Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip

Volume 9 | Issue 1 | January-April 2023 | Page: 21-25 | Abdus Sami, Anil Agarwal, Lokesh Sharma., Yogesh Patel, Varun Garg 

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.151

Authors: Abdus Sami [1]  MS Orth., Anil Agarwal [1] MS Orth., Lokesh Sharma [1] MS Orth., Yogesh Patel [1] MS Orth., Varun Garg [1] MS Orth.

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

Address of Correspondence

Dr. Anil Agarwal,
Specialist, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: anilrachna@gmail.com

Abstract

Purpose: We assessed the functional and radiological outcomes of children with sequelae of bilateral septic hips. Additionally, we attempted to determine the impact of radiological unstable hips on clinical functionality of the child.
Material and methods: The retrospective case series included 9 children minimum 2 years post infection. The functional outcomes were assessed using Lower Extremity Function Score (LEFS) and Children Health Assessment Questionnaire (CHAQ). Follow up hip radiographs were classified according to the Choi’s classification. We labelled the patient as having instability if either hip had a Choi type >3A.
Results: The mean age at final follow-up was 7.6 years. Five patients had multiple joints affection. The mean LEFS score was 62.7 and CHAQ-DI 0.2. The mean LEFS values for radiological stable hips (n= 5 patients) was 66 ± 19.4 and 58.5 ± 15.3 for unstable hips (p=0.5487) while corresponding CHAQ-DI scores were 0.12 ± 0.13 and 0.27 ± 0.12 respectively (p=0.1098) indicating poor relatability between functional capabilities of the child and the radiological appearances of the hips. A strong negative correlation however existed between LEFS/ CHAQ-DI values (R= -0.897; p=0.001).
Conclusions: Septic hip sequelae in children leads to various degrees of functional limitations and patients with multiple joint involvement have worse outcomes. The hip radiological findings do not relate with the overall functional status of the child.
Keywords: Functional outcome, Disability, Hip, Sepsis, Child

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How to Cite this Article: Sami A, Agarwal A, Sharma L, Patel Y, Garg V | Functionality Against Odds: Lower Extremity Functional Scale and Children Health Assessment Questionnaire in Children with Bilateral Septic Sequelae of Hip | International Journal of Paediatric Orthopaedics| January-April 2023; 9(1): 21-25 | https://doi.org/10.13107/ijpo.2023.v09.i01.151

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Results of Antegrade Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children

Volume 9 | Issue 1 | January-April 2023 | Page: 26-32 |Piyush Gadegone, Wasudeo Gadegone, Vijayanand Lokhande

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.152

Authors: Piyush Gadegone [1] MS Orth., DNB Orth., Wasudeo Gadegone [1] MS Gen. Surg., MS Orth., MNAMS Orth., SICOT (Fellow), Vijayanand Lokhande [1] MS Orth., DNB Orth.

[1] Trauma and Orthopaedics Hospital, Chandrapur, Maharashtra, India.

Address of Correspondence

Dr. Wasudeo Gadegone
Consultant Orthopaedic Surgeon, Trauma and Orthopaedics Hospital, Chandrapur, Maharashtra, India.
E-mail: gadegone123@yahoo.co.in

Abstract

Objective: The objective of this study is to present a new method of Antegrade elastic wires, which is a minimally invasive surgical approach to treat displaced fractures in the distal radial metaphyseal and dia-metaphyseal fractures in children.
Materials and Methods: We conducted a retrospective analysis of 18 patients who received antegrade elastic wires treatment for distal radial fractures from January 2019 to January 2023. The surgical indications encompassed closed, significantly displaced, and unstable fractures located in the metaphysis or diaphyseo-metaphyseal region of the radius. The fractures were stabilized using two prebent short elastic nails that were introduced from the diaphysis to the metaphysis. In instances when an ulnar fracture was present, a traditional anterograde nailing procedure was also carried out. A long or short arm plaster cast was administered for a duration of 3 weeks.
Results: The group consisted of 15 boys and 3 girls, with an average age of 10.8 years (ranging from 7 to 16 years). The right hand was implicated in 12 instances, whereas the left hand was implicated in 6 instances. The mean duration of follow-up was 7.8 months, with a range of 4 to 28 months. Out of the 18 patients, 2 individuals experienced skin irritations, which were resolved after the removal of the radial nails. All patients had complete restoration of their range of motion and experienced successful bone healing without any problems.
Conclusions: An antegrade elastic wire fixation is a very efficient, secure, and readily replicable technique for treating unstable fractures of the distal radius, while also preventing harm to the physeal plate. It successfully attains favorable functional and radiological outcomes and allows early mobilization.
Keywords: Distal radius, Metaphyseal fracture, dia-metaphyseal fractures, Elastic wires, Antegrade.

References

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16. Lieber J, Schmid E, Schmittenbecher PP. Unstable diametaphyseal forearm fractures: transepiphyseal intramedullary Kirschner-wire fixation as a treatment option in children. *Eur J Pediatr Surg.* 2010;20(6):395-398. DOI: 10.1055/s-0030-1262843.
17. Cai H, Wang Z, Cai H. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children. *Int Surg.* 2014;99:269-275. *Injury.* 2019 Feb;50(2):598-601. doi: 10.1016/j.injury.2019.01.001. Epub 2019 Jan 6.
18. Cai H, Wang Z, Cai H. Fixation of distal radial epiphyseal fracture: Comparison of K-wire and prebent intramedullary nail. *J Int Med Res.* 2016;44:122-130.
19. Du M, Han J. Antegrade elastic stable intramedullary nail fixation for pediatric distal radius diaphyseal metaphyseal junction fractures: A new operative approach. *Injury.* 2019 Feb;50(2):598-601. doi: 10.1016/j.injury.2019.01.001.
20. Gadegone P, Gadegone W, Lokhande V, Jawrani N. Distal Radial Fracture Fixation in Adults using Intramedullary Elastic Wires Augmented with either Cast Immobilization or External Fixation. *Malays Orthop J.* 2021 Nov;15(3):36–44. doi: 10.5704/MOJ.2111.006.
21. Glanvill R, Boon JM, Birkholtz F, Meiring JH, van Schoor AN, Greyling L. Superficial radial nerve injury during standard K-wire fixation of uncomplicated distal radial fractures. *Orthopedics.* 2006 Jul;29(7):639-41. doi: 10.3928/01477447-20060701-15.

 

How to Cite this Article: Gadegone P, Gadegone W, Lokhande V Results of Antegrade | Intramedullary Elastic Wires for Severely Displaced Distal Radial Fractures in Children | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 26-32 | https://doi.org/10.13107/ijpo.2023.v09.i01.152

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Atypical Osteoid Osteoma of Proximal Femur and its Surgical Challenges: A Technical Note on ‘Wandering Nidus’ and Double Lesion

Volume 9 | Issue 1 | January-April 2023 | Page: 33-36 | Sitsabesan Chokkalingam, Arunan Murali, Roy Santhosham, Gopinath Menon

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.153

Authors: Sitsabesan Chokkalingam [1] D Ortho., Arunan Murali [2] MD Rad., Roy Santhosham [2] MD Rad., Gopinath Menon [1] MS Ortho.

[1] Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
[2] Department of Radiology, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.

Address of Correspondence

Dr. Sitsabesan Chokkalingam,
Department of Trauma & Orthopaedics, (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India.
E-mail: sabesan101@gmail.com

Abstract

Introduction: Osteoid osteomas are painful benign bone tumors, accounting for 10% of overall primary bone tumors. Typical osteoid osteomas are located intracortical or intramedullary in the metadiaphyseal region of the long bones. The Atypical ones are the Juxta and Intraarticular type, posing greater challenges in its diagnosis and management. CT and MRI scans have better chances of defining the nidus lesions in Atypical osteoid osteoma of the hip joints. Surgical treatment options include, image guided percutaneous interventions such as Radio frequency ablation, Laser or Cryo ablation. These modalities achieve surgical cure, but lacks the opportunity for a histo-pathological confirmation. Our cases will highlight the ‘wandering nidus’ in hip osteoid osteoma and the possibility of dual pathology (Osteoid osteoma and Osteomyelitis) in the same hip.
Case study: We present two cases of hip joint osteoid osteomas (aged 18 yrs and 10 yrs) to highlight the diagnostic challenges and to discuss the different methodology of treatment. CT scan with additional MRI studies confirmed the radiological diagnosis after a delay of 6-8 months. The first case will highlight the wandering nature of the nidus (explained by the position of the calcific spicule within the nidus with reference to the needle tip), the challenges for needle trajectory with close proximity to femoral vessels and the “coaxial technique using chopstick maneuver” for CT guided needle excision. The second case will highlight the feasibility of percutaneous excision and surgical curettage in the presence of dual pathology.
Conclusion: Both the cases were successfully treated by CT guided n excision biopsy and had the histopathological confirmation. Needle technique allows confirmation of diagnosis and exclusion of other differential pathology.
Keywords: Wandering nidus, Atypical osteoid osteoma hip, Chopstick maneuver, Coaxial technique, Double hip lesion.

References

[1] Carneiro BC, Da Cruz IAN, Ormond Filho AG, et al. Osteoid osteoma: the great mimicker. Insights Imaging. 2021;12(1):32. Published 2021 Mar 8. doi:10.1186/s13244-021-00978-8
[2] Ciftdemir M, Tuncel SA, Usta U. Atypical osteoid osteomas. Eur J Orthop Surg Traumatol. 2015 Jan;25(1):17-27. doi: 10.1007/s00590-013-1291-1. Epub 2013 Aug 23. PMID: 23975583.
[3] Kayser F, Resnick D, Haghighi P, Pereira ER, Greenway G, Schweitzer M, et al. Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging. AJR Am J Roentgenol. 1998;170(3):609–614. doi: 10.2214/ajr.170.3.9490939
[4] Orth P, Kohn D. Diagnostik und Therapie des Osteoidosteoms [Diagnostics and treatment of osteoid osteoma]. Orthopade. 2017 Jun;46(6):510-521. German. doi: 10.1007/s00132-017-3428-0. PMID: 28447111.
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[6] D. I. Rosenthal, F. J. Hornicek, M. Torriani, M. C. Gebhardt, and H. J. Mankin, “Osteoid osteoma: percutaneous treatment with radiofrequency energy,” Radiology, vol. 229, no. 1, pp. 171–175
[7] Chai JW, Hong SH, Choi JY, Koh YH, Lee JW, Choi JA et al (2010) Radiologic diagnosis of osteoid osteoma: from simple to challenging fndings. Radiographics 30(3):737–749
[8] Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN (2002) The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol 31(10):559–569
[9] Mungo DV, Zhang X, O’Keefe RJ, Rosier RN, Puzas JE, Schwarz EM (2002) COX-1 and COX-2 expression in osteoid osteomas. J Orthop Res 20(1):159–162
[10] Edeiken J, DePalma AF, Hodes PJ (1966) Osteoid osteoma. (Roentgenographic emphasis). Clin Orthop Relat Res 49:201–206
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[12] Aynaci, O., Turgutoglu, O., Kerimoglu, S. et al. Osteoid osteoma with a multicentric nidus: a case report and review of the literature. Arch Orthop Trauma Surg 127, 863–866 (2007). https://doi.org/10.1007/s00402-007-0421-9

How to Cite this Article: Chokkalingam S, Murali A, Santhosham R, Menon G | Atypical Osteoid Osteoma of Proximal Femur and Its Surgical Challenges: A Case Study on ‘Wandering Nidus’ and Double Lesion | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 33-36 | https://doi.org/10.13107/ijpo.2023.v09.i01.153

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Epidemiology and Antibiotic Sensitivity Patterns in Pyogenic Bone and Joint Infections in Children

Volume 9 | Issue 1 | January-April 2023 | Page: 07-12 | Amit Sharma, G Nirmal Raj Gopinathan, Garima Sharma, Pallavi Sharma, Sange Negi

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.149

Authors: Amit Sharma [1] MS Ortho., G Nirmal Raj Gopinathan [2] MS Ortho., Garima Sharma [3] MD Microbiology, Pallavi Sharma [4] MS ObGy., Sange Negi [1] MS Ortho.

[1] Department of Orthopaedics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[2] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
[3] Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
[4] Department of Obstetrics and Gynaecology, Government Medical College Hospital, Chandigarh, India.

Address of Correspondence

Dr. Garima Sharma,
Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
E-mail: garimaserene@gmail.com

Abstract

Staphylococcus aureus is the most common organism causing paediatric bone and joint infections accounting for 86% of pus culture-positive cases. Methicillin resistant staphylococcus aureus (MRSA) has become a major challenge in the tertiary care setting as the majority (56%) of all pus culture postive cases were MRSA. The male to female ratio in these infections was approximately 2:1. The lower limbs were affected in the majority of children with osteomyelitis (OM) with hip joint being the commonest (50%) followed by the knee. Broad spectrum antibiotics were used emperically in 40% of cases prior to referral to a tertiary care centre. MRSA infections were associated with a higher likelihood of complications.
Keywords: Paediatric, Pyogenic, Bone and joint infections, Antibiotic practices

References

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How to Cite this Article: Sharma A, Gopinathan GNR, Sharma G, Sharma P, Negi S | Epidemiology and Antibiotic Sensitivity Patterns in Pyogenic Bone and Joint Infections in Children | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 07-12 | https://doi.org/10.13107/ijpo.2023.v09.i01.149

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Frontal Plane Angular Knee Deformities in Schoolchildren in Kribi, South Region of Cameroon

Volume 9 | Issue 1 | January-April 2023 | Page: 13-20 | Jean Gustave Tsiagadigui, Robinson Mbako Ateh, Marie-Ange Ngo Yamben, Franck Olivier Ngongang, Daniel Handy Eone, Maurice Aurelien Sosso

DOI- https://doi.org/10.13107/ijpo.2023.v09.i01.150

Authors: Jean GustaveTsiagadigui [1, 3] MD, PhD, Robinson Mbako Ateh [2] MD, Marie-Ange Ngo Yamben [1] MD, Franck Olivier Ngongang [1] MD, Daniel Handy Eone [1] MD, Maurice Aurelien Sosso [1] MD

[1] Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon
[2] Faculty of Medicine and Pharmaceutical Sciences of the University of Douala, BP 2701, Douala, Littoral Region, Cameroon.
[3] Department of Mechanical Engineering, ENSET, University of Douala, BP 2701, Douala, Littoral Region, Cameroon.

Address of Correspondence

Dr. Jean GustaveTsiagadigui,
Department of Surgery and Specialties of Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon.
E-mail: jtsiagad@gmail.com

Abstract

Bone problems such as angular deformities of the knee are common in children in Africa. The aim of this survey was to study epidemiologic aspects of frontal plane angular knee deformities in school children in Kribi. A total of 860 school children in Kribi aged 3 to 18 years were surveyed in a cross-sectional descriptive study from December 2019 to March 2020. Each child was examined. Intercodylar distances, intermalleolar distances and the tibiofemoral angles were assessed. The type of knee deformity in the frontal plane was determined from the children`s tibiofemoral angles and compared with reference values of normal children in the same age ranges. One hundred and fourty two (142, 16.5%) children surveyed presented with frontal plane knee deformities, with genu varum representing 68.0% (96 cases) of the deformities. The prevalence of these deformities in school children in Kribi varied significantly with age. We did not find any significant difference in the variation of these deformities with gender or ethnic groups. We identified some frontal plane angular knee deformities, including bilateral deformities being predominant 90.71% (127 cases). The mean body mass index was higher than those of normal children. 15.5% (22) of them presented with associated deformity in the sagital plane, dominated by bilateral genu recurvatum and 33.8% (48) of them presented with associated rotational knee deformities, dominated by bilateral medial rotation. Frontal plane knee angular deformities are common amongst school children in Kribi. Their prevalence is 16.51% (142 cases). This prevalence varies with ages. Sagittal plane and rotational plane deformities are equally present in children presenting with these deformities.
Keywords: Bone, Children, Deformities, Cameroon.

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How to Cite this Article: Tsiagadigui JG, Ateh RM, Yamben MAN, Ngongang FO, Eone DH, Sosso MA | Frontal Plane Angular Knee Deformities in School Children in Kribi, South Region of Cameroon | International Journal of Paediatric Orthopaedics | January-April 2023; 9(1): 13-20 | https://doi.org/10.13107/ijpo.2023.v09.i01.150

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Chronic Recurrent Multifocal Osteomyelitis – A Case Report

Volume 8 | Issue 3 | September-December 2022 | Page: 22-26| Ebin Rahman, Subin Sugath, Unnikrishnan R, Joe Thomas

DOI- https://doi.org/10.13107/ijpo.2022.v08.i03.146

Authors: Ebin Rahman [1] DNB Ortho, Subin Sugath [1] DNB Ortho, Unnikrishnan R [2] MD Radiology, Joe Thomas [3] MD Med. DNB Rheumatology

[1] Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
[2] Department of Radiology, Aster Medcity, Kochi, Kerala, India.
[3] Department Of Rheumatology, Aster Medcity, Kochi, Kerala, India.

Address of Correspondence

Dr Ebin Rahman,
Senior Specialist, Department Of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com

Abstract

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic auto-inflammatory bone disease of unknown aetiology that typically affects children and adolescents. It presents as recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures from lesions are sterile. It is unresponsive to antibiotic therapy. CRMO is a diagnosis of exclusion since no single clinical feature is pathognomonic. Radiological tests are often required and a bone biopsy may be needed in unclear cases.
Case Report: We report a case of an 8-year-old girl, with pain over both ankles and upper chest; history and radiological evaluation suggested osteomyelitis, but no adequate response to antibiotic treatment was observed. A bone biopsy was done to rule out malignancy. Whole body imaging revealed multiple bony lesions; based on which a diagnosis of chronic recurrent multifocal osteomyelitis was made. Patient was started on specific anti-inflammatory treatment with resolution of symptoms.
Conclusion: Chronic recurrent multifocal osteomyelitis should be suspected in a child with recurrent, multiple bone pain, modest increase of inflammatory indices, and lytic or sclerotic bone lesion on radiographs. Typical locations are the metaphyses of long bones, pelvis, clavicle, vertebral column, sternum, but any bone can be involved. We want to increase the awareness of this entity and as a differential diagnosis of recurrent, multifocal bone pain in an adolescent, thereby avoiding unnecessary antibiotic administration and bone biopsies.
Keywords: Chronic recurrent multifocal osteomyelitis, Bone pain, Non-steroidal anti-inflammatory drugs

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How to Cite this Article: Rahman E, Sugath S, Unnikrishnan R, Thoma J | Chronic Recurrent Multifocal Osteomyelitis – A Case Report | International Journal of Paediatric Orthopaedics | September-December 2022; 8(3): 22-26 | https://doi.org/10.13107/ijpo.2022.v08.i03.146

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