Orthogate Subspecialty Journal Scan: Pediatric Orthopaedics
Curated critical appraisals of recent high-impact trials and practice-changing studies across pediatric orthopaedics, structured using the SBAR framework for immediate surgical and clinical application.
- 1. Evaluation of the clicky hip as a screening tool in the diagnosis of developmental dysplasia of the hip. - The bone & joint journal Level II
- 2. Femoral Nerve Palsy as a Complication of Pavlik Harness Treatment for Developmental Dysplasia of the Hip: Ten-Year Prospective Study. - Journal of pediatric orthopedics Level II
- 3. The Effect of Transportation Barriers on the Risk of Relapse for Idiopathic Clubfoot. - The Journal of the American Academy of Orthopaedic Surgeons Level III
1. Evaluation of the clicky hip as a screening tool in the diagnosis of developmental dysplasia of the hip.
Authors: Poacher A, Bilal M, Smith A, Scourfield L, Hawes E et al. | Journal: The bone & joint journal (Oct 2026) | View Source / DOI
Situation
To evaluate the association between a clicky hip documented at the newborn or six- to eight-week examination and pathological developmental dysplasia of the hip (DDH) requiring treatment within a selective screening programme in the UK.
Background
Early diagnosis of developmental dysplasia of the hip (DDH) is important because treatment in early infancy is usually nonoperative. A consensus statement from the British Society for Children's Orthopaedic Surgery highlighted ongoing uncertainty regarding the predictive value of a documented clicky hip in selective screening pathways.
Assessment & Findings
- Study Design & Methodology: Retrospective analysis of prospectively collected registry data for all live births in the catchment area of a single UK tertiary centre between January 2016 and December 2023. Infants underwent examination at birth and again at six to eight weeks, with ultrasound screening offered for those with primary risk factors or abnormal clinical examination findings, including a clicky hip. The primary outcome was pathological DDH requiring treatment. Multivariable logistic regression estimated adjusted odds ratios (ORs) for DDH, alongside positive predictive value (PPV), risk difference (RD), and number needed to screen (NNS).
- Primary & Secondary Findings: Among 42,338 infants analyzed, 7,564 (17.9%) underwent ultrasound screening. Pathological DDH requiring treatment was identified in 245 infants (5.8 per 1,000 live births). A clicky hip was recorded in 1,125 infants, of whom 40 (3.56%) had DDH requiring treatment. A clicky hip was independently associated with DDH (adjusted OR 4.68, 95% CI 3.11 to 7.03; p < 0.001). Within the selective screening pathway, the RD was 3.86% (95% CI 2.65 to 5.07), the PPV was 3.56%, and the NNS was 26.
Recommendation & Practice Takeaway
Clinical Pearl: In a selective screening programme, an isolated documented clicky hip is independently associated with DDH requiring treatment (adjusted OR 4.68; NNS 26). These findings support the prospective evaluation of a documented clicky hip as an indication for ultrasound referral in selective DDH screening pathways.
2. Femoral Nerve Palsy as a Complication of Pavlik Harness Treatment for Developmental Dysplasia of the Hip: Ten-Year Prospective Study.
Authors: Khan T, Douglas C, Khan Z, Edel P | Journal: Journal of pediatric orthopedics | View Source / DOI
Situation
To determine the incidence, risk factors, and clinical course of femoral nerve palsy (FNP) in infants undergoing Pavlik harness (PH) treatment for developmental dysplasia of the hip (DDH), and to evaluate whether FNP predicts treatment failure.
Background
Femoral nerve palsy is a recognized complication of Pavlik harness management for DDH, but its true incidence and clinical significance may be underestimated. Understanding the clinical trajectory and recovery of FNP is essential to prevent premature abandonment of nonoperative treatment.
Assessment & Findings
- Study Design & Methodology: A 10-year prospective study (2015 to 2025) of all infants treated with a PH for Graf II to IV DDH at a specialist center. Patients underwent weekly clinical and ultrasound assessments during the initial phase of treatment. Parents received structured education to facilitate early FNP identification. Recorded data included demographics, Graf type, age, weight, onset and duration of FNP, parental detection, management strategies, and final treatment outcome.
- Primary & Secondary Findings: Of 339 consecutive infants treated with a PH, 20 (5.89%) developed clinically evident FNP. Onset ranged from day 1 to 6 weeks, and 35% (n=7) were first identified by parents. All cases demonstrated full neurological recovery following harness adjustment or temporary cessation. PH treatment was successful in 65% of infants with FNP, compared with 93% in those without FNP. FNP occurred more frequently in older infants and in those with more severe DDH, with 16/20 cases involving at least 1 Graf III or IV hip. Traditional DDH risk factors showed no association. Treatment failure in the FNP cohort was confined to severe (Graf III/IV) dislocations.
Recommendation & Practice Takeaway
Clinical Pearl: Femoral nerve palsy has a prospective incidence of 5.89% during Pavlik harness treatment and is fully reversible with prompt harness adjustment or temporary cessation. FNP is not an independent predictor of harness failure; treatment failure is driven primarily by baseline hip dysplasia severity (Graf III/IV). Individualized harness adjustment, rather than routine abandonment, preserves successful nonoperative treatment.
3. The Effect of Transportation Barriers on the Risk of Relapse for Idiopathic Clubfoot.
Authors: Myers A, Bent M, Phan T, Padilla A, Wren T et al. | Journal: The Journal of the American Academy of Orthopaedic Surgeons (Nov 2026) | View Source / DOI
Situation
To evaluate the effect of transportation barriers on the risk of relapse in pediatric patients undergoing Ponseti method treatment for idiopathic clubfoot.
Background
Clubfoot is a common orthopaedic birth defect affected by both clinical and psychosocial risk factors. Identifying how social determinants of health such as transit barriers influence compliance and deformity recurrence is vital for improving long-term care pathways.
Assessment & Findings
- Study Design & Methodology: Patients diagnosed with idiopathic clubfoot were enrolled in a prospective registry at a single tertiary care center between May 2019 and August 2022. A prospective survey evaluated demographics and transportation barriers, alongside retrospective chart review and community health needs database queries mapped to patient zip codes.
- Primary & Secondary Findings: A total of 97 patients meeting inclusion criteria underwent the Ponseti treatment method, with a median of eight serial casts. Eighty patients (83.3%) underwent an Achilles tenotomy. A total of 46 patients (47.4%) experienced a relapse, and 27 patients (27.8%) experienced multiple relapses. For the first episode of relapse, 27 of 46 patients (58.7%) underwent repeat casting, 15 of 46 (32.6%) underwent a surgical procedure, and 4 of 46 (8.7%) underwent both. Patients with a longer commute to the clinic were significantly more likely to experience relapse (median 38 versus 52.5 minutes; P = 0.031). Additionally, patients from areas with higher rates of households without vehicles (P = 0.008) and areas with more households below the federal poverty level (P = 0.037) were significantly more likely to experience relapse.
Recommendation & Practice Takeaway
Clinical Pearl: Transportation barriers correlate directly with higher relapse rates in patients undergoing Ponseti clubfoot treatment (longer commute median 38 versus 52.5 minutes, P = 0.031; vehicle lack P = 0.008). Addressing social determinants of health and transportation access is essential to optimize clinical outcomes and prevent deformity relapse.
