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New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: 15 October 2025 | Viewed by 13958

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Dr. Sergio De Salvatore

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1. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
2. Orthopaedic Unit of Ospedale Pediatrico Bambino Gesù, Via della Torre di Palidoro, 00050 Fiumicino, Italy
Interests: spine surgery; scoliosis; pediatric orthopaedics; Scheuermann disease; early onset scoliosis

Dr. Laura Ruzzini

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Guest Editor

Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Interests: pediatric orthopedics; pediatric traumatology; flatfoot; developmental hip dysplasia
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Special Issue Information

Dear Colleagues,

We are pleased to announce a Special Issue of the Journal of Clinical Medicine (JCM) focused on “New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children”. This Special Issue aims to explore innovative diagnostic methods, cutting-edge treatments, and comprehensive care strategies for pediatric orthopedic conditions.

Pediatric orthopedic diseases present unique challenges and require specialized approaches to ensure effective management and positive outcomes for young patients. This Special Issue seeks to gather high-quality research papers and reviews that will provide valuable insights into the latest advancements in this field.

We invite contributions that cover a broad range of topics, including but not limited to the following:

Advanced imaging techniques and their applications in pediatric orthopedics.
Novel surgical techniques and minimally invasive procedures.
Recent developments in non-surgical treatments and rehabilitation.
Case studies and clinical trials showcasing new therapeutic approaches.
Long-term outcomes and quality of life assessments for pediatric orthopedic patients.

Our goal is to create a comprehensive collection of articles that will serve as a valuable resource for clinicians, researchers, and healthcare professionals involved in the care of children with orthopedic conditions. We encourage submissions from both established experts and emerging researchers to foster a diverse and rich discussion within the field. We look forward to your participation and to a fruitful collaboration that will advance our understanding and treatment of pediatric orthopedic diseases.

Dr. Sergio De Salvatore
Dr. Laura Ruzzini
Guest Editors

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Keywords

pediatric orthopedics
flatfoot
genu valgum
genu varum
hip dysplasia
clubfoot
early-onset scoliosis
Scheuermann disease
perthes
epiphysiolysis
scoliosis
pediatric trauma

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Published Papers (9 papers)

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12 pages, 1202 KB

Open AccessArticle

The Role of Physical Examination in Assessing Hip Migration in Children with Cerebral Palsy

by Merel Charlotte Rosalie Roelen, Renée Anne van Stralen, Jim Bono Aalbers, Denise Eygendaal, Max Reijman and Jaap Johannes Tolk

J. Clin. Med. 2025, 14(16), 5813; https://doi.org/10.3390/jcm14165813 - 17 Aug 2025

Viewed by 481

Abstract

Background: Hip migration is a common comorbidity in children with cerebral palsy (CP) and can progress to complete hip dislocation, resulting in a reduced quality of life. Structured surveillance programs designed to prevent complete hip dislocation have demonstrated success regarding the early identification of hip migration. The objectives of this study are to determine whether there is a correlation between hip abduction in flexion (AIF) and migration percentage (MP) and to determine if there are clear cutoff values for hip abduction in flexion that are associated with progressive hip migration. Methods: This retrospective study evaluated children at our neuromuscular clinic between 2018 and 2022. We included children diagnosed with spastic CP for whom hip radiographs and concurrent physical examinations were available. The outcomes were assessed using AIF as a measure of range of motion and migration percentage according to Reimers. Results: In total, 83 patients were included, with a mean MP of 30.7% and a median AIF of 40 degrees. Mixed-effects modeling revealed a significant correlation between MP and AIF (β = −0.51, p < 0.001). Using generalized linear mixed-effects models and ROC analysis, we established a cutoff value of 40 degrees for AIF in predicting MP above 30%, with a sensitivity of 94.5% and a specificity of 80%. Conclusions: A negative correlation between AIF and MP was found, indicating that as AIF decreases, MP increases. Furthermore, a distinct cutoff value of 40° for AIF in progressive hip migration was found, which can guide timely referrals and early imaging. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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12 pages, 2815 KB

Open AccessArticle

Counter-Rotate Technique Is Substantial for Correcting Thoracolumbar/Lumbar Curvature in AIS Patients with Thoracic Scoliosis

by Shoji Seki, Peter O. Newton, Hiroto Makino, Hayato Futakawa, Katsuhiko Kamei, Yushi Yashima and Yoshiharu Kawaguchi

J. Clin. Med. 2025, 14(3), 706; https://doi.org/10.3390/jcm14030706 - 22 Jan 2025

Viewed by 1233

Abstract

Background/Objectives. Correction of thoracolumbar/lumbar curvature in adolescent idiopathic scoliosis (AIS) patients with Lenke 1-2 B and C is still controversial, with regard to extension of the caudal side to the lowest instrumented vertebra (LIV) and method of correction. We assessed the association between change in thoracolumbar/lumbar curvature after surgery with counterrotate technique (CRT) and clinical factors in 45 thoracic AIS patients. Methods. Forty-five AIS patients (mean follow-up 5.1 y, age 15 y, Type B: 28, Type C: 17) were analyzed. Posterior spinal fusion was performed by the placing of segmental uni-planar screws, concave rod rotation, differential rod countering, and segmental CRT. Association between change in thoracolumbar/lumbar curvature after surgery with counter-rotate technique and clinical factors was analyzed in 45 thoracic AIS patients. Results. Mean main thoracic Cobb angle was 52°, and mean thoracolumbar/lumbar curvature Cobb angle was 35°. Postoperative thoracolumbar/lumbar Cobb was 10.1, and final follow-up was 8.2. Multi logistic regression analysis of change in thoracolumbar/lumbar Cobb after surgery was performed. Age (p < 0.05), Risser sign (p < 0.05), and postoperative thoracolumbar/lumbar Cobb (p < 0.0001) were significantly associated with a change in Cobb angle. Conclusions. Correction of thoracolumbar/lumbar curvature using CRT showed significant improvement of thoracolumbar/lumbar curvature, LIV tilting angle, and vertebral rotation. Postoperative thoracolumbar/lumbar Cobb angle (1st erect) was the most significant factor associated with deterioration of thoracolumbar/lumbar curvature after surgery. Subsequent rotational correction of thoracolumbar/lumbar curvature is likely to prevent the deterioration of thoracolumbar/lumbar Cobb after surgery. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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16 pages, 3280 KB

Open AccessArticle

Efficacy and Risks of Posterior Vertebral Column Resection in the Treatment of Severe Pediatric Spinal Deformities: A Case Series

by Emanuela Asunis, Chiara Cini, Konstantinos Martikos, Francesco Vommaro, Gisberto Evangelisti, Cristiana Griffoni and Alessandro Gasbarrini

J. Clin. Med. 2025, 14(2), 374; https://doi.org/10.3390/jcm14020374 - 9 Jan 2025

Viewed by 1361

Abstract

Background/Objectives: Surgery for adolescent idiopathic deformities is often aimed at improving aesthetic appearance, striving for the best possible correction. However, severe and rigid scoliotic curves not only present aesthetic issues but can also compromise cardiopulmonary health and cause early neurological impairment due to spinal cord compression, posing significant risks of morbidity and mortality if untreated. Conservative treatments are ineffective for severe curves, defined by scoliotic angles over 70° and flexibility below 30% on lateral bending X-rays. Treatment often requires invasive interventions, such as osteotomies and vertebral resections. In particular, posterior vertebral column resection (PVCR) has shown effectiveness in realigning vertebral structures in complex cases. This study describes the efficacy and risks of PVCR through a series of cases treated at our institution. Methods: This case series was conducted at the Rizzoli Orthopedic Institute in Bologna, involving eight pediatric patients with severe, rigid spinal deformities, operated upon between 2018 and 2023. The underlying pathologies included idiopathic kyphoscoliosis, neurofibromatosis type 1, Pott’s disease, and other congenital anomalies. Preoperative assessment included standard radiographs, magnetic resonance imaging, and computed tomography. During PVCR, motor and sensory evoked potentials were monitored to minimize neurological injury risk. Postoperative management included blood transfusions, antibiotic support, and early physiotherapy. Results: PVCR resulted in an average reduction in the Cobb angle from 86.3° preoperatively to 22.4° postoperatively, with a mean correction of 64%. The mean duration of the procedures was 337.4 min. Three patients had an uneventful postoperative course, while five developed complications, including infections and temporary neurological deficits, which were successfully managed. One patient developed an epidural hemorrhage that required emergency surgery for hematoma evacuation, with partial recovery. This study demonstrates the potential of PVCR for correcting rigid spinal deformities, highlighting the importance of postoperative management to minimize the associated risks. Conclusions: Posterior vertebral resection techniques offer significant promise in the correction of pediatric spinal deformities. Although ours is a small case series, it can provide important data for such treatment. Long-term monitoring is needed to fully understand the impact of these procedures and to further refine surgical techniques. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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9 pages, 246 KB

Open AccessArticle

Pediatric Supracondylar Humerus Fracture: When Should We Surgically Treat? A Case-Series

by Filippo Familiari, Andrea Zappia, Giorgio Gasparini, Michele Mercurio, Giuseppe Tedesco, Daria Anna Riccelli, Livio Perticone, Giovanni Carlisi, Gianluca Testa, Ludovico Lucenti, Vito Pavone and Andrea Vescio

J. Clin. Med. 2025, 14(1), 237; https://doi.org/10.3390/jcm14010237 - 3 Jan 2025

Cited by 1 | Viewed by 1584

Abstract

Background/Objectives: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. Methods: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann’s angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with p < 0.05 considered significant. Results: No significant differences were observed in BA (p = 0.84) or SCA (p = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (p = 0.92) or radiation exposure (p = 0.12). The complication rate was 6.45%. Conclusions: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

16 pages, 2605 KB

Open AccessArticle

The Effect of the Cheneau Brace on Respiratory Function in Girls with Adolescent Idiopathic Scoliosis Participating in a Schroth Exercise Program

by Anna Badowska, Paulina Okrzymowska, Elzbieta Piatek-Krzywicka, Bozena Ostrowska and Krystyna Rozek-Piechura

J. Clin. Med. 2024, 13(23), 7143; https://doi.org/10.3390/jcm13237143 - 26 Nov 2024

Cited by 1 | Viewed by 2048

Abstract

Objectives: The aim of this study was to evaluate the effect of brace use application and the Schroth intervention on lung ventilation and respiratory muscle strength in patients treated long-term with a Chaneau brace and the Schroth method. Methods: A total of 26 post-menarche females aged 15.7 ± 1.5 years, with a Cobb angle of 18–48° and a diagnosis of AIS in inpatient rehabilitation were examined. All participants received brace treatment for a minimum of 3 months with a dosage of 20–22 h/day. This study protocol was performed three times: 1—brace intervention—first day of the present study; 2—without the brace—second day of the present study; and 3—Schroth intervention on the same day. Results: During the period of brace use, girls treated with a long-term therapy showed significantly reduced values for VC, FVC, and FEV₁ and significantly higher values for inspiratory muscle strength PI_max compared to values obtained in studies without the brace and after single exercises. Expiratory muscle strength did not differ significantly. Conclusions: The majority showed restrictive lung ventilation disorders and decreased respiratory muscle strength in relation to norms. There was a significant correlation of PI_max with the duration of wearing the brace and the duration of therapy. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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9 pages, 787 KB

Open AccessArticle

Risk Factors for Developmental Dysplasia of the Hip: A Critical Analysis About an Unclear Relationship

by Tamir Dib, Matteo Nanni, Ilaria Sanzarello, Giada Salvatori, Daniela Alessia Marletta, Biagio Zampogna and Danilo Leonetti

J. Clin. Med. 2024, 13(22), 6898; https://doi.org/10.3390/jcm13226898 - 16 Nov 2024

Viewed by 1315

Abstract

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc–IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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13 pages, 2811 KB

Open AccessSystematic Review

Traumatic Bilateral Lumbosacral Jumped Facet Without Fracture in Childhood: Case Report and Systematic Review

by Maria Ilaria Borruto, Michele Pomponi, Calogero Velluto, Achille Marciano, Luca Proietti and Laura Scaramuzzo

J. Clin. Med. 2025, 14(17), 6228; https://doi.org/10.3390/jcm14176228 - 3 Sep 2025

Viewed by 428

Abstract

Background/Objectives: Traumatic dislocation of the lumbosacral facet joints without associated fractures is exceedingly rare in the pediatric population. Due to the unique anatomical and biomechanical features of the pediatric spine, such injuries present diagnostic and therapeutic challenges. This study aims to describe a rare case of bilateral L5–S1 jumped facets without fracture in a 13-year-old boy and to review the existing literature on pediatric traumatic facet dislocations. Methods: We performed a systematic review according to PRISMA guidelines, searching PubMed, Embase, Scopus, and the Cochrane Library up to 16 January 2025. Keywords included “pediatric traumatic spondylolisthesis” and “pediatric traumatic facet joint”. Eligible studies reported traumatic lumbosacral or thoracolumbar facet dislocations in patients aged <18 years. In addition, we report the clinical course, surgical management, and outcome of a representative case from our institution. Results: The systematic review identified 14 pediatric cases across 11 studies. Most patients were male (71.4%), with high-energy trauma as the primary mechanism. The L5–S1 level was most frequently involved (57.1%). Neurological impairment was present in 57.1% of cases. All patients underwent surgical treatment, with posterior fixation being the most common approach. Our case involved bilateral L5–S1 jumped facets without fracture, successfully treated with open reduction and posterior fusion. Postoperative recovery was favorable, with neurological improvement. Conclusions: Traumatic bilateral facet dislocation without fracture is an extremely rare but serious condition in pediatric patients. Early recognition and surgical stabilization are essential to prevent permanent neurological damage. This study reinforces the importance of advanced imaging and prompt multidisciplinary management in optimizing outcomes. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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11 pages, 622 KB

Open AccessSystematic Review

The Role of Glenoid Osteotomy in the Treatment of Shoulder Dysplasia in Brachial Plexus Birth Palsy: A Systematic Review of the Literature

by Chiara Arrigoni, Roberto Facchi and Nunzio Catena

J. Clin. Med. 2025, 14(16), 5610; https://doi.org/10.3390/jcm14165610 - 8 Aug 2025

Viewed by 357

Abstract

The treatment of shoulder dysplasia resulting from brachial plexus birth injury (BPBI) remains a matter of debate within pediatric orthopedic and neurosurgical communities. Various approaches have been proposed to address the muscular imbalance and joint incongruity that develop in affected children, with special attention paid to the roles of humeral head reduction and tendon transfers. Background/Objectives: These procedures aim to correct the disproportionate strength between internal and external rotators of the shoulder. However, the specific contribution of skeletal procedures such as glenoid osteotomy to restoring shoulder mechanics remains controversial. Glenoid osteotomy, a technique that involves surgically reorienting the glenoid cavity, is hypothesized to promote better containment of the humeral head and allow more physiological joint development. On one hand, altering the glenoid axis could enhance joint congruency and facilitate remodeling during growth. On the other hand, there is limited evidence supporting its efficacy and safety. Methods: This review aims to assess the available literature to determine whether glenoid osteotomy represents a safe and effective procedure for patients with BPBI-associated shoulder dysplasia. A comprehensive literature search yielded 1380 titles. After excluding studies focused on adults and those failing to meet inclusion criteria, only three studies were selected for final analysis. Due to the limited data and variability in study design, no statistical meta-analysis could be performed. Results: Findings suggest that glenoid osteotomy, particularly when combined with tendon transfers, may lead to improvements in shoulder abduction and external rotation. However, outcomes are often difficult to interpret in isolation, and the specific benefits attributable to the osteotomy remain unclear. The lack of standardized imaging, follow-up, and scoring systems limits the strength of current conclusions. Conclusions: Further multicenter, prospective studies are needed to evaluate the long-term efficacy of glenoid osteotomy, its role in skeletal remodeling, and its contribution to overall shoulder stability and function. Such studies would help clarify the true potential of this surgical technique in the broader context of BPBI treatment. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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15 pages, 1070 KB

Open AccessSystematic Review

The Impact of Physical Activity on Adolescent Low Back Pain: A Systematic Review

by Edoardo Costici, Sergio De Salvatore, Leonardo Oggiano, Sergio Sessa, Cloe Curri, Laura Ruzzini and Pier Francesco Costici

J. Clin. Med. 2024, 13(19), 5760; https://doi.org/10.3390/jcm13195760 - 27 Sep 2024

Cited by 2 | Viewed by 4338

Abstract

Background: The relationship between physical activity and low back pain (LBP) in adolescents is complex, with conflicting evidence on whether activity is protective or a risk factor. The COVID-19 pandemic has introduced new challenges, increasing sedentary behaviors among adolescents. This systematic review updates the evidence on the association between physical activity and LBP in this population, focusing on the impact of the pandemic. Methods: A systematic search of PubMed, Cochrane Library, Web of Science, Medline, and SCOPUS identified observational studies published between January 2011 and December 2023. This review focused on adolescents aged 10 to 19 years, examining the effects of various physical activity levels and types on LBP incidence. Quality assessment was conducted using the ROBINS-I tool. Results: Twelve studies were included, with a total of 78,850 adolescents. The findings suggest a U-shaped relationship between physical activity and LBP, where low and high activity levels increase LBP risk, while moderate activity appears protective. The pandemic exacerbated LBP prevalence, likely due to increased sedentary behavior. Gender differences were noted, with females more likely to report LBP, particularly related to sports participation. Conclusions: Moderate physical activity may protect against LBP in adolescents, whereas both inactivity and excessive activity heighten risk. The pandemic’s impact highlights the need for balanced physical activity to prevent LBP. Further research should explore the long-term effects of these changes. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

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