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 

1. Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: A study using the general practice research database. J Bone Miner Res 2004;19:1976-81.
2. Lyons RA, Delahunty AM, Kraus D, Heaven M, McCabe M, Allen H et al. Children’s fractures: A population based study. Inj Prevent 1999;5:129-32.
3. Flynn JM, Skaggs D, Sponseller PD, Ganley TD, Kay RM, Leitch KK. The operative management of pediatric fractures of the lower extremity. J Bone Joint Surg Am 2002;84:2288-300.
4. Thomson JD, Stricker SJ, Williams MM. Fractures of the distal femoral epiphyseal plate. J Pediatr Orthop 1995;15:474-8.
5. Canale TS, Tolo VT. Fractures of the femur in children. Instr Course Lect 1995;44:255-73.
6. Srinivasan J, Ryan MM, Escolar DM, Darras B, Jones HR. Pediatric sciatic neuropathies: A 30-year prospective study. Neurology 2011;76:976-80.
7. Clawson DK, Seddon HJ. The results of repair of the sciatic nerve. J Bone Joint Surg Br 1960;42-B:205-12.
8. Holstein A, Lewis GB. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am 1963;45:1382-8.
9. Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg 2004;101:8-17.


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.

 


(Article Text HTML)      (Download PDF)


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 

1. Chargé SB, Rudnicki MA. Cellular and molecular regulation of muscle regeneration. Physiol Rev 2004;84:209-38.
2. Collins CA, Olsen I, Zammit PS, Heslop L, Petrie A, Partridge TA et al. Stem cell function, self-renewal, and behavioral heterogeneity of cells from the adult muscle satellite cell niche. Cell 2005;122:289-301.
3. Mauro A. Satellite cell of skeletal muscle fibers. J Biophys Biochem Cytol 1961;9:493-5.
4. Kuang S, Rudnicki MA. The emerging biology of satellite cells and their therapeutic potential. Trends Mol Med 2008;14:82-91.
5. Holterman CE, Rudnicki MA. Molecular regulation of satellite cell function. Semin Cell Dev Biol 2005;16:575-84.
6. Sacco A, Doyonnas R, Kraft P, Vitorovic S, Blau HM. Self-renewal and expansion of single transplanted muscle stem cells. Nature 2008;456:502-6.
7. Usas A, Huard J. Muscle-derived stem cells for tissue engineering and regenerative therapy. Biomaterials 2007;28:5401-6.
8. Ostrovidov S, Hosseini V, Ahadian S, Fujie T, Parthiban SP, Ramalingam M et al. Skeletal muscle tissue engineering: Methods to form skeletal myotubes and their applications. Tissue Eng Part B Rev 2014;20:403-36.
9. Liao H, Zhou GQ. Development and progress of engineering of skeletal muscle tissue. Tissue Eng Part B Rev 2009;15:319-31.
10. Danoviz ME, Yablonka-Reuveni Z. Skeletal muscle satellite cells: Background and methods for isolation and analysis in a primary culture system. Methods Mol Biol 2012;798:21-52.
11. Keire P, Shearer A, Shefer G, Yablonka-Reuveni Z. Isolation and culture of skeletal muscle myofibers as a means to analyze satellite cells. Methods Mol Biol 2013;946:431-68.
12. Bischoff R. Proliferation of muscle satellite cells on intact myofibers in culture. Dev Biol 1986;115:129-39.
13. Seale P, Sabourin LA, Girgis-Gabardo A, Mansouri A, Gruss P, Rudnicki MA. Pax7 is required for the specification of myogenic satellite cells. Cell 2000;102:777-86.
14. Boldrin L, Muntoni F, Morgan JE. Are human and mouse satellite cells really the same? J Histochem Cytochem 2010;58:941-55.
15. Cornelison D, Wold BJ. Single-cell analysis of regulatory gene expression in quiescent and activated mouse skeletal muscle satellite cells. Dev Biol 1997;191:270-83.
16. Otto A, Collins‐Hooper H, Patel K. The origin, molecular regulation and therapeutic potential of myogenic stem cell populations. J Anat 2009;215:477-97.
17. Nierobisz LS, Cheatham B, Buehrer BM, Sexton JZ. High-content screening of human primary muscle satellite cells for new therapies for muscular atrophy/dystrophy. Curr Chem Genom Transl Med 2013;7:21-9.
18. Kajbafzadeh AM, Elmi A, Payabvash S, Salmasi AH, Saeedi P, Mohamadkhani A et al. Transurethral autologous myoblast injection for treatment of urinary incontinence in children with classic bladder exstrophy. J Urol 2008;180:1098-105.
19. Frudinger A, Kölle D, Schwaiger W, Pfeifer J, Paede J, Halligan S. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut 2010;59:55-61.
20. Nikolavasky D, Stangel-Wójcikiewicz K, Stec M, Chancellor MB. Stem cell therapy: A future treatment of stress urinary incontinence. Semin Reprod Med 2011;29:61-70.
21. Gerullis H, Eimer C, Georgas E, Homburger M, El-Baz AG, Wishahi M et al. Muscle-derived cells for treatment of iatrogenic sphincter damage and urinary incontinence in men. ScientificWorldJournal 2012;2012:898535.
22. Bean AC, Huard J. Tissue Engineering Applications in Orthopedic Surgery. In: Mayer U, editor. Fundamentals of Tissue Engineering and Regenerative Medicine. Berlin: Springer-Berlin Heidelberg; 2009. p. 913-9.
23. Rajagopal K, Chilbule SK, Madhuri V. Viability, proliferation and phenotype maintenance in cryopreserved human iliac apophyseal chondrocytes. Cell Tissue Bank 2014;15:153-63.
24. Harel I, Nathan E, Tirosh-Finkel L, Zigdon H, Guimarães-Camboa N, Evans SM, Tzahor E. Distinct origins and genetic programs of head muscle satellite cells. Dev Cell 2009;16:822-32.
25. Halum SL, Naidu M, Delo DM, Atala A, Hingtgen CM. Injection of autologous muscle stem cells (myoblasts) for the treatment of vocal fold paralysis: A pilot study. Laryngoscope 2007;117:917-22.
26. Koning M, Harmsen MC, van Luyn MJ, Werker PM. Current opportunities and challenges in skeletal muscle tissue engineering. J Tissue Eng Regen Med 2009;3:407-15.
27. Sirabella D, De Angelis L, Berghella L. Sources for skeletal muscle repair: From satellite cells to reprogramming. J Cachexia Sarcopenia Muscle 2013;4:125-36.
28. Montarras D, Morgan J, Collins C, Relaix F, Zaffran S, Cumano A et al. Direct isolation of satellite cells for skeletal muscle regeneration. Science 2005;309:2064-7.
29. Scott IC, Tomlinson W, Walding A, Isherwood B, Dougall IG. Large-scale isolation of human skeletal muscle satellite cells from post-mortem tissue and development of quantitative assays to evaluate modulators of myogenesis. J Cachexia Sarcopenia Muscle 2013;4:157-69.
30. Boldrin L, Morgan JE. Human satellite cells: identification on human muscle fibres. PLoS Curr 2012;3:1-14.
31. Sharifiaghdas F, Taheri M, Moghadasali R. Isolation of human adult stem cells from muscle biopsy for future treatment of urinary incontinence. Urol J 2011;8:54-9.
32. Zammit PS, Relaix F, Nagata Y, Ruiz AP, Collins CA, Partridge TA, Beauchamp JR. Pax7 and myogenic progression in skeletal muscle satellite cells. J Cell Sci 2006;119:1824-32.
33. Christov C, Chrétien F, Abou-Khalil R, Bassez G, Vallet G, Authier F-J et al. Muscle satellite cells and endothelial cells: close neighbors and privileged partners. Mol Biol Cell 2007;18:1397-409.
34. Kuang S, Gillespie MA, Rudnicki MA. Niche regulation of muscle satellite cell self-renewal and differentiation. Cell Stem Cell 2008;2:22-31.
35. Akhyari P, Kamiya H, Haverich A, Karck M, Lichtenberg A. Myocardial tissue engineering: The extracellular matrix. Eur J Cardiothorac Surg 2008;34:229-41.
36. Chaturvedi V, Dye DE, Coombe DR, Grounds MD. Bioactive scaffolds in skeletal muscle regeneration and tissue engineering. Australian Biochemist 2011;42:8-10.
37. Aicher A, Heeschen C, Sasaki K, Urbich C, Zeiher AM, Dimmeler S. Low-energy shock wave for enhancing recruitment of endothelial progenitor cells: A new modality to increase efficacy of cell therapy in chronic hind limb ischemia. Circulation 2006;114:2823-30.
38. Wang CJ, Huang HY, Pai CH. Shock wave-enhanced neovascularization at the tendon-bone junction: An experiment in dogs. J Foot Ankle Surg 2002;41:16-22.


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.

 


(Article Text HTML)      (Download PDF)


Paediatric orthopaedics and global initiative for children’s surgery

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

Authors: Vrisha Madhuri [1]

[1] Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

Address for 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-commissionon-
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.

(Article Text HTML)      (Download PDF)


Grievous injuries in children due to tractor-related accidents

Volume 4 | Issue 1 | January-June 2018 | Page: 34-37 | Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

DOI- 10.13107/ijpo.2018.v04i01.008


Authors: Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

Paediatric Intensive Care Unit, [2] Paediatric Orthopaedic Unit, [1] Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Kala Ebenezer,
Paediatric Intensive Care Unit (PICU), Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: picu@cmcvellore.ac.in


Abstract

Introduction: Tractor-related accidents are common among the agricultural injuries. Children are prone to such incidents as farmers live in the vicinity of the farmland.
Materials and Methods: From the Paediatric Intensive Care unit (PICU) database we extracted the details of children with unintentional injuries and poisonings during the period January 2008 to June 2009. Those with tractor-related injuries were further analyzed using outpatient and inpatient charts, computerized hospital records were accessed to obtain laboratory and radiological investigations details. The clinical characteristics, injuries, and outcome of these children are presented.
Results: In the 18 months period, there were 107 children with trauma, envenomations and poisoning constituting 6.5% of all PICU admissions. Of the 31 (29%) with polytrauma, four (12.9%) children, three of them boys had sustained tractor-related injuries. The injuries included three with multiple limb fractures, two each of head, chest, musculoskeletal and perineal injury and one each of abdominal and major vascular injury. All had reached the hospital in life-threatening shock and were resuscitated. Multidisciplinary surgical intervention including craniectomy, liver resection and femoral vessels anastomosis were required along with blood transfusions, ventilatory support and inotropes. Three of them survived the injuries after a mean PICU stay of 34 days.
Conclusion: Tractor-related incidents among rural children are associated with major injuries and fatalities in children. The findings call for interventions to prevent such injuries and education of the farming community involved with tractors and other agricultural machineries.
Keywords: Critically ill, Farming machinery, Tractor


References 

1. Nag PK, Nag A. Drudgery, accidents and injuries in Indian agriculture. Ind Health 2004;42:149-62.
2. Mandal SK, Maity A. Current trends of Indian tractor industry: A critical review. App Sci Rep 2013;3:132-9.
3. Reed DB, Claunch DT. Nonfatal farm injury incidence and disability to children: A systematic review. Am J Prev Med 2000;18(Suppl 4):70-9.
4. Rivara FP. Fatal and non-fatal farm injuries to children and adolescents in the United States, 1990-3. Inj Prev 1997;3:190-4.
5. Mitchell RJ, Franklin RC, Driscoll TR, Fragar LJ. Farm-related fatalities involving children in Australia, 1989-92. Aust N Z J Public Health 2001;25:307-14.
6. Smith GA, Scherzer DJ, Buckley JW, Haley KJ, Shields BJ. Paediatric farm-related injuries: A series of 96 hospitalized patients. Clin Pediatr 2004;43:335-42.
7. Cogbill TH, Busch HM Jr, Stiers GR. Farm accidents in children. Pediatrics 1985;76:562-6.
8. Goldcamp EM, Myers J, Hendricks K, Layne L, Helmkamp J. Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001. J Rural Health 2006;22:308-13.
9. Kumar A, Mohan D, Mahajan P. Studies on tractor related injuries in northern India. Accid Anal Prev 1998;30:53-60.
10. Rees WD. Agricultural tractor accidents: A description of 14 tractor accidents and a comparison of road traffic accidents. Br Med J 1965;2:63-6.
11. Tiwari PS, Gite LP, Dubey AK, Kot LS. Agricultural injuries in Central India: Nature, magnitude and economic impact. J Agric Saf Health 2002;8:95-111.


How to Cite this Article:  Ebenezer K, Manners R, Karl S, Madhuri V | Grievous injuries in children due to tractor-related accidents | January-June 2018; 4(1): 34-37.

(Article Text HTML)      (Download PDF)


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 

1. Noonan KL, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-56.
2. Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Conservative interventions for diaphyseal fractures of the forearm bones in children. Cochrane Database Syst Rev 2013;2013:CD008775.
3. Anderson D, Sisk TD, Tooms RE, Park WI III. Compression plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 1975;57:287-96.
4. Hughston JC. Fractures of the forearm in children. An Instructional Course Lecture, the American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 1962;44-A: 1678-87.
5. Fuller DJ, McMullough CJ. Malunited fractures of the forearm in children. J Bone Joint Surg 1982;64:364-7.
6. Creasman C, Zaleske DJ, Ehrilch MG. Analyzing forearm fractures in children. The more subtle signs of impending problems. Clin Orthop Relat Res 1984;188:40-53.
7. Gandhi RK, Wilson P, Mason-Brown JJ, Macleod W. Spontaneous correction of deformity following fractures of the forearm in children. Br J Surg 1962;50:5-10.
8. Flynn JM, Sarwark JF, Waters PM, Bae DS, Lenke LP. The operative management of pediatric fractures of the upper extremity. J Bone Joint Surg Am 2002;84:2078-98.
9. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10:167-71.
10. Luhmann SJ, Gordon JE, Shoenecker PL. Intramedullary fixation for unstable both bones forearm fractures in children. J Pediatr Orthop 1998;18:451-5.
11. Blackburn M, Ziv I, Rang M. Correction of malunited forearm factures. Clin Orthop Relat Res 1984;188:54-7.
12. Amit Y, Salai M, Chechik A, Blankslein A, Horoszowski H. Closed intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence − a prelimnary report. J Pediatr Orthop 1985;5:143-6.
13. Pankovitch AM. Flexible intramedullary nailing of long bone fractures. A review. J Orthop Trauma 1987;1:78-95.
14. Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury 2005;36(Suppl 1):A25-34.
15. Firl M, Wunsch L. Measurement of bowing of the radius. J Bone Joint Surg Br 2004;86:1047-9.
16. Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 1979;139:114-20.
17. American Association of Orthopedic Surgeons (AAOS) Outcome Instrument scores. Available from: http://www.aaos.org/research/outcomes_documentatio.asp [Last accessed on 2016 May 18]
18. Shah AS, Lesniak BP, Wolter TP, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 2010;24:440-7.
19. Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP. Elastic intramedullary nailing: A minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 1998;18:457-61.
20. Case collection of forearm fractures. AO manual of fracture management. In: Dietz HG, Schittenbecher PP, Slongo T, Wilkins KE, editors. Elastic stable intramedullary nailing in children. Richmond, TX, USA: AO Publishing, Thieme; 2006. p. 71-108.
21. Jubel A, Andermahr J, Isenberg J, Issanvand A, Axel R, Klause E. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop 2005;14:375-80.
22. Bhasker A. Treatment of long bone fractures in children by flexible titanium elastic nails. Indian J Orthop 2005;39:166-8.
23. Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing. Injury 2005;36:1210-6.
24. Flynn JM, Waters PM. Single bone fixation of both bone forearm fractures. J Pediatr Orthop 1996;16:655-9.
25. Suzanne BK, Jaffe KA, Petur NG, Rosenberg AE. Orthopaedic implant-related sarcoma: A study of twelve cases. Mod Pathol 2001;14:969-77.
26. Ballal MS, Garg NK, Bruce CE, Bass A. Nonunion of the ulna after elastic stable intramedullary nailing for unstable forearm fractures; a case series. J Pediatr Orthop B 2009;18:261-4.
27. Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Orthop Trauma 2008;65:109-15.
28. Lieber J, Joeris A, Knorr A, Schalamon J, Schmittenbecher PP. ESIN in forearm fractures, clear indications, often used, but some avoidable complications. Eur J Trauma 2005;31:3-11.
29. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36(Suppl 1):A78-85.
30. Adamczyk MJ, Riley PM. Delayed union and nonunion following closed treatment of diaphyseal pediatric forearm fractures. J Pediatr Orthop 2005;25:51-5.


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.

 


(Article Text HTML)      (Download PDF)


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 

1. Hass J. A subtrochanteric osteotomy for pelvic support. J Bone Joint Surg Am 1943;25:281-91.
2. Hass J. Congenital dislocation of the hip. Palliative procedures. Springfield, IL: Thomas; 1951. p. 289-307.
3. Milch H. The pelvic support osteotomy. J Bone Joint Surg Am 1941;23:581-95.
4. Milch H. The “pelvic support” osteotomy. 1941. Clin Orthop Relat Res 1989;(249):4-11.
5. Schiltenwolf M, Carstens C, Bernd L, Lukoschek M. Late results after subtrochanteric angulation osteotomy in young patients. J Pediatr Orthop B 1996;5:259-67.
6. Samchukov ML, Birch JG. Pelvic support femoral reconstruction using the method of Ilizarov: A case report. Bull Hosp Jt Dis 1992;52:7-11.
7. Rozbruch SR, Paley D, Bhave A, Herzenberg JE. Ilizarov hip reconstruction for the late sequelae of infantile hip infection. J Bone Joint Surg Am 2005;87:1007-18.
8. Ilizarov GA. Transosseous osteosynthesis: Theoretical and clinical aspects of regeneration and growth of tissue. In: Hip dislocations. Berlin: Springer 1992. p. 701-5.
9. Ilizarov GA, Samchukov ML. Reconstruction of the femur by the Ilizarov method in the treatment of arthrosis deformans of the hip joint [in Russian]. Ortop Travmatol Protez 1988;(6):10-3.
10. Lai KA, Lin CJ, Su FC. Gait analysis of adult patients with complete congenital dislocation of the hip. J Formos Med Assoc 1997;96:740-4.
11. Choi IH, Pizzutillo PD, Bowen JR, Dragann R, Malhis T. Sequelae and reconstruction after septic arthiritis of the hips in infants. J Bone Joint Surg Am 1990;72:1150-65.
12. Lord BA, Parsell B. Measurement of pain in the prehospital setting using a visual analogue scale. Prehosp Disaster Med 2003;18:353-58.
13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.
14. Paley D. Hip joint consideration. In: Paley D, editor. Principles of deformity correction. Springer-Verlag: Heidelberg; 2002.
15. Bombelli R. Structure and function in normal and abnormal hips. 3rd ed. Springer-Verlag: Berlin; 1993. p. 1-55.
16. Fabry G, Meire E. Septic arthritis of the hip in children: Poor results after late and inadequate treatment. J Pediatr Orthop 1983;3:461-6.
17. Wopperer JM, White JJ, Gillespie R, Obletz BE. Long-term follow-up of infantile hip sepsis. J Pediatr Orthop 1988;8:322-5.
18. Betz RR, Cooperman DR, Wopperer JM, Sutherland RD, White JJ Jr, Schaaf HW et al. Late sequelae of septic arthritis of the hip in infancy and childhood. J Pediatr Orthop 1990;10:365-72.
19. Schanz A. ZurBehandlung der veraltetenangeborenen Huftverrenkung. Munchen Med Wschr 1922;69:930-41.
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.

(Article Text HTML)      (Download PDF)


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.

(Article Text HTML)      (Download PDF)


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.

(Article Text HTML)      (Download PDF)