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Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 12-15 | Samuel K. Van de Velde, Jack Pang, Lachlan Milne, Jitendra Balakumar Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1]. [1] Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Parkville (VIC) 3052, Australia Address of Correspondence […]

Reliability of Beighton’s Score in a Pediatric Population

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 9-11 | Nimesh G Patel, Peter Riddlestone, Roshan Gunalan, Anthony Gough, James Metcalfe, Ben Holroyd Authors : Nimesh G Patel [1], Peter Riddlestone [1], Roshan Gunalan [1], Anthony Gough [1], James Metcalfe [1], Ben Holroyd [1]. [1] Department of Paediatric Orthopaedics Derriford Hospital, Plymouth, UK Address […]

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Reliability of Beighton’s Score in a Pediatric Population

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Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 12-15 | Samuel K. Van de Velde, Jack Pang, Lachlan Milne, Jitendra Balakumar

Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1].

[1] Department of Orthopaedics, The Royal Children’s Hospital Melbourne, Parkville (VIC) 3052, Australia

Address of Correspondence
Dr. Samuel K. Van de Velde,
Department of Orthopaedics, The Royal Children’s Hospital Melbourne
50 Flemington Road, Parkville (VIC) 3052, Australia
Email : svandevelde@post.harvard.edu

Abstract

Purpose: Femoral neck fractures in children are rare injuries which are associated with a high incidence of osteonecrosis of the femoral head. We aimed to determine the predictive accuracy of bone scintigraphy for femoral head osteonecrosis after pediatric femoral neck fractures.
Materials and Methods: Thirteen scintigrams were performed in 10 children (6–15 years) at diverse moments after fixation of a femoral neck fracture.The results of the bone scintigrams were compared with the hip radiographs at final follow-up.
Results: Eight of the 10 femoral heads eventually developed osteonecrosis. Scintigrams performed within 2 weeks showed decreased uptake for these heads. However,four of the five scans that were performed more than 1 month after surgery showed normal uptake despite the subsequent collapse of these femoral heads.
Conclusions: Bone scintigraphy has a very low accuracy in predicting compromised vascularity of the femoral head when performed more than 1month after surgery of a femoral neck fracture in children. This findingquestions the value of scintigraphy performed late in the follow-up of pediatric femoral neck fractures.
Level of Evidence: Level IV.
Keywords: Pediatric Hip Fracture; Bone Scan; Outcome

References

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How to Cite this Article: Van de Velde SK, Pang J, Milne L, Balakumar J.Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):12-15.

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Reliability of Beighton’s Score in a Pediatric Population

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 9-11 | Nimesh G Patel, Peter Riddlestone, Roshan Gunalan, Anthony Gough, James Metcalfe, Ben Holroyd

Authors : Nimesh G Patel [1], Peter Riddlestone [1], Roshan Gunalan [1], Anthony Gough [1], James Metcalfe [1], Ben Holroyd [1].

[1] Department of Paediatric Orthopaedics Derriford Hospital, Plymouth, UK

Address of Correspondence
Dr. Nimesh Patel,
Department of Paediatric Orthopaedics Derriford Hospital Plymouth, UK
E-mial: dr.nimeshpatel1@gmail.com

Abstract

Introduction: Beighton’s score (BS) is a valid screening tool in an adult population, but its use in pediatrics to assess generalized joint mobility is not fully validated. The correlation of hypermobility and joint pain in children is also not fully understood. We, therefore, aim to investigate the reliability of BS in the pediatric population.
Materials and Methods: Over a 3-month period, children presenting to our pediatric orthopedic unit had their BS measured by a trained orthopedic surgeon. Non-ambulatory children were excluded, as were those with known hypermobility syndrome or neuromuscular disorders.We also screened them for joint pain and measured their lower limb rotational profile.
Results: A total of 200 patients (92 males and 108 females) were assessed, aged between 3 and 15 years (mean 10.1). Mean standard deviation (SD) BS was 2.06 (2.2), and the range was 0–8. Comparing males versus females, mean BS SD was 1.71 (2.25) versus 2.36 (2.14); p=0.0378, age was 9.75 versus 10.13, and BS range was 0–7 versus 0–8.64 children (32%) complained of pain in at least one joint, though the mean SD BS in these patients was 1.71 (1.86).
Discussion: We found that the average BS was just over 2 in all of our children, though significantly lower in males.In adults, a score of 4 or higher has been attributed to generalized hypermobility, though a true diagnostic cutoff has not been defined in children.Since there is already an innate tendency to have an increased BS in normal children, it makes interpretation of the score in a pediatric population difficult and less meaningful.Of note, there was no correlation between arthralgia and a high BS or abnormal lower limb rotational profile. We therefore do not recommend routine measurement of BS to diagnose hypermobility in a pediatric population.
Keywords: Beighton’s score, hypermobility, joint laxity, pediatric population

References

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8. Junge T, Jespersen E,Wedderkopp N,Juul-KristensenB.Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children.BMC Pediatr2013;13:214.
9. van Trijffel E, van de Pol RJ,Oostendorp RA, LucasC.Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: A systematic review.JPhysiother2010;56:223-35.
10. Carter C, wilkinson J.Persistent joint laxity and congenital dislocation of the hip.J Bone Joint Surg Br1964;46:40-5.
11. Wynne-Davies R. Acetabular dysplasia and familial joint laxity: Two etiological factors in congenital dislocation of the hip. A review of 589 patients and their families. J Bone Joint Surg Br 1970;52:704-16.
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How to Cite this Article: Patel N G, Riddlestone P, Gunalan R, Gough A, Metcalfe J, Holroyd B.Reliability of Beighton’s Score in a Pediatric Population. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):9-11.

Half Sized Blog Element (Single Author Style)

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Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Reliability of Beighton’s Score in a Pediatric Population

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Reliability of Beighton’s Score in a Pediatric Population

Full Sized Blog Element (Big Preview Pic)

Limited Use for Bone Scintigraphy in the Follow-Up of Pediatric Femoral Neck Fractures

Authors : Samuel K. Van de Velde [1], Jack Pang [1], Lachlan Milne [1], Jitendra Balakumar [1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

Reliability of Beighton’s Score in a Pediatric Population

Authors : Nimesh G Patel [1], Peter Riddlestone [1], Roshan Gunalan [1], Anthony Gough [1], James Metcalfe [1], Ben Holroyd [1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

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