Bilateral Wrisberg discoid menisci mimicking bucket handle tears associated with osteochondritis dissecans: case report
We report the case of a 14-year-old boy who had bilateral unstable lateral discoid menisci with unilateral stage 3 OCD treated with meniscoplasty, meniscal rim stabilization, and fixation of the OCD. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Upper Limb Source Type: research

Case report: lateral capsular release for acute extension deficit in a child with congenital radioulnar synostosis
We report the case of an 11-year-old girl with congenital radioulnar synostosis who developed acute extension deficit of the right elbow and whose elbow range of motion was restored following lateral capsular release. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Upper Limb Source Type: research

Chronic slipping of bilateral distal humeral epiphyses in a gymnastist
We report a case of an 11-year-old male patient who sustained separation of the distal humeral epiphyses bilaterally after 2 years of gymnastics, without a clear mechanism of injury. This patient had been using the vault since he was 9 years old, although children of that age do not normally perform on the vault. When gymnasts place their hands on the vault with their elbows flexed and subsequently extend their elbows to push off, the biomechanical load is placed equally on the right and left arms. Consequently, this type of repeated stress induces injury to the epiphyseal cartilages bilaterally, resulting in chronic progr...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Upper Limb Source Type: research

Kimura’s disease involving the peripheral nerve of the arm in a child: a case report
A 7-year-old Korean boy was referred for a nontender mass in the left arm. He had a 5-year history of a poorly defined painless mass on the medial side of the left elbow. The ultrasonogram of the left arm indicated an ill-defined, lobulating solid mass involving the deep soft tissue layer. The fat-suppressed T2-weighted magnetic resonance image showed a poorly marginated, homogeneous high-signal intensity mass. On further follow-up of 1 year and 6 months, the mass showed no change in size and nature. At surgery, a poorly demarcated inflammatory mass was dissected from a branch of the superficial radial nerve and excised co...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Upper Limb Source Type: research

The preliminary outcome of syndactyly management in children with a new external separation device
To introduce a new external fixation device for the management of syndactyly in children. To evaluate its preliminary clinical result. From January 2011 to June 2012, 12 cases with cutaneous syndactyly of the middle/ring finger were managed with a new external fixator designed by our department. There were eight cases on the right side and four on the left side. The web space and soft tissue were stretched gradually using the new device. A Z-plasty of syndactylies was performed when the web space has reached the width that we required. The results were evaluated according to the clinical appearance and function of the fing...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Upper Limb Source Type: research

Tibial turn-up procedure as an alternative to rotationplasty in a 4-year-old with osteosarcoma of the distal femur
We report a case of osteosarcoma of the distal femur in a 4-year-old boy that was, unusually, treated by amputation and a tibial turn-up procedure; we discuss the rationale for the procedure and report the results at early follow-up. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Tibia vara and slipped upper femoral epiphysis: is there an association?
We report a child who was treated for bilateral tibia vara at the age of 3 years and subsequently developed a SUFE at the age of 13 years. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Epiphysiolysis of the femoral neck due to closed reduction of an adolescent hip dislocation with a 4-year follow-up: a case report and review of the literature
This case study discusses a 13-year-old girl diagnosed with a displaced Salter Harris II fracture of the proximal femoral epiphysis post reduction of a dislocated hip. Radiographs before reduction revealed a small fracture of the inferomedial femoral head. This, however, did not induce concern before reduction. The patient underwent reparative surgery of the epiphysis only to develop a collapsed femoral head, which was remedied through total hip arthroplasty. A decrease in blood flow, the delicacy in reduction, and unknown predispositions might have been contributing factors toward the unique development in this case. (Sou...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip
This study evaluates improvement of the acetabular index (AI) in patients with developmental dysplasia of the hip at 4 years after closed reduction, and determines the association between the final AI and a set of factors. Sixty-two patients (74 hips) treated with closed reduction were categorized into three groups according to age: group A (0–12 months, 18 hips), group B (13–18 months, 24 hips), and group C (>18 months, 32 hips). There was no difference in AI among the three groups before reduction (P=0.293). In groups A and C, the AI decreased significantly over time until 3 years after reduction and no di...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Prognostic radiographic factors in developmental dysplasia of the hip following Salter osteotomy
Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their prognostic value require further validation. A total of 63 patients who underwent open reduction and Salter osteotomy for unilateral hip dysplasia were evaluated with Severin classification 10.8 years later. The initial first-year postoperative acetabular index, c/b ratio, head–teardrop distance, and head coverage were compared with the final outcome of Severin classification. Greater c/b ratio was significantly associated with later Severin class III hip. Using receiver operating characteristics curve, a c/b ratio great...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Osteochondrosis of the accessory ossification centre of the medial malleolus
We report a case of a painful accessory ossification centre of the medial malleolus in an 11-year-old girl who was not involved in sports activities. The patient was treated conservatively, with complete clinical and radiographic healing of the medial malleolus 6 months after the first presentation. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during skeletal growth, such as traction apophysitis of the medial malleolus, osteochondrosis, osteochondritis or avascular necrosis of the distal tibial epiphysis. We speculate that this painful condition may be classified as an oste...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Clinical outcome of posteromedial versus posteromedial-lateral release for clubfoot
Although the Ponseti serial casting method is the gold standard for the management of clubfoot, surgical correction remains the best option for resistant cases. Therefore, we compared posteromedial and posteromedial-lateral surgical approaches for the correction of resistant clubfoot. Between 2007 and 2013, 68 patients with idiopathic nonsyndromic resistant clubfoot, who were admitted to our referral institute, were enrolled in our study. The patients were divided into two groups. The patients in group 1 (33 cases of clubfoot) underwent posteromedial release with a single incision and those in group 2 (35 cases of clubfoot...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Walking capacity of children with clubfeet in primary school: something to worry about?
Although the main aim of clubfoot correction is to create a foot without limitations in daily activities and sport, studies on the walking capacity of children with corrected clubfeet are rare. In this cross-sectional study, the outcome of the six-minute walking test in 44 children with clubfeet (16 unilateral and 28 bilateral, mean age 8.57±2.45 years) was compared with the reference values of Geiger, clinical status measured with the Clubfoot Assessment Protocol (CAP), and regression analysis used to calculate which CAP subgroup predicts walking capacity. The mean walking capacity was decreased to 79% (P (Source: ...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Conservative treatment of severe clubfoot using a novel functional dynamic splint
This study clearly showed the effectiveness of a functional dynamic splint for the correction of equinus in cases of severe clubfoot. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Does the Ponseti technique affect the vascular development in patients with congenital talipes equinovarus?
In this study, we have evaluated the changes observed in the main arteries of the foot before and after the Ponseti technique. Arterial structures of seven patients were examined using Doppler ultrasound and the parameters studied included the course of the arteries, lumen filling, flow direction, pattern, and velocity. Before the treatment, the side with congenital talipes equinovarus deformity showed decreased blood flow in all arteries, except for the posterior tibial artery. At the second examination, the increase in the flow velocity of both arteries except tibialis anterior arteries was statistically significant. The...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Effect of unintentional partial Achilles tenotomy on Ponseti clubfoot management outcomes
This study was carried out to evaluate the effect of unintentional partial Achilles tendon cut during percutaneous tenotomy on the success rate of Ponseti management. Percentage of Achilles tendon cut following percutaneous tenotomy was measured by ultrasound in 16 clubfeet (11 patients). After a mean of 21 months of follow-up, the final results (Dimeglio score) were compared between two groups of patients: those with complete tendon cut and those with partial cut. Complications and parameters such as feeling of pop during tenotomy and ankle dorsiflexion during tenotomy were also compared. There was no significant correlat...
Source: Journal of Pediatric Orthopaedics B - December 4, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Severe Sprengel deformity associated with Klippel–Feil syndrome and a complex vascular abnormality that determined the corrective surgery technique
We present the case of an 11-year-old girl with severe SD and KFS. The left vertebral artery arose from the subclavian artery in a very high cervical location, which made surgical descent of the scapula unfeasible. The patient was treated using a Mears procedure, with osteotomy of the scapula and tenotomy of the long head of the triceps. The appearance and range of motion of the shoulders improved considerably, and there were no vascular complications. A morphologic vascular assessment is essential in children with SD and concomitant KFS to avoid potentially serious iatrogenic vascular injury when performing a scapular-des...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Laminoplasty preserving the deep extensor musculature for a pediatric cervicothoracic epidural hematoma case of hemophilia A
Postoperative malalignment after either a laminectomy or a laminoplasty in pediatric cases is a well-known complication. A 5-year-old boy with a history of hemophilia A presented with severe paresis. MRI showed an extensive epidural hematoma extending from C2 to T1. We performed decompression of the spinal cord using laminoplasty, preserving the insertion of the deep extensors. The patient completely recovered from the paresis. Even 7 years after the surgery we could not find any kyphotic deformities. The use of laminoplasty preserving the deep extensor musculature may be crucial for maintaining the postoperative cervical ...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Radial nerve safety in Dorgan’s lateral cross-pinning of the supracondylar humeral fracture in children: a case report and cadaveric study
We report the first incidence of radial nerve injury with lateral cross-pinning and suggest that the wire should be placed posterolaterally within 2 cm from the lateral epicondyle. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Trauma Source Type: research

Mid-term results of pediatric vascular injured supracondylar humerus fractures and surgical approach
The purpose of this study was to describe our experience with poorly perfused hands after supracondylar fracture of the humerus (SFH) in children and to present mid-term outcomes of a single trauma center. This is a retrospective analysis of SFH patients with vascular injuries, conducted from 2003 to 2012. Nine patients (2.1% of all SFH patients) underwent vascular reconstruction with no hand perfusion after adequate reduction and fixation at a mean age of 8.3 years (±1.8, range 4–12 years). No amputation was needed, and satisfactory elbow and hand functions were obtained. Immediate close anatomic reduction an...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Trauma Source Type: research

The effectiveness of cast wedging for the treatment of pediatric fractures
We present the results of cast wedging for correction of alignment during the closed treatment of tibial and radial shaft fractures in children. We retrospectively reviewed the radiographic and clinical outcome of 249 cast wedges performed after reangulation of a previously manipulated tibial or radial shaft fracture. A mean improvement of close to 5 in coronal alignment was observed. A satisfactory outcome was obtained in 96% of patients with tibial fractures and 94% of patients with radial fractures. Cast wedging is a safe and effective tool for the treatment of angulated, pediatric tibial and radial shaft fractures. (So...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Trauma Source Type: research

Psychological–behavioral characteristics and fractures in children are closely related
This work aimed to study the relationship between psychological–behavioral characteristics and fractures in children to provide a basis for development of preventive strategies. The study included 84 children hospitalized for fractures (fracture group) and 78 children without fractures (control group). The following questionnaires were utilized: temperament questionnaire, Eysenck Personality Questionnaire, and the Achenbach Child Behavior Checklist (CBCL). There were more children with problem behaviors in the fracture group than in the control group (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Trauma Source Type: research

Sclerosing osteomyelitis as a complication of pediatric femur fracture fixation
Complications of flexible nailing of pediatric femur fractures include angular and rotational malunions, leg-length discrepancy, and, in rare instances, infection. To our knowledge, the development of a sclerosing type of chronic osteomyelitis, which appears most similar to chronic sclerosing osteomyelitis of Garre’, has not been reported as a complication of, or associated with, flexible nail fixation of a pediatric femur fracture. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

How does rectus femoris fibrosis affect gait?
We report on a female patient with stiff-knee gait resulting from rectus femoris fibrosis, following multiple injections into the quadriceps musculature. Treatment planning and outcome were aided by instrumented three-dimensional gait analysis. One year after surgery, improvements were found in walking speed, step length, anterior pelvic tilt, knee flexion in swing, and ankle dorsiflexion in swing. Instrumented three-dimensional gait analysis was a useful tool for characterizing gait impairments and detecting changes after surgical intervention. Intramuscular injections into the rectus femoris muscle should be avoided to p...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Traumatic posterior hip dislocation and ipsilateral distal femoral fracture in a 22-month-old child: a case report
Minor trauma may cause hip dislocation in young children because of physiologic hip joint laxity and the soft cartilaginous structure of the acetabulum. In this work, we report on a 22-month-old boy with right-sided traumatic posterior hip dislocation and ipsilateral distal femoral fracture because of an outdoor motor vehicle accident. The patient was treated with emergency closed reduction and one and a half hip spica under general anaesthesia. The femoral fracture and hip dislocation were healed smoothly without any complication. Traumatic hip dislocation is rare in children, which may occur after trivial trauma. Prognos...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Isolated congenital absence of inferior pubic rami ossification: a case report
Previously reported cases of congenital absence of the pubic rami have been associated with urogenital and musculoskeletal anomalies. Presented here is the case of an 11-year-old female who presented to the outpatient clinic and was incidentally found to have absence of inferior pubic rami ossification in the setting of otherwise normal pelvic, genitourinary, and musculoskeletal development. Radiographic, computed tomography, and MRI studies are shown and demonstrate normal musculoskeletal anatomy and a cartilaginous anlage in the location of the inferior pubic rami. Isolated absence of inferior pubic rami ossification can...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Developmental dysplasia of the hip associated with aplasia of the pubic bone (hook-pelvis): report of a case and review of the literature
We report the case of an 18-month-old boy with developmental dysplasia of the hip associated with isolated total aplasia of the pubic bone. Patient was successfully treated with modified Salter osteotomy and reverse U-shaped capsuloplasty. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Do normal hips dislocate?
There have been a small number of case reports describing late normal-hip dislocations in children who were later diagnosed with developmental dysplasia of the hip. Here, we contest the assumption that normal hips can dislocate. We argue that (as in our case) the ultrasound scans in all published case reports on late dislocated normal hips did not show results that were entirely normal and therefore, so far, there has been no convincing evidence of a dislocation of a normal hip. We also want to highlight the importance of meticulous ultrasound and clinical assessments of high-risk children by an experienced orthopaedic sur...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Myositis ossificans circumscripta of the psoas muscle due to overuse in an adolescent gymnast
Myositis ossificans is a pseudoinflammatory tumour that originates from skeletal muscle and corresponds to a heterotopic, metaplastic, nonmalignant bone tumour. The purpose of this article is to report the case of myositis ossificans circumscripta (MOC) of the psoas muscle due to overuse in an adolescent gymnast. A 16-year-old female athlete presented at our outpatient orthopaedic clinic for evaluation of a 1-month history of low back pain. Initial plain radiographs were initially interpreted as negative, and laboratory values were normal. MRI imaging demonstrated a circumscribed mass with associated oedema in the psoas mu...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Derotational femoral osteotomy technique with locking nail fixation for adolescent femoral antetorsion: surgical technique and preliminary study
Rotational femoral osteotomies for excessive femoral antetorsion may be considered only for symptomatic adolescents. Our main objective was to describe our femoral osteotomy technique. Preoperative planning was performed clinically and with the EOS imaging system. Percutaneous osteotomy was performed on distal femoral metaphysis under radioscopic control. Fixation was achieved with an antegrade locking nail. Rotation was checked precisely using a specially designed protractor before distal locking. We carried out a prospective pilot study between 2009 and 2010 on six patients (nine procedures). All the patients included pr...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Hip & Femur Source Type: research

Use of botulinum toxin in the treatment of ankle plantar flexor spasticity in children with cerebral palsy
The aim of this study was to assess the effects of botulinum on spasticity of gastrocnemius and soleus muscles. Forty-one children with spastic cerebral palsy were assessed (muscle tone, range of motion of ankle joint extension with straightened and bent knee, and gait pattern using the Physician Rating Scale) before administration and 2, 6, and 13 weeks after. Changes on Physician Rating Scale and dorsiflexion with extended knee were significant after 2, 6, and 13 weeks. Differences in the remaining parameters were significant after the first two check-ups. Over 90% of the changes were positive. This research confirms the...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Ponseti treatment for clubfoot in Romania: a 9-year single-centre experience
Manipulation and casting according to the Ponseti method are the ‘gold standard’ for clubfoot treatment, and this method is endorsed by the American Association of Orthopaedic Surgeons. We conducted a retrospective study from January 2004 to December 2012 in our institution. All patients with idiopathic clubfoot were included, and a very strict analysis of the treatment outcomes, relapses and their treatment was carried out. A total of 382 children were included and followed up for a mean period of 6 years. The initial correction rate was 100%. At latest follow-up, the relapse rate was 19.03%, the initial corre...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Clubfoot associated with preaxial polydactyly
We report on three children with bilateral, congenital clubfoot. Four of the six clubfeet were associated with preaxial polydactyly. Five of the six clubfeet were treated without extensive surgery. A plantigrade foot was achieved, even in the three clubfeet with polydactyly, using serial casting and percutaneous Achilles tenotomy. Casting was adapted according to the existing polydactyly. One case with tibial hemimelia and a complex clubfoot deformity with preaxial tarsal polydactyly required more comprehensive surgery. A foot with good weight-bearing function was also achieved in this case following resection of the acces...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Prospective evaluation of the use of Mitchell shoes and dynamic abduction brace for idiopathic clubfeet
Ponseti treatment for clubfoot has been successful, but recurrence continues to be an issue. After correction, patients are typically braced full time with a static abduction bar and shoes. Patient compliance with bracing is a modifiable risk factor for recurrence. We hypothesized that the use of Mitchell shoes and a dynamic abduction brace would increase compliance and thereby reduce the rate of recurrence. A prospective, randomized trial was carried out with consecutive patients treated for idiopathic clubfeet from 2008 to 2012. After casting and tenotomy, patients were randomized into either the dynamic or static abduct...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Inter-rater reliability of physiotherapists using the Pirani scoring system for clubfoot: comparison with a modified five-point scale
This study examines inter-rater reliability between physiotherapists using the Pirani scoring system for clubfoot, and whether the addition of two scale points to give a modified five-point severity scale improves reliability. A total of 65 infant feet were assessed by two raters, with 21 different rater combinations used. The Pirani scoring system was found to be a reliable assessment tool when used by physiotherapists to score clubfoot, with a minimum of fair to good inter-rater reliability demonstrated across all clinical signs. The modified five-point scale proved significantly more reliable than the three-point scale;...
Source: Journal of Pediatric Orthopaedics B - October 3, 2014 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Multicentric giant cell tumor in adolescents: three case reports
We report three cases of a multicentric giant cell tumor of the bone in adolescents, and a review of the literature is also presented. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Treatment of deformational plagiocephaly and torticollis using a weight distribution ring: a report of three cases
Plagiocephaly, from the Greek ‘plagios’ (slanting) and ‘kephale’ (head), refers to a condition of an infant’s head deformation by forces acting upon a malleable cranium. Marked plagiocephaly causes distress and stigma towards the baby and their family and has knock-on effects with craniofacial abnormalities, visual-field defects and delay in motor skills, and may also cause developmental difficulties. Current treatment methods have multiple drawbacks. This small, illustrated case series presents a novel, cost-effective, practical first-line treatment using a horseshoe-shaped gel head ring to r...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Hypertension as a complication of circular external fixators
Hypertension is not a recognized complication of circular external fixation. The aim of this study was to determine the incidence of hypertension following this procedure. A retrospective review of 57 patients was carried out between January 2006 and May 2010. At least three blood pressure readings were used to define hypertension. Five of the 41 qualifying patients (12.2%) developed hypertension. Three of these were found to have a sustained hypertension throughout the frame period, two requiring treatment for visual symptoms and left ventricular hypertrophy. A limb reconstruction surgeon needs to be alert to this potenti...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Musculoskeletal problems in pediatric acute leukemia
Acute leukemia (AL) in children can mimic several orthopedic pathologies at presentation, with a variable delay in the correct diagnosis. This is a major problem, which may result in fractures, loss of mobility, and deformity, with resultant adverse effects on quality of life. Here, we studied the clinical and radiological musculoskeletal manifestations in children with AL. We reviewed 328 children [208 boys (62%), median age 7.2 years] with acute lymphoblastic (279, 85%) or myeloid (49, 15%) leukemia, treated between January 1982 and December 2003 by the Paediatric Oncology Service, Second University of Naples. The group ...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Distal tibial physeal bridge: a complication from a tension band plate and screw construct. Report of a case
We report on a case of a tension band plate and screw construct (Eight Plate) used over the anterior distal tibia in an 9-year-old girl in an attempt to induce recurvatum of the ankle joint to correct a recalcitrant equinus deformity. With growth of the distal tibial physis, the epiphyseal screw was drawn through the physis into the distal tibial metaphysis, resulting in the creation of a transphyseal bony bar. Caution should be exercised when attempting temporary hemiepiphyseodesis using a plate and screw construct in small epiphyses or in an osteopenic bone. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Avascular necrosis of the intermediate cuneiform bone in a child: a very rare cause of limp in a child. A variant of the normality?
Only four cases of avascular necrosis in the intermediate cuneiform bone have been described. A new case of avascular necrosis of the intermediate cuneiform bone as a very rare cause of limp is presented. A boy aged 4 years and 4 months came to the clinic with a 1-month history of pain in the left foot and on palpation of the base of the third metatarsal of the left foot. There were no signs of inflammation, bruising, erythema or fever. In the radiograph, a clear increase in the radiological density of the second cuneiform bone was seen. No treatment was prescribed. The symptoms remitted spontaneously after 2 weeks. The pa...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Resection interposition arthroplasty of calcaneonavicular coalition using a lateral supramalleolar adipofascial flap: case report
Space after the resection of calcaneonavicular coalition has been interposed by fat graft or the extensor digitorum brevis muscle. Nonvascularity of fat graft and insufficient volume of the extensor digitorum brevis muscle cause regrowth of the coalition. A pedicled lateral supramalleolar adipofascial flap was interposed into the space created by resection of the calcaneonavicular bar in the case of a 10-year-old boy. Regrowth of the coalition was successfully prevented by sufficient volume of the vascularized fatty tissue. The range of motion of the affected right ankle joint was similar to that of the unaffected side at ...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

The posterior to anterior controlled technique of percutaneous Achilles tenotomy in the correction of idiopathic clubfoot: a technical report
We describe a new tenotomy technique, the posterior to anterior controlled technique, that may decrease the possibility of neurovascular damage, does not require exposure of the Achilles tendon and can be performed as an office procedure under local anaesthesia. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Ilizarov techniques with limited adjunctive surgical procedures for the treatment of preadolescent recurrent or neglected clubfeet
When choosing the Ilizarov technique for the treatment of recurrent or neglected clubfeet deformity, there was a consensus on the treatment of 3–8-year-old children by the soft-tissue distraction ‘bloodless method’ either alone or with an adjunctive-limited soft tissue release; whereas, in older children, adjunctive osteotomies were required. Major foot osteotomies such as V, U, Y, or supramalleolar types were established for patients after puberty when the foot bones become fully ossified. So, children falling in the age group between 8 and 13 years (preadolescents) represents a transitional growing stag...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Medial column stabilization improves the early result of calcaneal lengthening in children with cerebral palsy
Calcaneal lengthening is a popular surgical treatment for pronated foot deformity. The aim of this study is to assess the effectiveness of medial column stabilization in improving the results of calcaneal lengthening for pronated foot deformity in ambulatory children with cerebral palsy. Twenty-one consecutive (37 feet) children with cerebral palsy with pronated foot deformity who received calcaneal lengthening from 2004 to 2009 were reviewed. Talonavicular stabilizations were performed by either stapling alone or fusion depending on the children’s age and correctability of midfoot deformity. Satisfaction rates were ...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Foot & Ankle Source Type: research

Emergency surgical treatment of an ulcerative and hemorrhagic congenital/infantile fibrosarcoma of the lower leg: case report and literature review
We report a unique case of congenital infantile fibrosarcoma of the lower leg, its treatment and pathology. The large expansive and destructive lesion was not appreciated on routine prenatal ultrasound exams at 20 and 33 weeks gestation. The newborn required immediate emergency surgical intervention after delivery to prevent death by hemorrhagic shock. Initial debulking of the tumor was performed and hemostasis was attained on the day of birth. The child was resuscitated and definitive treatment of the leg was deferred until a pathologic diagnosis was obtained. Given the extent of the fibrosarcoma, the lower leg was not sa...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Leg Source Type: research

Ewing sarcoma of the tibia mimicking fibrous dysplasia
In this study, we performed a retrospective review of children who presented with an otherwise benign-appearing lesion of the tibia, suggestive of FD, which proved to be ES after biopsy. As a result, all patients presented with a history of indolent lower extremity pain of several months of duration, without significant swelling or constitutional symptoms. Plain films revealed an otherwise benign-appearing/FD-like lesion without bone destruction and mild cortical thinning, little or no periosteal reaction. Magnetic resonance imaging revealed the intramedullary extension of the lesion without significant cortical or periost...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Leg Source Type: research

Tibial hemimelia–polydactyly–five-fingered hand syndrome associated with a 404 G>A mutation in a distant sonic hedgehog cis-regulator (ZRS): a case report
Tibial hemimelia–polydactyly–triphalangeal thumb syndrome is a distinct congenital limb anomaly complex, whose association with the 404 G>A mutation in a distant sonic hedgehog cis-regulator (ZRS) was suggested. The authors report a sporadic case of bilateral tibial hemimelia–preaxial polydactyly–five-fingered hands harboring the same mutation. This case further supports a causal relationship between this mutation and the phenotype. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Leg Source Type: research

Congenital tibial dysplasia with lateral bowing and duplication of hallux: case presentations
This article reports on two children with congenital unilateral tibial dysplasia with lateral bowing with no associated sagittal plane deformity. In both cases, it is associated with ipsilateral duplication of the hallux. Long-term follow-up of the patients showed spontaneous, almost complete resolution of the bowing without progressing into fracture or pseudoarthrosis. Leg length discrepancy appeared to be the only orthopedic sequela related to this phenomenon. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Leg Source Type: research

Congenital pseudoarthrosis of the tibia: healing by lengthening over a rod without compression of the nonunion. A preliminary report
This preliminary report is on two patients with congenital pseudoarthrosis of the tibia who had a persistent nonunion following intramedullary rodding and bone grafting. We do not advocate repeated surgery to achieve union. When limb length discrepancy becomes greater than 5 cm, we proceeded with an Ilizarov procedure with the primary aim of equalizing limb length rather than achieving union. Healing of the pseudoarthrosis occurred in both patients after lengthening over the intramedullary rod without compression of the nonunion site. We believe that union occurs because of hyperaemia during the lengthening. This approach ...
Source: Journal of Pediatric Orthopaedics B - May 1, 2013 Category: Orthopaedics Tags: Leg Source Type: research