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

1. Unkila-Kallio L, Kallio MJ, Peltola H. Acute haematogenous osteomyelitis in children in Finland. Ann Med. 1993, 25:545–49
2. Dahl LB, HLyland AL, Dramsdahl H, Kaaresen Pl. Acute osteomyelitis in children: a population-based retrospective study 1965 to 1994. Scand J Infect Dis. 1998; 30:573-77.
3. McCarthy JJ, Dormans JP, Kozin SH, Pizzutillo PD. Musculoskeletal infections in children. Basic treatment principles and recent advancements. J Bone Joint Surg.2004;86:850-63.
4. Blyth MJG, Kincaid R, Craigen MAC, Bennet GC. The changing epidemiology of acute and subacute haematogenous osteomyelitis in children. J Bone Joint Surg2001;83:99-102.
5. Stanitski CL. Changes in pediatric acute hematogenous osteomyelitis management. J Pediatr Orthop.2004;24:444-45.
6. Goergens ED, McEvoyA,Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health. 2005;41:59-62.
7. Hollmig ST, Copley LA, Browne RH, Grande LM, Wilson PL. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg. 2007;89:1517-23.
8. Crary SE, Buchanan GR, Drake CE, Journeycake JM . Venous thrombosis and thromboembolism in children with osteomyelitis. J Pediatr. 2006;149:537-41.
9. Van Boeckel T.P., Gandra S., Ashok A., Caudron Q., Grenfell B.T., Levin S.A., et al. Global antibiotic consumption 2000 to 2010: An analysis of national pharmaceutical sales data.Lancet Infect Dis. 2014;14:742–50.
10. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. The Lancet Infectious Diseases. 2013;13:1057–98.
11. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011;134:281–94.
12. Gordon JE, Wolff A, Luhmann SJ, Ortman MR, Dobbs MB, Schoenecker PL. Primary and delayed closure after open irrigation and debridement of septic arthritis in children. J PediatrOrthopB.2005;14:101-4.
13. Maraqa NF, Gomez MM, Rathore MH. Outpatient parenteral antimicrobial therapy in osteoarticular infections in children. J PediatrOrthop. 2002;22:506-10.
14. Perlman MH, Patzakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in paediatric patients. J PediatrOrthop. 2000;20:40-3.
15. Shirtliff ME, Mader JT. Acute septic arthritis. ClinMicrobiol Rev 2002;15:527-44.
16. Saavedra-Lozano J, Mejías A, Ahmad N, Peromingo E, Ardura MI, Guillen S, et al. J PediatrOrthop. 2008;28:569-75.
17. Pääkkönen M, Peltola H. Acute osteomyelitis in children. N EnglJMed. 2014;370:1365–66
18. Street M, Puna R , Huang M, Crawford H. . Pediatric acute hematogenous osteomyelitis. J PediatrOrthop. 2015;35:634–39.
19. Kiang KM, Ogunmodede F, Juni BA , Boxrud DJ, Glennen A , Bartkus JM et al. Outbreak of osteomyelitis/septic arthritis caused by Kingellakingae among child care center attendees. Pediatrics. 2005;116:e206–e213.
20. McIntosh N, Helms PJ, Smyth PRL, Logan S. Forfar &Arneil Textbook of Pediatrics. 7th International edition edition. Edinburgh; New York: Churchill Livingstone; 2008. 1808 p.
21. Barker A, Verhoeven K, Ahsan M, Alam S, Sharma P, Sengupta S, et al Id:25: Social Determinants of Patient Antibiotic Misuse in Haryana, India. J Investig Med. 2016; 64:935–935.
22. Yu F, Liu H, Li K, Lei G, Gao S, Chen Y, et al. Causative organisms and their antibiotic resistance patterns for childhood septic arthritis in china between 1989 and 2008. Orthopedics. 2011; 34:179.
23. Emily RD. Osteomyelitis and septic arthritis in children: current concepts.CurrOpinPediatr. 2013; 25:58–63.
24. Khatoon R, Khan SA, Jahan N. Antibiotic resistance pattern among aerobic bacterial isolates from osteomyelitis cases attending a Tertiary care hospital of North India with special reference to ESBL, AmpC, MBL and MRSA production. Int J Res Med Sci. 2017;5:482–90.
25. Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. Antimicrobial resistance in India: A review. J Nat SciBiol Med. 2013;4:286–91.
26. Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study. J Med AssocThailChotmaihetThangphaet. 2011;94:S209-216.
27. Stoesser N, Pocock J, Moore CE, Soeng S, Hor P, Sar P et al. The epidemiology of pediatric bone and joint infections in Cambodia, 2007-11. J Trop Pediatr. 2013;59:36–42.
28. Lavy CB. Septic arthritis in Western and sub-Saharan African children – a review. Int Orthop. 2007 Apr;31(2):137-44. doi: 10.1007/s00264-006-0169-9. Epub 2006 Jun 2. PMID: 16741731; PMCID: PMC2267558.

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.

References

[1] Ezeuko VC, Owah S, Ukoima HS, Ejimofor OC, Aligwekwe AU, Bankole L. Clinical study of the chronological changes in knee alignment pattern in normal south-east nigerian children aged between 0 and 5 years. Electron J Biomed. 2010;1:16–21.
[2] Gale Group. Knee deformities. Gale Encyclopedia of Medecine. The Gale Group; 2008.
[3] Houghton Mifflin Company. Genu varum. The American Heritage Medical Dictionary. Houghton Mifflin Company; 2007.
[4] Mathew SE, Madhuri V. Clinical tibiofemoral angle in south Indian children. Bone Jt Res. 2013 Aug;2(8):155–61.
[5] George HT. Angular deformities of the lower extremities in children. Chapman’s Orthopaedic Surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 4288–326.
[6] Cahuzac JP, Vardron D, Sales J. Development of the clinical tibiofemoral angle in normal adolescents: a study of 427 normal subjects from 10 to 16 years of age. J Bone Jt Surg. 1995 Sep;77B(5):729–32.
[7] Salenius P, Vankka E. The Development of the Tibio-femoral Angle in Children. J Bone Jt Surg. 1975;(57 A):259–61.
[8] Samia AA , Wafa BA. Normal Development of the Tibiofemoral Angle in Saudi Children from 2 to 12 Years of Age. World Appl Sci J. 2011;12(8):1353–61.
[9] Mahmoud KM, Alireza K, Zahra Y. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. J Med Sci. 2005;5:52–4.
[10] Heath CH, Staheli LT Normal limits of knee angle in white children genu varum and genu valgum. J Pediatr Orthop. 1993;(13):259–62.
[11] Cheng JC, Chan PS, Chiang SC, Hui PW. Angular and rotational profile of the lower limb in 2,630 Chinese children. J Pediatr Orthop. 1991 Apr;11(2):154–61.
[12] Ibrahima F, Pisoh T, Abolo ML, Sosso MA, Malonga EE. Déformations angulaires de genu varum/genu valgum chez l’enfant et l’adulte jeune : Revue préliminaire de 158 cas observés à Yaoundé. Médecine Afr Noire. 2002;49(4):169–75.
[13] Udoaka AI, Olotu J, Oladipo GS. The Prevalence of Genu Varum in Primary School Children in Port Harcourt, Nigeria. Sci Afr. 2012 Dec;11(2):115–7.
[14] Oginni LM, Badru OS, Sharp CA, Davie MW, Worsfold M. Knee angles and rickets in Nigerian children. J Pediatr Orthop. 2004;24:403–7.
[15] Singh O, Maheshwari TP, Hasan S, Ghatak S, Ramphal SK. A study of Tibiofemoral angle among Healthy Male Maharashtrian population. Int J Biomed Res. 2013;4(7):323–9.
[16] Ramin E, Seyed MM, Taghi B. Angular Deformities of the Lower Limb in Children. Asian J Sports Med. 2010 Mar;1(1):46–53.
[17] Sharrard WJ. Knock knees and bow legs. Br Med J. 1976;1:826–7.
[18] Mehmet A, Tunc¸ OC, Recep M. Normal Development of the Tibiofemoral Angle in Children: A Clinical Study of 590 Normal Subjects From 3 to 17 Years of Age. J Pediatr Orthop. 2001;21(2):264–7.
[19] Engel GM, Staheli LT. The natural history of torsion and other factors influencing gait in childhood. Clin Orthop. 1974;991:12–7.
[20] Thacher TD, Fischer PR, Tebben PJ, Ravinder J Singh, Cha SS, Maxson JA, et al. Increasing incidence of nutritional rickets: a population-based study in Olmsted County, Minnesota. Mayo Clinic Proceedings [Internet]. Elsevier; 2013.
[21] Echarrri JJ, Bazeboso JA, Gullen GF. Rachitic deformities of lower members in congolese children. An Sist Sanit Navar. 2008 Sep;31(3):235–40.
[22] Ahmed S. Methods in sample survey: Cluster Sampling. Johns Hopkins Bloomberg School of Public Health; 2009.
[23] William C. Sampling Techniques. 3rd Edition. New York: John Wiley & Sons; 1977. 233-290 p.
[24] Ross K. Sample design for educational survey research. Quantitative research methods in educational planning [Internet]. Paris, France: International Institute for Educational Planning/UNESCO; 2005. p. 17–25.
[25] Naing L, Winn T, Rusli B. Practical Issues in Calculating the Sample Size for Prevalence Studies. Arch Orofac Sci. 2006;1:9–14.
[26] Yoo JH, Cho TJ, Chung CY, Yoo WJ. Development of tibiofemoral angle in Korean children. J Korean Med Sci. 2008;23:714–7.
[27] Omololu B, Tella A, Ogunlade SO, Adeyemo AA, Adebisi A, Alonge TO, et al. Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children. West Afr J Med. 2003;22:301–4.
[28] Qureshi MA, Soomro MB, Jokhio IA. Normal limits of knee angle in Pakistani children. Prof Med J. 2000;7:221–6.
[29] Rahmani NF, Daneshmandi H, Irandoust KH. Prevalence of Genu Valgum in Obese and Underweight Girls. World J Sport Sci. 2008;1(1):27–31.
[30] Ibrahima F, Bernadette NN, Bahebeck J. A study of 2711 cases observed at the National Centre for the Rehabilitation of the Disabled of Yaoundé (Cameroon). Oral presentation presented at: Socot; 2014; Brazil.

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

References

[1]. Hedrich CM, Hofmann SR, Pablik J, et al. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol. 2013;11:47.
[2]. Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic ‘‘symmetrical’’ osteomyelitis. Ann Radiol 1972;15:329-42.
[3]. Probst FP, Björksten B, Gustavson KH. Radiological aspect of chronic recurrent multifocal osteomyelitis. Ann Radiol 1978;21:115–25.
[4]. Ertürk C, Altay MA, Aşkar H. Osteomiyelitin farklı klinik şekilleri. The different forms of osteomyelitis. TOTBİD Dergisi 2011;10:225-32.
[5]. Roderick MR, Shah R, Rogers V, Finn A, Ramanan AV. Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis. Pediatr Rheumatol Online J. 2016;14(1):47.
[6]. Jansson AF, Müller TH, Gliera L, et al. Clinical score for nonbacterial osteitis in children and adults. Arthritis Rheum. 2009;60(4):1152–9.
[7]. Fergusson PJ, Sandu M. Current understanding of the pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis. Curr Rheumatol Rep. 2012;14:130–41.
[8]. Girschick HJ, Raab P, Surbaum S, Trusen A, Kirschner S, Schneider P, et al. Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 2005;64:279-85.
[9]. Girschick HJ, Zimmer C, Klaus G, et al. Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol. 2007;3:733–8.
[10]. Oligbu G, Jacobs B, Khan T. The Dilemma of Chronic Recurrent Multifocal Osteomyelitis. Reumatol Clin. 2019;18:30235–3.
[11]. Wipff J, Adamsbaum C, Kahan A, et al. Chronic recurrent multifocal osteomyelitis. Jt Bon Spine. 2011;78:555–60.
[12]. Jansson A, Renner ED, Ramser J, et al. Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford). 2007;46(1):154–60.
[13]. Manson D, Wilmot DM, King S, et al. Physeal involvement in chronic recurrent multifocal osteomyelitis. Pediatr Radiol. 1989;20(1–2):76–9.
[14]. Beretta-Piccoli BC, Sauvain MJ, Gal I, et al. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in childhood: a report of ten cases and review of the literature. Eur J Pediatr. 2000;159:594–601.
[15]. Tronconi E, Miniaci A, Baldazzi M, et al. Biologic treatment for chronic recurrent multifocal osteomyelitis: report of four cases and review of the literature. Rheumatol Int. 2018 Jan;38(1):153–60.
[16]. Miettunen PM, Wei X, Kaura D, et al. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 2009;7(2).
[17]. Taddio A, Zennaro F, Pastore S, et al. An update on the pathogenesis and treatment of chronic recurrent multifocal osteomyelitis in children. Paediatr Drugs. 2017 Jun;19(3):165-72.
[18]. Marion R. Roderick, Ethan S. Sen and Athimalaipet V. Ramanan. Chronic recurrent multifocal osteomyelitis in children and adults: current understanding and areas for development. Rheumatology 2018;57:41 48.

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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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

1. Agarwal A, Aggarwal AN. Acute hematogenous osteomyelitis. In: Agarwal A, Aggarwal AN, editors. Pediatric osteoarticular infections. Delhi: Jaypee; 2014. p. 93-106.
2. Peterson HA. Physeal injury other than fracture. Heidelberg Dordrecht London New York: Springer; 2012.
3. Langenskiöld A. Growth disturbance after osteomyelitis of femoral condyles in infants. Acta Orthop Scand. 1984;55:1-13.
4. Morsy M, Sur YJ, Akdag O, Eisa A, El-Gammal TA, Lachman N, Moran SL. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg. 2018;71:33-43.
5. Scapinelli R. Studies on the vasculature of the human knee joint. Acta Anat (Basel). 1968;70:305-31.
6. Wirth T, Syed Ali MM, Rauer C, Süss D, Griss P, Syed Ali S. The blood supply of the growth plate and the epiphysis: a comparative scanning electron microscopy and histological experimental study in growing sheep. Calcif Tissue Int. 2002;70:312-9.
7. Damsin JP, Zambelli JY, Ma R, Roume J, Colonna F, Hannoun L. Study of the arterial vascularisation of the medial tibial condyle in the fetus. Surg Radiol Anat. 1995;17:13-7.
8. Hannouche D, Duparc F, Beaufils P. The arterial vascularization of the lateral tibial condyle: anatomy and surgical applications. Surg Radiol Anat. 2006;28:38-45.
9. Gutiérrez Carbonell P, Ruiz Piñana E, Valiente Valero JM. Intracapsular pressure in children with septic arthritis of the hip. J Pediatr Orthop B. 2021;30:80-4.
10. Kwack KS, Cho JH, Lee JH, Cho JH, Oh KK, Kim SY. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol. 2007;189:437-45.
11. Vidigal Júnior EC, Vidigal EC, Fernandes JL. Avascular necrosis as a complication of septic arthritis of the hip in children. Int Orthop. 1997;21:389-92.
12. Agarwal A, Rastogi P. Septic sequelae of hip in children: long-term clinicoradiological outcome study. J Pediatr Orthop B. 2021;30:563-71.
13. Wong VW, Bürger HK, Iorio ML, Higgins JP. Lateral femoral condyle flap: an alternative source of vascularized bone from the distal femur. J Hand Surg Am. 2015;40:1972-80.
14. Parvizi D, Vasilyeva A, Wurzer P, Tuca A, Lebo P, Winter R, et al. Anatomy of the vascularized lateral femoral condyle flap. Plast Reconstr Surg. 2016;137:1024e-1032e.
15. Hall RM. Regeneration of the lower femoral epiphysis; report of a case. J Bone Joint Surg Br. 1954;36:116-7.
16. Lloyd-Roberts GC. Suppurative arthritis of infancy. Some observations upon prognosis and management. J Bone Joint Surg Br. 1960;42:706-20.
17. Roberts PH. Disturbed epiphysial growth at the knee after osteomyelitis in infancy. J Bone Joint Surg Br. 1970;52:692-703.
18. Vizkelety TL. Partial destruction of the distal femoral epiphysis as a consequence of osteomyelitis: regeneration after transplantation of a bone graft. J Pediatr Orthop. 1985;5:731-3.
19. Singson RD, Berdon WE, Feldman F, Denton JR, Abramson S, Baker DH. “Missing” femoral condyle: an unusual sequela to neonatal osteomyelitis and septic arthritis. Radiology. 1986;161:359-61.
20. Tercier S, Siddesh ND, Shah H, Girisha KM, Joseph B. Loss of a condyle of the femur or tibia following septic arthritis in infancy: problems of management and testing of a hypothesis of pathogenesis. J Child Orthop. 2012;6:319-25.
21. Strong M, Lejman T, Michno P, Hayman M. Sequelae from septic arthritis of the knee during the first two years of life. J Pediatr Orthop. 1994;14:745-51.
22. O’Grady A, Welsh L, Gibson M, Briggs J, Speirs A, Little M. Cadaveric and angiographic anatomical considerations in the genicular arterial system: implications for genicular artery embolisation in patients with knee osteoarthritis. Cardiovasc Intervent Radiol. 2022;45:80-90.
23. Montgomery CO, Siegel E, Blasier RD, Suva LJ. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop. 2013;33:464-7.
24. Perlman MH, Patzakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric patients. J Pediatr Orthop. 2000;20:40-3.

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.
2. Orimolade EA, Ikem IC, Akinyoola AL, Adegbehingbe OO, Oginni LM, Esan O. Pattern of Congenital Musculoskeletal Abnormalities in South West, Nigeria: A Hospital Based Study. Niger J Orthop Trauma. 2013;12(1):52–5.
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.
5. Matos MA, de Oliveira LAA. Comparison between Ponseti’s and Kite’s clubfoot treatment methods: a meta-analysis. J Foot Ankle Surg. 2010;49(4):395–7.
6. Segev E, Keret D, Lokiec F, Yavor A, Wientroub S, Ezra E, et al. Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot. Isr Med Assoc J. 2005;7(5):307–10.
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

1. Morris BS, Varma R, Garg A, Awasthi M, Maheshwari M. Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography. Skeletal Radiol 2002;31:1-8.
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.
3. Chandane PG, Shah I, Mehta R, Jadhao N. Isolated scapular involvement: uncommon presentation of childhood tuberculosis. Oxford Medical Case Reports. 2016 Aug 1;2016(8).
4. Tripathy SK, Sen RK, Sharma A, Tamuk T. Isolated cystic tuberculosis of scapula: case report and review of literature. J Orthop Surg Res 2010;5:72.
5. Shannon FB, Moore M, Houkom JA, Waecker NJ. Multifocal cystic tuberculosis of bone. Report of a case. J Bone Joint Surg Am 1990;72:1089–92.
6. Greenhow TL, Weintrub PS. Scapular mass in an adolescent. Pediatr Infect Dis J 2004;23:84–5.
7. Husen YA, Nadeem N, Aslam F, Shah MA. Tuberculosis of the scapula. J Pak Med Assoc 2006;56:336–8.
8. Balaji G, Arockiaraj J, Cyril Roy A, Ashok A. Isolated tubercular osteomyelitis of scapula – a report of two cases and review of literature. J Orthop Case Rep 2013;3:7–11.
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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