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The Bone & Joint Journal
Vol. 104-B, Issue 2 | Pages 302 - 308
1 Feb 2022
Dala-Ali B Donnan L Masterton G Briggs L Kauiers C O’Sullivan M Calder P Eastwood DM

Aims

Osteofibrous dysplasia (OFD) is a rare benign lesion predominantly affecting the tibia in children. Its potential link to adamantinoma has influenced management. This international case series reviews the presentation of OFD and management approaches to improve our understanding of OFD.

Methods

A retrospective review at three paediatric tertiary centres identified 101 cases of tibial OFD in 99 patients. The clinical records, radiological images, and histology were analyzed.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 7 - 7
1 Jun 2017
Calder P Shaw S Roberts A Tennant S Sedki I Hanspal R Eastwood D
Full Access

Purpose

This study compares outcomes in patients with complete congenital fibula absence, associated with severe lower limb deformity, treated with an amputation protocol to those using an extension prosthesis.

Method

32 patients were identified. 9 patients (2M: 7F, median age at presentation of 22 yrs) utilized an extension prosthesis. 23 patients (16M: 7F, median age at presentation of 10 months) underwent 25 amputations during childhood: only two underwent tibial kyphus correction to facilitate prosthetic wear.

Mobility was assessed using the SIGAM and K scores. Quality of life was assessed using the PedsQL inventory questionnaire; pain by a verbal severity score. Patients undergoing amputation were further subdivided by age, below and above 2 yrs at the time of surgery.


The Bone & Joint Journal
Vol. 98-B, Issue 11 | Pages 1548 - 1553
1 Nov 2016
Tennant SJ Eastwood DM Calder P Hashemi-Nejad A Catterall A

Aims

Our aim was to assess the effectiveness of a protocol involving a standardised closed reduction for the treatment of children with developmental dysplasia of the hip (DDH) in maintaining reduction and to report the mid-term results.

Methods

A total of 133 hips in 120 children aged less than two years who underwent closed reduction, with a minimum follow-up of five years or until subsequent surgery, were included in the study. The protocol defines the criteria for an acceptable reduction and the indications for a concomitant soft-tissue release. All children were immobilised in a short- leg cast for three months. Arthrograms were undertaken at the time of closed reduction and six weeks later. Follow-up radiographs were taken at six months and one, two and five years later and at the latest follow-up. The Tönnis grade, acetabular index, Severin grade and signs of osteonecrosis were recorded.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_6 | Pages 3 - 3
1 Feb 2013
Wright J Randhawa S Gooding C Lowery S Calder P
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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.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_6 | Pages 17 - 17
1 Feb 2013
Stöhr K Randhawa S Calder P Tennant S Hashemi-Nejad A Eastwood D
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Purpose of study

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.

Methods

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.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIV | Pages 4 - 4
1 May 2012
de Gheldere A Hashemi-Nejad A Calder P Tennant S Eastwood D
Full Access

Purpose

To document the success rate of closed reduction and soft tissue release in the treatment of bilateral true dislocation in developmental dysplasia of the hip (DDH).

Methods

Case-note review of 22 children (44 hips) with idiopathic bilateral hip dislocation referred to a tertiary centre before walking age. The management protocol was as follows:

Examination under general anaesthesia, arthrogram, closed reduction and appropriate soft tissue release (adductors/psoas), application of a ‘frog’ cast.

CT scan at 2 weeks to confirm reduction.

Change of cast and arthrogram at 6 weeks to confirm improving position and stability.

Cast removal at 12 weeks, and application of an abduction brace for 6 weeks.

Treatment failure could occur on day 1 (failure of reduction), at week 2 (failure to maintain reduction), at week 6, or after cast removal.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VII | Pages 7 - 7
1 Mar 2012
Calder P Tennant S Hashemi-Nejad A Catterall A Eastwood D
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Purpose

To investigate the effect of soft tissue release (STR) and the length of postoperative immobilisation on the long term outcomes of closed reduction (CR) of the hip for developmental dysplasia of the hip.

Materials

77 hips (72 patients) who had undergone closed reduction (CR) between 1977-2005 were studied retrospectively to review their outcome (Severin grade), identify the reasons for failure and to assess factors associated with residual dysplasia. Particular attention was paid to the use of a STR at the time of CR (to improve initial hip stability) and the duration of postoperative immobilisation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_VII | Pages 10 - 10
1 Mar 2012
de Gheldere A Calder P Bradish C Eastwood D
Full Access

Purpose

To document the incidence and nature of complications associated with hemiepiphysiodesis using a screw and plate device (8-plate, Orthofix).

Methods

We reviewed case notes and radiographs of 71 children (130 segments) with lower limb deformities treated with temporary hemiepiphyseal arrest using the 8-plate. 96% of deformities were in the coronal plane, 4% sagittal. 72% of coronal deformities demonstrated valgus malalignment. We defined three types of complications:

early (perioperative) complications eg infection and/or wound breakdown, bleeding, neurological impairment

implant related complications such as soft tissue irritation, plate breakage or migration,

complications involving the growth plate including rebound deformity, early physeal closure or iatrogenic deformity.

Complications were related to variables of patient age, gender, diagnosis, location of deformity and associated surgery.