Agreement of radiographic measurements and patient-reported outcome in 61 patients with Legg–Calvé–Perthes disease at mean follow-up of 28 years
It is unclear how patient-reported outcome in patients with Legg–Calvé–Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. At a mean follow-up of 28 years (15–42), 61 patients were investigated clinic...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Pediatric obesity is associated with short-term risks after pelvic osteotomy
The risk factors for increased perioperative morbidity following pediatric pelvic osteotomies are poorly understood. The purpose of this study was to characterize differences in adverse events, operative time, length of stay, and readmission following pelvic osteotomy for obese and nonobese patients. A retrospective cohort study was carried out using the National Surgical Quality Improvement Program Pediatric database to identify patients that underwent pelvic osteotomy with or without femoral osteotomy. Obesity was found to be an independent risk factor for blood transfusion (relative risk: 1.4, P=0.007) and readmission (...
Source: Journal of Pediatric Orthopaedics B - February 1, 2019 Category: Orthopaedics Tags: HIP & FEMUR Source Type: research

Response to ‘Is the extensive anterolateral approach for the treatment of developmental dysplasia of the hip more favorable than conventional surgical methods?’ by Citlak and Baki
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: LETTER TO THE EDITOR Source Type: research

Surgical site infection following elective nonspinal paediatric orthopaedic surgery: a prospective review
The aim of this study was to determine the rate of surgical site infection (SSI) and the factors that predispose to it in children undergoing nonspinal orthopaedic surgery. Over a 6-month period, 326 children who underwent 334 nonspinal elective orthopaedic surgical procedures were prospectively reviewed for the development of surgical site infections. A total of 14 sites became infected, with an overall infection rate of 4.19%. All the infections were superficial, and the only causative organism detected was Staphylococcus aureus. Operating times longer than 1 h and surgical wounds greater than 10 cm in length were...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: INFECTION Source Type: research

Dupuytren’s disease in a child: a long-term evolution after surgery
We report the case of a 13-year-old girl who presented with a fibrous nodular lesion on the palm of her hand. After ultrasonographic examination, surgical resection of the skin (dermofasciectomy) was performed, and a nodular phase mass was recovered, characterized as fusocellular fibroblast proliferation in a dense collagenous stroma with a cell population consisting of parallel fascicles of densely packed fusiform cells of a fibroblast strain. No signs of encapsulation or malignant changes were observed, all of which was consistent with Dupuytren’s disease. This lesion is exceptional in childhood. Sixteen years late...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Missed proximal radioulnar joint translocation with ulnar nerve entrapment: an unusual injury in a child
We report an unusual case of a missed PRUJ translocation with ulnar nerve entrapment in a 10-year-old child. The key to diagnosing the translocation is the position of the proximal radius, which lies medial to the ulna. This was treated by open reduction and release of the entrapped nerve. The ulnar nerve palsy recovered fully at the 1-year follow-up. Although PRUJ translocation with ulnar nerve entrapment is a rare injury, a successful outcome is possible with timely open reduction and release of the ulnar nerve. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Buttress plating for volar Barton fractures in children: Salter–Harris II distal radius fractures in sagittal plane
We report the radiological and clinical outcomes after follow-up for at least 3 years. From March 2008 to September 2014, nine consecutive children were treated by buttress plating. Their mean age at the time of injury was 13.1 years. All of the fractures were metaphyseal fractures in the coronal plane and typical Salter–Harris II fractures in the sagittal plane. After accurate reduction of the fragment, a cortical screw was inserted in the proximal area until the maximum compressive force against the fragment was obtained. Then, one or two locking screws were added adjacent to the initial cortical screw. No screw wa...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Gradual ulnar lengthening by an Ilizarov ring fixator for correction of Masada IIb forearm deformity without tumor excision in hereditary multiple exostosis: preliminary results
Bony exostoses are benign osteocartilaginous growths that start close to growth plates. Approximately 30–60% of patients have forearm deformities. The commonly encountered forearm deformities in these patients are bowing of the radius, with or without ulnar drift of the carpus, radial head dislocation, shortening of the ulna, and radial head dislocation. The current study reported on the results of management of radial head dislocation for type IIb Masada and Oho classification of forearm deformities by Ilizarov ulnar lengthening and without tumor excision. A series of 12 patients with Masada type IIb deformity were ...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Severity of ulnar deficiency and its relationship with lower extremity deficiencies
To assess the characteristics of ulnar deficiency (UD) and their relationship to lower extremity deficiencies, we retrospectively classified 82 limbs with UD in 62 patients, 55% of whom had femoral, fibular, or combined deficiencies. In general, UD severity classification at one level (elbow, ulna, fingers, thumb/first web space) statistically correlated with similar severity at another. Ours is the first study to show that presence of a lower limb deficiency is associated with less severe UD on the basis of elbow, ulnar, and thumb/first web parameters. This is consistent with the embryological timing of proximal upper ext...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Normal value and range of the humerus–elbow–wrist angle in a sample of healthy children with even distributions of age, sex, and laterality
This study was performed to evaluate the normal value of the humerus–elbow–wrist angle (HEWA) in a sample of healthy children with even distributions of age, sex, and laterality. A total of 168 radiographs of the elbows of healthy children with even distributions of age, sex, and laterality were reviewed. The mean HEWA was 12.1° (range: 5°–20°). The value of HEWA was significantly associated with increasing age. Neither sex nor side showed significant differences for the HEWA. The data should be useful for postoperative radiographic assessment of cubitus varus or valgus deformities. (Source: J...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Comparison of three surgical treatment options for unicameral bone cysts in humerus
Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991–2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surg...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Nonoperative versus operative treatment for displaced midshaft clavicle fractures in adolescents: a comparative study
We aimed to compare the outcomes and complications of nonoperative and operative treatment for displaced midshaft clavicle fractures in adolescents. Radiological and functional evaluations and complications for 23 patients with nonoperative treatment were compared with those for 18 patients with operative treatment. No nonunion developed in either group. No significant intergroup differences were observed for occurrence of delayed union or time to union (P=0.851 and 0.887, respectively). Both groups showed excellent functional outcomes on the basis of Disabilities of the Arm, Shoulder and Hand scores and Constant Shoulder ...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: UPPER LIMB Source Type: research

Unexpected higher blood loss associated with higher dose ε-aminocaproic acid in pediatric scoliosis surgery
The purpose of this study was to determine if a higher dosing of ε-aminocaproic acid (EACA) is associated with less perioperative blood loss than a lower dose. A total of 74 patients having scoliosis surgery were analyzed. Of the 74 patients, 36 patients received EACA (10 mg/kg/h) and 38 patients received EACA (33 mg/kg/h). After controlling for key variables, an infusion of 33 mg/kg/h of EACA was associated with an increase in intraoperative blood loss of 8.1 ml/kg compared with an infusion of 10 mg/kg/h of EACA. A 33 mg/kg/h intraoperative infusion is associated with high...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Does fusion to T2 compared with T3/T4 lead to improved shoulder balance in adolescent idiopathic scoliosis with a double thoracic curve?
This study included 74 patients who underwent corrective surgery for Lenke-2 AIS with the right main thoracic and left proximal thoracic (PT) curve at a single center. Various radiological parameters were measured using whole-spine standing radiographs preoperatively and postoperatively. Patients were grouped by proximal fusion level: T2 (group F; fusion, N=15) or T3/T4 (group NF; nonfusion, N=59). Preoperative and postoperative radiological parameters were compared between the two groups. Group NF was divided on the basis of the existence of a postoperative shoulder imbalance (PSI;>15 mm) and a subgroup analysis...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery
Accelerated discharge protocols for scoliosis surgery have recently been described in the literature. There are limited data describing the association of length of stay (LOS) during the index admission with postoperative outcomes. We sought to define the economic and clinical implications of an additional 1 day in the hospital for scoliosis surgery. The Statewide Planning and Research Cooperative System database was used to identify patients with adolescent idiopathic scoliosis who underwent spinal fusion from 1 October 2007 to 30 September 2012 at high-volume institutions (>20 cases/year) in the state of New York. Reg...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

The effect of Cobb angle correction on spinal length gain in patients with adolescent idiopathic scoliosis
The relationship between curve correction and spinal length gain in adolescent idiopathic scoliosis was examined. A total of 102 patients who underwent posterior spinal correction and fusion alone or in combination with anterior spinal correction and fusion (ASF) were studied. The Cobb angle correction, increase in the main thoracic length, T1–L5 spinal length gain, and T1–L5 spinal length gain/Cobb angle correction were reported. The length gain/Cobb angle correction value was not significantly associated with sex, fusion approach, and the number of fused levels. Surgical T1–L5 spinal length gain (mm) eq...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Standardized traction versus side-bending radiographs in adolescent idiopathic scoliosis: a preliminary study
The objective was to develop a test that was standardized and allow for the measurement of in-vivo forces required for curve correction. It was undertaken to compare the results of this new test with side-bending radiographs. Various preoperative radiographic techniques have been used to assess flexibility in patients awaiting scoliosis correction surgery. The major limitation of these investigations is a lack of standardization. The side-bending radiograph is the current gold standard, against which this new test was compared. A prospective clinical study was conducted. An axial traction force of 1.5 times body weight was...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Experience with definitive instrumented final fusion after posterior-based distraction lengthening in patients with early-onset spinal deformity: single center results
Limited reports exist with regard to clinical and radiographic details of patients with early-onset spinal deformity (EOSD) undergoing definitive instrumented final fusion (FF) following implantation of a growing construct. Charts and radiographs were queried for all patients who underwent FF after management of EOSD with a distraction-based posterior construct at a single institution from 2006 to 2017. Patients managed during the growth modulation period with either proximal rib or spinal fixation were included. Thirteen patients qualified for inclusion. Spinal deformity etiologies were varied (neuromuscular: 5, idiopathi...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Posterior hemivertebral resection for upper thoracic congenital scoliosis: be aware of high risk of complications
The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 8...
Source: Journal of Pediatric Orthopaedics B - November 30, 2018 Category: Orthopaedics Tags: SPINE Source Type: research

Incidence of congenital idiopathic clubfoot in the Netherlands
The incidence of clubfoot patients is an important factor for centralization of care. Medical records of 21 accredited clubfoot centers were selected using the diagnosis treatment codes and checked to confirm diagnosis. All idiopathic clubfoot cases born during 2013–2014 were analyzed with respect to sex, affected foot, regional distribution, and seasonal variation. Among the 346 522 live births, 377 idiopathic clubfoot cases were registered. The incidence of the congenital idiopathic clubfoot in the Netherlands during 2013 and 2014 was 1.09 per 1000 live births, indicating that every year, ~200 children with ...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children
The aim of this study was to analyze the management of displaced intra-articular calcaneal fractures in children at our pediatric orthopedic and to determine the results following open reduction via minimally invasive sinus tarsi approach and fixation with Kirschner wires (K-wires). Overall, 25 available cases of calcaneal fractures in children with mean age of 9.8 years were treated by open reduction from January 2010 to December 2015. All patients were followed up from 12 to 30 months (mean: 19 months). Clinical functional outcomes were graded using the American Orthopedic Foot and Ankle Society hindfoot scores. Radiogra...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Percutaneous versus open reduction and fixation for Tillaux and triplane fractures: a multicenter cohort comparison study
The goal of this study was to compare open reduction versus percutaneous fixation of adolescent ankle fractures with regards to the incidence of growth disturbance. We performed a retrospective cohort analysis of adolescent patients with triplane or Tillaux fractures. There was an even distribution of triplane fractures and mean initial displacement between cohorts. Analysis of follow-up radiographs revealed no instances of growth disturbance in the percutaneous fixation group and six in the open reduction group (P=0.29). Growth disturbance does not pose a significant concern when selecting a surgical approach. Owing to th...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Current treatment of congenital pseudarthrosis of the tibia: a systematic review and meta-analysis
To compare the current treatments for congenital pseudarthrosis of tibia, a total of 33 studies were reviewed. Vascularized fibular graft with external fixation or combined fixation had the fastest time till initial union (P (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Changes in the range of motion of the lower limb joints during extensive tibial lengthening in achondroplasia
Increase in the magnitude of lengthening during the limb lengthening procedure involves a high risk of decreased range of motion (ROM) in adjacent joints. Even though patients with achondroplasia can tolerate a relatively larger amount of lengthening owing to its inherent soft-tissue laxity, they often exhibit significant joint contractures during extensive lengthening. In the present study, we evaluated temporal changes in the ROM of the hip, knee, and ankle joints throughout the treatment period in 12 limbs of six patients with achondroplasia who had undergone extensive tibial lengthening. The ROM of hip extension, knee ...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Lower-extremity rotational profile and toe-walking in preschool children with autism spectrum disorder
The aim of this study was to establish the torsional and toe-walking profiles of children with autism spectrum disorder (ASD), and to analyze the correlations between torsion, toe-walking, autism severity score, and age. In total, 79 consecutive children with autism were examined to determine their hip rotations, thigh–foot angle, degree of toe-walking, and autism severity. Femoral and tibial torsion values, of the preschool patients, were compared statistically with age-matched controls. The hip rotation profile of the patients was similar to the normal group. Nearly a half of the patients with ASD present excessive...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: Knee Source Type: research

Treatment failures and complications in patients with Blount disease treated with temporary hemiepiphysiodesis: a critical systematic literature review
This systematic review sums up the state of knowledge about complications and reasons for failure when children with Blount disease are treated with temporary hemiepiphysiodesis. Twelve studies meet the inclusion criteria. The main reported obstacles were under correction and the poor predictability of the amount of correction that was obtainable. Obese patients with severe deformity are the most challenging groups of patients in the treatment of angular deformities. Patients with Blount disease require a careful evaluation regarding the deformity, age, body weight, and social background to reach the optimal treatment stra...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: Knee Source Type: research

Limitation of in-situ arthroscopic fixation for stable juvenile osteochondritis dissecans in the knee
Current treatment algorithms for stable juvenile osteochondritis dissecans (JOCD) of the knee have not been established. For arthroscopically stable lesion, in-situ arthroscopic fixation with bioabsorbable pins was introduced as a more desirable approach because of less surgical morbidity and faster recovery. However, there is a paucity of literature that concludes on its efficacy. The aim of this study is to determine the efficacy and limitation of in-situ arthroscopic fixation on stable JOCD lesion in the knee. Ninety-six patients with 110 affected knees were reviewed. Subsequently, patients who underwent in-situ arthros...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: Knee Source Type: research

A novel method for determining sagittal pediatric patellar height with the Blumensaat-Epiphyseal Containment of the Knee Angle
Defining normal pediatric patellar height is complicated. Current methods use ratios calculated from lateral radiographs, but often provide inconsistent results and are time-consuming. It has been observed that the angle formed by Blumensaat’s line and the distal femoral physis, when extended, form an area of patellar containment throughout a range of knee flexion. Deemed the Blumensaat-Epiphyseal Containment of the Knee (BECK) Angle, the objective of this study was to investigate this as a simple alternative to identify normal pediatric patellar height. Lateral radiographs were taken every 15° from 0° to 90&...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: Knee Source Type: research

Outcomes and subjective assessment of rotation-plasty in patients with proximal femoral focal deficiency
This study presents outcomes of rotation-plasty for unilateral proximal femoral focal deficiency in the adolescent population. The function, timing of knee fusion, and complications were presented as well as patients’ assessment of their function and appearance. Eight patients, aged 8.37 years (range: 3–16 years) during surgery, were evaluated. The mean follow-up duration was 9.25 years (range: 6–12 years). At follow-up, all the patients were pain free and able to ambulate outdoors. Complications included derotation of the foot in five patients, necessitating a re-rotation osteotomy in two. All patients a...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

The reliability of radiostereometric analysis in determining physeal motion in slipped capital femoral epiphysis in standard uniplanar and low-dose EOS biplanar radiography: a phantom model study
Physeal closure after slipped capital femoral epiphysis fixation can be difficult to assess on two-dimensional conventional radiographs. Radiostereometric analysis offers improved motion detection over conventional radiography, whereas the EOS biplanar imager provides a means for low radiation weight-bearing images. This phantom study assessed the reliability of measuring motion using radiostereometric analysis in the EOS using a slipped capital femoral epiphysis model. The accuracy and precision were better than 0.09±0.05 mm and 0.20°±0.36° when centered in the imaging space, were within the l...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Intracapsular cuneiform osteotomy compared with in-situ pinning for the management of slipped capital femoral epiphysis
Intracapsular cuneiform osteotomy was initially introduced to restore the morphology of the proximal femur after slipped capital femoral epiphysis (SCFE). However, whether this procedure results in a higher risk of avascular necrosis (AVN) or lower incidence of cam deformity than in-situ pinning is unclear. The aim of this study was to compare the outcomes of intracapsular cuneiform osteotomy and in-situ pinning to treat SCFE in children. Twenty-three children who suffered from SCFE underwent either intracapsular cuneiform osteotomy (eight patients, eight hips) or in-situ pinning (15 patients, 18 hips) between 2006 and 201...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Guided growth for caput valgum in developmental dysplasia of the hip
This study reported guided growth for caput valgum deformity and subsequent hip development. Ten children with unilateral hip dysplasia had guided growth by one eccentric transphyseal screw at age 9.1 years with minimum 2 years of follow-up. The first change was decreasing articulotrochanteric distance and then increasing physis tilt angle and head-shaft angle by 1.5 years. The center edge angle that was significantly less than the normal side (18.3 vs. 24.8°) preoperatively became comparable between both the hips 2 years later. Rebounding of physis inclination after screw back out suggested mechanical tethering, rathe...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Arthrodiastasis followed by open reduction associated with pelvic and femoral osteotomies for the treatment of high inveterate congenital hip dislocation
Our purpose is to analyze results, following the use of arthrodiastasis for the treatment of inveterate congenital hip dislocations. The study included eight patients. The mean age was 6 years. Three (37.5%) were male patients, and five (62.5%) were female patients. The patients were followed-up for 46 months. Teratologic, neurologic, rheumatic, and syndrome-associated dislocations were excluded. The following scores were used: Harris Hip Score, displacement of femoral head with respect to Hilgenreiner’s line, Acetabular index, Wiberg angle, Reimer’s extrusion index, and leg length discrepancy. Statistical anal...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Anteverting Bernese periacetabular osteotomy in the treatment of neurogenic hip dysplasia in cerebral palsy
All patients with hypertonic cerebral palsy undergoing Bernese periacetabular osteotomy (PAO) between 2005 and 2014 were reviewed. Clinical and radiographic parameters, including the cerebral palsy hip classification and anterior and posterior wall indices were collected to assess acetabular reorientation. Twenty (83%) of 24 procedures involved the correction of posterolateral acetabular insufficiency and were ‘anteverting PAOs’. All 20 experienced improvements in radiographic indices. Eleven (58%) of 19 PAOs in ambulatory patients were performed in the setting of other multilevel orthopedic surgery. The anteve...
Source: Journal of Pediatric Orthopaedics B - October 5, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

What to do when percutaneous Achilles tenotomy fails in Ponseti technique?
No abstract available (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: Letter to the Editor Source Type: research

Vitamin D and tibiofemoral joint orientation angles in children
Vitamin D is an important component in musculoskeletal development and function in children. The aim of our study was to investigate serum vitamin D levels and tibiofemoral joint orientation angles in children. We performed a retrospective review on a consecutive series of children presenting with lower limb complaints. The children underwent an assessment of serum vitamin D level and full-length standing lower limb anteroposterior radiographs, and were divided into normal and deficient vitamin D groups. Tibiofemoral angles (TFAs) [lateral distal femoral angle (LDFA); medial proximal tibial angle (MPTA)] were measured by t...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Presenting features of extremity necrotizing fasciitis in the pediatric patient: a case–control analysis
This analysis sought to develop a tool for early differentiation between pediatric necrotizing fasciitis (NF) of the extremity and more benign infection. All diagnoses of extremity NF, cellulitis, and abscess from a single institution from 2009 to 2015 were included. Vitals and laboratory values were compared between cohorts using analysis of variance and decision tree analysis. NF was associated with thrombocytopenia, hyperthermia, tachycardia, and tachypnea. Decision tree analysis identified C-reactive protein more than 7.0 to be 100% sensitive and 95.7% specific for differentiating NF from cellulitis or abscess. The res...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Percutaneous excision of difficult osteoid osteomas using intraoperative AIRO CT navigation: a preliminary report
We report a technique of intraoperative computed tomography (CT) navigation for localization and excision of osteoid osteomas of the long bones. Six patients (four femoral and two tibial lesions) with a radiological diagnosis of osteoid osteoma, in whom the nidus could not be visualized clearly on plain radiographs, were treated with this technique. Intraoperative CT navigation with AIRO was performed and the images were registered to the computer. The lesion was then localized and excised using a high-speed burr. All patients underwent postexcision on-table CT scans, which showed complete excision of the nidus. All patien...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Managing large bone defects in children: a systematic review of the ‘induced membrane technique’
Thirty years after its description by Masquelet in 1986, this is the first systematic review aiming to critically evaluate the ‘induced membrane technique’ effectiveness in achieving bone union in children. Only six papers fulfilled our inclusion criteria (54 patients). The relatively small number of reported cases did not allow a formal meta-analysis. The tibia was the most involved bone. Most frequent aetiologies were congenital pseudoarthrosis and tumour resections. Although effective in achieving bone healing in ∼91% of the patients (bone defects ≤24 cm long), the induced membrane technique wa...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: Miscellaneous Source Type: research

Midterm functional outcomes in operatively treated adolescent Lisfranc injuries
This study evaluates the midterm outcomes of Lisfranc injuries in adolescents operatively treated with Kirschner wire or screw fixation. Eight adolescent patients with Lisfranc injuries operatively treated in a single institution were included in this study. The mean duration of follow-up was 3.8 years. Analysis of radiographs with respect to the degree of initial displacement and final reduction was carried out in terms of the intermetatarsal distances. All cases were scored functionally using the American Orthopaedic Foot and Ankle Society Midfoot Scale. We concluded that most operatively treated cases of adolescent Lisf...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Complex iatrogenic clubfoot: is it a real entity?
In our study, we aimed to demonstrate whether a complex iatrogenic clubfoot really exists; identify the causative mechanisms; and determine the outcome if properly treated. We observed 54 clubfeet previously treated unsuccessfully by manipulation and casting elsewhere. All the feet had been classified at diagnosis as typical clubfeet. In 26 cases, the cast had slipped down, entrapping the foot in a plantar-flexed position. Nine clubfeet out of those 26 cases presented the clinical features of a complex iatrogenic deformity. These were treated with the modified Ponseti protocol and evaluated at follow-up according to the In...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Extended Ponseti method for failed tenotomy in idiopathic clubfeet: a pilot study
We evaluated the outcome of a new protocol of an extended Ponseti method in the management of idiopathic club foot with residual equinus following failed Achilles tenotomy. We also compared the failed with a successful tenotomy group to analyze the parameters for failure. The Ponseti technique-treated idiopathic club foot patients with failed percutaneous Achilles tenotomy (failure to achieve (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Role of a tendon transfer as a dynamic checkrein reducing recurrence of equinus following distal tibial dorsiflexion osteotomy
We present the results of closing wedge tibial dorsiflexion osteotomy and tendon transfers in 15 feet and 11 patients. The mean age at presentation was 7 (range: 3.98–12.38) years. At a mean follow-up of 4.16 (range: 2.09–6.87) years, 11 of the 15 feet remained corrected. Mean correction of the dorsiflexion was 24.5° and mean correction of anterior distal tibial angle was 10.9° at final review. Muscle rebalancing appears to influence bone remodeling and reduce recurrence of equinus. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Is an operation always needed for pediatric triplane fractures? Preliminary results
We compared the outcomes of nonoperative and operative treatments of triplane fractures. Thirty-three patients with triplane fractures were treated conservatively (n=19) or surgically (n=14). Bone union and postoperative complications were radiographically examined. The mean American Orthopedic Foot and Ankle Society scores were 100 (nonoperative group) and 98.1 (operative group) (P=0.304). The modified Weber protocol scores were excellent in both groups. One patient in each group showed a leg-length discrepancy of more than 10 mm at the last follow-up. According to our preliminary data, it appears that nonoperative...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: LEG, ANKLE & FOOT Source Type: research

Postinfectious heterotopic ossification of the ilium involving the iliacus muscle
Heterotopic ossification in soft tissue or muscle is rare in the pediatric and adolescent age group. Most cases are associated with musculoskeletal injury and trauma to the central nervous system. Here, we describe an adolescent patient without a history of trauma or lesions in the central nervous system who presented with a painful limp with limited motion of the left hip. Investigations indicated unusually large heterotopic ossification extending from the inner aspect of the ilium down to the anterior part of the hip, highly likely to have developed after an unrecognized periacetabular pyomyositis primarily involving the...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Simultaneous bilateral avulsion fracture of the anterior–superior iliac spine in a teenager: a case report with a literature review
An anterior–superior iliac spine avulsion fracture is an uncommon injury in adolescent athletes and simultaneous bilateral avulsion fracture is fairly rare. The authors report cases of traumatic avulsion fractures of anterior–superior iliac spine after sports activity in teenagers. Open reduction and cannulate screws fixation resulted in an excellent functional outcome for this relatively uncommon fracture. The authors also stress the importance of careful clinical examination and recommend open reduction and internal fixation for patients requiring rapid rehabilitation. (Source: Journal of Pediatric Orthopaedics B)
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Gain of length–loss of strength? Alteration in muscle strength after femoral leg lengthening in young patients: a prospective longitudinal observational study
This study aimed to determine the alteration in maximum isokinetic torque in patients after intramedullary femoral leg lengthening. Thirty patients with a median leg-length discrepancy of 3.0 cm underwent femoral limb lengthening with an intramedullary motorized device. Maximum isokinetic, concentric torque of the extensors, and flexors of the knee was measured before (n=30) and 2 years after surgery (n=21). Postoperatively, a significant difference remained for the maximum isokinetic torque of the extensors (22%) between the lengthened and the normal leg, which might have been caused by muscle response to the distr...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Three-dimensional MRI analyses of prereduced femoral head sphericity in patients with developmental dysplasia of the hip after Pavlik harness failure
We used three-dimensional (3D) MRI to assess the sphericity of the cartilaginous femoral head in developmental dysplasia of the hip. We assessed 21 children using 3D-MRI. The smallest sphere including the femoral head cartilage was drawn, the diameter was measured, and the center of the sphere was defined. We compared the diameters of the femoral heads between unaffected and diseased sides. The diameter of the affected side was smaller, with flattening at the posteromedial area and proximoposterior areas. 3D-MRI showed that the shape of the dislocated femoral head was aspherical with focal growth failure. (Source: Journal ...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Closed reduction of congenital dislocation of the hip: prediction factors and results
From 2009 to 2015, 15 infants with a congenital dislocation of the hip were treated with closed reduction under anaesthesia, after first being treated with Pavlik bandaging. A retrospective study was carried out with a minimum follow-up of 1 year to assess the success rate of the procedure and predictive factors. Twelve out of 15 (80%) patients achieved successful reduction. In the successful cases, the Barlow test was positive and the safe zone was 20° or more. In the unsuccessful cases, there was a negative Barlow present in the outpatient clinic and the safe zone was less than 20°. These three cases all had tera...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research

Universal versus selective ultrasound screening for developmental dysplasia of the hip: a single-centre retrospective cohort study
A total of 28 068 infants were studied to investigate whether universal ultrasound screening for developmental dysplasia of the hip results in fewer delayed presentations than selective screening, and whether the screening protocol affects subsequent treatment. The rate of delayed presentation was not lower with selective screening compared with universal screening but all cases of delayed presentation in this cohort were administrative errors. There were no sonographic errors (false-negatives). The treatment rate was significantly higher with universal screening but infants were treated earlier and were significant...
Source: Journal of Pediatric Orthopaedics B - July 24, 2018 Category: Orthopaedics Tags: PELVIS, HIP & FEMUR Source Type: research