A prospective study on the role of foot evertor muscle activity in recurrence of clubfoot.

BACKGROUND: Even after corrective casting and bracing, clubfoot recurrence is challenging throughout childhood, with around 14-40 % recurrence rates. Most of the literature on recurrence was attributed to various factors, and minimal research was conducted to know the role of foot evertor muscle activity and its stimulation benefits. This study aimed to assess the role of foot evertor muscle activity in idiopathic congenital clubfoot recurrence by using clinical, sonographic, and electromyographic parameters. METHODS: A prospective cohort study was conducted at our tertiary care hospital from 2020 to 2022. The patient's demographic data, Pirani, Dimeglio, Clinical Evertor Muscle Activity scores, sonographic cross-sectional areas of leg muscle, and evertor motor activity using surface electromyography were recorded in adherence to the pre-defined intervals. RESULTS: In total, 51 patients (51 feet) were included in the study, and the overall recurrence rate was 27.5 % (14/51). In this study, around 47 % (24/51) of children had mild or poor clinical evertor activity; among them, 58 % (14/24) children had a recurrence, and the insufficient clinical evertor activity and recurrence were strongly correlated (p = 0.01). Evertor muscle cross-sectional area ratio, motor unit potentials, and recruitment were comparatively less in the recurred group; however, only the cross-sectional area ratio was statistically significant (p = 0.02). CONCLUSION: Early detection of evertor muscle weakness can help to individualize the treatment plans by predicting recurrence. Therefore, it should be included in routine clinical evaluations. Further research is required to determine the advantages of evertor muscle-strengthening activities in preventing idiopathic clubfoot deformity. LEVEL OF CLINICAL EVIDENCE: A prospective cohort study, Level of evidence-II.

Imaging Parameters of Hip Dysplasia in Cerebral Palsy: A Systematic Review.

Background: Cerebral Palsy is the leading cause of childhood physical disability globally. The motor disorders of CP are often associated with musculoskeletal anomalies, of which hip displacement is the second most common abnormality after abnormalities of foot and ankle. Various radiological parameters have been described in the literature which detects and quantifies hip dysplasia, with MP being the current gold standard. This study aims to review these radiological indicators of hip dysplasia in children with cerebral palsy from the published literature. Methods: A literature search using PubMed, Embase, and Google Scholar was done on 15th June 2021 focusing on surveillance of hip dysplasia in cerebral palsy. The studies to be included were to have used anyone or more radiological parameter for detection of hip dysplasia with the use of any of the radiological methods. Results: The initial search yielded 1184 results. After the screening of the abstracts and full texts, a final of 30 studies was included for this systematic review. The majority of the studies were graded as Level 3 evidence (16/30), followed by Level 2 studies (14/30). X-ray was the most common modality of detection of dysplasia followed by CT scan, ultrasonography, and arthrogram. The reproducibility of the various parameters shows good to excellent intraclass coefficients. Conclusions: Parameters other than MP can be used to screen hips in CP. This would be useful in patients in whom either the lateral acetabular edge is not discernible on a plain anteroposterior radiograph or there are issues in the positioning of the patient. Additional views and structures can be visualized which can lead to improved screening and planning. Further investigations are required to appreciate the full potential of these parameters and how they can be better utilized.

Trochanteric Advancement and Limb Lengthening by Monorail External Fixator in Sequelae of the Septic Hip in Children - A Simpler Alternative to Other Complex Procedures.

INTRODUCTION: Acute septic arthritis of the hip in children requires prompt diagnosis and treatment. The resulting sequelae of septic arthritis are diverse. Varieties of procedures have been described in the orthopedic literature. The common goal of treatment of all these procedures is to achieve a mobile, stable, pain-free hip joint with minimal limp and limb length inequality. CASE REPORT: We present two cases of Choi's Type 2 septic hip sequelae, a 14-year-old female and a 13-year-old male, both had painless limp and limb length discrepancy managed by greater trochanteric advancement with limb lengthening by monorail external fixator at single sitting. CONCLUSION: Distal greater trochanteric advancement with limb lengthening by monorail external fixator is a useful technique to treat septic hip sequelae with stable hip joint.