This paper reports a new method for expressing numerically asymmetry of the contour of the back in a forward-bending position. Information is given at three spinal levels (T8, T12 and L3) for 636 schoolchildren aged 8 to 15 years. Rib-hump and lumbar-hump scores were standardised to create trunk asymmetry scores (TASs) making comparison possible between children of different age, size and sex. Two groups of children were defined: those with clinically straight spines (585 children); and those with clinical evidence of lateral spinal curves (51 children). In the children with clinically straight spines the main findings were: about 1:4 had objectively detectable rib and lumbar humps; female-to-male ratios were 1.2:1 for the thoracic region and 1.4:1 for the lumbar region; right humps were about 10 times more common than left; TASs in the boys and girls at each spinal level had normal distributions about means to the right of zero (where zero represents perfect symmetry); at T8 and T12, a wider scatter of TASs in girls than in boys; at L3, larger TASs in girls than in boys; a relation between shortening of one lower limb and a contralateral hump on the back; and no relation to age (except at L3), stature (corrected for age) or handedness. The findings are discussed in relation to possible causes of back contour asymmetry, early diagnosis of
There remains confusion in the literature with regard to the spinopelvic relationship, and its contribution to ideal acetabular component position. Critical assessment of the literature has been limited by use of conflicting terminology and definitions of new concepts that further confuse the topic. In 2017, the concept of a Hip-Spine Workgroup was created with the first meeting held at the American Academy of Orthopedic Surgeons Annual Meeting in 2018. The goal of this workgroup was to first help standardize terminology across the literature so that as a topic, multiple groups could produce literature that is immediately understandable and applicable. This consensus review from the Hip-Spine Workgroup aims to simplify the spinopelvic relationship, offer hip surgeons a concise summary of available literature, and select common terminology approved by both hip surgeons and spine surgeons for future research. Cite this article:
The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis.Aims
Patients and Methods
Using 90% of final height as a benchmark, we sought to develop
a quick, quantitative and reproducible method of estimating skeletal
maturity based on topographical changes in the distal femoral physis. Serial radiographs of the distal femoral physis three years prior
to, during, and two years following the chronological age associated
with 90% of final height were analyzed in 81 healthy children. The
distance from the tip of the central peak of the distal femoral
physis to a line drawn across the physis was normalized to the physeal width.Aims
Patients and Methods
The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors. A total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion.Objectives
Methods
The purpose of this study was to examine whether leg-length discrepancy (LLD) following unilateral total hip arthroplasty (THA) affects the incidence of contralateral head collapse and subsequent THA in patients with bilateral osteonecrosis, and to determine factors associated with subsequent collapse. We identified 121 patients with bilateral non-traumatic osteonecrosis who underwent THA between 2003 and 2011 to treat a symptomatic hip, and who also exhibited medium-to-large lesions (necrotic area ≥ 30%) in an otherwise asymptomatic non-operated hip. Of the 121 patients, 71 were male (59%) and 50 were female (41%), with a mean age of 51 years (19 to 71) at the time of initial THA. All patients were followed for at least five years and were assessed according to the presence of a LLD (non-LLD Aims
Patients and Methods
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
The mucopolysaccharidoses (MPS) are a group of
inherited lysosomal storage disorders with clinical manifestations relevant
to the orthopaedic surgeon. Our aim was to review the recent advances
in their management and the implications for surgical practice. The current literature about MPSs is summarised, emphasising
orthopaedic complications and their management. Recent advances in the diagnosis and management of MPSs include
the recognition of slowly progressive, late presenting subtypes,
developments in life-prolonging systemic treatment and potentially
new indications for surgical treatment. The outcomes of surgery
in these patients are not yet validated and some procedures have
a high rate of complications which differ from those in patients
who do not have a MPS. The diagnosis of a MPS should be considered in adolescents or
young adults with a previously unrecognised dysplasia of the hip.
Surgeons treating patients with a MPS should report their experience
and studies should include the assessment of function and quality
of life to guide treatment. Cite this article:
Clinical and radiological data were reviewed for all patients
with mucopolysaccharidoses (MPS) with thoracolumbar kyphosis managed
non-operatively or operatively in our institution. In all 16 patients were included (eight female: eight male; 50%
male), of whom nine had Hurler, five Morquio and two Hunter syndrome.
Six patients were treated non-operatively (mean age at presentation
of 6.3 years; 0.4 to 12.9); mean kyphotic progression +1.5o/year;
mean follow-up of 3.1 years (1 to 5.1) and ten patients operatively (mean
age at presentation of 4.7 years; 0.9 to 14.4); mean kyphotic progression
10.8o/year; mean follow-up of 8.2 years; 4.8 to 11.8)
by circumferential arthrodesis with posterior instrumentation in
patients with flexible deformities (n = 6).Aims
Methods
The aims of this study were to measure sagittal standing and sitting lumbar-pelvic-femoral alignment in patients before and following total hip arthroplasty (THA), and to consider what preoperative factors may influence a change in postoperative pelvic position. A total of 161 patients were considered for inclusion. Patients had a mean age of the remaining 61 years (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
