Distribution, sources, and potential health risks of fluoride, total iodine, and nitrate in rural drinking water sources of North and East China.

Small-scale water sources serving villages and towns are the main source of drinking water in rural areas. Compared to centralized water sources, rural water sources are less frequently monitored for water quality and have poor post-treatment facilities, making them vulnerable to drinking health risks. To reveal the hydrochemical characteristics, contaminant sources, and health risks in rural water sources, 189 water samples were collected from lakes and reservoirs, rivers, and groundwater in North and East China for major ions, nutrient salts, microelements, and stable isotope analysis. Statistical analysis and isotopic tracing were performed, as well as human health risk assessment. The exceeding threshold rates for fluoride (F-) and nitrate (NO3-) in surface water were 1.8 % and 9.1 %, respectively. For groundwater, the exceeding threshold rates were 20.9 % for F-, 15.7 % for total iodine (TI), and 4.5 % for NO3-. F- and TI were mainly derived from the leaching of fluoride- and iodine-containing minerals by cationic exchange, and NO3- is mainly derived from nitrogen in the soil (31.7-43.9 %), the use of ammonia fertilizers (24.3-36.1 %), and the discharge of manure and sewage (19.4-31.9 %). Nitrogen in the soil can be an important source of nitrate in the aquatic environment, and soils with higher clay content have a greater retention effect on the migration of nitrogen pollutants from the surface to the groundwater. F- in water sources contributes most to human health risks for drinking, followed by NO3- and TI, and a higher proportion of groundwater (37 %) present health risks for drinking than surface water (14 %) for children. Authorities should give high priority to optimizing the choice of water sources and technology for water treatment, and rational measures should be taken to protect water sources from the threats of anthropogenic pollution.

Species transformation and removal mechanism of various iodine species at the Bi2O3@MnO2 interface.

Long-term exposure to excessive iodine via drinking water significantly increases the risk of thyroid diseases. Further, the mechanisms and feasible technologies for iodine removal are far from being well elucidated. In this study, we constructed a heterogeneous Bi2O3@MnO2 interface with oxidation and adsorption efficiency toward iodide (I-), and investigated the performance and mechanisms involved in iodine removal. Bi2O3@MnO2 at the optimized Bi/Mn ratio of 0.05:1 had a maximum adsorption capacity of 1.19, 1.21, and 1.06 mg/g toward I-, iodine elemental (I2), and iodate (IO3-), respectively. According to the density functional theory (DFT) calculation, Bi2O3@MnO2 had an adsorption energy of -2.34, -2.11, and -3.89 eV for I-, I2, and IO3-, and exhibited a better band structure and state density character for iodine removal. Based on the results of XPS, HPLC, and LC-ICP-MS characterization, Bi2O3 plays an important role in adsorbing and capturing I- whereas MnO2 dominates the moderate oxidation of I- and the adsorption of I- and I2. The adsorbed I- and I2 concentrations on the Bi2O3@MnO2 surfaces were 146.3 µg/L and 18.3 µg/L. Notably, IO3- was not detected owing to its moderate oxidation effect. The coexisting ions of chloride (Cl-) and bromide (Br-) tended to occupy the Bi2O3 lattice and form insoluble BiOCl and BiOBr. Further, reductive species, such as sulphite (SO32-), may reduce MnO2 to Mn(III) and Mn(II). The synergistic effect between moderate oxidation and adsorption led to Bi2O3@MnO2 with high iodine removal capability. Overall, this study proposes a strategy for designing suitable interfaces and adsorbents for iodine removal; however, further studies are necessary to advance its application in practice.

Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study.

AIM: To investigate the protective behaviours of longer near work distance, discontinuing near work and more time outdoors in recess from parent self-report in the myopia prevalence and progression among myopic children aged 9-11 years. METHODS: Myopia Investigation study in Taipei is a longitudinal population-based study that enrolled elementary school students in Taipei. We provided vision and refraction examination every 6 months. Spherical equivalent (SE) of cycloplegic refraction ≤-0.50 Diopter (D) is defined as myopia. Total 10 743 (70.4%) students completed 2-year refraction data and questionnaire. The myopia prevalence and progression (difference of SE) in baseline, 6, 12, 18 and 24 months were compared by generalised estimating equations. RESULTS: Children with persistent protective behaviour had significant lower prevalence of myopia. The protective impact was statistically significant from 6 to 24 months. In 2 years follow-up, risk ratio after adjusting the background variables and the other two behaviours in near work distance, near work time and outdoor time were 0.71, 0.89 and 0.77. In SE analysis, after adjusting the other two behaviours, near work distance >30 cm (-0.7 vs -1.04 D; p<0.001), discontinuing near work every 30 min (-0.77 vs -0.96 D, p=0.005) and more time outdoors in recess from parent self-report (-0.75 vs -0.98 D; p=0.012) revealed protective impacts on diminishing myopia progression from 6 to 24 months. CONCLUSION: In myopic children aged around 10 years in Taipei, longer distance in near work, discontinuing near work every 30 min and more outdoor time from parent self-report are protective behaviours in myopia prevalence and progression in 6-24 months.

Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis.

BACKGROUND: This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. METHODS: Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. RESULTS: The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = -.611, P = .003). CONCLUSION: Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Guided Growth Improves Coxa Valga and Hip Subluxation in Children with Cerebral Palsy.

BACKGROUND: Spastic hip subluxation or dislocation that is associated with an excessive coxa valga deformity is a common pathologic condition in children with cerebral palsy (CP) that is often treated with large bone reconstructive procedures. Guided growth techniques (such as stapling, plate, or transphyseal screw) have been widely used to alter the growth axis in patients with a lower-limb deformity but only a few reports have described their use in patients with coxa valga deformities. QUESTIONS/PURPOSES: (1) Does guided growth surgery using a transphyseal screw combined with adductor tenotomy prevent progressive coxa valga deformity and lateral hip subluxation in children with CP? (2) What factors influence the correction of coxa valga deformity and the success of hip stabilization? (3) What complications were associated with this operation and how often did children treated with it undergo reoperation? METHODS: From 2012 to 2016, at our institution, three authors (H-CH, KNK, K-WW) retrospectively studied data on children with CP who underwent guided growth of the hip for progressive bilateral hip subluxation associated with coxa valga deformities. A single percutaneous screw was inserted across the inferomedial portion of proximal femoral physis in an AP view and centered along femoral neck in lateral view under fluoroscopy guidance. During the period, we treated 25 consecutive children with CP who had progressive hip subluxation with coxa valga deformities. The indications for surgery were migration percentage > 30% and head-shaft angle > 155° with at least 2 years growth remaining. Of those, 13 patients underwent guided growth alone, and 48% (12) underwent a combination of guided growth and adductor tenotomy. Of the 25 patients treated with this approach, 96% (24) were available for follow-up with complete data at a minimum of 2 years follow-up (mean 50 months; range 25 to 72). All children (17 boys and seven girls; 48 hips) underwent surgery at a mean age of 8 years (range 5 to 12). With regard to the gross motor function classification system, three patients were Level 1, four patients were Level II, seven patients were Level III, seven were Level IV, and three were Level V. Radiographic parameters including the head-shaft angle, Hilgenreiner's epiphyseal angle, acetabular index, and Reimer's migration percentage were assessed before surgery and at the latest follow-up examination by one author (H-CH). Complications and reoperations were assessed by chart review. During the period in question, we generally offered secondary reconstructive surgery to patients who underwent a guided growth procedure once their subluxation progressed. RESULTS: With the data available, the coxa valga and lateral hip subluxation improved in terms of the reduction of head-shaft angle by a mean of 13° ± 7° (95% CI 11 to 15; p < 0.001) and the reduction of the migration percentage by 10% ± 11% (95% CI 7 to 13; p < 0.001). After controlling for potentially confounding variables like gender, gross motor function classification system, Hilgenreiner's epiphyseal angle and acetabular index, we found that longer follow-up duration (r = 0.234; p < 0.001) and a smaller preoperative migration percentage (r = -0.258; p = 0.004) were associated with larger changes in the head-shaft angle. In terms of complications, we found that the proximal femoral physis grew off the screw tip in 44% (21 of 48 hips) at a mean of 28 months. Among these, 31% of hips (15 of 48) in 33% of patients (eight of 24) underwent replacement with a longer screw. Among the 17% of hips (eight of 48) in 21% of patients (five of 24) who had progressive lateral subluxation and underwent secondary reconstructive surgery, we found that their preoperative acetabular index was higher (mean 29° versus 21°; p < 0.001), as was their head-shaft angle (mean 166° versus 162°; p = 0.045), and migration percentage (mean 54% versus 36 %; p < 0.001). CONCLUSIONS: Although guided growth with single transphyseal screw did not create as large a degree of varus as proximal femoral osteotomy, it did stabilize the hip in children with cerebral palsy with migration percentage less than 50% in our series. It is a simple procedure that can be of benefit to children with cerebral palsy with unstable hip. Reoperation in patients where the physis has grown off the screw tip can be a problem; fortunately, it is a rather minor procedure to replace with a longer screw. LEVEL OF EVIDENCE: Level III, therapeutic study.

Comparison of two methods for idiopathic clubfoot treatment: A case-controlled study in Taiwan.

BACKGROUND/PURPOSE: In last century, two distinctive methods of manipulation and casting were developed, Kite method and Ponseti method. The purpose of this study is to compare the outcomes of parallel series between two methods in one institution. METHODS: From 2003 to 2008, two pediatric orthopedic services in one institution treated 57 patients with 88 idiopathic clubfeet. One service continued using Kite casting method consisted of 58 feet, and other service employed Ponseti casting method consisted of 30 feet. There was a minimum of 4 years follow-up. RESULTS: Both groups had similar Dimeglio severity scores before treatment. Initial correction was achieved in 40 feet (69%) in the Kite group compared with 27 feet (90%) in the Ponseti group, while 19 feet (63.3%) had percutaneous Achilles tenotomy. The Ponseti method was found to have a significantly higher correction rate (p = 0.028). After a mean follow-up of 72 months, there were 29 relapses (50%) in the Kite group and 8 relapses (26.7%) in the Ponseti group with significant difference (p = 0.036). At the latest follow-up, the outcome measures were 24 feet (41.4%) good, 18 feet (31%) fair and 16 (27.6%) poor in the Kite group and 25 feet (83.3%) good, 3 feet (10%) fair and 2 feet (6.7%) poor in the Ponseti group with significant difference between two groups (p < 0.001). CONCLUSION: In this simultaneous series of two casting methods in a single institution with more than 4 years follow up, we concluded that Ponseti method significantly achieved better midterm outcome in clubfoot management.

The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction.

INTRODUCTION: The treatment of neglected radial head dislocation after missed Monteggia fracture dislocation in children is a controversial issue. The purpose of this study is to report our clinical experience in the treatment of the condition without annular ligament reconstruction. METHOD: This is a retrospective review of 20 patients between 2008 and 2014. Procedures included open reduction of the radial head and ulnar lengthening angulation osteotomy. In cases of unstable radial head reduction, a trans-capitellar K wire was applied. The pre- and post-operative radiographs were available for evaluation as well as the Mayo Elbow Performance Index (MEPI). RESULTS: The average pre-operative elbow extension-flexion arc was 99.5° and pronation-supination arc was 151°. At last follow-up, the flexion of elbow had significant improvement (from 110° to 124°), while the average pronation and supination arc decreased, most in pronation (from 75° to 65°). Post-operatively, MEPI scored higher, especially in elbow pain and stability. Patients underwent surgery within one year of injury had better functional outcome than those injured over one year. The patients required trans-capitellar K wire for unstable radial head reduction and were in the older age group. At final follow-up, the reduction of radial head was maintained in all cases except two with mild subluxations of the radial head in radiographs. Two cases required radial shaft shortening to facilitate the reduction because of proximal migration of the radius. CONCLUSION: For neglected radial head dislocation following Monteggia fracture dislocation, we presented our surgical strategy to reduce the radial head without annual ligament reconstruction. Our patients functionally benefited from the procedure with significant improvement in elbow pain and stability, as well as improved flexion of the elbow with stable radial head reduction. LEVEL OF EVIDENCE: IV.

Loading rates during walking in adolescents with type II osteonecrosis secondary to pelvic osteotomy.

Although Pemberton osteotomy has shown a high success rate even in older children, the occurrence of osteonecrosis (ON) remains one of the most severe complications, leading to premature osteoarthritis. Patients with type II ON are characterized by a valgus deformity of the proximal femur with altered musculoskeletal conditions, affecting the ability to attenuate or sustain the impulsive loading from the ground reaction force. It remains unclear whether these conditions also predispose these patients to harmful impulsive loadings. This study aimed to bridge the gap by measuring the loading rates in the lower limbs during level walking in adolescents who were treated during their infancy for unilateral developmental dysplasia of the hip by a pelvic osteotomy, with or without having developed type II ON. Patients with type II ON were found to display increased loading rates, not only at both the affected and unaffected hip, but also at other joints of the affected limb during level walking when compared to patients without ON changes (p < 0.05). These results suggest that patients with type II ON may be at a higher risk of developing premature hip osteoarthritis that is closely related to abnormal loading rates during gait. It is suggested that regular monitoring of joint loading rates in patients with type II ON is necessary for early identification of damaging loadings, and that early intervention aimed at reducing these loadings should be considered. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2199-2206, 2016.

Pronator teres transfer for forearm and wrist deformity in cerebral palsy children.

BACKGROUND: Forearm pronation and wrist flexion contracture can be a disability for daily living care and 2-hand function in cerebral palsy (CP) children. It may be beneficial to improve their posture and hand-grip power for better functional outcome. The purpose of our study was to investigate the outcome of pronator transfer in CP children. METHODS: Seventeen spastic CP patients (14 hemiplegic, 3 diplegic; 14 male, 3 female; mean age, 12 y 5 mo) underwent pronator teres transfer for forearm pronation and wrist flexion contractures. The mean follow-up period was 46 months. We recorded Gross Motor Function Classification System level, modified Ashworth scale, forearm and wrist range of motion, forearm resting position, grip power, and 3 basic daily living skills preoperatively and postoperatively. Paired t test was used for statistical analysis. RESULTS: The average forearm active supination gained 80.9 degrees (P<0.05) and the active forearm pronation lost 22 degrees (P<0.05), with average postoperative total active forearm range of motion 130.9 degrees (P<0.05). The average active wrist extension gained 76.9 degrees (P<0.05) and the active wrist flexion lost 31.8 degrees (P<0.05). The average grip power gained 4.5 kg (P<0.05). The average forearm resting position improved to 10 degrees pronation (P<0.05). The basic daily living skills showed great improvement. CONCLUSIONS: Our procedure improved the functional outcome in wrist extension and decreased the forearm pronation. Therefore, significant grip-strength enhancement and better forearm posture was noted. It is an additional armamentarium in the management of upper extremity disability in CP children. LEVEL OF EVIDENCE: Level IV-case series.

A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip.

INTRODUCTION: A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation. STEP 1 SURGICAL APPROACH: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage. STEP 2 EXPLORE THE HIP JOINT: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction. STEP 3 FEMORAL HEAD REDUCIBILITY: Check the reducibility of the femoral head in different positions through a full range of hip motion. STEP 4 FIRST FEMORAL OSTEOTOMY: Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy. STEP 5 HIP JOINT STABILITY: Check femoral head reduction stability with the proximal end of the osteotomized femur. STEP 6 FEMORAL SHORTENING: Decide the amount of shortening and rotation for the best femoral head reduction. STEP 7 PEMBERTON ACETABULOPLASTY: In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy. STEP 8 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace. RESULTS: The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).IndicationsContraindicationsPitfalls & Challenges.

Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

BACKGROUND: The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered. QUESTIONS/PURPOSES: The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty. METHODS: Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured vertical-center-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup. RESULTS: In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p < 0.001). Compared with that in the Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95% CI, 0.70, 1.17], Pemberton procedure, 0.53 [95% CI, 0.40, 0.65]; p < 0.001). Three patients in the Pemberton group had an anterior impingement sign at followup, whereas none in the Salter group did. The SF-36 and Harris hip scores were good and showed no differences between the two groups. CONCLUSIONS: Our study suggests the weightbearing zone acetabular index on false profile radiographs of the hip, a parameter focusing on morphologic features of the anterior acetabulum, decreased after Pemberton acetabuloplasty compared with the nonoperated side and after the Salter acetabuloplasty. This suggests that by modifying the shape of the acetabulum with a hinge in the triradiate cartilage, a Pemberton acetabuloplasty may result in increasing acetabular anterior coverage and the risk of hip impingement. However, the functional results with at least 10 years followup were good and similar for both procedures. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome?

BACKGROUND: The purpose of this study was to compare the outcomes of surgical treatment in children of walking age with unilateral and bilateral developmental dysplasia of the hip (DDH). METHODS: We examined the records of fifty-six children of walking age with bilateral dysplasia and 156 children of walking age with unilateral dysplasia treated with open reduction and pelvic osteotomy with or without femoral osteotomy from 1990 to 2000. The minimum duration of follow-up was five years. The mean age at surgery was thirty-four months in the bilateral group and twenty-five months in the unilateral group. Preoperative radiographs were evaluated to determine the Tönnis grade of the dislocation and the acetabular index, and the latest radiographs were evaluated to determine the Severin classification. The Kalamchi and MacEwen classification was used to assess osteonecrosis, and the McKay classification was used to assess the clinical outcome at the time of the latest follow-up. For the statistical analyses, we selected the worse side in patients in the bilateral group as the index hip if the outcome was asymmetrical and the left hip if the outcome was symmetrical. The Fisher exact and Student t tests were used for comparisons of outcomes between the groups. Multiple logistic regression models were used to analyze factors associated with osteonecrosis and with the McKay classification. RESULTS: Age at surgery and preoperative Tönnis grade differed significantly between the groups. Forty-five (80.3%) of the patients in the bilateral group and 135 (86.5%) of the patients in the unilateral group had a satisfactory Severin classification (Ia, Ib, or II); the difference between the groups was not significant. According to the McKay classification, twenty-six (46%) of the patients in the bilateral group had an satisfactory outcome compared with 111 (71%) of the patients in the unilateral group (p = 0.006). Osteonecrosis was significantly greater in the bilateral group as well (p = 0.01). Patient age at surgery and Tönnis grade were risk factors for osteonecrosis. Older age and bilaterality were associated with a poorer McKay classification. The logistic regression analysis was repeated after removing the nineteen patients (34%) in the bilateral group who had an asymmetrical outcome, and this analysis confirmed that asymmetrical outcome was a risk factor for a poorer McKay classification. CONCLUSIONS: Our data confirmed that the clinical outcome of bilateral developmental dysplasia of the hip was worse primarily because of asymmetrical outcomes. Age and Tönnis grade played an important role in the risk of occurrence of osteonecrosis. The radiographic outcome according to the Severin classification did not differ significantly between the groups.

Medial column stabilization improves the early result of calcaneal lengthening in children with cerebral palsy.

Calcaneal lengthening is a popular surgical treatment for pronated foot deformity. The aim of this study is to assess the effectiveness of medial column stabilization in improving the results of calcaneal lengthening for pronated foot deformity in ambulatory children with cerebral palsy. Twenty-one consecutive (37 feet) children with cerebral palsy with pronated foot deformity who received calcaneal lengthening from 2004 to 2009 were reviewed. Talonavicular stabilizations were performed by either stapling alone or fusion depending on the children's age and correctability of midfoot deformity. Satisfaction rates were assessed using Mosca's radiographic, Mosca's clinical, and Yoo's clinical criteria. Talonavicular coverage angle was also measured. Results between groups with and without stabilization of the talonavicular joint were compared. Group 1 included 11 children (19 feet) who had no talonavicular stabilization. Group 2 included 10 children (18 feet) who had talonavicular fixation. Groups were further divided into subgroups A [Gross Motor Function Classification System (GMFCS)≤II] and B (GMFCS≥III). Factors including demography, geographical classification, functional status, and preoperative degree of deformity were similar between the two groups. After the operation, all four radiographic parameters improved significantly. The talonavicular coverage angle was better in group 2 than in group 1. Mosca's radiographic results were satisfactory in 73.68% of cases in group 1 and 100% in group 2; the difference was statistically significant (P=0.027). As for Mosca's clinical results, 63.16% in group 1 and 83.33% in group 2 achieved satisfactory results (P=0.156). On the basis of Yoo's criteria, the results were satisfactory in 57.89% of cases in group 1 and in 94.44% of cases in group 2 (P=0.012). Further analysis on the satisfaction rates between the subgroups showed similar results between the patients in subgroup 1A and 2A, and significantly better results in subgroup 2B than in subgroup 1B. Concurrent stabilization of the talonavicular joint is an effective method to improve clinical and radiographic results of calcaneal lengthening in children with cerebral palsy with pronated feet, and the effect is more significant in children with worse GMFCS levels.

Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures.

OBJECTIVES: Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survival of patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis. METHODS: An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed. RESULTS: Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty. CONCLUSIONS: Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.

Residual gait deviations in adolescents treated during infancy for unilateral developmental dysplasia of the hip using Pemberton's osteotomy.

Early reduction using Pemberton's osteotomy has been suggested for treating DDH but no data on the long-term residual gait changes in such patients are available in the literature. This study aimed to bridge the gap by performing quantitative gait analysis on eleven females (age: 10.6 ± 1.0 years) who were treated for unilateral DDH using open reduction with Pemberton's osteotomy at 1.6 ± 0.5 years of age, and eleven age-matched healthy controls. Walking at a normal speed, the Pemberton group displayed significantly more anterior tilt, hiking at the affected side and rotation towards the unaffected side of the pelvis, and more knee flexion and ankle dorsiflexion in the affected limb. With this asymmetrical gait, they appeared to reduce the demands on the hip flexors and abductors, and knee extensors in the affected limb, which might have been involved during the osteotomy, but increased compensatory efforts from the hip extensors, ankle plantarflexors and knee flexors in the unaffected limb.

Modified triple innominate osteotomy for acetabular dysplasia: for better femoral head medialization and coverage.

UNLABELLED: Steel's triple innominate osteotomy was created for correcting dysplastic acetabulum in adolescents and young adults. We modified Steel's triple innominate osteotomy with two anterior incisions and ramus cuts close to the acetabulum to improve the mobility of the fragment for better coverage of the hip. The purpose of this study was to compare these two techniques with respect to acetabular morphology, femoral head coverage, and medialization. From 1989 to 2007, 22 hips from 19 adolescents and young adults underwent triple innominate osteotomy for symptomatic acetabular dysplasia with Tonnis grades 1 or 2. We divided patients into group A (11 hips from 10 patients), comprising patients who underwent classical Steel's osteotomy, and group B (11 hips from nine patients), comprising patients who underwent modified Steel's osteotomy, with a minimum follow-up of 2 years. Preoperative and postoperative radiographs of pelvis in the standing position were available for comparison. We used Sharp's angle, center-edge angle, femoral head extrusion index, and center-head distance discrepancy to evaluate hip morphology, femoral head coverage, and medialization, respectively. The paired t-test was used for statistical calculation with P-value less than 0.05 considered significant. The postoperative Sharp's angle, center-edge angle, femoral head extrusion index, and center-head distance discrepancy all had better results in group B with statistical significance. Other variants such as age, sex, and operation side did not have any significance. No postoperative complication was encountered. Our modified technique provided a better mobility of the rotated fragment in correcting acetabular dysplasia with a short learning curve. Most importantly, we provided greater coverage and medialization of the femoral head for better long-term results. LEVEL OF EVIDENCE: level III, retrospective comparative study.

Adolescents after Pemberton's osteotomy for developmental dysplasia of the hip displayed greater joint loading than healthy controls in affected and unaffected limbs during gait.

Patients after reduced developmental dysplasia of the hip (DDH) are at higher than normal risk of developing avascular necrosis (AVN) of the femoral head and degenerative hip osteoarthritis (OA) that are closely related to abnormal loadings. We aimed to determine the lower limb loadings in adolescents after Pemberton's osteotomy for unilateral DDH. Eleven females (age: 10.6 ± 1.0 years), who had received Pemberton's osteotomy for unilateral DDH at 1.6 ± 0.5 years of age, and 12 age-matched healthy controls were studied using gait analysis. Compared to the normal controls, the patients were displayed greater peak axial forces at the hip, knee, and ankle in both limbs, with greater loading rates in the ground reaction force (GRF) and at the hips (p < 0.05 for all comparisons). The increased rates of repetitive loading around heel strike in both hips suggest that patients treated for unilateral DDH using Pemberton's osteotomy may be at higher risk of premature hip OA. The increased axial forces at the affected hip may be a contributing factor to the development of AVN of the femoral head in these patients, especially when incomplete coverage, insufficient congruency, and/or damaged articular surfaces remain after the osteotomy. Therefore, monitoring the loading condition at the hip is necessary for a more accurate assessment of the risk of developing joint pathology in patients after reduced DDH.

Giant ganglionic cyst of the hip as a rare cause of sciatica.

Although ganglionic cysts located at the hip joint are described infrequently, those found in this region are usually small, deep-seated, and asymptomatic. Occasionally, however, a large ganglionic cyst of the hip area is observed that becomes symptomatic following compression of adjacent neurovascular bundles. In this report, the authors describe a 51-year-old man with symptoms of sciatica caused by a giant ganglionic cyst of the posterior hip joint. Because of its intermuscular location, the cyst was not palpable, and was probably misdiagnosed previously as a herniated disc of the lumbar spine. After resection of the cyst, the patient's symptoms resolved completely. This case highlights the importance of a detailed clinical examination for patients with multiple degenerative joint diseases.

Pemberton Osteotomy for Acetabular Dysplasia.

INTRODUCTION: We have performed open reduction with Pemberton osteotomy, as our primary treatment method for developmental dysplasia of the hip, in more than 550 patients at our institution since 1993. STEP 1 EXPOSURE: With the patient supine, make an anterior iliofemoral incision that is not directly on the iliac crest, dissect the subcutaneous tissue in the line of the incision, expose the iliac crest, and divide the cartilage at the iliac crest. STEP 2 PERFORM ILIOPSOAS TENOTOMY: Identify the rectus femoris tendon, release the iliopsoas muscle, and identify the acetabulum-hip capsule junction. STEP 3 PERFORM OPEN REDUCTION AND OSTEOTOMY: Perform an open reduction, check hip stability, make medial and lateral cut lines, and complete the osteotomy. STEP 4 INSERT ILIAC BONE GRAFT: Harvest the graft, position the reduced hip joint, insert the bone graft, repair the capsule, and close the wound. STEP 5 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast after skin closure. RESULTS & PREOP/POSTOP IMAGES: In our clinical and radiographic review of forty-nine patients followed for more than ten years after treatment of developmental dysplasia of the hip with a unilateral Pemberton osteotomy, there were no redislocations and no patient required additional surgery for residual hip dysplasia after the original Pemberton osteotomy. WHAT TO WATCH FOR: Indications Contraindications Pitfalls & Challenges.

Outcomes in advanced Legg-Calvé-Perthes disease treated with the Staheli procedure.

BACKGROUND: Containment and preservation of hip range of motion have been the principles governing the treatment of Legg-Calvé-Perthes disease. The Staheli's slotted acetabular augmentation (SAA) procedure is an alternative approach for older children with Perthes disease with lateral subluxation, incongruent hip, and abduction hinge. It provides effective coverage, restricts lateral displacement of the femoral head, and achieves containment and congruency in short-term follow-up. MATERIALS AND METHODS: This study evaluated pre- and postoperative symptoms, range of motion (ROM), and radiographic images in advanced Perthes disease with an incongruent hip or hinge abduction in lateral pillar groups B and C of 21 children who underwent a SAA procedure. RESULTS: Postoperative evaluation showed improved abduction, internal rotation, subluxation ratio, femoral head ratio, and acetabular coverage. At final follow-up, ROM of abduction went from 20° preoperatively to 45° postoperatively, and internal rotation went from 15° preoperatively to 35° postoperatively. The radiographic findings revealed 33% and 38% of patients achieved spherical congruence of the hip and an ovoid or mushroom femoral head, respectively. CONCLUSION: SAA restricts lateral displacement or subluxation of the femoral head and preserves sphericity, resulting in containment and acetabular coverage.