Role of Proximal Femoral Osteotomy in the Management of Developmental Dysplasia of Hip

Volume 6 | Issue 2 | May-August 2020 | Page: 33-38 | Prateek Behera

Authors: Prateek Behera [1]

[1] Department of Orthopedics, All India Institute of Medical Sciences, Bhopal, 462020 India

Address of Correspondence
Dr. Prateek Behera,
Department of Orthopedics, All India Institute of Medical Sciences,
Bhopal, 462020 India
E-mail: pbehera15@outlook.com , prateek.ortho@aiimsbhopal.edu.in

Abstract

Proximal femoral osteotomy as a component of the treatment of developmental dysplasia of hip (DDH) has been used for almost a century now, after being described by Hey-Groves in 1928. Over the years, understanding of its role has evolved alongside our improved knowledge on the pathoanatomy and biomechanics of DDH. It has come a long way from being used exclusively in older walking children; being used as the only other concomitant procedure with open reduction of hip and being used with pre-determined values to be achieved on table, to its present state of being an indispensable component of the a la carte approach of the treatment of DDH. A femoral osteotomy is used for shortening, decreasing the femoral anteversion, or for producing a varus at the proximal femur. The surgical technique has remained largely unchanged over the years although proximal femoral locking plates are increasingly employed in addition to the traditional options such as angle blade plate, DCP, or one-third tubular plates. This review aims to analyze and summarize the current understanding of the role played by a proximal femoral osteotomy in the management of DDH.
Keywords: Developmental dysplasia of hip; Proximal femoral osteotomy; Varus derotation osteotomy; Avascular necrosis of femoral head.

References 

1. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
2. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part I. Instr Course Lect 2004;53:523-30.
3. Herring JA. Congenital coxa vara. In: Tachdjian’s Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 483-579.
4. Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 1985;67:39-47.
5. Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br 1998;80:711-9.
6. Doudoulakis JK, Cavadias A. Open reduction of CDH before one year of age. 69 hips followed for 13 (10-19) years. Acta Orthop Scand 1993;64:188-92.
7. Weinstein SL. Developmental hip dysplasia and dislocation. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Pediatric Orthopaedics. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2014. p. 983-1111.
8. Forlin E, Munhoz da Cunha LA, Figueiredo DC. Treatment of developmental dysplasia of the hip after walking age with open reduction, femoral shortening, and acetabular osteotomy. Orthop Clin North Am 2006;37:149-60.
9. Klisic P, Jankovic L. Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children. Clin Orthop Relat Res 1976;119:60-9.
10. Weinstein SL, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect 2004;53:531-42.
11. Moseley CF. Open reduction of a congenital dislocated hip and salter innominate osteotomy. In: Tolo VT, Skaggs DL, editors. Master Techniques in Orthopaedic Surgery: Pediatrics. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008. p. 120-35.
12. Zadeh HG, Catterall A, Hashemi-Nejad A, Perry RE. Test of stability as an aid to decide the need for osteotomy in association with open reduction in developmental dysplasia of the hip. J Bone Joint Surg Br 2000;82:17-27.
13. Weinstein SL, Dolan LA, Morcuende JA. The 2018 Nicholas Andry Award: The evidence base for the treatment of developmental dysplasia of the hip: The Iowa contribution. Clin Orthop Relat Res 2018;476:1043-51.
14. Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am 1980;62:876-88.
15. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol 1981;137:97-101.
16. Sankar WN, Neubuerger CO, Moseley CF. Femoral anteversion in developmental dysplasia of the hip. J Pediatr Orthop 2009;29:885-8.
17. Sarban S, Ozturk A, Tabur H, Isikan UE. Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip. J Pediatr Orthop B 2005;14:410-4.
18. Spence G, Hocking R, Wedge JH, Roposch A. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg Am 2009;91:2622-36.
19. Galpin RD, Roach JW, Wenger DR, Herring JA, Birch JG. One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening. J Bone Joint Surg Am 1989;71:734-41.
20. Wenger DR, Lee CS, Kolman B. Derotational femoral shortening for developmental dislocation of the hip: Special indications and results in the child younger than 2 years. J Pediatr Orthop 1995;15:768-79.
21. Wenger DR, Weinstein SL. Operative Treatment of Developmental Dysplasia of the Hip with Open Reduction and Salter Osteotomy. Available from: https://www.vjortho.com/2000/12/operative-treatment-of-ddh-with-open-reduction-and-salters-osteotomy.
22. Kelly DM. Congenital and developmental abnormalities of the hip and pelvis. In: Azar FM, Beaty JH, Canale ST, editors. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier Saunders; 2017. p. 1118-54.
23. Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB. Post reduction computed tomography in developmental dislocation of the hip: Part I: Analysis of measurement reliability. J Pediatr Orthop 1997;17:626-30.
24. Sangavi SM, Szöke G, Murray DW, Benson MK. Femoral remodelling after subtrochanteric osteotomy for developmental dysplasia of the hip. J Bone Joint Surg Br 1996;78:917-23.

How to Cite this Article: Behera P | Role of Proximal Femoral Osteotomy in the Management of
Developmental Dysplasia of Hip | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 27-32.

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Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 23-26 | Naveen Kumar Singh, Sunny Chaudhary, Nishat Setia, Prateek Girotra

Authors: Naveen Kumar Singh [1], Sunny Chaudhary [2], Nishat Setia [1], Prateek Girotra [1]

[1] Department of Orthopaedics, Hindurao Hospital,Delhi, India.
[2] Department of Orthopaedics, AIIMS Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Sunny Chaudhary,
Department of Orthopedics,AIIMS Rishikesh,India
E-mail: dr.sunny.ortho@gmail.com

Abstract

An elbow dislocation with ipsilateral fracture both bones forearm in a pediatric age group is a very rare injury. Although fracture both bones forearm alone in same age group is very common. These injuries in conjunction usually resulted from a high energy trauma and can be missed if clinician is not aware of such injuries so these injuries need to be addressed carefully. Success of functional outcome depends on concentric reduction of dislocated elbow with anatomical restoration of fractured both bones forearm. Here, we report a case of right-sided elbow dislocation with ipsilateral fracture of both bones forearm in a 11-year-old girl. In this case, closed reduction was performed for dislocated elbow in emergency department using reduction maneuver followed by closed reduction of both bones of forearm. Post-reduction neurovascular status of affected limb was checked and found to be uneventful. Active finger movements were present. Patient was followed-up for a period of 1 year. There was good clinical, radiological, and functional outcome. Previously, only two similar cases were reported and the last reported case had an additional finding of fracture lateral humeral condyle. Our case is an elbow dislocation with ipsilateral fracture both bones forearm in the pediatric age group and it was completely managed conservatively which makes our case-report unique in its presentation.
Keywords: Elbow dislocation; Both bone forearm fracture; Paediatric age.

References 

1. Ramesh S, Lim YJ. Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: A rare combination. Strateg Trauma Limb Reconstr 2011;6:97-101.
2. Madhar M, Saidi H, Fikry T, Cermak K, Moungondo F, Schuind F. Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases. Chir Main 2013;32:299-304.
3. Goni V, Behera P, Meena UK, Gopinathan N, Akkina N, Arjun RH. Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review. Chin J Traumatol 2015;18:113-115.
4. Hung SC, Huang CK, Chiang CC, Chen TH, Chen WM, Lo WH. Monteggia Type I equivalent lesion: Diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult. Arch Orthop Trauma Surg 2003;123:311-313.
5. Frazier JL, Buschmann WR, Insler HP. Monteggia Type I equivalent lesion: Diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation in a child. J Orthop Trauma 1991;5:373-375.
6. Kose O, Durakbasa MO, Islam NC. Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: A case report. J Orthop Surg (Hong Kong) 2008;16:122-123.
7. Rijal L, Kc KM, Sagar G. Elbow dislocation with ipsilateral radius and ulna fracture: Is it so common? Nepal Med Coll J 2012;14:163-164.
8. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566-580.
9. Fleming FJ, Flavin R, Poynton AR. Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures–a rare combination. Injury 2004;35:90-92.
10. Kumar P, Manjhi LB, Rajak RL. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius. Indian J Orthop 2013;47:307-309.
11. Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin North Am 2008;39:141-154.

How to Cite this Article: Singh NK, Chaudhary S, Setia N, Girotra P | Elbow Dislocation with Ipsilateral Fracture both Bones Forearm in a Pediatric Age: A Rare Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 23-26.

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Posterior Dislocation of Sternoclavicular Joint- A Case Report

Volume 6 | Issue 2 | May-August 2020 | Page: 18-22 | Shikhar Yadav, Renjit John Mathew, Dileep Sasi, John Thayyil John

Authors : Shikhar Yadav [1], Renjit John Mathew [1], Dileep Sasi [1], John Thayyil John [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Shikhar Yadav,
Bombay Hospital Institute of Medical Sciences,
Mumbai, Maharashtra, India.
E-mail: dr.shikhar.yadav@gmail.com

Abstract

Background: Traumatic sternoclavicular joint dislocation is a very rare occurrence worldwide and is seen in only 0.5-3% of all injuries to the shoulder girdle . It is seen in high-velocity injuries resulting mostly from road traffic accidents or usually in contact sports such as rugby which is a game not played in our country. The sternoclavicular joint has a lot of important structures belonging to the cardiovascular, nervous, respiratory, and digestive system posterior to it and hence it creates a major challenge to the orthopedic surgeon while dealing with the same. With the lack of incidence and experience on this subject, the surgeon might often miss the diagnosis by not suspecting it or struggle to manage the patient after its diagnosis.
Case Report: A case report of a 12 year old male who has history trauma to the chest which resulted in a posterior dislocation of left sternoclavicular joint and the same was reduced successfully using a closed technique without any complications. A one year follow up of the patient shows complete range of left shoulder with no pain and no history of subsequent instability of the sternoclavicular joint.
Keywords: Posterior dislocation; Sternoclavicular joint; Closed reduction.

References 

1. Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 2011;19:1-7.
2. Choo C, Wong H, Nordin A. Traumatic floating clavicle: A case report. Malays Orthop J 2012;6:57-9.
3. Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior sternoclavicular joint dislocation in a division I football player: A case report. Int J Sports Phys Ther 2015;10:700-11.
4. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996;330:3-12.
5. Spencer EE, Kuhn JE, Huston LJ, Carpenter JE, Hughes RE. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elbow Surg 2002;11:43-7.
6. Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ. Effect of plane of arm elevation on glenohumeral kinematics: A normative biplane fluoroscopy study. J Bone Joint Surg Am 2013;95:238-45.
7. Booth CM, Roper BA. Chronic dislocation of the sternoclavicular joint: An operative repair. Clin Orthop Relat Res 1979;140:17-20.
8. Rajaratnam S, Kerins M, Apthorp L. Posterior dislocation of the sternoclavicular joint: A case report and review of the clinical anatomy of the region. Clin Anat 2002;15:108-11.
9. Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016;7:244-50.
10. Howard FM, Shafer SJ. Injuries to the clavicle with neurovascular complications. A study of fourteen cases. J Bone Joint Surg Am 1965;47:1335-46.
11. Jain S, Monbaliu D, Thompson JF. Thoracic outlet syndrome caused by chronic retrosternal dislocation of the clavicle. Successful treatment by transaxillary resection of the first rib. J Bone Joint Surg Br 2002;84:116-8.
12. Nakayama E, Tanaka T, Noguchi T, Yasuda J, Terada Y. Tracheal stenosis caused by retrosternal dislocation of the right clavicle. Ann Thorac Surg 2007;83:685-7.
13. Gardner MA, Bidstrup BP. Intrathoracic great vessel injury resulting from blunt chest trauma associated with posterior dislocation of the sternoclavicular joint. Aust N Z J Surg 1983;53:427-30.
14. Bicos J, Nicholson GP. Treatment and results of sternoclavicular joint injuries. Clin Sports Med 2003;22:359-70.
15. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s Fractures in Adults. Phildelphia, PA: Lippincott Williams and Wilkins; 2015. p. 1623-25.
16. Buckerfield CT, Castle ME. Acute traumatic retrosternal dislocation of the clavicle. J Bone Joint Surg Am 1984;66:379-85.
17. Lehmann W, Laskowski J, Grossterlinden L, Rueger JM. Refixation of sternoclavicular luxation with a suture anchor system. Unfallchirurg 2010;113:418-21.
18. Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP. Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elbow Surg 2006;15:315-8.
19. Franck WM, Jannasch O, Siassi M, Hennig FF. Balser plate stabilization: An alternate therapy for traumatic sternoclavicular instability. J Shoulder Elbow Surg 2003;12:276-81.
20. Burrows HJ. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint. J Bone Joint Surg Br 1951;33B:240-3.
21. Castropil W, Ramadan LB, Bitar AC, Schor B, De Oliveira D’Elia C. Sternoclavicular dislocation–reconstruction with semitendinosus tendon autograft: A case report. Knee Surg Sports Traumatol Arthrosc 2008;16:865-8.
22. Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am 2004;86:98-105.

How to Cite this Article: Yadav S, Mathew RJ, Sasi D, John JT | Posterior Dislocation of Sternoclavicular Joint- A Case Report | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 18-22.

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Assessment in adolescent scoliosis

Volume 6 | Issue 1 | Jan – April 2020 | Page 2-6 |  Connor J. S. McKee.

Authors : Connor J. S. McKee [1]

[1] Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.

Address of Correspondence
Dr. Connor J. S. McKee,
Royal Victoria Hospital, 274 Grosvenor Rd, Belfast BT12 6BA, Belfast, Northern Ireland.
E-mail: connor.mckee@ntlworld.com,
cmckee43@qub.ac.uk

Abstract

Background: Adolescent idiopathic scoliosis is associated with lateral spinal curvature, vertebral rotation and rib cage distortion which disrupts normal, symmetrical thoracic movement leading to restriction of lung expansion and impaired pulmonary function. The effects of scoliosis on lung growth, airway function and exercise capacity are well documented but it is unclear how altered rib positioning affects lung function. This paper compares two different radiological measurements with pulmonary function.
Methods: The study compared two measures of deformity: Cobb angle and average rib-vertebral angle difference with pulmonary functioning. Existing literature describes Cobb angle as a useful indicator of pulmonary dysfunction. However, there are few reports on the use of rib-vertebral angle difference and these are limited to a single measurement taken at the apical vertebrae. This study of 53 patients used an average rib-vertebral angle difference over five vertebral levels. This measure gives a more representative measurement of the scoliotic deformity. This measure was then correlated with the patient’s Cobb angle and pulmonary function.
Results: Using Spearman’s rank correlation coefficient, average rib-vertebral angle difference correlated strongly with Cobb angle (0.83), forced vital capacity (-0.81), forced expiratory volume in 1 second (-0.76), and peak expiratory flow (-0.60).
Conclusions: The study found that measurement of Cobb angle is superior to average rib-vertebral angle difference across five vertebral levels.
Keywords: Idiopathic, scoliosis, RVAD, Cobb, measurement.
Study design: Retrospective correlation of pre-operative pulmonary function tests and radiological measurements

References 

1. Konieczny M, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2012;7(1):3-9.
2. Koumbourlis AC. Scoliosis and the respiratory system. Paediatric respiratory reviews. 2006 Jun 1;7(2):152-60.
3. Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. Scoliosis. 2012 Dec;7(1):7.
4. Grauers A, Einarsdottir E, Gerdhem P. Genetics and pathogenesis of idiopathic scoliosis. Scoliosis and spinal disorders. 2016 Dec;11(1):45.
5. Lenke LG. Pulmonary and chest cage physiology. In: Spinal deformities. The comprehensive text. New York, NY: Thieme. 2003:126-34.
6. Bowen RM. Respiratory management in scoliosis. In: Moe JH, Bradford DS, Eds., Moe’stextbookofscoliosis and other spinal deformities. Philadelphia: Saunders. p 572.
7. Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine. 2011; 36, 1096-1102.
8. Loder RT, Urquhart A, Steen H, et al. Variability in Cobb angle measurements in children with congenital scoliosis. The Journal of bone and joint surgery. British volume. 1995 Sep;77(5):768-70.
9. Praud JP, Canet E. Chest wall function and dysfunction. In: Kendig’s Disorders of the Respiratory Tract in Children (Seventh Edition) 2006. p 733-746.
10. Mehta M. The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. The Journal of bone and joint surgery. 1972. 54, 230-243.
11. Rimmer KP, Ford GT, Whitelaw WA. Interaction between postural and respiratory control of human intercostal muscles. Journal of Applied Physiology. 1995 Nov 1;79(5):1556-61.
12. Upadhyay SS, Mullaji AB, Luk KD, Leong JC. Relation of spinal and thoracic cage deformities and their flexibilities with altered pulmonary functions in adolescent idiopathic scoliosis. Spine. 1995 Nov;20(22):2415- 20.
13. Canavese F, Turcot K, Holveck J, Farhoumand AD, Kaelin A. Changes of concave and convex rib–vertebral angle, angle difference and angle ratio in patients with right thoracic adolescent idiopathic scoliosis. European Spine Journal. 2011 Jan 1;20(1):129-34.
14. Ferreira JH, de Janeiro R, James JI. Progressive and resolving infantile idiopathic scoliosis: the differential diagnosis. The Journal of bone and joint surgery. British volume. 1972 Nov;54(4):648-55.
15. Kristmundsdottir F, Burwell RG, James JI. The rib-vertebra angles on the convexity and concavity of the spinal curve in infantile idiopathic scoliosis. Clinical orthopaedics and related research. 1985 Dec(201):205-9.
16. Burwell RG, Cole AA, Cook TA, et al. Pathogenesis of idiopathic scoliosis. The Nottingham concept. Acta OrthopaedicaBelgica. 1992;58:33-58.
17. Xiong B, Sevastik JA, Hedlund R, Sevastik B. Radiographic changes at the coronal plane in early scoliosis. Spine. 1994 Jan;19(2):159-64.
18. Sevastik B, Xiong B, Sevastik J, Lindgren U, Willers U. Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis. European Spine Journal. 1997 Mar 1;6(2):84-8.
19. Modi HN, Suh SW, Song HR, Yang JH, Ting C, Hazra S. Drooping of apical convex rib-vertebral angle in adolescent idiopathic scoliosis of more than 40 degrees: a prognostic factor for progression. Clinical Spine Surgery.
2009 Jul 1;22(5):367-71.
20. Widmann RF, Bitan FD, Laplaza FJ, Burke SW, DiMaio MF, Schneider R. Spinal deformity, pulmonary compromise, and quality of life in osteogenesis imperfecta. Spine. 1999 Aug 15;24(16):1673.
21. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. JBJS. 2005 Sep 1;87(9):1937-46.
22. Boyer J, Amin N, Taddonio R, Dozor AJ. Evidence of airway obstruction in children with idiopathic scoliosis. Chest. 1996 Jun 1;109(6):1532-5.
23. Farrell J, Garrido E. Effect of idiopathic thoracic scoliosis on the tracheobronchial tree. BMJ open respiratory research. 2018 Mar 1;5(1):e000264.
24. Kearon C, Killian J. Factors Determining Pulmonary Function in Adolescent Idiopathic Thoracic Scoliosis. American Journal of Respiratory and Critical Care Medicine. 1993;148:288-94.
25. Pehrsson K, Danielsson A, Nachemson A. Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax. 2001 May 1;56(5):388-93.
26. Lenke LG, Bridwell KH, Baldus C, Blanke K. Analysis of pulmonary function and axis rotation in adolescent and young adult idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Journal of spinal disorders. 1992 Mar;5(1):16-25.
27. Vedantam R, Lenke LG, Bridwell KH, Haas J, Linville DA. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine.
2000 Jan 1;25(1):82.
28. Lenke LG, Bridwell KH, Blanke K, Baldus C. Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine. 1995 Jun;20(12):1343-50.

How to Cite this Article: McKee C J S Assessment in adolescent | scoliosis | International Journal of
Paediatric Orthopaedics | Jan-April 2020; 6(1):- .

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Congenital Muscular Torticollis: A study

Volume 6 | Issue 1 | Jan-April 2020 | Page: 11-15 | Md. Ashraful Islam, Datta N K, Arefin K M N, Faisal A, Mahmud C I, Murad S A, Rahman M M, Alam M M U, Begum I A

Authors : Md. Ashraful Islam [1], Datta N K [1], Arefin K M N [1], Faisal A [1], Mahmud C I [1], Murad S A [1], Rahman M M [1], Alam M M U [1], Begum I A [2]

[1] Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
[2] Department of Biochemistry, Popular Medical College, Dhaka, Bangladesh.

Address of Correspondence
Dr. Md. Ashraful Islam
Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Email: dr_ashraf007@yahoo.com

Abstract

Congenital muscular torticollis is not an uncommon problem. We evaluated 14 patients who were operated by bipolar releases and Z-lengthening. Post operatively Halter traction was used for 20 hours for 6 weeks and only at night for another 6 weeks. Out of 14 patients 5 were male, 9 were female with mean age of 9.06 years (2-17yrs) and mean follow up period was 3yrs and 4 months (3 months to 7 years), with involvement of the right side in all the patients. Mean lateral flexion deficit improved 16o and mean rotational deficit improved 12o. According to modified Lee scoring system 3 patients had excellent, 7 well, 3 fair and 1 poor result. Cosmetic improvement was significant and patients and parents were happy. There were no post-operative complications. Scar was not an issue and one patient had residual band due to poor post-operative rehabilitation as the age of the child was 2 years. Bipolar release with Z- lengthening gives well to excellent results in most patients.

Key words: Congenital, Torticollis, Post operatively

References 

1. Cheng JC, Au AW. Infantile torticollis: a review of 624 cases. J Pediatr Orthop 1994; 14:802-8.
2. Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis.Clin Orthop 1999; 362:190-200.
3. Chandler FA, Altenberg A. “Congenital” muscular torticollis. JAMA 1944; 125:476-83.
4. Coventry MB, Harris LE. Congenital muscular torticollis in infancy: some observationregarding treatment. J Bone Joint Surg [Am] 1959; 41-A: 815-22.
5. Ling CM. The influence of age on the results of open sternomastoid tenotomy in musculartorticollis. Clin Orthop 1976; 116:142-8.
6. Morrison DL, MacEwen GD. Congenital muscular torticollis: observation regarding clinical findings, associated conditions, and results of treatment. J Pediatr Orthop 1982; 2:500-5.
7. Ferkel D, Westin GW, Dawson EG, Oppenheim WL. Muscular torticollis: a modified surgical approach. J Bone Joint Surg [Am] 1983; 65-A: 894-900.
8. Hellstadius A. Torticollis congenita. Acta Clin Scand 1972; 62:586-9.
9. Hulbert KF. Congenital muscular torticollis. J Bone Joint Surg [Br] 1950; 32-B: 50-9.
10. Wirth CJ, Hagena FW, Wuelker N, Siebert WE. Biterminal tenotomy for the treatment of congenital muscular torticollis: long-term results. J Bone Joint Surg [Am] 1992; 74-A: 427-34.
11. Ippolito E, Tudisco C, Massobrio M. Long-term results of open sternocleidomastoid tenotomy for idiopathic muscular torticollis. J Bone Joint Surg [Am] 1985; 67- A: 30-8.
12. Lee EH, Kang YK, Bose K. Surgical correction of muscular torticollis in the older child. J Pediatr Orthop 1986;6:585-9
13. Canale ST, Griffin DW, Hubbard CN. Congenital muscular torticollis: a long-term follow-up. J Bone Joint Surg [Am] 1982; 64-A: 810-16.
14. Chen CE, Ko JY. Surgical treatment of muscular torticollis for patients above 6 years of age. Arch Orthop Trauma Surg 2000; 120:149-51.
15. Arslan H, Gündüz S, Subasi M, Kesemenlin C, Necmioglu S. Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age. Arch Orthop Trauma Surg 2002; 122:489-93.
16. Soeur R. Treatment of congenital torticollis. J Bone Joint Surg 1940; 22:35-42.
17. Staheli LT. Muscular torticollis: late results of operative treatment. Surgery 1971; 69:469-73.
18. Omidi-Kashani F, Hasankhani EG, Sharifi R, Mazlumi M. Is surgery recommended in adults with neglected congenital muscular torticollis?: a prospective study. BMC Musculoskelet Disord 2008; 9:158.
19. Shim JS, Jang HP. Operative treatment of congenital torticollis. J Bone Joint Surg [Br] 2008; 90-B: 934-9.
20. Alldred, A: Congenital muscular torticollis. In Proceeding of the New Zealand Orthopardic Association. J Bone and Joint Surg. 53-B(2):358. 1971.

How to Cite this Article: Islam M A, Datta N K, Arefin K M N, Faisal A, Mahmud C I, Murad S A, Rahman M M, Alam M M U, Begum I A | Congenital Muscular Torticollis: A study | International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 11-15.

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Correction of coronal, rotational deformity and shortening in a paediatric femur using Ilizarov technique – A case report

Volume 6 | Issue 1 | Jan – April 2020 | Page: 16-19 | Ramprasath Ramlal Dhurvas, Vetrivel Chezian Sengodan, Surendar Vellaiyan

Authors : Ramprasath Ramlal Dhurvas [1], Vetrivel Chezian Sengodan [1], Surendar Vellaiyan [1]

[1] Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital (The TN Dr.MGR Medical University) Coimbatore, Tamil Nadu, India.

Address of Correspondence
Dr. Ramprasath Ramlal Dhurvas,
12/23, Murugappa street, Purasaiwakkam, Chennai, Tamil Nadu, India
E-mail: dhurvasramprasath@gmail.com

Abstract

Background: Deformities in femur in children usually involves more than one axis with angular as well as displacement components. Moreover, the remaining growth in the opposite limb necessitates adequate lengthening of the ipsilateral limb.
Case Details: A 9 year old female child presented with genu varum deformity and shortening of 8 cm. X ray revealed the deformity to be localized to distal femur. CT (computed tomography) showed physeal bar in the medial half of distal femoral physis. We performed corrective osteotomy just proximal to the CORA (center of rotation of angulation) and corrected the deformity using Ilizarov apparatus, following which lengthening was done using same apparatus.
Results: A lengthening of 10 cm (over lengthening) was achieved with a lengthening index of 1.4 cm/month. Varus deformity was slightly over corrected to 5 degree of valgus. The range of motion of knee two months after fixator removal was 20 degree. One major complication in the form of regenerate fracture was encountered when the fixator was insitu. This was managed by reapplication of the pins. We achieved correction of varus, internal rotation, and shortening in the right femur.
Conclusion: Multiplanar deformities in children need prolonged treatment after corrective osteotomy. Ilizarov fixator provides the required mechanical stability as well as versatility to achieve this goal. Prolonged physiotherapy is necessary to restore the range of motion after fixator removal.
Key words: Multiplanar deformity, Ilizarov, osteotomy, lengthening, Paediatric femur
MeSH terms: Femur, rotation, Osteotomy, Genu varum, Bone lengthening

References 

1. Achterman,c., and kalamachi,A.: congenital deficiency of fibula. J bone and joint surg., 61-B (2): 133-137, 1979
2. Ilizarov GA. Trohova CG. Operative elongation of femur OrthopTravmatolProtez 1973; 34:11, 51
3. Maffuli N , Nele U, Matarazzo L. Changes in knee range of motion following femoral and tibial lengthening using Ilizarov apparatus : a chorot study .J Orthop Sci 2001;6(4) :333-38.
4. Dahl MT,Gulli B, Berg T. complications of limb lengthening A learning curve .Clin Orthop 1994; 301:10-18
5. Marc B. Danziger, M D., Anant Kumar, ; Fracture after femoral lengthening using the Ilizarov fixator method . Journal of pediatric orthopaedics 15:220-223
6. Daniel E. Prince, John E. Herzenberg; lengthening with external fixator is effective in congenital femoral deficiency. Clinical orthopaedics and related research July 2015
7. Hiroyuki Tsuchiya; kenji Uehara; Deformity correction followed by lengthening with Ilizarov method. Clinical orthopaedics and related research 402, PP. 176-183
8. Goodship AE, Watkins PE, Rigby HS et al (1993) The role of rigid frame stiffness in the control of fracture healing. An experimental study. J biomech 26: 1027-1035
9. Kenwright J, Richardson JB, Cunningham JL et al (1991) Axial movement and tibial fractures. A controlled randomised trial of treatment J Bone Joint surg Br73:654-659
10. Paley D, fleming B, Catagni M et al (1990) Mechanical evaluation of external fixators used in limb lengthening. Clin OrthopRelat Res 250; 50-57.
11. Gasser B, Boman B, Wyder D et al(1990) stiffness characteristics of the circular Ilizarov device as opposed to conventional external fixatoors. J Biomech Eng 112:15-21.
12. Podolsky A, Chao EY (1993) Mechanical performance of Ilizarov circular external fixators in comparison with other external fixators. Clin Orthop Relat Res 293:61-70.
13. Drorpaley; Problems, Obstacles, and complications of limb lengthening by Ilizarov technique.Clinical orthopaedics and related research 250; jan, 1990
14. R.J.Velazquez, D.F. Bfil; Complications of use of Ilizarov technique in the correction of limb deformities in children. Journal of bone and joint surgery vol 75-A, no.8. August 1993 1148-1156.

How to Cite this Article: Dhurvas R R, Sengodan V C, Vellaiyan S.| Correction of coronal, rotational deformity and shortening in a paediatric femur using Ilizarov technique – A case report.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 20-23.

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