Purpose Osteogenesis Imperfecta (OI) is characterized by severe bone fragility, requiring intramedullary telescopic rodding such as the Fassier-Duval (FD) rod to correct and prevent progressive deformities. Although the FD rod is widely used, the revision rates, especially in the femur, remain high. This study aims to evaluate a structured decision-making framework and detailed surgical techniques for FD femoral revision in OI.Methods We retrospectively reviewed a cohort of 76 limbs from 37 patients with OI who underwent surgery between 2020 and 2024. A specific sub-cohort of 21 femoral FD revisions was evaluated to establish baseline failure characteristics. Within this group, a sample of 9 patients (10 limbs) was reviewed in detail to analyze specific technical strategies and mid-term clinical outcomes.Results Among 21 femoral revision limbs evaluated at a median follow-up of 28 months (range, 12 - 42 months), union was achieved in 89.5% of indicated cases (17/19) at a median of 16 weeks (range, 12-28 weeks). Postoperative complications occurred in 6 of 21 limbs (28.6%), of which three were managed nonoperatively, and three (14.3%) required secondary re-revision including refracture with rod bending, distal pull-out, and symptomatic nonunion. Overall, 18 limbs maintained functional hardware in situ, yielding an 85.0% FD rod survival rate (17/20 limbs) at a median of approximately two years post-revision.Conclusion Femoral FD rod revision requires a tailored approach for each patient. Using a systematic decision-making flowchart, combined with meticulous surgical techniques, could help reduce the potential lifetime burden of surgery and provide reliable mid-term implant survival.
Purpose: The purpose of this study was to assess the mid-term Health-Related Quality of Life after treatment of calcaneus fractures in childhood and adolescence. Methods: We conducted a retrospective review of data from 19 Patients who were treated for calcaneus fractures at our institution between 2004 and 2019. Radiological assessment was done according to the classification of Schmidt and Weiner. Patients completed a questionnaires with help of there parents when needed, that included the Foot and Ankle Ability Measure (FAAM) and the Pediatric Quality of Life Inventory (Peds-QL). Results: Out of 19 patients with calcaneus fractures, 9 patients had unilateral fractures with a mean age of 9.5 years. There were ten patients with bilateral fractures, with a mean age of 8.9 years. The most common type of fracture was the joint depression type 56%, followed by avulsion fracture 17%. In 65 % non-operative treatment was conducted. At a mean follow-up of 6.3 years, the average FAAM score was 98.8. The mean PedsQL-PF (Pediatric Quality of Life Inventory-Physical function) was 97.9 and the mean PedsQL-PS (Pediatric Quality of Life Inventory-Psychosocial function) was 88.9. Joint depression type fractures were associated with inferior outcomes with a mean PedsQL-PF of 95.9 and mean PedsQL-PS of 84.8. Conclusions: HRQoL, as measured by FAAM and PedsQL, was high overall in children and adolescents with calcaneal fractures. Lower scores were observed primarily in patients with joint depression type fractures. Significance of Study: This study provides the first assessment of mid-term health-related quality of life after pediatric calcaneal fractures, demonstrating excellent outcomes that contrast sharply with those reported in adults.
Purpose Parents increasingly consult large language model (LLM) chatbots about pediatric flexible flatfoot, a common condition that rarely requires treatment and in which the clinical task is chiefly communication. We compared four LLMs on the quality, readability, and reproducibility of parent-oriented answers. Methods This was a cross-sectional, comparative content analysis of AI-generated text. No patients, clinical records, or human participants were involved; the units of analysis were parent-oriented questions and the chatbot responses they generated. Twenty parent-oriented questions were submitted in triplicate to ChatGPT, Claude, DeepSeek, and Gemini in independent, memory-disabled sessions (240 responses). Two blinded pediatric orthopedic surgeons scored responses (Mika grade, four-point Likert, and a hallucination taxonomy; PEMAT-P, DISCERN, and QUEST on pooled material). Readability used five indices. Between-model differences were tested with Friedman and Dunn–Bonferroni post-hoc tests; agreement and reproducibility used intraclass correlation coefficients (ICC). Results All five readability indices differed between models (P < 0.001); none reached the recommended sixth-grade level. DeepSeek was most accessible (FRES 66.3) and ChatGPT least (FRES 17.7). On pooled-material instruments (inter-rater ICC 0.63–0.74), Claude scored highest for understandability (91.6%) and actionability (88.3%). Per-response clinical-quality measures were closely clustered, showed poor inter-rater agreement (ICC −0.01 to +0.07), and did not discriminate. Readability reproducibility across identical queries was moderate (FRES ICC 0.49–0.72). Conclusions Clinical-quality scales did not reliably distinguish the four LLMs, whereas readability differed substantially; none met recommended readability standards, and output was only moderately reproducible. Model choice should be guided by readability and actionability, under clinician oversight. Significance of Study For a condition managed mainly through parent education, LLM selection should rest on readability and actionability rather than presumed clinical accuracy, with output used under clinician oversight. Level of Evidence V (cross-sectional comparative content analysis of AI-generated text; no human participants).
