Prevalence of congenital limb defects in Uttarakhand state in India – A hospital-based retrospective cross-sectional study

The need for prosthetic and orthotic rehabilitation inclusion in early pediatric intervention centers in India: A viewpoint

The article focuses on the need for prosthetic and orthotic services in India to improve the quality of life of children with disabilities through early identification and intervention. Early intervention is the earliest identification and comprehensive service and support for children with developmental delays and disabilities ranging from 0 to 6 years to improve their ability to adapt to society. A practical early intervention delays or prevents future complications and prepares the child for functional adult life. It may positively affect the quality of life of the differently abled and their family members, and they can lead an active personal and social life. Also, such interventions promote the well-being and dignity of the differently abled and their parents, which may result in national economic progress. Prosthetic and orthotic rehabilitation facilities under the leadership of qualified professionals are needed in India's government and private setups.

Congenital talipes equinovarus: A literature review

Congenital talipes equinovarus (CTEV) is a congenital disability characterized by leg deformities in the cavus, adducts, varus, and equinus. The etiology of CTEV is poorly understood, despite its incidence ranging from 0.76 to 3.49 cases per 1000 live births in Indonesia. CTEV involves the fixation of the foot in the adducts, varus, and equinus with concurrent soft tissue anomalies. Despite advances in treatment, disability often persists. Theoretical models have been proposed for neurological, vascular, connective tissue, bone, and muscular causes; however, the currently available data suggests that mild cases are associated with intrauterine position. CTEV's etiology appears to involve a hereditary component, as its prevalence varies by ethnic group. Genetic factors have been identified in 24–50% of cases, depending on the community studied. Based on a complex segregation analysis, the most plausible inheritance pattern is a single large-effect gene interacting with a polygenic background.

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CTEV is a congenital disability characterized by leg deformities in the cavus, adducts, varus, and equinus.

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In Indonesia, its incidence ranges from 0.76 to 3.49 cases per 1000 live births.

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Genetic factors have been identified in 24–50% of cases, depending on the community studied.

Incidence of Neonatal Developmental Dysplasia of the Hip and Late Detection Rates Based on Screening Strategy: A Systematic Review and Meta-analysis

IMPORTANCE

Universal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials.

OBJECTIVE

To report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies.

DATA SOURCES

PubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search.

STUDY SELECTION

All observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis.

DATA EXTRACTION AND SYNTHESIS

The number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines.

MAIN OUTCOMES AND MEASURES

The main outcome measures were early detection, early treatment, late detection, and operative treatment incidences.

RESULTS

A total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16 901 079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening.

CONCLUSIONS AND RELEVANCE

This meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.

Congenital hand differences: Prevalence among school going children in Mangalore city

Introduction

Congenital upper extremity anomalies are present in 1 in every 626 live births. They are mostly isolated phenomena but can also be associated with other congenital deformities and may be the only external feature of a syndromic entity. A study on it in India, especially the southern part, is limited. As the quality of life gets compromised, there is a need to identify and diagnose the anomalies at the earliest. Current study is aimed to identify congenital hand deformities among the school-going population in the coastal city of Mangalore.A cross sectional study was done in the schools in Mangalore city. By simple random sampling, 35 out of 70 schools were selected, and 10,000 children in age group of 5-15years were included by non-probability sampling after taking their consent from school authorities and parents. Data was analyzed by FISHER's exact test.

Result

41 cases of congenital hand anomalies were identified with 23 boys and 18 girls. Twelve children had bilateral involvement. 28 cases where of polydactyly followed by four cases of acrosyndactyly with constriction band, three cases each of syndactyly and camptodactyly,one case of lobster hand and one case each of transverse deficiency of hand and forearm. Associated lower limb anomalies were seen in 9 cases. Familial associations were seen in 6 cases, and 1 polydactyly child had a downs syndrome association. All cases[4cases] of acrosyndactyly with constriction band syndrome were operated at childhood, and most other deformities were unoperated. Polydactyly[duplication] tops the list and needs further studies to look into genetic, environmental, and regional variations.

Conclusion

The prevalence of congenital hand difference in Mangalore is 41 per 10000 school-going children examined. . A future national registry in India should be the way forward to assess the true prevalence and risk factors.

The Incidence, Diagnosis, and Treatment practices of Developmental Dysplasia of Hip (DDH) in India: A Scoping Systematic Review

PURPOSE

To identify literature on variations and knowledge gaps in the incidence, diagnosis, and management of developmental dysplasia of hip (DDH) in India.

METHODS

Following standard methodology and PRISMA-ScR guidelines, a scoping systematic review of literature on incidence, diagnosis, and treatment of DDH in India was conducted. Studies conducted in India, published in indexed or non-indexed journals between 1975 and March 2021, were included in the search.

RESULTS

Of 57 articles which met the inclusion criteria, only 33 studies (57.8%) were PubMed-indexed. Twenty-eight studies (49%) were published in Orthopaedic journals and majority had orthopaedic surgeon as the lead author (59.6%). Sixteen studies were mainly epidemiological, 20 reported screening/diagnosis, and 21 reported treatment of DDH. Almost 90% of the studies (51) were Level 4 or 5 according to the levels of evidence in research. There is lack of clarity in the definition of hip dysplasia and screening/diagnostic guidelines to be used. The incidence of hip dysplasia in India is reported to be 0-75 per 1000 live births, with true DDH between 0 and 2.6/1000. Late-presenting DDH is common in India, with most studies reporting a mean age of > 20 months for children presenting for treatment. The treatment is also varied and there is no clear evidence-based approach to various treatment options, with lack of long-term studies.

CONCLUSION

This systematic scoping review highlights various knowledge gaps pertaining to DDH diagnosis and management in India. High-quality, multicentric research in identified gap areas, with long-term follow-up, is desired in future.