Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis

Volume 8 | Issue 3 | September-December 2022 | Page: 16-21| Anil Agarwal

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.145

Authors: Anil Agarwal [1] MS Ortho.

[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

Background: The septic sequelae of knee following infantile infection is scantily described in literature. This case series depicts the various anatomical zones affected, the radiological presentation and proposes a vascular hypothesis for the sequelae.
Methods and results: Sequelae presented with three distinct radiological findings namely, unicondylar loss of lateral distal femur (n=4), hemicondylar loss of anterior portion of proximal tibia (n=3), and epiphyseal overgrowth and deficient tibial metaphysis of medial/ lateral side (n=4). The anatomical zones for above findings were seen approximately matching with the supply of specific genicular arteries around knee. On corroborating the early post infective radiographs and the sequelae radiographs, it was found that most patients had concomitant osteomyelitis, sometimes extensive.
Conclusions: We could recognize three distinct anatomical patterns of septic sequelae of knee following osteoarticular knee infection in infancy. An ischemic etiopathogenesis is suggested based on consistent radiological findings and the vascular supply zones. Most cases followed concomitant occurrence of septic arthritis and extensive osteomyelitis.
Keywords: Knee, Sepsis, Sequelae, Ischemia, Infants

References

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How to Cite this Article: Agarwal A | Specific Anatomical Patterns of Septic Sequelae of Knee in Children: Possibility of a Vascular Etiopathogenesis | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 16-21 | https://doi.org/10.13107/ijpo.2022.v08.i03.145

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Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria

Volume 8 | Issue 3 | September-December 2022 | Page: 06-10| Selema B. Bob-Manuel, Richard C. Echem, Somiari L. Harcourt

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.143

Authors: Selema B. Bob-Manuel FWACS (Ortho) [1], Richard C. Echem FWACS (Ortho) [1], Somiari L. Harcourt FMCS (Ortho) [1]

[1] Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.

Address of Correspondence

Dr. Bob-Manuel Selema Benibo
Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
E-mail: selema_md@yahoo.com

Abstract

Background: Scoring systems are being employed in the objective assessment of the severity of idiopathic clubfoot deformities . Popular among these scoring systems are the Diméglio and Pirani Scoring Systems. This study aims to find the correlation of idiopathic club foot scores (Pirani and Diméglio) with the number of castings by Ponseti method.
Methodology: It was a prospective study carried out over a 12-month period in a tertiary hospital. Children with idiopathic congenital talipes equinovarus under 3 years were included in the study. All data was analysed with the Statistical Package for Social Sciences (SPSS) version 20 for Windows. Pearson correlation coefficient was used to determine the correlation between clubfoot scores and number of castings done.
Results: The study comprised of 42 subjects with a total of 58 feet . Male and females were 45.2% (19) and 54.8% (23) respectively. Idiopathic clubfoot was unilateral in 61.9% of cases. The mean Pirani and Diméglio scores at presentation were 4.58± 1.42 and 14.28± 3.37 respectively. The mean number of casting sessions required to achieve correction was 4.00±1.19. There was a significant positive correlation between total number of castings with both Pirani scores (r=0.449, p<0.05) and Diméglio scores (r=0.619, p<0.05). Fifty percent (50%) of feet required percutaneous tenotomy in the final stages of correction.
Conclusion: Pirani and Diméglio scores have significant correlation with number of casts a patient will require for correction. Thus, either of these scores can be used and are useful tools in the monitoring of patients’ treatment with Ponseti method.
Keywords: Idiopathic Clubfoot, Ponseti, Pirani Score, Diméglio Score, Manipulation and casting.

References

1. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenital orthopaedic malformations in an African teaching hospital. West Afr J Med. 2005;24(2):92–5.
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3. Staheli L. Clubfoot: Ponseti Management. 3rd ed. Global Help; 2009. Available from: https://storage.googleapis.com/global-help-cdn/2020/07/5e0684b9-help_cfponseti.pdf
4. Ponseti I V. Congenital Clubfoot: Fundamentals of treatment. New York: Oxford University Press; 1996.
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7. Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop. 2014;34(6):639–42.
8. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082–4.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129–36.
10. Mejabi JO, Esan O, Adegbehingbe OO, Orimolade EA, Asuquo J, Badmus HD, Anipole AO. The Pirani scoring system is effective in assessing severity and monitoring treatment of clubfeet in children. Br J Med Med Res. 2016;17(4):1-9.
11. Cosma D, Vasilescu DE. A Clinical Evaluation of the Pirani and Dimeglio Idiopathic Clubfoot Classifications. J Foot Ankle Surg. 2015;54(4):582–5.
12. Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J. 2010;30:7–14.
13. Sanghvi A V., Mittal VK. Conservative management of idiopathic clubfoot: Kite versus Ponseti method. J Orthop Surg (Hong Kong). 2009;17(1):67–71.
14. Boakye H, Nsiah A, Thomas A, Bello A. Treatment Outcome of Ponseti Method in the Management of Club Foot at Komfo Anokye Teaching Hospital, Ghana: A Retrospective Study. Arch Curr Res Int. 2016;3(2):1–8.
15. Morcuende JA, Dolan LA, Dietz FR, Ponseti I V. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113(2):376–80.
16. Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop. 2014;38(3):569–72.
17. Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160–4.
18. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg Br. 2006;88(3):377–9.
19. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24(4):349–52.
20. 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(10):2199–205.

How to Cite this Article: Bob-Manuel SB, Echem RC, Harcourt SL | Correlation of Idiopathic Clubfoot Scores with Number of Manipulations and Castings Using Ponseti Method: A Prospective Study in Port Harcourt, Nigeria | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 06-10. https://doi.org/10.13107/ijpo.2022.v08.i03.143

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Scapular Tuberculosis in the Paediatric Population: Suspicion and Early Treatment is the Key

Volume 8 | Issue 3 | September-December 2022 | Page: 11-15| Bushu Harna, Shivali Arya, Sukhmin Singh, Raj Kumar, Dhanajaya Sabat, Anil Arora

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.144

Authors: Bushu Harna [1] MS Ortho., Shivali Arya [2] MD Rad., Sukhmin Singh [3] MS Ortho., Raj Kumar [4] MS Ortho., Dhanajaya Sabat [5] MS Ortho., Anil Arora [6] MS Ortho

 

[1] Department of Orthopaedics, , Indus International Hospital, Panjab, India.
[2] Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
[3] Department of Orthopaedics, AIIMS Bilaspur, Himachal Pradesh, India.
[4] Department of Orthopaedics, AIIMS, New Delhi, India.
[5] Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.
[6] Department of Orthopaedics, Max Superspecialty Hospital, Parpatganj, New Delhi, India.

Address of Correspondence

Dr. Bushu Harna,
Consultant, Department of Orthopaedics, Indus International Hospital, Panjab, India.
E-mail: bushu.edu@gmail.com

Abstract

Background: Scapular tuberculosis (TB) in paediatric population is very rare and required clinician suspicion for early diagnosis and treatment.
Methods and Materials: We conducted a retrospective study involving 8 children with a diagnosis of TB of the scapula that was confirmed by histopathological examination. The patients were clinically assessed for signs and symptoms. Pediatric/adolescent shoulder survey (PASS) and numerical rating scale (NRS) scores were used to assess the improvement with treatment.
Results: The mean age of the patients was 10.5 years with a mean duration of symptoms around 4 months. All the patients had raised ESR and CRP values with MRI evidence of inflammation or cold abscess. In all the patients, either FNAC or biopsy was performed. Gene Xpert and histopathological examination confirmed the diagnosis of tuberculosis. All the patients were given (Anti-TB therapy) ATT according to their age/weight for a period of 12 months, as per the RNTCP guidelines. There was significant improvement in ESR, CRP, NRS, and PASS scores with MRI-evidence of disease resolution.
Conclusion: Scapular tuberculosis should be suspected in children presenting with vague shoulder or scapular pain. The patients should be investigated thoroughly and treated with anti-tubercular therapy.
Keywords: Flat bone tuberculosis, Scapular tuberculosis, Paediatric tuberculosis, Ant-tubercular therapy, Biopsy

References

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2. Hosalkar HS, Agrawal N, Reddy S, Sehgal K, Fox EJ, Hill RA. Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature. J Child Orthop 2009;3:319–24.
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9. Jain D, Jain VK, Singh Y, Kumar S, Mittal D. Cystic tuberculosis of the scapula in a young boy: a case report and review of the literature. Journal of Medical Case Reports. 2009 Dec;3:1-4.
10. Teo HE, Peh WC. Skeletal tuberculosis in children. Pediatr Radiol 2004;34:853–60.

How to Cite this Article: Harna B, Arya S, Singh S, Kumar R, Sabat D, Arora A | Scapular Tuberculosis in the Paediatric Population: Suspicion and Early Treatment is the Key | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 11-15 | https://doi.org/10.13107/ijpo.2022.v08.i03.144

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A Review of Decision Making in Foot Problems in Cerebral Palsy

Volume 8 | Issue 3 | September-December 2022 | Page: 02-05| Rohan Parwani

DOI- https://doi.org/10.13107/ijpo.2022.v08i03.142

Authors: Rohan Parwani [1]

[1] Department of Orthopaedics, Shri M P Shah Medical College, Jamnagar, Gujarat, India.

Address of Correspondence

Dr. Rohan Parwani
Assistant Professor, Department of Orthopaedics, Shri M. P Shah Medical College, Jamnagar, Gujarat, India.
E-mail: arthorohan@gmail.com

Abstract

Ambulatory children with cerebral palsy suffer from a range of problems. There are issues with stance, stability, posture, and endurance. The foot plays a significant role in the pathogenesis and treatment of these problems, especially in the lower limb. Our review article tries to highlight the foot problems and their solutions. The most common deformity in a child with cerebral palsy is the hindfoot equinus. This fixed deformity leads to poor balance in stance and reduced power generated during the push-off phase. Proper identification of the gait pattern and the role of the foot in deranging the gait can help decide ways to enhance the walk of a cerebral palsy child. Physiotherapy and stretching are vital to improving muscle physiology and growth. The weak muscles need to be supplemented with splints. There is also a significant role in the judicious use of surgery in cerebral palsy. Deciding which surgery to employ is critical and often contributes to the success or a disastrous failure. Our article highlights various facets of decision-making and ways to arrive at a proper decision.
Keywords- Cerebral palsy, Foot, Equinus, Gait

References

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2. Abd El Aziz HG, Khatib AHE, Hamada HA. Does the Type of Toeing Affect Balance in Children With Diplegic Cerebral Palsy? An Observational Cross-sectional Study. J Chiropr Med. 2019;18(3):229-235.
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4. Kadhim M, Holmes L Jr, Church C, Henley J, Miller F. Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy. J Child Orthop. 2012;6(3):217-227.
5. Brunner R, Rutz E. Biomechanics and muscle function during gait. J Child Orthop. 2013;7(5):367-371.
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7. DOBSON, F. (2010), Assessing selective motor control in children with cerebral palsy. Developmental Medicine & Child Neurology, 52: 409-410.
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9. Maas, Josina & Dallmeijer, Annet & Huijing, Peter & Brunstrom-Hernandez, Janice & Kampen, Petra & Jaspers, Richard & Becher, Jules. (2012). Splint: The efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial. BMC pediatrics. 12. 38. 10.1186/1471-2431-12-38.
10. Ganjwala D, Shah H. Management of the Knee Problems in Spastic Cerebral Palsy. Indian J Orthop. 2019;53(1):53-62.
11. Givon U. Beyin felcinde kas zayifliği [Muscle weakness in cerebral palsy]. Acta Orthop Traumatol Turc. 2009 Mar-Apr;43(2):87-93.
12. Chambers MA, Moylan JS, Smith JD, Goodyear LJ, Reid MB. Stretch-stimulated glucose uptake in skeletal muscle is mediated by reactive oxygen species and p38 MAP-kinase. J Physiol. 2009;587(Pt 13):3363-3373.
13. Graham, H.K.. (2001), Botulinum toxin type A management of spasticity in the context of orthopaedic surgery for children with spastic cerebral palsy. European Journal of Neurology, 8: 30-39.
14. Kadhim M, Miller F. Crouch gait changes after planovalgus foot deformity correction in ambulatory children with cerebral palsy. Gait Posture. 2014 Feb;39(2):793-8.
15. Sung KH, Chung CY, Lee KM, Lee SY, Park MS. Calcaneal lengthening for planovalgus foot deformity in patients with cerebral palsy. Clin Orthop Relat Res. 2013;471(5):1682-1690.
16. Bishay S, Morshed GM, Tarraf Y, Pasha N (2016) Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy. Clin Res Foot Ankle 4:198.

How to Cite this Article: Parwani R | A Review of Decision Making in Foot Problems in Cerebral Palsy | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 02-05.
https://doi.org/10.13107/ijpo.2022.v08.i03.142

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Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique

Volume 8 | Issue 2 | May-August 2022 | Page: 20-23 | Anil Agarwal, Ankit Jain, Ravi Jethwa, Jatin Raj Sareen

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.139

Authors: Anil Agarwal MS Ortho [1], Ankit Jain D Ortho [1], Ravi Jethwa MS Ortho [1], Jatin Raj Sareen MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Address of Correspondence

Dr. Anil Agarwal
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India.
E-mail: rachna_anila@yahoo.co.in

Abstract

Skeletal dysplasia in children is sometimes associated with severe coronal plane angulations around the knee. The associated ligament laxity adds to the complexity of surgical correction. Osteotomies require precise surgical planning and execution. Hemiepiphyseodesis is usually employed only in mild and moderate deformity. Distraction osteogenesis method is labour intensive, costly and requires a prolonged treatment course. We describe an innovative surgical technique which combines hemiepiphysiodesis using tension-band plates and a metaphyseal osteotomy. The technique utilises acute bony correction by osteotomy followed by residual correction, if any and soft tissue fine tuning through growth modulation. Growth modulation also addresses recurrence to some extent. The surgical technique is described along with illustrative case examples.
Keywords: Skeletal dysplasia, Osteotomy, Hemiepiphyseodesis

References

1. Bassett GS. Orthopaedic aspects of skeletal dysplasias. Instr Course Lect. 1990;39:381-387.
2. Rosskopf AB, Buck FM, Pfirrmann CW, Ramseier LE. Femoral and tibial torsion measurements in children and adolescents: comparison of MRI and 3D models based on low-dose biplanar radiographs. Skeletal Radiol. 2017;46:469-476.
3. Thacker MM, Davis ED, Ditro CP, Mackenzie W. Limb lengthening and deformity correction in patients with skeletal dysplasias. In: Sabharwal S (eds.). Pediatric Lower Limb Deformities. Springer, Cham; 2016. doi: 10.1007/978-3-319-17097-8_19
4. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290. doi: 10.1097/01241398-199205000-00003
5. Pinkowski JL, Weiner DS. Complications in proximal tibial osteotomies in children with presentation of technique. J Pediatr Orthop. 1995;15:307-312.
6. Yilmaz G, Oto M, Thabet AM, Rogers KJ, Anticevic D, Thacker MM, Mackenzie WG. Correction of lower extremity angular deformities in skeletal dysplasia with hemiepiphysiodesis: a preliminary report. J Pediatr Orthop. 2014;34:336-345. doi: 10.1097/BPO.0000000000000089
7. Cho TJ, Choi IH, Chung CY, Yoo WJ, Park MS, Lee DY. Hemiepiphyseal stapling for angular deformity correction around the knee joint in children with multiple epiphyseal dysplasia. J Pediatr Orthop. 2009;29:52-56.
8. Shabtai L, Herzenberg JE. Limits of growth modulation using tension band plates in the lower extremities. J Am Acad Orthop Surg. 2016;24):691-701. doi: 10.5435/JAAOS-D-14-00234
9. Masquijo JJ, Artigas C, de Pablos J. Growth modulation with tension-band plates for the correction of paediatric lower limb angular deformity: current concepts and indications for a rational use. EFORT Open Rev. 2021;6:658-668. doi: 10.1302/2058-5241.6.200098
10. Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop. 1992;12:283-290.
11. Myers GJ, Bache CE, Bradish CF. Use of distraction osteogenesis techniques in skeletal dysplasias. J Pediatr Orthop. 2003;23:41-45.

How to Cite this Article: K Agarwal A, Jain A, Jethwa R, Sareen JR |  Combined Hemiepiphysiodesis Using Tension Band Plate and Osteotomy for Severe Coronal Plane Deformities Around Knee Joint in Children with Skeletal Dysplasia – An Innovative Technique | International Journal of Paediatric Orthopaedics | May- August 2022; 8(2): 20-23.
https://doi.org/10.13107/ijpo.2022.v08i02.139

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Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series with Comprehensive Review of Literature

Volume 8 | Issue 2 | May-August 2022 | Page: 11-15 | K Venkatadass, V Durga Prasad, Deepak Jain, S Rajasekaran

DOI- https://doi.org/10.13107/ijpo.2022.v08i02.138

Authors: K Venkatadass MS Orth [1], V Durga Prasad D Orth [1], Deepak Jain MS Orth [1], S Rajasekaran MS Orth [1]

[1] Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. K Venkatadass,
Consultant & Head of Paediatric Orthopaedics, Department of Orthopaedics & Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: venkatpedortho@gmail.com

Abstract

Concomitant tibia shaft and ipsilateral triplane fracture in the paediatric population is a known but uncommon presentation. After the first report in 2001, approximately 27 cases have been reported to date. We aimed to do a comprehensive literature review and to present our experience with these rare fractures. We report three such cases of distal-third spiral tibial fractures with three-part triplane fracture. The average age was 15.3 years. The average Body mass index was 31.3 kg/m2. Two patients underwent rigid intramedullary locking nail for shaft fractures, and one patient underwent Ender’s nailing. All triplane fractures were fixed with percutaneous screws. There were no intraoperative or postoperative complications. The average union time was 10.6 weeks. We highlight the patient and injury characteristics in these fractures. A high index of suspicion of an associated ankle fracture is needed in obese adolescents presenting with distal-third tibia fractures. Tibia fractures demand rigid internal fixation whenever possible due to associated obesity.
Keywords: Concomitant, Ipsilateral, Triplane, Tibia, Shaft, Ankle Fracture, Obesity

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How to Cite this Article: K Venkatadass, V Durga Prasad, Jain D, S Rajasekaran | Concomitant Tibia Shaft And Triplane Fracture in Adolescents: A Case Series With Comprehensive Review Of Literature | International Journal of Paediatric Orthopaedics | May-August 2022; 8(2): 11-15.
https://doi.org/10.13107/ijpo.2022.v08i02.138

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