Reporting quality of abstracts and inconsistencies with full text articles in pediatric orthopedic publications.

BACKGROUND: Abstracts should provide a brief yet comprehensive reporting of all components of a manuscript. Inaccurate reporting may mislead readers and impact citation practices. It was our goal to investigate the reporting quality of abstracts of interventional observational studies in three major pediatric orthopedic journals and to analyze any reporting inconsistencies between those abstracts and their corresponding full-text articles. METHODS: We selected a sample of 55 abstracts and their full-text articles published between 2018 and 2022. Included articles were primary therapeutic research investigating the results of treatments or interventions. Abstracts were scrutinized for reporting quality and inconsistencies with their full-text versions with a 22-itemized checklist. The reporting quality of titles was assessed by a 3-items categorical scale. RESULTS: In 48 (87%) of articles there were abstract reporting inaccuracies related to patient demographics. The study's follow-up and complications were not reported in 21 (38%) of abstracts each. Most common inconsistencies between the abstracts and full-text articles were related to reporting of inclusion or exclusion criteria in 39 (71%) and study correlations in 27 (49%) of articles. Reporting quality of the titles was insufficient in 33 (60%) of articles. CONCLUSIONS: In our study we found low reporting quality of abstracts and noticeable inconsistencies with full-text articles, especially regarding inclusion or exclusion criteria and study correlations. While the current sample is likely not representative of overall pediatric orthopedic literature, we recommend that authors, reviewers, and editors ensure abstracts are reported accurately, ideally following the appropriate reporting guidelines, and that they double check that there are no inconsistencies between abstracts and full text articles. To capture essential study information, journals should also consider increasing abstract word limits.

A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map.

Mycetoma is a chronic infectious disease endemic in sub-Saharan Africa (SSA), India and parts of South and North America. The epidemiologic profile of the disease in Egypt, which neighbours SSA, has not been explored previously. Therefore we conducted a scoping review of the literature on mycetoma in Egypt. We searched the literature comprehensively on MEDLINE and Google Scholar using free-text words and Medical Subject Headings and terms. Both published and non-peer-reviewed (grey literature) articles were included. The initial search identified 133 reports. Of these, only eight were found to be relevant and were included in the study. The total number of mycetoma patients was 59, reported between 1949 and 2015. There was a predilection for eumycetoma (44 of 59) patients (75%), while actinomycetoma constituted 15 patients (25%). Six patients were female, 28 were male and 25 were unreported. Children and adolescents constituted 3 of 59 (5%), 52 (88%) were adults and age was not provided for 4 patients. Only four patients (7%) were non-autochthonous. The incidence of mycetoma in Egypt is higher than previously reported. Egypt is probably a low-endemic country. An accurate estimate of the prevalence and epidemiology of mycetoma necessitates further research collaboration.

Ambulatory Duchenne muscular dystrophy children: cross-sectional correlation between function, quantitative muscle ultrasound and MRI.

Duchenne muscular dystrophy (DMD) is a progressive genetic muscle disease. Quantitative muscle ultrasound (US), muscle MRI, and functional tools are important to delineate characteristics of muscle involvement. We aimed to establish correlations between clinical/functional and above-named imaging tools respecting their diagnostic and prognostic role in DMD children. A cross-sectional retrospective study of 27 steroid-naive, ambulant male children/adolescents with genetically-confirmed DMD (mean age, 8.8 ± 3.3 years). Functional performance was assessed using motor function measure (MFM) which assess standing/transfer (D1), proximal (D2) and distal (D3) motor function, and six-minute walk test (6MWT). Imaging evaluation included quantitative muscle MRI which measured muscle fat content in a specific location of right rectus femoris by mDixon sequence. Quantitative muscle US measured right rectus femoris muscle brightness in standardized US image as an indicator of muscle fat content. We found a highly significant positive correlation between the mean MFM total score and 6MWT (R = 0.537, p = 0.007), and a highly significant negative correlation between fat content by muscle US and MFM total score (R = -0.603, p = 0.006) and its D1 subscore (R =-0.712, p = 0.001), and a significant negative correlation between fat content by US and 6MWT (R = -0.529, p = 0.02), and a significant positive correlation between muscle fat content by mDixon MRI and patient's age (R = 0.617, p = 0.01). Quantitative muscle US correlates significantly with clinical/functional assessment tools as MFM and 6MWT, and augments their role in disease-tracking of DMD. Quantitative muscle US has the potential to act as a substitute to functional assessment tools.

Naviculectomy With Limited Soft-Tissue Releases as a Third Way Beyond Manipulative Treatment and Extensive Soft-Tissue Releases for Ambulatory Children With Complex Congenital Vertical Talus: A Technical Note.

We investigated the radioclinical outcomes of naviculectomy and limited/tailored soft-tissue releases in a short series of ambulatory children with complex/intractable congenital vertical talus subsets namely neglected, multiple operated, and recurrent patients. We postulated that this technique will yield satisfactory radioclinical outcomes and minimal complications because it avoids extensive surgical release/trauma that is otherwise classically recommended for complex congenital vertical talus. The cohort consisted of 5­4 boys and 1 girl­complex congenital vertical talus children with neglected, multiple operated, and/or recurrent subsets. Patients were included if manipulative casting techniques were deemed unlikely to produce a plantigrade foot. Patients underwent naviculectomy with variable on-demand limited soft-tissue releases. Two patients had bilateral affection and 2 had a nonidiopathic cause. The mean age was 5.2 years (4-6.25) and mean follow-up was 2.3 years (1-3). We reported satisfactory outcomes as per foot posture, function, overall parent satisfaction including pain and radiography per lateral views of talar-axis-first metatarsal base angle on the short/intermediate term. Whereas manipulative casting is unlikely to yield lasting outcomes in ambulatory children with complex subsets of congenital vertical talus, extensive surgical soft-tissue releases have unfavorable long-term complications. As a substitute, naviculectomy as a form of resection arthroplasty created a practical and affordable third way between manipulative casting with or without minimally invasive surgery and the extensive surgical soft-tissue releases on the short-to-intermediate term. LEVEL OF EVIDENCE: Level IV case series.

Whole-body muscle MRI characteristics of LAMA2-related congenital muscular dystrophy children: An emerging pattern.

Merosin-deficient or LAMA2-related congenital muscular dystrophy (CMD) belongs to a group of muscle diseases with an overlapping diagnostic spectrum. MRI plays an important role in the diagnosis and disease-tracking of muscle diseases. Whole-body MRI is ideal for describing patterns of muscle involvement. We intended to analyze the pattern of muscle involvement in merosin-deficient CMD children employing whole-body muscle MRI. Ten children with merosin-deficient CMD underwent whole-body muscle MRI. Eight of which were genetically-confirmed. We used a control group of other hereditary muscle diseases, which included 13 children (mean age was 13 SD +/- 5.5 years), (8 boys and 5 girls) for comparative analysis. Overall, 37 muscles were graded for fatty infiltration using Mercuri scale modified by Fischer et al. The results showed a fairly consistent pattern of muscle fatty infiltration in index group, which differs from that in control group. There was a statistically significant difference between the two groups in regard to the fatty infiltration of the neck, serratus anterior, intercostal, rotator cuff, deltoid, triceps, forearm, gluteus maximus, gluteus medius, gastrocnemius and soleus muscles. Additionally, the results showed relative sparing of the brachialis, biceps brachii, gracilis, sartorius, semitendinosus and extensor muscles of the ankle in index group, and specific texture abnormalities in other muscles. There is evidence to suggest that whole-body muscle MRI can become a useful contributor to the differential diagnosis of children with merosin deficient CMD. The presence of a fairly characteristic pattern of involvement was demonstrated. MRI findings should be interpreted in view of the clinical and molecular context to improve diagnostic accuracy.

Multicentric Osteolysis, Nodulosis, and Arthropathy in two unrelated children with matrix metalloproteinase 2 variants: Genetic-skeletal correlations.

Multicentric Osteolysis, Nodulosis, and Arthropathy (MONA) syndrome is a rare genetic skeletal dysplasia. Its diagnosis can be deceptively similar to childhood-onset genetic skeletal dysplasias and juvenile idiopathic arthritis. We aimed to report the syndrome's clinical and radiologic features with emphasis on skeletal manifestations. And establish relevant phenotype-genotype correlations. We evaluated two boys, 4-and-7-years-old with MONA syndrome. Both patients had consanguineous parents. We verified the diagnosis by correlating the outcomes of clinical, radiologic and molecular analysis. We specifically evaluated the craniofacial morphology and clinical and radiographic skeletal abnormalities. We contextualized the resultant phenotype-genotype correlations to publications on MONA and its differential diagnosis. Skeletal manifestations were the presenting symptoms and mostly restricted to hands and feet in terms of fixed extension deformity of the metacarpophalangeal and flexion deformity of the interphalangeal joints with extension deformity of big toes. There were arthritic symptoms in the older patient especially of the wrists and minute pathologic fractures. The skeletal radiographs showed osteopenia/dysplastic changes of hands and feet. Both patients had variants in the matrix metalloproteinase2 gene which conformed to phenotype of previously reported literature in one patient while the other had a novel variant which conformed to MONA phenotype. Craniofacial abnormalities were present. However, minimal extra-skeletal manifestations. Overall, there is an emerging distinctive skeletal pattern of involvement in terms of both clinical and radiographic features. This includes age of onset and location of presenting skeletal manifestations, chronological order of joint affection, longitudinal disease progression, specifics of skeletal radiographic pathology and craniofacial features. Nevertheless, physicians are cautioned against differential diagnosis of similar genetic skeletal dysplasias and juvenile idiopathic arthritis.

Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood disability globally. Botulinum toxin A injections are widely used to manage limb spasticity in children with CP. Intramuscular botulinum toxin A has been used in the upper limbs of children with CP to manage preoperative and postoperative pain, facilitate nursing, and achieve functional and/or cosmetic improvement of hand position. These goals are achieved primarily through reduction of spasticity. The aim of this review was to assess the evidence for the effect of botulinum toxin A injections used to manage upper limb spasticity in children with spastic CP. Specifically, we examined the role of botulinum toxin A as an adjunctive treatment to other physical therapy modalities. Additionally, we analyzed the associated complications. METHODS: The literature extraction process involved 4 phases: identification, screening, eligibility, and inclusion. We used a combination of Google Scholar, PubMed, and ScienceDirect. The choice of the search terms was based on the Medical Subject Headings. We extracted the relevant studies using a combination of words or terms related to (1) patient population, (2) pathology, (3) clinical intervention, and (4) anatomical distribution of pathology. Studies were included if they were randomized controlled trials conducted on children and/or adolescents with CP targeting the upper extremities in which botulinum toxin A was used as an adjunctive treatment to a primary intervention. RESULTS: The literature extraction process yielded 15 randomized controlled trials for inclusion in this review. The total number of participants enrolled in the included studies was 499, with 255 in the intervention group (51%) and 244 controls (49%). All participants in the eligible studies had unilateral spastic CP except for those in 4 studies (27%) with 198 participants (40%) that included a heterogeneous sample of unilateral and bilateral spastic CP. The mean age of participants in the intervention group ranged from 2.6 to 10.7 years among the individual studies. The mean age of participants in the control group ranged from 3.1 to 10.55 years among the individual studies. This review indicated that botulinum toxin A had a positive effect on the degree of spasticity and cosmetic appearance of the injected upper limb. The results with respect to functional gains and quality of life were either conflicting or not significant. CONCLUSIONS: Randomized controlled trials of botulinum toxin A injection in the treatment of upper limb spasticity in children with CP used variable outcome measures and yielded mixed results. Overall, there is some evidence to support the use of botulinum toxin A as an adjuvant treatment to other physical therapy regimens or placebo to reduce spasticity in the short term. There is insufficient evidence to support its use as an adjunctive treatment to improve upper limb function or quality of life. The complications were acceptable and did not outweigh the clinical gains incurred. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm.

To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm. Methods: Fifty children (male:female, 27:23) with knee coronal plane deformities (knees:physes, 86:99), (varum:valgum, 51:35) secondary to nutritional rickets were subjected to femoral and/or tibial temporary hemiepiphysiodesis using a two-hole 8-plate. The mean age at implantation was 3.8 ± 1.5 years (range 2.5 to 5). The mean follow-up was 2.8 years (range 2 to 4). All children received a standing full-length AP radiographs of both lower limbs in neutral rotation to measure the mechanical axis deviation, tibiofemoral angle, and joint orientation angles. Tibial torsion was objectively assessed by measuring the bimalleolar axis. Results: The radiologic measurements, tibiofemoral angle, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and Hilgenreiner-epiphyseal angle, showed a highly statistically significant improvement (P ≤ 0.001). Radiographic outcomes correlated with their clinical counterparts. The mean duration of correction of the mechanical axis was 10.8 ± 2.4 months (7 to 21). The mean follow-up for rebound of the deformity was 1.5 years (range 1 to 3). Conclusion: The radioclinical outcome is rewarding with a tolerable complication profile. The mechanical complications were mostly related to lengthy implant retainment encountered in severe deformities. Internal tibial torsion seems profoundly responsive to correction of coronal plane deformity. And, derotation osteotomies are rarely justified. Our proposed algorithm may be used as a decision-taking guide for achieving the desired growth modulation in a more efficient manner.

Naviculectomy for two ambulatory children with intractable congenital vertical talus: redefining the indications of an old technique.

Congenital vertical talus is a rare and complex foot anomaly. Serial casting with or without minimally invasive surgery is a universal management strategy especially for children in the first year of life. Nevertheless, extensive surgical treatment of late-presenting, neglected and multiple operated children with congenital vertical talus may be required with guarded results. The results of naviculectomy as a more conservative intervention and directed exclusively at ambulatory children with intractable congenital vertical talus have not been reported. We present the radioclinical outcomes of two ambulatory children with intractable congenital vertical talus treated by naviculectomy/midtarsal resection and limited soft tissue release. One child had an isolated congenital vertical talus whereas the other had a non-isolated etiology. Generally, naviculectomy/midtarsal resection revealed a positive benefit-risk profile in children with intractably severe congenital vertical talus on the short-term. We reported favorable results in terms of foot appearance, function and radiology. We believe that a less invasive procedure like naviculectomy/midtarsal resection is an encouraging technique to investigate in children with intractable congenital vertical talus.

Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons.

INTRODUCTION: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons' current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons. METHODS: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children's orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher's exact test were used to examine the relationship between two qualitative variables. RESULTS: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items. DISCUSSION: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge-practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons' educational curricula and an updated health referral system.

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review.

INTRODUCTION: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis? METHODS: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence. RESULTS: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/- associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others. DISCUSSION: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.

Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review.

Hip dislocation is a common source of disability in cerebral palsy children. It has been remedied by various reconstructive procedures. This review aims at providing the best evidence for bony reconstructive procedures in cerebral palsy hip migration. The literature extraction process yielded 36 articles for inclusion in this review. There is fair evidence to indicate that the comparative effectiveness of femoral versus combined pelvifemoral reconstruction favours pelvifemoral reconstruction. All except one were retrospective articles with a significant degree of selection and performance bias and confounding variables that limited the validity and generalizability of the conclusions. The findings of this systematic review provide fair evidence for the use of adequate soft tissue and combined pelvifemoral reconstruction in the management of hip migration in none and minimally ambulatory cerebral palsy children in the short and long term. This has been shown in studies with a summed sizable patient population. There is limited evidence available that would support the use of soft-tissue and isolated femoral reconstruction. In the context of these retrospective and biased studies, it is extremely difficult to identify, with great precision, predictors of surgical success. Future studies should consider prospective designs that allow for bias control, strict patient selection criteria and incorporation of validated quality-of-life scales.