Journal of Children's Orthopaedics

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Meningococcal purpura fulminans in children: I. Initial orthopedic management
Journal of Children's Orthopaedics - Tập 4 - Trang 401-407 - 2010
E. Nectoux, A. Mezel, S. Raux, D. Fron, M. Maillet, B. Herbaux
Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis frequently causing early orthopedic lesions. Few studies have reported on the initial surgical management of acute purpura fulminans. The aim of this study is to look at the predictive factors in orthopedic outcome in light of the initial surgical management in children surviving initial resuscitation. Nineteen patients referred to our institution between 1987 and 2005 were taken care of at the very beginning of the purpura fulminans. All cases were retrospectively reviewed so as to collect information on the total skin necrosis, vascular insufficiency, gangrene, and total duration of vasopressive treatment. All patients had multiorgan failure; only one never developed any skin necrosis or ischemia. Eighteen patients lost tissue, leading to 22 skin grafts, including two total skin grafts. There was only one graft failure. Thirteen patients were concerned by an amputation, representing, in total, 54 fingers, 36 toes, two transmetatarsal, and ten transtibial below-knee amputations, with a mean delay of 4 weeks after onset of the disease. Necrosis seems to affect mainly the lower limbs, but there is no predictive factor that impacted on the orthopedic outcome. We did not perform any fasciotomy or compartment pressure measurement to avoid non-perfusion worsening; nonetheless, our outcome in this series is comparable to existing series in the literature. V.A.C.® therapy could be promising regarding the management of skin necrosis in this particular context. While suffering from general multiorgan failure, great care should be observed not to miss any additional osseous or articular infection, as some patients also develop local osteitis and osteomyelitis that are often not diagnosed. We do not advocate very early surgery during the acute phase of purpura fulminans, as it does not change the orthopedic outcome in these children. By performing amputations and skin coverage some time after the acute phase, we obtained similar results to those found in the literature.
Idiopathic scoliosis: etiological concepts and hypotheses
Journal of Children's Orthopaedics - Tập 7 - Trang 11-16 - 2013
Romain Dayer, Thierry Haumont, Wilson Belaieff, Pierre Lascombes
Scoliosis is diagnosed as idiopathic in 70 % of structural deformities affecting the spine in children and adolescents, probably reflecting our current misunderstanding of this disease. By definition, a structural scoliosis should be the result of some primary disorder. The goal of this article is to give a comprehensive overview of the currently proposed etiological concepts in idiopathic scoliosis regarding genetics, molecular biology, biomechanics, and neurology, with particular emphasis on adolescent idiopathic scoliosis (AIS). Despite the fact that numerous potential etiologies for idiopathic scoliosis have been formulated, the primary etiology of AIS remains unknown. Beyond etiology, identification of prognostic factors of AIS progression would probably be more relevant in our daily practice, with the hope of reducing repetitive exposure to radiation, unnecessary brace treatments, psychological implications, and costs-of-care related to follow-up in low-risk patients.
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Journal of Children's Orthopaedics - Tập 4 - Trang 273-274 - 2010
Inter-observer and intra-observer agreement in the radiographic diagnosis of avascular necrosis of the femoral head following slipped capital femoral epiphysis
Journal of Children's Orthopaedics - Tập 4 - Trang 327-330 - 2010
Darin Davidson, Arvindera Ghag, Richard D. Beauchamp, Stephen J. Tredwell, Kishore Mulpuri
Slipped capital femoral epiphysis (SCFE) is a common pediatric hip disorder. Avascular necrosis (AVN) of the femoral head is a devastating complication of SCFE. The frequency of this complication reported in the literature has been variable. It was the objective of this study to estimate the inter- and intra-observer agreement between two experienced pediatric orthopaedic surgeons for the radiographic diagnosis of AVN following SCFE. A retrospective review of all cases of SCFE treated at our center between 1995 and 2005 was performed. All cases of AVN and a random sample of 19 of the remaining cases were selected for study. The most recent anteroposterior and lateral radiographs were presented to two experienced pediatric orthopaedic surgeons in a random order. Inter-observer reliability was determined by calculating the kappa statistic to assess for clinical agreement. Each observer repeated this process two weeks after the initial review. There were a total of 103 cases of SCFE, of which four were diagnosed with AVN. The inter-observer agreement in the first trial was 0.79. The intra-observer agreement for the first observer was 0.9 and for the second observer, it was 0.88. The agreement, both inter- and intra-observer, for the radiographic diagnosis of AVN amongst adolescents with previous SCFE is very high. The results of this study suggest that the reported discrepancy of AVN in the literature following SCFE is not likely due to the lack of inter- and intra-observer agreement.
The effectiveness of the Ponseti method for treating clubfoot associated with arthrogryposis: Up to 8 years follow-up
Journal of Children's Orthopaedics - - 2016
Hosam E Matar, Peter Beirne, Neeraj Garg
Purpose

To evaluate the effectiveness of the Ponseti method in treating clubfoot associated with arthrogryposis.

Methods

Retrospective consecutive review over a 10-year period in a tertiary centre of all patients with arthrogrypotic clubfoot treated with the Ponseti method. The primary outcome measure at final follow-up was the functional correction of the deformity.

Results

There were ten children with 17 arthrogrypotic clubfeet, with an average follow-up of 5.8 years (range 3–8 years). The average age at presentation was 5 weeks (range 2–20 weeks). Deformities were severe, with an average Pirani score of 5.5 (range 3–6). Initial correction was achieved in all children with an average of 8 (range 4–10) Ponseti casts and a tendo-Achilles tenotomy (TAT) was performed in 94.1 %. Two-thirds of patients had a satisfactory outcome at final follow-up, with functional plantigrade, pain-free feet.

Conclusions

The Ponseti method is an effective first-line treatment for arthrogrypotic clubfeet to achieve functional plantigrade feet. Children will often require more casts and have a higher risk of relapse.

Pediatric femur neck fractures: a retrospective analysis of 39 hips
Journal of Children's Orthopaedics - Tập 3 - Trang 259-264 - 2009
Ulukan İnan, Nusret Köse, Hakan Ömeroğlu
The aim of this retrospective study was to analyze the radiological and clinical results of pediatric femur neck fractures. This study included 39 children (mean age 11.1, range 4 to 16 years) who had a femur neck fracture and had at least one year of complete follow-up. The most common etiological factor was traffic accident and the most common associated skeletal injury was pelvis fracture. According to Delbet’s classification system, there were no type I (transepiphyseal) fractures and 21 type II (transcervical), 14 type III (cervicotrochanteric), and four type IV (intertrochanteric) fractures. The mean follow-up was 3.4 (1–9.5) years. A satisfactory outcome according to Ratliff’s radiological and clinical criteria was obtained in 28 (72%) hips. Avascular necrosis (AVN) of the femoral head was seen in 11 (28%) hips and the rate of satisfactory outcome was significantly higher in hips without AVN than in hips with AVN (P < 0.001). Transcervical fractures had the worst outcome (P = 0.014) and the highest rate of AVN (P = 0.077) when compared with cervicotrochanteric and intertrochanteric fractures. No significant correlation was found between both the outcome and development of AVN and age, gender, laterality, amount of fracture displacement, treatment time, and the type of reduction (open/closed) (P > 0.05). It has been concluded that the development of AVN primarily influences the outcome in pediatric femur neck fractures and that fracture type is essentially correlated with the development of AVN and outcome.
Screening for hip dysplasia in congenital muscular torticollis: is physical exam enough?
Journal of Children's Orthopaedics - Tập 8 - Trang 115-119 - 2014
Elizabeth R. A. Joiner, Lindsay M. Andras, David L. Skaggs
An association between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) has been established in the literature; however, whether the screening of patients with CMT for DDH requires hip imaging remains controversial. The purpose of this study is to determine (1) the coexistence rate of DDH requiring treatment in individuals with CMT and (2) if physical exam alone is sufficient screening. A single-center retrospective chart review was performed among 97 consecutive patients between 1/1/2003 and 9/1/2012 with CMT who had hip imaging performed. 12 % (12/97) of patients with CMT had DDH, all requiring treatment. 75 % (9/12) of the patients with DDH had an abnormal clinical exam. Of the three patients with DDH and a normal clinical exam, two patients were presenting for a second opinion after being treated for DDH prior to evaluation. 90 % (9/10) of patients with DDH at the time of presentation had an abnormal hip exam. All 12 patients with hip dysplasia were referred for DDH or DDH with CMT. There were no patients who were referred for CMT alone that had DDH. In the care of a patient with CMT, it is important that the clinician remains vigilant about screening for DDH. An ultrasound or radiograph of the hips should be strongly considered as part of the evaluation of a child with CMT. Level of evidence: IV.
Scoliosis after chest wall resection
Journal of Children's Orthopaedics - Tập 7 Số 4 - Trang 301-307 - 2013
Glotzbecker, Michael P., Gold, Meryl, Puder, Mark, Hresko, M. Timothy
There has been an increased focus on the role of rib abnormalities in the development of scoliosis. Rib resection may influence the development of scoliosis. Although scoliosis has been identified in patients after thoracotomy, most of the currently available information is from case reports. We examined records of 37 patients who underwent a chest wall or rib resection for rib lesions at our institution during the period of 1992 to 2005. Adequate data was available in 21 patients. We gathered data on demographic information, location of resection, and changes in curvature after resection based on radiograph or scout CT films at the latest follow-up appointment. Fourteen of 21 patients developed scoliosis with a mean Cobb angle of 25.8° (10°–70°). Eleven of these 14 patients had a progressive spinal deformity after chest wall resection with an average change in curvature of 29° (10°–70°). Eight of those 11 developed a convex toward the resection, while 3/11 developed a convex away from the resection. Seven of the eight patients with resections that included a rib superior to the sixth rib developed scoliosis, while four of 13 with resections below the sixth rib developed scoliosis. Patients who have had a rib or chest wall resection are at risk for developing scoliosis, particularly if the resection is performed above the sixth rib.
Electronic monitoring of orthopedic brace compliance
Journal of Children's Orthopaedics - Tập 9 - Trang 365-369 - 2015
Tariq Rahman, Whitney Sample, Petya Yorgova, Geraldine Neiss, Kenneth Rogers, Suken Shah, Peter Gabos, Dan Kritzer, J. Richard Bowen
Brace compliance measurement in adolescent idiopathic scoliosis (AIS) has been the subject of a few recent studies. Various sensors have been developed to measure compliance. We have developed a temperature-based data logger—the Cricket—specifically for scoliosis braces, with associated custom software, that is embedded directly in the brace. The purpose of this study was to analyze patterns of brace wear and patient compliance among children with AIS using the Cricket. Fifty-five AIS patients prescribed various brace-time regimens were monitored using the Cricket. All subjects were treated with the Wilmington brace. The compliance rate for each group was determined. Overall compliance among subjects was 69.9 ± 31.5 %. Only 14.5 % met or exceeded prescribed brace time. This is consistent with previous compliance monitoring results. The results of this study objectively show the difference between prescribed and actual brace wear time and reaffirm the Cricket sensor as an accurate and comfortable brace-monitoring device.
Use of end caps in elastic stable intramedullary nailing of femoral and tibial unstable fractures in children: preliminary results in 11 fractures
Journal of Children's Orthopaedics - Tập 2 - Trang 309-314 - 2008
E. Nectoux, M. C. Giacomelli, C. Karger, P. Gicquel, J. M. Clavert
Elastic stable intramedullary nailing (ESIN) is used routinely world-wide for treating femoral and tibial shaft fractures in children before skeletal maturity. Overall, ESIN allows rapid limb mobilisation with few complications. However, many centres have experienced some complications resulting from secondary fracture displacement, especially in heavy adolescents and in spiroid or complex fractures due to changes in the nail’s position, leading to limb shortening, malrotation and malalignment. End caps were designed by the AO expert group to address these complications. The purpose of this study is to evaluate the efficiency, safety and tolerance of this new device in our first series of ten patients and 11 fractures. Prospective follow-up of our first ten patients operated on with end caps. Our results show that there were no serious complications at a mean follow-up of 13.1 months. There was only one 10-mm leg shortening in a patient in whom the end caps could not be properly inserted. There were no infections, no additional pain and no skin irritation. The use of end caps eased the removal of the nails after bone healing, thereby preventing the formation of ossification over the tips of the nails and appeared to protect the skin next to the nail tip. These results seem to prove the advantage of using end caps when performing ESIN in lower limb shaft fractures in children. A longer follow-up that includes more patients and a randomised prospective study should be carried out in the future to determine more precisely the indications of this new device.
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