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Alomran AK, Alzahrani BA, Alanazi BS, Alharbi MA, Bojubara LM, Alyaseen EM. Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study. World J Orthop 2024; 15:635-641. [PMID: 39070938 PMCID: PMC11271697 DOI: 10.5312/wjo.v15.i7.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Clubfoot, or congenital talipes equinovarus, is a widely recognized cause of disability and congenital deformity worldwide, which significantly impacts the quality of life. Effective management of clubfoot requires long-term, multidisciplinary intervention. It is important to understand how common this condition is in order to assess its impact on the population. Unfortunately, few studies have investigated the prevalence of clubfoot in Saudi Arabia. AIM To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital (KFUH). METHODS This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions. RESULTS Of the 7792 births between 2015 to 2023 that were included in the analysis, 42 patients were diagnosed with clubfoot, resulting in a prevalence of 5.3 per 1000 live births at KFUH. CONCLUSION The observed prevalence of clubfoot was significantly higher than both global and local estimates, indicating a substantial burden in the study population.
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Affiliation(s)
- Ammar K Alomran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | - Bandar A Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | - Bader S Alanazi
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammed A Alharbi
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | - Loay M Bojubara
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam 34212, Saudi Arabia
| | - Eman M Alyaseen
- College of Medicine, Arabian Gulf University, Manama 329, Bahrain
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McLaughlin D, De Salvo S, Brewerton K, Hui C, Bouchard M. Routine ultrasound screening for hip dysplasia in children with clubfoot is not supported. INTERNATIONAL ORTHOPAEDICS 2024; 48:1793-1797. [PMID: 38602555 DOI: 10.1007/s00264-024-06169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. METHODS This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. RESULTS Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. CONCLUSION A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system.
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Affiliation(s)
| | - Sara De Salvo
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Kathryn Brewerton
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Caitlyn Hui
- The Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Maryse Bouchard
- The Division of Orthopaedics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- The Division of Orthopaedics, University of Toronto, Toronto, ON, Canada.
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Golshan-Tafti M, Dastgheib SA, Alijanpour K, Bahrami R, Mazaheri M, Neamatzadeh H. A thorough analysis of data on the correlation between COL9A1 polymorphisms and the susceptibility to congenital talipes equinovarus: a meta-analysis. J Orthop Surg Res 2024; 19:345. [PMID: 38858754 PMCID: PMC11163731 DOI: 10.1186/s13018-024-04834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Congenital talipes equinovarus (CTEV) is a prevalent pediatric deformity with a multifactorial etiology. The objective of this meta-analysis was to explore the association between genetic variations in COL9A1 and the susceptibility to CTEV. METHODS A comprehensive analysis of pertinent literature released before November 15, 2023, in electronic bibliographic databases was carried out. The importance of the connection was clarified through odds ratios (ORs) with 95% confidence intervals (CIs), utilizing random or fixed-effects models depending on study heterogeneity. Statistical analysis was executed using Comprehensive Meta-Analysis software (Version 4.0). RESULTS A total of eight case-control studies involving 833 CTEV patients and 1280 healthy individuals were included in the analysis. Among these, four studies investigated the rs1135056 variant, encompassing 432 CTEV cases and 603 controls; two studies examined the rs35470562 variant, with 189 CTEV cases and 378 controls; and two studies explored the rs592121 variant, including 212 CTEV cases and 299 controls. The results revealed a significant association between the rs1135056 and rs35470562 polymorphisms in the COL9A1 gene, suggesting an increased risk of CTEV in the overall population. Conversely, no such association was found for the rs592121 variant. CONCLUSION Our findings reveal a substantial association between the genetic variants COL9A1 rs1135056 and rs35470562 and susceptibility to CTEV. Conversely, the variant rs592121 did not exhibit any corresponding link. However, the limitations imposed by the small study population have compromised the statistical reliability and generalizability of the results.
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Affiliation(s)
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Alijanpour
- General Practitioner, Babol University of Medical Sciences, Babol, Iran.
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahta Mazaheri
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Developmental dysplasia of the hip and clubfoot treated by Pavlik and Ponseti methods. J Pediatr Orthop B 2019; 28:446-451. [PMID: 31246178 DOI: 10.1097/bpb.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children having both typical developmental dysplasia of the hip (DDH) and clubfoot are rare, and early treatments of both conditions are recommended. The aim of this study was to evaluate the effects of the Ponseti method of clubfoot treatment on hips with DDH. After institutional review board approval, we identified children treated by the Ponseti and Pavlik methods between 2003 and 2016. During the Ponseti method treatment, the duration of manipulations, number of casts, tenotomies performed, and days in clubfoot orthosis were recorded. During DDH treatment, we registered duration for Pavlik and hip brace usage. Hips had dynamic sonography and radiographic evaluations. The cases were grouped according to the combination of DDH and clubfoot treatments: (a) concurrent, (b) sequential, and (c) hip observation. Seven cases of DDH and clubfoot were identified. The average number of Ponseti casts was 5.8 (range: 4-8 casts). The average number of days following the post-Achilles-tenotomy casting to the end of clubfoot bracing was 870 days (range: 90-1605 days). Eleven (four bilateral cases and three unilateral) clubfeet were corrected initially by the Ponseti method. The average number of days for Pavlik harness treatment was 74 (range: 10-126 days). Additionally, a hip orthosis was utilized in three children for an average of 131 days. At follow-up, all children had a high femoral neck-shaft angle averaging 152° (range: 144°-164°). One child (case 5) developed avascular necrosis of the femoral head, Kalamchi type I. Children with typical and nonsyndromic DDH and clubfoot treated by Pavlik harness and Ponseti methods are associated with abnormal hip development (coxa valga).
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Samarah OQ, Al Hadidi FA, Hamdan MQ, Hantouly AT. Late-presenting developmental dysplasia of the hip in Jordanian males. A retrospective hospital based study. Saudi Med J 2017; 37:151-5. [PMID: 26837397 PMCID: PMC4800913 DOI: 10.15537/smj.2016.2.13050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objectives: To describe the pattern of developmental dysplasia of the hip (DDH) in late presenting Jordanian male patients and identify the risk factors and associated findings. Methods: This is a retrospective study of 1145 male patients who attended the Pediatric Orthopedic Clinic for a DDH check up. This study was carried out in the Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan between March 2011 and October 2014. Data was collected from medical records, and x-ray measurements were evaluated. Results: Of the 1145 male patients, 43 (3.75%) with 70 involved hips were diagnosed with late- presenting DDH. Being a first-born baby resulted in 41.9% increased risk for DDH. Cesarian delivery was significantly associated with an increased risk of hip dislocation (p=0.004) while normal delivery was significantly associated with acetabular dysplasia (p=0.004). No predictable risk factors were found in 44.2% patients with DDH. Bilateral cases were more common than unilateral cases: (26 [60.5%] versus 17 [39.5%]). Limited abduction was a constant finding in all dislocated hips (p<0.001). Associated conditions, such as club foot and congenital muscular torticollis were not observed. Conclusion: Cesarian section is a significant risk for dislocated hips while normal delivery is significantly associated with acetabular dysplasia. Bilateral DDH is more common than the unilateral. Club foot and torticollis were not observed in this series.
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Affiliation(s)
- Omar Q Samarah
- Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan. E-mail.
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Tomlinson J, O'Dowd D, Fernandes JA. Managing Developmental Dysplasia of the Hip. Indian J Pediatr 2016; 83:1275-1279. [PMID: 27246825 DOI: 10.1007/s12098-016-2160-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/12/2016] [Indexed: 12/27/2022]
Abstract
Developmental dysplasia of the hip (DDH) involves a spectrum of hip disorders that affect hip anatomy and development and can range from mild anatomical deformity with a reduced but subluxatable hip to a frankly dislocated hip. It was previously known as congenital dislocation of the hip (CDH) but this name is no longer used due to the fact that the hip may be anatomically abnormal whilst not being dislocated. The key aim of clinical management of DDH is early diagnosis and referral as this can often mean less invasive treatment is possible, and outcomes are significantly improved if treatment is initiated at an early stage and certainly before 6 wk of age.
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Affiliation(s)
| | - Dominic O'Dowd
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Abstract
Idiopathic clubfoot has a tremendous worldwide prevalence. If left untreated, the deformity has severely disabling effects on mobility and quality of life. Given its prevalence and significance, numerous studies are published on this condition every year. In this article, we attempt to highlight important themes and findings of studies published on idiopathic clubfoot over the past 3 years.
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Affiliation(s)
- Ryan M O'Shea
- San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA
| | - Coleen S Sabatini
- UCSF Benioff Children's Hospital Oakland, 747 52nd Street, OPC 1st Floor, Oakland, CA, 94609, USA.
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Ibrahim T, Riaz M, Hegazy A. The prevalence of developmental dysplasia of the hip in idiopathic clubfoot: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2015; 39:1371-8. [DOI: 10.1007/s00264-015-2757-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/14/2015] [Indexed: 11/29/2022]
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Paton RW, Choudry QA, Jugdey R, Hughes S. Is congenital talipes equinovarus a risk factor for pathological dysplasia of the hip? : a 21-year prospective, longitudinal observational study. Bone Joint J 2015; 96-B:1553-5. [PMID: 25371473 DOI: 10.1302/0301-620x.96b11.34130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is controversy whether congenital foot abnormalities are true risk factors for pathological dysplasia of the hip. Previous United Kingdom screening guidelines considered congenital talipes equinovarus (CTEV) to be a risk factor for hip dysplasia, but present guidelines do not. We assessed the potential relationship between pathological dysplasia of the hip and fixed idiopathic CTEV. We present a single-centre 21-year prospective longitudinal observational study. All fixed idiopathic CTEV cases were classified (Harrold and Walker Types 1 to 3) and the hips clinically and sonographically assessed. Sonographic Graf Type III, IV and radiological irreducible hip dislocation were considered to be pathological hip dysplasia. Over 21 years there were 139 children with 199 cases of fixed idiopathic CTEV feet. Sonographically, there were 259 normal hips, 18 Graf Type II hips, 1 Graf Type III hip and 0 Graf Type IV hip. There were no cases of radiological or sonographic irreducible hip dislocation. Fixed idiopathic CTEV should not be considered as a significant risk factor for pathological hip dysplasia. This conclusion is in keeping with the current newborn and infant physical examination guidelines in which the only risk factors routinely screened are family history and breech presentation. Our findings suggest CTEV should not be considered a significant risk factor in pathological dysplasia of the hip.
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Affiliation(s)
- R W Paton
- Department of Orthopaedics, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK
| | - Q A Choudry
- Department of Orthopaedics, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK
| | - R Jugdey
- Department of Orthopaedics, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK
| | - S Hughes
- Department of Orthopaedics, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK
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