Quantification of the severity of chest wall deformation in children with spinal deformities is essential for understanding the effects on trunk appearance and cardiopulmonary function. Magnetic resonance imaging (MRI) is particularly valuable for this purpose, as it does not employ ionizing radiation and can provide three-dimensional (3D) imaging of thoracic anatomy. Acquiring sufficient quality images of the chest wall, lungs and airways at key stages of the respiratory cycle, such as end-inspiratory or expiratory phase, is crucial for accurately assessing chest wall deformation and pulmonary function and mechanics. Regarding image quality, low proton density and short relaxation times of the lung tissues result in poor quality images, and long acquisition times result in blurring caused by respiratory and cardiac motion. This overview summarizes strategies developed to address the inherent challenges of visualization of lung tissue and respiratory motion in MRI acquisition of the chest of pediatric patients with spinal deformities. An overview of the main methods for motion-resolved image acquisition and measurement of chest wall motion and thoracic volumes is presented and discussed. It is concluded that despite the development of multiple techniques and diverse strategies for obtaining high-quality, motion-resolved chest MRI, further validation of these methods is required before their implementation in clinics for routine evaluation of chest deformation in pediatric spinal deformity patients.

Introduction: Madelung deformity is a rare wrist condition characterized by progressive angular deformity secondary to asymmetric premature closure of the distal volar-ulnar radial physis. Standardized treatment guidelines remain lacking. This study aimed to evaluate clinical and radiologic outcomes following different surgical strategies and to identify key parameters to guide surgical decision-making. Methods: A retrospective review was performed on 74 wrists in 41 patients treated between 1999 and 2023. Data collected included demographics, range of motion (ROM), and radiographic parameters: ulnar tilt (UT), lunate fossa angle (LFA), lunate subsidence (LS), and palmar carpal displacement (PCD), assessed preoperatively and postoperatively. Results: Of 74 wrists, 56 (75.7%) underwent surgical treatment: 33 (44.6%) received Vickers ligament resection (VLR) at a mean age of 11.3 ± 2.5 years, and 23 (31.1%) underwent radial dome osteotomy (RDO) at 13.0 ± 1.9 years. RDO was indicated in patients presenting with marked ROM limitations (>20 degrees), LS ≥ 7.2 mm, and PCD ≥ 25.7 mm ( P < 0.01). After VLR, radiologic parameters remained stable, while RDO significantly reduced PCD ( P = 0.0006); however, other radiographic changes were not statistically significant. Functional gains following RDO were limited, except for modest improvement in wrist extension. Reoperations were required in 12.1% of VLR and 17.4% of RDO cases, particularly when LS ≥ 6 mm and/or PCD ≥ 23 mm at baseline. Conclusions: VLR performed in early skeletal maturity may stabilize deformity progression in mild cases. In contrast, patients with advanced deformity (LS ≥ 6 mm, PCD ≥ 23 mm, and significant ROM limitation) are better candidates for primary RDO. Radiologic correction does not consistently translate into functional recovery, emphasizing the need for individualized clinical-radiological assessment. This represents the largest single-center series to date and supports LS and PCD as key objective markers for surgical decision-making in Madelung deformity. Level of Evidence: Level IV—retrospective cohort study.

Introduction: Neglected Monteggia Fractures (NMF) in children typically result from missed diagnoses at initial assessment, and may lead to pain, instability, and functional impairment. The optimal treatment strategy remains controversial. This study evaluates surgical outcomes and prognostic factors in pediatric NMF. Method: A retrospective review was conducted of children under 14 years treated for NMF (>4 weeks postinjury) from 2010 to 2024 at a tertiary pediatric referral center, with a minimum follow-up of 12 months. All patients underwent open reduction of the radial head, with or without ulnar osteotomy, annular ligament reconstruction (ALR), or temporary radiocapitellar fixation (TRCF). Outcomes were assessed using the Mayo Elbow Performance Index (MEPI), and preoperative maximum ulnar bow (MUB) was analyzed as a predictor of osteotomy. Results: Twenty-seven patients (16 boys, 11 girls; median age 6.5 years) were included. The median time to surgery was 73 days (51 to 220.5). Ulnar osteotomy was performed in 14 cases, ALR in 12, and TRCF in 12. The median MUB was −4.5 mm, most commonly located in the proximal third (57.7%). A significant association was found between MUB magnitude and the need for osteotomy ( P =0.03), with a predictive threshold of −3.45 mm. Time to surgery was not associated with surgical complexity ( P =0.59) or poorer outcomes ( P =0.85). MEPI scores were excellent in 22 cases and good in 5, with no poor outcomes. Four complications were reported. Conclusion: Open reduction of the radial head, with selective use of ulnar osteotomy, ALR, or TRCF, is effective for treating pediatric NMF. A preoperative MUB ≥3.45 mm was predictive of the surgeon’s decision to perform osteotomy, offering a practical parameter for surgical planning. Delayed intervention did not adversely affect outcomes. Level of Evidence: Level IV—retrospective case series.

Optoelectronic motion capture systems provide objective and high-resolution measurements of upper limb kinematics. The hand-to-mouth movement is closely related to motor development in children. The “Rab Hand-to-Mouth protocol” (BTS Bioengineering) is widely used; however, its seated configuration constrains elbow posture and may limit the ecological validity of the movement. In this study, we propose a methodological adaptation of the protocol in a standing position to allow a more physiological elbow configuration and to increase the dynamic range of elbow and shoulder motion. The objective was to characterize kinematic patterns of the hand-to-mouth movement in typically developing children aged 4 to 9 years using this adapted setup. This study was designed as a descriptive analysis and does not aim to provide formal validation of the standing protocol against the original seated configuration. An observational study that included 40 children was conducted. Motion data were acquired using eight optoelectronic cameras (sampling frequency: 250 Hz) and 17 reflective markers placed on the trunk and upper limbs. Kinematic patterns and spatiotemporal parameters were computed using dedicated motion analysis software. No significant differences were observed between dominant and non-dominant limbs in spatiotemporal parameters, whereas kinematic differences were minimal and limited to trunk rotation, as identified by Statistical Parametric Mapping (SPM). Some isolated statistically significant associations with age were identified in specific spatiotemporal variables; however, these variables showed low coefficients of determination (R²), indicating limited explanatory power of age. Overall, kinematic parameters did not exhibit consistent age-related patterns. These findings provide preliminary descriptive data for hand-to-mouth kinematics in a standing condition, which may contribute to the future development of assessment protocols. However, the limited sample size and the absence of pathological populations restrict the direct generalization of these findings. Future studies should evaluate the applicability of this approach in clinical cohorts and explore its integration into sensor-based and data-driven models for movement analysis.

Background: Preaxial polydactyly is a common congenital hand anomaly with substantial anatomic variability. Although several classification systems exist, the relationship between anatomic subclassification and postoperative outcomes remains incompletely defined. This study evaluated clinical and radiographic outcomes after surgical reconstruction, compared associations of the Wassel-Flatt (WF) and JK classifications with outcomes, and assessed the Japanese Society for Surgery of the Hand (JSSH) and Rotterdam scoring systems. Methods: We retrospectively reviewed 58 patients (59 thumbs) treated surgically between 2012 and 2024. Thumbs were classified using the WF and JK systems. Final outcomes included range of motion, alignment, stability, JSSH and Rotterdam scores, and reoperation. Associations with classification subtype, surgical procedures, and temporary transarticular K-wire fixation were analyzed at the thumb level. Results: WF type IV and JK type IV were the most common categories. Total range of motion exceeded 70 degrees in 39 thumbs, and joint stability was preserved in 52. Fifty-three thumbs had good or excellent outcomes acoording to JSSH criteria; the mean Rotterdam score was 27.1±2.5. Eleven thumbs were classified differently by the 2 systems. Of 29 WF type IV thumbs, 26 remained JK type IV and 3 were reclassified as JK type VIIB; the latter had lower JSSH total and functional scores. Overall, the JK classification was associated with postoperative alignment and JSSH total score, although the small type VIIB subgroup limits interpretation. Temporary K-wire fixation was associated with lower interphalangeal joint and total range of motion and lower functional scores; however, confounding by deformity severity and reconstruction complexity cannot be excluded. No reoperations were required during the available follow-up period. Conclusions: Surgical reconstruction yielded favorable outcomes in most patients. The JK classification provided additional anatomic granularity, particularly by identifying a small type VIIB subgroup within heterogeneous WF categories, but its prognostic value requires validation in larger cohorts. Temporary K-wire fixation was associated with reduced postoperative motion without establishing causation. The JSSH and Rotterdam instruments provided complementary outcome assessment. Levels of Evidence: Level III—retrospective comparative study.