This is the first study in the Ponseti-era to compare severity and outcomes in cases of idiopathic congenital talipes equinovarus (CTEV) diagnosed antenatally versus those diagnosed at birth. Small pre-Ponseti studies showed antenatal diagnosis to be a predictor of severity and poor prognosis. Prospective data collection was used to compare indicators of severity and outcomes for idiopathic CTEV between these two groups. These include Pirani score, number of casts, follow-up Roye score and need for surgery. 68 children with 106 affected feet were included. Antenatal diagnosis (AD) was made in 45 children (71 feet), with birth diagnosis (BD) in 23 children (35 feet). Mean follow-up age was 4.8 years (AD = 4.9, BD = 4.7), male:female ratio 2:1 (AD=BD) with bilateral CTEV in 55% (AD = 58%, BD=52%). Mean initial Pirani scores were 5.25 in the AD group vs 4.86 in the BD group (p=0.06). Mean Roye score at follow-up was 1.39/4 in the AD group vs 1.26/4 in the BD group (p=0.33) with 33% vs 30% complaining of pain respectively (p=0.80). Surgery was needed in 11/71 (15.5%) in the AD group vs 1/35 (2.9%) in the BD group (p=0.06)) There is no significant difference in severity between antenatal and birth diagnoses of idiopathic CTEV and no difference in outcomes between these groups when treated with the Ponseti regime. Although small, our sample size is greater than the largest published comparable study.
AIS causes a loss of trunk height. This paper documents this loss against sitting height standards and assesses formulae for adjusting height loss back to the standard. A total of 334 patients (84% female) with AIS and no other known systemic disease had sitting height measured. This was compared to standards of sitting height with age and the ratio of height to sitting height with age (HSH). The corrected height was calculated using published formulae and replotted against these standards.Aim:
Methods:
Monitoring of scoliosis is traditionally done with radiographs, which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigated whether the findings from surface topography can be used to monitor scoliosis curves and how much this method affects outcome scores in patients with scoliosis. This study therefore had two subsets: (1) to investigate whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic Cobb angle, providing an alternative non-invasive means of monitoring patients with scoliosis (LA and Cobb subset); and (2) to establish the relationships between the magnitude of the deformity in scoliosis, measured by Cobb angle on radiograph and volumetric asymmetry (VA) with the ISIS2 surface topography, and the patient perception of self-image and mental health, measured with SRS-22 scores (Cobb, VA, and SRS subset). In the LA and Cobb subset, 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55° or less were included in the study. They had clinical assessment, Cobb angle measurement taken from a standard radiograph, and surface topography done on the same day. A comparison of Cobb angle and LA was done. In the Cobb, VA, and SRS subset, 89 untreated patients with scoliosis were included in the study. They had clinical assessment, Cobb angle measurement of radiograph, and surface topography done on the same day along with SRS-22 questionnaires. A comparison correlation of SRS scores for function, pain, self-image, and mental health against Cobb angle and VA was undertaken. All statistical analysis was done with software R.Introduction
Methods
To establish the relation between the magnitude of the deformity in scoliosis, measured by cobb angle on radiograph & Volumetric asymmetry with the ISIS2 surface topography, and the patient perception of self image and mental health, measured with SRS-22 scores. A total of 89 untreated patients with scoliosis were included in the study. They had clinical assessment, cobb angle measurement of radiograph and surface topography performed on the same day along with SRS-22 questionnaires. The cobb angle was measured by single surgeon using a digital PACS system, who was unaware of the volumetric asymmetry score. Volumetric asymmetry was measured by ISIS2 surface topography performed by a research nurse who was unaware of the cobb angle. Volumetric asymmetry was calculated using standard ISIS2 software. A comparison correlation of SRS scores for function, pain, self image and mental health against cobb angle and volumetric asymmetry was undertaken by clinical scientist. Scores for patient satisfaction to treatment was excluded as these were untreated patients. Statistical analysis was performed using cor. test on software RPurpose of the study
Methodology
Monitoring of scoliosis is traditionally done with radiographs which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigates whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic cobb angle, to provide an alternative non- invasive means of monitoring scoliosis patients. A total of 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55 degrees or less were included in the study. They had clinical assessment, cobb angle measurement taken from a standard radiograph and surface topography done on the same day. The cobb angle were measured by single surgeon using digital PACS system. The surgeon was unaware of the LA score. Lateral asymmetry was measured using ISIS2 surface topography done by a research nurse who was also unaware of the cobb angle as previously described. Lateral asymmetry was calculated using the standard ISIS2 software. A comparison of cobb angle and LA was performed. Linear regression analysis was performed to define an equation predicting Cobb from LA. The predicted Cobb angles were then compared with the measured radiographic Cobb angles using Bland-Altman analysis. All statistical analysis was carried out using R.Purpose of the study
Methods
57 controls and 69 subjects were found to be low risk for emotional disorder (p>
0.05). Similarly 58 control and 74 subjects were predicted to be low risk for behavioural disorder. 16 controls and 18 subjects had medium or high risk for hyperactivity or concentration disorder (p>
0.05; student t test). There was no significant difference between the self report and parent questionnaires for difficulties or their impact.
Racial and ethnic disparities in pain perception diagnosis and management have become apparent in different specialities. Oswestry Disability Scores (ODI) (completed at every outpatient visit), and other information were obtained retrospectively for 1568 patients seen at our spinal unit over the last two years. Statistical analysis using analysis of variance (ANOVA) was used to determine any true difference in ODI scores between Caucasian, Afro-Caribbean and South Asian different groups pre and post surgery. Overall scores were significantly higher for the South Asian group when compared with the white using analysis of variance (ANOVA) p<
0.001. Afro-Caribbean patients also showed a trend to higher overall scores from the white group p=0.091 (least squares difference post-hoc test). From a total of 280 patients who had undergone surgery, South Asians had significantly higher pre-operative scores compared to Caucasians (p>
0.001). Afro-Caribbean’s also scored higher than Caucasians pre-operatively although the difference was not significant (p=0.091). Scores for South Asians and Afro-Caribbean’s remained higher than those for Caucasians postoperatively. All groups however, did show a statistically significant reduction in ODI score compared to the pre-operative score. Despite the differences in symptom perception or expression we have found to exist between ethnic groups, we conclude that in appropriately selected patients, this does not affect their ability to benefit from surgery
We present a retrospective review of a single-surgeon series of 30 consecutive lengthenings in 27 patients with congenital short femur using the Ilizarov technique performed between 1994 and 2005. The mean increase in length was 5.8 cm/18.65% (3.3 to 10.4, 9.7% to 48.8%), with a mean time in the frame of 223 days (75 to 363). By changing from a distal to a proximal osteotomy for lengthening, the mean range of knee movement was significantly increased from 98.1° to 124.2° (p = 0.041) and there was a trend towards a reduced requirement for quadricepsplasty, although this was not statistically significant (p = 0.07). The overall incidence of regenerate deformation or fracture requiring open reduction and internal fixation was similar in the distal and proximal osteotomy groups (56.7% and 53.8%, respectively). However, in the proximal osteotomy group, pre-placement of a Rush nail reduced this rate from 100% without a nail to 0% with a nail (p <
0.001). When comparing a distal osteotomy with a proximal one over a Rush nail for lengthening, there was a significant decrease in fracture rate from 58.8% to 0% (p = 0.043). We recommend that in this group of patients lengthening of the femur with an Ilizarov construct be carried out through a proximal osteotomy over a Rush nail. Lengthening should also be limited to a maximum of 6 cm during one treatment, or 20% of the original length of the femur, in order to reduce the risk of complications.
Arthroscopic lavage is commonly used in the management of mild to moderate arthritis of the knee. In the last few years the use of Hyaluronic Acid and its derivatives has become popular in the management of this same group of patients. The study was set up to establish whether Synvisc (HylanGF-20) produced equivalent or improved symptomatic relief when compared to arthroscopic lavage. A prospective randomised trial. Fifty patients with knee OA were randomly allocated to either the arthroscopic lavage or Synvisc group. All patients were assessed prior to treatment using the WOMAC knee evaluation questionnaire, and further assessments were made at 6 weeks, 3 months, 6 months and one year post treatment. The Synvisc group showed greater and more consistent improvement in WOMAC scores than the lavage group at all assessments post treatment. The difference between the treatment groups was statistically significant at 6 months (p<
0. 05) and at 1 Year (p=0. 0018). We conclude that a course of Synvisc injections can be administered on an out-patient basis and is a safer, more cost-effective and more reliable treatment for Knee OA compared to arthroscopic lavage.
