Current Concept Review: The Role of Bracing in Pediatric Orthopaedics

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Selina Poon, MD
Brett Lullo, MD
Cynthia Nguyen, MD
Ebubechi Okwumabua
Marilan Luong
Meghan Imrie, MD
Geordy Gantsoudes, MD
Robert H. Cho, MD

Abstract

Background: Many pediatric conditions of the lower extremity are self-limiting and have no known long-term prognostic effects. The Pediatric Orthopaedic Society of North America (POSNA), the American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) all have analogous guidelines regarding the use of orthotics for benign lower limb pathologies, but it is unknown whether clinicians adhere to these guidelines.


Methods: A review of current recommendations for treatment of four common benign lower limb conditions and Blount’s disease was performed. The recommendations were used as a basis to determine adherence of providers regarding treatment of the described conditions. An anonymous online survey was then distributed to POSNA members (N=1402). Respondents were queried regarding practice, education, frequency and reason for prescribing orthotics for flexible metatarsus adductus (MA), painless flexible flatfeet (PFF), internal tibial torsion (ITT) and femoral anteversion (FA).


Results: The online response rate was 26.1 % (366). Pediatric orthopaedic fellowship trained members comprised of 87.4% of the respondents.


A majority of members reported “never” prescribing orthotics for FA (83%; 304) in comparison to the other conditions—75% (275) for ITT, 48% (176) for PFF, and 35% (127) for MA. Few reported “always” or “almost always” prescribing orthotics for any of the benign conditions; 3.6% (13) for MA, 1.1% (4) for PFF, 0.8% (3) for ITT, and 0.5% (2) for FA.


Members without pediatric orthopaedic fellowship training are more likely to “always” or “almost always” prescribe orthotics for PFF than fellowship-trained clinicians (14.3% vs. 0.6%; p<0.001). Long practicing POSNA members were more likely to prescribe orthotics for ITT (p<0.001, B = 0.068) and FA (p = 0.009, B = 0.034).


Physical therapists were the most common prescribers for MA, ITT, and FA, and podiatrists for PFF.


Conclusions: Most POSNA members adhered to the recommended guidelines for orthotics prescription for the conditions surveyed. Adherence to recommendations were less common among long practicing members and non-pediatric orthopaedic fellowship-trained providers.


Level of Evidence: II

Article Details

Section
Lower Extremity