One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report

Volume 8 | Issue 1 | January-April 2022 | Page: 43-46 | Harsharan Singh Oberoi, Baldish Singh Oberoi

DOI-10.13107/ijpo.2022.v08i01.133

Authors: Harsharan Singh Oberoi MS, DNB Ortho [1], Baldish Singh Oberoi MS Ortho, MPH [1]

[1] Department of Orthopaedics, Oberoi Hospital, Jalandhar City, Punjab, India.

Address of Correspondence

Dr. Baldish Singh Oberoi
Orthopaedic Surgeon, Oberoi Hospital, Jalandhar City, Punjab, India.
Email: baldishoberoi@gmail.com

Abstract

Streeter’s dysplasia is a rare condition that occurs in 1 in 1200 to 1 in 15000 live births. Timely intervention is the key in saving the limb in vascular compromised cases. A 7 days old neonate presented with Streeter’s Dysplasia with a grossly swollen, deformed and cyanosed foot. The deformity was a clubfoot deformity. There was a circumferential amniotic constriction band in the lower third left leg, causing a vascular compromise leading to bluish discoloration and gross swelling of the foot and toes. There was another semicircular band in the mid-foot region. One stage urgent circumferential band excision and multiple Z plasties for skin cover were done. The foot and the toes turned pink immediately. The swollen foot was treated by debulking of the foot and the clubfoot deformity by the Ponseti method.
Keywords: Streeter’s dysplasia, Vascular compromise, Constriction ring, One stage release, Clubfoot, Debulking

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How to Cite this Article:  Oberoi HS, Oberoi BS| One-Stage Emergency Surgical Release of Amniotic Constriction Band in Streeter’s Dysplasia with Clubfoot- A Case Report | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 43-46.

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Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires

Volume 8 | Issue 1 | January-April 2022 | Page: 31-34 | Deepak Jain, Tushar Agrawal, Saijyot Raut, Parimal Malviya

DOI-10.13107/ijpo.2022.v08i01.131

Authors: Deepak Jain MS Ortho [1], Tushar Agrawal MS Ortho [2, 3], Saijyot Raut MS Ortho [2],
Parimal Malviya MS Ortho. [2]

[1] Department of Orthopaedics & Spine Surgery Ganga Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Orthopaedics, MGM Hospital, Navi Mumbai, Maharashtra, India.
[3] Aastha Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Deepak Jain,
Paediatric Orthopaedic Fellow, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: deepaksjain1993@gmail.com

Abstract

Background- Management of paediatric humeral lateral condyle fractures by 2 Kirschner wire or screw fixation in parallel or divergent manner remains the treatment of choice and has long remained unchallenged. In this study, we are recommending using a third K wire for fracture fixation technique for the age group less than 10 years which provides a more stable fixation enhances stability and ensures better outcomes without any significant disadvantages.
Materials & Methods- We Present a Cohort of 20 pediatric lateral condyle fractures of Song et al stage 3 and above. Of the 20 patients treated, 12 were male and 8 females. All fractures were fixed using 3 lateral Kirschner wires of size 1.2 or 1.5mm. Out of the 20 fractures, 12 were opened and 8 were fixed percutaneously.
Results- All Patients showed union at 6 weeks. K-wires were removed at 6 weeks. Good radiological and clinical outcomes were noted on the periodical check-up. Hardacre score was used to calculate clinical outcome. None of the patients had any loss of reduction, non-union, or implant-related failure except for pin tract infections in a few patients.
Conclusion- We recommend adding a third wire to the construct for three k wires fixation for lateral condyle humerus fractures in all patients less than 10 years which is useful tool, cost-effective, enhances stability and ensures good outcomes without any significant disadvantages. We found all benefits of the cannulated screws by inserting the third wire and the fracture was found to be biomechanically more stable, none showed loss of reduction, had early union, early mobilization, minimal chances of nonunion, full ROM, no infection with the added advantage of no re-surgery for implant removal
Keywords- Pediatric fractures, Elbow fractures, Lateral condyle fractures, K-wires

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25. Ya¬ Fei Qin, MD, Zhi¬ Jun Li, MD, Cheng¬ Kai Li, MD, Shu ¬Cai Bai, MD, Hui Li, MD Unburied versus buried wires for fixation of pediatric lateral condyle distal humeral fractures A meta-analysis Qin et al. Medicine (2017) 96:34.

26. Avijeet Prasad, Puneet Mishra, Aditya N Aggarwal, Manish Chadha, Rohit Pandey, Rahul Anshuman Exposed versus Buried Kirschner Wires Used in Displaced Pediatric Fractures of Lateral Condyle of Humerus. Indian Journal of Orthopaedics | Volume 52| Issue 5 | September¬-October 2018

How to Cite this Article:  Jain D, Agrawal T, Raut SJ, Malviya P | Fixation of Displaced Paediatric Humeral Lateral Condyle Fractures with 3 K-Wires | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 31-34.

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Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children

Volume 8 | Issue 1 | January-April 2022 | Page: 24-30 | Anil Agarwal, Ankur, Ankit Jain

DOI-10.13107/ijpo.2022.v08i01.130

Authors: Anil Agarwal MS Ortho. [1], Ankur MS Ortho. [1], Ankit Jain D Ortho. [1]

[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

Osteomyelitis continues to be widely prevalent in low socioeconomic countries. The challenges associated with the disease include weakened pathological bone, cavities, pathological fractures, non-union and gaps. This article discusses the uses of non-vascularized fibular graft for the management of the sequelae of osteomyelitis. A review of literature reveals this technique to be quite successful with fewer complications. Being technically less demanding and easy, this procedure remains an important tool in the management of bone defects due to osteomyelitis in children.
Keywords: Osteoarticular infection, Reconstruction, Bone graft

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How to Cite this Article:  Agarwal A, Ankur, Jain A | Role of Non Vascularized Fibula Graft in the Management of Post Osteomyelitic Bone Defects in Children | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 24-30.

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Diagnosis of Pediatric Musculoskeletal Infections: Current Concepts Review

Volume 8 | Issue 1 | January-April 2022 | Page: 14-23 | Neeraj Vij, Jessica Burns, Melissa Esparza, Alexandra Dominianni, Yerin Cho, Mohan V Belthur

DOI-10.13107/ijpo.2022.v08i01.129

Authors: Neeraj Vij BS [1], Jessica Burns MD [2], Melissa Esparza MD [2], Alexandra Dominianni BA [1], Yerin Cho BS [1], Mohan V Belthur MD [1, 2]

[1] Department of Child Health & Orthopaedics, University of Arizona, College of Medicine, Phoenix, Arizona, USA.
[2] Department of Orthopedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.

Address of Correspondence
Dr. Mohan V. Belthur,
Department of Child Health & Orthopaedics, University of Arizona, College of Medicine, Phoenix, Arizona, USA. Department of Orthopedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.
E-mail: mbelthur@phoenixchildrens.com

Abstract

Introduction: Pediatric musculoskeletal infections are common and constitute one of the top five conditions contributing to the burden of musculoskeletal disease in childhood. With early accurate diagnosis and appropriate treatment, the clinical course, and outcomes of musculoskeletal infections can be favorable. However, poor outcomes (morbidity/mortality), a wide spectrum of post-infective sequela and significant functional impairment can occur, especially in the setting of delayed diagnosis and inadequate treatment. The purpose of this narrative review is to provide an overview of the standard diagnostic modalities with an emphasis on the recent literature and to summarize the current state of knowledge on the newer diagnostic modalities of the 21rst century.
Materials and Methods: A literature search was performed using the following keywords: “diagnosis”, OR “diagnostic modalities”, OR “diagnostic capability” AND “children” OR “pediatric” AND “musculoskeletal” OR “bony” OR “orthopedic” OR “muscular” AND “infection” OR “bacterial” OR “viral” OR “fungal”. Databases searched included PubMed, EMBASE, Cochrane Library, and SCOPUS. This returned a total of 315 articles. English language articles published between January 1990 and March 2022 regarding traditional or newer diagnostic modalities and pediatric musculoskeletal infection were included in this review.
Results: A total of 62 articles met the inclusion criteria. Our knowledge base regarding the traditional diagnostic modalities has evolved to include several scoring systems with good sensitivities and specificities. Cellular acute phase reactants show promise in the recent literature. There is good literature regarding the evolution of imaging techniques to improve diagnosis. Novel diagnostic modalities in the recent literature include plasma-based acute phase reactants, polymerase chain reaction, and next-generation sequencing.
Conclusion: Continuing to improve our diagnostic accuracy of Pediatric MSKIs can help decrease the worldwide burden of these conditions. As the use of adjunctive biomarkers becomes more common, diagnoses and pathogen identification could be made timelier and antibiotic choices could be individualized leading to improved outcomes. Limited sequence imaging techniques can reduce the associated costs. Polymerase chain reaction and next generation sequencing are important novel technologies that can revolutionize the diagnosis of pediatric musculoskeletal infection.
Keywords:  Paediatric, Musculoskeletal infection, Diagnosis.

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How to Cite this Article:  Vij N, Burns J, Esparza M, Dominianni A, Cho Y, Belthur MV | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 14-23.

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Septic Arthritis Management: Current Guidelines

Volume 8 | Issue 1 | January-April 2022 | Page: 08-13 | Gaurav Gupta, Easwar T. Ramani, Gaurav Garg, Maulin Shah
DOI-10.13107/ijpo.2022.v08i01.128

Authors: Gaurav Gupta MS Ortho. [1, 2], Easwar T. Ramani MS Ortho. [3, 4 ], Gaurav Garg MS Ortho. [5], Maulin Shah MS Ortho. [6]

[1] Department of Paediatric Orthopaedics, Asian Hospital, Faridabad, UP, India.
[2] Department of Orthopaedics, Child Ortho Clinic, Faridabad & Delhi, India.
[3] Department of Paediatric Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
[4] Department of Paediatric Orthopaedics and Spine Surgery, Palakkad District Cooperative & Research Centre, Palakkad, Kerala, India.
[5] Department of Paediatric Orthopaedics, Excelcare Hospital, Jaipur, India.
[6] Department of Paediatric Orthopaedics, Orthokid Clinic, Ahmedabad, Gujarat, India.

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

Abstract

Septic arthritis is an orthopaedic emergency that is more commonly seen in infants and young children. Release of proteolytic enzymes leads to permanent destruction of intra-articular cartilage and subchondral bone as early as 72 hours after onset. Hip and knee are the most commonly involved joints. Staphylococcus aureus is the most common causative organism across all paediatric age groups. Recently, there is a significant increase in incidence of Klebsiella and Pseudomonas, especially in neonates. Sensitivity patterns of causative organisms are also changing with increasing resistance to empirical antibiotics, requiring the use of higher antibiotics.
The detection of septic arthritis in neonates is challenging. The physician has to rely on indirect signs and maintain a high index of suspicion. C-reactive protein (CRP) along with difficulty in weight bearing have a better predictive value in diagnosis. Ultrasonography (USG) is a useful tool for quick screening of a joint and to detect effusion. Many recent studies have suggested percutaneous drainage/aspiration as an equally effective modality to manage septic joints, thus avoiding the morbidity of open arthrotomy and the risks of general anaesthesia. Lack of response to minimally invasive methods warrant an open approach. Antero-lateral arthrotomy is preferred over the posterior approach to avoid iatrogenic damage to the blood supply of the femoral head. Arthroscopic lavage of the septic joint is also becoming popular. The choice of empiric antibiotic treatment should be based on age, vaccination status and underlying co-morbidities. There is growing evidence in literature for short-course intravenous (IV) therapy. Delayed diagnosis, sickle cell disease, and infection caused by certain strains of methicillin-resistant staphylococcus aureus (MRSA) are predispose to orthopaedic sequelae.
Keywords:  Septic Arthritis, Arthrotomy, Osteomyelitis.

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How to Cite this Article:  Gupta G, Ramani ET, Garg G, Shah M | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 08-13.

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Pelvic Pyomyositis in Children: Current Concepts Review

Volume 8 | Issue 1 | January-April 2022 | Page: 02-07 | Archan Desai, Ashish Ranade, Mohan V. Belthur, Sandeep Patwardhan, Gauri A. Oka
DOI-10.13107/ijpo.2022.v08i01.127

Authors: Archan Desai [1], Ashish Ranade [1, 2], Mohan V. Belthur [3], Sandeep Patwardhan [4], Gauri A. Oka [1]

[1] Department of Orthopaedics, Bharati Hospital and Research Centre, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India.
[3] Department of Child Health & Orthopaedics, University of Arizona College of Medicine-Phoenix, USA.
[4] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Ashish Ranade,
Consultant Paediatric Orthopaedic Surgeon, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India. Visiting Pediatric Orthopaedic Surgeon, Bharati Vidyapeeth Medical College Hospital, Pune, Maharashtra, India
E-mail: ranadea2@gmail.com

Abstract

Pyomyositis in children is an uncommon bacterial infection of skeletal muscles which has more frequently been described in tropical areas, but it is becoming increasingly recognized in temperate climates too. Any muscle group in the body can be involved, but it commonly affects the large muscle groups which are located around the pelvic girdle and lower extremities. Clinical presentation is very similar to septic arthritis of the hip and needs to be diagnosed early. MRI is the investigation of choice. Depending on the severity this condition, it can be treated conservatively with antibiotics in its early stage and with percutaneous or formal incision and drainage in later stages. Generally, if it is diagnosed early, good outcomes can be expected.
Keywords: Pelvic Pyomyositis, Septic arthritis, Infection, Magnetic resonance imaging

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How to Cite this Article:  Desai A, Ranade A, Belthur MV, Patwardhan S, Oka GA | Pelvic Pyomyositis in Children: Current Concepts Review | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 02-07.

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