Submit to Children Review for Children Propose a Special Issue

Journal Menu

Journal Browser

► Journal Browser

Orthopaedics and Biomechanics in Children

Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Orthopedics".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 30386

Share This Special Issue

Special Issue Editors

Dr. Pieter Bas de Witte

E-Mail Website1 Website2
Guest Editor

Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
Interests: paediatric orthopaedic surgery; hip surgery; trauma

Dr. Jaap J. Tolk

E-Mail Website1 Website2
Guest Editor

Orthopaedics and Sports Medicine, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
Interests: paediatric orthopaedic surgery; paediatric hip surgery; limb reconstruction; patient centered care

Special Issue Information

Dear Colleagues,

Biomechanics play a key role in the progression and treatment of musculoskeletal disease in children. On the one hand, there is great remodeling potential; however, on the other hand, growth disturbances can lead to significant problems.

The mechanical aspects of the growing skeleton can often be used as an advantage during treatment, for example, in clubfoot correction with stepwise casting and/or tendon transfers, or limb length discrepancies and mechanical axis correction by guided growth. Disadvantageous effects of growth have to be considered as well; examples include physeal injuries leading to growth disturbance, or the progression of idiopathic scoliosis during adolescence. Furthermore, specifics on growth and biomechanical properties in children can be utilized in the development of software for the prediction of limb length and alignment; artificial Intelligence methods for, e.g., skeletal age or measurements of joint angles; gait analyses in children; and the development of instrumentation systems.

For this Special Issue in Children, we would like to address biomechanics in pediatric orthopedics. We welcome contributions with regards to this subject, including, but not limited to, growth plate injuries and guided growth, (mal)alignment, tendon transfers, redirecting osteotomies, development of diagnostic methods, artificial intelligence, virtual reality, smart healthcare, or biomechanical studies (in vivo, in vitro, or model studies).

We accept original research from basic and clinical researchers, as well as, e.g., review articles on various aspects of biomechanics in pediatric orthopedics.

Dr. Pieter Bas de Witte
Dr. Jaap J. Tolk
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

pediatric orthopedic surgery
biomechanical analysis
limb alignment
gait analysis
correction osteotomy
growth prediction
deformity correction
growth disturbance
guided growth
scoliosis

Published Papers (13 papers)

Download All Papers

Editorial

Jump to: Research, Review, Other

4 pages, 160 KiB

Open AccessEditorial

Friend or Foe? Biomechanics and Its Key Role in Paediatric Orthopaedics

by Jaap J. Tolk and Pieter Bas De Witte

Children 2024, 11(1), 90; https://doi.org/10.3390/children11010090 - 11 Jan 2024

Viewed by 754

Abstract

Biomechanics play a key role in the development, progression and treatment of musculoskeletal disease in children [...] Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

Research

Jump to: Editorial, Review, Other

12 pages, 2720 KiB

Open AccessArticle

Factors for Prolonged Pain and Restriction of Movement Following Hemiepiphysiodesis Plating for the Correction of Lower Limb Malalignment in the Frontal Plane: An Explorative Analysis

by Sebastian Braun, Marco Brenneis, Andrea Meurer, Jana Holder and Felix Stief

Children 2023, 10(4), 686; https://doi.org/10.3390/children10040686 - 04 Apr 2023

Viewed by 1439

Abstract

The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018–July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

15 pages, 780 KiB

Open AccessArticle

Functional Benefit and Orthotic Effect of Dorsiflexion-FES in Children with Hemiplegic Cerebral Palsy

by Idan Segal, Sam Khamis, Liora Sagie, Jacob Genizi, David Azriel, Sharona Katzenelenbogen and Aviva Fattal-Valevski

Children 2023, 10(3), 531; https://doi.org/10.3390/children10030531 - 09 Mar 2023

Viewed by 2221

Abstract

Functional electrical stimulation of the ankle dorsiflexor (DF-FES) may have advantages over ankle foot orthoses (AFOs) in managing pediatric cerebral palsy (CP). This study assessed the functional benefit and orthotic effect of DF-FES in children with hemiplegic CP. We conducted an open-label prospective study on children with hemiplegic CP ≥ 6 years who used DF-FES for five months. The functional benefit was assessed by repeated motor function tests and the measurement of ankle biomechanical parameters. Kinematic and spatiotemporal parameters were assessed by gait analysis after one and five months. The orthotic effect was defined by dorsiflexion ≥ 0° with DF-FES at either the mid or terminal swing. Among 26 eligible patients, 15 (median age 8.2 years, range 6–15.6) completed the study. After five months of DF-FES use, the results on the Community Balance and Mobility Scale improved, and the distance in the Six-Minute Walk Test decreased (six-point median difference, 95% CI (1.89, 8.1), –30 m, 95% CI (−83.67, −2.6), respectively, p < 0.05) compared to baseline. No significant changes were seen in biomechanical and kinematic parameters. Twelve patients (80%) who showed an orthotic effect at the final gait analysis experienced more supported walking over time, with a trend toward slower walking. We conclude that the continuous use of DF–FES increases postural control and may cause slower but more controlled gait. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

12 pages, 2285 KiB

Open AccessArticle

Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure

by Ian Hollyer, Taylor Renee Johnson, Stephanie Tieu Kha, Cameron Foreman, Vivian Ho, Christian Klemt, Calvin K. Chan and John Schoeneman Vorhies

Children 2023, 10(3), 470; https://doi.org/10.3390/children10030470 - 27 Feb 2023

Viewed by 2940

Abstract

Ponte osteotomy is an increasingly popular technique for multiplanar correction of adolescent idiopathic scoliosis. Prior cadaveric studies have suggested that sequential posterior spinal releases increase spinal flexibility. Here we introduce a novel technique involving a sequential approach to the Ponte osteotomy that minimizes spinal canal exposure. One fresh-frozen adult human cadaveric thoracic spine specimen with 4 cm of ribs was divided into three sections (T1–T5, T6–T9, T10–L1) and mounted for biomechanical testing. Each segment was loaded with five Newton meters under four conditions: baseline inferior facetectomy with supra/interspinous ligament release, superior articular process (SAP) osteotomy in situ, spinous process (SP) osteotomy in situ, and complete posterior column osteotomy with SP/SAP excision and ligamentum flavum release (PCO). Compared to baseline, in situ SAP osteotomy alone provided 3.5%, 7.6%, and 7.2% increase in flexion/extension, lateral bending, and axial rotation, respectively. In situ SP osteotomy increased flexion/extension, lateral bending, and axial rotation by 15%, 18%, and 10.3%, respectively. PCO increased flexion/extension, lateral bending, and axial rotation by 19.6%, 28.3%, and 12.2%, respectively. Our report introduces a novel approach where incremental increases in range of motion can be achieved with minimal spinal canal exposure and demonstrates feasibility in a cadaveric model. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

9 pages, 5508 KiB

Open AccessArticle

Rotational Guided Growth: A Preliminary Study of Its Use in Children

by Dror Paley and Claire Shannon

Children 2023, 10(1), 70; https://doi.org/10.3390/children10010070 - 29 Dec 2022

Cited by 2 | Viewed by 1705

Abstract

Torsional malalignment of the legs is common in children, and those that do not remodel may benefit from surgical correction. Traditionally, this is corrected with an open osteotomy. Guided growth is the gold standard for minimally invasive angular correction and has been investigated for use in torsional deformities. This study presents our preliminary results of rotationally guided growth in the femur and tibia using a novel technique of peripheral flexible tethers. A total of 8 bones in 5 patients were treated with flexible tethers consisting of separated halves of a hinge plate (Orthopediatrics Pega Medical, Montreal, QC, Canada), which were fixed to the epiphysis and metaphysis at 45° angles to the physis and connected with Fibertape (Arthrex, Naples, FL, USA). The implants are placed medially and laterally in the opposite 45° inclination, determined by the desired direction of rotation. Additionally, the average treatment time was 12 months. All patients corrected the rotational malalignment by clinical evaluation. The average rotational change was 30° in the femurs and 9.5° in the tibias. Further, the average follow-up was 18 months, with no recurrence of the rotational deformity. There was no change in longitudinal growth in the patients who underwent bilateral treatment. Rotational guided growth with flexible tether devices is a novel technique that successfully corrects torsional malalignment without invasive osteotomy surgery. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

10 pages, 952 KiB

Open AccessArticle

The Importance of Monitoring and Factors That May Influence Leg Length Difference in Developmental Dysplasia of the Hip

by Rajiv M. Merchant, Jaap J. Tolk, Anouska A. Ayub, Deborah M. Eastwood and Aresh Hashemi-Nejad

Children 2022, 9(12), 1945; https://doi.org/10.3390/children9121945 - 12 Dec 2022

Cited by 3 | Viewed by 1535

Abstract

In unilateral Developmental Dysplasia of the Hip (DDH), avascular necrosis (AVN), femoral or pelvic osteotomy, and residual dysplasia causing subluxation of the proximal femur may influence Leg Length Discrepancy (LLD). This can lead to gait compensation, pelvic obliquity, and spinal curvature. The aim of this study is to determine the prevalence of LLD, establish which limb segment contributes to the discrepancy, describe how AVN influences LLD, and ascertain variables that may influence the need for LLD corrective procedures. Methodology: This study assessed long-leg radiographs at skeletal maturity. Radiographs were assessed for the articulo-trochanteric distance (ATD) and femoral and tibial length. AVN was classified according to Kalamchi–MacEwen. Results: 109 patients were included. The affected/DDH leg was longer in 72/109 (66%) patients. The length difference was mainly in the subtrochanteric segment of the femur. AVN negatively influenced leg length. Older (≥three years) patients with multiple procedures were more likely to have AVN. LLD interventions were performed in 30 (27.5%) patients. AVN grade or type of DDH surgery did not influence the odds of needing a procedure to correct LLD. Conclusions: Procedures to correct LLD were performed irrespective of previous DDH surgery or AVN grades. In most patients, the affected/DDH leg was longer, mainly in the subtrochanteric segment of the femur, largely influenced by femoral osteotomy in patients with multiple operative procedures for DDH. We recommend careful monitoring of LLD in DDH. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

10 pages, 1294 KiB

Open AccessArticle

Musculoskeletal and Gait Characteristics in Patients with Stickler Syndrome: A Cross-Sectional Study

by Juan José Fernández-Pérez, Paloma Mascaraque-Ruiz, Carlos Martín-Gómez, Ignacio Martínez-Caballero, Teresa Otón, Loreto Carmona and Sergio Lerma-Lara

Children 2022, 9(12), 1895; https://doi.org/10.3390/children9121895 - 02 Dec 2022

Viewed by 1366

Abstract

Background: Stickler syndrome (SS) is a connective tissue disorder of fibrillary collagen with very variable clinical manifestations, including premature osteoarthritis and osteopenia. This musculoskeletal alteration may affect gait maturity or produce strength difficulties. Objective: Our aim was to describe the musculoskeletal characteristics, bone stiffness, gait kinematics, and kinetics of SS patients. Methods: This is a cross-sectional study of children and youngsters with SS recruited by telephone calls through the Spanish SS Association. All participants underwent an analysis of musculoskeletal characteristics, including a 3D gait analysis. Results: The sample included 26 SS patients, mainly boys (65.4%) with a median age of 11 (IQR 5–14). The manual muscle testing was normal in 88.5% of patients. The median distance covered in the 6-min walking test was 560.1 ± 113.4 m. Bone stiffness index scores were 70.9 ± 19.7 for children under 10 years and 88.3 ± 17.5 for children older than 10 years. The gait indicators GPS and GDI were: 7.4 ± 1.9 and 95.3 ± 9.7, respectively, for the left side and 6.8 ± 2.0 and 97.7 ± 9.5 for the right side, respectively. Conclusions: In our series of patients with SS, we found muscle-articular involvement does not have a high impact on strength or gait problems. More work is needed to understand the effect of SS on the musculoskeletal system. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

8 pages, 710 KiB

Open AccessArticle

The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip

by Sanjiv S. G. Gangaram-Panday, Suzanne de Vos-Jakobs and Max Reijman

Children 2022, 9(9), 1325; https://doi.org/10.3390/children9091325 - 31 Aug 2022

Cited by 1 | Viewed by 1667

Abstract

Developmental dysplasia of the hip (DDH) with a dislocated hip can be treated with traction before closed reduction (CR). Currently, there is insufficient evidence supporting the use of preoperative traction treatment for a successful CR. The objective of this study was to determine the effect of preoperative traction on the success rate of primary CR in DDH patients with dislocated hips. A retrospective pair-matched study was performed in DDH patients with dislocated hips. Patients with preoperative traction treatment prior to primary CR were matched (based on age and the severity of DDH on the radiograph) to patients without preoperative traction treatment. The primary outcome was the presence or absence of maintained reduction after three weeks. A match was found for 37 hips, which resulted in the inclusion of 74 hips. No significant difference was found in the number of successful reductions after three weeks between the traction group and the control group (31 vs. 33 hips, p = 0.496). Traction treatment did not significantly improve the short-term or mid-term outcomes for closed reduction. Based on these results, we suggest that traction treatment should not be used as standard care for dislocated hips in DDH. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

8 pages, 890 KiB

Open AccessArticle

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

by Sophie Moerman, Nienke Zijlstra-Koenrades, Max Reijman, Dagmar R. J. Kempink, Johannes H. J. M. Bessems and Suzanne de Vos-Jakobs

Children 2022, 9(6), 865; https://doi.org/10.3390/children9060865 - 10 Jun 2022

Cited by 1 | Viewed by 1426

Abstract

There are few validated predictors of the need for additional surgery in idiopathic clubfeet treated according to the Ponseti method. Our aim was to examine if physical examination (Pirani score) and radiographs at the age of three months (after initial correction of the clubfeet) can predict the future need for additional surgery. In this retrospective cohort study, radiographs of idiopathic clubfeet were made at the age of three months. The Pirani score was determined at the first cast, before tenotomy, and at the age of three months. Follow-up was at least five years. The correlation between the radiograph, Pirani score, and the need for additional surgery was explored with logistic regression analysis. Parent satisfaction was measured with a disease-specific instrument. The study included 72 clubfeet (50 children) treated according to the Ponseti method. Additional surgery was needed on 27 feet (38%). A larger lateral tibiocalcaneal angle (i.e., equinus) and a smaller lateral talocalcaneal angle (i.e., hindfoot varus) at the age of three months were correlated with the need for additional surgery. Higher Pirani scores before tenotomy and at the age of three months also correlated with additional surgery. Parent satisfaction was lower in patients who needed additional surgery. Both the Pirani scores and the lateral radiographs are predictive for future additional surgery. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

22 pages, 1100 KiB

Open AccessReview

Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis

by Lianne Grin, Lisa van Oorschot, Benedicte Vanwanseele, Saskia D. N. Wijnands, H. J. J. (Cojanne) Kars, Arnold T. Besselaar and M. C. (Marieke) van der Steen

Children 2023, 10(5), 785; https://doi.org/10.3390/children10050785 - 26 Apr 2023

Cited by 3 | Viewed by 1651

Abstract

Background: Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). Methods: A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. Results: Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. Conclusions: Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

23 pages, 593 KiB

Open AccessReview

Windswept Deformity a Disease or a Symptom? A Systematic Review on the Aetiologies and Hypotheses of Simultaneous Genu Valgum and Varum in Children

by Niels J. Jansen, Romy B. M. Dockx, Adhiambo M. Witlox, Saartje Straetemans and Heleen M. Staal

Children 2022, 9(5), 703; https://doi.org/10.3390/children9050703 - 10 May 2022

Cited by 2 | Viewed by 4839

Abstract

Objective: The objective of this study is to create an overview of the possible aetiologies of windswept deformity and to emphasize the points of attention when presented with a case. Methods: A systematic search according to the PRISMA statement was conducted using PubMed, African Journals Online, Cochrane, Embase, Google Scholar, and Web of Science. Articles investigating the aetiology of windswept deformity at the knee in children, and articles with windswept deformity as an ancillary finding were included. The bibliographic search was limited to English-language articles only. The level of evidence and methodological appraisal were assessed. Results: Forty-five articles discussing the aetiology of windswept deformity were included. A variety of aetiologies can be brought forward. These can be divided into the following groups: ‘Rickets and other metabolic disorders’, ‘skeletal dysplasias and other genetic disorders’, ‘trauma’ and ‘descriptive articles without specific underlying disorder’. With rickets being the largest group. Interestingly, in the group without a specific underlying disorder, all patients were from African descent, being otherwise healthy and presented with windswept deformity between two and three years of age. Conclusion: We have presented an overview that may help identify the underlying disorder in children with windswept deformity. A step-by-step guide for clinicians who see a child with windswept deformity is provided. Even though, according to the Oxford level of evidence, most articles have a low level of evidence. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Graphical abstract

16 pages, 701 KiB

Open AccessEditor’s ChoiceReview

Biomechanical Characteristics of the Typically Developing Toddler Gait: A Narrative Review

by Wei Liu, Qichang Mei, Peimin Yu, Zixiang Gao, Qiuli Hu, Gustav Fekete, Bíró István and Yaodong Gu

Children 2022, 9(3), 406; https://doi.org/10.3390/children9030406 - 13 Mar 2022

Cited by 6 | Viewed by 4668

Abstract

Independent ambulation is one of the most important motor skills in typically developing toddlers. Gait analysis is a key evaluation method in basic and clinical research. A narrative review on the literature of toddler gait development was conducted following inclusion criteria, explicitly including the factors of English article, age range, no external intervention during the experimental process of studies involved, the non-symptomatic toddler, and no pathological gait. Studies about toddlers’ morphological, physiological, and biomechanical aspects at this developmental stage were identified. Remarkable gait characteristics and specific development rules of toddlers at different ages were reported. Changes in gait biomechanics are age and walking experience-dependent. Gait patterns are related to the maturation of the neuro and musculoskeletal systems. This review thus provides critical and theoretical information and the nature of toddler walking development for clinicians and other scientific researchers. Future studies may systematically recruit subjects with more explicit criteria with larger samples for longitudinal studies. A particular design could be conducted to analyze empirically before practical application. Additionally, the influence of external interventions on the development of toddler gait may need consideration for gait development in the toddler cohort. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

12 pages, 1828 KiB

Open AccessSystematic Review

Guided Growth of the Proximal Femur for the Management of the ‘Hip at Risk’ in Children with Cerebral Palsy—A Systematic Review

by Moritz Lebe, Renée Anne van Stralen and Pranai Buddhdev

Children 2022, 9(5), 609; https://doi.org/10.3390/children9050609 - 25 Apr 2022

Cited by 1 | Viewed by 2583

Abstract

Background: Guided growth is frequently used to modify lower-limb alignment in children, and recently temporary medial hemiepiphysiodesis of the proximal femur (TMH-PF) has been used for the management of hips at risk of subluxation in cerebral palsy (CP) patients. The aim of our study was to evaluate the efficacy of TMH-PF in the management of neuromuscular hip dysplasia in children with cerebral palsy. Methods: A systematic search of the literature was performed by using PubMed, EMBASE, CINAHL, MEDLINE, Scopus and Cochrane databases. Pre- and postoperative radiographic changes of the migration percentage (MP), head-shaft angle (HSA) and acetabular index (AI) were included in a meta-analysis. Secondary outcomes were treatment complication rates, technical considerations and the limitations of this novel technique. Results: Four studies (93 patients; 178 hips) met the eligibility criteria for inclusion in the meta-analysis. All three radiographic measurements showed significant changes at a minimum of 2 years of follow-up. Mean changes for MP were 8.48% (95% CI 3.81–13.14), HSA 12.28° (95% CI 11.17–13.39) and AI 3.41° (95% CI 0.72–6.10), with I² of 75.74%, 0% and 87.68%, respectively. The serious complication rate was overall low; however, physeal ‘growing off’ of the screw was reported in up to 43% of hips treated. Conclusion: TMH-PF is an effective and predictable method to treat CP patients with ‘hips at risk’, and the overall complication rate is low; however, further work is required to identify the best candidates and surgical timing, as well as choice of technique and implant. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Orthopaedics and Biomechanics in Children

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (13 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI