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A Case of Osteofibrous Dysplasia Treated with a Hybrid Approach: Clinical and Radiological Outcomes

Volume 10 | Issue 3 | September-December 2024 | Page: 33-38 | Vivek Madankar, K. Ramkumar Reddy, Roshan Kumar Mohanty

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.208

Open Access License: CC BY-NC 4.0

Submitted: 15/11/2024; Reviewed: 22/11/2024; Accepted: 01/12/2024; Published: 10/12/2024

Authors: Vivek Madankar MS Ortho [1], K. Ramkumar Reddy MS Ortho [1], Roshan Kumar Mohanty MS Ortho [1]

[1] Department of Orthopaedics, Kakatiya Medical College, Warangal, Telangana, India.

Address of Correspondence

Dr. Vivek Madankar,
Department of Orthopaedics, Kakatiya Medical College, Warangal, Telangana, India.
E-mail: vivekmadankar@gmail.com

Abstract

Introduction: Osteofibrous dysplasia (OFD) is a rare, benign, and self-limiting fibro-osseous lesion primarily affecting the cortical bone of the tibia and fibula in children and adolescents. OFD presents diagnostic challenges due to its clinical and radiological resemblance to adamantinoma, a malignant bone tumor. Accurate diagnosis and appropriate treatment are essential to prevent complications and recurrence.
Case Report: We report the case of an 11-year-old boy with a four-month history of pain and a longstanding swelling in his right tibia. Clinical examination revealed a firm, well-circumscribed lesion in the tibial cortex. Imaging demonstrated a mixed sclerotic and lytic lesion with characteristic features, including a multilocular “soap bubble” appearance. Histopathological evaluation confirmed the diagnosis of OFD. The patient underwent a hybrid treatment approach involving surgical excision sparing the posterior cortex, followed by functional cast bracing. This strategy facilitated early mobilization and complete recovery. Radiological evaluation at six weeks demonstrated neo-osteogenesis, with full bone healing achieved by 12 weeks. At the two-year follow-up, the patient exhibited full functional recovery with no signs of recurrence.
Conclusion: This case highlights the successful management of OFD using a hybrid surgical and non-surgical approach, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Combining surgical resection with functional bracing allowed for effective management, early weight-bearing, and prevention of complications. This approach adds to the orthopedic literature by illustrating an alternative, cost-effective treatment protocol for this rare bone disorder.
Keywords: Osteofibrous dysplasia, Tibial lesion, Hybrid treatment, Surgical excision, Functional cast bracing, Pediatric orthopedics

References

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How to Cite this Article: Madankar V, Reddy KR, Kumar R | A Case of Osteofibrous Dysplasia Treated with a Hybrid Approach: Clinical and Radiological Outcomes | International Journal of Paediatric Orthopaedics | September-December 2024; 10(3): 33-38.

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A New Technique in the Treatment of Congenital Vertical Talus: A Case Series of Four Patients

Volume 10 | Issue 3 | September-December 2024 | Page: 25-32 | Harsharan Singh Oberoi, Baldish Singh Oberoi

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.206

Open Access License: CC BY-NC 4.0

Submitted: 21/11/2024; Reviewed: 23/11/2024; Accepted: 01/12/2024; Published: 10/12/2024

Authors: Harsharan Singh Oberoi MS, DNB Ortho [1], Baldish Singh Oberoi MS Ortho, MPH [2]

[1] Department of Orthopaedics, Oberoi Hospital, Jalandhar City, Punjab, India.

Address of Correspondence

Dr. Baldish Singh Oberoi
Consultant Orthopaedic Surgeon, Oberoi Hospital, Jalandhar City, Punjab, India.
Email: baldishoberoi@gmail.com

Abstract

Congenital Vertical talus is a rare condition present at birth that occurs in 1 in 10000 live births. We present a case series of four patients that we treated by the minimal invasive procedure followed by serial casting. Satisfactory correction, both cosmetic and functional, was achieved in all the cases. These results indicate that minimal invasive surgery followed by serial casting is a good way to correct the deformity in patients presenting early. Often, Vertical Talus patients are corrected by extensive surgical procedures and wire fixations leading to complications and resulting in a stiff and painful foot. We have devised a minimally invasive procedure without any wire fixation for patients presenting early with satisfactory results.
Keywords: Congenital Vertical talus, Foot abduction Orthosis, Talo-calcaneal angle

References

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13. Alaee F, Boehm S, Dobbs MB. A new approach to the treatment of congenital vertical talus. J Child Orthop. 2007 Sep;1(3):165-74.
14. Zorer G, Bagatur AE, Dogan A. Single stage surgical correction of congenital vertical talus by complete subtalar release and peritalar reduction by using the Cincinnati incision. J Pediatr Orthop B. 2002 Jan;11(1):60-7.
15. Miller M, Dobbs MB. Congenital Vertical Talus: Etiology and Management. J Am Acad Orthop Surg. 2015 Oct;23(10):604-11.
16. Sehmi S. Etiology and Treatment of Congenital Vertical Talus: A Clinical Review. AMEI’s Curr Trends Diagn Treat 2020;4(2):91–94.
17. Giannestras NJ. Recognition and treatment of flatfeet in infancy. Clin Orthop Relat Res. 1970 May-Jun;70:10-29.
18. Silk FF, Wainwright D. The recognition and treatment of congenital flat foot in infancy. J Bone Joint Surg Br. 1967 Nov;49(4):628-33.
19. Hafez M, Davis N. Outcomes of a Minimally Invasive Approach for Congenital Vertical Talus With a Comparison Between the Idiopathic and Syndromic Feet. J Pediatr Orthop. 2021 Apr 1;41(4):249-254.
20. Doski J. Current lines and angles used in paediatric foot radiograph: a scoping review of literature. Ann Ib Postgrad Med. 2024 Apr 30;22(1):51-61.

How to Cite this Article: Oberoi HS, Oberoi BS | A New Technique in the Treatment of Congenital Vertical Talus: A Case Series of Four Patients | International Journal of Paediatric Orthopaedics | September-December 2024; 10(3): 25-32.

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Tibial Tuberosity Fractures in Adolescents: Anatomo – Clinical Assessment and Treatment Results

Volume 10 | Issue 3 | September-December 2024 | Page: 12-18 | Ake YL, Ouattara SJJ, Bonny R, Kouassi-Dria AKS

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.202

Open Access License: CC BY-NC 4.0

Submitted: 28/10/2024; Reviewed: 10/11/2024; Accepted: 03/12/2024; Published: 10/12/2024

Authors: Ake YL [1], Ouattara SJJ [1], Bonny R [1], Kouassi-Dria AKS [1]

[1] Department of Paediatric Surgery, Cocody Teaching Hospital, Abidjan, Ivory Coast

Address of Correspondence

Dr. Ake Yapi Landry
Associate Lecturer, Department of Paediatric Surgery, Cocody Teaching Hospital, Abidjan, Ivory Coast
Email: akeyapilandry@yahoo.fr

Abstract

Background: The objective of this study was to describe the anatomo-clinical, therapeutic aspect of TT fractures and the results.
Methods: This retrospective study was conducted over a period of 5 years (01 January 2018 to 01 January 2023) in the Paediatric Surgery Department of the Teaching Hospital and at theInternational clinic. The epidemiological- clinical, anatomopathological, therapeutic, and the results variables of TT fractures were studied.
Results: Data from 10 cases were included in this study. All patients were male, and their mean age was 14.3 years [range: 11-15 years]. All fractures occurred during sports activities through indirect mechanisms. Fractures occurred on both the left and right sides of the knee. We have compiled fractures of type IB (2 cases), type IIB (03 cases), IIIA (01 case), type IIIB (03 cases), and type IV (01 case). All patients underwent open reduction and osteosynthesis. No complications occurred in any of the patients, and their long-term results were satisfactory.
Conclusion: TT fractures are uncommon in adolescents; however, they are common in sports that involve jumping. The indications for treatment are based on the modified Ogden classification. These fractures have a good prognosis, with full recovery of function and activity after consolidation.
Keywords: Fracture, Tibial tuberosity, Adolescence

References

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How to Cite this Article: Ake YL, Ouattara SJJ, Bonny R, Kouassi-Dria AKS | Tibial Tuberosity Fractures in Adolescents: Anatomo – Clinical Assessment and Treatment Results | International Journal of Paediatric Orthopaedics | September-December 2024; 10(3): 12-18.

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Hip Displacement in Children with Cerebral Palsy- A Clinico- Radiological Evaluation

Volume 10 | Issue 3 | September-December 2024 | Page: 6-11 | Deepa Metgud, Shruti Desai, Shreya Bavi, Vinuta Deshpande, Naveenkumar Patil, Santosh Patil

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.200

Open Access License: CC BY-NC 4.0

Submitted: 20/11/2024; Reviewed: 26/11/2024; Accepted: 08/12/2024; Published: 10/12/2024

Authors: Deepa Metgud PhD, MPT [1], Shruti Desai MPT [1], Shreya Bavi MPT [1], Vinuta Deshpande MPT [1], Naveenkumar Patil MS Ortho [2], Santosh Patil MD Rad [3]

[1] Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India.
[2] Department of Orthopaedics, KAHER’S JGMM Medical College Gabbur, Kotagondhunshi, Hubbali, Karnataka, India.
[3] Department of Radiology, JN Medical College, Belagavi, Karnataka, India.

Address of Correspondence

Dr. Deepa Metgud
Department of Paediatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India.
Email Id: deepametgud@klekipt.edu.in

Abstract

Background: Children with cerebral palsy (CP) are at risk for hip subluxation due to the spasticity and contractures of the hip adductors, medial hamstrings, and hip flexors. Hip displacement is often asymptomatic in these children until the hip is particularly or fully dislocated resulting in pain, gait disturbances and impaired sitting balance. Hip surveillance is a process of actively monitoring a child for early identification of hip displacement. In India, the National Hip Surveillance Program was established to support surveillance in preventing dislocations and reducing the need for surgery. In light of this, the present study aims to determine the prevalence of hip displacement in children with cerebral palsy in Belagavi.
Method: This descriptive, cross-sectional observational study was conducted at a tertiary care hospital and inclusive education schools. Children aged 2–18 years with cerebral palsy, underwent clinical examinations followed by radiographic evaluation and the Migration Percentage (MP) was calculated to categorize hip displacement, the primary outcome measure of the study. Prevalence of subluxation and its association with gender, age, GMFCS E&R levels and CP subtypes were assessed.
Results: Out of 128 children with CP assessed, 104 had subluxation, with the majority (73.44%) showing bilateral involvement, while 7.81% had right-sided subluxation. The prevalence of subluxation varied by CP subtypes, with spastic type accounting for the higher prevalence. A statistically significant association between CP subtype and subluxation was found on the right side (p = 0.003).
Conclusion: The study identifies an 81.3% occurrence of hip subluxation in children with CP, with bilateral involvement being the most prevalent (73.44%). The likelihood of subluxation was notably impacted by CP subtype, especially in spastic CP. Timely detection through clinical assessment and radiographic monitoring is vital to prevent advancement to dislocation. Future investigations should prioritize extended follow-ups and therapeutic approaches to optimize outcomes.
Keywords: Hip subluxation, Cerebral palsy, Radiography, Migration percentage

References

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15. Picciolini O, Albisetti W, Cozzaglio M, Spreafico F, Mosca F, Gasparroni V. “Postural Management” to prevent hip dislocation in children with cerebral palsy. Hip International. 2009 Jan;19(6_suppl):56-62.

How to Cite this Article: Metgud D, Desai S, Bavi S, Deshpande V, Patil N, Patil S | Hip Displacement in Children with Cerebral Palsy – A Clinico- Radiological Evaluation | International Journal of Paediatric Orthopaedics | September-December 2024; 10(3): 6-11.

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Outcomes in Paediatric Proximal Third Forearm Fractures: A Systematic Review

Volume 10 | Issue 3 | September-December 2024 | Page: 2-5 | Nathan McKenzie, Connor Zale, Ryan Nguyen, Kevin Krul

DOI- https://doi.org/10.13107/ijpo.2024.v10.i03.198

Open Access License: CC BY-NC 4.0

Submitted: 14/11/2024; Reviewed: 20/11/2024; Accepted: 04/12/2024; Published: 10/12/2024

Authors: Nathan McKenzie B.S. [2], Connor Zale M.D. [1], Ryan Nguyen B.S. [3], Kevin Krul M.D. [1]

[1] Tripler Army Medical Center. 1 Jarrett White Rd. Medical Center. Honolulu, HI. 96859.
[2] University of Oklahoma College of Medicine. 800 Stanton L Young Blvd. Oklahoma City, OK. 73117.
[3] John A. Burns School of Medicine. University of Hawaii. 651 lalo St, Honolulu, HI 96813.

Address of Correspondence

Dr. Connor Zale,
Tripler Army Medical Center. 1 Jarrett White Rd. Medical Center. Honolulu, HI. 96859.
Email: Connor.zale11@gmail.com

Abstract

Objective: To analyze initial treatment failure, functional and radiographic outcomes following non-operative management of Paediatric third proximal forearm fractures.
Methods: A search was performed on PUBMED/MEDLINE, Cochrane Database and Embase on 28 January 2024. Search keywords were “Paediatric, proximal, forearm and fracture”. Articles were reviewed for non-operative management of proximal forearm fractures. Articles were reviewed for acceptable angulation for successful treatment, rate of conversion to operative management or remanipulation, functional outcomes and final radiographic angulation.
Results: 181 articles were obtained from a literature search. 10 articles had incomplete data. 10 articles reported the rate for initial treatment failure. 4 articles reported individual patient functional outcomes. 3 articles reported individual residual angulation.
There were 392 cases of proximal forearm fractures. The rate of initial treatment failure which required remanipulation or surgery ranged from 0-83.8%. Individual functional outcomes were reported for 22 patients. The average age was 10.93.9 years old. 16/22 cases had full range of motion. The 6 cases with limited range of motion had residual angulation of 5-15 (11.54.2). 3/5 cases with 15 of residual angulation had full range of motion.
Conclusion: The rate of initial non-operative treatment failure ranged from 0-83.8% for proximal forearm fractures. Families should be advised on the high rate of failure for initial non-operative management and the possible need for remanipulation or surgery. Patients that are 10 years and older are at an increased risk for loss of reduction and possible need for surgical treatment.
Keywords: Both bone, Proximal third forearm, Paediatric forearm fracture

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How to Cite this Article: McKenzie N, Zale C, Nguyen R, Krul K Outcomes in Paediatric Proximal Third Forearm Fractures: A Systematic Review | International Journal of Paediatric Orthopaedics | September-December 2024;10(3):2-5.

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Lower Limb Deformity Management in Arthrogryposis – What to Correct and When

Volume 10 | Issue 2 | May-August 2024 | Page: 40-47 | Ishani P Shah, Sujika Ranmuthuge, Varun Parnami, Anastasios Chytas

DOI- https://doi.org/10.13107/ijpo.2024.v10.i02.192

Submitted: 18/05/2024; Reviewed: 06/06/2024; Accepted: 16/07/2024; Published: 10/08/2024

Authors: Ishani P Shah DNB Ortho. FRCS (T & O) [1], Sujika Ranmuthuge MD, FRCS (T & O) [1], Varun Parnami DNB Ortho. [1], Anastasios Chytas MD, MSc [1]

[1] Department of Paediatric Orthopaedic Surgery, Royal Manchester Children’s Hospital, Oxford Road, M13 9WL

Address of Correspondence

Dr. Ishani P Shah,
Consultant Paediatric Orthopaedic Surgeon, Royal Manchester Children’s Hospital, Oxford Road, M13 9WL.
E-mail: ishanipshah@gmail.com

Abstract

Arthrogryposis is a descriptive term involving non – progressive joint contractures of two or more joints at birth. It is associated with more than 300 diseases. Lower limb involvement is seen in about 95% of the cases with variable affection of the foot, knee and hip. Management depends on the severity, affection of number of joints and co-morbidities. Multidisciplinary management is crucial with realistic expectations. Prognosis should be discussed with parents prior to undertaking surgical intervention, especially the risk of recurrence as age advances. Deformities include soft tissue contractures, fibrotic hypoplastic muscles and in older children, deformed articular congruity. Foot is most commonly affected and Ponseti casting is the gold standard first line of treatment. Failed correction or late presentations are treated with soft tissue/bony surgery and/or fixator. Knee contractures can be flexion or extension with or without joint subluxation and patella involvement. Options for management are serial casting, soft tissue release, growth modulation, bony surgery, gradual correction with fixator or a combination of these based on the severity and age at presentation. Pterygium management is difficult due to proximity of neurovascular structures to the skin web and higher risk of recurrence. Hip contractures and dislocation when unilateral should be treated surgically. Treatment of bilateral affection is controversial and should be individualised.
Keywords: Arthrogryposis, Amyoplasia, Arthrogryposis multiplex congenita, Hip contracture, Knee contracture, Lower limb deformity, Atypical clubfoot.

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How to Cite this Article: Shah IP, Ranmuthuge S, Parnami V, Chytas A | Lower Limb Deformity Management in Arthrogryposis – What to Correct and When | International Journal of Paediatric Orthopaedics | May-August 2024; 10(2): 40-47.
https://doi.org/10.13107/ijpo.2024.v10.i02.192

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