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Purpose of Review: Myths, widely held but false or unproven beliefs, exist in pediatric orthopedics, with the most common examples related to flexible flatfeet, in-toeing/out-toeing, W-sitting, and toe-walking. Concerns regarding these findings and suggested treatments, unfounded in science, may be passed along verbally or published through various media, without citation. The current review investigates these myths and provides up to date recommendations on diagnosis and treatment (or lack of necessary treatment) for these common pediatric orthopedic findings., Recent Findings: Orthotics used in childhood do not alter foot development for flexible flatfeet. W-sitting is not associated with developmental dysplasia of the hip, and there is no scientific evidence to support that it leads to contractures, hip dislocations, or functional deficits., Summary: Misinformation about normal variants of growth in childhood and suggested treatments are rampant and can be found published through various media without citation, as supportive scientific studies do not exist or existing studies refute the claims. Flexible flatfeet, in-toeing/out-toeing, W-sitting, and toe-walking typically improve throughout childhood without intervention. Physical therapy, orthotics and bracing have not been proven effective. Treatment is required in rare scenarios and should be directed by the orthopedic surgeon., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Our understanding of the epidemiology, diagnosis, and management of developmental dysplasia of the hip (DDH) is evolving. This review focuses on the most up-to-date literature on DDH in patients from birth to six months of age., Recent Findings: Well known risk factors for DDH include family history, female sex, and breech positioning. Recent evidence suggests higher birth weight is a risk, whereas prematurity may be protective. Screening includes physical examination of all infant hips and imaging when abnormal findings or risk factors are present. Treatment in the first six months consists of a harness, with 70-95% success. Failure risk factors include femoral nerve palsy, static bracing, irreducible hips, initiation after seven weeks of age, right hip dislocation, Graf-IV hips, and male sex. Rigid bracing may be trialed if reduction with a harness fails and closed reduction is indicated after failed bracing. If the hip is still irreducible, nonconcentric, or unstable, open reduction may be required following closed reduction. Evidence does not support delaying hip reduction until the ossific nucleus is present., Summary: DDH affects 1-7% of infants. All infants should be examined and selective screening with imaging should be performed for abnormal physical exams or risk factors. Early treatment is associated with optimal outcomes.

Purpose of Review: The purpose is to review the indications for epiphysiodesis in the treatment of pediatric limb length discrepancies; provide an update on current diagnostic, planning, and surgical techniques; and to introduce possible future alternatives., Recent Findings: Retrospective comparative studies have failed to demonstrate superiority of one epiphysiodesis technique over the others. EOS low-dose biplanar X-ray and smartphone growth prediction applications are improving our ability to diagnose and plan treatment for leg length discrepancy. Arthroscopically guided percutaneous epiphysiodesis and radiofrequency ablation are newer techniques that are still under investigation., Summary: Epiphysiodesis is the treatment of choice for children with predicted leg length discrepancies between 2-5 cm, provided that the physes are open with sufficient growth remaining. The most common epiphysiodesis techniques are performed percutaneously and either ablate the physis with drills/curettes or use metal implants to tether the physis and prevent further growth. Surgical treatment is typically ambulatory in nature, and allows for early return to weight bearing. In modern series, complication rates are less than 10%, with the majority being minor complications. Further high-quality prospective research is needed to determine the optimal epiphysiodesis surgical technique.

Purpose of Review: The present review includes the most up-to-date literature on the causes, epidemiology, diagnosis, and treatment of toe walking., Recent Findings: The prevalence of toe walking at age 5.5 years is 2% in normally developing children, and 41% in children with a neuropsychiatric diagnosis or developmental delays. A recent systematic review concluded that there is good evidence for casting and surgery in the treatment of idiopathic toe walking, with only surgery providing long-term results beyond 1 year. Botox combined with casting does not provide better outcomes compared with casting alone. Ankle-foot-orthoses restrict toe walking when worn, but children revert to equinus gait once the orthosis is removed., Summary: Toe walking can occur because of an underlying anatomic or neuromuscular condition, but in the majority of cases toe walking is idiopathic, without a discernable underlying cause. For some families, toe walking may simply be a cosmetic concern, whereas in other cases it can cause pain or functional issues. Treatment for toe walking is based on age, underlying cause, and the severity of tendon contracture. Described treatments include casting, chemical denervation, orthotics, physical therapy, and surgical lengthening of the gastroc-soleus-Achilles complex. A careful history, clinical exam, and selective diagnostic testing can be used to differentiate between different types of toe walking and determine the most appropriate treatment for each child.

Purpose of Review: The present review discusses the relevant anatomy, clinical presentation, and management of medial epicondyle fractures, including diagnostic controversies, the indications for operative and nonoperative management, and outcomes., Recent Findings: Recent studies have highlighted the underestimation of fracture displacement seen on typical radiographic views and have attempted to define the location of the medial epicondyle on radiographs to improve the accuracy of measuring displacement. They have demonstrated variable outcomes following open reduction and internal fixation of medial epicondyle fractures that are associated with intra-articular incarceration. Newer evidence supports the fixation of medial epicondyle fractures in adolescent athletes, to allow return to competitive sports., Summary: Medial epicondyle fractures of the distal humerus account for 12% of pediatric elbow fractures and are frequently associated with intra-articular incarceration of the fracture fragment, elbow dislocation, ulnar nerve injury, and other upper extremity fractures. Recent literature calls into question the accuracy of measuring fracture displacement, and controversy exists regarding optimal management of these fractures. Good outcomes have been achieved with nonoperative treatment for minimally displaced fractures, despite a high rate of nonunion. In patients with displaced fractures, fixation yields stability, functional range of motion, and the ability to return to previous activity levels, including sports. Complications include stiffness, instability, deformity, superficial wound infections, and symptomatic nonunion. Further study is required to standardize the measurement of displacement and to clarify indications for operative treatment in both sedentary and active children.

Purpose of Review: The current review includes the most up to date literature on the cause, epidemiology, diagnosis, and treatment of pediatric flatfeet., Recent Findings: Recent systematic reviews concur that the evidence supporting the use of orthotics in pediatric flexible flatfeet is poor. Multiple studies have recently reported on the results of arthroereisis, yet these are mostly retrospective and do not include a comparative group or long-term follow up. Other options for symptomatic flatfeet may include osteotomies and/or fusions, but similarly high quality comparative studies are lacking., Summary: Pediatric flatfeet range from the painless flexible normal variant of growth, to stiff or painful manifestations of tarsal coalition, collagen abnormalities, neurologic disease, or other underlying condition. Most children with flexible flatfeet do not have symptoms and do not require treatment. In symptomatic children, orthotics, osteotomies, or fusions may be considered. Arthroereisis has gained popularity in Europe, but has not been widely adopted in North America. Children with asymptomatic rigid flatfeet may not require treatment, whereas those with pain or functional deficits may benefit from orthotics, osteotomies, or fusions. A careful history, clinical exam, and selective diagnostic testing can be used to determine the appropriate treatment option for each child.

Purpose of Review: The cause, epidemiology, diagnosis, and treatment of osteoarticular infections have changed considerably in recent years. The current review includes the most up to date literature on pediatric septic arthritis and osteomyelitis., Recent Findings: There is controversy over whether osteoarticular infection rates are increasing or decreasing. Changes in epidemiology may be related to improved methods of diagnosis. The pathogens responsible for osteoarticular infections in children have changed with alterations in immunization practices, emergence of resistant bacteria, and changes in patterns of immune modulating diseases and medications in children. Special culture techniques and PCR may help to identify pathogens that are difficult to culture. Surgical debridement is typically required for joint infections and chronic osteomyelitis, whereas acute osteomyelitis can typically be treated with medication alone. Needle aspiration/irrigation alone has been described as an alternative to surgical incision/drainage for septic arthritis, but this practice has not been widely adopted. Intravenous antibiotic therapy for 2-4 days followed by 20 days of oral therapy is effective for treating uncomplicated cases of osteomyelitis, whereas 2-4 days of intravenous antibiotics followed by 10 days of oral therapy is sufficient for septic arthritis. Steroids have shown some improved short-term clinical outcomes in patients with septic arthritis., Summary: Up to date knowledge of emerging pathogens, utilization of modern diagnostic techniques and implementation of new shorter treatment regimens can optimize the treatment of pediatric septic arthritis and osteomyelitis.