Notable findings in pediatric orthopaedics are presented in the JBJS Guest Editorial What’s New in Pediatric Orthopaedics. Here, we summarize the 5 most impactful studies, as selected by co-author Christina K. Hardesty, MD.
Trauma
A level II randomized controlled trial compared the outcomes of treating femoral fractures with single-limb versus one-and-a-half spica casts in patients 2 to 6 years old. The 2 treatment groups (42 patients in each) had similar functional and radiographic outcomes. However, the group that received a single-limb spica cast had higher parental satisfaction and a lower rate of skin pressure ulcers1.
Infection
A recent study published in JBJS assessed the effectiveness of a rapid magnetic resonance imaging (MRI) protocol (i.e., MRI without contrast and anesthesia) for diagnosing acute pediatric musculoskeletal infections in patients 18 months to 18 years old. This protocol was associated with improvements in time to MRI, duration of MRI, and interpretation time, with an approximately 10% rescan rate. Rapid MRI was also associated with a shorter length of stay and lower charges for the hospital visit2.
Neuromuscular Disorders
A prospective study compared the 5-year outcomes of children with cerebral palsy and hip displacement who underwent either proximal femoral osteotomy alone or proximal femoral osteotomy combined with a pelvic osteotomy. Although patients in the combined procedure group had a higher preoperative hip migration percentage, they had a lower rate of failure postoperatively (defined as a migration percentage of >50%) compared with those who underwent proximal femoral osteotomy alone3.
Hip
The relationship between human growth hormone (HGH) treatment and the risk of slipped capital femoral epiphysis (SCFE) in pediatric patients was investigated in a retrospective cohort study using a multi-institutional database. HGH treatment was associated with an increased risk of SCFE. Patients with higher exposure to HGH (>10 prescriptions) were at a greater risk than those with less exposure4.
Spine
A retrospective database review of 2,355 patients from the Pediatric Spine Study Group was performed to evaluate back pain as a risk factor for abnormal MRI findings in patients with congenital early-onset scoliosis. Of 107 patients with a reported back pain symptom, only 42 were evaluated with an MRI. Twenty-one (50%) of those 42 patients had an underlying pathology on MRI5.
What’s New in Pediatric Orthopaedics is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Adult Reconstructive Knee Surgery, What’s New in Musculoskeletal Tumor Surgery, and What’s New in Musculoskeletal Basic Science.
References
- Hamdy MS, Sabry AO, Helmy BA, Hana AZ, El Zawahry AME, Gamal A. Comparative study between single-limb versus one-and-a-half hip spica cast in fracture femur in young children. J Pediatr Orthop. 2024 Aug 15. [Epub ahead of print].
- Chan KS, McBride D, Wild J, Kwon S, Samet J, Gibly RF. A rapid MRI protocol for the evaluation of acute pediatric musculoskeletal infections: eliminating contrast and decreasing anesthesia, scan time, and hospital length of stay and charges. J Bone Joint Surg Am. 2024 Apr 17;106(8):700-7.
- Kiapekos N, von Heideken J, Broström E, Hägglund G, Åstrand P. Treatment of hip displacement in children with cerebral palsy: a 5-year comparison of proximal femoral osteotomy and combined femoral-pelvic osteotomy in 163 children. J Pediatr Orthop. 2024 Jul 1;44(6):e536-41.
- Mittal M, Momtaz D, Gonuguntla R, Singh A, Dave D, Mohseni M, Torres-Izquierdo B, Schaibley C, Hosseinzadeh P. The effect of human growth hormone treatment on the development of slipped capital femoral epiphysis: a cohort analysis with 6 years of follow-up. J Pediatr Orthop. 2024 Apr 1;44(4):e344-50.
- Ramirez N, Deliz-Jimenez D, Torres-Lugo N, Olivella G, Cahill P, Gupta P, Garg S, Pahys J, Mac-Thiong JM. Clinical relevance of painful congenital early-onset scoliosis: a magnetic resonance image-based study. J Pediatr Orthop. 2024 Apr 1;44(4):232-5.
