(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in many patients. Often, the primary minimal invasive incision needs to be widened during implant removal. In order to decrease the burden of care of pediatric fractures, significant efforts were made to develop biodegradable implants, which make hardware removal unnecessary. Our study will conduct an observational trial on the clinical use of the Activa IM-Nail™ in forearm fractures in children between 3 and 13 years of age. The objective of this trial is to evaluate the risks and benefits of the Activa IM-Nail™. Among other objectives, the rate of refracture will be determined. (2) Methods: An international Europe-based, multicenter, prospective, single-arm, open-label study will be performed to ascertain the rate of refracture and to determine the subjective benefits of Activa IM-Nail™ for patients, parents and other caregivers. The study will include clinical follow-up including early post-operative complication, radiographs until bony healing and an additional follow-up after 1 year. At this stage, preliminary results and early complications on 76 patients are analyzed in this study and presented. (3) Results: As of April 2022, 76 patients were enrolled as per study protocol. There were 31 girls (40.8%) and 45 boys (59.2%). The mean age at the time of inclusion was 8.9 years (±2.4 years). The mean operation time was 58.9 ± 22.9 min (range, 15–119 min). The mean follow-up time was 8.9 ± 5.1 months (range, 0.2–18.6). Up to now, one refracture has occurred in one child falling from a height of about one meter 7 months after index surgery (1/76; 1.3%). (4) Conclusion: The research project assesses the safety and effectiveness of Activa IM-Nails™ as part of the surgical treatment of dislocated forearm fractures in children in the context of a PMCF study. The use of Activa IM-Nails™ with regard to various objectives, including postoperative complications and refracture rate, seems to be equal to the standard titan ESIN procedure compared to the literature. Preliminary results are encouraging and are made available.

Purpose: Manual anthropometric evaluations of pediatric lower extremities are essential in orthopedic pediatric practice due to their noninvasive and time-feasible nature. Therefore, this study aims to assess the test–retest reliability of clinical measurements obtained on children to examine measurement stability over time. Methods: In a test–retest design, data were collected from 50 Danish school children with 5–to 6 weeks between sessions. Measurements encompassed the joint range of motion (ROM), rotational profile, and angular alignment of lower extremities for a representative sample of school children. Reliability was assessed using intraclass correlations (ICC), and agreement was assessed using limits of agreement (LoA) and precision. Results: Reliability analysis revealed excellent results for foot length (ICC > 0.9), good results for foot width (ICC < 0.9), and poor to moderate results for all other measurements (ICC < 0.5, ICC < 0.75). Agreement results for hallux valgus were acceptable (within established reference) and the remaining variables were not acceptable (outside established reference). Conclusions: The majority of the manual assessment procedures were found to have poor reliability. This study highlights the need for reliable and time-efficient tools to assist clinicians in assessing manual clinical measurements and future research should explore this. Level of evidence: Level III.

Aims: The aim of this study was to investigate whether a hip-related tenotomy is associated with a lower risk of severe hip outcomes in nonambulant children with cerebral palsy and established displacement of the hip. Methods: This nationwide register-based cohort study included children classified as Gross Motor Function Classification System (GMFCS) level IV or V who were enrolled in the Danish Cerebral Palsy Follow-Up Program (CPOP) between 1 January 2008 and 31 December 2023. Hips with a baseline migration percentage (MP) of between 30% and 49% were included and followed until the first occurrence of a severe hip outcome, defined as a MP of ≥ 50% or osteotomy of the hip. Death was treated as a competing event. The cumulative incidence was estimated using the Aalen-Johansen estimator. Associations were analyzed using Fine-Gray competing-risk regression with cluster-robust standard errors. Results: A total of 259 children, contributing 406 hips, were included, of which 110 underwent a tenotomy. At ten years, the cumulative incidence of a severe hip outcome was 34.7% (95% CI 28.8 to 40.7) without tenotomy, and 20.4% (95% CI 12.4 to 28.5) with tenotomy. In adjusted competing-risk regression, tenotomy was associated with a significantly lower risk of a severe hip outcome (sub-distribution hazard ratio (sHR) 0.53 (95% CI 0.34 to 0.84); p = 0.006). GMFCS-specific Fine-Gray analyses showed a significant association in GMFCS level IV (sHR 0.35 (95% CI 0.16 to 0.78); p = 0.010), whereas the association did not reach significance in GMFCS level V (sHR 0.68 (95% CI 0.40 to 1.19); p = 0.180). Spasticity, as classified according to the Modified Ashworth Scale (MAS) 1 and ≥ 3, was independently associated with a significantly increased risk of a severe hip outcome. Conclusion: A hip-related tenotomy was associated with a significantly lower incidence of the subsequent development of a severe hip outcome among nonambulant children with established displacement of the hip, particularly in GMFCS level IV. In GMFCS level V, progression remained substantial irrespective of the soft-tissue release, emphasizing the importance of careful patient selection and continued surveillance. Cite this article: Bone Joint J 2026;108-B(11):1379–1384.

Background: Caregivers often seek medical assistance when their child experiences podiatric medical ailments. Podiatric medical diseases such as ingrown toenails, callosities, warts, metatarsus varus, and hallux valgus frequently occur in children and adolescents. However, treatment, prevention, and rehabilitation are often based on empirical experiences; thus, as a first endeavor, clinical and epidemiologic mapping of podiatric medical diseases in children is warranted. We describe the prevalence of common foot conditions—callosities, ingrown toenails, hallux valgus, metatarsus varus, and warts—among Danish schoolchildren aged 6 to 16 years. Methods: In this cross-sectional study, we evaluated foot conditions in children in first (aged 6–8 years), fifth (aged 10–12 years), and ninth (aged 14–16 years) grades. The clinical status of the feet was examined by teams of two podiatric physicians each. Specifically, we evaluated deformities of the foot, foot pathologies, and their anatomical localization. Results: Of 501 children (1002 extremities) evaluated, 417 had one or more of the investigated foot deformities or pathologies. We found 266 various foot pathologies among Danish schoolchildren. Metatarsus varus (53%) and callosities (46%) were the most frequently occurring foot conditions. The prevalence of foot pathologies of ingrown toenails and warts was 14% and 12%, respectively. The prevalence of ingrown toenails, metatarsus varus, and hallux valgus increased with age. Conclusions: This study found that foot pathologies such as warts and ingrown toenails and conditions such as metatarsus varus and callosities are common in Danish primary school students. These findings of high prevalences of foot pathologies and conditions motivate future research projects to clarify how this affects general health and subsequently the relation to pain, health challenges, socioeconomics, and quality of life.