Pub Date : 2019-11-01DOI: 10.1097/BPB.0000000000000597
K. Lee, C. Chung, M. Park, K. Sung, S. Koo, S. Moon, Soon Do Wang, K. Jung
Intraosseous alignment of the tarsal bone has not been investigated in relation to various foot deformities. This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also analyzed. The neuromuscular group showed significantly more severe deformity than the idiopathic group in the radiographic and 3D sagittal talus measurements. The 3D coronal talus measurement showed a significant negative correlation with the axial hindfoot alignment in the idiopathic group while the 3D transverse talus measurement was significantly correlated with the lateral talocalcaneal angle in the neuromuscular group. 3D intraosseous alignment of the talus is correlated with pes planus deformity. Longitudinal and biomechanical studies including a control group are necessary to elucidate the role of 3D talar morphology on a dynamic imbalance in pes planovalgus.
{"title":"Analysis of three-dimensional computed tomography talar morphology in relation to pediatric pes planovalgus deformity.","authors":"K. Lee, C. Chung, M. Park, K. Sung, S. Koo, S. Moon, Soon Do Wang, K. Jung","doi":"10.1097/BPB.0000000000000597","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000597","url":null,"abstract":"Intraosseous alignment of the tarsal bone has not been investigated in relation to various foot deformities. This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also analyzed. The neuromuscular group showed significantly more severe deformity than the idiopathic group in the radiographic and 3D sagittal talus measurements. The 3D coronal talus measurement showed a significant negative correlation with the axial hindfoot alignment in the idiopathic group while the 3D transverse talus measurement was significantly correlated with the lateral talocalcaneal angle in the neuromuscular group. 3D intraosseous alignment of the talus is correlated with pes planus deformity. Longitudinal and biomechanical studies including a control group are necessary to elucidate the role of 3D talar morphology on a dynamic imbalance in pes planovalgus.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74493382","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 : 2019-11-01DOI: 10.1097/BPB.0000000000000647
L. A. M. Cunha, L. M. Ávila, J. Gonçalves, S. Pereira, C. M. Jamur, Bruna Medeiros de Souza
The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.
{"title":"Brachial artery pseudoaneurysm after fixation of supracondylar fracture in a 9-year-old child.","authors":"L. A. M. Cunha, L. M. Ávila, J. Gonçalves, S. Pereira, C. M. Jamur, Bruna Medeiros de Souza","doi":"10.1097/BPB.0000000000000647","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000647","url":null,"abstract":"The supracondylar humerus fracture is the most common elbow fracture in children, corresponding to 58% of these cases. The objective of this study is to report a rare postoperative complication, the pseudoaneurysm of the brachial artery. A 9-year-old girl with was admitted with a Gartland III supracondylar fracture of the right humerus, presenting normal neurological and vascular exams. The patient underwent a surgical treatment with percutaneous fixation and immobilization and was re-evaluated after 2 and 4 weeks. In the last evaluation the immobilization and fixation were removed. She returned after 3 months, presenting a progressive palpable, painless mass in the 1/3 distal right arm. The arterial ultrasound showed a mass in the cubital fossa, which presented internal flow and some wall thrombi, compatible with pseudoaneurysm of the brachial artery. After diagnosis, the treatment was a vascular surgery for dissection and reconstruction of the artery. The incidence of vascular involvement in Gartland III fractures ranges from 2% to 38%. False aneurysms originate from arterial hematomas caused by trauma to the arterial lumen, and their developing time can vary. There are few reports of this complication, so there is no consensus about the treatment.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73738134","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 : 2019-11-01DOI: 10.1097/BPB.0000000000000657
I. Sanzarello, M. Nanni, F. Perna, F. Traina, C. Faldini
Congenital vertical talus is an uncommon rigid flatfoot deformity present at birth, producing pain and disability if untreated. This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive soft tissue release and reduction of talo-navicular and subtalar joint, pinned with percutaneous Kirschner wires. The talar axis-first metatarsal base angle (TAMBA) was measured preoperatively and at follow-up. Results were summarized using the Adelaar score and the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire. The mean follow-up was 2.6 years (2-4). No major intraoperative complications were observed. The TAMBA passed from 74.4º (range 68-82º) to 20.2º (range 18-24º). No talar osteonecrosis was observed. The results were excellent in three cases, good in five cases and fair in one (Adelaar score). The mean postoperative PODCI score was 48 (range 38-60). None of the patients underwent further surgery. In case of neglected congenital vertical talus and limited health resources, this surgical technique has proved to be a viable option, providing satisfactory results, with low rate of surgical and postsurgical complications.
{"title":"One-stage release by double surgical approach for neglected congenital vertical talus: results in a series of walking children in Tanzania.","authors":"I. Sanzarello, M. Nanni, F. Perna, F. Traina, C. Faldini","doi":"10.1097/BPB.0000000000000657","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000657","url":null,"abstract":"Congenital vertical talus is an uncommon rigid flatfoot deformity present at birth, producing pain and disability if untreated. This study reports results and complications in a series of walking children affected by neglected congenital vertical talus treated by one-stage release through a double surgical approach in a hospital sited in the Tanzanian rural outback. Between 2009 and 2014, nine consecutive congenital vertical talus were observed in five patients (three males and two females) aged between 2 and 4 years. In two children, the deformity was idiopathic, in two it was associated to distal arthrogryposis and in one to Larsen syndrome. The surgical procedure was performed through a posteromedial and a lateral incision and included extensive soft tissue release and reduction of talo-navicular and subtalar joint, pinned with percutaneous Kirschner wires. The talar axis-first metatarsal base angle (TAMBA) was measured preoperatively and at follow-up. Results were summarized using the Adelaar score and the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire. The mean follow-up was 2.6 years (2-4). No major intraoperative complications were observed. The TAMBA passed from 74.4º (range 68-82º) to 20.2º (range 18-24º). No talar osteonecrosis was observed. The results were excellent in three cases, good in five cases and fair in one (Adelaar score). The mean postoperative PODCI score was 48 (range 38-60). None of the patients underwent further surgery. In case of neglected congenital vertical talus and limited health resources, this surgical technique has proved to be a viable option, providing satisfactory results, with low rate of surgical and postsurgical complications.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75344265","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 : 2019-11-01DOI: 10.1097/BPB.0000000000000659
Yosif Mansor, Amir Givon, N. Sherr-Lurie, Anna Seltser, A. Schindler, U. Givon
OBJECTIVE Displaced supracondylar fractures of the humerus (SCFH) require surgical treatment, most commonly closed reduction with pin fixation. Postoperative displacement following pin fixation is uncommon. Routinely, an early follow-up visit with a radiograph was recommended after fixation of SCFH. The aim of this study was to examine the rate of displacement of SCHF treated with pin fixation using objective radiologic measurements and to determine the need for the early follow-up radiographs. METHODS We retrospectively reviewed 161 patients with displaced SFCH treated surgically. The primary outcome measure was loss of reduction (LOR). We examined patient and fracture characteristics and postoperative complications. LOR was defined as a change of 5º or more in measurement of Bauman's angle or the lateral capitellohumeral angle. RESULTS After applying exclusion criteria, the study group consisted of 131 patients; 87 (66.4%) were male; the left limb was involved in 76 patients (58%); 98 were classified as Gartland type 3 (74.8%); 118 patients had extension type fractures (90%); complications included nerve injury in 32 patients (24.4%), mostly involving the ulnar nerve (17, 13%). Pin-tract infection occurred in four patients (3%). LOR was found in five patients (3.8%). In all these patients, there was evidence of inadequate fixation in the intraoperative radiographs. CONCLUSIONS When adequate fixation is obtained intraoperatively, the next follow-up radiograph is recommended after 3 weeks, at the time of pin removal.
{"title":"Is a radiograph needed one week after internal fixation of a supracondylar humeral fracture?","authors":"Yosif Mansor, Amir Givon, N. Sherr-Lurie, Anna Seltser, A. Schindler, U. Givon","doi":"10.1097/BPB.0000000000000659","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000659","url":null,"abstract":"OBJECTIVE\u0000Displaced supracondylar fractures of the humerus (SCFH) require surgical treatment, most commonly closed reduction with pin fixation. Postoperative displacement following pin fixation is uncommon. Routinely, an early follow-up visit with a radiograph was recommended after fixation of SCFH. The aim of this study was to examine the rate of displacement of SCHF treated with pin fixation using objective radiologic measurements and to determine the need for the early follow-up radiographs.\u0000\u0000\u0000METHODS\u0000We retrospectively reviewed 161 patients with displaced SFCH treated surgically. The primary outcome measure was loss of reduction (LOR). We examined patient and fracture characteristics and postoperative complications. LOR was defined as a change of 5º or more in measurement of Bauman's angle or the lateral capitellohumeral angle.\u0000\u0000\u0000RESULTS\u0000After applying exclusion criteria, the study group consisted of 131 patients; 87 (66.4%) were male; the left limb was involved in 76 patients (58%); 98 were classified as Gartland type 3 (74.8%); 118 patients had extension type fractures (90%); complications included nerve injury in 32 patients (24.4%), mostly involving the ulnar nerve (17, 13%). Pin-tract infection occurred in four patients (3%). LOR was found in five patients (3.8%). In all these patients, there was evidence of inadequate fixation in the intraoperative radiographs.\u0000\u0000\u0000CONCLUSIONS\u0000When adequate fixation is obtained intraoperatively, the next follow-up radiograph is recommended after 3 weeks, at the time of pin removal.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90731130","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000687
P. Stevens, R. Epperson, Nicholas B. Taylor, Mary Dickerson, Dustin L. Williams
Obtaining a biopsy of the physis in a pediatric/juvenile could provide the ability to diagnose and manage children with physeal abnormalities. However, it has not yet been determined whether a physeal biopsy procedure affects angular deformity. We employed a rabbit model to collect biopsies of the distal femoral and proximal tibial physes on anesthetized, 8-week old New Zealand rabbits. The contralateral limb served as a control. At 8 (n = 5) and 16 (n = 5) weeks postbiopsy, animals were euthanized. Micro-computed tomography (CT) was employed to estimate percentage of the physis biopsied and assess structural abnormalities resulting from biopsy. Bone samples were embedded in polymethylmethacrylate and analyzed. The percentage of physis sampled was ≤1.5% of the total femoral physis while all but one of the tibiae had ≤2.3% removed. There were no iatrogenic clinical or radiographic deformities (frontal or sagittal). Micro-CT and histological analysis suggested that physeal defects had signs of healing that did not lead to subsequent angular deviation. A defect caused by physeal biopsy may not lead to angular deformity. Long-term data could help determine the safety and efficacy of collecting biopsies for histological analyses. Advanced imaging may demonstrate a detailed picture of anatomic or structural alteration of a given physis, but provides no functional information. The diagnostic and therapeutic information that could be gleaned from one or more serial biopsy samples could be invaluable in decision making and clinical management (e.g. skeletal dysplasias and metabolic conditions), so long as subsequent deformity is not a future possibility.
{"title":"Assessing the effect of physeal biopsy on angular deformity in a rabbit model","authors":"P. Stevens, R. Epperson, Nicholas B. Taylor, Mary Dickerson, Dustin L. Williams","doi":"10.1097/BPB.0000000000000687","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000687","url":null,"abstract":"Obtaining a biopsy of the physis in a pediatric/juvenile could provide the ability to diagnose and manage children with physeal abnormalities. However, it has not yet been determined whether a physeal biopsy procedure affects angular deformity. We employed a rabbit model to collect biopsies of the distal femoral and proximal tibial physes on anesthetized, 8-week old New Zealand rabbits. The contralateral limb served as a control. At 8 (n = 5) and 16 (n = 5) weeks postbiopsy, animals were euthanized. Micro-computed tomography (CT) was employed to estimate percentage of the physis biopsied and assess structural abnormalities resulting from biopsy. Bone samples were embedded in polymethylmethacrylate and analyzed. The percentage of physis sampled was ≤1.5% of the total femoral physis while all but one of the tibiae had ≤2.3% removed. There were no iatrogenic clinical or radiographic deformities (frontal or sagittal). Micro-CT and histological analysis suggested that physeal defects had signs of healing that did not lead to subsequent angular deviation. A defect caused by physeal biopsy may not lead to angular deformity. Long-term data could help determine the safety and efficacy of collecting biopsies for histological analyses. Advanced imaging may demonstrate a detailed picture of anatomic or structural alteration of a given physis, but provides no functional information. The diagnostic and therapeutic information that could be gleaned from one or more serial biopsy samples could be invaluable in decision making and clinical management (e.g. skeletal dysplasias and metabolic conditions), so long as subsequent deformity is not a future possibility.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91485177","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000686
J. Marasigan, M. Solano, B. Wicklund, R. Schwend
The objective of this study was to make surgeons aware of a potential pressure complication in posterior spine surgery for patients with hereditary spherocytosis (HS) and to present a plausible hypothesis for injury. Posterior spine surgery is common practice for adolescent idiopathic scoliosis (AIS). Common, less severe surgical risks include pressure ulcers; while rare, more severe pressure complications include rhabdomyolysis and compartment syndrome. In patients with HS, a familial hemolytic disorder with altered red cell deformability, it is unknown if their red cell disorder is an additional risk factor for pressure-related surgical injuries. Two patients with HS, an 18-year-old male and a 17-year-old female, were both post-splenectomy and underwent revision posterior spinal fusion and instrumentation for progressive AIS. Surgery lasted 9 hours and 7 hours respectively, with no intraoperative complications other than prolonged surgical time due to revision nature of the deformities. Thigh redness and swelling was noted in both patients directly deep to the thigh pads. Thigh myonecrosis was diagnosed with eventual recovery in both cases. Patients with HS may be at inherent more risk of pressure complications during posterior spine surgery. We propose that thigh myonecrosis occurs with decreased perfusion and hemolysis from HS erythrocytes’ inherent fragility, decreased deformability within capillaries, and prolonged microvasculature compression from positioning, causing poor microvascular perfusion, tissue ischemia, and reperfusion injury. Level of veidence: IV.
{"title":"Hereditary spherocytosis: a risk factor for thigh pressure myonecrosis in posterior spine surgery","authors":"J. Marasigan, M. Solano, B. Wicklund, R. Schwend","doi":"10.1097/BPB.0000000000000686","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000686","url":null,"abstract":"The objective of this study was to make surgeons aware of a potential pressure complication in posterior spine surgery for patients with hereditary spherocytosis (HS) and to present a plausible hypothesis for injury. Posterior spine surgery is common practice for adolescent idiopathic scoliosis (AIS). Common, less severe surgical risks include pressure ulcers; while rare, more severe pressure complications include rhabdomyolysis and compartment syndrome. In patients with HS, a familial hemolytic disorder with altered red cell deformability, it is unknown if their red cell disorder is an additional risk factor for pressure-related surgical injuries. Two patients with HS, an 18-year-old male and a 17-year-old female, were both post-splenectomy and underwent revision posterior spinal fusion and instrumentation for progressive AIS. Surgery lasted 9 hours and 7 hours respectively, with no intraoperative complications other than prolonged surgical time due to revision nature of the deformities. Thigh redness and swelling was noted in both patients directly deep to the thigh pads. Thigh myonecrosis was diagnosed with eventual recovery in both cases. Patients with HS may be at inherent more risk of pressure complications during posterior spine surgery. We propose that thigh myonecrosis occurs with decreased perfusion and hemolysis from HS erythrocytes’ inherent fragility, decreased deformability within capillaries, and prolonged microvasculature compression from positioning, causing poor microvascular perfusion, tissue ischemia, and reperfusion injury. Level of veidence: IV.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83683156","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000688
D. Westberry, R. Davis, Rachel Binkley-Vance, Andrew Westberry, Alison Westberry, Linda I Wack
In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.
{"title":"In-toeing gait in children with clubfoot and the effect of tibial rotation osteotomy","authors":"D. Westberry, R. Davis, Rachel Binkley-Vance, Andrew Westberry, Alison Westberry, Linda I Wack","doi":"10.1097/BPB.0000000000000688","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000688","url":null,"abstract":"In-toeing gait is common after treatment for clubfoot deformity and is often secondary to residual internal tibial torsion. The purpose of the current study was to characterize the gait pattern in children with an intoeing gait pattern associated with talipes equinovarus (TEV) deformity, identify secondary changes at the hip that occur with intoeing, and determine if these secondary effects resolve after correction of tibial torsion. Patients with a diagnosis of TEV deformity, in-toeing gait secondary to residual internal tibial torsion corrected with tibial rotation osteotomy (TRO) and complete preoperative and postoperative motion analysis studies obtained approximately 1 year apart, were included in the study. Nineteen children (19 left extremities) with a TRO at a mean age of 8.2 years met inclusion criteria. Clinical examination showed improvement in tibial torsion assessment by measure of the thigh foot axis and transmalleolar axis. Kinematically, an abnormal internal FPA was present in all cases preoperatively, was corrected to normal in 12 (63%), remained internal in 5 (26%), and was abnormally external in 2 (11%). External hip rotation was identified in 13 (68%) cases preoperatively. Hip rotation was normalized postoperatively in 7 (54%), and was unchanged in the remaining 6 (46%). TRO provides effective correction of excessive internal tibial torsion, resolution of kinematic internal knee rotation, and normalization of the internal foot progression angle in the majority of patients with TEV deformity. External hip rotation resolved in approximately 50% of cases. Overcorrection of the internal FPA is possible when secondary changes at the hip do not resolve.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74787165","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000685
S. Richardson, J. H. Dove, J. Beaty, Benjamin W. Sheffer, David D. Spence, W. Warner, J. Sawyer, D. Kelly
Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning indications for open reduction. The purpose of this study was to determine radiographic and clinical features likely to lead to open reduction before flexible intramedullary nailing. Record review identified 158 femoral shaft fractures treated with flexible intramedullary nailing. In addition to patient demographics and mechanism of injury, data obtained included surgeon name, estimated blood loss, type of reduction, type and diameter of nail, type of operating table, the use of percutaneous reduction techniques or supplemental casting, time to and duration of surgery, total time in operating room, and time to union. Fracture ratios were calculated based on established radiographic protocol. Of 158 fractures, 141 were treated with closed reduction and 17 with open reduction. The anteroposterior fracture index (1.3 ± 0.4, P = 0.0007), surgeon (P = 0.002), and flattop operating table (0.05) were associated with open reduction. Smaller lateral diameter of bone at the fracture site, transverse fracture, and surgeon were all found to be independent risk factors for open reduction; patient characteristics, including age, sex, and BMI, did not seem to influence the choice of open reduction. Fractures with a lower fracture index or pattern resembling a transverse fracture rather than oblique or spiral had an increased risk of converting to an open reduction. Surgeon preference and use of flattop tables also had a significant influence on how the fracture was treated.
{"title":"Flexible intramedullary nailing of femoral shaft fractures: closed versus open reduction","authors":"S. Richardson, J. H. Dove, J. Beaty, Benjamin W. Sheffer, David D. Spence, W. Warner, J. Sawyer, D. Kelly","doi":"10.1097/BPB.0000000000000685","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000685","url":null,"abstract":"Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning indications for open reduction. The purpose of this study was to determine radiographic and clinical features likely to lead to open reduction before flexible intramedullary nailing. Record review identified 158 femoral shaft fractures treated with flexible intramedullary nailing. In addition to patient demographics and mechanism of injury, data obtained included surgeon name, estimated blood loss, type of reduction, type and diameter of nail, type of operating table, the use of percutaneous reduction techniques or supplemental casting, time to and duration of surgery, total time in operating room, and time to union. Fracture ratios were calculated based on established radiographic protocol. Of 158 fractures, 141 were treated with closed reduction and 17 with open reduction. The anteroposterior fracture index (1.3 ± 0.4, P = 0.0007), surgeon (P = 0.002), and flattop operating table (0.05) were associated with open reduction. Smaller lateral diameter of bone at the fracture site, transverse fracture, and surgeon were all found to be independent risk factors for open reduction; patient characteristics, including age, sex, and BMI, did not seem to influence the choice of open reduction. Fractures with a lower fracture index or pattern resembling a transverse fracture rather than oblique or spiral had an increased risk of converting to an open reduction. Surgeon preference and use of flattop tables also had a significant influence on how the fracture was treated.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81325637","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000684
Wentao Wang, F. Canavese, Ran Lin, Yuancheng Pan, Dianhua Huang, Zhu Xiong, Shunyou Chen
This study evaluated the outcomes of distal tibia metaphyseal fractures (DTMFs) managed surgically and compared the outcomes of patients with and without associated fibula fracture fixation. Thirty-two consecutive patients (14 males; mean age at the time of injury: 7.8 years) with closed displaced DTMFs, with (22 patients; group A) or without associated fibula fractures fixation (10 patients; group B), were included. Besides standard radiographic measurements, the following static and dynamic pedobarographic parameters were evaluated: foot total static plantar pressure percentage (PP%tot), static plantar pressure percentage of the forefoot (PP%ff) and of the rear foot (PP%rf), landing sequence of the metatarsals during contact with the ground (MTland), and impulse percentage of the metatarsal heads (MT%imp) and the medial and lateral heel (MH%imp and LH%imp). All patients were followed for at least 2 years (range: 2–4.5 years). Functional outcomes were excellent to good in all but two patients (93.8%) at the last follow-up visit using the Johner-Wruths criteria’. Radiographic measurements, PP%tot, PP%ff, PP%rf, MT%imp, MH%imp and LH%imp were not significantly different between two groups as well as between injured and uninjured side of patients within the same group (P > 0.05). Abnormal MTland sequence was found in 40.9% of group A (9/22) and in 40% of group B patients (4/10) (P > 0.05). Stabilization of associated fibula fractures did not significantly impact the clinical, radiographic and pedobarographic outcomes of the children with displaced DTMFs who were surgically treated. Level of evidence: Level III.
{"title":"Clinical, radiographic and pedobarographic analysis of skeletally immature patients with surgically treated distal metaphyseal fractures of the tibia: is concomitant fixation of the fibula necessary?","authors":"Wentao Wang, F. Canavese, Ran Lin, Yuancheng Pan, Dianhua Huang, Zhu Xiong, Shunyou Chen","doi":"10.1097/BPB.0000000000000684","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000684","url":null,"abstract":"This study evaluated the outcomes of distal tibia metaphyseal fractures (DTMFs) managed surgically and compared the outcomes of patients with and without associated fibula fracture fixation. Thirty-two consecutive patients (14 males; mean age at the time of injury: 7.8 years) with closed displaced DTMFs, with (22 patients; group A) or without associated fibula fractures fixation (10 patients; group B), were included. Besides standard radiographic measurements, the following static and dynamic pedobarographic parameters were evaluated: foot total static plantar pressure percentage (PP%tot), static plantar pressure percentage of the forefoot (PP%ff) and of the rear foot (PP%rf), landing sequence of the metatarsals during contact with the ground (MTland), and impulse percentage of the metatarsal heads (MT%imp) and the medial and lateral heel (MH%imp and LH%imp). All patients were followed for at least 2 years (range: 2–4.5 years). Functional outcomes were excellent to good in all but two patients (93.8%) at the last follow-up visit using the Johner-Wruths criteria’. Radiographic measurements, PP%tot, PP%ff, PP%rf, MT%imp, MH%imp and LH%imp were not significantly different between two groups as well as between injured and uninjured side of patients within the same group (P > 0.05). Abnormal MTland sequence was found in 40.9% of group A (9/22) and in 40% of group B patients (4/10) (P > 0.05). Stabilization of associated fibula fractures did not significantly impact the clinical, radiographic and pedobarographic outcomes of the children with displaced DTMFs who were surgically treated. Level of evidence: Level III.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90427353","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 : 2019-10-22DOI: 10.1097/BPB.0000000000000677
Radjen R Banwarie, F. Hollman, N. Meijs, J. Arts, Pascal Vroemen, P. Moh, H. Staal
Blount’s disease or bowed leg deformity, is a unilateral or bilateral growth deformity of the medial proximal tibia that leads to a tibial varus deformity. A distinction can be made in an early and late onset type. The disease seems to have a predisposition for certain descends. Since the first publication of Blount’s disease, different hypotheses on the aetiology are proposed but no consensus exists. The objective of this study is to provide an overview of the available hypotheses on the aetiology of Blount’s disease since its first description and assessment of the available level of evidence, the quality of evidence and the occurrence of bias supporting these individual hypotheses. A systematic search according to the PRISMA statement was conducted using PubMed, MEDLINE, EMBASE and the Cochrane Library using a broad combination of terminology to ascertain a complete selection. Proper MESH search criteria were formulated and the bibliographic search was limited to English and Dutch language articles. Articles with no mention of aetiology or a disease related to Blount’s were excluded. Level of evidence and types of bias were assessed. Thirty-two articles that discuss the aetiology of Blount’s disease were selected. A variety of hypotheses was postulated in these articles with most research in the field of increased mechanical pressure (obesity, early walking age) and race (descend). Blount’s disease most likely has a multifactorial origin with influence of genetic and racial predisposition, increased mechanical pressure on the growth plate as a consequence of obesity or early walking age and possibly also nutrition. However, the exact aetiology remains unclear, the probable explanation is that multifactorial factors are all contributing to the development of Blount’s disease. Histological research has shown that a disorganization of bone and cartilage structures on the medial side of the proximal tibial physis is present in patients with Blount’s disease. Based on the available evidence on the aetiology of Blount’s disease, we conclude that it is multifactorial. Most papers focus only on one hypotheses of Blount’s disease occurrence and all are characterized as low level of evidence. There seems to be a preference for certain descends. Further research on especially genetic predisposition is needed to provide more insight in this factor of Blount’s disease.
{"title":"Insight into the possible aetiologies of Blount’s disease: a systematic review of the literature","authors":"Radjen R Banwarie, F. Hollman, N. Meijs, J. Arts, Pascal Vroemen, P. Moh, H. Staal","doi":"10.1097/BPB.0000000000000677","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000677","url":null,"abstract":"Blount’s disease or bowed leg deformity, is a unilateral or bilateral growth deformity of the medial proximal tibia that leads to a tibial varus deformity. A distinction can be made in an early and late onset type. The disease seems to have a predisposition for certain descends. Since the first publication of Blount’s disease, different hypotheses on the aetiology are proposed but no consensus exists. The objective of this study is to provide an overview of the available hypotheses on the aetiology of Blount’s disease since its first description and assessment of the available level of evidence, the quality of evidence and the occurrence of bias supporting these individual hypotheses. A systematic search according to the PRISMA statement was conducted using PubMed, MEDLINE, EMBASE and the Cochrane Library using a broad combination of terminology to ascertain a complete selection. Proper MESH search criteria were formulated and the bibliographic search was limited to English and Dutch language articles. Articles with no mention of aetiology or a disease related to Blount’s were excluded. Level of evidence and types of bias were assessed. Thirty-two articles that discuss the aetiology of Blount’s disease were selected. A variety of hypotheses was postulated in these articles with most research in the field of increased mechanical pressure (obesity, early walking age) and race (descend). Blount’s disease most likely has a multifactorial origin with influence of genetic and racial predisposition, increased mechanical pressure on the growth plate as a consequence of obesity or early walking age and possibly also nutrition. However, the exact aetiology remains unclear, the probable explanation is that multifactorial factors are all contributing to the development of Blount’s disease. Histological research has shown that a disorganization of bone and cartilage structures on the medial side of the proximal tibial physis is present in patients with Blount’s disease. Based on the available evidence on the aetiology of Blount’s disease, we conclude that it is multifactorial. Most papers focus only on one hypotheses of Blount’s disease occurrence and all are characterized as low level of evidence. There seems to be a preference for certain descends. Further research on especially genetic predisposition is needed to provide more insight in this factor of Blount’s disease.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81494533","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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