Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 45-54 | Rujuta Mehta, Qaisur Rabbi, Praveen Bhardwaj, Maulin M. Shah, Dhiren Ganjwala

Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2],
Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5]

[1] Department of Orthopaedics, HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[2] Department of Paediatric Orthopaedic Surgery, Center for the Rehabilitation of the Paralysed, CRPBangladesh.
[3] Department of Orthopaedics, Consultant Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[4] Department of Paediatric Orthopaedic Surgery, Orthokids Clinic, Ahmedabad
[5] Ganjwala Orthopedic Hospital, Ahmedabad, Gujrat, India.

Address of Correspondence
Dr. Rujuta Mehta,
HOD Bai Jerbai Wadia Hospital for Children, Consultant Paediatric Orthopedic and Paediatric
Upper Limb Surgeon- Nanavati Superspeciality Hospital, Jaslok Hospital and Shushrusha Hospital.
E-mail: rujutabos@gmail.com

Abstract

Shoulder dysplasia is common constituting 80% of sequelae secondary to BPBP. Muscle imbalance due to uninhibited co-contractions and eccentric forces across the shoulder joint are the main causes of shoulder sequelae. This leads to limitation of shoulder movements and gleno-humeral deformity. This article discusses the presentations, investigations and treatment approach to various severities of deformities resulting from the muscular imbalance about the shoulder in BPBP.

Keywords: Shoulder sequelae, Rebalancing conjoint transfer, Salvage surgery.

References 

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How to Cite this Article:  Mehta R, Rabbi Q, Bhardwaj P, Shah MM, Ganjwala D | Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 45-54.

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Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 37-44 | Parag B. Lad, Nischal Naik, Bharat K. Kadadi, P. S. Bhandari, Mukund R. Thatte

Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3],
P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5]

[1] Jupiter Hospital, Thane, Maharashtra, India.
[2] Divyam Hospital, Ahmedabad, Gujarat, India.
[3] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.
[4] Brij Lal Super specialty Hospital, Haldwani, Nainital, Uttarakhand, India.
[5] Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mukund R Thatte,
Plastic Surgeon, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
E-mail: mthatte@gmail.com

Abstract

This article discusses the role of primary nerve surgery for Brachial Plexus Birth Palsy (BPBP). Spontaneous recovery in brachial plexus birth palsy is known and in such cases the prognosis is good. However, the incidence of such recovery is 30 – 90%. In some infants however, the course of motor recovery is inadequate necessitating nerve repair. BPBP presents clinically as a lower motor neuron type of upper limb monoplegia at birth. Indications of primary nerve reconstruction or distal nerve transfer, the technique of exploration of brachial plexus, common anatomical variations and the methods for identification of intact roots are discussed in detail.
Keywords: Primary nerve reconstruction, Brachial Plexus Birth Palsy (BPBP), Nerve transfer, co-contractions, Brachial plexus surgery.

References 

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How to Cite this Article:  Lad PB, Naik N, Kadadi BK, Bhandari PS, Thatte MR | Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 37-44.

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Clinical Examination and Early Management of Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 28-36 | Gaurav Gupta, Tejas Patel, Chasanal Rathod, Amila Shashanka Ratnayake, Maulin M Shah, Bharat K. Kadadi

Authors: Gaurav Gupta MBBS, MS Ortho. [1], Tejas Patel PT, C/NDT, SI. [2], Chasanal Rathod MBBS, MS Ortho. [3], Amila S. Ratnayake MBBS, MS MRCS(Ed) [4], Maulin M. Shah MBBS, MS Ortho. [5], Bharat K. Kadadi MBBS, MS Ortho. [6]

[1] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi
[2] Consultant, Paediatric Physiotherapist, Sparsh Paediatric Rehabilitation Clinic, Ahmedabad, Gujrat, India.
[3] Consultant Pediatric Orthopedic Surgeon, NHSRCC Children’s Hospital, Mumbai, Maharashtra, India.
[4] Plastic & Reconstructive Surgeon, National Hospital Kandy, Sri Lanka
[5] Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
[6] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
E-mail: maulinmshah@gmail.com

Abstract

Brachial Plexus Birth Palsy (BPBP) is defined as a flaccid paralysis of the upper limb that occurs as a result of traction injury to the brachial plexus during the process of birth. The incidence of BPBP has been estimated between 0.4% to 5.1% in various studies worldwide.
A precise clinical examination is the key to ascertain the type of injury, prognosticate the outcome and forecast the probable need of surgical intervention. A detailed clinical examination methodology and important signs directing to the intervention are described in this paper. The importance of regular clinical follow up has been emphasised. Early rehabilitation of infants with BPBP and physiotherapy protocols are discussed.

Keywords:

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39. Eismann EA, Little KJ, Laor T, Cornwall R. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy. J Bone Joint Surg Am. 2015;97(2):112-118.
40. Shah Maulin M. Pectoralis Major trans positioning to improve shoulder abduction in Brachial Plexus Birth Palsy. Presented at Annual POSI meeting 2018.
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43. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis;6th Edition:52-54
44. Smania N, Berto G, La Marchina E, et al. Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med. 2012;48(3):483-506.

45. Kuchera ML. Clinical Application of Counterstrain. J Am Osteopath Assoc 2008;108(5):267–268.
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50. Angela F, Nigel P. Clayton’s electrotherapy: Theory and practical (9th edn). AITBS Publishers: New Delhi, 2000;55-94.

How to Cite this Article: Gupta G, Patel T, Rathod C, Ratnayake AS, Shah MM | Clinical examination and Early Management of Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 28-36.

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Factors affecting the outcome of Chronic Osteomyelitis in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 16-21 | Gaurav Gupta, Maulin M. Shah, Akash S. Makadia, Qaisur Rabbi

Authors: Gaurav Gupta MS Ortho. [1], Maulin M. Shah MBBS, M.S.Orth., DNB Orth. [1],
Akash S. Makadia MS Ortho. [2], Qaisur Rabbi D-Ortho. [2]

[1] Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, Gujarat, India.
[2] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi, India.
[3] Clinical Fellow (Paediatric Orthopaedics), OrthoKids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, India
E-mail: maulinmshah@gmail.com

Abstract

Background: Treatment of Chronic Osteomyelitis in children results in varied outcome ranging from uneventful bone healing to gap non-union. We evaluated the factors associated with adverse outcome after a uniform treatment executed at a single centre.
Methods: 40 patients (1.5 -14 years) with Chronic Osteomyelitis managed with debridement & splintage were included in this study. Detailed history, laboratory investigations, local x rays & MRI were available for all the patients. Average follow up was of 2.5 years. Patients who ended up having healing of the bone after primary treatment were defined as ‘Good Outcome’, patients who required additional procedures to improve function of limb or morphology of bone were defined as ‘Fair Outcome’ and patients who resulted in gap non-union were defined as ‘Poor Outcome’.
Results: Delay in surgical intervention beyond 6 weeks after beginning of symptoms, multiple local debridement without pan-medullary decompression & presence of concomitant soft tissue abscess on MRI were the statistically significant factors associated with poor outcome.
Conclusion: Aggressive & early surgical debridement is suggested for patients with failed conservative treatment to avoid long term complications. Current study will help in identifying the patients who are likely to have long-term sequelae of Chronic Osteomyelitis.
Keywords: Chronic Osteomyelitis, pan-osseous, non-union, debridement, outcome.

Level of Evidence: IV, retrospective analytical study.

References 

1. Patwardhan S, Shyam A K, Reconstruction of Bone Defects After Osteomyelitis with Nonvascularized Fibular Graft. A Retrospective Study in Twenty-six Children. J Bone Joint Surg Am.2013; 95: e56 (1-6).
2. Spiegel DA, Penny JN. Chronic Osteomyelitis in Children. Techniques in Orthopaedics, 2005; 20 (2) 142-152.
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5. Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis. Journal of Bone & Joint Surgery American Volume 1989; 71(10): 1448-68.
6. Eckardt JJ, Wirganowicz PZ, Mar T. An aggressive surgical approach to the management of chronic osteomyelitis. Clinical Orthopaedics & Related Research 1994(298): 229-39.
7. Carlos Pineda, Rolando Espinosa Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy,
8. Gylys-Morin VM. MR imaging of paediatric musculoskeletal inflammatory and infectious disorders. Magn Reson Imaging Clin N Am. 1998; 6:537–539.
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12. Belthur MV, Birchansky SB et. al. Pathologic Fractures in Children with Acute Staphylococcus aureus Osteomyelitis. Bone Joint Surg Am. 2012; 94:34-42.

How to Cite this Article: Gupta G, Shah MM, Makadia AS, Rabbi Q | Factors affecting the outcome of Chronic Osteomyelitis in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 16-21.

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Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware!

Volume 4 | Issue 1 | January-June 2018 | Page: 38-40 | Kiran Sasi, Binu P Thomas

DOI- 10.13107/ijpo.2018.v04i01.009

Authors: Kiran Sasi, Binu P Thomas

Department of Hand Surgery, Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Address of Correspondence
Dr. Binu P Thomas,
Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore – 632 004, Tamil Nadu, India.
E-mail: binu@cmcvellore.ac.in

Abstract

Distal femoral metaphyseal fracture is a common injury faced by paediatric orthopaedic surgeons. This injury is usually managed with closed reduction and percutaneous Kirschner wire fixation. We present an unusual case wherein the common peroneal nerve was completely severed and entrapped in the fracture site following closed reduction and percutaneous Kirschner wire fixation of a distal femoral metaphyseal fracture.
Keywords: Distal femur fracture, Foot drop, Nerve entrapment

References 

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How to Cite this Article:  Sasi K, Thomas BP | Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware! | January-June 2018; 4(1): 38- 40.

 

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Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle

Volume 4 | Issue 1 | January-June 2018 | Page: 16-22 | David Livingstone, Albert A Kota1, Sanjay K Chilbule, Karthikeyan Rajagopal, Sukria Nayak, Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.005

Authors: David Livingstone, Albert A Kota [1], Sanjay K Chilbule, Karthikeyan Rajagopal, Sukria Nayak [1], Vrisha Madhuri

 

Department of Orthopaedics, Paediatric Orthopaedics Unit, 1Department of Surgery, Unit IV, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Vrisha Madhuri,
Paediatric Orthopaedics Unit, Christian Medical College, Vellore – 632 009, Tamil Nadu, India.
E-mail: madhuriwalter@cmcvellore.ac.in

Abstract

Introduction: Satellite cells are a resident population of stem cells beneath the basal lamina of mature skeletal muscle fibers. Their capacity to regenerate muscle makes them a potentially ideal source for human cell therapy with respect to muscle-related diseases such as urinary and fecal incontinence, and others. In this study, we describe a protocol to isolate, expand in-vitro, and characterize human muscle satellite cells from the rectus abdominis muscle. Materials and Methods: Muscle biopsies from human donors were harvested, digested using collagenase type II, and then plated on extracellular matrix-coated plates.
Results: Immunocytochemistry revealed that satellite cells on day 8 were 70–80% Pax7 positive; in contrast, cells expanded until day 12 showed 50–75% positivity for Pax7. The real-time polymerase chain reaction for day 8 culture indicated four-fold increase in Pax3 and Pax7 gene expression, four-fold increase in MyoD gene expression, and five-fold increase in Myf5 gene expression.
Conclusion: These findings suggest that satellite cells can be cultured until day 8 for translational purposes. The protocol described here is modest, operational, and reproducible and involves only basic cell culture equipment.
Keywords: Cell therapy, Human skeletal muscle, Myoblast, Satellite cells, Sphincter injuries, Tissue regeneration

References 

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How to Cite this Article:  Livingstone D, Kota AA, Chilbule SK, Rajagopal K, Nayak S, Madhuri V | Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle | January-June 2018; 4(1): 16-22.

 

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