Background: Lateral condyle fracture (LCF) of the immature humerus is a transphyseal intra-articular injury. Where there is more than two millimeters of displacement, open reduction and internal fixation (ORIF) with anatomic reduction and secure fixation are essential to avoid complications. The aim of this study is to analyze the outcome of cannulated screw versus two divergent Kirschner wire (K-wire) fixation following open reduction of displaced lateral condyle fracture of humerus. Methods: A prospective randomized controlled trial was performed including 64 children in 2 treatment groups: Group-A (screw fixation) and Group-B (Kirschner wires). Primary outcome measures were radiological outcome and functional outcome. Secondary outcomes were stability of fixation and post-operative complications. Results: There was no significant difference in demographic characteristics of the children between two groups. Screw fixation was significantly superior in radiological outcome than K-wires. There was no significant difference in functional outcome or the stability of fixation between the two groups. Surgical site infection and lateral condylar overgrowth were significantly higher in the K-wire fixation group. Conclusion: Cannulated screw fixation is superior in radiological outcome with fewer complications than K-wire fixation in displaced LCF of humerus in children. But there was no significant difference in functional outcome and stability of fixation. Keywords: Cannulated screw, Kirschner wire, Lateral condyle fracture of Humerus, Children
References
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How to Cite this Article: Moe S, Win HL, Kyaw K, Tun WL, Aung YH | Cannulated Screw Versus Kirschner Wire Fixation Following Open Reduction of Lateral Condyle Fracture of Humerus | International Journal of Paediatric Orthopaedics| January-April 2023; 9(1): 00-00 | https://doi.org/10.13107/ijpo.2023.v09.i01.000https://doi.org/10.13107/ijpo.2023.v09.i01.000
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2023-11-30 17:18:242023-12-01 19:05:53Cannulated Screw Versus Kirschner Wire Fixation Following Open Reduction of Lateral Condyle Fracture of Humerus
Authors: Sitsabesan Chokkalingam [1] D Ortho., Arunan Murali [2] MD Rad., Roy Santhosham [2] MD Rad., Gopinath Menon [1] MS Ortho.
[1] Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
[2] Department of Radiology, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
Address of Correspondence
Dr. Sitsabesan Chokkalingam,
Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
E-mail: sabesan101@gmail.com
Abstract
Introduction: Osteoid osteomas are painful benign bone tumors, accounting for 10% of overall primary bone tumors. Typical osteoid osteomas are located intracortical or intramedullary in the metadiaphyseal region of the long bones. The Atypical ones are the Juxta and Intraarticular type, posing greater challenges in its diagnosis and management. CT and MRI scans have better chances of defining the nidus lesions in Atypical osteoid osteoma of the hip joints. Surgical treatment options include, image guided percutaneous interventions such as Radio frequency ablation, Laser or Cryo ablation. These modalities achieve surgical cure, but lacks the opportunity for a histo-pathological confirmation. Our cases will highlight the ‘wandering nidus’ in hip osteoid osteoma and the possibility of dual pathology (Osteoid osteoma and Osteomyelitis) in the same hip. Case study: We present two cases of hip joint osteoid osteomas (aged 18 yrs and 10 yrs) to highlight the diagnostic challenges and to discuss the different methodology of treatment. CT scan with additional MRI studies confirmed the radiological diagnosis after a delay of 6-8 months. The first case will highlight the wandering nature of the nidus (explained by the position of the calcific spicule within the nidus with reference to the needle tip), the challenges for needle trajectory with close proximity to femoral vessels and the “coaxial technique using chopstick maneuver” for CT guided needle excision. The second case will highlight the feasibility of percutaneous excision and surgical curettage in the presence of dual pathology. Conclusion: Both the cases were successfully treated by CT guided n excision biopsy and had the histopathological confirmation. Needle technique allows confirmation of diagnosis and exclusion of other differential pathology. Keywords: Wandering nidus, Atypical osteoid osteoma hip, Chopstick maneuver, Coaxial technique, Double hip lesion.
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How to Cite this Article: Chokkalingam S, Murali A, Santhosham R, Menon G | Atypical Osteoid Osteoma of Proximal Femur and Its Surgical Challenges: A Case Study on ‘Wandering Nidus’ and Double Lesion | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 00-00 | https://doi.org/10.13107/ijpo.2023.v09.i01.000
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2023-04-10 16:51:432023-10-07 17:06:33Atypical Osteoid Osteoma of Proximal Femur and its Surgical Challenges: A Technical Note on ‘Wandering Nidus’ and Double Lesion
Authors: Amit Sharma [1] MS Ortho., G Nirmal Raj Gopinathan [2] MS Ortho., Garima Sharma [3] MD Microbiology, Pallavi Sharma [4] MS ObGy., Sange Negi [1] MS Ortho.
[1] Department of Orthopaedics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[2] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
[3] Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[4] Department of Obstetrics and Gynaecology, Government Medical College Hospital, Chandigarh, India.
Address of Correspondence
Dr. Garima Sharma,
Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
E-mail: garimaserene@gmail.com
Abstract
Staphylococcus aureus is the most common organism causing paediatric bone and joint infections accounting for 86% of pus culture-positive cases. Methicillin resistant staphylococcus aureus (MRSA) has become a major challenge in the tertiary care setting as the majority (56%) of all pus culture postive cases were MRSA. The male to female ratio in these infections was approximately 2:1. The lower limbs were affected in the majority of children with osteomyelitis (OM) with hip joint being the commonest (50%) followed by the knee. Broad spectrum antibiotics were used emperically in 40% of cases prior to referral to a tertiary care centre. MRSA infections were associated with a higher likelihood of complications. Keywords: Paediatric, Pyogenic, Bone and joint infections, Antibiotic practices
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How to Cite this Article: Sharma A, Gopinathan GNR, Sharma G, Sharma P, Negi S | Epidemiology and Antibiotic Sensitivity Patterns in Pyogenic Bone and Joint Infections in Children | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 00-00 | https://doi.org/10.13107/ijpo.2023.v09.i01.000
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2023-04-10 16:37:002023-11-30 17:23:20Epidemiology and Antibiotic Sensitivity Patterns in Pyogenic Bone and Joint Infections in Children
[1] Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon
[2] Faculty of Medicine and Pharmaceutical Sciences of the University of Douala, BP 2701, Douala, Littoral Region, Cameroon.
[3] Department of Mechanical Engineering, ENSET, University of Douala, BP 2701, Douala, Littoral Region, Cameroon.
Address of Correspondence
Dr. Jean GustaveTsiagadigui,
Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon.
E-mail: jtsiagad@gmail.com
Abstract
Bone problems such as angular deformities of the knee are common in children in Africa. The aim of this survey was to study epidemiologic aspects of frontal plane angular knee deformities in school children in Kribi. A total of 860 school children in Kribi aged 3 to 18 years were surveyed in a cross-sectional descriptive study from December 2019 to March 2020. Each child was examined. Intercodylar distances, intermalleolar distances and the tibiofemoral angles were assessed. The type of knee deformity in the frontal plane was determined from the children`s tibiofemoral angles and compared with reference values of normal children in the same age ranges. One hundred and fourty two (142, 16.5%) children surveyed presented with frontal plane knee deformities, with genu varum representing 68.0% (96 cases) of the deformities. The prevalence of these deformities in school children in Kribi varied significantly with age. We did not find any significant difference in the variation of these deformities with gender or ethnic groups. We identified some frontal plane angular knee deformities, including bilateral deformities being predominant 90.71% (127 cases). The mean body mass index was higher than those of normal children. 15.5% (22) of them presented with associated deformity in the sagital plane, dominated by bilateral genu recurvatum and 33.8% (48) of them presented with associated rotational knee deformities, dominated by bilateral medial rotation. Frontal plane knee angular deformities are common amongst school children in Kribi. Their prevalence is 16.51% (142 cases). This prevalence varies with ages. Sagittal plane and rotational plane deformities are equally present in children presenting with these deformities. Keywords: Bone, Children, Deformities, Cameroon.
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How to Cite this Article: Tsiagadigui JG, Ateh RM, Yamben MAN, Ngongang FO, Eone DH, Sosso MA | Frontal Plane Angular Knee Deformities in School Children in Kribi, South Region of Cameroon | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 00-00 | https://doi.org/10.13107/ijpo.2023.v09.i01.000
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2023-04-10 16:36:052023-10-07 17:06:32Frontal Plane Angular Knee Deformities in Schoolchildren in Kribi, South Region of Cameroon
Authors: Ebin Rahman [1] DNB Ortho, Subin Sugath [1] DNB Ortho, Unnikrishnan R [2] MD Radiology, Joe Thomas [3] MD Med. DNB Rheumatology
[1] Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Radiology, Aster Medcity, Kochi, Kerala, India.
[3] Department Of Rheumatology, Aster Medcity, Kochi, Kerala, India.
Address of Correspondence
Dr Ebin Rahman,
Senior Specialist, Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com
Abstract
Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic auto-inflammatory bone disease of unknown aetiology that typically affects children and adolescents. It presents as recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures from lesions are sterile. It is unresponsive to antibiotic therapy. CRMO is a diagnosis of exclusion since no single clinical feature is pathognomonic. Radiological tests are often required and a bone biopsy may be needed in unclear cases. Case Report: We report a case of an 8-year-old girl, with pain over both ankles and upper chest; history and radiological evaluation suggested osteomyelitis, but no adequate response to antibiotic treatment was observed. A bone biopsy was done to rule out malignancy. Whole body imaging revealed multiple bony lesions; based on which a diagnosis of chronic recurrent multifocal osteomyelitis was made. Patient was started on specific anti-inflammatory treatment with resolution of symptoms. Conclusion: Chronic recurrent multifocal osteomyelitis should be suspected in a child with recurrent, multiple bone pain, modest increase of inflammatory indices, and lytic or sclerotic bone lesion on radiographs. Typical locations are the metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, but any bone can be involved. We want to increase the awareness of this entity and as a differential diagnosis of recurrent, multifocal bone pain in an adolescent, thereby avoiding unnecessary antibiotic administration and bone biopsies. Keywords: Chronic recurrent multifocal osteomyelitis, Bone pain, Non-steroidal anti-inflammatory drugs
References
[1]. Hedrich CM, Hofmann SR, Pablik J, et al. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol. 2013;11:47.
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[16]. Miettunen PM, Wei X, Kaura D, et al. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 2009;7(2).
[17]. Taddio A, Zennaro F, Pastore S, et al. An update on the pathogenesis and treatment of chronic recurrent multifocal osteomyelitis in children. Paediatr Drugs. 2017 Jun;19(3):165-72.
[18]. Marion R. Roderick, Ethan S. Sen and Athimalaipet V. Ramanan. Chronic recurrent multifocal osteomyelitis in children and adults: current understanding and areas for development. Rheumatology 2018;57:41 48.
How to Cite this Article: Rahman E, Sugath S, Unnikrishnan R, Thoma J | Chronic Recurrent Multifocal Osteomyelitis – A Case Report | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 22-26 | https://doi.org/10.13107/ijpo.2022.v08.i03.146
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2022-12-10 18:47:282023-09-08 17:56:42Chronic Recurrent Multifocal Osteomyelitis – A Case Report
[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
Address of Correspondence
Dr. Anil Agarwal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com
Abstract
Background: The septic sequelae of knee following infantile infection is scantily described in literature. This case series depicts the various anatomical zones affected, the radiological presentation and proposes a vascular hypothesis for the sequelae. Methods and results: Sequelae presented with three distinct radiological findings namely, unicondylar loss of lateral distal femur (n=4), hemicondylar loss of anterior portion of proximal tibia (n=3), and epiphyseal overgrowth and deficient tibial metaphysis of medial/ lateral side (n=4). The anatomical zones for above findings were seen approximately matching with the supply of specific genicular arteries around knee. On corroborating the early post infective radiographs and the sequelae radiographs, it was found that most patients had concomitant osteomyelitis, sometimes extensive. Conclusions: We could recognize three distinct anatomical patterns of septic sequelae of knee following osteoarticular knee infection in infancy. An ischemic etiopathogenesis is suggested based on consistent radiological findings and the vascular supply zones. Most cases followed concomitant occurrence of septic arthritis and extensive osteomyelitis. Keywords: Knee, Sepsis, Sequelae, Ischemia, Infants
References
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How to Cite this Article:Agarwal A | Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 16-21 | https://doi.org/10.13107/ijpo.2022.v08.i03.145
http://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpg00ijpoonlilnehttp://ijpoonline.com/wp-content/uploads/2021/07/ijpo-header.jpgijpoonlilne2022-12-10 18:03:152023-09-08 17:56:55Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis
Cannulated Screw Versus Kirschner Wire Fixation Following Open Reduction of Lateral Condyle Fracture of Humerus
Volume 9 | Issue 1 | January-April 2023 | Page: 00-00 | Shane Moe, Hein Latt Win, Kyaw Kyaw, Wai Lin Tun, Ye Htut Aung
DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.000
Authors: Shane Moe [1] M.D, Ph.D., Hein Latt Win [2] M.D, Ph.D. FRCS, Kyaw Kyaw [1] M.D, Ph.D., Wai Lin Tun [1] M.D, Ph.D.,
Ye Htut Aung [2] M.D
[1] Department of Orthopaedics, DSOH, Yangon, Myanmar.
[2] Department of Orthopaedics, DSMA, Yangon, Myanmar.
Address of Correspondence
Dr. Shane Moe
Consultant Orthopaedic Surgeon, DSOH, Yangon, Myanmar.
E-mail: drshanemoe@gmail.com
Abstract
Background: Lateral condyle fracture (LCF) of the immature humerus is a transphyseal intra-articular injury. Where there is more than two millimeters of displacement, open reduction and internal fixation (ORIF) with anatomic reduction and secure fixation are essential to avoid complications. The aim of this study is to analyze the outcome of cannulated screw versus two divergent Kirschner wire (K-wire) fixation following open reduction of displaced lateral condyle fracture of humerus.
Methods: A prospective randomized controlled trial was performed including 64 children in 2 treatment groups: Group-A (screw fixation) and Group-B (Kirschner wires). Primary outcome measures were radiological outcome and functional outcome. Secondary outcomes were stability of fixation and post-operative complications.
Results: There was no significant difference in demographic characteristics of the children between two groups. Screw fixation was significantly superior in radiological outcome than K-wires. There was no significant difference in functional outcome or the stability of fixation between the two groups. Surgical site infection and lateral condylar overgrowth were significantly higher in the K-wire fixation group.
Conclusion: Cannulated screw fixation is superior in radiological outcome with fewer complications than K-wire fixation in displaced LCF of humerus in children. But there was no significant difference in functional outcome and stability of fixation.
Keywords: Cannulated screw, Kirschner wire, Lateral condyle fracture of Humerus, Children
References
1. Schroeder, K. M., Gilbert, S. R., Ellington, M., Souder, C. D., & Yang, S. Pediatric lateral humeral condyle fractures. Journal of Paediatric Orthopaedic Society North America, 2020; 2(1): 1-10.
2. Shirley, E., Anderson, M., Neal, K., & Mazur, J. Screw fixation of lateral condyle fractures: results of treatment. Journal of Pediatric Orthopaedics, 2015; 35(8): 821-824. https://doi.org/10.1097/BPO.0000000000000377
3. Gilbert, S. R., MacLennan, P. A., Schlitz, R. S., & Estes, A. R. Screw versus pin fixation with open reduction of pediatric lateral condyle fractures. Journal of Pediatric Orthopaedics, 2016; 25(2): 148-152.
https://doi.org/ 10.1097/bpb.0000000000000238
4. Stein, B. E., Ramji, A. F., Hassanzadeh, H., Wohlgemut, J. M., Ain, M. C., & Sponseller, P. D. Cannulated lag screw fixation of displaced lateral humeral condyle fractures is associated with lower rates of open reduction and infection than pin fixation. Journal of Pediatric Orthopaedics, 2017; 37(1): 7-13.
https://doi.org/ 10.1097/bpo.0000000000000579
5. Birkett, N., Al-Tawil, K., & Montgomery, A. Functional outcomes following surgical fixation of paediatric lateral condyle fractures of the elbow – A systematic review. Orthopedic Research and Reviews, 2020; 12: 45-52.
https://doi.org/10.2147/ORR.S215742
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10. Baharuddin, M., & Sharaf, I. Screw osteosynthesis in the treatment of fracture lateral humeral condyle in children. The Medical journal of Malaysia, 2001; 56: 45-47.
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12. Sial, N. A., Iqbal, M. J., & Shaukat, M. K. Open reduction and k-wire fixation of displaced unstable lateral condyle fractures of the humerus in children. The Professional Medical Journal, 2011; 18(03): 501-509.
13. Singh, R. S., Garg, L., Jaiman, A., Sharma, V. K., & Talwar, J. Comparison of kirschner wires and cannulated screw internal fixation for displaced lateral humeral condyle fracture in skeletally immature patients. Journal of Clinical Orthopaedics & Trauma, 2015; 6(1): 62.
14. Li, W. C., & Xu, R. J. Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. International orthopaedics, 2012; 36(6): 1261-1266. https://doi.org/ 10.1007/s00264-011-1452-y
15. Stevenson, R. A., & Perry, D. C. Paediatric lateral condyle fractures of the distal humerus. Orthopaedics and Trauma, 2018; 32(5): 352-359. https://doi.org/ 10.1016/j.mporth.2018.07.013
16. Franks, D., Shatrov, J., Symes, M., Little, D. G., & Cheng, T. L. (2018). Cannulated screw versus Kirschner-wire fixation for Milch II lateral condyle fractures in a paediatric sawbone model: a biomechanical comparison. Journal of Children’s Orthopaedics, 12(1), 29-35. https://doi.org/10.1302/1863-2548.12.170090
17. Schlitz, R. S., Schwertz, J. M., Eberhardt, A. W., & Gilbert, S. R. (2015). Biomechanical analysis of screws versus K-wires for lateral humeral condyle fractures. Journal of Pediatric Orthopaedics, 35(8), e93-e97. https://doi.org/ 10.1097/BPO.0000000000000450
18. Ganeshalingam, R., Donnan, A., Evans, O., Hoq, M., Camp, M., & Donnan, L. Lateral condylar fractures of the humerus in children: Does the type of fixation matter? The Bone & Joint Journal, 2018; 100(3): 387-395. https://doi.org/ 10.1302/0301-620X.100B3
19. Luo, X., Chen, X., & Wang, J. A retrospective comparative study of open reduction and cannulated screw fixation and Kirschner wire fixation in the treatment of fracture of lateral condyle of humerus in children. Research Square. 2021; 1-12
20. Sharma, H., Maheshwari, R., & Wilson, N. Lateral humeral condyle fractures in children: a comparative cohort study on screws versus K-wires. Orthopaedic Proceedings. 2006; 88-B: Supp-III, 434-434.
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Atypical Osteoid Osteoma of Proximal Femur and its Surgical Challenges: A Technical Note on ‘Wandering Nidus’ and Double Lesion
Volume 9 | Issue 1 | January-April 2023 | Page: 00-00 | Sitsabesan Chokkalingam, Arunan Murali, Roy Santhosham, Gopinath Menon
DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.000
Authors: Sitsabesan Chokkalingam [1] D Ortho., Arunan Murali [2] MD Rad., Roy Santhosham [2] MD Rad., Gopinath Menon [1] MS Ortho.
[1] Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
[2] Department of Radiology, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
Address of Correspondence
Dr. Sitsabesan Chokkalingam,
Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
E-mail: sabesan101@gmail.com
Abstract
Introduction: Osteoid osteomas are painful benign bone tumors, accounting for 10% of overall primary bone tumors. Typical osteoid osteomas are located intracortical or intramedullary in the metadiaphyseal region of the long bones. The Atypical ones are the Juxta and Intraarticular type, posing greater challenges in its diagnosis and management. CT and MRI scans have better chances of defining the nidus lesions in Atypical osteoid osteoma of the hip joints. Surgical treatment options include, image guided percutaneous interventions such as Radio frequency ablation, Laser or Cryo ablation. These modalities achieve surgical cure, but lacks the opportunity for a histo-pathological confirmation. Our cases will highlight the ‘wandering nidus’ in hip osteoid osteoma and the possibility of dual pathology (Osteoid osteoma and Osteomyelitis) in the same hip.
Case study: We present two cases of hip joint osteoid osteomas (aged 18 yrs and 10 yrs) to highlight the diagnostic challenges and to discuss the different methodology of treatment. CT scan with additional MRI studies confirmed the radiological diagnosis after a delay of 6-8 months. The first case will highlight the wandering nature of the nidus (explained by the position of the calcific spicule within the nidus with reference to the needle tip), the challenges for needle trajectory with close proximity to femoral vessels and the “coaxial technique using chopstick maneuver” for CT guided needle excision. The second case will highlight the feasibility of percutaneous excision and surgical curettage in the presence of dual pathology.
Conclusion: Both the cases were successfully treated by CT guided n excision biopsy and had the histopathological confirmation. Needle technique allows confirmation of diagnosis and exclusion of other differential pathology.
Keywords: Wandering nidus, Atypical osteoid osteoma hip, Chopstick maneuver, Coaxial technique, Double hip lesion.
References
[1] Carneiro BC, Da Cruz IAN, Ormond Filho AG, et al. Osteoid osteoma: the great mimicker. Insights Imaging. 2021;12(1):32. Published 2021 Mar 8. doi:10.1186/s13244-021-00978-8
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[6] D. I. Rosenthal, F. J. Hornicek, M. Torriani, M. C. Gebhardt, and H. J. Mankin, “Osteoid osteoma: percutaneous treatment with radiofrequency energy,” Radiology, vol. 229, no. 1, pp. 171–175
[7] Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA et al (2010) Radiologic diagnosis of osteoid osteoma: from simple to challenging fndings. Radiographics 30(3):737–749
[8] Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN (2002) The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol 31(10):559–569
[9] Mungo DV, Zhang X, O’Keefe RJ, Rosier RN, Puzas JE, Schwarz EM (2002) COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res 20(1):159–162
[10] Edeiken J, DePalma AF, Hodes PJ (1966) Osteoid osteoma. (Roentgenographic emphasis). Clin Orthop Relat Res 49:201–206
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[12] Aynaci, O., Turgutoglu, O., Kerimoglu, S. et al. Osteoid osteoma with a multicentric nidus: a case report and review of the literature. Arch Orthop Trauma Surg 127, 863–866 (2007). https://doi.org/10.1007/s00402-007-0421-9
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Epidemiology and Antibiotic Sensitivity Patterns in Pyogenic Bone and Joint Infections in Children
Volume 9 | Issue 1 | January-April 2023 | Page: 00-00 | Amit Sharma, G Nirmal Raj Gopinathan, Garima Sharma, Pallavi Sharma, Sange Negi
DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.000
Authors: Amit Sharma [1] MS Ortho., G Nirmal Raj Gopinathan [2] MS Ortho., Garima Sharma [3] MD Microbiology, Pallavi Sharma [4] MS ObGy., Sange Negi [1] MS Ortho.
[1] Department of Orthopaedics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[2] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
[3] Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[4] Department of Obstetrics and Gynaecology, Government Medical College Hospital, Chandigarh, India.
Address of Correspondence
Dr. Garima Sharma,
Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
E-mail: garimaserene@gmail.com
Abstract
Staphylococcus aureus is the most common organism causing paediatric bone and joint infections accounting for 86% of pus culture-positive cases. Methicillin resistant staphylococcus aureus (MRSA) has become a major challenge in the tertiary care setting as the majority (56%) of all pus culture postive cases were MRSA. The male to female ratio in these infections was approximately 2:1. The lower limbs were affected in the majority of children with osteomyelitis (OM) with hip joint being the commonest (50%) followed by the knee. Broad spectrum antibiotics were used emperically in 40% of cases prior to referral to a tertiary care centre. MRSA infections were associated with a higher likelihood of complications.
Keywords: Paediatric, Pyogenic, Bone and joint infections, Antibiotic practices
References
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Frontal Plane Angular Knee Deformities in Schoolchildren in Kribi, South Region of Cameroon
Volume 9 | Issue 1 | January-April 2023 | Page: 00-00 | Jean Gustave Tsiagadigui, Robinson Mbako Ateh, Marie-Ange Ngo Yamben, Franck Olivier Ngongang, Daniel Handy Eone, Maurice Aurelien Sosso
DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.000
Authors: Jean GustaveTsiagadigui [1, 3] MD, PhD, Robinson Mbako Ateh [2] MD, Marie-Ange Ngo Yamben [1] MD, Franck Olivier Ngongang [1] MD, Daniel Handy Eone [1] MD, Maurice Aurelien Sosso [1] MD
[1] Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon
[2] Faculty of Medicine and Pharmaceutical Sciences of the University of Douala, BP 2701, Douala, Littoral Region, Cameroon.
[3] Department of Mechanical Engineering, ENSET, University of Douala, BP 2701, Douala, Littoral Region, Cameroon.
Address of Correspondence
Dr. Jean GustaveTsiagadigui,
Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon.
E-mail: jtsiagad@gmail.com
Abstract
Bone problems such as angular deformities of the knee are common in children in Africa. The aim of this survey was to study epidemiologic aspects of frontal plane angular knee deformities in school children in Kribi. A total of 860 school children in Kribi aged 3 to 18 years were surveyed in a cross-sectional descriptive study from December 2019 to March 2020. Each child was examined. Intercodylar distances, intermalleolar distances and the tibiofemoral angles were assessed. The type of knee deformity in the frontal plane was determined from the children`s tibiofemoral angles and compared with reference values of normal children in the same age ranges. One hundred and fourty two (142, 16.5%) children surveyed presented with frontal plane knee deformities, with genu varum representing 68.0% (96 cases) of the deformities. The prevalence of these deformities in school children in Kribi varied significantly with age. We did not find any significant difference in the variation of these deformities with gender or ethnic groups. We identified some frontal plane angular knee deformities, including bilateral deformities being predominant 90.71% (127 cases). The mean body mass index was higher than those of normal children. 15.5% (22) of them presented with associated deformity in the sagital plane, dominated by bilateral genu recurvatum and 33.8% (48) of them presented with associated rotational knee deformities, dominated by bilateral medial rotation. Frontal plane knee angular deformities are common amongst school children in Kribi. Their prevalence is 16.51% (142 cases). This prevalence varies with ages. Sagittal plane and rotational plane deformities are equally present in children presenting with these deformities.
Keywords: Bone, Children, Deformities, Cameroon.
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Chronic Recurrent Multifocal Osteomyelitis – A Case Report
Volume 8 | Issue 3 | September-December 2022 | Page: 22-26| Ebin Rahman, Subin Sugath, Unnikrishnan R, Joe Thomas
DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.146
Authors: Ebin Rahman [1] DNB Ortho, Subin Sugath [1] DNB Ortho, Unnikrishnan R [2] MD Radiology, Joe Thomas [3] MD Med. DNB Rheumatology
[1] Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Radiology, Aster Medcity, Kochi, Kerala, India.
[3] Department Of Rheumatology, Aster Medcity, Kochi, Kerala, India.
Address of Correspondence
Dr Ebin Rahman,
Senior Specialist, Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com
Abstract
Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic auto-inflammatory bone disease of unknown aetiology that typically affects children and adolescents. It presents as recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures from lesions are sterile. It is unresponsive to antibiotic therapy. CRMO is a diagnosis of exclusion since no single clinical feature is pathognomonic. Radiological tests are often required and a bone biopsy may be needed in unclear cases.
Case Report: We report a case of an 8-year-old girl, with pain over both ankles and upper chest; history and radiological evaluation suggested osteomyelitis, but no adequate response to antibiotic treatment was observed. A bone biopsy was done to rule out malignancy. Whole body imaging revealed multiple bony lesions; based on which a diagnosis of chronic recurrent multifocal osteomyelitis was made. Patient was started on specific anti-inflammatory treatment with resolution of symptoms.
Conclusion: Chronic recurrent multifocal osteomyelitis should be suspected in a child with recurrent, multiple bone pain, modest increase of inflammatory indices, and lytic or sclerotic bone lesion on radiographs. Typical locations are the metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, but any bone can be involved. We want to increase the awareness of this entity and as a differential diagnosis of recurrent, multifocal bone pain in an adolescent, thereby avoiding unnecessary antibiotic administration and bone biopsies.
Keywords: Chronic recurrent multifocal osteomyelitis, Bone pain, Non-steroidal anti-inflammatory drugs
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Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis
Volume 8 | Issue 3 | September-December 2022 | Page: 16-21| Anil Agarwal
DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.145
Authors: Anil Agarwal [1] MS Ortho.
[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
Address of Correspondence
Dr. Anil Agarwal,
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com
Abstract
Background: The septic sequelae of knee following infantile infection is scantily described in literature. This case series depicts the various anatomical zones affected, the radiological presentation and proposes a vascular hypothesis for the sequelae.
Methods and results: Sequelae presented with three distinct radiological findings namely, unicondylar loss of lateral distal femur (n=4), hemicondylar loss of anterior portion of proximal tibia (n=3), and epiphyseal overgrowth and deficient tibial metaphysis of medial/ lateral side (n=4). The anatomical zones for above findings were seen approximately matching with the supply of specific genicular arteries around knee. On corroborating the early post infective radiographs and the sequelae radiographs, it was found that most patients had concomitant osteomyelitis, sometimes extensive.
Conclusions: We could recognize three distinct anatomical patterns of septic sequelae of knee following osteoarticular knee infection in infancy. An ischemic etiopathogenesis is suggested based on consistent radiological findings and the vascular supply zones. Most cases followed concomitant occurrence of septic arthritis and extensive osteomyelitis.
Keywords: Knee, Sepsis, Sequelae, Ischemia, Infants
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