Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1-3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH. This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing. Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes. Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia. Level IV.

Hip displacement and dislocation are among the most disabling musculoskeletal sequelae of cerebral palsy (CP) yet reported incidence and risk-factor estimates vary widely across studies. We undertook a systematic review and pooled analysis to quantify cumulative incidence across Gross Motor Function Classification System (GMFCS) strata and identify reproducible clinical and radiographic predictors. A protocol was registered in PROSPERO (CRD420251026860). MEDLINE (PubMed), Embase, CINAHL and CENTRAL were searched from inception to March 30, 2025. Eligible longitudinal studies enrolled ≥30 children with CP aged 2-18 years, provided ≥2 years' follow-up without confounding hip-directed intervention, and reported migration percentage (MP) data or equivalent permitting derivation. Hip displacement and dislocation were harmonized as MP >30 % and >50 %, respectively. Study quality was appraised with ROBINS I. Proportions were stabilized with the Freeman-Tukey double-arcsine transformation and pooled in random-effects (REML) models; odds ratios (ORs) for candidate predictors were combined using inverse-variance random-effects methods. Heterogeneity (I², τ²), prediction intervals, influence diagnostics, Hartung-Knapp sensitivity and Egger tests were performed. Certainty was graded with adapted GRADE. Nineteen studies met inclusion; nine natural-history cohorts (n = 1556; median follow-up 5.1 y) contributed extractable incidence data. The pooled cumulative incidence of hip displacement/dislocation was 38.2 % (95 % CI 31.7-45.1 %; I² = 77 %; prediction interval 6.0 53.8 %). Incidence was 17.1 % in ambulant children (GMFCS I-III) and 71.9 % in non-ambulant children (IV-V), yielding an OR 3.72 (95 % CI 2.56-5.40) for non-ambulant vs ambulant groups. A baseline MP ≥ 30 % quadrupled subsequent risk (OR 4.48, 95 % CI 2.66-7.54; I² = 0 %). Pelvic obliquity ≥10° was associated with increased risk in a single cohort (OR 2.70, 95 % CI 1.34-5.46) and should be regarded as suggestive pending replication. No consistent effects were found for sex, gestational age or CP subtype. Approximately four in ten children with CP, and more than two thirds of those in GMFCS IV-V, develop clinically important hip displacement without targeted intervention. GMFCS IV-V status and an early MP ≥ 30 % are robust, actionable triggers for intensifying hip surveillance to six-monthly radiography; pelvic obliquity ≥10° may further stratify risk but requires confirmation. Uniform MP thresholds, time-to-event analyses and reporting of modifiable exposures are needed in future multicenter cohorts to refine preventive care.

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions.

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc–IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH.

Pediatric fracture overgrowth is an unpredictable complication of long bone fractures in children, leading to excessive growth of the injured limb and resulting in limb length discrepancies (LLDs) and angular deformities that impact mobility and quality of life. Traditional methods struggle to predict at-risk children, hindering early detection and management. Artificial intelligence (AI), including machine learning and deep learning, offers advanced data analysis capabilities to enhance predictive accuracy and personalize treatment strategies. This comprehensive review explores the current understanding of pediatric fracture overgrowth, examines AI applications in medicine and orthopedics, evaluates potential AI applications specific to fracture overgrowth, and discusses ethical considerations and patient-centric approaches. We highlight how AI can improve diagnostic precision, facilitate early intervention, and optimize clinical outcomes. Though direct studies on AI in fracture overgrowth are limited, evidence from related areas underscores its potential. Embracing AI could revolutionize pediatric fracture management, leading to earlier detection, targeted interventions, and better outcomes for affected children.

Determining whether a pediatric fracture is congruent with the reported mechanism is challenging even with age-based guidance. We synthesize fracture evidence by neurodevelopmental milestones to organize plausibility judgments that augment, not replace, multidisciplinary abuse evaluations. To synthesize evidence linking fracture patterns to developmental milestones in children ≤36 months evaluated for suspected non-accidental injury (NAI) and to propose a milestone-anchored, evidence-informed plausibility framework. Following PRISMA 2020, we searched PubMed, Embase and Scopus from inception to 19 August 2025. Two reviewers independently screened/extracted data and assessed risk of bias (Newcastle-Ottawa Scale for cohort/case-control). PROSPERO CRD420251120765. Eligibility required data linking fracture type/location to age or explicit motor milestones (e.g., pre-rolling, crawling and walking). Quantitative synthesis was restricted to within-cohort strata: we calculated stratum-specific odds ratios, a Mantel-Haenszel within-cohort stratified pooled estimate across long-bone strata and (where informative) Bayesian Beta-Binomial posterior summaries; cross-cohort pooling was avoided because of cohort overlap and heterogeneous abuse determination. Across primary studies, non-ambulatory infants with long-bone (diaphyseal) fractures had markedly higher odds of abuse than ambulatory toddlers (within-cohort pooled OR 15.12, 95 % CI 2.88-79.36). Infants <12 months with rib fractures had abuse prevalences 67-82 % when motor-vehicle crashes and bone disease were included and ~91 % when excluded; rib fracture location was not independently associated with abuse likelihood. Classic metaphyseal lesions (CMLs) are highly suggestive, though not pathognomonic, of abuse in non-ambulatory infants. In one cohort, multiple fractures were present in 84 % (16/19) of children reported as suspected abuse. Collectively, findings support a milestone-aware approach to plausibility. Fracture patterns correlate with developmental capabilities. Organized by milestones, these data inform, but do not determine, abuse evaluations and should be integrated with history, examination, guideline-concordant imaging, differential for bone fragility when indicated and multidisciplinary assessment.