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 

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

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Congenital Muscular Torticollis: A study

Volume 6 | Issue 1 | Jan-April 2020 | Page: 11-15 | Md. Ashraful Islam, Datta N K, Arefin K M N, Faisal A, Mahmud C I, Murad S A, Rahman M M, Alam M M U, Begum I A

Authors : Md. Ashraful Islam [1], Datta N K [1], Arefin K M N [1], Faisal A [1], Mahmud C I [1], Murad S A [1], Rahman M M [1], Alam M M U [1], Begum I A [2]

[1] Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
[2] Department of Biochemistry, Popular Medical College, Dhaka, Bangladesh.

Address of Correspondence
Dr. Md. Ashraful Islam
Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Email: dr_ashraf007@yahoo.com

Abstract

Congenital muscular torticollis is not an uncommon problem. We evaluated 14 patients who were operated by bipolar releases and Z-lengthening. Post operatively Halter traction was used for 20 hours for 6 weeks and only at night for another 6 weeks. Out of 14 patients 5 were male, 9 were female with mean age of 9.06 years (2-17yrs) and mean follow up period was 3yrs and 4 months (3 months to 7 years), with involvement of the right side in all the patients. Mean lateral flexion deficit improved 16o and mean rotational deficit improved 12o. According to modified Lee scoring system 3 patients had excellent, 7 well, 3 fair and 1 poor result. Cosmetic improvement was significant and patients and parents were happy. There were no post-operative complications. Scar was not an issue and one patient had residual band due to poor post-operative rehabilitation as the age of the child was 2 years. Bipolar release with Z- lengthening gives well to excellent results in most patients.

Key words: Congenital, Torticollis, Post operatively

References 

1. Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop 1994; 14:802-8.
2. Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis.Clin Orthop 1999; 362:190-200.
3. Chandler FA, Altenberg A. “Congenital” muscular torticollis. JAMA 1944; 125:476-83.
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5. Ling CM. The influence of age on the results of open sternomastoid tenotomy in musculartorticollis. Clin Orthop 1976; 116:142-8.
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7. Ferkel D, Westin GW, Dawson EG, Oppenheim WL. Muscular torticollis: a modified surgical approach. J Bone Joint Surg [Am] 1983; 65-A: 894-900.
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9. Hulbert KF. Congenital muscular torticollis. J Bone Joint Surg [Br] 1950; 32-B: 50-9.
10. Wirth CJ, Hagena FW, Wuelker N, Siebert WE. Biterminal tenotomy for the treatment of congenital muscular torticollis: long-term results. J Bone Joint Surg [Am] 1992; 74-A: 427-34.
11. Ippolito E, Tudisco C, Massobrio M. Long-term results of open sternocleidomastoid tenotomy for idiopathic muscular torticollis. J Bone Joint Surg [Am] 1985; 67- A: 30-8.
12. Lee EH, Kang YK, Bose K. Surgical correction of muscular torticollis in the older child. J Pediatr Orthop 1986;6:585-9
13. Canale ST, Griffin DW, Hubbard CN. Congenital muscular torticollis: a long-term follow-up. J Bone Joint Surg [Am] 1982; 64-A: 810-16.
14. Chen CE, Ko JY. Surgical treatment of muscular torticollis for patients above 6 years of age. Arch Orthop Trauma Surg 2000; 120:149-51.
15. Arslan H, Gündüz S, Subasi M, Kesemenlin C, Necmioglu S. Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age. Arch Orthop Trauma Surg 2002; 122:489-93.
16. Soeur R. Treatment of congenital torticollis. J Bone Joint Surg 1940; 22:35-42.
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18. Omidi-Kashani F, Hasankhani EG, Sharifi R, Mazlumi M. Is surgery recommended in adults with neglected congenital muscular torticollis?: a prospective study. BMC Musculoskelet Disord 2008; 9:158.
19. Shim JS, Jang HP. Operative treatment of congenital torticollis. J Bone Joint Surg [Br] 2008; 90-B: 934-9.
20. Alldred, A: Congenital muscular torticollis. In Proceeding of the New Zealand Orthopardic Association. J Bone and Joint Surg. 53-B(2):358. 1971.

How to Cite this Article: Islam M A, Datta N K, Arefin K M N, Faisal A, Mahmud C I, Murad S A, Rahman M M, Alam M M U, Begum I A | Congenital Muscular Torticollis: A study | International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 11-15.

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Correction of coronal, rotational deformity and shortening in a paediatric femur using Ilizarov technique – A case report

Volume 6 | Issue 1 | Jan – April 2020 | Page: 16-19 | Ramprasath Ramlal Dhurvas, Vetrivel Chezian Sengodan, Surendar Vellaiyan

Authors : Ramprasath Ramlal Dhurvas [1], Vetrivel Chezian Sengodan [1], Surendar Vellaiyan [1]

[1] Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital (The TN Dr.MGR Medical University) Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. Ramprasath Ramlal Dhurvas,
12/23, Murugappa street, Purasaiwakkam, Chennai, Tamil Nadu, India
E-mail: dhurvasramprasath@gmail.com

Abstract

Background: Deformities in femur in children usually involves more than one axis with angular as well as displacement components. Moreover, the remaining growth in the opposite limb necessitates adequate lengthening of the ipsilateral limb.
Case Details: A 9 year old female child presented with genu varum deformity and shortening of 8 cm. X ray revealed the deformity to be localized to distal femur. CT (computed tomography) showed physeal bar in the medial half of distal femoral physis. We performed corrective osteotomy just proximal to the CORA (center of rotation of angulation) and corrected the deformity using Ilizarov apparatus, following which lengthening was done using same apparatus.
Results: A lengthening of 10 cm (over lengthening) was achieved with a lengthening index of 1.4 cm/month. Varus deformity was slightly over corrected to 5 degree of valgus. The range of motion of knee two months after fixator removal was 20 degree. One major complication in the form of regenerate fracture was encountered when the fixator was insitu. This was managed by reapplication of the pins. We achieved correction of varus, internal rotation, and shortening in the right femur.
Conclusion: Multiplanar deformities in children need prolonged treatment after corrective osteotomy. Ilizarov fixator provides the required mechanical stability as well as versatility to achieve this goal. Prolonged physiotherapy is necessary to restore the range of motion after fixator removal.
Key words: Multiplanar deformity, Ilizarov, osteotomy, lengthening, Paediatric femur
MeSH terms: Femur, rotation, Osteotomy, Genu varum, Bone lengthening

References 

1. Achterman,c., and kalamachi,A.: congenital deficiency of fibula. J bone and joint surg., 61-B (2): 133-137, 1979
2. Ilizarov GA. Trohova CG. Operative elongation of femur OrthopTravmatolProtez 1973; 34:11, 51
3. Maffuli N , Nele U, Matarazzo L. Changes in knee range of motion following femoral and tibial lengthening using Ilizarov apparatus : a chorot study .J Orthop Sci 2001;6(4) :333-38.
4. Dahl MT,Gulli B, Berg T. complications of limb lengthening A learning curve .Clin Orthop 1994; 301:10-18
5. Marc B. Danziger, M D., Anant Kumar, ; Fracture after femoral lengthening using the Ilizarov fixator method . Journal of pediatric orthopaedics 15:220-223
6. Daniel E. Prince, John E. Herzenberg; lengthening with external fixator is effective in congenital femoral deficiency. Clinical orthopaedics and related research July 2015
7. Hiroyuki Tsuchiya; kenji Uehara; Deformity correction followed by lengthening with Ilizarov method. Clinical orthopaedics and related research 402, PP. 176-183
8. Goodship AE, Watkins PE, Rigby HS et al (1993) The role of rigid frame stiffness in the control of fracture healing. An experimental study. J biomech 26: 1027-1035
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10. Paley D, fleming B, Catagni M et al (1990) Mechanical evaluation of external fixators used in limb lengthening. Clin OrthopRelat Res 250; 50-57.
11. Gasser B, Boman B, Wyder D et al(1990) stiffness characteristics of the circular Ilizarov device as opposed to conventional external fixatoors. J Biomech Eng 112:15-21.
12. Podolsky A, Chao EY (1993) Mechanical performance of Ilizarov circular external fixators in comparison with other external fixators. Clin Orthop Relat Res 293:61-70.
13. Drorpaley; Problems, Obstacles, and complications of limb lengthening by Ilizarov technique.Clinical orthopaedics and related research 250; jan, 1990
14. R.J.Velazquez, D.F. Bfil; Complications of use of Ilizarov technique in the correction of limb deformities in children. Journal of bone and joint surgery vol 75-A, no.8. August 1993 1148-1156.

How to Cite this Article: Dhurvas R R, Sengodan V C, Vellaiyan S.| Correction of coronal, rotational deformity and shortening in a paediatric femur using Ilizarov technique – A case report.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 20-23.

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Reliability of a New Radiographic Classification System for Developmental Dysplasia of the Hip

Volume 6 | Issue 1 | Jan – April 2020 | Page: 16-19 | B. Pasupathy, M. Sathish

Authors : B. Pasupathy [1], M. Sathish [1]

[1] Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, TamilNadu India.

Address of Correspondence
Dr. M.Sathish,
Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai Tamil Nadu India.
E-mail: drsathishmuthu@gmail.com

Abstract

The Tonnis radiographic classification for developmental dysplasia of the hip (DDH) has been widely used for grading the severity of the disease. By definition, this method requires the presence of an ossification centre, which can be delayed in appearance and eccentric in location at times. The International Hip Dysplasia Institute (IHDI) classification, a new classification system recently developed by the IHDI, answers the scenario unanswered by the Tonnis classification. This study aimed to validate its reliability in evaluating DDH with an ossification center and to compare the 2 classifications in evaluating all DDH hips. In total, the pelvic radiographs of 92 DDH patients (115 hips) between the ages of 6 and 48 months between 2014 and 2017 were assessed by 3 observers retrospectively using the 2 classifications. Intraobserver and interobserver variations were evaluated using Cohen’s kappa method and graded with Munro’s correlation strength categories. Both classifications showed excellent intraobserver and interobserver reliability. However, the IHDI demonstrated more interobserver reliability, especially for evaluating DDH without an ossification center. The IHDI classification exhibited good practicability in classifying the radiographic severity of DDH compared to the Tonnis classification, particularly in hips without an ossification center. Therefore, the IHDI classification seems to be the expanded version of the Tonnis classification and can be used as a reliable tool in the management of the early stages of DDH to stage the disease and plan treatment accordingly.
Keywords: Tonnis classification, IHDI classification, DDH.

References 

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10. Narayanan U, Mulpuri K, Sankar WN, Clarke NM, Hosalkar H, Price CT, et al. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop 2015;35:478-84.
11. Judd J, Clarke NM. Treatment and prevention of hip dysplasia in infants and young children. Early Hum Dev 2014;90:731-4.
12. Alsaleem M, Set KK, Saadeh L. Developmental dysplasia of hip: A review. Clin Pediatr (Phila) 2015;54:921-8.
13. Ramo BA, De La Rocha A, Sucato DJ, Jo CH. A new radiographic classification system for developmental hip dysplasia is reliable and predictive of successful closed reduction and late pelvic osteotomy. J Pediatr Orthop 2018;38:16-21.
14. Viera AJ, Garett JM. Understanding interobserver agreement: The Kappa statistic. Fam Med 2005;27:360-3.
15. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015;6:886-901.
16. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
17. Roposch A, Odeh O, Doria AS, Wedge JH. The presence of an ossific nucleus does not protect against osteonecrosis after treatment of developmental dysplasia of the hip. Clin Orthop Relat Res 2011;469:2838-45.
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How to Cite this Article: Pasupathy B, Sathish M.| Reliability of a New Radiographic Classification System for Developmental Dysplasia of the Hip.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 16-19.

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Observational Study on Impact of Pediatric Foot Pathology and its Management in Ossification of Midfoot Tarsal bones

Volume 6 | Issue 1 | Jan – April 2020 | Page: 7-10 | B. Pasupathy, M. Sathish

Authors : B. Pasupathy [1], M. Sathish [1]

[1] Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, TamilNadu India.

Address of Correspondence
Dr. M.Sathish,
Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai Tamil Nadu India.
E-mail: drsathishmuthu@gmail.com

Abstract

As Julius Wolff in 1868 stated that every change in the form or function of a bone is followed by adaptive changes in its internal architecture and its external shape, we conducted an observational study radiologically in the children attending our hospital to note the trend in the ossification of the midfoot tarsal bones in normal and in pathological conditions and determine the impact that each disease levies on the bone re-modelling and maturation. We studied the ossification status of 402 foot with a sex ratio of M: F 2.86:1. The mean age of the children enrolled in the study is 50.23 months (range 0.3-144). There was equal distribution of the side of the foot studied. The pathological distribution of the foot was as follows: 278 Club Foot, 88 Normal Foot, 16 Congenital Vertical Talus, 8 Flat foot, 4 Coalition of tarsal bones, 4 Cerebral Palsy, 4 Hereditary Sensory and Autonomic Neuropathy. We compared the rate of ossification of pathological foot with the normal foot. Out of the 278 club foot involved in the study 20 underwent Tibialis Anterior Tendon Transfer (TATT) for residual deformity following Ponsetti correction. We found that there is a significant delay in the ossification of the medial midfoot tarsal bones like intermediate and medial cuneiform and navicular in club foot cases. Intervention in the form of Ponsetti casting and tendon transfer significantly altered the rate of ossification of the tarsal bones. This establishes the pathology involved in the disease like club foot which results in the varus positioning of the foot in children resulting in faster ossification of the lateral midfoot tarsal bones and significant delay in the ossification of the medial midfoot tarsal bones comparing to the normal population of same age. By procedures like Ponsetti and TATT which normalises the weight bearing of all the midfoot tarsal bones resulted in a significant change in the rate of ossification of the midfoot tarsal bones compared to the untreated patients of same age.
Keywords: Foot Ossification, Club Foot, TATT, Ponsetti casting.

References 

1. Richard D, Wayne VA, Adam WM. Gray’s Anatomy for Students E-Book. London: Churchill Livingstone; 2009.
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4. Zionts LE, Jew MH, Ebramzadeh E, Sangiorgio SN. The Influence of sex and laterality on clubfoot severity. J PediatrOrthop 2017;37:129-33.
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7. Dietz FR.Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. Instruct Course Lect 2006;55:625-9.
8. Ezra E, Hayek S, Gilai AN, Khermosh O, Wientroub S.Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet. J PediatrOrthop B 2000;9:207-11.
9. Holt JB, Oji DE, Yack HJ, Morcuende JA. Long-term results of tibialis anterior tendon transfer for relapsed idiopathic clubfoot treated with the ponseti method: A follow-up of thirty-seven to fifty-five years. J Bone Joint Surg Am 2015;97:47-55.
10. Farsetti P, Caterini R, Mancini F, Potenza V, Ippolito E. Anterior tibial tendon transfer in relapsing congenital clubfoot: Long-term follow-up study of two series treated with a different protocol. J PediatrOrthop 2006;26:83-90
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14. Miyagi N, Iisaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot. J PediatrOrthop 1997;17:36-40.

How to Cite this Article: Pasupathy B, Sathish M.| Observational Study on Impact of Pediatric Foot Pathology and its Management in Ossification of Midfoot Tarsal bones.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 7-10.

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