
Yael GelferSt George's Healthcare NHS Trust · Trauma and Orthopaedics
Yael Gelfer
Associate Professor BSc MD PhD FRCS
About
93
Publications
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Introduction
Yael Gelfer is a paediatric orthopaedic consultant, St George's Hospital. An Associate Professor, City St George's University of London. Her research interests are clubfoot, DDH, skeletal dysplasia and neuromuscular conditions. Her current projects are a Core Outcome Set for orthopaedic management of Spinal Dysraphism and a British consensus statement informing treatment in Idiopathic Toe Walking (ITW).
Publications
Publications (93)
Previous studies have identified clinical and demographic risk factors for recurrence in the treatment of idiopathic clubfoot (congenital talipes equinovarus). Evertor muscle activity is not usually considered amongst them. This study aimed to evaluate whether recurrence could be predicted by demographic, clinical and gait parameters. From a series...
Background
Idiopathic genu valgum beyond physiological limits may require treatment, which is based on age, growth remaining, and the magnitude of the deformity. There is no consensus on clinical, or radiologic evaluation, indications, and management of idiopathic genu valgum, which can range from observation to surgical treatment using various mod...
Background Legg-Calve-Perthes disease (LCPD) is a developmental disorder causing avascular necrosis of the femoral head in children, with long-term consequences that can extend into adulthood. Early diagnosis and management in primary care are crucial but challenging.
Aim This review aims to provide a concise overview of the presentation, differen...
Aims
The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care.
Methods
An established Delphi approach with predetermined steps and degree of agreement based on a standardized p...
Aims
The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care.
Methods
An established Delphi approach with predetermined steps and degree of agreement based on a standardized pro...
The British Orthopaedic Association Standards for Trauma-4 includes pediatric Gustilo–Anderson type I upper limb open fractures and recommends surgical debridement as the preferred method of treatment. The reported incidence of fracture-related infection is low in patients with this injury pattern and the evidence supporting debridement is therefor...
Aim
Attrition of females during surgical training remains a significant problem; only 14.7% become consultants. This project aimed to assess barriers to surgical careers and provide diverse role models to support uptake.
Method
A mentoring event was held, first-of-its-kind locally, including surgeons from diverse backgrounds and career stages discu...
Aims
There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse.
Methods
A total of 11 international centres participate...
The Ponseti method of clubfoot correction is the global gold-standard primary treatment. However, recurrence rates, treatment of recurrence and the frequency of further interventions including surgery vary widely. All increase with duration of follow up. There is lack of high-quality research looking at the clinical and quality of life (QoL) outcom...
Aims:
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphi...
Objective
Despite idiopathic toe walking (ITW) being a significant source of stress and anxiety for children and parents alike, little is known about the effect on health-related quality of life (HRQoL). The primary research question for this study was “Is ITW associated with impaired HRQoL, and is the degree of equinus contracture related to the d...
Purpose
Tourniquets are commonly used intraoperatively in orthopaedic surgery to control bleeding and improve visibility in the surgical field. Recent evidence has thrown into question the routine use of tourniquets in the adult population resulting in a British Orthopaedic Association standard for intraoperative use. This systematic review evaluat...
Introduction:
This study aimed to assess carer attitudes towards the use of artificial intelligence (AI) in management of fractures in paediatric patients. As fracture clinic services come under increasing pressure, innovative solutions are needed to combat rising demand. AI programs can be used to diagnosis fractures, but patient perceptions towa...
This review presents the principal features of paediatric femoral shaft fractures including the contemporary management strategies and relevant supporting evidence. The article is an overview of information relevant to clinical practice, in addition to preparation for the FRCS (Orth) examination.
Aims
The Ponseti method is the gold standard treatment for congenital talipes equinovarus (CTEV), with the British Consensus Statement providing a benchmark for standard of care. Meeting these standards and providing expert care while maintaining geographical accessibility can pose a service delivery challenge. A novel ‘Hub and Spoke’ Shared Care...
To assess health-related quality of life in children being treated for idiopathic toe-walking across the United Kingdom using the Oxford Ankle Foot Questionnaire for Children (OxAFQ_C).
Twelve paediatric orthopaedic centres across the United Kingdom participated in this prospective, cross- sectional, observational study of children under 18 years o...
Introduction:
In the UK, 1 in 50 children sustain a fractured bone yearly, yet studies have shown that 34% of children sustaining an injury do not have a visible fracture on initial radiographs. Wrist fractures are particularly difficult to identify because the growth plate poses diagnostic challenges when interpreting radiographs.
Methods:
We d...
Aims
The ‘pink, pulseless hand’ is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse. The management guidelines are based on the assessment of perfusion, which is difficult to undertake and poorly evaluated objectively...
This instructional review presents the literature and guidelines relevant to the classification, management and prognosis of paediatric tibial shaft fractures at a level appropriate for the FRCS exit examination in Trauma and Orthopaedic surgery.
Preoperative vascular assessment of patients with a supracondylar humeral fracture and a perfused, pulseless limb A SYSTEMATIC REVIEW Aims The 'pink, pulseless hand' is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse...
Objectives: The aim of this study is to understand current practice in the referral, management and treatment of idiopathic toe- walking gait in children in the UK
Design: A cross-sectional survey design was utilised to collect data from paediatric physiotherapists and orthopaedic surgeons. Setting: Data were collected from UK-based members of the...
physiotherapy and allied healthcare services for children living with Cerebral Palsy (CP) across the United Kingdom (UK).
Method: A cross-sectional survey was developed by clinicians and distributed to members of the Association of Paediatric Chartered Physiotherapists. Participants all worked within the UK, with children living with neurodisabilit...
Aim: This study aimed to establish any variability in access to physiotherapy and allied healthcare services for children living with cerebral palsy (CP) across the United Kingdom (UK).
Method: A cross-sectional survey was developed by clinicians and distributed to members of the Association of Paediatric Chartered Physiotherapists. Participants...
An instructional review of the literature and guidelines relevant for the classification, management and prognosis of paediatric distal radius fractures. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination.
Purpose To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geo- graphical locations—the United Kingdom (UK) and India. Children were divided into age groups of 5–7 and 8–1...
Aims
The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV.
Methods
The consensus process followed an established Delphi approach with a predetermined de...
The outcomes of idiopathic congenital talipes equinovarus: a core outcome set for research and treatment
Yael Gelfer, Donato G. Leo, Aisling Russell, Anna Bridgens, Daniel C. Perry, Deborah M. Eastwood
Published Online:27 Jan 2022
The aim of this study is to define a core outcome set (COS) to allow consistency in outcome reporting amongst studies investigating the management of orthopaedic treatment in children with spinal dysraphism (SD).
Relevant outcomes will be identified in a four-stage process from both the literature and key stakeholders (patients, their families, and...
Aims
To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV).
Methods
A list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected f...
Introduction:
Idiopathic congenital talipes equinovarus (CTEV) is the most common congenital limb deformity. Non-operative intervention using the Ponseti method has shown to be superior to soft tissue release and has become the gold standard for first-line treatment. However, numerous deviations from the Ponseti protocol are still reported followi...
A correction to this paper has been published: https://doi.org/10.1007/s00590-021-02998-y
Purpose
An Achilles tenotomy is routinely required to correct the equinus deformity in Congenital talipes equinovarus (CTEV) patients as part of the gold standard treatment using the Ponseti method. This procedure can be performed in clinic under local anaesthetic or in theatre under general anaesthetic. The COVID-19 pandemic reduced theatre capaci...
Purpose
Supracondylar fractures are common injuries accounting for approximately 15% of all fractures in children with a large body of literature on this subject.
Methods
This article critically appraises the available evidence to provide an overview of the treatment options including the role and timing of surgery, the geometry of wire fixation a...
IntroductionPremature physeal arrest (PPA) of the distal radius is considered a rare complication of physeal wrist fractures. Standardised guidelines for duration of follow up do not exist. The aim of this review is to recognise the risk factors of PPA and guide follow up protocols. The secondary aim is to understand the typical presenting symptoms...
AimsThis review provides a summary of recent evidence surrounding the treatment of paediatric tibial shaft fractures and presents an algorithm to aid management of these injuries.SummaryThis article reviews the relevant anatomy, epidemiology and aetiology of tibial shaft fractures and summarises contemporary treatment principles. Management recomme...
Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) ori...
Aims:
Open reduction in developmental dysplasia of the hip (DDH) is regularly performed despite screening programmes, due to failure of treatment or late presentation. A protocol for open reduction of DDH has been refined through collaboration between surgical, anaesthetic, and nursing teams to allow same day discharge. The objective of this study...
Aims
This study aims to define a set of core outcomes (COS) to allow consistent reporting in order to compare results and assist in treatment decisions for idiopathic clubfoot.
Methods
A list of outcomes will be obtained in a three-stage process from the literature and from key stakeholders (patients, parents, surgeons, and healthcare profession...
This article discusses the incidence, applied anatomy and classification of paediatric femoral fractures based on critical appraisal of the available evidence. The aim is to identify techniques that are relevant to contemporary practice whilst excluding the technical details of individual procedures that are beyond the scope of this review. Injurie...
Three-dimensional (3D) printing technology is increasingly being utilized in various surgical specialities. In paediatric orthopaedics it has been applied in the pre-operative and intra-operative stages, allowing complex deformities to be replicated and patient-specific instrumentation to be used. This systematic review analyses the literature on t...
Purpose: To de!ne the volume of paediatric orthopaedic surgical work requiring re-prioritisation and resourcing at two major hospitals
following the COVID-19 pandemic.
Methods: All patients on the waiting list as of 23rd March 2020 at two institutions were reviewed. The data recorded included demographics,
diagnosis and treatment needed. As advised...
Aims
To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot.
Methods
A systematic review of the literature was performed to identify a list of outcomes and outcome tools reported in the literature. A total of 865 studies were screened following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA...
Aims
To analyze outcomes reported in studies of Ponseti correction of idiopathic clubfoot.
Methods
A systematic review of the literature was performed to identify a list of outcomes and outcome
tools reported in the literature. A total of 865 studies were screened following Preferred
Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA)...
Background:
The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how...
The optimal management and long-term outcomes of olecranon fractures in the paediatric population is not well understood. This systematic review aims to analyse the literature on the management of paediatric olecranon fractures and the long-term implications. A systematic review of several databases was conducted according to PRISMA guidelines. Eng...
Background: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.
Therefore, the study aim is to determine among at-risk newborns how...
Background: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.
Therefore, the study aim is to determine among at-risk newborns how...
Variations in pedal circulation in congenital talipes equinovarus (CTEV) are well documented. There is a reported risk of vascular injury to the posterior tibial artery (PTA) during operative procedures for CTEV, potentially leading to necrosis and amputation. The aim of this systematic review was to identify the most common anomalies in arterial p...
Purpose
The Ponseti method is a well-established approach to treating clubfoot. Potentially, both the underlying pathology and adherence to post-correction bracing can affect lower limb function and age of independent standing and walking. This cohort study investigates the age at which infants with idiopathic clubfoot treated using the Ponseti met...
Aims
The Ponseti method is the benchmark treatment for the correction of clubfoot. The primary rate of correction is very high, but outcome further down the treatment pathway is less predictable. Several methods of assessing severity at presentation have been reported. Classification later in the course of treatment is more challenging. This system...
Level III
Introduction and Objective: The Ponseti method of clubfoot correction is the “gold standard”. A variety of methods assessing severity at presentation have been reported. Classification later in the treatment course is more challenging. Reporting standards vary widely with often a complete absence of definition of the corrected or relapse...
Introduction and Objective: Variations in pedal circulation in CTEV are well documented. The aim of this review was to identify the most common aberrancies in arterial pedal circulation in CTEV and to determine the relevance of this for clinical practice.
Materials and Methods: The review was registered on PROSPERO and was carried out according to...
Introduction and Objectives
After successful primary correction of the idiopathic clubfoot deformity with the Ponseti method, recurrence has been reported to affect up to 40% of children. So far, it has been difficult to predict which feet are at risk of recurrence, despite numerous studies investigating various potential risk factors. The foot ab...
Background:
After successful primary correction of the deformity in idiopathic clubfoot with the Ponseti method, recurrence has been reported to affect up to 40% of children. So far, it has been difficult to predict which feet are at risk of recurrence, despite numerous studies investigating various potential risk factors. The foot abduction brace...
Purpose
The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for t...
Purpose
This study aims to correlate the clinical assessment of stability in slipped capital femoral epiphysis (SCFE) with intraoperative findings during open reduction; and asks if the often-used Loder classification of stability requires review.
Method and Results
Ten children with severe SCFE underwent the modified Dunn realignment osteotomy...
Purpose
The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for...
Introduction and Objectives
The Ponseti method is a well-established approach to treating clubfoot. Potentially, both the underlying pathology and adherence to post- correction bracing can affect lower limb function and age of independent standing and walking. This study investigates the age at which infants with idiopathic clubfoot treated using...
Paediatrics for The FRCS (Tr + Orth) Examination is a comprehensive revision resource providing candidates with over 200 high-quality questions to prepare for this challenging subject. Written and edited by consultant paediatric orthopaedic surgeons and senior fellows, this book provides comprehensive coverage of both paediatric trauma and orthopae...
Study design: An experimental human study of retrieval material.
Objectives: Assessment and evaluation of the involvement of TNFα and Nitric oxide in sciatic pain.
Summary and background data: It appears that the inflammation produced by the herniated fragment is at least partially related to the sciatic pain. TNFα was found to be expressed by he...
Aims Clavicle fracture nonunions are extremely rare in children.
The aim of this systematic review was to assess what
factors may predispose children to form clavicle fracture nonunions
and evaluate the treatment methods and outcomes.
Methods We performed a systematic review according to
Preferred Reporting Items for Systematic Reviews and Meta-Ana...
Introduction and Objectives
The paediatric sickle cell population has been recognised to be susceptible to infections, including osteomyelitis. The reported incidence in the literature ranges from 0.36% to 12%. We present a retrospective review of prospectively collected data of osteomyelitis amongst a paediatric sickle cell cohort from our region...
This study aims to compare 1) the demographic characteristics and method of diagnosis of DDH in two tertiary referral centres from two culturally different countries, and 2) the subsequent effect on age at diagnosis and need for surgical intervention. The official criteria for an ultrasound scan referral in Israel and UK is equivalent however the e...
A comprehensive revision source providing candidates with over 200 high quality questions to prepare for this challenging subject. This book provides comprehensive coverage of both paediatric trauma and orthopaedic topics. Split into 3 parts, this source contains over 100 single best answer questions, 50 extended matching questions and 50 viva topi...
Background
Reimer’s migration percentage (MP) is the most established radiographic risk factor for hip migration in cerebral palsy (CP), and it assists surgical decision-making. The head–shaft angle (HSA) measures the valgus of the head and neck in relation to the shaft and may also be a useful predictor of hip migration at a young age. This study...
The definitive treatment of paediatric femoral diaphyseal fractures remains controversial. Modalities of treatment vary mostly according to age, with fracture pattern and site having a lesser impact. Current evidence is reflective of this variation with most evidence cited by the American Academy of Orthopedic Surgeons being level 4 or 5. The autho...
Upper extremity fractures account for up to 90% of pediatric fractures. Among these fractures Supracondylar Humerus fractures are one of the commonest requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. The epidemiology, classific...
Establishing Evidence-based guidelines for elective paediatric orthopaedic procedures
Skeletal dysplasia’s are conditions with generalised abnormalities of the skeleton comprising a heterogenous group of more than 436 disorders. Correct and early diagnosis is important for management of complications. There is considerable genetic and phenotypic heterogeneity and infants and children have variable presentations and full medical supp...
The Ponseti method is the preferred treatment for idiopathic clubfoot. Although popularised by orthopaedic surgeons it has expanded to physiotherapists and other health practitioners. This study reviews the results of a physiotherapist-led Ponseti service for idiopathic and non-idiopathic clubfeet and compares these results with those reported by o...
This study was a retrospective radiographic study involving analysis of computed tomography scans obtained for patients with degenerative spondylolisthesis of the L4-L5 segment and a control group. The purpose of the study was to identify radiological predisposing factors for degenerative spondylolisthesis of the L4-L5 segment. The authors reviewed...