Abstracts of the 7th International Clubfoot Congress, Rio de Janeiro, November 19-22, 2014.
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: ABSTRACTS: PDF Only Source Type: research

Delayed presentation of a heteropagus (parasitic) twin: a case report of a 17-year-old patient
We present an unusual case of an ischiopagus patient presenting at 17 years of age, which appears to be the oldest recorded presentation for surgery of a heteropagus twin in the English literature. The patient had two additional developed lower extremities along with two additional rudimentary upper extremities. The challenges and lessons learned from this rare and complex surgery are discussed. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Single forearm radius and ulna asymmetric lengthening in multiple cartilaginous exostoses: a case report and a long-term follow-up
We describe one case of forearm deformity in a patient affected by multiple cartilaginous exostoses – also known as the forearm ‘candy stick deformity’. Surgical treatment usually focuses on the correction of the wrist deformity without correcting the forearm shortening, the latter not being given the same consideration as lower limb shortening. In the presented case, radius and ulna corticotomies were performed and distal forearm deformity and shortening were corrected by two independent monoaxial external fixators, with full pronosupination. It is our belief that simultaneous treatment of forearm shorte...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Fracture dislocation of the pisiform bone in children: a case report and review of the literature
Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed clinical and radiographic data of a child with a type II Salter–Harris fracture of the distal radius, associated with fracture dislocation of the pisiform. In addition, we performed a systematic review of the literature available to date. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Acute forearm compartment syndrome in a newborn caused by reperfusion after spontaneous axillary artery thrombosis
Acute compartment syndrome of the forearm in newborns is often misdiagnosed and can be disastrous if left untreated. Here, we report a full-term infant of a diabetic mother with underlying heterozygosity for MTHFR C677T and A1298C alleles. A spontaneous thrombosis occurred in the left axillary artery immediately after birth. The patient responded well to anticoagulant (heparin) and thrombolytic (tissue plasminogen activator) agents. After reperfusion of the extremity, acute compartment syndrome developed. Emergent fasciotomy was performed. In this case, effective collaboration between pediatricians and orthopedic surgeons ...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

The distal radius and ulna classification in assessing skeletal maturity: a simplified scheme and reliability analysis
This study concludes that the simplified distal radius and ulna classification is a reliable tool for assessment of skeletal maturity. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Obesity in children with brachial plexus birth palsy
Fetal macrosomia is associated with a 14-fold increased risk of brachial plexus birth palsy (BPBP), and is a predictor of childhood obesity. The purpose of this study was to identify the relationships between BPBP, fetal macrosomia, and childhood obesity. We retrospectively reviewed 214 children with BPBP. The average age was 8 years and 53% had a Narakas 1 grade BPBP. Overall, 49% of children were normal weight, 22% overweight, and 29% obese. Of the children with a history of fetal macrosomia, 41% were obese; a statistically significant difference. Overall quality of life scores, however, were not correlated with obesity....
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Scarf–Akin osteotomy for hallux valgus in juvenile and adolescent patients
We report the clinical, functional and radiological outcomes of the Scarf–Akin procedure in the treatment of juvenile and adolescent HV. A review of single surgeon series was carried out of all children who underwent Scarf and Akin osteotomies as a combined procedure for HV between February 2001 and 2010. The preoperative and postoperative intermetatarsal angle (IMA1–2), hallux valgus angle, distal metatarsal articular angle and ratio of the length of first metatarsal to that of the second metatarsal were determined. The American Orthopaedic Foot and Ankle Score was used for functional assessment. Twenty-nine p...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Foot Source Type: research

Symmetric limb overgrowth following anterior cruciate ligament reconstruction in a skeletally immature patient
This report describes a case of symmetric femoral and tibial overgrowth of 2.8 cm in a 13-year-old patient after undergoing reconstruction surgery for his torn right anterior cruciate ligament. A literature review of previous cases is also provided. Following a pediatric anterior cruciate ligament tear, delaying surgery until the patient approaches skeletal maturity may avoid long-term growth disturbances, however, delaying this procedure may increase the probability of further joint damage. This growth disturbance was managed with a percutaneous epiphysiodesis that corrected the limb length deformity. (Source: Jour...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Knee Source Type: research

A severe systemic presentation of pigmented villonodular synovitis in a child with underlying Chediak–Higashi syndrome
This report describes a complex paediatric patient who underwent bone marrow transplantation to control the accelerated phase of the Chediak–Higashi syndrome. Diffuse PVNS developed in one knee 2.75 years later. Progression of PVNS was accompanied by the development of severe systemic symptoms, which resolved rapidly following subtotal surgical debridement. The patient remains well with minimal elevation of inflammatory marker levels 10.5 years later. As PVNS and Chediak–Higashi syndrome are both very rare diseases we propose a potential unifying hypothesis for this combination. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Knee Source Type: research

Osteochondritis dissecans of the lateral femoral condyle in a patient affected by osteogenesis imperfecta: a case report
Osteochondritis dissecans is a very uncommon phenomenon in osteogenesis imperfecta (OI). A 14-year-old boy, affected by OI and followed in our Center for Congenital Osteodystrophies, had a knee trauma and MRI indicated a hollowed area of 2.5×1.5 cm in the lateral femoral condyle, which was classified as grade III. The patient underwent surgery, performed as a one-step surgical treatment: the osteochondral fragment was removed, curettage of lesion’s bottom was performed, and a biphasic scaffold was used to fill the defect, implanted with a press-fit technique. MRI at 12 and 24 months after surgery showed ...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Knee Source Type: research

Are patient demographics different for early-onset and late-onset Blount disease? Results based on meta-analysis
Early-onset and late-onset Blount disease has been described with some clinical overlap between the two forms. Using PRISMA guidelines, we searched for articles that included demographics of patients with both types of Blount disease. On the basis of 24 articles that met our inclusion criteria, patients with early-onset Blount disease were more likely to have bilateral involvement [odds ratio (OR) 4.30, 95% confidence interval (CI) 2.27–8.17] and less likely to be Black (OR 0.20, 95% CI 0.08–0.53) or male (OR 0.32, 95% CI 0.13–0.78). Our results confirm that differences based on laterality, race, and sex ...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Knee Source Type: research

Acute, unstable slipped capital femoral epiphysis with associated congenital coxa vara
We present a case of a 5-year-old girl with an acute, unstable, severe slipped capital femoral epiphysis associated with congenital coxa vara and its surgical management. This association has not been described in previous literature. Surgical treatment is proposed and described. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Effect of increase in birth weight in a newborn on hip ultrasonography
Exposure to the pressure experienced by higher birth weight babies during the intrauterine period might cause hip dysplasia. The aim of this study is to determine the effect of birth weight in newborns on hip ultrasonography when the paternal and maternal risk factors are excluded. A total of 701 babies born at 38–42 gestational weeks were included in the study. Hip ultrasonography was performed within 7 days following birth using the Graf technique in the babies without risk factors for developmental dysplasia of the hip. Images obtained were controlled with respect to conformity to the Graf method and angular measu...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Assessment of lateral subluxation in Legg–Calvé–Perthes disease: a time-sequential study of magnetic resonance imaging and plain radiography
Lateral subluxation of the femoral head is one of the poor prognostic factors of Legg–Calvé–Perthes disease. The aim of this study was to investigate the cause of lateral subluxation of the femoral head on the basis of the changes over time on MRI. Twenty-four patients with unilateral Legg–Calvé–Perthes disease were analyzed retrospectively. Lateral subluxation was measured as the tear drop distance on radiographs. We focused on joint fluid, medial articular cartilage thickening, and abnormal lesion on MRI. Lateral subluxation continued significantly in patients with poor results. Amon...
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Synergistic local drug delivery in a piglet model of ischemic osteonecrosis: a preliminary study
A locally injectable system sequentially delivering an antiresorptive drug (clodronate) followed by an osteogenic agent (simvastatin) was hypothesized to improve femoral head microarchitecture, size, and shape compared with untreated or partial treatment groups in an established piglet osteonecrosis model. After 6 weeks, the clodronate+simvastatin treatment resulted in no collapse, microCT measurements and epiphyseal quotients within 10% of control, normal microstructure, and healthy histology. All other groups exhibited collapse, lower epiphyseal quotients and total femoral head volumes (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - September 25, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Glenohumeral dislocation with a proximal humerus physeal fracture
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Response to comment on the article ‘Dysplasia epiphysealis hemimelica of the knee: an unusual presentation with intra-articular loose bodies and literature review’ by Wheeldon and Altiok. J Pediatr Orthop B 2015; 24:377–378
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Letters to the Editor Source Type: research

Mid-term radiological and functional results of biological reconstructions of extremity-located bone sarcomas in children and young adults
Biological reconstruction is a useful option for reconstruction following bone sarcoma resection in children. The mid-term functional and radiological outcomes of biological reconstructions after resection of bone sarcomas in children are presented in this study. Eighteen patients [average age 12.5 years (range 4–22 years)] with primary sarcomas of long bones underwent wide surgical resection and biological reconstruction. The bone defects were managed by intercalary (n=14), osteoarticular (n=3) reconstructions and arthrodesis (n=1) with a vascularized fibular graft (VFG). VFG was combined with a massive allograft in...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Oncology Source Type: research

Surgical treatment of active or aggressive aneurysmal bone cysts in children
The aim of this study was to evaluate functional and radiological results, tumor control, and complications of the surgical treatment of aneurysmal bone cysts (ABCs) in children by extended curettage using a mechanical burr and cauterization, grafting, and internal fixation in specific locations. Sixty-four children [38 males, 26 females, median age=10 years (range, 5–18 years)] with active or aggressive ABCs of long and flat bones were subjected to a median follow-up of 66 months (range, 28–130 months) following surgical treatment. The pathological fracture rate was 72%. Surgical procedures included intralesio...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Oncology Source Type: research

Arch of the foot and postural balance in young judokas and peers
Twenty-nine male judocas and nontraining peers participated in this study. The arch of the foot (as Clarke’s angular values) was measured under non-weight-bearing conditions in two-leg and one-leg stands. Postural balance was assessed by the Flamingo balance test. Judocas presented better static balance and higher arches of the foot. Significant differences in Clarke’s angular values in a sitting and standing on two-leg position were found in both groups. After transition to a one-leg stand, the height of the arches of the foot in nontraining participants was still significantly decreased. Weight bearing did no...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Leg, Foot & Ankle Source Type: research

Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children
This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Leg, Foot & Ankle Source Type: research

Congenital tibial pseudarthrosis, changes in treatment protocol
Ten children with congenital pseudarthrosis of the tibia were treated with resection of pathologic bone, bone grafting, intramedullary rodding, compression with circular frame, simultaneous proximal tibia lengthening, and bone morphologic proteins. Thirteen operations were performed to achieve union. Four patients underwent simultaneous lengthening and four patients received recombinant human bone morphologic protein. Six children required complementary operations for residual ankle and knee valgus, and shortening. Union of the pseudarthrosis was achieved in all cases with lengthening up to 5 cm. This protocol is ef...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Leg, Foot & Ankle Source Type: research

Unusual entrapment of deep peroneal nerve after femoral distal extension osteotomy
This report is aimed at warning surgeons about the division of the CPN at a higher level and highlighting a need for a high-powered cadaveric research. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Knee Source Type: research

Does the GMFCS level influence the improvement in knee range of motion after rectus femoris transfer in cerebral palsy?
The aim of this study was to evaluate the influence of the Gross Motor Function Classification System (GMFCS) on the outcomes of rectus femoris transfer (RFT) for patients with cerebral palsy and stiff knee gait. We performed a retrospective review of patients seen at our gait laboratory from 1996 to 2013. Inclusion criteria were (i) spastic diplegic cerebral palsy, (ii) GMFCS levels I–III, (iii) reduced peak knee flexion in swing (PKFSw (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Knee Source Type: research

Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy
Patients with cerebral palsy (CP) disorder often develop rotational hip deformity. Increasing deformities impair already diminished walking abilities; femoral osteotomies are often performed to maintain and improve walking abilities. Fixation of osteotomies with condylar plates has been used successfully, but does not often enable immediate postoperative full weight-bearing. To avoid considerable postoperative rehabilitation deficit and additional bone loss because of inactivity, a postoperative treatment with full weight-bearing, is therefore, desirable. Self-tapping Schanz screws with a unilateral external fixator crossi...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Geometrical and mechanical factors that influence slipped capital femoral epiphysis: a finite element study
This study was carried out to determine the influence of the physeal–diaphysis angle, body mass, the presence of the perichondrial ring, the type of physical activity, and physeal thickness on SCFE. For this purpose, a finite element analysis of the hip joint and the femur–physis interface was carried out. With the computational model, the Von Mises stresses along the growth plate were calculated and subsequently analyzed statistically to find their correlation with the studied factors. It was found that body mass, the type of physical activity, and the presence of the perichondrial ring had more statistical re...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Hip Source Type: research

Isolated shear fracture of the humeral trochlea in an adolescent: a case report and literature review
This report documents a rare case of isolated trochlear shear fracture in an adolescent patient and provides a literature review. Radiographic analysis of the distal humerus revealed an intra-articular fracture of the anterior trochlea, evidenced by a full moon-shaped osteochondral fragment. Open reduction and internal fixation with two headless Herbert screws secured the fragment. Because of the paucity of information on this injury, standard treatment and management have not been established. Prospective studies with longer follow-up are needed before a consensus with regard to these fractures is established. (Source: Jo...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Unusual humeral medial condyle fracture in an adolescent because of a previous post-traumatic fishtail deformity: a case report
We report a rare case of a medial humeral condyle fracture in a 12-year-old boy who had had a fishtail deformity because of a lateral condyle fracture in childhood. Radiographs showed a longitudinal fracture plane of the medial condyle extending to the articular surface, which is different from the three types of medial condyle fracture classified by Kilfoyle. We present our case and reviewed the literature to clarify the difference in the mechanism of medial humeral condyle fracture after a fishtail deformity. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Variation in practice habits in the treatment of pediatric distal radius fractures
Distal radius fractures are widespread in the pediatric population. Standardized treatment protocols have not been well defined. We sought to examine the diversity of current practice patterns in the treatment of these fractures by surveying hand, pediatric, and general orthopedic surgeons. Hand, pediatric, and general orthopedic surgeons were surveyed using an internet-based questionnaire on the management of pediatric distal radius fractures. Each surgeon was asked to select a criterion from among choices of ‘acceptable’ alignment criteria at the onset of the survey. Ten cases were then provided to represent ...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Stiffness of various pin configurations for pediatric supracondylar humeral fracture: a systematic review on biomechanical studies
To compare the biomechanical stability of various pin configurations for pediatric supracondylar humeral fractures under varus, internal rotation, and extension conditions. After electronic retrieval, 11 biomechanical studies were included. Stiffness values of pin configurations under different loading conditions were extracted and pooled. There were no statistically significant differences between two cross pins and two divergent lateral pins on the basis of the ‘Hamdi method’ (P=0.249−0.737). An additional pin did not strengthen two-pin construct (P=0.124−0.367), but better stabilized fractures wi...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Pulled elbow in children: a case series including 66 patients
The aim of this case series was to assess the data of 66 children (mean age 28 months) with a diagnosis of pulled elbow. The most common time interval of injury was 12–6 p.m. and spring was the peak season. Children younger than 2 years of age had a higher rate of atypical injury history. A successful reduction by supination and flexion maneuver was achieved at the first attempt in 57 of 66 patients. The patients admitted to the hospital within the first 2 h following the injury had a higher rate of successful reduction at the first attempt. The rate of radiographic examination was considerably high and...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Potential barriers to randomized clinical trials in infants with brachial plexus birth palsy
Randomized clinical trials (RCTs) are the gold standard for comparing medical treatments. However, pediatric surgical RCTs are uncommon. We sought the opinions of parents whose children had undergone reconstructive nerve surgery on participating in research studies. Twenty-nine of 30 parents indicated that they would enroll their child in a research study, and 24 of them indicated that they would enroll their child in a surgical RCT. However, the most common reason for willingness to participate was a desire to help their child, demonstrating a fundamental misunderstanding of RCTs. The burden is on the researcher to ascert...
Source: Journal of Pediatric Orthopaedics B - July 31, 2015 Category: Orthopaedics Tags: Upper Limb Source Type: research

Experimental model in cadavera of arthroscopic resection of calcaneonavicular coalition and its first in-vivo application: preliminary communication: Erratum
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Erratum Source Type: research

Comment on the article ‘Dysplasia epiphysealis hemimelica of the knee: an unusual presentation with intra-articular loose bodies and literature review’ by Wheeldon and Altiok
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Letter to the Editor Source Type: research

Potocki–Lupski syndrome in conjunction with bilateral clubfoot
This report highlights the complex interaction of chromosomal and familial factors that contribute to musculoskeletal birth defects. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap: a case report
Fibular hemimelia, or fibular hypoplasia-aplasia, is the most frequent congenital long-bone deficiency. There is still some debate on reconstruction versus amputation for the severe type Ib and type II cases. Limb-length discrepancy can be corrected with Ilizarov methods, but ankle stability remains a problem. The absence of the lateral malleolus destabilizes the mortise in valgus and ankle fusion is usually needed. A case of lateral malleolus reconstruction in a teenage patient with severe type-Ib fibular hemimelia using a contralateral free proximal fibular epiphyseal transfer is reported. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Osteonecrosis of the distal tibial metaphysis after Salter–Harris type-2 injury: a case report
We report a case of osteonecrosis of the metaphysis in distal tibia, confirmed radiologically and histologically. The natural history was followed with serial MRI scans and we comment on the possible pathophysiology. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Treatment outcomes of adolescents with Iselin’s apophysitis
This study assessed the presentations and outcomes of patients treated for Iselin’s apophysitis. A total of 27 patients with Iselin’s apophysitis were retrospectively analyzed for presentation, treatment, and clinical outcome. The mean age of presentation was 11.5 years (range: 9.2–15 years). All patients played sports, and their symptomatic severity and acuity varied. Treatments included rest, footwear modification, use of a controlled ankle movement boot, and use of a post-op shoe. Treatment lasted for an average of 24 days (range: 14–33 days), and the average time to return to play was 38 days (r...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Peroneal spastic flatfoot in adolescents with accessory talar facet impingement: a preliminary report
This study analyzed imaging, arthroscopic findings, and treatment responses for peroneal spastic flatfoot (PSFF) caused by talocalcaneal impingement at the accessory anterolateral talar facet (AALTF) (accessory talar facet impingement) in 13 adolescents without histories of trauma and tarsal coalition. The AALTF was determined with computed tomography and MRI. Focal abutting bone marrow edema (FABME) on MRI around the AALTF was confirmed. In seven patients who underwent AALTF resection, subtalar arthroscopy was performed. All experienced alleviation PSFF after treatment; reduction in FABME was observed. AALTF resection alo...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet
We prospectively compared subtalar arthroereisis with lateral column calcaneal lengthening for the treatment of painful flatfeet. Twenty-four feet (mean age of patients 12.8 years) were treated. Kinematic motion analysis, pedobarometry, and radiography were performed, and the Oxford Ankle–Foot Questionnaire for Children was administered for each patient before surgery and at the 1-year follow-up. We found statistically significant improvements in both groups, with no difference in their outcomes. Both groups showed significantly improved hindfoot and midfoot motion and positioning. Hindfoot range of motion was preser...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

The need for Achilles tenotomy in the Ponseti method: Is it predictable at the initiation or during the treatment?
The aim of this study was to determine whether the need for tenotomy can be predicted at the initiation or during the treatment of the clubfoot treatment according to the Ponseti method. One hundred and eight feet of 77 babies who required tenotomy and who did not were compared statistically according to the parameters of sex, side, bilaterality, presentation day, number of casts, Pirani scores, and the percentage change in Pirani scores, respectively. The mean number of casts required, the initial Pirani scores, and the percentage change in Pirani scores were significantly different between the groups that required tenoto...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Dynamic pedobarography and radiographic evaluation of surgically treated cavovarus foot deformity in children with Charcot–Marie–Tooth disease
We describe our radiographic and pedobarographic outcomes of surgical treatment of cavovarus foot deformity in children with Charcot–Marie–Tooth disease. Nineteen patients for a total of 30 feet were included. Preoperative and postoperative dynamic pedobarographic measurements were made and analyzed using the five-mask technique. Pedobarographic measures showed statistical significance for increased contact area and decreased peak forces in most mask areas after surgical treatment. Peak pressure and redistribution of varus pressure patterns trended toward improvement. We found pedobarographic studies helpful; h...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Ankle & Foot Source Type: research

Macrophage activation syndrome or septic arthritis: a case of mistaken identity
We present an interesting case of macrophage activation syndrome in a 2-year-old, with no previous rheumatological diagnoses, incorrectly diagnosed with septic arthritis, to highlight the diagnostic difficulties, especially in small hospital units. We aim to present the similarities between the two conditions and to summarize the clinical, radiological and epidemiological features of macrophage activation syndrome, an underdiagnosed condition. A review of the current literature was performed, and a diagnostic algorithm was created. No current set treatment regimen exists, but current recommendations have been included. We ...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Knee & Leg Source Type: research

Dysplasia epiphysealis hemimelica of the knee: an unusual presentation with intra-articular loose bodies and literature review
Dysplasia epiphysealis hemimelica (DEH) is a rare disease characterized by the formation of osteochondromas asymmetrically at the epiphysis of extremities, typically involving the ankle and the knee. It progresses during childhood and presents with limited range of motion, swelling, and angular deformities. A 9-year-old boy with a 7-year history of DEH and previous removal of ankle osteochondromas presented with acute knee pain, swelling, and limited range of motion. A clinical, radiographic, and literature review of this case was conducted to better describe this occurrence. On the basis of clinical and radiographic analy...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Knee & Leg Source Type: research

Treatment of avulsion fractures of the intercondylar eminence by medial parapatellar approach, open reduction and cross wire fixation
In this study, a small medial parapatellar approach was used with open reduction and percutaneous cross Kirschner wire fixation. The aim of this study was to evaluate the effectiveness of this method. From 2007 to 2012, eight children were treated, mean age 11.8 years (range 10–14 years). All underwent open reduction by a medial parapatellar incision and fixation by two cross Kirschner wires introduced in an oblique crossed manner from the medial and lateral aspects of the proximal tibia. Fractures were classified as Meyers and McKeever type III and were not candidates for conservative treatment. All operated limbs w...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Knee & Leg Source Type: research

Solitary cystic tuberculosis of the distal femur and proximal tibia in children
Pediatric skeletal (extraspinal) tuberculosis may mimic pyogenic infections and bone tumors. The aim of this study was to show a multimodality approach to the correct diagnosis and to evaluate the long-term clinical and radiological results of curettage and antituberculosis treatment. Between 2004 and 2012, we treated eight children (five boys, three girls) with histologically proven solitary cystic tuberculosis of the proximal tibia and distal femur. The average age at presentation was 4 years (range, 2–6 years). Except for one case with metadiaphyseal involvement, all lesions were located in the metaphysis and cros...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Knee & Leg Source Type: research

Histological differences between various methods of hemiepiphysiodesis: is guided growth really different?
Traditional systems of hemiepiphysiodesis are based on the application of asymmetrical compression to the physis to correct angular deformities. The guided growth method claims to act as a tension plate avoiding compression. The aim of this study was to confirm or refute this claim. Twenty-four White New Zealand rabbits were subjected to a proximal tibial hemiepiphysiodesis using either staples or a plate and two-screws method. Both methods succeeded in producing deformity. The initial existent histological differences between systems became less apparent after 6 weeks of hemiepiphysiodesis, when histological results were ...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Knee & Leg Source Type: research

Avulsion fracture of the lesser trochanter in a skeletally immature freestyle footballer
We report the case of a skeletally immature freestyle footballer who presented with avulsion fracture of the lesser trochanter. The patient had precursor symptom before onset during a ball juggling. Nonoperative treatment demonstrated good clinical course. This new sporting activity involves kicking the ball continuously, typically with both the hip and the knee in flexion. This repetitive movement might cause continuous stretching stress of the iliopsoas muscle at the apophysis of the lesser trochanter, causing disruption at this site. This new sporting activity in this age cohort may have higher prevalence of this type o...
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Pelvis, Hip & Femur Source Type: research

Postencephalitic bilateral heterotopic ossification of the hip in a pediatric patient
We describe a case of bilateral heterotopic ossification of hip in a 13-year-old female. The patient had a history of encephalitis, prolonged vegetative state, and intubation for 6 weeks. The patient had fixed deformities of both hips in 30° of flexion and 30° of external rotation. A diagnosis of Brooker stage 4 heterotopic ossification was made. The patient underwent a staged procedure for excision of the heterotopic mass. Postoperatively, the patient was administered radiotherapy and indomethacin for 6 weeks. At the 2-year follow-up, there was no recurrence and both the hips were mobile with full range of motion....
Source: Journal of Pediatric Orthopaedics B - June 5, 2015 Category: Orthopaedics Tags: Pelvis, Hip & Femur Source Type: research