Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management

Volume 8 | Issue 2 | May-August 2022 | Page: 06-10 | Sandeep Patwardhan, Arkesh Madegowda, Sujith Omkaram, Pavan Patil, Ashok Shyam, Parag Sancheti

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.137

Authors: Sandeep Patwardhan MS Ortho [1], Arkesh Madegowda MS Ortho [1], Sujith Omkaram MS Ortho [1], Pavan Patil MS Ortho [1], Ashok Shyam MS Ortho [1], Parag Sancheti MS Ortho [1]

[1] Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr. Arkesh Madegowda,
Clinical Fellow, Department of Paediatric Orthopaedics Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: dr.arkesh@gmail.com

Abstract

Objectives: To report the incidence of overcorrection as complication following eight-plate application for genu varum/valgum deformities and its management.
Methods: This was a retrospective review of children who underwent growth modulation for genu varum/valgum between 2012-2019. Data of patients who had presented with overcorrection of their primary deformity, the reasons for such complication and its management were collected and analysed.
Results: 110 children had undergone growth modulation during the study period. 75 children (68%) had achieved deformity correction in mean time of 14.4 months and had their implant removed on time when intercondylar (ICD)/intermalleolar (IMD) distance was ≤ 5 centimeters (cms) and/or Hip Knee Ankle (HKA) angle was < ±6⁰. 29 children (26%) were lost to follow up. 6 children (5.4%) had presented with overcorrection of moderate to severe grade with mean ICD/IMD of 13.3 cms (range 11-18) and mean HKA angle of 14.3⁰ (range 11-21⁰). Mean age of initial surgery was 6.1 years (range 5-8). Mean time gap of presentation with overcorrection was 33.6 months (range 24-45). Lack of awareness, long distance of hospital, medical expenses were some of the notable reasons for irregular follow-up. All 6 had an open physes with growth remaining when they presented with overcorrection. These children managed with repeat growth modulation. Final correction was achieved at mean time of 15.3 months and underwent implant removal. At the latest follow up of 4.4 years, limb alignment within physiologic limits was maintained.
Conclusion: Children undergoing growth modulation should be carefully monitored with regular follow-up to avoid complication of overcorrection. Overcorrection beyond physiologic limits can be managed with repeat growth modulation in younger children with open physes.
Keywords: Growth modulation, Genu valgum, Genu varum, Irregular follow up, Complication, Overcorrection.

References

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How to Cite this Article:  Patwardhan S, Madegowda A, Omkaram S, Patil P, Shyam A, Sancheti P | Overcorrection as Complication of Growth Modulation with Eight-Plate for Coronal Plane Deformities of Knee and its Management | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 06-10.
https://doi.org/10.13107/ijpo.2022.v08i02.137

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Modified Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder

Volume 8 | Issue 2 | May-August 2022 | Page: 02-05 | Tushar Nayak, Amrut Raje, Ashish Ragase, Love Kapoor , Venkatesan Sampath Kumar, Shah Alam Khan

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.136

Authors: Tushar Nayak MS Ortho [1], Amrut Raje MS Ortho [2], Ashish Ragase MS Ortho [2], Love Kapoor MS Ortho [3], Venkatesan Sampath Kumar MS Ortho [1], Shah Alam Khan MS Ortho [1]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
[2][ Department of Musculoskeletal Oncology, All India Institute of Medical Sciences, New Delhi, India.
[3] Department of Orthopaedics, N.C.I.; A.I.I.M.S, Jhajjar, Haryana, India.

Address of Correspondence
Dr. Tushar Nayak,
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
E-mail: orthodrtushar@gmail.com

Abstract

Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases.
Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity.
Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity.
Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years.
Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.

References

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16. Robinson RA. The surgical importance of the clevicular component of Sprengel’s deformity. J Bone Joint Surg, A. 1967;49:1481.

How to Cite this Article:  Nayak T, Raje A, Ragase A, Kapoor L, Kumar VS, Khan SA | Modified  Woodward’s Procedure in the Management of Neglected Sprengel’s Shoulder | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 02-05.  https://doi.org/10.13107/ijpo.2022.v08i02.136

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Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note

Volume 8 | Issue 2 | May-August 2022 | Page: 16-19 | R M Chandak, Mohit Sharma, Amit Nemade

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.140

Authors: R M Chandak [1], Mohit Sharma [1], Amit Nemade [2]

[1] Department of Orthopedics & Trauma, Chandak Nursing Home, Nagpur, Maharashtra, India.
[2] Department of Orthopedics, Kids Orth Clinic, Nagpur, Maharashtra, India.

Address of Correspondence
Dr. Amit Nemade,
Consultant Pediatric Orthopedic Surgeon, Kids Orth Clinic, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com

Abstract

Introduction: Anterior tibial spine avulsion (ATSA) fractures are uncommon intra-articular knee injuries in children. They are common in adolescents. Treatment for displaced ATSA fracture is fixation. Various methods of fixation are documented, most common being arthroscopic assisted fixation using various sutures or anchors. Antegrade screw fixation is also an accepted method of treatment but is associated with implant back out and impingement. We describe our technique of retrograde extraphyseal percutaneous fixation for type II and III ATSA fractures.
Method: Under image intensifier (IITV) guidance, fracture reduction was achieved and fixed with a specially designed, short-threaded, 4mm cannulated screw. The screw was inserted in retrograde fashion proximal to the proximal tibial physis. The patient was immobilized in a cylinder cast and was allowed weight bearing as tolerated. Cast was removed at 6 weeks and range of movement exercises started.
Result: Our technique of percutaneous retrograde extraphyseal screw fixation for ATSA fracture is simple. The learning curve is less and can be used in selected case. In resource-limited situations where facilities for arthroscopy are not readily available, our technique can provide good results
Keywords: Anterior tibial spine avulsion, Percutaneous fixation, Retrograde, extraphyseal.

References

[1] Adams AJ, Talathi NS, Gandhi JS, Patel NM, Ganley TJ. Tibial Spine Fractures in Children: Evaluation, Management, and Future Directions. J Knee Surg. 2018;31(5):374–81.
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[3] Hallam PJB, Fazal MA, Ashwood N, Ware HE, Glasgow MMS, Powell JM. An alternative to fixation of displaced fractures of the anterior intercondylar eminence in children. J Bone Jt Surg – Ser B. 2002;84(4):579–82.
[4] Furlan D, Pogorelić Z, Biočić M, Jurić I, Meštrović J. Pediatric tibial eminence fractures: Arthroscopic treatment using K-wire. Scand J Surg. 2010;99(1):38–44.
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[7] Louis M-L, Guillaume J-M, Toth C, Launay F, Jouve J-L, Bollini G. Fracture de l’éminence intercondylienne du tibia de type II chez l’enfant. Rev Chir Orthop Reparatrice Appar Mot. 2007;93(1):56–62.
[8] Mann MA, Desy NM, Martineau PA. A new procedure for tibial spine avulsion fracture fixation. 2012;2395–8.
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[11] Ando T, Nishihara K. Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia. Arthroscopy. 1996;12(5):616–22.
[12] Xu X, Liu Z, Wen H, Pan X. Arthroscopic fixation of pediatric tibial eminence fractures using suture anchors: a mid-term follow-up. Arch Orthop Trauma Surg. 2017;137(10):1409–16.
[13] Xu P, Liu LC, Chen QJ, Yang P, Chen X Bin, Xie XP. The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials. Med (United States). 2020;99(23).
[14] Watts CD, Larson AN, Milbrandt TA. Open versus arthroscopic reduction for Tibial eminence fracture fixation in children. J Pediatr Orthop. 2016;36(5):437–9.
[15] Shin CH, Lee DJ, Choi IH, Cho TJ, Yoo WJ. Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents. BMC Musculoskelet Disord. 2018;19(1):1–9.

How to Cite this Article:  Chandak RM, Sharma M, Nemade A |  Percutaneous Retrograde Extraphyseal screw fixation for Type II and III Anterior Tibial Spine Avulsion Fractures: A Technical Note | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 16-19. https://doi.org/10.13107/ijpo.2022.v08i02.140

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Editorial

Volume 8 | Issue 1 | January-April  2022 | Page: 01 | Jayant  S. Sampat
DOI-10.13107/ijpo.2022.v08i01.126

Authors: Jayant S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Dear Friends,
The first issue of IJPO in 2022 features a symposium on current concepts in musculoskeletal infections in children. Our associate editors, Dr Mohan V Belthur and Dr Ashish Ranade were instrumental in producing the symposium, from topic selection to coordinating with individual authors. A wide-ranging array of subjects feature in the symposium including tropical pyomyositis, diagnostic tools in infection, management guidelines for septic arthritis and the role of non-vascularised fibular grafting for post-infection bony defects.
The original article in this issue highlights improvements in the treatment outcomes of lateral condyle fracture of the humerus in children by a simple modification of existing techniques. In addition, there are 3 case reports which will be of interest to readers.
As life returns to normal following the pandemic, orthopaedic surgeons have less spare time to devote to academic pursuits. We appeal to POSI members to maintain the momentum that was created in 2020 by submitting their articles to IJPO on a regular basis. We will provide the necessary editorial assistance so that your ideas and research work can be shared with the global community of orthopaedic surgeons. This will be particularly useful to trainees and first-time authors.
The Editorial Board would like to thank the team of reviewers without whom this journal would not be possible.

Dr Jayanth S Sampath FRCSEd (Tr&Orth)
Editor

editor.ijpo@gmail.com

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2022; 8(1): 01.

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Surgical and Medical Management of Deformity and Non-union with Implant Failure of Femur in OI Type III

Volume 8 | Issue 1 | January-April 2022 | Page: 35-42 | Sanjay Chhawra, Raman Jain, Unus Ahmed, Nimish Agarwal, Rajiv Chaubey, Gaganpreet Singh
DOI-10.13107/ijpo.2022.v08i01.132

Authors: Sanjay Chhawra D Ortho., DNB Ortho. FICS, Raman Jain MS Ortho., Unus Ahmed MS Ortho., Nimish Agarwal MS Ortho., Rajiv Chaubey MS Ortho., Gaganpreet Singh MS Ortho.

[1] Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.

Address of Correspondence
Dr. Sanjay Chhawra
Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
E-mail: sanjaychhawra@yahoo.com

Abstract

Purpose: Osteogenesis imperfecta (OI) is characterized by increased bone fragility and susceptibility for fracture because of the mutation of genes. A few studies are there for treatment modalities of non-union femur fractures in children with OI. This study on adult OI patients aims to give insight into non-unions and their best treatment reporting the surgical modification by using a humeral nail for femoral fixation options to avert non-union. Best implant in the adolescent OI patients for the surgical reconstruction of the femur for correction of deformity healing non-union.
Methods: This is a retrospective, descriptive study of the OI type III fracture non-union and its treatment modality.
Conclusions: In Adolescent OI patients with the rare percentage of non-union with deformity with implant failure of the femur was fixed with Humerus nail having stable fixation deformity correction by both osteotomy rotational translational and conversion of non-union to union with a better result.
Keywords: Osteogenesis imperfecta (OI), TENS Tensile Elastic Nail System, Adolescent, Humeral nail, Femoral bowing deformity

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How to Cite this Article:  Chhawra S, Jain R, Ahmed U, Agarwal N, Chaubey R, Singh G | Surgical and Medical Management of Deformity and Non-union with Implant failure of Femur in OI Type III | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 35-42.

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A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage

Volume 8 | Issue 1 | January-April 2022 | Page: 47-50 | Alina Frolova, Joana Freitas, Rui Martins, Jorge Coutinho

DOI-10.13107/ijpo.2022.v08i01.134

Authors: Alina Frolova MD [1], Joana Freitas MD [1], Rui Martins MD [1], Jorge Coutinho MD [1]

[1] Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.

Address of Correspondence

Dr. Alina Frolova,
Department of Pediatric Orthopedics, The University Hospital Centre São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.
E-mail: alina.frolova.238@gmail.com

Abstract

Pyomyositis is an uncommon clinical entity affecting predominantly pediatric population. It presents with diffuse muscle involvement, mostly in the lower limb, with occasional abscess formation and need of drainage, coupled to an appropriate antibiotic therapy.
In this article we present a case of a previously healthy 11-year old boy with an acute onset of hip pain and fever, as well as elevation in blood leukocyte count and C-reactive protein. Magnetic resonance imaging showed a gadolinium-enhanced oedema of internal obturator, external obturator, adductors and quadratus femoris, with an intra-muscular abscess of external obturator. After two attempted percutaneous drainages the patient progressed to sepsis, with the need of open surgical drainage through transgluteal approach. Concomitantly, a deep venous thrombosis was also diagnosed.
After the appropriate drainage and a prolonged antibiotic regimen, patient’s condition improved, with full recovery and no sequelae.
Keywords: Pyomyositis, External obturator, Muscle abscess, Transgluteal approach

References

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How to Cite this Article:  Frolova A, Freitas J, Martins R, Coutinho J | A Case of Pyomyositis in a Healthy 11-Year Old Boy with Need of Surgical Drainage | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 47-50.

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