About

Alexandre Arkader, MD, is a Professor of Orthopaedic Surgery at the Children's Hospital of Philadelphia and the University of Pennsylvania. His clinical expertise includes limb-sparing surgery for children with bone and soft-tissue malignancies, quality of life in children with such malignancies, complex pediatric orthopaedic trauma, and skeletal or angular deformities associated with congenital abnormalities. He holds a medical degree from Fundacao Tecnico-Educacional Souza Marques, obtained in 1998. Dr. Arkader is actively involved in research and clinical practice, contributing to the management of pediatric bone tumors, fractures, and deformities, and has authored numerous publications in these areas. He also serves as Co-Director of the Bone and Soft Tissue Tumors Program at CHOP and is the Director of Culture and Engagement within the Orthopaedics department.

Research topics

• Surgery
• Medicine
• Psychology
• Biology
• Genetics
• Radiology
• Pathology

Selected publications

• Comparative Analysis of 3 Anterior Tibialis Tendon Transfer Techniques in Idiopathic Clubfoot: Traditional Pull-through Button Technique, Pull-through Interference Screw Technique, and Anchor Technique

  Journal of Pediatric Orthopaedics · 2025-07-21 · 1 citations

  article

  BACKGROUND: Recurrence in clubfoot after the Ponseti technique is a well-recognized phenomenon. The use of the anterior tibial tendon transfer (ATTT), is a well-documented technique for addressing dynamic supination following treatment. Despite its widespread use, there is a lack of comparative studies evaluating different fixation techniques for ATTT. We conducted a multicenter study to assess and compare the outcomes of 3 techniques. METHODS: Three centers collaborated in this comparative analysis. Children with dynamic supination after initial Ponseti treatment who underwent ATTT between 2008 and 2023 were included. A pull-through technique with suture over a button (group A) was employed in 52 patients (72 feet), a pull-through technique using an interference screw fixation (group B) was employed in 23 patients (26 feet), and a suture anchor technique (group C) was employed in 55 patients (65 feet). A retrospective review included demographics, surgical procedures, and outcomes. The comparison between the 3 groups was made with ANOVA and Kruskal-Wallis tests. P values of <0.05 were considered statistically significant. RESULTS: A total of 130 children (163 feet), were included. There were no statistically significant differences in age, sex, side, isolated ATTT, and additional surgery between groups. At final follow-up (mean 42.0 mo), 28 patients (38 feet) experienced some form of relapse: group A, 27.8% (20/72 feet); group B, 30.8% (8/26 feet); and group C, 15.4% (10/65), P=0.56. There were 5 postoperative complications directly related to the ATTT, comprising 4 cases in group A (5.6%) and one in group B (1.5%), P=0.165. Of these complications only one case from group A included pull out of the transferred tendon. There were no cases of overcorrection. CONCLUSIONS: All 3 fixation techniques effectively secured the tibialis anterior tendon transfer in this pediatric population following recurrent clubfoot. While the suture anchor technique may offer certain advantages, the decision on fixation method should be individualized, taking into account patient anatomy and the surgeon's experience. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

  PublisherDOI

• Commentary on Quality Improvement Case Series: Leukemic Arthritis Mimicking Septic Arthritis in a Pediatric Patient

  Journal of the Pediatric Orthopaedic Society of North America · 2025-07-03

  editorialOpen access1st authorCorresponding
  PublisherDOI

• Principles of Surgical Treatment in the Pediatric Patient

  2025-01-01

  book-chapterSenior author
  PublisherDOI

• Gene Variants Characterize and Distinguish Osteochondromas in Patients With Hereditary Multiple Osteochondromas

  Journal of Orthopaedic Research® · 2025-12-13

  articleOpen accessSenior authorCorresponding

  Hereditary Multiple Osteochondromas (HMO) is a rare, pediatric skeletal disorder characterized by osteochondromas that form along the growth plates. These benign tumors can cause skeletal deformities, joint dysfunction, chronic pain and other health problems. Most HMO patients are born with a heterozygous mutation in EXT1 or EXT2 that encode Golgi enzymes responsible for heparan sulfate synthesis. However, prior studies have established that these mutations alone are insufficient to trigger osteochondroma formation, but additional genetic changes are needed. Loss-of-heterozygosity (LOH) has been invoked in some cases, but the full genomic landscape of osteochondromas remains unclear. Here, we carried out a proof-of-principle study and asked whether gene variants occur in osteochondromas in addition to EXT mutations, whether the variants are shared by osteochondromas in same or different patients and what putative pathogenic roles they may have. A total of 8 tumors from 4 patients were subjected to whole exome sequencing (WES) along with saliva DNA from the 4 patients and 3 parents that was used as specific reference. WES identified over 1,600 somatic single nucleotide variants or insertion/deletions that were only partially shared amongst the tumors and were absent in the saliva DNA. Six genes were commonly mutated, including PABC1, TDG and ANKRD36. These genes exert action which could directly or indirectly influence chondrogenesis, the first differentiation step in osteochondroma formation. The study reveals that osteochondromas do possess gene variants distinguishing them in the same or different patients. These traits could modulate their tumorigenic character and add complexity to HMO pathogenesis. Clinical Significance: This study provides insights into the genomic landscape of osteochondromas, potentially leading to development of disease diagnostic and prognostic tools.

  PublisherOA PDFDOI

• Hold that K Wire! Fixing Nondisplaced Distal Forearm Fractures in Pediatric Floating Elbow Injuries is Unnecessary

  Journal of the Pediatric Orthopaedic Society of North America · 2025-09-04

  articleOpen access

  Floating elbow injuries are uncommon, combined injuries in children involving a supracondylar humerus fracture and a distal fracture of the forearm. Orthopaedic dogma has suggested that a more aggressive stance for the distal fracture is necessary due to the potential risk of acute compartment syndrome. Our group recently showed that the rate of compartment syndrome was less than one percent. As such, we hypothesized that concomitant nondisplaced distal forearm fracture’s operative fixation would result in similar outcomes compared to non-surgical treatment. A multicenter retrospective database was queried for pediatric patients who presented with floating elbow injuries – supracondylar humerus fracture with a concomitant nondisplaced distal forearm (AO OTA-23-M/2.1) between 2014 and 2019. Patient demographics, injury characteristics, treatment course, and outcomes were evaluated. Patients were compared based on the management strategy of the nondisplaced distal forearm fracture. A total of 102 patients (of the 454 patients in the database) met inclusion criteria of which 26 (25.4%) underwent operative fixation with an overall median follow-up of 2.2 months. With respect to distal fracture characteristics, there was not an increased incidence of internal fixation of the forearm fracture in patients with a displaced supracondylar fracture (Types 3 and 4) (p=0.563). Total operative time trended higher but was statistically similar in the internal fixation (45.5 minutes) versus non-internal fixation (34 minutes) cohort (p=0.06). A higher proportion of patients returned to early full activity in the non-fixation distal fracture cohort (80% vs 68%; p=0.04). Other outcomes between fixation and non-fixation management were similar with respect to modified Flynn Criteria, symptoms, persistent neurological deficits, and malunion. The overall rate of return to the operating room between cohorts was also similar (5% vs 3.8%; p=1.00). No patient in either cohort was diagnosed with compartment syndrome or required fasciotomies. While return to full activity at median 2.2 months was higher in the non-internal fixation group, other outcomes, including functional recovery, symptoms, complications, and reoperation rates were similar between the two cohorts. III

  PublisherDOI

• Tumors and Tumor-like Lesions of the Pediatric Hand and Wrist: Clinical Presentation and Risk Factors for Malignancy

  Journal of Pediatric Orthopaedics · 2025-06-04

  articleCorresponding

  BACKGROUND: Malignant tumors of the pediatric hand and wrist are rare. We hypothesize that pain, large size, and palm/wrist location are risk factors for malignancy in children. METHODS: A retrospective review was conducted of patients younger than 18.9 years of age presenting to our institution with hand and wrist tumors or tumor-like lesions over a 15-year period. Patients with skin lesions, commonly encountered subcutaneous masses (lipomas, ganglion cysts, and sebaceous cysts), multiple hereditary exostoses, and Ollier disease were excluded. Data collection included demographics, clinical presentation, imaging features, and surgical management. Risk factors for malignancy were determined using receiver operating characteristic and descriptive statistical analysis. RESULTS: Three hundred twenty-seven tumors and tumor-like lesions were identified in 312 patients, with a mean age of 10.1 ± 4.6 years. Three hundred fifteen (96.3%) lesions were benign, and 12 (3.7%) lesions were malignant. The most common benign bone tumors were osteochondromas (75/160, 46.9%) and enchondromas (50/160, 31.3%), while the most common benign soft-tissue masses were vascular malformations (39/155, 25.2%) and giant cell tumors of the tendon sheath (30/155, 19.3%). The most common location was the digit. All malignant tumors (3 bone, 9 soft tissue) were in either the palm or wrist. Epithelioid sarcoma (4/9) and synovial sarcoma (2/9) were the most common soft-tissue malignancies, and osteosarcoma (3/3) was the only identified malignant bone tumor. Overall, the most common presenting complaints were swelling (63%) and pain (19.9%). Bivariate analysis found size >11.4 mm and palm/wrist location as risk factors for malignancy. Based on ROC analysis, age and pain ratings were poor predictors of malignancy. Among bone tumors, an aggressive zone of transition, periosteal reaction, and cortical destruction were significant radiographic risk factors for malignancy. CONCLUSIONS: The most common tumors and tumor-like conditions of the pediatric hand and wrist include osteochondromas, enchondromas, vascular malformations, and giant cell tumors of the tendon sheath. Larger tumors (>11.4 mm) and lesions found in the palm/wrist are more likely to represent malignancies and should be approached with caution. LEVEL OF EVIDENCE: Level III-therapeutic.

  PublisherDOI

• Single Flexible Nailing of the Humerus for Recurrent Bone Cysts

  Journal of the Pediatric Orthopaedic Society of North America · 2025-06-10

  articleOpen accessSenior authorCorresponding

  Unicameral bone cysts (UBCs) in the proximal humerus are prone to pathologic fractures. We have discovered that using a single flexible nail, along with comprehensive curettage and grafting of humeral UBCs, is effective for safeguarding the bone and facilitating an early return to activity. Employing just one nail offers several advantages: technical simplicity in contouring and inserting a single nail, reduced surgical time, and elimination of a medial distal humeral dissection while ensuring stable internal fixation and promoting early motion even in cases of cyst recurrence. Our indications, surgical techniques, and helpful tips are outlined in this article. Key Concepts: (1)Curettage and flexible intramedullary nailing with a single nail for treating pediatric humeral unicameral bone cysts is an effective prophylactic fixation strategy.(2)This enables ongoing activity even in the presence of cyst recurrence;-; in essence, "protect the bone and forget the cyst."(3)The judicious use of fluoroscopy, the appropriate starting point, and a suitably bent flexible nail allow for the straightforward passage of the nail into the humerus.

  PublisherDOI

• Keratin-Positive Giant Cell Tumor of Bone and Soft Tissue With <i>HMGA2::NCOR2</i> Fusion in Children Under 10 With Response to Imatinib Therapy: A Case Series

  JCO Precision Oncology · 2024-06-01 · 4 citations

  article

  HMGA2::NCOR2 keratin-positive giant cell tumors in children with response to imatinib in an infant.

  PublisherDOI

• Who is the PROM King? Patient-reported Outcome Measures in Pediatric Musculoskeletal Oncology: A Systematic Review

  Journal of Pediatric Orthopaedics · 2024-12-09 · 1 citations

  reviewSenior author

  BACKGROUND: Patient-reported outcome measures (PROMs) are important companions to traditional, physician-reported measures. The purpose of this study was to systematically review and identify PROMs used in pediatric musculoskeletal oncology and evaluate these instruments. METHODS: A systematic literature review was conducted for studies pertaining to pediatric musculoskeletal tumors from 2010 to 2024. Two experts selected eligible papers for inclusion through a systematic approach. PROMs used in the eligible papers were cataloged, and the top 10 most frequently used instruments were evaluated with Evaluating Measures of Patient-Reported Outcomes (EMPRO), which is a standardized evaluation tool for PROs. RESULTS: A total of 316 publications were included in the final analysis, reporting a total of 82 unique PROMs. Of the papers, 24% reported no PROMs, whereas 67% of the instruments were only reported once. Nine out of the 10 top PROMs scored over 50 on EMPRO, meeting the minimum acceptable criteria. Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, Disabilities of the Arm, Shoulder, and Hand (DASH), and Quick DASH were disease-specific instruments scoring high on EMPRO. Short Form-36, Pediatric Quality of Life Questionnaire, Quality of Life Questionnaire-30, BSI-18, and TNO AZL Child Quality Of Life met the requirements in the general instruments. Short Form-12 was the lowest-scored PROM. CONCLUSIONS: Our results show minimal consensus on the ideal PROM in pediatric musculoskeletal oncology. We recommend using instruments that are already in widespread use instead of obscure PROMs, which defy the purpose of reporting outcomes from a patient perspective. All 4 disease-specific instruments scored highly and are already widely used, including Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, DASH, and Quick DASH. However, we found no consensus on general instruments. With the development and increasing popularity of Patient-Reported Outcomes Measurement Information System, it may replace other general instruments that are proprietary, unreliable, or not developed with pediatric patients in mind. LEVEL OF EVIDENCE: Level IV-systematic review of level II to IV studies.

  PublisherDOI

• Do Patients of Different Levels of Affluence Receive Different Care for Pediatric Osteosarcomas? One Institution’s Experience

  Clinical Orthopaedics and Related Research · 2024-10-30 · 2 citations

  articleOpen accessSenior author

  BACKGROUND: The published reports examining socioeconomic factors and their relationship to osteosarcoma presentation and treatment suggest an association between lower socioeconomic status and a worse response to chemotherapy and lower survivorship. However, the driving factors behind these disparities are unclear. The Child Opportunity Index was developed by diversitydatakids.org ( https://www.diversitydatakids.org/ ) in 2014 to cumulatively quantify social determinants of health in an index specifically tailored toward a pediatric population and organized by census tract. The Childhood Opportunity Index can be used to explore the relationship between a patient's socioeconomic background and disparities in osteosarcoma presentation, treatment, and outcomes. QUESTION/PURPOSES: Are differences in a child's Childhood Opportunity Index score associated with differences in (1) time from symptom onset to first office visit for osteosarcoma, (2) timing of chemotherapy or timing and type of surgical resection, or (3) initial disease severity, development of metastatic disease, or overall survival? METHODS: A retrospective therapeutic study was conducted using data drawn from the institutional records of a large pediatric tertiary cancer center located in the Mid-Atlantic region of the United States from the years 2006 to 2022. Our main site is in an urban setting, with ample access to public transit. Patients were excluded from analysis if they were seeking a second opinion or our institution was not the main point of orthopaedic care (20% [45 of 223]). Of the remaining patients, those with incomplete electronic medical records (24% [43 of 178]), resided in an international country (5% [9 of 178]), presented after relapse (4% [8 of 178]), or lacked 2 years of follow-up at our institution (3% [5 of 178]) were excluded as well. A total of 113 pediatric patients (children younger than 18 years) met the inclusion criteria. The Child Opportunity Index is a composite index derived from three domains (education, health and environment, and social and economic) and 29 indicators within the domains that serve to capture the cumulative effect of disparities on child well-being. National Childhood Opportunity scores were collected and scored from 1 to 100. Each score represents an equal proportion of the US population of children 18 years of age or younger. A higher number indicates higher levels of socioeconomic opportunity. The overall Childhood Opportunity Index score was then broken down into three groups representative of the child's relative socioeconomic opportunity: lowest tertile for scores < 34, middle tertile for scores between 34 and 66, and highest tertile for scores > 66. Means, ranges, medians, IQRs, and percentages were used to describe the study sample. Data analysis was conducted across the three groups (lowest tertile, middle, and highest), assessing differences in time to presentation, treatment variations, disease severity, and overall survivorship. Chi-square and Fisher exact tests were applied to compare categorical variables. Mann-Whitney U tests compared continuous data. Kaplan-Meier survival analysis, stratified by Childhood Opportunity Index tertile, was performed for a 5-year period to evaluate the development of metastatic disease and overall survivorship. A log-rank test was applied to evaluate statistical significance. Due to the small sample size, we were unable to control potential confounders such as race and insurance. However, the three domains (education, health and environment, and social and economic) encapsulated by the Childhood Opportunity Index data indirectly account for disparities related to race and insurance status. RESULTS: There was no association between lower levels of socioeconomic opportunity, as expressed by the lack of difference between the Childhood Opportunity Index tertiles for the interval between symptom onset and first office visit (mean ± SD lowest tertile 77 ± 67 days [95% confidence interval (CI) 60 to 94], middle tertile 69 ± 94 days [95% CI 50 to 89], and highest tertile 56 ± 58 days [95% CI 41 to 71]; p = 0.3). Similarly, we found no association between lower levels of socioeconomic opportunity, as expressed by the lack of difference between the Childhood Opportunity Index tertiles and the time elapsed from the first office visit to the first chemotherapy session (lowest tertile 19 ± 12 days [95% CI 12 to 26], middle 19 ± 14 days [95% CI 11 to 26], and highest 15 ± 9.7 days [95% CI 8.4 to 21]; p = 0.31), the time to surgical resection (lowest tertile 99 ± 35 days [95% CI 87 to 111], middle 88 ± 28 days [95% CI 77 to 99], and highest 102 ± 64 days [95% CI 86 to 118]; p = 0.24), or the type of surgical resection (limb-sparing versus amputation: 84% [21 of 25] in lowest tertile, 83% [24 of 29] in the middle tertile, and 81% [48 of 59] in the highest tertile received limb-sparing surgery; p = 0.52). Finally, we found no differences in terms of disease-free survival at 5 years (lowest tertile 27% [95% CI 7.8% to 43%], middle 44% [95% CI 23% to 59%], and highest 56% [95% CI 40% to 67%]; p = 0.22), overall survival (lowest 74% [95% CI 58% to 95%], middle 82% [95% CI 68% to 98%], and highest 64% [95% CI 52% to 78%]; p = 0.27), or in terms of survivorship of the cohort, excluding patients who presented with metastatic disease (lowest 84% [95% CI 68% to 100%], middle 91% [95% CI 80% to 100%], and highest 68% [95% CI 55% to 83%]; p = 0.10). CONCLUSION: In our single-center retrospective study of 113 children who presented with osteosarcoma, we did not find an association between a patient's national socioeconomic opportunity and their time to presentation, chemotherapy treatment, time to and type of surgical resection, or disease-free and overall survival. Prior work has shown an association between socioeconomic background and disparities in osteosarcoma treatment. It is possible that these findings will be similar to those from other hospitals and geographic areas, but based on our findings, we believe that proximity to providers, access to public transit, and regional insurance policies may help diminish these disparities. Future multicenter studies are needed to further explore the role that regional variations and the aforementioned factors may play in osteosarcoma treatment to help inform the direction of public policy. LEVEL OF EVIDENCE: Level III, therapeutic study.

  PublisherOA PDFDOI

Frequent coauthors

• John P. Dormans

  University of Pennsylvania

  48 shared

• Antoinette W. Lindberg

  Seattle Children's Hospital

  27 shared

• Regina P. Woon

  27 shared

• Keith D. Baldwin

  Children's Hospital of Philadelphia

  17 shared

• Soroush Baghdadi

  Lurie Children's Hospital

  15 shared

• Vernon T. Tolo

  Orthopedic Center

  15 shared

• David L. Skaggs

  Cedars-Sinai Medical Center

  14 shared

• Apurva S. Shah

  Children's Hospital of Philadelphia

  13 shared

Education

• M.D.

  Fundacao Tecnico-Educacional Souza Marques

  1998