Pediatric Orthopaedics Journal Scan

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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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A prospective comparison of computer-navigated and fluoroscopic-guided in situ fixation of slipped capital femoral epiphysis.

J Pediatr Orthop. 2013 Mar;33(2):128-34

Authors: Bono KT, Rubin MD, Jones KC, Riley PM, Ritzman TF, Schrader WC, Fleissner P, Steiner RP, Morscher MA, Adamczyk MJ

Abstract
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is usually treated with percutaneous in situ screw fixation to prevent further progression of deformity. The purpose of this investigation is to compare computer navigation (CN) techniques with traditional fluoroscopic (fluoro) techniques for in situ fixation of SCFE.

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Management of Legg-Calvé-Perthes disease using an A-frame orthosis and hip range of motion: a 25-year experience.

J Pediatr Orthop. 2013 Mar;33(2):112-9

Authors: Rich MM, Schoenecker PL

Abstract
BACKGROUND: Containment treatment is widely accepted in the management of Legg-Calvé-Perthes disease. Many reports indicate the need to regain hip motion before pelvic or femoral osteotomy, but have not indicated how osteotomy affected motion. Recent studies have suggested that osteotomy treatment of lateral pillar B hips may result in a higher proportion of spherical hips than those managed nonoperatively; however, outcomes for children older than 8 years of age or with pillar C involvement remain unsatisfactory.

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Demographic differences in adolescent-diagnosed and adult-diagnosed acetabular dysplasia compared with infantile developmental dysplasia of the hip.

J Pediatr Orthop. 2013 Mar;33(2):107-11

Authors: Lee CB, Mata-Fink A, Millis MB, Kim YJ

Abstract
BACKGROUND: Acetabular dysplasia is a common cause of hip pain that can lead to premature osteoarthritis. This study explores whether demographic characteristics of patients diagnosed with acetabular dysplasia in adolescence and adulthood [adult-diagnosed dysplasia (AD)] differ from those who are diagnosed with developmental dysplasia of the hip (DDH) in infancy.
METHODS: Database review identified 633 patients undergoing periacetabular osteotomy for dysplasia from August 1991 to January 2008. Excluding patients with syndromal conditions and 80 lacking contact information, 421 patients received a questionnaire regarding birth and family history; 324 (70.3%) completed the survey. Thirteen were excluded because of unrelated hip conditions, leaving 311 patients for analysis.
RESULTS: Respondents were divided into 2 groups according to whether they had a history of DDH in infancy (102 patients) or were diagnosed in adolescence/adulthood (209 patients). Statistically significant differences (P < 0.05) were found in sex distribution (female: DDH = 98.0%, AD = 88.0%), affected limb

Sitting Sagittal Balance is Different From Standing Balance in Children With Scoliosis.

J Pediatr Orthop. 2013 Aug 20;

Authors: Vaughn JJ, Schwend RM

Abstract
BACKGROUND:: Several variables can have effect on sagittal balance. The changes that occur between standing and sitting have been inadequately studied, especially in the, pediatric population.
METHODS:: Preoperative sagittal radiographs were obtained in both standing and sitting positions for 26 patients with idiopathic scoliosis before spinal fusion and instrumentation. Standard measurements of thoracic kyphosis, lumbar lordosis, sacral slope (SS), pelvic incidence, pelvic tilt, and lumbar intervertebral angles were, recorded. Differences were compared between positions using 2-sided paired t tests.
RESULTS:: When moving from standing to a seated position, the spine loses 5-degree thoracic kyphosis (P=0.007), 29-degree lumbar lordosis (P<0.0001), and the sacrum rotates 20 degrees (P<0.0001) to a more vertical position. The greatest change in sitting sagittal balance occurs due to increased pelvic tilt with decreased SS. The next greatest change is increased forward flexion of the lowest 2 lumbar vertebrae, 6.5 degrees between L4-L5 (P<0.0001) and 5.9 degrees between L5-S1 (P<0.0001). Flexion occurs throughout the lumbar spine but its magnitude decreases in the more proximal lumbar segments, 1.6 degrees between L1-L2 (P=0.028). The sagittal vertical axis also moves more anterior by 44 mm (P<0.0001).

Distal Humerus Atrophic Nonunion in a Child With Osteogenesis Imperfecta.

J Pediatr Orthop. 2013 Aug 20;

Authors: Hsiao CM, Mormino MA, Esposito PW, Burke BA

Abstract
Atrophic nonunion of the distal humerus in children with osteogenesis imperfecta is a vexing and disabling problem. Traditional treatments, including casting, intramedullary nailing, plating and bone grafting have not been universally successful. We report on a case of successful treatment of one atrophic nonunion of the distal humerus in ad 2 year 10 month old child with type III OI who had failed more traditional treatments. The treatment used a combination of telescoping intramedullary nails, locking plate fixation and bone morphogenic protein.Level of Evidence: Level IV.

PMID: 23965914 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23965914?dopt=Abstract

Chronic Exertional Compartment Syndrome of the Forearm in Adolescents.

J Pediatr Orthop. 2013 Aug 20;

Authors: García-Mata S

Abstract
PURPOSE:: Chronic exertional compartment syndrome (CECS) is a well-known process, although rare in the forearm. The diagnosis is based on history, clinical examination, and compartment pressure readings. My objective is to present the largest series of CECS of the forearm in adolescents and describe my experience in its management and evolution.
METHODS:: I reviewed 5 patients, 4 male (competing in motorcycling or motocross) and 1 female (CECS in both the legs and forearms), aged between 15 and 18 years. Volar and dorsal compartments were affected in 3 patients and isolated volar in 2 cases. The clinical diagnosis was objectively confirmed by measuring ICP with a low-pressure digital transducer (Stryker).
RESULTS:: Open fasciotomy was carried out in 4 patients. They resumed their athletic activities 6 weeks after surgery without complications, increasing their athletic performance level in line with their preoperative status. All these patients remained asymptomatic, recovering their previous competitive levels. The results were objectively classified as excellent in all 4 cases. After a mean follow-up of 6 years, the condition has not relapsed in any of the patients. Two of the patients agreed to a new ICP measurement 1 year after the surgery, showing normal values.

Positive Communication Paradigm Decreases Early Recurrence in Clubfoot Treatment.

J Pediatr Orthop. 2013 Aug 20;

Authors: Morin ML, Hoopes DM, Szalay EA

Abstract
BACKGROUND:: The Ponseti method has become the treatment standard for idiopathic clubfoot. Deformity recurrence is most commonly attributed to premature abandonment of the requisite abduction orthosis. A study in 2009 from our center revealed a high rate of deformity recurrence in our patient population. It was surmised that the importance of bracing to maintain correction had not been adequately communicated to some families, especially Native Americans. As a result, the principal investigator developed a different communication protocol for parents of infants.
METHODS:: All children treated for clubfoot at the University of New Mexico Carrie Tingley Hospital, Albuquerque, NM, from 2008 to 2010 were reviewed. They were compared with a historical control group from this institution, the subjects of the 2009 study, and were analyzed for the rate of recurrence and Pirani score improvement.
RESULTS:: Our study cohort comprised 69 infants (104 clubfeet), all of whom were treated with the new communication style. The recurrence rate for the new communication paradigm was 2.88% compared with 18.2% in the control group (P<0.001). The Pirani score improvement was 4.0 in the treatment group compared with 3.5 in the control group (P=0.001). Native American recurrence was zero in the treatment group and 41% in the control group (P=0.011).

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Corticosteroids can reduce the severity of scoliosis in Duchenne muscular dystrophy.

J Bone Joint Surg Am. 2013 Jun 19;95(12):e86

Authors: Connolly AM, Kim HJ, Bridwell KH

PMID: 23783217 [PubMed - indexed for MEDLINE]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23783217?dopt=Abstract