic radiograph be performed as a precaution at the end of puberty of children with these conditions. Level II retrospective study.
    Journal of Children s Orthopaedics 07/2015; DOI:10.1007/s11832-015-0667-7
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    ABSTRACT: To describe knee alignment in children of different ages with severe mucopolysaccharidosis (MPS) I and II and the outcome of treatment with guided growth in a patient subgroup. This is a retrospective observational study of 58 knees in 29 children with severe MPS I and II. Long-leg standing radiographs were evaluated to determine mechanical axis deviation, mechanical lateral distal femoral angle and medial proximal tibial angle at different ages throughout childhood. The change in deformity in individual children over time is reported. 20 knees in 10 patients were treated with guided growth using eight-plates. Radiographic measurements were recorded at the time of plate insertion, at plate removal and at 1 year following removal. At 8 years of age, all MPS I children and three-quarters of MPS II children had valgus knee alignment. There was deformity progression in two-thirds of MPS I knees and half of MPS II knees. Guided growth corrected the deformities. There was recurrence in most cases 1 year after plate removal. Knee deformity is common in children with severe MPS I and II. Guided growth can be considered where there is significant and/or or progressive deformity with the aim of halting progression and correcting existing deformity and thus minimizing the risk of gross deformity. Patients should be aware of the high rate of recurrence and the need for repeat surgery.
    Journal of Children s Orthopaedics 06/2015; DOI:10.1007/s11832-015-0661-0
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    ABSTRACT: Previous studies have described the complex undulation pattern in the distal femoral physis. We investigated whether standard radiographs can visualize these landmarks, in order to guide hardware placement in the distal immature femur. We studied 36 cadaveric immature femora in specimens 3 to 18 years of age. Anteroposterior (AP) and lateral radiographs were obtained with and without flexible radiodense markers placed on the major undulations and were analyzed to determine the relative height or depth of each topographical landmark. Intraclass correlation coefficients (ICCs) were calculated between measurements taken with and without markers for each undulation on each view. Examination of the specimens confirmed a central peak and anteromedial and posterolateral valleys as the major physeal structures. AP radiographs without markers correlated well with marked AP radiographs for all three landmarks (ICC = 0.92, 0.92, 0.91), but the lateral radiographs had lower correlations for the posterolateral valley (ICC = 0.36). The correlation between AP and lateral radiographs without markers on the posterolateral valley was also decreased compared to the other two landmarks (ICC = 0.28 versus 0.57 for the central ridge and 0.62 for the anteromedial valley). This is the first study to rigorously evaluate radiographic visibility of the distal femur physeal undulations. The position of the central ridge, anteromedial valley, and posterolateral valley are reliably seen on AP radiographs, while the lateral view is less consistent, especially for the posterolateral valley. We recommend that caution should be taken when placing screws near the posterolateral aspect of the epiphysis, as lateral views do not visualize those undulations well.
    Journal of Children s Orthopaedics 06/2015; DOI:10.1007/s11832-015-0660-1
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    ABSTRACT: Cervical spine fractures with spinal cord injury (CFSCI) can be devastating. We describe the epidemiology of children and adolescents with CFSCI. Using the Nationwide Inpatient Sample (NIS) database, we identified 4418 patients (≤18 years old) who had CFSCI from 2000 through 2010. Outcomes of interest were patient characteristics (age, sex), injury characteristics [fracture location, spinal cord injury (SCI) pattern], economic variables (duration of hospital stay, total hospital charges), and mortality. Upper cervical fractures (UCFs) occurred half as often (31.4 %) as lower cervical fractures (LCFs; 68.8 %). Among patients <8 years old, 73.6 % had UCFs; among patients ≥8 years old, 72.3 % had LCFs. Overall, 68.7 % had incomplete SCI, 22.4 % had complete SCI, 6.6 % had central cord syndrome, and 2.3 % had anterior cord syndrome. Patients with complete SCI had the longest hospital stays and highest hospital charges. The overall in-hospital mortality rate was 7.3 %, with a sixfold higher rate in patients <8 (30.6 %) vs. those ≥8 (5.1 %) years old (p < 0.001). There was a threefold higher mortality rate in patients with upper (13.5 %) vs. lower (4.3 %) cervical fractures (p < 0.001). Patients with complete SCI had a 1.85-fold higher mortality rate than patients with other cord syndromes (p < 0.001). Patients <8 years old were more likely than older patients to sustain UCFs. Patients with UCFs had a significantly higher mortality rate than those with LCFs. Patients with complete SCI had the longest duration of hospital stay and highest hospital charges and in-hospital mortality rate.
    Journal of Children s Orthopaedics 05/2015; DOI:10.1007/s11832-015-0657-9
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    ABSTRACT: The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV. A comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed. The published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5-22). The mean follow-up was 41.6 months (range 12-134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019). Based on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).
    Journal of Children s Orthopaedics 04/2015; 9(2). DOI:10.1007/s11832-015-0655-y
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    ABSTRACT: Retrospective database, chart and medical imaging review. To report on the outcome and evaluate possible risk factors for postoperative complications following selective spinal fusion in patients with adolescent idiopathic scoliosis (AIS). All patients with AIS who underwent either a selective thoracic or selective thoracolumbar/lumbar spinal fusion at our institution from January 2001 to December 2011 inclusive were included in this study. The minimum postoperative follow-up period of all patients was 2 years. During the 11-year study period, 157 patients with AIS underwent surgery for their progressive spinal deformity. Thirty patients (19 %) had a selective spinal fusion, with 16 patients (group A) having a selective thoracic, and 14 patients (group B) having a selective thoracolumbar/lumbar spinal arthrodesis. In both groups the main postoperative complications were adding-on (25 % group A, 36 % group B) and coronal decompensation (25 % group A, 29 % group B). In group A, no statistically significant risk factors for postoperative complications were identified. In group B, global coronal balance was identified as a significant risk factor for adding-on. Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03). In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015). None of the patients who underwent selective spinal fusion required revision surgery. Although the complication rate after performing a selective spinal fusion is high, the revision rate remains low and the debate whether or not to perform a selective spinal fusion will continue.
    Journal of Children s Orthopaedics 04/2015; 9(2). DOI:10.1007/s11832-015-0653-0
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    ABSTRACT: Retrospective, case-control. Knee morphometric risk factors for noncontact anterior cruciate ligament (ACL) injury have been a popular topic with skeletally mature patients. Little research has focused on the skeletally immature, with conflicting conclusions. This study performs a comprehensive analysis of identified parameters thought to predispose to ACL injury in a skeletally immature cohort. A retrospective review of pediatric patients undergoing knee magnetic resonance imaging (MRI) was performed over a 4-year period. Inclusionary criteria included mid-substance ACL disruption, skeletal immaturity, noncontact injury, without associated ligamentous disruption, and no medical condition associated with ligamentous laxity. MRI studies were analyzed by a pediatric musculoskeletal radiologist, measuring identified bony parameters, and compared with an age-matched control group without ligamentous injury. Data were analyzed using unpaired t-tests and logistic regression. One hundred and twenty-eight patients sustained an ACL disruption, 39 met all inclusionary criteria (66 excluded for associated ligamentous disruption, 23 skeletally mature, three traumatic mechanisms, one with Marfan syndrome). When compared to an age-matched control cohort, the notch width index (NWI) was found to be significantly smaller in the ACL-injured group (p = 0.046). Subgroups analysis demonstrated significant differences in morphometric parameters between subjects with isolated ACL injuries and concomitant medial collateral ligament (MCL) strain. The NWI was significantly smaller in the ACL injury group. Significant differences were noted between isolated ACL injuries and ACL injuries with an MCL strain. This study further highlights the need for incorporating associated injury patterns when investigating the influence of morphometric factors for ACL injury in the skeletally immature. Level III.
    Journal of Children s Orthopaedics 03/2015; 9(2). DOI:10.1007/s11832-015-0652-1
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    ABSTRACT: Proximal femoral osteotomy is the most common major reconstructive surgery in the region of the hip joint in children and adolescents. Given that it may be required across a wide range of ages and indications, appropriate instrumentation is necessary to ensure a technically satisfactory result. Recent developments in fixation include cannulation of the blade plate and locking screw technology. We conducted a prospective audit of our first 25 patients who had a unilateral or bilateral proximal femoral osteotomy using a recently available system which combines cannulation and locking plate technology. The principal outcome measures were the radiographic position of the osteotomy at the time of union and surgical adverse events. Forty-five proximal femoral osteotomies were performed in 25 patients, mean age 8 years (range 3-17 years), for a variety of indications, the most common of which was hip subluxation in children with cerebral palsy. All osteotomies were soundly united by 6 weeks in children and by 3 months in adolescents, in the position achieved intra-operatively. There were no revision procedures and the technical goals of surgery were achieved in all patients. There was one adverse event, a low-grade peri-prosthetic infection, diagnosed at the time of implant removal. In this prospective audit of our first 25 patients, the new system performed well across a wide range of ages, body weights and surgical indications. Further comparative studies will be required to determine whether it offers additional advantages over more traditional systems.
    Journal of Children s Orthopaedics 03/2015; 9(2). DOI:10.1007/s11832-015-0649-9
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    ABSTRACT: I read with interest the article “Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant club foot deformity (the bean-shaped foot) by Elgeidi and Abulsaad [1]. I would, however, like to draw attention to some errors in their description of the double osteotomy technique.In their article the authors mention that the procedure described by Jawish [2] in his 1994 article was the sole opening wedge osteotomy of the first cuneiform technique. This is not correct, and in fact in this article the author describes a single medial osteotomy for the foot with primus varus, as well as a double osteotomy for feet with resistant metatarsus adductus observed in the clubfoot and Z-shaped-foot. To quote part of the abstract of Jawish’s [2] article: “in resistant metatarsus adductus, closed wedge osteotomy of the cuboid has been added to correct the varus deformity of the fore foot, it allows lateral swing of the fore foot: the bone excised from the cuboid is u ...
    Journal of Children s Orthopaedics 03/2015; 9(2). DOI:10.1007/s11832-015-0650-3
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    ABSTRACT: Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300(®) Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground reaction ankle foot orthotics (GRAFOs) and using an FES device. Walking with the FES device showed an increase in the patient's knee extension at midstance and increased knee maximal extension at the stance phase. In addition, the patient was able to ascend and descend stairs with a "step-through" pattern immediately after adjusting the FES device. This report suggests that FES to the quadriceps muscles may affect knee extension at stance and decrease crouch gait, depending on the adequate passive range of motion of the hip, knee extension, and plantar flexion. Further studies are needed in order to validate these results.
    Journal of Children s Orthopaedics 03/2015; 9(2). DOI:10.1007/s11832-015-0651-2