UT Southwestern Orthopaedic Journal 2019-2020 from the Editor Table of Contents
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Loss of Correction in Cubitus Varus Deformity After Osteotomy
Loss of correction in cubitus varus deformity after osteotomy Chao You Shenzhen children's hospital Yibiao Zhou Shenzhen children's hospital https://orcid.org/0000-0001-9754-1089 Jingming Han ( [email protected] ) Research article Keywords: cubitus varus osteotomy Loss of correction Posted Date: May 5th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-26279/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract Purpose Cubitus varus deformity in the pediatric population is an infrequent but clinically important disease to orthopedic surgeons. Since these patient populations are different in many respects, we sought out to investigate the rates of loss of correction over time as well as the factors associated with loss of correction in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity. Methods Between 2008-7 and 2017-7, we treated 30 cases of cubital varus had underwent the the osteotomy. We compared preoperative and postoperative clinical and imaging parameters (H-cobb angle,Baumman angle) for all patients. Postoperative evaluation was performed by telephone interview. Results In our study,there were 30 patients,included 17 males and 13 females.the mean age was 75 months old.In the rst follow-up,Approximately 80 % of patients had a loss of correction of H-cobband 83% of patients at the second follow-up. The Baumann angle also had a loss of correction,about 57% was lost at the rst follow-up,and 43% was lost at the second follow-up. The average interval between the rst follow-up and the second follow-up was 24 days The H-cobb angle mean loss was 2.4°.There was a statistically signicant difference between the H-cobb angle measured before surgery and the angle measured after surgery (p <0.05). -
Genetics of Congenital Hand Anomalies
G. C. Schwabe1 S. Mundlos2 Genetics of Congenital Hand Anomalies Die Genetik angeborener Handfehlbildungen Original Article Abstract Zusammenfassung Congenital limb malformations exhibit a wide spectrum of phe- Angeborene Handfehlbildungen sind durch ein breites Spektrum notypic manifestations and may occur as an isolated malforma- an phänotypischen Manifestationen gekennzeichnet. Sie treten tion and as part of a syndrome. They are individually rare, but als isolierte Malformation oder als Teil verschiedener Syndrome due to their overall frequency and severity they are of clinical auf. Die einzelnen Formen kongenitaler Handfehlbildungen sind relevance. In recent years, increasing knowledge of the molecu- selten, besitzen aber aufgrund ihrer Häufigkeit insgesamt und lar basis of embryonic development has significantly enhanced der hohen Belastung für Betroffene erhebliche klinische Rele- our understanding of congenital limb malformations. In addi- vanz. Die fortschreitende Erkenntnis über die molekularen Me- tion, genetic studies have revealed the molecular basis of an in- chanismen der Embryonalentwicklung haben in den letzten Jah- creasing number of conditions with primary or secondary limb ren wesentlich dazu beigetragen, die genetischen Ursachen kon- involvement. The molecular findings have led to a regrouping of genitaler Malformationen besser zu verstehen. Der hohe Grad an malformations in genetic terms. However, the establishment of phänotypischer Variabilität kongenitaler Handfehlbildungen er- precise genotype-phenotype correlations for limb malforma- schwert jedoch eine Etablierung präziser Genotyp-Phänotyp- tions is difficult due to the high degree of phenotypic variability. Korrelationen. In diesem Übersichtsartikel präsentieren wir das We present an overview of congenital limb malformations based Spektrum kongenitaler Malformationen, basierend auf einer ent- 85 on an anatomic and genetic concept reflecting recent molecular wicklungsbiologischen, anatomischen und genetischen Klassifi- and developmental insights. -
Right Amelia in a Patient with Neurofibromatosis Type 1
J Surg Med. 2020;4(3):240-242. Case report DOI: 10.28982/josam.630597 Olgu sunumu Right amelia in a patient with neurofibromatosis type 1 Nörofibromatozis tip 1’li hastada sağ amelia Hilal Aydın 1 1 Department of Pediatric Neurology, Faculty of Abstract Medicine, Balikesir University, Balikesir, Turkey Neurofibromatosis type 1 (NF1) affects many different systems such as the skeletal, endocrine, gastrointestinal ORCID ID of the author(s) systems, as well as the skin, peripheral and central nervous systems (CNS). The NF-1 gene, located in the 11p12 region HA: 0000-0002-2448-1270 of chromosome 17, encodes a tumor suppressor protein, called neurofibromin, and is expressed in a diverse range of cell and tissue types. Neurofibromin negatively regulates the activity of an intracellular signaling molecule, p21ras (Ras), acting as a GTPase-activating protein (Ras-GAP). The Ras-GAP function of neurofibromin has been associated with various NF1-related clinical symptoms. We aimed to present a case of clinically and genetically diagnosed neurofibromatosis type 1 with a developmental anomaly in the right hand (right hand amelia). Our knowledge about whether the coexistence of these two conditions is coincidental or a result of neurofibromatosis is limited. We wanted to present this case since the coexistence of amelia and neurofibromatosis is a first. Keywords: Neurofibromatosis type 1, Amelia, Neurofibromin Öz Nörofibromatozis tip 1 (NF1); deri, periferal ve santral sinir sistemi (SSS) yanında kemik, endokrin, gastrointestinal sistem gibi bir çok değişik sistemi etkiler. Otozomal dominant geçişli olup görülme sıklığı 1/3000-1/4000 olarak saptanmıştır. NF-1 geni 17. kromozom 11p12 bölgesindedir, bu gen nörofibromin olarak adlandırılan tümor supresor bir proteini kodlamaktadır. -
Efficacy and Safety of a Novel Personalized Navigation Template in Proximal Femoral Corrective Osteotomy for the Treatment of DDH Qiang Shi1,2 and Deyi Sun1*
Shi and Sun Journal of Orthopaedic Surgery and Research (2020) 15:317 https://doi.org/10.1186/s13018-020-01843-y RESEARCH ARTICLE Open Access Efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH Qiang Shi1,2 and Deyi Sun1* Abstract Background: This present study is aimed to retrospectively evaluate the efficacy and safety of a novel personalized navigation template in proximal femoral corrective osteotomy for the treatment of DDH. Methods: Twenty-nine consecutive patients with DDH who underwent proximal femoral corrective osteotomy were evaluated between August 2013 and June 2017. Based on the different surgical methods, they were divided into the conventional group (n = 14) and navigation template group (n = 15). The osteotomy degrees, radiation exposure, and operation time were compared between the two groups. Results: No major complications relating to osteotomy surgery such as redislocation or avascular necrosis occurred in the navigation template group, which had more accurate osteotomy degrees, less radiation exposure, and shorter operation time when compared with the conventional group (P < 0.05). Moreover, there was significant difference according to the McKay criteria between the two groups (P = 0.0362). Conclusions: The novel personalized navigation template in proximal femoral corrective osteotomy is effective and safe, which could improve the femoral osteotomy accuracy, reduce radiation exposure, and shorten operation time. Keywords: Femoral corrective osteotomy, 3D printing, Navigation template, Developmental dysplasia of the hip Background [3–5]. The performance and positioning of femoral oste- Developmental dysplasia of the hip (DDH) is considered otomy is one of the most important surgical procedures one of the most common three-dimensional (3D) hip to ensure ideal correction effects, but the conventional deformities in children [1]. -
1 Tips7pp P654-660CR2.Indd
Tips From The Experts SingaporeSingapore Med Med J 2006; J 2006; 47(8) 47(8) : 654 : 1 Common paediatric orthopaedic problems in the upper limb Shafi M, Hui J H P In this article, we attempt to provide guidance of the upper limb in children and adolescents, for conducting the paediatric examination in an paying particular attention to clinical problems orderly, comprehensive sequence to arrive at the such as cubitus varus, polydactyly and Sprengel’s diagnosis in common musculoskeletal problems shoulder. CONGENITAL MUSCULAR TORTICOLLIS Description Torticollis or wry neck is defined as a condition where the head is tilted toward one side and the chin is pointing in the opposite direction. Congenital muscular torticollis (CMT) is a postural deformity detected at birth or shortly after birth. Frequency CMT has an estimated incidence of 1-2% and male-to-female ratio is 3:2 in the Chinese population(1). Location Fig. 1 Photograph of a 3-year-old girl with left 75% of CMT cases involve the right side. torticollis. Note the hemihypoplasia. Pathogenesis CMT (present at birth) may be caused by malpositioning of the head in the uterus, or by prenatal injury to the sternocleidomastoid muscle (SCM) that results in fibrosis or soft tissue compression leading to compartment syndrome, as evidenced by CMT being more frequent after breech presentations and with congenital hip dysplasia(2). In rare instances, bony anomalies of the cervical spine include the Klippel-Feil syndrome, or ocular imbalance might be causative. Other possibilities are spontaneous subluxation of a cervical vertebra, cervical adenitis secondary to upper respiratory tract infection, unilateral soft tissue infection, neck tumours or myositis. -
GUIDE to ADAPTED SWIMMING CLASSIFICATIONS Swimming Is
GUIDE TO ADAPTED SWIMMING CLASSIFICATIONS Swimming is the only sport that combines the conditions of limb loss, cerebral palsy (coordination and movement restrictions), spinal cord injury (weakness or paralysis involving any combination of the limbs) and other disabilities (such as Dwarfism (little people); major joint restriction conditions) across classes. Classes 1-10 – are allocated to swimmers with a physical disability Classes 11-13 – are allocated to swimmers with a visual disability Class 14 – is allocated to swimmers with an intellectual disability The Prefix S to the Class denotes the class for Freestyle, Backstroke and Butterfly The Prefix SB to the class denotes the class for Breaststroke The Prefix SM to the class denotes the class for Individual Medley. The range is from the swimmers with severe disability (S1, SB1, SM1) to those with the minimal disability (S10, SB9, SM10) In any one class some swimmers may start with a dive or in the water depending on their condition. This is factored in when classifying the athlete. The examples are only a guide – some conditions not mentioned may also fit the following classes. Locomotor Impaired (S1-S10): S1: Generally persons with complete spinal cord injuries below C4-C5 or cerebral palsy characterized by severe quadriplegia. Unable to catch the water. Severely limited propulsion from the arms due to muscle weakness, restricted range of motion or uncoordinated movements. No trunk control. No functional leg movements and significant leg drag. Assisted water start. Ordinarily uses the backstroke because of an inability to turn the head to breathe when swimming freestyle. S2: Generally persons with complete spinal cord injuries below C6-C7 or similar musculoskeletal impairment or cerebral palsy characterized by severe quadriplegia. -
Case Report Upper Limb Meromelia with Oligodactyly and Brachymesophalangy of the Foot: an Unusual Association
Hindawi Case Reports in Radiology Volume 2019, Article ID 3419383, 5 pages https://doi.org/10.1155/2019/3419383 Case Report Upper Limb Meromelia with Oligodactyly and Brachymesophalangy of the Foot: An Unusual Association Meltem Özdemir , Rasime Pelin Kavak , and Önder Eraslan University of Health Sciences, Dıs¸kapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey Correspondence should be addressed to Meltem Ozdemir;¨ [email protected] Received 1 May 2019; Accepted 7 June 2019; Published 24 June 2019 Academic Editor: Ravi Bhargava Copyright © 2019 Meltem Ozdemir¨ et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Meromelia is a rare skeletal abnormality characterized by the partial absence of at least one limb. Several mechanisms have been postulated to explain the etiopathogenesis of the disorder. Most of the cases of meromelia are reported to be sporadic. It can occur either in isolation or with other congenital malformations. VACTERL association, gastroschisis, atrial septal defect, proximal femoral focal defciency, and fbular hemimelia are the congenital abnormalities reported to be in association with meromelia. However, no other congenital abnormalities in association with meromelia have been recorded to date. We herein present an unusual case of bilateral upper limb meromelia accompanied by unilateral oligodactyly and brachymesophalangy of the foot. 1. Introduction herein present an unusual case of meromelia accompanied by congenital deformity of the foot. Amelia refers to the complete absence of at least one limb, and meromelia is characterized by the partial absence of at least one limb. -
A CLINICAL STUDY of 25 CASES of CONGENITAL KEY WORDS: Ectromelia, Hemimelia, Dysmelia, Axial, Inter- LIMB DEFICIENCIES Calary
PARIPEX - INDIAN JOURNAL OF RESEARCH Volume-7 | Issue-1 | January-2018 | PRINT ISSN No 2250-1991 ORIGINAL RESEARCH PAPER Medical Science A CLINICAL STUDY OF 25 CASES OF CONGENITAL KEY WORDS: Ectromelia, Hemimelia, Dysmelia, Axial, Inter- LIMB DEFICIENCIES calary M.B.B.S., D.N.B (PMR), M.N.A.M.S Medical officer, D.P.M.R., K.G Medical Dr Abhiman Singh University Lucknow (UP) An Investigation of 25 patients from congenital limb deficient patients who went to D. P. M. R. , K.G Medical University Lucknow starting with 2010 with 2017. This study represents the congenital limb deficient insufficient number of the India. Commonest deficiencies were Adactylia Also mid Ectromelia (below knee/ below elbow deficiency).Below knee might have been basic in male same time The following elbow for female Youngsters. No conclusive reason for the deformity might be isolated, however, A large number guardians accepted that possible exposure to the eclipse throughout pregnancy might have been those reason for ABSTRACT those deficiency. INTRODUCTION Previous Treatment Only 15 patients had taken some D. P. M. R., K.G Medical University Lucknow (UP) may be a greatest treatment, 5 underwent some surgical treatment and only 4 Also its identity or sort of Rehabilitation Centre in India. Thusly the patients used prosthesis. This indicates the ignorance or lack of limb deficient children attending this department can easily be facilities to deal with the limb deficient children. accepted as a representative sample of the total congenital limb deficiency population in the India. DEFICIENCIES The deficiencies are classified into three categories:- MATERIAL AND METHODS This study incorporates 25 patients congenital limb deficiency for 1) Axial Dysmelia where medial or lateral portion is missing lack who originated for medicine at D. -
Limb Deficiencies in Newborn Infants
Limb Deficiencies in Newborn Infants Caroline K. McGuirk, MPH*; Marie-Noel Westgate, MEd‡; and Lewis B. Holmes, MD*‡§ ABSTRACT. Objective. The prevalence rate of all imb deficiencies are a widely known outcome types of limb reduction defects in general and those that associated with teratogenic exposures during potentially are caused by vascular disruption in particu- pregnancy, such as thalidomide,1 misoprostol lar is needed to provide a baseline for the evaluation of L 2 (prostaglandin E1 analog), and the prenatal diagno- infants who are exposed in utero to teratogens that cause sis procedure chorionic villus sampling (CVS).3–5 vascular disruption. The objective of this study was to Each of these teratogens produces a distinctive pat- determine this prevalence rate. tern of limb defects. Specifically, infants who are Methods. All infants with any limb deficiency among damaged in utero by thalidomide have a symmetri- 161 252 liveborn and stillborn infants and elective termi- cal pattern of deficiency (or polydactyly) on the pre- nations were identified in a hospital-based Active Mal- axial side of both arms and legs.1 By contrast, infants formations Surveillance Program in Boston in the years 1972 to 1974 and 1979 to 1994. An extensive search was who are exposed early in pregnancy to misoprostol made to identify infants who were missed by the Sur- and CVS have asymmetrical digit loss, constriction veillance Program; an additional 8 infants (7.3% of total) rings, and syndactyly. These abnormalities are attrib- were identified. The limb reduction defects were classi- uted to the process of vascular disruption in limb fied in 3 ways: 1) by the anatomic location of the defect, structures that had formed normally and include that is longitudinal, terminal, intercalary, etc; 2) for in- defects referred to as the amniotic band syndrome. -
Expanded Indications for Guided Growth in Pediatric Extremities
Current Concept Review Expanded Indications for Guided Growth in Pediatric Extremities Teresa Cappello, MD Shriners Hospitals for Children, Chicago, IL Abstract: Guided growth for coronal plane knee deformity has successfully historically been utilized for knee val- gus and knee varus. More recent use of this technique has expanded its indications to correct other lower and upper extremity deformities such as hallux valgus, hindfoot calcaneus, ankle valgus and equinus, rotational abnormalities of the lower extremity, knee flexion, coxa valga, and distal radius deformity. Guiding the growth of the extremity can be successful and is a low morbidity method for correcting deformity and should be considered early in the treatment of these conditions when the child has a minimum of 2 years of growth remaining. Further expansion of the application of this concept in the treatment of pediatric limb deformities should be considered. Key Concepts: • Guiding the growth of pediatric physes can successfully correct a variety of angular and potentially rotational deformities of the extremities. • Guided growth can be performed using a variety of techniques, from permanent partial epiphysiodesis to tem- porary methods utilizing staples, screws, or plate and screw constructs. • Utilizing the potential of growth in the pediatric population, guided growth principals have even been success- fully applied to correct deformities such as knee flexion contractures, hip dysplasia, femoral anteversion, ankle deformities, hallux valgus, and distal radius deformity. Introduction Guiding the growth of pediatric orthopaedic deformities other indications and uses for guided growth that may is represented by the symbol of orthopaedics itself, as not have wide appreciation. the growth of a tree is guided as it is tethered to a post (Figure 1). -
Malunion of Long Bones
Malunion of long bones Andreas Panagopoulos Assistant professor in Orthopaedics University Hospital of Patras Definition A malunited fracture is one that has healed with the fragments in a non- anatomical position Acceptability of fracture reduction alignment rotation normal length actual position of fragments (least important) Classification Based to location Intrarticular Metaphsial Diaphysial Based to complexity Simple (one plane) e.g. valgus-varus Complex ( multi planes) However, some malalignments are better tolerated from the neighboring joints than others (e.g. malunions of the upper extremity) Also lower leg valgus is more acceptable than varus This means there are both relative and absolute indications to correct deformities and leg length discrepancies Absolute Indications - Presence of disabling pain - Severe functional disability Relative Indications - Cosmetic reasons - No response to nonoperative treatment The object of surgery for malunion is to restore function Operative treatment for malunion of most fractures should not be considered until 6 to 12 months after the fracture has occurred. However, in intraarticular fractures, surgery may be required sooner if satisfactory function is to be restored When considering surgical correction of the malunion we should take in account: 1. Age of the patient 2. Socio-economic factors 3. The function of the joint 4. The bone stock and the degree of osteoporosis 5. The state of the soft tissue envelope Corrective surgery at the site of malunion is not always feasible. In some instances, -
Anatomy, Physical Examination and Imaging of Thoracic and Lumbosacral Spine
Anatomy, Physical Examination and Imaging of Thoracic and Lumbosacral Spine NGUYỄN THÀNH NHÂN LEARNING OBJECTIVES Understand: * Basic anatomy of the spine * Thoracic and Lumbar spine anatomy Understand basic imaging of X ray, CT Scan and MRI Identify and assess functions of the structures in clinical aspect: * Identify structures: inspection, palpation * Assess: Thoracic - Lumbar spine movements Understand: dermatomes, * SLR test, Bragard’s test, Neri’s test, … CONTENT Basic anatomy of the spine Thoracic - Lumbosacral spine anatomy Imaging of Thoracic - Lumbar spine Physical examination of Thoracic and Lumbar spine Anatomy Basic anatomy of the spine - The vertebral column consists of 33 vertebrae, - 5 segments: cervical, thoracic, lumbar, sacral, and coccygeal. - There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. - The two major exceptions are C1 (atlas) and C2 (axis) - Atlantoaxial joint - cervical rotation Anatomy Basic anatomy of the spine [1] Anatomy Basic anatomy of the spine [1] Anatomy Basic anatomy of the spine - The spinal cord - Conus medullaris: L1 - L2 - There are 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral pairs, and 1 coccygeal pair of spinal nerves. - The sacral spinal nerves make up the cauda equina The neural anatomy is such that the spinal cord resides within the bony canal between C1 and L1 and/or L2. The filum terminale extends from the conus and attaches to the coccyx.[1] Anatomy Basic neurology of the spine - Gray matter + Spinal neurons (lower motor neurons), + Interneurons