The effect of COVID-19 on children with congenital talipes equinovarus in a tertiary service in the United Kingdom.

During the coronavirus disease 2019 (COVID-19) pandemic, many aspects of healthcare have been hindered. The primary aim of this study was to identify what the impact of COVID-19 was on the delivery of outpatient care for children with congenital talipes equinovarus deformity (CTEV) at a large tertiary hospital in the UK. This study reviewed the patients who commenced their Ponseti treatment between March and September 2020, representing the cohort who received hands-on care during the first wave of the COVID-19 pandemic. Equivalent 6-month periods were searched in 2019 and 2018 as control cohorts. This study included a total of 45 children (72 affected feet) presenting for treatment of clubfoot. Twenty-three babies were seen with CTEV in 2020. For the same time period in 2018 and 2019, 11 babies were treated each year. The distance commuted to by families was higher in 2020 compared to 2019 and 2018, although the difference did not reach statistical significance (P = 0.301). Treatment with Ponseti casting was commenced at a mean age of 52 days, with no statistically significant differences between cohorts (P = 0.758). Using strict precautions, the Ponseti service at a large tertiary hospital in the UK grew in size and successfully provided treatment for children presenting with CTEV during the first wave of the COVID-19 pandemic. This study has shown that with careful protocols in place, children with CTEV can be treated successfully during times of pandemic, thereby reducing the post-pandemic burden of older children requiring treatment.

A novel technique to assess rotational deformities in lower extremities using CT-based motion analysis.

Rotational deformities following intramedullary (IM) nailing of tibia has a reported incidence of as high as 20%. Common techniques to measure deformities following IM nailing of tibia are either based on clinical assessment, plain X-rays or Computed Tomography (CT) comparing the treated leg with the uninjured contralateral side. All these techniques are based on examiners manual calculation inherently subject to bias. Following our previous rigorous motion analysis and symmetry studies on hemi pelvises, femurs and orthopaedic implants, we aimed to introduce a novel fully digital technique to measure rotational deformities in the lower legs. Following formal institutional approval from the Imperial College, CT images of 10 pairs of human lower legs were retrieved. Images were anonymized and uploaded to a research server. Three dimensional CT images of the lower legs were bilaterally reconstructed. CT-based motion analysis (CTMA) was used and the mirrored images of the left side were merged with the right side proximally as stationary and distally as moving objects. Discrepancies in translation and rotation were automatically calculated. Our study population had a mean age of 54 ± 20 years. There were six males and four females. We observed a greater variation in translation (mm) of Centre of Mass (COM) in sagittal plane (95% CI - 2.959-.292) which was also presented as rotational difference alongside the antero-posterior direction or Y axis (95% CI .370-1.035). In other word the right lower legs in our study were more likely to be in varus compared to the left side. However, there were no statistically significant differences in coronal or axial planes. Using our proposed fully digital technique we found that lower legs of the human adults were symmetrical in axial and coronal plane. We found sagittal plane differences which need further addressing in future using bigger sample size. Our novel recommended technique is fully digital and commercially available. This new technique can be useful in clinical practice addressing rotational deformities following orthopaedic surgical intervention. This new technique can substitute the previously introduced techniques.

The seasonality of slipped upper femoral epiphysis--meta-analysis: a possible association with vitamin D.

We performed a meta-analysis of studies evaluating the seasonality of slipped upper femoral epiphysis (SUFE). In addition we compared the monthly incidences of SUFE at latitudes greater than 40° with the established serum 25-hydroxyvitamin levels for children resident at a comparative latitude. In total 11 relevant studies were identified, involving 7451 cases of SUFE. There was significant variation in the month of onset of SUFE. The degree of variability increased with increasing latitude. The modal month of symptomatic onset was dependent upon latitude. At latitudes greater than 40°, the most common month of onset was August. At latitudes between 20° and 40°, this was earlier in the calendar year, around April. The seasonal variability was statistically significant (p<0.0001 and p<0.005 for latitudes >40° and 20°-40° respectively). The pattern of monthly fluctuation in onset of SUFE very closely mirrored the monthly pattern of variation for serum 25-hydroxyvitamin D3. There was a very strong positive correlation (Spearman rank rho = + 0.8, p = 0.001). There is a monthly variation in incidence of SUFE. The degree of variability increases with increasing latitude. There may be an association with vitamin D. We hypothesise that elevated serum 25-hydroxyvitamin D3 accelerates growth thus rendering the growth plate vulnerable to slippage in analogous manner to the pubertal growth spurt.