Osteogenesis imperfecta (OI) is a rare skeletal disorder that increases a patient\'s susceptibility to bone fracture. One complication commonly associated with fractures in this population is the occurrence of non-union leading to pseudoarthrosis. In this case series, three cases of non-union of the distal humerus leading to pseudoarthrosis in the pediatric OI population are presented. One case presents a successful attempt at treatment, one case presents a failed attempt at treatment, and the third case presents a patient\'s refusal to get treated. Furthermore, a literature review highlighting other institutions\' attempts, successes, and failures at treating this clinical entity is presented. Combining the data retrieved from our institution and others, this review demonstrates that there is currently no standard for treating these patients. Additionally, based on the small case series and literature review presented in this article, definitive guidelines for the treatment of pseudoarthrosis of the distal humerus in pediatric OI patients cannot be outlined. However, our findings suggest that both non-surgical and surgical treatments could be viable options for patients with asymptomatic pseudoarthrosis of the distal humerus.

Dietrich\'s disease, also known as Mauclaire\'s disease, is a rare condition characterized by avascular necrosis of the metacarpal heads, predominantly affecting adolescents. This case report aims to elucidate the diagnostic process and management of Dietrich\'s disease in adolescents. A 15-year-old male adolescent presented with left ring finger metacarpophalangeal joint pain and restricted range of motion following a remote history of sports-related trauma. Clinical examination revealed tenderness and limited flexion at the affected joint. Radiographic evaluation demonstrated characteristic features of Dietrich\'s disease, including lucency and loss of height in the fourth metacarpal head and volar subluxation of the ring finger. Computed tomography and magnetic resonance imaging (MRI) confirmed the diagnosis, revealing flattening of the metacarpal head, subchondral marrow edema, and joint effusion consistent with avascular necrosis. The pathogenesis of Dietrich\'s disease remains incompletely understood, likely involving acquired deficits in arteriolar blood supply. Radiographic and MRI findings aid in diagnosis, distinguishing it from other conditions such as chondroblastoma and osteomyelitis. Treatment options range from conservative management to surgical interventions, depending on the severity of symptoms. Dietrich\'s disease, though rare, should be considered in adolescents presenting with metacarpal pain and predisposing factors such as trauma or steroid use. Recognition of characteristic imaging features is essential for accurate diagnosis and appropriate management in adolescent populations. This case highlights the importance of early detection and multidisciplinary management in adolescents with Dietrich\'s disease to optimize outcomes and preserve hand function.

UNASSIGNED: Patient-reported outcome measures have become crucial in the clinical evaluation of patients. Appropriate selection, in a young population, of the instrument is vital to providing evidence-based patient-centered healthcare. This systematic review applies the COnsensus-based Standards for selection of health Measurement INstruments methodology to provide a critically appraised overview of patient-reported outcome measures targeted at pediatric orthopedic patients with lower limb impairment.
UNASSIGNED: A systematic search of electronic databases was performed to identify original studies reporting the development and/or validation of patient-reported outcome measures evaluating children with impairment of the lower extremity. Data extraction, quality assessment, and risk of bias evaluation were performed following the COnsensus-based Standards for selection of health Measurement INstruments guidelines and Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.
UNASSIGNED: A total of 6919 articles were screened. Thirty-three studies were included, reporting evidence on the measurement properties of 13 different patient-reported outcome measures and 20 translations. Four studies reported on content validity and patient-reported outcome measure development. The methodological quality of studies on structural validity, content validity, or patient-reported outcome measure development was mostly rated as \"doubtful\" or \"very good.\" The quality of evidence on measurement properties varied noticeably, with most studies needing to perform improve their methodological quality to justify their results.
UNASSIGNED: This review provides an extensive overview of all available patient-reported outcome measures for patients with lower extremity impairment within pediatric orthopedics. We cautiously advise the use of four patient-reported outcome measures. However, the scarce availability of research on content validity and patient-reported outcome measure development highlights an area for future research endeavors to improve our knowledge on the currently available patient-reported outcome measures.
UNASSIGNED: Diagnostic level 1.

BACKGROUND: Adolescent spinal injuries such as flexion-distraction injuries with posterior ligament complex (PLC) stripping require specialized management because of the unique interplay between injury mechanics and spinal growth. This case report sheds light on these rare occurrences and their management.
METHODS: An 11-year-old boy sustained spinal flexion-distraction injuries resulting in posterior ligament complex stripping following a passenger traffic accident. He underwent a meticulously planned surgical intervention involving urgent posterior fusion with pedicle screw fixation at the L1-2-3 levels and allograft bone grafting. This approach was chosen considering the unique challenges posed by his adolescent spinal anatomy and the nature of his injuries. Postoperative management included using thoracolumbar-sacral orthosis (TLSO), facilitating early ambulation and recovery.
CONCLUSIONS: The rarity of PLC stripping in adolescents underscores the importance of case studies for guiding care. This instance validates the surgical approach and highlights the importance of postoperative management with TLSO for early mobility and prevention of growth-related deformities. This case emphasizes the need for vigilant surgical and postoperative strategies in adolescent spinal injury management.
CONCLUSIONS: An early surgical approach complemented by strategic postoperative management, including the use of TLSO for early mobilization, is vital for the treatment of adolescent spinal injuries. Effective recovery and careful consideration of spinal growth are essential during treatment. Documenting such cases contributes to the body of knowledge necessary to enhance the care strategies for patients with similar injuries.

Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this systematic review was to identify factors that patients look for that help build a strong therapeutic alliance in their pediatric sports or orthopedics healthcare provider, to identify if these factors differ across healthcare professions, and to identify any differences in therapeutic alliance between patients and their provider regarding in-person and telehealth visits. Scientific databases were searched from inception until August 2022. The search strategy resulted in 2195 articles with 11 studies included in the final analysis. The main attributes adolescents look for in their pediatric sports healthcare provider were shared decision making and understanding patients\' sports and goals. These factors were found to differ among parents, sex, race, and socioeconomic status. The top factors improving therapeutic alliance in telehealth were having an already established relationship with the provider, visits lasting longer than 30 min, and having an English-speaking provider for English-speaking patients. The available literature highlights factors that contribute to the development of a stronger therapeutic alliance in the pediatric sports and orthopedics population. As these factors differ among adolescents, parents, sex, race, and socioeconomic status, this review provides insight in what patients and families look for in their provider when seeking care.

Distal radius buckle fractures (DRBFs) are the most common pediatric fractures and resemble the rounded portion of a Greek pillar or torus. They result from compressive forces applied to a child\'s highly plastic radius. DRBFs lack cortical and physeal disruption, which makes them relatively stable. In this review, we discuss angled DRBFs, a hypothesized subset of buckle fractures that results from an off-center compressive force. Some authors refute the existence of angled DRBFs, instead proposing new criteria for DRBF classification: measuring more than 1 cm away from the physis with two to three inflection points. Without universal diagnostic criteria, misdiagnosis is common, and the utilization of flexible treatment modalities is infrequent. Rigid immobilization with short-arm casting continues to be the mainstay of treatment in clinical practice. Yet, new protocols implementing removable elastic bandages have had comparable results to casting, including reduced healthcare expenditure, less stiffness, and improved convenience and patient tolerability. Despite the discrepancies in categorizing DRBFs, complication rates remain low, and diagnostic confusion insignificantly affects clinical outcomes. Angled DRBFs have been theorized to have intraphyseal extension, making them unstable Salter-Harris fractures. Radiographic evidence supporting or denying this claim is limited. Further research is essential to determine the stability of the angled DRBF subtype and whether they should continue to be defined and managed as buckle fractures.

BACKGROUND: As patient-reported outcome measures (PROMs) have become of significant importance in patient evaluation, adequately selecting the appropriate instrument is an integral part of pediatric orthopedic research and clinical practice. This systematic review provides a comprehensive overview of PROMs targeted at children with impairment of the upper limb, and critically appraises and summarizes the quality of their measurement properties by applying the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) methodology.
METHODS: A systematic search of the MEDLINE and EMBASE databases was performed to identify relevant publications reporting on the development and/or validation of PROMs used for evaluating children with impairment of the upper extremity. Data extraction and quality assessment (including a risk of bias evaluation) of the included studies was undertaken by two reviewers independently and in accordance with COSMIN guidelines.
RESULTS: Out of 6423 screened publications, 32 original articles were eligible for inclusion in this review, reporting evidence on the measurement properties of 22 self- and/or proxy-reported questionnaires (including seven cultural adaptations) for various pediatric orthopedic conditions, including cerebral palsy (CP) and obstetric brachial plexus palsy (OBPP). The measurement property most frequently evaluated was construct validity. No studies evaluating content validity and only four PROM development studies were included. The methodological quality of these development studies was either \'doubtful\' or \'inadequate\'. The quantity and quality of the evidence on the other measurement properties of the included questionnaires varied substantially with insufficient sample sizes and/or poor methodological quality resulting in significant downgrading of evidence quality.
CONCLUSIONS: This review provides a comprehensive overview of currently available PROMs for evaluation of the pediatric upper limb. Based on our findings, none of the PROMs demonstrated sufficient evidence on their measurement properties to justify recommending the use of these instruments. These findings provide room for validation studies on existing pediatric orthopedic upper limb PROMs (especially on content validity), and/or the development of new instruments.

UNASSIGNED: Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery.
UNASSIGNED: A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications.
UNASSIGNED: Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients\' average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively.
UNASSIGNED: Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system.
UNASSIGNED: Level 3.

Electronic cigarette (EC) use is highly prevalent, especially in the adolescent population, where 29% of Canadian adolescents have used an EC in the past thirty days per national surveys. Our pediatric orthopedic referral centre observed a cluster of delayed unions of bone fractures in adolescents using ECs and present the case series here. We then asked whether electronic cigarettes impair bone healing or influence orthopedic outcomes. A PRISMA-compliant systematic review was carried out, which revealed no human clinical studies and a general paucity of evidence around ECs and musculoskeletal health. The existing experimental evidence relevant to orthopedics is summarized. The effect of ECs on the musculoskeletal system is poorly understood and is a target for further research.

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor\'s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor\'s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.