Purpose

Analyze the results of reconstruction of post osteomyelitic bone defect using non-vascularised fibula graft in children and correlation of results with magnitude of defect.

Methods

11 boys and 15 girls (mean age 6.8±2.33 years) were prospectively enrolled in the study. All had primary acute hematogeneous osteomyelitis with diaphyseal sequestration and active discharging sinuses. 7 femur, 12 tibia, 3 humerus, 3 radius and 1 ulna were the bone involved. As first step a radical debridement and sequestrectomy was performed. Second step was considered after a ‘dry’ period judged clinically and by normalized CRP. A subperiosteal resection of fibula was done and used as graft to fill in the diaphyseal defect. Graft was stabilized using intramedullary ‘K’ wires and supported by post-operative casts. Weight-bearing was started on radiological evidence of union.

Introduction

Albania is one of the poorest countries in Western European with a GDP per capita standing at 26 percent of the EU average in 2010. Whilst there is government-funded universal free provision of healthcare, it is accepted that delivery is patchy, not accessible to all and lacking expertise for more complex paediatric orthopaedic conditions. With the sponsorship of a UK-based charity, we have set up and completed 5 visits to Albania (3 assessment and 2 operative) to provide additional expertise for paediatric orthopaedic disorders running parallel to and utilising currently available local services. We present the results of this treatment and training programme to date.

Patients and methods

Between 2008 and 2011, we assessed 204 children and adolescents with paediatric orthopaedic disorders in Tirana and Durres on 3 separate visits. Of these, 28 were listed for surgical procedures whilst the rest were treated non-operatively. Of the listed patients, 14 patients underwent surgical intervention (total of 18 procedures).

Purpose of study

To assess the risk of early re—dislocation following closed reduction (CR) of the hip for idiopathic developmental dysplasia of the hip (DDH).

Methods

Review of case notes and radiographs of all who underwent CR for DDH between January 2005 and January 2010 was undertaken. Parameters recorded included sex, side of dysplasia, age at the time of attempted reduction and concomitant complications. The main outcome measure was clinical and radiographic evidence of successful reduction. Early failure of reduction was regarded as loss of concentric reduction requiring an open procedure within a year of CR. CR was performed via a standardised protocol under general anaesthetic, with arthrographic control, adductor tenotomy as required and hip spica application. Post procedure reduction was confirmed with MRI and the spica was maintained for 12 weeks.

Purpose of study

The management of developmental hip dysplasia requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus anterior open reduction with Salter osteotomy (delayed until the child is of sufficient size) in such patients.

Patients and methods

19 consecutive patients who underwent MAOR aged 12-22 months were reviewed at a mean follow-up of 3.5 years (range: 1.0-6.2). This group was compared to 14 patients who underwent anterior reduction and Salter osteotomy aged 18-23 months (mean follow-up 4.1 years).

Purpose of study

This study is to determine the survival and outcomes of the Birmingham Interlocking Triple Pelvic Osteotomy. A dysplastic hip predisposes to early arthritis. The Triple Pelvic Osteotomy (TPO) is a joint-preserving option for the treatment of young adults with hip dysplasia. The long term success of the procedure is not known.

Patients and methods

The senior author has been performing Birmingham Interlocking Triple Pelvic Osteotomies for 18 years. The outcomes of the first 100 patients (117 TPOs) were reviewed using postal questionnaires, telephone interviews and radiograph review. The primary outcome measure of the study was the Kaplan—Meier survival curve for the TPO. Hip replacement or resurfacing were taken as failure points. The Oxford Hip Score (OHS) and University of California, Los Angeles (UCLA) score were used as secondary outcome measures for the surviving osteotomies. The pre-and post-operative acetabular index and centre-edge angles were measured from surviving radiographs.

Purpose

To evaluate the efficacy of Kocher's criteria to differentiate between transient synovitis and septic arthritis in children.

Methods and results

All children with a presentation of ‘atraumatic limp’ and a proven effusion on hip ultrasound between 2004 and 2009 were included. Patient demographics, details of the clinical presentation and laboratory investigations were documented to identify a response to each of the four variables (Weight bearing status, WCC >12,000 cells/m3, CRP >20mg/L and Temperature >38.5°C). SA was defined based upon culture and microscopy of the operative findings. 311 hips were included within the study. Of these 282 were considered to have transient synovitis. 29 patients met criteria to be classified as SA based upon laboratory assessment of the synovial fluid. The introduction of CRP eliminated the need for a four variable model as the prediction for two variables (CRP and weight bearing status) was of similar efficacy. Treating individuals who were non-weight-bearing and a CRP >20mg/L as SA correctly classified 94.8% individuals, with a sensitivity of 75.9%, specificity of 96.8%, positive predictive value of 71.0%, and negative predictive value of 97.5%. CRP was a significant independent predictor of septic arthritis.

Purpose

To assess the initial rise in inflammatory markers in paediatric patients presenting with long bone osteomyelitis and whether this is comparable with that in septic arthritis, and diagnostic.

Methods

All radiologically confirmed cases of long bone osteomyelitis without septic arthritis, joint effusion or abscess, in paediatric patients, presenting to one hospital over an eighteen-month period were included. These patients were compared with all culture positive septic arthritides presenting to the same hospital within the same period. Inflammatory markers taken on the day of admission were studied.

Purpose of Study

A description of a procedure to stabilize symptomatic complete discoid menisci with medium term results.

Methods and Results

Children with mechanical symptoms of lateral meniscal instability were assessed by MRI scan. In those with a lateral discoid meniscus an arthroscopic examination was performed to identify the presence of tears and confirm the radiological diagnosis. No incomplete or Wrisberg variant types were encountered. An antero-lateral arthrotomy was performed. The anterior horn of the meniscus was mobilized and traction sutures inserted. Flexion and extension of the knee whilst traction was applied led to delivery of the anterior horn into the wound. After confirmation of position with image intensifier a groove was fashioned in the anterior aspect of the cartilaginous portion of the proximal tibial epiphysis. Typically three titanium bone anchors with non absorbable sutures were placed in the base of the groove. The anterior horn of the meniscus was drawn into the groove and anchored with sutures. Active range of motion exercises were encouraged but a canvas knee immobilizer was employed whilst walking for the first six weeks.

Four boys and three girls underwent meniscopexy performed at a mean age of 9.4 years (range 5.7 to 12.4 years). Follow up was at a mean of 4.9 years. At last follow up no patient reported symptoms of locking or pain. No patient has required revision surgery but one girl had a subsequent meniscopexy procedure on the opposite knee. Five of the children have had Lysholm scores performed at last follow up averaging 93.5 (80 to 100 points).

Introduction

The purpose of this study was to comprehensively evaluate syndactyly correction. Patient selection, complexity, technique and aftercare are compared with scar quality, web-creep, hand function and patient satisfaction.

Methods

49 syndactyly releases (in 32 patients between 1999-2010) attended evaluation clinics. Demographics, surgical technique (island web transfer, graft vs graftless) aftercare and complications were identified from case notes. Patient satisfaction was obtained via questionnaire.

Function was assessed by grip and pincer strength, range of motion, and age of developmental milestones. Where appropriate this was compared to the contralateral side.

Purpose of this study

This study was designed to assess the utility of the scarf osteotomy in the management of symptomatic adolescent hallux valgus.

Methods

This is a consecutive case series of 30 patients (38 feet) with a mean follow up of 38.2 months (range 6-60 months). The mean age at the time of surgery was 14.2 years (range 10-17 years). American Orthopaedic Foot and Ankle Society scores (AOFAS) were collected at final follow up, along with a rating of the overall satisfaction. Any complications were recorded.