Early Surgical Intervention in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified?

Volume 4 | Issue 2 | July-December 2018 | Page: 03-10 | Petnikota Harish

DOI- 10.13107/ijpo.2018.v04i02.011

Authors: Petnikota Harish

Vasudev Children’s Orthopaedics Centre, Bellary, Karnataka, India

Address of Correspondence
Dr. Petnikota Harish,
‘Vasudev’, Opp. Shanti Sishu Vihar School, Talur Road, Bellary – 583 103, Karnataka, India.
E-mail: harishportho@gmail.com

Abstract

Context: Early surgical intervention is the key for good outcome in children with acute haematogenous osteomyelitis (AHO) or septic arthritis. Often there is an impasse to observe or intervene early when the diagnosis is inconclusive due to blunted clinical findings and equivocal investigations. Aim: This study is aimed at justifying early surgical intervention in these doubtful/suspected cases. Settings and
Design: This study was a retrospective review of AHO/septic arthritis treated by the author between August 2010 and January 2015. A new scoring system, haematogenous osteomyelitis and septic arthritis (HOMSA) score was developed to aid in classifying and decision-making. With a maximum score of 8, a score >6 in the absence of infection elsewhere or a score <6 with radiological evidence makes the diagnosis of AHO/septic arthritis definite. A score 6 without radiological evidence makes the diagnosis suspected/doubtful. Outcome was measured by a new discrete criterion for the upper and lower limbs.
Materials and Methods: The protocol was early surgical intervention in both the groups. In septic arthritis, open arthrotomy along with joint lavage and debridement was performed. In AHO, bone decompression with abscess drainage was performed. Initial parenteral administration of antibiotics was followed by oral antibiotic administration. Necessary adjuvant treatment was given.
Results: Thirty-four children with 40 sites of infection were identified. Among them, 50% were neonates. Only 4/40 children were treated conservatively. Following surgery, outcome was excellent-to-good in 92.8% of the children with doubtful/suspected diagnosis and 96.6% with definite infection. One child in each group who were treated surgically, and two children in the group with definite infection treated non-operatively had fair-to-poor outcomes. Conclusion: Early surgical intervention is justified even in children with a doubtful/suspected diagnosis of AHO or Septic Arthritis. The new scoring system, HOMSA Score, is a better tool to diagnose Acute septic arthritis or osteomyelitis, even with limited resources.
Keywords: Acute haematogenous osteomyelitis, Early surgery, Infants and children, Neonates, New outcome, Measure, New scoring system, Septic arthritis

References 

1. Kuong EE, To M, Yuen MH, Choi AK, Fong CM, Chow W. Pitfalls in diagnosing septic arthritis in Hong Kong children: Ten years experience. Hong Kong Med J 2012;18:482-7.
2. Stans AA. Musculoskeletal infection. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s Paediatric Orthopaedics. 7th ed. Philadelphia: Lippincott Williams & Wilkins, Wolters Kluwer 2014. p. 369–425.
3. Herring JA, editor. Infections of the musculoskeletal system. Tachdjian’s Paediatric Orthopaedics. 4th ed. Philadelphia: Saunders Elsevier 2008. p. 2089-155.
4. Bennet OM, Namnyak SS. Acute septic arthritis of the hip joint in infancy and childhood. Clin Orthop Relat Res 1992; 281: 123-32.
5. Chen CE, Ko JY, Li CC, Wang CJ. Acute septic arthritis of the hip in children. Arch Orthop Trauma Surg 2001;121:521.
6. Kocher MS, Mandiga R, Murphy JM, Goldmann D, Harper M, Sundel R, et al. A clinical practice guideline for treatment of septic arthritis in children. J Bone Joint Surg Am 2003;85:994-9.
7. Lyon RM, Evanich JD. Culture-negative septic arthritis in children. J Pediatr Orthop 1999;19:655.
8. Morrey BF, Bianco AJ Jr, Rhodes KH. Septic arthritis in children. Orthop Clin N Am 1975;6:923-34.
9. Cole WG, Dalziel RE, Leitl S. Treatment of acute osteomyelitis in childhood. Bone Joint J 1982;64:218-23.
10. Wang CL, Wang SM, Yand YJ, Tsai CH, Liu CC. Septic arthritis in children: Relationship of causative pathogens, complications and outcomes. J Microbial Immunol Infect 2003;36:41-6.
11. Scoor RJ, Christofersen MR, Roberson WW Jr, Davidson RS, Rankin L, Drummond DS. Acute osteomyelitis in children: A review of 116 cases. J Pediatr Orthop 1990;10:649-52.
12. Klein DM, Barbera C, Gray ST, Spero CR, Perrier G, Teicher JL. Sensitivity of objective parameters in the diagnosis of paediatric septic hips. Clin Orthop Relat Res 1997;338:153-9.
13. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: An evidencebased clinical prediction algorithm. J Bone Joint Surg Am 1999;81: 1662-70.
14. Luhmann SJ, Jones A, Schootman M, Gordon JE, Schoenecker PL, Luhmann JD. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. J Bone Joint Surg 2004;86:956-62.
15. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg 2004;86:1629-35.
16. Caird MS, Flynn JM, Leung YL, Millman JE, Joann GD, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. J Bone Joint Surg Am 2006;88:1251-7.
17. Bonheffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children’s Hospital Basel. Swiss MedWkly 2001;131:575-81.
18. Peltola H, Vahvanen V, Aalto K. Fever, C-reactive protein, and erythrocyte sedimentation rate in monitoring recovery from septic arthritis: A preliminary study. J Pediatr Orthop 1984;4:170-4.
19. Morrey BF, Peterson HS. Hematrogenous pyogenic osteomyelitis in children. Orthop Clin North Am 1976;6:935-51.
20. Segbefia M, Howard A. Acute Septic Arthritis and Osteomyelitis in Children − An African Perspective; 2013. Available from:
http:// ptolemy.library.utoronto.ca/sites/default/files/review/2010/February- Acuteseptic Arthritis and Osteomyelitis.pdf. [Last accessed on 2015 Apr].
21. Smith RL, Schurman DJ, Kajiyama G, Mell M, Gilkerson E. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg Am 1987;69:1063-8.
22. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br 2007;89:100-6.
23. Welcon CJ, Long SS, Fisher MC, Alburger PD. Pyogenic arthritis in infants and children: A review of 95 cases. Pediatr Infect Dis 1986;5: 669-76.

How to Cite this Article:  Harish P Early Surgical Intervention | in Children with a Suspected Diagnosis of Acute Septic Arthritis or Osteomyelitis: Is it Justified? | July-December 2018; 4(2): 03-10.

 

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Stop Maligning the Asymptomatic Child’s Flatfoot

Volume 4 | Issue 2 | July-December 2018 | Page: 01-02 | Benjamin Joseph

DOI- 10.13107/ijpo.2018.v04i02.010

Authors: Benjamin Joseph

Aster Medcity, Kochi, Kerala, India

Address of Correspondence
Prof. Benjamin Joseph,
18 H.I.G. Colony, Manipal − 576 104, Karnataka, India
E-mail: bjosephortho@yahoo.co.in

Recently, a lady met me and gave me some very colourful pamphlets about a range of fancy foot wear and shoe inserts for toddlers and young children designed to ’correct’ flatfeet. I asked her why asymptomatic flatfeet need to be treated. I patiently listened to her as she listed several ‘harmful effects of flatfeet’ including a predilection for foot injury, back ache and so on, which, according to her could be avoided by using the shoes and shoe inserts she was promoting. Needless to say, there were no scientific data to support these claims. After she left, I reflected about what the scientific literature had to say about flatfoot and also recollected my personal experience of dealing with flatfeet in young children in my practice.
There has been a long-held notion that flatfeet are bad and that they may interfere with strenuous physical activity. On the basis of this, young men with flatfeet were rejected from recruitment into the armed forces. However, Cowan et al.[1] did a study on army recruits in the USA and could not demonstrate a higher frequency of injuries in those with flatfeet. Esterman and Pilotto[2] did a similar study in Australia and concluded that ’foot shape has little impact on pain, injury and function’. Tudor et al.[3] studied athletic performance in school children with flatfoot and normal arches and documented no difference in performance in 17 different tasks. So it is high time we dispel the erroneous notion that the flatfoot is in some way inferior to feet with a well-formed arch.
Stemming from the belief that flatfoot is undesirable, concerted efforts have been made to ‘treat’ young children with shoe modifications and various types of shoe inserts that elevate the medial longitudinal arch or control the hindfoot valgus. Despite the fact that Wenger et al.,[4] in as early as 1989, demonstrated clearly that shoes and shoe inserts in no way alter the natural history of flatfoot, orthopaedic surgeons continue to prescribe them. This wasteful and meaningless practice needs to stop.
The natural history of asymptomatic flexible flatfoot is that of resolution in the vast majority of children because the arch develops by the age of 6–7 years. This is very evident as at 1 year of age, 95% of children have flatfeet and by the age of 10, the prevalence is as low as 5%. The increase in the tone of muscles that support the arch and spontaneous reduction in joint laxity as the child grows facilitate the arch to develop. Barefoot activity in early childhood also facilitates the arch to develop while shoe-wearing appears to be detrimental to the development of the arch. This was demonstrated in two large cross-sectional surveys, which showed that the prevalence of flatfoot was highest among children who wore closed-toe shoes below the age of 6 years and lowest in the unshod.[5,6] The frequency of flatfoot in children who wore sandals and slippers fell between these two. With this evidence, it seems hardly logical to prescribe shoes for a young child with flatfoot. Instead, we need to spread the message to encourage children to play barefoot outdoors on sand and gravel. We could also encourage school authorities to have sandals rather than shoes as the regulation footwear. These suggestions are perfectly appropriate in the warm climate in India.
In my practice, I have never had parents from the lower socio-economic strata bring a child for the treatment of flatfoot. Every single child brought to me with the complaints of flatfoot has been from an affluent family. Often it has been a paediatrician, or family physician, who referred the child with flatfoot to me. For a long time, I wondered why there was this socio-economic difference in my flatfoot practice. It then dawned on me; the poor child is unshod and in early childhood has played barefoot, and the poor child consequently is unlikely to have flatfoot. Even if the poor child has flatfeet, they cause no pain and the feet function perfectly well. The child’s parents have no access to the internet, so they have never heard anyone maligning their child’s feet. No wonder, I never saw a poor child with flatfoot in my clinic.

Benjamin Joseph
Aster Medcity, Kochi, Kerala, India

References 

1. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 1993;2: 773-7.
2. Esterman A, Pilotto L. Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 1: Prospective cohort study. Mil Med 2005;170:623-8.
3. Tudor A, Ruzic L, Sestan B, Sirola L, Prpic T. Flat-footedness is not a disadvantage for athletic performance in children aged 11 to 15 years. Pediatrics 2009;123:e386-92.
4. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am 1989;71:800-10.
5. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992;74:525-7.
6. Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br 1995;77:254-7.

How to Cite this Article:  Joseph B Stop Maligning the | Asymptomatic Child’s Flatfoot | July- December 2018; 4(2): 01-02.

 

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Paediatric orthopaedics and global initiative for children’s surgery

Volume 4 | Issue 1 | January-June 2018 | Page: 01-02 | Vrisha Madhuri

Authors: Vrisha Madhuri [1]

[1] Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.

Address for correspondence:
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College,
Vellore, Tamil Nadu, India
E-mail: madhuriwalter@cmcvellore.ac.in

Global burden of surgical disease and attendant morbidity and mortality has received much attention in the recent past from the World Health Organization and the Lancet Commission on Global Surgery.[1],[2],[3] This has led to several initiatives in the last 2 years by the global surgical community to address the relevant issues. Among them is a coalition of children’s surgery organizations, led by American Paediatric Surgery Association and British Association of Paediatric Surgeons, who are working to bring together the providers and the implementers of surgical services for children in low- and medium-income countries. The coalition consists of health, advocacy and policy experts from the western world. Two meetings of this Global Initiative for Children’s Surgery (GICS) have taken place with the aim of analysing the current state of the surgical care; develop priorities to improve its delivery and identify and bring together needed resources.[4] The dream of GICS is that every child in the world with a surgical need will have access to the resources necessary to optimise his or her individual care.[4]

India has the largest child population in the world. Similar to other developing countries, we have a very wide range of causes including acute, chronic and neglected problems, with many of them being amenable to surgical treatment. The few centres providing high-quality specialised paediatric surgical care are concentrated in the metropolises, and inadequately trained non-paediatric specialists are available to address these problems in the community. Despite the success of a few focussed programs, such as ‘Smile Train’ for cleft lip and palate and the collaborative program between CURE International, India and several state governments for clubfoot conservative treatment and bracing, much of the surgical needs of the children in the community remain unaddressed because of the lack of adequate infrastructure to support children’s surgery, service delivery systems and trained manpower. The supporting services such as paediatric anaesthesia, intensive care, nursing and orthotics also lack infrastructure and trained personnel. Adequate planning at national and regional levels requires paediatric-specific determination of burden of illnesses in different areas such as congenital, neuromuscular disorders, trauma and oncology.

Rashtriya Bal Swasthya Karyakram, a new initiative by the Government of India, envisages the screening of all children and adolescents for key medical and surgical conditions and their referral and treatment by the existing healthcare providers in public and private sectors. However, in the existing system, the lack of paediatric surgical specialists forms a crisis, wherein identified children are unable to access or obtain quality care, and those suffering from complex conditions do not receive comprehensive care. The lack of a triaging system burdens the tertiary care referral centres with routine surgical conditions, which are best handled at secondary levels, causing overcrowding.

The paediatric orthopaedic community is a major stakeholder in the development of surgical services in the country. Our help, along with other paediatric surgical specialists, is required in needs assessment in the area of infrastructure, service delivery and manpower. A specialist organization such as paediatric orthopaedic society can do these in addition to setting up appropriate standards of care for different conditions, triaging systems by level of hospital, standardizing training programs and identifying areas of research. They can also be great advocates for children’s surgery and attract funding and resources. The baseline demographic studies can be used to determine optimal resources such as the number of children’s hospitals required for the population served. The other important areas are the standardization of equipment to be made available for children’s need and integration of infrastructure needs into national children’s surgical plan. They can also promote preventive strategies such as improved prenatal diagnosis and health promotion and rehabilitation.

While GICS is setting up the needs assessment and standards for infrastructure, healthcare delivery and processes and personnel at all levels of care, we can join hands with them and other paediatric surgical colleagues to provide the appropriate inputs and help build up systems and best practices to provide safe affordable surgical care for children.

References 

1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA,
et al. Global Surgery 2030: Evidence and solutions for achieving health,
welfare, and economic development. Lancet 2015;386:569-624.
2. Available from: http://www.who.int/bulletin/volumes/86/8/07-050435/
en/. [Last accessed on 2017 Jan 23].
3. Available from: http://bulletin.facs.org/2015/04/the-lancet-commissionon-
global-surgery-makes-progress-in-first-year-of-work-an-update/.
[Last accessed on 2017 Jan 23].
4. Global Initiative for Children’s Surgery (GICS) Organizing Committee,
GICS I Summary.Available from: http://www.baps.org.uk/announcements/
global-initiative-childrens-surgery-gics-inaugural-meeting-report/.
June 2016. [Last accessed on 2017 Jan 31].

How to Cite this Article:  Madhuri V | Paediatric orthopaedics and global initiative for children’s surger y| International Journal of Paediatric Orthopaedics | January-June 2018; 4(1): 01-02.

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Grievous injuries in children due to tractor-related accidents

Volume 4 | Issue 1 | January-June 2018 | Page: 34-37 | Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

DOI- 10.13107/ijpo.2018.v04i01.008

Authors: Kala Ebenezer, Rimi Manners, Sampath Karl [1], Vrisha Madhuri [2]

Paediatric Intensive Care Unit, [2] Paediatric Orthopaedic Unit, [1] Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Kala Ebenezer,
Paediatric Intensive Care Unit (PICU), Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: picu@cmcvellore.ac.in

Abstract

Introduction: Tractor-related accidents are common among the agricultural injuries. Children are prone to such incidents as farmers live in the vicinity of the farmland.
Materials and Methods: From the Paediatric Intensive Care unit (PICU) database we extracted the details of children with unintentional injuries and poisonings during the period January 2008 to June 2009. Those with tractor-related injuries were further analyzed using outpatient and inpatient charts, computerized hospital records were accessed to obtain laboratory and radiological investigations details. The clinical characteristics, injuries, and outcome of these children are presented.
Results: In the 18 months period, there were 107 children with trauma, envenomations and poisoning constituting 6.5% of all PICU admissions. Of the 31 (29%) with polytrauma, four (12.9%) children, three of them boys had sustained tractor-related injuries. The injuries included three with multiple limb fractures, two each of head, chest, musculoskeletal and perineal injury and one each of abdominal and major vascular injury. All had reached the hospital in life-threatening shock and were resuscitated. Multidisciplinary surgical intervention including craniectomy, liver resection and femoral vessels anastomosis were required along with blood transfusions, ventilatory support and inotropes. Three of them survived the injuries after a mean PICU stay of 34 days.
Conclusion: Tractor-related incidents among rural children are associated with major injuries and fatalities in children. The findings call for interventions to prevent such injuries and education of the farming community involved with tractors and other agricultural machineries.
Keywords: Critically ill, Farming machinery, Tractor

References 

1. Nag PK, Nag A. Drudgery, accidents and injuries in Indian agriculture. Ind Health 2004;42:149-62.
2. Mandal SK, Maity A. Current trends of Indian tractor industry: A critical review. App Sci Rep 2013;3:132-9.
3. Reed DB, Claunch DT. Nonfatal farm injury incidence and disability to children: A systematic review. Am J Prev Med 2000;18(Suppl 4):70-9.
4. Rivara FP. Fatal and non-fatal farm injuries to children and adolescents in the United States, 1990-3. Inj Prev 1997;3:190-4.
5. Mitchell RJ, Franklin RC, Driscoll TR, Fragar LJ. Farm-related fatalities involving children in Australia, 1989-92. Aust N Z J Public Health 2001;25:307-14.
6. Smith GA, Scherzer DJ, Buckley JW, Haley KJ, Shields BJ. Paediatric farm-related injuries: A series of 96 hospitalized patients. Clin Pediatr 2004;43:335-42.
7. Cogbill TH, Busch HM Jr, Stiers GR. Farm accidents in children. Pediatrics 1985;76:562-6.
8. Goldcamp EM, Myers J, Hendricks K, Layne L, Helmkamp J. Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001. J Rural Health 2006;22:308-13.
9. Kumar A, Mohan D, Mahajan P. Studies on tractor related injuries in northern India. Accid Anal Prev 1998;30:53-60.
10. Rees WD. Agricultural tractor accidents: A description of 14 tractor accidents and a comparison of road traffic accidents. Br Med J 1965;2:63-6.
11. Tiwari PS, Gite LP, Dubey AK, Kot LS. Agricultural injuries in Central India: Nature, magnitude and economic impact. J Agric Saf Health 2002;8:95-111.

How to Cite this Article:  Ebenezer K, Manners R, Karl S, Madhuri V | Grievous injuries in children due to tractor-related accidents | January-June 2018; 4(1): 34-37.

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Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children

Volume 4 | Issue 1 | January-June 2018 | Page: 29-33 | Deeptiman James, Vrisha Madhuri

DOI- 10.13107/ijpo.2018.v04i01.007

Authors: Deeptiman James, Vrisha Madhuri

 

Paediatric Orthopaedics Unit, Christian Medical College, Vellore, Tamil Nadu, India

Address of Correspondence
Dr. Vrisha Madhuri,
Professor and Head, Paediatric Orthopaedics Unit, Christian Medical College, Vellore – 632 004, Tamil Nadu, India.
E-mail: madhuriwalter@cmcvellore.ac.in

Abstract

Aims: To determine the clinical profile and clinical, functional, and radiological outcomes and complications in children who underwent elastic stable intramedullary nailing (ESIN) for unstable fractures of both bones of forearm. Materials and Methods: A retrospective observational study was conducted in the Paediatric Orthopaedic Unit of the institution. Children with forearm fractures, who underwent ESIN of both the bones with titanium nails from January 2004 to June 2010, were included in the study. Clinical evaluation for deformity, range of motion at wrist and elbow, Daruwalla’s grading for forearm fractures, and radiological evaluation for bony union, malalignment, and radial bow were done. Paediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to assess functional outcome.
Results: Twenty-six patients were followed up for a mean of 2.14 years. These included one primary internal fixation for unstable injury in a 15-year old, 10 open fractures, and 15 with malalignment after closed reduction. Age ranged from 5 to 15 years (mean of 11.39). Average time to bony union was 6 weeks. Twelve children had excellent, 12 good, and two fair outcomes according to Daruwalla’s grade. Average PODCI score was 50.78 (standardized range is minimum of −140 to maximum of 53). There were no major complications related to ESIN. Three patients had paraesthesia over superficial radial nerve distribution, three patients had hypertrophied scars, and one patient had superficial wound infection. One child had distal radial physeal arrest following inadvertent physeal injury during implant removal.
Conclusion: ESIN is safe and effective for internal fixation of unstable forearm fractures.
Keywords: ESIN, Paediatric both bones forearm fractures, PODCI questionnaire

References 

1. Noonan KL, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146-56.
2. Madhuri V, Dutt V, Gahukamble AD, Tharyan P. Conservative interventions for diaphyseal fractures of the forearm bones in children. Cochrane Database Syst Rev 2013;2013:CD008775.
3. Anderson D, Sisk TD, Tooms RE, Park WI III. Compression plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 1975;57:287-96.
4. Hughston JC. Fractures of the forearm in children. An Instructional Course Lecture, the American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 1962;44-A: 1678-87.
5. Fuller DJ, McMullough CJ. Malunited fractures of the forearm in children. J Bone Joint Surg 1982;64:364-7.
6. Creasman C, Zaleske DJ, Ehrilch MG. Analyzing forearm fractures in children. The more subtle signs of impending problems. Clin Orthop Relat Res 1984;188:40-53.
7. Gandhi RK, Wilson P, Mason-Brown JJ, Macleod W. Spontaneous correction of deformity following fractures of the forearm in children. Br J Surg 1962;50:5-10.
8. Flynn JM, Sarwark JF, Waters PM, Bae DS, Lenke LP. The operative management of pediatric fractures of the upper extremity. J Bone Joint Surg Am 2002;84:2078-98.
9. Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10:167-71.
10. Luhmann SJ, Gordon JE, Shoenecker PL. Intramedullary fixation for unstable both bones forearm fractures in children. J Pediatr Orthop 1998;18:451-5.
11. Blackburn M, Ziv I, Rang M. Correction of malunited forearm factures. Clin Orthop Relat Res 1984;188:54-7.
12. Amit Y, Salai M, Chechik A, Blankslein A, Horoszowski H. Closed intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence − a prelimnary report. J Pediatr Orthop 1985;5:143-6.
13. Pankovitch AM. Flexible intramedullary nailing of long bone fractures. A review. J Orthop Trauma 1987;1:78-95.
14. Schmittenbecher PP. State-of-the-art treatment of forearm shaft fractures. Injury 2005;36(Suppl 1):A25-34.
15. Firl M, Wunsch L. Measurement of bowing of the radius. J Bone Joint Surg Br 2004;86:1047-9.
16. Daruwalla JS. A study of radioulnar movements following fractures of the forearm in children. Clin Orthop Relat Res 1979;139:114-20.
17. American Association of Orthopedic Surgeons (AAOS) Outcome Instrument scores. Available from: http://www.aaos.org/research/outcomes_documentatio.asp [Last accessed on 2016 May 18]
18. Shah AS, Lesniak BP, Wolter TP, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both bone forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 2010;24:440-7.
19. Richter D, Ostermann PA, Ekkernkamp A, Muhr G, Hahn MP. Elastic intramedullary nailing: A minimally invasive concept in the treatment of unstable forearm fractures in children. J Pediatr Orthop 1998;18:457-61.
20. Case collection of forearm fractures. AO manual of fracture management. In: Dietz HG, Schittenbecher PP, Slongo T, Wilkins KE, editors. Elastic stable intramedullary nailing in children. Richmond, TX, USA: AO Publishing, Thieme; 2006. p. 71-108.
21. Jubel A, Andermahr J, Isenberg J, Issanvand A, Axel R, Klause E. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop 2005;14:375-80.
22. Bhasker A. Treatment of long bone fractures in children by flexible titanium elastic nails. Indian J Orthop 2005;39:166-8.
23. Fernandez FF, Egenolf M, Carsten C, Holz F, Schneider S, Wentzensen A. Unstable diaphyseal fractures of both bones of the forearm in children: Plate fixation versus intramedullary nailing. Injury 2005;36:1210-6.
24. Flynn JM, Waters PM. Single bone fixation of both bone forearm fractures. J Pediatr Orthop 1996;16:655-9.
25. Suzanne BK, Jaffe KA, Petur NG, Rosenberg AE. Orthopaedic implant-related sarcoma: A study of twelve cases. Mod Pathol 2001;14:969-77.
26. Ballal MS, Garg NK, Bruce CE, Bass A. Nonunion of the ulna after elastic stable intramedullary nailing for unstable forearm fractures; a case series. J Pediatr Orthop B 2009;18:261-4.
27. Garg NK, Ballal MS, Malek IA, Webster RA, Bruce CE. Use of elastic stable intramedullary nailing for treating unstable forearm fractures in children. J Orthop Trauma 2008;65:109-15.
28. Lieber J, Joeris A, Knorr A, Schalamon J, Schmittenbecher PP. ESIN in forearm fractures, clear indications, often used, but some avoidable complications. Eur J Trauma 2005;31:3-11.
29. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36(Suppl 1):A78-85.
30. Adamczyk MJ, Riley PM. Delayed union and nonunion following closed treatment of diaphyseal pediatric forearm fractures. J Pediatr Orthop 2005;25:51-5.

How to Cite this Article:  James D, Madhuri V | Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children | January-June 2018; 4(1): 29-33.

 

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Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases

Volume 4 | Issue 1 | January-June 2018 | Page: 23-28 | Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi [1], Chasanal Rathod [2], Rujuta Mehta, Dominic D’Silva, Alaric Aroojis

DOI- 10.13107/ijpo.2018.v04i01.006

Authors: Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi [1], Chasanal Rathod [2], Rujuta Mehta, Dominic D’Silva, Alaric Aroojis

 

Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, 1Indian Spinal Injuries Centre, New Delhi, 2Seven Hills Hospital, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Alaric Aroojis, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: aaroojis@gmail.com

Abstract

Introduction: Hip instability in older children and adolescents is mainly because of the loss of bone in the proximal femur or conditions that cause loss of the fulcrum. These may be related to infantile septic hip sequelae or neglected developmental dysplasia of the hip.
Materials and Methods: We retrospectively analyzed six patients with hip instability treated by Ilizarov hip reconstruction from 2004 to 2007 at our institute. The mean age of the patients was 10 years (range 7–14 years). Results: The etiology was septic hip sequelae (Choi type IV) in four patients and neglected developmental dysplasia of hip in two patients. The fixator was kept for an average of 7 months (range 6–8 months). The average follow-up was 3 years. The visual analog score for pain improved from a preoperative mean of 8 to 2 postoperatively. The gait improved in all the patients and the leg length discrepancy improved from a preoperative mean of 5 to 1 cm postoperatively. All the limbs were aligned to a satisfactory level with the mean mechanical axis deviation of 3 mm (laterally) and pelvic mechanical axis of 90°. The Harris hip score improved from 41 preoperatively to 84 postoperatively (P < 0.0001).
Conclusion: Ilizarov Hip Reconstruction is an excellent salvage procedure for adolescent patients with unstable hips, giving good results in the short-term.
Keywords: Ilizarov hip reconstruction, Neglected developmental dysplasia of the hip, Postseptic sequelae, Unstable hip

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How to Cite this Article:  Ghanghurde B, Agashe M, Rustagi T, Rathod C, Mehta R, D’Silva D, Aroojis | A Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases | January-June 2018; 4(1): 23-28.

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