Journal of pediatric orthopedics
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Previous studies have shown a significant association between osteopenia and adolescent idiopathic scoliosis (AIS). And initial bone mineral density (BMD) was proposed to serve as a new prognostic factor of curve progression in AIS. However, it remains unknown whether there is a link between the initial bone mineral status and the outcome of brace treatment. This study aimed to investigate whether the initial bone mineral status could influence the final outcome of brace treatment in AIS. ⋯ Level II.
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Loss of coronal correction has been reported in the presence of a solid posterior fusion mass in patients who are skeletally immature. Significant increases in postoperative coronal curvature are typically attributed to the presence of pseudarthrosis, loss of instrumentation fixation, or adding-on. We evaluated the clinical and radiographic factors associated with a loss of correction that was not attributed to these etiologies as well as the impact of pedicle screw fixation on loss of correction. ⋯ III.
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Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity. ⋯ Level IV-therapeutic study.
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Comparative Study
Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures.
Studies have demonstrated a higher risk of complications when children with fractures in the proximal third of the femur and length-unstable fractures are treated with titanium elastic nails. Alternative treatment methods include open plating and submuscular plating. We are not aware of any published studies that directly compare titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. The purpose of the present study was to retrospectively compare the outcomes and complications of titanium elastic nail and plate fixation of subtrochanteric femur fractures in children and young adolescents. ⋯ Therapeutic Level III.
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Mechanical low back pain is common in the pediatric population; recent studies have shown that undiagnosed mechanical low back pain (UMLBP) is the most common cause of low back pain presenting in adolescents, accounting for up to 78% of cases. Spondylolysis/spondylolisthesis is the most common cause with diagnosed pathology observed in this age group. The goals of this study are to: determine the natural history of low back pain, evaluate the value of radiographic studies in establishing a diagnosis of spondylolysis, and determine the cost and radiation effective doses (EDs) associated with those studies with the associated risks radiation exposure. ⋯ Mechanical low back pain is common in adolescents and in most cases is undiagnosed; most require no imaging and ≤2 office visits. For spondylolysis, 2-view plain films are often diagnostic and oblique views did not add significant value. Advanced imaging increases diagnostic accuracy, but adds to the cost and considerable radiation exposure. Because diagnosis of spondylolysis rarely changes clinical management, physicians should use ionizing radiation studies sparingly in children.