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

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To evaluate the effectiveness of the Ponseti method in treating clubfoot associated with arthrogryposis. Methods: Retrospective consecutive review over a 10-year period in a tertiary centre of all patients with arthrogrypotic clubfoot treated with the Ponseti method. The primary outcome measure at final follow-up was the functional correction of the deformity. Results: There were ten children with 17 arthrogrypotic clubfeet, with an average follow-up of 5.8 years (range 3-8 years). The average age at presentation was 5 weeks (range 2-20 weeks). Deformities were severe, with an average Pirani score of 5.5 (range 3-6). Initial correction was achieved in all children with an average of 8 (range 4-10) Ponseti casts and a tendo-Achilles tenotomy (TAT) was performed in 94.1 %. Two-thirds of patients had a satisfactory outcome at final follow-up, with functional plantigrade, pain-free feet. Conclusions: The Ponseti method is an effective first-line treatment for arthrogrypotic clubfeet to achieve functional plantigrade feet. Children will often require more casts and have a higher risk of relapse.
    No preview · Article · Jan 2016 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR). Methods The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015. Results Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5–48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6–13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy. Conclusions In conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.
    No preview · Article · Jan 2016 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose: We present a surgical technique for chest wall reconstruction using custom-designed titanium implants developed for two female patients to provide both chest wall symmetry and adequate stability for staged breast reconstruction. Methods: A retrospective review was performed for two adolescent female patients with large chest wall defects who underwent the described technique. The etiology of the chest wall deficiency was secondary to Poland's syndrome in one patient, and secondary to surgical resection of osteosarcoma in the other patient. For each patient, a fine-cut computed tomography scan was obtained to assist with implant design. After fabrication of the prosthesis, reconstruction was performed though a curvilinear thoracotomy approach with attachment of the implant to the adjacent ribs and sternum. Wound closure was obtained with use of synthetic graft material, local soft tissue procedures, and flap procedures as necessary. Results: The two patients were followed post-operatively for 35 and 38 months, respectively. No intra-operative or post-operative complications were identified. Mild scoliosis that had developed in the patient following chest wall resection for osteosarcoma did not demonstrate any further progression following reconstruction. Conclusions: We conclude that this technique was successful at providing a stable chest wall reconstruction with satisfactory cosmetic results in our patients.
    No preview · Article · Jan 2016 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose: Mild slipped capital femoral epiphyses (SCFE) nevertheless show significant femoral head-neck deformities which may put cartilage and acetabular labrum at risk. Whether this deformity can be restored to normal has not yet been described in the literature. Methods: In a prospective follow-up study, 14 patients with mild SCFE underwent in situ fixation with a single 6.5-mm cancellous, partially threaded screw. In 14 patients arthroscopic osteochondroplasty was performed, and in 13 patients pre- and postoperative measurements of the α-angle were made using antero-superior radial magnetic resonance imaging. Results: After arthroscopic osteochondroplasty, the mean α-angle decreased from 57° (range 50°-74°) to 37° (range 32°-47°; p < 0.001). Six patients showed beginning degenerative intra-articular changes (four antero-superior cartilage and three antero-superior labrum lesions) at the time of hip arthroscopy. No intra-operative complications occurred. In one patient, arthroscopic debridement was necessary due to arthrofibrosis and persistent pain. Conclusion: Arthroscopic osteochondroplasty can successfully correct the antero-superior α-angle in patients with mild SCFE to normal values. Clinical randomized controlled studies with long-term follow-up are required to find evidence of improved functional and radiographic mid- and long-term outcome compared to in situ fixation alone.
    No preview · Article · Nov 2015 · Journal of Children s Orthopaedics
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    ABSTRACT: Introduction Fibrodysplasia ossificans progressiva (FOP) is a rare disorder characterized by episodes of acute pain and heterotopic ossification of soft tissue, and progressively limited physical function and social participation. Objective We aimed to determine the impact of FOP on quality of life, specifying areas or dimensions most affected. Materials and methods This was a transverse observational study; patients with FOP were assessed using the Short Form 36. Questionnaire results were obtained using Quality Metric software and analyzed using frequency distribution, percentages and measures of central tendency. Results Eight patients, mean age 30.2 years, were included. The physical dimension was the most affected, with an average of 25.5 points. The most representative items were impaired function and physical role. Physical pain was found with an average of 44.5 points. The best scores were reported in the areas of emotional role and mental health, with an average of 79 and 76 respectively. Conclusions FOP is a severely disabling disease, generating a significant deterioration in quality of life secondary to progressive deterioration in physical abilities. The findings of this study demonstrate good self-rated health of participants.
    Preview · Article · Nov 2015 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose: Arthrogryposis multiplex congenita (AMC) can be described as a complex condition characterized by deformed joints with an intact sensory system. Consequences of muscle weakness and joint contractures in the lower limbs influence walking ability. With orthoses most children achieve functional ambulation. Based on four studies, the aim of this article was to describe gait pattern wearing habitual orthoses, to quantify quiet standing, to test and describe a new orthosis and compare gait differences with regular orthoses, in children with AMC. Methods: In total 83 children, of which 35 with AMC took part in the studies. All children had underwent clinical examination. Based on joint range of motion and muscle strength they had been prescribed various orthosis types, ranging from insoles to knee-ankle-foot orthoses with locked knee joints. 3D gait and motion analysis was performed during standing and walking with 34 reflective markers aligned with anatomical landmarks. Results: The findings are presented with respect to each of the included studies. Conclusions: According to the positive subjective impressions from parents and children, the clinical experiences of our research group, and the objective results from the gait assessments, continuously wearing of orthoses in persons with AMC is recommended.
    Preview · Article · Nov 2015 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose: To access the long-term outcomes for patients with arthrogryposis multiplex congenita at adult age. Materials and methods: The cases were traced for most of them thanks to direct contact maintained from child hood, from colleagues interested from other parts of the country, and from the list from Alliance arthrogryposis association (parents and patients). The methods used were: mostly direct clinical examination, some phone calls or email. All answered a questionnaire for general life and mainly for function. One of these questions was: what is the function you missed most during your life? Results: 65 patients( 41 females and 24 males) were reviewed at adult age from 22 to 65 years. For the personal life: 38 are married and had 34 children with only 4 having arthrogryposis. Only 27 (15 F/12 M) were living alone. Self-sufficiency was observed in 35, partial in 20, total dependence in 10 people. 38 reached university level, 20 had secondary school level, 10 had primary school level. Ambulation was made possible with wheelchair: permanent for 18, partial for 9 ambulating at home only, 8 ambulating outside with crutches and 29 were free walkers. 36 patients out of 65 were driving a car sometimes modified with special equipment. The involvement of spine was seen in 26 patients requiring surgical treatment sometimes complex combining anterior and posterior approach in 14 cases. Surgery of the lower limbs (hips, knee, feet) was very often repeated, with almost always stability, pain free and function. The most important finding was that 52 patients had more or less severe involvement of the upper limbs which was considered by the majority of the patients to be the most disabling, more than the absence of walking! Conclusion: Finally, it appeared that for the care of these patients, priority goes to the upper limbs function, because majority of these patients have a high level of intelligence. A remarkable fact is that many of these patients had to spend a lot of time during infancy and childhood in rehabilitation centers with education adapted for schools and teachers. Finally, they are grateful for that, telling often that it would have been much more difficult if not impossible to have such a treatment and education at home.
    Preview · Article · Oct 2015 · Journal of Children s Orthopaedics
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    ABSTRACT: Pathology: Hip dislocation is seen in approximately 30 % of children with amyoplasia and approximately 50 % of these will be bilateral. Treatment: Closed reduction is rarely successful. Open reduction is indicated for unilateral dislocations and for the majority of bilateral dislocations. Reduction is recommended via a medial approach. Results: A long-term satisfactory outcome can be achieved but with some loss of hip range of movement.
    Preview · Article · Oct 2015 · Journal of Children s Orthopaedics
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    ABSTRACT: Purpose: Research on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods. Methods: The Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment. Results: During the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0-19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %). Conclusions: The incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.
    Full-text · Article · Oct 2015 · Journal of Children s Orthopaedics