A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Volume 6 | Issue 2 | May-August 2020 | Page: 7-11 | Atul Bhaskar, Purva Kansara

Authors : Atul Bhaskar [1][2], Purva Kansara [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Atul Bhaskar,
Hon.Paediatric Orthopaedic Surgeon, Bombay Hospital Institute of Medical Sciences, Mumbai,
Maharashtra, India.
E-mail: arb_25@yahoo.com

Abstract

Background: The manifestations of DDH (Developmental Dysplasia of Hip) from newborn to walking age can go undetected due to several factors in the developing world. Lack of screening, reduced awareness amongst primary care physicians, socio-economic factors of family and access to healthcare facility. In many children the initial diagnosis is established only after an alert caregiver of physician notices suspicious asymmetry in gait pattern or limp.
The purpose of this review to compare the “capture’’ rate between physicians and caregivers suspicion that lead to the initial diagnosis of DDH and suggest strategies to enhance early detection of DDH.
Patient and Methods: A retrospective observational study was conducted between January 2002 and December 2018 at a single surgeon specialty centre in Mumbai, India. All children with a diagnosis of idiopathic DDH were included. Syndromic and teratologic hips were excluded. The data recorded from the charts included the following: birth history, mode and presentation of delivery, breech or normal, first born or later, age at initial presentation, demographic data, and whether hailing from urban or semi-urban and rural areas, and initial awareness by physician or caregiver. Any associated anomalies, and the side of involvement and surgical intervention was also recorded.
Results: The median age of diagnosis of DDH in the study was 22 months (one week-10 years) but in bilateral DDH it was 32 months (p<.0001). Physicians diagnosed DDH primarily in 37 children (28%) and 95 children (70.45%) were brought to the attention by caregivers especially in semi-urban and rural areas (p<0.001). Eighty-five children (64.39%) were diagnosed in the walking ages between 12 months – 48 months. Ninety-eight children (74.24%) in the entire study required surgical intervention mainly due to the late diagnosis made after infancy.
Conclusion: Delay in diagnosis of idiopathic DDH has significant implications both for surgeons, caregivers, and health care service providers. Any suspicious gait or limp in a child at walking age should alert investigation to rule out DDH.
Keywords: DDH; CAREGIVER; LIMP.

References 

1. Singh M, Sharma NK. Spectrum of congenital malformations in the newborn. Ind J Pediatr. 1980; 47: 239–244.
2. Sankar WN, Weiss J, Skaggs DL. Orthopaedic conditions in the newborn. J Am Acad Orthop Surg. 2009; 17(2): 112–122.
3. Gupta AK, Kumar S, Arora PL, et al. Hip instability in newborns in an urban community. Nat Med J India. 1992; 5: 269–272.
4. Kaushal V., Kaushal SP., Bhakoo ON. Congenital dysplasia of the hip in Northern India. Int Surg. 1976; 61: 29.
5. Rebello G, Joseph B. Late presentation of Developmental Dysplasia of the Hip in children from southwest India – will screening help. Ind J Orthop, 2003; 37(4): 210-14.
6. Kocher MS. Ultrasonographic screening for developmental dysplasia of the hip: an epidemiologic analysis (Part I) Am J Orthop. 2000; 29(12): 929–33.
7. Graf R, Tschauner C, Klapsch W. Progress in prevention of late developmental dislocation of the hip by sonographic newborn “screening”: results of a comparative follow-up study. J Pediatr Orthop B. 1993; 115–21.
8. Sochart DH, Paton RW. Role of ultrasound assessment and harness treatment in the management of developmental dysplasia of the hip. Ann R Coll Surg Engl. 1996; 78: 505–8.
9. Castelein RM, Sauter AJ, de Vlieger M, et al. Natural history of ultrasound hip abnormalities in clinically normal newborns. J Pediatr Orthop. 1992; 12: 423–427.
10. Shorter D, Hong T, Osborn DA. Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013; 8(1): 11-54.
11. Biedermann R, RiccabonnaJ, Giesinger JM et al. Results of Universal Screening for developmental dysplasia of hip: a prospective follow up of 28, 092 consecutive infants. Bone Joint Surg, 2018:100-B (10), 1399-1404.
12. Castañeda P, Moscona L, Masrouha K. The effect of femoral shortening in the treatment of DDH after walking age. J Child Orthop. 2019; 13(4): 371-6
13. Nelson SE, DeFrancesco CJ, Sankar WN. Operative reduction for developmental dysplasia of the hip: Epidemiology over 16 years. J Pediatr Orthop. 2019; 39(4): 272-6.
14. Barlow TG. Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg [Br]1962;44-B:292–301.
15. Morin C, Wicart P. Congenital dislocation of hip, with late diagnosis after 1 year of age: Update and Management. Ortho & Trauma: Surg & Res.2012 98S:154-158
16. Zimri FK, Ali Shah SS, Saaiq M et al. Presentation and Management of Neglected Developmental Dyspalsia of Hip (DDH): 8 years’ experience with single stage triple procedure. Pak J Med Sci. 2018,34(3):682-686
17. Bhatti A, Kumar J, Butt SA. Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hip of children younger than three years of age. J Pak Med Asso. 2014,64:1015-1020
18. Banskota AK, Paudel B, Pradhan I et al. Results of simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip. Kathmandu Univ Med J (KUMJ), 2005, 3:6-10
19. Lindberg AW, Bompadre V, Satchell EK et al. Patient factors associated with delay in diagnosis of developmental dysplasia of hip. J Child Ortho. 2017,11:223-228
20. Ganger R, Radler C, Petje G et al. Treatment options for developmental dislocation of hip after walking age. J Pediatr Orthp B,2005,14:139-150
21. Ortolani M. Un segno poco noto e suaimportanza per la diagnosiprecoce di prelussazione congenital dell’anca. Pediatria (Napoli) 1937; 45:129–136. (In Italian).
22 Kural B, Karapinar ED, Yilmazbas P et al. Risk factor assessment and Ten-years’ experience in DDH screening in a Well-Child Population. Biomed Res Int, 2019, https://doi.org/10.1155/2019/7213681.
23. Tonnis D. Berlin, Heidelberg: Springer-Verlag; 1987. Congenital Dysplasia and Dislocation of Hip in Children and Adults.
24. Biedermann R, Eastwood DM. Universal or selective ultrasound screening for DDH? a discussion of the key issues. J Child Orthop. 2018 Aug 1;12(4):296-301
25. Choudry QA, Paton RW. Neonatal screening and selective sonographic screening in the diagnosis of DDH. Bone Joint J. 2018 Jun 1;100-B(6):806-810.
26. Broadhurst C, Rhodes AML, Harper P et al. What is the incidence of late detection of DDH in England? a 26-year national study of children diagnosed after one year. Bone Joint J. 2019 Mar;101-B(3):281-287.
27. Price KR, Dove R, Hunter JB. Current screening recommendations for DDH may lead to an increase in open reduction. Bone Joint J 2013;95-B:846–50.
28. Azzopardi T, Van Essen P, Cundy PJ et al. Late diagnosis of developmental dysplasia of hip: analysis of risk factors. J Pediatr Orthp B,2011;20:1-7
29. Gul R, Coffey JC, Khayyat G, Mc Guinness. Late presentation of DDH. Irish J Med Sci 2002; 171: 139-140.

How to Cite this Article: Bhaskar A | A Review of “capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 07-11.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Volume 6 | Issue 2 | May-August 2020 | Page: 4-6 | India Cox, Fergal Monsell

Authors : India Cox [1], Fergal Monsell [2]

[1] Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK.

[2] Department of Orthopaedics, Bristol Royal Hospital for Children, Bristol, UK.

Address of Correspondence
Dr. India Cox,
Clinical Fellow Trauma and Orthopaedics, Musgrove
Park Hospital, Taunton, UK.
E-mail: india.cox@gmail.com

Abstract

Septic arthritis is a clinical diagnosis but ultrasound has long been used as an adjunct, with a lack of effusion on ultrasound examination being viewed as a reassuring sign. This report describes two cases of children with clinical features suggestive of septic arthritis in whom initial ultrasound failed to demonstrate a joint effusion but subsequent arthrotomy confirmed septic arthritis. We discuss some potential reasons behind this and caution that wherever clinical suspicion exists, a negative ultrasound should not be viewed as ruling out septic arthritis.
Keywords: Septic arthritis; Ultrasound, joint effusion.

References 

1. Zawin JK, Hoffer FA, Rand RR, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology 1993; 187:459-63
2. Zamzam M. The role of ultrasound in differentiating septic arthritis from transient synovitis. Journal of Pediatric Orthopedics 2006; 15:418-22
3. Chau C, Griffith J. Musculoskeletal infections: ultrasound appearances. Clinical Radiology 2005; 60:149-159
4. Jacobson JA, Andresen R, Jaovisidha S, De Maeseneer M, Foldes K, Trudell DR, Resnick D. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging. American Journal Roentgenology 1997;170(5):1231-8
5. Gordon JE, Huang M, Dobbs M, Luhmann SJ, Szymanski DA, Schoenecker PL. Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. Journal of Pediatric Orthopedics 2002;22:312-16.

How to Cite this Article: Cox I, Monsell F | Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 04-06.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Role of Proximal Femoral Osteotomy in the Management of Developmental Dysplasia of Hip

Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Prateek Behera

Authors: Prateek Behera [1]

[1] Department of Orthopedics, All India Institute of Medical Sciences, Bhopal, 462020 India

Address of Correspondence
Dr. Prateek Behera,
Department of Orthopedics, All India Institute of Medical Sciences,
Bhopal, 462020 India
E-mail: pbehera15@outlook.com , prateek.ortho@aiimsbhopal.edu.in

Abstract

Proximal femoral osteotomy as a component of the treatment of developmental dysplasia of hip (DDH) has been used for almost a century now, after being described by Hey-Groves in 1928. Over the years, understanding of its role has evolved alongside our improved knowledge on the pathoanatomy and biomechanics of DDH. It has come a long way from being used exclusively in older walking children; being used as the only other concomitant procedure with open reduction of hip and being used with pre-determined values to be achieved on table, to its present state of being an indispensable component of the a la carte approach of the treatment of DDH. A femoral osteotomy is used for shortening, decreasing the femoral anteversion, or for producing a varus at the proximal femur. The surgical technique has remained largely unchanged over the years although proximal femoral locking plates are increasingly employed in addition to the traditional options such as angle blade plate, DCP, or one-third tubular plates. This review aims to analyze and summarize the current understanding of the role played by a proximal femoral osteotomy in the management of DDH.
Keywords: Developmental dysplasia of hip; Proximal femoral osteotomy; Varus derotation osteotomy; Avascular necrosis of femoral head.

References 

1. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
2. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part I. Instr Course Lect 2004;53:523-30.
3. Herring JA. Congenital coxa vara. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 483-579.
4. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
5. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998;80:711-9.
6. Doudoulakis JK, Cavadias A. Open reduction of CDH before one year of age. 69 hips followed for 13 (10-19) years. Acta Orthop Scand 1993;64:188-92.
7. Weinstein SL. Developmental hip dysplasia and dislocation. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2014. p. 983-1111.
8. Forlin E, Munhoz da Cunha LA, Figueiredo DC. Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 2006;37:149-60.
9. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Relat Res 1976;119:60-9.
10. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect 2004;53:531-42.
11. Moseley CF. Open reduction of a congenital dislocated hip and salter innominate osteotomy. In: Tolo VT, Skaggs DL, editors. Master Techniques in Orthopaedic Surgery: Pediatrics. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 120-35.
12. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:17-27.
13. Weinstein SL, Dolan LA, Morcuende JA. The 2018 Nicholas Andry Award: The evidence base for the treatment of developmental dysplasia of the hip: The Iowa contribution. Clin Orthop Relat Res 2018;476:1043-51.
14. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
15. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol 1981;137:97-101.
16. Sankar WN, Neubuerger CO, Moseley CF. Femoral anteversion in developmental dysplasia of the hip. J Pediatr Orthop 2009;29:885-8.
17. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B 2005;14:410-4.
18. Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:2622-36.
19. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am 1989;71:734-41.
20. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: Special indications and results in the child younger than 2 years. J Pediatr Orthop 1995;15:768-79.
21. Wenger DR, Weinstein SL. Operative Treatment of Developmental Dysplasia of the Hip with Open Reduction and Salter Osteotomy. Available from: https://www.vjortho.com/2000/12/operative-treatment-of-ddh-with-open-reduction-and-salters-osteotomy.
22. Kelly DM. Congenital and developmental abnormalities of the hip and pelvis. In: Azar FM, Beaty JH, Canale ST, editors. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier Saunders; 2017. p. 1118-54.
23. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Post reduction computed tomography in developmental dislocation of the hip: Part I: Analysis of measurement reliability. J Pediatr Orthop 1997;17:626-30.
24. Sangavi SM, Szöke G, Murray DW, Benson MK. Femoral remodelling after subtrochanteric osteotomy for developmental dysplasia of the hip. J Bone Joint Surg Br 1996;78:917-23.

How to Cite this Article: Behera P | Role of Proximal Femoral Osteotomy in the Management of
Developmental Dysplasia of Hip | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 27-32.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 23-26 | Naveen Kumar Singh, Sunny Chaudhary, Nishat Setia, Prateek Girotra

Authors: Naveen Kumar Singh [1], Sunny Chaudhary [2], Nishat Setia [1], Prateek Girotra [1]

[1] Department of Orthopaedics, Hindurao Hospital,Delhi, India.
[2] Department of Orthopaedics, AIIMS Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Sunny Chaudhary,
Department of Orthopedics,AIIMS Rishikesh,India
E-mail: dr.sunny.ortho@gmail.com

Abstract

An elbow dislocation with ipsilateral fracture both bones forearm in a pediatric age group is a very rare injury. Although fracture both bones forearm alone in same age group is very common. These injuries in conjunction usually resulted from a high energy trauma and can be missed if clinician is not aware of such injuries so these injuries need to be addressed carefully. Success of functional outcome depends on concentric reduction of dislocated elbow with anatomical restoration of fractured both bones forearm. Here, we report a case of right-sided elbow dislocation with ipsilateral fracture of both bones forearm in a 11-year-old girl. In this case, closed reduction was performed for dislocated elbow in emergency department using reduction maneuver followed by closed reduction of both bones of forearm. Post-reduction neurovascular status of affected limb was checked and found to be uneventful. Active finger movements were present. Patient was followed-up for a period of 1 year. There was good clinical, radiological, and functional outcome. Previously, only two similar cases were reported and the last reported case had an additional finding of fracture lateral humeral condyle. Our case is an elbow dislocation with ipsilateral fracture both bones forearm in the pediatric age group and it was completely managed conservatively which makes our case-report unique in its presentation.
Keywords: Elbow dislocation; Both bone forearm fracture; Paediatric age.

References 

1. Ramesh S, Lim YJ. Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: A rare combination. Strateg Trauma Limb Reconstr 2011;6:97-101.
2. Madhar M, Saidi H, Fikry T, Cermak K, Moungondo F, Schuind F. Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases. Chir Main 2013;32:299-304.
3. Goni V, Behera P, Meena UK, Gopinathan N, Akkina N, Arjun RH. Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review. Chin J Traumatol 2015;18:113-115.
4. Hung SC, Huang CK, Chiang CC, Chen TH, Chen WM, Lo WH. Monteggia Type I equivalent lesion: Diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult. Arch Orthop Trauma Surg 2003;123:311-313.
5. Frazier JL, Buschmann WR, Insler HP. Monteggia Type I equivalent lesion: Diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation in a child. J Orthop Trauma 1991;5:373-375.
6. Kose O, Durakbasa MO, Islam NC. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: A case report. J Orthop Surg (Hong Kong) 2008;16:122-123.
7. Rijal L, Kc KM, Sagar G. Elbow dislocation with ipsilateral radius and ulna fracture: Is it so common? Nepal Med Coll J 2012;14:163-164.
8. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566-580.
9. Fleming FJ, Flavin R, Poynton AR. Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures–a rare combination. Injury 2004;35:90-92.
10. Kumar P, Manjhi LB, Rajak RL. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius. Indian J Orthop 2013;47:307-309.
11. Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin North Am 2008;39:141-154.

How to Cite this Article: Singh NK, Chaudhary S, Setia N, Girotra P | Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 23-26.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Posterior Dislocation of Sternoclavicular Joint- A Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 18-22 | Shikhar Yadav, Renjit John Mathew, Dileep Sasi, John Thayyil John

Authors : Shikhar Yadav [1], Renjit John Mathew [1], Dileep Sasi [1], John Thayyil John [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Shikhar Yadav,
Bombay Hospital Institute of Medical Sciences,
Mumbai, Maharashtra, India.
E-mail: dr.shikhar.yadav@gmail.com

Abstract

Background: Traumatic sternoclavicular joint dislocation is a very rare occurrence worldwide and is seen in only 0.5-3% of all injuries to the shoulder girdle . It is seen in high-velocity injuries resulting mostly from road traffic accidents or usually in contact sports such as rugby which is a game not played in our country. The sternoclavicular joint has a lot of important structures belonging to the cardiovascular, nervous, respiratory, and digestive system posterior to it and hence it creates a major challenge to the orthopedic surgeon while dealing with the same. With the lack of incidence and experience on this subject, the surgeon might often miss the diagnosis by not suspecting it or struggle to manage the patient after its diagnosis.
Case Report: A case report of a 12 year old male who has history trauma to the chest which resulted in a posterior dislocation of left sternoclavicular joint and the same was reduced successfully using a closed technique without any complications. A one year follow up of the patient shows complete range of left shoulder with no pain and no history of subsequent instability of the sternoclavicular joint.
Keywords: Posterior dislocation; Sternoclavicular joint; Closed reduction.

References 

1. Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 2011;19:1-7.
2. Choo C, Wong H, Nordin A. Traumatic floating clavicle: A case report. Malays Orthop J 2012;6:57-9.
3. Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior sternoclavicular joint dislocation in a division I football player: A case report. Int J Sports Phys Ther 2015;10:700-11.
4. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996;330:3-12.
5. Spencer EE, Kuhn JE, Huston LJ, Carpenter JE, Hughes RE. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elbow Surg 2002;11:43-7.
6. Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ. Effect of plane of arm elevation on glenohumeral kinematics: A normative biplane fluoroscopy study. J Bone Joint Surg Am 2013;95:238-45.
7. Booth CM, Roper BA. Chronic dislocation of the sternoclavicular joint: An operative repair. Clin Orthop Relat Res 1979;140:17-20.
8. Rajaratnam S, Kerins M, Apthorp L. Posterior dislocation of the sternoclavicular joint: A case report and review of the clinical anatomy of the region. Clin Anat 2002;15:108-11.
9. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016;7:244-50.
10. Howard FM, Shafer SJ. Injuries to the clavicle with neurovascular complications. A study of fourteen cases. J Bone Joint Surg Am 1965;47:1335-46.
11. Jain S, Monbaliu D, Thompson JF. Thoracic outlet syndrome caused by chronic retrosternal dislocation of the clavicle. Successful treatment by transaxillary resection of the first rib. J Bone Joint Surg Br 2002;84:116-8.
12. Nakayama E, Tanaka T, Noguchi T, Yasuda J, Terada Y. Tracheal stenosis caused by retrosternal dislocation of the right clavicle. Ann Thorac Surg 2007;83:685-7.
13. Gardner MA, Bidstrup BP. Intrathoracic great vessel injury resulting from blunt chest trauma associated with posterior dislocation of the sternoclavicular joint. Aust N Z J Surg 1983;53:427-30.
14. Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med 2003;22:359-70.
15. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s Fractures in Adults. Phildelphia, PA: Lippincott Williams and Wilkins; 2015. p. 1623-25.
16. Buckerfield CT, Castle ME. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg Am 1984;66:379-85.
17. Lehmann W, Laskowski J, Grossterlinden L, Rueger JM. Refixation of sternoclavicular luxation with a suture anchor system. Unfallchirurg 2010;113:418-21.
18. Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP. Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elbow Surg 2006;15:315-8.
19. Franck WM, Jannasch O, Siassi M, Hennig FF. Balser plate stabilization: An alternate therapy for traumatic sternoclavicular instability. J Shoulder Elbow Surg 2003;12:276-81.
20. Burrows HJ. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint. J Bone Joint Surg Br 1951;33B:240-3.
21. Castropil W, Ramadan LB, Bitar AC, Schor B, De Oliveira D’Elia C. Sternoclavicular dislocation–reconstruction with semitendinosus tendon autograft: A case report. Knee Surg Sports Traumatol Arthrosc 2008;16:865-8.
22. Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am 2004;86:98-105.

How to Cite this Article: Yadav S, Mathew RJ, Sasi D, John JT | Posterior Dislocation of Sternoclavicular Joint- A Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 18-22.

(Abstract)      (Full Text HTML)      (Download PDF)

 

 

 

 

 

 

 

 

Assessment in adolescent scoliosis

Volume 6 | Issue 1 | Jan – April 2020 | Page 2-6 |  Connor J. S. McKee.

Authors : Connor J. S. McKee [1]

[1] Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.

Address of Correspondence
Dr. Connor J. S. McKee,
Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.
E-mail: connor.mckee@ntlworld.com,
cmckee43@qub.ac.uk

Abstract

Background: Adolescent idiopathic scoliosis is associated with lateral spinal curvature, vertebral rotation and rib cage distortion which disrupts normal, symmetrical thoracic movement leading to restriction of lung expansion and impaired pulmonary function. The effects of scoliosis on lung growth, airway function and exercise capacity are well documented but it is unclear how altered rib positioning affects lung function. This paper compares two different radiological measurements with pulmonary function.
Methods: The study compared two measures of deformity: Cobb angle and average rib-vertebral angle difference with pulmonary functioning. Existing literature describes Cobb angle as a useful indicator of pulmonary dysfunction. However, there are few reports on the use of rib-vertebral angle difference and these are limited to a single measurement taken at the apical vertebrae. This study of 53 patients used an average rib-vertebral angle difference over five vertebral levels. This measure gives a more representative measurement of the scoliotic deformity. This measure was then correlated with the patient’s Cobb angle and pulmonary function.
Results: Using Spearman’s rank correlation coefficient, average rib-vertebral angle difference correlated strongly with Cobb angle (0.83), forced vital capacity (-0.81), forced expiratory volume in 1 second (-0.76), and peak expiratory flow (-0.60).
Conclusions: The study found that measurement of Cobb angle is superior to average rib-vertebral angle difference across five vertebral levels.
Keywords: Idiopathic, scoliosis, RVAD, Cobb, measurement.
Study design: Retrospective correlation of pre-operative pulmonary function tests and radiological measurements

References 

1. Konieczny M, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2012;7(1):3-9.
2. Koumbourlis AC. Scoliosis and the respiratory system. Paediatric respiratory reviews. 2006 Jun 1;7(2):152-60.
3. Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. Scoliosis. 2012 Dec;7(1):7.
4. Grauers A, Einarsdottir E, Gerdhem P. Genetics and pathogenesis of idiopathic scoliosis. Scoliosis and spinal disorders. 2016 Dec;11(1):45.
5. Lenke LG. Pulmonary and chest cage physiology. In: Spinal deformities. The comprehensive text. New York, NY: Thieme. 2003:126-34.
6. Bowen RM. Respiratory management in scoliosis. In: Moe JH, Bradford DS, Eds., Moe’stextbookofscoliosis and other spinal deformities. Philadelphia: Saunders. p 572.
7. Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine. 2011; 36, 1096-1102.
8. Loder RT, Urquhart A, Steen H, et al. Variability in Cobb angle measurements in children with congenital scoliosis. The Journal of bone and joint surgery. British volume. 1995 Sep;77(5):768-70.
9. Praud JP, Canet E. Chest wall function and dysfunction. In: Kendig’s Disorders of the Respiratory Tract in Children (Seventh Edition) 2006. p 733-746.
10. Mehta M. The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. The Journal of bone and joint surgery. 1972. 54, 230-243.
11. Rimmer KP, Ford GT, Whitelaw WA. Interaction between postural and respiratory control of human intercostal muscles. Journal of Applied Physiology. 1995 Nov 1;79(5):1556-61.
12. Upadhyay SS, Mullaji AB, Luk KD, Leong JC. Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine. 1995 Nov;20(22):2415- 20.
13. Canavese F, Turcot K, Holveck J, Farhoumand AD, Kaelin A. Changes of concave and convex rib–vertebral angle, angle difference and angle ratio in patients with right thoracic adolescent idiopathic scoliosis. European Spine Journal. 2011 Jan 1;20(1):129-34.
14. Ferreira JH, de Janeiro R, James JI. Progressive and resolving infantile idiopathic scoliosis: the differential diagnosis. The Journal of bone and joint surgery. British volume. 1972 Nov;54(4):648-55.
15. Kristmundsdottir F, Burwell RG, James JI. The rib-vertebra angles on the convexity and concavity of the spinal curve in infantile idiopathic scoliosis. Clinical orthopaedics and related research. 1985 Dec(201):205-9.
16. Burwell RG, Cole AA, Cook TA, et al. Pathogenesis of idiopathic scoliosis. The Nottingham concept. Acta OrthopaedicaBelgica. 1992;58:33-58.
17. Xiong B, Sevastik JA, Hedlund R, Sevastik B. Radiographic changes at the coronal plane in early scoliosis. Spine. 1994 Jan;19(2):159-64.
18. Sevastik B, Xiong B, Sevastik J, Lindgren U, Willers U. Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis. European Spine Journal. 1997 Mar 1;6(2):84-8.
19. Modi HN, Suh SW, Song HR, Yang JH, Ting C, Hazra S. Drooping of apical convex rib-vertebral angle in adolescent idiopathic scoliosis of more than 40 degrees: a prognostic factor for progression. Clinical Spine Surgery.
2009 Jul 1;22(5):367-71.
20. Widmann RF, Bitan FD, Laplaza FJ, Burke SW, DiMaio MF, Schneider R. Spinal deformity, pulmonary compromise, and quality of life in osteogenesis imperfecta. Spine. 1999 Aug 15;24(16):1673.
21. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. JBJS. 2005 Sep 1;87(9):1937-46.
22. Boyer J, Amin N, Taddonio R, Dozor AJ. Evidence of airway obstruction in children with idiopathic scoliosis. Chest. 1996 Jun 1;109(6):1532-5.
23. Farrell J, Garrido E. Effect of idiopathic thoracic scoliosis on the tracheobronchial tree. BMJ open respiratory research. 2018 Mar 1;5(1):e000264.
24. Kearon C, Killian J. Factors Determining Pulmonary Function in Adolescent Idiopathic Thoracic Scoliosis. American Journal of Respiratory and Critical Care Medicine. 1993;148:288-94.
25. Pehrsson K, Danielsson A, Nachemson A. Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax. 2001 May 1;56(5):388-93.
26. Lenke LG, Bridwell KH, Baldus C, Blanke K. Analysis of pulmonary function and axis rotation in adolescent and young adult idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Journal of spinal disorders. 1992 Mar;5(1):16-25.
27. Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine.
2000 Jan 1;25(1):82.
28. Lenke LG, Bridwell KH, Blanke K, Baldus C. Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine. 1995 Jun;20(12):1343-50.

How to Cite this Article: McKee C J S Assessment in adolescent | scoliosis | International Journal of
Paediatric Orthopaedics | Jan-April 2020; 6(1):- .

(Abstract)      (Full Text HTML)      (Download PDF)