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Journal of Children's Orthopaedics

M van der Merwe, K Rooks, H Crawford, C M A Frampton, M J Boyle
Purpose: To assess the influence of antibiotic timing on surgical culture yield in paediatric patients with haematogenous osteoarticular infection. Methods: All patients aged 0 to 15 years admitted to a National Children's Hospital with the diagnosis of acute, haematogenous, osteoarticular infection (osteomyelitis and/or septic arthritis) between June 1997 and December 2016 were retrospectively analyzed. Only patients with positive blood cultures undergoing surgery for culture and debridement were included...
February 1, 2019: Journal of Children's Orthopaedics
D M Knapik, H D Archibald, K K Xie, R W Liu
Purpose: The variables causing symptomatic accessory navicular are largely unknown and may inform management of symptomatic patients. The purpose of this study was to examine patient specific factors associated with the development of accessory navicular symptoms. Methods: A total of 71 patients with clinical and radiographic evidence of accessory navicular syndrome were evaluated. Patient gender, race, date of birth, date of earliest foot complaint and laterality were recorded...
February 1, 2019: Journal of Children's Orthopaedics
D Barbier, D N'Dele, M Bennis, C Thevenin-Lemoine, J Sales De Gauzy, F Accadbled
Purpose: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. Methods: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy...
February 1, 2019: Journal of Children's Orthopaedics
A-M Wu, G Li, J-W Zheng, C-H Chen, D Chen, Z-G Qiao, J-G Zhao, B Wang, W-L Fu, S-R Sheng, Y-S Wu, N-F Tian, Z-K Lin, H Xu
Purpose: The aims of present study are to clarify the follow questions: 1) what constitutes paediatric chondrosarcoma?; 2) what are the effects of the demographic and tumour characteristics on survival in patients with paediatric chondrosarcoma?; 3) which prognostic factors of paediatric chondrosarcoma differ from those of the adult population, which have been reported previously? Methods: Paediatric patients who were diagnosed with chondrosarcoma were searched for using the case listing session protocol of the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 databases (1973 to 2014)...
February 1, 2019: Journal of Children's Orthopaedics
K Jamil, T Walker, E Onikul, C F Munns, D G Little
Purpose: Perthes' disease (PD) results from loss of blood supply to the hip and can progress to femoral head deformity. MRI in the early course of the disease can provide data on the initial extent of infarct. Vascularity of the femoral head is assessed by gadolinium-enhanced MRI (contrast MRI), which may be improved by the digital subtraction technique (subtraction MRI). We hypothesized that gadolinium-enhanced MRI without subtraction was comparable with subtraction MRI in depicting the femoral head perfusion...
February 1, 2019: Journal of Children's Orthopaedics
J Y Zhou, E Lowe, K Cahill-Rowley, G B Mahtani, J L Young, J Rose
Purpose: Spastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP. Methods: The relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years...
February 1, 2019: Journal of Children's Orthopaedics
G A Schmale, A F Bayomy, A O O'Brien, V Bompadre
Purpose: Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction. Methods: A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs...
February 1, 2019: Journal of Children's Orthopaedics
H H Eltayeby, C A Iobst, J E Herzenberg
Purpose: When using tension band plates for angular deformity correction, the literature is unclear regarding the most effective screw insertion angle to use. This study evaluates the correlation between initial screw angle and the average rate of correction during hemiepiphysiodesis using tension band plates. Methods: This retrospective study includes 35 patients (47 physes) with genu valgum deformity (17 idiopathic and 18 fibular hemimelia) who underwent insertion of Eight-Plates between 2010 and 2015...
February 1, 2019: Journal of Children's Orthopaedics
S Kenney, J Schlechter
Purpose: Fluoroscopy is commonly used to confirm acceptable position of percutaneously placed pins when treating paediatric fractures. There is a paucity of literature investigating the accuracy of fluoroscopic imaging when determining pin position relative to the far cortex of the fixated bone. The purpose of this study was to evaluate the accuracy of fluoroscopic and radiographic imaging in measuring smooth pin protrusion from the far cortex of a bone model. Methods: Eight bone models were implanted with smooth pins and anteroposterior fluoroscopic and radiographic studies were obtained...
February 1, 2019: Journal of Children's Orthopaedics
W Zhou, F Canavese, L Zhang, L Li
Purpose: To quantitatively evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) in children with transphyseal fracture of the distal humerus (TFDH) treated surgically. Methods: During the period between 2005 and 2015, a total of 16 patients (ten male, six female) met the inclusion criteria. Mean age at the time of injury was 18 months (11 to 37) and mean follow-up was 42.3 months (6 to 98). Based on a modified version of Delee's classification (Group A to C), the clinical and radiographic outcome of TFDH in toddlers treated surgically were retrospectively evaluated...
February 1, 2019: Journal of Children's Orthopaedics
A J Saarinen, I Helenius
Purpose: The effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared. Methods: A retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications...
February 1, 2019: Journal of Children's Orthopaedics
A Fontalis, K Hughes, M P Nguyen, M Williamson, A Yeo, D Lui, Y Gelfer
Purpose: The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. Methods: A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures...
February 1, 2019: Journal of Children's Orthopaedics
R M Castelein, C Hasler, I Helenius, D Ovadia, M Yazici
The severity of osteogenesis imperfecta (OI), the associated reduced quality and quantity of collagen type I, the degree of bone fragility, ligamentous laxity, vertebral fractures and multilevel vertebral deformities all impair the mechanical integrity of the whole spinal architecture and relate to the high prevalence of progressive kyphoscoliotic deformities during growth. Bisphosphonate therapy may at best slow down curve progression but does not seem to lower the prevalence of deformities or the incidence of surgery...
February 1, 2019: Journal of Children's Orthopaedics
T Wirth
Purpose: Diseases such as osteogenesis imperfecta, fibrous dysplasia, hypophosphataemic rickets and others lead to soft and weak bones and long bone deformity in affected patients. As a consequence, these patients lose their walking capacity and functional abilities of the upper extremities as well. Methods: In combination with bisphosphonate treatment and physical rehabilitation programmes surgical interventions are being applied to correct and stabilize the deformed and less mechanically resistant long bones...
February 1, 2019: Journal of Children's Orthopaedics
W H Nijhuis, D M Eastwood, J Allgrove, I Hvid, H H Weinans, R A Bank, R J Sakkers
The majority of patients with osteogenesis imperfecta (OI) have mutations in the COL1A1 or COL1A2 gene, which has consequences for the composition of the bone matrix and bone architecture. The mutations result in overmodified collagen molecules, thinner collagen fibres and hypermineralization of bone tissue at a bone matrix level. Trabecular bone in OI is characterized by a lower trabecular number and connectivity as well as a lower trabecular thickness and volumetric bone mass. Cortical bone shows a decreased cortical thickness with less mechanical anisotropy and an increased pore percentage as a result of increased osteocyte lacunae and vascular porosity...
February 1, 2019: Journal of Children's Orthopaedics
Y Camurcu, H Sofu, H Ucpunar, S Duman, A Cobden
Purpose: Some famous artistic representations created throughout the centuries can reveal a hidden or mysterious diagnosis of some diseases and these paintings have always drawn the attention of physicians interested in art. Artistic illustration of a child with a malformation or disability can reflect the characteristic appearance of a disease and its historic perspective. Some articles have revealed the definite diagnosis of a child with achondroplasia through portraits of dwarfs and some studies have discussed the secret diagnosis of a crippled child with Pes Equinovarus or poliomyelitis...
December 1, 2018: Journal of Children's Orthopaedics
A B Siy, L A Lins, J S Dahm, J T Shaw, N M Simske, K J Noonan, P S Whiting
Purpose: Orthopaedic residents are increasingly seeking international health electives (IHEs) during training, many of which involve providing paediatric orthopaedic care. However, little is known about the availability of IHEs during orthopaedic fellowship training. Our study sought to assess the global health opportunities available to North American paediatric orthopaedic fellows. Methods: We conducted an online, REDCap-based survey of paediatric orthopaedic fellowship programme directors (PDs) in the United States and Canada...
December 1, 2018: Journal of Children's Orthopaedics
K E Bugler, M S Gaston, J E Robb
Purpose: The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. Methods: Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals...
December 1, 2018: Journal of Children's Orthopaedics
W-C Lee, H-K Kao, W-E Yang, C-H Chang
Purpose: Little data is available on the efficiency of different implants for epiphysiodesis. The purpose of this study is to compare the efficacy between plates and staples in decreasing leg-length discrepancy. Methods: A retrospective review of 19 children who underwent temporary epiphysiodesis of the legs was conducted, with a minimum of two years of follow-up. The bone length and length ratio to the short side were measured at six months, one year and two years postoperatively...
December 1, 2018: Journal of Children's Orthopaedics
R F Gibly, T Shomaker, V Bompadre, S E Steinman
Purpose: Paediatric hand injuries are a frequent reason for acute medical evaluation. Previous studies have reported only fracture rates, surgical injuries or are limited to database diagnosis coding. The average fracture rates and injury distributions across the hand for all mechanical injuries have not been well-described. Methods: We performed a retrospective review of all emergent/urgent care visits over 18 months at a US paediatric tertiary hospital with hand injuries recorded anywhere in the encounter...
December 1, 2018: Journal of Children's Orthopaedics
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