Search Results (215)

Neuromuscular hip dysplasia (NHD) is a common deformity in children with cerebral palsy (CP). Although some predictive factors of NHD are known, the prediction of NHD is in its infancy. We present a Clinical Decision Support System (CDSS) designed to calculate the probability of developing NHD in children with CP. The system utilizes an ensemble of three machine learning (ML) algorithms: Neural Network (NN), Support Vector Machine (SVM), and Logistic Regression (LR). The development and evaluation of the CDSS followed the DECIDE-AI guidelines for AI-driven clinical decision support tools. The ensemble was trained on a data series from 182 subjects. Inclusion criteria were age between 12 and 18 years and diagnosis of CP from two specialized units. Clinical and functional data were collected prospectively between 2005 and 2023, and then analyzed in a cross-sectional study. Accuracy and area under the receiver operating characteristic (AUROC) were calculated for each method. Best logistic regression scores highlighted history of previous orthopedic surgery (p = 0.001), poor motor function (p = 0.004), truncal tone disorder (p = 0.008), scoliosis (p = 0.031), number of affected limbs (p = 0.05), and epilepsy (p = 0.05) as predictors of NHD. Both accuracy and AUROC were highest for NN, 83.7% and 0.92, respectively. The novelty of this study lies in the development of an efficient Clinical Decision Support System (CDSS) prototype, specifically designed to predict future outcomes of neuromuscular hip dysplasia (NHD) in patients with cerebral palsy (CP) using clinical data. The proposed system, PredictMed-CDSS, demonstrated strong predictive performance for estimating the probability of NHD development in children with CP, with the highest accuracy achieved using neural networks (NN). PredictMed-CDSS has the potential to assist clinicians in anticipating the need for early interventions and preventive strategies in the management of NHD among CP patients. Full article

Background/Objectives: Lateral patellar dislocation (LPD) is a common pathology of the adolescent knee and a major predisposing factor for patellofemoral instability (PFI). The pathogenesis of PFI involves a combination of anatomical and biomechanical contributors, with increasing evidence pointing to sex-specific differences in knee morphology. Despite this, the developmental course of these parameters and their variation between sexes remain insufficiently characterized. This study aims to investigate sex-related differences in patellofemoral joint geometry among skeletally immature patients with a history of PFI, focusing on how these anatomical variations evolve with increasing knee size, as represented by femoral condylar width. Methods: A total of 315 knee MRIs from patients under 18 years with documented PFI were retrospectively analyzed. Trochlear morphology, patellar tilt, axial positioning, and sagittal alignment were assessed using established MRI-based parameters. All measurements were normalized to bicondylar width to account for individual knee size. Sex-specific comparisons were performed using independent t-tests and linear regression analysis. Results: Females exhibited significantly smaller femoral widths, shallower trochlear depth (TD), shorter tibial tubercle–posterior cruciate ligament (TTPCL) distances, and lower patellar trochlear index (PTI) values compared to males (p < 0.05). In males, increasing femoral width was associated with progressive normalization of patellar tilt and sagittal alignment parameters. In contrast, these alignment parameters in females remained largely unchanged or worsened across different femoral sizes. Additionally, patellar inclination angle and PTI were significantly influenced by knee size in males (p < 0.05), whereas no such relationship was identified in females. Conclusions: Sex-specific morphological differences in patellofemoral geometry are evident early in development and evolve distinctly with growth. These differences may contribute to the higher prevalence of PFI in females and underscore the importance of considering sex and knee size in anatomical assessments. Full article

Background: The rationale for strict fluid fasting for pediatric and adult patients has been questioned recently. Point-of-care tools for the evaluation of gastric content have evolved over time, often using gastric ultrasound. Usually, the gastric antral cross-sectional area (CSA) is determined. A liberal fluid fasting regimen, that is, ingestion of liquid fluids until the call for theatre, does not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound. Anesthesia is safe, and no adverse events result from a liberal regimen. Methods: The ethics committee of LMU Munich approved the study (21-0903). Liberal fluid fasting in a geriatric orthopedic surgery department (LFFgertrud) is a sub-study within a project investigating perioperative neurocognitive disorders (Study Registration: DRKS00026801). After obtaining informed consent from 134 geriatric patients 70 years or older, we investigated the gastric antral cross-sectional area (CSA) prior to and postimplementation of liberal fluid management, respectively. Results: After the implementation of liberal fluid fasting, fasting times for solid food and liquids decreased from 8.8 (±5.5) to 1.8 (±1.8) hours (p < 0.0001). In 39 patients where CSA was obtained, a slight increase in fluid was encountered. No critical amount of gastric content was observed, and no adverse events occurred. Conclusions: A liberal fluid fasting concept was safe even for comorbid elderly patients in orthopedic surgery. Applying a gastric ultrasound may be helpful to increase safety. According to the incidence of complications encountered in our study, it seems indispensable. Full article

Introduction: Cystic fibrosis (CF) is a genetic condition affecting several organs and systems, including the pancreas, colon, respiratory system, and reproductive system. The detection of a growing number of CFTR variants and genotypes has contributed to an increase in the CF population which, in turn, has had an impact on the overall statistics regarding the prognosis and outcome of the condition. Given the increase in life expectancy, it is critical to better predict outcomes and prognosticate in CF. Thus, each person’s choice to aggressively treat specific disease components can be more appropriate and tailored, further increasing survival. The objective of our narrative review is to summarize the most recent information concerning the value and significance of clinical parameters in predicting outcomes, such as gender, diabetes, liver and pancreatic status, lung function, radiography, bacteriology, and blood and sputum biomarkers of inflammation and disease, and how variations in these parameters affect prognosis from the prenatal stage to maturity. Materials and methods: A methodological search of the available data was performed with regard to prognostic factors in the evolution of CF in children and young adults. We evaluated articles from the PubMed academic search engine using the following search terms: prognostic factors AND children AND cystic fibrosis OR mucoviscidosis. Results: We found that it is crucial to customize CF patients’ care based on their unique clinical and biological parameters, genetics, and related comorbidities. Conclusions: The predictive significance of more dynamic clinical condition markers provides more realistic future objectives to center treatment and targets for each patient. Over the past ten years, improvements in care, diagnostics, and treatment have impacted the prognosis for CF. Although genotyping offers a way to categorize CF to direct research and treatment, it is crucial to understand that a variety of other factors, such as epigenetics, genetic modifiers, environmental factors, and socioeconomic status, can affect CF outcomes. The long-term management of this complicated multisystem condition has been made easier for patients, their families, and physicians by earlier and more accurate identification techniques, evidence-based research, and centralized expert multidisciplinary care. Full article

Childhood obesity is a major global health problem, and its management involves a multidisciplinary approach that includes lifestyle changes, dietary interventions, and the use of dietary supplements. In this review, we summarize current findings on the role of amino acids in pediatric obesity, with a particular focus on their involvement in metabolic pathways and weight regulation. The involvement of branched-chain and aromatic amino acids in the pathophysiology and potential management of pediatric obesity is highlighted in recent studies. Both experimental and clinical studies have shown that obese children often exhibit altered plasma amino acid profiles, including increased levels of leucine, isoleucine, valine, phenylalanine, and tyrosine, as well as decreased levels of glycine and serine. These imbalances are correlated with insulin resistance, inflammation, and early metabolic dysfunction. One of the mechanisms through which branched-chain amino acids can promote insulin resistance is the activation of the mammalian target of rapamycin (mTOR) signaling pathway. Metabolomic profiling has demonstrated the potential of specific amino acid patterns to predict obesity-related complications before they become clinically evident. Early identification of these biomarkers could be of great help for individualized interventions. Although clinical studies indicate that changes in dietary amino acids could lead to modest weight loss, improved metabolic profiles, and increased satiety, further studies are needed to establish standardized recommendations. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH) affects 1–3% of newborns and requires early detection for optimal outcomes. DDH involves abnormal acetabular–femoral congruence between the acetabulum and femoral head, resulting from either shallow acetabular development or delayed femoral ossification of the femoral head. We evaluated the ossification nucleus of the femoral head (ONFH) to determine prevalence, radiographic timing, and associations with perinatal factors. Methods: We analyzed 100 pelvic radiographs of infants between 90 and 150 days of age. Participants were selected by convenience sampling, based on inclusion criteria. We identified the presence of ONFH and measured biometric parameters, morphology, and anatomical location. Sociodemographic and perinatal data were collected from the participating infants. Results: The prevalence of ONFH was 33%, and the mean age at visualization was 104 days. The presence of ONFH was correlated with birth weight (p = 0.011), discharge weight (p = 0.005), and weight at 1 month (p = 0.034). In our study, female sex (p = 0.004) was associated with a 4.966-fold higher odds of ONFH prevalence compared to males. Conclusions: This study provides relevant evidence regarding the prevalence, morphology, and characteristics of ONFH. Few studies report this information on ONFH in different populations. The optimal timing for radiographic visualization of ONFH in infants remains undefined, but the appearance of the ONFH was concentrated around 104 days of life. The novel association between weight and ONFH provides new insights into DDH. This provides new insights for DDH screening. This association warrants further research for the early detection of DDH. Full article

Background/Objectives: Subtalar arthroereisis (STA) is a widely used surgical procedure for symptomatic pediatric flexible flatfoot. However, implant migration remains a concern due to its potential impact on long-term correction and complications. This study evaluated the migration pattern of STA implants and assessed long-term clinical and radiographic outcomes. Methods: This retrospective cohort study included 47 feet from children aged 8–13 years who underwent STA with adjunctive soft tissue procedures between 2014 and 2018, following ≥6 months of failed conservative treatment, with a minimum follow-up of 5 years. Exclusion criteria included neuromuscular or rigid flatfoot. Weight-bearing radiographs assessed anteroposterior (AP) and lateral Meary’s angles, reflecting forefoot-to-hindfoot alignment, and calcaneal pitch, indicative of longitudinal arch height. Implant migration was recorded and clinical outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) score. Measurements were recorded preoperatively, immediately postoperatively, and at 1 month, 3 months, 6 months, 1 year, and 5 years. Results: Radiographic correction was significant and sustained at 5 years. The AP Meary’s angle improved from 13.09° to 5.26° at 1 month and 6.69° at 5 years (p < 0.001); lateral Meary’s angle from 9.77° to 4.06° and 4.88° (p < 0.001); and calcaneal pitch from 14.52° to 16.87° and 16.89° (p < 0.001), respectively. AOFAS scores increased from 67.52 to 90.86 at 1 month and 96.33 at 5 years (p < 0.001). Implant migration peaked within the first postoperative month (mean: 3.2 mm on ankle AP view; 3.0 mm on foot AP view) and stabilized thereafter. Four cases of complications included implant dislodgement, subsidence, and persistent sinus tarsi tenderness, which were successfully resolved after appropriate management. No recurrence of deformity was observed. Conclusions: STA implant migration is most pronounced during the first month, likely due to physiological settling as the foot adapts to altered biomechanics. With appropriate implant selection, technique, and follow-up, migration does not compromise long-term correction or outcomes. In general, symptomatic cases can often be managed conservatively prior to implant removal. Full article

Biodegradable magnesium-based composites show potential application in orthopedic implants, with excellent biocompatibility, low density, and biodegradable characteristics inside the human body. In this study, the stir casting procedure was employed to produce magnesium–zinc MMCs (metal matrix composites) reinforced with MgO nanoparticles, and they were characterized intensively. The analyzed compositions were Mg/4Zn, Mg/4Zn/0.4MgO, and Mg/4Zn/0.6MgO. Their mechanical properties, corrosion resistance, and microstructure were then investigated employing tensile, impact, hardness, wear, and corrosion tests, supplemented with SEM analysis. The results indicate that the Mg-4Zn-0.6MgO composite exhibited the highest performance among the tested formulations, with a tensile strength of 150 MPa, a hardness of 65 HRE (Rockwell Hardness, E-scale), and enhanced corrosion resistance. These improvements are attributed to the uniform dispersion of MgO nanoparticles and the formation of a protective Mg(OH)₂ layer, which together contribute to mechanical reinforcement and controlled degradation behavior. The combination of superior mechanical properties and customizable biodegradability verifies the engineered Mg/4Zn/0.6MgO composite as a promising candidate for a biodegradable orthopedic fixation plate without secondary surgery. Full article

Background/Objectives: Skeletal dysplasias are a heterogeneous group of rare genetic disorders with diverse and overlapping clinical presentations, posing diagnostic challenges even for experienced clinicians. With the increasing availability of artificial intelligence (AI) in healthcare, large language models (LLMs) offer a novel opportunity to assist in rare disease diagnostics. This study aimed to compare the diagnostic accuracy of two advanced LLMs, ChatGPT (version GPT-4) and DeepSeek, with that of a clinical expert panel in a cohort of pediatric patients with genetically confirmed skeletal dysplasias. Methods: We designed a prospective vignette-based diagnostic benchmarking study including 45 children with confirmed skeletal dysplasias from two tertiary centers. Both LLMs were prompted to provide primary and differential diagnoses based on standardized clinical case vignettes. Their outputs were compared with those of two human experts (a pediatric endocrinologist and a pediatric orthopedic surgeon), using molecular diagnosis as the gold standard. Results: ChatGPT and DeepSeek achieved a comparable diagnostic top-3 accuracy (62.2% and 64.4%, respectively), with a high intermodel agreement (Cohen’s κ = 0.95). The expert panel outperformed both models (82.2%). While LLMs performed well on more common disorders, they struggled with ultra-rare and multisystemic conditions. In one complex case missed by experts, the DeepSeek model successfully proposed the correct diagnosis. Conclusions: LLMs offer a complementary diagnostic value in skeletal dysplasias, especially in under-resourced medical settings. Their integration as a supportive tool in multidisciplinary diagnostic workflows may enhance early recognition and reduce diagnostic delays in rare disease care. Full article

Background: The reproducible measurement of tibial torsion (TT) is essential for the diagnosis and evaluation of rotational deformities of the tibia, particularly in the planning of tibial derotational osteotomy. While various CT-based methods for determining the distal tibial axis have been described for adult patients, rotational Magnetic Resonance Imaging (MRI) represents a radiation-free alternative, especially for assessing lower limb rotation in pediatric patients. The aim of this study was to analyze the reliability of TT measurements as well as to investigate potential differences in the application of rotational MRI within a pediatric orthopedic cohort. Methods: In this retrospective study, 78 lower legs from 39 patients aged 4 to 18 years who underwent rotational MRI were included. Measurements for TT were performed using the Jend method, the Waidelich method, and the bimalleolar method. Reliability assessments were conducted by three different examiners, and the results were determined using the intraclass correlation coefficient (ICC). Results: All three methods demonstrated excellent interobserver reliability. The highest intraobserver reliability was achieved using the bimalleolar method (ICC: 0.947). When comparing the assessment of TT, the Jend method showed the highest mean values (34°, standard deviation (SD) 11.0°) followed by the Waidelich method (29°, SD 10.2°) and the bimalleolar method (26°, SD 9.9°). Measurement methods showed a mean difference of up to 8° (p < 0.001). Conclusions: Rotational MRI is a feasible radiation-free option to assess tibial torsion in pediatric and adolescent patients. All tested methods show excellent inter- and intraobserver reliability. Notably, significant differences were found between the measurement methods, with the bimalleolar method showing lower mean values. This has to be taken into account for preoperative planning of rotational and derotational tibial and supramalleolar osteotomies. Full article

Background/Objectives: The aim of this study was to establish the reliability and accuracy of a new noninvasive tool for FLLA (frontal plane lower limb alignment) assessment: a photometric method. Methods: Sixty-seven subjects (31 males, 36 females, age 11–47 years) participated in the study. Seventeen subjects with orthopedic disorders were marked with radiopaque markers over the anterior superior iliac spines and femoral condyles. One pelvis-to-floor radiograph and one photograph were taken in the same standardized standing position. The hip–knee–ankle (HKA) angle (radiography) and the pelvis–knee–ankle (PKA) angle (photography) were measured by one rater. In 50 healthy participants, anterior superior iliac spines and femoral condyles were marked, and two pelvis-to-floor photographs were taken in a standardized standing position. The PKA angle was measured two times by three raters. The accuracy of the photometric method was tested with Pearson’s correlation coefficient, simple linear regression, and Bland–Altman analysis. The reliability was tested with ICC(2,k) and Bland–Altman analysis. Results: The HKA angle was on average 3.9° more varus than the PKA angle, with a high correlation between measures (r = 0.97, p < 0.0001) and limits of agreement between −1.300 and −6.482. Intrarater (ICC(2,k) > 0.972), interrater (ICC(2,k) = 0.991), and test–retest (ICC(2,k) = 0.980) reliability were excellent. Conclusions: The photometric method is promising as a reliable and accurate noninvasive tool for assessing FLLA. Its accuracy across different study groups has yet to be confirmed in a larger cohort. The advantage of the presented photometric method is the use of the easily palpable anterior superior iliac spine as the proximal femoral axis point. Full article

Background: Skewfoot, also known as Z-foot, is a rare and complex deformity characterized by a combination of forefoot adduction and hindfoot valgus, resulting in a “Z” shape. Due to its rarity, diagnostic criteria and standardized treatment guidelines are lacking. This scoping review aims to systematically map and summarize the current knowledge regarding skewfoot. Methods: A comprehensive literature search of the PubMed, Cochrane Library, and Scopus databases was conducted to identify relevant articles. Patient-specific data were meticulously extracted from eligible studies and analyzed in detail. Results: A total of 12 studies met the inclusion criteria. Each study was independently reviewed, and data on epidemiology, etiology, clinical presentation, imaging assessment, and treatment options were extracted. Conclusions: The true incidence of skewfoot remains unknown. Etiology is likely multifactorial, often associated with systemic and neurological disorders. Skewfoot management ranges from conservative approaches to surgery. A medial cuneiform opening wedge osteotomy is the most used technique; however, the frequent need for additional procedures emphasizes the complexity of the deformity and the importance of a personalized approach. Full article

Background/Objectives: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder characterized by the posterior and inferior slippage of the femoral head through the growth plate. This study aimed to assess seasonal trends in the incidence of SCFE above 40° N latitude using cosinor regression analysis. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registration in Prospero. A keyword search of PubMed, Scopus, Web of Science, and Ovid was conducted using terms related to SCFE and seasonal or monthly variation. Studies were included if they reported month-by-month SCFE incidence in pediatric populations. Studies were excluded if they had duplicated population cohorts. Data from studies conducted above 40° N were extracted for cosinor regression analysis. Quality assessment was performed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: A total of seventeen studies were included, amassing a total of 21,428 children analyzed. Six investigations reported monthly incidence data for populations > 40° N. The highest pooled monthly incidence was observed in August (482 cases). Alternatively, February was the month with the lowest SCFE incidence (293). Cosinor regression analysis demonstrated that SCFE occurs more frequently during early summer and fall months (p < 0.0001). Conclusions: SCFE incidence follows a significant seasonal trend in higher-latitude (>40° N) populations, with a consistent late-summer peak. Recognizing seasonal variation patterns may inform early diagnosis and intervention in SCFE, improving outcomes in pediatric physeal injuries. Full article

Background: Reamer–irrigator–aspirators (RIAs) are newer orthopedic devices intended to harvest bone while minimizing complications associated with traditional harvesting techniques. Its high success rate has resulted in relatively few studies on its intraoperative and postoperative complications, especially in pediatric populations. This study provides a scoping review of complications associated with the RIA and presents an institutional case series of RIA complications. Materials and Methods: The scoping review was conducted via modified Joanna Briggs Institute (JBI) guidelines. Cases at a single institution were selected on an individual basis as they occurred during or after RIA-associated surgeries. Results: Our case series consists of three males and one female, ranging from 8 to 14 years old, with varying comorbid orthopedic conditions. All complications occurred intraoperatively, with three instances of retained hardware and one instance of cortical disruption. Each complication was classified as stage I according to the modified Clavien–Dindo–Sink classification system. There were no long-term sequelae despite limited management. A scoping review of the literature revealed extremely limited data on pediatric complications, but several mechanical and clinical complications have been described. Conclusions: Complications associated with RIA use in children appear to be inconsequential, but data are very sparse, and further studies are required. Full article

Background/Objectives: Large-language modules facilitate accessing health information instantaneously. However, they do not provide the same level of accuracy or detail. In pediatric orthopedics, where parents have urgent concerns regarding knee deformities (bowlegs and knock knees), the accuracy and dependability of these chatbots can affect parent decisions to seek treatment. The goal of this study was to analyze how AI chatbots addressed parental concerns regarding pediatric knee deformities. Methods: A set of twenty standardized questions, consisting of ten questions each on bowlegs and knock knees, were designed through literature reviews and through analysis of parental discussion forums and expert consultations. Each of the three chatbots (ChatGPT, Gemini, and Copilot) was asked the same set of questions. Five pediatric orthopedic surgeons were then asked to rate each response for accuracy, clarity, and comprehensiveness, along with the degree of misleading information provided, on a scale of 1–5. The reliability among raters was calculated using intraclass correlation coefficients (ICCs), while differences among the chatbots were assessed using a Kruskal–Wallis test with post hoc pairwise comparisons. Results: All three chatbots displayed a moderate-to-good score for inter-rater reliability. ChatGPT and Gemini’s scores were higher for accuracy and comprehensiveness than Copilot’s (p < 0.05). However, no notable differences were found in clarity or in the likelihood of giving incorrect answers. Overall, more detailed and precise responses were given by ChatGPT and Gemini, while, with regard to clarity, Copilot performed comparably but was less thorough. Conclusions: There were notable discrepancies in performance across the AI chatbots in providing pediatric orthopedic information, which demonstrates indications of evolving potential. In comparison to Copilot, ChatGPT and Gemini were relatively more accurate and comprehensive. These results highlight the persistent requirement for real-time supervision and stringent validation when employing chatbots in the context of pediatric healthcare. Full article