Effectiveness of Global Optimisation and Direct Kinematics in Predicting Surgical Outcome in Children with Cerebral Palsy.

Multibody optimisation approaches have not seen much use in routine clinical applications despite evidence of improvements in modelling through a reduction in soft tissue artifacts compared to the standard gait analysis technique of direct kinematics. To inform clinical use, this study investigated the consistency with which both approaches predicted post-surgical outcomes, using changes in Gait Profile Score (GPS) when compared to a clinical assessment of outcome that did not include the 3D gait data. Retrospective three-dimensional motion capture data were utilised from 34 typically developing children and 26 children with cerebral palsy who underwent femoral derotation osteotomies as part of Single Event Multi-Level Surgeries. Results indicated that while, as expected, the GPS estimated from the two methods were numerically different, they were strongly correlated (Spearman's ρ = 0.93), and no significant differences were observed between their estimations of change in GPS after surgery. The two scores equivalently classified a worsening or improvement in the gait quality in 93% of the cases. When compared with the clinical classification of responders versus non-responders to the intervention, an equivalent performance was found for the two approaches, with 27/41 and 28/41 cases in agreement with the clinical judgement for multibody optimisation and direct kinematics, respectively. With this equivalent performance to the direct kinematics approach and the benefit of being less sensitive to skin artefact and allowing additional analysis such as estimation of musculotendon lengths and joint contact forces, multibody optimisation has the potential to improve the clinical decision-making process in children with cerebral palsy.

Paediatric orthopaedics in lockdown: A study on the effect of the SARS-Cov-2 pandemic on acute paediatric orthopaedics and trauma.

AIMS: To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). METHODS: A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. RESULTS: Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). CONCLUSION: During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast.Cite this article: Bone Joint Open 2020;1-7:424-430.

A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip.

PURPOSE: Developmental dysplasia of the hip (DDH) affects approximately 1 % of live births. Dislocated hips require reduction and stabilisation in a spica cast, and reduction efficacy is assessed radiologically. Numerous measurements are used to ascertain the adequacy of reduction but can be inconsistent in evaluating femoral head position. This study describes the morphology of the developing acetabulum in DDH and validates a novel method to assess adequate reduction of the dysplastic hip following closed or open reduction. METHODS: A retrospective review was performed of 66 consecutive patients undergoing reduction of hip dislocation over a 2-year period. Three independent reviewers evaluated postoperative CT scans to assess anterior-posterior (AP) displacement and modified Shenton's line. Acetabular morphology was also assessed along with hip congruency using a described novel 'posterior neck line'. RESULTS: Dislocated hips were successfully identified using the posterior neck line with a sensitivity of 0.71 and specificity of 0.88 giving a negative predictive value of 0.97. The interobserver reliability of this technique was higher in comparison against both (AP) displacement and modified Shenton's line. CONCLUSIONS: We have shown a novel approach in assessing the acetabular morphology of DDH and a novel technique to accurately confirm the reduction of dislocated hips following open or closed reduction.

Optimizing knee arthroscopy documentation using a new template.

INTRODUCTION: The purpose of the study was to assess the quality of documentation of knee arthroscopy and evaluate the implementation of a novel operative template. METHOD: A 34-point assessment was undertaken based on published national guidelines. A retrospective study of 50 operative notes of patients (group A) undergoing knee arthroscopy was completed. A new operative note template was devised to include important criteria and assessed in 49 patients (group B) for its efficacy in providing appropriately detailed findings. RESULTS: Group A was lacking the minimum essential documentation standards expected. Some essential criteria for arthroscopic procedures were as low as 4%. Group B showed a statistically significant increase (P<0.001) in documentation accuracy throughout the essential criteria compared to the findings in group A. CONCLUSIONS: The authors conclude that the use of an evidence-based operative template for knee arthroscopy significantly improves the quality and accuracy of documentation compared to conventional free-hand operative notes.