Split Transfer of Tibialis Posterior for Dynamic Equinovarus Deformity in Children with Cerebral Palsy

Volume 9 | Issue 2 | May-August 2023 | Page: 06-09 | Ravi Chandra Vattipalli, Manoranjan Bandela

DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.164

Submitted: 14/12/2022; Reviewed: 12/02/2023; Accepted: 15/05/2023; Published: 10/08/2023

Authors: Ravi Chandra Vattipalli DNB Ortho, Manoranjan Bandela MS Ortho 

[1] Department of Orthopaedics, Apollo Hospitals, Visakhapatnam, Andhra Pradesh, India.

Address of Correspondence

Dr. Ravichandra Vattipalli,
Consultant Orthopaedic Surgeon, Apollo Hospitals, Visakhapatnam, Andhra Pradesh, India.
E-mail: vatravi@hotmail.com

Abstract

Children with cerebral palsy often have foot deformities, equinovarus being one of the most common deformities. Several procedures have been advocated, centered around rerouting the tibialis posterior tendon. Whole transfer of the tendon is associated with poor results. The current study aims to establish the efficacy of split tendon transfer of the posterior tibial tendon rerouted through the interosseous membrane and anchored to the lateral cuneiform. Surgical results were analyzed using an indigenously developed score, considering the cultural need for bare foot walking.
Keywords- Split tendon transfer of tibialis posterior, Equinovarus deformity, Cerebral palsy

References

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How to Cite this Article:  Vattipalli R, Bandela M | Split Transfer of Tibialis Posterior for Dynamic Equinovarus Deformity in Children with Cerebral Palsy | International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 06-09 | https://doi.org/10.13107/ijpo.2023.v09.i02.164

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Functional Outcome after Revision Surgery for Developmental Dysplasia of the Hip (DDH)

Volume 9 | Issue 2 | May-August 2023 | Page: 21-26 | Atul Bhaskar

DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.167

Submitted: 24/02/2023; Reviewed: 18/03/2023; Accepted: 25/05/2023; Published: 10/08/2023

Authors: Atul Bhaskar MS Ortho, FRCS Ortho [1]

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

Address of Correspondence

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

Abstract

Background: Failure after primary DDH surgery can occur early or immediate, delayed (within six months) and late due to poor remodelling. We report the short-term results after revision surgery in eighteen children including four early and 14 delayed failures.
Patient and Methods: Between 2002 and 2017, eighteen children (19 hips) underwent primary surgery at a mean age of 19 months (range: 9 months – 24 months). There were 12 girls and 6 boys in the study, with nine left and eight right sided dislocations. One child had bilateral dislocation. The mean age at revision surgery was 30 months (range: 22 months – 48 months).
Results: All cases were assessed with the modified Ponseti score to include squatting and cross-leg sitting. Eleven children (61%) were completely pain free, able to squat (Modified Ponseti score 1 and 2), three (17%) had mild limp and four (22%) had gross limitation of function. Avascular necrosis (AVN) was recorded according to Kalamchi and MacEwen criteria. Nine hips (50%) had mild AVN and six (33%) had coxa valga due to lateral physeal arrest.
The radiological outcome at final radiograph was based on Severin grade. Only 4 hips (22%) had a spherical head. Ten hips had moderate deformity (55%) and 5 hips (27%) had aspherical incongruency.
Conclusion: Early and delayed failures in DDH surgery are mainly due to inadequate initial exposure and poor hip stabilization techniques. About 50% of the revision cases had a satisfactory outcome on short term follow-up.
Keywords: Hip, Revision, Surgery, Function, Outcome

References

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How to Cite this Article:  Bhaskar | A Functional Outcome after Revision Surgery for Developmental Dysplasia of the Hip (DDH) | International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 21-26. https://doi.org/10.13107/ijpo.2023.v09.i02.167

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Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip

Volume 9 | Issue 1 | January-April 2023 | Page: 21-25 | Abdus Sami, Anil Agarwal, Lokesh Sharma., Yogesh Patel, Varun Garg 

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.151

Authors: Abdus Sami [1]  MS Orth., Anil Agarwal [1] MS Orth., Lokesh Sharma [1] MS Orth., Yogesh Patel [1] MS Orth., Varun Garg [1] MS Orth.

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal,
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com

Abstract

Purpose: We assessed the functional and radiological outcomes of children with sequelae of bilateral septic hips. Additionally, we attempted to determine the impact of radiological unstable hips on clinical functionality of the child.
Material and methods: The retrospective case series included 9 children minimum 2 years post infection. The functional outcomes were assessed using Lower Extremity Function Score (LEFS) and Children Health Assessment Questionnaire (CHAQ). Follow up hip radiographs were classified according to the Choi’s classification. We labelled the patient as having instability if either hip had a Choi type >3A.
Results: The mean age at final follow-up was 7.6 years. Five patients had multiple joints affection. The mean LEFS score was 62.7 and CHAQ-DI 0.2. The mean LEFS values for radiological stable hips (n= 5 patients) was 66 ± 19.4 and 58.5 ± 15.3 for unstable hips (p=0.5487) while corresponding CHAQ-DI scores were 0.12 ± 0.13 and 0.27 ± 0.12 respectively (p=0.1098) indicating poor relatability between functional capabilities of the child and the radiological appearances of the hips. A strong negative correlation however existed between LEFS/ CHAQ-DI values (R= -0.897; p=0.001).
Conclusions: Septic hip sequelae in children leads to various degrees of functional limitations and patients with multiple joint involvement have worse outcomes. The hip radiological findings do not relate with the overall functional status of the child.
Keywords: Functional outcome, Disability, Hip, Sepsis, Child

References

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How to Cite this Article: Sami A, Agarwal A, Sharma L, Patel Y, Garg V | Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip | International Journal of Paediatric Orthopaedics| January-April 2023; 9(1): 21-25 | https://doi.org/10.13107/ijpo.2023.v09.i01.151

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Results of Antegrade Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children

Volume 9 | Issue 1 | January-April 2023 | Page: 26-32 |Piyush Gadegone, Wasudeo Gadegone, Vijayanand Lokhande

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.152

Authors: Piyush Gadegone [1] MS Orth., DNB Orth., Wasudeo Gadegone [1] MS Gen. Surg., MS Orth., MNAMS Orth., SICOT (Fellow), Vijayanand Lokhande [1] MS Orth., DNB Orth.

[1] Trauma and Orthopaedics Hospital, Chandrapur, Maharashtra, India.

Address of Correspondence

Dr. Wasudeo Gadegone
Consultant Orthopaedic Surgeon, Trauma and Orthopaedics Hospital, Chandrapur, Maharashtra, India.
E-mail: gadegone123@yahoo.co.in

Abstract

Objective: The objective of this study is to present a new method of Antegrade elastic wires, which is a minimally invasive surgical approach to treat displaced fractures in the distal radial metaphyseal and dia-metaphyseal fractures in children.
Materials and Methods: We conducted a retrospective analysis of 18 patients who received antegrade elastic wires treatment for distal radial fractures from January 2019 to January 2023. The surgical indications encompassed closed, significantly displaced, and unstable fractures located in the metaphysis or diaphyseo-metaphyseal region of the radius. The fractures were stabilized using two prebent short elastic nails that were introduced from the diaphysis to the metaphysis. In instances when an ulnar fracture was present, a traditional anterograde nailing procedure was also carried out. A long or short arm plaster cast was administered for a duration of 3 weeks.
Results: The group consisted of 15 boys and 3 girls, with an average age of 10.8 years (ranging from 7 to 16 years). The right hand was implicated in 12 instances, whereas the left hand was implicated in 6 instances. The mean duration of follow-up was 7.8 months, with a range of 4 to 28 months. Out of the 18 patients, 2 individuals experienced skin irritations, which were resolved after the removal of the radial nails. All patients had complete restoration of their range of motion and experienced successful bone healing without any problems.
Conclusions: An antegrade elastic wire fixation is a very efficient, secure, and readily replicable technique for treating unstable fractures of the distal radius, while also preventing harm to the physeal plate. It successfully attains favorable functional and radiological outcomes and allows early mobilization.
Keywords: Distal radius, Metaphyseal fracture, dia-metaphyseal fractures, Elastic wires, Antegrade.

References

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3. Younger ASE, Tredwell SJ, Mackenzie WG. Factors affecting fracture position at cast removal after pediatric forearm fracture. *J Pediatr Orthop.* 1997;17:332–336.
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8. Varga M, Józsa G, Fadgyas B, Kassai T, Renner A. Short, double elastic nailing of severely displaced distal pediatric radial fractures: A new method for stable fixation. *Medicine (Baltimore).* 2017 Apr;96(14):e6532. Published online 2017 Apr 7.
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10. Hargreaves DG, Drew SJ, Eckersley R. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. *J Hand Surg Br.* 2004;29:374–6.
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12. Price CT, Scott DS, Kurzner ME, Flynn JC. Malunited forearm fractures in children. *J Pediatr Orthop.* 1990;10(6):705-712.
13. Dua K, Abzug JM, Sesko Bauer A, Cornwall R, Wyrick TO. Pediatric distal radius fractures. *Instr Course Lect.* 2017;66:447–60.
14. Khandekar S, Tolessa E, Jones S. Displaced distal end radius fractures in children treated with Kirschner wires – A systematic review. *Acta Orthop Belg.* 2016;82(4):681–9.
15. Wasiak M, Piekut M, Ratajczak K, Waśko M. Early complications of percutaneous K-wire fixation in pediatric distal radius fractures: a prospective cohort study. *Arch Orthop Trauma Surg.* 2023 Nov;143(11):6649-6656. doi: 10.
16. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. *Eur J Pediatr Surg.* 2010;20(6):395-398. DOI: 10.1055/s-0030-1262843.
17. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. *Int Surg.* 2014;99:269-275. *Injury.* 2019 Feb;50(2):598-601. doi: 10.1016/j.injury.2019.01.001. Epub 2019 Jan 6.
18. Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent intramedullary nail. *J Int Med Res.* 2016;44:122-130.
19. Du M, Han J. Antegrade elastic stable intramedullary nail fixation for pediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach. *Injury.* 2019 Feb;50(2):598-601. doi: 10.1016/j.injury.2019.01.001.
20. Gadegone P, Gadegone W, Lokhande V, Jawrani N. Distal Radial Fracture Fixation in Adults using Intramedullary Elastic Wires Augmented with either Cast Immobilization or External Fixation. *Malays Orthop J.* 2021 Nov;15(3):36–44. doi: 10.5704/MOJ.2111.006.
21. Glanvill R, Boon JM, Birkholtz F, Meiring JH, van Schoor AN, Greyling L. Superficial radial nerve injury during standard K-wire fixation of uncomplicated distal radial fractures. *Orthopedics.* 2006 Jul;29(7):639-41. doi: 10.3928/01477447-20060701-15.

 

How to Cite this Article: Gadegone P, Gadegone W, Lokhande V Results of Antegrade | Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 26-32 | https://doi.org/10.13107/ijpo.2023.v09.i01.152

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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: 33-36 | Sitsabesan Chokkalingam, Arunan Murali, Roy Santhosham, Gopinath Menon

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.153

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): 33-36 | https://doi.org/10.13107/ijpo.2023.v09.i01.153

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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: 07-12 | Amit Sharma, G Nirmal Raj Gopinathan, Garima Sharma, Pallavi Sharma, Sange Negi

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.149

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): 07-12 | https://doi.org/10.13107/ijpo.2023.v09.i01.149

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