The paediatric global musculoskeletal task force - 'towards better MSK health for all'.

There is increasing concern about the emerging global non-communicable diseases (NCDs) burden. The focus has mainly been on NCDs in adults but it is important that MSK morbidity in both children and adults is included in strategic planning. There have been considerable advances in the understanding and treatment options for children and young people (CYP) and clinical outcomes are improving for those who can access such high quality care. However vast inequity exists and there are many CYP who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments. The Paediatric Global Musculoskeletal Task Force aims to raise awareness about unmet needs for CYP with MSK conditions, promotion of MSK health through lifestyle and the avoidance of injury. We aim to leverage change through 'working together better'.

A new dynamic foot abduction orthosis for clubfoot treatment.

Recurrent clubfoot deformity after successful initial correction with the use of the Ponseti method continues to be a common problem and is often caused by noncompliance with wear of the traditional foot abduction brace. The purpose of this study was to assess the results of a newly designed dynamic foot abduction orthosis in terms of (1) parental compliance and (2) effectiveness in preventing recurrent clubfoot deformities. Twenty-eight patients (49 clubfeet) who were treated with a dynamic foot abduction orthosis in accordance with the Ponseti method were included in this study. Of the 28 patients, 18 had idiopathic clubfeet (31 clubfeet), 2 had complex idiopathic clubfeet (4 clubfeet), 5 had myelodysplasia (8 clubfeet), and 3 were syndromic (6 clubfeet). The mean duration of follow-up was 29 months (range, 24-36 months). Noncompliance was reported in only 2 (7.1%) of the 28 patients in the new orthosis compared with the authors' previously reported 41% (21/51) noncompliance rate in patients treated with the use of the traditional foot abduction brace. The two patients in this study, in which parents were noncompliant with orthosis wear, developed recurrent deformities. There were 2 patients (7%) who experienced skin blistering in the new orthosis compared with 12 (23.5%) of 51 patients who experienced blistering with the use of traditional abduction brace in the authors' previously reported study. Logistic regression modeling compliance and recurrence revealed that noncompliance with the foot abduction orthosis was most predictive of recurrence of deformity (odds ratio, 27; 95% confidence interval, 2.2-326; P = 0.01). The articulating foot abduction orthosis is well tolerated by patients and parents and results in a higher compliance rate and a lower complication rate than what were observed with the traditional foot abduction orthosis.

Smoking and socio-economic status in the etiology and severity of Legg-Calvé-Perthes' disease.

BACKGROUND: The etiology of Legg-Calvé-Perthes disease is poorly understood. An association has been found in the past between Legg-Calvé-Perthes disease and smoking as well as low socio-economic status. METHODS: A prospective study was carried out in which families with a child diagnosed with Legg-Calvé-Perthes' disease were interviewed about the presence and duration of household second-hand smoke exposure to children. A control group of randomly selected families seen at our institution were interviewed with identical questions. The radiographs of children with Legg-Calvé-Perthes disease were reviewed and classified according to the Herring lateral pillar classification system. RESULTS: Thirty-eight of the 60 patients (63.3%) with Legg-Calvé-Perthes disease were noted to have at least one smoker living in the child's household with a mean of 1.03 smoker-years per year of life exposure to smoke. The median income of the patients with Legg-Calvé-Perthes disease was USD 20,300. The median income of the patients in the control group was USD 17,000. Thirty-eight of the 96 control patients (39.6%) were noted to have at least one smoker living in the child's household with a mean of 0.48 smoker-years per year of life. A significant association was noted between living with a smoker and Legg-Calvé-Perthes disease as well as between increasing smoke exposure and increased risk of developing Legg-Calvé-Perthes disease. No significant association was noted between lower income and Legg-Calvé-Perthes disease. There was no association between increased smoke exposure and increased severity of Legg-Calvé-Perthes disease as measured by the lateral pillar classification. CONCLUSIONS: The presence of second-hand smoke seems to be a significant risk factor in the development of Legg-Calvé-Perthes disease. The presence of second-hand smoke may represent the 'unknown industrial factor' that has been discussed.