September-December 2021

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September-December 2021

September-December 2021

Editorial

Volume 7 | Issue 3 | September-December 2021 | Page: 01 | Jayant  S. Sampat
DOI-10.13107/ijpo.2021.v07i03.113

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 and colleagues
This issue of IJPO features original articles and case reports on a wide variety of paediatric orthopaedic conditions ranging from congenital deformities to infection and trauma. The POSI fraternity from India and around the globe have been sending in their submissions on a regular basis. This has enabled the IJPO team to publish twelve articles in this issue including 4 original papers, a new record for the POSI journal.
The “arm board” technique for the management of supracondylar fractures highlights the constant innovations being introduced into surgical practice by POSI members. Barick and colleagues have conducted a well-designed prospective study on walking age in children with clubfoot. Their work will help us to counsel parents of children with clubfoot appropriately. Other original articles on the management of osteoid osteoma and hemi-epiphyseodesis of the ankle add to the existing literature and provide new insights into the management of these conditions.
The case reports represent an eclectic mix of conditions from the rare “dysosteosclerosis” to the common problem of fingertip injuries in children. Each report is well written and presented to convey a clear message to the reader. On behalf of the Editorial Board, we commend each of the authors for their contribution and recognise the significant effort involved in seeing a submission through to publication. In the background, a large team of paediatric orthopaedic surgeons have provided their invaluable support for the peer-review process.
This issue also showcases the non-surgical skills of POSI members. Our cover page illustration is by Dr Easwar. T. R from Palakkad who dedicates his considerable artistic gift for charitable causes. Dr Taral Nagda has overseen the style and presentation of IJPO since its inception, in addition to creating previous cover page illustrations.
We have evolved substantially over the last 18 months. From reliance on invited article and symposia in the early days, IJPO is now composed entirely of original research work.
As always, we request interested POSI members to send in their submissions to the journal, volunteer to review articles and join the Editorial Board of the journal. Please visit our website www.ijpoonline.com for further details.

Jayanth S Sampath FRCSEd (Tr & Orth)
Editor, International Journal of Paediatric Orthopaedics (IJPO), POSI
editor.ijpo@gmail.com

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 01.

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The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically

Volume 7 | Issue 2 | May-August 2021 | Page: 12-16 | Anil Agarwal, Prateek Rastogi

Authors: Anil Agarwal [1], Prateek Rastogi[2]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
[2] Department of Orthopedics, Sharda Medical College, Greater Noida, Uttar Pradesh, India.

Address of Correspondence
Dr. Anil Agarwal
4/103, East End Apartments, Mayur Vihar Ph-1 Ext., Delhi-110096, India.
E-mail: rachna_anila@yahoo.co.in

Abstract

Background
We graphically analyzed the correction of total Pirani and Dimeglio scores and their subcomponents at sequential casting sessions for children with idiopathic clubfeet.
Methods
Correction of scores at weekly sessions was represented graphically. The tenotomy effect was accounted for separately. We classified 1st to 3rd casts as early, 4th and 5th cast midlevel, and beyond 5 as final casts to describe casting treatment.
Results
A total of 88 clubfeet (34 bilateral) in 54 patients were studied. Both total Pirani and Dimeglio graphs were characterized by a steep fall in early casts; subsequent minimal improvement in midlevel and final casts; later marked correction with tenotomy. Equinus in both scores stood as the most resistant deformity, showed full correction only following tenotomy. Dimeglio graphs captured coupling of various foot motions better over early casts than Pirani graphs.
Conclusions
Both Pirani and Dimeglio scores can adequately guide caregivers to progressive deformity correction in clubfoot.
Keywords: Clubfoot, CTEV, Pirani, Dimeglio, Scores, Graphs

References

1. Staheli L. Clubfoot: Ponseti management. Seattle, WA: Global HELP; 2009.
2. Pirani S, Naddumba E, Staheli L. Ponseti Clubfoot management: Teaching manual for healthcare providers in Uganda. Seattle, WA: Global HELP; 2008.
3. Chaudhry S, Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B. 2012;21: 73-78.
4. 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;40:2199-2205.
5. Lampasi M, Abati CN, Stilli S, Trisolino G. Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: are we coming to the same decisions? J Orthop Surg (Hong Kong). 2017;25:2309499017713916
6. Agarwal A, Shanker M. Temporal variation of scores along the course of the Ponseti treatment in older children: A ready guide to progress of treatment. J Pediatr Orthop. 2020;40:246-250.
7. Pirani S, Outerbridge HK, Sawatzki B, et al. A reliable method of clinically evaluating a virgin clubfoot evaluation. In: Proceedings of the 21st SICOT World Congress, Sydney, Australia, 18-23 April 1999.
8. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4:129-136.

How to Cite this Article:  Agarwal A, Rastogi P | The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 12-16.

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Should we Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature

Volume 7 | Issue 2 | May-August 2021 | Page: 07-11 | Teixeira R, Ovídio J, Arcangelo J, Campagnolo J, Tavares D

Authors: Teixeira R [1], Ovídio J [2], Arcangelo J [2], Campagnolo J [2], Tavares D [2]

[1] Hospital São Francisco Xavier, Lisbon, Portugal.
[2] Hospital Dona Estefânia, Lisbon, Portugal

Address of Correspondence
Dr. Raquel Teixeira,
Rua dos Quartéis 80, r/c direito, 1300-483 Ajuda, Lisbon, Portugal.
E-mail: rt.corda@gmail.com

Abstract

Objective: The association between clubfoot and developmental dysplasia of the hip (DDH) remains uncertain, with only a few studies linking both. However, clubfoot is considered as a risk factor for DDH. The aim of this study was to determine the incidence of DDH and evaluate the need for routine hip imaging in our population of children with clubfoot.
Methods: Retrospective analysis of all patients treated for clubfoot in our center between 2010 and 2019. We included patients with hip imaging for DDH in the first 12 months of life.
Results: There were 108 children with clubfoot who underwent DDH screening. 92 had idiopathic clubfoot and 16 had syndromic clubfoot. Of the patients with idiopathic clubfoot, 2 (2.2%) had DDH; one had a clinically unstable hip and the other patient underwent hip screening on account of the clubfoot alone. Among patients with syndromic clubfoot, 3 (18.8%) had developmental dysplasia of the hip. Two of them had an abnormal hip examination while the other had normal hip clinical examination but other established risk factors for DDH.
Conclusion: A targeted ultrasound or radiological screening programme for DDH in idiopathic clubfoot diagnosed hip dysplasia in only 1 child that would have otherwise been missed by clinical examination alone. We conclude that hip imaging is not warranted in children with idiopathic clubfoot and regular clinical screening may suffice. In syndromic clubfoot, due to the higher incidence of DDH, we recommend specific ultrasound screening even in the presence of a normal hip examination.
Keywords: Clubfoot, Screening, Developmental dysplasia of the hip.

References

1. Westberry DE, Davids JR, Pugh LI. Clubfoot and developmental dysplasia of the hip: Value of screening hip radiographs in children with clubfoot. J Pediatr Orthop. 2003;23(4):503-507.
2. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146-1153.
3. Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: A systematic review. J Orthop Surg Res. 2018;13(1):1-11.
4. Silva C, Costa G. Importância da ecografia no rastreio e diagnóstico precoce da displasia do desenvolvimento da anca. Rev Port Ortop e Traumatol. 2013;21(2):147-163.
5. Chou DTS, Ramachandran M. Prevalence of developmental dysplasia of the hip in children with clubfoot. J Child Orthop. 2013;7(4):263-267.
6. French, L; Dietz F. Screening for developmental dysplasia of the hip. Am Fam Physician. 1999;60(1):177-184.
7. Gurnett CA, Boehm S, Connolly A, Reimschisel T, Dobbs MB. Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Med Child Neurol. 2008;50(7):498-502.
8. Sadler B, Gurnett CA, Dobbs MB. The genetics of isolated and syndromic clubfoot. J Child Orthop. 2019;13(3):238-244.
9. Werler MM, Yazdy MM, Mitchell AA, et al. Descriptive epidemiology of idiopathic clubfoot. Am J Med Genet Part A. 2013;161(7):1569-1578.
10. Mahan, Susan; Yazdy, Mahsa; Kasser, James; Werler M. Is it worthwhile to routinely ultrasound screen children with idiopathic clubfoot for hip dysplasia? J Pediatr Orthop. 2013;33(8).
11. Ömeroğlu H, Akceylan A, Köse N. Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: A retrospective case control study. J Child Orthop. 2019;13(2):161-166.
12. D’Alessandro M, Dow K. Investigating the need for routine ultrasound screening to detect developmental dysplasia of the hip in infants born with breech presentation. Paediatr Child Heal. 2019;24(2):E88-E93. d
13. Perry DC, Tawfiq SM, Roche A, et al. The association between clubfoot and developmental dysplasia of the hip. J Bone Jt Surg – Ser B. 2010;92 B(11):1586-1588.
14. Gomes S, Antunes S, Diamantino C, et al. Displasia de desenvolvimento da anca: seis anos de rastreio ecográfico a crianças de risco. Nascer e Crescer – Rev do Hosp Crianças Maria Pia. 2012;21(4):226-229.
15. Calonge N, Allan JD, Berg AO, et al. Screening for developmental dysplasia of the hip: Recommendation statement – US Preventive Services Task Force. Pediatrics. 2006;117(3):898-902.
16. Vaquero-Picado A, González-Morán G, Garay EG, Moraleda L. Developmental dysplasia of the hip: Update of management. EFORT Open Rev. 2019;4(9):548-556.
17. The H. Screening for the detection of congenital dislocation of the hip. Arch Dis Child. 1987;62(3):315-316.
18. Santos, L; Fonseca M. Protocolo de rastreio de displasia de desenvolvimento da anca (DDA). 2012
19. Wynne-Davies R, Littlejohn A, Gormley J. Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). J Med Genet. 1982;19(5):321-328.
20. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-96.

How to Cite this Article:  Teixeira R, Ovídio J, Arcangelo J, Campagnolo J, Tavares D | Should We Continue to Screen for Developmental Dysplasia of the Hip in Clubfoot? Our Experience and Review of the Literature | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 07-11.

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Iliopsoas Abscess in Children – A Forgotten Diagnosis

Volume 7 | Issue 2 | May-August 2021 | Page: 17-19 | Vinod Raj, Abhishek Chinya, Sanjay Sardessai, Jeevan Vernekar

Authors: Vinod Raj [1], Abhishek Chinya [1], Sanjay Sardessai [2], Jeevan Vernekar [2]

[1] Department of Paediatric Surgery, Goa Medical College and Hospital, Goa, India.
[2] Department of Radiology, Goa Medical College and Hospital, Goa, India

Address of Correspondence
Dr. Vinod Raj
Department of Paediatric Surgery, Goa Medical College and Hospital, NH 17, Bambolim, Tiswadi, North Goa,
Goa, India. 403202
E-mail: doc.vraj89@gmail.com

Abstract

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases.
Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

References

  1. Cronin CG, Lohan DG, Meehan CP, Delappe E, McLoughlin R, O’Sullivan GJ, et al. Anatomy, pathology, imaging and intervention of the iliopsoas muscle revisited. Vol. 15, Emergency Radiology. 2008. p. 295–310.
  2. Wong-Chung J, Bagali M, Kaneker S. Physical signs in pyomyositis presenting as a painful hip in children: A case report and review of the literature. Vol. 13, Journal of Pediatric Orthopaedics Part B. 2004. p. 211–3.
  3. Wang E, Ma L, Edmonds EW, Zhao Q, Zhang L, Ji S. Psoas abscess with associated septic arthritis of the hip in infants. J Pediatr Surg. 2010 Dec;45(12):2440–3.
  4. Elliott C. Paediatric Iliopsoas abscess: A case report. Australas J Ultrasound Med. 2013 Nov;16(4):198–201.
  5. Dietrich A, Vaccarezza H, Vaccaro CA. Iliopsoas abscess: Presentation, management, and outcomes. Surg Laparosc Endosc Percutaneous Tech. 2013 Feb;23(1):45–8.
  6. López VN, Ramos JM, Meseguer V, Pérez Arellano JL, Serrano R, Ordonez MAG, et al. Microbiology and outcome of iliopsoas abscess in 124 patients. Medicine (Baltimore). 2009 Mar;88(2):120–30.
  7. Zhou Y, Li G. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Chinese J Infect Chemother. 2010 Jul 20;10(4):241–7.
How to Cite this Article:  Raj V, Chinya A, Sardessai S, Vernekar J | Iliopsoas Abscess  in Children – A Forgotten Diagnosis | International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 17-19.

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