Mitten deformity

Volume 7 | Issue 1 | January-April 2021 | Page: 27 | Yashdeep Singh Pathania

Authors: Yashdeep Singh Pathania MD [1]

[1] Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342005, India.

Address of Correspondence
Dr. Yashdeep Singh Pathania
Senior Resident, Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342005, India.
Email: yashdeepsinghpathania@gmail.com

A 10-year-old boy, a known case of severe recessive dystrophic epidermolysis bullosa since childhood, presented with widespread scarring over scalp, face, upper and lower limbs. Hands and feet showed flexion contracture, anonychia. There was fusion of digits of the feet by a thin membrane of scar tissue producing pseudosyndactyly, known as mitten deformity (Figure 1). In pseudosyndactyly, digits are fused together by thin membrane and involve only the distal portion of digits, which can be released through surgery where as in syndactyly actual and complete fusion of digits occur and involve base of the digits.

Figure: Scarring over legs with flexion contracture and pseudosyndactyly of foot.

 

How to Cite this Article:  Singh Pathania Y  | Mitten deformity | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 27.

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Horizontal Intra-articular dislocation of patella with intact periosteal sleeve in an adolescent: Case report and review of literature

Volume 7 | Issue 1 | January-April 2021 | Page: 22-26 | Mudit Shah, Amin Shah, Mandar Agashe

Authors: Mudit Shah MBBS, MS Ortho. [1], Amin Shah MBBS, MS Ortho.[2], Mandar Agashe MBBS, MS Ortho.[3]

[1] Director and CEO, Sapna Healthcare centre, Ghatkopar west, Mumbai, Maharashtra, India.
[2] Fellow of Paediatric Orthopaedic, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India Mumbai, Maharashtra, India.
[3] Consultant paediatric Orthopaedic surgeon, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mandar Agashe,
Consultant paediatric Orthopaedic surgeon, Dr. Agashe`s Maternity & Surgical Nursing Home, Kurla west, Mumbai, Maharashtra, India.
E-mail: mandarortho@gmail.com

Abstract

Intra-articular patella dislocations are uncommon, but the majority of cases can be reduced by closed methods. We present a rare case that required open reduction and highlight the reasons and present a review of the same.
We describe a rare case of horizontal intra-articular patella dislocation associated with an intact periosteal sleeve and extensor retinaculum in a 13-year-old boy requiring open reduction.
Horizontal intra-articular patellar dislocation is an uncommon injury, especially in the adolescent age group. Open reduction should only be performed if closed reduction is unsuccessful.
Keywords: Horizontal intra-articular dislocation of patella, Intact periosteal sleeve, Open reduction.

References 

1. Pagdal S, Lande O, Jadhav U. Intra-articular dislocation of patella reduced by closed method – A rare case report. J Clin Orthop trauma [Internet]. 2016;7(Suppl 1):118–20. Available from: http://dx.doi.org/10.1016/j.jcot.2016.03.002.
2. Uluyardımcı E, Bozkurt İ, Öçgüder DA, Yalçın N. Unusual Horizontal Patellar Dislocation Reduced without General Anesthesia. JBJS Case Connect [Internet]. 2019 Jan;9(1):e2. Available from: http://insights.ovid.com/crossref an=01709767-201903000-00003.
3. Rangdal S, Bachhal V, Vashisht S, Dhillon MS. Intra-articular dislocation of the patella: a rare variant to an uncommon injury. BMJ Case Rep [Internet]. 2019 Apr 24;12(4). Available from: http://www.ncbi.nlm.nih.gov/pubmed/31023730.
4. Shaw DL, Giannoudis P V., Archer IA. Intra-articular dislocation of patella. Injury [Internet]. 1995 May;26(4):273–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7649634.
5. Bashir S, Manan A, Wani D, Tantray O, Beigh M, Sharma R. Bilateral intra-articular dislocation of patella in an elderly: a rare presentation. Internet J Orthop Surg. 2010;19(1).
6. Fithian DC, Paxton EW, Stone M Lou, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med [Internet]. 32(5):1114–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15262631.
7. Kramer DE, Simoni MK. Horizontal intra-articular patellar dislocation resulting in quadriceps avulsion and medial patellofemoral ligament tear: a case report. J Pediatr Orthop B [Internet]. 2013 Jul;22(4):329–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22828187.
8. Tsai C-H, Hsu C-J, Hung C-H, Hsu H-C. Primary traumatic patellar dislocation. J Orthop Surg Res [Internet]. 2012;7(1):21. Available from: http://josr-online.biomedcentral.com/articles/10.1186/1749-799X-7-21.
9. Venkatesh Gupta SK, H P P, Prathik R, Jeetesh L. Traumatic Intra-articular Intercondylar Dislocation of the Patella Reduced by the Closed Method with Open Quadriceps Repair in an Adolescent: A Rare Case Report. Cureus [Internet]. 2018 Dec 8; Available from: https://www.cureus.com/articles/14706-traumatic-intra-articular-intercondylar-dislocation-of-the-patella-reduced-by-the-closed-method-with-open-quadriceps-repair-in-an-adolescent-a-rare-case-report.
10. McHugh G, Ryan E, Cleary M, Kenny P, O’Flanagan S, Keogh P. Intra-Articular Dislocation of the Patella. Case Rep Orthop [Internet]. 2013;2013:1–3. Available from: http://www.hindawi.com/journals/crior/2013/535803/
11. Al Khalifa A, Syed K. Intra-articular dislocation of patella with femoral impaction—A case report and review of literature. Int J Surg Case Rep [Internet]. 2019;59:176–9. Available from: https://doi.org/10.1016/j.ijscr.2019.05.041.
12. van den Broek TAA, Moil PJ. Horizontal rotation of the patella: A case report with review of the literature. Acta Orthop Scand [Internet]. 1985 Jan 8;56(5):436–8. Available from: http://www.tandfonline.com/doi/full/10.3109/17453678508994367.
13. Berenger V, Pesenti S, Ollivier M, Buord J-M, Pinelli P-O. Traumatic inter-condylar dislocation of the patella: Report of two cases. Orthop Traumatol Surg Res [Internet]. 2013 Dec;99(8):979–81. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1877056813002077.
14. Potini VC, Gehrmann RM. Intra-Articular Dislocation of the Patella With Associated Hoffa Fracture in a Skeletally Immature Patient. Am J Orthop (Belle Mead NJ) [Internet]. 2015 Jun;44(6):E195-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26047005.

How to Cite this Article:  Shah M, Shah A, Agashe M  | Horizontal Intra-articular dislocation of patella with intact periosteal sleeve in an adolescent: Case report and review of literature | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 22-26.

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Elbow, Forearm and Wrist Issues in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 55-64 | Praveen Bhardwaj, Darshan Kumar A Jain, Maulin M Shah, Rujuta Mehta, Badarinath Athani

Authors: Praveen Bhardwaj MS Ortho., DNB Ortho. FNB [1], Darshan Kumar A Jain MS Ortho., FNB [2],
Maulin M Shah MS Ortho. [3], Rujuta Mehta MS Ortho. DNB Ortho. [4], Badarinath Athani MS Ortho., DNB (PMR) [5]

[1] Consultant Hand and Reconstructive Microsurgeon, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[2] Consultant Hand and Reconstructive Microsurgeon. Ramaiah Hospitals, Bangalore, Karnataka, India.
[3] Consultant Paediatric Orthopaedic Surgeon, Orthokids Clinic, Ahmedabad, Gujarat, India.
[4] HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[5] Principle consultant Safdarjung Hospital, Vardhaman Mahavir Medical College, New Delhi, India.

Address of Correspondence
Dr. Praveen Bhardwaj ,
Consultant Hand and Reconstructive Microsurgeon, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: drpb23@gmail.com

Abstract

The variable presentation of the sequelae of brachial plexus birth palsy (BPBP) at the elbow, forearm and wrist and their association with much extensive brachial plexus involvement makes reconstruction at these levels demanding . Functional limitation and cosmetic concern are common indications for surgical intervention. This article presents a synopsis of the incidence, pathogenesis, clinical presentation and parental concerns related to these deformities, decision-making considerations, management strategies and expected outcome for correction of these deformities. Deformities at the forearm and wrist can be often corrected simultaneously as they could be interrelated. The pattern of deformities, their severity and their impact on the overall function of the limb and parental concern differ. Each child needs a tailor-made management plan, weighing the expected outcome against parental expectation.
Keywords: Brachial plexus birth palsy, Forearm deformity, Supination deformity, Elbow flexion deformity, Pronation deformity, Ulnar deviation deformity.

References 

1. Venkatramani H, Bhardwaj P, Sabapathy SR. Birth Brachial Plexus Palsy. In: Agarwal K. ed. Text book of Plastic & Reconstructive & Aesthetic Surgery. (Chapter 29) Vol 2. First edition Delhi: Thieme, 2017: p 665-695.
2. Sebastin SJ, Chung KC. Reconstructive strategy for recovery ofhand function. In: Chung KC, Yang LJS, McGillicuddy JE, eds.Practical Management of Pediatric and Adult Brachial Plexus Palsies. New York, NY: Elsevier Saunders; 2012:114–142
3. Nath RK, Somasundaram C, Melcher SE, Bala M, Wentz MJ. Arm rotated medially with supination – the ARMS variant: description of its surgical correction. BMC MusculoskeletDisord. 2009; 10:32.
4. Bhardwaj P, Venkatramani H, Sabpathy SR. Elbow flexion deformity in birth brachial plexus palsy. Presented at- Asia Pacific Hand Surgery Meet at Melbourne, March 2020. https://apfssh2020.org/downloads/APFSSH-APFSHT-Program-&-Abstract-Book.pdf
5. Nikolaou S, Hu L, Cornwall R. Afferent Innervation, Muscle Spindles, and Contractures Following Neonatal Brachial Plexus Injury in a Mouse Model. J Hand Surg Am2015; 40:2007-16.
6. Nikolaou S, Peterson E, Kim A, Wylie C, Cornwall R. Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury. J Bone Joint Surg Am. 2011;93(5):461e470.
7. van der Sluijs JA, van der Sluijs MJ, van de Bunt F, van Ouwerkerk WJR. What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury. J Child Orthop. 2018;12(5):544-549.
8. Sheffler LC, Lattanza L, Hagar Y, Bagley A, James MA. The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg Am 2012;94(5):403–409.
9. Al-Qattan MM. Total obstetric brachial plexus palsy in children with internal rotation contracture of the shoulder, flexion contracture of the elbow, and poor hand function. Ann PlastSurg2010; 65:38-42.
10. Sheffler LC, Lattanza L, Sison-Williamson M, James MA. Biceps brachii long head overactivity associated with elbow flexion contracture in brachial plexus birth palsy. J Bone Joint Surg Am. 2012;94(4):289-297.
11. Ho ES, Roy T, Stephens D, Clarke HM. Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy. J Hand Surg Am. 2010;35(1):84-91.
12. Nath RK, Somasundaram C. Biceps Tendon Lengthening Surgery for Failed Serial Casting Patients with Elbow Flexion Contractures Following Brachial Plexus Birth Injury. Eplasty. 2016;16: e24.
13. Vekris MD, Pafilas D, Lykissas MG, Soucacos PN, Beris AE. Correction of elbow flexion contracture in late obstetric brachial plexus palsy through arthrodiatasis of the elbow (Ioannina method). Tech Hand Up Extrem Surg. 2010;14(1):14-20. doi:10.1097/BTH.0b013e3181c848cb
14. Bhardwaj P, Venkatramani H, Sabpathy SR. Forearm deformities in birth brachial plexus palsy- Deformity profile and correction strategy. Presented at- Asia Pacific Hand Surgery Meet at Melbourne, March 2020. https://apfssh2020.org/downloads/APFSSH-APFSHT-Program-&-Abstract-Book.pdf| 12APFSSH/8APFSHT [Internet]. [cited 2020 Aug 18]. Available from: https://apfssh2020.org/program-wednesday.php
15. Allende CA, Gilbert A. Forearm supination deformity after obstetric paralysis. Clin OrthopRelat Res. 2004;(426):206-211.
16. Yam A, Fullilove S, Sinisi M, Fox M. The supination deformity and associated deformities of the upper limb in severe birth lesions of the brachial plexus. J Bone Joint Surg Br. 2009;91(4):511-516.
17. Zancolli EA II. Palliative surgery: pronosupination in obstetricpalsy. In: Gilbert A, ed. Brachial Plexus Injuries. London, UK:Martin Dunitz; 2001:275–29.
18. Al-Qattan MM, Al-Khawashki H. The “beggar’s” hand and the “unshakable” hand in children with total obstetric brachial plexus palsy. PlastReconstrSurg 2002;109(6):1947–1952
19. Zancolli, EA. Paralytic supination contracture of the forearm. J Bone Joint Surg Am. 1967, 49: 1275–84
20. Kozin, SH. Treatment of the supination deformity in the pediatric brachial plexus patient. Tech Hand Up Extrem Surg. 2006, 10: 87–95
21. Hankins SM, Bezwada HP, Kozin SH. Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury. J Hand Surg Am. 2006;31(1):118-124.
22. Manske, PR, McCarroll, HR, Hale, R. Biceps tendon rerouting and percutaneous osteoclasis in the treatment of supination deformity in obstetrical palsy. J Hand Surg Am. 1980, 5:153–9.
23. Lipskeir E, Weizenbluth M. Derotation osteotomy of the forearm in management of paralytic supination deformity. J Hand Surg Am. 1993;18(6):1069-1074.
24. Ozkan T, Aydin A, Ozer K, Ozturk K, Durmaz H, OzkanS. A surgical technique for pediatric forearm pronation:brachioradialis rerouting with interosseous membrane release.
J Hand Surg Am 2004;29(1):22–27.
25. Soucacos, Panayotis&Vekris, Marios& Kostas, John & Johnson, Elizabeth. Secondary Reconstructive Procedures in Obstetrical Brachial Plexus Palsy: Forearm, Wrist, and Hand Deformities. Semin Plast Surg. 2005;19(01):96–102.
26. Anderson GA, Thomas BP, Pallapati SC. Flexor carpi ulnaris tendon transfer to the split brachioradialis tendon to restore supination in paralytic forearms. J Bone Joint Surg Br. 2010;92(2):230-234.
27. Ozkan T, Tuncer S, Aydin A, Hosbay Z, Gulgonen A. Brachioradialis re-routing for the restoration of active supination and correction of forearm pronation deformity in cerebral palsy. J Hand Surg Br. 2004;29(3):265-270.
28. Amrani A, Dendane MA, El Alami ZF. Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury. J Bone Joint Surg Br.2009;91(5):616-618.
29. Cheema, TA, Firoozbakhsh, K, De Carvalho, AF, Mercer, D. Biomechanic comparison of 3 tendon transfers for supination of the forearm. J Hand Surg Am. 2006, 31: 1640–4.
30. Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009;34(6):788-791.
31. Chuang DC, Ma HS, Borud LJ, Chen HC. Surgical strategy for improving forearm and hand function in late obstetric brachial plexus palsy. PlastReconstr Surg. 2002; 109:1934–1946.
32. Bhardwaj P, Parekh H, Venkatramani H, Raja Sabapathy S. Surgical correction of ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy sequelae. Hand Surg. 2015;20(1):161-165.
33. Ozkan T, Aydin HU, BerkozO, Ozkan S, Kozanoglu E. ‘Switch’ technique to restore pronation and radial deviation in 17 patients with brachial plexus birth palsy. J Hand Surg Eur Vol. 2019;44(9):905-912.
34. Duclos L, Gilbert A. Restoration of wrist extension by tendon transfer in cases of obstetrical brachial plexus palsy. Ann Chir Main Memb Super. 1999; 18:7–12.
35. Bertelli JA. Brachialis muscle transfer to the forearm muscles in obstetric brachial plexus palsy. J Hand Surg Br 2006; 31:261–5.
36. Boulahouache A, Cambon-Binder A, Chouiha M, Lardjane ML, Belkheyar Z. Chondrodesis of the wrist in children with severe paralytic hand deformities. Hand SurgRehabil. 2020;39(4):251-255.

How to Cite this Article:  Bhardwaj P, Jain DA, Shah MM, Mehta R, Athani B | Elbow, Forearm and Wrist Issues in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric
Orthopaedics | January-April 2021; 7(1): 55-64.

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Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 45-54 | Rujuta Mehta, Qaisur Rabbi, Praveen Bhardwaj, Maulin M. Shah, Dhiren Ganjwala

Authors: Rujuta Mehta MS Ortho. DNB Ortho. [1], Qaisur Rabbi MBBS, DNB Ortho. [2],
Praveen Bhardwaj MS Orth., DNB Ortho. FNB [3], Maulin M. Shah MS Ortho. [4], Dhiren Ganjwala MS Ortho. [5]

[1] Department of Orthopaedics, HOD Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
[2] Department of Paediatric Orthopaedic Surgery, Center for the Rehabilitation of the Paralysed, CRPBangladesh.
[3] Department of Orthopaedics, Consultant Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[4] Department of Paediatric Orthopaedic Surgery, Orthokids Clinic, Ahmedabad
[5] Ganjwala Orthopedic Hospital, Ahmedabad, Gujrat, India.

Address of Correspondence
Dr. Rujuta Mehta,
HOD Bai Jerbai Wadia Hospital for Children, Consultant Paediatric Orthopedic and Paediatric
Upper Limb Surgeon- Nanavati Superspeciality Hospital, Jaslok Hospital and Shushrusha Hospital.
E-mail: rujutabos@gmail.com

Abstract

Shoulder dysplasia is common constituting 80% of sequelae secondary to BPBP. Muscle imbalance due to uninhibited co-contractions and eccentric forces across the shoulder joint are the main causes of shoulder sequelae. This leads to limitation of shoulder movements and gleno-humeral deformity. This article discusses the presentations, investigations and treatment approach to various severities of deformities resulting from the muscular imbalance about the shoulder in BPBP.

Keywords: Shoulder sequelae, Rebalancing conjoint transfer, Salvage surgery.

References 

1) Waters PM, Smith GR, Jaramillo D. Glenohumeral deformity secondary to brachial plexus birth palsy. J Bone Joint Surg Am. 1998; 80(5): 668-77.
2)M L Pearl, B W Edgerton. Glenoid deformity secondary to brachial plexus birth palsy J Bone Joint Surg Am. 1998 May;80(5):659-67. doi: 10.2106/00004623-199805000-00006.
3)Susan V Duff, Sudarshan Dayanidhi, Scott H Kozin. Asymmetrical shoulder kinematics in children with brachial plexus birth palsy. Clin Biomech (Bristol, Avon). 2007 Jul; 22(6):630-8. doi: 10.1016/j.clinbiomech.2007.02.002.
4) Dahlin LB, Erichs K, Andersson C et al. Incidence of early posterior shoulder dislocation
in brachial plexus birth palsy. J Brachial Plex Peripher Nerve Inj. 2007; 16: 2:24.
5) Ezaki M, Malungpaishrope K, Harrison RJ, Mills JK, Oishi SN, Delgado M, Bush PA, Browne RH. Botulinum toxin A injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. The Journal of Bone and Joint surgery. American Volume, 01 Sep 2010, 92(12):2171-2177.
6): Bertelli JA. Lengthening of subscapularis and transfer of the lower trapezius in the correction of recurrent internal rotation contracture following obstetric brachial plexus palsy. J Bone Joint Surg Br. 2009 Jul;91(7):943-8.
7) Scott H. Kozin, MD Correlation Between External Rotation of the Glenohumeral Joint and Deformity after Brachial Plexus Birth Palsy. J Pediatr Orthop • Volume 24, Number 2, March/April 2004.
8) Donald S. Bae, Peter M. Waters and David Zurakowski. Reliability of Three Classification Systems Measuring Active Motion in Brachial Plexus Birth Palsy. J Bone Joint Surg Am. 2003; 85:1733-1738.
9) Staphanie A. Russo, Scott Kozin, Dav Zlotolov. Motion Necessary to achieve Mallet Internal Rotation Positions in Children with Brachial Plexus Birth Palsy. J Pediatr Orthop, January 2019 – Volume 39 – Issue 1 – p 14-21.
10) Rahul K Nath, Chandra Somasundaram, Sonya E Melcher, Meera Bala Arm rotated medially with supination the ARMS variant: Description of its surgical correction. Disorders volume 10, Article number: 32 (2009).
11) Gilbert A. Obstetrical brachial plexus palsy. In: Tubiana R, ed. The Hand. W B Saunders: Philadelphia: 576-601.
12) Hunter JD. Franklin K. Hughes PM. The ultrasound diagnosis of posterior shoulder dislocation associated with Erb’s palsy. Pediatr Radioi. 1998:28: 510-1.
13) Vathana T, Rust S, Mills J, Wilkes D, Browne R, Carter PR, Ezaki M. Intra observer and inter observer reliability of two ultrasound measures of humeral head position in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am. 2007 Aug;89 (8):1710-5.
14) Sanchez TR, Chang J, Bauer A, Joyce NC, Patel CV. Dynamic sonographic evaluation of posterior shoulder dislocation secondary to brachial plexus birth palsy injury. J Ultrasound Med. 2013 Sep;32(9):1531-4.
15) Andrea S. Bauer, Justin F. Lucas, Nasser Heyrani, Ryan L. Anderson, Leslie A. Kalish, and Michelle A. James. Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy. J Bone Joint Surg Am. 2017; 99:778-83.
16). Donohue KW, Little KJ, Gaughan JP, Kozin SH, Norton BD, Zlotolow DA. Comparison of ultrasound and MRI for the diagnosis of glenohumeral dysplasia in brachial plexus birth palsy. The Journal of Bone and Joint Surgery. American Volume. 2017 Jan;99(2):123-132
17) van der Sluijs JA, van Ouwerkerk WJ, de Gast A, Wuisman P, Nollet F, Manoliu RA. Retroversion of the humeral head in children with an obstetric brachial plexus lesion. Journal of Bone and Joint Surgery. British Volume (London). 2002 May;84(4):583-587
18) Pearl ML, Batech M, van de Bunt F. Humeral retroversion in children with shoulder internal rotation contractures secondary to upper-trunk neonatal brachial plexus palsy. The Journal of Bone and Joint Surgery. American Volume. 2016 Dec;98(23):1988-1995
19) Verchere C, Durlacher K, Bellows D, Pike J, Bucevska M. An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol. Hand (New York, N.Y.), 01 Jun 2014, 9(2):187-195.
20) Shah MM, Naik N, Patel T, Gupta G, Makadia A. Minimally Invasive Subscapularis Release: A Novel Technique and Results. J Pediatr Orthop. 2020;40(6): e466-e472.
21) Waters PM. Management of shoulder deformities in brachial plexus birth injuries. J Pediatr Orthop. 2010;30: S53–6
22) Waters PM, Bae DS. The early effects of tendon transfers and open capsulorrhaphy on Glenohumeral deformity in Brachial Plexus Birth palsy. J Bone Joint Surg Am. 2008; 90:2171–9.
23) James Hui, Ian Torode. Changing Glenoid Version After Open Reduction of Shoulders in Children with Obstetric Brachial Plexus Palsy. Journal of Pediatric Orthopaedics 23:109–113 ,2003.
24) Kirkos JM, Kyrkos MJ, Kapetanos GA, Haritidis JH. Brachial Plexus Palsy secondary to birth injuries: Long term results of anterior release and tendon transfers around the shoulder. J Bone Joint Surg Br.2005; 87:231–5
25) Anderson KA, O’Dell MA, James MA. Shoulder Tech Hand Up Extrem Surg. 2006 Jun;10(2):60-7
26) Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clinics. 1995 Nov;11(4):583-594; discussion 94-5
27) Chuang DC, Hae-Shya M, Wei F. A new strategy of muscle transposition for shoulder deformity caused by Obstetric brachial plexus palsy. Plast Recontr Surg. 1998; 101:686–94
28) Abzug JM, Kozin SH, Waters PM. Open Glenohumeral Joint Reduction and Latissimus Dorsi and Teres Major Tendon Transfers for Infants and Children Following Brachial Plexus Birth Palsy. Tech Hand Up Extrem Surg. 2017 Jun;21(2):30-36
29) Mehta Rujuta, Johari Ashok, Maheshwari Ratna. Role of muscle transfers and tendon transfers in birth brachial plexus injury. Current Orthopaedic Practice: January/February 2015 – Volume 26 – Issue 1 – p 9-14 doi: 10.1097/BCO.0000000000000191 SPECIAL FOCUS: International Orthopaedics.
30) Thatte MR, Agashe MV, Rao A, Rathod CM, Mehta Rujuta. cases. Indian J Plast Surg. 2011 Jan;44(1):21-8.
31) Elhassan B, Bishop A, Shin A, Spinner R. injury Hand Surg Am. 2010 Jul;35(7):1211-9. doi: 10.1016/j.jhsa.2010.05.001.
32) Bertelli JA. adults. Microsurgery. 2011 May;31(4):263-7. doi: 10.1002/micr.20838. Epub 2010 Dec 3
33) J M Kirkos , I A Papadopoulos. Late treatment of brachial plexus palsy secondary to birth injuries: rotational osteotomy of the proximal part of the humerus. J Bone Joint Surg Am. 1998;80(10):1477-83.
34)Al-Qattan MM. Rotation osteotomy of the humerus for Erb’s palsy in children with humeral head deformity. J Hand Surg Am. 2002;27(3):479–83.
35) Venkatramani H, Bhardwaj P, Sabapathy SR. Birth Brachial Plexus Palsy. In: Agarwal K. ed. Text book of Plastic & Reconstructive & Aesthetic Surgery. Vol 2. First edition Delhi: Thieme, 2017: p 665-695.
36) Waters PM, Bae DS. The effect of derotational humeral osteotomy on global shoulder function in brachial plexus birth palsy. J Bone Joint Surg Am. 2006;88(5):1035–42.
37) Donald S Bae, Peter M Waters. External rotation humeral osteotomy for brachial plexus birth palsy. Tech Hand Up Extrem Surg. 2007;11(1):8-14.
38) M M Al-Qattan, H Al-Husainan, A Al-Otaibi, M S El-Sharkawy. Long-term results of low rotation humeral osteotomy in children with Erb’s obstetric brachial plexus palsy. J Hand Surg Eur Vol. 2009;34(4):486-92.
39) Abzug JM, Chafetz RS, Gaughan JP, Ashworth S, Kozin SH. Shoulder function after medial approach and derotational humeral osteotomy in patients with brachial plexus birth palsy. J Pediatr Orthop. 2010;30(5):469-74.
40) Dodwell E, O’Callaghan J, Anthony A, Jellicoe P, Shah M, Curtis C, et al. Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: Early outcomes. The Journal of Bone and Joint Surgery. American Volume. 2012 Dec; 94(23):2145-2152
41) Peter M Waters, Donald S Bae. Effect of tendon transfers and extra-articular soft-tissue balancing on glenohumeral development in brachial plexus birth palsy. J Bone Joint Surg Am. 2005 Feb;87(2):320-5.

How to Cite this Article:  Mehta R, Rabbi Q, Bhardwaj P, Shah MM, Ganjwala D | Shoulder Rebalancing Surgery for Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 45-54.

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Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts

Volume 7 | Issue 1 | January-April 2021 | Page: 37-44 | Parag B. Lad, Nischal Naik, Bharat K. Kadadi, P. S. Bhandari, Mukund R. Thatte

Authors: Parag B. Lad D Ortho., MS Ortho. [1], Nischal Naik M.Ch. [2], Bharat K. Kadadi MS Ortho. [3],
P. S. Bhandari M.Ch. [4], Mukund R. Thatte M.Ch. [5]

[1] Jupiter Hospital, Thane, Maharashtra, India.
[2] Divyam Hospital, Ahmedabad, Gujarat, India.
[3] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.
[4] Brij Lal Super specialty Hospital, Haldwani, Nainital, Uttarakhand, India.
[5] Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Mukund R Thatte,
Plastic Surgeon, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
E-mail: mthatte@gmail.com

Abstract

This article discusses the role of primary nerve surgery for Brachial Plexus Birth Palsy (BPBP). Spontaneous recovery in brachial plexus birth palsy is known and in such cases the prognosis is good. However, the incidence of such recovery is 30 – 90%. In some infants however, the course of motor recovery is inadequate necessitating nerve repair. BPBP presents clinically as a lower motor neuron type of upper limb monoplegia at birth. Indications of primary nerve reconstruction or distal nerve transfer, the technique of exploration of brachial plexus, common anatomical variations and the methods for identification of intact roots are discussed in detail.
Keywords: Primary nerve reconstruction, Brachial Plexus Birth Palsy (BPBP), Nerve transfer, co-contractions, Brachial plexus surgery.

References 

1. Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46(2):138-144.
2. Kao JT, Sharma S, Curtis CG, Clarke HM. The role of the brachioradialis H reflex in the management and prognosis of obstetrical brachial plexus palsy. Handchir Mikrochir Plast Chir. 2003;35(2):106-111.
3. Thatte MR, Mehta R. Obstetric brachial plexus injury. Indian J Plast Surg. 2011;44(3):380-389.
4. Somashekar D, Yang LJ, Ibrahim M, Parmar HA. High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography. AJNR Am J Neuroradiol. 2014;35(6):1209-1213
5. Vanderhave KL, Bovid K, Alpert H, et al. Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy. J Neurosurg Pediatr. 2012;9(3):283-289.
6. Narakas AO. Obstetrical brachial plexus injury. The paralyzed hand. 1987.
7. Kawabata H, Shibata T, Matsui Y, Yasui N. Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy. J Neurosurg. 2001;94(3):386-391
8. Kendall FP, McCreary EK, Provance PG, Rodgers M, Romani WA. Muscles, testing and function: with posture and pain. Baltimore, MD: Williams & Wilkins; 1993.
9. Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. The Journal of hand surgery. 2002 May 1;27(3):470-1.
10. Gilbert A, Raimondi P. Indications of Plexus Reconstruction in Obstetrical Paralysis. Journal of Peripheral Nerve Surgery (Volume 2, No. 1, July 2018).;2:9.
11. Borschel GH, Clarke HM. Obstetrical brachial plexus palsy. Plast Reconstr Surg. 2009;124(1 Suppl):144e-155e.
12. Waters PM. Obstetric brachial plexus injuries: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 1997 Jul 1;5(4):205-14.
13. Al-Qattan MM. The outcome of Erb’s palsy when the decision to operate is made at 4 months of age. Plast Reconstr Surg. 2000;106(7):1461-1465.
14. Lee HY, Chung IH, Sir WS, et al. Variations of the ventral rami of the brachial plexus. J Korean Med Sci. 1992;7(1):19-24.
15. Roger Cornwall, Peter M Waters. Pediatric Brachial Plexus Surgery. Text book of Green’s operative hand surgery,7th Edition, Elsevier,2017;1391-1424.
16. Emamhadi M, Chabok SY, Samini F, et al. Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study. Arch Bone Jt Surg. 2016;4(3):253-258.
17. Thatte MR, Agashe M, Rathod C, Lad P, Mehta R. An approach to the supraclavicular and infraclavicular aspects of the brachial plexus. Tech Hand Up Extrem Surg. 2011;15(3):188-197.
18. Thatte MR, A Hiremath, N Nayak. “Obstetric Brachial Plexus Palsy. Diagnosis and Management Strategy.” Journal of Peripheral Nerve Surgery (Volume 1, No. 1, July 2017) 2: 9.
19. Malessy MJ, Pondaag W. Nerve repair/reconstruction strategies for neonatal brachial plexus palsies. Practical Management of Pediatric and Adult Brachial Plexus Palsies E-Book. 2011 Aug 22;6:86.
20. Gilbert A, Tassin JL. Réparationchirurgicale du plexus brachial dans la paralysieobstétricale [Surgical repair of the brachial plexus in obstetric paralysis]. Chirurgie. 1984;110(1):70-75.
21. Pondaag W, Malessy MJ. The evidence for nerve repair in obstetric brachial plexus palsy revisited. Biomed Res Int. 2014;2014:434619.
22. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583-595.
23. Oberlin C, Béal D, Leechavengvongs S, et al. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994;19(2):232-237.
24. Thatte MR, Nayak NS, Hiremath AS. Management of Birth Brachial Plexus Injury Including Use of Distal Nerve Transfers. J Hand Surg Asian Pac Vol. 2020;25(3):267-275.
25. Ghanghurde BA, Mehta R, Ladkat KM, Raut BB, Thatte MR. Distal transfers as a primary treatment in obstetric brachial plexus palsy: a series of 20 cases. J Hand Surg Eur Vol. 2016;41(8):875-881.
26. Tse R, Kozin SH, Malessy MJ, Clarke HM. International Federation of Societies for Surgery of the Hand Committee report: the role of nerve transfers in the treatment of neonatal brachial plexus palsy. J Hand Surg Am. 2015;40(6):1246-1259.
27. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583-595.
28. Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent Horner’s syndrome in total obstetric brachial plexus injury. J Hand Surg Br. 2000;25(2):166-167.
29. Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu Y. Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children – a report of 12 cases. J Hand Surg Am. 2007;32(1):96-103.
30. Gilbert A. Results of repair to the obstetrical plexus. Brachial plexus injuries. London: Martin Duniz. 2001 Jun 21:211-5.

How to Cite this Article:  Lad PB, Naik N, Kadadi BK, Bhandari PS, Thatte MR | Primary Nerve Reconstruction in Brachial Plexus Birth Palsy: Current Concepts | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 37-44.

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Clinical Examination and Early Management of Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 28-36 | Gaurav Gupta, Tejas Patel, Chasanal Rathod, Amila Shashanka Ratnayake, Maulin M Shah, Bharat K. Kadadi

Authors: Gaurav Gupta MBBS, MS Ortho. [1], Tejas Patel PT, C/NDT, SI. [2], Chasanal Rathod MBBS, MS Ortho. [3], Amila S. Ratnayake MBBS, MS MRCS(Ed) [4], Maulin M. Shah MBBS, MS Ortho. [5], Bharat K. Kadadi MBBS, MS Ortho. [6]

[1] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi
[2] Consultant, Paediatric Physiotherapist, Sparsh Paediatric Rehabilitation Clinic, Ahmedabad, Gujrat, India.
[3] Consultant Pediatric Orthopedic Surgeon, NHSRCC Children’s Hospital, Mumbai, Maharashtra, India.
[4] Plastic & Reconstructive Surgeon, National Hospital Kandy, Sri Lanka
[5] Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
[6] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
E-mail: maulinmshah@gmail.com

Abstract

Brachial Plexus Birth Palsy (BPBP) is defined as a flaccid paralysis of the upper limb that occurs as a result of traction injury to the brachial plexus during the process of birth. The incidence of BPBP has been estimated between 0.4% to 5.1% in various studies worldwide.
A precise clinical examination is the key to ascertain the type of injury, prognosticate the outcome and forecast the probable need of surgical intervention. A detailed clinical examination methodology and important signs directing to the intervention are described in this paper. The importance of regular clinical follow up has been emphasised. Early rehabilitation of infants with BPBP and physiotherapy protocols are discussed.

Keywords:

References 

1. Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46(2):138-144.
2. Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008;90(6):1258-1264.
3. Buterbaugh KL, Shah AS. The natural history and management of brachial plexus birth palsy. Curr Rev Musculoskelet Med. 2016;9(4):418-426.
4. Foad SL, Mehlman CT, Foad MB, Lippert WC. Prognosis following neonatal brachial plexus palsy: an evidence-based review. J Child Orthop. 2009;3(6):459-463.
5. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am. 2010;35(2):322-331.
6. Lagerkvist AL, Johansson U, Johansson A, Bager B, Uvebrant P. Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol. 2010;52(6):529-534.
7. Abzug JM, Mehlman CT, Ying J. Assessment of Current Epidemiology and Risk Factors Surrounding Brachial Plexus Birth Palsy. J Hand Surg Am. 2019;44(6): 515.e1-515.e10.
8. Thatte MR, Mehta R. Obstetric brachial plexus injury. Indian J Plast Surg. 2011;44(3):380-389.
9. Toupchizadeh V, Abdavi Y, Barzegar M, Eftekharsadat B, Tabrizi I. Obstetrical brachial plexus palsy: electrodiagnostical study and functional outcome. Pak J Biol Sci. 2010;13(24):1166-1177.
10. DeFrancesco CJ, Shah DK, Rogers BH, Shah AS. The Epidemiology of Brachial Plexus Birth Palsy in the United States: Declining Incidence and Evolving Risk Factors. J Pediatr Orthop. 2019;39(2): e134-e140.
11. Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstet Gynecol. 2005;106(5 Pt 1):913-918.
12. al-Qattan MM, al-Kharfy TM. Obstetric brachial plexus injury in subsequent deliveries. Ann Plast Surg. 1996;37(5):545-548.
13. Coroneos CJ, Voineskos SH, Coroneos MK, et al. Obstetrical brachial plexus injury: burden in a publicly funded, universal healthcare system. J Neurosurg Pediatr. 2016;17(2):222-229.
14. Jennett RJ, Tarby TJ, Kreinick CJ. Brachial plexus palsy: an old problem revisited. Am J Obstet Gynecol. 1992;166(6 Pt 1):1673-1677.
15. Dunn DW, Engle WA. Brachial plexus palsy: intrauterine onset. Pediatr Neurol. 1985;1(6):367-369.
16. Gandhi RA, DeFrancesco CJ, Shah AS. The Association of Clavicle Fracture With Brachial Plexus Birth Palsy. J Hand Surg Am. 2019;44(6):467-472.
17. Li Y, Zhou Q, Liu Y, et al. Delayed treatment of septic arthritis in the neonate: A review of 52 cases. Medicine (Baltimore). 2016;95(51):e5682.
18. Karadavut KI, Uneri SO. Burnout, depression and anxiety levels in mothers of infants with brachial plexus injury and the effects of recovery on mothers’ mental health. Eur J Obstet Gynecol Reprod Biol. 2011;157(1):43-47.
19. Narakas AO (1987) Obstetric brachial plexus injuries. In: Lamb DW (ed) The paralysed hand. Churchill Livingstone, Edinburgh, pp 116–135
20. Al-Qattan MM, El-Sayed AA, Al-Zahrani AY, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009;34(6):788-791.
21. Gilbert A, Tassin J-L. Obstetrical palsy: a clinical, pathologic, and surgical review. In: Terzis JK, ed. Microreconstruction of nerve injuries. Philadelphia: Saunders, 1987: 529.
22. Gilbert A, Razaboni R, Amar-Khodja S. Indications and results of brachial plexus surgery in obstetrical palsy. Orthop Clin North Am. 1988;19(1):91-105.
23. Curtis C, Stephens D, Clarke HM, Andrews D. The active movement scale: an evaluative tool for infants with obstetrical brachial plexus palsy. J Hand Surg Am. 2002;27(3):470-478.
24. Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin. 1995;11(4):563-581.
25. Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews DF. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg. 1994;93(4):675-681.
26. Waters PM, Bae DS. Brachial Plexus Birth Palsy: Rationale for a Multicenter Prospective Study. Semin Plast Surg. 2004;18(4):377-384. doi:10.1055/s-2004-837263.
27. Bertelli JA, Ghizoni MF. The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy. J Hand Surg Br. 2004;29(2):155-158.
28. Bauer AS, Lucas JF, Heyrani N, Anderson RL, Kalish LA, James MA. Ultrasound Screening for Posterior Shoulder Dislocation in Infants with Persistent Brachial Plexus Birth Palsy. J Bone Joint Surg Am. 2017;99(9):778-783.
29. Whitman R. VIII. The Treatment of Congenital and Acquired Luxations at the Shoulder in Childhood. Ann Surg. 1905;42(1):110-115.
30. Moukoko D, Ezaki M, Wilkes D, Carter P. Posterior shoulder dislocation in infants with neonatal brachial plexus palsy. J Bone Joint Surg Am. 2004;86(4):787-793.
31. Ezaki M, Malungpaishrope K, Harrison RJ, et al. Onabotulinumtoxin A injection as an adjunct in the treatment of posterior shoulder subluxation in neonatal brachial plexus palsy. J Bone Joint Surg Am. 2010;92(12):2171-2177.
32. Pöyhiä TH, Lamminen AE, Peltonen JI, Kirjavainen MO, Willamo PJ, Nietosvaara Y. Brachial plexus birth injury: US screening for glenohumeral joint instability [published correction appears in Radiology. 2010 Apr;255(1):308]. Radiology. 2010;254(1):253-260.
33. Abzug JM, Kozin SH. Evaluation and management of brachial plexus birth palsy. Orthop Clin North Am. 2014;45(2):225-232.
34. Al-Qattan MM, El-Sayed AA. Obstetric brachial plexus palsy: the mallet grading system for shoulder function–revisited. Biomed Res Int. 2014; 2014:398121.
35. Russo SA, Kozin SH, Zlotolow DA, Nicholson KF, Richards JG. Motion Necessary to Achieve Mallet Internal Rotation Positions in Children with Brachial Plexus Birth Palsy. J Pediatr Orthop. 2019;39(1):14-21.
36. Kozin SH. Correlation between external rotation of the glenohumeral joint and deformity after brachial plexus birth palsy. J Pediatr Orthop. 2004;24(2):189-193.
37. Nath, R.K., Somasundaram, C., Melcher, S.E. et al. Arm rotated medially with supination – the ARMS variant: description of its surgical correction. BMC Musculoskelet Disord 10, 32 (2009).
38. Bae DS, Waters PM, Zurakowski D. Reliability of three classification systems measuring active motion in brachial plexus birth palsy. J Bone Joint Surg Am. 2003;85(9):1733-1738.
39. Eismann EA, Little KJ, Laor T, Cornwall R. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy. J Bone Joint Surg Am. 2015;97(2):112-118.
40. Shah Maulin M. Pectoralis Major trans positioning to improve shoulder abduction in Brachial Plexus Birth Palsy. Presented at Annual POSI meeting 2018.
41. Chuang DC, Ma HS, Wei FC. A new strategy of muscle transposition for treatment of shoulder deformity caused by obstetric brachial plexus palsy. Plast Reconstr Surg. 1998;101(3):686-694.
42. Frade F, Gómez-Salgado J, Jacobsohn L, Florindo-Silva F. Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. J Clin Med. 2019;8(7):980. Published 2019 Jul 5.
43. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis;6th Edition:52-54
44. Smania N, Berto G, La Marchina E, et al. Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med. 2012;48(3):483-506.

45. Kuchera ML. Clinical Application of Counterstrain. J Am Osteopath Assoc 2008;108(5):267–268.
46. Chaitow L. Positional release techniques. Churchill Livingstone Elsevier; 1996.
47. Singh J. Textbook of electrotherapy. Jaypee Brothers Publishers; 2012:75,83,84.
48. Low JL, Reed A. Electrotherapy explained: principles and practice. Elsevier Health Sciences; 2000;71-75.
49. Cameron MH. Physical agents in rehabilitation: from research to practice. Elsevier Health Sciences; 2012 Oct 12; 243,246.
50. Angela F, Nigel P. Clayton’s electrotherapy: Theory and practical (9th edn). AITBS Publishers: New Delhi, 2000;55-94.

How to Cite this Article: Gupta G, Patel T, Rathod C, Ratnayake AS, Shah MM | Clinical examination and Early Management of Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 28-36.

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Factors affecting the outcome of Chronic Osteomyelitis in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 16-21 | Gaurav Gupta, Maulin M. Shah, Akash S. Makadia, Qaisur Rabbi

Authors: Gaurav Gupta MS Ortho. [1], Maulin M. Shah MBBS, M.S.Orth., DNB Orth. [1],
Akash S. Makadia MS Ortho. [2], Qaisur Rabbi D-Ortho. [2]

[1] Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, Gujarat, India.
[2] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi, India.
[3] Clinical Fellow (Paediatric Orthopaedics), OrthoKids Clinic, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Maulin M Shah,
Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, India
E-mail: maulinmshah@gmail.com

Abstract

Background: Treatment of Chronic Osteomyelitis in children results in varied outcome ranging from uneventful bone healing to gap non-union. We evaluated the factors associated with adverse outcome after a uniform treatment executed at a single centre.
Methods: 40 patients (1.5 -14 years) with Chronic Osteomyelitis managed with debridement & splintage were included in this study. Detailed history, laboratory investigations, local x rays & MRI were available for all the patients. Average follow up was of 2.5 years. Patients who ended up having healing of the bone after primary treatment were defined as ‘Good Outcome’, patients who required additional procedures to improve function of limb or morphology of bone were defined as ‘Fair Outcome’ and patients who resulted in gap non-union were defined as ‘Poor Outcome’.
Results: Delay in surgical intervention beyond 6 weeks after beginning of symptoms, multiple local debridement without pan-medullary decompression & presence of concomitant soft tissue abscess on MRI were the statistically significant factors associated with poor outcome.
Conclusion: Aggressive & early surgical debridement is suggested for patients with failed conservative treatment to avoid long term complications. Current study will help in identifying the patients who are likely to have long-term sequelae of Chronic Osteomyelitis.
Keywords: Chronic Osteomyelitis, pan-osseous, non-union, debridement, outcome.

Level of Evidence: IV, retrospective analytical study.

References 

1. Patwardhan S, Shyam A K, Reconstruction of Bone Defects After Osteomyelitis with Nonvascularized Fibular Graft. A Retrospective Study in Twenty-six Children. J Bone Joint Surg Am.2013; 95: e56 (1-6).
2. Spiegel DA, Penny JN. Chronic Osteomyelitis in Children. Techniques in Orthopaedics, 2005; 20 (2) 142-152.
3. Jain AK, Sharma DK, Kumar S, Sethi A, Arora A, Tuli SM. Incorporation of diaphyseal sequestra in chronic haematogenous osteomyelitis. Int Orthop. 1995;19(4):238-41.
4. Cole WG. The management of chronic osteomyelitis. Clinical Orthopaedics & Related Research 1991(264): 84-9.
5. Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis. Journal of Bone & Joint Surgery American Volume 1989; 71(10): 1448-68.
6. Eckardt JJ, Wirganowicz PZ, Mar T. An aggressive surgical approach to the management of chronic osteomyelitis. Clinical Orthopaedics & Related Research 1994(298): 229-39.
7. Carlos Pineda, Rolando Espinosa Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy,
8. Gylys-Morin VM. MR imaging of paediatric musculoskeletal inflammatory and infectious disorders. Magn Reson Imaging Clin N Am. 1998; 6:537–539.
9. Mazur JM, Ross G, Cummings J, et al. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children. J Pediatr Orthop. 1995; 15:144–147.
10. Morrison WB, Schweitzer ME, Bock GW, et al. Diagnosis of osteomyelitis: utility of fat-suppressed contrast-enhanced MR imaging. Radiology. 1993; 189:251–257.
11. AH Simpson. The blood supply of periosteum. Journal of Anatomy 1985;140 (Pt4):697-704.
12. Belthur MV, Birchansky SB et. al. Pathologic Fractures in Children with Acute Staphylococcus aureus Osteomyelitis. Bone Joint Surg Am. 2012; 94:34-42.

How to Cite this Article: Gupta G, Shah MM, Makadia AS, Rabbi Q | Factors affecting the outcome of Chronic Osteomyelitis in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 16-21.

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Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria

Volume 7 | Issue 1 | January-April 2021 | Page: 10-15 | Anikwe I.A, Lasebikan O.A, Enweani U.N

Authors: I. A. Anikwe MBBS, FMC Ortho. [1], O. A. Lasebikan MBCHB, MPH, MBA, FWACS, FMC Ortho, FICS [2],
U. N. Enweani MBBS, FMCS, FMCOrtho, FWACS, FICS [3]

[1] Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
[2] Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
[3] Consultant Orthopedic Surgeon, City Hospital Enugu, Nigeria.

Address of Correspondence
Dr. Omolade. A. Lasebikan,
Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
Email: ladelash@yahoo.com

Abstract

Introduction: Congenital clubfoot is a developmental deformity of the foot. Management by the Ponseti method has been shown to be produce better results with fewer complications than traditional surgical methods. Some studies have shown that shorter intervals of serial manipulation/casting provide similar outcome to standard Ponseti technique. This study compared management outcome using an accelerated twice weekly technique, with standard weekly Ponseti casting.
Methodology: A prospective comparative study was conducted involving 62 patients with 90 clubfeet. From the study, 48 clubfeet in 34 patients were managed with standard Ponseti technique (weekly manipulation and casting), while 42 clubfeet in 28 patients were managed with accelerated Ponseti technique (twice weekly manipulation and casting). Pirani score was used for initial assessment and for follow-up.
Results: Children were 1 month to 36 months of age at the time of commencement of treatment. Majority of patients were male, (63%). The average number of casts did not differ significantly between the treatment groups (p = 0.13). The accelerated Ponseti technique patients were therefore able to complete their treatment within a significantly shorter period than those who went through the standard Ponseti protocol. The standard group had mean duration of correction of 29.65±11.69 days and 12.36±5.45 days for the accelerated group (p<0.001). The episodes of early relapses were 2.1% in the standard group and 2.4% in the accelerated group. The rates of complications were comparable between the groups.
Conclusion: Treatment of congenital clubfeet using the twice weekly casting appears to provide comparable outcomes to the weekly Ponseti casting with a significant reduction in the duration of the casting phase.
Keywords: Clubfoot; Pirani score; Ponseti technique; Accelerated.

References 

1. Morrissy RT, Weinstein SL. Clubfoot (Congenital Talipes Equinovarus) Lovell and Winter’s Paediatric Orthopaedics, 6th edition, Lippincott Williams and Wilkins, Philadelphia, 2006; 1262-1273.
2. Bridgens J, Kiely N. Current Management of Clubfoot (Congenital Talipes Equinovarus). British Medical Journal, 2010; 340: 308-311.
3. Dobbs MB, Gurnett CA. Update on Clubfoot: Etiology and Treatment. Clin Orthop Relat Res, 2009; 467(5) 1146-1153.
4. Solomon L, Warwick D. Congential Talipes Equinovarus (Idiopathic Clubfoot). Apley’s System of Orthopaedics and Fractures, 9th ed, Hodder Arnold, an Hachette UK company, London, 2010; 591-595.
5. Kampa R, Binks K, Dunkley M, Coates C. Multidisciplinary Management of Clubfeet Using the Ponseti method in a District General Hospital Setting. Journal of child Orthopaedics, 2008; 2:463-467.
6. Dobbs MB, Nunley R, Schoenecker PL. Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft Tissue Release. J Bone Joint Surg (Am), 2006; 88:986-996.
7. Siapkara A, Duncan R. Congenital Talipes Equinovarus: A review of Current Management. J Bone Joint Surg (Br), 2007; 89-B: 995-1000.
8. Dyer PJ, Davis N. The Role of the Pirani Scoring System in the Management of Clubfoot by the Ponseti Method. J Bone joint Surg (Br), 2006; 88-B: 1082-1084.
9. Herzenberg JE, Radler C, Bor N. Ponseti versus Traditional Methods of Casting for Idiopathic Clubfoot. J Pediatr Orthop, 2002; 22:517-521.
10. Ponseti IV. Common Errors in the Treatment of Congential Clubfoot. International orthopaedic (SICOT), 1997; 21:137-141.
11. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an Accelerated Ponseti Protocol for Cubfoot. J Pediatr Orthop, 2005;25:623-626.
12. Ponseti IV. Current concepts review: Treatment of Congenital Clubfoot. J Bone Surg, Inc, 1992; 74-A: 448-454.
13. Cosma D, Vasilescu D, Vasilescu D, Valeanu M. Comparative results of the conservation Treatment in Clubfoot by two different protocol. J Pediat. Orthop B, 2007; 16:317-321
14. Ukoha U, Egwu OA, Okafor IJ, Ogugua PC, Udemezue OO, Olisah R et al. Incidence of congenital talipes equinovarus among children in Southeast Nigeria. Int. J. Biol Med. Res. 2011; 2(3): 712-715.
15. Adewole OA, Williams OM, Kayode MO, Shoga MO, Giwa SO. Early Experience with Ponseti Clubfoot Management in Lagos, Nigeria. East Cent.Afri.J.surg. 2014; 19(2): 72-77.
16. Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles. An Accelerated Ponseti versus standard Ponseti method: A Prospective Randomized Controlled Trial. J Bone Joint Surg B. 2011; 93(3): 404-408.
17. Sharma P, Yadav V, Verma R, Gohiya A, Gaur S. Comparative Analysis of Results Between Conventional and Accelerated Ponseti Technique for Idiopathic Congenital Clubfoot. OrthopJMPC 2016;22(1):3-7.
18. Elgohary HAS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol. 2015.
19. Ibraheem GH, Adegbehingbe OO, Babalola OM, Agaja SB, Ahmed BA, Olawepo A et al. Evaluation of an Accelerated Ponseti protocol for the treatment of Talipesequinovarus in Nigeria. East Cent.Afr.J.surg. 2016;22(1): 28-38.
20. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J et al. Treatment of Idiopathic Clubfoot using Ponseti Method: Initial experience. J Bone Joint Surg Br. 2006;88-B: 1385-1387.
21. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: A preliminary report. J PediatrOrthop. 2011; 31: 317-319.

How to Cite this Article: Anikwe I.A, Lasebikan O.A, Enweani U.N | Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 10-15.

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Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 06-09 | Sanjay Kumar Meena, Ashok Tiwari, Dinesh Kumar Bairwa, Bharat Sharma

Authors: Sanjay Kumar Meena MS Orth. [1], Ashok Tiwari MS Orth. [1],
Dinesh Kumar Bairwa MS Orth. [1], Bharat Sharma  MS Orth. [2]

[1] Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
[2] Department of Orthopaedic, Government Medical College, Pali, Rajasthan.

Address of Correspondence
Dr. Sanjay Kumar Meena,
Senior Resident, Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
E-mail: drsanjayroop@gmail.com

Abstract

Introduction: Supracondylar fractures of the humerus are the most frequently occurring elbow fractures in children. They account for approximately 50-70% of all fractures around the elbow. The peak incidence is between 5 and 6 years of age. The incidence of supracondylar fractures amongst girls are on the rise.
Patients and Methods: 75 patients with a closed supracondylar humerus fracture were treated by closed reduction and percutaneous crossed Kirschner wire fixation (2 lateral and one medial entry) technique. All fractures were treated by general orthopaedic surgeons with no specialised training in paediatric orthopaedic surgery.
Results: Out of the 71 children available for follow-up, the outcomes were excellent in 55 patients, good in10, fair in 4, and poor in 2 patients.
Conclusions: We found closed reduction and percutaneous cross-pinning for the treatment of Type II and III supracondylar fractures of humerus in children (Modified Gartland Classification) to be an effective method of treatment. The outcomes obtained in our study suggest that childhood supracondylar humerus fractures can be managed successfully by general orthopaedic surgeons with comparable results to those achieved in tertiary centres dedicated to paediatric orthopaedic care.
Keywords: Children; Humerus; Supracondylar fracture.

References 

1. Pathania VP, Dubey N, Gupta S. Treatment of Displaced Supracondylar Fracture of Humerus in Children by Lateral Entry Pinning versus Cross Pinning. Int J Sci Stud 2016;4(1):70-74.
2. Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J PediatrOrthop B, 2001;10(1):63-67.
3. Cheng JC, Lam TP, Shen WY. Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 1995; 9(6):511-515.
4. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J PediatrOrthop 1998;18(1):38-42.
5. Higaki T, Ikuta Y. The new operation method of the dome osteotomy for four children with varus deformity of the elbow joint. J JpnOrthop 1982;31:300-335
6. Minkowitz B 1. Busch MT. Supracondylar fracture of humerus,current trends and controversies. Orthop Clin North Am1994;25:581-94
7. Pirone A, Graham HK, Krajbich JI (1988) Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 70:641–650 3.
8. Howard A, Mulpuri K, Abel MF et al (2012) The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 20:320–327 4.
9. Skaggs DL, Sankar WN, Albrektson J et al (2008) How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children? J Pediatr Orthop 28:139–141
10. Tellisi N, Abusetta G, Day M et al (2004) Management of Gartland’s type III supracondylar fractures of the humerus in children: the role audit and practice guidelines. Injury 35:1167– 1171
11. Khan MS, Sultan S, Ali MA, Khan A et al 2005) Comparison of percutaneous pinning with casting in supracondylar humeral fractures in children. 17(2):33-6.
12. Muhammad Salim, ZakaUllah Malik, Ejaz Ashraf Mallhiet al (2013)Outcome of Close Reduction and Percutaneous Pinning In Displaced Pediatric Supracondylar Fracture of Humerus Assessed By Flynn’s Criteria, Journal of Surgery Pakistan (International). 18(3) :121124
13. Khan-D, Khan-A, Amanullah -Aet al(2016) outcome of closed reduction and percutaneous pinning in supracondylar type 11 and type 111 fractures in children Gomal J Medi Sci . 14:67-70
14. Swenson AL et al(1948) The treatment of supracondylarfractures of the humerus by Kirshner wire transfixation. J Bone Joint Surg Am. 30A(4):993-7.
15. Webb AJ, Sherman FC et al (1989) Supracondylar fracturesof the humerus in children. J PediatrOrthop .9(3):315-25.
16. Boyd DW, Aronson DD et al(1992) Supracondylar fracturesof the humerus: a prospective study of percutaneouspinning. J PediatrOrthop . 12:789-94.
17. Mehserle WL, Meehan PL,et al (1991) Treatment of the displaced displaced supracondylar fracture of the humerus(type III) with closed reduction and percutaneous cross-pin fixation. J PediatrOrthop .11(6):705-11
18. Awal Hakeem, Naji Ullah Khan, Tamjeed Gul, Faheem Ullah et al( 2010 ) Closed reduction and percutaneous pinning with crossed k- wire in type 111 supracondylar fracture of humerus in children Pak J Surg . 26(1):10-12
19. Rajesh Govindasamy1*, Ramkumar Gnanasundaram2, Saravanan Kasirajan1,Fawas Thonikadavath1, Rajeev K. Tiwari et al(2016) Cross pinning versus lateral pinning in type III supracondylar fracture a retrospective analysisInternational Journal of Research in Orthopaedics .2(3):138-142
20. Vito Pavone*, Maria Riccioli, Gianluca Testa, Ludovico Lucenti, Claudia de Cristo, GiuseppeCondorelli, surgical treatment of displaced supracondylar pediatric humerus fractures:Comparison of two pinning technique,Journal of functional morphology and kinesiology. 1:39–47
21. Yadagiri Surender Rao, Manoj Chakravorthy, Yadagiri et al (2015) A study of percutaneous k wire fixation in supracondylar fracture of humerus in children J Med Allied Sci .5(1):6-9
22. Khurram barlas, TajeshbagAet al (2005) Medial approach for fixation of displaced supracondylar fractures of the humerus in children ,Acta Orthop. Belg.71:149-153.
23. Alfonso Vaquero-Picado, et al (2018) Management of supracondylar fractures of the humerus in children journal of Efort Open Rev .3(10):526-540
24. Dr. Praveen.S.K1, Dr.Venkatachalam.K, Dr. Mani Arumugam1, , Dr. Prakash Karrun, et a l(2016) A prospective study of the functional and cosmetic outcome of supracondylar fracture of humerus in children treated by percutaneous pinning and orif with kirschner wires scholars Academic Journal of Biosciences.4(10B):934-951.

How to Cite this Article: Meena SK, Tiwari A, Bairwa DK, Sharma B | Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 06-09.

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Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration

Volume 7 | Issue 1 | January-April 2021 | Page: 02-05 | Shobhit Gupta, Anil Agarwal, Mukesh Shanker

Authors: Shobhit Gupta MS Orth. [1], Anil Agarwal MS Orth. [1], Mukesh Shanker MS Orth. [1]

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

Address of Correspondence
Dr. Shobhit Gupta,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: drshobhitgupta@gmail.com

Abstract

Calf circumference is reduced in the leg affected by clubfoot. The effect of brace duration and whether calf circumference increases with age has not been studied in the Indian population. We conducted a cross sectional study on 156 children with idiopathic non-operated clubfeet treated by serial Ponseti casting method. The mean age was 32.7 months (range, 2-120 months). We found significant calf circumference difference in legs with clubfoot which increased with age. The duration of bracing did not significantly affect calf circumference.
Keywords: CTEV; Clubfeet; Calf circumference.

References 

1. Shimode K, Miyagi N, Majima T, Yasuda K, Minami A. Limb length and girth discrepancy of unilateral congenital clubfeet. J Pediatr Orthop B, 2005; 14: 280-4.
2. Maffulli N, Capasso G, Testa V, Borrelli L. Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot. Foot Ankle, 1992; 13: 80-4.
3. Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A. Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired? J Child Orthop, 2009; 3: 171-8.
4. Ippolito E, Dragoni M, Antonicoli M, Farsetti P, Simonetti G, Masala S. An MRI volumetric study for leg muscles in congenital clubfoot. J Child Orthop, 2012; 6: 433-8.
5. Duce SL, D’Alessandro M, Du Y, Jagpal B, Gilbert FJ, Crichton L, et al. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). PLoS One, 2013; 8: e54100.
6. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop, 1990; 10: 109-19.
7. Fulton Z, Briggs D, Silva S, Szalay EA. Calf circumference discrepancies in patients with unilateral clubfoot: Ponseti versus surgical release. J Pediatr Orthop, 2015; 35: 403-6.
8. Barker S, Downing M, Chesney D, Maffulli N. Assessment of calf volume in congenital talipes equinovarus by computer analysed digital photography. Surgeon, 2012; 10: 84-9.
9. Bohner Beke A, Leidecker E, Koch T, Sramo A, Kránicz J. Lower leg atrophy in congenital talipes equinovarus. Paediatria Croatica, 2014; 58: 176-83.
10. Gamble J, Batista E, Rinsky I. How small is the leg and foot in unilateral clubfoot. Orthopaedic Proceedings, 2012; 94-B: 34.
11. Bechtol CO, Mossman HW. Clubfoot; an embryological study of associated muscle abnormalities. J Bone Joint Surg Am, 1950; 32: 827-38.
12. Flinchum D. Pathological anatomy in talipes equinovarus. J Bone Joint Surg Am, 1953; 35: 111-4.
13. Gray K, Barnes E, Gibbons P, Little D, Burns J. Unilateral versus bilateral clubfoot: an analysis of severity and correlation. J Pediatr Orthop B, 2014; 23: 397-9.
14. Agarwal A, Agrawal N, Barik S, Gupta N. Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis. J Orthop Surg (Hong Kong), 2018; 26(2): 1 – 2.

How to Cite this Article: Gupta S, Agarwal A, Shanker M | Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 02-05.

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