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Journal of Children's Orthopaedics

T A Edwards, R Hughes, F Monsell
Purpose: The purpose of this study is to evaluate a surgical technique that aims to address the multi-planar deformities occurring in early onset Blount's disease. Methods: Seven patients (eight lower limbs) with early onset Blount's disease were treated with a surgical technique that used an external fixator to simultaneously address all aspects of deformity. Presenting radiographic parameters including mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and medial plateau angle (MPA) were compared with final follow-up and the unaffected limb...
December 1, 2017: Journal of Children's Orthopaedics
R L Lenhart, C R Smith, M H Schwartz, T F Novacheck, D G Thelen
Purpose: The distal femoral extension osteotomy (DFEO) is often used in the treatment of crouch gait to help compensate for knee flexion contractures. The effects of DFEO on skeletal and muscle lengths are incompletely understood, but are important to consider in planning concomitant surgeries such as patellar tendon advancement (PTA). Therefore, the purpose of this study was to quantify the changes in femur, quadriceps, and hamstring lengths with DFEO, and to determine the sensitivity to surgical factors such as wedge location and magnitude...
December 1, 2017: Journal of Children's Orthopaedics
J C R Wormald, C Y Park, D M Eastwood
Purpose: Fractures of the lateral condyle of the humerus in children are a common injury. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). K-wires are placed using either an open or closed technique. The decision to bury or leave the ends extending through the skin is surgeon-dependent and based on factors including post-operative infection risk, bony union and ease of wire removal. Methods: We performed a systematic review and meta-analysis of non-buried versus buried K-wires for lateral condyle elbow fractures in children in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology...
December 1, 2017: Journal of Children's Orthopaedics
A Boduch, M Hennrikus, T Adebayo, J Brian, W Hennrikus
Purpose: Spica casting of femoral shaft fractures is standard practice for young children. In 1983, Dr. Rang published an illustration demonstrating that radiographs can be misleading when measuring femoral fracture shortening. Today, fluoroscopy is used to determine shortening after closed reduction and spica casting. This paper aims to determine the accuracy of fluoroscopy when measuring 25 mm of shortening in a femur fracture sawbone model. Methods: Magnification, elevation and angulation were evaluated using a femur fracture sawbone model with a fixed overlap of 25 mm...
December 1, 2017: Journal of Children's Orthopaedics
J Murison, P Jehanno, F Fitoussi
Purpose: Nerve transfers to restore elbow flexion have been described for traumatic brachial plexus palsy in adults. Indications are less frequent in infants and the results are less published. Methods: Ten patients with obstetrical brachial plexus palsy were operated on for lack of flexion against gravity with ulnar or median nerve transfer to biceps motor branch. The primary endpoint was improvement in elbow flexion and supination. Results: Mean age at surgery was 12...
December 1, 2017: Journal of Children's Orthopaedics
I Ghanem, N Nicolas, M Rizkallah, S Slaba
Purpose: This study aims to review the results of sclerotherapy using Surgiflo in addition to alcohol in primary aneurysmal bone cysts (ABC). Methods: A total of 16 consecutive patients with histologically confirmed diagnosis of primary ABC were treated by percutaneous Surgiflo and alcohol injection at our institution. Clinical follow-up included the assessment of pain, swelling, limping and functional impairment. Radiological parameters included tumour volume, physis-cyst distance, thickness of cyst cortex, and presence of intracystic septations...
December 1, 2017: Journal of Children's Orthopaedics
A Rhodes, J Gray, N Harvey, J H Davis, R O C Oreffo, I Reading, N M P Clarke, A Aarvold
Purpose: To determine the prevalence of osteonecrosis (ON) in children following treatment of acute lymphoblastic leukaemia (ALL), characterise these cases and review treatment methods. Methods: All children diagnosed and treated for ALL between 01 January 2003 and 31 December 2013 at our centre were retrospectively reviewed. Logistic regression was used to investigate risk factors for ON occurrence. Results: Of 235 children treated for ALL, 48/235 (20...
December 1, 2017: Journal of Children's Orthopaedics
J J Beck, S N Sangiorgio, M H Jew, T Marcum, S D Cooper, E Ebramzadeh, L E Zionts
Purpose: Previous reports have demonstrated diminished size of the hindfoot bones in patients with idiopathic clubfoot deformity. However, no study has quantified the percentage of hypoplasia as a function of early growth, during the brace phase of Ponseti treatment. Methods: We measured the dimensions of ossified structures on radiographs in patients with unilateral Ponseti-treated clubfeet to determine changes in the percentage of hypoplasia between two and four years of age...
December 1, 2017: Journal of Children's Orthopaedics
S K Van de Velde, B Loh, L Donnan
Purpose: Total hip arthroplasty (THA) is rarely recommended in skeletally immature patients. The goal of the present study was to report our short- to mid-term results of THA in a series of children aged 16 years or younger, including clinical outcomes and post-operative complications, signs of radiographic loosening of the prostheses, and revision rate. Methods: The 18 children (two male and 16 female patients, 24 hips) underwent cementless THA at a mean age of 14...
December 1, 2017: Journal of Children's Orthopaedics
M Lastikka, J Aarnio, I Helenius
Purpose: To report indications, outcomes and complications of instrumented cervical spinal fusion in a consecutive series of children at major university hospitals. Methods: A retrospective, single surgeon series identified 35 consecutive children with a mean follow-up (FU) of 2.5 years undergoing instrumented cervical spinal fusion between 2005 and 2015. Results: The main indications were skeletal dysplasia and trauma associated cervical instability...
December 1, 2017: Journal of Children's Orthopaedics
C J DeFrancesco, J M Flynn, J T Smith, S J Luhmann, J R Sawyer, M Glotzbecker, J Pahys, S Garg, M Vitale, D M Farrington, P Sturm
Purpose: Spine surgeons have increasingly used intraoperative application of topical vancomycin powder (TVP) to prevent surgical site infections (SSIs). The goals of this study were to define the rate of pharmacological adverse reaction to TVP in young patients undergoing posterior spinal surgery and to summarise institutional variation in TVP dosing. Methods: This retrospective observational study included ten spine centres in the United States and one in Europe...
December 1, 2017: Journal of Children's Orthopaedics
D Bruce, C Kocialkowski, F Bintcliffe, F Monsell, J Barnes, R Brown
PURPOSE: We report our experience of a paediatric orthopaedic network, based on a 'hub and spoke' model, covering the South West of the United Kingdom. We identify the areas of most clinical concern, the effect of the network on stream-lining patient management and the benefits of the network to the clinician. METHODS: Prospective data were collected from the minutes of the bi-annual meetings of the South West Paediatric Network (UK) between November 2006 and May 2012...
October 1, 2017: Journal of Children's Orthopaedics
S Gaukel, S Leu, L Fink, S R Skovgaard, L E Ramseier, R N Vuille-Dit-Bille
PURPOSE: The objective of this systematic review was to summarise the outcome after cast wedging due to loss of angulation in conservative fracture treatment of children's fractures. METHODS: Electronic searches were performed using MEDLINE, PubMed, OVID, CENTRAL and EMBASE without language restrictions. RESULTS: Three studies comprising 316 patients (210 radius, 52 forearm/both bone forearm fractures and 54 tibia fractures) were included in the present analysis...
October 1, 2017: Journal of Children's Orthopaedics
E Nielsen, L M Andras, N Bonsu, R Y Goldstein
PURPOSE: Traditionally, flexible intramedullary nails (FINs) are not to be used to fix femur fractures in patients > 50 kg (110 lbs). However, studies have not examined the efficacy of this technique in overweight and obese patients who may be under this 'weight cutoff'. The purpose of this study was to assess how patient body mass index (BMI) impacts the treatment of paediatric femur fractures managed with FINs. METHODS: Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period...
October 1, 2017: Journal of Children's Orthopaedics
D L Kerr, E K Loraas, A C Links, T V Brogan, G A Schmale
PURPOSE: The objective of this study was to compare the frequency of severe systemic, multi-organ involvement and toxic shock syndrome (TSS) in patients with Staphylococcus aureus (SA) and Group A β-haemolytic Streptococcus pyogenes (GABS) bone and joint infections. METHODS: We retrospectively reviewed patients treated for septic arthritis or osteomyelitis at one children's hospital between 2002 and 2009. The rates of intensive care unit (ICU) admission for methicillin-sensitive SA (MSSA), methicillin-resistant SA (MRSA) and GABS infections were compared, as were the lengths of stay, number of surgeries, operative procedures and cases of TSS...
October 1, 2017: Journal of Children's Orthopaedics
O Linkoaho, R Kivisaari, M Ahonen
PURPOSE: Small spinal canal dimensions play a role in symptomatic adult disc herniation, but its role in adolescent disc herniation has not been investigated with MRI. The goal of this study was to examine retrospectively if there is a correlation with dimensions of osseous spinal canal and need of discectomy in an adolescent population suffering from disc herniation. METHODS: A retrospective review of child and adolescent patients who were treated in our institution for back or back--related leg pain was conducted...
October 1, 2017: Journal of Children's Orthopaedics
A Goldin, D A Muzykewicz, J Dwek, S J Mubarak
PURPOSE: We aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF's location and aetiology. METHODS: Charts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompassed a diagnosis of NOF of the distal femur by imaging, and histologically, if available. Radiographs, CT and MRI were used to characterise the relationship of the NOF lesions with the surrounding soft tissues...
October 1, 2017: Journal of Children's Orthopaedics
S T Mahan, S A Spencer, C J May, V I Prete, J R Kasser
PURPOSE: Treatment of idiopathic clubfoot with the Ponseti method is now standard, but predicting relapse can be difficult. Most experts recommend bracing to the age of four years, but this can be challenging for families, and may not be necessary in all patients. The purpose of this study is to compare patterns of bracing and age of relapse to help determine if predictable patterns exist. METHODS: The 70 patients with idiopathic clubfoot treated initially with the Ponseti technique who had relapse of their clubfoot were identified...
October 1, 2017: Journal of Children's Orthopaedics
K Studer, N Williams, P Studer, M Baker, A Glynn, B K Foster, P J Cundy
PURPOSE: Identification of anatomical structures that block -reduction in developmental dysplasia of the hip (DDH) is -important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians. METHOD: This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014)...
October 1, 2017: Journal of Children's Orthopaedics
T S Kaastad, A T Tveter, H Steen, I Holm
PURPOSE: The primary aim was to examine if there were differences in physical function and health-related quality of life (HRQoL) between young adults (18 to 35 years) with unilateral congenital lower-limb deficiency (CLLD) who had been surgically lengthened (Surg) and those using lengthening prostheses (Pros). Second, we wanted to compare their health status with an age- and gender-matched reference group (Ref) without CLLD. METHODS: Cross-sectional study including a study-specific questionnaire, clinical examination, two field tests evaluating physical function (the six-minute walk test and the Stair test) and HRQoL questionnaires (Short Form (SF)-36 and EuroQol (EQ)-5D-3L)...
October 1, 2017: Journal of Children's Orthopaedics
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