Search Results (249)

Introduction: Finger injuries are common in pediatric patients and typically heal well with conservative management. However, rare fracture patterns involving significant displacement and physeal injury, such as the one described in this case, require specialized surgical intervention to ensure proper healing and prevent long-term complications. Case Presentation: A 12-year-old left-hand-dominant female presented with pain, swelling, and deformity at the distal interphalangeal (DIP) joint following hyperextension of the left fifth digit. Initial radiographs revealed a volar displaced intra-articular fracture with physis involvement, confirmed by computed tomography (CT) imaging. Conservative management with closed reduction and splinting failed to achieve adequate alignment. Surgical intervention was performed via a dorsal approach, utilizing ORIF with K-wire fixation to restore joint congruity and ensure anatomic alignment. Outcomes: Postoperative follow-up demonstrated satisfactory healing, maintained reduction, and resolution of pain with no complications. The patient regained functional use of the digit with minimal stiffness, and the growth plate remained uninvolved during the recovery period. Discussion: This case underscores the importance of advanced imaging, early referral, and tailored surgical intervention for rare mallet fractures involving volar displacement and physeal injury. ORIF provided reliable stabilization and optimal outcomes in this complex case. Conclusions: Volar displaced Salter–Harris III fractures of the DIP joint are rare and challenging injuries in pediatric patients. This case highlights the role of ORIF in achieving successful outcomes and emphasizes the importance of precise reduction and stabilization to prevent long-term complications. Full article

Objective: Due to the increasing esthetic demand among pediatric patients and different restorative materials, we focused on analyzing which of the options of restorations may provide superior clinical outcomes. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Cochrane databases. Results: Five articles met all inclusion criteria from an initial pool of 359 articles identified in the initial search. Greater bond strength was observed when pulpotomized teeth were restored with Biodentine^® and resin composites compared to resin-modified glass ionomer cements (RMGICs). When comparing pulpotomies in primary teeth with MTA and Biodentine^®, the fracture resistance values were higher in the pulpotomized teeth with Biodentine^® than with MTA. Additionally, following a narrative synthesis in MTA-treated teeth, a higher risk of failure was observed using RMGICs or composite instead of stainless-steel crowns (SCCs) as the final restorative material. Conclusions: Variables such as the type of final restoration can affect the survival of primary teeth after pulpotomy reconstruction. Regardless of the pulp material, survival with SSCs is higher, but resin composites appear to be a viable restorative material after Biodentine^® application. Full article

Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background: Despite the high incidence of surgical treatment of lower leg fractures in children, there is little research focusing on the emotional consequences of such trauma, particularly the distinction between somatic and cognitive anxiety symptoms. Given the important role of social support and manifest anxiety in emotional recovery, there is a clear need to investigate factors that predict the development of anxiety in this population. Objectives: This study aimed to identify predictors of anxiety and to assess differences between somatic and cognitive anxiety symptoms in children undergoing surgery for lower leg fractures, addressing the need to better understand psychological effects in this vulnerable group. Methods: The research included 63 children with lower leg fractures, of whom 40 were boys (63.5%) and 23 were girls (36.5%), with a mean age of M = 15.174 (SD = 3.701). The instruments used in this research were as follows: the Demographic Data Questionnaire, the Children’s Anxiety Scale, the Beck Anxiety Inventory (BAI), and the Multidimensional Scale of Perceived Social Support. Results: The results showed that the only significant predictor of somatic symptoms of anxiety was the presence of paresthesia, while significant predictors of cognitive symptoms of anxiety were social support from friends and the presence of paresthesia. Conclusions: Paresthesia was identified as a significant predictor of somatic symptoms of anxiety, while social support from friends was associated with lower levels of cognitive anxiety symptoms in children with lower leg and ankle fractures. These results point to the relevance of considering both somatic and psychological factors in the recovery process following pediatric fractures. Full article

Osteoporosis is the most common metabolic bone disorder, characterized by reduced bone mass and abnormal bone microarchitecture, resulting in increased bone fragility and a heightened risk of low-energy fractures. Pediatric osteoporosis may be either primary, due to genetic factors, or secondary, arising from chronic diseases and/or their treatment. Oral health and proper occlusion are integral components of overall health, influencing functionality, nutrition, facial aesthetics, and psychosocial development during childhood. Severe malocclusion can adversely affect speech, mastication, appearance, psychological well-being, and social interactions. The aim of this narrative review is to examine the existing literature on orthodontic anomalies and management strategies in pediatric patients with osteoporosis while highlighting clinical challenges, treatment limitations, and areas necessitating further research. A comprehensive literature search was conducted in the PubMed database, focusing on studies involving human subjects aged 3 to 18 years, published in English between 2002 and 2024. The findings indicate that children with osteoporosis present with more severe dental and occlusal complications compared to their healthy peers, often facing increased orthodontic complexity due to skeletal fragility and systemic comorbidities. These challenges necessitate careful, individualized treatment planning and close multidisciplinary collaboration. Although research in this field remains limited due to the rarity of pediatric osteoporosis, recognizing and addressing the specific needs of this population is critical to improving clinical outcomes and guiding future therapeutic approaches. Full article

Background and Objectives: Artificial intelligence (AI) has seen rapid integration into various areas of medicine, particularly with the advancement of machine learning (ML) and deep learning (DL) techniques. In pediatric orthopedics, the adoption of AI technologies is emerging but still not comprehensively reviewed. The purpose of this study is to review the latest evidence on the applications of artificial intelligence in the field of pediatric orthopedics. Materials and Methods: A literature search was conducted using PubMed and Web of Science databases to identify peer-reviewed studies published up to March 2024. Studies involving AI applications in pediatric orthopedic conditions—including spinal deformities, hip disorders, trauma, bone age assessment, and limb discrepancies—were selected. Eligible articles were screened and categorized based on application domains, AI models used, datasets, and reported outcomes. Results: AI has been successfully applied across several pediatric orthopedic subspecialties. In spinal deformities, models such as support vector machines and convolutional neural networks achieved over 90% accuracy in classification and curve prediction. For developmental dysplasia of the hip, deep learning algorithms demonstrated high diagnostic performance in radiographic interpretation. In trauma care, object detection models like YOLO and ResNet-based classifiers showed excellent sensitivity and specificity in pediatric fracture detection. Bone age estimation using DL models often matched or outperformed traditional methods. However, most studies lacked external validation, and many relied on small or single-institution datasets. Concerns were also raised about image quality, data heterogeneity, and clinical integration. Conclusions: AI holds significant potential to enhance diagnostic accuracy and decision making in pediatric orthopedics. Nevertheless, current research is limited by methodological inconsistencies and a lack of standardized validation protocols. Future efforts should focus on multicenter data collection, prospective validation, and interdisciplinary collaboration to ensure safe and effective clinical integration. Full article

Background and Objectives: Musculoskeletal disorders (MSDs) are a leading cause of absenteeism among healthcare workers (HCWs), impacting healthcare delivery. Pediatric HCWs face specific physical demands such as lifting and awkward postures. While absenteeism rose during the COVID-19 pandemic, its effects on pediatric MSD-related leave remain unclear. This study examined MSD-related absenteeism trends among pediatric HCWs in a Romanian hospital across the pre-pandemic (2017–2019), pandemic (2020–2021), and post-pandemic (2022–2023) periods. Materials and Methods: We conducted a retrospective observational study using records from the hospital’s occupational health database. We included all HCWs who took MSD-related leave during 2017–2023. Diagnoses included arthropathies, dorsopathies, other osteoarticular/connective tissue disorders, and acute trauma or fractures. We used chi-square tests, ANOVA, and regression models to identify trends and predictors. Results: A total of 3388 cases were analyzed. Post-pandemic absenteeism increased significantly (40.1%), especially among women (86.8%), nurses (46.7%), and workers aged ≥46 (62.7%). A seasonal shift was observed, with spring peaks (March 9.7% and May 9.9%) replacing the pre-pandemic autumn peaks (October 11.9% and November 12.8%). The regression models identified age, occupation, and diagnosis type as significant predictors of leave duration. Conclusions: MSD-related absenteeism rose post-pandemic and showed altered seasonal patterns. Occupational and demographic predictors identified through a multivariate analysis highlight the need for anticipatory, evidence-based strategies to support pediatric HCWs, enhance workforce resilience, and sustain healthcare performance. Full article

Background: Traumatic injuries to the alveolar process and primary teeth in early childhood can have long-term consequences on the development of permanent dentition and eruption pathways. Objective: This case report aims to illustrate the impact of early orofacial trauma on the eruption and development of permanent maxillary incisors and to emphasize the importance of timely interdisciplinary management. Case Presentation: An 8-year-old female patient presented to a pediatric dentistry clinic with delayed eruption of the maxillary anterior permanent teeth. In contrast, her monozygotic twin sister exhibited complete eruption of all permanent anterior teeth, raising parental concern regarding a possible pathological delay. Her medical history revealed orofacial trauma at the age of two, resulting in an alveolar process fracture, avulsion of the primary maxillary left central incisor (tooth 61), and luxation of the primary maxillary right central incisor (tooth 51). A clinical examination demonstrated sufficient arch space without signs of eruption and enamel defects on tooth 52. Radiographic evaluations, including panoramic imaging and cone beam computed tomography (CBCT), confirmed the presence of impacted permanent teeth with structural anomalies suggestive of trauma-related developmental disturbances. Results: The patient underwent a multidisciplinary treatment over a three-year period involving pediatric dentistry, oral surgery, and orthodontics. Management included surgical exposure of the impacted teeth followed by orthodontic traction to guide the eruption and treatment of enamel hypoplasia. Conclusions: This case highlights the long-term consequences of early traumatic dental injuries on permanent dentition development. It underscores the necessity of early diagnosis and a coordinated interdisciplinary approach to optimize outcomes and enhance the long-term oral health and quality of life of affected individuals. Full article

Background: Pediatric diaphyseal forearm fractures, often caused by sports or leisure activities, require treatment based on fracture stability. While stable fractures can be managed conservatively, unstable fractures typically require surgery, with elastic stable intramedullary (IM) nailing (ESIN) being the gold standard. Bioabsorbable IM nails (BINs) offer an alternative by eliminating the need for implant removal surgery. Methods: Between May 2023 and January 2025, we consecutively managed 161 children with poly-L-lactic-co-glycolic acid (PLGA) BINs in two healthcare centers for diaphyseal forearm fracture and evaluated every reported difficulty and complication of resorbable IM nails. Results: Seven unique peri- or postoperative events occurred during the study period. Even with a high success rate, some complications occurred during the study period. Difficulties and complications were mainly dependent on the surgical technique. Iatrogenic complications such as bone cortex perforation and implant end split were evaluated, along with anatomical variations like focal and general medullary cavity stenosis narrowings that affected implant insertion. Secondary malalignment, one early (2 months) refracture, and one recurrent fracture (2 years) were also noted. Conclusions: Although BINs reduce the need for a second surgery, careful planning, technique, and follow-up are crucial for optimal outcomes. Further research is needed to assess long-term results and complications. Full article

Background and Objectives: Distal radius fractures are among the most common pediatric injuries, accounting for approximately 25% of all fractures in children. Displaced fractures are prone to re-displacement, necessitating additional interventions. K-wire fixation is effective in reducing re-displacement risks, but no one has systematically assessed its use. This study aims to compare the outcomes of cast immobilization alone versus cast immobilization with K-wire fixation in pediatric patients with displaced distal radius fractures. Methods: A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Embase databases for studies comparing these treatments. The quality assessment was conducted using the Cochrane Collaboration Risk of Bias for randomized studies and the Methodological Index for non-randomized studies. The meta-analysis was carried out using RevMan software V5.4. Results: Out of 267 initial records, 12 studies met the inclusion criteria, encompassing 1455 patients (853 treated with cast alone and 602 with K-wire fixation). Meta-analysis of 10 studies showed significantly higher re-displacement rates with cast immobilization compared to K-wire fixation (OR: 11.42, 95% CI: 2.43–53.77, p = 0.002, I² = 82%). The risk of secondary surgery was also higher in the cast group (OR: 6.91, 95% CI: 1.5–31.72, p = 0.01, I² = 75%). However, complications were lower with cast immobilization (OR: 0.68, 95% CI: 0.45–1.03, p = 0.07, I² = 74%), though not statistically significant. Conclusions: K-wire fixation appears to offer superior fracture stability and reduces the need for secondary surgeries compared to cast immobilization for displaced distal radius fractures in pediatric patients. However, both treatment modalities are associated with comparable complication rates, emphasizing the importance of individualized treatment planning. Full article

Pediatric obesity is associated with a wide range of comorbidities beyond metabolic changes, affecting cardiovascular, endocrine, reproductive, musculoskeletal systems, and also mental health. Hypertension, commonly observed in children with obesity, increases the risk of long-term cardiovascular disease. Polycystic ovary syndrome (PCOS) presents another significant endo-reproductive challenge that often develops during adolescence in females, leading to further comorbidities in adulthood. Additionally, excess adiposity can negatively impact bone health by modifying bone metabolism and increasing fracture risk. Obesity is also strongly linked to mental health disorders, including depression, anxiety, and low self-esteem, which can further exacerbate unhealthy lifestyle behaviors and disorders. Given the limitations and poor adherence of traditional treatment strategies, nutraceuticals have emerged as potential complementary therapies due to their bioactive properties. Various compounds have demonstrated antihypertensive, insulin-sensitizing, and anti-inflammatory effects, while others support bone metabolism and promote mental well-being. Herewith, we discuss the role of nutraceuticals in managing hypertension, PCOS, bone health, and mental health issues in individuals with obesity, evaluating their mechanisms of action and clinical relevance. Integrating nutraceutical compounds with dietary and lifestyle interventions may improve treatment outcomes and prevent obesity-related comorbidities. Further, we emphasize the need for further large-scale clinical studies, especially in pediatric patients. Full article

Wrist fractures, especially those involving the elbow and distal radius, are the most common injuries in children, teenagers, and young adults, with the highest occurrence rates during adolescence. However, the demand for medical imaging and the shortage of radiologists make it challenging to ensure accurate diagnosis and treatment. This study explores how AI-driven approaches are used to enhance fracture detection and improve diagnostic accuracy. In this paper, we propose the latest version of YOLO (i.e., YOLO11) with an attention module, designed to refine detection correctness. We integrated attention mechanisms, such as Global Attention Mechanism (GAM), channel attention, and spatial attention with Residual Network (ResNet), to enhance feature extraction. Moreover, we developed the ResNet_GAM model, which combines ResNet with GAM to improve feature learning and model performance. In this paper, we apply a data augmentation process to the publicly available GRAZPEDWRI-DX dataset, which is widely used for detecting radial bone fractures in X-ray images of children. Experimental findings indicate that integrating Squeeze-and-Excitation (SE_BLOCK) into YOLO11 significantly increases model efficiency. Our experimental results attain state-of-the-art performance, measured by the mean average precision (mAP50). Through extensive experiments, we found that our model achieved the highest mAP50 of 0.651. Meanwhile, YOLO11 with GAM and ResNet_GAM attained a maximum precision of 0.799 and a recall of 0.639 across all classes on the given dataset. The potential of these models to improve pediatric wrist imaging is significant, as they offer better detection accuracy while still being computationally efficient. Additionally, to help surgeons identify and diagnose fractures in patient wrist X-ray images, we provide a Fracture Detection Web-based Interface based on the result of the proposed method. This interface reduces the risk of misinterpretation and provides valuable information to assist in making surgical decisions. Full article

Due to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue with a unique mode of action and broad-spectrum activity against both Gram-positive (GP) and Gram-negative (GN) pathogens. It is used in various severe and deep-seated infections, including BJIs. This review article focuses on preclinical and clinical data surrounding the use of FOS for biofilm-related BJIs. Data from several in vitro and animal models of infection demonstrated that FOS, especially in combination with other antibiotics, is effective against biofilms of (methicillin-resistant) Staphylococcus spp., (vancomycin-resistant) Enterococcus spp., carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacterales, and MDR Pseudomonas aeruginosa. Data from clinical studies, mostly retrospective observational studies and case reports/case series, revealed that FOS was typically used in combination with other antibiotics for the treatment of various BJI, including acute and chronic osteomyelitis, prosthetic joint infections, and fracture-related infections, in adult and pediatric patients. Success rates often exceeded 80%. FOS exhibits good and fast penetration into bone tissue and is generally well tolerated, with only a few adverse drug reactions, such as gastrointestinal disorders and electrolyte imbalances. Collectively, the data indicate that FOS is a valuable option as part of combination regimens for the treatment of BJIs caused by both GP and GN bacteria. Full article