Reliability of a Photo-Based Modified Foot Posture Index (MFPI) in Quantifying Severity of Foot Deformity in Children With Cerebral Palsy.

INTRODUCTION: Children with cerebral palsy (CP) have high rates of foot deformity. Accurate assessment of foot morphology is crucial for therapeutic planning and outcome evaluation. This study aims to evaluate the reliability of a novel photo-based Modified Foot Posture Index (MFPI) in the evaluation of foot deformity in children with CP. METHODS: Thirteen orthopaedic surgeons with neuromuscular clinical focus from 12 institutions evaluated standardized standing foot photographs of 20 children with CP, scoring foot morphology using the MFPI. Raters scored the standardized photographs based on five standard parameters. Two parameters assessed the hindfoot: curvature above and below the malleoli and calcaneal inversion/eversion. Three parameters assessed the midfoot and forefoot: talonavicular congruence, medial arch height, and forefoot abduction/adduction. Summary MFPI scores range from -10 to +10, where positive numbers connote planovalgus, whereas negative numbers connote a tendency toward cavovarus. Intra- and interrater reliability were calculated using a 2-way mixed model of the intraclass correlation coefficient (ICC) set to absolute agreement. RESULTS: Feet spanned the spectrum of potential pathology assessable by the MFPI, including no deformity, mild, moderate, and severe planovalgus or cavovarus deformities. All scored variables showed high intrarater reliability with ICCs from 0.891 to 1. ICCs for interrater reliability ranged from 0.965 to 0.984. Hindfoot total score had an ICC of 0.979, with a 95% CI, 0.968-0.988 (P<0.001). The forefoot total score had an ICC of 0.984 (95% CI, 0.976-0.991, P<0.001). Mean total score by the MFPI was 3.67 with an ICC of 0.982 (95% CI, 0.972-0.990, P<0.001). CONCLUSIONS: The photo-based MFPI demonstrates high intra- and interrater reliability in assessing foot deformities in children with CP. Its noninvasive nature and ease of use make it a promising tool for both clinical and research settings. MFPI should be considered as part of standard outcomes scores in studies regarding the treatment of CP-associated foot deformities. LEVEL OF EVIDENCE: Level V.

Dissolution of the Capitellum After Lateral Condylar Fracture of the Humerus in a Child: A Case Report.

Lateral condyle fractures of the humerus are a common elbow injury sustained by pediatric patients. Complications from surgical intervention can include malunion, fishtail deformity, osteonecrosis, and avascular necrosis (AVN). AVN of the capitellum is a rare complication of lateral condyle fractures with very few cases reported in the current literature. Here we report the rare case of dissolution of the capitellum following closed reduction and percutaneous pinning for a lateral condylar fracture of the humerus of a six-year-old child performed at an outside hospital that was subsequently managed at our academic pediatric level 1 trauma center. Other than a long-arm cast, no specific intervention was provided as the patient remained neurovascularly intact and improved clinically. Through careful follow-up and conservative management, the patient regained the full range of motion of the elbow and clinical resolution of the fracture. The single posterior blood supply of the capitellum likely contributes to the pathophysiology of this condition and further supports the methodology of avoiding posterior soft tissue stripping during surgical correction of distal humerus fractures. We conclude that the prognosis of this condition is favorable and can be managed by conservative treatment.

The American Association of Latino Orthopaedic Surgeons: Our History, Achievements, and Future Goals.

ABSTRACT: The mission of the American Association of Latino Orthopaedic Surgeons (AALOS) is to provide collegiality, advancement, education, and social justice for Latino orthopaedic surgeons and the minority populations they represent. We strive to enhance diversity within the field of orthopaedic surgery by increasing the visibility of AALOS, highlighting its core focus, and emphasizing its mission. The purposes of this article are to discuss the need for this organization and highlight its history and future goals. As AALOS recently celebrated its 15-year anniversary, we are excited to continue advancing the field of orthopaedic surgery and improving our patients' care.

Traumatic Irreducible Pediatric Radial Head Dislocations: A Unique Case and Review of the Literature.

Background: Irreducible radial head dislocations are uncommon injuries and blocks to reduction typically result from interposed soft tissue. We report the case of a pediatric patient who sustained an irreducible radial head dislocation with a concomitant posterior elbow dislocation and coronoid process fracture. To the author's knowledge, irreducible radial head dislocations presenting as part of a terrible triad like constellation of injuries have not been previously reported. A case-based review of the literature was also performed. Case Description: A 7-year-old male presents to our pediatric hospital as a transfer from an outside hospital after sustaining a posterolateral radial head and posterior elbow dislocation secondary to a fall. CT imaging and 3D reconstruction revealed a Type 1 coronoid process fracture. At our institution, closed attempts at reduction in the operating room under fluoroscopy with general anesthesia were also unsuccessful. Open reduction of the radial head and repair of the soft tissue structures was ultimately required to stabilize the patient's elbow injury. Conclusion: Irreducible pediatric radial head dislocations are rare and inherently unstable injuries. To the authors' knowledge, there are no prior reports of irreducible radial head dislocations that present in a terrible triad like fashion with a coronoid process fracture and posterior elbow dislocation. In the present report, successful treatment of this injury required open reduction and soft tissue repair. Level of Evidence: IV.

The Limping Child.

A limp is a common presentation to pediatricians, emergency centers, and orthopedists. A directed history and physical examination, and the development of a differential diagnosis based on limp type, patient's age, and the anatomic site that is most likely affected, provides a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignancy is considered. Imaging usually begins with plain radiography. Ultrasonography is valuable in assessing irritable hips. Advanced imaging is done in select cases. Prompt referral to an orthopedist is essential, especially if septic joint, vascular or compartment issues, or open fractures are suspected.

Pediatric Orthopedic Examination.

This article serves as a guide for the pediatric orthopedic physical examination for newborn, children, and adolescents. The newborn physical examination is very unique and therefore is classified separately from the children and adolescent examination. The following pages should be used as an overview of the pediatric orthopedic physical examination and to provide normal parameters, guide a more focused approach that will improve proper diagnoses, and aid in developing a proper management plan. The art of examining a pediatric patient comes with time, and some helpful hints (look for the ♠) can improve the experience.

Surgical Management of Spasticity of the Elbow.

A spastic limb refers to one with increased tone. This commonly results from an upper motor neuron injury, which, in turn, leads to disinhibition of reflex arcs. At the level of the elbow, affected individuals typically exhibit a flexion posture secondary to spastic contracture of the biceps, brachialis, and brachioradialis muscles. Surgical treatment aims to improve access for hygiene, function, and cosmetic appearance of the affected limb. The specific surgical intervention performed depends on the degree of elbow flexion contracture and whether there is an associated joint contracture or soft tissue deficit.