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. 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 paediatric orthopaedic surgeons in our region. A DFO model was created, using an anatomic sawbone with foam covering. 8 orthopaedic surgeons each performed two 30-degree DFOs, one using K-wires and visual estimation (VE), and the other using a Digital Inclinometer (DI). Two radiologists reported pre and post procedure rotational profile CT scans to assess the achieved rotational correction.Introduction
Materials & Methods
We present the long term outcome from children with Legg-Calves-Perthes (LCPD) treated at our unit. Patients treated for LCPD were identified retrospectively from an orthopaedic database between 1990 and 2005. Patient demographics, clinical examination, treatment and Herring classification were recorded at initial presentation and treatment. Long-term clinical and radiological follow-up was also recorded. 85 patients were identified and 4 excluded due to insufficient data giving a total of 81 patients. Of these, 58 were male and 23 female. Average age range at presentation was 6.5 years (range 1.5–14 yrs). The side affected was 34 right, 35 left, 24 bilateral giving 93 hips in total. Time between presentation and diagnosis averaged 4.7 months (range 0–48 months). In patients with recorded clinical examination 87% had reduced abduction and 88% reduced internal rotation. Treatment was largely conservative with 12 hips (13%) undergoing surgery within the first 4 years of diagnosis. Radiographs were available for 71 hips. Herring classification was A-12, B-22, C-37. Long term follow up averaged 16 years (range 10–25 yrs). Stulberg grading was available in 67 hips; Grade I 13, Grade II 21, Grade III 19, Grade IV 18 and Grade V 6. There were ongoing issues (mostly pain) in 18 hips, 5 of which required a subsequent operation. No correlation was found between abduction and Stulberg grade (p-value = 0.7). A correlation was found between delay in diagnosis of ≥6 months and the need for a subsequent operation (p-value = 0.0408). The overall trend as expected showed that a better Herring classification generally led to a more favourable Stulberg classification. Range of motion was not predictive for Stulberg grade. The need for further surgical intervention for symptoms at long term follow up was 0.05%.
The recent NICE guidelines on management of osteoarthritis outline weight loss as first line treatment in degenerative joint disease in the obese. There is little data surrounding the effects of obesity on the outcomes in spinal surgical interventions. Intervertebral discectomy is one treatment for prolapse of a lumbar vertebral disc. We aim to investigate the effect of obesity on outcomes for discectomy. Demographic details including age, sex, weight and BMI were recording with a pre-operative Oswestry Disability Index (ODI). The fat thickness was measured at L5/S1 using calibrated MRI scans. Outcome measures included complications, length of surgery and change in ODI at 1 year following surgery. Obesity was defined as a body mass index of over 30. The units Serial patients undergoing discectomy were recruited into the study. Patients with bony decompression, instrumentation, revision surgery or multilevel disease were excluded. Fifty patients with a single level uncomplicated disc prolapse were entered into the study. Sixteen patients had a BMI over 30 and so were obese, whilst 34 had a BMI of less than 30. The mean pre-operative ODI was 46.5 in the obese group and 52 in the normal group this difference was not significant (p>
0.05). The mean post operative ODI was statistically improved in the high BMI group at 28 (18.5 point improvement) and 25.2 (29.1 point improvement) in the normal group. The ODI improvement was significantly better in the low BMI group (p=0.036). There was no significant difference in operative time (p=0.24). Only a single patient had a complication (dural leak), so no valid comparison could be made. The outcomes of spinal surgery in the obese are mixed. We found no increase in the complication rate or intra-operative time associated with an increased BMI. However, the improvement in ODI was significantly better in the normal BMI group.
