The comparative, long-term effect of the Salter osteotomy and Pemberton acetabuloplasty on pelvic height, scoliosis and functional outcome.

AIMS: This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. PATIENTS AND METHODS: We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. RESULTS: During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p < 0.001). The difference in the increase in pelvic height was insignificant at the most recent review (Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. CONCLUSION: In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145-50.

Psychosocial problems in children with allergic diseases: a population study in Taiwan.

BACKGROUND: A few studies had pointed out the relationship between a single allergic disease and children's psychosocial problems; however, all of these researchers considered the allergic diseases separately. Therefore, this study aimed to investigate the relationship between collective allergic diseases and psychosocial problems among 4- to 12-year-old children in Taiwan. METHODS: The data were generated from the 2005 Taiwan National Health Interview Survey. A total of 2955 parents or guardians completed the answers for their 4- to 12-year-old children. We used logistic regressions to investigate the association of allergic diseases and the psychosocial problems. RESULTS: About 40.62% children had at least one allergic disease in the past year, and 17.75% children had a score of psychosocial problems higher than or equal to the 75th percentile. After controlling for demographic factors, the risk of having high-level psychosocial problem for children with any allergic disease was 1.84 times of those without allergy. For those who had one, two or more than two allergic diseases, the risks of having psychosocial problems were 1.56, 2.20 and 3.39 times of those had no allergy disease respectively. Children with asthma, dermatitis and rhinitis simultaneously had the highest psychosocial impact (odds ratio = 5.10). CONCLUSIONS: Collective allergic diseases were associated with psychosocial problems in children, and the effect was gradient. Parents and paediatricians should pay attention to psychosocial problems in children with allergic diseases and vice versa.

Anterior tibial tendon transfer in residual dynamic clubfoot deformity.

Residual forefoot adduction and supination deformities with functional problems and difficulty with shoe wear may occur during the course of management of the congenital clubfoot. Between 1975 and 1988, 55 patients with 71 feet who had residual dynamic clubfoot deformity underwent anterior tibial tendon transfer. There were 42 full anterior tibial tendon transfers (FTs) and 29 split anterior tibial tendon transfers (STs). The average age of the patient at the time of the procedure was 6 years. The age at surgery for FT was 5.3 years compared with 7.1 years in ST. The clinical appearance of the feet improved in both groups, according to Garceau's criteria. The range-of-motion improvement was noted in dorsiflexion and eversion. There was an increase of eversion strength of both groups by 1.5 grades. The radiographic improvement was noted in both forefoot adduction and supination. Although the FT group had a little better statistical data than did the ST group, the ST group had better preservation of inversion function.

Resistant talipes equinovarus associated with congenital constriction band syndrome.

Thirty-seven clubfeet in 28 patients with concomitant congenital constriction band syndrome were reviewed. The bands were considered to be of significance if located in the calf region (zone 2). The severity of the bands was classified. Grade 1 bands involved subcutaneous tissue, grade 2 bands extended to the fascia, grade 3 bands extended to the fascia and required release, and grade 4 bands were congenital amputations. The patients were divided based on neurologic deficit. Group A consisted of 26 clubfeet without neurologic deficit and had 1.4 surgeries per clubfoot. Group B consisted of 11 clubfeet with neurologic deficit and had 3.7 surgeries per clubfoot. Children with grade 3 bands in zone 2 were most likely to have a neurologic deficit. Twenty-three clubfeet had a good clinical result, seven clubfeet fair, and seven clubfeet poor. Group B had poorer results than Group A. These feet ultimately required numerous and more extensive surgeries to obtain correction, and ultimately had a poorer result.

Simultaneous ipsilateral femoral and tibial lengthening with the Ilizarov method.

Eight pediatric patients who underwent nine simultaneous ipsilateral femoral and tibial lengthenings with the Ilizarov external fixator were reviewed. The patient's demographics, diagnoses, corticotomy levels, mechanical axes, healing indices, amounts of lengthening, and complications were recorded. The patients' average age was 8 years 10 months (5 years 4 months-15 years 10 months) with an average follow-up of 49 months (30-88 months). The percentage of femoral lengthening averaged 16.7% (8-23%) with an average healing index of 28 days/cm (20-38 days/cm). The percentage of tibial lengthening averaged 18% (9.6-23.6%) with an average healing index of 29 days/cm (1940 days/cm). Four complications in three patients occurred as a direct result of the lengthening process. Three of the complications involved soft-tissue contractures, which were each successfully treated with one additional surgical procedure, whereas the fourth complication involved poor bone regeneration and required bone grafting and additional immobilization.

Congenital idiopathic clubfoot.

Clubfoot or talipes equinovarus is a complex deformity characterized by three distinct manifestations. The foot is in an equinus position; the forefoot and heel are in varus; and the entire foot is supinated. While the exact etiology of this problem remains unknown, many advancements have been made in the treatment of clubfeet. The surgical procedure is progressive and tailored according the severity of the deformity. Pain management, thorough neurovascular assessments, and education of the family are essential to caring for these patients.

Rotatory dorsal subluxation of the navicular: a complication of clubfoot surgery.

One hundred fifty-seven patients with 208 idiopathic clubfeet were operated on by a single surgeon (K.K.) from 1976 through 1987. Retrospective analysis was performed with a mean follow-up of 7.3 years on 126 patients with 168 operated-on feet. Twelve (7.1%) of 168 feet developed dorsal subluxation of the tarsal navicular. Six (6.3%) of 95 patients developed subluxation with the posterior medial incision. Six (8.2%) of 78 patients developed subluxation with the Cincinnati incision. Seven (58%) of these 12 feet required additional surgery. An anatomic model was constructed to demonstrate how rotation of the navicular alone mimics the radiographic appearance of dorsal subluxation of the navicular. The navicular dorsal subluxation is a common complication and is associated with a high rate of additional corrective surgery. We suggest that dorsal subluxation of the navicular should be redefined as a rotatory deformity with the medial border of the navicular rotating superiorly in the coronal plane. Attention to the position and rotation of navicular at the time of internal fixation may prevent this complication.

Differential lengthening of the radius and ulna using the Ilizarov method.

Three patients with relative length discrepancy between the radius and ulna and with wrist angular deformity are reported. The Ilizarov apparatus was used for correction of the deformity by differential lengthening of the radius and ulna. The total lengthening percentages ranged from 21 to 52%. All patients obtained a good functional result after surgery with full range of motion of fingers and moderate loss of wrist range of motion in two patients. All patients were able to achieve primary bone healing.

Idiopathic hip instability. An unrecognized cause of coxa saltans in the adult.

The painful, snapping hip often presents a diagnostic dilemma having many potential etiologies. An understanding of the precise cause increases the potential for successful treatment. Five patients with no prior history of significant trauma were evaluated, all of whom had longstanding painful snapping in the groin and consistent symptoms of gait disturbance and increased pain in the provocative position of hip flexion, adduction, and internal rotation. Multiple prior tests and procedures had been nondiagnostic. Simple manual longitudinal traction under fluoroscopy showed subluxation with appearance of a vacuum sign in the symptomatic hip, whereas no such finding was observed on the asymptomatic side. This strongly suggests atraumatic hip instability as a previously unrecognized cause of the painful, snapping hip. The easily obtainable diagnostic traction radiograph is described.

Musculoskeletal assessment of the newborn.

Components of the newborn musculoskeletal exam include a concise history, complete developmental assessment, and thorough physical exam. The clinician must separate normal anomalies related to intrauterine positioning from more serious abnormalities that may require early intervention and treatment. This article focuses on assessment techniques and identifying common musculoskeletal disorders in the newborn.

Arthrographic evaluation of developmental dysplasia of the hip. Outcome prediction.

Arthrograms of 35 hips in 33 children less than 2 years of age with typical development dysplasia of the hip were reviewed. After arthrograms were repeated for 11 hips 6 weeks following the initial test, results were classified into 6 types based on medial pooling ratio and morphology of the acetabular limbus. Using modified Severin's criteria for outcome evaluation, 7 of the 11 hips had been upgraded in type. All hips that were classified as Type I by arthrogram had Severin I results. The relation of arthrographic type and radiographic results was statistically significant. Immediate open reduction is recommended in hips classified as Type VI at first arthrogram or Type III and above at repeat arthrogram.

Correction of foot deformity by the Ilizarov method in a patient with Segawa disease.

Hereditary progressive dystonia, or Segawa disease, is rare. Diagnosis depends on typical clinical features with normal laboratory findings. It responds well to levodopa treatment. This article contains a case report of a patient with Segawa disease with a fixed equinovarus foot. A 21-year-old woman was diagnosed with Segawa disease since she was 8 years old; she became wheelchair dependent at the age of 15. The dystonia responded well to levodopa, except for the fixed-foot deformity. The deformity was corrected successfully by the Ilizarov method. The patient returned to independent ambulation after surgery. Because similar types of foot deformities appeared in several progressive degenerative neurologic diseases, the treatable Segawa disease should be added to the list of differential diagnoses of progressive degenerative neurological diseases with talipes equinovarus.

Clubfoot deformity in Down's syndrome.

The association of Down's syndrome (trisomy 21) with clubfeet has not previously been elaborated. Eight patients with a total of 15 clubfeet were identified for review. Five of these had trisomy 21 noted by chromosomal analysis, and 1 had a mosaic pattern. Two patients did not have chromosomal documentation, but had characteristic features of Down's syndrome. Interestingly, 2 patients had evidence of arthrogryposis as well as Down's syndrome. Four of the 8 patients had other orthopedic anomalies, including scoliosis, atlantoaxial instability, brachydactyly, and coxa valga. All 8 patients had an initial period of casting prior to any surgical intervention. Fourteen of the 15 feet required surgical intervention to afford correction of the deformity. The 6 feet with relatively long-term follow up (average: 5 years) showed that there was 1 excellent, 4 good, and 1 fair result using the criteria of Turco. It appears that, even though Down's syndrome is usually characterized by ligamentous laxity, when clubfeet are associated with this syndrome they are often resistant to nonoperative treatment, and surgical treatment seems to produce an acceptable result.

Prognosticating factors in acetabular development following reduction of developmental dysplasia of the hip.

A number of predictors that may influence acetabular development after reduction were studied in 75 hips with developmental dysplasia of the hip (DDH). Seventy-nine percent of the hips had satisfactory results of Severin group I or II, and 21% had unsatisfactory results. The best predictor of success in a unilateral case is the center-head distance discrepancy (CHDD) measurement at 1 year follow-up. Ninety-six percent of hips with a CHDD of < or = 6% had satisfactory results, whereas 78% with a CHDD > 6% had unsatisfactory results. This study also confirms that age at reduction and significant improvement in the acetabular index in the first year after reduction are important predictors.

Pseudoaneurysm after foot surgery.

Pseudoaneurysm (PA) is recognized as a rare complication after pediatric foot surgery. We identified the incidence, pertinent clinical features, and response to surgical intervention in PA as a complication of foot surgery. Four PAs were identified after 2,756 foot operations, an overall incidence of 0.14%. These patients typically had symptoms between 2 and 3 months after index operation with an enlarging, pulsatile, compressible mass in the plantar medial aspect of the foot. Arteriography was helpful in planning surgical intervention. Operative treatment consisted of ligation and excision of PA in all patients. Final outcome of foot deformity surgery was not compromised.

The influence of walking mechanics and time on the results of proximal tibial osteotomy.

The current study describes the influence of the passage of time on the original findings. The mechanisms used by some patients to reduce loading at the knee (adduction moment) also were analyzed. We evaluated the gait of twenty-seven patients (thirty-two knees) who had had a proximal tibial osteotomy for a varus gonarthrosis. Twenty-four patients (twenty-eight knees) returned for follow-up at three to 8.9 years after the osteotomy. This is a follow-up to our original study (Prodromos et al.), which described a relationship between the magnitude of the adduction moment at the knee during walking and the outcome of proximal tibial osteotomy. The patients were divided into low and high adduction-moment groups on the basis of the magnitude of the adduction moment at the knee as measured preoperatively during walking. All fourteen patients in the low adduction-moment group and nine of the fourteen patients in the high adduction-moment group had a good or excellent result. The varus deformity recurred in ten patients in the high adduction-moment group and in three patients in the low adduction-moment group. All of the results degenerated over time. The adaptive mechanism that was used to lower the adduction moment during gait included shortening the stride and toeing-out. The significant correlation between the magnitudes of the inversion moment at the ankle and the adduction moment at the knee suggested that the toe-out gait reduced the adduction moment at the knee.(ABSTRACT TRUNCATED AT 250 WORDS)

Posteromedial release for idiopathic talipes equinovarus. A long-term follow-up study.

Eighteen children with 26 idiopathic talipes equinovarus deformities were treated by postermedial release (PR) in the interval between 1975 and 1980 and investigated retrospectively. Evaluations included physical examination, functional evaluation, roentgenographic evaluation, and evaluation of foot track tracing pattern. The average follow-up period was 8.2 years. Thirty percent had had previous tendo Achilles lengthenings and 15% had had previous lengthenings plus posterior capsulotomies. Based on Turco's criteria, the results of PR were graded 38.9% excellent, 26.9% good, 15.6% fair, and 18.6% failure.