Northern Ireland has previously demonstrated high incidence of Perthes' disease (11.6 per 100,000). The aim of this study is to confirm a declining incidence in this diagnosis in Northern Ireland. A reduction in new Perthes' patients had been noted by the senior author. A retrospective study was designed to identify patients with a new diagnosis of this disease over a 7 year period (2004–10). Clinical notes were interrogated using word searches. Further cross referencing with x-ray system reports were utilised to capture all new patients presenting with subsequently proven Perthes'. Patients not resident in Northern Ireland at the time of diagnosis were excluded. Patients with epiphyseal dysplasia or avascular necrosis secondary to treatment of developmental dysplasia of the hip were also excluded. A previous study from this unit had demonstrated 313 new cases over the 7 year period 1992–1998, with average incidence of approximately 45/year for the population. All years in our study (2004–10) have had less than 30 for the entire population (<8.3 per 100,000). Significant variation between years with some years much less detected, so further searches are been undertaken to ensure completeness if data capture.Methods
Results
The Ponseti and French taping methods have reduced
the incidence of major surgery in congenital idiopathic clubfoot
but incur a significant burden of care, including heel-cord tenotomy.
We developed a non-operative regime to reduce treatment intensity
without affecting outcome. We treated 402 primary idiopathic clubfeet
in patients aged <
three months who presented between September
1991 and August 2008. Their Harrold and Walker grades were 6.0%
mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient
taping regime over five weeks based on Ponseti manipulation, modified
Jones strapping and home exercises. Feet with residual equinus (six
feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent
one to three additional tapings. Correction was maintained with
below-knee splints, exercises and shoes. The clinical outcome at
three years of age (385 feet, 95.8% follow-up) showed that taping
alone corrected 357 feet (92.7%, ‘good’). Late relapses or failure
of taping required limited posterior release in 20 feet (5.2%, ‘fair’)
or posteromedial release in eight feet (2.1%, ‘poor’). The long-term
(>
10 years) outcomes in 44 feet (23.8% follow-up) were assessed
by the Laaveg–Ponseti method as excellent (23 feet, 52.3%), good
(17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%).
These compare favourably with published long-term results of the
Ponseti or French methods. This dynamic taping regime is a simple
non-operative method that delivers improved medium-term and promising
long-term results. Cite this article:
We evaluated the outcome of conservative versus surgical treatment in lateral humeral condyle fractures in children. The management in some of these fractures remains controversial, ultimately relying upon the individual practitioner. We identified 73 children who sustained such fractures, with varying degrees of displacement, during the period between April 2006 and October 2011.Aim
Methods
Fractures are the second commonest presentation of non-accidental injury (NAI) in children. Approximately one third of abused children will present to Acute Trauma Services (ATS) with fractures. Any cases of suspected child maltreatment should be referred to Safeguarding Services for follow-up, as outlined by Trust Guidelines. Our aim was to examine the referral of children with suspicious fractures to safeguarding and assess if cases with high risk of abuse are being missed by ATS. A comprehensive literature review identified commonly cited indicators of abuse. Inclusion criteria included age less than 18 months seen in A&E or Fracture Clinic with a long bone fracture. Patient notes were analysed to identify occurrence of these risk factors and findings cross-referenced with Safeguarding Services' records to verify whether high-risk patients were detected. The origin of each referral was also noted.Aim
Method
This study presents the early results of a novel procedure, both in timing and surgical technique, aimed to treat those cases of congenital hip dysplasia that present late or fail conservative treatment. 48 patients and 55 hips treated over the period from December 2004 to February 2011 were retrospectively reviewed. All were treated with adductor and psoas tenotomy, open reduction, capsulorrhaphy and acetabuloplasty by the senior author.Aim
Methods
There is mounting evidence to suggest a vascular insult is responsible for Perthes' disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes' disease. This case control study encompassed 149 cases and 146 controls, frequency matched for age and sex. Endothelial function was measured using the technique of flow-mediated dilatation of the brachial artery, and alterations in arterial flow were recorded in response to an ischaemic stimulus.Objective
Material and Methods
Perthes' disease is associated with coxa breva, plana and magna, and a high riding prominent greater trochanter causing abductor shortening and weakness, leg shortening and extra-articular impingement. A trochanteric advancement with an infero-lateralising oblique sliding osteotomy of the proximal femur would lengthen femoral neck, improve abductor length and strength, relieve impingement and improve leg length. We assessed the mid-term outcomes for this procedure. We included patients who underwent the operation by the senior author (JNOH) with more than 2 years follow-up. The osteotomies were performed minimally invasively under image intensifier guidance and fixed with blade plate or locking plates. We assessed functional scores, radiological changes in neck length, Tonnis grading for arthritis and evidence of femoral head avascular necrosis, time interval for conversion to hip arthroplasty and associated complications.Introduction
Method
A study to assess the clinical importance of asymmetric thigh creases as the sole clinical sign in the diagnosis of developmental dysplasia of the hip. All consultant clinic letters have been saved on a hospital hard drive since 1999. This drive was searched for the terms “thigh crease” and “skin crease”. Irrelevant letters and referral letters describing factors that would indicate screening in our unit were excluded leaving those with the sole referral complaint of asymmetric thigh creases (ATC). We also reviewed the original referrals of developmental dysplasia of the hip (DDH) patients managed by open or closed reduction. These patients were identified through operative coding. All available hard copy notes were reviewed and patients with neuromuscular conditions or longitudinal deficiency were excluded. Results were inputted into an Excel spreadsheet and analysed by a statistician at the University of Sheffield assuming a background population incidence for DDH of 1 in 1000. 399 computer files containing the search terms were identified. Many contained whole clinics of patient letters. After exclusions we identified 229 patients with the sole referral complaint of ATC. Three of the 229 patients had DDH, which was not statistically significant (p=0.107). The majority of the normal patients had radiological investigations. Hard copy notes were available and relevant for 130 of the 289 operatively managed patients, of whom one was initially referred with the sole complaint of ATC. Orthopaedic specialist examination demonstrated all four patients initially referred with only ATC had decreased abduction and shortening.METHOD
RESULTS
Several authors have suggested that the final
five weeks of gestation are a critical period for the development
of the hip. In order to test the hypothesis that gestational age
at birth may influence the development of the hip joint, we analysed
the sonographic findings in 1992 hips (in 996 term newborns) with
no risk factor for developmental dysplasia of the hip. The 996 infants
were born at a mean gestational age of 39 weeks (37 to 41). The mean bony roof angle (α), cartilage roof angle (β) and the
distribution of the type of hip were compared between the 37th,
38th, 39th, 40th and 41st birth week groups. There was a significant
difference in the distribution of type of hip between the different
birth week groups (p <
0.001), but no significant difference
between the α angles of all groups (p = 0.32). There was no correlation
between birth week and roof angle (p = 0.407 and p = 0.291, respectively)
and no significant correlation between birth weight and roof angle
(p = 0.735 and p = 0.132, respectively). The maturity of the infant hip, as assessed sonographically,
does not appear to be affected by gestational age, and the fetal
development of the acetabular roof appears to plateau from 37 weeks. Cite this article:
Debate remains over the optimal treatment for severe unstable SCFE. AVN is the principle problem; current thinking suggests this can be minimized by emergent reduction and fixation within 24 hours. If emergent treatment is not possible, open osteotomy with a variable delay of 10–21 days has been advocated. We present our experience of delayed intracapsular cuneiform osteotomy (ICO) SCFE cases were identified through ICD-10 coding and theatre records. Unstable slips were identified and reviewed retrospectively. When ICO was performed, the hip was accessed via anterior approach without hip dislocation. A cuneiform shortening osteotomy of the neck with physeal excision was undertaken. The epiphysis was carefully reduced and stabilized with a single screw.Aim
Methods
Identification of the paediatric orthopaedic patient at high risk of venous thromboembolism (VTE) can allow a targeted approach to thromboprophylaxis. There is currently no national consensus on the correct method of risk assessment in this patient group. The Royal National Orthopaedic Hospital has developed a guideline using the evidence available to allow stratification of risk for the paediatric orthopaedic patient. A list of departments offering specialist paediatric orthopaedic surgery was obtained from the member list of the British Society of Paediatric Orthopaedic Surgeons (BSCOS). These hospitals were contacted via telephone interview to determine if they have a specific guideline or risk assessment proforma for paediatric VTE risk. A total of 74 hospitals were identified with a specialist paediatric orthopaedic practice in the United Kingdom. A response rate was gained from 100% of these hospitals. Only 3/74 of these hospitals had a guideline or protocol in place for the formal assessment of VTE risk in the paediatric patient (Royal National Orthopaedic Hospital, Stanmore; Sheffield Children's Hospital; Barts & the London NHS Trust). All three hospitals were able to provide details of their guideline. Both the RNOH and Barts & the London commented that their guideline was based on that of the Sheffield group, with adaptations for their own requirements. The majority of hospitals in the UK with a paediatric orthopaedic interest do not have guidance available for the management of VTE risk. Presented here is the outcome of using the limited evidence available, in combination with expert opinion, to develop a guideline suitable for the requirements of a paediatric unit in an orthopaedic hospital. This may be of benefit to other units producing their own guidelines, producing thought and discussion as to the specific requirements of paediatric patients undergoing orthopaedic procedures.
Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters, arthroplasty conversion rate, time interval before conversion to arthroplasty and other associated complications.Introduction
Methods
We analysed retrospectively the risk factors
leading to femoral overgrowth after flexible intramedullary nailing
in 43 children (mean age 7.1 years (3.6 to 12.0)) with fractures
of the shaft of the femur. We reviewed their demographic data, mechanism
of injury, associated injuries, the type and location of the fractures,
the nail–canal diameter (NCD) ratios and femoral overgrowth at a
mean follow-up of 40.7 months (25.2 to 92.7). At that time, the
children were divided into two groups, those with femoral overgrowth
of <
1 cm (Group 1), and those with overgrowth of ≥ 1 cm (Group
2). The mean femoral overgrowth of all patients was 0.6 cm at final
follow-up. Overgrowth of ≥ 1 cm was noted in 11 children (25.6%).
The NCD ratio was significantly lower in Group 2 than in Group 1,
with an odds ratio of 30.0 (p = 0.003). We believe that a low NCD ratio is an indicator of an unstable
configuration with flexible intramedullary nailing, and have identified
an association between a low NCD ratio and femoral overgrowth resulting
in leg-length discrepancy after flexible intramedullary nailing
in paediatric femoral shaft fractures. Cite this article:
In Norway total joint replacement after hip dysplasia
is reported more commonly than in neighbouring countries, implying
a higher prevalence of the condition. We report on the prevalence
of radiological features associated with hip dysplasia in a population
of
2081 19-year-old Norwegians. The radiological measurements used
to define hip dysplasia were Wiberg’s centre-edge (CE) angle at
thresholds of <
20° and <
25°, femoral head extrusion index
<
75%, Sharp’s angle >
45°, an acetabular depth to width ratio
<
250 and the sourcil shape assessed subjectively. The whole
cohort underwent clinical examination of their range of hip movement,
body mass index (BMI), and Beighton hypermobility score, and were
asked to complete the EuroQol (EQ-5D) and Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC). The prevalence of hip
dysplasia in the cohort varied from 1.7% to 20% depending on the
radiological marker used. A Wiberg’s CE angle <
20° was seen
in 3.3% of the cohort: 4.3% in women and 2.4% in men. We found no
association between subjects with multiple radiological signs indicative
of dysplasia and BMI, Beighton score, EQ-5D or WOMAC. Although there
appears to be a high prevalence of hip dysplasia among 19-year-old
Norwegians, this is dependent on the radiological parameters applied. Cite this article:
Evaluation of the pre-operative documentation of neurovascular status in children presenting with Gartland Grades 2 and 3 supracondylar fractures and the development of an Emergency Department Proforma. A retrospective case-note review was performed on patients with Gartland Grade 2 and 3 supracondylar fractures observed in a two-year period from July 2008 – July 2010. 137 patients were included; sixteen patients (11.7%) sustained a Gartland Grade 2a fracture, sixty patients (43.8%) a Gartland Grade 2b fracture and sixty-one (44.5%) a Gartland Grade 3 fracture. Mean patient age at presentation was 5.59 years (range 12 months to 13 years). Nineteen patients (13.9%) had evidence of neurological deficit at presentation and thirteen patients (9.5%) presented with an absent radial pulse. Only twelve patients (8.8%) and nineteen patients (13.9%) respectively had a complete pre-operative neurological or vascular assessment documented. Regarding the individual nerves, fifty-nine (43.1%) patients had median nerve integrity documented, fifty-five (40.1%) ulnar nerve and forty-nine (35.8%) radial nerve integrity documented. Only eighteen patients (13.1%) had their anterior interosseous nerve function documented. Ten patients (7.3%) had post-operative neurological dysfunction, consisting of eight ulnar nerve injuries, and two radial nerve injuries.Purposes of study
Methods and results
The association between idiopathic scoliosis and intrinsic abnormalities of the spinal cord are well known. MRI is the most sensitive imaging modality available to diagnose an intraspinal anomaly. The use of a routine ‘screening MRI’ prior to scoliosis correction is controversial. This study sought to quantify the frequency of previously unidentified cord anomalies identified by a routine pre-operative MRI, in patients planned for surgical scoliosis correction.Background
Purpose
To assess the efficacy of combined medical and surgical management in obtaining normal lower limb mechanical alignment in a patient cohort with genotypically similar hypophosphataemic rickets. A notes and radiograph audit was performed of all patients attending our institution with hypophosphataemic rickets: a subset with PHEX gene anomalies was studied further. Lower limb radiographs were assessed at two points during childhood and note made of treatment start, compliance; indication, timing and result of surgery. Standing leg alignment radiographs were measured at skeletal maturity or at latest review.Aim
Methods
Differing reports about the surgical management of the supracondylar humeral fracture make evidence-based practice very difficult, so knowledge of the contemporary practices and opinions of an expert body can provide a useful benchmark for appraisal; the aim of this study was to obtain this information. An electronic 18 item, single response multiple-choice questionnaire was designed to investigate various aspects of the surgical management of supracondylar fractures, with particular focus on areas that remain controversial in the literature. Members of BSCOS were invited by email, on three occasions, to complete the questionnaire, which was posted on the web-based SurveyMonkey™ platform (Aim
Methods
Vascular compromise following supracondylar fractures is frequently described. Near Infra-red Spectrometry (NIRS) is a technique through which real-time data can be gathered non-invasively on the oxygenation status of tissues. The drive now is to gain knowledge on how NIRS data can be interpreted and to validate its use in the clinical setting. This ethically approved prospective study looks at volar forearm compartment oxygen saturation (StO2) in 20 patients with supracondylar fractures requiring operative intervention. Both the injured limb and the contra-lateral, uninjured limb were monitored. 20 patients from a cohort of 29 had full data sets and are thus presented.Aim
Methods
Paediatric fractures are common but those occurring in non-ambulant children are associated with higher rates of Non Accidental Injury (NAI). There is little published on the mechanisms of injury associated with accidental fracture in young children. This study explores the aetiology of long bone fractures in non-ambulant children. This retrospective multicentre study looked at children aged ≤18 months presenting to three hospitals over 3 years (2009 to 2011). Information was gathered on age, gender, fracture type, injury mechanism, final diagnosis, treatment and details of screening for NAI.Aim
Methods
The use of intraoperative cell salvage as a tool for reducing allogenic transfusion has been demonstrated in pelvic osteotomies. The aims of this audit were to identify any problems or complications with cell salvage, reduction in allogenic transfusion and identify procedures that would benefit. The use of cell salvage and allogenic transfusions were prospectively recorded over a 27-month period for all those who had major non spinal surgery looking at whether cell-salvage reduced allogenic transfusions and where cell salvage was used it was matched to procedure, diagnosis and age with cases where it was not used over the same time period.Aim
Methods
To determine if the instigation of Magnetic Resonance Extremity (MRE) scanning in our unit as part of the management of suspected paediatric scaphoid fractures has prevented overuse of splints or casts reduced unnecessary clinic appointments and saved our department financially. Children with traumatic anatomical snuffbox tenderness and negative radiographs are seen 10 days following injury having been given a Futura® splint. If repeat radiographs are negative with on-going positive clinical findings the child has an MRE scan, which is usually reported the same day. If negative, the splint is removed on that day, but if positive, a cast is applied and the child referred onto paediatric fracture clinic.Aim
Methods
We reviewed the long-term radiological outcome,
complications and revision operations in 19 children with quadriplegic
cerebral palsy and hip dysplasia who underwent combined peri-iliac
osteotomy and femoral varus derotation osteotomy. They had a mean
age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations
and subluxations. We also studied the outcome for the contralateral
hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne
cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade
3 in five, and grade 5 in one. There were five complications seen
in four hips (21%, four patients), including one dislocation, one
subluxation, one coxa vara with adduction deformity, one subtrochanteric
fracture and one infection. A recurrent soft-tissue contracture occurred
in five hips and ten required revision surgery. In pre-adolescent children with quadriplegic cerebral palsy good
long-term outcomes can be achieved after reconstruction of the hip;
regular follow-up is required.
Cite this article:
Our aim was to compare the Wilkins'-modified Gartland classification and AO classifications of supracondylar humeral fracture with respect to: -Inter-observer reliability; Association of fracture-grade with radiological quality of reduction; Association of fracture-grade with complications. The unit database was interrogated to identify all operated supracondylar fractures between 2007–2011. Radiographs from each case were evaluated by four observers (three consultants, one trainee) and classified according to Gartland and the AO system. Inter-observer reliability was calculated using Cohen's Kappa coefficient. Radiological quality of reduction was evaluated using a new scoring system, combining the anterior humeral line, the lateral capitello-humeral angle (LCHA) and Baumann's angle, (compared to reference values). Analysis of variance (ANOVA) was performed to determine whether there was a statistically significant difference in scores between the fracture grades. Case notes were reviewed for pre- and post-operative complication, and chi-squared test performed to compare the incidence between different fracture grades.Aim
Methods
In previous small series, some authors have suggested a difference between re-fractures through immature callus and remodelled bone. We aimed to determine whether different fracture patterns occur in early and late re-fractures of paediatric forearm bones. Notes and radiographs of 77 forearm re-fractures from children aged 2–14 years were retrieved from our institution's radiographic database. Children treated surgically at initial presentation and re-fractures beyond one year were excluded. A control group of 100 forearm fractures without complication was used for comparison. Statistical analysis used chi-square and unpaired t-tests and statistically significant results were based on a two-tailed p-value <0.05Aim
Methods
Case Report presentation of traumatic cartilage loss in a child. We present a case report of a 3-year-old girl who sustained a severe open fracture dislocation of her talus with complete loss of full thickness articular cartilage and subchondral bone over 80% of the talar dome. At presentation there was also a Salter Harris I fracture of the fibular, and an extensive soft tissue defect including absent anterior joint capsule. She required a free anterolateral thigh (ALT) flap to reconstruct this defect. The talar dome defect was treated with a cell-free chondro-inductive implant. This was the first use of this implant in the UK and the first use of such an implant in a child anywhere in the world.Aim
Method
We hypothesised that Vitamin D deficiency could be related to SUFE in children without endocrinological abnormalities. We therefore sought to examine prevalence and severity of Vitamin D insufficiency in a cross-section of SUFE patients. Vitamin D levels were tested for at time of hospital admission for operative treatment of SUFE. Seven patients, between the months of July 2011 to November 2011, presented to our institution. All were chronic, stable slips treated with in-situ screw fixation. All patients presented in the summer months and were operated on within 3 weeks of presentation.Purpose of study
Methods
The relationship between the index (2D) to ring finger (4D) is one of the most commonly studied anthropometric measures, which is believed to offer insight into early growth and the foetal environment. This study aimed to determine the relationship between the 2D:4D ratio and the risk of Perthes' disease in children. The 2D:4D ratio was measured in 144 cases of Perthes' disease, and 144 controls. Cases and controls were frequency matched for age and sex. Measurements were recorded using a digital venier calliper on the palmar surface of the hand. Logistic regression was undertaken adjusting for age, with stratification for sex.Objective
Methods
To compare the early medial open approach (MO) with the anterior approach (AO) performed after the appearance of the ossific nucleus for DDH that has failed closed reduction or presented late. We present the experience of 2 UK surgeons with prospectively gathered data for MO (26 hips) compared with that of a third surgeon in the same unit for the AO (21 hips) in 41 children under 24 months of age at index surgery. Femoral head osteonecrosis (FHO) risk was predicted using the height-to-width index of Bruce et al, measured at 12–18 months post reduction, and graded with the Kalamchi and MacEwen classification where follow-up exceeded 3 years. Acetabular index (AI) was measured at or close to 2 years post reduction.Purpose
Methods
Assess the incidence of Vitamin D deficiency from a cohort of new referrals to a general Paediatric Orthopaedic outpatient clinic and evaluate the relationship between Vitamin D deficiency and the diagnosis of radiological or biochemical nutritional rickets. We performed a retrospective case note and biochemistry database review of all new patients seen in an elective Paediatric Orthopaedic clinic in the year 2010, who had Vitamin D levels measured. Radiographs were reviewed by the senior author to determine the presence or absence of radiological rickets. Biochemical rickets was diagnosed if there was deficient Vitamin D (< 20 mcg/ml) and raised PTH.Aim
Methods
In Northern Ireland the Health Visitor assessment at 6 months was demonstrated to be successful in detecting the majority of cases of DDH and was maintained, although moved to 4 months. There has been increased numbers of referrals resulting in prolonged waiting times for low risk infants. A retrospective review was performed of the records of all children treated for DDH in the three-year birth cohort from 2008 to 2010. Data was obtained by collating the records of the nurse led clinics, inpatient records and theatre logs from the three treating centres. 584 children were treated, 87% female. Treatment rate was 7.7/1,000 live births (2003 = 5.2). Twenty-three cases were diagnosed later than 1 year of age, 0.3/1,000 (2003 = 0.6); 146 cases were diagnosed later than 6 months 1.9/1000 (2003=1.7) of these 62 required operative treatment, 0.8/1,000 (2003 =1.1). The median age at referral was 7 weeks and ranged from 0 to 119 weeks. The median delay to be seen was 29 days with a highly skewed distribution, which ranged from 0 to 39 weeks. We found if waiting times had been capped at 9 weeks, as has been the case for other orthopaedic conditions, 52 patients who were seen after 6 months would have been seen on average 140 days earlier.Methods
Results
To evaluate the influence of arthrodiatasis in the natural history of the stages of the disease radiologically and also the timing of arthrodiatasis. 44 patients with Perthes' disease that had articulated hip distraction were radiologically evaluated. We assessed these based on Joseph's modified Elizabethtown classification before, during and soon after distraction. Other parameters used were the application of common radiological grading systems and other features.Aim
Materials and methods
2010 marked a century since Perthes' disease was first described, but the aetiology and mechanism remain unknown. Worldwide, the incidence of Perthes' disease varies widely, yet this may be through differences in study design, population denominators or case ascertainment. It is suggested that differential exposure to adverse socioeconomic circumstances may be a key precipitant, although this remains the subject of debate. This work draws on several epidemiological studies that have sought to develop the understanding of Perthes' disease by examining a case register from Merseyside, discharge data from Scotland and the world's largest community disease register. A systematic review was performed to ensure a robustness and homogeneity between published studies in order to allow meaningful comparisons. Studies were based on data from the Merseyside Perthes' Disease Register (1976–2008), the UK General Practice Research Database (GPRD, 1990–2008) and hospital discharge data for Scotland (2000–2009). Temporal trends and geographic patterns were analysed and the relationship to deprivation investigated. A systematic review of the published literature was used to explore international variations in incidence up to December 2010 focusing upon the influence of race and latitude. Analyses were conducted using Poisson regression.Introduction
Methods
Meningococcal septicaemia can result in growth arrest and angular deformities. The aim of this case series was to review the pattern of involvement in the lower leg. The notes and radiographs of all patients presenting with a growth arrest or deformity affecting the lower leg following meningococcal septicaemia between 1995 and 2010 were reviewed. There were fourteen patients, eight girls and six boys. The mean age of the patients at the time of presentation was 9.6 years.Aims
Patients and Methods
The aim of this mechanical study was to investigate the ability of cannulated fixation bolts to stop wire slippage in Ilizarov circular external fixators. Three types of cannulated fixation bolts (Smith and Nephew, Orthofix and one designed by the authors) were tested on Ilizarov rings to compare their performance. Three levels of bolt torques were applied and the wires were pulled to measure the load at which the wire will start to slip or fail. It was revealed that the initial resistance to slippage is due to plastic deformation of the wire under the clamp and is in fact governed by the size of this deformation. The slippage was found to occur in a slip/stick fashion, as the plastic deformation was propagated along the wire.Purpose of the study
Methods and Results
Circular frames treatment for limb reconstruction involves repeated follow up visits, and a substantial number of these appointments are for pin site review only, and incur a significant cost to the NHS. We advocate ‘Telemedicine’ as a logistically and economically viable option for routine post-operative review of pin-sites. The senior author performs fifty to sixty frame circular frame treatments in adults for trauma every year. For the past 12 months, we have been encouraging our frame patients to take photographs of their pin-sites when they do their weekly dressing changes. This is done with digital cameras by the patients themselves, and the images are then emailed to the senior author on his work email address, and get replied to by the next day. If the images are a cause for concern, further steps are initiated (Images 1 and 2 demonstrate pin-sites before and after a course of antibiotics, started because the first image was a cause for concern). This arrangement is for pin-site reviews only. This method has been used for the post-op pin site review of five patients with circular frames.Statement of purpose
Methods and results
We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hindfoot problems the Portsmouth experience with the Ilizarov ring fixator. We report on 10 patients who underwent ankle and hindfoot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR). All patients had undergone multiple previous surgeries which had failed. There were 7 males and 3 females in this group. Average age of the patients was 60 (47 years–77 years) Mean follow up was 32 months (6–56 months) BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hindfoot nail. All patients were satisfied with their overall improvement in pain and function.Purpose of the study
Methods and results
We describe a novel method to encourage children to weight-bear after frame surgery using a whoopee cushion; the objective of this study is to assess the amount of force taken though a limb using this method. The amount force is required to activate the whoopee cushion is measured when a subject takes weight though a whoopee cushion on a force plate. The speed of the foot in vertical and horizontal planes is assessed with motion analysis to correlate this to the activation of the cushion and is assessed under different conditions, and with different whoopee cushionsPurpose
Design/participants
The aim of this study is to evaluate the role of low intensity pulsed ultrasound, Exogen in the treatment of delayed and non unions. Methodology: We conducted a retrospective study of 292 patients who has had Exogen treatment for delayed and non union from 2005 to 2009. Patient's age, sex, associated co morbidities, smoking history, medications, type of fractures (open/closed), infection and site of fractures were sought for. 271 patients' data (228 delayed and 43 non unions) were available during the study with mean age of 53.5 yrs. Exogen therapy was initiated at 3–4 months for delayed unions and 6–12 months for non unions in 61 tibia (15 open); 31 femur (2 open); 20 scaphoid; 38 5th metatarsal; 31 ankle (2 open); 17 ulna (1 open); 15 radius (3 open); 29 humerus (2 open); 16 clavicles; 6 olecranon; 4 pilon (2 open) and 2 metacarpal fractures. Union was achieved in 196 patients (72.3%) of which 11 (5.6%) were smokers. In 73 (26.9 %) patients union was not achieved of which 53 (72 %) were smokers. The mean healing timing after application of Exogen was 16 weeks for delayed union and 26.6 weeks for non union. 5 (31.2%) pt out of 16 in the DM group went into non union.Purpose of study
Discussion
Conventional surgical treatment of relapsed or neglected club foot deformities is not always successful or easy to apply. The presence of shortened neurovascular structures and unhealthy skin may preclude the surgical interference. Bone resection in severe deformities results in short foot which is not satisfactory functionally and cosmetically. In this study we evaluate the use of the bloodless technique for management of relapsed or neglected club foot deformities. From Jan 2000–2006, 64 cases older than 2 years with relapsed or neglected club foot deformities were referred to our center. Four cases were excluded because of inadequate follow up data. This thesis based on 60 consecutive cases (67 feet). The patients average age was 8 years and 4 months (range, 2–16 years). Seven cases were bilateral, 20 Left sides, and 34 Right sides. There were 57 relapsed club foot (5 bilateral), and 3 cases were neglected (2 bilateral). Patients with relapsed club foot had average 3 previous operations (range, 1–8 operations). There was no preoperative assembling of the apparatus. The construct was designed according to the condition of deformity: equinus, varus forefoot etc. Additional procedures, elongation of tendoachilis was done concomitantly with the original procedure in 10 cases. The patients were discharged from the hospital the same day of the operationObjectives
Methods
This study retrospectively reviews all forearm lengthenings carried out by the author in order to assess results and complications and determine the efficacy of this treatment in children with various pathologies. The records of all patients who had undergone a forearm lengthening between 1995 and 2009 were reviewed. 23 forearm lengthenings in 20 patients were identified but in one case there was insufficient information for the study. The study is therefore based on 22 lengthenings. The patients were divided into two groups, Group A in whom the purpose of treatment was to restore the length relationship between the radius and ulna and Group B in whom the purpose was to gain forearm length. In Group A patients the aim was to protect the radial head against dislocation by lengthening the ulna (with if necessary a corrective radial osteotomy) or to protect the wrist from subluxation by a radial lengthening. In Group B patients the aim was to improve function and cosmesis. The average age of the patients at time of surgery was 9.78 years, average follow up was 26 months post frame removal. There were 11 patients in Group A with an average radio ulnar discrepancy of 2.34 cms and 11 patients in Group B. In Group A patients the average length achieved was 2.69 cms i.e. overcorrection and in Group B the average lengthening was 3.84 cms. In Group A patients lengthening was only partially successful at preventing subluxation or dislocation of the radial head. Common complications were pin site infection and poor regenerate formation. Forearm lengthening by distraction osteogenesis is a worthwhile procedure in paediatric patients with improved cosmesis and function particularly in Group B patients.
A prospective study to report the results of using gentamycin-collagen in the surgical treatment of osteomyelitis. After complete radiological and laboratory studies, empirical systemic Imipenem antibiotic was started pre-operatively followed by radical operation and implantation of Collatamp-EG®. Bone defects were treated with iliac or composite ceramic bone graft. Primary or secondary soft tissue reconstructive procedures were used. Closed gravitational suction drainage was used. Parental systemic antibiotics were continued for 2–3 weeks according to culture sensitivity results followed by oral therapy for another 4 weeks. Cattaneo et al scoring system was used to evaluate the final bony and functional results.Aim
Materials and Methods
The incidence of relapses could be occur in sever clubfeet deformities whether treated surgically or non surgically. In this study, we evaluate the results of correction of residual and recurrent congenital clubfoot with soft tissue distraction or osteotomy techniques using Ilizarov external fixation. This study included 35 feet in 28 patients were treated between 1999 to 2007. 16 feet in thirteen patients with an average age 13.7 (range from 11–29 years) were treated with percutaneous calcaneal V steotomy and gradual correction by Ilizarov method. 19 feet in fifteen patients with an average age 10.5 (range from 4–22 years) were treated with distraction of joints through soft tissue with Ilizarov technique. The mean average follow up period was 5.6 years ranged from (1–8 years).Purpose
Methods
In poliomyelitis; hand to knee gait is the sum of quadriceps weakness and fixed knee flexion deformity. Limb shortening is another added problem. Usually, each problem is attacked separately; with variable end results and complication rates for each procedure. 22 patients (16–46 y.); with poliomyelitis with hand to knee gait due to fixed knee flexion deformity of mild to moderate degree (10–400); and limb shortening of 4.5–9.5 cm., were managed simultaneously by a single operation. A distal femoral metaphyseal anterior closing wedge (recurvatum) corrective osteotomy was done to treat acutely the fixed knee flexion deformity(and subsequently hand to knee gait). A modified Wagner or Orthofix frame was applied as a mono-plane mono-axial lengthening device to stabilize the osteotomy and to lengthen the short limb. Lengthening was started in all cases two weeks post-operatively.Background
Patients and methods
Twins are often considered to be at an increased
risk of developmental dysplasia of the hip (DDH); we therefore investigated
whether multiple births have a higher incidence of DDH, and if selective
ultrasound scanning should be considered for these infants. We reviewed our records of all live births between 1 January
2004 and 31 December 2008 and included 25 246 single and 990 multiple
births. Multiple births did not have a significantly higher incidence
of DDH compared with single births (0.0030 We conclude that being a twin or triplet in itself is not a risk
factor for DDH and that selective ultrasound scanning is not indicated
for this population. Cite this article:
To study the results of using recombinant human bone morphogenic protein-2 (rhBMP-2) to achieve bone union in children with complex orthopaedic problems including skeletal dysplasia, congenital limb deficiencies and complex trauma. Between November 2006 to April 2010, rhBMP-2 was used to achieve bone healing in a total of 19 children. The indications were delayed union or non-union in 16 long bones where previous surgeries had failed and 4 posterior spinal fusions. All children had underlying complex orthopaedic problems predisposing them to delayed bone healing. The average age at the time of surgery was 13 years and 8 months (Range: From 4 years to 19 years and 4 months). There were 7 boys and 12 girls.Aim
Materials & Methods
Complex tibial fractures are difficult to treat. The costs associated with hospitalization can be substantial, yet it is unknown how these vary depending upon the type of implant used. There have been multiple studies on economics of tibial fractures but none of these studies actually focussed on costing of illizarov and taylor spatial frames. We discuss the cost analysis of 200 tibial fractures treated with illizarov or taylor spatial frames. The purpose of this study was to compare the cost of treatment of complex tibial fractures with reimbursement given to the hospital in treating such injuries. We evaluated the economical data of 200 patients with complex tibial fractures treated with illizarov frame or taylor spatial frame from May 2005 to May 2010. Demographic data, fracture classification and method of surgical treatment along with the length of hospital stay were recorded in detail. The total cost calculated was then compared to the range of reimbursement price based on HRG (human Resource Group) coding. The implant cost was determined from the buying cost of institution.Background
Methods
We report 3 cases from different centres of infantile tibia vara in which the deformity was due to slippage of the proximal tibial epiphysis on the metaphysis; the aim of this study was to define the features of this previously unreported condition, and their implications for management. Three cases of tibia vara secondary to atraumatic slippage of the upper tibial epiphysis on the metaphysis were identified from three different centres. The case notes and imaging studies were retrospectively reviewed to distinguish common clinical and radiographic features.Introduction
Method
The present study was conducted to evaluate the cost of physiotherapy both for inpatient and outpatient services. Significant physiotherapy resources are required to rehabilitate patients with an Ilizarov or Taylor Spatial Frame (TSF). Within Hull and East Yorkshire Hospitals NHS Trust Physiotherapy department the average number of outpatient treatment sessions per routine patient is 6. In comparison, the average number of treatment sessions required for a patient with an ilizarov (or TSF) is 24 for a trauma patient and 33 for a patient undergoing an elective procedure. Seventy three (73) patients received physiotherapy treatment with an Ilizarov frame or a Taylor spatial frame between April 2008 and April 2010. Physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient (if the patient received their treatment within Hull and East Yorkshire NHS trust). Data collection was divided into either trauma or elective procedure for analytical purposes. The average cost of physiotherapy treatment to Hull and East Yorkshire Hospitals NHS Trust for an inpatient with an ilizarov frame is £121.82 per case (trauma) and £133.15 per case (elective). The average cost of physiotherapy treatment to Hull and East Yorkshire Hospitals NHS Trust for an outpatient for a trauma case was calculated as £404.65 and £521.41for an average elective case. This is in comparison to a routine patient costing the service £60.29 (when treated by a Band 7 physiotherapist). The present study gives valuable data for future business planning and assistance with the setting of local or national tariffs for the treatment of this patient group.
The specific methods of skeletal reconstruction of massive bone loss remains a topic of controversy. The problem increased in case of massive bone loss, extensive soft tissue scar, vascular compromise, and short tibial remnants. We evaluate the use of fibula in association of Ilizarov external fixator in management of massive post traumatic bone loss of tibial shaft.Abstract
Aim of the work
