Pediatric osteochondral fractures: clinical insights associate early diagnosis to early rehabilitation via arthroscopy.

PURPOSE: This retrospective observational cohort analysis aims to address diagnostic and therapeutic challenges in managing osteochondral fractures (OCFs) resulting from acute patella dislocation and ankle sprains in children. METHODS: The study includes 15 children treated for OCFs between January 2020 and July 2022. Data were obtained from medical records and analyzed using logistic regression. RESULTS: The diagnostic and treatment algorithm involves detailed history, clinical examination, and imaging, with MRI guiding therapeutic decisions. Arthroscopic or mini open fixation led to successful rehabilitation, with 93% achieving full mobility at 9 months. Age was identified as a slight risk factor for free fragments in MRI, and arthroscopic management correlated with faster recovery at 3 months. CONCLUSION: This study underscores the importance of immediate diagnosis and minimally invasive intervention for OCFs in children. Timely treatment, guided by a diagnostic algorithm, facilitates joint restoration and prevents degenerative consequences, ensuring a return to regular activities within a year postoperatively. LEVEL OF EVIDENCE: IV.

Gender equality challenges in orthopaedic surgery: a systematic review.

PURPOSE: Several studies have examined gender-equality challenges and ways to improve women's representation and management. Orthopaedic surgeons and patients are less gender equitable than them of other surgical disciplines. This systematic review summarizes these findings and highlights orthopaedic surgery gender inequality. METHODS: Search of the PubMed, Embase, and Cochrane databases was carried out to extract human studies investigating the gender gap in orthopaedics, trying to highlight the equality challenges orthopaedic surgery faces. Studies incorporating patients with comorbidities in which gender is a proven risk factor, and pregnant women were excluded. RESULTS: This systematic review included 59 studies involving 692,435 people (mean females/males ratio: 4.44), spanning the years 1987-2023. Regarding the targeted population, 35 (59.32%) studies focused on patients, while 24 (40.68%) on physicians. Orthopaedic surgery is described as an unfriendly career field for women as surgeons or sports leading physicians while women are generally under represented in the academic field of orthopaedics. Regarding patients, female gender consists both a risk and prognostic factor influencing the prevalence of degenerative disease and the outcome of the operative treatment in reconstructive orthopaedics. Female gender is a risk factor for multiple sports injuries and influences the pathogenetic mechanisms resulting in ACL reconstruction. Regarding spine surgery, women are less likely to have surgery suggested, and such suggestion underlines severe disease's progression. CONCLUSIONS: Gender differences affect orthopaedic patient-physician-healthcare system interactions. Recognizing biases and their patterns is useful to improve the actual situation. By preventing those an unbiased, tolerant, and egalitarian workplace for physicians and a healthcare system that provides the best treatment to patients could be created.

Pediatric Ankle Fractures: Successful Remodeling and Restoration Through Comprehensive Diagnosis and Conservative Management in a Diverse Context.

Diagnosing toddler ankle fractures, especially those that affect several bones, can be difficult. The infrequency of such complex injuries, particularly in household environments, emphasizes the importance of increased awareness in diagnosing and managing these types of injuries. We present a compelling case study of a 20-month-old toddler of a low socioeconomic background who sustained fractures in the ankle, calcaneus, tibia, and fibula after being trapped under furniture. The diagnostic process involved trauma guidelines, radiographic assessments, and axial CT scans. Conservative management, including an eight-week plaster cast, was chosen based on the careful consideration of the child's age, the nature of the fracture, and the absence of immediate surgical indications. The follow-up period involved radiographic assessments, as well as repeated regular clinical examinations, revealing consistent alignment and the absence of complications. The successful outcome underscores the importance of a comprehensive diagnostic approach, thoughtful treatment planning, and meticulous follow-up. Individualized care, considering both clinical and socioeconomic factors, proved crucial for optimal outcomes in pediatric orthopedics. The case contributes valuable insights into the evolving landscape of early childhood orthopedics, emphasizing the need for a discerning approach to diagnosing and managing complex fractures in this population. Conservative treatment could significantly assist when absolute surgical indications are lacking both in cases of minimal resources where multiple operations are not plausible and when the patient's social history raises awareness.

Late Repair, One Year After a Knee Twisting Injury, of a Missed Femoral Trochlea Osteochondral Fragment, With Bioabsorbable Nails, in a 14-Year-Old Boy.

The authors report a case of a late repair of a missed, large, osteochondral fracture of the femoral trochlea in a 14-year-old boy due to lateral patellar dislocation after a twisting injury of the knee a year ago. The late-1 year after the knee injury-imaging assessment of the patient regarding radiograph images, CT scan, and MRI was misleading, misinterpreted, and failed to reveal this osteochondral fracture. The free osteochondral fragment was detected during diagnostic arthroscopy. Open reduction and fixation of the osteochondral fragment with bioabsorbable pins were done, and healing was achieved within an acceptable time. The patient's clinical and imaging examination with knee MRI, a year after the surgical treatment, was highly satisfactory. Fixation with bioabsorbable pins showed to be a worthwhile option in this case. The technique used was straightforward, with excellent short- and long-term results. Bioabsorbable pins may be used to restore successfully even an old, large osteochondral fracture in the immature skeleton.

Identification of an Autosomal Dominant Mutation in the COL2A1 Gene Leading to Spondyloepiphyseal Dysplasia Congenita in a Greek Family.

A boy and his father with severe short stature, progressively evolving body asymmetry, and skeletal abnormalities are presented. A next-generation sequencing exome study was performed, and the patient was found heterozygous for the c.1609G>A (p.Gly537Ser) mutation in the COL2A1 gene. This mutation is considered a pathogenic variant and has been previously registered in the Human Gene Mutation Database (HGMD) in association with spondyloepiphyseal dysplasia (accession: CM052184). It has been described in a patient as a sporadic case and resulted in a severe phenotype. Segregation studies, in order to determine the inheritance pattern, identified the same mutation in our patient's father. The variant was transmitted in an autosomal dominant pattern. In conclusion, we describe a patient with hereditary spondyloepiphyseal dysplasia congenita, caused by a c.1609G_A (p.Gly537Ser) mutation in the COL2A1 gene, which resulted in a milder phenotype.

An 11-Year-Old Male With Vertebral Osteomyelitis and a Paraspinal Abscess.

We report the case of an 11-year-old immunocompetent patient presenting with a 2-week history of upper back pain, diagnosed with thoracic vertebral osteomyelitis and a paraspinal abscess caused by Bartonella henselae. He was treated with gentamicin and doxycycline followed by oral rifampicin and doxycycline with favorable outcome.