Bone Development and Disease in Infants

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

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 32949

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Guest Editor

Special Issue Information

Dear Colleagues,

I cordially invite you to contribute to a Special Edition of Children, dedicated to bone development and diseases in infants.

Children’s bone growth is continuous, and remodelling is always extensive. Growth proceeds from a vulnerable part of the bone, the growth plate. In remodelling, old bone tissue is gradually replaced by new tissue. Many bone disorders arise from the changes that occur in a growing child’s musculoskeletal system, and these disorders can positively or negatively impact bone development. Other bone disorders may be inherited or occur in childhood for unknown reasons.

Bone disorders in children can result from factors that affect people of all ages, including injury, infection (osteomyelitis), cancer, and metabolic diseases. Causes of bone disorders can involve the gradual misalignment of bones and stress on growth plates during growth. Congenital deformities such as clubfoot or developmental dysplasia of the hip can lead to important alterations of bone development, causing severe dysfunction. Certain rare connective tissue disorders can also affect the bones, such as Marfan syndrome, osteogenesis imperfecta, and osteochondrodysplasias.

Many specialists are involved in the management of bone development disorders in children and adolescents, such as neurosurgeons, plastic surgeons, general surgeons, ORL surgeons, maxillofacial surgeons, orthopaedics, radiologists, and pediatric intensive care physicians.

The aim of this Special Issue is to present the latest research on the etiology, physiopathology, diagnosis and screening, management, and rehabilitation related to bone development and disease in infants, focusing on congenital, developmental, post-traumatic, and post-infective disorders.

Prof. Vito Pavone
Guest Editor

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Keywords

  • congenital disease
  • developmental bone affection
  • lower limb deformity
  • foot
  • hip pathology
  • hand and wrist
  • knee
  • arthritis

Published Papers (10 papers)

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Editorial

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2 pages, 168 KiB  
Editorial
Bone Development and Disease in Infants
by Vito Pavone
Children 2022, 9(4), 519; https://doi.org/10.3390/children9040519 - 6 Apr 2022
Viewed by 1022
Abstract
The aim of this Editorial is to introduce the content of the present Special Issue, entitled “Bone Development and Disease in Infants” [...] Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)

Research

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8 pages, 1837 KiB  
Article
Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips
by Maurizio De Pellegrin, Chiara Maria Damia, Lorenzo Marcucci and Desiree Moharamzadeh
Children 2021, 8(3), 179; https://doi.org/10.3390/children8030179 - 26 Feb 2021
Cited by 7 | Viewed by 4578
Abstract
Hip flexion and abduction is fundamental for developmental dysplasia of the hip (DDH) treatment. At present, double diaper treatment has been inappropriately adopted when DDH is suspected. The aim of this study was to verify whether double diapers influence a newborn’s hip position. [...] Read more.
Hip flexion and abduction is fundamental for developmental dysplasia of the hip (DDH) treatment. At present, double diaper treatment has been inappropriately adopted when DDH is suspected. The aim of this study was to verify whether double diapers influence a newborn’s hip position. Here, we studied 50 children (23 female; 27 male; average age 62.33 ± 20.50 days; average birth weight 3230 ± 447 g) with type I hips according to Graf. At the same time of the ultrasound (US) examination, the following hip positions were measured using a manual protractor: (1) spontaneous position, supine on the outpatient bed without a diaper; (2) spontaneous position, with a double diaper; and (3) squatting position on the caretakers’ side. Statistical analysis was performed with a t-test to compare between (1) the spontaneous position without a diaper and with double diapers; (2) the spontaneous position with double diapers as well as the squatting position on the caretakers’ side with a diaper. The comparison between the hip position without diaper and with double diapers was statistically not significant for all measurements, i.e., right hip flexion (p < 0.33), left hip flexion (p < 0.34), and right and left hip abduction (p < 0.87). The comparison between the hip position with double diapers and on the caretakers’ side was statistically significant for all measurements, i.e., right hip flexion (p < 0.001), left hip flexion (p < 0.001) and right and left hip abduction (p < 0.001). We found that the use of double diapers did not affect hip position, while the position formed on the caretaker’s side shows favorable influence. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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8 pages, 636 KiB  
Article
Chronological Age in Different Bone Development Stages: A Retrospective Comparative Study
by Abel Emanuel Moca, Luminița Ligia Vaida, Rahela Tabita Moca, Anamaria Violeta Țuțuianu, Călin Florin Bochiș, Sergiu Alin Bochiș, Diana Carina Iovanovici and Bianca Maria Negruțiu
Children 2021, 8(2), 142; https://doi.org/10.3390/children8020142 - 13 Feb 2021
Cited by 5 | Viewed by 2974
Abstract
The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the [...] Read more.
The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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6 pages, 587 KiB  
Article
Does the Duration of Each Waldenström Stage Affect the Final Outcome of Legg–Calvé–Perthes Disease Onset before 6 Years of Age?
by Ho-Seok Oh, Myung-Jin Sung, Young-Min Lee, Sungmin Kim and Sung-Taek Jung
Children 2021, 8(2), 118; https://doi.org/10.3390/children8020118 - 6 Feb 2021
Cited by 4 | Viewed by 2193
Abstract
The purpose of this study was to evaluate the outcomes of patients with Legg–Calvé–Perthes disease (LCPD) with disease onset before 6 years of age who were treated with conservative methods and to identify prognostic factors. Moreover, we evaluated the duration of the Waldenström [...] Read more.
The purpose of this study was to evaluate the outcomes of patients with Legg–Calvé–Perthes disease (LCPD) with disease onset before 6 years of age who were treated with conservative methods and to identify prognostic factors. Moreover, we evaluated the duration of the Waldenström stage and its correlation with the disease outcome. Disease severity was assessed using the lateral pillar classification, and the final outcome was evaluated using the Stulberg classification. We divided patients with LCPD into two groups according to the age at onset: group 1 (<4 years) and group 2 (4–6 years). The final outcomes of the two groups were compared. We also assessed the duration of each Waldenström stage. LCPD was noted in 49 hips of 49 patients. The lateral pillar class was A in one patient, B in 29 patients, and B/C or C in 19 patients. The Stulberg class was I or II (good) in 30 patients, III (fair) in 13 patients, and IV or V (poor) in six patients. The lateral pillar class significantly correlated with the final outcome. Groups 1 and 2 comprised 25 and 24 patients, respectively. The prevalence of good outcomes did not significantly differ between the groups (p = 0.162). The duration of the initial stage was 4.1 months in the good outcome group and 6.2 months in the fair or poor outcome group. The duration of the fragmentation stage of the femoral head was 5.9 months in the good outcome group and 11.9 months in the fair or poor outcome group. The durations of initial and fragmentation stages significantly differed between good outcome group and fair or poor outcome group (p = 0.009 and p < 0.001, respectively). The prognosis of patients with disease onset before the age of 6 years was favorable. The disease severity and duration of each Waldenström stage can be predictors of the outcome. Patients with prolonged initial and fragmentation stages showed worse outcomes and often required more active treatment to shorten the durations of the initial and fragmentation stages. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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6 pages, 613 KiB  
Article
The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics
by Alexandru Herdea, Alexandru Ulici, Alexandra Toma, Bogdan Voicu and Adham Charkaoui
Children 2021, 8(1), 51; https://doi.org/10.3390/children8010051 - 15 Jan 2021
Cited by 5 | Viewed by 2875
Abstract
It is known that during a fall, a child would rather protect their dominant hand by using the non-dominant one, although the role of handedness in upper limb fractures has not been studied in-depth. We carried out a retrospective, cross-sectional cohort study, including [...] Read more.
It is known that during a fall, a child would rather protect their dominant hand by using the non-dominant one, although the role of handedness in upper limb fractures has not been studied in-depth. We carried out a retrospective, cross-sectional cohort study, including pediatric patients who presented to the emergency room with a supracondylar humerus fracture following an injury by falling from the same height. In total, 245 patients were selected and grouped according to age. In the 1–3 years group, no statistical significance was found between hand dominance and the side of fracture (p = 0.7315). During preschool years (4–6 years old), the non-dominant hand is more often involved (p = 0.03, odds ratio: 3.5). In the 7–14 years group this trend was maintained and actually increased (p = 0.052, odds ratio: 3.8). We might conclude that children tend to protect their dominant hand by falling on their non-dominant one. The main objective of this study is to highlight a link between handedness and the side of the body where the hand fracture will be identified in the pediatric population, regarding supracondylar humerus fracture. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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Review

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7 pages, 228 KiB  
Review
Sports and Children with Hemophilia: Current Trends
by Lorenzo Moretti, Davide Bizzoca, Claudio Buono, Teresa Ladogana, Federica Albano and Biagio Moretti
Children 2021, 8(11), 1064; https://doi.org/10.3390/children8111064 - 19 Nov 2021
Cited by 7 | Viewed by 3257
Abstract
Hemophilia is a sex-linked recessive disorder characterized by a lack of blood factors necessary for clotting. This review aims to investigate the benefits of sports activities in children with hemophilia in terms of both physical and psychological wellness. Sports activity is necessary for [...] Read more.
Hemophilia is a sex-linked recessive disorder characterized by a lack of blood factors necessary for clotting. This review aims to investigate the benefits of sports activities in children with hemophilia in terms of both physical and psychological wellness. Sports activity is necessary for children with hemophilia to preserve joints’ range of motion, reduce joint bleeding, improve muscle mass and strength, enhance proprioception and prevent secondary chronic diseases. In the past, high-impact sports were usually forbidden in children with hemophilia because of their high bleeding risk. Recent studies, however, have shown that prophylaxis therapy can allow a hemophilic child to take part in vigorous activities or high-impact sports. The benefits of sports activity in children with hemophilia are expressed by a better muscular trophism and an improved bone mineral density. Moreover, physical activity has a positive impact on children’s psychosocial well-being. Due to prophylaxis therapy, the quality of life of children with hemophilia is similar to their peers, and this has allowed an improvement in sports participation, including team sports. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
12 pages, 919 KiB  
Review
Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review
by Vito Pavone, Claudia de Cristo, Andrea Vescio, Ludovico Lucenti, Marco Sapienza, Giuseppe Sessa, Piero Pavone and Gianluca Testa
Children 2021, 8(2), 104; https://doi.org/10.3390/children8020104 - 4 Feb 2021
Cited by 29 | Viewed by 5755
Abstract
Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one [...] Read more.
Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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11 pages, 808 KiB  
Review
Treatment of Complex Regional Pain Syndrome in Children and Adolescents: A Structured Literature Scoping Review
by Andrea Vescio, Gianluca Testa, Annalisa Culmone, Marco Sapienza, Fabiana Valenti, Fabrizio Di Maria and Vito Pavone
Children 2020, 7(11), 245; https://doi.org/10.3390/children7110245 - 20 Nov 2020
Cited by 13 | Viewed by 4619
Abstract
Background: Complex regional pain syndrome (CRPS) is characterized by chronic, spontaneous and provoked pain of the distal extremities whose severity is disproportionate to the triggering event. Diagnosis and treatment are still debated and multidisciplinary. The purpose of this systematic review is to analyze [...] Read more.
Background: Complex regional pain syndrome (CRPS) is characterized by chronic, spontaneous and provoked pain of the distal extremities whose severity is disproportionate to the triggering event. Diagnosis and treatment are still debated and multidisciplinary. The purpose of this systematic review is to analyze the available literature to provide an update on the latest evidence related to the treatment of CRPS in growing age. Methods: Data extraction was performed independently by three reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Newcastle–Ottawa Quality Assessment Scale Cohort Studies. Results: At the end of the first screening, following the previously described selection criteria, we selected n = 103 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 6. The articles focused on physical (PT), associated with cognitive behavioral (CBT) and pharmacological (PhT) treatments. The combination of PT + CBT shows the most efficacy as suggested, but a commonly accepted protocol has not been developed. Conclusions: Physical therapy in association with occupational and cognitive behavioral treatment is the recommended option in the management of pediatric CPRS. Pharmacological therapy should be reserved for refractory and selected patients. The design and development of a standard protocol are strongly suggested. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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Other

6 pages, 526 KiB  
Brief Report
Trauma in Children during Lockdown for SARS-CoV-2 Pandemic. A Brief Report
by Daniela Dibello, Marcella Salvemini, Carlo Amati, Antonio Colella, Giusi Graziano, Giovanni Vicenti, Biagio Moretti and Federica Pederiva
Children 2021, 8(12), 1131; https://doi.org/10.3390/children8121131 - 4 Dec 2021
Cited by 4 | Viewed by 1380
Abstract
Purpose: The national lockdown established by the Italian government began on the 11th of March 2020 as a means to control the spread of SARS-CoV-2 infections. The purpose of this brief report is to evaluate the effect of the national lockdown on the [...] Read more.
Purpose: The national lockdown established by the Italian government began on the 11th of March 2020 as a means to control the spread of SARS-CoV-2 infections. The purpose of this brief report is to evaluate the effect of the national lockdown on the occurrence and characteristics of trauma in children during lockdown. Methods: All children admitted to our paediatric orthopaedic unit with a diagnosis of fracture or trauma, including sprains and contusions, between 11 March 2020 and 11 April 2020, were retrospectively reviewed. Their demographic data, type of injury, anatomical location and need for hospitalisation were compared with the equivalent data of children admitted for trauma in the same period of 2018 and 2019. Results: Sixty-nine patients with trauma were admitted in 2020, with a significant decrease in comparison with 2019 (n = 261) and 2018 (n = 289) (p < 0.01). The patients were significantly younger, and the rate of fractures significantly increased in 2020 (p < 0.01). Conclusions: Home confinement decreased admissions to the emergency department for trauma by shutting down outdoor activities, schools and sports activities. However, the rate of fractures increased in comparison with minor trauma, involved younger children and had a worse prognosis. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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8 pages, 1476 KiB  
Case Report
A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case
by Carmine Zoccali, Silvia Careri, Dario Attala, Michela Florio, Giuseppe Maria Milano and Marco Giordano
Children 2021, 8(6), 442; https://doi.org/10.3390/children8060442 - 25 May 2021
Cited by 4 | Viewed by 2958
Abstract
For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to [...] Read more.
For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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