Aims

To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV).

Aims

The aim of this study is to define a core outcome set (COS) to allow consistency in outcome reporting amongst studies investigating the management of orthopaedic treatment in children with spinal dysraphism (SD).

Aims

This study aims to define a set of core outcomes (COS) to allow consistent reporting in order to compare results and assist in treatment decisions for idiopathic clubfoot.

Aims

To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot.

Introduction

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.

Purpose

To review the natural history of posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition.

Purpose: In neuromuscular conditions, ankle foot orthoses (AFO) prevent deformity and improve functional balance by increasing the base of support, stabilizing the ankle joint and influencing the kinematics of more proximal joints; this study was designed to evaluate the role of fixed AFOs on balance in spastic diplegic children.

Methods: 12 children (age 7–15yrs) with spastic diplegia were recruited. All were community ambulators (GMFCS II/III). All had used AFOs for 12 months. Each child walked along the GAITRite electronic walkway at their preferred speed: barefoot, in shoes, and in AFOs with shoes. The order of the walks was randomized limiting the effects of fatigue and confidence. Normalized velocity, cadence, stride length and percentage of gait cycle in single leg support were selected as surrogate measures of stability. The child’s balance during other functional activities was assessed with the paediatric balance scale (PBS).

A two-way analysis of variance (ANOVA) explored differences in gait between the various walks. Fried-man’s test tested for differences in PBS scores between subjects and conditions.

Results: Significant improvements were seen in mean values for normalized velocity (p=0.02), stride length (p< 0.01) and percentage of gait cycle in single leg support (p< 0.01) in footwear-AFO compared to barefoot. Whilst there were also improvements in mean values for these parameters in shoes alone compared to barefoot, only the difference in stride length reached statistical significance (p< 0.01). There were no significant differences in PBS scores in shoes alone or with AFOs compared with walking barefoot.

Conclusions: AFOs improved balance during gait but had no effect on balance during other activities. Whilst shoes alone had a positive impact on gait, the most significant effects were seen in the AFO-footwear combination.

Significance: Advice regarding AFO use and footwear choice should consider the effects on gait as well as prevention of deformity.

Purpose of study: To investigate the contribution of 11p15 defects to hemi-hypertrophy (HH) and clarify the potential association with Wilms’ tumour.

Methods: Clinical data and blood/DNA samples were collected from patients with hemi- hypertrophy and from their parents. Where normal/abnormal tissue samples were available, fibroblast DNA was also analysed. Recruitment criteria included any patient with growth asymmetry. All patients were analysed for uni-parental disomy of 11p15 by quantitative PCR and for abnormal methylation at imprinting centres 1 and 2 by Pyrosequencing.

Results: Samples from 78 patients, including 30 with a history of a childhood tumour were analysed. Abnormalities at 11p15 were detected in 11 individuals: 9 had uni-parental disomy 11p15; two had isolated hyper-methylation of imprinting centre 1. Four of 11 patients had a history of Wilms’ tumour and one a history of neuroblastoma. The asymmetry and other clinical features in the individuals with 11p15 defects are variable, but often subtle.

Conclusions: HH is a poorly defined term that refers to asymmetrical growth of one region of the body. There is a recognised but poorly defined association with childhood malignancy, particularly Wilms’ tumour. HH is a feature of a number of genetic disorders, including Beckwith-Wiedemann syndrome, which are caused by abnormalities of imprinting at chromosome 11p15. Certain of these defects are associated with an increased risk of Wilms’ tumour. Our data demonstrate that analysis of imprinting at 11p15 in patients with growth asymmetry identifies a subgroup at increased risk of Wilms’ tumour. Tumour surveillance should be encouraged in this group.

Further analyses are required to determine the molecular defects underlying those in whom no 11p15 defect is identifiable. Analyses of paired normal/abnormal tissue samples may be crucial in identifying such abnormalities.

Introduction: Traumatic and iatropathic nerve injuries complicate 6–16% of paediatric supracondylar extension fractures of the humerus. The majority recover spontaneously. This retrospective review of lesions referred to our tertiary unit determined the incidence of surgical intervention.

Methods: Between 1997–2002, 37 neuropathies (32 fractures) in 19 males and 13 females (mean age 7.9yrs) were referred for further management. 8 fractures were Gartland grade 2 and 24 grade 3. All fractures were closed. Two were originally treated non-operatively, 20 by closed reduction and percutaneous pinning and 10 by open reduction and internal fixation.

Results: The ulnar nerve was most frequently injured (19, 51.4%), followed by median (10, 27%) and radial (8, 21.6%) nerve palsies. 14 (37.8%) neuropathies were fracture-related but 23 (62.2%) were treatment-related. 10 patients (31.3%) required operative exploration. Three (9.4%) were listed for surgery but cancelled due to nerve recovery. Nerve grafting using either the forearm medial cutaneous nerve or the superficial radial nerve was necessary in 4 of 10 operated cases. 26 patients (81.3%) had excellent outcomes, 5 (15.6%) good and 1 (3.1%) fair.

Discussion: In contrast to current literature suggesting that 86 to 100% of supracondylar associated neuropathies recover spontaneously within 2 to 3 months, surgical exploration was required in over 30% of cases.