Pub Date : 2017-07-01DOI: 10.1097/BPB.0000000000000433
A. Johari, Aravind Hampannavar, Ratna A Johari, A. Dhawale
The behavior and treatment of coxa vara and pseudarthrosis of the proximal femur secondary to sepsis is not well described. The aim of this study is to describe the pathoanatomy for coxa vara and pseudarthrosis in postseptic hips, evaluate progression of neck shaft angle (NSA), and discuss treatment. This is a retrospective case series of 20 patients (21 hips). There were 11 hips with predominant avascular necrosis of the capital femoral epiphysis without pseudarthrosis (type 1) and 10 with pseudarthrosis (type 2). The interobserver &kgr; value was 0.79. There was a decrease in NSA from 110.3° to 99.3° during an average follow-up duration of 5.2 years (range: 2–14 years). The average change in NSA between the initial presentation and the final follow-up was 5.5° in type 1 and 17.1° in type 2. Nine patients underwent a surgical intervention. In cases where subtrochanteric valgus osteotomy was performed, the mean preoperative NSA was 94° and the mean NSA at the final follow-up was 128°; all operated pseudarthroses healed without bone grafting. Acetabuloplasty is not necessary in most cases.
{"title":"Coxa vara in postseptic arthritis of the hip in children","authors":"A. Johari, Aravind Hampannavar, Ratna A Johari, A. Dhawale","doi":"10.1097/BPB.0000000000000433","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000433","url":null,"abstract":"The behavior and treatment of coxa vara and pseudarthrosis of the proximal femur secondary to sepsis is not well described. The aim of this study is to describe the pathoanatomy for coxa vara and pseudarthrosis in postseptic hips, evaluate progression of neck shaft angle (NSA), and discuss treatment. This is a retrospective case series of 20 patients (21 hips). There were 11 hips with predominant avascular necrosis of the capital femoral epiphysis without pseudarthrosis (type 1) and 10 with pseudarthrosis (type 2). The interobserver &kgr; value was 0.79. There was a decrease in NSA from 110.3° to 99.3° during an average follow-up duration of 5.2 years (range: 2–14 years). The average change in NSA between the initial presentation and the final follow-up was 5.5° in type 1 and 17.1° in type 2. Nine patients underwent a surgical intervention. In cases where subtrochanteric valgus osteotomy was performed, the mean preoperative NSA was 94° and the mean NSA at the final follow-up was 128°; all operated pseudarthroses healed without bone grafting. Acetabuloplasty is not necessary in most cases.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78358374","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000411
L. Karlin, Peter Weinstock, Daniel J. Hedequist, S. Prabhu
This study was carried out to evaluate the benefits of personalized three-dimensional printing as an aid to the performance of surgery for the correction of spinal deformity in children with myelomeningocele. We performed a retrospective review to include all such children for whom personalized three-dimensional spine models were used for surgical planning (group A) and compared them through subjective and objective criteria to a similar group that had no models (group B). The seven children in group A were younger and had more complex deformities than the 10 children in group B. The models provided a markedly improved appreciation of the complex anatomy and enabled the planning and performance of patient-specific spinal instrumentation that was secure and low profile. The efficiency of the surgery as measured by intraoperative fluoroscopy time and blood loss and the extent of the deformity correction was comparable or superior in group A.
{"title":"The surgical treatment of spinal deformity in children with myelomeningocele: the role of personalized three-dimensional printed models","authors":"L. Karlin, Peter Weinstock, Daniel J. Hedequist, S. Prabhu","doi":"10.1097/BPB.0000000000000411","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000411","url":null,"abstract":"This study was carried out to evaluate the benefits of personalized three-dimensional printing as an aid to the performance of surgery for the correction of spinal deformity in children with myelomeningocele. We performed a retrospective review to include all such children for whom personalized three-dimensional spine models were used for surgical planning (group A) and compared them through subjective and objective criteria to a similar group that had no models (group B). The seven children in group A were younger and had more complex deformities than the 10 children in group B. The models provided a markedly improved appreciation of the complex anatomy and enabled the planning and performance of patient-specific spinal instrumentation that was secure and low profile. The efficiency of the surgery as measured by intraoperative fluoroscopy time and blood loss and the extent of the deformity correction was comparable or superior in group A.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78089735","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000426
E. Kuong, W. T. Gardner, P. Koljonen, S. Mahapatra, W. Chow
Paediatric pelvic and hip radiographs are a common investigation used when assessing a child for suspected developmental dysplasia of the hip. This report describes an attempt to establish normal values of medial joint space, acetabular index and centre edge angle according to specific age groups and sex in a Chinese population. Patients who had undergone a pelvic radiograph as part of their assessment, but were subsequently found to have normal hips were recruited retrospectively. These patients were grouped according to sex and age; medial joint space, acetabular index and centre edge angle were measured in all radiographs. A mean±SD was calculated for each group, and then each age group was tested for statistical significance between the male and the female groups. A total of, 98 patients were recruited, who underwent 188 pelvic radiographs, resulting in images of 376 ‘normal’ hips. The results for medial joint space, acetabular index and centre edge angle for each age and sex group are described. Only the acetabular index requires different reference ranges for male and female patients because of consistent statistical significance between the two groups. It was found that medial joint space remained fairly constant throughout the age groups, whereas the acetabular index decreased and the centre edge angle increased slightly. The reference ranges for the parameters described here are quite different from those established previously in a population of Northern-European descent, which could be because of a variety of reasons including genetics, body habitus and measurement technique. We believe that it would be prudent to implement these different ranges when assessing patients of Chinese heritage to optimize care of patients who may suffer as a consequence of not receiving treatment for missed hip dysplasia. Level of Evidence: Diagnostic Study Level III – Study of nonconsecutive patients (without consistently applying the reference ‘gold’ standard).
{"title":"Normal radiographic parameters in paediatric pelvic radiographs from a Chinese population","authors":"E. Kuong, W. T. Gardner, P. Koljonen, S. Mahapatra, W. Chow","doi":"10.1097/BPB.0000000000000426","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000426","url":null,"abstract":"Paediatric pelvic and hip radiographs are a common investigation used when assessing a child for suspected developmental dysplasia of the hip. This report describes an attempt to establish normal values of medial joint space, acetabular index and centre edge angle according to specific age groups and sex in a Chinese population. Patients who had undergone a pelvic radiograph as part of their assessment, but were subsequently found to have normal hips were recruited retrospectively. These patients were grouped according to sex and age; medial joint space, acetabular index and centre edge angle were measured in all radiographs. A mean±SD was calculated for each group, and then each age group was tested for statistical significance between the male and the female groups. A total of, 98 patients were recruited, who underwent 188 pelvic radiographs, resulting in images of 376 ‘normal’ hips. The results for medial joint space, acetabular index and centre edge angle for each age and sex group are described. Only the acetabular index requires different reference ranges for male and female patients because of consistent statistical significance between the two groups. It was found that medial joint space remained fairly constant throughout the age groups, whereas the acetabular index decreased and the centre edge angle increased slightly. The reference ranges for the parameters described here are quite different from those established previously in a population of Northern-European descent, which could be because of a variety of reasons including genetics, body habitus and measurement technique. We believe that it would be prudent to implement these different ranges when assessing patients of Chinese heritage to optimize care of patients who may suffer as a consequence of not receiving treatment for missed hip dysplasia. Level of Evidence: Diagnostic Study Level III – Study of nonconsecutive patients (without consistently applying the reference ‘gold’ standard).","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88090196","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000396
Vivek Chawathe, A. Gaur, B. Athani, Shefali Gupta
A 14-year-old boy reported with congenital deformity of the left lower limb, with gross shortening, hip and knee flexion deformities, ankle with equinus deformity, and polydactyly of the left foot. Radiologic examination showed proximal femoral focal deficiency, double fibula, and duplication of the tarsal bones, and a diagnosis of ‘proximal femoral focal deficiency associated with fibular duplication and diplopodia with complete agenesis of tibia’ was made. Such association of deformities is very rare and poses difficulties in rehabilitation of the case. This patient was managed with elective knee disarticulation, early prosthetic fitment, and gait training.
{"title":"Proximal femoral focal deficiency associated with fibular duplication and diplopodia and complete agenesis of the tibia: a case report","authors":"Vivek Chawathe, A. Gaur, B. Athani, Shefali Gupta","doi":"10.1097/BPB.0000000000000396","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000396","url":null,"abstract":"A 14-year-old boy reported with congenital deformity of the left lower limb, with gross shortening, hip and knee flexion deformities, ankle with equinus deformity, and polydactyly of the left foot. Radiologic examination showed proximal femoral focal deficiency, double fibula, and duplication of the tarsal bones, and a diagnosis of ‘proximal femoral focal deficiency associated with fibular duplication and diplopodia with complete agenesis of tibia’ was made. Such association of deformities is very rare and poses difficulties in rehabilitation of the case. This patient was managed with elective knee disarticulation, early prosthetic fitment, and gait training.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84150748","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000280
I. Ghanem, A. Sebaaly, Nakhle Pedro, E. Saliba
The aim of this article is to describe a minimally invasive iliac crest-sparing approach (ICSA) allowing common iliac osteotomies in children. The ICSA was used for 98 hips in 72 consecutive patients who underwent a pelvic osteotomy. The mean follow-up duration ranged from 3 to 7 years. Skin incision ranged from 3 to 5.5 cm. Displacement of the distal osteotomy fragment was easy and without tension. The duration of surgery varied from 50 min in the beginning of our experience to 20–25 min for the last cases of the series. In conclusion, the ICSA fulfills all the criteria of minimally invasive surgery.
{"title":"Minimally invasive, iliac crest-sparing approach for pelvic osteotomies in children","authors":"I. Ghanem, A. Sebaaly, Nakhle Pedro, E. Saliba","doi":"10.1097/BPB.0000000000000280","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000280","url":null,"abstract":"The aim of this article is to describe a minimally invasive iliac crest-sparing approach (ICSA) allowing common iliac osteotomies in children. The ICSA was used for 98 hips in 72 consecutive patients who underwent a pelvic osteotomy. The mean follow-up duration ranged from 3 to 7 years. Skin incision ranged from 3 to 5.5 cm. Displacement of the distal osteotomy fragment was easy and without tension. The duration of surgery varied from 50 min in the beginning of our experience to 20–25 min for the last cases of the series. In conclusion, the ICSA fulfills all the criteria of minimally invasive surgery.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76380552","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000392
Sherif Galal
Developmental coxa vara (DCV) develops during early childhood between the age of independent walking and 6 years. The deformity includes a decrease in the neck–shaft angle and femoral retroversion. Recently, good results have been reported using external fixator systems for the correction of proximal femoral deformities secondary to slipped capital femoral epiphysis, Perthes’ disease in children, and percutaneous proximal femoral osteotomy for coxa vara. This preliminary study was performed to evaluate the results of percutaneous subtrochanteric osteotomy in restoring the normal alignment and orientation (radiographic outcome), thereby restoring the normal mechanics of the hip joint, overcoming shortening of the limb, and re-establishing the length–tension relationship of the abductor muscles (functional outcome). During the period between January 2009 and January 2012, a prospective study was conducted involving 30 (33 hips) patients with DCV and a preoperative Hilgenreiner’s epiphyseal angle of 60° or greater on coronal radiographs. Clinical and radiological (anteroposterior radiograph of the pelvis) evaluation of patients was carried out preoperatively and postoperatively until union was achieved and fixator removal was carried out, and then at 6 months and at the final follow-up, with a minimum of 12 and a maximum of 33 months after surgery and an average of 20.8 months. We used the technique described by Sabharwal and colleagues (2005) to perform an acute, opened wedge subtrochanteric valgus-flexion-derotation femoral osteotomy using a percutaneous multiple drill hole technique. A low-profile Ilizarov external fixator was applied in each case. The average operative time (including anesthesia time) was 74 (range 60–130) min. The average time spent in the external fixator until union was 11 (range 7–15) weeks. The average intraoperative blood loss was 35 (range 10–150) ml, and no patient developed hemodynamic instability or required any postoperative blood transfusion. The hospital stay averaged 1.2 (range 1–2) days. Hilgenreiner’s epiphyseal angle preoperatively averaged 70.6° (ranging from 55° to 90°). At 6 months it averaged 40.6° (ranging from 15° to 60°). At final follow-up it averaged 41.16° (ranging from 15° to 60°). Percutaneous subtrochanteric osteotomy with external fixation appears safe and effective in treating multiplanar proximal femoral deformities associated with DCV in children. Level of Evidence: Level IV.
{"title":"Percutaneous multiplanar subtrochanteric osteotomy with external fixation for developmental coxa vara (preliminary results)","authors":"Sherif Galal","doi":"10.1097/BPB.0000000000000392","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000392","url":null,"abstract":"Developmental coxa vara (DCV) develops during early childhood between the age of independent walking and 6 years. The deformity includes a decrease in the neck–shaft angle and femoral retroversion. Recently, good results have been reported using external fixator systems for the correction of proximal femoral deformities secondary to slipped capital femoral epiphysis, Perthes’ disease in children, and percutaneous proximal femoral osteotomy for coxa vara. This preliminary study was performed to evaluate the results of percutaneous subtrochanteric osteotomy in restoring the normal alignment and orientation (radiographic outcome), thereby restoring the normal mechanics of the hip joint, overcoming shortening of the limb, and re-establishing the length–tension relationship of the abductor muscles (functional outcome). During the period between January 2009 and January 2012, a prospective study was conducted involving 30 (33 hips) patients with DCV and a preoperative Hilgenreiner’s epiphyseal angle of 60° or greater on coronal radiographs. Clinical and radiological (anteroposterior radiograph of the pelvis) evaluation of patients was carried out preoperatively and postoperatively until union was achieved and fixator removal was carried out, and then at 6 months and at the final follow-up, with a minimum of 12 and a maximum of 33 months after surgery and an average of 20.8 months. We used the technique described by Sabharwal and colleagues (2005) to perform an acute, opened wedge subtrochanteric valgus-flexion-derotation femoral osteotomy using a percutaneous multiple drill hole technique. A low-profile Ilizarov external fixator was applied in each case. The average operative time (including anesthesia time) was 74 (range 60–130) min. The average time spent in the external fixator until union was 11 (range 7–15) weeks. The average intraoperative blood loss was 35 (range 10–150) ml, and no patient developed hemodynamic instability or required any postoperative blood transfusion. The hospital stay averaged 1.2 (range 1–2) days. Hilgenreiner’s epiphyseal angle preoperatively averaged 70.6° (ranging from 55° to 90°). At 6 months it averaged 40.6° (ranging from 15° to 60°). At final follow-up it averaged 41.16° (ranging from 15° to 60°). Percutaneous subtrochanteric osteotomy with external fixation appears safe and effective in treating multiplanar proximal femoral deformities associated with DCV in children. Level of Evidence: Level IV.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83522840","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000290
Shingo Hama, Ichiro Tonogai, T. Sakai, Yuichiro Goda, Fumitake Tezuka, T. Matsuura, N. Suzue, Rui Takahashi, T. Terai, Kosaku Higashino, S. Fukuta, A. Nagamachi, K. Sairyo
The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.
{"title":"Pediatric isthmic spondylolisthesis showing radiologic evidence of slippage after physis injury","authors":"Shingo Hama, Ichiro Tonogai, T. Sakai, Yuichiro Goda, Fumitake Tezuka, T. Matsuura, N. Suzue, Rui Takahashi, T. Terai, Kosaku Higashino, S. Fukuta, A. Nagamachi, K. Sairyo","doi":"10.1097/BPB.0000000000000290","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000290","url":null,"abstract":"The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80795743","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000394
P. Carbonell, M. Peña
The aim of this study was to investigate the correlation between radiograph [acetabular index (AI)] and MRI measurements of the angles of children’s hips and the percentage of coverage that labrum provides to the acetabulum in healthy hips of children. The healthy hips of 38 children, of a mean age of 7.7 years, were studied using anteroposterior radiographs and coronal plane MRI. We used picture archiving and communication systems software to measure the AI in hip radiographs and the acetabular bone index (ABI) and acetabular labrum index (ALI) in hip MRIs. The Kolmogorov–Smirnov test and t-test were performed. Pearson’s correlation and Bland and Altman plots were determined for analysis of measurement error and interobserver and intraobserver errors. Statistical significance was set at P value less than 0.05. Interobserver and intraobserver agreement was between 0.8 and 0.98. AI was 13.7°. ABI was 16.4° and ALI was 6.7°. There was a correlation between the angles of the hips determined by radiographs and MRI. The ALI accounted for 40.8% of the mean value of the ABI. The measurements of hip angles by radiographs were similar to the ones derived from MRI. In addition, the labrum adds stability to the healthy hip in a child, indicating a significant portion of the total coverage of the acetabulum to the femoral epiphysis. AI measurements from radiographs were lower than ABI measurements obtained from MRI. ALI was 41% of the ABI, which means that the labrums, in healthy hips of children significantly increase the coverage of the femoral epiphysis and also increase the stability of the acetabulum. Level of Evidence: III.
{"title":"MRI assessment of the importance of the acetabular labrum: a comparative radiographic and MRI study in children’s hips","authors":"P. Carbonell, M. Peña","doi":"10.1097/BPB.0000000000000394","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000394","url":null,"abstract":"The aim of this study was to investigate the correlation between radiograph [acetabular index (AI)] and MRI measurements of the angles of children’s hips and the percentage of coverage that labrum provides to the acetabulum in healthy hips of children. The healthy hips of 38 children, of a mean age of 7.7 years, were studied using anteroposterior radiographs and coronal plane MRI. We used picture archiving and communication systems software to measure the AI in hip radiographs and the acetabular bone index (ABI) and acetabular labrum index (ALI) in hip MRIs. The Kolmogorov–Smirnov test and t-test were performed. Pearson’s correlation and Bland and Altman plots were determined for analysis of measurement error and interobserver and intraobserver errors. Statistical significance was set at P value less than 0.05. Interobserver and intraobserver agreement was between 0.8 and 0.98. AI was 13.7°. ABI was 16.4° and ALI was 6.7°. There was a correlation between the angles of the hips determined by radiographs and MRI. The ALI accounted for 40.8% of the mean value of the ABI. The measurements of hip angles by radiographs were similar to the ones derived from MRI. In addition, the labrum adds stability to the healthy hip in a child, indicating a significant portion of the total coverage of the acetabulum to the femoral epiphysis. AI measurements from radiographs were lower than ABI measurements obtained from MRI. ALI was 41% of the ABI, which means that the labrums, in healthy hips of children significantly increase the coverage of the femoral epiphysis and also increase the stability of the acetabulum. Level of Evidence: III.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82780750","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000399
K. Park, Ishani Shah, A. Ramanathan, Tae-Jin Lee, Hae-Ryong Song
Although external fixation methods have been described for proximal femoral osteotomy for various etiologies, none are dedicated to a single disease entity. Our study introduces a technique of proximal femoral osteotomy and fixation with a monolateral external fixator system in Legg-Calvé-Perthes disease (LCPD). Twenty-three patients (19 males, four females) with LCPD underwent surgery at our institute between 2004 and 2012. Varus osteotomy (group A, 11 hips) and valgus osteotomy (group B, 12 hips) were performed and the monolateral external fixator system was used. The average age of patients at surgery was 13 years (6–23 years) and the mean follow-up duration was 21 months (12–64 months). The mean angular correction of the varus osteotomy in group A was 20° (10°–28°) and the mean medial displacement was 21% (10–49%). The angular correction of valgus osteotomy in group B was 28° (14°–49°) and lateral displacement was 41% (38–58%). The mean fixation time was 14 weeks (8.4–31 weeks). Complications occurred in nine hips (39.1%) and included pin-tract infections (five), hip abduction contracture (one), nonunions (two), and refracture (one). Our surgical technique provides precise correction and stable fixation with minimal intervention. Therefore, the monolateral external fixator could be considered an acceptable alternative fixation device for the correction of proximal femoral deformities in patients with LCPD. Level of evidence: Level IV, case series.
{"title":"Proximal femoral osteotomy in Legg-Calvé-Perthes disease using a monolateral external fixator: surgical technique, outcome, and complications","authors":"K. Park, Ishani Shah, A. Ramanathan, Tae-Jin Lee, Hae-Ryong Song","doi":"10.1097/BPB.0000000000000399","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000399","url":null,"abstract":"Although external fixation methods have been described for proximal femoral osteotomy for various etiologies, none are dedicated to a single disease entity. Our study introduces a technique of proximal femoral osteotomy and fixation with a monolateral external fixator system in Legg-Calvé-Perthes disease (LCPD). Twenty-three patients (19 males, four females) with LCPD underwent surgery at our institute between 2004 and 2012. Varus osteotomy (group A, 11 hips) and valgus osteotomy (group B, 12 hips) were performed and the monolateral external fixator system was used. The average age of patients at surgery was 13 years (6–23 years) and the mean follow-up duration was 21 months (12–64 months). The mean angular correction of the varus osteotomy in group A was 20° (10°–28°) and the mean medial displacement was 21% (10–49%). The angular correction of valgus osteotomy in group B was 28° (14°–49°) and lateral displacement was 41% (38–58%). The mean fixation time was 14 weeks (8.4–31 weeks). Complications occurred in nine hips (39.1%) and included pin-tract infections (five), hip abduction contracture (one), nonunions (two), and refracture (one). Our surgical technique provides precise correction and stable fixation with minimal intervention. Therefore, the monolateral external fixator could be considered an acceptable alternative fixation device for the correction of proximal femoral deformities in patients with LCPD. Level of evidence: Level IV, case series.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91535395","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 : 2017-07-01DOI: 10.1097/BPB.0000000000000406
M. Kadhim, O. Binitie, P. O’Toole, E. Grigoriou, C. D. De Mattos, J. Dormans
Intraoperative radiographic guidance has traditionally been utilized in orthopedic surgery through 2-D navigation with the C-arm and recently with 3-D navigation with the O-arm. The aim of this study was to describe the outcome of surgical treatment of spinal osteoblastoma and osteoid osteoma with the utilization of the O-arm and conventional C-arm guidance. This is a retrospective cohort study of patients with spinal osteoid osteoma and or osteoblastoma who were treated at our institution between 2002 and 2011. Seventeen patients were examined in this study including seven with spinal osteoblastoma and 10 with spinal osteoid osteoma. The mean age of the patients at surgery was 11.5±3.9 years. The O-arm was used in seven patients and the C-arm in 10 patients. The C-arm failed to identify the tumor in one case and needed transport to perform a computed tomographic-scan. The length of surgery was shorter when the O-arm was used, especially in the osteoblastoma group. Thirteen patients were pain free at the last follow-up visit and two patients developed recurrence. Radiographs at the last follow-up did not show signs of vertebral instability following tumor resection. Safe and effective localization of spine tumors and confirmation of tumor removal during surgery was achieved by intraoperative radiographic guidance specifically with the O-arm 3-D navigation system. Level of Evidence: III.
{"title":"Surgical resection of osteoid osteoma and osteoblastoma of the spine","authors":"M. Kadhim, O. Binitie, P. O’Toole, E. Grigoriou, C. D. De Mattos, J. Dormans","doi":"10.1097/BPB.0000000000000406","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000406","url":null,"abstract":"Intraoperative radiographic guidance has traditionally been utilized in orthopedic surgery through 2-D navigation with the C-arm and recently with 3-D navigation with the O-arm. The aim of this study was to describe the outcome of surgical treatment of spinal osteoblastoma and osteoid osteoma with the utilization of the O-arm and conventional C-arm guidance. This is a retrospective cohort study of patients with spinal osteoid osteoma and or osteoblastoma who were treated at our institution between 2002 and 2011. Seventeen patients were examined in this study including seven with spinal osteoblastoma and 10 with spinal osteoid osteoma. The mean age of the patients at surgery was 11.5±3.9 years. The O-arm was used in seven patients and the C-arm in 10 patients. The C-arm failed to identify the tumor in one case and needed transport to perform a computed tomographic-scan. The length of surgery was shorter when the O-arm was used, especially in the osteoblastoma group. Thirteen patients were pain free at the last follow-up visit and two patients developed recurrence. Radiographs at the last follow-up did not show signs of vertebral instability following tumor resection. Safe and effective localization of spine tumors and confirmation of tumor removal during surgery was achieved by intraoperative radiographic guidance specifically with the O-arm 3-D navigation system. Level of Evidence: III.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89514157","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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