Clinical Examination and Early Management of Brachial Plexus Birth Palsy (BPBP)

Volume 7 | Issue 1 | January-April 2021 | Page: 28-36 | Gaurav Gupta, Tejas Patel, Chasanal Rathod, Amila Shashanka Ratnayake, Maulin M Shah, Bharat K. Kadadi

Authors: Gaurav Gupta MBBS, MS Ortho. [1], Tejas Patel PT, C/NDT, SI. [2], Chasanal Rathod MBBS, MS Ortho. [3], Amila S. Ratnayake MBBS, MS MRCS(Ed) [4], Maulin M. Shah MBBS, MS Ortho. [5], Bharat K. Kadadi MBBS, MS Ortho. [6]

[1] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi
[2] Consultant, Paediatric Physiotherapist, Sparsh Paediatric Rehabilitation Clinic, Ahmedabad, Gujrat, India.
[3] Consultant Pediatric Orthopedic Surgeon, NHSRCC Children’s Hospital, Mumbai, Maharashtra, India.
[4] Plastic & Reconstructive Surgeon, National Hospital Kandy, Sri Lanka
[5] Consultant, Paediatric Orthopaedic Surgeon, OrthoKids Clinic, Ahmedabad, Gujrat, India.
[6] Bengaluru Hand Centre & Manipal Hospitals, Bangalore, Karnataka, India.

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

Abstract

Brachial Plexus Birth Palsy (BPBP) is defined as a flaccid paralysis of the upper limb that occurs as a result of traction injury to the brachial plexus during the process of birth. The incidence of BPBP has been estimated between 0.4% to 5.1% in various studies worldwide.
A precise clinical examination is the key to ascertain the type of injury, prognosticate the outcome and forecast the probable need of surgical intervention. A detailed clinical examination methodology and important signs directing to the intervention are described in this paper. The importance of regular clinical follow up has been emphasised. Early rehabilitation of infants with BPBP and physiotherapy protocols are discussed.

Keywords:

References 

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How to Cite this Article: Gupta G, Patel T, Rathod C, Ratnayake AS, Shah MM | Clinical examination and Early Management of Brachial Plexus Birth Palsy (BPBP) | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 28-36.

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Factors affecting the outcome of Chronic Osteomyelitis in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 16-21 | Gaurav Gupta, Maulin M. Shah, Akash S. Makadia, Qaisur Rabbi

Authors: Gaurav Gupta MS Ortho. [1], Maulin M. Shah MBBS, M.S.Orth., DNB Orth. [1],
Akash S. Makadia MS Ortho. [2], Qaisur Rabbi D-Ortho. [2]

[1] Consultant Paediatric Orthopaedic Surgeon at OrthoKids Clinic, Ahmedabad, Gujarat, India.
[2] Consultant, Paediatric Orthopaedic Surgeon, Child Ortho Clinic, New Delhi, India.
[3] Clinical Fellow (Paediatric Orthopaedics), OrthoKids Clinic, Ahmedabad, Gujarat, India.

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

Abstract

Background: Treatment of Chronic Osteomyelitis in children results in varied outcome ranging from uneventful bone healing to gap non-union. We evaluated the factors associated with adverse outcome after a uniform treatment executed at a single centre.
Methods: 40 patients (1.5 -14 years) with Chronic Osteomyelitis managed with debridement & splintage were included in this study. Detailed history, laboratory investigations, local x rays & MRI were available for all the patients. Average follow up was of 2.5 years. Patients who ended up having healing of the bone after primary treatment were defined as ‘Good Outcome’, patients who required additional procedures to improve function of limb or morphology of bone were defined as ‘Fair Outcome’ and patients who resulted in gap non-union were defined as ‘Poor Outcome’.
Results: Delay in surgical intervention beyond 6 weeks after beginning of symptoms, multiple local debridement without pan-medullary decompression & presence of concomitant soft tissue abscess on MRI were the statistically significant factors associated with poor outcome.
Conclusion: Aggressive & early surgical debridement is suggested for patients with failed conservative treatment to avoid long term complications. Current study will help in identifying the patients who are likely to have long-term sequelae of Chronic Osteomyelitis.
Keywords: Chronic Osteomyelitis, pan-osseous, non-union, debridement, outcome.

Level of Evidence: IV, retrospective analytical study.

References 

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How to Cite this Article: Gupta G, Shah MM, Makadia AS, Rabbi Q | Factors affecting the outcome of Chronic Osteomyelitis in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 16-21.

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Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware!

Volume 4 | Issue 1 | January-June 2018 | Page: 38-40 | Kiran Sasi, Binu P Thomas

DOI- 10.13107/ijpo.2018.v04i01.009

Authors: Kiran Sasi, Binu P Thomas

Department of Hand Surgery, Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Address of Correspondence
Dr. Binu P Thomas,
Dr. Paul Brand Centre for Hand Surgery and Peripheral Nerve Surgery, Christian Medical College and Hospital, Vellore – 632 004, Tamil Nadu, India.
E-mail: binu@cmcvellore.ac.in

Abstract

Distal femoral metaphyseal fracture is a common injury faced by paediatric orthopaedic surgeons. This injury is usually managed with closed reduction and percutaneous Kirschner wire fixation. We present an unusual case wherein the common peroneal nerve was completely severed and entrapped in the fracture site following closed reduction and percutaneous Kirschner wire fixation of a distal femoral metaphyseal fracture.
Keywords: Distal femur fracture, Foot drop, Nerve entrapment

References 

1. Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: A study using the general practice research database. J Bone Miner Res 2004;19:1976-81.
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How to Cite this Article:  Sasi K, Thomas BP | Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware! | January-June 2018; 4(1): 38- 40.

 

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Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle

Volume 4 | Issue 1 | January-June 2018 | Page: 16-22 | David Livingstone, Albert A Kota1, Sanjay K Chilbule, Karthikeyan Rajagopal, Sukria Nayak, Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.005

Authors: David Livingstone, Albert A Kota [1], Sanjay K Chilbule, Karthikeyan Rajagopal, Sukria Nayak [1], Vrisha Madhuri

 

Department of Orthopaedics, Paediatric Orthopaedics Unit, 1Department of Surgery, Unit IV, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Vrisha Madhuri,
Paediatric Orthopaedics Unit, Christian Medical College, Vellore – 632 009, Tamil Nadu, India.
E-mail: madhuriwalter@cmcvellore.ac.in

Abstract

Introduction: Satellite cells are a resident population of stem cells beneath the basal lamina of mature skeletal muscle fibers. Their capacity to regenerate muscle makes them a potentially ideal source for human cell therapy with respect to muscle-related diseases such as urinary and fecal incontinence, and others. In this study, we describe a protocol to isolate, expand in-vitro, and characterize human muscle satellite cells from the rectus abdominis muscle. Materials and Methods: Muscle biopsies from human donors were harvested, digested using collagenase type II, and then plated on extracellular matrix-coated plates.
Results: Immunocytochemistry revealed that satellite cells on day 8 were 70–80% Pax7 positive; in contrast, cells expanded until day 12 showed 50–75% positivity for Pax7. The real-time polymerase chain reaction for day 8 culture indicated four-fold increase in Pax3 and Pax7 gene expression, four-fold increase in MyoD gene expression, and five-fold increase in Myf5 gene expression.
Conclusion: These findings suggest that satellite cells can be cultured until day 8 for translational purposes. The protocol described here is modest, operational, and reproducible and involves only basic cell culture equipment.
Keywords: Cell therapy, Human skeletal muscle, Myoblast, Satellite cells, Sphincter injuries, Tissue regeneration

References 

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How to Cite this Article:  Livingstone D, Kota AA, Chilbule SK, Rajagopal K, Nayak S, Madhuri V | Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle | January-June 2018; 4(1): 16-22.

 

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Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria

Volume 7 | Issue 1 | January-April 2021 | Page: 10-15 | Anikwe I.A, Lasebikan O.A, Enweani U.N

Authors: I. A. Anikwe MBBS, FMC Ortho. [1], O. A. Lasebikan MBCHB, MPH, MBA, FWACS, FMC Ortho, FICS [2],
U. N. Enweani MBBS, FMCS, FMCOrtho, FWACS, FICS [3]

[1] Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
[2] Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
[3] Consultant Orthopedic Surgeon, City Hospital Enugu, Nigeria.

Address of Correspondence
Dr. Omolade. A. Lasebikan,
Department of Orthopaedics, National Orthopedic Hospital, Enugu, Nigeria.
Email: ladelash@yahoo.com

Abstract

Introduction: Congenital clubfoot is a developmental deformity of the foot. Management by the Ponseti method has been shown to be produce better results with fewer complications than traditional surgical methods. Some studies have shown that shorter intervals of serial manipulation/casting provide similar outcome to standard Ponseti technique. This study compared management outcome using an accelerated twice weekly technique, with standard weekly Ponseti casting.
Methodology: A prospective comparative study was conducted involving 62 patients with 90 clubfeet. From the study, 48 clubfeet in 34 patients were managed with standard Ponseti technique (weekly manipulation and casting), while 42 clubfeet in 28 patients were managed with accelerated Ponseti technique (twice weekly manipulation and casting). Pirani score was used for initial assessment and for follow-up.
Results: Children were 1 month to 36 months of age at the time of commencement of treatment. Majority of patients were male, (63%). The average number of casts did not differ significantly between the treatment groups (p = 0.13). The accelerated Ponseti technique patients were therefore able to complete their treatment within a significantly shorter period than those who went through the standard Ponseti protocol. The standard group had mean duration of correction of 29.65±11.69 days and 12.36±5.45 days for the accelerated group (p<0.001). The episodes of early relapses were 2.1% in the standard group and 2.4% in the accelerated group. The rates of complications were comparable between the groups.
Conclusion: Treatment of congenital clubfeet using the twice weekly casting appears to provide comparable outcomes to the weekly Ponseti casting with a significant reduction in the duration of the casting phase.
Keywords: Clubfoot; Pirani score; Ponseti technique; Accelerated.

References 

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How to Cite this Article: Anikwe I.A, Lasebikan O.A, Enweani U.N | Comparison of Standard and Accelerated Ponseti Technique in the Treatment of Idiopathic Clubfoot at a Regional Orthopaedic Hospital in Nigeria | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 10-15.

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Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children

Volume 7 | Issue 1 | January-April 2021 | Page: 06-09 | Sanjay Kumar Meena, Ashok Tiwari, Dinesh Kumar Bairwa, Bharat Sharma

Authors: Sanjay Kumar Meena MS Orth. [1], Ashok Tiwari MS Orth. [1],
Dinesh Kumar Bairwa MS Orth. [1], Bharat Sharma  MS Orth. [2]

[1] Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
[2] Department of Orthopaedic, Government Medical College, Pali, Rajasthan.

Address of Correspondence
Dr. Sanjay Kumar Meena,
Senior Resident, Department of Orthopaedic, Government Medical College, Kota, Rajasthan.
E-mail: drsanjayroop@gmail.com

Abstract

Introduction: Supracondylar fractures of the humerus are the most frequently occurring elbow fractures in children. They account for approximately 50-70% of all fractures around the elbow. The peak incidence is between 5 and 6 years of age. The incidence of supracondylar fractures amongst girls are on the rise.
Patients and Methods: 75 patients with a closed supracondylar humerus fracture were treated by closed reduction and percutaneous crossed Kirschner wire fixation (2 lateral and one medial entry) technique. All fractures were treated by general orthopaedic surgeons with no specialised training in paediatric orthopaedic surgery.
Results: Out of the 71 children available for follow-up, the outcomes were excellent in 55 patients, good in10, fair in 4, and poor in 2 patients.
Conclusions: We found closed reduction and percutaneous cross-pinning for the treatment of Type II and III supracondylar fractures of humerus in children (Modified Gartland Classification) to be an effective method of treatment. The outcomes obtained in our study suggest that childhood supracondylar humerus fractures can be managed successfully by general orthopaedic surgeons with comparable results to those achieved in tertiary centres dedicated to paediatric orthopaedic care.
Keywords: Children; Humerus; Supracondylar fracture.

References 

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How to Cite this Article: Meena SK, Tiwari A, Bairwa DK, Sharma B | Supracondylar Humerus Fracturetreated With Closed Reduction and Percutaneous Cross Pinning Technique in Children | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 06-09.

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