Triplane ankle fractures are complex injuries typically occurring in children aged between 12 and 15 years. Classic teaching that closure of the physis dictates the overall fracture pattern, based on studies in the 1960s, has not been challenged. The aim of this paper is to analyze whether these injuries correlate with the advancing closure of the physis with age. A fracture mapping study was performed in 83 paediatric patients with a triplane ankle fracture treated in three trauma centres between January 2010 and June 2020. Patients aged younger than 18 years who had CT scans available were included. An independent Paediatric Orthopaedic Trauma Surgeon assessed all CT scans and classified the injuries as n-part triplane fractures. Qualitative analysis of the fracture pattern was performed using the modified Cole fracture mapping technique. The maps were assessed for both patterns and correlation with the closing of the physis until consensus was reached by a panel of six surgeons.Aims
Methods
Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years’ follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein’s line were recorded. Subanalysis was performed according to sex and age.Aims
Methods
Aims. The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems. Methods. A Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of
Aims. This study aimed to evaluate the relationship between hip shape and mid-term function in Perthes’ disease. It also explored whether the modified three-group Stulberg classification can offer similar prognostic information to the five-group system. Methods. A total of 136 individuals aged 12 years or older who had Perthes’ disease in childhood completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility score (function), Nonarthritic Hip Score (NAHS) (function), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) score (quality of life), and the numeric rating scale for pain (NRS). The Stulberg class of the participants’ hip radiographs were evaluated by three fellowship-trained
Avascular necrosis (AVN) of the femoral head is a devastating complication of slipped capital femoral epiphysis (SCFE). The reported prevalence of AVN following unstable SCFE has ranged between fifteen and forty-seven per cent in the literature. The explanation for this discrepancy is not clear. The inter-observer and intra-observer agreement between Orthopaedic surgeons for the radiographic diagnosis of AVN following SCFE has not been reported. It is the objective of this study to estimate these parameters between two experienced
Introduction. Derotation osteotomies are commonly performed in paediatric orthopaedic and limb reconstruction practice. The purpose of this study was to determine whether the use of a digital inclinometer significantly improves the accuracy in attaining the desired correction. Materials & Methods. We designed an electronic survey regarding derotation femoral osteotomy (DFO) including methods of intra-operative angular correction assessment and acceptable margins of error for correction. This was distributed to 28
Introduction. Activity scales are used throughout orthopaedics as a component of PROMs. Tegner Activity Scale is commonly used and is validated in various knee injuries in adults. It has a reading age of 18 years presenting an understanding problem for children. An alternative is HSS-PediFABS, but this looks at specific skills like running, cutting, pivoting rather than sporting level. Our aim was to determine if children understood TAS and whether their answers compared to how their parents scored them and determine if our suggested sporting levels were more appropriate for them. Method. We created a study form to compare levels given by children and their parent. We added our own suggested levels, with a reading age of 9, created by a discussion group of
Introduction: School screening for scoliosis aims to reduce the need for surgery by detecting curve changes in children at an early stage when bracing may be effective in halting the progression of the deformity. Although the effectiveness of the current screening techniques has not been established yet, AAOS and SRS continue to support school screening.. The major criticism focuses on the cost-ineffectiveness of the process, as too many students are unjustifiably referred to specialists. Moreover, examiner’s skills and experience are important factors in screening outcome. An ongoing, large-scale study of school screening is conducted in public schools at the northern part of Israel comparing the screening performance of a Scoliometer and a new, hand-held computerized device (SpineScan). SpineScan was designed to automatically measure the “angle of trunk inclination” (ATI), and is less dependent on examiner’s level of medical training. Furthermore, this tool enables also fast assessment of the kyphosis angle. Methods: In a first phase of the study, 1000 children aged 10 to 14 years were screened. Each child underwent “blinded” examinations by two examiners with different skills (a
Guiding growth by harnessing the ability of growing bone to undergo plastic deformation is one of the oldest orthopaedic principles. Correction of deformity remains a major part of the workload for
We have tested the reliability of a recently reported classification system of hip morphology in adolescents with cerebral palsy in whom the triradiate cartilage was closed. The classification is a six-grade ordinal scale, based on the measurement of the migration percentage and an assessment of Shenton’s arch, deformity of the femoral head, acetabular deformity and pelvic obliquity. Four
The Gartland extension-type supracondylar humerus fracture is the most common elbow fracture in the paediatric population. Depending on fracture classification, treatment options range from nonoperative treatment such as taping, splinting or casting to operative treatments such as closed reduction and percutaneous pinning or open reduction. Classification variability between surgeons is a potential contributing factor to existing controversy over nonoperative versus operative treatment for Type II supracondylar fractures. The purpose of this study was to investigate levels of agreement in classification of extension-type supracondylar humerus fractures using the Gartland classification system. A retrospective chart review was conducted on patients aged 2–12 years who had sustained an extension-type supracondylar fracture and received either operative or nonoperative treatment at a tertiary children's hospital. De-identified baseline anteroposterior (AP) and lateral plain elbow radiographs were provided along with a brief summary of the modified Gartland classification system to surgeons across Canada, United States, Australia, United Kingdom and India. Each surgeon was blinded to patient treatment and asked to classify the fractures as Type I, IIA, IIB or III according to the classification system provided. A total of 21
Dynamic 2D sonography of the infant hip is a commonly used clinical procedure for developmental dysplasia of the hip (DDH) screening. It however has been found to be unreliable with some studies reporting associated misdiagnosis rates of up to 29%. In a recent systematic review, Charlton et al. examined dynamic ultrasound (US) screening for hip instability in the first six weeks after birth and found current best practices for such early screening techniques to be divergent between international institutions in terms of clinical scanning protocols. Such protocols include: the appropriate scanning plane and US probe position (e.g. coronal, transverse, lateral, anterior), DDH diagnostic metrics (e.g. femoral head coverage, alpha angle), appropriate patient age when scanning, and follow up procedures. To improve reliability of diagnosis and to help in standardizing diagnosis across different raters and health-centers, we propose an automated method for dynamically assessing hip instability using 3D US. 38 infant hips from 19 patients were scanned with B-mode 3D US by a
Developmental Dysplasia of the Hip (DDH) is the most common orthopaedic disorder in newborns. Whilst the Pavlik harness is one of the most frequently used treatments for DDH, there is immense variability in treatment parameters reported in the literature and in clinical practice, leading to difficulties in standardising teaching and comparing outcomes. In the absence of definitive quantitative evidence for the optimal Pavlik harness management strategy in DDH, we addressed this problem by scientifically obtaining international expert-based consensus on the same. An initial list of items relevant to Pavlik harness treatment was derived by systematic review of the literature according to PRISMA criteria and reviewed by two expert clinicians in DDH management. Delphi methodology was used to guide serial rounds of surveying and feedback to content matter experts from the International Hip Dysplasia Institute (IHDI), a collaborative group of
Avascular necrosis (AVN) of the femoral head is a potentially devastating complication of treatment for developmental dysplasia of the hip (DDH). AVN most commonly occurs following operative management by closed (CR) or open reduction (OR). This occurrence has frequently been examined in single centre, retrospective studies, however, little high-level evidence exists to provide insight on potential risk factors. The purpose of this observational, prospective multi-centre study was to identify predictors of AVN following operatively-managed DDH. A multi-centre, prospective database of infants diagnosed with DDH from 0–18 months was analyzed for patients treated by CR and/or OR. At minimum one year follow-up, the incidence of AVN (Salter criteria) was determined from AP pelvis radiographs via blinded assessment and consensus discussion between three senior
Musculoskeletal ultrasound (MSK-US) can have many uses for orthopaedic surgeons, such as assisting in clinical diagnosis for muscle, tendon and ligament injuries, providing direct guidance for joint injections, or assessing the adequacy of a reduction in the emergency department. However, proficiency in sonography is not a requirement for Royal College certification, and orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK-US course in an orthopaedic surgery program. A MSK-US course for orthopaedic surgery residents was developed by an interdisciplinary team involving a
Purpose. To assess the use of radiographic measurement compared to descriptive classification in the evaluation of Perthes'
disease. Method. Fifteen consultant
Congenital talipes equinovarus (CTEV) is a complex three-dimensional deformity with an incidence of 1–3 per 1000 live births. The Ponseti method is widely accepted and practiced, giving reliably good long-term results. There are a number of studies showing the benefits of a physiotherapy led Ponseti service with outcomes similar to a consultant led service. We present the first prospective randomised series comparing a physiotherapy led Ponseti service with a standard orthopaedic surgeon led series. 16 infants with bilateral CTEV were randomised into two groups. Each infant had one foot treated by a physiotherapist and the other foot treated by an orthopaedic surgeon using the Ponseti technique. Both groups had a premanipulation Pirani score of 5.5. All patients were followed up for a minimum of 12 months and the results demonstrated no significant difference in the post-treatment Pirani scores (p=0.77) and no significant difference in the success rate the Ponseti technique (p=1.00). This study is the first of its kind and demonstrates the value of a physiotherapy led Ponseti service in the management of CTEV. Although overall supervision by a
The management of the dysplastic hip represents a clinical and a technical challenge to the
Early detection of Developmental Dysplasia of the Hip (DDH), and treatment, may prevent the need for surgical correction following late presentation. Neonatal examination, and ultrasound screening of at risk groups, does not detect all cases. Most neonates treated in the Intensive Care Unit (NICU) have abdominal radiographs performed during their stay. These include the hips but DDH is not routinely looked for. 50 neonatal abdominal films (five from patients who subsequently were found to have DDH, 45 from patients without this condition) were randomly shown to three
Supracondylar humeral fractures are common in
children, but there are no classification systems or radiological parameters
that predict the likelihood of having to perform an open reduction.
In a retrospective case–control study we evaluated the use of the
medial spike angle and fracture tip–skin distance to predict the
mode of reduction (closed or open) and the operating time in fractures
with posterolateral displacement. A total of 21 patients (4.35%) with
a small medial spike angle (<
45°) were identified from a total
of 494 patients, and 42 patients with a medial spike angle of >
45° were randomly selected as controls. The medial spike group had
significantly smaller fracture tip–skin distances (p <
0.001),
longer operating times (p = 0.004) and more complications (p = 0.033)
than the control group. There was no significant difference in the
mode of reduction and a composite outcome measure. After adjustments
for age and gender, only fracture tip–skin distance remained significantly
associated with the operating time (β = -0.724, p = 0.042) and composite
outcome (OR 0.863 (95% confidence interval 0.746 to 0.998); p = 0.048).