Journal of Pediatric Orthopaedics (J PEDIATR ORTHOPED)
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.
Journal Impact: 1.07*
Journal impact history
|2016 Journal impact||Available summer 2017|
|2015 Journal impact||1.07|
|2014 Journal impact||1.20|
|2012 Journal impact||0.61|
|2011 Journal impact||0.56|
|2010 Journal impact||1.59|
|2009 Journal impact||1.69|
|2008 Journal impact||1.43|
|2007 Journal impact||1.28|
|2006 Journal impact||1.05|
|2005 Journal impact||0.79|
|2004 Journal impact||0.85|
|2003 Journal impact||0.67|
|2002 Journal impact||0.64|
|2001 Journal impact||0.69|
|2000 Journal impact||0.57|
Journal impact over time
|Website||Journal of Pediatric Orthopaedics website|
|Other titles||Journal of pediatric orthopedics, Journal of pediatric orthopaedics|
|Material type||Periodical, Internet resource|
|Document type||Journal / Magazine / Newspaper, Internet Resource|
Publications in this journal
- [Show abstract] [Hide abstract] ABSTRACT: Background: Children with osteomyelitis demonstrate a wide spectrum of illness. Objective measurement of severity is important to guide resource allocation and treatment decisions, particularly for children with advanced illness. The purpose of this study is to validate and improve a previously published severity of illness scoring system for children with acute hematogenous osteomyelitis (AHO). Methods: Children with AHO were prospectively studied during evaluation and treatment by a multidisciplinary team who provided care according to evidence-based guidelines to reduce variation. A severity of illness score was calculated for each child and correlated with surrogate measures of severity. Univariate analysis was used to assess the significance of each parameter within the scoring model along with new parameters, which were evaluated to improve the model. The scoring system was then modified by the addition of band count to replace respiratory rate. The modified score was calculated and applied to the prospective cohort followed by correlation with the surrogate measures of severity. Results: One hundred forty-eight children with AHO were consecutively studied. The original severity of illness score correlated well with length of stay and other established measures of severity. Band percent of the white blood cell differential ≥1.5% was found to be significantly associated with severity and chosen to replace respiratory rate in the model. The modified calculated severity scores correlated well with the chosen surrogate measures and significantly differentiated children with osteomyelitis on the basis of causative organism, length of stay, intensive care, surgeries, bacteremia, and disseminated or multifocal disease. Conclusions: The findings of this study validate the previously published severity of illness scoring tool in large cohort of children who were prospectively evaluated. The replacement of respiratory rate with band count improved the scoring system.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Medial epicondyle fractures may occur in isolation or with associated elbow dislocation. In the absence of open fracture or fragment incarceration, nonoperative management with immobilization has been shown to result in generally successfully outcomes comparable with those reported after surgical fixation. However, no comparative investigation has assessed outcomes after nonoperative treatment based on the presence or absence of elbow dislocation. Methods: A systematic review was conducted investigating all studies in the literature reporting nonoperative outcomes for isolated medial epicondyle fractures and fracture-dislocations. Databases included in this review were PubMed, Biosis Preview, SPORTDiscus, PEDro, and EMBASE. We sought to evaluate results related to the incidence and outcomes of bony nonunion and the incidence of elbow stiffness, pain, ulnar neuropathy, cubitus valgus deformity, and laxity between isolated fractures of the medial epicondyle and fracture-dislocations. Results: Review of the literature yielded 7 studied meeting appropriate inclusion and exclusion criteria, comprising 81 total patients (n=42 patients with fracture-dislocations, n=39 patients with isolated fracture). Bony nonunion occurred in 69% (n=29) of patients with fracture-dislocation versus 49% (n=19) with isolated fractures (P=0.11); however, both groups had minimal clinical or functional disabilities at final follow-up. Decreased elbow flexion and extension range of motion were significantly more frequent after fracture-dislocation than isolated fractures [43% (n=18) vs. 15% (n=6), respectively, P=0.01], while patients rarely demonstrated pain, ulnar neuropathy, or deformity in the presence or absence of dislocation. Conclusions: In the absence of absolute surgical indication, nonoperative management of isolated medical epicondyle fractures with or without concomitant elbow dislocation seems to be successful with few long-term complications leading to functional disability. However, increased rates of nonunion, elbow stiffness, and elbow laxity may occur with fracture-dislocations, and merit further study with validated functional outcome scores. Further comparative studies are necessary to determine the true indications and outcomes in nonoperatively managed medial epicondyle fractures. Level of evidence: Level II-systematic review of level-II or level-I studies with inconsistent results.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The radiocapitellar line (RCL) was originally described for evaluation of the alignment of the RC joint on lateral images of the elbow. Although, many authors have translated the utilization of RCL into coronal imaging, previous studies have not been performed to confirm validity. The purpose of this paper was to identify an accurate way of evaluating pediatric RC alignment in the coronal plane. Methods: Thirty-seven anteroposterior (AP) radiographs of 37 children were evaluated to determine the position of the RC joint in the coronal plane. All had acceptable magnetic resonance imaging (MRI) studies available for comparison. The lateral humeral line (LHL), consisting of a line along the lateral edge of the ossified condyle of the distal humerus parallel to the axis of the distal humeral shaft, was studied as it related to the lateral cortex of the radial neck. Three children with a confirmed diagnosis of a Bado III, lateral displaced radius, Monteggia fracture were also evaluated. Results: The LHL passed along the edge of or lateral to the radial neck on all AP radiographs and all MRI studies. The RCL failed to intersect the capitellum on 2 AP radiographs. On MRI, the RCL also passed lateral to the capitellar ossification center in 3 patients. In addition, the RCL was seen passing through the capitellum at a mean of the lateral 30% (range, 0% to 64%) on AP radiographs and 26% (range, 0% to 48%) on MRI. For all 3 children with a Bado III Monteggia fracture, the LHL crossed the radial neck and the RCL did not intersect the capitellum. Conclusions: The RCL can fail to intersect the capitellar ossification center on AP radiographs and MRI in pediatric elbows without injury. The LHL consistently lies lateral to the radial neck in normal elbows and medial to the lateral aspect of the radial neck on all Bado III fracture-dislocations. It, therefore, can be used as an adjunct in evaluating the RC joint on AP imaging. The RCL most commonly intersects the lateral one third of the ossification center on both plain radiographs and MRIs. Level of evidence: Level III-diagnostic.
- [Show abstract] [Hide abstract] ABSTRACT: Background: It is challenging that some Ponseti method corrected clubfeet have a tendency to relapse. Controversies remain as to the implication of initial severity, representing the deformity degree, as well as number of casts needed, representing the treatment process, in predicting relapse. However, no study has been reported to take these 2 parameters into comprehensive consideration for outcome measurement. The purpose of this study is to investigate the correlation between the initial Pirani score and the number of casts required to correct the deformity in our series; to evaluate noncompliance as a risk factor of the deformity recurrence in Ponseti treatment; to test the validity and predictive value of a new proposed parameter, ratio of correction improvement (RCI) which is indicated by the initial Pirani scores divided by the number of casts. Methods: A total of 116 consecutive patients with 172 idiopathic clubfeet managed by Ponseti method were followed prospectively for a minimum of 2 years from the start of brace wearing. RCI value and the other clinical parameters were studied in relation to the risk of relapse by using multivariate logistic regression analysis modeling. Results: A positive correlation between the initial Pirani score and the number of casts required to correct the deformity was found in our series (r=0.67, P<0.01). There were 45 patients (39%) with brace noncompliance. The relapse rate was 49% (22/45). The odds ratio of relapse in noncompliant patients was 10 times more that in compliant patients (odds ratio=10.30 and 95% confidence interval, 2.69-39.42; P<0.01). The multivariate logistic regression analysis showed that there was significant association between relapse and RCI value. There were 42 patients (36%) with RCI value <1, among them, the relapse rate was 57% in 24 patients. The odds ratio of relapse in patients with RCI value <1 was 27 times more likely to relapse than those >1 (odds ratio=26.77 and 95% confidence interval, 5.70-125.72; P<0.01). Conclusions: On the basis of the findings from our study, we propose the RCI to be a new parameter in predicting the risk of relapse in Ponseti method of clubfoot management. Early intervention is recommended to optimize the brace compliance particularly in case with lower RCI value. Level of evidence: Level II-prognostic.
Article: Spine Injuries in Child Abuse[Show abstract] [Hide abstract] ABSTRACT: Background: Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse. Methods: A retrospective review of the Kids' Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries. Patients with a documented diagnosis of abuse were identified using ICD-9-CM diagnosis codes. Our statistical models consisted of multivariate linear regressions that were adjusted for age, race, and sex. Results: There were 22,192 pediatric patients with a diagnosis of spinal cord or vertebral column injury during the study period, 116 (0.5%) of whom also had a documented diagnosis of abuse. The most common type of abuse was physical (75.9%). Compared with nonabused patients, abused patients were more likely to be below 2 years of age (OR=133.4; 95% CI, 89.5-198.8), female (OR=1.67; 95% CI, 1.16-2.41), and nonwhite (black: OR=3.86; 95% CI, 2.31-6.45; Hispanic: OR=2.86; 95% CI, 1.68-4.86; other: OR=2.33; 95% CI, 1.11-4.86). Abused patients also presented with an increased risk of thoracic (OR=2.57; 95% CI, 1.67-3.97) and lumbar (OR=1.67; 95% CI, 1.03-2.72) vertebral column fractures and had a multivariate-adjusted mean length of stay that was 62.2% longer (P<0.001) and mean total charges that were 52.9% higher (P<0.001) compared with nonabused patients. Furthermore, 19.7% of all pediatric spine patients under 2 years of age admitted during the study period belonged to the abused cohort. Conclusions: Spine injuries are rare but can be found in the pediatric population. With an additional documented diagnosis of abuse, these injuries affect younger patients in the thoracolumbar region of the spine, and lead to longer lengths of stay and higher hospital costs when compared with nonabused patients. Because of these findings, physicians should maintain a higher level of suspicion of abuse in patients with spine injuries, especially patients under 2 years of age. Level of evidence: Level III evidence-a case-control study.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Multiple enchodromatosis of bone, termed Ollier's disease, or Maffucci syndrome when associated with hemangiomas, is a rare disease that can affect the pediatric hand. This condition often causes a finger mass, deformity, pain and possible pathologic fractures, and has been associated with malignant transformation to chondrosarcoma. The aim of our study is to describe the long-term sequela of multiple enchondromatosis of the hand in the pediatric population, specifically the rates of malignant transformation, tumor recurrence, rates of pathologic fracture, and phalangeal growth arrest. Methods: We examined 15 pediatric patients who were treated in our institute with a total of 127 phalanges and metacarpals lesions. Only patients with follow-up of at least 4 years were included. We retrospectively reviewed patients' chart and hand radiograph for symptoms including pathologic fractures, indications for surgery, and postoperative complications including tumor recurrence, and malignant transformation. We assessed phalangeal growth arrest with radiographs and normalized phalangeal growth charts. Results: Mean age of diagnosis was 5.8 years and mean follow-up time was 15.4 years. Pathologic fractures were common at 46% of pediatric patients, but ceased to occur once reaching adulthood. Outcomes of pathologic fractures were excellent, regardless of treatment. Malignant transformation occurred in 1 patient and did not occur during childhood. A total of 80% of patients and 29% of lesions underwent surgical treatment of curettage and bone graft for the lesion, yet recurrence was common and affected 33% of treated patients. Phalangeal growth arrest was the most common long-term sequela and affected 11% of phalanxes and metacarpals. This sequela was significantly more prevalent in patients who had surgical excision of the tumor. Conclusions: Our findings reassure that malignant transformation of enchodromatosis of the hand is unlikely in the pediatric population. Pathologic fracture is common, but has excellent outcomes. When considering surgery, parents should be counseled about the possibility of phalangeal growth arrest and recurrence of the lesion. Type of study/level of evidence: Level IV-therapeutic.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Prompt open arthrotomy is historically utilized to treat pediatric septic arthritis of the hip, but arthroscopy has been described as a valid alternative to prevent long-term sequelae. Standard hip arthroscopy in adolescents and adults utilizes lateral-based portals, but successful irrigation in infants may necessitate a medial portal due to the smaller joint size. The purpose of this study was to determine the safety of a medial hip portal in children based on its anatomic relation to neurovascular structures. Methods: A retrospective review of children 6 years of age or below with septic hip arthritis who obtained a preoperative magnetic resonance imaging (MRI) between 2009 and 2015 was performed. Multiple measures were recorded from the MRI to create a 3D cone with the vertex just posterior to the adductor longus at the convergence of the gluteal and inguinal creases-a previously described posteromedial portal-with the cone base being a circle defined as the central joint diameter. The distance to the femoral vessels and nerve were then recorded. An adult cadaver was then utilized to replicate the proposed portal starting point and trajectory to confirm that it could be reproducible in a clinical setting. Results: After applying criteria, 47 MRI were evaluated (21 boys, 26 girls) demonstrating a mean distance to femoral vessels and nerve: at insertion, 18.9 mm (minimum 10.5 mm) and at the hip joint, 11.1 mm (minimum 5.2 mm). Girls and boys did not differ significantly, but there was a significant correlation of both age (r=0.75) and body weight (r=0.84) to the measured distance (P<0.001). Imaging of the cadaver confirmed that the starting point could be replicated. Conclusions: There is a direct relation to size of the child and the distance from the neurovascular structures to the cannula trajectory, but even the smallest of children have at least 5.5 mm of adductor longus to protect the femoral structures. A medial-based portal that utilizes a medial needle for initial aspiration features a wide margin of safety for children requiring treatment for septic hip arthritis. Level of evidence: Level IV.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The aim of this paper was to determine the prognostic potential of the ossific nucleus center edge angle (ONCEA) in patients below 5 years of age treated for developmental dysplasia of the hip (DDH) to predict final outcome and the need for a secondary procedure. Methods: The interobserver and intraobserver reliability was calculated using the intraclass correlation coefficient for measurement of the ONCEA. The ONCEA was divided a priori into 3 groups: group A?10 degrees, group B -9 to 9 degrees, and group C ?-10 degrees. Final outcome was measured using the McKay score and Severin classification. The presence of osteonecrosis was recorded at final follow-up. Results: One hundred one patients with 133 dislocated hips underwent closed or open reduction for DDH. Mean age at presentation was 19 months with a mean age at final follow-up of 12.4 years. A significant difference was shown in a comparison of the 3 ONCEA groups using the McKay score, Severin classification, and need for a secondary procedure. Eighty seven of the 101 patients underwent ONCEA reliability measurements. The ONCEA was shown to have a mean intrarater reliability of 0.89, and a mean interrater reliability of 0.77. Conclusions: The ONCEA is a reliable measurement in predicting medium-term outcome of the hip post reduction in children under the age of 5 years with DDH and might be useful as a predictor for a secondary procedure before the age of 5 years. Level of evidence: Level III-prognostic case control study. Clinical relevance: This case control study shows the importance of measuring the ONCEA within 6 months of removing the final cast after reduction of a dislocated hip and its implications for further management and outcome.
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