1
|
Luo S, Canavese F, Aroojis A, Andreacchio A, Anticevic D, Bouchard M, Castaneda P, De Rosa V, Fiogbe MA, Frick SL, Hui JH, Johari AN, Loro A, Lyu X, Matsushita M, Omeroglu H, Roye DP, Shah MM, Yong B, Li L. Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review. J Pediatr Orthop 2024:01241398-990000000-00534. [PMID: 38597198 DOI: 10.1097/bpo.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings. METHODS Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care. RESULTS GPT-4's responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 (P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses' quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores (P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions (P = 0.034). CONCLUSIONS This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| | - Federico Canavese
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Alaric Aroojis
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Antonio Andreacchio
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Darko Anticevic
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | | | - Pablo Castaneda
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Vincenzo De Rosa
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | | | - Steven L Frick
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - James H Hui
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ashok N Johari
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | - Antonio Loro
- Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Xuemin Lyu
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - David P Roye
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Bicheng Yong
- Department of Pediatric Orthopaedics, Beit CURE Children's Hospital of Malawi, Chichiri Blantyre, Malawi
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| |
Collapse
|
2
|
Aroojis A, Kapoor D, Gulati Y, Jain D, Agrawal A, Chavan S. Can the Achilles tendon regenerate completely following percutaneous tenotomy in older children with clubfoot? Int Orthop 2024:10.1007/s00264-024-06107-6. [PMID: 38340143 DOI: 10.1007/s00264-024-06107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. METHODS A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. RESULTS Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1-10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0-25°) and mean plantarflexion range of 37.95° (10-40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17-30) and mean height of heel rise of 6.29 cm (range 4-10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3-16 mm) and thickness of 5.1 mm (1.8-15 mm), comparable with unaffected feet. CONCLUSIONS Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012, Maharashtra, India.
| | - Darshan Kapoor
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012, Maharashtra, India
| | - Yash Gulati
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012, Maharashtra, India
| | - Divit Jain
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012, Maharashtra, India
| | - Aniruddh Agrawal
- Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Saroj Chavan
- Department of Paediatric Radiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| |
Collapse
|
3
|
Mehta R, Agrawal A, Aroojis A, Lavande A, Karnik A. Perfusion Changes in Acute Septic Arthritis of the Hip Joint During Infancy Using Doppler USG. Indian J Orthop 2024; 58:98-106. [PMID: 38161395 PMCID: PMC10754777 DOI: 10.1007/s43465-023-01044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
Objectives To quantitatively assess vascularity changes of acute septic hips in infants using Doppler ultrasonography. To compare these findings with asymptomatic hips, and establish a correlation for accurate diagnosis between these findings. Methods In this prospective case-control study, we included all children under 1 year of age with a diagnosis of acute septic arthritis of the hip in the case group. For the control group, we enrolled apparently healthy, full-term neonates and infants not affected with any hip pathology. Doppler ultrasound of the medial femoral circumflex artery of the hip joint was done using a single Phillips HDI 5000 sonography machine. Following parameters were studied: peak systolic velocity (PSV), resistive index (RI), pulsatility index (PI), and systolic to diastolic ratio (SD ratio). Results Doppler signals and spectral waveforms were obtainable in 100% of hips in both groups. A statistically significant difference was found between the cases and controls with respect to their PSVs, RIs, PIs and SD ratios. The most striking difference was found between the PSVs of the two groups, whose mean was 6.18 in the control group and 11.8 in the case group. No significant correlation between age/gender and any of the 4 parameters was found. Conclusion Doppler parameters are useful in raising suspicion of onset in the diagnosis of septic arthritis. No correlation was found between age or gender and any parameter in control group. These baseline values can be held valid for all children below the age of 7 months.
Collapse
Affiliation(s)
- Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
- Nanavati Max Super Specialty Hospital, Mumbai, India
| | | | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | | | - Alka Karnik
- Nanavati Max Super Specialty Hospital, Mumbai, India
| |
Collapse
|
4
|
Bouchard M, Rezakarimi M, Sadat M, Reesor M, Vigneshwaran P, Aroojis A. Comparing patient-reported outcomes of the Oxford Ankle and Foot Questionnaire in children with clubfoot from two different geographic and cultural environments: a cohort study in India and Canada. Int Orthop 2023:10.1007/s00264-023-06064-6. [PMID: 38153430 DOI: 10.1007/s00264-023-06064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE The purpose of this study is to compare the results of the Oxford Ankle and Foot Questionnaire (OxAFQ) in children with clubfoot in Canada and India to assess its ability to predict outcomes and capture patient experiences in different cultural contexts. METHODS This is a retrospective study of children with clubfoot in India and Canada who completed the OxAFQ. Statistical analyses were implemented on registry-collected data to test for independent predictors of poor outcomes and compare scores between countries, among children and their parents, and in Canada where relapse data was collected and the effect of a relapse on scores. RESULTS A total of 361 children were included. The mean Indian OxAFQ scores were higher (p < 0.001) in all domains. Pirani score, tenotomy, laterality, and age at presentation were found to be predictive of outcomes between the sites (p < 0.05). OxAFQ scores decreased after relapse for children in Canada (p < 0.05). Canadian children were found to generally have lower OxAFQ scores in all domains compared to their parents (n = 95; Z = -3.178, -3.493, -3.353, and -3.635 for physical, school and play, emotion, and footwear, respectively; p < 0.001). Indian parents and children showed no significant differences in their scores. CONCLUSIONS A difference was observed in scores between both sites, suggesting there may be differences in how these populations assess personal health outcomes. These findings support the need for cultural validity of patient-reported outcome measures.
Collapse
Affiliation(s)
- Maryse Bouchard
- Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maryam Rezakarimi
- Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marwah Sadat
- Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mikyla Reesor
- Division of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India.
| |
Collapse
|
5
|
Kiani SN, Gornitzky AL, Matheney TH, Schaeffer EK, Mulpuri K, Shah HH, Yihua G, Upasani V, Aroojis A, Krishnamoorthy V, Sankar WN. A Prospective, Multicenter Study of Developmental Dysplasia of the Hip: What Can Patients Expect After Open Reduction? J Pediatr Orthop 2023; 43:279-285. [PMID: 36882887 DOI: 10.1097/bpo.0000000000002383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Although there are several predominantly single-center case series in the literature, relatively little prospectively collected data exist regarding the outcomes of open hip reduction (OR) for infantile developmental dysplasia of the hip (DDH). The purpose of this prospective, multi-center study was to determine the outcomes after OR in a diverse patient population. METHODS The prospectively collected database of an international multicenter study group was queried for all patients treated with OR for DDH. Minimum follow-up was 1 year. Proximal femoral growth disturbance (PFGD) was defined by consensus review using Salter's criteria. Persistent acetabular dysplasia was defined as an acetabular index >90th percentile for age. Statistical analyses were performed to compare preoperative and operative characteristics that predicted re-dislocation, PFGD, and residual acetabular dysplasia. RESULTS A cohort of 232 hips (195 patients) was identified; median age at OR was 19 months (interquartile range 13 to 28) and median follow-up length was 21 months (interquartile range 16 to 32). Re-dislocation occurred in 7% of hips (n=16/228). The majority (81%; n=13/16) occurred in the first year after initial OR. Excluding patients with repeat dislocation, 94.5% of hips were IHDI 1 at most recent follow-up. On the basis of strict radiographic review, some degree of PFGD was present in 44% of hips (n=101/230) at most recent follow-up. Seventy-eight hips (55%) demonstrated residual dysplasia compared with established normative data. Hips that had a pelvic osteotomy at index surgery had about half the rate of residual dysplasia (39%; n=32/82) versus those without a pelvic osteotomy with at least 2 years follow-up (78%; n=46/59). CONCLUSIONS In the largest prospective, multicenter study to date, OR for infantile DDH was associated with a 7% risk of re-dislocation, 44% risk of PFGD, and 55% risk of residual acetabular dysplasia at short term follow-up. The incidence of these adverse outcomes is higher than previous reports. Patients treated with concomitant pelvic osteotomy had lower rates of residual dysplasia. These prospectively collected, multicenter data provide better generalizable information to improve family education and appropriately set expectations. LEVEL OF EVIDENCE Level II, prospective comparative study.
Collapse
Affiliation(s)
- Sara N Kiani
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alex L Gornitzky
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Emily K Schaeffer
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Hitesh H Shah
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka
| | - Ge Yihua
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra
| | - Vidyadhar Upasani
- Department of Orthopaedics, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Alaric Aroojis
- Department of Orthopaedics, Shanghai Children's Medical Center, Shanghai, China
| | | | - Wudbhav N Sankar
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
6
|
Pinto D, Leo DG, Aroojis A, Eastwood D, Gelfer Y. The Impact of Living with Clubfoot on Children and Their Families: Perspectives from Two Cultural Environments. Indian J Orthop 2022; 56:2193-2201. [PMID: 36507216 PMCID: PMC9705620 DOI: 10.1007/s43465-022-00748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023]
Abstract
Purpose To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations-the United Kingdom (UK) and India. Children were divided into age groups of 5-7 and 8-11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an 'emoji' system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents' responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes.
Collapse
Affiliation(s)
- Deepika Pinto
- Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH UK
| | - Donato Giuseppe Leo
- St George’s Healthcare NHS Trust, London, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Yael Gelfer
- St George’s Hospital, St George’s University of London, London, UK
| |
Collapse
|
7
|
Anne RP, Li J, Schaeffer E, Aroojis A, Mulpuri K, Murki S. Care Practices of Indian Pediatricians for the Screening and Diagnosis of Developmental Dysplasia of the Hip. Indian J Pediatr 2022; 89:911-915. [PMID: 35731501 DOI: 10.1007/s12098-022-04200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022]
Abstract
Pediatricians play a key role in identifying neonates with hip instability or at risk for developmental dysplasia of the hip (DDH); however, the clinical practices related to screening and further management in India are unknown. A web-based survey was circulated to members of the National Neonatology Forum of India (NNFI). Of the 231 eligible responses, about 92% were from an urban setup. It was noted that 38% (88/231) had not diagnosed any DDH in the past 12 mo, 8% (17/224) had diagnosed cases beyond walking age, 50% (116/231) would pursue further evaluation in children < 3 mo with risk-factors and normal hip exam, 53% (122/229) were aware of hip-safe swaddling, 30% (68/226) were comfortable with performing Ortolani and Barlow maneuvers and < 50% (107/226) were aware of the current guidelines for the management of DDH. Almost all respondents (97.3%, 220/226) felt a need for a DDH care pathway for screening and early management in India. Thus, substantial deficits and variability in screening practices for DDH amongst pediatricians in India.
Collapse
Affiliation(s)
- Rajendra Prasad Anne
- Department of Pediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Jacqueline Li
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Emily Schaeffer
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Alaric Aroojis
- Department of Orthopedic Surgery, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India
| | - Kishore Mulpuri
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada.,Department of Orthopedic Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Srinivas Murki
- Department of Neonatology, Paramitha Children's Hospital, Kothapet, Hyderabad, Telangana, 500035, India.
| |
Collapse
|
8
|
Aroojis A, Anne RP, Li J, Schaeffer E, Kesavan TMA, Shah S, Patwardhan S, Karnik A, Thanawala U. Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association. Indian Pediatr 2022; 59:626-635. [PMID: 35348125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
JUSTIFICATION When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. PROCESS A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. OBJECTIVES To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. RECOMMENDATIONS Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra. Correspondence to: Dr Alaric Aroojis, Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai 400 012, Maharashtra.
| | - Rajendra Prasad Anne
- Department of Pediatrics, All India Institute of Medical Sciences, Hyderabad, Telangana
| | - Jacqueline Li
- Department of Orthopaedics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Emily Schaeffer
- Department of Orthopaedics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Sandeep Patwardhan
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra
| | - Alka Karnik
- Department of Ultrasonography, Max Nanavati Superspeciality Hospital, Mumbai, Maharashtra
| | - Uday Thanawala
- Department of Gynaecology, Thanawala Maternity Home, Vashi, Navi Mumbai, Maharashtra
| |
Collapse
|
9
|
Aroojis A, Anne RP, Li J, Schaeffer E, Kesavan TMA, Shah S, Patwardhan S, Karnik A, Thanawala U. Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Pinto D, Agrawal A, Agrawal A, Sinha S, Aroojis A. Factors Causing Dropout From Treatment During the Ponseti Method of Clubfoot Management: The Caregivers' Perspective. J Foot Ankle Surg 2022; 61:730-734. [PMID: 34896010 DOI: 10.1053/j.jfas.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
A retrospective comparative study was conducted, aiming to identify factors associated with dropout from clubfoot treatment by Ponseti method in low- and middle-income countries. A prospectively gathered database of patients who received treatment at a high-volume urban clubfoot clinic over 6 years was queried for dropouts. A "dropout" was identified as any child that had not had a visit within 3 weeks of casting, 4 weeks of tenotomy or 6 months of brace follow-up. The second part of the study was a telephonic interview with caregivers of the identified dropouts to ascertain their reasons for discontinuing treatment. Of the 965 patients treated during the study period, there were 155 (16.06%) dropouts-137 (88.38%) during bracing phase and 18 (11.62%) during casting phase. Age at presentation was significantly higher among the dropouts as compared to those who did not dropout (median 9.5 and 7 months for casting and bracing dropouts respectively versus 3.5 months for regular follow-ups, p < .001). No significant correlation was found between patient dropout and sex (p = .061), or laterality (p = .071). Thirty-seven caregivers (23.8%) could be contacted telephonically; including 6 casting and 31 bracing dropouts. The most commonly cited reason for dropout from treatment was lack of family support (75.7%), followed by distance to the clinic (59.5%) and unavailability of transport (54.1%). Sixteen caregivers (43.2%) dropped out on account of migration to another town/state. Maintenance of a meticulous registry with regular update of caregivers' contact details, and interventions to mitigate the identified hurdles can help in reducing treatment dropouts.
Collapse
Affiliation(s)
- Deepika Pinto
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | | | - Sourabh Sinha
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
| |
Collapse
|
11
|
Li J, Aroojis A, Mulpuri K, Shea KG, Schaeffer EK. Development of a DDH Care Pathway for India: A Study Methodology to Guide Similar Efforts in Other Countries and for Other Conditions. Indian J Orthop 2021; 55:1549-1558. [PMID: 34720173 PMCID: PMC8533670 DOI: 10.1007/s43465-021-00534-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE In India and other Global South countries, developmental dysplasia of the hip (DDH) is often diagnosed after walking age, leading to more invasive surgeries and long-term disability. DDH care pathways aim to enhance early detection and must be tailored to meet a country's needs and diverse practice settings. We describe a multi-phase methodology for context-specific DDH care pathway development, demonstrating its use in India. METHODS In Phase I, Orthopaedic surgeons, Pediatricians/Neonatologists, and Radiologists in India were surveyed regarding DDH screening. Seven relevant Indian organizations partnered together and assembled a multidisciplinary working group, which then met fortnightly to establish an evidence base and prepare for the subsequent consensus-building phase. During Phase II, panelists participated in a modified Delphi process to reach consensus on a list of DDH screening statements. Phase III applied the statements to develop the care pathway. RESULTS The Delphi process concluded after a preliminary survey and two Delphi rounds, reaching consensus on 47 statements, which were condensed into 35. The developed care pathway for India features periodic clinical hip examinations integrated with the country's immunization schedule and selective imaging screening, providing flexibility in the timing and modality of imaging. DISCUSSION/CONCLUSION In Global South countries, there is a need for DDH care pathways specific to local contexts. Successful care pathway development requires accounting for cultural differences in healthcare and strategies to facilitate engagement and to address country-specific barriers. This methodology was feasible in India and can be applied to other conditions and/or countries wishing to establish care pathways. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Jacqueline Li
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA USA
| | - Emily K. Schaeffer
- Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| |
Collapse
|
12
|
Abstract
BACKGROUND Developmental dysplasia of hip (DDH) is a relatively common disorder of the paediatric age group and can have a significant impact on the quality of life, if left untreated. Some research has been done in this field from India over the past many decades, thereby helping to attain the present state of knowledge about DDH. Through this review, an attempt was made to identify and acknowledge important contributions in this field from India. PURPOSE To provide some historical aspects and summarise the evidence developed in India concerning different facets of DDH since 1920. METHODS Information about the evolution of DDH management in India was collated from recollections of the senior author (ANJ), from existing records, and contributions from senior Paediatric Orthopaedic surgeons of the country. The Medline database was searched for Indian literature concerning different aspects of DDH. All studies published in English language were included. Included studies were categorised into original studies, reviews, book chapters, case series and case reports, and their contribution to the understanding of DDH was highlighted. RESULTS The analysis showed 63 published studies on DDH from India. The majority of publications occurred between 2011 and 2020. Retrospective cohort studies and reviews comprised 46% of the published literature. CONCLUSION There is a scarcity of research on DDH from India, with many knowledge gaps still prevalent. The overall quality of published literature is poor, with very few good quality original research. However, an increasing trend for research on different aspects of DDH was observed.
Collapse
Affiliation(s)
- Ashok N. Johari
- Children’s Orthopaedic Centre, 2nd Floor, Bobby Apartments, 143 L. J. Road, Mahim (West), Mumbai, 400016 India
| | - Ritesh Arvind Pandey
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Phulwari Sharif, Aurangabad Road, Patna, Bihar 801507 India
| | - Suresh Chand
- Department of Paediatric Orthopaedics, King George’s Medical University, Lucknow, India
| | - Alaric Aroojis
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| |
Collapse
|
13
|
Chand S, Aroojis A, Pandey RA, Johari AN. The Incidence, Diagnosis, and Treatment practices of Developmental Dysplasia of Hip (DDH) in India: A Scoping Systematic Review. Indian J Orthop 2021; 55:1428-1439. [PMID: 35003534 PMCID: PMC8688615 DOI: 10.1007/s43465-021-00526-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- Suresh Chand
- Department of Paediatric Orthopaedics, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Ritesh A. Pandey
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Patna, Bihar India
| | - Ashok N. Johari
- Department of Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, Maharashtra India
| |
Collapse
|
14
|
Pinto D, Dhawale A, Shah I, Rokade S, Shah A, Chaudhary K, Aroojis A, Mehta R, Nene A. Tuberculosis of the spine in children - does drug resistance affect surgical outcomes? Spine J 2021; 21:1973-1984. [PMID: 34116216 DOI: 10.1016/j.spinee.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The emergence of drug resistance has complicated the management of spinal tuberculosis (TB). While it is well known that the medical management of drug-resistant spinal TB is more difficult, the surgical outcomes of the same have not been studied sufficiently, particularly in children. PURPOSE To analyze the surgical outcomes in a cohort of children treated for spinal TB, and to thus assess whether drug resistant (DR) disease is associated with poorer surgical outcomes. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE All children diagnosed and treated for tuberculous spondylodiscitis at a single center between January 2014 and June 2017. OUTCOME MEASURES Surgical outcomes in terms of neurological status and kyphosis angle at final follow-up, and complication rates. METHODS Radiographic and clinical data of children treated for spinal TB with minimum two-year follow-up were retrospectively analyzed. Data gathered included age, gender, level of spine affected, number of vertebrae involved, neurology (Frankel grade), microbiological reports, duration and type of anti-tuberculous therapy (ATT), details of Orthopaedic management and complications during treatment. In DR cases, the time from presentation to starting of second-line ATT was also assessed. Radiographs were reviewed to note the pre- and post-operative degree of kyphosis as well as the angle at final follow-up. Patients that developed major complications were compared statistically with those that did not. RESULTS Forty-one consecutive children (mean age 8.5 ± 4.2 years, 20 boys, 21 girls) were treated for spinal TB with a mean follow-up of 31.2 ± 6.4 months. Fifteen were managed conservatively, of which only one had DR-TB. Of the 26 managed surgically, 13 were managed with first-line ATT and 13 required second-line ATT. Of this latter group, eight had microbiologically proven drug resistance, whereas five were switched to second-line therapy presumptively because of failure to show an adequate response to first-line regimen. At last follow-up, all children had completed the prescribed course of ATT and had been declared cured. Neurological improvement was seen in all but one patient; and at last follow-up, 18 children were Frankel E, seven were Frankel D, and one was Frankel B. 1The immediate post-operative Kyphosis angle averaged 24.38° ± 15.21°. However, six children showed a subsequent worsening of kyphosis, and the Kyphosis angle at last follow-up averaged 30.96° ± 23.92°. Five children had major complications requiring revision surgery; complications included wound dehiscence, vertebral collapse, screw pull-out and implant breakage. Significantly higher number of patients in the group with complications had required second-line ATT (p < .05). CONCLUSIONS In a cohort of children treated surgically for spinal tuberculosis, a higher complication rate, and thus poor surgical outcomes, were found to be associated with drug resistant disease.
Collapse
Affiliation(s)
- Deepika Pinto
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Arjun Dhawale
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India; Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India.
| | - Ira Shah
- Paediatric TB Clinic, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Sarang Rokade
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Avi Shah
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Kshitij Chaudhary
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India
| | - Alaric Aroojis
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Rujuta Mehta
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Abhay Nene
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| |
Collapse
|
15
|
Aroojis A, Mehta R. Hip and Happening: Current Concepts in the Diagnosis and Management of Developmental Dysplasia of the Hip in 2022. Indian J Orthop 2021; 55:1351-1354. [PMID: 35003530 PMCID: PMC8688597 DOI: 10.1007/s43465-021-00587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 400012 Maharashtra India
| | - Rujuta Mehta
- Bai Jerbai Wadia Hospital for Children, Nanavati Max Superspecialty Hospital, Jaslok Hospital, Mumbai, India
| |
Collapse
|
16
|
Karnik A, Lawande A, Lawande MA, Patkar D, Aroojis A, Bhatnagar N. Practice Essentials of Imaging in Early Diagnosis of DDH. Indian J Orthop 2021; 55:1466-1479. [PMID: 35003537 PMCID: PMC8688607 DOI: 10.1007/s43465-021-00539-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/27/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Developmental dysplasia of hip joint (DDH) is a dynamic progressive pathology which can tilt either way. The term strictly applies to primary dysplasia, where etiology is not clearly known. Secondary dysplasia can be due multiple causes, such as neuromuscular disorders, connective tissue disorders or skeletal syndromes. METHODS The etiology being multifactorial, it needs a multidisciplinary team to address the issue at hand. The management starts antenatally with a detailed history of any risk factors and a dedicated ultrasound of the foetus, since forewarned is forearmed. At birth, a paediatrician having a keen sense of DDH will perform Barlow's or Ortolani's manoeuvre and can be the first one to sound the alarm in the event of positive findings. How and when a Radiologist needs to step in will depend on inter-departmental discussions between the paediatrician and the orthopedician. RESULTS In the presence of positive clinical screening tests, and non-availability of ultrasound, a preliminary X ray pelvis AP view including both hip joints should be the requisitioned in a child of any age, particularly, if belonging to the high-risk group. If ultrasound is available, a screening exam till 6 months of age is recommended to rule out DDH. DISCUSSIONS India is known for its vast numbers and little babies with occult diseases are the first to bear the brunt of conditions which have very few symptoms to start with. DDH is one such condition which most unfortunately expresses itself as a symptom only when it's too late, i.e., most often when the child begins to walk. Ultrasound is the modality of choice in neonates; however, since India is a country of modest means, in majority of the regions, radiographs still remain the first line of investigation.
Collapse
Affiliation(s)
- Alka Karnik
- Head of Ultrasound Department, Nanavati Superspeciality Hospital, Mumbai, India
| | | | | | - Deepak Patkar
- Department of Imaging, Medical Services and Head, Nanavati Super -Speciality Hospital, Mumbai, India
| | - Alaric Aroojis
- grid.414135.60000 0001 0430 6611Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Nidhi Bhatnagar
- Deapratment of Radiology, Max Superspeciality Centre, Panchsheel, E-7, East of Kailash, New Delhi, 110065 India
| |
Collapse
|
17
|
Vaidya S, Aroojis A, Mehta R. Developmental Dysplasia of Hip and Post-natal Positioning: Role of Swaddling and Baby-Wearing. Indian J Orthop 2021; 55:1410-1416. [PMID: 35003533 PMCID: PMC8688658 DOI: 10.1007/s43465-021-00513-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Traditional swaddling, which implies restrictive immobilisation of the infant's lower limbs with the hips in forced extension and adduction, has been shown to be a risk factor for Developmental Dysplasia of Hip (DDH). METHODS We reviewed the literature regarding the correlation between DDH and post-natal positioning by swaddling and baby-wearing, to draw awareness of healthcare professionals towards an important risk factor for DDH that has often been overlooked. RESULTS There is overwhelming evidence in the literature, by both experimental and clinical studies, that proves the close association between improper post-natal positioning of the baby's hips in extension-adduction and an increased incidence of DDH. On the other hand, "hip safe" swaddling which allows unrestricted flexion-abduction movements of the infants' hips, and the use of baby-wearing devices which keep the lower limbs in an attitude of hip flexion-abduction and knee flexion, is optimal for hip development. Populations which practice these "hip-safe" techniques of infant immobilisation have a lower incidence of DDH as compared to those which practice restrictive immobilisation. Furthermore, populations which have adopted "hip-safe" positioning have demonstrated a significant decrease in the incidence of DDH. Understanding this association is vital, since this is a modifiable risk factor, rectification of which can decrease the incidence of DDH. CONCLUSION Policy makers and governments must design educational campaigns tailored to their respective populations to increase awareness regarding the benefits of "hip-safe" techniques of infant positioning, since this simple intervention has the potential of decreasing the incidence of DDH.
Collapse
Affiliation(s)
- Sandeep Vaidya
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Mumbai, 40012 Maharashtra India
| |
Collapse
|
18
|
Pinto D, Aroojis A, Shah H, Patwardhan S, Venkatadass K, Sahu C, Schaeffer E, Mulpuri K. Demographic and Practice Variability Amongst Indian Centres in a Multicentre Prospective Observational Study on Developmental Dysplasia of the Hip. Indian J Orthop 2021; 55:1559-1567. [PMID: 35003542 PMCID: PMC8688623 DOI: 10.1007/s43465-021-00516-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Since 2017, five Indian centres have enrolled into the International Hip Dysplasia Registry for prospective collection of data on Developmental Dysplasia of Hip (DDH). AIMS To assess how baseline patient characteristics and initial treatment modalities differ across these five centres. METHODS Registry data collected over 3 years were analyzed. Children with DDH that had radiograph-based diagnoses were included. RESULTS Collectively, there were 234 hips (181 patients), of which 218 had undergone surgery. Overall, median age at presentation was 25.3 months (IQR 16.8-46.0); female/male ratio was 2.6:1 (range 1.46-4.75:1); with 42%, 29%, and 29% unilateral left, bilateral and unilateral right hip dislocations respectively. Most were IHDI grade III and IV dislocations (94%). Closed reduction was performed at all but one centre, at median 15.3 months (IQR 9.6-21.1). Open reduction (OR) as a stand-alone procedure was performed at all centres, at median 20.8 months (IQR 15.4-24.9). Combination of OR with a single osteotomy, femoral (FO) or acetabular (AO), was performed at all centres at median 29.7 months (IQR 22.1-43.5). However, for the same age group, three centres exclusively performed FO, whereas the other two exclusively performed AO. The combination of OR with both FO and AO was used at all centres, at median 53.4 months (IQR 42.1-70.8). CONCLUSIONS The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.
Collapse
Affiliation(s)
- Deepika Pinto
- grid.414135.60000 0001 0430 6611Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Alaric Aroojis
- grid.414135.60000 0001 0430 6611Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Hitesh Shah
- grid.465547.10000 0004 1765 924XDepartment of Orthopaedics, Kasturba Medical College, Manipal, India
| | - Sandeep Patwardhan
- grid.489159.80000 0004 1767 0852Department of Orthopaedics, Sancheti Institute, Pune, India
| | - K. Venkatadass
- grid.415287.d0000 0004 1799 7521Department of Orthopaedics, Ganga Medical Centre, Coimbatore, India
| | - Chittaranjan Sahu
- Department of Orthopaedics, Balaji Institute of Surgery, Research and Rehabilitation, Tirupati, India
| | - Emily Schaeffer
- grid.414137.40000 0001 0684 7788Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | - Kishore Mulpuri
- grid.414137.40000 0001 0684 7788Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| |
Collapse
|
19
|
Gibbard M, Ponton E, Sidhu BV, Farrell S, Bone JN, Wu LA, Schaeffer E, Cooper A, Aroojis A, Mulpuri K. Survey of the Impact of COVID-19 on Pediatric Orthopaedic Surgeons Globally. J Pediatr Orthop 2021; 41:e692-e697. [PMID: 34171889 PMCID: PMC8357035 DOI: 10.1097/bpo.0000000000001887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic required rapid, global health care shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopaedic surgeons during this time. We aimed to investigate COVID-19-related changes in practice, training, and research among pediatric orthopaedic surgeons globally. METHODS An online survey was administered to orthopaedic surgeons with interest in pediatrics in April 2020 and a follow-up was administered in February 2021. The surveys captured demographics and surgeons' self-reported experiences during the pandemic. Participants were recruited from web media and available email lists of orthopaedic societies over a 2-month period. Descriptive statistics were used to analyze results, stratified by the severity of local COVID-19-related measures. RESULTS A total of 460 responses from 45 countries were collected for initial survey. Of these, 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported a reduction in the average number of surgeries per week, from 6.89 (SD=4.61) prepandemic to 1.25 (SD=2.26) at time of survey (mean difference=5.64; 95% confidence interval=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) prepandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% confidence interval=5.61, 60.58). In total, 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported implementation of systems to continue training such as webinars or virtual rounds. Of 192 respondents with research, 149 (82.8%) reported continuing research activities during the pandemic with most reporting either cessation (n=75, 64.15%), or reduction (n=25, 29.9%) in participant recruitment. A total of 111 responses from 28 countries were collected during follow-up. Surgeons described policy and circumstantial changes that facilitated resumption of clinical work. CONCLUSIONS The COVID-19 pandemic and its related counter measures have had significant impacts on pediatric orthopaedic practice and increased uptake of technology to provide care continuity. Rigorous epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.
Collapse
Affiliation(s)
- Marissa Gibbard
- Departments of Orthopaedics
- BC Children’s Hospital Research Institute
| | - Ethan Ponton
- Departments of Orthopaedics
- Office of Pediatric Surgical Evaluation and Innovation, BC Children’s Hospital, University of British Columbia
| | | | - Sarah Farrell
- Department of Orthopaedics, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Jeffrey N. Bone
- Obstetrics and Gynaecology
- BC Children’s Hospital Research Institute
| | - Luke A. Wu
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Emily Schaeffer
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Anthony Cooper
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children
- Lilavati Hospital and Research Centre, Mumbai, India
| | - Kishore Mulpuri
- Departments of Orthopaedics
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC, Canada
| |
Collapse
|
20
|
Vaidya SV, Pinto DA, Mehta R, Agashe MV, Aroojis A. Lower-Limb Ischemia at Birth Because of Spontaneous Arterial Thrombosis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00079. [PMID: 34398853 DOI: 10.2106/jbjs.cc.20.00643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A full-term neonate presented with right lower extremity ischemia at birth because of spontaneous thrombosis of the right common iliac artery. He was initially managed with supportive treatment, anticoagulation, and dressings; however, advanced gangrenous changes precluded salvage of the ischemic limb. A guillotine amputation was performed at day 15 of life, and the stump went on to heal well by secondary intention. CONCLUSION Thromboembolic events occurring in infancy are well-recognized phenomena; however, it is far rarer to encounter a neonate born with "congenital gangrene". We discuss the etiology, approach to diagnosis, and treatment of this rare but devastating condition.
Collapse
Affiliation(s)
- Sandeep V Vaidya
- Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | | | | | | |
Collapse
|
21
|
Aroojis A, Sagade B, Chand S. Usability and Reliability of the Edinburgh Visual Gait Score in Children with Spastic Cerebral Palsy Using Smartphone Slow-Motion Video Technology and a Motion Analysis Application: A Pilot Study. Indian J Orthop 2021; 55:931-938. [PMID: 34194650 PMCID: PMC8192632 DOI: 10.1007/s43465-020-00332-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Edinburgh Visual Gait Score (EVGS) is a comprehensive measure of gait abnormalities in children with cerebral palsy (CP) and has good psychometric properties. However, it is cumbersome to administer and requires multiple devices to record and measure its various components. We conducted this study to determine if a smartphone video protocol could be used to improve the usability and reliability of the EVGS for daily use in a clinic setting. METHODS We used a handheld smartphone camera with slow-motion video technology and a motion analysis application to record and measure the EVGS of 30 ambulatory children with spastic CP. We tested the inter- and intra-rater reliability of various components of the EVGS between two observers. RESULTS Average age was 7 years 3 months (range 4-14 years). The mean (range) EVGS scores for the trunk, pelvis, hip, knee, ankle, and foot were 1.18 (0-3), 0.68 (0-3), 1.1 (0-4), 3.95 (1.5-7.5), 1.87 (0-4) and 4.13 (2-6.5) respectively. Total score was 12.92 (7-21.5). The mean (SD) scores for Gross Motor Function Classification System (GMFCS) levels II and III were 10.73 (3.86) and 14.96 (4.2) (p < 0.001). The intra-observer and inter-observer reliability using percentage of complete agreement was 65-98.3% and 61.7-92.5% respectively, with kappa values ranging from 0.15 to 0.87. Reliability was more for distal limb segments as compared to proximal segments. CONCLUSION We have described a simple and reliable method for quantitative OGA of children with CP, using smartphone video technology and motion analysis application, which can be performed by every clinician in an office setting. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Bhushan Sagade
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Suresh Chand
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012 India
| |
Collapse
|
22
|
Aroojis A, Pandey T, Dusa A, Krishnan AG, Ghyar R, Ravi B. Development of a functional prototype of a SMART (Sensor-integrated for Monitoring And Remote Tracking) foot abduction brace for clubfoot treatment: a pre-clinical evaluation. Int Orthop 2021; 45:2401-2410. [PMID: 33885922 PMCID: PMC8061451 DOI: 10.1007/s00264-021-05042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
Purpose Recurrences following clubfoot correction by the Ponseti method can be prevented by regular use of a foot abduction brace (FAB) until the child is four to five years old. However, there is a lack of an objective method to measure actual hours of brace usage. The aim was to develop a functional prototype of a SMART (Sensor-integrated for Monitoring And Remote Tracking) clubfoot brace to record accurate brace usage and transmit the data remotely to healthcare providers treating clubfoot. Methods A collaborative team of engineers and doctors was formed to investigate various types of sensors and wireless technologies to develop a functional prototype of a SMART brace. Results Infrared sensors were used to detect if the feet were placed inside the shoes and magnetic Hall effect sensors to detect that the shoes were latched on to the bar of the existing FAB. Brace usage data were captured by the sensors every 15 minutes and stored locally on a data card. A Bluetooth low energy (BLE)-based wireless transmission system was used to send the data daily from the brace to the remote cloud server via a smartphone application. Accurate brace usage data could be recorded by the sensors and visualized in real time on a web-based application in a pre-clinical setting, demonstrating feasibility in clinical practice. Conclusion The low-cost SMART brace prototype that we have developed can accurately measure and remotely transmit brace usage data and has the potential to transform caregivers’ behaviour towards brace adherence, which could result in a tangible reduction in recurrence rates.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Tapas Pandey
- Biomedical Engineering and Technology (Incubation) Center (BETiC), Indian Institute of Technology-Bombay (IIT-B), Mumbai, India
| | - Ajay Dusa
- Biomedical Engineering and Technology (Incubation) Center (BETiC), Indian Institute of Technology-Bombay (IIT-B), Mumbai, India
| | - Arun G. Krishnan
- Biomedical Engineering and Technology (Incubation) Center (BETiC), Indian Institute of Technology-Bombay (IIT-B), Mumbai, India
| | - Rupesh Ghyar
- Biomedical Engineering and Technology (Incubation) Center (BETiC), Indian Institute of Technology-Bombay (IIT-B), Mumbai, India
| | - Bhallamudi Ravi
- Department of Mechanical Engineering, Indian Institute of Technology-Bombay (IIT-B), Mumbai, India
| |
Collapse
|
23
|
Sarathy K, Dhawale A, Rokade S, Badve S, Mandlecha P, Aroojis A, Mehta R, Chaudhary K, Nene A. Assessment of pedicle screw malposition in uniplanar versus multiplanar spinal deformities in children. North American Spine Society Journal (NASSJ) 2021; 5:100049. [PMID: 35141615 PMCID: PMC8820053 DOI: 10.1016/j.xnsj.2021.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
Background Spinal deformities can either be uniplanar or multiplanar. The current study aims to compare mal-positioned pedicle screw assessment on radiographs versus CT in children <12 years with multiplanar and uniplanar spinal deformities. Methods A cohort of 15 children, mean age 10.1 years, who underwent posterior spinal fusion using free-hand pedicle screw insertion for multiplanar (M) or uniplanar (U) deformities with post-operative radiograph and CT evaluation of 154 screws. The outcome measures included the assessment of malpositions detected on plain radiographs versus CT scans in U and M deformities. The overall breaches in post-operative plain radiographs and CT in each group were compared and analyzed by two independent observers. The mal-positioned screws were graded on extent of cortical breach on CT. Inter and intra-observer variability was calculated with Kappa(k) method. Sensitivity, Specificity and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated by comparing breaches on radiographs versus CT considered the gold standard. Results In total,154 pedicle screws were analyzed, 65 in U group and 89 in M group. There were 23 (14.9%) malpositioned screws identified on plain radiographs and 43 (27.9%) on CT (p = 0.008). There were 17/154 (11.03%) Grade 1 breaches, 16/154 (10.38%) Grade 2 breaches and 10/154(6.49%) Grade III breaches. Among the 43 CT breaches, 12/65 (18.46%) were in U group, 31/89 (34.83%) were in M group (p = 0.013).The overall Sensitivity, Specificity and PPV of plain radiographs compared to CT in detecting malpositions were 32.56%, 91.89% and 60.87% respectively. Conclusions There was a significant discrepancy in identification of pedicle screw malposition based on plain radiographic versus CT based assessment, more so in multiplanar deformities. The ability to detect a breach on plain radiographs is lesser in multiplanar versus uniplanar deformities.
Collapse
Affiliation(s)
- Kailash Sarathy
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - Arjun Dhawale
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, India
| | - Sarang Rokade
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - Siddharth Badve
- Musculoskeletal Institute, Geisinger Health System, Geisinger Lewistown Hospital, PA, United States
| | | | - Alaric Aroojis
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - Rujuta Mehta
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - Kshitij Chaudhary
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, India
| | - Abhay Nene
- Department of Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| |
Collapse
|
24
|
Abstract
INTRODUCTION Hip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment. HIP SURVEILLANCE PROGRAMMES Several population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients' age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement. CONCLUSION Despite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Nihit Mantri
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra 400012 India
| | - Ashok N. Johari
- Paediatric Orthopaedics, Balabhai Nanavati Super Speciality Hospital, Mumbai, India
| |
Collapse
|
25
|
Rangasamy K, Mehta R, Gopinathan NR, Aroojis A, Behera P, Dhillon MS. Changes in the Management of Clubfoot Cases During COVID-19 Pandemic-A Survey Among Orthopaedic Specialists. Indian J Orthop 2020; 55:188-194. [PMID: 33041362 PMCID: PMC7538280 DOI: 10.1007/s43465-020-00277-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The on-going COVID-19 pandemic has curtailed the established practice norms of many ailments including clubfoot. We conducted a survey to study the changes in the clubfoot treatment practices, Achilles tenotomy methods, and the role along with the possible impact of teleconsultation during this pandemic. METHODS A web-based survey was conducted using a questionnaire prepared on Google forms. The link for this questionnaire was sent to Indian Orthopaedic specialists with a special interest in clubfoot management via a social messaging platform. RESULTS 127 eligible responses were analysed. Of them, 67% respondents were in practice for more than 10 years. During the study period, 30.7% of doctors did not perform any casting; 66.9% performed casting in 1-5 cases per week and only 2.4% performed casting in more than five cases per week. A statistically significant difference was noted in the number of doctors who performed casting in less than five cases per week and the doctors who performed casting in more than five cases per week, before and during the COVID-19 pandemic. 30.7% of doctors deferred doing Achilles tenotomy during the study period, and among those who performed one, a significant number of them avoided tenotomy under general anaesthesia. CONCLUSION The COVID-19 pandemic has significantly impacted clubfoot treatment practices during the lockdown period in India. Significant reductions in the number of cases, and a reduction with changes in Achilles tenotomy practices were noted too. However, whether this had any adverse influence on the eventual outcome in these feet is yet to be determined.
Collapse
Affiliation(s)
- Karthick Rangasamy
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rujuta Mehta
- Paediatric Orthopaedic Division, B J Wadia Hospital for Children, Mumbai, India
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alaric Aroojis
- Department of Paediatric Orthpaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India
| | - Mandeep S. Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
26
|
Hooper N, Aroojis A, Narasimhan R, Schaeffer EK, Habib E, Wu JK, Taylor IK, Burlile JF, Agrawal A, Shea K, Mulpuri K. Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India. Indian J Orthop 2020; 55:158-168. [PMID: 33569110 PMCID: PMC7851210 DOI: 10.1007/s43465-020-00233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND We evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India. METHODS An online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019. RESULTS 173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12 months, and 49.1% had assessed children with DDH aged > 2 years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays. CONCLUSIONS In India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners.
Collapse
Affiliation(s)
- Nikki Hooper
- Department of Orthopaedic Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Alaric Aroojis
- Department of Pediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 India
| | - Ramani Narasimhan
- Department of Pediatric Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Emily K. Schaeffer
- Department of Orthopaedic Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, BC Canada
| | - Eva Habib
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | - Judy K. Wu
- Department of Orthopaedic Surgery, BC Children’s Hospital, Vancouver, BC Canada
| | | | | | | | - Kevin Shea
- Department of Pediatric Orthopaedics, Stanford University, Stanford, CA USA
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, BC Canada
| |
Collapse
|
27
|
Shah A, Aroojis A, Mehta R. The Ponseti method of treatment for neuromuscular and syndromic (non-idiopathic) clubfeet: evaluation of a programme-based approach at a mean follow-up of 5.8 years. Int Orthop 2020; 45:155-163. [PMID: 32651710 DOI: 10.1007/s00264-020-04677-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyse the results of the Ponseti method in the treatment of non-idiopathic clubfeet and compare them with idiopathic clubfeet in a programme-based setting using a standardized protocol METHODS: We reviewed two groups of 782 children treated prospectively in our programme-based Clubfoot Clinic: group I comprised of 89 patients (146 feet) with non-idiopathic clubfoot and group II comprised of 693 patients (1032 feet) with idiopathic clubfoot. Both groups were compared on the basis of patient demographics, number of casts, tenotomy rate, success rate, rate of recurrences, and the need for additional secondary procedures. RESULTS Non-idiopathic clubfeet had a higher incidence of bilateral involvement (p = 0.0093) and affected both males and females equally (p = 0.002) as compared with idiopathic clubfeet. Non-idiopathic clubfeet (group I) required significantly more casts (6.75 ± 4.2) compared with idiopathic clubfeet (4.23 ± 4.14), had a higher rate of Achilles tenotomy (90.4% vs 75%, p < 0.0001), and had a lower initial correction rate compared with idiopathic clubfeet (92.5% vs 100%, p < 0.0001). There was a significant difference in the recurrence rates between the two groups, as 42.5% of non-idiopathic feet (38 patients) relapsed compared with 10.2% (71 patients) in the idiopathic group (p < 0.0001). Most recurrences in group I were amenable to re-casting, with only nine patients (14 non-idiopathic clubfeet) requiring extensive soft tissue releases. The final success rate in the non-idiopathic group at a mean follow-up of 5.8 years (2-8 years) was 87.7%. CONCLUSIONS We recommend the use of the Ponseti method as an effective treatment for non-idiopathic clubfeet associated with neuromuscular and syndromic conditions.
Collapse
Affiliation(s)
- Avi Shah
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India.
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India
| |
Collapse
|
28
|
Pinto DA, Aroojis A, Mehta R. Swaddling Practices in an Indian Institution: Are they Hip-Safe? A Survey of Paediatricians, Nurses and Caregivers. Indian J Orthop 2020; 55:147-157. [PMID: 33569109 PMCID: PMC7851204 DOI: 10.1007/s43465-020-00188-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Traditional infant swaddling or binding with hips and knees extended is a known risk factor for Developmental Dysplasia of the Hip (DDH), while 'hip-safe swaddling' with hips and knees flexed is believed to eliminate this risk. We conducted a survey to determine the prevalent practices for infant swaddling in India; why mothers practice swaddling and who teaches them; and whether Paediatricians, nurses and caregivers are aware of hip-safe swaddling. METHODS Anonymous one-time surveys were conducted in three groups-Paediatricians, Nurses and caregivers - at a tertiary-care, urban based, paediatric and maternity hospital. RESULTS Forty-five paediatricians, 219 nurses and 100 caregivers were surveyed. Ninety percent caregivers practiced traditional swaddling, for on average 10.2 hours a day, starting soon after birth, up to 4.2 months of life. Traditional swaddling was advocated by 99% nurses and 53% Paediatricians. Reasons for swaddling included sleep, warmth and the misbelief that the child's legs would remain bowed if not bound straight; contrarily few mothers (8%) avoided swaddling out of superstition. Mothers learnt swaddling mainly from relatives (94%) and nurses (64%). Most nurses (70%) had learnt the practice during nursing training. Only 6.6% Paediatricians, 4% caregivers and 0% nurses were aware of 'hip-safe swaddling'. CONCLUSION Traditional swaddling of infants is a practice deeply rooted in India, born out of misbeliefs, and propagated by lack of awareness. Training in hip-safe swaddling targeted at nurses and Paediatricians would be an effective initial step in creating awareness among mothers and changing their practices.
Collapse
Affiliation(s)
- Deepika A. Pinto
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, 400012 Maharashtra India
| |
Collapse
|
29
|
de Podesta Haje D, Maranho DA, Ferreira GF, Rocha Geded AC, Aroojis A, Queiroz AC, Bhatti A, Gonçalves Brandão AL, Valencia Lucero EG, Hernández EIA, Tierno GOH, Ocampo JC, Kim JH, Leite LMDS, Oyoun NA, Kumar R, Canto SJS, Nogueira MP. Ponseti Method After Walking Age - A Multi-Centric Study of 429 Feet: Results, Possible Treatment Modifications and Outcomes According to Age Groups. Iowa Orthop J 2020; 40:1-12. [PMID: 33633502 PMCID: PMC7894059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Ponseti method is suitable to treat neglected clubfoot after the walking age. However, limited evidence exists on its effectiveness, outcomes and rate of relapse. Methods: 429 clubfeet in 303 patients with no previous treatment and older than one-year were treated with the Ponseti method in 15 centers from seven countries. The median age at treatment onset was three years, and the median follow-up of 1.3 years. Standard Ponseti Method was applied. Bilateral abduction brace was recommended after casting. Patients were classified according to group ages (<2 years, 2-4 years, >4-8years, >8 years). Feet were evaluated by Pirani score and a clinical outcome classification. Relapses were described in a subset of 103 clubfeet with minimal follow-up of two years. RESULTS Ponseti method was able to correct the deformity in 87% (373 of 429) of neglected clubfeet, after a mean of 6.8 casts. Residual equinus was treated with percutaneous sectioning of the Achilles tendon in 356 (83%) of 429 clubfeet. A bilateral foot abduction brace was prescribed and used in 70% of children. Relapses occurred in 31% (32 of 103) of clubfeet and were associated with age less than 4 years at treatment onset, and bracing noncompliance. CONCLUSION The Ponseti method is effective to correct neglected clubfeet. Relapses occurred in one-third of clubfeet, mainly in children younger than four years and in noncompliance with the brace. Our study reinforces the recommendation for the Ponseti method with no major modification to treat neglected clubfoot in patients after walking age.Level of Evidence: IV.
Collapse
Affiliation(s)
- Davi de Podesta Haje
- Hospital de Base do Distrito Federal and Clinical Center Orthopectus - Brasília, DF, Brazil
- Hospital Sírio Libanês - Brasília, DF, Brazil
| | | | - Gabriel Ferraz Ferreira
- Department of Pediatric Orthopaedics and Limb Reconstruction, Hospital do Servidor Público Estadual - São Paulo, SP, Brazil
| | | | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children - Parel, Mumbai, Maharashtra, India
| | | | - Anisuddin Bhatti
- Jinnah Postgraduate Medical Centre - J. S. Medical University - Karachi, Pakistan
| | | | | | - Erika Iliana Arana Hernández
- Department of Pediatric Orthopaedic Surgery, Benemérito Hospital Civil de Guadalajara Fray Antonio Alcalde - Guadalajara, Jalisco, México
| | | | | | - Jung Ho Kim
- Universidade Federal da Fronteira Sul - Passo Fundo, RS, Brazil
| | | | - Nariman Abol Oyoun
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Assiut University - Assiut, Egypt
| | - Ranjeet Kumar
- Jinnah Postgraduate Medical Centre - J. S. Medical University - Karachi, Pakistan
| | | | - Monica Paschoal Nogueira
- Department of Pediatric Orthopaedics and Limb Reconstruction, Hospital do Servidor Público Estadual - São Paulo, SP, Brazil
| |
Collapse
|
30
|
Teo TL, Schaeffer EK, Habib E, Cherukupalli A, Cooper AP, Aroojis A, Sankar WN, Upasani VV, Carsen S, Mulpuri K, Reilly C. Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures. J Child Orthop 2019; 13:569-574. [PMID: 31908673 PMCID: PMC6924127 DOI: 10.1302/1863-2548.13.190005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The Gartland extension-type supracondylar humerus (SCH) fracture is the most common paediatric elbow fracture. Treatment options range from nonoperative treatment (taping or casting) to operative treatments (closed reduction and percutaneous pinning or open reduction). Classification variability between surgeons is a potential contributing factor to existing controversy over treatment options for type II SCH fractures. This study investigated levels of agreement in extension-type SCH fracture classification using the modified Gartland classification system. METHODS A retrospective review was conducted on 60 patients aged between two and 12 years who had sustained an extension-type SCH fracture and received operative or nonoperative treatment at a tertiary children's hospital. Baseline radiographs were provided, and surgeons were asked to classify the fractures as type I, IIA, IIB or III according to the modified Gartland classification. Respondents were then asked to complete a second round of classifications using reshuffled radiographs. Weighted kappa values were calculated to assess interobserver and intraobserver levels of agreement. RESULTS In all, 21 paediatric orthopaedic surgeons responded to the survey and 15 completed a second round of ratings. Interobserver agreement for classification based on the Gartland criteria between surgeons was substantial with a kappa of 0.679 (95% confidence interval (CI) 0.501 to 0.873). Intraobserver agreement was substantial with a kappa of 0.796, (95% CI 0.628 to 0.864). CONCLUSION Radiographic classification of extension-type SCH fractures demonstrated substantial agreement both between and within surgeon raters. Therefore, classification variability may not be a major contributing factor to the treatment controversy for type II SCH fractures and treatment variability may be due to differences in surgeon preferences. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- T. L. Teo
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - E. K. Schaeffer
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - E. Habib
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - A. Cherukupalli
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - A. P. Cooper
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - A. Aroojis
- Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Children, Mumbai, India
| | - W. N. Sankar
- Children’s Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - V. V. Upasani
- Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - S. Carsen
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - K. Mulpuri
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada,Correspondence should be sent to K. Mulpuri, Department of Orthopaedic Surgery, BC Children’s Hospital, 1D.66-4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada. E-mail:
| | - C. Reilly
- Department of Orthopaedic Surgery, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
31
|
Abstract
Cerebral palsy (CP), a heterogeneous disorder of movement and posture, is one of the most important causes of disability affecting children. With a wide variability in the clinical presentation and a paucity of reliable diagnostic tests, decision-making in CP is fraught with difficulties and challenges. The plethora of musculoskeletal manifestations includes poor muscle function, spasticity, rigidity, muscle weakness, poor selective motor control, soft-tissue and joint contractures, torsional malalignments, and lever arm dysfunctions. Children with CP are at a high risk of further worsening and progression of these musculoskeletal abnormalities with the natural course of the disease. A comprehensive assessment that includes a combination of detailed medical history, functional assessment, clinical examination, analysis of gait, and radiological assessment is required to provide a favorable treatment outcome in these children. A close surveillance is essential so as to identify risk factors for the development and progression of musculoskeletal problems so that early interventions can be carried out to circumvent them. This review article is to highlight the importance of clinical examination in the assessment of children with CP.
Collapse
Affiliation(s)
- Kailash Sarathy
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Chintan Doshi
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India,Address for correspondence: Dr. Alaric Aroojis, Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| |
Collapse
|
32
|
Aroojis A, Patel M, Shah A, Sarathy K, Vaidya S, Mehta R. Distal Femoral Extension Osteotomy with 90° Pediatric Condylar Locking Compression Plate and Patellar Tendon Advancement for the Correction of Crouch Gait in Cerebral Palsy. Indian J Orthop 2019; 53:45-52. [PMID: 30905981 PMCID: PMC6394194 DOI: 10.4103/ortho.ijortho_410_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various treatment modalities are available for the correction of crouch gait, ranging from hamstring lengthening to a combination of soft-tissue and bony procedures. We report the results of distal femoral extension osteotomy (DFEO) fixed with 90° pediatric condylar locking compression plate (LCP) and patellar tendon advancement (PTA) for crouch gait in children with cerebral palsy. MATERIALS AND METHODS A total of 26 patients (52 knees) with a mean age of 14.36 years (range 11.6-20 years) who presented with crouch gait were treated with DFEO and PTA. Patients were analyzed prospectively using clinical (knee flexion deformity, knee range of motion, extensor lag), functional (modified Ashworth, Tardieu scores, muscle strength, gross motor functional classification system [GMFCS], functional mobility scale [FMS], gross motor functional measure [GMFM]) and radiological (Koshino Index) outcome measures and followed up at a mean of 22 months (range 12-53 months). RESULTS There was an improvement in all outcome measures postoperatively, with improved function and independence. The mean knee flexion deformity improved significantly from 20.7° ± 6.59 to 0.67° ± 2.62, mean muscle strength of quadriceps improved from 3.01 ± 0.5 to 3.5 ± 0.54 and mean extensor lag improved from 20° ± 7.14 to 4.13° ± 4.16. The mean Koshino Index improved from 1.4 ± 0.16 to 1.0 ± 0.08. The mean GMFM-D improved from 15.58 ± 6.2 to 26.31 ± 5.8 and mean FMS for 5 m improved from 2.9 ± 1.09 to 3.6 ± 0.84, indicating significant improvement in household ambulation. There were four complications; transient peroneal nerve palsy in 3 patients, which recovered completely and 1 superficial wound dehiscence. There was no loss of fixation, tendon pull-out or deep infection. CONCLUSION The combined procedure of DFEO and PTA can correct knee flexion deformity, restore knee extensor strength, and improve function in patients with crouch gait. The pediatric condylar LCP provides stable fixation to allow early mobilization and faster rehabilitation.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India,Address for correspondence: Dr. Alaric Aroojis, Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital For Children, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Maulik Patel
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Avi Shah
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Kailash Sarathy
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Sandeep Vaidya
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Rujuta Mehta
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| |
Collapse
|
33
|
Vaidya SV, Aroojis A, Mehta R, Agashe MV, Dhawale A, Bansal AV, Sarathy K. Short Term Results of a New Comprehensive Protocol for the Management of Congenital Pseudarthrosis of the Tibia. Indian J Orthop 2019; 53:736-744. [PMID: 31673175 PMCID: PMC6804390 DOI: 10.4103/ortho.ijortho_155_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of Congenital Psuedarthrosis of Tibia (CPT) often poses significant challenges due to difficulty in achieving union and subsequent complications like refractures, implant failures, etc. Our new comprehensive protocol is aimed at achieving crossunion between the tibia and fibula. AIMS AND OBJECTIVES The aim of the present study is to evaluate the short-term results of our new protocol and to compare the results with our previously used techniques. MATERIALS AND METHODS 10 patients with mean age 2.35 years (1 to 6.5 years) who were treated by our new comprehensive protocol were included in Group A, and 11 patients with mean age 2 years (1 to 5.5 years) who primarily underwent intramedullary rodding with bone graft were included in Group B. The new comprehensive protocol consisted of pre-operative Zolendronate infusion, surgery consisting of intramedullary fixation of tibia supplemented with Ilizarov ring fixator and bone grafting aimed at achieving tibia-fibula cross-union. Retrospective evaluation of serial radiographs was performed and outcomes with respect to union and subsequent complications were analysed. RESULTS 10/10 (100%) patients in Group A united, whereas union was achieved in only 8/11 (72%) patients in Group B. The index surgery was successful in achieving union in all 10 patients in Group A, whereas in Group B 2.25 (1 to 4) surgeries were needed to achieve union. The time to union was significantly shorter in Group A (4.68 months) as compared to Group B (30.88 months). The cross sectional area of union was significantly greater in Group A (3.82 cm2) as compared to Group B (1.18 cm2). One patient in Group A needed a subsequent corrective osteotomy for tibial valgus, and one patient underwent tibia lengthening; whereas in Group B, two patients needed corrective osteotomes for residual malaligments. CONCLUSION Our study demonstrates that the new comprehensive protocol is extremely effective for achieving sound union in Congenital Pseudarthrosis of Tibia.
Collapse
Affiliation(s)
- Sandeep Vijaykumar Vaidya
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India,Address for correspondence: Dr. Sandeep Vijaykumar Vaidya, Pinnacle Orthocentre Hospital, 1st/2nd Floor, Blue Nile Commercial Complex, Chandanwadi Signal, Junction of LBS Marg and Almeida Road, Thane West, Thane - 400 602, Maharashtra, India. E-mail:
| | - Alaric Aroojis
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Rujuta Mehta
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Mandar Vikas Agashe
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Arjun Dhawale
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Ankita Vijay Bansal
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Kailash Sarathy
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| |
Collapse
|
34
|
Abstract
Pediatric elbow dislocations are rare injuries and are often accompanied by concomitant fractures. We report a rare case of medial dislocation of the right elbow without accompanying fracture in a 10.5-year-old boy after fall from a bicycle. After radiographic and magnetic resonance imaging evaluation, closed reduction under general anesthesia was performed and the elbow was immobilized in a posterior above-elbow slab. Elbow mobilization was started after 2 weeks and the posterior slab was discontinued after 4 weeks. At 3 months, the patient had a full range of active elbow flexion extension and pronation supination. At 4-year followup, radiographs show a normal alignment of the elbow with mild changes of heterotopic ossification. We believe that this is the first such case ever reported in literature. Early recognition and prompt diagnosis is the key to achieve a good result.
Collapse
Affiliation(s)
- Alaric Aroojis
- Department of Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India,Address for correspondence: Dr. Alaric Aroojis, Department of Paediatric Orthopaedics, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Four Bungalows, Andheri (West), Mumbai - 400 053, Maharashtra, India. E-mail:
| | - Varun Narula
- Department of Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Darshana Sanghvi
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
35
|
Motwani G, Mehta R, Aroojis A, Vaidya S. Current trends of microorganisms and their sensitivity pattern in paediatric septic arthritis: A prospective study from tertiary care level hospital. J Clin Orthop Trauma 2017; 8:89-92. [PMID: 28360506 PMCID: PMC5359515 DOI: 10.1016/j.jcot.2016.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/22/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Early treatment of septic arthritis is essential before irreversible damage to the articular cartilage occurs. Clinicians often start empirical antibiotic therapy for symptomatic relief while awaiting a definitive culture report. In present day parlance with variations in different centres in the private and public sector and rampant antibiotic abuse, a lot of resistance is being seen in the flora and their sensitivity patterns. Hence it is imperative to document and analyze these changing trends. METHODS The authors conducted a retrospective analysis of prospectively gathered data of 60 patients under 14 years of age. Joint arthrotomy was performed as a standard therapeutic protocol and the drained pus or synovial fluid was sent for gram stain and culture by 2 different methods: conventional agar plate method and BACTEC Peds Plus/F bottle method. Antibiotic susceptibility tests were done by the disc diffusion method of Clinical Laboratory Standards Institute (CLSI). RESULTS The commonest presenting age group was below 1 year (80% patients) including 24 neonates. There were 19 hospital and 41 community acquired cases of septic arthritis. The hip (56%) was the commonest affected joint followed by knee (28%), shoulder joint (11%) and elbow (5%). Microorganism was isolated in 53% isolates of joint fluid only (36 culture positive patients). Conventional agar methods of culture showed positive report in only 42% patients (15/36 patients) while with the BACTEC method the yield was 71%. In the Community acquired septic arthritis, methicillin sensitive Staphylococcus aureus was isolated as commonest microbe while resistant variety of gram negative bacilli including E. coli and Klebsiella were found as predominant organism causing hospital acquired nosocomial infection of joints. The results strikingly differ in terms of response to treatment as most patients (11/19 patients) showed significant resistance to the most commonly practiced empirical antibiotic regimen of ampicillin-cloxacillin group in routine practice. When cefazolin was used as empirical antibiotic, it has shown good response and better sensitivity in 82% patients (27/33 patients). CONCLUSION S. aureus is still the most common organism in septic arthritis. The BACTEC system was found to improve the yield of clinically significant isolates. Though a significant resistance to common antibiotic regimen is noticed, the strain is susceptible to cephalosporin group of antibiotics. We recommend the use of cephalosporine antibiotics as an empirical therapy till culture and sensitivity report are available.
Collapse
|
36
|
Dodge GR, Bowen JR, Oh CW, Tokmakova K, Simon BJ, Aroojis A, Potter K. Electrical stimulation of the growth plate: A potential approach to an epiphysiodesis. Bioelectromagnetics 2007; 28:463-70. [PMID: 17492657 DOI: 10.1002/bem.20329] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Epiphysiodesis is an operative procedure that induces bony bridges to form across a growth plate of a bone to stop longitudinal growth. This is a very common orthopedic procedure to correct disproportional long-bone growth discrepancies; however, present techniques require an operation and anesthesia. Our study was designed to develop a minimally invasive method of epiphysiodesis by using electrical stimulation with DC current. In a rabbit model, a thin titanium electrode was inserted into a single location of the distal femoral growth plate in three groups: one without current (control), one group with a constant 10 microA (low current, LC), and one group with a 50 microA (high current, HC). The current was delivered for 2 weeks. The nontreated femur served as a control for each animal. Femur lengths were measured and comparisons were made between operated (left) and nonoperated (right) femurs. Digitized histomorphometric and volumetric analyses were performed on each growth plate, and detailed assessments were made of any morphological changes. Using length measurements, the difference in femur length was significantly larger in the HC group and not in the LC or control groups, showing bone growth inhibition at the higher current. In the HC group, bony bridges and disorganized growth plates were observed. This study shows that delivery of an electrical current of 50 microA for as little as 2 weeks can markedly affect bone growth as evidenced by changes in epiphyseal plate volume and architectural organization, and the study supports the use of this minimally invasive approach as a potential method of achieving an epiphysiodesis.
Collapse
Affiliation(s)
- George R Dodge
- Bone & Cartilage Research Laboratory, Nemours Biomedical Research, & Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, Delaware.
| | | | | | | | | | | | | |
Collapse
|
37
|
Karmarkar S, Aroojis A, Deshpande S, Thakur M. The ideal approach to back closure; Are we closing the backs properly ? Is laminectomy always necessary? Cerebrospinal Fluid Res 2005. [DOI: 10.1186/1743-8454-2-s1-s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
38
|
Vaidya SV, Aroojis A. Multiple joint replacement in chronically neglected polyarthritic patients: Two case reports. J Orthop Surg (Hong Kong) 2000; 8:75-81. [PMID: 12468865 DOI: 10.1177/230949900000800214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multiple joint replacement is a viable option for rehabilitation of young polyarthritic patients with unsalvageable joints. Young polyarthritic patients in this part of the world suffer from chronic neglect because of ignorance, apathy and low socio-economic status. During the period of chronic neglect, these patients acquire extreme deformities of various joints either due to active disease (ankylosing spondylitis, rheumatoid arthritis) or irreversible changes in the joint configuration like ankylosis and soft-tissue contracture. Associated spine and thoracic cage affection create problems for anaesthesia and peri-operative positioning. We report 2 cases of multiple joint replacements for young polyarthritic patients who were bedridden for 6 to 11 years. Surgeries were performed in a phased manner and after extensive rehabilitation both patients were able to walk unaided. Various problems and difficulties encountered have been addressed so as to serve as a guide to surgeons who may have to deal with such unusual situations of chronic neglect. We also report a modified exposure technique without trochanteric osteotomy for total hip replacement, which is valuable in extreme external rotation ankylosis.
Collapse
Affiliation(s)
- Shrinand V Vaidya
- Department of Orthopaedics, King Edward VII Memorial Hospital, Mumbai, India
| | | |
Collapse
|
39
|
Abstract
An anthropometric computed tomography scan study was undertaken to design femoral components in 86 knees (47 osteoarthritic Indians-21 men, 26 women) who matched standards suggested by the Indian Council of Medical Research, 1990. Patients were classified into 3 random groups based on anteroposterior diameter (<55 mm, 55-59 mm, >59 mm). Most Indian men (86.8%) could have the femoral component satisfactorily replaced by available designs. A statistically significant number of women (60.4%, P < .001) had femoral anteroposterior diameters smaller than the smallest available (55 mm) femoral component. Splaying in mediolateral dimension (> 10 mm) in a given anteroposterior size was noted in all 3 groups. This pilot study representative of the Indian population can be used to manufacture prosthetic inventories suitable for most of the Asian-Pacific population having smaller anthropometric measurements than Western populations.
Collapse
Affiliation(s)
- S V Vaidya
- Department of Orthopaedics, KEM Hospital, Parel, Mumbia, India
| | | | | | | |
Collapse
|
40
|
Affiliation(s)
- A Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, India
| | | | | |
Collapse
|
41
|
D'Souza H, Aroojis A, Chawara GS. Talectomy in arthrogryposis: analysis of results. J Pediatr Orthop 1998; 18:760-4. [PMID: 9821132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Talectomy is recommended as a primary or salvage procedure for management of rigid or recurrent equinovarus deformity in arthrogryposis. Twenty-one feet (11 children) that had undergone talectomy were reviewed at a mean follow-up of 11.1 years (range, 2-24). Fourteen (73.7%) feet were satisfactory at final review, whereas five (26.3%) had an unsatisfactory result. Attention to technical details and accurate positioning of calcaneus in the ankle mortise are the two important prerequisites to guarantee a satisfactory long-term result. Fusion of the tibiocalcaneal articulation in optimal position, either spontaneous or induced, is a favorable sign, as it ensures lasting correction of the deformity. The role of a tight and fibrotic tibialis anterior in causing recurrence of severe forefoot adduction and supination is discussed.
Collapse
Affiliation(s)
- H D'Souza
- Children's Orthopaedic Hospital, Mumbai, India
| | | | | |
Collapse
|
42
|
D'Souza H, Aroojis A, Yagnik MG. Rotation fasciocutaneous flap for neglected clubfoot: a new technique. J Pediatr Orthop 1998; 18:319-22. [PMID: 9600556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily the result of excessive tension on the skin edges and a poor understanding of the abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure by using a local-rotation fasciocutaneous flap. Posteromedial skin incision is taken. Posterior tibial artery perforators supplying the medial flap and saphenous vein are preserved. After soft-tissue release and correction of deformity, a defect appears in the posteromedial part of wound. Horizontal backcut is taken at proximal part of the incision and entire medial fasciocutaneous flap is rotated inferiorly to cover the defect. Triangular defect appearing proximally is sutured primarily or covered with skin graft. Primary uncomplicated wound healing was achieved within 2 weeks in all 20 rigid and neglected clubfeet (1-7 years) operated on with this technique. This flap is scientifically logical, technically easy, and ensures primary wound healing.
Collapse
Affiliation(s)
- H D'Souza
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | | | | |
Collapse
|
43
|
Affiliation(s)
- A Aroojis
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, India
| | | | | |
Collapse
|
44
|
Chhaparwal M, Aroojis A, Divekar M, Kulkarni S, Vaidya SV. Irreducible lateral dislocation of the elbow. J Postgrad Med 1997; 43:19-20. [PMID: 10740709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
A rare case of an irreducible post-traumatic lateral dislocation of elbow is presented. The mechanism of injury was fall on a flexed elbow with trauma on its medial aspect resulting in pronation of the forearm. At open reduction, the brachialis muscle was in the form of a tight band which prevented reduction. The ulnar nerve was entrapped in the joint.
Collapse
Affiliation(s)
- M Chhaparwal
- Department of Orthopaedics, King Edward Memorial Hospital, Parel, Mumbai
| | | | | | | | | |
Collapse
|
45
|
D'Souza H, Aroojis A, Yagnik MG, Nagda TV. Rotation fasciocutaneous flap for neglected club feet--a new technique. J Postgrad Med 1996; 42:112-4. [PMID: 9715312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily due to excessive tension on the skin edges and a poor understanding of abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure using a local rotation fasciocutaneous flap using the conventional posteromedial skin incision (Turco). Primary uncomplicated wound healing was achieved within 2 weeks in all 16 rigid and neglected clubfeet (1-7 years) operated by this technique. This flap is scientifically logical, technically easy and ensures primary wound healing.
Collapse
Affiliation(s)
- H D'Souza
- Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, India
| | | | | | | |
Collapse
|