Chronic Recurrent Multifocal Osteomyelitis – A Case Report

Volume 8 | Issue 3 | September-December 2022 | Page: 22-26| Ebin Rahman, Subin Sugath, Unnikrishnan R, Joe Thomas

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.146

Authors: Ebin Rahman [1] DNB Ortho, Subin Sugath [1] DNB Ortho, Unnikrishnan R [2] MD Radiology, Joe Thomas [3] MD Med. DNB Rheumatology

[1] Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Radiology, Aster Medcity, Kochi, Kerala, India.
[3] Department Of Rheumatology, Aster Medcity, Kochi, Kerala, India.

Address of Correspondence

Dr Ebin Rahman,
Senior Specialist, Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com

Abstract

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic auto-inflammatory bone disease of unknown aetiology that typically affects children and adolescents. It presents as recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures from lesions are sterile. It is unresponsive to antibiotic therapy. CRMO is a diagnosis of exclusion since no single clinical feature is pathognomonic. Radiological tests are often required and a bone biopsy may be needed in unclear cases.
Case Report: We report a case of an 8-year-old girl, with pain over both ankles and upper chest; history and radiological evaluation suggested osteomyelitis, but no adequate response to antibiotic treatment was observed. A bone biopsy was done to rule out malignancy. Whole body imaging revealed multiple bony lesions; based on which a diagnosis of chronic recurrent multifocal osteomyelitis was made. Patient was started on specific anti-inflammatory treatment with resolution of symptoms.
Conclusion: Chronic recurrent multifocal osteomyelitis should be suspected in a child with recurrent, multiple bone pain, modest increase of inflammatory indices, and lytic or sclerotic bone lesion on radiographs. Typical locations are the metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, but any bone can be involved. We want to increase the awareness of this entity and as a differential diagnosis of recurrent, multifocal bone pain in an adolescent, thereby avoiding unnecessary antibiotic administration and bone biopsies.
Keywords: Chronic recurrent multifocal osteomyelitis, Bone pain, Non-steroidal anti-inflammatory drugs

References

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How to Cite this Article: Rahman E, Sugath S, Unnikrishnan R, Thoma J | Chronic Recurrent Multifocal Osteomyelitis – A Case Report | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 22-26 | https://doi.org/10.13107/ijpo.2022.v08.i03.146

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Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis

Volume 8 | Issue 3 | September-December 2022 | Page: 16-21| Anil Agarwal

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.145

Authors: Anil Agarwal [1] MS Ortho.

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

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

Abstract

Background: The septic sequelae of knee following infantile infection is scantily described in literature. This case series depicts the various anatomical zones affected, the radiological presentation and proposes a vascular hypothesis for the sequelae.
Methods and results: Sequelae presented with three distinct radiological findings namely, unicondylar loss of lateral distal femur (n=4), hemicondylar loss of anterior portion of proximal tibia (n=3), and epiphyseal overgrowth and deficient tibial metaphysis of medial/ lateral side (n=4). The anatomical zones for above findings were seen approximately matching with the supply of specific genicular arteries around knee. On corroborating the early post infective radiographs and the sequelae radiographs, it was found that most patients had concomitant osteomyelitis, sometimes extensive.
Conclusions: We could recognize three distinct anatomical patterns of septic sequelae of knee following osteoarticular knee infection in infancy. An ischemic etiopathogenesis is suggested based on consistent radiological findings and the vascular supply zones. Most cases followed concomitant occurrence of septic arthritis and extensive osteomyelitis.
Keywords: Knee, Sepsis, Sequelae, Ischemia, Infants

References

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How to Cite this Article: Agarwal A | Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 16-21 | https://doi.org/10.13107/ijpo.2022.v08.i03.145

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Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria

Volume 8 | Issue 3 | September-December 2022 | Page: 06-10| Selema B. Bob-Manuel, Richard C. Echem, Somiari L. Harcourt

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.143

Authors: Selema B. Bob-Manuel FWACS (Ortho) [1], Richard C. Echem FWACS (Ortho) [1], Somiari L. Harcourt FMCS (Ortho) [1]

[1] Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.

Address of Correspondence

Dr. Bob-Manuel Selema Benibo
Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
E-mail: selema_md@yahoo.com

Abstract

Background: Scoring systems are being employed in the objective assessment of the severity of idiopathic clubfoot deformities . Popular among these scoring systems are the Diméglio and Pirani Scoring Systems. This study aims to find the correlation of idiopathic club foot scores (Pirani and Diméglio) with the number of castings by Ponseti method.
Methodology: It was a prospective study carried out over a 12-month period in a tertiary hospital. Children with idiopathic congenital talipes equinovarus under 3 years were included in the study. All data was analysed with the Statistical Package for Social Sciences (SPSS) version 20 for Windows. Pearson correlation coefficient was used to determine the correlation between clubfoot scores and number of castings done.
Results: The study comprised of 42 subjects with a total of 58 feet . Male and females were 45.2% (19) and 54.8% (23) respectively. Idiopathic clubfoot was unilateral in 61.9% of cases. The mean Pirani and Diméglio scores at presentation were 4.58± 1.42 and 14.28± 3.37 respectively. The mean number of casting sessions required to achieve correction was 4.00±1.19. There was a significant positive correlation between total number of castings with both Pirani scores (r=0.449, p<0.05) and Diméglio scores (r=0.619, p<0.05). Fifty percent (50%) of feet required percutaneous tenotomy in the final stages of correction.
Conclusion: Pirani and Diméglio scores have significant correlation with number of casts a patient will require for correction. Thus, either of these scores can be used and are useful tools in the monitoring of patients’ treatment with Ponseti method.
Keywords: Idiopathic Clubfoot, Ponseti, Pirani Score, Diméglio Score, Manipulation and casting.

References

1. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenital orthopaedic malformations in an African teaching hospital. West Afr J Med. 2005;24(2):92–5.
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3. Staheli L. Clubfoot: Ponseti Management. 3rd ed. Global Help; 2009. Available from: https://storage.googleapis.com/global-help-cdn/2020/07/5e0684b9-help_cfponseti.pdf
4. Ponseti I V. Congenital Clubfoot: Fundamentals of treatment. New York: Oxford University Press; 1996.
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7. Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop. 2014;34(6):639–42.
8. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082–4.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129–36.
10. Mejabi JO, Esan O, Adegbehingbe OO, Orimolade EA, Asuquo J, Badmus HD, Anipole AO. The Pirani scoring system is effective in assessing severity and monitoring treatment of clubfeet in children. Br J Med Med Res. 2016;17(4):1-9.
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12. Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J. 2010;30:7–14.
13. Sanghvi A V., Mittal VK. Conservative management of idiopathic clubfoot: Kite versus Ponseti method. J Orthop Surg (Hong Kong). 2009;17(1):67–71.
14. Boakye H, Nsiah A, Thomas A, Bello A. Treatment Outcome of Ponseti Method in the Management of Club Foot at Komfo Anokye Teaching Hospital, Ghana: A Retrospective Study. Arch Curr Res Int. 2016;3(2):1–8.
15. Morcuende JA, Dolan LA, Dietz FR, Ponseti I V. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376–80.
16. Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop. 2014;38(3):569–72.
17. Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160–4.
18. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg Br. 2006;88(3):377–9.
19. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24(4):349–52.
20. Lampasi M, Trisolino G, Abati CN, Bosco A, Marchesini Reggiani L, Racano C, et al. Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score. Int Orthop. 2016;40(10):2199–205.

How to Cite this Article: Bob-Manuel SB, Echem RC, Harcourt SL | Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 06-10. https://doi.org/10.13107/ijpo.2022.v08.i03.143

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Scapular Tuberculosis in the Paediatric Population: Suspicion and Early Treatment is the Key

Volume 8 | Issue 3 | September-December 2022 | Page: 11-15| Bushu Harna, Shivali Arya, Sukhmin Singh, Raj Kumar, Dhanajaya Sabat, Anil Arora

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.144

Authors: Bushu Harna [1] MS Ortho., Shivali Arya [2] MD Rad., Sukhmin Singh [3] MS Ortho., Raj Kumar [4] MS Ortho., Dhanajaya Sabat [5] MS Ortho., Anil Arora [6] MS Ortho

 

[1] Department of Orthopaedics, , Indus International Hospital, Panjab, India.
[2] Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
[3] Department of Orthopaedics, AIIMS Bilaspur, Himachal Pradesh, India.
[4] Department of Orthopaedics, AIIMS, New Delhi, India.
[5] Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.
[6] Department of Orthopaedics, Max Superspecialty Hospital, Parpatganj, New Delhi, India.

Address of Correspondence

Dr. Bushu Harna,
Consultant, Department of Orthopaedics, Indus International Hospital, Panjab, India.
E-mail: bushu.edu@gmail.com

Abstract

Background: Scapular tuberculosis (TB) in paediatric population is very rare and required clinician suspicion for early diagnosis and treatment.
Methods and Materials: We conducted a retrospective study involving 8 children with a diagnosis of TB of the scapula that was confirmed by histopathological examination. The patients were clinically assessed for signs and symptoms. Pediatric/adolescent shoulder survey (PASS) and numerical rating scale (NRS) scores were used to assess the improvement with treatment.
Results: The mean age of the patients was 10.5 years with a mean duration of symptoms around 4 months. All the patients had raised ESR and CRP values with MRI evidence of inflammation or cold abscess. In all the patients, either FNAC or biopsy was performed. Gene Xpert and histopathological examination confirmed the diagnosis of tuberculosis. All the patients were given (Anti-TB therapy) ATT according to their age/weight for a period of 12 months, as per the RNTCP guidelines. There was significant improvement in ESR, CRP, NRS, and PASS scores with MRI-evidence of disease resolution.
Conclusion: Scapular tuberculosis should be suspected in children presenting with vague shoulder or scapular pain. The patients should be investigated thoroughly and treated with anti-tubercular therapy.
Keywords: Flat bone tuberculosis, Scapular tuberculosis, Paediatric tuberculosis, Ant-tubercular therapy, Biopsy

References

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10. Teo HE, Peh WC. Skeletal tuberculosis in children. Pediatr Radiol 2004;34:853–60.

How to Cite this Article: Harna B, Arya S, Singh S, Kumar R, Sabat D, Arora A | Scapular Tuberculosis in the Paediatric Population: Suspicion and Early Treatment is the Key | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 11-15 | https://doi.org/10.13107/ijpo.2022.v08.i03.144

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A Review of Decision Making in Foot Problems in Cerebral Palsy

Volume 8 | Issue 3 | September-December 2022 | Page: 02-05| Rohan Parwani

DOI- https://doi.org/10.13107/ijpo.2022.v08i03.142

Authors: Rohan Parwani [1]

[1] Department of Orthopaedics, Shri M P Shah Medical College, Jamnagar, Gujarat, India.

Address of Correspondence

Dr. Rohan Parwani
Assistant Professor, Department of Orthopaedics, Shri M. P Shah Medical College, Jamnagar, Gujarat, India.
E-mail: arthorohan@gmail.com

Abstract

Ambulatory children with cerebral palsy suffer from a range of problems. There are issues with stance, stability, posture, and endurance. The foot plays a significant role in the pathogenesis and treatment of these problems, especially in the lower limb. Our review article tries to highlight the foot problems and their solutions. The most common deformity in a child with cerebral palsy is the hindfoot equinus. This fixed deformity leads to poor balance in stance and reduced power generated during the push-off phase. Proper identification of the gait pattern and the role of the foot in deranging the gait can help decide ways to enhance the walk of a cerebral palsy child. Physiotherapy and stretching are vital to improving muscle physiology and growth. The weak muscles need to be supplemented with splints. There is also a significant role in the judicious use of surgery in cerebral palsy. Deciding which surgery to employ is critical and often contributes to the success or a disastrous failure. Our article highlights various facets of decision-making and ways to arrive at a proper decision.
Keywords- Cerebral palsy, Foot, Equinus, Gait

References

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How to Cite this Article: Parwani R | A Review of Decision Making in Foot Problems in Cerebral Palsy | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 02-05.
https://doi.org/10.13107/ijpo.2022.v08.i03.142

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