The aim of this study was to investigate the changes in femoral
trochlear morphology following surgical correction of recurrent
patellar dislocation associated with trochlear dysplasia in children. A total of 23 patients with a mean age of 9.6 years (7 to 11)
were included All had bilateral recurrent patellar dislocation associated
with femoral trochlear dysplasia. The knee with traumatic dislocation
at the time of presentation or that had dislocated most frequently
was treated with medial patellar retinacular plasty (Group S). The
contralateral knee served as a control and was treated conservatively
(Group C). All patients were treated between October 2008 and August
2013. The mean follow-up was 48.7 months (43 to 56). Axial CT scans
were undertaken in all patients to assess the trochlear morphological
characteristics on a particular axial image which was established
at the point with the greatest epicondylar width based on measurements
preoperatively and at the final follow-up.Aims
Patients and Methods
Open reduction is required following failed conservative treatment
of developmental dysplasia of the hip (DDH). The Ludloff medial
approach is commonly used, but poor results have been reported,
with rates of the development of avascular necrosis (AVN) varying
between 8% and 54%. This retrospective cohort study evaluates the
long-term radiographic and clinical outcome of dislocated hips treated
using this approach. Children with a dislocated hip, younger than one year of age
at the time of surgery, who were treated using a medial approach
were eligible for the study. Radiographs were evaluated for the
degree of dislocation and the presence of an ossific nucleus preoperatively,
and for the degree of AVN and residual dysplasia at one and five
years and at a mean of 12.7 years (4.6 to 20.8) postoperatively.
Radiographic outcome was assessed using the Severin classification,
after five years of age. Further surgical procedures were recorded.
Functional outcome was assessed using the Pediatric Outcomes Data
Collection Instrument (PODCI) or the Hip Disability and Osteoarthritis
Outcome Score (HOOS), depending on the patient’s age.Aims
Patients and Methods
The aim of this prospective cohort study was to evaluate the
effectiveness of the neonatal hip instability screening programme. The study involved a four-year observational assessment of a
neonatal hip screening programme. All newborns were examined using
the Barlow or Ortolani manoeuvre within 72 hours of birth; those
with positive findings were referred to a ‘one-stop’ screening clinic
for clinical and sonographic assessment of the hip. The results
were compared with previous published studies from this unit.Aims
Patients and Methods
The aim of this study was to identify the association between
asymmetrical skin creases of the thigh, buttock or inguinal region
and pathological developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2016, all patients referred
to our unit from primary or secondary care with risk factors for
DDH were assessed in a “one stop” clinic. All had clinical and sonographic
assessment by the senior author (RWP) with the results being recorded
prospectively. The inclusion criteria for this study were babies and
children referred with asymmetrical skin creases. Those with a neurological
cause of DDH were excluded. The positive predictive value (PPV)
for pathological DDH was calculated.Aims
Patients and Methods
High-quality clinical research in children’s orthopaedic surgery
has lagged behind other surgical subspecialties. This study used
a consensus-based approach to identify research priorities for clinical
trials in children’s orthopaedics. A modified Delphi technique was used, which involved an initial
scoping survey, a two-round Delphi process and an expert panel formed
of members of the British Society of Children’s Orthopaedic Surgery.
The survey was conducted amongst orthopaedic surgeons treating children
in the United Kingdom and Ireland.Aims
Methods
The purpose of this study was to evaluate the long-term outcome
of adolescents with cerebral palsy who have undergone single-event
multilevel surgery for a flexed-knee gait, followed into young adulthood
using 3D motion analysis. A total of 59 young adults with spastic cerebral palsy, with
a mean age of 26 years (Aims
Patients and Methods
This multicentre, retrospective study aimed to improve our knowledge
of primary pyogenic spinal infections in children by analyzing a
large consecutive case series. The medical records of children with such an infection, treated
at four tertiary institutions between 2004 and 2014, were analyzed
retrospectively. Epidemiological, clinical, paraclinical, radiological,
and microbiological data were evaluated. There were 103 children,
of whom 79 (76.7%) were aged between six months and four years.Aims
Patients and Methods
Preserving growth following limb-salvage surgery of the upper
limb in children remains a challenge. Vascularized autografts may
provide rapid biological incorporation with the potential for growth
and longevity. In this study, we aimed to describe the outcomes
following proximal humeral reconstruction with a vascularized fibular
epiphyseal transfer in children with a primary sarcoma of bone.
We also aimed to quantify the hypertrophy of the graft and the annual
growth, and to determine the functional outcomes of the neoglenofibular
joint. We retrospectively analyzed 11 patients who underwent this procedure
for a primary bone tumour of the proximal humerus between 2004 and
2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean
age at the time of surgery was five years (two to eight). The mean
follow-up was 5.2 years (1 to 12.2).Aims
Patients and Methods
Displaced fractures of the lateral condyle of the humerus are
frequently managed surgically with the aim of avoiding nonunion,
malunion, disturbances of growth and later arthritis. The ideal
method of fixation is however not known, and treatment varies between
surgeons and hospitals. The aim of this study was to compare the
outcome of two well-established forms of surgical treatment, Kirschner
wire (K-wire) and screw fixation. A retrospective cohort study of children who underwent surgical
treatment for a fracture of the lateral condyle of the humerus between
January 2005 and December 2014 at two centres was undertaken. Pre,
intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean
age at the time of injury was 5.8 years (0 to 15) with a male:female
patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture
and the fracture was displaced by > 2 mm in 228 (68%). In all, 235
patients underwent K-wire fixation and 101 had screw fixation. Aims
Patients and Methods
The aim of this study was to report the clinical, functional
and radiological outcomes of children and adolescents with tibial
fractures treated using the Ilizarov method. Between 2013 and 2016 a total of 74 children with 75 tibial fractures
underwent treatment at our major trauma centre using an Ilizarov
frame. Demographic and clinical information from a prospective database
was supplemented by routine functional and psychological assessment
and a retrospective review of the notes and radiographs.Aims
Patients and Methods
The aim of this study was to describe the epidemiology of closed
isolated fractures of the femoral shaft in children, and to compare
the treatment and length of stay (LOS) between major trauma centres
(MTCs) and trauma units (TUs) in England. National data were obtained from the Trauma and Audit Research
Network for all isolated, closed fractures of the femoral shaft
in children from birth to 15 years of age, between 2012 and 2015.
Age, gender, the season in which the fracture occurred, non-accidental
injury, the mechanism of injury, hospital trauma status, LOS and
type of treatment were recorded.Aims
Patients and Methods
A clicky hip is a common referral for clinical and sonographic
screening for developmental dysplasia of the hip (DDH). There is
controversy regarding whether it represents a true risk factor for
pathological DDH. Therefore a 20-year prospective, longitudinal,
observational study was undertaken to assess the relationship between
the presence of a neonatal clicky hip and pathological DDH. A total of 362 infants from 1997 to 2016 were referred with clicky
hips to our ‘one-stop’ paediatric hip screening clinic. Hips were
assessed clinically for instability and by ultrasound imaging using
a simplified Graf/Harcke classification. Dislocated or dislocatable
hips were classified as Graf Type IV hips.Aims
Patients and Methods
Despite the presence of screening programmes, infants continue
to present with late developmental dysplasia of the hip (DDH), the
impact of which is significant. The aim of this study was to assess
infants with late presenting dislocation of the hip despite universal
clinical neonatal and selective ultrasound screening. Between 01 January 1997 to 31 December 2011, a prospective, longitudinal
study was undertaken of a cohort of 64 670 live births. Late presenting
dislocation was defined as presentation after three months of age.
Diagnosis was confirmed by ultrasound and plain radiography. Patient
demographics, referral type, reason for referral, risk factors (breech
presentation/strong family history) and clinical and radiological
findings were recorded.Aims
Patients and Methods
It is well established that there is a strong association between
Perthes’ disease and worsening socioeconomic deprivation. It has
been suggested that the primary determinant driving this association
is exposure to tobacco smoke. This study aimed to examine this hypothesis. A hospital case-control study (n = 149/146) examined the association
between tobacco smoke exposure and Perthes’ disease, adjusting for
area-level socioeconomic deprivation. Tobacco smoke exposure was
assessed by parental questionnaire of smoking habits during pregnancy,
and by quantitative assay of current exposure using the urinary
cotinine-creatinine ratio, which is a widely used and validated
measure of tobacco smoke exposure.Aims
Patients and Methods
The aim of this study was to evaluate the correlation between
Salter’s criteria and Kalamchi’s classification of avascular necrosis
in patients treated for developmental dysphasia of the hip (DDH). The study involved a retrospective analysis of 123 patients (123
hips) with DDH treated by operative and non-operative reduction
before the age of two years, with a minimum follow-up of ten years.
Salter’s criteria (S1 to S4) were determined from radiographs obtained
at one to two years post-reduction, whilst the Kalamchi grade was determined
from radiographs obtained at ten or more years of age. Early post-reduction
radiographs were also used to evaluate the centre-head distance
discrepancy (CHDD) and the occurrence of a dome-shaped deformity
of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI),
fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for
analysis and correlation with the early Salter criteria, CHDD and
D-shaped metaphysis.Aims
Patients and Methods
After the initial correction of congenital talipes equinovarus
(CTEV) using the Ponseti method, a subsequent dynamic deformity
is often managed by transfer of the tendon of tibialis anterior
(TATT) to the lateral cuneiform. Many surgeons believe the lateral
cuneiform should be ossified before surgery is undertaken. This
study quantifies the ossification process of the lateral cuneiform
in children with CTEV between one and three years of age. The length, width and height of the lateral cuneiform were measured
in 43 consecutive patients with unilateral CTEV who had been treated
using the Ponseti method. Measurements were taken by two independent
observers on standardised anteroposterior and lateral radiographs
of both feet taken at one, two and three years of age.Aims
Patients and Methods
To assess the long-term effect of distal trochanteric transfer
(DTT) on the clinical and radiographic outcomes of patients with
Legg-Calvé-Perthes’ disease (LCPD) following a varus derotational
osteotomy (VDRO). For this single centre cross-sectional retrospective study we
analysed the data of 22 patients (24 hips) with LCPD who had greater
trochanteric overgrowth (GTO), following a VDRO performed in our
institution between 1959 and 1983. GTO was defined as an articular
trochanteric distance (ATD) of <
5 mm. We compared the radiographic
and clinical outcomes of patients who underwent DTT for GTO (ten
patients, ten hips) with those who did not (12 patients, 14 hips).
Age at presentation was 6.9 years (4 to 10) and 8.0 years (3.2 to
12) respectively. Symptoms associated with the hip and general quality
of life were assessed using the Harris hip score (HHS) and the Short Form
(SF)-36 questionnaires.Aims
Patients and Methods
This pilot study aimed to evaluate prospectively the use of inlet
radiographs of the hip as an alternative method of the assessment
of reduction after the surgical treatment of developmental dysplasia
of the hip (DDH). The children in this study underwent surgery between January
2013 and January 2015. All had inlet radiographs and CT scans post-operatively.
Data were analysed by determining inter-observer reliability and
intra-observer reproducibility, using the kappa value (K). Differences
were settled by discussion between the two observers until a consensus
was reached. The sensitivity and specificity of the radiographic
and CT results were compared. A total of 26 radiographs were obtained
from 23 children, with a mean age of 2.38 years (one to five).Aims
Patients and Methods
Following the introduction of national standards in 2009, most
major paediatric trauma is now triaged to specialist units offering
combined orthopaedic and plastic surgical expertise. We investigated
the management of open tibia fractures at a paediatric trauma centre,
primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between
2007 and 2015 presented with an open tibia fracture. Their mean
age was nine years (2 to 16) and the median follow-up was ten months
(interquartile range 5 to 18). Management involved IV antibiotics,
early debridement and combined treatment of the skeletal and soft-tissue injuries
in line with standards proposed by the British Orthopaedic Association.Aims
Patients and Methods
Our aim was to describe the mid-term appearances of the repair
process of the Achilles tendon after tenotomy in children with a
clubfoot treated using the Ponseti method. A total of 15 children (ten boys, five girls) with idiopathic
clubfoot were evaluated at a mean of 6.8 years (5.4 to 8.1) after
complete percutaneous division of the Achilles tendon. The contour
and subjective thickness of the tendon were recorded, and superficial
defects and its strength were assessed clinically. The echogenicity,
texture, thickness, peritendinous irregularities and potential for
deformation of the tendon were evaluated by ultrasonography.Aims
Patients and Methods