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. 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 paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children’s Orthopaedic Surgery (BSCOS). Statements were only included (‘consensus in’) in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded (‘consensus out’) if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation.Aims
Methods
High myelomeningocele lesions do not preclude an acceptable level of functional walking provided that an integrated programme of surgical treatment and bracing is adopted. Clinical analysis of 100 patients with myelomeningocele shows that the development of the "swivel walker" and "hip guidance orthosis" has been associated with an improved level of function. Over 30 per cent of patients with thoracic lesions and 68 per cent of those with lumbar lesions achieved independent walking. For this reason the criteria used at present by
Between 1956 1999, 132 601 living children were born in and Malmö, and screened for neonatal instability of the hip. All late diagnosed patients have been followed and re-examined clinically and radiologically. During the first years of screening, less than five per 1000 living newborn infants were treated. This figure increased to 35 per 1000 in 1980, but later diminished again to about six per 1000 annually after 1990. The number of referred cases decreased from 45 per 1000 in 1980 to between 10 to 15 per 1000 from 1990. During the period of high rates of referral and treatment a larger number of
A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children’s Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening. A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group.Aims
Methods
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs. A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.Aims
Methods
The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care. An established Delphi approach with predetermined steps and degree of agreement based on a standardized protocol was used to determine consensus. The steering group members and Delphi survey participants included members from the British Society of Children’s Orthopaedic Surgery (BSCOS) and the Association of Paediatric Chartered Physiotherapists (APCP). The statements included definition, assessment, treatment indications, nonoperative and operative interventions, and outcomes. Descriptive statistics were used for analysis of the Delphi survey results. The AGREE checklist was followed for reporting the results.Aims
Methods
This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method.Aims
Methods
To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed.Aims
Methods
We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by Aims
Methods
The significance of the ‘clicky hip’ in neonatal and infant examination
remains controversial with recent conflicting papers reigniting
the debate. We aimed to quantify rates of developmental dysplasia
of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated
DDH clinic. A three-year prospective cohort study was undertaken between
2014 and 2016 assessing the diagnosis and treatment outcomes of
all children referred specifically with ‘clicky hips’ as the primary
reason for referral to our dedicated DDH clinic. Depending on their
age, they were all imaged with either ultrasound scan or radiographs.Aims
Patients and Methods
The health-related quality of life (HRQoL) of paediatric patients with orthopaedic conditions and spinal deformity is important, but existing generic tools have their shortcomings. We aim to evaluate the use of Paediatric Quality of Life Inventory (PedsQL) 4.0 generic core scales in the paediatric population with specific comparisons between those with spinal and limb pathologies, and to explore the feasibility of using PedsQL for studying scoliosis patients’ HRQoL. Paediatric patients attending a speciality outpatient clinic were recruited through consecutive sampling. Two groups of patients were included: idiopathic scoliosis, and paediatric orthopaedic upper and lower limb condition without scoliosis. Patients were asked to complete PedsQL 4.0 generic core scales, Youth version of 5-level EuroQol-5-dimension questionnaire, and Refined Scoliosis Research Society 22-item (SRS-22r) questionnaire. Statistical analyses included scores comparison between scoliosis and limb pathology patients using independent-samples Aims
Methods
The purpose of this study was to compare the prevalence of hip displacement and dislocation in a total population of children with cerebral palsy (CP) in Scotland before and after the initiation of a hip surveillance programme. A total of 2,155 children with CP are registered in the Cerebral Palsy Integrated Pathway Scotland (CPIPS) surveillance programme, which began in 2013. Physical examination and hip radiological data are collected according to nationally agreed protocols.Aims
Patients
The purpose of this study was to analyze the incidence of the different ultrasound phenotypes of developmental dysplasia of the hip (DDH), and to determine their subsequent course. A consecutive series of 28 092 neonates was screened and classified according to the Graf method as part of a nationwide surveillance programme, and then followed prospectively. Abnormal hips were followed until they became normal (Graf type I). Type IIb hips and higher grades were treated by abduction in a Tübinger orthosis until normal. Dislocated hips underwent closed or open reduction.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
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
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
To determine the normal values and usefulness of the C1/4 space
available for spinal cord (SAC) ratio and C1 inclination angle,
which are new radiological parameters for assessing atlantoaxial
instability in children with Down syndrome. We recruited 272 children with Down syndrome (including 14 who
underwent surgical treatment), and 141 children in the control group.
All were aged between two and 11 years. The C1/4 SAC ratio, C1 inclination
angle, atlas-dens interval (ADI), and SAC were measured in those
with Down syndrome, and the C1/4 SAC ratio and C1 inclination angle
were measured in the control group.Aims
Patients and Methods
