Lumbar disc herniation (LDH) is uncommon in youth
and few cases are treated surgically. Very few outcome studies exist
for LDH surgery in this age group. Our aim was to explore differences
in gender in pre-operative level of disability and outcome of surgery
for LDH in patients aged ≤ 20 years using prospectively collected
data. From the national Swedish SweSpine register we identified 180
patients with one-year and 108 with two-year follow-up data ≤ 20
years of age, who between the years 2000 and 2010 had a primary
operation for LDH. Both male and female patients reported pronounced impairment
before the operation in all patient reported outcome measures, with
female patients experiencing significantly greater back pain, having
greater analgesic requirements and reporting significantly inferior
scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects
of Short Form-36 and Oswestry Disabilities Index, when compared
with male patients. Surgery conferred a statistically significant
improvement in all registered parameters, with few gender discrepancies.
Quality of life at one year following surgery normalised in both
males and females and only eight patients (4.5%) were dissatisfied with
the outcome. Virtually all parameters were stable between the one-
and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in
both male and female patients aged 20 years or younger, who failed
to recover after non-operative management. Cite this article:
Magnetically controlled growing rods (MCGRs) allow non-invasive
correction of the spinal deformity in the treatment of early-onset
scoliosis. Conventional growing rod systems (CGRS) need repeated
surgical distractions: these are associated with the effect of the
‘law of diminishing returns’. The primary aim of this study was to quantify this effect in
MCGRs over sequential distractions. A total of 35 patients with a maximum follow-up of 57 months
were included in the study. There were 17 boys and 18 girls with
a mean age of 7.4 years (2 to 14). True Distraction (TD) was determined
by measuring the expansion gap on fluoroscopy. This was compared
with Intended Distraction (ID) and expressed as the ‘T/I’ ratio.
The T/I ratio and the Cobb angle were calculated at several time
points during follow-up.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
Risk of revision following total knee arthroplasty (TKA) is higher
in patients under 55 years, but little data are reported regarding
non-revision outcomes. This study aims to identify predictors of
dissatisfaction in these patients. We prospectively assessed 177 TKAs (157 consecutive patients,
99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender,
implant, indication, body mass index (BMI), social deprivation,
range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis
(OA) and prior knee surgery were recorded. Pre- and post-operative
Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS)
and mental component scores were obtained. Post-operative range
of movement, complications and satisfaction were measured at one
year.Aims
Patients and Methods
The purpose of this study was to compare symptomatic treatment
of a fracture of the base of the fifth metatarsal with immobilisation
in a cast. Our null hypothesis was that immobilisation gave better patient
reported outcome measures (PROMs). The alternative hypothesis was
that symptomatic treatment was not inferior. A total of 60 patients were randomised to receive four weeks
of treatment, 36 in a double elasticated bandage (symptomatic treatment
group) and 24 in a below-knee walking cast (immobilisation group).
The primary outcome measure used was the validated Visual Analogue
Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician,
blinded to the form of treatment, at presentation and at four weeks,
three months and six months after injury. Loss to follow-up was
43% at six months. Multiple imputations missing data analysis was performed.Aims
Patients and Methods
Back pain is a common symptom in children and
adolescents. Here we review the important causes, of which defects
and stress reactions of the pars interarticularis are the most common
identifiable problems. More serious pathology, including malignancy
and infection, needs to be excluded when there is associated systemic
illness. Clinical evaluation and management may be difficult and
always requires a thorough history and physical examination. Diagnostic
imaging is obtained when symptoms are persistent or severe. Imaging
is used to reassure the patient, relatives and carers, and to guide
management. Cite this article:
The February 2014 Children’s orthopaedics Roundup360 looks at: flexible plasters; dual 8-plate or ablation for knee epiphysiodesis; ultrasounds for pulled elbow; leg length without the radiation; Boyd amputation in limb deficiencies; gold standard club foot treatment; quadrupled semitendinosis graft effective in paediatric ACL reconstruction; and predicting complications following cerebral palsy hip reconstruction
Single event multilevel surgery (SEMLS) has been shown to improve
gait in children with cerebral palsy (CP). However, there is limited
evidence regarding long-term outcomes and factors influencing them. In total 39 children (17 females and 22 males; mean age at SEMLS
ten years four months, standard deviation 37 months) with bilateral
CP (20 Gross Motor Function Classification System (GMFCS) level
II and 19 GMFCS level III) treated with SEMLS were included. Children
were evaluated using gait analysis and the Gait Deviation Index
(GDI) before SEMLS and one, two to three, five and at least ten
years after SEMLS. A linear mixed model was used to estimate the
effect of age at the surgery, GMFCS and follow-up period on GDI. Aims
Methods
Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral
dysfunction as a key symptom. We present the first in-depth radiological
evaluation of the knee in a large series of NPS patients and describe
the typical malformations. Conventional radiological examination of 95 skeletally mature
patients with NPS was performed. Patellar morphology was classified
according to the Wiberg classification as modified by Baumgartl
and Ficat criteria, and trochlear shape was classified according
to the Dejour classification.Aim
Patients and Methods
Lateral clavicular physeal injuries in adolescents
are frequently misinterpreted as acromioclavicular dislocations. There
are currently no clear guidelines for the management of these relatively
rare injuries. Non-operative treatment can result in a cosmetic
deformity, warranting resection of the non-remodelled original lateral
clavicle. However, fixation with Kirschner (K)-wires may be associated
with infection and/or prominent metalwork. We report our experience
with a small series of such cases. Between October 2008 and October 2011 five patients with lateral
clavicular physeal fractures (types III, IV and V) presented to
our unit. There were four boys and one girl with a mean age of 12.8
years (9 to 14). Four fractures were significantly displaced and
treated operatively using a tension band suture technique. One grade
III fracture was treated conservatively. The mean follow-up was
26 months (6 to 42). All patients made an uncomplicated recovery. The mean time to
discharge was three months. The QuickDASH score at follow-up was
0 for each patient. No patient developed subsequent growth disturbances. We advocate the surgical treatment of significantly displaced
Grade IV and V fractures to avoid cosmetic deformity. A tension
band suture technique avoids the problems of retained metalwork
and the need for a secondary procedure. Excellent clinical and radiological
results were seen in all our patients. Cite this article:
Sagittal alignment of the lumbosacral spine, and specifically pelvic incidence (PI), has been implicated in the development of spine pathology, but generally ignored with regards to diseases of the hip. We aimed to determine if increased PI is correlated with higher rates of hip osteoarthritis (HOA). The effect of PI on the development of knee osteoarthritis (KOA) was used as a negative control. We studied 400 well-preserved cadaveric skeletons ranging from 50 to 79 years of age at death. Each specimen’s OA of the hip and knee were graded using a previously described method. PI was measured from standardised lateral photographs of reconstructed pelvises. Multiple regression analysis was performed to determine the relationship between age and PI with HOA and KOA.Objectives
Methods
Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel’s release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results. Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel’s bipolar release gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.
The June 2012 Oncology Roundup360 looks at: avoiding pelvic hemipelvectomy; proximal femoral metastasis; extendible prostheses; rotationplasty; soft-tissue sarcomas; osteosarcoma of the pelvis; recurrent chondrosarcoma ; MRI and the differentiation between benign and malignant lesions; and malignant fibrous histiocytoma.
Acetabular labral tears and associated intra-articular
pathology of the hip have been recognised as a source of symptoms.
However, it is now appreciated that there is a relatively high prevalence
of asymptomatic labral tears. In this study, 70 young asymptomatic
adult volunteers with a mean age of 26 years (19 to 41) were recruited
and underwent three tesla non-arthrographic MR scans. There were
47 women (67.1%) and 23 men (32.9%). Labral tears were found in 27 volunteers (38.6%); these were
an isolated finding in 16 (22.9%) and were associated with other
intra-articular pathology in the remaining 11 (15.7%) volunteers.
Furthermore, five (7.1%) had intra-articular pathology without an
associated labral tear. Given the high prevalence of labral pathology in the asymptomatic
population, it is important to confirm that a patient's symptoms
are due to the demonstrated abnormalities when considering surgery. Cite this article:
The subject of central nervous system damage includes a wide variety of problems, from the slow selective ‘picking off’ of characteristic sub-populations of neurons typical of neurodegenerative diseases, to the wholesale destruction of areas of brain and spinal cord seen in traumatic injury and stroke. Experimental repair strategies are diverse and the type of pathology dictates which approach will be appropriate. Damage may be to grey matter (loss of neurons), white matter (cutting of axons, leaving neurons otherwise intact, at least initially) or both. This review will consider four possible forms of treatment for repair of the human central nervous system.
Stress fractures occurring in the pubis and ischium
after peri-acetabular osteotomy (PAO) are not well recognised, with
a reported incidence of 2% to 3%. The purpose of this study was
to analyse the incidence of stress fracture after Bernese PAO under
the care of two high-volume surgeons. The study included 359 patients
(48 men, 311 women) operated on at a mean age of 31.1 years (15
to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up
radiographs were available for 348 patients, 64 of whom (18.4%)
developed a stress fracture of the inferior pubic ramus, which was
noted at a mean of 9.1 weeks (5 to 55) after surgery. Most (58;
91%) healed. In 40 of the patients with a stress fracture (62.5%),
pubic nonunion also occurred. Those with a stress fracture were
significantly older (mean 33.9 years (16 to 50) Cite this article:
The natural history of primary anterior dislocation
of the glenohumeral joint in adolescent patients remains unclear and
there is no consensus for management of these patients. The objectives of this study were to report the natural history
of primary anterior dislocation of the glenohumeral joint in adolescent
patients and to identify the risk factors for recurrent dislocation. We reviewed prospectively-collected clinical and radiological
data on 133 adolescent patients diagnosed with a primary anterior
dislocation of the glenohumeral joint who had been managed non-operatively
at our hospital between 1996 and 2008. There were 115 male (86.5%)
and 18 female patients (13.5%) with a mean age of 16.3 years (13
to 18) and a mean follow-up of 95.2 months (1 to 215). During follow-up, 102 (absolute incidence of 76.7%) patients
had a recurrent dislocation. The median interval between primary
and recurrent dislocation was ten months (95% CI 7.4 to 12.6). Applying
survival analysis the likelihood of having a stable shoulder one
year after the initial injury was 59% (95% CI 51.2 to 66.8), 38%
(95% CI 30.2 to 45.8%) after two years, 21% (95% CI 13.2 to 28.8)
after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither
age nor gender significantly predicted recurrent dislocation during
follow-up. We conclude that adolescent patients with a primary anterior
dislocation of the glenohumeral joint have a high rate of recurrent
dislocation, which usually occurs within two years of their initial
injury: these patients should be considered for early operative
stabilisation. Cite this article:
The August 2014 Children’s orthopaedics Roundup360 looks at: Conservative treatment still OK in paediatric clavicular fractures; Femoral anteversion not the usual suspect in patellar inversion; Shoulder dislocation best treated with an operation; Perthes’ disease results in poorer quality of adult life; Physiotherapy little benefit in supracondylar fractures; Congenital vertical talus addressed at the midtarsal joint; Single-sitting DDH surgery worth the effort; and cubitus valgus associated with simple elbow dislocation
