A total of 47 non-walking patients (52 hips) with severe cerebral palsy and with a mean age of 14 years, (9 to 27) underwent a Dega-type pelvic osteotomy after closure of the triradiate cartilage, together with a derotation varus-shortening femoral osteotomy and soft-tissue correction for hip displacement which caused pain and/or difficulties in
To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child. A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29).Aims
Methods
We report a postal survey of 59 families of children with osteogenesis imperfecta. From the 51 replies we collected data on developmental milestones and walking ability and related them to the Sillence and the Shapiro classifications of osteogenesis imperfecta. Twenty-four of the patients had been treated by intramedullary rodding. Both classifications helped to predict eventual walking ability. We found that independent
In order to treat painful subluxation or dislocation secondary to cerebral palsy, 11 patients (12 hips) underwent combined femoral and Chiari pelvic osteotomies with additional soft-tissue releases at a mean age of 14.1 years (9.1 to 17.8). Relief of pain, improvement in movement of the hip, and in
The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures. A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders.Aims
Methods
The reduction in mobility due to hip diseases in children is likely to affect their physical activity (PA) levels. Physical inactivity negatively influences quality of life and health. Our aim was to objectively measure PA in children with hip disease, and correlate it with the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Score. A total of 28 children (12 boys and 16 girls) with hip disease aged between 8and 17 years (mean 12 (SD 3)) were studied between December 2018 and July 2019. Children completed the PROMIS Paediatric Item Bank v. 2.0 – Mobility Short Form 8a and wore a hip accelerometer (ActiGraph) for seven consecutive days. Sedentary time (ST), light PA (LPA), moderate to vigorous PA (MVPA), and vigorous PA were calculated from the accelerometers' data. The PROMIS Mobility score was classified as normal, mild, and moderate functions, based on the PROMIS cut scores on the physical function metric. A one-way analysis of covariance (ANCOVA) was used to assess differences among mobility (normal; mild; moderate) and measured PA and relationships between these variables were assessed using bivariate Pearson correlations.Aims
Methods
The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management. A retrospective review of two prospective multicentre EOS databases identified 33 children with skeletal dysplasia and EOS (major curve ≥ 30°) who were treated with growth-friendly instrumentation at younger than ten years of age, had a minimum two years of postoperative follow-up, and had undergone three or more lengthening procedures. From the same registries, 33 matched controls with idiopathic EOS were identified. A total of 20 children in both groups were treated with growing rods and 13 children were treated with vertical expandable prosthetic titanium rib (VEPTR) instrumentation.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 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
The aims of this study were to report functional
outcomes of salvage procedures for patients with cerebral palsy (CP)
who have chronic dislocation of the hip using validated scoring
systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the
time of surgery was 12.2 years (8 to 22) and the mean follow-up
was 56 months (24 to 114). Patients were divided into three groups:
14 who underwent proximal femoral resection arthroplasty (PFRA group
1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2),
and 13 who underwent subtrochanteric valgus osteotomy with resection
of the femoral head (SVO with FHR group 3). All patients were evaluated
using the Caregiver Priorities and Child Health Index of Life with
Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory
(PedsQL). Significant improvements occurred in most CPCHILD and PedsQL
subsection scores following surgery in all patients, without significant
differences between the groups. There were 12 post-operative complications.
Less severe complications were seen in group 1 than in groups 2
and 3. Salvage surgery appears to provide pain relief in patients with
CP who have painful chronic dislocation of the hip. The three salvage
procedures produced similar results, however, we recommend the use
of PFRA as the complications are less severe. Take home message: Salvage surgery can be of benefit to patients
with CP with chronic painful hip dislocation, but should be limited
to selected patients considering complications. Cite this article:
Proximal femoral resection (PFR) is a proven
pain-relieving procedure for the management of patients with severe cerebral
palsy and a painful displaced hip. Previous authors have recommended
post-operative traction or immobilisation to prevent a recurrence
of pain due to proximal migration of the femoral stump. We present
a series of 79 PFRs in 63 patients, age 14.7 years (10 to 26; 35
male, 28 female), none of whom had post-operative traction or immobilisation. A total of 71 hips (89.6%) were reported to be pain free or to
have mild pain following surgery. Four children underwent further
resection for persistent pain; of these, three had successful resolution
of pain and one had no benefit. A total of 16 hips (20.2%) showed
radiographic evidence of heterotopic ossification, all of which
had formed within one year of surgery. Four patients had a wound
infection, one of which needed debridement; all recovered fully.
A total of 59 patients (94%) reported improvements in seating and
hygiene. The results are as good as or better than the historical results
of using traction or immobilisation. We recommend that following
PFR, children can be managed without traction or immobilisation,
and can be discharged earlier and with fewer complications. However,
care should be taken with severely dystonic patients, in whom more
extensive femoral resection should be considered in combination
with management of the increased tone. Cite this article:
We report the use of the distal radius and ulna (DRU) classification
for the prediction of peak growth (PG) and growth cessation (GC)
in 777 patients with idiopathic scoliosis. We compare this classification
with other commonly used parameters of maturity. The following data were extracted from the patients’ records
and radiographs: chronological age, body height (BH), arm span (AS),
date of menarche, Risser sign, DRU grade and status of the phalangeal
and metacarpal physes. The mean rates of growth were recorded according
to each parameter of maturity. PG was defined as the summit of the curve
and GC as the plateau in deceleration of growth. The rates of growth
at PG and GC were used for analysis using receiver operating characteristic
(ROC) curves to determine the strength and cutoff values of the
parameters of growth.Aims
Patients and Methods
This study compared the long-term results following Salter osteotomy
and Pemberton acetabuloplasty in children with developmental dysplasia
of the hip (DDH). We assessed if there was a greater increase in
pelvic height following the Salter osteotomy, and if this had a
continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively
following a unilateral Salter osteotomy or Pemberton acetabuloplasty.
We measured the increase in pelvic height and the iliac crest tilt
and sacral tilt at the most recent review and at an earlier review
point in the first decade of follow-up. We measured the lumbar Cobb angle
and the Short Form-36 (SF-36) and Harris hip scores were collected
at the most recent review.Aims
Patients and Methods
The aim of this study was to determine whether
an osteoplasty of the femoral neck performed at the same time as an
intertrochanteric Imhäuser osteotomy led to an improved functional
outcome or increased morbidity. A total of 20 hips in 19 patients
(12 left, 8 right, 13 male, 6 female), who underwent an Imhäuser
intertrochanteric osteotomy following a slipped capital femoral
epiphysis were assessed over an eight-year period. A total of 13
hips in 13 patients had an osteoplasty of the femoral neck at the
same time. The remaining six patients (seven hips) had intertrochanteric
osteotomy alone. The mean age was 15.3 years (13 to 20) with a mean
follow-up of 57.8 months (15 to 117); 19 of the slips were severe
(Southwick grade III) and one was moderate (grade II), with a mean
slip angle of 65.3° (50° to 80°); 17 of the slips were stable and
three unstable at initial presentation. The mean Non-Arthritic Hip Scores
(NAHS) in patients who underwent osteoplasty was 91.7 (76.3 to 100)
and the mean NAHS in patients who did not undergo osteoplasty was
76.6 (41.3 to 100) (p = 0.056). Two patients required a subsequent
arthroplasty and neither of these patients had an osteoplasty. No
hips developed osteonecrosis or chondrolysis, and there was no increase
in complications related to the osteoplasty. We recommend that for
patients with a slipped upper femoral epiphysis undergoing an intertrochanteric
osteotomy, the addition of an osteoplasty of the femoral neck should
be considered. Cite this article:
Assessment of skeletal age is important in children’s
orthopaedics. We compared two simplified methods used in the assessment
of skeletal age. Both methods have been described previously with
one based on the appearance of the epiphysis at the olecranon and
the other on the digital epiphyses. We also investigated the influence
of assessor experience on applying these two methods. Our investigation was based on the anteroposterior left hand
and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1
) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal
growth spurt. A total of nine observers examined the radiographs
with the observers assigned to three groups based on their experience (experienced,
intermediate and novice). These raters were required to determined
skeletal ages twice at six-week intervals. The correlation between
the two methods was determined per assessment and per observer groups. Interclass
correlation coefficients (ICC) evaluated the reproducibility of
the two methods. The overall correlation between the two methods was r = 0.83
for boys and r = 0.84 for girls. The correlation was equal between
first and second assessment, and between the observer groups (r ≥ 0.82).
There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%)
and observer effect (ICC ≤ 3%) for each method. There was no significant
(p <
0.05) difference between the levels of experience. The two methods are equally reliable in assessing skeletal maturity.
The olecranon method offers detailed information during the pubertal
growth spurt, while the digital method is as accurate but less detailed,
making it more useful after the pubertal growth spurt once the olecranon
has ossified. Cite this article:
We reviewed the long-term radiological outcome,
complications and revision operations in 19 children with quadriplegic
cerebral palsy and hip dysplasia who underwent combined peri-iliac
osteotomy and femoral varus derotation osteotomy. They had a mean
age of 7.5 years (1.6 to 10.9) and comprised 22 hip dislocations
and subluxations. We also studied the outcome for the contralateral
hip. At a mean follow-up of 11.7 years (10 to 15.1) the Melbourne
cerebral palsy (CP) hip classification was grade 2 in 16 hips, grade
3 in five, and grade 5 in one. There were five complications seen
in four hips (21%, four patients), including one dislocation, one
subluxation, one coxa vara with adduction deformity, one subtrochanteric
fracture and one infection. A recurrent soft-tissue contracture occurred
in five hips and ten required revision surgery. In pre-adolescent children with quadriplegic cerebral palsy good
long-term outcomes can be achieved after reconstruction of the hip;
regular follow-up is required.
Cite this article:
We report five children who presented at the mean age of 1.5 years (1.1 to 1.9) with a progressive thoracolumbar kyphosis associated with segmental instability and subluxation of the spine at the level above an anteriorly-wedged hypoplastic vertebra at L1 or L2. The spinal deformity appeared to be developmental and not congenital in origin. The anterior wedging of the vertebra may have been secondary to localised segmental instability and subsequent kyphotic deformity. We suggest the term ‘infantile developmental thoracolumbar kyphosis with segmental subluxation of the spine’ to differentiate this type of deformity from congenital displacement of the spine in which the congenital vertebral anomaly does not resolve. Infantile developmental kyphosis with segmental subluxation of the spine, if progressive, may carry the risk of neurological compromise. In all of our patients the kyphotic deformity progressed over a period of three months and all were treated by localised posterior spinal fusion. At a mean follow-up of 6.6 years (5.0 to 9.0), gradual correction of the kyphosis was seen on serial radiographs as well as reconstitution of the hypoplastic wedged vertebra to normality. Exploration of the arthrodesis was necessary at nine months in one patient who developed a pseudarthrosis.
We describe a patient with cerebral palsy, of normal intelligence, who could not walk but who by the age of 16 had been successfully managed with a staged bilateral total hip arthroplasty using a constrained liner.
Subluxation of the hip is common in patients with intermediate spinal muscular atrophy. This retrospective study aimed to investigate the influence of surgery on pain and function, as well as the natural history of subluxed hips which were treated conservatively. Thirty patients were assessed clinically and radiologically. Of the nine who underwent surgery only one reported satisfaction and four had recurrent subluxation. Of the 21 patients who had no surgery, 18 had subluxation at the latest follow-up, but only one reported pain in the hip. We conclude that surgery for subluxation of the hip in these patients is not justified.
We have tested the reliability of a recently reported classification system of hip morphology in adolescents with cerebral palsy in whom the triradiate cartilage was closed. The classification is a six-grade ordinal scale, based on the measurement of the migration percentage and an assessment of Shenton’s arch, deformity of the femoral head, acetabular deformity and pelvic obliquity. Four paediatric orthopaedic surgeons and four physiotherapists received training in the use of the classification which they applied to the assessment of 42 hip radiographs, read on two separate occasions. The inter- and intra-observer reliability was assessed using the intraclass correlation coefficient and found to be excellent, with it ranging from 0.88 to 0.94. The classification in our study was shown to be valid (based on migration percentage), and reliable. As a result we believe that it can now be used in studies describing the natural history of hip displacement in cerebral palsy, in outcome studies and in communication between clinicians.
