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Background This study aimed to investigate the presence of physeal abnormality and its effect on growth in children with high-risk neuroblastoma treated by intensive multimodal treatment with/without 13-cis-retinoic acid (13-CRA). Methods Fifteen patients diagnosed with high-risk neuroblastomas at the age of 1 to 10 years, who received treatment such as high-dose chemotherapy and autologous stem cell transplantation with/without 13-CRA, and with complete data during their >2-year follow-up were retrospectively reviewed. The physeal abnormalities were investigated by whole-body magnetic resonance imaging, serially performed every 3 to 6 months. The patients' height growth was also investigated and compared with that of age-and-sex-matched patients with brain tumors who also underwent high-dose chemotherapy and autologous stem cell transplantation. Results Six of 15 patients presented multifocal physeal abnormalities during follow-up, and all lesions occurred in patients with 13-CRA use. The lesions in 3 patients completely resolved spontaneously without any adverse effect on growth, but some lesions in the other 3 patients progressed to disturb the bony growth. Height growth of matched patients with brain tumors were not significantly different, and none of the matched controls showed definite bony deformity during the follow-up. Conclusions Some children who were treated for high-risk neuroblastomas experienced multifocal physeal insults, probably due to the use of 13-CRA. Most lesions resolved spontaneously, but some led to bony deformity. If the lesions are not followed by premature physeal closure, there seems to be no further adverse effect of 13-CRA on leg length growth. Routine periodic screening for physeal status is needed for the patients with high-risk neuroblastomas using 13-CRA. Level of evidence Level IV-prognostic study.

Background The middle phalangeal type of postaxial polysyndactyly (MPPP) of the foot is a common congenital limb anomaly and is usually treated surgically at a young age. Owing to the insufficiency of radiologic evaluation due to largely cartilaginous portions of the pediatric foot, we performed intraoperative arthrography (IOA) for MPPP. This study was aimed at presenting a new classification system for foot MPPP in young children based on IOA findings and investigating its intraoperative decision-making. Methods Thirty-seven patients aged below 2 years who underwent IOA and surgical treatment of foot MPPP in our institute between January 2018 and April 2020 were retrospectively reviewed. The mean patient age at operation was 1.31 years (range, 0.91 to 1.99 y). IOA was performed in the common proximal interphalangeal (PIP) joint. The excisional level and side were determined on the basis of the IOA findings and bony alignment between the proximal and distal phalanges for functional and cosmetic purposes. Arthrographic findings and surgical procedures were recorded. Results A new classification divided MPPP into 2 major types according to the presence (type A) or absence (type B) of longitudinal contrast filling between the fifth and sixth middle phalanges. These 2 major types were further divided into 4 subtypes according to the shape of the PIP joint by contrast filling. There were 19, 15, and 3 cases of type A, B, and indeterminate IOA. Fifth and sixth ray excisions were performed in 26 and 11 cases, respectively. Interobserver reliability of the classification represented excellent agreement (Cohen κ coefficient=0.823). Conclusions Our new classification based on IOA helped determine the articular dominance and its detailed morphology, which can help predict postoperative stability and mobility of the remaining toe. IOA is a simple, safe, and useful imaging tool for the surgical treatment of foot MPPP in patients aged below 2 years. Level of evidence Level III.

Background Since 2015, we have performed arthroscopy-assisted closed reduction and percutaneous pinning (A/S-CRPP) for children with a displaced lateral condylar humeral fracture (LCF). The purpose of this study is to introduce our A/S-CRPP method and present its outcomes. Methods In total, 39 displaced (>2 mm) LCFs for which A/S-CRPP was initially attempted and with available follow-up data of >12 months were retrospectively reviewed. A/S-CRPP is performed in the following order: closed reduction, 1 provisional K-wire fixation, arthroscopic verification of the reduction status, rereduction if needed, and additional fixation. Our reduction technique using articulations of the ulnohumeral and radiohumeral joints and direct compression is introduced. For rereduction, modified reduction forces were applied based on the arthroscopic findings. To evaluate the learning curve effect, the initial 6 months after the first case of A/S-CRPP was regarded as the "initial period." There were 12 cases during this period. Results Among the 39 cases, surgical method was intraoperatively converted to open reduction and percutaneous pinning in 9 and A/S-CRPP was completed in 30. Among the 9 open reduction and percutaneous pinning conversion cases, 7 conversions occurred in the initial period. Among the 30 patients who underwent A/S-CRPP alone, 10 needed rereduction after an arthroscopic examination. No patients presented with >10-degree angular deformity or elbow motion limited >20 degrees, compared with the contralateral elbow. Postoperative radial nerve palsy occurred in 2 patients, all in the initial period. Both were resolved within 5 months, postoperatively. Conclusions We suggested our A/S-CRPP surgical technique for displaced pediatric LCF. It may require a 6-month learning curve period. Although more studies are needed, it seems to be a safe and appropriate surgical technique for treatment. Level of evidence Level IV-therapeutic study.

BACKGROUND Patients with multiple hereditary exostoses (MHE) frequently present with a genu valgum deformity. Temporary hemiepiphysiodesis, such as hemiepiphyseal stapling, is a relatively safe surgical method to correct angular deformities in skeletally immature patients, but its outcomes for genu valgum deformity in MHE patients have not been extensively reported. We investigated the outcomes of hemiepiphyseal stapling in MHE patients (MHE group) and compared those with the outcomes in patients with idiopathic deformities (idiopathic group) after adjusting for potential bias. METHODS Data from 70 limbs with genu valgum deformity (15 MHE and 55 idiopathic), which had undergone hemiepiphyseal stapling, were retrospectively reviewed. The outcomes were focused on the achievement of satisfactory correction and the velocity of correction. The independent effects of each characteristic on each outcome were investigated using multivariate analyses. The outcomes between the groups were also compared after 1:2 matching using propensity score analysis. RESULTS The mean valgus angle of the MHE group was 7.4±4.1 degrees at stapling and was corrected to 1.3±3.0 degrees at staple removal. The rate of satisfactory corrections was not different between the MHE and idiopathic groups (67% and 70%, respectively, P=0.820). However, the correction velocity was significantly lower in the MHE group than in the idiopathic group on both multivariate analysis (P=0.001) and matching comparison (4.4 vs. 7.9 degrees/y, P