Sean Tabaie

Background: Recurrence remains a major challenge after Ponseti treatment for idiopathic clubfoot, and the long-term outcomes of treatment for recurrent deformity are incompletely characterized. This study evaluated recurrence, associated factors, and management outcomes, including the association between tibialis anterior tendon transfer (TATT) and repeat recurrence. Methods: We retrospectively reviewed 257 children treated with the Ponseti method for idiopathic clubfoot from 2007 to 2025, collecting demographic, perinatal, treatment, brace-adherence (full-time and part-time phases), and neighborhood socioeconomic data. Recurrence was defined as the reappearance of any component of the deformity after initial correction that prompted a change in management. Odds ratios (ORs) were estimated by univariable and multivariable logistic regression, and recurrence-free survival by the Kaplan-Meier analysis. Results: At least 1 recurrence occurred in 150 children (58.4%). Children with recurrence more frequently had prenatal or birth complications (OR=2.32; 95% CI: 1.34-4.01), less frequently underwent initial Achilles tenotomy (OR=0.50; 95% CI: 0.28-0.90), and had lower Child Opportunity Index percentiles ( P =0.032). Partial or absent adherence during full-time bracing was the strongest factor (adjusted OR=5.23; 95% CI: 2.53-10.84 for partial adherence), and among 171 children who reached part-time bracing, recurrence after the transition occurred in 70.3% with incomplete part-time adherence versus 29.0% with full adherence (OR=5.81; 95% CI: 2.94-11.46). Casting alone corrected 78% of first recurrences but was followed by further recurrence in 65%, compared with 25% after surgery alone. Younger age at first recurrence predicted repeat recurrence (OR=0.68 per year), and repeat recurrence was less frequent after surgery, including TATT (11.1% vs. 50.5%, P <0.0001). Conclusions: Recurrence after Ponseti treatment was common and was most strongly associated with incomplete brace adherence during both the full-time and part-time phases. Repeat casting frequently restored correction but was often followed by further recurrence, particularly after recurrence before 12 months of age, whereas TATT was associated with more durable correction. Adherence support should extend through the entire bracing period, with timely treatment of persistent muscle imbalance. Level of Evidence: Level III.

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are rarely performed in children and adolescents but may be required for end-stage joint disease. Evidence regarding safety, survivorship, and patient-reported outcomes in patients younger than 25 years remains limited. The aim of this study was to systematically evaluate postoperative complications, functional outcomes, quality of life, and revision rates following THA and TKA in this age group. Methods: A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, Embase, Scopus, and Web of Science were searched through October 2025 for studies reporting outcomes of THA or TKA in patients aged younger than 25 years. Random-effects models were used to pool complication rates, functional outcomes, quality of life, and all-cause revision separately for THA and TKA. Meta-regression explored the influence of age, sex, year of patient inclusion, arthroplasty indications, and bearing surface types. Results: A total of 44 studies involving 3,317 patients and 5,632 joints were included. Following THA, pooled rates of periprosthetic joint infection (PJI), aseptic loosening, and periprosthetic fracture were 1.6%, 5.4%, and 1.4%, respectively, and all-cause revision rate was 8.7%. Functional scores (standardized mean difference [SMD] = 4.9) and quality-of-life measures (SMD = 1.8) improved substantially after THA. For TKA, pooled PJI and aseptic loosening rates were 2.9% and 9.9%, with an all-cause revision rate of 12.4%. Subgroup analyses demonstrated that more recent years of patient inclusion were associated with lower revision and infection rates following THA. Conclusion: THA and TKA in patients younger than 25 years can improve function and quality of life, although the risks of revision and infection remain higher than those in older adults. Outcomes have improved in more recent cohorts with advances in implant design and surgical technique. Further prospective studies with standardized reporting are needed to define optimal implant selection and long-term outcomes in this population. PROSPERO Registration Code: CRD420261303010. Level of Evidence: Therapeutic Level III (systematic review of retrospective cohort studies). See Instructions for Authors for a complete description of levels of evidence.

Transphyseal screw hemiepiphysiodesis is a minimally invasive technique for guided growth correction of angular deformities and limb-length discrepancies of the lower extremities in the pediatric population. Pathological bone conditions, including Blount disease, hereditary multiple exostoses (HME), cerebral palsy (CP), and other neuromuscular disorders, present unique challenges that may affect correction rates, rebound risk, and postoperative complications. The purpose of this study is to review the outcomes and complications of transphyseal screw hemiepiphysiodesis in skeletally immature patients with defined pathological bone conditions. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD420261426720), a systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception to May 2026. Inclusion required a defined pathological etiology, transphyseal screw intervention, at least five patients or limbs, a quantitative radiographic outcome, and a minimum of six months of follow-up, with study quality assessed using the methodological index for non-randomized studies (MINORS) criteria. Twenty studies encompassing 657 patients and 1,072 limbs/segments were ultimately included and grouped into four anatomic categories: ankle/distal tibia (9 studies, 358 patients), knee coronal plane (4 studies, 121 patients), knee sagittal plane (4 studies, 113 patients), and hip (3 studies, 65 patients). Ankle valgus correction rates ranged from 0.24° to 0.90°/month across pathological diagnoses, with significantly faster rates in CP than in spina bifida or HME. For coronal knee deformity in Blount disease, the mean mechanical axis deviation correction rate was 3.66 ± 1.51 mm/month, and 90% surgical success was achieved in adolescent tibia vara. Additionally, coxa valga in CP improved, with mean head-shaft angle reductions of 13°-14° over two years. Complications were predominantly hardware-related, including difficult screw extraction, the physis growing off the screw, and rebound valgus in several ankle cases depending on etiology. In conclusion, transphyseal screw hemiepiphysiodesis is effective across a broad spectrum of pathological bone conditions, producing statistically and clinically significant deformity correction at the ankle, knee, and hip. However, correction rates vary meaningfully by etiology, hardware issues remain the primary complication, and rebound deformity remains a distinct concern after premature screw removal, particularly in patients with HME and CP.

Traditional spica casting is the standard treatment for pediatric femoral fractures in children under five years of age, but it carries well-documented limitations, including the need for general anesthesia, increased caregiver burden, and high rates of skin complications. Prefabricated functional bracing, such as the Dynamic Femur Fracture (DF2) brace (OrthoPediatrics, Warsaw, IN), has emerged as an alternative that eliminates anesthesia exposure and improves patient mobility. However, clinical data regarding the practical limitations, complication profiles, and patient selection boundaries during early adoption remain limited. This case series describes our institution's early experience with the DF2 brace to provide practical insights into patient selection and brace management. Following Institutional Review Board (IRB) approval, a case series was conducted at a single tertiary care pediatric institution. Records were reviewed for patients aged under 18 years diagnosed with a fracture requiring functional bracing treatment between January 1, 2020, and October 17, 2025. Patients were excluded if they had inadequate clinical and radiographic follow-up of less than six weeks. Demographic variables, injury characteristics, treatment parameters, radiographic time to union, and soft-tissue complications were extracted from electronic medical records into a secure database. Five pediatric patients were evaluated (four traumatic fractures and one elective postoperative reconstruction). Successful fracture healing and a return to age-appropriate activity were achieved in all four traumatic fracture cases. Open, superficial pressure injuries of the proximal lateral calf occurred in two patients, with both successfully managed in the outpatient clinic setting with local wound care. In an elective hip reconstruction case involving a 12-year-old nonambulatory patient with advanced cerebral palsy, the brace dug deeply into the groin and impinged on a pre-existing vesicostomy site, necessitating discontinuation on postoperative day 1 in favor of a straight knee immobilizer. Ultimately, the DF2 brace serves as an alternative to spica casting for acute, isolated femoral fractures in young children, providing reliable bone healing with simplified hygiene access. However, it did not eliminate the risk of pressure injuries in this series, highlighting the need for vigilant stockinette hygiene and proactive padding.

Background: Vitamin D is essential for pediatric bone health and fracture healing. Children with autism spectrum disorder (ASD) may have risk factors for fracture injuries and vitamin D insufficiency. However, patterns of vitamin D testing and insufficiency among pediatric fracture patients with ASD are not well defined. Methods: A single-institution retrospective cohort study of pediatric patients treated for fractures between 2012 and 2024 was conducted. Patients with ASD were compared with an age- and sex-matched cohort without ASD. Chart review identified demographics, comorbidities, medication use, serum 25-hydroxyvitamin D testing, ordering specialty, and supplementation status. Low vitamin D levels were categorized as insufficient and deficient, defined as 2 and Fisher exact tests. Logistic regression was used to identify predictors of vitamin D testing and low vitamin D levels. Results: A total of 290 patients (78% male; 145 ASD, 145 non-ASD) were included. Cohorts were similar in age, sex, race/ethnicity, and BMI. Eighty-eight patients (30%) had vitamin D testing, with testing more common among patients with ASD (67 vs. 21, 46% vs. 14%; P P =0.8). Most testing was ordered by psychiatry, behavioral health, or primary care, while orthopaedic services ordered 4 tests (5%). Multivariable regression identified ASD ( OR =3.7, 95% CI: 1.9-7.6) and atypical antipsychotic use ( OR =7.6, CI: 2.7-25.1) as predictors of testing. Increasing age ( OR =1.2, CI: 1.1-1.4) and worse ADI ( OR =1.3, CI: 1.1-1.6) were predictors of low vitamin D. Conclusions: The prevalence of low vitamin D was high among pediatric patients with fractures. Although children with ASD were more frequently tested, the prevalence of low vitamin D was not higher than in children without ASD. Low vitamin D was associated with socioeconomic disadvantage. Screening approaches incorporating socioeconomic risk may complement diagnosis-specific testing practices. Level of Evidence: Level III—retrospective comparative study.

Background: Despite the existence of the Journal of Pediatric Orthopaedic (JPO) as a leading platform for pediatric musculoskeletal research since 1981, comprehensive bibliometric analyses of authorship, publication data, and journal impact over its decades of history remain limited. Methods: All JPO articles from 1990 to 2024 were extracted from Web of Science. The 100 most prolific authors were identified. Their professional backgrounds, institutional affiliations, and publication metrics including authorship positions and H-index were analyzed. JPO’s citation trends, journal impact factor (IF), normalized Eigenfactor (nEF), geographic distribution of citations, and open-access utilization were extracted from Journal Citation Reports and compared with the Journal of Pediatric Orthopaedics B and Journal of Children’s Orthopaedics. Results: A total of 6834 articles and 14,671 authors were identified. The top 100 authors (0.7%) were predominantly orthopaedic surgeons (91%) and United States-based (90%). One in 4 surgeons held an advanced degree beyond a medical degree. Surgeons had higher odds of holding senior (OR: 12.7, 95% CI: 7.9-20.5) and first authorships (2.1, 1.4 to 3.1). Female authors were underrepresented overall (12%) and among surgeons (6, 7%; P < 0.001), although female and male surgeons did not differ in average number of senior authorships (F 11.8±4 vs. M 18.2±10.4; P = 0.09). The mean H-index for surgeons was higher than other authors (17.9±5.5 vs. 14.6 ±1.8; P = 0.04). JPO’s IF increased 152% since 1997. International contribution rose from 28% to 39% since 2019. Use of open-access rose to 5.1% of yearly publications in 2024 although open-access articles did not show higher odds of being cited (95% CI: 0.9-1.4). Conclusions: JPO’s sustained growth and scholarly impact over 3 decades, driven largely by highly academic orthopaedic surgeons and increasing interdisciplinary and international contributions, highlights the Journal’s role in advancing pediatric orthopaedics knowledge. Level of Evidence: Level III—database study.

Background: Congenital talipes equinovarus (clubfoot) affects 1–2 per 1000 newborns worldwide. The Ponseti method, based on staged manipulations and casting, is the gold standard for correction. However, the biomechanical processes underlying these corrections remain poorly understood, as infants rarely undergo imaging. Computational modeling may offer a non-invasive approach to studying correction pathways and exploring novel applications, such as customized casts. Methods: We developed a proof-of-concept framework using iterative finite element analysis (iFEA) to approximate the surface-level geometric corrections targeted in Ponseti treatment. A 3D surface model of a training clubfoot foot was scanned, meshed, and deformed stepwise under applied computational loads. The model was assumed to be homogeneous and hyperelastic, and correction was quantified using Cavus, Adductus, Varus, Equinus, and Derotation angles. We also introduced a secondary adult leg 3D surface model to assess whether model simplification influences correction outcomes, by comparing a homogeneous soft tissue model with a non-homogeneous model incorporating bone structure. Results: In the training model, iFEA generated progressive deformations consistent with Ponseti correction, with mean angular deviations of ±3.2°. In the adult leg model, homogeneous and non-homogeneous versions produced comparable correction geometries, differing by <2° in outcomes. The homogeneous model required less computation, supporting its use for feasibility testing. Applied loads were computational drivers, not physiological forces. Conclusions: This feasibility study shows that iFEA can reproduce surface-level geometric changes consistent with Ponseti correction, independent of model homogeneity. While not replicating clinical biomechanics, this framework lays the groundwork for future work that incorporates clinician-applied forces, pediatric tissue properties, and patient-specific geometries, with potential applications in customized 3D-printed casts.

As orthopaedic surgeons, we embrace a lifestyle and career defined by action, seeking to improve not only our patients’ lives but also our profession. One critical area where we can improve lies in diversity, equity, and inclusion (DEI). Despite mounting evidence of the profound value that diverse teams bring to innovation, problem-solving, and patient care, orthopaedics has lagged behind most medical specialties in achieving a representative workforce. Addressing this disparity is important in advancing our profession and improving the equitable treatment of our patients. Recognizing this imperative, the American Orthopaedic Association (AOA) hosted a DEI symposium in June 2024, in conjunction with its annual meeting, that brought together orthopaedic surgeons, researchers, and educators to build upon the importance of creating inclusive spaces in order to ensure that diverse voices are present and are actively contributing to the future of the profession of orthopaedics. A standout feature of the 2024 symposium was a fireside chat format that was accompanied by dynamic audience participation, offering valuable insights and actionable strategies drawn from both the business world and medical oncology. These fields have made substantial strides in promoting diversity and inclusivity, providing a model for orthopaedics in overcoming similar challenges. The discussions illuminated the critical concept of allyship and examined the tangible steps that individuals and institutions can take. Allyship, as emphasized during the forum, requires deliberate, sustained effort. It is an active commitment to understanding and supporting underrepresented individuals and groups within the orthopaedic community. This means listening to their experiences, challenging biases, and working collaboratively to dismantle structural barriers. For institutions, it involves cultivating policies, mentorship opportunities, and recruitment strategies that prioritize equity and that reflect the diverse patient populations that we serve. By embracing allyship and adopting lessons from other fields, this symposium demonstrated opportunities to transform our profession and the lives of those who depend on our care, ensuring that our actions align with the ideals that we strive to uphold.