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Hwang S, Lee YJ, Song MH, Cho TJ, Choi IH, Shin CH. Incidence and Clinical Characteristics of Slipped Capital Femoral Epiphysis in Patients with Endocrinopathy: A Population-Based Cohort Study. J Bone Joint Surg Am 2024; 106:381-388. [PMID: 38079482 DOI: 10.2106/jbjs.23.00790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Endocrinopathy is a risk factor for slipped capital femoral epiphysis (SCFE). We aimed to determine (1) the incidence of endocrinopathy-associated SCFE compared with that of non-endocrinopathy-associated SCFE, (2) whether the incidence of SCFE increases with the number of deficient hormones, and (3) the clinical characteristics of endocrinopathy-associated SCFE. METHODS We conducted a population-based cohort study using a nationwide database in South Korea. All new diagnoses of endocrinopathy or SCFE between 2002 and 2019 in children born between 2002 and 2005 were identified. The incidence of SCFE was calculated for each type of endocrinopathy. The trend of the incidence of SCFE relative to the number of deficient hormones was analyzed. The male:female ratio was compared between endocrinopathy-associated SCFE and non-endocrinopathy-associated SCFE. For endocrinopathy-associated SCFE, the time between the diagnoses of SCFE and endocrinopathy was evaluated. RESULTS The incidence of SCFE was higher in children with endocrinopathy than in those without endocrinopathy (37.1/100,000 versus 9.0/100,000 children) (relative risk, 4.1 [95% confidence interval, 2.8-6.1]). Among various endocrinopathies, growth hormone deficiency showed the highest incidence of SCFE (583.8/100,000 children). The Cochran-Armitage test showed a linear trend, with an increased number of deficient hormones being associated with a higher incidence of SCFE (p < 0.001). Male sex was dominant in the non-endocrinopathy-associated SCFE group (73%; 117 of 161), whereas female sex was dominant in the endocrinopathy-associated SCFE group (53%; 16 of 30) (p = 0.009). Twenty-two of the 30 cases of endocrinopathy-associated SCFE were diagnosed after the diagnosis of endocrinopathy, with a median time of 3.6 years between the diagnoses. Six (27%) of these 22 children developed SCFE >5 years after the diagnosis of endocrinopathy. CONCLUSIONS The incidence of SCFE was approximately 4 times higher in children with endocrinopathy than in those without endocrinopathy. The risk of SCFE increased with an increased number of deficient hormones. Long-term monitoring of SCFE occurrence in children with endocrinopathies is strongly recommended. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sunghyun Hwang
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Mi Hyun Song
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Ho Choi
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Ho Shin
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Zhao H, Ruan H, Cao Y, Yuan H, Kang Q. Outcomes of Eight-Plate Epiphysiodesis for Residual Clubfoot Deformities. Orthop Surg 2022; 14:3417-3422. [PMID: 36254364 PMCID: PMC9732615 DOI: 10.1111/os.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight-plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot. METHODS We retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid-foot, which in detail, an eight-plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight-bearing radiographic measurements including talo-first metatarsal angle, calcaneo-fifth metatarsal angle and medial-to-lateral column length. RESULTS A total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow-up (range, 28 to 54 months). The average talo-first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo-fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow-up. The mean ratio of the medial-to-lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001). CONCLUSIONS Eight-plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy.
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Affiliation(s)
- Haoyu Zhao
- Department of Orthopedic Surgery, Shanghai Sixth People's HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Hongjiang Ruan
- Department of Orthopedic Surgery, Shanghai Sixth People's HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Yuting Cao
- Department of Orthopedic Surgery, Shanghai Sixth People's HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Hengfeng Yuan
- Department of Orthopedic Surgery, Shanghai Sixth People's HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Sixth People's HospitalShanghai Jiao Tong UniversityShanghaiChina
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Laliotis N, Chrysanthou C, Konstandinidis P, Anastasopoulos N. Anatomical Structures Responsible for CTEV Relapse after Ponseti Treatment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050581. [PMID: 35626758 PMCID: PMC9139296 DOI: 10.3390/children9050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/03/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Relapse of deformity after a successful Ponseti treatment remains a problem for the management of clubfoot. An untreated varus heel position and restricted dorsal flexion of the ankle are the main features of recurrences. We analyze the anatomical structures responsible for these recurrences. Materials and methods: During 5 years, 52 children with CTEV (Congenital Talipes Equino Varus) were treated with casts according to the Ponseti method, with a mean number of 7 casts. Closed percutaneous tenotomy was performed in 28 infants. Children were followed monthly and treated with the continuous use of a molded cast. We had 9 children with relapsed clubfeet. During the standing and walking phase, they had a fixed deformity with a varus position of the heel and dorsal flexion of the ankle <10 d. They were surgically treated with the posterolateral approach. Results: In all patients, we found a severe thickening of the paratenon of the Achilles in the medial side, with adhesions with the subcutaneous tissue. The achilles after the previous tenotomy was completely regenerated. The achilles was medially displaced. Conclusions: A severe thickening of the paratenon of the achilles and adhesions with the subcutaneous tissue are anatomical structures in fixed relapsed cases of clubfoot. We treated our patients with an appropriate surgical release.
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Affiliation(s)
- Nikolaos Laliotis
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
- Correspondence:
| | - Chrysanthos Chrysanthou
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
| | - Panagiotis Konstandinidis
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
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Li J, Xu C, Li Y, Liu Y, Xu H, Canavese F. Are early antero-posterior and lateral radiographs predictive of clubfoot relapse requiring surgical intervention in children treated by Ponseti method? J Child Orthop 2022; 16:35-45. [PMID: 35615392 PMCID: PMC9124919 DOI: 10.1177/18632521221080478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/05/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose To investigate the value of antero-posterior and lateral radiographs in predicting clubfoot relapse after treatment with the Ponseti method. Methods This was a retrospective review of 104 children (157 feet) younger than 3 months of age with idiopathic clubfoot treated using the Ponseti method at our institution between January 2007 and December 2014. All patients underwent Achilles tenotomy and were divided into two groups according to the need for further surgery to correct the deformity: relapsed group (24 patients; 36 feet) and non-relapsed group (80 patients; 121 feet). All antero-posterior and lateral foot radiographs were performed less than 3 months after Achilles tenotomy. The talo-calcaneal (TC-AP) and talus-first metatarsal (TM-AP) angles were measured in the antero-posterior view, while the tibio-calcaneal (TIC-L), talus-first metatarsal (TM-L), and talo-calcaneal (TC-L) angles were measured in the lateral view. The multi-factor logistic regression model of the stepwise selection method was used to predict the relapse of clubfoot deformity from the potential predictive values. Results The mean age at initial plain radiography examination was 99.45 ± 21.54 days. Differences in TC-AP, TM-AP, TC-L, and TIC-L between the two groups were statistically significant. However, only TM-AP and TIC-L were included in the "risk of relapse" formula using the multi-factor logistic stepwise selection method. Conclusion Early antero-posterior and lateral radiographs in children younger than 3 months of age at initial Ponseti treatment have positive predictive value for relapse. Reduced TM-AP angle and increased TIC-L were associated with an increased risk of relapse. Level of evidence level III.
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Affiliation(s)
- Jingchun Li
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chenchen Xu
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yiqiang Li
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuanzhong Liu
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongwen Xu
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Federico Canavese
- Department of Paediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Lille, France
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Lee WC, Kao HK, Wang SM, Yang WE, Chang CH, Kuo KN. Cold Weather as a Risk Factor for Late Diagnosis and Surgery for Developmental Dysplasia of the Hip. J Bone Joint Surg Am 2022; 104:115-122. [PMID: 34793368 DOI: 10.2106/jbjs.21.00460] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Newborn hip screening aims to prevent the late diagnosis of and subsequent surgical procedures for developmental dysplasia of the hip (DDH). Weather may affect how parents swaddle their babies in early life, but weather has never been formally regarded as a risk factor in hip screening. This study investigates the association between the incidence of surgically treated DDH and the outdoor temperature. METHODS Surgical procedures for late-diagnosed DDH were investigated in 12 birth-year cohorts (1999 to 2010) using the Taiwan National Health Insurance Research Database. The number of children who underwent a DDH-related surgical procedure between 6 months and 5 years of age per total live births was evaluated as an outcome of hip screening. Trend and regression analyses were used to determine the association between the incidence of surgically treated DDH and birth year, birth month, and the temperature during the birth month and first 3 months of life. RESULTS The mean incidence of surgically treated DDH was 0.48 per 1,000 live births (1,296 surgically treated patients per 2,712,002 live births). The incidence of surgically treated DDH among babies born in winter months (0.70 per 1,000) was significantly higher than that among babies born in summer months (0.32 per 1,000), and it was significantly correlated with mean temperature in the first 3 months of life (r2 = 0.91; p < 0.0001) and birth month (r2 = 0.68; p < 0.001). Multivariable regression revealed that external temperature in the first 3 months of life was the most significant factor (β = -0.034 [95% confidence interval, -0.042 to -0.022]; p < 0.001) for the incidence of surgically treated DDH (adjusted r2 = 0.485). The trend of seasonal differences remained the same throughout the study years following implementation of the hip-screening policy. CONCLUSIONS As the incidence of surgically treated DDH is the ultimate outcome of newborn hip screening, cold weather should be regarded as a risk factor and should be incorporated into future screening programs. Weather patterns of different geographical areas should be studied to determine if children born in the winter are at an increased risk for requiring a surgical procedure for DDH, and newborn hip-screening programs should be revised accordingly. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wei Chun Lee
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan Kai Kao
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu Mei Wang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen E Yang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia Hsieh Chang
- Department of Pediatric Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Souchet P, Delaby JP, Campana M, Chinnappa J, Ilharreborde B, Simon AL. The functional method: experience from the Robert Debré Hospital. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1098. [PMID: 34423010 PMCID: PMC8339822 DOI: 10.21037/atm-20-7727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/24/2021] [Indexed: 12/15/2022]
Abstract
Background In the 1970s a conservative treatment for clubfoot (CF) deformity based on daily physiotherapy combining specific sequences was developed: the French functional method (FFM). Over time, the FFM technique has improved and additional measures have been introduced. The aim of this study was to report mid-term and long-term results of clubfeet treated conservatively by the FFM at birth. Methods All patients consecutively treated for clubfoot by the FFM between 1993 and 2010 were prospectively included. Initial severity was assessed by the Dimeglio classification. All patients were followed up by the same treating surgeon until skeletal maturity. Final assessment was performed using the International Clubfoot Study Group evaluation system (ICFSG). Results A total of 779 feet were included. Surgery was required in 41% of cases (mean age 2.0±0.1 years). The incidence of surgery significantly decreased after the introduction of percutaneous Achilles tenotomy (PAT) in 2000 (63.4% vs. 29.6%). At latest evaluation (mean follow-up 12±0.2 years), 86% of patients had excellent or good outcomes (mean ICFSG was 1.83±0.1). Mean ankle dorsiflexion was 10° in non-idiopathic CF and 12.1° in idiopathic CF. Eleven percent of the idiopathic clubfeet exhibited decreased ankle function (0–10°). There were no cases of overcorrection into excess ankle dorsiflexion or rocker bottom foot deformities. Conclusions Current team was the funding institution of the FFM and several modifications were proposed over times to improve outcomes. Eighty-six percent of feet had excellent to good outcomes according to the ICFSG score, with minimal residual deformities (ankle dorsiflexion between 0° and 10°, calcaneal-thigh angle between 10° and 20°) or insufficient radiological correction (defined by talo-calcaneal angle between 10° and 20°) at latest follow-up.
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Affiliation(s)
- Philippe Souchet
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Jean-Pierre Delaby
- Department of Functional Rehabilitation, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Matthieu Campana
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Jason Chinnappa
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
| | - Anne-Laure Simon
- Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France
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Monforte S, Alberghina F, Paonessa M, Canavese F, Andreacchio A. Synthetic Cast Material Versus Plaster of Paris for the Treatment of Idiopathic Clubfoot by the Ponseti Protocol: A Comparative Analysis of 136 Feet. J Pediatr Orthop 2021; 41:296-300. [PMID: 33710129 DOI: 10.1097/bpo.0000000000001788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Synthetic casting materials have been used as alternatives to plaster of Paris (POP) in the treatment of clubfoot using the Ponseti method. The aim of this study was to evaluate the clinical outcome of children with idiopathic clubfoot managed by the Ponseti method using POP versus semirigid fiberglass (SRF). METHODS Medical records were retrospectively reviewed for all newborns with idiopathic clubfoot who underwent manipulation and casting by the Ponseti technique between January 2013 and December 2016 at 2 different institutions. In all, 136 consecutive clubfeet were included, of which 68 underwent casting with POP (Group A), and 68 were casted using SRF (Group B). Statistical analysis was performed using the Fisher exact test for categorical variables, and the unpaired t test for quantitative parameters. RESULTS Mean age at time of first cast was 10 days (range, 3 to 21 d). Mean Pirani score at start of treatment was 4.6 and 4.5 in Groups A and B, respectively. Mean number of casts for each patient in Group A was 5.2 against 4.2 in patients in Group B. Mean follow-up was 63.8 months (range, 42 to 88 mo). In each group, 4 cases of relapse were reported (2.9%). No complications related to cast phase or brace phase were recorded. Shorter duration of cast treatment was recorded in Group B. CONCLUSIONS Despite its higher cost and slightly lower moldability, the use of SRF in experienced hands showed comparable results in idiopathic clubfeet treated by the Ponseti technique. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sergio Monforte
- Pediatric Orthopedic Surgery Department, "Vittore Buzzi" Children's Hospital, Milano
| | - Flavia Alberghina
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Torino, Italy
| | - Matteo Paonessa
- Pediatric Orthopedic Surgery Department, "Regina Margherita" Children's Hospital, Torino, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Loos, France
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, "Vittore Buzzi" Children's Hospital, Milano
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