BACKGROUND: Idiopathic chondrolysis (IC) of the hip is a rare, disabling condition affecting mainly adolescent females. Cartilage necrosis results in a stiff, painful hip which in the majority of cases have a poor outcome. The aetiology still remains unknown and the treatment is controversial and relatively unsuccessful. Subtotal capsulectomy with soft tissue releases has been reported to give good results
METHODS: Five female adolescents with IC of the hip were reviewed in order to shed light on the aetiology, delineate the role of magnetic resonance imaging (MRI) pre- and post-operatively and assess the outcome of a subtotal capsulectomy. The surgical technique was performed as originally described with concomitant releases of the deformities. Samples of synovium and cartilage were sent for histology and culture (including tuberculosis culture). Pre- and post-operatively the patients were evaluated regarding pain, deformity and range of motion (ROM). Follow-up radiographs and MRI scans were performed and compared to pre-operative imaging
RESULTS: Blood tests for auto-immune markers were negative in all cases. MRI pre-operatively showed erosions and mainly destruction of the superomedial acetabular cartilage. Histology of the synovium showed chronic, non-specific inflammation with a plasma cell infiltrate, suggesting an auto-immune cause. Histology of the cartilage confirmed cartilage necrosis. At follow-up (mean 11 months) four of the five patients were pain free and one patient reported an improvement in pain. There was an improvement in deformity and range of motion in four cases. Post-operative imaging (radiographs and MRI) at a mean of eight months, however, showed deterioration of the pathology with increase of the erosions, joint space narrowing and cartilage destruction
CONCLUSIONS: We conclude that the aetiology is most likely an auto-immune process. MRI was helpful in delineating the cartilage pathology. A subtotal capsulectomy offers early post-operative clinical relief. Radiological deterioration however suggests that the surgery does not prevent deterioration of pathology.
LEVEL OF EVIDENCE: Level IV: Case series
We reviewed our experience of tibialis anterior transfer and anterior release for calcaneus deformity in 46 feet of 26 ambulant patients with myelomeningocele. At an average follow-up of 8.4 years (2 to 17.6) there were 89% who had satisfactory results; 64% of the patients having tibialis anterior transfers were able to stand on their toes. Hip abductor power was a good predictor of a functional transfer. Pre-operative trophic ulceration of the heel increased from 3.2% to 33% if surgery was delayed. Secondary deformities, two-thirds of them into valgus, developed in 76% of feet.
Purpose of study Serial manipulations and casting for the treatment of congenital clubfoot has long been the practice internationally. There are, however, a great variety of manipulative techniques being practiced with differing results. We aim to determine how the rate of major surgery, ie. a full posteromedial-release (PMR), as initial surgical intervention has changed since introducing the Ponseti method of plastering at our centre in 2002. We also aim to determine whether pre-operative radiographs have any bearing on the type of surgery performed. Methods Clinical records and radiographs of all patients presenting to our clubfoot clinic in the years 1999–2000 and 2009–2010 respectively were reviewed. Patients were included if they had clinical clubfoot, and excluded if they presented after 3 months of age, had undergone prior treatment or suffered from associated congenital anomalies. We then determined which patients underwent PMR as primary surgical intervention following serial castings. We also measured the radiographic parameters on all available radiographs (tibiocalcaneal, talometatarsal-I, lateral and AP talocalcaneal angles) and performed a statistical analysis to determine their value in predicting the type of surgery required. Results In the pre-Ponseti group we included 83 feet of which 34 had undergone PMR. In the Ponseti group there were 68 feet, of which none had undergone PMR. This was found to be statistically significant. Of the measured angles, the tibiocalcaneal and lateral talocalcaneal had the highest correlation with clinical severity (.67 and −.45 respectively). Conclusion Employing the Ponseti method of plastering has significantly decreased the need for major surgery at our centre. This is in keeping with published results internationally. We found the tibiocalcaneal angle to be the most predictive of need for major surgery, and the talometatarsal-I to be the least predictive. The role of pre-operative X-rays, however, remains unclear as surgical decisions are made on clinical grounds. NO DISCLOSURES
Purpose of studySerial manipulations and casting for the treatment of congenital clubfoot has long been the practice internationally. There are, however, a great variety of manipulative techniques being practiced with differing results. We aim to determine how the rate of major surgery, ie. a full posteromedial-release (PMR), as initial surgical intervention has changed since introducing the Ponseti method of plastering at our centre in 2002. We also aim to determine whether pre-operative radiographs have any bearing on the type of surgery performed.MethodsClinical records and radiographs of all patients presenting to our clubfoot clinic in the years 1999–2000 and 2009–2010 respectively were reviewed. Patients were included if they had clinical clubfoot, and excluded if they presented after 3 months of age, had undergone prior treatment or suffered from associated congenital anomalies. We then determined which patients underwent PMR as primary surgical intervention following serial castings. We also measu...
Femur shaft fractures constitute 21.9% of the orthopaedic fractures seen in our unit. The epidemiology is well described in literature from developed countries. To assess the epidemiology in a developing country and to identify socio-demographic risk factors, we did a retrospective study of 759 children with femur fractures treated over a 5-year period. We utilised the Census of 2011 to calculate the annual incidence. The socio-economic status was determined by means of a social deprivation category based on the parental occupation obtained from the Census as per the parental address. The mean annual incidence of 152 patients with femur fractures extrapolated to 0.25 per 1 000 children per year. The commonest mechanism of injury was a fall (39%) with a peak at 2 to 3 years of age, followed by motor vehicle accident (MVA) (33.7%), of which 88% were pedestrian (PVA). Ninety per cent of the patients were from the lowest two socioeconomic classes. The peak incidence at 4 to 5 years due to a PVA was younger than the ≥6 years reported from developed countries. Children at 4 to 5 years have not developed the cognitive and perceptuo-motor abilities to adapt to a traffic environment. The peak of 4 to 5 years due to PVAs is the result of lack of guided parental training, adequate supervision and play area in the lower socio-economic classes. In children <1 year of age, 59.3% were due to non-accidental injury (NAI) and 23.7% due to osteogenesis imperfecta.
Purpose of the studyTo evaluate the outcome of the Modified French osteotomy for the correction of cubitus varus resulting from a supracondylar distal humerus fracture in children.Description of me...
Thirty-four neonates with osteomyelitis were reviewed. The hip (19) was the most common site involved. Swelling and pseudoparalysis were the most significant local signs. Radiographic abnormalities, such as metaphyseal rarefaction and/or joint subluxation were found on the initial radiographs in 18 of the 19 hips involved. All patients were treated with antibiotics and all infections involving joints were drained surgically. Good results were achieved in 75% of all sites and in 68% of hips.
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