Purpose: Medial epicondyle fractures (MEF) are a common pediatric injury, with little evidence to guide decision-making with respect to treatment. Both casting alone and operative treatment with reduction and fixation have been shown to give reliably good results with low complication rates. High-level comparative studies to establish superiority of one treatment are lacking. We hypothesize that this will lead to large variability in operative treatment rates between hospitals as decisions are based on surgeon and patient preference. The purpose of this study is to describe MEF treatment variation and to evaluate which …
Case: We describe a patient who was diagnosed with developmental hip dislocation at 21 months of age despite having had normal ultrasonography findings at 5 weeks of age. Conclusion: This case report provides evidence that late developmental hip dislocation can occur despite normal clinical and sonographic findings early in life, and that it is difficult to know the cause of developmental hip dislocation when it presents late.
Clubfeet are associated with many neuromuscular and congenital conditions. Nonidiopathic clubfeet are typically thought to be resistant to nonoperative management. The Ponseti method has revolutionized the treatment of patients with idiopathic clubfeet. The purpose of this study was to describe the use of the Ponseti method in the treatment of patients whose clubfeet are associated with a neuromuscular diagnosis or a syndrome.All patients with clubfeet who were treated at the Hospital for Sick Children, Toronto, from 2001 to 2005 were reviewed. Patients were included only if a neuromuscular condition or a syndrome associated with clubfeet could be identified and if the primary treatment was at our institution. Twenty-three patients with 40 nonidiopathic clubfeet and 171 patients with 249 idiopathic clubfeet have been treated with a minimum follow-up time of 1 year. The outcomes evaluated included the number of casts, the percentage of patients requiring percutaneous Achilles tendon lengthening (tenotomy of the Achilles tendon [TAT]), rate of recurrences, rate of failures, and the need for additional secondary procedures.The mean age at presentation for nonidiopathic clubfeet was 11 weeks. The mean follow-up time was 33 months, and the mean number of casts was 6.4; a percutaneous TAT was necessary in 27 (68%) of 40 feet. Failure of the Ponseti casting occurred in 4 (10%) of the 40 feet. Recurrence requiring additional treatment occurred in 16 (44%) of 36 feet. Additional procedures included second percutaneous TAT, limited posterior/plantar release, or complete posteromedial release totaling 11 (28%) of 40. When compared with idiopathic clubfeet, nonidiopathic clubfeet required more casts and had a higher rate of failures, recurrences, and additional procedures than idiopathic clubfeet.Although not as successful as for idiopathic clubfeet, when the Ponseti technique is applied to nonidiopathic clubfeet, correction can be achieved and maintained in most patients.Prognostic level 2.
Purpose: To evaluate the validity of seven PROMIS measures to assess HRQoL relevant to pediatric patients with LCPD. Methods: This was a multicenter prospective study (13 institutions) of patients with Perthes disease (age 8 to 18 years) who had non-surgical or surgical treatments > 6 months prior . Waldenstrom …
Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic and spinal curvature due to secondary reasons. The majority of scoliosis cases encountered by the general practitioner will be idiopathic. The natural history relates to the etiology and age at presentation, and usually dictates the treatment. However, it is the patient's history, physical examination and radiographs that are critical in the initial evaluation of scoliosis, and in determining which patients need additional considerations. Scoliosis with a primary diagnosis (nonidiopathic) must be recognized by the physician to identify the causes, which may require intervention. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. School screening for scoliosis is controversial and is falling out of favour. The treatment for idiopathic scoliosis is based on age, curve magnitude and risk of progression, and includes observation, orthotic management and surgical correction with fusion. A child should be referred to a specialist if the curve is greater than 10° in a patient younger than 10 years of age, is greater than 20° in a patient 10 years of age or older, has atypical features or is associated with back pain or neurological abnormalities.
