Aims. This study sought to estimate the clinical outcomes and describe the nationwide variation in practice, as part of the feasibility workup for a National Institute for Health and Care Excellence (NICE) recommended randomized clinical trial to determine the optimal treatment of torus fractures of the distal radius in children. Methods. Prospective data collection on torus fractures presenting to our emergency department. Patient consent and study information, including a copy of the Wong-Baker Faces
Aims. Torus fractures of the distal radius are the most common fractures in children. The NICE non-complex fracture guidelines recently concluded that bandaging was probably the optimal treatment for these injuries. However, across the UK current treatment varies widely due to a lack of evidence underpinning the guidelines. The Forearm Fracture Recovery in Children Evaluation (FORCE) trial evaluates the effect of a soft bandage and immediate discharge compared with rigid immobilization. Methods. FORCE is a multicentre, parallel group randomized controlled equivalence trial. The primary outcome is the Wong-Baker FACES
Paediatric fractures are highly prevalent and are most often treated with plaster. The application and removal of plaster is often an anxiety-inducing experience for children. Decreasing the anxiety level may improve the patients’ satisfaction and the quality of healthcare. Virtual reality (VR) has proven to effectively distract children and reduce their anxiety in other clinical settings, and it seems to have a similar effect during plaster treatment. This study aims to further investigate the effect of VR on the anxiety level of children with fractures who undergo plaster removal or replacement in the plaster room. A randomized controlled trial was conducted. A total of 255 patients were included, aged five to 17 years, who needed plaster treatment for a fracture of the upper or lower limb. Randomization was stratified for age (five to 11 and 12 to 17 years). The intervention group was distracted with VR goggles and headphones during the plaster treatment, whereas the control group received standard care. As the primary outcome, the post-procedural level of anxiety was measured with the Child Fear Scale (CFS). Secondary outcomes included the children’s anxiety reduction (difference between CFS after and CFS before plaster procedure), numerical rating scale (NRS) pain, NRS satisfaction of the children and accompanying parents/guardians, and the children’s heart rates during the procedure. An independent-samples Aims
Methods
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. 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 paediatric orthopaedic surgeons. Hip shape and Stulberg class were compared to PROM scores.Aims
Methods
Aims. The management of fractures of the medial epicondyle is one of the greatest controversies in paediatric fracture care, with uncertainty concerning the need for surgery. The British Society of Children’s Orthopaedic Surgery prioritized this as their most important research question in paediatric trauma. This is the protocol for a randomized controlled, multicentre, prospective superiority trial of operative fixation versus nonoperative treatment for displaced medial epicondyle fractures: the Surgery or Cast of the EpicoNdyle in Children’s Elbows (SCIENCE) trial. Methods. Children aged seven to 15 years old inclusive, who have sustained a displaced fracture of the medial epicondyle, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb
The aim was to assess the effect of caudal block on patients who have had proximal femoral &/or pelvic osteotomy compared to patients who have had epidural anaesthesia with regards to pain relief and hospital stay. We looked at two patient cohorts; epidural & caudal pain relief in aforementioned procedures. Interrogation of our clinical database (WinDip, BlueSpeir&clinical notes) identified 57 patients: 33 proximal femoral osteotomy, 13 pelvic osteotomy and 11 combined(25 Males 32 Females), aged 1–18 years-old between 2012–2014, in two institutions. A database of demographics, operative indications, associated procedures, analgesia and type of anaesthesia was constructed in relation to daily
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. Results. 19 Syme and one Boyd amputation in 19 patients were performed early (mean age 15 months). 4 Syme and one trans-tibial amputation in 4 patients took place in older children (mean age 6.6 years). K Scores were significantly higher (mean 4 versus 2) and
Purpose. The purpose of this paper is to describe the outcomes of major hip surgery for children with cerebral palsy and communication difficulties using a validated health related quality of life measure and a validated
This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced upper limb fractures in children. An exploratory RCT was performed at a tertiary paediatric referral hospital between 1 June 2018 and 30 September 2019. The intention-to-treat population consisted of 170 patients (mean age 8.42 years (SD 3.42); Woodcast (WCG), n = 84, 57 male (67.9%); Dynacast (DNG), n = 86, 58 male (67.4%)). Patients with undisplaced upper limb fractures were randomly assigned to WCG or DNG treatment groups. Primary outcome was the stress stability of the splint material, defined as absence of any deformations or fractures within the splint during study period. Secondary outcomes included patient satisfaction and medical staff opinion. Additionally, biomechanical and chemical analysis of the splint samples was carried out.Aims
Methods
Slipped upper femoral epiphysis (SUFE) is the
most common hip disorder to affect adolescents. Controversy exists over
the optimal treatment of severe slips, with a continuing debate
between in situ fixation versus corrective surgery.
We present our experience in a series of 57 patients presenting
with severe unilateral SUFE (defined >
50°) managed with a subcapital
cuneiform osteotomy. Between 2001 and 2011, 57 patients (35 male, 22 female) with
a mean age of 13.1 years (9.6 to 20.3, SD 2.3) were referred to
our tertiary referral institution with a severe slip. The affected
limb was rested in slings and springs before corrective surgery
which was performed via an anterior Smith-Petersen approach. Radiographic
analysis confirmed an improvement in mean head–shaft slip angle
from 53.8. o. (standard deviation (. sd) 3.2). pre-operatively
to 9.1. o. (. sd. 3.1) post-operatively, with minimal
associated femoral neck shortening. In total 50 (88%) patients were complication
free at a mean follow-up of seven years (2.8 to 13.9 years, . sd. 3).
Their mean Oxford hip score was 44 (37 to 48) and median visual
analogue
Purpose. To establish the early outcome, satisfaction and complications of sinus tarsi implants in the management of symptomatic flexible flatfeet for a paediatric population. Methods and results. We included all patients aged 18 years or less who were treated for flexible flatfeet with a sinus tarsi implant between January 2010 and June 2012. We excluded patients who had a history of clubfeet or tarsal coalition. 34 patients had 59 implants. The mean age at surgery was 13.7 yrs (9–17 yrs), with mean follow-up of 22 months (range 10–35). Mean AOFAS improved from 65.7 to 87.9 (p<0.001), with an improvement in AOFAS
Delayed diagnosis is a well-known complication of a Monteggia
fracture-dislocation. If left untreated, the dislocated radial head
later becomes symptomatic. The purposes of this study were firstly,
to evaluate the clinical and radiological results of open reduction
of the radial head and secondly, to identify the factors that may
affect the outcome of this procedure. This retrospective study evaluated 30 children with a chronic
Monteggia lesion. There were 18 boys and 12 girls with a mean age
of 7.4 years (4 to 13) at the time of open reduction. The mean interval
to surgery, after the initial fracture, was 23.4 months (6 to 120).
Clinical grading used a Kim modified elbow score: radiological outcome
was recorded. The effect of the patient’s age, gender, duration
from initial injury, Bado classification, and annular ligament reconstruction
were analyzed. The mean follow-up was 42.2 months (15 to 20).Aims
Materials and Methods
Background. Congenital vertical talus (CVT) is a rare deformity of the foot. It has been historically treated with extensive soft tissue releases with significant associated complications. Recently, reverse Ponseti-type casting followed by minimally invasive or percutaneous reduction and fixation has been described with excellent results in separate cohorts of either idiopathic or teratologic cases of CVT. There are currently no studies that compare the outcomes between the two types. Methods. We present a prospective cohort of 13 patients (21 feet) in which this technique has been used in both idiopathic and teratologic associated cases of CVT. Clinical, radiographic and parent-reported outcomes were obtained at a mean follow up of 36 months (range 8–57). Clinical and radiographic scoring was according to the system of Adelaar and parent-reported outcomes were assessed using the POSNA paediatric outcomes data collection instrument (PODCI). Results. Six patients (9 feet) had associated neuromuscular conditions or syndromes; seven patients (11 feet) were idiopathic. Initial correction was achieved in all patients with significant improvement in all radiographic parameters. The recurrence rate was 48%; there was no statistical significance between idiopathic and teratologic cases for rate of recurrence. Further treatment was required in the form of casting in 2 feet and open release in 6 feet. Adelaar scores were significantly lower in the recurrence group than in those with no recurrence. PODCI scores for global functioning at latest follow-up were a mean of 72 (range 18–98).
To compare the structural durability of hydroxyapatite-tricalcium
phosphate (HATCP) to autologous iliac crest bone graft in calcaneal
lengthening osteotomy (CLO) for pes planovalgus in childhood. We present the interim results of ten patients (HATCP, n = 6
and autograft, n = 5) with a mean age of 11.5 years (8.2 to 14.2)
from a randomised controlled non-inferiority trial with six months
follow-up. The primary outcome was the stability of the osteotomy
as measured by radiostereometric analysis. A non-inferiority margin
of ≤ 2 mm osteotomy compression was set.Aims
Patients and Methods
Children with congenital vertical talus (CVT)
have been treated with extensive soft-tissue releases, with a high
rate of complications. Recently, reverse Ponseti-type casting followed
by percutaneous reduction and fixation has been described, with
excellent results in separate cohorts of children with CVT, of either
idiopathic or teratological aetiology. There are currently no studies
that compare the outcome in these two types. We present a prospective cohort
of 13 children (21 feet) with CVT of both idiopathic and teratological
aetiology, in which this technique has been used. Clinical, radiological
and parent-reported outcomes were obtained at a mean follow-up of
36 months (8 to 57). Six children (nine feet) had associated neuromuscular
conditions or syndromes; the condition was idiopathic in seven children
(12 feet). Initial correction was achieved in all children, with significant
improvement in all radiological parameters. Recurrence was seen
in ten feet. Modification of the technique to include limited capsulotomy
at the initial operation may reduce the risk of recurrence. The reverse Ponseti-type technique is effective in the initial
correction of CVT of both idiopathic and teratological aetiology.
Recurrence is a problem in both these groups, with higher rates
than first reported in the original paper. However, these rates
are less than those reported after open surgical release. Cite this article: