The levels of evidence in pediatric orthopaedic journals: where are we now?

Background: In recent years, it has become common to publish a level of evidence grading for orthopaedic journal publications. Our primary research question is: is there an improvement in levels of evidence of articles published in pediatric orthopaedic journals over time? In addition, what is the current status of levels of evidence in pediatric orthopaedic journals?

Methods: All articles in Journal of Pediatric Orthopaedics-A (JPO-A) and Journal of Pediatric Orthopaedics-B (JPO-B) for 2001, 2002, 2007, and 2008 and those in Journal of Children's Orthopaedics (JCO) for 2007 and 2008, were collected by an independent reviewer. Of the 1,039 articles identified, animal, cadaveric and basic science studies, expert opinion and review articles were excluded.

Management of severe crouch gait in children and adolescents with cerebral palsy.

Background: Crouch gait in cerebral palsy is associated with spasticity and contracture of the hamstrings and weakness of the extensors of the hip and knee and ankle plantar flexors. Different treatment options have been described in the literature to deal with this difficult problem. We devised a different protocol of treatment aimed at correction of the flexion deformity of the knee, weakening of the hamstrings, and augmenting the power of the knee and hip extension, which we used on 17 children with severe crouch.

Levels of evidence at the Pediatric Orthopaedic Society of North America annual meetings.

Background: Since 2003, levels of evidence have been used in the orthopaedic literature to inform the reader of the study quality and its relative significance. Our primary research question was to identify if, since their introduction, there has been an improvement in the levels of evidence of the scientific papers presented at Pediatric Orthopaedic Society of North America (POSNA) meetings.

Methods: The abstract of every paper presented orally at the POSNA annual meeting were identified for the years 2001, 2002 (pre-2003) and 2007, 2008 (post-2003).

Congenital aplasia of the patella and the distal third of the quadriceps mechanism.

Congenital absence of the patella and aplasia of the muscles are very rare anomalies. We describe a 4-year-old boy with bilateral congenital aplasia of the patella and agenesis of the distal third of the quadriceps muscle who was unable to walk owing to the lack of active knee extension. The features of this child differed from all other conditions associated with patellar aplasia.

Measurement of tissue hardness: can this be a method of diagnosing compartment syndrome noninvasively in children?

In order to assess the feasibility of using the measurement of tissue hardness as a method of diagnosing compartment syndrome noninvasively in children, a simple hand-held device to measure tissue hardness was fabricated. The relationship between hardness and compartmental pressure was studied in an experimental model and in three fresh amputated lower limbs. Normal tissue hardness of the forearm was measured in 189 children and 20 adults to identify the factors that influence normal tissue hardness.

Evaluation of outcome of treatment of congenital clubfoot.

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible. Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems.

Congenital distal humeral dysplasia: a case report.

Congenital dysplasia of the humerus is very rare. It is characteristically seen in omodysplasia and has also been reported as one of the associated features of Larsen's syndrome. We report a 4-year-old girl with bilateral humero-ulnar dysplasia, with dislocation of the elbows, facial dysmorphism, ball-and-socket ankles and foot deformities.