Is subclassification of Gartland extension-type pediatric supracondylar fracture into types IIA and IIB necessary for treatment decision? A result of pediatric orthopedist's survey and review of literature.

Extension-type pediatric supracondylar humeral fractures are very common. The Gartland classification is typically used to guide treatment. However, there is still no consensus on what factors should be used to subclassify the type II fractures and whether subclassification is needed to guide treatment.

Comparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network meta‑analysis of observational studies.

Purpose: There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD.

No Difference in the Incidence of Complications in Pediatric Patients with Moderate Anemia 30 Days after Pediatric Hip Surgery with and without Blood Transfusion.

This study investigated the association between postoperative blood transfusion and the incidence of postoperative complications 30 days after pediatric hip surgery as well as factors significantly associated with 30-day postoperative complications. Patients were divided into two groups: those with postoperative complications and those with no complications. Postoperative hematocrit (Hct) was categorized as <25%, 25-30%, and >30%.

Using Combinations of Both Clinical and Radiographic Parameters to Develop a Diagnostic Prediction Model Demonstrated an Excellent Performance in Early Detection of Patients with Blount's Disease.

Early identification of pathological causes for pediatric genu varum (bowlegs) is crucial for preventing a progressive, irreversible knee deformity of the child. This study aims to develop and validate a diagnostic clinical prediction algorithm for assisting physicians in distinguishing an early stage of Blount's disease from the physiologic bowlegs to provide an early treatment that could prevent the progressive, irreversible deformity. The diagnostic prediction model for differentiating an early stage of Blount's disease from the physiologic bowlegs was developed under a retrospective case-control study from 2000 to 2017.

Identifying children at high risk for recurrence child abuse.

Purpose: To evaluate the characteristics of abused children, families and abusive event and to identify risk factors associated with recurrence of child abuse.

Methods: Retrospective data from 133 children aged between 2 months to 15 years old who were diagnosed as abuse between year 2002 and 2017. Thirteen items related to characteristics of the child, families, abusive event were selected.

Medial Metaphyseal Beak Angle as a Predictor for Langenskiöld Stage II of Blount's Disease.

Objective: To determine the medial metaphyseal beak (MMB) cut-off angle predicting Langenskiöld stage II of Blount's disease and to study the intra-observer and inter-observer reliabilities of angle measurements and the influence of the experience level of observers.

Methods: A retrospective study was conducted on children aged 2-4 years from January 2000 to December 2017. Children were identified through a computer-based search.

Pediatric elbow measurement parameters: Evaluation of the six angles in inter- and intra-observer reliability.

Background: Several radiographic measurements of the humerus can be used to evaluate the treatment outcome of supracondylar fractures in children. Because of the cartilaginous nature of the immature elbow, interpretation of radiographs around this area is sometimes challenging and can be unreliable. This study was conducted to determine the inter-observer and intra-observer reliability of the six commonly used radiographic measurements of the distal humerus.

Medial Metaphyseal Slope as a Predictor of Recurrence in Blount Disease.

Objective: This study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.

Method: We retrospectively reviewed radiographs of 82 legs from 49 patients diagnosed with stage 2 Blount's disease by Langenskiöld classification who had failed brace treatment and underwent valgus osteotomy between 1998 to 2016. Age ranged from 26 to 47 months.

Periarticular large bone defects treatment with ring external fixator.

Background: Joint stiffness and limited bone stock for fixation were the main problems in management of periarticular bone defects. The present study aimed to report clinical and radiographic outcome of periarticular, large (≥8 cm) bone defects treated with ring external fixator.

Materials And Methods: Seventeen patients (10 males and 7 females) who had periarticular bone loss at the minimum of 8 cm were treated with ring external fixator.

Potential risk factors for birth fractures: a case-control study.

Introduction And Hypothesis: Birth fractures are uncommon but remain a concern among obstetricians. Although such fractures usually heal without long-term sequelae, some are associated with lifelong disabilities, such as brachial plexus injuries. The purpose of this study was primarily to investigate risk factors related to birth fractures.

Evertor muscle activity as a predictor for recurrence in idiopathic clubfoot.

Background: Clubfoot is a complex three-dimensional deformity. Although brace compliance after initial correction was previously found to be significantly associated with recurrence in clubfoot, few previous studies have specifically examined evertor muscle function as a factor that contributes to recurrence in children with idiopathic and non-idiopathic clubfoot. The aim of this study was to investigate the relationship among brace compliance, evertor muscle grading, and recurrence rate in pediatric clubfoot patients.

Free non-vascularized fibular graft for treatment of large bone defect around the elbow in pediatric patients.

Background: Large bone defect is a challenging problem in orthopedics practice. Several methods are available for bridging of these bone defects, including cancellous bone graft, free vascularized fibula graft, and bone transport with external ring fixator. The aim of this study was to describe our experience in nine pediatric cases of free non-vascularized autogenous fibular strut bone graft in which large bone defect and bone loss of >7 cm was caused by open fracture and infective nonunion around the elbow joint.

Does the parental stretching programs improve metatarsus adductus in newborns?

Background: Metatarsus adductus (MA) is a common pediatric foot deformity. Current recommendations suggest observation until 4-6 months, then casting if the deformity persists. Based on our review of the literatures, no randomized controlled trial has been conducted to study the effectiveness of parental stretching in the correction of MA in newborn.

Complications Associated with Ponseti Serial Casting and Surgical Correction via Soft Tissue Release in Congenital Idiopathic Clubfoot.

Background: The current standard treatment used worldwide for management of congenital idiopathic clubfoot is serial casting by Ponseti method. Prior to 2006, standard treatment for congenital idiopathic clubfoot at Siriraj Hospital involved major soft tissue release by any of the following release techniques, modified posteromedial release, complete subtalar release, and posterior release.

Objective: To evaluate the complications and recurrence of deformity associated with treatment of congenital idiopathic clubfoot by Ponseti serial casting and major soft tissue release at Siriraj Hospital.

The Comparison between Computer-Assisted Hexapods and Ilizarov Apparatus in Gradual Tibial Deformity Correction: A Preliminary Study.

Background: The Hexagonal external fixator (Hexapods) is known to have the ability to correct complex multi-planar deformities faster than the Ilizarov apparatus. However, the difficulty of achieving deformity correction by Hexapods seems to limit its popularity.

Objective: This study aims to compare the advantages and disadvantages of Hexapods and Ilizarov in the gradual correction of complex tibial deformities.

The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B).

In type 2 supracondylar fracture, closed pinning has been recommended in most patients. However, a stable, mildly displaced fracture can be treated with nonsurgical means. If stable, mildly displaced fractures are categorized as Gartland type 2A and unstable fractures as type 2B, orthopedic surgeons will be greatly benefited while selecting the most appropriate treatment.

Results of Primary Talectomy for Clubfoot in Infants and Toddlers with Arthrogryposis Multiplex Congenita.

Background: Equinovarus deformity in arthrogryposis multiplex congenita patients is rigid and difficult to treat. Radical soft tissue operations yielded good results though recurrence of deformity was high. Talectomy is a bony procedure recommended as either a salvage procedure or a primary operation.

Should we repair nonunion of the lateral humeral condyle in children?

Purpose: Patients with nonunion of the lateral humeral condyle often present with pain, instability, progressive cubitus valgus and tardy ulnar nerve palsy. At present repairing of this nonunion is still controversial due to previous reported complications such as stiffness and avascular necrosis (AVN). This study reported the outcomes of treatment in nonunion of the lateral humeral condyle in children.

The most important risk factors for avascular necrosis and chondrolysis in patients with slipped capital femoral epiphysis.

Objective: To study the most important risk factors for avascular necrosis (AVN) and chondrolysis in children with slipped capital femoral epiphysis (SCFE).

Material And Method: Thirty patients with SCFE, who were surgically treated by single-screw fixation with goodpositioning from 1998 to 2012, were reviewed (22 male and 8 female patients, 35 hips; bilateral involvement in 1 male and 4 female patients). The following clinical and radiographic data were analyzed: age, sex, weight, height, onset, grading, stability, severity, history of trauma, anterior physeal separation (APS), and major complications such as AVN and chondrolysis.

Prevalence and patterns of fractures in children.

Objective: To study the prevalence, patterns, and causes of fractures in children at Siriraj Hospital in the years 2006, 2009, and 2012.

Material And Method: Patient records, files, and radiographs of all children under 16 years of age who had sustained a fracture and came to Siriraj Hospital in the years 2006, 2009, and 2012 were collected. The prevalence and patterns of fractures were reviewed for details, such as age at time of injury, gender, side, location, types, and causes offractures.

Results of surgical treatment of coxa vara in children: valgus osteotomy with angle blade plate fixation.

Background: Coxa vara is a rare condition. Surgical correction of coxa vara has been challenging. A few reports present correction coxa vara in multiple causes.

The effectiveness of parent manipulation on newborns with postural clubfoot: a randomized controlled trial.

Objective: The aim of the present study was to determine the effectiveness of parent manipulation on newborns with postural clubfoot, as compared to newborns that receive no treatment in a randomized controlled trial.

Material And Method: Ninety-two healthy newborns, including 40 boys and 52 girls, (169 postural clubfeet, including 77 with bilaterally involvement) were included and categorized into two groups by simple randomization using the sealed opaque envelope technique. In Group A, the parent manipulation group, there were 14 boys and 33 girls in 85 postural clubfeet with 38 bilateral involvements.

Management of fibular hemimelia using the Ilizarov method at Siriraj Hospital in Thailand.

Background: Fibular hemimelia is one of the most common congenital longitudinal bone deficiencies. Previous treatment protocols called for amputation of the deficient limb; while others made attempts to save the limb. The objective of treatment is to restore function and achieve patient satisfaction.

Results of surgical release in pediatric trigger thumb.

Objective: To observe and evaluate the treatment outcome of pediatric trigger thumb in patients who had undergone surgical release of the annular ligament with the oblique pulley partially released in patients who did not achieve full IP joint extension.

Material And Method: From 2003 to 2010, 21 surgically operated thumbs in 17 patients were reviewed. Bowstringing, range of motion (ROM) of thumb interphalangeal joint, Notta's node resolution and assessment of patient/parent satisfaction were used as outcome parameters.

Four-point molding: a new cast molding technique for closed reduction treatment of developmental dysplasia of the hip.

Background: In order to achieve added stability in a hip spica cast and decrease unnecessary open reduction, the authors have devised a new hip spica cast molding technique that has been named, "Four-point molding technique". Our aim was to evaluate the efficacy of this technique, in terms of its ability to deliver a stable, concentric reduction of the hip.

Material And Method: The authors retrospectively reviewed the patients, aged 6-24 months, that were diagnosed with DDH and who had undergone closed reduction with a hip spica cast.