Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000416
A. Presedo, A. Simon, C. Mallet, B. Ilharreborde, K. Mazda, G. Penneçot
In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.
{"title":"Correlation between transverse plan kinematics and foot progression angle in children with spastic diplegia","authors":"A. Presedo, A. Simon, C. Mallet, B. Ilharreborde, K. Mazda, G. Penneçot","doi":"10.1097/BPB.0000000000000416","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000416","url":null,"abstract":"In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89525117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000423
F. Canavese, Mounira Mansour, Guillemette Moreau-Pernet, Y. Gorce, A. Diméglio
Over the past 4 years, our pediatric orthopedic unit has developed a new hybrid protocol combining the advantages of Ponseti’s method and the French functional physiotherapy method. Sixty-one patients (92 feet) completed treatment. Clubfoot was unilateral in 30 (49.2%) patients and bilateral in 31 (50.8%) patients. The mean Dimeglio score at the start of treatment was 13.5/20 (range: 6/20–19/20). All patients had clinical and radiographic follow-up for at least 2 years (range: 2–4 years). If orthopedic treatment was ineffective and feet showed no improvement, further surgery was performed. Posterior release was performed in eight (8.7%) feet. Clinical evaluation at the last follow-up found a mean dorsal flexion of 20°±5° (range: 5°–35°). The hybrid method is a combination approach applying the strengths of Ponseti’s method, that is, serial casting, and the French physiotherapy method, that is, manipulations and radiographs, to achieve long-term correction with a foot that is fully functional and pain free.
{"title":"The hybrid method for the treatment of congenital talipes equinovarus: preliminary results on 92 consecutive feet","authors":"F. Canavese, Mounira Mansour, Guillemette Moreau-Pernet, Y. Gorce, A. Diméglio","doi":"10.1097/BPB.0000000000000423","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000423","url":null,"abstract":"Over the past 4 years, our pediatric orthopedic unit has developed a new hybrid protocol combining the advantages of Ponseti’s method and the French functional physiotherapy method. Sixty-one patients (92 feet) completed treatment. Clubfoot was unilateral in 30 (49.2%) patients and bilateral in 31 (50.8%) patients. The mean Dimeglio score at the start of treatment was 13.5/20 (range: 6/20–19/20). All patients had clinical and radiographic follow-up for at least 2 years (range: 2–4 years). If orthopedic treatment was ineffective and feet showed no improvement, further surgery was performed. Posterior release was performed in eight (8.7%) feet. Clinical evaluation at the last follow-up found a mean dorsal flexion of 20°±5° (range: 5°–35°). The hybrid method is a combination approach applying the strengths of Ponseti’s method, that is, serial casting, and the French physiotherapy method, that is, manipulations and radiographs, to achieve long-term correction with a foot that is fully functional and pain free.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83320673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000247
S. Cha, H. Shin, Dong Yeol Kim
Solitary osteochondromas originating from the carpal bones are very uncommon; when they occur, they usually arise from the scaphoid or capitate. We report a solitary, unilobed osteochondroma arising from the hamate that was excised, with no evidence of recurrence at the 3-year follow-up.
{"title":"A solitary unilobed osteochondroma of the hamate: a case report.","authors":"S. Cha, H. Shin, Dong Yeol Kim","doi":"10.1097/BPB.0000000000000247","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000247","url":null,"abstract":"Solitary osteochondromas originating from the carpal bones are very uncommon; when they occur, they usually arise from the scaphoid or capitate. We report a solitary, unilobed osteochondroma arising from the hamate that was excised, with no evidence of recurrence at the 3-year follow-up.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76126166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000393
Y. Charles, Amélie Marcoul, M. Schaeffer, F. Canavese, A. Diméglio
We aimed to measure thoracic dimensions and volume in relation to growth and verify the influence of scoliosis on thoracic growth. A reference group of 294 healthy volunteers was compared with a group of 557 patients with idiopathic scoliosis ranging in age from 3 to 25 years. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic volume, perimeter, anterior–posterior and transversal diameters, T1–T12 length, and sternal length. There was no significant difference in thoracic dimensions and volume between scoliosis and reference groups in either girls or boys. Thoracic volume correlated with weight and with sitting height. The transversal diameter represented ∼30%, the anterior–posterior diameter 20%, and the thoracic perimeter 100% of sitting height. Mild and moderate scoliosis does not affect thoracic diameters and volume at any stage of growth. Relationships between thoracic parameters and sitting height are valuable indicators in clinical practice. They do not differ between normal individuals and scoliotic patients with moderate trunk asymmetry.
{"title":"Three-dimensional and volumetric thoracic growth in children with moderate idiopathic scoliosis compared with normal","authors":"Y. Charles, Amélie Marcoul, M. Schaeffer, F. Canavese, A. Diméglio","doi":"10.1097/BPB.0000000000000393","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000393","url":null,"abstract":"We aimed to measure thoracic dimensions and volume in relation to growth and verify the influence of scoliosis on thoracic growth. A reference group of 294 healthy volunteers was compared with a group of 557 patients with idiopathic scoliosis ranging in age from 3 to 25 years. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic volume, perimeter, anterior–posterior and transversal diameters, T1–T12 length, and sternal length. There was no significant difference in thoracic dimensions and volume between scoliosis and reference groups in either girls or boys. Thoracic volume correlated with weight and with sitting height. The transversal diameter represented ∼30%, the anterior–posterior diameter 20%, and the thoracic perimeter 100% of sitting height. Mild and moderate scoliosis does not affect thoracic diameters and volume at any stage of growth. Relationships between thoracic parameters and sitting height are valuable indicators in clinical practice. They do not differ between normal individuals and scoliotic patients with moderate trunk asymmetry.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84327413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000400
K. Studer, M. Baker, A. Krieg
Congenital pseudarthrosis of the clavicle (CPC) is a very rare condition with a predilection for the right clavicle. Young children are often only symptomatic with activities and as they grow. Operative management in an asymptomatic child is debatable, with various techniques reported in the literature. This is a retrospective, single-centre case series study. All children with CPC treated surgically by resection, bone grafting (nonvascular iliac crest) and plate fixation between 2004 and 2012 at our centre were included. Excluded conditions were traumatic or obstetric fractures of the clavicle, children with musculoskeletal or neurological disorders and children lost to follow-up. Clinical and radiological examination was performed at 6 weeks, 3 months and between 6 and 12 months postoperatively. A total of eight clavicles in seven children (four girls and three boys), with a mean age of 7.1 years (5–8 years), were operated with a mean follow-up of 7 years (4–10 years). In six children, the right (dominant) side was affected, with one child affected bilaterally. Overall, 85% of our patients showed good functional results 6 weeks postoperatively and complete radiographic consolidation at a mean of 8.5 months (3–25 months) postoperatively. One female child showed delayed union, but without clinical deficit. There was low donor-site morbidity. We recommend early operative treatment of CPC with a nonvascularized bone graft from the iliac crest and plate fixation. Level of Evidence: IV.
{"title":"Operative treatment of congenital pseudarthrosis of the clavicle: a single-centre experience","authors":"K. Studer, M. Baker, A. Krieg","doi":"10.1097/BPB.0000000000000400","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000400","url":null,"abstract":"Congenital pseudarthrosis of the clavicle (CPC) is a very rare condition with a predilection for the right clavicle. Young children are often only symptomatic with activities and as they grow. Operative management in an asymptomatic child is debatable, with various techniques reported in the literature. This is a retrospective, single-centre case series study. All children with CPC treated surgically by resection, bone grafting (nonvascular iliac crest) and plate fixation between 2004 and 2012 at our centre were included. Excluded conditions were traumatic or obstetric fractures of the clavicle, children with musculoskeletal or neurological disorders and children lost to follow-up. Clinical and radiological examination was performed at 6 weeks, 3 months and between 6 and 12 months postoperatively. A total of eight clavicles in seven children (four girls and three boys), with a mean age of 7.1 years (5–8 years), were operated with a mean follow-up of 7 years (4–10 years). In six children, the right (dominant) side was affected, with one child affected bilaterally. Overall, 85% of our patients showed good functional results 6 weeks postoperatively and complete radiographic consolidation at a mean of 8.5 months (3–25 months) postoperatively. One female child showed delayed union, but without clinical deficit. There was low donor-site morbidity. We recommend early operative treatment of CPC with a nonvascularized bone graft from the iliac crest and plate fixation. Level of Evidence: IV.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74701690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000435
A. Diméglio, D. Ceroni, Y. Charles, V. de Rosa, P. Kelly, A. Presedo, F. Canavese
Faculty of Medicine, University of Montpellier, Department of Pediatric Orthopedic Surgery, Clinique St. Roch, Montpellier, Department of Spine Surgery, University Hospital of Strasbourg, Strasbourg Cedex, Department of Pediatric Surgery, University Hospital Estaing, Clermont-Ferrand, Department of Pediatric Orthopedic Surgery, Robert Debré University Hospital, Paris, France, Department of Pediatric Orthopedic Surgery, University Hospital of Geneva, Geneva, Department of Pediatric Orthopedics, Bellinzona e Valli Regional Hospital, Bellinzona, Switzerland and Department of Orthopaedic Surgery, Our Lady’s Children’s Hospital, Dublin, Ireland
{"title":"The Montpellier School of Pediatric Orthopedics: with the children, by the children, for the children.","authors":"A. Diméglio, D. Ceroni, Y. Charles, V. de Rosa, P. Kelly, A. Presedo, F. Canavese","doi":"10.1097/BPB.0000000000000435","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000435","url":null,"abstract":"Faculty of Medicine, University of Montpellier, Department of Pediatric Orthopedic Surgery, Clinique St. Roch, Montpellier, Department of Spine Surgery, University Hospital of Strasbourg, Strasbourg Cedex, Department of Pediatric Surgery, University Hospital Estaing, Clermont-Ferrand, Department of Pediatric Orthopedic Surgery, Robert Debré University Hospital, Paris, France, Department of Pediatric Orthopedic Surgery, University Hospital of Geneva, Geneva, Department of Pediatric Orthopedics, Bellinzona e Valli Regional Hospital, Bellinzona, Switzerland and Department of Orthopaedic Surgery, Our Lady’s Children’s Hospital, Dublin, Ireland","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72685506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000410
Y. Charles, F. Canavese, A. Diméglio
We aimed to determine the curve progression risk of idiopathic scoliosis in patients at the time of peak height velocity by plotting curve magnitudes against olecranon stages of skeletal maturation. Register data of 372 patients with juvenile or adolescent idiopathic scoliosis followed at 6-month intervals from onset of scoliosis to skeletal maturity were reviewed. At the onset of the pubertal growth spurt, curves greater than 30° have a 100% risk of progressing over 45° (P<0.0001). Curves 21–30° have a progression risk of 72.5% (P=0.0034). A curve progression velocity 6–10° per year represents a risk of 71.8% (P=0.0001) to require surgical treatment and a velocity greater than 10° per year represents a risk of 100% (P<0.0001). Plotting curve magnitudes against height measurements and the stages of olecranon maturation offers a reliable prediction of curve progression risk in idiopathic scoliosis during Risser 0.
{"title":"Curve progression risk in a mixed series of braced and nonbraced patients with idiopathic scoliosis related to skeletal maturity assessment on the olecranon","authors":"Y. Charles, F. Canavese, A. Diméglio","doi":"10.1097/BPB.0000000000000410","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000410","url":null,"abstract":"We aimed to determine the curve progression risk of idiopathic scoliosis in patients at the time of peak height velocity by plotting curve magnitudes against olecranon stages of skeletal maturation. Register data of 372 patients with juvenile or adolescent idiopathic scoliosis followed at 6-month intervals from onset of scoliosis to skeletal maturity were reviewed. At the onset of the pubertal growth spurt, curves greater than 30° have a 100% risk of progressing over 45° (P<0.0001). Curves 21–30° have a progression risk of 72.5% (P=0.0034). A curve progression velocity 6–10° per year represents a risk of 71.8% (P=0.0001) to require surgical treatment and a velocity greater than 10° per year represents a risk of 100% (P<0.0001). Plotting curve magnitudes against height measurements and the stages of olecranon maturation offers a reliable prediction of curve progression risk in idiopathic scoliosis during Risser 0.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84405808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1097/BPB.0000000000000417
S. Aubret, T. Lecointe, Mounira Mansour, M. Rousset, A. Andreacchio, B. Pereira, Y. Charles, F. Canavese
This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25–37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician’s office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.
{"title":"Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing","authors":"S. Aubret, T. Lecointe, Mounira Mansour, M. Rousset, A. Andreacchio, B. Pereira, Y. Charles, F. Canavese","doi":"10.1097/BPB.0000000000000417","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000417","url":null,"abstract":"This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25–37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician’s office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86807452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1097/BPB.0000000000000363
E. Lebel, E. Weinberg, Tamar Berenstein-Weyel, R. Bromiker
The treatment of congenital clubfoot has been changing rapidly since the mid-1990s with the worldwide use of the Ponseti method for serial casting and limited operative interventions. This method was first applied for isolated clubfeet and later on for other types of clubfoot (teratologic, residual, and neurogenic). Premature babies sustaining clubfoot commonly suffer from additional congenital and acquired medical problems. These may postpone clubfoot management until urgent issues are resolved. The current study describes early initiation of treatment of clubfoot in premature babies at the neonatal intensive care unit (NICU) and their outcomes. The study group included all babies diagnosed with clubfoot and managed in the NICU (for any etiology) between 2006 and 2012. Management was based on the Ponseti protocol for serial casting. We also report on neonates who died in the NICU before or during treatment. We specifically describe adverse events of early casting and situations necessitating removal of casts or termination of treatment. We diagnosed and treated 20 neonates with clubfoot (four females and 16 males, 10 bilateral cases). Gestational age ranged from 27 weeks to term. Eight were identified with clubfoot by prenatal sonographic survey and 10 were diagnosed with a defined syndrome. Seven had respiratory support, including one with a chest drain (50%). Length of stay in the NICU ranged from 3 to 90 days. Four neonates died while in the NICU (all syndromatic). In the remaining 16 cases, treatment began as early as medically possible. The first cast was applied within the first week of life in 14 cases. A total of 75 casts were applied during the study period. Three casts (4%) were removed because of leg edema or a need for venous access. Casts were routinely replaced every 4–7 days. Achilles tenotomies were performed in the NICU for babies achieving satisfactory correction. At last follow-up, 10 children were independent walkers and six were nonambulatory; all showed successful correction of clubfeet. The results of this study show that in most cases, clubfoot treatment is feasible and effective within the first week of life. Instances necessitating immediate cast removal are highlighted. Although while facing acute life-threatening medical problems, the treatment of clubfoot may not be considered a priority, most neonates will grow up into independent individuals; thus, every effort should be made to initiate the best clubfoot management with minimal delay.
{"title":"Early application of the Ponseti casting technique for clubfoot correction in sick infants at the neonatal intensive care unit","authors":"E. Lebel, E. Weinberg, Tamar Berenstein-Weyel, R. Bromiker","doi":"10.1097/BPB.0000000000000363","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000363","url":null,"abstract":"The treatment of congenital clubfoot has been changing rapidly since the mid-1990s with the worldwide use of the Ponseti method for serial casting and limited operative interventions. This method was first applied for isolated clubfeet and later on for other types of clubfoot (teratologic, residual, and neurogenic). Premature babies sustaining clubfoot commonly suffer from additional congenital and acquired medical problems. These may postpone clubfoot management until urgent issues are resolved. The current study describes early initiation of treatment of clubfoot in premature babies at the neonatal intensive care unit (NICU) and their outcomes. The study group included all babies diagnosed with clubfoot and managed in the NICU (for any etiology) between 2006 and 2012. Management was based on the Ponseti protocol for serial casting. We also report on neonates who died in the NICU before or during treatment. We specifically describe adverse events of early casting and situations necessitating removal of casts or termination of treatment. We diagnosed and treated 20 neonates with clubfoot (four females and 16 males, 10 bilateral cases). Gestational age ranged from 27 weeks to term. Eight were identified with clubfoot by prenatal sonographic survey and 10 were diagnosed with a defined syndrome. Seven had respiratory support, including one with a chest drain (50%). Length of stay in the NICU ranged from 3 to 90 days. Four neonates died while in the NICU (all syndromatic). In the remaining 16 cases, treatment began as early as medically possible. The first cast was applied within the first week of life in 14 cases. A total of 75 casts were applied during the study period. Three casts (4%) were removed because of leg edema or a need for venous access. Casts were routinely replaced every 4–7 days. Achilles tenotomies were performed in the NICU for babies achieving satisfactory correction. At last follow-up, 10 children were independent walkers and six were nonambulatory; all showed successful correction of clubfeet. The results of this study show that in most cases, clubfoot treatment is feasible and effective within the first week of life. Instances necessitating immediate cast removal are highlighted. Although while facing acute life-threatening medical problems, the treatment of clubfoot may not be considered a priority, most neonates will grow up into independent individuals; thus, every effort should be made to initiate the best clubfoot management with minimal delay.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88641315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1097/BPB.0000000000000387
M. Dobbs, S. Frick, V. Mosca, E. Raney, Harold J. VanBosse, J. Lerman, V. Talwalkar, K. Steger-May, C. Gurnett
The aim of this study was to describe the design and baseline characteristics of participants enrolled in the prospective randomized-controlled Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Foot abduction bracing is currently the standard of care for preventing clubfoot relapse. Current recommendations include full-time bracing for the first 3 months and then 8–12 h a day for 4 years; however, the optimal length of bracing is not known. The FAB24 trial is a clinical randomized study to determine the effectiveness of 2- versus 4-year foot abduction bracing. Participant enrollment for FAB24 was conducted at eight sites in North America and included enrollment and randomization of 139 participants with isolated clubfoot. This clinical trial will generate evidence-based data that will inform and improve patient care.
{"title":"Design and descriptive data of the randomized Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24)","authors":"M. Dobbs, S. Frick, V. Mosca, E. Raney, Harold J. VanBosse, J. Lerman, V. Talwalkar, K. Steger-May, C. Gurnett","doi":"10.1097/BPB.0000000000000387","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000387","url":null,"abstract":"The aim of this study was to describe the design and baseline characteristics of participants enrolled in the prospective randomized-controlled Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Foot abduction bracing is currently the standard of care for preventing clubfoot relapse. Current recommendations include full-time bracing for the first 3 months and then 8–12 h a day for 4 years; however, the optimal length of bracing is not known. The FAB24 trial is a clinical randomized study to determine the effectiveness of 2- versus 4-year foot abduction bracing. Participant enrollment for FAB24 was conducted at eight sites in North America and included enrollment and randomization of 139 participants with isolated clubfoot. This clinical trial will generate evidence-based data that will inform and improve patient care.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89427774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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