Background Pediatric acute compartment syndrome (PACS) is a rare limb-threatening emergency. Diagnosis is complicated by pediatric developmental physiology and communication barriers. Although traumatic fractures are the primary cause, non-fracture etiologies present unique diagnostic challenges. This review summarizes the latest evidence on the changing epidemiology, pathophysiology and diagnostic approaches to acute, chronic, and non-fracture compartment syndromes in children. Methods A comprehensive literature search was conducted across the PubMed/MEDLINE, Embase, and the Cochrane Library databases. The review included English-language, peer-reviewed articles published between January 1966 and May 2026, utilizing Medical Subject Headings and keywords such as “compartment syndrome,” “pediatric,” “children,” and “fasciotomy”. Results The diagnostic approach to PACS has shifted from the unreliable “5 Ps” at late stages to the early “3 As”: increased anxiety, agitation, and analgesic requirements. Children naturally have higher baseline compartment pressures than adults, so pediatric-specific interpretations of pressure monitoring are required. While fracture-related PACS generally has an excellent prognosis if recognised and treated promptly, non-fracture acute compartment syndrome frequently suffers from critical diagnostic delays, leading to high rates of myonecrosis. The definitive standard of care remains an emergent decompressive fasciotomy. However, pediatric tissue demonstrates robust regenerative capacity, enabling conservative initial muscle debridement and achieving high success rates with delayed primary wound closure. Conclusions Although pediatric patients have remarkable healing potential, even following delayed surgical interventions, early recognition is essential to preventing permanent disability. The ability to safeguard limbs depends entirely on clinician’s ability to prioritize the behavioral “3 As” over late-stage neurovascular changes.
Purpose:Early-onset scoliosis (EOS) presents a unique therapeutic challenge, requiring interventions that achieve deformity correction while preserving spinal and thoracic growth. This systematic review and meta-analysis aimed to synthesise current evidence on serial casting outcomes in EOS, with a primary focus on treatment-related complications and secondary evaluation of radiographic, pulmonary, and quality-of-life outcomes. Methods:Comprehensive searches were performed in MEDLINE, Embase, Cochrane Library and CINAHL without date restrictions to identify eligible studies. The primary outcome was treatment-related complications; secondary outcomes included Cobb angle correction, thoracic height progression, pulmonary function, and patient-reported quality of life. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were conducted using random-effects models, and narrative synthesis was applied where quantitative pooling was not feasible. Results:From 578 records, 23 studies met inclusion criteria. Sixteen studies were rated as low risk of bias, six moderate, and one high. The pooled complication rate from the single-arm meta-analysis was 17% (95% CI 9-24%), with moderate heterogeneity. Dermatological complications predominated (skin irritation, ulceration), while gastrointestinal and transient respiratory symptoms were infrequent. Comparative studies demonstrated lower complication rates with casting compared to growth rods (1/27 vs 12/27), with outcomes comparable or superior to bracing. Mean annual thoracic growth ranged from 0.8 to 3.8 cm. Cobb angle correction was generally greater in non-congenital compared to congenital scoliosis. Pulmonary function may transiently decline during casting but improves following cast removal, while long-term outcomes remained acceptable when early surgery was avoided. Quality-of-life analysis demonstrated inverse associations between residual curvature and domains including daily living, pain, and emotional wellbeing. Conclusion:Serial casting remains an effective, low-risk, and growth-preserving intervention for managing early-onset scoliosis. The predominance of minor, reversible complications underscores its safety, while radiographic and functional outcomes affirm its therapeutic value. Future research should prioritise prospective evaluation of pulmonary and psychosocial outcomes to optimise patient selection and refine treatment protocols.
Purpose:To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone. Method:This retrospective cohort study included children aged 5-12 years at baseline with ≥2 Assisting Hand Assessment (AHA) evaluations over ≥3 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination). Results:Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (Δ = -3.6 ± 2.7), versus improvements in 5/6 PT patients (Δ = +9.0 ± 6.4). Wrist extension declined in all BoNT-A+PT patients (Δ = -53° ± 19°) versus 1/5 PT patients (Δ = -4° ± 8°). Supination deteriorated in 4/5 cases of BoNT-A+PT patients (Δ = -30° ± 7°) but remained stable in all PT patients (Δ = +2° ± 9°). Conclusion:Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function. Significance of Study:These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy. Level of evidence:III (retrospective cohort study).
Purpose It was aimed to evaluate publication trends, scientific impact, and collaboration patterns in developmental dysplasia of the hip (DDH) research. Methods DDH-related publications indexed in the Web of Science database between January 1, 2000, and December 31, 2025, were analyzed. Publication output, citation metrics, author and institutional collaboration networks, leading journals, and major research themes were assessed. Results A total of 3462 articles were identified. Annual publication output increased substantially over the study period. The most cited article, by Steppacher et al., reported long-term outcomes of periacetabular osteotomy. Sankar WN (USA) was the most prolific author, while Clohisy JC (USA) had the highest citation impact and h-index. Shanghai Jiao Tong University (China) produced the greatest number of publications, whereas Western institutions achieved higher citation impact despite lower publication volumes. The USA led in publication output, while Switzerland demonstrated the highest citation impact. North American authors and institutions showed the strongest international collaboration rates, with the USA occupying the central position in the global collaboration network. The Journal of Pediatric Orthopaedics published the largest number of DDH-related articles. Research themes exhibited notable geographical variation. Conclusion DDH research has grown rapidly over the past 25 years. North American and Western European researchers have played a leading role through strong international collaborations and publication in high-impact journals. Publication quality and global partnerships appear to be key determinants of scientific influence in the field. Significance of the study This study provides novel bibliometric insights into the current landscape of DDH research for trainees, researchers, clinicians, and policymakers.
Purpose To evaluate the efficacy of Ti-Robot system (Beijing TINAVI Medical Technology Company, China) compared with conventional surgery. Methods We retrospectively analyzed 56 pediatric patients with femoral neck fractures. Patients ranged in age from 3.06 to 16.06 years. Twenty-six patients underwent Ti-Robot-assisted surgery, while thirty patients underwent freehand surgery. Baseline and intraoperative data were collected. During a follow-up period of at least 1 year, fracture healing and functional outcomes were assessed using radiographic evaluation and questionnaires. Results All patients were successfully fixed with three screws. Baseline characteristics were similar between the two groups. Screw parallelism and femoral neck width coverage were better in the Ti-Robot group. Intraoperative fluoroscopy frequency, radiation dose, drilling frequency, and total screw implantation time were lower in the Ti-Robot group than in the conventional group. There were no significant differences in operative time, intraoperative blood loss, healing time, complication rate, Harris Hip Score, Non-Arthritic Hip Score, or Hip and Groin Outcome Score between the two groups. Conclusion The Ti-Robot system is a feasible adjunctive approach for the treatment of pediatric femoral neck fractures. It improves screw placement accuracy and reduces radiation exposure, although its effect on long-term clinical outcomes requires further investigation. Level of Evidence Level III, retrospective cohort study.
Purpose:Recovery of elbow motion is a primary concern following fixation of pediatric lateral condyle fractures, yet the influence of postoperative displacement on early motion outcomes remains unclear. This study aimed to evaluate the association between postoperative displacement magnitude and early elbow motion limitation. Methods:We retrospectively reviewed 63 pediatric patients (mean age 5.4 years) who underwent surgical fixation for lateral condyle fractures between 2015 and 2025. Immediate postoperative displacement was measured on postoperative radiographs. Early elbow motion limitation was defined as ROM <140° within the first year. Multivariable logistic regression identified independent predictors, and ROC curve analysis determined the optimal displacement threshold. Results:Twelve of 63 patients (19.0%) demonstrated early elbow motion limitation. This group had significantly greater postoperative displacement (1.53 ± 0.72 mm vs. 0.79 ± 0.62 mm, p = 0.002) and older age (6.5 ± 2.1 vs. 5.2 ± 2.1 years, p = 0.038) than the normal ROM group. Multivariable regression identified postoperative displacement as the sole independent predictor (OR 5.95; 95% CI 1.44-24.56; p = 0.014). ROC analysis demonstrated moderate predictive ability (AUC = 0.782). Using a 1.0 mm cutoff, early motion limitation was significantly more frequent in patients with displacement ≥1.0 mm than <1.0 mm (32.3% vs. 6.3%, p = 0.011). Conclusions:Immediate postoperative displacement independently predicted early elbow motion limitation after lateral condyle fracture fixation. A threshold of approximately 1.0 mm may serve as a practical reference for anticipating early motion recovery. Minimizing residual displacement may be beneficial, though longer follow-up studies are warranted.
Purpose:To identify risk factors and characterize the timing and nature of proximal junctional kyphosis (PJK) following dual-rod distraction-based growth-friendly treatment (DB-GFT) in early-onset scoliosis (EOS). Methods:Ninety-five EOS patients (37 male, 58 female) treated with dual growing rod systems between 2004 and 2023, with ≥ 2 years of follow-up, were retrospectively reviewed at a single center. Radiographic parameters were assessed preoperatively, postoperatively, and at final follow-up. PJK was defined as a proximal junctional angle(PJA) ≥10° at final follow-up with an increase of ≥10° compared with preoperative measurement. Serial lateral radiographs were evaluated at 3 or 6 month intervals to determine occurrence and timing of PJK. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results:The mean age at index surgery was 6.8 years, with a mean follow-up of 5.8 years. PJK developed in 17 patients (17.9%): 3 immediately postoperatively(mechanical) and 14 gradually (biological), of whom 12 were diagnosed after the first year. Univariate analysis identified UIV at T3 or below and T5-T12 kyphosis correction ≥ 30° as significant risk factors. Each 1° increase in preoperative T5-T12 kyphosis increased PJK risk by 3%. Multivariate analysis confirmed preoperative T2-T12 kyphosis ≥45° and UIV at T3 or below as independent risk factors. Conclusions:While extensive kyphosis correction was identified as a significant risk factor on univariate analysis, preoperative T2-T12 kyphosis ≥45° and UIV at T3 or below emerged as independent predictors, underscoring the importance of both preoperative sagittal alignment and UIV selection in surgical planning. Segment-adjusted PJA values may better identify clinically significant cases at risk of progression to proximal junctional failure. As most PJK develops after 1 year, long-term follow-up is essential. The significance of study:Distal upper instrumented vertebra (T3 or below) and preoperative T2-12 thoracic kyphosis significantly increase the risk of proximal junctional kyphosis, which most commonly develops after the first postoperative year.
Purpose: This analysis seeks to clarify the clinical efficacy of each treatment modality and inform evidence-based decision-making in the management of this common yet complex injury. Methods: A comprehensive systematic search was performed across major medical databases, including Medline (PubMed), Scopus, Web of Science, Embase, The Cochrane Library, ClinicalTrials.gov, and CINAHL Ultimate, to identify studies addressing the outcomes of treatment for primary medial epicondyle fractures. Results: A total of 65 studies published between 1982 and 2026 were included in the meta-analysis. The pooled incidence of fracture union rate following surgical treatment was 97% (95% confidence interval (CI): 95%–98%). Conservative immobilization resulted in a markedly lower union rate of 46% (95% CI: 20%–74%). The overall complication rate following surgical treatment was 21% (95% CI: 16%–27%), compared to 36% (95% CI: 13%–63%) for conservative immobilization. Conclusion: Among surgical options, screw fixation was associated with high union rate and the lowest complication profile, with statistically distinct pooled estimates supporting its reliability in achieving stable healing and early mobilization. We believe that the pooled estimates from our study will be valuable in guiding clinical decision-making and will help assess the risk of potential outcomes and complications in patients with medial epicondyle fractures. Significance of Study: This study provides high-quality pooled evidence comparing surgical and conservative management of medial epicondyle fractures, helping clinicians make more informed, evidence-based decisions by clarifying differences in union rates, functional outcomes, and complication risks.
Purpose:Percutaneous tendon lengthening (PTL), including selective percutaneous myofascial lengthening (SPML), is popular in cerebral palsy (CP) with advocates arguing that it is minimally invasive and may result in less pain and faster rehabilitation than open techniques, but supporting evidence is limited. The purpose of this study was to develop consensus for the surgical indications of PTL and SPML in CP. Methods:A 16-member panel, established experts with at least 10 years' experience in the surgical management of CP, was created to determine opinion consensus on orthopaedic surgical indications. The modified Delphi method was used, utilising a five-level Likert scale. Consensus was defined at 80% of responses being in the highest or lowest two of the five Likert ratings. General agreement was defined as 60%-79%. Results:Thirty-two statements were surveyed; consensus or general achievement was achieved for 22 questions (69%). The panel reached consensus that percutaneous methods for plantar flexor lengthening (PFL) for equinus in CP should be avoided due to the risk of overlengthening. There was disagreement on 10 questions (31%), primarily on the need for more evidence of differences between PTL and SPML. Conclusions:Expert consensus suggests more evidence is needed to establish the safety and efficacy of all types of percutaneous techniques across anatomical levels but confirmed that all percutaneous PFL in CP should be avoided due to the consequences of overlengthening. Significance of Study:In the absence of prospective high-quality evidence, consensus opinion helps guide surgical decision-making for children with CP. Level of evidence:Level IV.
Aim:To evaluate the radiological outcomes of femoral head osteonecrosis (FHO) in children with sickle cell disease (SCD), comparing non-operative treatment (bisphosphonates) and head-preserving surgical interventions-core decompression with bone marrow aspirate concentrate (CD-BMAC) and proximal femur reorientation osteotomy (PFRO)-by analyzing changes in Steinberg stage before treatment to final follow-up. Methods:Retrospective review of 28 hips from 17 pediatric SCD patients treated between 2010 and 2024, analyzed patient demographics, disease stage, treatment modalities, disease progression, and follow-up duration; and compared pre-collapse and post-collapse stages. Results:Among 75 hips with FHO in 51 children, 61 (81%) were non-traumatic. Of the 28 hips (13 pre-collapse, 15 post-collapse) in 17 children (mean age 11.6 years; 58.8% male), the average interval from SCD diagnosis to FHO onset was 78.8 months (Standard deviation-36.6). Treatments included bisphosphonates (11 hips), CD-BMAC (5), and PFRO (6). After excluding salvage procedures and lost follow-up, 20 hips were available for the final outcome analysis. At final follow-up (mean 30.7 months), FHO improved or remained stable in 15 hips (75%), while it progressed by at least 1 Steinberg stage in 5 hips (25%). In pre-collapse hips, no further disease progression was seen. In post-collapse cases, progression was noted in three of five bisphosphonate-treated hips and two CD-BMAC-treated hips; PFRO-treated hips showed no progression. Two hips developed arthritis. Conclusion:Bisphosphonates, CD-BMAC, and PFRO prevent disease progression in pre-collapse hips. In post-collapse hips, PFRO showed no further progression, while CD-BMAC and bisphosphonates showed mixed results. Significance of Study:Early radiological screening and intervention before femoral head collapse is critical to preserving joint anatomy. Level of Evidence:Level IV.
Purpose: To compare revision and complication rates between telescopic and non-telescopic intramedullary rods in children with osteogenesis imperfecta (OI). Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the PROSPERO database (CRD42021287054). Databases were searched up to December 2025. Studies reporting surgical outcomes of intramedullary fixation in OI were included. Meta-analysis was performed using random-effects models. Results: Thirty-six studies including 1711 patients and 2459 treated bones were analyzed. Telescopic rods were associated with significantly lower revision rates compared to non-telescopic rods. No significant difference in overall complication rates was observed. Conclusion: Telescopic rods provide improved implant survival and reduce the need for reoperation in growing children with osteogenesis imperfecta, supporting their preferential use in clinical practice.
Background: Hereditary multiple osteochondromas (HMO) affecting the proximal radius and ulna represent a rare condition with limited documentation in the clinical literature. This study aims to describe a rare presentation of HMO involving the proximal forearm and discusses potential implications for management. Methods: We retrospectively reviewed patients with HMO treated at our center between 2010 and 2021. Radiographic measurements included the presence or absence of osteochondromas in the entire forearm, radial head status, degree of ulnar bow, and ulnar length percentage. Radiographic measurements were compared using a Brown-Forsythe and Welch test with Tamhane’s T2 post hoc analysis. Results: A total of 12 patients with 14 forearms were included in the study. At the final follow-up, all patients with proximal ulnar tumors who did not undergo resection developed subluxation or dislocation. In contrast, all patients with proximal tumors limited in the radius remained free of subluxation or dislocation of the radial head throughout the follow-up period. The mean ulna length percentage in the Located group was 1.07 ± 0.05, while 1.09 ± 0.03 in the Subluxation group and 0.98 ± 0.09 in the Dislocated group. The mean ulna bow in Located group was 12° ± 7°, while 9° ± 6° in Subluxation group and 15° ± 8° in Dislocated group. No significant differences were observed. Conclusions: Proximal osteochondromas from the lateral side of the ulna may be a high-risk factor leading to radial head dislocation. Therefore, surgical excision of the proximal ulnar tumor could serve as a potential intervention to reduce the risk of radial head dislocation in affected patients.
The principle of guided growth is grounded in the observations of Hueter and Volkmann, who proposed that longitudinal bone growth is stimulated by tension and inhibited by compression. The importance of guided growth lies in its ability to address limb malalignment in a more physiological and less invasive manner compared to traditional osteotomies. By modulating growth at the physis, guided growth allows for gradual correction of deformities, minimizing the disruption to the child’s developing musculoskeletal system and harnessing the child’s own growth potential. Guided growth has been most frequently applied for coronal plane angular deformities around the knee, but is increasingly used for deformities in other locations throughout the growing skeleton. A wide range of deformities with underlying idiopathic and non-idiopathic etiologies are amendable to guided growth procedures. Understanding the influence of the underlying etiology, type, and severity of deformity, the growth rate of the treated physis, and skeletal age is essential for treatment success. This review explores current concepts and novel applications of guided growth and highlights areas that warrant further investigation. The focus is on the clinical aspects of guided growth to correct angular or rotational deformities in both the upper and lower extremities.
Purpose: Supracondylar fractures of the humerus are the most common elbow fractures in children. Surgical fixation is necessary in cases with complete displacement (Gartland type III), with closed reduction and pin fixation being preferred. It is sometimes impossible. This study examined radiological and clinical factors that influence the selection of open reduction methods for these fractures. Methods: A retrospective study was designed to investigate children aged 3–13 years with Gartland type III supracondylar humeral fractures (OTA/AO 13-M/3.1 III) treated with closed and open reduction techniques. We enrolled 140 patients in the closed reduction group (mean age 6.27) and 90 in the open reduction group (mean age 6.86). The main outcomes were achieving adequate closed reduction or switching to open reduction. We used univariate analysis and multivariate logistic regression to find independent risk factors and odds ratios for open reduction and internal fixation. Results: Older children were significantly more likely to have flexion-type fractures ( P = 0.001). The final univariate analysis showed that older age (odds ratios (95% confidence interval): 1.1 (1, 1.3)), flexion-type fractures (odds ratios (95% confidence interval): 3.2 (1.4, 7.4)), low-level (below isthmus) fractures (odds ratios (95% confidence interval): 2.2 (1.3, 3.9)), and Pucker sign (odds ratios (95% confidence interval): 2 (1, 4)) were factors that significantly increased the chance of open reduction and internal fixation. The influence of older age and low-level fracture was also strongly demonstrated in multivariate analysis. Conclusions: As age increases, the chance of a flexion-type fracture rises, and thus the chance of needing open reduction. Low-level fractures reduce the possibility of achieving a stable closed reduction by creating a smaller, more cartilaginous distal fragment. Type of study/level of evidence: Level III
Purpose: Although most pediatric extremity fractures can be managed with closed reduction, even when operative fixation is required, youth rodeo exposes participants to high-energy livestock-related trauma that may produce fracture patterns associated with failed closed reduction. This study described operative management and fracture irreducibility in pediatric and adolescent extremity injuries sustained during organized rodeo participation. Methods: A retrospective case series was performed at a Level I pediatric trauma center. Patients aged ≤18 years who sustained injuries during organized rodeo participation between November 2017 and December 2023 were identified through trauma registry review. Demographics, injury characteristics, operative management, and intraoperative findings were recorded. Fractures were classified as irreducible when documented closed reduction attempts failed, and open reduction was required to obtain satisfactory alignment. Results: Forty-one patients with rodeo-related injuries were identified. Orthopedic injuries occurred in 21 patients (51.2%), including 18 extremity fractures (43.9%). Thirteen of eighteen extremity fractures (72.2%) were managed operatively. Open reduction after unsuccessful closed reduction attempts was required in 5 of 13 operatively treated fractures (38.5%), representing 27.8% of all extremity fractures. Irreducible injuries included femoral shaft fractures, elbow fracture-dislocations, Monteggia injuries, proximal humerus fractures, and both-bone forearm fractures. Conclusion: Pediatric and adolescent rodeo-related extremity fractures were frequently managed operatively, and open reduction was required in a substantial proportion of surgically treated cases. These findings should be interpreted descriptively because no matched comparison cohort was available. Significance of study: This single-center series suggests that failed closed reduction may occur in several pediatric and adolescent rodeo-related extremity fracture patterns. Level of evidence: IV (Therapeutic Case Series)
Background: Pavlik harness is a widely accepted first-line treatment for Developmental dysplasia of the hip in infants. Given the increasing use of online video platforms by caregivers seeking medical information, this study aimed to evaluate the content, quality, and reliability of the most-viewed YouTube™ videos related to the Pavlik harness. Methods: A YouTube™ search was conducted using the terms “Pavlik harness,” “Pavlik harness treatment,” “Pavlik harness overview,” “Pavlik harness how to apply,” “Pavlik harness application,” and “Pavlik harness tips.” 48 videos were included for analysis. Data collected included upload source, video length, date of upload, number of views, likes, dislikes, comments, and the interaction index. Video quality and reliability were evaluated using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) benchmark criteria, and DISCERN instrument. Results: Of the 48 videos analyzed, 26 (54.2%) were classified as high quality, 10 (20.8%) as intermediate, and 12 (25%) as low quality. Videos uploaded by healthcare professionals and academic institutions had significantly higher GQS, JAMA, and DISCERN scores compared to those uploaded by non-medical sources( p < 0.001). High-quality videos also had a higher number of likes per day and views per day ( p = 0.001 and p = 0.001, respectively). Conclusion: Nearly half of the most-viewed YouTube™ videos on this topic were of intermediate or low quality. Pediatric orthopedic specialists and professional societies should be encouraged to contribute high-quality, evidence-based videos to guide caregivers appropriately. Parents should be advised to rely on videos uploaded by reputable academic sources to ensure accurate and safe application of the Pavlik harness.
Background:Adolescent idiopathic scoliosis (AIS) develops between the ages of 10 and skeletal maturity and can lead to physical, psychosocial, and medical complications if untreated. Posterior spinal fusion (PSF) is the primary surgical intervention when bracing fails. Although sociodemographic factors affect access to care, surgical candidacy, perioperative risk, and recovery, these variables are rarely reported in randomized controlled trials (RCTs), limiting assessment of equity and generalizability in AIS outcomes. Methods:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Scopus were searched on 9 April 2024, using "posterior spinal fusion," "randomized controlled trial," and "adolescent idiopathic scoliosis." Inclusion criteria were full-text RCTs on PSF in AIS; exclusions were non-English publications, cadaver studies, and technique articles. Two authors independently screened studies, with disagreements resolved by a third. Extracted variables included demographics and social factors. Analyses used descriptive statistics, chi-squared tests, and Fisher's exact test (p < 0.05). Results:Of 148 studies, 44 met the inclusion criteria. Age (97.7%) and sex (95.5%) were reported more frequently than race (6.8%) or ethnicity (9.1%) (p < 0.001). No studies reported household income, insurance status, housing, employment, or education. Reporting did not differ by journal (Fisher's exact test, p = 0.999) or publication year (chi-squared test, p = 0.185), although reporting increased slightly after 2017. Conclusions:RCTs on PSF for AIS rarely report sociodemographic variables beyond age and sex. This gap limits understanding of whether outcomes are consistent across populations or if disparities exist in treatment response or recovery. Improved sociodemographic reporting is essential for transparency, external validity, and equity in AIS care. Level of Evidence:Systematic review of Level II.
Purpose: Clinical management of rare bone diseases (RBDs) is challenged by low prevalence, delayed diagnosis, and complex multidisciplinary needs. This survey aimed to map current clinical practices in RBDs, identify unmet needs, and generate foundational data to guide the development of minimum standards for patient assessment. Methods: An anonymous online survey was distributed to members of the European Paediatric Orthopaedic Society (EPOS) and the European Reference Network on Rare Bone Diseases (ERN BOND) in September 2025. Questions addressed diagnostic work-up, interdisciplinary care, transition practices, and future perspectives. Quantitative data were analysed descriptively, and free-text responses thematically. Results: A total of 119 respondents (35 countries), mostly orthopaedic surgeons (74%), completed the survey. Almost all (118/119) provided direct care, and 63% had >10 years’ experience treating RBDs. Over 80% routinely used anthropometric, posture, and alignment measures, whereas the use of advanced tools varied. Interdisciplinary care is widely applied at varying frequencies, with a high consideration for shared decision-making and quality of life. Most lacked registry access (>80%) and formal transition protocols (~70%). Respondents prioritised clinical frameworks over technological advances and anticipated increasing future relevance for technological innovations. Conclusions: This survey highlights considerable variability in clinical decision-making for RBDs. The findings underscore the importance and need of standardised interdisciplinary care, registry data, and structured protocols and frameworks. Study Significance: This is the first systematic survey of clinical practice and decision-making process in RBD care among EPOS and ERN BOND members. The findings may guide future recommendations and standards, supporting more harmonised care for individuals with RBDs, especially ultra-rare conditions.
Purpose: The study aimed to evaluate the risk and contributing factors leading to compensation claims and permanent disability following complications of treatment in the management of paediatric forearm fractures.Methods: Data were gathered from the Finnish Patient Insurance Centre (PIC), which reviews all claims regarding potential treatment complications in Finland. PIC grants monetary compensation based on excess pain or permanent cosmetic and/or functional disability. We evaluated all claims concerning paediatric forearm fracture management in children under 16 years of age between 1990 and 2019.Results: One hundred and forty-four (58 distal forearm, 55 forearm shaft and 31 proximal forearm) of 226 claims were compensated for a total of 156 separate treatment complications. The overall calculated risk for sustaining a compensated treatment complication was 0.1%. Unsatisfactory standard of surgery was the reason for the compensation in 29/55 children with forearm shaft fractures and delayed diagnosis in 20/31 children with proximal forearm fractures, respectively. Compensation was granted for permanent functional disability to 35 children and for permanent cosmetic disability to 62 children. Permanent functional disability was compensated in 6/58 children with distal, 19/55 with shaft and 10/31 with proximal forearm fractures.Conclusions: The risk of sustaining a compensated complication of treatment after a paediatric forearm fracture is low. Forearm shaft and proximal forearm fractures are associated with a clearly higher risk of iatrogenic injuries with permanent disability than distal forearm fractures.Study Significance: This paper is significant due to the lack of previous publications on this topic and can contribute to minimizing treatment complications in the future.
Background: Pediatric horizontal distal metaphyseal tibial fractures are relatively uncommon injuries. While nonoperative treatment remains the standard of care for most cases, certain fracture patterns may carry a higher risk of treatment failure, and optimal treatment strategies are still unclear. The aim of this study was to investigate the frequency, anatomical location of these fractures within the metaphysis, and risk factors associated with treatment failure in nonoperative management. Methods: A retrospective, registry-based cohort study was conducted to evaluate treatment success in 86 consecutive pediatric patients with distal metaphyseal horizontal tibial fractures between 2014 and 2023. Demographic, clinical, and radiographic data were analyzed. Logistic regression analysis was performed to identify independent predictors of nonoperative treatment failure. Nonoperative treatment failure was defined as the requirement for cast wedging, re-reduction, or surgical intervention due to loss of reduction or coronal angulation greater than 10° observed on final follow-up radiographs. Results: Of the 86 patients included, 70 (81%) were initially treated non-operatively, while 16 (19%) underwent primary surgical fixation. The overall failure rate in the nonoperative group was 35.3% (25/70). Multivariable logistic regression identified 3 independent predictors of treatment failure: age >11 years (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 1.3–81.7; p = 0.030), the presence of a complete fibular fracture (adjusted OR, 6.1; 95% CI, 1.2–30.1; p = 0.027), and initial coronal angulation >10° (adjusted OR, 4.9; 95% CI, 1.1–23.0; p = 0.042). The complication rate was significantly higher in the operative group compared to the nonoperative group (18.3% vs. 4.3%; relative risk, 4.4; 95%CI 1.0–19.7, p = 0.042). Conclusions: Nonoperative treatment remains an effective approach for the majority of pediatric horizontal distal metaphyseal tibial fractures. However, patients with older age, concomitant complete fibular fractures, or marked initial angulation may benefit from early surgical intervention to mitigate the risk of treatment failure. Level of Evidence: IV
