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d'Entremont A.G.,University of British Columbia | d'Entremont A.G.,Bc Childrens Hospital | Cooper A.P.,University of British Columbia | Cooper A.P.,Bc Childrens Hospital | And 3 more authors.
Clinical Orthopaedics and Related Research | Year: 2015

Background: Patient-reported outcomes (PROs) are an increasingly popular research tool used to evaluate the outcomes of surgical intervention. If applied appropriately, they can be useful both for disease monitoring and as a method of assessing the efficacy of treatment. Many disorders can lead to impingement in children and adolescents, but it is not clear if any PROs have been validated to evaluate outcomes in these populations. Questions/purposes: We performed a systematic review of the literature to answer the following research questions: (1) Which hip-specific PROs are used in pediatric populations with impingement? (2) What clinimetric evidence exists for the use of these specific PROs in this population? Methods: We performed two systematic searches of three databases (Medline, EMBASE, and Ovid All EBM Reviews). The first search aimed to identify specific PROs that have been applied to pediatric impingement populations. The second search aimed to find clinimetric evaluations of the PROs from the first search in this population. Results: We found six hip-specific PROs applied in pediatric impingement: Harris Hip Score, modified Harris Hip Score, Iowa Hip Score, Merle d’Aubigné Hip Score, Hip Outcome Score, and Non-arthritic Hip Score. However, we found no papers validating any of these PROs in this population. Furthermore, we found no papers validating any of these PROs in any pediatric population. Conclusions: A number of adult PROs have been applied in pediatric impingement disorders without evidence of validation in any pediatric population. Further work to develop and validate a hip-specific pediatric PRO is required. © 2014, The Association of Bone and Joint Surgeons®.


Shaheen S.,University of Khartoum | Mursal H.,Ministry of Health | Rabih M.,Ministry of Health | Johari A.,Childrens Orthopaedic Center
Journal of Pediatric Orthopaedics Part B | Year: 2015

Clubfoot, talipes equino varus (TEV), is a common congenital foot anomaly. Some cases are resistant to conservative treatment. Many causes of resistance have been reported, among these, the presence of anomalous muscles; however, the effect of the presence of anomalous muscles on the outcome of conservative management is not well studied. These aberrant muscles are discovered during the extensive surgical release as an abnormal finding. The aim of this work is to study the demographic characteristics of patients with resistant TEV that necessitated extensive soft tissue release at Sudan Clubfoot Clinic and to document the prevalence of flexor digitorum accessorius longus (FDAL) muscle in a large series of clubfoot patients treated by extensive surgery: posteromedial release. Also, we introduce a new observation as an indication by which the surgeon can predict the presence of FDAL. On the basis of an observation that there is a special posture of the big toe in extension in relation to other flexed toes associated with the presence of FDAL, records of patients of clubfoot treated by extensive surgery between 2007 and 2012 at the Sudan Clubfoot Project were reviewed. Demographic characteristics were studied. Only patients with idiopathic TEV were included. Resistant clubfeet necessitated extensive release in 261 patients, 197 males and 64 females. Their ages ranged between 1 day and 15 years at presentation. FDAL muscle was found in 48 patients (54 feet) out of 261 patients (411 feet, 13.14%). In 46 of the 48 patients (95.8%), the presence of the FDAL could be predicted by a sign. FDAL is prevalent in 13% of resistant TEV cases requiring extensive soft tissue release, and the surgeon can expect resistant clubfoot and predict the presence of the FDAL in over 95% before he operates by observing the Samir-Adam sign. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Andras L.,Childrens Orthopaedic Center | Louie K.,Childrens Orthopaedic Center | Skaggs D.L.,Childrens Orthopaedic Center
Spine Deformity | Year: 2014

Study Design A retrospective, single-center review of all spinal deformity surgeries at the authors' institution. Objectives To determine the most sensitive physical examination finding as a test for motor deficits after spinal deformity surgery. Background Despite both reported false negatives of neuromonitoring and the potential for development of delayed deficits, the literature has paid relatively little attention to the postoperative evaluation and monitoring of neurologic integrity after correction of spinal deformity. Methods A retrospective, single-center review of 1,274 consecutive spinal deformity surgeries from 2003 to 2011 was performed. Patients with limited neurologic function or an inability to undergo an examination preoperatively were excluded. A total of 1,023 patients were included in the analysis. Records were analyzed for postoperative motor deficit. Results A total of 12 patients had a motor deficit in the perioperative period. Eight had a deficit on the immediate postoperative exam; 6 had absent ankle dorsiflexion and 2 had weak ankle dorsiflexion; And 4 developed a delayed motor deficit: 3 with absent ankle dorsiflexion and 1 with weak ankle dorsiflexion. There were no cases of a motor deficit in which ankle dorsiflexion was not weak or absent. Of the 12 patients with a deficit, 8 had complete loss of motor function. Of the 4 patients with incomplete neurologic injury, loss of ankle dorsiflexion was the only common physical examination finding. In this review, ankle dorsiflexion was 100% sensitive (12 of 12) and 100% specific (1,011 of 1,011) for neurologic injury. Conclusions Ankle dorsiflexion was the most sensitive test for lower extremity motor function after spinal deformity surgery, both for immediate and delayed deficits. Without testing ankle dorsiflexion specifically, neurologic motor deficits may be missed. © 2014 Scoliosis Research Society.


Johari A.N.,Childrens Orthopaedic Center | Johari R.A.,Childrens Orthopaedic Center | Maheshwari S.K.,Childrens Orthopaedic Center
Current Orthopaedic Practice | Year: 2013

Delayed or missed diagnosis of septic arthritis of the hip in children results in various sequelae. In septic hips, dislocations with the capital femoral epiphysis (CFE) present have not been well described. This group is a distinct entity with different management protocol and prognostic implications. There is a paucity of reports in the literature discussing the management difficulties, results, and outcome, and hence the need for a review on the subject. This review looks at the diagnostic and investigative modalities, problems in management, and the results of intervention for this condition. The presence of CFE can be confirmed radiographically or at the time of intervention. MRI is helpful in planning treatment. Interventions for dislocation include closed reduction (with or without adductor tenotomy) and open reduction (with or without supplemental femoral and acetabular procedures). A significant number of patients need open reduction with other procedures. Results of treatment are compromised by the presence of avascular necrosis of the CFE. Femoral varus osteotomy may result in coxa vara. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Johari A.N.,Childrens Orthopaedic Center | Dhawale A.A.,Childrens Orthopaedic Center | Johari R.A.,Childrens Orthopaedic Center
Journal of Pediatric Orthopaedics Part B | Year: 2011

Delayed or missed diagnosis of septic arthritis of hip in children results in various sequelae. The group of post septic hip dislocations when the capital femoral epiphysis (CFE) is present has not been described in the commonly used classifications. This is a retrospective series of 21 hips in 18 children. The presence of the CFE was confirmed radiologically or at the time of intervention. The mean follow-up after intervention was 6.3 years. Interventions for dislocations included closed reduction±adductor tenotomy, open reduction±supplementary femoral procedures, and acetabular procedures. Results were evaluated clinically with Ponseti hip scoring and radiologically with the modified Severin grading. Closed reduction was successful in seven of 20 hips (35%) and open reduction in 13 of 14 hips. At follow-up, good clinical result was seen in nine of 18 cases (50%). The mean neck shaft angle was 129° in all hips and 124° after femoral varus osteotomy. There was one redislocation and three subluxations. The modified Severin classification was class 2 in five hips (good), class 3 in 12 hips (fair), class 4 in three hips (poor), and class 6 in one hip (failure). Septic hip dislocation with CFE present is a distinct entity. MRI is helpful for planning treatment. A significant number of patients need open reduction with other procedures. Femoral varus osteotomy may contribute to coxa vara. In the short term, intervention results in a stable, functional, and mobile hip. © 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins.


Johari A.N.,Childrens Orthopaedic Center | Dhawale A.A.,Childrens Orthopaedic Center | Salaskar A.,Childrens Orthopaedic Center | Aroojis A.J.,KDA Hospital
Journal of Pediatric Orthopaedics Part B | Year: 2010

We report the results of surgical treatment of congenital postero-medial bowing of the tibia and fibula. Twenty patients with congenital postero-medial bowing were seen with nine patients treated surgically (corrective osteotomy or lengthening and deformity correction with Ilizarov fixator) and 11 patients managed conservatively. The angles of medial and posterior angulation and limb length discrepancy were recorded serially and compared. Surgical complications were recorded. The mean follow-up was 9.5 and 6.1 years after surgery. Although there was a reduction in angulation and correction of limb length discrepancy, we encountered complications in the surgically treated patients. There was no statistically significant difference between the surgically treated and conservatively managed groups with respect to mean angulation, though there was a significant difference in the mean limb length discrepancy. In conclusion, we advocate a one-stage lengthening and correction of the residual deformity closer to skeletal maturity. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Dhawale A.A.,Childrens Orthopaedic Center | Johari A.N.,Childrens Orthopaedic Center | Nemade A.,Childrens Orthopaedic Center
Journal of Pediatric Orthopaedics Part B | Year: 2012

Hip dislocation is a serious but rarely reported complication of femoral lengthening in congenital short femora. We report a retrospective series of three hip dislocations that occurred during lengthening, analyze the factors contributing to the dislocation, and discuss the treatment of this difficult problem. The average lengthening achieved was 9 cm. We found progressive acetabular dysplasia and decreasing center edge angle. Closed reduction failed. Treatment included soft tissue release, open reduction with femoral shortening, and acetabular procedures. At a mean follow-up of 4.4 years, two patients had a good modified Mckay score and a modified Severin score of 3. Excessive lengthening should be avoided. © 2012 Lippincott Williams & Wilkins, Inc.


PubMed | Childrens Orthopaedic Center
Type: Comparative Study | Journal: Journal of pediatric orthopedics. Part B | Year: 2010

We report the results of surgical treatment of congenital postero-medial bowing of the tibia and fibula. Twenty patients with congenital postero-medial bowing were seen with nine patients treated surgically (corrective osteotomy or lengthening and deformity correction with Ilizarov fixator) and 11 patients managed conservatively. The angles of medial and posterior angulation and limb length discrepancy were recorded serially and compared. Surgical complications were recorded. The mean follow-up was 9.5 and 6.1 years after surgery. Although there was a reduction in angulation and correction of limb length discrepancy, we encountered complications in the surgically treated patients. There was no statistically significant difference between the surgically treated and conservatively managed groups with respect to mean angulation, though there was a significant difference in the mean limb length discrepancy. In conclusion, we advocate a one-stage lengthening and correction of the residual deformity closer to skeletal maturity.


PubMed | Childrens Orthopaedic Center
Type: Journal Article | Journal: Journal of pediatric orthopedics. Part B | Year: 2011

Delayed or missed diagnosis of septic arthritis of hip in children results in various sequelae. The group of post septic hip dislocations when the capital femoral epiphysis (CFE) is present has not been described in the commonly used classifications. This is a retrospective series of 21 hips in 18 children. The presence of the CFE was confirmed radiologically or at the time of intervention. The mean follow-up after intervention was 6.3 years. Interventions for dislocations included closed reduction adductor tenotomy, open reduction supplementary femoral procedures, and acetabular procedures. Results were evaluated clinically with Ponseti hip scoring and radiologically with the modified Severin grading. Closed reduction was successful in seven of 20 hips (35%) and open reduction in 13 of 14 hips. At follow-up, good clinical result was seen in nine of 18 cases (50%). The mean neck shaft angle was 129 in all hips and 124 after femoral varus osteotomy. There was one redislocation and three subluxations. The modified Severin classification was class 2 in five hips (good), class 3 in 12 hips (fair), class 4 in three hips (poor), and class 6 in one hip (failure). Septic hip dislocation with CFE present is a distinct entity. MRI is helpful for planning treatment. A significant number of patients need open reduction with other procedures. Femoral varus osteotomy may contribute to coxa vara. In the short term, intervention results in a stable, functional, and mobile hip.


PubMed | Childrens Orthopaedic Center
Type: Journal Article | Journal: Journal of pediatric orthopedics. Part B | Year: 2012

Hip dislocation is a serious but rarely reported complication of femoral lengthening in congenital short femora. We report a retrospective series of three hip dislocations that occurred during lengthening, analyze the factors contributing to the dislocation, and discuss the treatment of this difficult problem. The average lengthening achieved was 9 cm. We found progressive acetabular dysplasia and decreasing center edge angle. Closed reduction failed. Treatment included soft tissue release, open reduction with femoral shortening, and acetabular procedures. At a mean follow-up of 4.4 years, two patients had a good modified Mckay score and a modified Severin score of 3. Excessive lengthening should be avoided.

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