Congenital Talipes Equinovarus (CTEV) is one
of the most common congenital limb deformities. We reviewed the records
of infants who had received treatment for structural CTEV between
1 January 2007 and 30 November 2012. This was cross-referenced with
the prenatal scans of mothers over a corresponding period of time.
We investigated the sensitivity, specificity, and positive and negative
predictive values of the fetal anomaly scan for the detection of CTEV
and explored whether the publication of Fetal Anomaly Screening
Programme guidelines in 2010 affected the rate of detection. During the study period there were 95 532 prenatal scans and
34 373 live births at our hospital. A total of 37 fetuses with findings
suggestive of CTEV were included in the study, of whom 30 were found
to have structural CTEV at birth. The sensitivity of screening for
CTEV was 71.4% and the positive predictive value was 81.1%. The negative
predictive value and specificity were more than 99.5%. There was
no significant difference between the rates of detection before
and after publication of the guidelines (p = 0.5). We conclude that a prenatal fetal anomaly ultrasound screening
diagnosis of CTEV has a good positive predictive value enabling
prenatal counselling. The change in screening guidance has not affected
the proportion of missed cases. This information will aid counselling
parents about the effectiveness and accuracy of prenatal ultrasound
in diagnosing CTEV. Cite this article:
We describe three cases of infantile tibia vara
resulting from an atraumatic slip of the proximal tibial epiphysis
upon the metaphysis. There appears to be an association between
this condition and severe obesity. Radiologically, the condition
is characterised by a dome-shaped metaphysis, an open growth plate
and disruption of the continuity between the lateral borders of
the epiphysis and metaphysis, with inferomedial translation of the
proximal tibial epiphysis. All patients were treated by realignment
of the proximal tibia by distraction osteogenesis with an external
circulator fixator, and it is suggested that this is the optimal
method for correction of this complex deformity. There are differences
in the radiological features and management between conventional
infantile Blount’s disease and this ‘slipped upper tibial epiphysis’
variant.
Guiding growth by harnessing the ability of growing bone to undergo plastic deformation is one of the oldest orthopaedic principles. Correction of deformity remains a major part of the workload for paediatric orthopaedic surgeons and recently, along with developments in limb reconstruction and computer-directed frame correction, there has been renewed interest in surgical methods of physeal manipulation or ‘guided growth’. Manipulating natural bone growth to correct a deformity is appealing, as it allows gradual correction by non- or minimally invasive methods. This paper reviews the techniques employed for guided growth in current orthopaedic practice, including the basic science and recent advances underlying mechanical physeal manipulation of both healthy and pathological physes.
Metal-on-metal hip bearings are being implanted into younger patients. The consequence of elevated levels of potentially carcinogenic metal ions is therefore a cause for concern. We have determined the levels of cobalt (Co), chromium (Cr), titanium (Ti) and vanadium (Va) in the urine and whole blood of patients who had had metal-on-metal and metal-on-polyethylene articulations We found significantly elevated levels of whole blood Ti, Va and urinary Cr in all arthroplasty groups. The whole blood and urine levels of Co were grossly elevated, by a factor of 50 and 300 times respectively in patients with loose metal-on-metal articulations when compared with the control group. Stable metal-on-metal articulations showed much lower levels. Elevated levels of whole blood or urinary Co may be useful in identifying metal-on-metal articulations which are loose.
