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- Gelink, Andrés, et al.
(författare)
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Valgus slipped capital femoral epiphysis : Presentation, treatment, and clinical outcomes using patient-reported measurements
- 2021
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Ingår i: Journal of Pediatric Orthopaedics Part B. - 1060-152X .- 1473-5865. ; 30:2, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- Valgus slipped capital femoral epiphysis (SCFE), is rare. This study describes the diagnosis, treatment and outcome of valgus SCFE in Uruguay. The medical records and radiographs were reviewed in eight consecutive children [mean age 11.9 years (range 9-13; six female)] with valgus SCFE between 1997-2017. In 2018-2019, all patients were reexamined clinically, new radiographs obtained, and patient-reported outcomes completed using the international tool of hip results (iHOT-12). The prevalence of clinical femoroacetabular impingement (FAI), avascular necrosis, and surgical complications were also studied. There were 11 valgus SCFEs in eight patients; two had primary bilateral SCFEs, and one child later developed a valgus SCFE in the contralateral hip. Seven out of eight patients were overweight. All were stable idiopathic SCFEs. The mean femoral head shaft angle on the anteroposterior radiographs for the 11 SCFEs was 145° (range 140-168) and 141° (range 139-145) for the six healthy contralateral hips. Slip severity measured on the Lauenstein projection was mild (<30°) in eight hips and moderate (30°-60°) in three hips. At a mean follow-up of 87 months (range 24-252), there were no cases of avascular necrosis. The mean iHOT12 was 74 (range 13-97). Significant remodeling was detected in both head shaft angle (8°) and alpha angle (10°) in the affected hips. Nine hips (81%) demonstrated clinical signs of FAI. Our study is the first to describe long-term results using both clinical and patient outcome measures (iHOT-12). A majority of patients have residual symptoms, likely associated with FAI.
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- Hailer, Yasmin, 1972-, et al.
(författare)
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Agreement of radiographic measurements and patient-reported outcome in 61 patients with Legg-Calvé-Perthes disease at mean follow-up of 28 years
- 2019
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Ingår i: Journal of pediatric orthopedics. Part B. - 1060-152X .- 1473-5865. ; 28:2, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear how patient-reported outcome in patients with Legg-Calvé-Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. At a mean follow-up of 28 years (15-42), 61 patients were investigated clinically and by plain radiography to evaluate the sphericity deviation score, femoral head enlargement and femoral neck growth inhibition. The patients also completed questionnaires for generic measures of health-related quality-of-life (ED-5D, EQ-visual analogue scale), the joint-specific Harris hip score and the nonarthritic hip score questionnaire. The radiographic measures sphericity deviation score, femoral head enlargement and femoral neck growth inhibition were strongly correlated with the joint-specific PROMs (Harris hip score and nonarthritic hip score) but not with EQ-5D and EQ-visual analogue scale. Inferior range of flexion and abduction and a positive Trendelenburg sign were associated with an inferior patient-reported outcome. Our findings highlight the importance of supporting femoral head re-modelling and containment and balancing trochanteric and femoral neck growth in patients with LCPD. To capture the whole picture of the outcome after LCPD, future studies should include a combination of radiographic measurements and joint-specific and generic outcome scores. Level of Evidence: Level III.
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- Hägglund, Gunnar, et al.
(författare)
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Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity
- 2005
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Ingår i: Journal of Pediatric Orthopedics. Part B. - 1473-5865. ; 14:4, s. 269-273
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Tidskriftsartikel (refereegranskat)abstract
- During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CID register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P=0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated.
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- Juréus, Jan, et al.
(författare)
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Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes.
- 2016
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Ingår i: Journal of Pediatric Orthopedics. Part B. - 1473-5865. ; 25:1, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with scintigraphy and all children had been followed radiographically for a minimum of 1 year. The Ficat classification was used to stage the AVN and the Stulberg classification was used to stage the sphericity of the femoral head at follow-up. In two patients, the femoral head had normal circulation postoperatively and they also had normal radiographs at follow-up. In two patients, the entire femoral head was avascular postoperatively and at follow-up, one patient had normal radiographs and one had both subchondral sclerosis and flattening. These two patients had been treated with bisphosphonates and prolonged non-weight-bearing. Four patients had postoperatively retained circulation in parts of the femoral head. Three of these four patients had normal radiographs at follow-up. Evaluation of the remaining circulation after surgery may help to predict the outcome and guide the postoperative regime in children with a femoral neck fracture.
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- Lohle-Akkersdijk, Jacqueline J, et al.
(författare)
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Walking capacity of children with clubfeet in primary school: something to worry about?
- 2015
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Ingår i: Journal of Pediatric Orthopedics. Part B. - 1473-5865. ; 24:1, s. 18-23
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Tidskriftsartikel (refereegranskat)abstract
- Although the main aim of clubfoot correction is to create a foot without limitations in daily activities and sport, studies on the walking capacity of children with corrected clubfeet are rare. In this cross-sectional study, the outcome of the six-minute walking test in 44 children with clubfeet (16 unilateral and 28 bilateral, mean age 8.57±2.45 years) was compared with the reference values of Geiger, clinical status measured with the Clubfoot Assessment Protocol (CAP), and regression analysis used to calculate which CAP subgroup predicts walking capacity. The mean walking capacity was decreased to 79% (P<0.001) and was not influenced by unilaterality or bilaterality (P=0.437). The subgroup CAP morphology was a significant predictor (R=0.103; P=0.034). Knowing that walking capacity is only slightly decreased can help adjust expectations and set goals for training.
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- Lyman, Amanda, et al.
(författare)
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Pediatric diaphyseal forearm fractures: epidemiology and treatment in an urban population during a 10-year period, with special attention to titanium elastic nailing and its complications.
- 2016
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Ingår i: Journal of Pediatric Orthopedics. Part B. - 1473-5865.
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to describe the epidemiology of pediatric diaphyseal forearm fractures in an urban population and the complications of titanium elastic nailing. The medical records of 456 consecutive fractures were reviewed. The annual incidence was 0.7/1000 children. Eighty-six (19%) fractures in 83 children were titanium elastic nailed. The complication rate was 24%. Dorsal entry to the radius was associated with extensor pollicis longus rupture and radial entry was associated with sensory nerve deficit in three cases each. Seventy-eight (94%) of the operated patients recovered completely. Titanium elastic nailing is effective, but associated with a high rate of complications, most of which resolve spontaneously.
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- Malmvik, J, et al.
(författare)
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Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up
- 2003
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Ingår i: Journal of Pediatric Orthopedics. Part B. - 1473-5865. ; 12:1, s. 63-68
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-four individuals, who were 16 years of age or younger when they sustained a fracture of the radial head or neck, were examined at a mean of 19 years (range 14-25 years) after injury. The 12 girls and 12 boys were a mean age of 11 years (range 5-16 years) when the fracture was sustained. Two were excluded due to late resection of the radial head following persisting pain. The fractures, which were of Mason type II in 19 and type III in three cases, were treated by mobilization in eight cases, plaster in eight, open reduction and internal fixation in three and closed reduction and plaster in three. At the follow-up examination, 19 (86%) had no complaints, while three (14%) had occasional pain. Flexion was decreased in the formerly injured compared with the uninjured elbow (139 + 8degrees versus 142+/-5degrees; P<0.05). None had developed elbow osteoarthritis. Isolated, closed fracture of the radial head and neck during growth has a favourable, long-term outcome.
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