Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children

Volume 4 | Issue 1 | January-June 2018 | Page: 29-33 | Deeptiman James, Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.007

Authors: Deeptiman James, Vrisha Madhuri

 

Paediatric Orthopaedics Unit, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: madhuriwalter@cmcvellore.ac.in

Abstract

Aims: To determine the clinical profile and clinical, functional, and radiological outcomes and complications in children who underwent elastic stable intramedullary nailing (ESIN) for unstable fractures of both bones of forearm. Materials and Methods: A retrospective observational study was conducted in the Paediatric Orthopaedic Unit of the institution. Children with forearm fractures, who underwent ESIN of both the bones with titanium nails from January 2004 to June 2010, were included in the study. Clinical evaluation for deformity, range of motion at wrist and elbow, Daruwalla’s grading for forearm fractures, and radiological evaluation for bony union, malalignment, and radial bow were done. Paediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to assess functional outcome.
Results: Twenty-six patients were followed up for a mean of 2.14 years. These included one primary internal fixation for unstable injury in a 15-year old, 10 open fractures, and 15 with malalignment after closed reduction. Age ranged from 5 to 15 years (mean of 11.39). Average time to bony union was 6 weeks. Twelve children had excellent, 12 good, and two fair outcomes according to Daruwalla’s grade. Average PODCI score was 50.78 (standardized range is minimum of −140 to maximum of 53). There were no major complications related to ESIN. Three patients had paraesthesia over superficial radial nerve distribution, three patients had hypertrophied scars, and one patient had superficial wound infection. One child had distal radial physeal arrest following inadvertent physeal injury during implant removal.
Conclusion: ESIN is safe and effective for internal fixation of unstable forearm fractures.
Keywords: ESIN, Paediatric both bones forearm fractures, PODCI questionnaire

References 

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How to Cite this Article:  James D, Madhuri V | Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children | January-June 2018; 4(1): 29-33.

 

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Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases

Volume 4 | Issue 1 | January-June 2018 | Page: 23-28 | Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi [1], Chasanal Rathod [2], Rujuta Mehta, Dominic D’Silva, Alaric Aroojis

DOI- 10.13107/ijpo.2018.v04i01.006

Authors: Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi [1], Chasanal Rathod [2], Rujuta Mehta, Dominic D’Silva, Alaric Aroojis

 

Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, 1Indian Spinal Injuries Centre, New Delhi, 2Seven Hills Hospital, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Alaric Aroojis, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: aaroojis@gmail.com

Abstract

Introduction: Hip instability in older children and adolescents is mainly because of the loss of bone in the proximal femur or conditions that cause loss of the fulcrum. These may be related to infantile septic hip sequelae or neglected developmental dysplasia of the hip.
Materials and Methods: We retrospectively analyzed six patients with hip instability treated by Ilizarov hip reconstruction from 2004 to 2007 at our institute. The mean age of the patients was 10 years (range 7–14 years). Results: The etiology was septic hip sequelae (Choi type IV) in four patients and neglected developmental dysplasia of hip in two patients. The fixator was kept for an average of 7 months (range 6–8 months). The average follow-up was 3 years. The visual analog score for pain improved from a preoperative mean of 8 to 2 postoperatively. The gait improved in all the patients and the leg length discrepancy improved from a preoperative mean of 5 to 1 cm postoperatively. All the limbs were aligned to a satisfactory level with the mean mechanical axis deviation of 3 mm (laterally) and pelvic mechanical axis of 90°. The Harris hip score improved from 41 preoperatively to 84 postoperatively (P < 0.0001).
Conclusion: Ilizarov Hip Reconstruction is an excellent salvage procedure for adolescent patients with unstable hips, giving good results in the short-term.
Keywords: Ilizarov hip reconstruction, Neglected developmental dysplasia of the hip, Postseptic sequelae, Unstable hip

References 

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20. Pafilas D, Nayagam S. The pelvic support osteotomy: Indications and preoperative planning. Strategies Trauma Limb Reconstr 2008;3:83-92.
21. E l-Mowafi H. Outcome of pelvic support osteotomy with the Ilizarov method in the treatment of the unstable hip joint. Acta Orthop Belg 2005;71:686-91.

How to Cite this Article:  Ghanghurde B, Agashe M, Rustagi T, Rathod C, Mehta R, D’Silva D, Aroojis | A Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases | January-June 2018; 4(1): 23-28.

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Step-cut Translation Osteotomy and Y-plate Fixation: A Novel Method for Correction of Cubitus Varus and Valgus Deformity

Volume 4 | Issue 1 | January-June 2018 | Page: 12-15 | Kumar Shashi Kant, Vikas Gupta

DOI- 10.13107/ijpo.2018.v04i01.004

Authors: Kumar Shashi Kant, Vikas Gupta [1]

Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalya, [1] Central Institute of Orthopaedics, Vardhaman Mahavir Medical College, Safdarjang Hospital, New Delhi, India

Address of Correspondence
Dr. Vikas Gupta,
Central Institute of Orthopaedics, Vardhaman Mahavir Medical College, Safdarjang Hospital, New Delhi – 110 029, India.
E-mail: drvikas@hotmail.com

Abstract

Introduction: Many types of osteotomy have been proposed for the treatment of cubitus varus and valgus deformity. All these osteotomies have their advantages and disadvantages; however, till date there is no uniform consensus as to which osteotomy is the best suited for correction of these deformities. Materials and Methods: We reviewed the results of step-cut translation osteotomy in the management of cubitus varus and cubitus valgus deformity. This study includes 27 cases of cubitus varus and five cases of cubitus valgus deformity that underwent supracondylar step-cut translation osteotomy with Y-plate fixation for correction of the deformity. Results: The results were evaluated according to the modified criteria of Oppenheim et al. There were 25 excellent, six good, and one poor result. Overall, complication rate in our series was 12.5% (4/32). There was no recurrence of deformity in the available follow-up. Conclusions: Step-cut translation osteotomy is a relatively simple procedure that corrects cubitus varus and valgus deformities without any prominence of the medial or lateral condyle. Moreover, a wide osteotomy surface and rigid fixation allows early mobilization of the joint with good clinical results.
Keywords: Cubitus valgus, Cubitus varus, Step-cut osteotomy

References 

1. Skaggs DL, Glassman D, Weiss JM, Kay RM. A new surgical technique for the treatment of supracondylar humerus fracture malunions in children. J Child Orthop 2011;5:305-12.
2. Siris IE. Supracondylar fracture of the humerus: Analysis of 330 cases. Surg Gynecol Obstet 1939;68:201-22.
3. French PR. Varus deformity of the elbow following supracondylar fractures of the humerus in children. Lancet 1959;2:439-41.
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5. Myint S, Molitor PJ. Dome osteotomy with T-plate fixation for cubitus varus deformity in an adult patient. J R Coll Surg Edinb 1988;43:352-4.
6. Tien YC, Chen JC, Fu YC, Chih TT, Huang PJ, Wang GJ. Supracondylar dome osteotomy for cubitus valgus deformity associated with a lateral condylar nonunion in children. J Bone Joint Surg Am 2005;87:1456-63.
7. Derosa GP, Graziano GP. A new osteotomy for cubitus varus. Clin Orthop Relat Res 1988;236:160-5.
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10. El-Adl W. The equal limbs lateral closing wedge osteotomy for correction of cubitus varus in children. Acta Orthop Belg 2007;73:580-7.
11. Oppenheim WL, Clader TJ, Smith C, Bayer M. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop Relat Res 1984;(188):34-9.
12. Chung MS, Baek GH. Three-dimensional corrective osteotomy for cubitus varus in adults. J Shoulder Elbow Surg 2003;12:472-5.
13. Chess DG, Leahey JL, Hyndman JC. Cubitus varus: Significant factors. J Paediatr Orthop 1994;14:190-2.
14. Labelle H, Bunnell WP, Duhaime M, Poitras B. Cubitus varus deformity following supracondylar fractures of the humerus in children. J Pediatr Orthop 1982;2:539-46.
15. Davids JR, Maquire MF, Mubarak SJ, Wenger DR. Lateral condylar fracture of the humerus following posttraumatic cubitus varus. J Pediatr Orthop 1994;14:466-70.
16. Takahara M, Sasaki I, Kimura T, Kato H, Minami A, Oqino T. Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children. J Bone Joint Surg Br 1998;80:791-7.
17. Abe M, Ishizu T, Morikawa J. Posterolateral rotatory instability of the elbow after posttraumatic cubitus varus. J Shoulder Elbow Surg 1997;6:405-9.
18. O’Driscoll SW, Spinner RJ, McKee MD, Kibler WB, Hastings H 2nd, Morrey BF et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am 2001;83:1358-69.
19. Abe M, Ishizu T, Shirai H, Okamoto M, Onomura T. Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg Am 1995;20:5-9.
20. Griffin PP. Supracondylar fractures of the humerus. Treatment and complications. Pediatr Clin North Am 1975;22:477-86.
21. Ippolito E, Moneta MR, D’Arrigo C. Post-traumatic cubitus varus. Long-term follow-up of corrective supracondylar humeral osteotomy in children. J Bone Joint Surg Am 1990;72:757-65.
22. Wong HK, Lee EH, Balasubramaniam P. The lateral condylar prominence. A complication of supracondylar osteotomy for cubitus varus. J Bone Joint Surg Br 1990;72:859-61.
23. Song HR, Cho SH, Jeong ST, Park YJ, Koo KH. Supracondylar osteotomy with Ilizarov fixation for elbow deformities in adults. J Bone Joint Surg Br 1997;79:748-52.

How to Cite this Article:  Kant KS, Gupta V | Step-cut translation osteotomy and Y-plate fixation: A novel method for correction of cubitus varus and valgus deformity | January-June 2018; 4(1): 12-15.

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Comparison of Two Different Medial Reference Points for Measurements of the Acetabular Index

Volume 4 | Issue 1 | January-June 2018 | Page: 07-11 | Sandeep Vijayan, Dhiren Ganjwala, Hitesh Shah

DOI- 10.13107/ijpo.2018.v04i01.003

Authors: Sandeep Vijayan, Dhiren Ganjwala [1], Hitesh Shah

Department of Orthopaedics, Paediatric Orthopaedic Service, Kasturba Medical College, Manipal, Karnataka,
[1] Paediatric Orthopaedic Service, Ganjwala Orthopaedic Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Hitesh Shah,
Department of Orthopaedics, Kasturba Medical College, Manipal – 576 104, Karnataka, India.
E-mail: hiteshshah12@gmail.com

Abstract

Introduction: Acetabular index (AI) is a commonly used quantitative measurement of acetabular inclination in plain radiographs. Repeated measurements of this index are used to determine dysplasia in children and for decision making about surgical management. Persistent acetabular dysplasia may be an indication for performing an acetabuloplasty. AI is commonly measured between the Hilgenreiner’s line (line that connects both triradiate cartilages) and the line joining lateral most ossified margin of the acetabulum and triradiate cartilage. Two different methods for measurement of AI with two different medial reference points at the triradiate cartilage have appeared in the literature. Aim: The specific aim of the study was to investigate the difference between AI measurements with two different methods and report on intraobserver and interobserver reliability of both the methods. Materials and Methods: Ninety-eight children with developmental dysplasia of the hip (DDH) (treated and untreated), younger than 9 years, were included in the study. Anteroposterior radiographs of the pelvis having acceptable pelvic rotation and pelvic tilt were included in the study. AI was measured using two different reference points for the affected and normal sides. AI was measured twice at 1-month interval by two investigators. The difference between the two measurement techniques was compared by the paired “t” test. Pearson’s correlation coefficient was calculated to test associations between the two measurement techniques. Results: The reproducibility of measurements of both the techniques was found satisfactory [intraclass correlation (ICC)-0.90 and 0.87]. Statistically significant difference (P value < 0.001) (5.7° for affected and 5.3° for normal side) between the indices measured by two techniques was noted. This difference was noted for all age groups. Significant positive correlations between both the techniques were noted in normal as well as dysplastic hips. Conclusion: Acetabular indices measured with two different medial points gave significantly different values. All subsequent assessment should be consistently carried out by the same method.
Keywords: Acetabular index, Acetabuloplasty, Developmental dysplasia of hip, Medial reference point

References 

1. Weinstein SL. Natural history of congenital hip dislocation (CDH) and hip dysplasia. Clin Orthop Relat Res 1987;(225):62-76.
2. Tonnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 1976;(119):39-47.
3. Salter RB. Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child. J Bone Joint Surg Am 1966;48:1413-39.
4. Brougham DI, Broughton NS, Cole WG, Menelaus MB. The predictability of acetabular development after closed reduction for congenital dislocation of the hip. J Bone Joint Surg Br 1988;70:733-6.
5. Boniforti FG, Fujii G, Angliss RD, Benson MK. The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br 1997;79:570-5.
6. Broughton NS, Brougham DI, Cole WG, Menelaus MB. Reliability of radiological measurements in the assessment of the child’s hip. J Bone Joint Surg Br 1989;71:6-8.
7. Kay RM, Watts HG, Dorey FJ. Variability in the assessment of acetabular index. J Pediatr Orthop 1997;17:170-3.
8. Skaggs DL, Kaminsky C, Tolo VT, Kay RM, Reynolds RA. Variability in measurement of acetabular index in normal and dysplastic hips, before and after reduction. J Pediatr Orthop 1998;18:799-801.
9. Kim HT, Kim JI, Yoo CI. Diagnosing childhood acetabular dysplasia using the lateral margin of the sourcil. J Pediatr Orthop 2000;20:709-17.
10. Pirpiris M, Payman KR, Otsuka NY. The assessment of acetabular index: Is there still a place for plain radiography? J Pediatr Orthop 2006;26:310-5.
11. Halanski MA, Noonan KJ, Hebert M, Nemeth BA, Mann DC, Leverson G. Manual versus digital radiographic measurements in acetabular dysplasia. Orthopedics 2006;29:724-6.
12. Race C, Herring JA. Congenital dislocation of the hip: An evaluation of closed reduction. J Pediatr Orthop 1983;3:166-72.
13. van der Bom MJ, Groote ME, Vincken KL, Beek FJ, Bartels LW. Pelvic rotation and tilt can cause misinterpretation of the acetabular index measured on radiographs. Clin Orthop Relat Res 2011;469:1743-9.
14. Upasani VV, Bomar JD, Parikh G, Hosalkar H. Reliability of plain radiographic parameters for developmental dysplasia of the hip in children. J Child Orthop 2012;6:173-6.
15. Spatz DK, Reiger M, Klaumann M, Miller F, Stanton RP, Lipton GE. Measurement of acetabular index intraobserver and interobserver variation. J Pediatr Orthop 1997;17:174-5.

How to Cite this Article:  Vijayan S, Ganjwala D, Shah H | Comparison of two different medial reference points for measurements of the acetabular index| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 07-11.

 

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Paediatric Orthopaedics Anaesthesia for Surgeons

Volume 4 | Issue 1 | January-June 2018 | Page: 03-06 | Serina Ruth Salins

DOI- 10.13107/ijpo.2018.v04i01.002

Authors: Serina Ruth Salins

Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India.

Address of Correspondence
Dr. Serina Ruth Salins,
Assistant Professor, Department of Anaesthesia, Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: serinaruthsalins@gmail.com

Abstract

Paediatric anaesthesia is a well-established subspecialty, which has allowed surgery to be safer, as the science advances in both the specialties. It is imperative for both surgeons and anesthesiologist to be aware of all the implications in children, especially syndromic, coming for surgery. This article gives a comprehensive overview of anaesthesia for orthopaedic surgery.
Keywords: Orthopaedic surgery, Paediatric anaesthesia, Perioperative

References 

1. Goobie SM, Haas T. Bleeding management for pediatric craniotomies and craniofacial surgery. Paediatr Anaesth 2014;24:678–89.
2. Nair S, Neil MJ. Paediatric pain: Physiology, assessment and pharmacology. Anaesth J Week July 2013;289.
3. Haberman E. Temperature management in children. Anaesth Tutorial of The Week, March 2014;305.
4. Rosenberg H, Pollock N, Schiemann A, Terasa Bulger, Stowell K. Malignant hyperthermia: a review. Orphanet J Rare Dis 2015;10:93.
5. Buck D, Kurth CD, Varughese A. Perspectives on quality and safety in pediatric anesthesia. Anesthesiol Clin 2014;32:281-94.

How to Cite this Article:  Salins SR | Paediatric orthopaedics anaesthesia for surgeons| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 03-06.

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Paediatric Orthopaedics and Global Initiative for Children’s Surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.001

Authors: Vrisha Madhuri

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

Address of Correspondence
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
E-mail: madhuriwalter@cmcvellore.ac.in

Global burden of surgical disease and attendant morbidity and mortality has received much attention in the recent past from the World Health Organization and the Lancet Commission on Global Surgery.[1],[2],[3] This has led to several initiatives in the last 2 years by the global surgical community to address the relevant issues. Among them is a coalition of children’s surgery organizations, led by American Paediatric Surgery Association and British Association of Paediatric Surgeons, who are working to bring together the providers and the implementers of surgical services for children in low- and medium-income countries. The coalition consists of health, advocacy and policy experts from the western world. Two meetings of this Global Initiative for Children’s Surgery (GICS) have taken place with the aim of analysing the current state of the surgical care; develop priorities to improve its delivery and identify and bring together needed resources.[4] The dream of GICS is that every child in the world with a surgical need will have access to the resources necessary to optimise his or her individual care.[4]
India has the largest child population in the world. Similar to other developing countries, we have a very wide range of causes including acute, chronic and neglected problems, with many of them being amenable to surgical treatment. The few centres providing high-quality specialised paediatric surgical care are concentrated in the metropolises, and inadequately trained non-paediatric specialists are available to address these problems in the community. Despite the success of a few focussed programs, such as ‘Smile Train’ for cleft lip and palate and the collaborative program between CURE International, India and several state governments for clubfoot conservative treatment and bracing, much of the surgical needs of the children in the community remain unaddressed because of the lack of adequate infrastructure to support children’s surgery, service delivery systems and trained manpower. The supporting services such as paediatric anaesthesia, intensive care, nursing and orthotics also lack infrastructure and trained personnel. Adequate planning at national and regional levels requires paediatric-specific determination of burden of illnesses in different areas such as congenital, neuromuscular disorders, trauma and oncology.
Rashtriya Bal Swasthya Karyakram, a new initiative by the Government of India, envisages the screening of all children and adolescents for key medical and surgical conditions and their referral and treatment by the existing healthcare providers in public and private sectors. However, in the existing system, the lack of paediatric surgical specialists forms a crisis, wherein identified children are unable to access or obtain quality care, and those suffering from complex conditions do not receive comprehensive care. The lack of a triaging system burdens the tertiary care referral centres with routine surgical conditions, which are best handled at secondary levels, causing overcrowding.
The paediatric orthopaedic community is a major stakeholder in the development of surgical services in the country. Our help, along with other paediatric surgical specialists, is required in needs assessment in the area of infrastructure, service delivery and manpower. A specialist organization such as paediatric orthopaedic society can do these in addition to setting up appropriate standards of care for different conditions, triaging systems by level of hospital, standardizing training programs and identifying areas of research. They can also be great advocates for children’s surgery and attract funding and resources. The baseline demographic studies can be used to determine optimal resources such as the number of children’s hospitals required for the population served. The other important areas are the standardization of equipment to be made available for children’s need and integration of infrastructure needs into national children’s surgical plan. They can also promote preventive strategies such as improved prenatal diagnosis and health promotion and rehabilitation.
While GICS is setting up the needs assessment and standards for infrastructure, healthcare delivery and processes and personnel at all levels of care, we can join hands with them and other paediatric surgical colleagues to provide the appropriate inputs and help build up systems and best practices to provide safe affordable surgical care for children.

References 

1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386:569-624.
2. Available from: http://www.who.int/bulletin/volumes/86/8/07-050435/en/. [Last accessed on 2017 Jan 23].
3. Available from: http://bulletin.facs.org/2015/04/the-lancet-commission-on-global-surgery-makes-progress-in-first-year-of-work-an-update/. [Last accessed on 2017 Jan 23].
4. Global Initiative for Children’s Surgery (GICS) Organizing Committee, GICS I Summary. Available from: http://www.baps.org.uk/announcements/global-initiative-childrens-surgery-gics-inaugural-meeting-report/. June 2016. [Last accessed on 2017 Jan 31].

How to Cite this Article: Madhuri V | Paediatric orthopaedics and global initiative for children’s surger y| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 01-02.

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