What’s New in Pediatric Orthopaedics 2021

Every month, JBJS publishes a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 14 specialty areas. Click here for a collection of all such OrthoBuzz Guest Editorial summaries.

This month, co-author Lindsay M. Andras, MD summarizes the 5 most compelling findings from the >80 studies highlighted in the most recent “What’s New in Pediatric Orthopaedics.”

Anterior Vertebral Body Tethering vs Spinal Fusion

–Motion-sparing approaches to scoliosis treatment are attracting increased interest. An informative retrospective study compared 2 to 5-year outcomes of anterior vertebral body tethering (AVBT, 23 patients) and posterior spinal fusion (26 patients) in the treatment of adolescent idiopathic scoliosis. Curve correction was significantly better in the posterior fusion group (mean curve magnitude of 16° vs 33° in the AVBT group). Posterior fusion also demonstrated a revision rate of 0%, while a revision rate of 39% was found for AVBT (9 of 23), with 12 patients (52%) showing evidence of tether breakage.

Antibiotic Regimens for Osteoarticular Infection

–While osteomyelitis is often treated with a 4 to 6-week course of intravenous (IV) antibiotics, intriguing results were reported in a study examining the data of 74 patients before and after the initiation of early transition to oral antibiotics for osteoarticular infection¹. In the early transition group, which received IV antibiotics for a median of 7 days, no return ED visits or readmissions were reported. Of note, this approach also appeared to stave off complications related to the peripherally inserted central catheters, which necessitated a return to the ED for 16% of the patients who received the longer course of IV antibiotics.

Developmental Dysplasia of the Hips

–What is the long-term likelihood of total hip arthroplasty (THA) when closed reduction or open reduction and Salter innominate osteotomy is used for the treatment of developmental dysplasia of the hips (DDH) in children after walking age? A comparative analysis of hip survival at 45 years showed that both open and closed reduction “provided substantial benefit relative to the natural history of DDH,” but THA is the expected outcome in middle adulthood, particularly for bilateral hips managed with closed reduction after the age of 18 months.

Legg-Calvé-Perthes Disease

–A case-series report noted “predictable radiographic healing and marked clinical improvement” after open reduction and surgical fixation (ORIF) of symptomatic osteochondritis dissecans lesions seen as sequelae to Legg-Calvé-Perthes disease². Mean follow-up was 4.6 years.

Pediatric Syndactyly Reconstruction

–Synthetic dermal substitute shows merit as an alternative to skin grafting in syndactyly reconstruction, as found in a recent study³. Of 21 webs, normal vascularity was noted in 20, normal pigmentation in 17, normal skin pliability in 13, and flat scar height in 15, with no complications observed. Of note, a small sheet of synthetic dermal substitute costs approximately $350.

References

1. Islam S, Biary N, Wrotniak B. Favorable outcomes with early transition to oral antibiotics for pediatric osteoarticular infections. Clin Pediatr (Phila). 2019 Jun;58(6):696-9. Epub 2019 Feb 8.
2. Lamplot JD, Schoenecker PL, Pascual-Garrido C, Nepple JJ, Clohisy JC. Open reduction and internal fixation for the treatment of symptomatic osteochondritis dissecans of the femoral head in patients with sequelae of Legg-Calvé-Perthes disease. J Pediatr Orthop. 2020 Mar;40(3):120-8.
3. Wall LB, Velicki K, Roberts S, Goldfarb CA. Outcomes of pediatric syndactyly repair using synthetic dermal substitute. J Hand Surg Am. 2020 Aug;45(8):773.e1-6. Epub 2020 Feb 13.