Showing papers in "Journal of Pediatric Orthopaedics in 2000"
TL;DR: Good test-retest reliability among parents and good interrater reliability between parents and community caregivers was demonstrated and content and concurrent validity were high, as assessed by correlation to standardized functional outcome measures, energy expenditure, and gait-analysis information.
Abstract: A 10-level, parent-report walking scale encompassing a range of walking abilities from nonambulatory to ambulatory in all community settings and terrains was developed at Gillette Children's Specialty Healthcare (GCSH) as part of the Gillette Functional Assessment Questionnaire (FAQ). The reliability and validity of the walking-scale portion of the FAQ were tested on a group of individuals seen in the Motion Analysis Laboratory at GCSH between May 1996 and January 1997. A complete data set on 41 individuals with neuromuscular conditions represented the community ambulation levels (6-10) of the walking scale. Good test-retest reliability among parents and good interrater reliability between parents and community caregivers was demonstrated. Content and concurrent validity were also high, as assessed by correlation to standardized functional outcome measures, energy expenditure, and gait-analysis information. A reliable and valid scale specific to the task of walking such as the FAQ can assist clinicians in documenting functional change in children with chronic neuromuscular conditions.
319 citations
TL;DR: The safety and short-term efficacy of BTX injections were evaluated in a prospective, 3-month, double-blind, randomized clinical trial involving 114 children with cerebral palsy and dynamic equinus foot deformity.
Abstract: Increased gastrocnemius/soleus muscle tone in children with cerebral palsy may cause an equinus of the ankle. Botulinum toxin type A (BTX), a neuromuscular blocking agent, reduces muscle tone in various neuromuscular disorders. The safety and short-term efficacy of BTX injections were evaluated in a prospective, 3-month, double-blind, randomized clinical trial involving 114 children with cerebral palsy and dynamic equinus foot deformity. Outcome was determined by observational gait analysis, ankle range-of-motion measurements, and quantification of muscle denervation by nerve conduction. Patients in the BTX group demonstrated improved gait function and partial denervation of the injected muscle. No serious adverse events were reported.
278 citations
TL;DR: Bone density in the lumbar spine and proximal femur was profoundly diminished even when gait was minimally affected, and then progressively decreased to nearly 4 standard deviations below age-matched normals after fracture.
Abstract: The relationships between bone density, mobility, and fractures were assessed in 41 boys with Duchenne muscular dystrophy. Bone density in the lumbar spine was only slightly decreased while the boys were ambulatory (mean z-score, -0.8), but significantly decreased with loss of ambulation (mean z-score, -1.7). In contrast, bone density in the proximal femur was profoundly diminished even when gait was minimally affected (mean z-score, -1.6), and then progressively decreased to nearly 4 standard deviations below age-matched normals (mean z-score, -3.9). These are consistent with the findings that 18 (44%) of the boys sustained a fracture, 66% of these fractures involved the lower extremities, and there were no spinal compression fractures. Furthermore, four (44%) of nine boys who were walking with aids or support at the time of fracture never resumed walking after the fracture. Osteoporosis is most profound in the lower extremities of boys with Duchenne muscular dystrophy, and begins to develop early while still ambulating. Frequent fractures that may result in loss of ambulation are the clinical consequences.
269 citations
TL;DR: The safety and short-term efficacy of BTX injections were evaluated in a prospective, 3-month, double-blind, randomized clinical trial involving 114 children with cerebral palsy and dynamic equinus foot deformity as mentioned in this paper.
Abstract: Summary Increased gastrocnemius/soleus muscle tone in children with cerebral palsy may cause an equinus of the ankle. Botulinum toxin type A (BTX), a neuromuscular blocking agent, reduces muscle tone in various neuromuscular disorders. The safety and short-term efficacy of BTX injections were evaluated in a prospective, 3-month, double-blind, randomized clinical trial involving 114 children with cerebral palsy and dynamic equinus foot deformity. Outcome was determined by observational gait analysis, ankle range-of-motion measurements, and quantification of muscle denervation by nerve conduction. Patients in the BTX group demonstrated improved gait function and partial denervation of the injected muscle. No serious adverse events were reported.
203 citations
TL;DR: Even hips with relative incongruity and some deformity of the femoral head can be successfully treated with this combined approach, and all hips remained well reduced at follow-up.
Abstract: Ninety-two patients with cerebral palsy underwent a special type of pericapsular acetabuloplasty designed to correct the hip dysplasia that occurs in cerebral palsy. The osteotomy was performed as part of a combined procedure (including femoral osteotomy and soft-tissue releases). Retrospective analysis was performed on 75 of the children (104 hips from 1982 through 1995) with a mean follow-up of 6.9 years. Ninety-nine (95%) of the 104 hips remained well reduced at follow-up. There were no redislocations. If the preoperative migration percentage was >70% (severe subluxation), improved results were noted in hips that had an open reduction with capsulorrhaphy. There were 13 complications including intraarticular extension of the acetabuloplasty (one) and avascular necrosis of the femoral head (eight hips, 8%). Indications for addition of a pericapsular acetabuloplasty include an open triradiate cartilage, acetabular dysplasia (acetabular index >25 degrees), and subluxation or dislocation with a migration percentage of >40%. Even hips with relative incongruity and some deformity of the femoral head can be successfully treated with this combined approach.
151 citations
TL;DR: Thirty-seven femoral shaft fractures, in 33 patients, were treated with unilateral external fixation after reduction from 1992 through 1998, and rate of refracture after removal of the external fixator is significantly higher than previously reported in literature.
Abstract: Thirty-seven femoral shaft fractures, in 33 patients, were treated with unilateral external fixation after reduction from 1992 through 1998. Ten girls and 23 boys ranged in age from 4 to 14 years. Thirteen children had multiple injuries, whereas 20 children had isolated fractures. Average follow-up was 3 years, 9 months, with only five children lost to follow-up. The average duration in fixator was 107 days. Thirty-six of 37 fractures healed, and there was one delayed union. There was minimal angulation, and limb-length inequality was generally <1 cm; 72.7% had pin-tract infections. Eight (21.6%) patients refractured; four occurred in the four patients with bilateral femur fractures. We agree with previous reports that external fixation remains a viable option for treatment of pediatric femoral shaft fractures. However, in our series, rate of refracture (21.6%) after removal of the external fixator is significantly higher than previously reported in literature. Children with bilateral femur fractures were at greatest risk.
121 citations
TL;DR: Based on the mathematical model, a wide range of patient positioning was found to result in a <10° error in the measurement of femoral NSA, which resulted in a more restricted range of acceptable femoral positioning.
Abstract: Femoral neck-shaft angle (NSA) was measured in a series of anteroposterior (AP) hip radiographs of a cadaveric femur in varying degrees of rotation. A mathematical model was developed to predict NSA on an AP radiograph in varying degrees of femoral rotation. The predictions of the model were found to correlate well with the experimental data (correlation coefficient = 0.94). Based on the mathematical model, a wide range of patient positioning was found to result in a 10 degrees change in the apparent NSA. For all patient populations, internally rotating the femur will allow for determination of the femoral NSA to within 10 degrees .
116 citations
TL;DR: MRI is helpful in evaluating patients with congenital spinal anomalies because of the poor correlation between findings on physical examination, plain radiographs, and subsequent occult intraspinal anomalies on MRI.
Abstract: Thirty consecutive patients with congenital spinal deformity underwent magnetic resonance imaging (MRI) to determine the incidence of occult intraspinal anomaly. These congenital spinal deformities included 29 cases of congenital scoliosis and one case of congenital kyphosis. Physical examination findings and plain radiographs were reviewed in an attempt to correlate these findings with subsequent intraspinal pathology. Nine patients had intraspinal anomalies identified on MRI consisting of five with tethered cord, four with syringomyelia, three with lipoma, and one with diastematomyelia. One patient required surgery for diastematomyelia; another underwent release of his tethered cord. Only one patient, with diastematomyelia associated with a syrinx and bifocal tethering, had his anomaly suggested by physical examination and plain radiographs. Two other patients had findings on plain radiographs previously associated with high prevalence of occult intraspinal anomalies; one patient with congenital kyphosis had a tethered cord, and one patient with a unilateral hemivertebrae associated with a contralateral bar had a tethered cord. Two of nine patients with occult intraspinal anomalies required surgery for their anomaly. In patients with a congenital spinal deformity, we found nine (30%) of 30 to have an associated anomaly within the spinal canal. Only three of these nine had plain radiographs and physical examination findings suggestive of their subsequent MRI findings. Given the poor correlation between findings on physical examination, plain radiographs, and subsequent occult intraspinal anomalies on MRI, we believe that MRI is helpful in evaluating patients with congenital spinal anomalies.
110 citations
TL;DR: A range of 20°–50° was determined as the range of “normalcy” in the radiologic measurement of thoracic kyphosis in children by using a standardized position and full-length radiograph in 121 normal children.
Abstract: The purpose of this prospective study was to determine the range of "normalcy" in the radiologic measurement of thoracic kyphosis in children by using a standardized position and full-length radiograph in 121 normal children. Using +/- two standard deviations from the mean as the definition of "normal," a range of 20 degrees - 50 degrees was determined. There was no difference between the various age subgroups or between genders.
107 citations
TL;DR: The use of serial radiographs during the treatment of idiopathic scoliosis, hip dysplasia, and leg-length discrepancy appears relatively safe, and the increased risk of carcinogenesis or hereditary defects in these patients is minimal.
Abstract: This study set out to determine whether cumulative radiograph exposure of children significantly increases their risk of radiation-induced carcinogenesis or hereditary defects. Records of children treated for idiopathic scoliosis, hip dysplasia, or leg-length discrepancy between 1980 and 1993 at the Shriners Hospital in Spokane, WA, were retrospectively reviewed. Total radiation and organ dose exposures were calculated using information from individual radiology reports. Surgically treated idiopathic scoliosis patients had the largest total radiation skin entrance and organ dose exposures. This group's risks for developing leukemia, breast cancer, or a heritable defect, respectively, were 0.8%, 2.1%, and 3.0% higher than baseline risks. The other treatment groups had increased carcinogenic risks of <1%. The use of serial radiographs during the treatment of idiopathic scoliosis, hip dysplasia, and leg-length discrepancy appears relatively safe. The increased risk of carcinogenesis or hereditary defects in these patients is minimal.
106 citations
TL;DR: Unless other evidence of abuse such as an inconsistent story, bruises, or other fractures are present, abuse is very unlikely to be involved in the walking-age child, analogous to the toddler fracture of the tibia.
Abstract: One hundred thirty-nine children younger than 4 years were identified retrospectively from the period of 1993 through 1997 to have an isolated fracture of the shaft of one or both femurs. Abuse was classified as group A (definite, likely, or questionable abuse) or group B (unknown cause, questionable accident, likely accident, or definite accident). The average age of the children was 2.3 +/- 1.1 years. Thirteen children, 9% of the total group, average age of 1.1 +/- 1.0 years, were likely to have been abused (group A). A total of 126 children, 91% of the total, average age 2.3 +/- 1.0 years, sustained their fracture most likely as a result of an accident (group B). Whether a child had not yet achieved walking age (toddler) was the strongest predictor of likely abuse. Ten (42%) of 24 of nonwalking children were in group A, whereas only three (2.6%) of 115 of walking children were in group A (p < 0.001). Child Protective Services may have been unnecessary in 42-63% of cases. Unless other evidence of abuse such as an inconsistent story, bruises, or other fractures are present, abuse is very unlikely to be involved in the walking-age child, analogous to the toddler fracture of the tibia.
TL;DR: Intramedullary nailing through a trochanteric starting point is a safe, effective method for treating femur fractures in this adolescent age group and no patient developed significant proximal femoral deformity with some follow-up as far as 60 months from the time of surgery.
Abstract: Fifty femoral shaft fractures were treated with reamed, interlocking, intramedullary nails utilizing a greater trochanteric starting point from 1991 through 1998. The 17 girls and 31 boys ranged in age from 10 to 16 years (mean, 13.2 years) at the time of injury. Average follow-up after fracture was 16 months. All fractures united, and the average leg-length discrepancy was 1 mm (range, -10 mm to +11 mm). No patient had angular or rotational deformities. No patients developed osseous necrosis of the femoral head. Despite intramedullary nailing through the greater trochanteric apophysis, articulotrochanteric distance measurements increased only 4.5 mm at the time of last follow-up. No patient developed significant proximal femoral deformity with some follow-up as far as 60 months from the time of surgery. Intramedullary nailing through a trochanteric starting point is a safe, effective method for treating femur fractures in this adolescent age group.
TL;DR: The study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature and that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyELitis.
Abstract: Sixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.
TL;DR: Serial casting to stretch the plantar-flexors has been advocated for idiopathic toe-walkers and children with spastic cerebral palsy and yielded positive outcomes that may be longer lasting in ITW.
Abstract: Serial casting to stretch the plantar-flexors has been advocated for idiopathic toe-walkers (ITW) and children with spastic cerebral palsy (CP), although outcomes have not been well studied. Neuromuscular function and gait were examined in eight children with CP (mean age, 7.1 years) and eight ITW (mean age, 7.5 years) casted for 3 to 6 weeks. Baseline comparisons indicated that children with CP produced lower isometric plantar-flexor torques (p 0.05). Serial casting yielded positive outcomes that may be longer lasting in ITW.
TL;DR: The authors prospectively followed 27 consecutive chil- 1-dren with tibial circular external fixators applied between July 1, 1995, and June 30, 1997, and recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures.
Abstract: We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997 A simple pin care system with no physical pin cleansing except that provided by daily showers was used Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days Pin sites were graded according to the system of Dahl et al on a 0 to 5 scale A total of 4,473 observations was made Patients developed 178 pin tract infections (40% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections No pin was removed because of infection Diaphyseal half pin sites were less commonly infected (16%) than periarticular wire or half pin sites (45%) We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures
TL;DR: It was concluded that close follow-up and not prophylactic pinning was most supported by the literature.
Abstract: The purpose of this review was to determine whether the literature supports in situ prophylactic pinning of the hip contralateral to a hip with a slipped capital femoral epiphysis (SCFE). Three hundred twenty-five articles on SCFE between 1931 and 1998 were reviewed. Two hundred six studies were used to establish normative data. Patients with a unilateral SCFE were 2,335 times more likely to develop a SCFE in the contralateral hip when compared to children in the general population experiencing an initial SCFE. Because a majority of these sequential SCFEs were detected and treated early, we concluded that close follow-up and not prophylactic pinning was most supported by the literature.
TL;DR: It is concluded that the Imhäuser osteotomy should be performed in severe deformities (>40° gliding angle) associated with poor function, because other studies show good long-term results after in situ pinning only.
Abstract: The management of severe slipped capital femoral epiphysis (SCFE) is still controversial, because of a lack of long-term follow-up studies. Thirty-five patients (39 hips) with severe slipped capital femoral epiphysis, treated by corrective intertrochanteric Imhauser osteotomy, were clinically and radiographically reexamined. The average age at the operation was 13.7 years (range, 8-17 years) and the reexamination was at an average of 23.4 years (range, 19-27 years) after the operation. At reexamination, 77% of patients were rated good to excellent clinically and 67% had good or excellent radiological results by the Southwick classification. Three patients had severe degenerative arthritic changes, and two patients developed avascular necrosis. We conclude that the Imhauser osteotomy should be performed in severe deformities (>40 degrees gliding angle) associated with poor function. Because other studies show good long-term results after in situ pinning only, the indication for Imhauser osteotomy should be made carefully depending on clinical and radiological findings.
TL;DR: The outcome of 101 femoral shaft fractures thus treated demonstrated excellent results with few complications and an age older than 7 to 8 years is the only variable that might be used to predict the need for a change in treatment at 7 to 10 days.
Abstract: The purpose of this prospective study was to document results of early spica casting in treating all children aged 10 years or younger presenting during a 30-month period with a femoral shaft fracture. The outcome of 101 femoral shaft fractures thus treated demonstrated excellent results with few complications. Four spicas had to be removed at 7 to 10 days for unacceptable shortening and an additional four probably should have been. Control of alignment was not a problem, with only one patient's femur on cast removal being in a position different from that accepted at 7 to 10 days. An age older than 7 to 8 years is the only variable that might be used to predict the need for a change in treatment at 7 to 10 days.
TL;DR: Calcaneal lengthening is a successful treatment for flexible planovalgus foot deformity in ambulatory children with spastic CP, but the high failure rate is a significant limitation to the procedure.
Abstract: The purpose of this study was to investigate the effectiveness of lateral column lengthening in the treatment of flexible, planovalgus foot deformity of ambulatory children with spastic cerebral palsy (CP). Fifteen ambulatory children (23 feet) with spastic CP and flexible planovalgus foot deformities received lateral column lengthenings through the calcaneus or calcaneocuboid joint. At an average of 4.1 years of follow-up (minimum, 2.3 years), 17 (74%) feet had good, two (9%) had fair, and four (17%) had poor outcomes. Poor outcomes resulted from recurrence of deformity. Improvements in preoperative, postoperative, and follow-up radiographic measurements were found. However, these improvements are not related to the clinical outcomes. Calcaneal lengthening is a successful treatment for flexible planovalgus foot deformity in ambulatory children with spastic CP. The high failure rate is a significant limitation to the procedure. Further investigation of the objective measurement of planovalgus foot deformity is needed.
TL;DR: In situ posterolateral arthrodesis with a large amount of autogenous bone graft followed by immobilization in a pantaloon cast yields a solid arthrodeis and provides satisfactory results.
Abstract: The purpose of the study was to analyze the results after in situ posterolateral arthrodesis without reduction in children and adolescents with Meyerding grades III and IV spondylolisthesis and in patients with spondyloptosis who had an average follow-up of 12.8 years. The study population consisted of 21 patients who underwent an in situ posterolateral spinal fusion from L4 to S1 with autogenous iliac bone graft and were immobilized in a pantaloon cast for 4 months. All patients reported improvement after the operation and had no limitation in daily activities. Only four of 21 patients complained of occasional mild pain after physical activity, which resolved with rest and did not disturb their work. After surgery there were no motor deficits, incontinence of bowel or bladder, or sexual dysfunction. Roentgenographic findings showed progression of the slip in five patients and increase of the slip angle and the displacement index in two patients. These changes happened during the first year after the operation. Progression of the slip was not associated with symptoms. There was no pseudarthrosis. In situ posterolateral arthrodesis with a large amount of autogenous bone graft followed by immobilization in a pantaloon cast yields a solid arthrodesis and provides satisfactory results.
TL;DR: This study suggests that an ill-appearing patient with a fever >38.2°C, pain, and swelling should prompt the physician to aspirate or biopsy the area and not rely on diagnostic studies that were found to be unreliable.
Abstract: Patients with sickle cell disease have been documented to be particularly susceptible to osteoarticular infections. Controversy exists concerning the bacteriology, etiology, and clinical presentation in differentiating osteoarticular infections from bone infarct. We retrospectively reviewed all cases from our institution over the past 22 years of osteoarticular infections in children who carry the diagnosis of sickle cell disease. Two thousand consecutive patient charts of children enrolled in the Pediatric Sickle Cell Clinic of our institution between 1973 and 1995 were evaluated. There were 14 cases of bone or joint infections (10 osteomyelitis, four septic arthritis). There was one case of multicentric osteomyelitis and one case of meningitis complicating the septic arthritis. There were nine male and five female patients with ages ranging from 6 months to 17 years (mean, 8.0). All patients were noted to have hemoglobin SS. The predominant presenting symptoms were pain (79% of cases) and swelling (71% of cases). The most frequent physical findings were fever >38.2 degrees C (71% of cases) and tenderness (86% of cases). Ninety-three percent of the children had a white blood count exceeding 15,000/mm3 (range, 7,900-32,300). Westergren sedimentation rates ranged from 14 to 89 mm/h with 93% of the children exceeding the normal value in our hospital. Cultures were positive in 75% of tissue biopsies, 58% of the blood cultures, and 70% of the bone or joint aspirates. The most common offending organism found in osteomyelitis was Salmonella (eight of 10 cases); however, no predominant organism found was identified in cases of septic arthritis. Radiographs and bone scans were of limited value in the differential diagnosis between osteoarticular infections and bone infarction. Early diagnosis and treatment of osteoarticular infections is key to satisfactory outcome. This study suggests that an ill-appearing patient with a fever >38.2 degrees C, pain, and swelling should prompt the physician to aspirate or biopsy the area and not rely on diagnostic studies that we found to be unreliable.
TL;DR: The use of peak height velocity to predict the length of time for remaining growth was superior to Risser sign, closure of the triradiate cartilage, and chronologic age for boys with idiopathic scoliosis.
Abstract: We retrospectively studied 43 adolescent boys treated with orthoses for idiopathic scoliosis to assess the usefulness of the timing of peak height velocity for predicting growth remaining and the likelihood of curve progression when compared with Risser sign, closure of the triradiate cartilage, and chronologic age. We compared the peak height velocity data in boys to our previous work for girls with adolescent idiopathic scoliosis. We found the median height velocity plots showed a similar high peak and sharp decline as is found in girls. All 13 patients with a curve magnitude > 30 degrees at the time of peak height velocity had progression of their scoliosis to > 45 degrees despite bracing. Four of 29 patients (14%) with curves < or = 30 degrees at peak height velocity progressed to 45 degrees. These values generate a sensitivity of 76%, specificity of 100% and accuracy of 91% in predicting progression to 45 degrees. Similar values have been found in female patients. The use of peak height velocity to predict the length of time for remaining growth was superior to Risser sign and chronologic age for boys with idiopathic scoliosis. Closure of the triradiate cartilage approximated the timing of peak height velocity in boys.
TL;DR: A computerized MEDLINE search was performed to determine the publication pattern of the abstracts submitted for podium presentation at the 1991-1994 annual meetings of the Pediatric Orthopaedic Society of North America (POSNA).
Abstract: A computerized MEDLINE search was performed to determine the publication pattern of the abstracts submitted for podium presentation at the 1991-1994 annual meetings of the Pediatric Orthopaedic Society of North America (POSNA). The publication percentage for all papers submitted to the POSNA meetings from 1991 through 1994 was 45%. Fifty-three percent of papers accepted for podium presentation were ultimately published in comparison with 38% of those not accepted for presentation (p < 0.001). The mean time to publication was 29 months and did not differ significantly for the two groups. The majority of papers (65%) were published in either Journal of Pediatric Orthopaedics (48%) or The Journal of Bone and Joint Surgery (American) (17%). The frequency of ultimate publication of abstracts submitted to the annual POSNA meetings compares favorably with the rates for other medical subspecialties.
TL;DR: The association between LCPD and passive smoking, after controlling for age and gender, became significant and the risk of LCPD in passive smoking children is more than five times higher than in children who are not exposed to smoke.
Abstract: We carried out a case-control study with 90 patients with Legg-Calve-Perthes disease (LCPD) and 183 normal children, as controls, selected at random to determine whether the condition of passive smoking is related to the disease. Seventy-one of 90 of the LCPD group (78.9%) were passive smokers. Only 79 of 183 (43.2%) in the control group were passive smokers (p = 0.00000). We did not find any statistical relationship between passive smoking and evolution of the condition (p = 0.42883), Catterall extension (p = 0.60544), final Stulberg result (p = 0.53201), or presence of sequelae (p = 0.53256). We also could not find any statistical difference between ages (p = 0.18). The odds ratio was 5.3203 (95% confidence interval 2.92-9.69). The association between LCPD and passive smoking, after controlling for age and gender, became significant (p = 0.0000). Thus the risk of LCPD in passive smoking children is more than five times higher than in children who are not exposed to smoke. It seems that passive smoking is a factor directly or indirectly associated with LCPD.
TL;DR: Although gait analysis data are themselves objective, this study demonstrates some subjectivity in their interpretation, similar to that reported for established classification systems of various orthopedic conditions.
Abstract: The purpose of this study was to assess the reliability of interpretation of gait analysis data between physicians and institutions. Gait analysis data from seven patients were reviewed by 12 experienced gait laboratory physicians from six institutions. Reviewers identified problems and made treatment recommendations based on the data provided. Agreement among physicians for the most commonly diagnosed problems was slight to moderate (kappa range, 0.14-0.46). Physicians agreed on identification of soft tissue more than bony problems (intraclass correlation, 0.56 vs. 0.37). Variability regarding surgical recommendations for soft-tissue procedures (kappa range, 0.20-0.64) was similar to that for diagnosis of both soft-tissue and bone problems, although recommendation for hamstring lengthening showed substantial agreement (kappa = 0.64). There was less agreement in recommendation of osteotomies (kappa range, 0.13-0.22). Physicians agreed more on the number of soft-tissue procedures than bone procedures recommended (intraclass correlation, 0.65 vs. 0.19). There was an interinstitutional difference in the frequency of soft-tissue (p = 0.0152) and osseous problem identification (p = 0.0002), as well as in the frequency of recommendations for soft-tissue surgery (p = 0.0004) and osteotomies (p < 0.0001). Although gait analysis data are themselves objective, this study demonstrates some subjectivity in their interpretation. The interobserver variability reported here is similar to that reported for established classification systems of various orthopedic conditions.
TL;DR: These data, which use SPECT scintigraphy, support prompt treatment with brace immobilization for acute spondylolysis in children and adolescents using quantitative single-photon emission computed tomography (SPECT).
Abstract: The evaluation and management of acute spondylolysis remains unclear in part because of outcome data that are primarily subjective. The aim of this study was to evaluate and monitor these patients objectively using quantitative single-photon emission computed tomography (SPECT). Thirty-four patients were so observed clinically between 1987 and 1996 and were studied with an initial and at least one follow-up SPECT scintigram. Initial radiographs and planar bone scans failed to demonstrate the pars lesion in 53 and 19% of the patients, respectively. The average SPECT ratio before brace treatment was 1.45. After treatment, this ratio significantly decreased to 1.27 (p = 0.03). A subset of patients remained symptomatic at follow-up. Their reduction in SPECT ratio averaged only 2.8% as compared with 13% for the remainder of the patients (p = 0.01). Patients diagnosed and braced in the early, more active stage of the condition (with greater intensity on SPECT) had more predictable symptom relief. An initial SPECT ratio of >1.5 was associated with complete symptom resolution after brace treatment. Patients treated with activity restriction only (>3 months) before bracing were more likely to have persistent symptoms and more modest improvement on SPECT (p = 0.01). These data, which use SPECT scintigraphy, support prompt treatment with brace immobilization for acute spondylolysis in children and adolescents.
TL;DR: This study provides the first clinical rationale for ablation of rapidly enlarging exostoses to reduce growth disturbance and suggests that the growth retardation in HME may result from the local effects of enlarging osteochondromas rather than a skeletal dysplasia effect.
Abstract: Hereditary multiple exostoses (HME) is traditionally described as a skeletal dysplasia. However, the discovery that the EXT family of tumour suppressor genes are responsible for HME suggests that it is more appropriate to classify HME as a familial neoplastic trait. In a clinical and radiographic analysis of paired bone length and exostoses number and dimensions in a HME cohort, the local presence of osteochondromas was consistently associated with growth disturbance. In particular, an inverse correlation between osteochondroma size and relative bone length (p<0.01) was found. These data suggest that the growth retardation in HME may result from the local effects of enlarging osteochondromas rather than a skeletal dysplasia effect. This study provides the first clinical rationale for ablation of rapidly enlarging exostoses to reduce growth disturbance.
TL;DR: The dynamic component of hip rotation during gait is significant, as anatomic deformity did not predict gait deviations.
Abstract: Internal rotation of hip is commonly seen in children with cerebral palsy. Existing muscle imbalance causes persistence of femoral deformity, which may contribute to rotational asymmetry. In cerebral palsy, gait deviations are the result of dynamic and static components, both caused by muscle imbalance. In this study we investigated the predictability of hip rotation in gait from the measurement of anatomic deformity. Computed tomography (CT) measurements of femoral anteversion and physical examination data failed to predict the hip rotation in gait. However, tibial (CT) measurements and physical examination data highly correlated with tibial rotation in gait. We conclude the dynamic component of hip rotation during gait is significant, as anatomic deformity did not predict gait deviations.
TL;DR: The Q angle, a coronal plane measurement generated by the Quantec Spinal Imaging System (QSIS), was compared with the Cobb angle in assessment of scoliosis curve magnitude, showing close correlation between the Cobb angles and the QSIS angle.
Abstract: The Quantec Spinal Imaging System (QSIS) is a raster stereography used to measure three-dimensional trunk images. The Q angle, a coronal plane measurement generated by the Quantec Spinal Imaging System (QSIS), was compared with the Cobb angle in assessment of scoliosis curve magnitude. One hundred forty-nine patients with idiopathic scoliosis were evaluated using both the Quantec system and plane radiographs. The Cobb and Q angles demonstrated significant correlation in the thoracic region (r = 0.65, p < 0.05), lumbar region (r = 0.63, p < 0.05), and in the thoracolumbar region (r = 0.70, p < 0.05). The difference between the Q and Cobb angles was small when the Cobb angle was <21 degrees with less than 6 degrees of axial surface rotation, as measured by the QSIS method. For smaller curves with minimal rotation, there is close correlation between the Cobb angle and the Quantec angle.
TL;DR: Most significant differences were at the ankle, between free-ankle and plantar flexion-limiting conditions, and no significant functional changes were evident with the addition of tone-reducing properties to a standard articulating AFO.
Abstract: This study analyzed the effects of tone-reducing features in ankle-foot orthotics (AFOs) on the gait of eight children (ages 4-11 years) with spastic diplegic cerebral palsy. A standard gait analysis was performed on each subject in each of three trial orthotics and in a baseline shoes-only condition. A 4-week accommodation period was allotted for each of the three devices: a standard hinged AFO, an AFO with tone-reducing features, and a supramalleolar orthotic with tone-reducing features. Most significant differences were at the ankle, between free-ankle and plantar flexion-limiting conditions. No significant functional changes in gait were evident with the addition of tone-reducing properties to a standard articulating AFO.