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Research in Paediatric Orthopaedic Surgery

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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Orthopedics".

Deadline for manuscript submissions: closed (10 November 2023) | Viewed by 12192

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Dr. Tomas Novotny

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Guest Editor

Department of Orthopaedics, University J.E. Purkyne, Masaryk Hospital, Usti nad Labem, Czech Republic
Interests: paediatric orthopaedics; soft tissue research (clubfoot, Dupuytren, scars); motion analysis; musculoskeletal ultrasound
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Randall T. Loder

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Department of Orthopaedic Surgery, Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
Interests: pediatric orthopaedic surgery; pediatric trauma/fractures; hip dysplasia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Paediatric orthopaedics has seen remarkable advancement in knowledge in recent decades, which has been further coupled with the considerable worldwide enthusiasm of researchers in this medical field. This research has resulted in new information about the aetiology, progression, diagnostics, and therapy of many paediatric musculoskeletal disorders.

Novel technical options and solutions have allowed us to gain knowledge about ultrastructural tissue composition in various paediatric deformities, such as clubfoot, and brought us one step closer to discovering the origin of these diseases. These findings will hopefully enable us to base new therapeutic approaches on cellular and tissue engineering in the future.

Three-dimensional printing and computer navigation allow us to perform surgical procedures more efficiently through minimally invasive approaches, and thus with lower tissue damage. The development of techniques of motion analysis has enabled us to describe the changes in movement patterns after various surgical procedures.

We welcome reviews and original papers based on research in paediatric orthopaedics.

We look forward to receiving your contributions.

Dr. Tomas Novotny
Prof. Dr. Randall T. Loder
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

research and basic science
paediatric orthopaedics
hip disorders
foot deformities
spinal disorders
neuromuscular disorders
paediatric trauma
ultrasound
motion analysis

Related Special Issue

Research in Paediatric Orthopaedic Surgery (Volume II) in Children

Published Papers (10 papers)

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10 pages, 1030 KiB

Open AccessArticle

3D Back Contour Metrics in Predicting Idiopathic Scoliosis Progression: Retrospective Cohort Analysis, Case Series Report and Proof of Concept

by Milan Patel, Xue-Cheng Liu, Kai Yang, Channing Tassone, Benjamin Escott and John Thometz

Children 2024, 11(2), 159; https://doi.org/10.3390/children11020159 - 26 Jan 2024

Cited by 1 | Viewed by 855

Abstract

Adolescent Idiopathic Scoliosis is a 3D spinal deformity commonly characterized by serial radiographs. Patients with AIS may have increased average radiation exposure compared to unaffected patients and thus may be implicated with a modest increase in cancer risk. To minimize lifetime radiation exposure, alternative imaging modalities such as surface topography are being explored. Surface topography (ST) uses a camera to map anatomic landmarks of the spine and contours of the back to create software-generated spine models. ST has previously shown good correlation to radiographic measures. In this study, we sought to use ST in the creation of a risk stratification model. A total of 38 patients met the inclusion criteria for curve progression prediction. Scoliotic curves were classified as progressing, stabilized, or improving, and a predictive model was created using the proportional odds logistic modeling. The results showed that surface topography was able to moderately appraise scoliosis curvatures when compared to radiographs. The predictive model, using demographic and surface topography measurements, was able to account for 86.9% of the variability in the future Cobb angle. Additionally, attempts at classification of curve progression, stabilization, or improvement were accurately predicted 27/38 times, 71%. These results provide a basis for the creation of a clinical tool in the tracking and prediction of scoliosis progression in order to reduce the number of X-rays required. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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10 pages, 1074 KiB

Open AccessArticle

Rotation and Asymmetry of the Axial Plane Pelvis in Cerebral Palsy: A CT-Based Study

by Akbar N. Syed, Jenny L. Zheng, Christine Goodbody, Patrick J. Cahill, David A. Spiegel and Keith Baldwin

Children 2024, 11(1), 63; https://doi.org/10.3390/children11010063 - 2 Jan 2024

Viewed by 1174

Abstract

Spinopelvic malignment is commonly seen with non-ambulatory cerebral palsy (CP). Axial plane deformation is not well described in the literature. The purpose of this study was to describe and quantify the axial plane deformity in CP using CT scans and compare it to normal controls. We retrospectively collected data using CT scans of the abdomen and pelvis of 40 patients with GMFCS IV/V CP and neuromuscular scoliosis (CPP) and normal controls (NP) matched by age and sex. Pre-operative Cobb angle was recorded for the CP patients. Pelvic anatomy was evaluated at the supra-acetabular region of bone using two angles—iliac wing angle and sacral ala angle, measured for each hemipelvis. The larger of each hemipelvis angle was considered externally rotated while the smaller angle was considered internally rotated, termed as follows—iliac wing external (IWE) and internal (IWI); sacral ala external (SAE), and internal (SAI). Differences were noted using an independent t-test while correlations with Cobb angle were performed using Pearson’s correlation. Iliac wing measurements showed the externally rotated hemipelvis showed a significantly greater magnitude compared with normal controls at 47.3 ± 18.1 degrees vs. 26.4 ± 3.7 degrees in NP (p < 0.001) while no internal rotation was observed (p > 0.05). Sacral ala measurements showed greater magnitude in both external and internal rotation. SAE was 119.5 ± 9.5 degrees in CPP vs. 111.2 ± 7.7 degrees in NP (p < 0.001) while SAI was 114.1 ± 8.5 degrees in CPP vs. 107.9 ± 7.5 degrees in NP (p = 0.001). In the CP cohort, the mean Cobb angle was 61.54 degrees (n = 37/40). Cobb angle correlated with the degree of external iliac wing rotation—IWE (r = 0.457, p = 0.004) and degree of absolute difference in the rotation of the iliac wing (r = 0.506, p = 0.001). The pelvis in a patient with CP scoliosis is asymmetrically oriented exhibiting a greater external rotation of one hemipelvis relative to normal controls. The severity of neuromuscular scoliosis is related to the pelvic axial rotation in CP patients. Axial plane deformity exists in the CP pelvis and this deformity warrants consideration when considering spinopelvic instrumentation strategies and outcomes of supra-pelvic and infra-pelvic pathologies. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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9 pages, 285 KiB

Open AccessArticle

Tranexamic Acid in Hip Reconstructions in Children with Cerebral Palsy: A Double-Blind Randomized Controlled Clinical Trial

by Alexandre Zuccon, Paulo Rogério Cardozo Kanaji, Dávia Serafini Barcellos, Saulo Zabulon, Ageu de Oliveira Saraiva and Thaila Andressa Yoshi de Freitas

Children 2023, 10(12), 1931; https://doi.org/10.3390/children10121931 - 15 Dec 2023

Viewed by 900

Abstract

Surgical treatment is indicated for hip dislocation in patients with cerebral palsy (CP), but it requires care due to the state of nutrition and associated clinical comorbidities. The use of resources that minimize blood loss and the need for blood transfusions are essential to avoid complications. Tranexamic acid (TXA) has been highlighted for orthopedic surgeries to control intraoperative bleeding; however, there is a lack of large studies for its use in hip surgeries in patients with CP. This study aims to evaluate the efficacy and safety of tranexamic acid to reduce bleeding in pediatric patients with cerebral palsy undergoing surgical treatment for hip instability. A sample of 31 patients with CP who underwent surgical treatment for hip dislocation (hip adductor stretching, varization osteotomy of the proximal femur and acetabuloplasty using the Dega technique) was randomly divided into groups: control (n = 10) and TXA (n = 21). Preoperative and 24 h hemoglobin concentrations, the length of hospital stay (LHS), and intraoperative bleeding (IB) were analyzed. TXA significantly reduced the IB (p = 0.02). The variance in hemoglobin concentration was lower for the TXA group, but without statistical significance (p = 0.06). There was no difference in LHS. Also, no statistical difference was observed for the number of transfusions (p = 0.08). The findings provide evidence of the effectiveness of TXA in decreasing intraoperative bleeding and its safety for use in pediatric patients with cerebral palsy. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

12 pages, 971 KiB

Open AccessArticle

Lengthening Patients Previously Treated for Massive Lower Limb Reconstruction for Bone Tumors with the PRECICE 2 Nail

by Laura Campanacci, Luca Cevolani, Marco Focaccia, Giovanni Luigi Di Gennaro, Barbara Dozza, Eric Staals, Federica Zuccheri, Giuseppe Bianchi, Davide Maria Donati and Marco Manfrini

Children 2023, 10(11), 1772; https://doi.org/10.3390/children10111772 - 31 Oct 2023

Viewed by 996

Abstract

The objective of this study was to determine the efficacy of the PRECICE 2^® nail in the treatment of lower limb length discrepancy in patients with a history of bone tumors. This study reports on outcomes, complications, and the safety of the PRECICE 2 limb lengthening nail in a cohort of pediatric patients with limb length discrepancy after surgery for bone tumors. Seventeen patients were treated with intramedullary magnetic nails. The average patient age at the time of surgery was 19 (range 11–32). The PRECICE 2 nail was used on 14 femurs (6 retrograde and 8 anterograde) and 3 tibias. The average consolidation time was 141 days (range 50–360) with a mean CI of 31 ± 12 days/cm. The ASAMI bone score showed 14 (82%) excellent results, 1 (6%) good result, and 2 (12%) poor results. The ASAMI functional score showed 13 (84.6%) excellent results, 3 (11.5%) good results, and 1 (3.8%) fair result. Patients treated with chemotherapy for bone cancer did not show any increase in distraction time or consolidation time. A total of 3 (17%) problems, 1 obstacle (5.5%), and 1 complication (5.5%) were encountered in our case series. The PRECICE 2 nail allows for effective and accurate lengthening preserving the range of motion in patients treated for bone tumors. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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15 pages, 2014 KiB

Open AccessArticle

Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents

by Natasha Oh, Nina Parrish, In Woo Lee, Sasha Temple, Oliver Perkins and Michail Kokkinakis

Children 2023, 10(8), 1409; https://doi.org/10.3390/children10081409 - 18 Aug 2023

Viewed by 1691

Abstract

The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years. This study aimed to evaluate the effectiveness of VR using ‘Rescape DR.VR Junior’ in reducing pain, anxiety, and enhancing the overall hospital experience for paediatric orthopaedic patients and their parents. A total of 64 patients aged 4–18 years were included in this study, which utilised a control group (interacting with a play specialist) and a VR intervention group (including pre-operative patients and fracture clinic patients). Anxiety and pain levels were measured using a 10-point Likert scale before and after the intervention, and validated questionnaires were used to assess parental anxiety and overall hospital experience. The results indicated that VR intervention significantly reduced patient and parental anxiety both before surgery and in the fracture clinic setting (p < 0.5). However, no significant reduction in pain scores was observed in either environments. Comparatively, VR intervention was found to be comparable to traditional play methods in terms of reducing anxiety in the pre-operative environment. All patients and parents agreed that the use of VR distraction methods significantly improved their hospital experience. In conclusion, VR is an effective method for reducing child and parental anxiety and enhancing the hospital experience and can be used alone or in conjunction with a play specialist. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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15 pages, 29546 KiB

Open AccessArticle

Changing Treatment Philosophy of Slipped Capital Femoral Epiphysis (SCFE) after Introduction of the Modified Dunn Procedure (MDP): Our Experience with MDP and Its Complications

by Enrico Micciulli, Laura Ruzzini, Giulio Gorgolini, Pier Francesco Costici, Fernando De Maio and Ernesto Ippolito

Children 2023, 10(7), 1163; https://doi.org/10.3390/children10071163 - 3 Jul 2023

Viewed by 1234

Abstract

Background. The modified Dunn procedure (MDP) has become popular during the last 16 years to treat severely displaced slipped capital femoral epiphysis (SCFE) while “in situ” pinning (ISP) has remained valid to treat mild to moderate SCFE, although the indication limit of the Southwick angle (SA) has not yet been established for either procedure. In this context, we reviewed two cohorts of patients with SCFE, one treated by ISP and the other by MDP. We also tried to better elucidate the etiopathogenesis of hip instability, a severe complication of MDP. Methods. Fifty-one consecutive patients with 62 hips affected by SCFE were treated by us from 2015 to 2019: 48 hips with a SA ≤ 40° had ISP while 14, with the SA > 40°, had MDP. The latter also had a CT scan to better investigate the SCFE morphology. Results were assessed using the Harris Hip Score. Results. The mean length of follow up of the two cohorts was 5.4 years (range: 3 to 8 years). Of the 35 hips operated by ISP with a full follow-up evaluation, 30 had an excellent or good result, 3, fair, and 2, poor. Of the 14 hips that underwent MDP, 11 had an excellent or good result, 1, fair, and 2, poor. A CT scan showed femoro-acetabular incongruency in two unstable hips following MDP. Conclusions. We performed ISP in chronic SCFE with the SA ≤ 40° and MDP in acute and chronic SCFE with the SA > 40°, with satisfactory results. In both acute-on-chronic and chronic long-lasting SCFE with severe displacement, planned for MDP, a CT scan should be carried out to evaluate possible femoro-acetabular incongruency that may cause hip instability. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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21 pages, 2384 KiB

Open AccessArticle

Fractures in Children Due to Firearm Activity

by Randall T. Loder and Taylor Luster

Children 2023, 10(4), 651; https://doi.org/10.3390/children10040651 - 30 Mar 2023

Viewed by 1038

Abstract

The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993–2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11–15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11–15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6–10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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10 pages, 248 KiB

Open AccessFeature PaperArticle

Perioperative Risk Factors for Bleeding in Adolescents Undergoing Pedicle Screw Instrumentation for Scoliosis

by Venla Soini, Johanna Syvänen, Ilkka Helenius, Linda Helenius and Arimatias Raitio

Children 2023, 10(2), 381; https://doi.org/10.3390/children10020381 - 15 Feb 2023

Cited by 4 | Viewed by 1261

Abstract

Progressive scoliosis eventually leads to extensive spinal fusion surgery, which carries a risk for significant bleeding. Neuromuscular scoliosis (NMS) patients have an additional inherent risk of major perioperative bleeding. The purpose of our research was to investigate the risk factors for measured (intraoperative, drain output) and hidden blood loss related to pedicle screw instrumentation in adolescents, divided into adolescent idiopathic scoliosis (AIS) and NMS patient groups. A retrospective cohort study with prospectively collected data of consecutive AIS and NMS patients undergoing segmental pedicle screw instrumentation at a tertiary level hospital between 2009 and 2021 was conducted. In total, 199 AIS (mean age 15.8 years, 143 females) and 81 NMS patients (mean age 15.2 years, 37 females) were included in the analysis. In both groups, levels fused, increased operative time, and smaller or larger size of erythrocytes were associated with perioperative blood loss (p < 0.05 for all correlations). In AIS, male sex (p < 0.001) and the number of osteotomies correlated with more drain output. In NMS, levels fused correlated with drain output, p = 0.00180. In AIS, patients’ lower preoperative MCV levels (p = 0.0391) and longer operation times, p = 0.0038, resulted into more hidden blood loss, but we did not find any significant risk factors for hidden blood loss in NMS patients. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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8 pages, 2324 KiB

Open AccessCase Report

10-Year Clinical Follow-Up after Decompression of Lipofibromatous Hamartoma of the Median Nerve in a 3-Year-Old Patient: Case Report and Review of the Literature

by Seung Jin Yoo, Dae Hwan Kim, Seong Hyun Cho, Kyung Ryeol Lee and Kyu Bum Seo

Children 2023, 10(9), 1581; https://doi.org/10.3390/children10091581 - 21 Sep 2023

Viewed by 870

Abstract

Lipofibromatous hamartoma, first reported in 1953, is a rare, slowly progressive soft tissue tumor, the characteristics of which include the enlargement of the affected nerve via the epineurial and perineurial proliferation of adipose and fibrous tissues. Out of 200 previously reported cases of lipofibromatous hamartoma of the median nerve, there have been approximately 25 pediatric cases under the age of 18. Herein, we report a case of lipofibromatous hamatoma of the median nerve in a 3-year-old female patient who was surgically decompressed via carpal tunnel release and epineurolysis. The patient was followed-up on an outpatient clinic basis annually with sonographic evaluations, and the postoperative 10th-year follow-up did not show recurrence or any deficits in motor and sensory functions. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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8 pages, 3719 KiB

Open AccessCase Report

Acute Progressive Pediatric Post-Traumatic Kyphotic Deformity

by Petr Vachata, Jan Lodin, Martin Bolcha, Štepánka Brušáková and Martin Sameš

Children 2023, 10(6), 932; https://doi.org/10.3390/children10060932 - 25 May 2023

Cited by 1 | Viewed by 1174

Abstract

Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe “chin-on-chest” deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery)

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