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Personalized Management of Pediatric Orthopaedic Surgery

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy and Drug Delivery".

Deadline for manuscript submissions: 15 January 2025 | Viewed by 10220

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Prof. Dr. Vito Pavone

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Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
Interests: pediatric orthopedics; joint replacement; trauma; pediatric trauma; hip; knee
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Prof. Dr. Federico Canavese

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Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, 59800 Lille, France
Interests: pediatric orthopedics; pediatric trauma; hip pediatric surgery; spine pediatric surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Marco Sapienza

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Dear Colleagues,

I cordially invite you to contribute to a Special Issue of the Journal of Personalized Medicine, dedicated to the individualized management of pediatric orthopedic surgery.

In recent decades, pediatric orthopedics has carved out its own place as a major specialist field with rapid advancements in the diagnosis and treatment of young patients with musculoskeletal disorders.

Correct management can result from factors that affect children of all ages, including injuries, congenital and acquired disorders, infections (osteomyelitis), tumors and neuromuscular, endocrine and metabolic diseases. Surgical approaches in the pediatric population are often complex, not only for the peculiarity of the growing skeleton, but mainly for the presence of growth plates, vulnerable parts of the bone.

Many specialists are involved in either traumatic surgical management or musculoskeletal disorders in children and adolescents, such as neurosurgeons, plastic, general, maxillofacial, ENT surgeons, orthopedics, radiologists and pediatric intensive physician.

The role of the pediatric orthopedist is crucial in the treatment of traumatic and orthopedic disorders. Anatomic disorders may involve the spine and upper and lower extremities, leading to variegate clinical features. Some bone pathologies may involve the gradual misalignment of bones and stress on growth plates during growth. Congenital deformities, such as clubfoot or hip development dysplasia, can lead to major bone development changes, causing severe dysfunction. Some connective tissue disorders can also affect bones, such as Marfan syndrome, imperfect osteogenesis and osteochondrodysplasia. Treating oncological, neuromuscular or septic pathologies is often complicated, requiring thorough competence and great expertise. In many cases, personalized orthopedic surgical approaches are mandatory.

The aim of this Special Issue is to present the latest research on personalized surgical management, focusing on traumatic, congenital, developmental, post-traumatic, neuromuscular, oncological and postinfectious disorders.

Prof. Dr. Vito Pavone
Prof. Dr. Federico Canavese
Dr. Marco Sapienza
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

children
pediatric orthopedics
traumatic disorders
orthopedic disorders
neuromuscular disorders
pediatric orthopedic surgery

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Published Papers (7 papers)

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14 pages, 4527 KiB

Open AccessArticle

Virtual Surgical Planning and Patient-Specific Instruments for Correcting Lower Limb Deformities in Pediatric Patients: Preliminary Results from the In-Office 3D Printing Point of Care

by Giovanni Trisolino, Alessandro Depaoli, Grazia Chiara Menozzi, Luca Lerma, Michele Di Gennaro, Carmelo Quinto, Leonardo Vivarelli, Dante Dallari and Gino Rocca

J. Pers. Med. 2023, 13(12), 1664; https://doi.org/10.3390/jpm13121664 - 28 Nov 2023

Cited by 2 | Viewed by 1274

Abstract

(1) Background: Virtual reality and 3D printing are transforming orthopedic surgery by enabling personalized three-dimensional (3D) models for surgical planning and Patient-Specific Instruments (PSIs). Hospitals are establishing in-house 3D printing centers to reduce costs and improve patient care. Pediatric orthopedic surgery also benefits from these technologies, enhancing the precision and personalization of treatments. This study presents preliminary results of an In-Office 3D Printing Point of Care (PoC), outlining considerations and challenges in using this program for treating lower limb deformities in pediatric patients through Virtual Surgical Planning (VSP) and 3D-printed Patient-Specific Instruments (PSIs). (2) Materials and Methods: Pediatric patients with congenital or acquired lower limb deformities undergoing surgical correction based on VSP, incorporating 3D-printed PSIs when required, were included in this study. The entire process of VSP and 3D printing at the In-Office PoC was illustrated. Data about deformity characteristics, surgical procedures, and outcomes, including the accuracy of angular correction, surgical times, and complications, were reported. (3) Results: In total, 39 bone correction procedures in 29 patients with a mean age of 11.6 ± 4.7 years (range 3.1–18.5 years) were performed according to VSP. Among them, 23 procedures were accomplished with PSIs. Surgeries with PSIs were 45 min shorter, with fewer fluoroscopy shots. Optimal correction was achieved in 37% of procedures, while the remaining cases showed under-corrections (41%) or over-corrections (22%). Major complications were observed in four patients (13.8%). (4) Conclusions: The In-Office 3D Printing Point of Care is becoming an essential tool for planning and executing complex corrections of lower limb deformities, but additional research is needed for optimizing the prediction and accuracy of the achieved corrections. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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9 pages, 853 KiB

Open AccessArticle

by Davide Bizzoca, Giuseppe Solarino, Anna Maria Moretti, Lorenzo Moretti, Pasquale Dramisino, Andrea Piazzolla and Biagio Moretti

J. Pers. Med. 2023, 13(11), 1585; https://doi.org/10.3390/jpm13111585 - 9 Nov 2023

Cited by 1 | Viewed by 1062

Abstract

The present study aims to depict the importance of gender-related factors in the subjective perception of spine deformity in adolescents undergoing posterior instrumented fusion for scoliosis. Patients undergoing posterior spinal instrumentation and fusion (PSF) for idiopathic adolescent scoliosis (AIS) were recruited. The following data were recorded: gender, age, parents’ civil status, Tegner Activity Scale (TAS), body mass index (BMI), concomitant diseases, and history of neuropsychological disorders. Each patient underwent clinical and radiological evaluations according to the protocol used at our institution. All the patients were assessed before surgery using the following Patient-Reported Outcome Measures (PROMs): the Italian version of the revised Scoliosis Research Society—22 patient questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities (QLPSDs) questionnaire, and the Spinal Appearance Questionnaire (SAQ). The present study recruited 80 patients (male: 19, female: 61). A significant correlation was observed between BMI, TAS, and subjective perception scores. A worse deformity perception was observed in female patients and patients with divorced parents. Gender-related factors impact the subjective perception of spine deformity in patients undergoing PSF for AIS. Specific assessment and correction are needed to improve postoperative outcomes in these patients. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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10 pages, 1540 KiB

Open AccessArticle

Relationship between Slip Severity and BMI in Patients with Slipped Capital Femoral Epiphysis Treated with In Situ Screw Fixation

by Jun-Hyuk Lim, Hyeongmin Song, Gyo Rim Kang, Sungmin Kim and Sung-Taek Jung

J. Pers. Med. 2023, 13(4), 604; https://doi.org/10.3390/jpm13040604 - 30 Mar 2023

Cited by 1 | Viewed by 1856

Abstract

Background: Slipped capital femoral epiphysis (SCFE) is a hip disorder that occurs in adolescence before epiphyseal plate closure, causing anatomical changes in the femoral head. Obesity is known to be the single most important risk factor for idiopathic slipped capital femoral epiphysis (SCFE), which is highly related to mechanical factors. Meanwhile, as increased slip angle increases major complications in patients with SCFE, slip severity is an important factor to evaluate prognosis. In obese patients with SCFE, higher shear stress is loaded on the joint, which increases the likelihood of slip. The study aim was to assess the patients with SCFE treated with in situ screw fixation according to the degree of the obesity and to find any factors affecting the severity of slip. Methods: Overall, 68 patients (74 hips) with SCFE who were treated with in situ fixation screw fixation were included (mean age 11.38, range: 6–16) years. There were 53 males (77.9%) and 15 females (22.1%). Patients were categorized underweight, normal weight, overweight, and obese depending on BMI percentile for age. We determined slip severity of patients using the Southwick angle. The slip severity was defined as mild if the angle difference was less than 30 degrees, moderate if the angle difference was between 30 and 50 degrees, and severe if the angle difference was greater than 50 degrees. To examine the effects of several variables on slip severity, we used a univariable and multivariate regression analysis. The following data were analyzed: age at surgery, sex, BMI, symptom duration before diagnosis (acute, chronic, and acute on chronic), stability, and ability to ambulate at the time of the hospital visit. Results: The mean BMI was 25.18 (range: 14.7–33.4) kg/m². There were more patients with overweight and obese than those with normal weight in SCFE (81.1% vs. 18.9%). We did not find significant differences between overall slip severity and degree of obesity or in any subgroup analysis. Conclusions: We did not find a relationship between slip severity and degree of obesity. A prospective study related to the mechanical factors affecting the slip severity according to the degree of obesity is needed. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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12 pages, 4318 KiB

Open AccessTechnical Note

Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis—A Surgical Technique Video

by Pawel Grabala

J. Pers. Med. 2024, 14(6), 548; https://doi.org/10.3390/jpm14060548 - 21 May 2024

Cited by 3 | Viewed by 980

Abstract

Background: Spinal deformities in children and adolescents can be easily divided into those occurring and diagnosed before the age of 10—early-onset scoliosis—and those occurring and diagnosed after the age of 10—late-onset scoliosis. When the curvature continues to progress and exceeds a Cobb angle of more than 60–65 degrees, surgical treatment should be considered. The most common treatment procedure for EOS is the surgical correction of the deformity using standard growing rods (SGRs), and in the case of congenital defects with additional hemivertebrae, it is the resection of the hemivertebra and short fusion. Minimally invasive controlled growing rods (MICGRs) need to be distracted every 6–9 months through a minimally invasive approach that involves sedation and neuromonitoring to obtain the best possible correction while minimizing complications. The aim of our study is to present a less-invasive surgical technique for MICGR implantation based on a two-case presentation—early-onset idiopathic scoliosis and congenital kyphosis. The surgical technique is the less-invasive percutaneous and subfascial implantation of MICGRs without long incisions in the back. Conclusions: The use of MICGRs is an alternative and safe surgical technique for patients undergoing surgical treatment for EOS. Without the risk of metallosis, like in other implant systems, and the need for replacement after 2 years of use, like in using magnetically controlled growing rods (MCGRs), the MICGR system can be used as a less-invasive procedure, allowing for the avoidance of many periodic invasive procedures in children with a wider opening of the spine (like in using standard growing rods), minimizing the number of planned hospitalizations, reducing the length of hospital stays, and reducing the physical and mental burdens on young patients, parents, and families. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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12 pages, 1075 KiB

Open AccessCase Report

Finite Element Analysis of Normal and Dysplastic Hip Joints in Children

by Zsuzsánna Incze-Bartha, Sandor Incze-Bartha, Zsuzsánna Simon Szabó, Andrei Marian Feier, Vlad Vunvulea, Ioan Alin Nechifor-Boilă, Ylenia Pastorello, Dezso Szasz and Lóránd Dénes

J. Pers. Med. 2023, 13(11), 1593; https://doi.org/10.3390/jpm13111593 - 10 Nov 2023

Cited by 2 | Viewed by 1277

Abstract

From a surgical point of view, quantification cannot always be achieved in the developmental deformity in hip joints, but finite element analysis can be a helpful tool to compare normal joint architecture with a dysplastic counterpart. CT scans from the normal right hip of an 8-year-old boy and the dysplastic left hip of a 12-year-old girl were used to construct our geometric models. In a three-dimensional model construction, distinctions were made between the cortical bone, trabecular bone, cartilage, and contact nonlinearities of the hip joint. The mathematical model incorporated the consideration of the linear elastic and isotropic properties of bony tissue in children, separately for the cortical bone, trabecular bone, and articular cartilage. Hexahedral elements were used in Autodesk Inventor software version 2022 (“Ren”) for finite element analysis of the two hips in the boundary conditions of the single-leg stance. In the normal hip joint on the cartilaginous surfaces of the acetabulum, we found a kidney-shaped stress distribution in a 471,672 mm² area. The measured contact pressure values were between 3.0 and 4.3 MPa. In the dysplastic pediatric hip joint on a patch of 205,272 mm² contact area, the contact pressure values reached 8.5 MPa. Furthermore, the acetabulum/femur head volume ratio was 20% higher in the dysplastic hip joint. We believe that the knowledge gained from the normal and dysplastic pediatric hip joints can be used to develop surgical treatment methods and quantify and compare the efficiency of different surgical treatments used in children with hip dysplasia. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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15 pages, 10374 KiB

Open AccessCase Report

Side-to-Side Flipping Wedge Osteotomy: Virtual Surgical Planning Suggested an Innovative One-Stage Procedure for Aligning Both Knees in “Windswept Deformity”

by Grazia Chiara Menozzi, Alessandro Depaoli, Marco Ramella, Giulia Alessandri, Leonardo Frizziero, Alfredo Liverani, Gino Rocca and Giovanni Trisolino

J. Pers. Med. 2023, 13(11), 1538; https://doi.org/10.3390/jpm13111538 - 26 Oct 2023

Cited by 1 | Viewed by 1319

Abstract

(1) Background: The adoption of Virtual Surgical Planning (VSP) and 3D technologies is rapidly growing within the field of orthopedic surgery, opening the door to highly innovative and individually tailored surgical techniques. We present an innovative correction approach successfully used in a child affected by “windswept deformity” of the knees. (2) Methods: We report a case involving a child diagnosed with “windswept deformity” of the knees. This condition was successfully addressed through a one-stage bilateral osteotomy of the distal femur. Notably, the wedge removed from the valgus side was flipped and employed on the varus side to achieve the correction of both knees simultaneously. The surgical technique was entirely conceptualized, simulated, and planned in a virtual environment. Customized cutting guides and bony models were produced at an in-hospital 3D printing point of care and used during the operation. (3) Results: The surgery was carried out according to the VSP, resulting in favorable outcomes. We achieved good corrections of the angular deformity with an absolute difference from the planned correction of 2° on the right side and 1° on the left side. Moreover, this precision not only improved surgical outcomes but also reduced the procedure’s duration and overall cost, highlighting the efficiency of our approach. (4) Conclusions: The integration of VSP and 3D printing into the surgical treatment of rare limb anomalies not only deepens our understanding of these deformities but also opens the door to the development of innovative, personalized, and adaptable approaches for addressing these unique conditions. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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13 pages, 5319 KiB

Open AccessSystematic Review

Clinical and Radiographic Outcomes and Treatment Algorithm for Septic Arthritis in Children

by Alessia Caldaci, Gianluca Testa, Marco Simone Vaccalluzzo, Andrea Vescio, Ignazio Prestianni, Ludovico Lucenti, Claudia de Cristo, Marco Sapienza and Vito Pavone

J. Pers. Med. 2023, 13(7), 1097; https://doi.org/10.3390/jpm13071097 - 4 Jul 2023

Cited by 3 | Viewed by 1720

Abstract

Background: Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2–7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments—arthrocentesis, arthrotomy, and arthroscopy—provides better results in children and when to use them. Methods: Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage’s findings. Results: A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique. Conclusions: We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it. Full article

(This article belongs to the Special Issue Personalized Management of Pediatric Orthopaedic Surgery)

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