Journal of Children s Orthopaedics

Publisher: Springer Verlag

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  • Other titles
    SpringerLink
  • ISSN
    1863-2521
  • OCLC
    288981587
  • Material type
    Document, Periodical
  • Document type
    Journal / Magazine / Newspaper, Computer File

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Springer Verlag

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Publications in this journal

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    ABSTRACT: The aim of this study was to determine the prevalence and pattern of upper limb involvement in children with cerebral palsy (CP), how this relates to function and how well these problems are recognised and treated. One hundred consecutive patients with CP attending non-hand-related clinics were assessed. Function was assessed according to the Gross Motor Functional Classification System (GMFCS), the Manual Ability Classification System (MACS) and the ABILHAND-Kids system, and correlated to age and pattern of upper limb involvement. Patients were examined for contractures in the shoulder, elbow, wrist and hand. Concerns about the appearance of the hand were also assessed in older children. Overall, 83 % of patients had upper limb involvement, 36 % had a demonstrable contracture and 69 % had reduced hand control. The most common contracture patterns were the thumb in palm with clasp hand, shoulder adduction with internal rotation and wrist flexion with pronation. The thumb in palm with clasp hand pattern was associated with the greatest functional disability, followed by wrist flexion with pronation. Single contractures such as elbow flexion caused significant disability, whereas swan-neck contractures were, by far, less debilitating. Children aged 12 years and older had more concerns about the appearance of their hand. The ABILHAND score was strongly correlated to both the GMFCS and the MACS score. Different patterns of upper limb involvement exist in CP and some have a significant impact on function and cause cosmetic concerns that should not be underestimated, particularly in older children.
    Journal of Children s Orthopaedics 05/2014;
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    ABSTRACT: Though developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for early-onset spine deformity. Observation of implant-related ossifications warrants further assessment, since they may be detrimental to the function-preserving non-fusion strategy. Radiographs (obtained pre and post index procedure, and at 4-year follow-up) and the records of 65 VEPTR patients from four paediatric spine centres were analysed. Ossifications were classified as type I (at anchor points), type II (along the central part) or type III (re-ossification after thoracostomy). The average age at the index procedure was 6.5 years (min 1, max 13.7). The most prevalent spine problem was congenital scoliosis (37) with rib fusions (34), followed by neuromuscular and syndromic deformities (13 and 8, respectively). Idiopathic and secondary scoliosis (e.g. after thoracotomy) were less frequent (3 and 4, respectively). Forty-two of the 65 (65 %) patients showed ossifications, half of which were around the anchors. Forty-five percent (15/33) without pre-existing rib fusions developed a type II ossification along the implant. Re-ossifications of thoracostomies were less frequent (5/34, 15 %). The occurrence of ossifications was not associated with patient-specific factors. Implant-related ossifications around VEPTR are common. In contrast to harmless bone formation around anchors, ossifications around the telescopic part and the rod section are troublesome in view of their possible negative impact on chest cage compliance and spinal mobility. This potential side effect needs to be considered during implant selection, particularly in patients with originally normal thoracic and spinal anatomy.
    Journal of Children s Orthopaedics 04/2014;
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    ABSTRACT: The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management. A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months. Ten patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed union and required additional procedures including adjustment of fixator and bone grafting. There was one malunion in the TSF group that required osteotomy and reapplication of frame. There were seven and nine pin-site infections in the ICF and TSF groups, respectively, all of which responded to antibiotics. There were no refractures in either group. In an appropriate patient, both types of circular fixator are equally effective but have different characteristics, with TSF allowing for postoperative deformity correction. Of concern are the two cases of delayed union in the TSF group, all in patients with high-energy injuries. We feel another larger study is required to provide further clarity in this matter. Level II-comparative study.
    Journal of Children s Orthopaedics 04/2014;
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    ABSTRACT: A retrospective study involving 65 non-ambulatory patients with hypotonic neuromuscular scoliosis has assessed the effectiveness of a sacral rod/bone onlay technique for extending spinal fusion to the sacrum. To extend posterior spinal fusion to the sacrum, we used either 1 Harrington rod and 1 Luque L rod with sublaminar wires in 14 patients (Group 1) or two rods with sublaminar wires in 51 patients (Group 2) along with abundant autograft and allograft bone covering the ends of the rods. Diagnoses were Duchenne muscular dystrophy 53, spinal muscular atrophy 4, myopathy 3, limb girdle muscular dystrophy 2, infantile FSH muscular dystrophy 1, cerebral palsy 1, and Friedreich ataxia 1. Mean age at surgery was 14.3 years (±2.2, range 10.9-25.2). Radiographic follow-up (2 years post-surgery or greater) was 6.4 years (±4.4, range 2-25.3). Using the onlay technique, all patients fused with no rod breakage or pseudarthrosis. For the entire series, the mean pre-operative scoliosis was 54.7° (±31.1, range 0°-120°) with post-operative correction to 21.8° (±21.7, range 0°-91°) and long-term follow-up 24° (±22.9, range 0°-94°). For pelvic obliquity, pre-operative deformity was 17.3° (±11.3, range 0°-51°) with post-operative correction to 8.9° (±7.8, range 0°-35°) and long-term follow-up 10.1° (±8.1, range 0°-27°). Five required revision at a mean of 3.3 years post-original surgery involving rod shortening at the distal end. One of these had associated infection. Lumbosacral stability and long-term sitting comfort have been achieved in all patients. Problems can be minimized by positioning the rods firmly against the sacrum at the time of surgery with a relatively short extension beyond the L5-S1 junction. The procedure is valuable in hypotonic non-ambulatory neuromuscular patients whose immobility enhances the success rate for fusion due to diminished stress at the lumbosacral junction. It is particularly warranted for those with osteoporosis and a small, deformed pelvis. Considerable weight loss and lengthy rods not closely apposed to the sacrum at the time of surgery played a major role in patients needing revision.
    Journal of Children s Orthopaedics 04/2014;
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    ABSTRACT: The purpose of this study was to investigate the epidemiology of paediatric patients sustaining supracondylar humeral fractures, to identify common mechanisms of injury and to corroborate the anecdotal evidence that fractures occur more frequently during school holidays. All paediatric patients who presented to the accident and emergency department with a supracondylar distal humerus fracture over the 3-year period from 1 July 2008 to 30 June 2011 were included in the study. Data were collected from the electronic medical records and radiology picture archiving and communication system (PACS) regarding age at injury, sex, Gartland type, date of injury, mechanism and management. The dates of all school holidays during the study period were obtained from the local education authority website. A total of 159 patients were identified, with a median age of 6 years 1 month (range 1 year to 14 years 4 months); 53 % of patients were male. The 155 extension-type injuries comprised 46, 28 and 26 % Gartland I, II and III fractures, respectively. Sixty-five patients (41 %) were treated operatively. Six patients had either neurological and/or vascular complications; however, none had any long-term neurological compromise and none required vascular surgical intervention. The mechanism of injury was recorded in 118 cases, the majority (37 %) of which were sustained during falls from play equipment. Among the patients, 115 were of school age. The weekly incidence during school holidays was significantly higher than that during term-time (1.16 vs. 0.60, p = 0.0005). This study demonstrates the epidemiology of paediatric supracondylar fractures managed at a district general hospital over a 3-year-period. This work supports the long-standing anecdotal evidence that play equipment carries a high risk of injury and that the incidence of supracondylar fractures is significantly higher during school holidays.
    Journal of Children s Orthopaedics 03/2014;
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    ABSTRACT: We present a systematic review of the literature for the management of tibial eminence fractures in the paediatric population. Our aims were to assess modalities of injury, treatment options available and their associated complications. We found 740 relevant citations in the English literature up to 1 October 2012, of which 36 full text articles met our inclusion criteria. Our results show that skiing, sports and motor vehicle accidents are increasingly common modes of injury, in addition to the commonly described fall off of a bicycle. Most studies advocate non-operative management for type I Meyer's and McKeever's fractures and reduction and internal fixation for type II and III fractures. Better long-term results have been reported with arthroscopic surgery compared to open surgery. There is no consensus as to which type of fixation is best suited for tibial eminence fractures; methods available include excision of the bony fragment, K-wire, screw and, absorbable suture fixation, and more recently, suture anchor and meniscal arrow. The main complications reported include arthrofibrosis, non-union, mal-union, pain and severe laxity. Early post-operative range of motion exercises have been shown to reduce the incidence of arthrofibrosis. As all papers report results from small case series, Level I studies are required to produce more definitive evidence for the management of paediatric tibial eminence fractures.
    Journal of Children s Orthopaedics 03/2014;
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    ABSTRACT: An association between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) has been established in the literature; however, whether the screening of patients with CMT for DDH requires hip imaging remains controversial. The purpose of this study is to determine (1) the coexistence rate of DDH requiring treatment in individuals with CMT and (2) if physical exam alone is sufficient screening. A single-center retrospective chart review was performed among 97 consecutive patients between 1/1/2003 and 9/1/2012 with CMT who had hip imaging performed. 12 % (12/97) of patients with CMT had DDH, all requiring treatment. 75 % (9/12) of the patients with DDH had an abnormal clinical exam. Of the three patients with DDH and a normal clinical exam, two patients were presenting for a second opinion after being treated for DDH prior to evaluation. 90 % (9/10) of patients with DDH at the time of presentation had an abnormal hip exam. All 12 patients with hip dysplasia were referred for DDH or DDH with CMT. There were no patients who were referred for CMT alone that had DDH. In the care of a patient with CMT, it is important that the clinician remains vigilant about screening for DDH. An ultrasound or radiograph of the hips should be strongly considered as part of the evaluation of a child with CMT. Level of evidence: IV.
    Journal of Children s Orthopaedics 02/2014;