Objective: The aim of this study was to verify whether the Pirani and Dimeglio clinical scoring systems could predict results of Ponseti therapy. Methods: Forty-seven patients with clubfoot deformities treated with the Ponseti method were enrolled in the study. Clinical evaluation with the Pirani and Dimeglio scoring systems was performed before the treatment and after the second cast fixation. The number of fixations, necessity for achillotomy, and recurrence of the deformity were determined as parameters of the therapy results. The patients were divided into three groups according to the severity of their deformities, and the groups were compared with one another. Results: Clubfoot correction required an average of 6.8 casts. Five patients developed a recurrence. Comparing the therapy outcomes among the groups, we found statistically significant differences in the Pirani classification after the second fixation (the number of casts [p =.003] and necessity to perform an achillotomy [p =.014]) and in the Dimeglio scores before therapy (number of casts [p =.034]) and after the second fixation (number of relapses [p =.032]). Conclusion: Although clinical scoring systems showed some dependence on the parameters of treatment outcomes, their predictive function can be used in only a limited way. Level of evidence II, Prospective comparative study.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION The clubfoot ranks among the most frequent paediatric structural deformities of the lower extremity. Currently, the Ponseti method is considered the gold standard for the treatment. To evaluate the degree and severity of the deformity, clinical classification systems have been developed, commonly used in clinical practice. This study aims to verify whether the Pirani and Dimeglio clinical scoring systems can be used to predict the results of treatment by the Ponseti method. MATERIAL AND METHODS The study included 31 patients. The patients had been referred from the neonatal departments to the Department of Paediatric Surgery, Orthopaedics and Traumatology in Brno with the diagnosed clubfoot deformity, where they were treated by an erudite orthopaedist experienced in this field according to the Ponseti treatment standards. The Pirani and Dimeglio clinical scoring of the deformity were performed always before the commencement of the therapy and after the second plaster cast fixation. The number of plaster cast fixations, the necessity to carry out achillotomy and the relapse rate were set as the parameters of treatment results. In the first stage of statistical analysis, the respective clinical systems were correlated with the treatment results, in the second part of the study the patients were based on the clinical evaluation divided into 3 groups depending on the severity of the deformity, and these groups were subsequently compared. RESULTS 22 patients from the group (71%) underwent percutaneous achillotomy and in 3 patients (9.7%) a relapse occurred. To correct deformities 7.1 corrective casts were used on average. The correlation between the number of plaster cast fixations and classification systems was significant in all the cases, with the strongest dependency shown by the correlation with the Pirani score after the second corrective cast (r = 0.594, p < 0.001). Positive correlation was found also between the necessity to perform achillotomy and both the classification systems. In this case the strongest correlation was established in the case of the Pirani clinical scoring after the second plaster cast fixation (r = 0.488, p = 0.003). Conversely, significant correlation was not established between the relapse rate and the used classification systems, not even in a single case (p ≥ 0.05). In the second stage of the statistical analysis, in the case of the Pirani scoring before the therapy no difference was found between the individual groups with diverse severity of clubfoot deformity during the evaluation of the aforementioned parameters of treatment results. In the Pirani classification after the second plaster cast fixation, a statistically significant difference was established in the number of plaster cast fixations (p = 0.003) and the necessity to perform achillotomy (p = 0.012). When the Dimeglio scoring was applied before the therapy, a statistically significant difference between the groups was found in the number of plaster cast fixations (p = 0.031) and after the second plaster cast fixation in the relapse rate (p = 0.035). DISCUSSION Although the clinical scoring systems belong to key indicators of severity of the deformity and are commonly used in clinical practice, the current literature provides only an inconsistent picture of their application in predicting the course and the results of treatment. Concurrently, the authors opinions on this issue differ. The scoring in later stages of treatment shows a better predictive value than the scoring at the beginning of the treatment, which was confirmed also by the results of our study. CONCLUSIONS Even though the clinical scoring systems show a certain dependency on the parameters of the treatment results, in practice their predictive function can be used to a limited degree only. The complexity of the evaluation of the deformity itself and subsequently of the results of treatment requires also the use of other parameters than the clinical classifications only so that the prediction of the course and results of the treatment of clubfoot according to Ponseti shows a higher degree of reliability. Key words:clubfoot, Ponseti, Pirani classification, Dimeglio classification.
- MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- pes equinovarus klasifikace diagnostické zobrazování chirurgie MeSH
- prediktivní hodnota testů MeSH
- recidiva MeSH
- reprodukovatelnost výsledků MeSH
- sádrové obvazy normy MeSH
- stupeň závažnosti nemoci MeSH
- tenotomie metody MeSH
- výsledek terapie MeSH
- výzkumný projekt normy MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The aim of this study was to assess the role of sonographic evaluation of Talar dysplasia in predicting the outcome of standard Ponseti method in the treatment of clubfoot deformity. METHODS: A total 23 children (15 boys and 8 girls; mean age: 18.2 ± 5.4 days (8-32)) who underwent Ponseti treatment were included in the study. Before the treatment, maximal talus length of affected and non-affected feet were measured by US and relative talar dysplasia ratio (RTDR) was calculated. The patients were categorized 2 groups according to RTDR: group A - mild and group B - severe deformity. Pirani score was used for clinical evaluation. The groups were compared in terms of number of the applied casts, need of percutaneous tenotomy of Achilles tendon (AchT) and frequency of deformity recurrence. RESULTS: Pirani score was 4.46 for population (4.33 for group A; 4.54 for group B). Number of casts significantly differed between groups (p < 0.001) and positive correlation was found (r = 0.851, p < 0.001). AchT was performed in 56% cases for group A and in 86% cases for group B; no statistically significant difference was obtained (p = 0.162). Recurrence occurred in 2 patients belonging to group B without significant difference compared to group A (p = 0.502). CONCLUSION: Talar dysplasia assessment appeared as a promising prognostic factor for predicting the outcome of the Ponseti technique in treatment of clubfoot deformity. LEVEL OF EVIDENCE: Level IV, diagnostic study.
- MeSH
- Achillova šlacha chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pes equinovarus * diagnóza patologie patofyziologie chirurgie MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- recidiva MeSH
- sádrové obvazy MeSH
- talus * abnormality diagnostické zobrazování MeSH
- tenotomie * metody statistika a číselné údaje MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Klíčová slova
- chondrolýza,
- MeSH
- coxa vara * diagnostické zobrazování etiologie chirurgie MeSH
- diagnostické zobrazování metody MeSH
- dítě MeSH
- kloubní chrupavka patologie MeSH
- kostní dráty využití MeSH
- lidé MeSH
- nekróza hlavice femuru etiologie MeSH
- nekróza etiologie terapie MeSH
- nemoci chrupavky MeSH
- ortopedické výkony metody využití MeSH
- osteotomie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate the mid-term results in a group of selected patients undergoing corrective surgery for juvenile hallux valgus, using double osteotomy of the first metatarsal. MATERIAL AND METHODS: The group included eight patients, seven girls and one boy, with a more severe form of this deformity treated by double osteotomy of the first metatarsal between 2010 and 2013. The indication for corrective surgery was serious pain when walking; all patients had previously undergone conservative treatment with no effect. All patients had pre-operative clinical examination, the affected foot was X-rayed with the patient standing and radiographic assessments of the intermetatarsal and hallux valgus angles were made. The evaluation of treatment outcomes was based on the scoring system of the American Orthopaedic Foot and Ankle Society (AOFAS) and X-ray images of the foot. The average follow-up was 37 months. RESULTS: Post-operatively, none of the patients reported pain while walking, only two of them experienced pain during sports activities. The average post-operative AOFAS score was 92 points. Both the intermetatarsal angle and the hallux valgus angle improved after surgery in all patients, with two reporting only mild hallux valgus deformity. One patient showed postoperative restriction of motion at the first metatarsophalangeal joint. This was the only complication recorded in association with the surgery. DISCUSSION: Almost all authors dealing with the treatment of hallux valgus deformity primarily prefer conservative therapy. However, this treatment is usually not very effective in severe forms of the disorder. Surgical management is indicated in symptomatic patients or in those with severe juvenile hallux valgus deformity. In paediatric patients it is necessary to respect the presence of an epiphyseal growth plate in the first proximal metatarsal and therefore it is often preferred to use distal first metatarsal osteotomy. At our department, Mitchell's osteotomy for hallux valgus deformity is usually used. However, post-operative outcomes are not satisfactory in severe forms of juvenile hallux valgus in which a high proportion of recurrent deformities is probably related to the growth potential of a juvenile bone. In such cases we use the Peterson and Newman procedure of double first metatarsal osteotomy, which can correct all three components of the deformity while maintaining functional first metatarsal length. This is a great advantage of the method. Although its authors have not reported any post-operative complications, the occurrence of restricted motion in the first metatarsophalangeal joint has been described in the relevant literature. The problem was also recorded in one patient of our group. CONCLUSIONS: Deformities of the forefoot and big toe are frequent orthopaedic disorders in children and adolescents. The results of this study confirm that the double first metatarsal osteotomy is an effective method of surgical treatment for serious hallux valgus deformities in paediatric and adolescent patients.
- MeSH
- hallux valgus diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- metatarzální kosti chirurgie MeSH
- metatarzofalangeální kloub chirurgie MeSH
- následné studie MeSH
- osteotomie metody MeSH
- rozsah kloubních pohybů fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of this paper is to present our first experience with and the results of treating angular deformities and length discrepancies of the lower limbs in children and adolescents using the Eight-plate system, and to compare our results with the literature data. MATERIAL AND METHODS: A total of 22 patients underwent surgery for the correction of angular deformities or length discrepancies of the lower limbs in 2014. Using Eight-plates, temporary medial hemiepiphysiodesis was carried out in 13 patients with the diagnosis of genu valgum (group 1). In nine patients (group 2) the Eight-plate was used to correct milder forms of leg length discrepancy by epiphysiodesis involving the distal femur only or also the proximal tibia. The Eight-plate system consists of a plate with two or more holes and two screws. Under X-ray image intensifier guidance, the plate was inserted above the physis of the long bone through a minimally invasive approach. Pre-operative long-standing radiographs of the lower extremities were measured. Post-operatively, radiographic assessments and clinical examinations were done at 3-month intervals to monitor the effects of therapy. RESULTS: In group 1, the average pre-operative intermalleolar distance (IMD) measured on standing radiographs was 15.2 cm. The average lateral distal femoral angle (LDFA) of 82° before surgery increased to 90° and the average pre-operative medial proximal tibial angle (MPTA) of 95° decreased to 88° at the time of plate removal. In all group 1 patients the therapy was completed successfully at an average of 9.2 months. The mean values of changes recorded at 3-month intervals of followup were 2.1° (± 0.9°) for LDFA and 1.5° (± 0.6°) for MPTA. The therapy in group 2 (average leg length inequality, 2.1 cm) was finished and evaluated in seven patients; in two patients it remained to be completed. The average Eight-plate guided growth treatment was 12.7 months, and the average reduction in leg-length discrepancy recorded at 3-month intervals was 4.9 mm. There were no complications. DISCUSSION: All our results so far obtained are in agreement with those of the authors pursuing this topic for a longer time. Compared to the currently used Blount's staples, the Eight-plate is a growth-plate sparring method which avoids damaging the growing physis and is thus suitable for use in children under 10 years of age. It is also associated with a fewer number of complications. CONCLUSIONS: Our first results, although based on a short follow-up, clearly show that the Eight-plate guided growth method has several advantages; it is a great contribution to surgery and brings new options particularly for the correction of angular deformities in patients under 10 years.
- MeSH
- dítě MeSH
- femur radiografie chirurgie MeSH
- genua valga chirurgie MeSH
- kostní destičky * MeSH
- kostní šrouby MeSH
- lidé MeSH
- mladiství MeSH
- nestejná délka dolních končetin chirurgie MeSH
- prodloužení kosti metody MeSH
- tibie radiografie chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate the outcomes of treatment in patients operated on in childhood for discoid meniscus, and to compare the results with those published in the relevant international literature. MATERIAL AND METHODS: The group evaluated consisted of 15 patients, 10 girls and five boys, who underwent surgery for symptomatic discoid meniscus in the period from 2000 to 2010. The average age at the time of surgery was 9 years and 2 months. The diagnosis was based on the patient's history of complaints, physical examination, X-rays of the knee joint taken in two planes, and ultrasonographic and magnetic resonance imaging of the knee. Arthroscopic verification of the diagnosis was done in all patients. They all had fibular discoid meniscus classified as type 1 in six and type 2 in nine patients according to the Watanabe classification system. Type 3 (Wrisberg variant) discoid meniscus was not recorded in this group. In six (40%) patients, the discoid meniscus had a tear in it. The patients were followed up on average for 8 years and 4 months. In addition to subjective evaluation by patients, the treatment outcome was assessed using the Ikeuchi and Lysholm scoring systems. RESULTS: Arthroscopic partial meniscectomy was performed in 10 patients. In five patients conversion to open surgery was necessary and partial or subtotal fibular meniscectomy was carried out by minimally invasive arthrotomy from the lateral approach. Total meniscectomy was not required in any of our patients. The average value for treatment evaluation by the patients was 2.25 on a 1-to-5 scale. The average Lysholm pre-operative score of 80.8 points increased to 95.4 points after surgery. The long-term results assessed by the Ikeuchi system were excellent in nine, good in four and satisfactory in two patients. None of the patients showed poor results and no intraoperative or post-operative complications were recorded. DISCUSSION: Discoid meniscus is a painful condition affecting the knee, particularly when a tear is also present. Meniscal lesions are found intra-operatively in many symptomatic patients. The majority of international authors prefer arthroscopic management of discoid meniscus. The team of our department also support this procedure unanimously. Arthroscopy is used as the primary method with the aim of preserving the largest possible margin of the meniscus. Some literature data suggest that there are no statistically significant differences between an open and an arthroscopic procedure. Accordingly, in our patients no differences in the evaluation of treatment results were recorded. However, the advantages of minimally invasive arthroscopy for the management for discoid meniscus are beyond any doubt. CONCLUSIONS: The long-term results of discoid meniscus management reported in the international literature are very good. The results of long-term follow-up in our group give support to active surgical treatment. We take care to avoid total meniscectomy which often results in early development of secondary gonarthrosis.
- MeSH
- artroskopie metody MeSH
- dítě MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- menisky tibiální abnormality chirurgie MeSH
- následné studie MeSH
- poranění kolena diagnóza chirurgie MeSH
- poranění menisku MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
PURPOSE OF THE STUDY An intercondylar eminence fracture is injury more common in children and adolescents than in adults. Also if it is considered a benign lesion, a displaced medial spine fracture can result in cruciate ligament laxity. We report the evaluation of long-term results of conservative and arthroscopic stabilisation in children and adolescents with different types of intercondylar eminence fracture. MATERIAL AND METHODS Forty-eight patients with intercondylar eminence fractures, 31 boys and 17 girls, were included in our retrospective study. Of them, 33 were at the end of skeletal growth. According to the Meyers and McKeever classification, 11 fractures were type I, 20 were type II and 17 were type III. The first step in the treatment was an attempt at conservative reduction. If it failed, arthroscopic reduction with crossed K-wire fixation was used. At clinical follow-up, the patients were examined for pain, range of motion, level of activity, and the laxity tests were done. RESULTS Conservative treatment was used in all type I cases (100 %), in eight type II cases (40%) and three type III cases (18%). The remaining patients were treated by arthroscopic reduction with crossed K-wires (type I, 0%; type II, 60%; type III, 82%). Six patients (12.5%) had symptoms of persistent anterior instability and five of them (10.4%) were indicated for anterior ligament reconstruction at the end of skeletal growth. We did not see serious complications. DISCUSSION Most of the authors recommend that type I and type II fractures should be treated conservatively; type III is better treated by arthroscopic reduction. Some of type II and type III fractures are indicated for minimally invasive surgical treatment at once. At the present time at our department, type II and some type III fractures are indicated first for conservative reduction and, when this fails, arthroscopic reduction with K-wire fixation is used. CONCLUSIONS The aim of our report was to report the results of our study and present our relatively conservative way of treatment as the method of choice for treating intercondylar eminence fractures in children and adolescents.
- Klíčová slova
- fraktury interkondylické eminence,
- MeSH
- artroskopie metody MeSH
- dítě MeSH
- fixace fraktur metody MeSH
- lidé MeSH
- mladiství MeSH
- ortopedické výkony metody MeSH
- poranění kolena * etiologie chirurgie klasifikace MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
- MeSH
- artroskopie * metody statistika a číselné údaje MeSH
- dítě MeSH
- kolenní kloub * chirurgie patofyziologie patologie MeSH
- lidé MeSH
- mladiství MeSH
- poranění kolena * diagnóza chirurgie terapie MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY In this retrospective study we analysed the major indications for knee arthroscopy and the diagnoses made using it in children and adolescents who had sustained knee joint injuries. MATERIAL AND METHODS A total of 731 knee joint artroscopies were performed and retrospectively evaluated in patients under 19 years of age. The group included patients with knee joint injuries treated at our department in the 2000-2010 period. There were 413 boys (58%) and 300 girls (42%) with an average age of 14 years and 2 months. The clinical diagnosis was compared with the arthroscopic diagnosis. RESULTS The results of our comparative study were divided into three groups. The clinical diagnosis was fully confirmed in 62%, partially confirmed in 17% (combined injuries) and was wrong in 21% of the patients. In this group, the most frequent diagnosis made by arthroscopy was injury to the lateral meniscus. Arthroscopy revealed patellar dislocations in 18%, osteo-chondral and cartilage lesions in 16%, plica injuries in 15 %, medial meniscus injuries in 14%, anterior cruciate ligament lesions in 12% and lateral meniscus injury in 8% of the patients. DISCUSSION With the number of knee injuries in children and adolescents increasing every year, the role of arthroscopy in their diagnosis and treatment is becoming increasingly important. The results of our analysis showed gradual improvement in clinical outcomes and subjective evaluation of the arthroscopic technique in children and adolescents with the history of knee injury. Some authors report difficulties with the pre-operative diagnosis at this age; our results were notably better. CONCLUSION Knee arthroscopy is a safe and effective method of a high diagnostic and therapeutic value and its use in children and adolescents should be recommended.
