Pediatric Orthopaedics Journal Scan

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Proximal femoral geometry before and after varus rotational osteotomy in children with cerebral palsy and neuromuscular hip dysplasia.

J Pediatr Orthop. 2013 Mar;33(2):182-9

Authors: Davids JR, Gibson TW, Pugh LI, Hardin JW

Abstract
BACKGROUND: Surgical management of hip dysplasia in children with cerebral palsy (CP) usually includes varus rotational osteotomy (VRO) of the proximal femur. Several techniques of VRO (end-to-end, EE; end-to-side, ES) have been designed to maximize correction and minimize associated deformities. The goals of the current study were to establish the prevalence and contribution of caput valgum to coxa valga deformity in children with CP, compare the geometry of the proximal femur after EE and ES techniques of VRO, and document the response of the proximal femur to subsequent growth after VRO.
METHODS: The records of 75 children with CP (Gross Motor Function Classification System, levels IV and V) with 137 surgically treated hips were retrospectively reviewed. Outcomes were limited to the technical domain (eg, radiographic measurements and surgical complications). Measurements made for each hip (preoperative, operative, and follow-up) included the neck-shaft angle (NSA), head-shaft angle (HSA), and the medialization index.
RESULTS: The mean age at the time of surgery was 7 years. The mean

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Unilateral hip reconstruction in children with cerebral palsy: predictors for failure.

J Pediatr Orthop. 2013 Mar;33(2):175-81

Authors: Shukla PY, Mann S, Braun SV, Gholve PA

Abstract
BACKGROUND: Unilateral hip reconstruction in patients with cerebral palsy can be complicated by contralateral subluxation and ipsilateral failure. We sought to identify predictors for failure after unilateral reconstruction in patients with GMFCS IV-V CP with unilateral hip involvement.
METHODS: We performed an IRB-approved retrospective study on GMFCS IV-V CP patients with unilateral hip reconstruction at a minimum 2-year follow-up. Radiologic data included acetabular index, femoral migration index (FMI), lateral center edge angle (LCE), and pelvic obliquity. The effects of age, sex, pelvic obliquity, scoliosis surgery, and contralateral hip soft-tissue release at the index surgery were analyzed for ipsilateral hip failure and contralateral hip subluxation. Statistical analysis was performed using the χ and t tests.
RESULTS: There were 35 patients (M:F, 23:12) with mean age of 110 months (range, 45 to 215 mo) with mean follow-up of 60.5 months (range, 24 to 129 mo). The mean preoperative ipsilateral hip FMI was 60% (range, 40% to 100%) and the mean LCE was -16.7 degrees (range, -85 to 17.2 degrees). Contralateral soft-tissue release was

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Correction of spine deformity in patients with Melnick-needles syndrome: report of 2 cases and literature review.

J Pediatr Orthop. 2013 Mar;33(2):170-4

Authors: Lykissas MG, Crawford AH, Shufflebarger HL, Gaines S, Permal V

Abstract
BACKGROUND: Melnick-Needles syndrome (MNS) is a rare X-linked dominant disorder affecting the skeletal system and connective tissue. To date, < 70 cases with MNS have been documented. Although few reports in the literature have shown that these patients might develop kyphoscoliosis, there is no report regarding long-term follow-up of patients with MNS undergo spine surgery. The aim of this study is to describe 2 unique cases of MNS with long-term follow-up after instrumented posterior spinal fusion, multiple-level Ponte osteotomies, and pedicle subtraction osteotomies.

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Interobserver variability using a commercially available system of archived digital radiography with integrated computer-assisted measurements for scoliosis Cobb angles.

J Pediatr Orthop. 2013 Mar;33(2):163-9

Authors: Hardesty CK, Aronson J, Aronson EA, Ranade AS, McCracken CW, Nick TG, Cordell CL

Abstract
BACKGROUND: The purpose of this study was to determine if digital enhancements could improve upon published and interobserver variability for Cobb angle measurements of idiopathic scoliosis using a commercially available PACS system. The study also sought to determine if experience of the observer affected overall variability and to evaluate the time required to measure Cobb angles using 3 different techniques. As the decision for scoliosis treatment requires serial radiographic measurements by 1 or more observers at different times, precise landmark identification and curve measurement should decrease variability and improve accuracy.

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Prevalence of hypovitaminosis D among children with upper extremity fractures.

J Pediatr Orthop. 2013 Mar;33(2):159-62

Authors: James JR, Massey PA, Hollister AM, Greber EM

Abstract
BACKGROUND: Recent publications show a high rate of hypovitaminosis D among children in general as well as among children with fractures. 25-hydroxyvitamin D levels were analyzed from hospital records to determine the prevalence of hypovitaminosis D, with the goal of using that information in fracture management and nutritional counseling.
METHODS: We retrospectively reviewed the records of 213 children with upper extremity fractures that were treated during a 14-month period. For 181 of those patients, the 25-hydroxyvitamin D level was measured at the time of emergency department presentation or at the first clinic appointment within 2 weeks after the initial presentation. The following information was collected from the charts: fracture mechanism (high or low energy), age, sex, race, and body mass index. Vitamin D levels were categorized as normal (≥ 32 ng/mL), insufficient (20 to 32 ng/mL), or deficient (< 20 ng/mL). The levels were analyzed with respect to fracture pattern and race.

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Ultrasound in pediatric peripheral nerve injuries: can this affect our surgical decision making? A preliminary report.

J Pediatr Orthop. 2013 Mar;33(2):152-8

Authors: Lee J, Bidwell T, Metcalfe R

Abstract
BACKGROUND: The treatment of closed fractures with associated peripheral nerve palsy is controversial. Traditionally, the nerve palsy is managed with watchful waiting and subsequent neurophysiological studies if no improvement is seen within 4 months. This may not be necessary if nerve integrity can be imaged acutely with ultrasound scan. We present a case series of pediatric patients with closed upper limb injuries and associated peripheral nerve palsy who underwent ultrasound scanning to assess nerve integrity.
METHODS: A retrospective review of patients attending Starship Children's Hospital between May 2008 and April 2010 with closed upper limb injuries and associated peripheral nerve palsy was undertaken. Those patients up to and including the age of 14 years (skeletally immature) with complete clinical records available were included.

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Pediatric nonaccidental injury: are orthopedic surgeons vigilant enough?

J Pediatr Orthop. 2013 Mar;33(2):145-51

Authors: Tenenbaum S, Thein R, Herman A, Chechik O, Shazar N, Zur S, Ganel A

Abstract
BACKGROUND: Nonaccidental pediatric injuries are major cause of morbidity and mortality, with fractures being second to soft-tissue injuries as the most common presentation. As the orthopedic surgeon might be the only physician an abused child would encounter, the role of the orthopedic surgeon is of great importance. It includes recognition, treatment, and appropriate report of suspected child abuse. The purpose of this study is to examine the attitude and knowledge of orthopedic surgeons treating suspected nonaccidental injuries.
METHODS: Evaluation of orthopedic surgeons included level of knowledge regarding pediatric nonaccidental injury, common practice, and reporting attitudes to Child Protection Services. We specifically examined whether seniority and professional experience had effect on knowledge and performance. Data were collected by a questionnaire distributed to orthopedic surgeons.
RESULTS: The study cohort includes 130 orthopedic surgeons. As much as 62.3% of participating physicians had 10 years or less experience practicing as orthopedic surgeons, and 37.7% had more than 10 years of experience. A mean of

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Gait findings in the adolescent subject with a stiff hip.

J Pediatr Orthop. 2013 Mar;33(2):139-44

Authors: Gordon AB, McMulkin ML, Tompkins B, Caskey P, Baird GO

Abstract
BACKGROUND: Adolescent subjects with severe unilateral hip disease are often stiff and painful yet have limited surgical options. Although hip fusion has been used successfully to minimize pain, acquired gait compensations after arthrodesis are factors felt to lead to knee and back pain over time. However, these gait compensations may already be present in a person with a stiff hip. The purpose of this study was to describe the quantitative gait findings of the adolescent subject with a unilateral stiff hip and to determine whether these findings are similar to those of subjects presenting after arthrodesis.
METHODS: This study was a retrospective review of 6 subjects seen in a motion analysis laboratory between 2005 and 2009 (age 13 to 17 y). All adolescents had been referred to the motion analysis laboratory for a routine clinical gait study. Subjects were selected for this study based on kinematic sagittal plane hip motion found to be < 25 degrees (mean 16.2 degrees). Diagnoses included: Legg-Calvé-Perthes (3) and hip avascular necrosis (3).

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Oblique in situ screw fixation of stable slipped capital femoral epiphysis.

J Pediatr Orthop. 2013 Mar;33(2):135-8

Authors: Gourineni P

Abstract
BACKGROUND: Percutaneous in situ single screw fixation is the preferred treatment for stable slipped capital femoral epiphysis. The recommended screw placement is in the center of the epiphysis and perpendicular to the physis. We reviewed the results of in situ fixation with the screw placed oblique to the physis.
METHODS: Thirty-six stable slips were treated with a modified technique. The screw was started as close to the mid lateral cortex of the proximal femur as possible while maintaining the screw anterior to the posterior cortex of the femoral neck and ending at the apex of the epiphysis ignoring the resultant angle to the physis. Thirty-five of these hips were followed till physeal closure.
RESULTS: Thirty-five of the 36 hips showed physeal closure at an average of 5 months. There were no screw-related complications or symptoms. The oblique screw path allowed for an extra screw thread to be placed in the epiphysis and also allowed adequate femoral neck osteoplasty.
CONCLUSIONS: Oblique placement of the screw for in situ fixation in stable slipped capital femoral epiphysis did not cause any deleterious effects and offered several potential advantages.