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Clement ND, Gaston MS, Simpson AH. Fractures in elderly mice demonstrate delayed ossification of the soft callus: a cellular and radiographic study. Eur J Orthop Surg Traumatol 2023; 33:977-985. [PMID: 35239001 PMCID: PMC10125932 DOI: 10.1007/s00590-022-03235-w] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the cellular age-related changes in fracture repair and relate these to the observed radiographic assessments at differing time points. METHODS Transverse traumatic tibial diaphyseal fractures were created in 12-14 weeks old (young n = 16) and 18 months old (elderly n = 20) in Balb/C wild mice. Fracture calluses were harvested at five time points from 1 to 35 days post fracture for histomorphometry (percent of cartilage and bone), radiographic analysis (total callus volume, callus index, and relative bone mineral content). RESULTS The elderly mice produced an equal amount of cartilage when compared to young mice (p > 0.08). However, by day 21 there was a significantly greater percentage of bone at the fracture site in the young group (mean percentage 50% versus 11%, p < 0.001). It was not until day 35 when the elderly group produced a similar amount of bone compared to the young group at 21 days (50% versus 53%, non-significant (ns)). The callus area and callus index on radiographic assessment was not significantly different between young and elderly groups at any time point. Relative bone mineral content was significantly greater in the young group at 14 days (545.7 versus -120.2, p < 0.001) and 21 days (888.7 versus 451.0, p < 0.001) when compared to the elderly group. It was not until day 35 when the elderly group produced a similar relative bone mineral content as the young group at 21 days (888.7 versus 921.8, ns). CONCLUSIONS Elderly mice demonstrated a delay in endochondral ossification which was associated with a decreased relative bone mineral content at the fracture site and may help assess these cellular changes in a clinical setting.
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Affiliation(s)
- N. D. Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - M. S. Gaston
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - A. H. Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Little France, Edinburgh, EH16 4SA UK
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Abstract
PURPOSE The purpose of this study is to report the number of children from a total population of children with cerebral palsy (CP) in Scotland who had a displaced or dislocated hip at first registration in a national surveillance programme. METHODS Migration percentage (MP), laterality, Gross Motor Function Classification System (GMFCS) level, CP subtype, distribution of CP and age were analyzed in 1171 children. Relative risk was calculated with 95% confidence intervals. Hip displacement and dislocation were defined as a MP of 40 to 99 and > 100 respectively. RESULTS Radiographs were available from the first assessment of 1171 children out of 1933 children registered on the system. In all, 2.5% of children had either one or both hips dislocated (29/1171) and dislocation only occurred in children of GMFCS levels IV and V. A total of 10% of children had a MP 40 to 99 in one or both hips (117/1171). An increasing GMFCS level was strongly associated with an abnormal MP. Hip dislocation was unusual in patients under the age of seven years. A MP of 40 to 99 was not seen in children with isolated dystonia. Displacement was more frequent in children with bilateral involvement and dislocation was only seen in spastic and mixed tone groups. CONCLUSION This data gives an overview of the number of CP children who have hip displacement/dislocation in Scotland and who will possibly require surgery. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | | | - J. E. Robb
- School of Medicine, University of St Andrews, St Andrews, UK, Correspondence should be sent to J. E. Robb, MD FRCS, School of Medicine, University of St Andrews, St Andrews, UK. E-mail:
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Finlayson L, Czuba T, Gaston MS, Hägglund G, Robb JE. The head shaft angle is associated with hip displacement in children at GMFCS levels III-V - a population based study. BMC Musculoskelet Disord 2018; 19:356. [PMID: 30286753 PMCID: PMC6172714 DOI: 10.1186/s12891-018-2275-4] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background An increased Head Shaft Angle (HSA) has been reported as a risk factor for hip displacement in children with cerebral palsy (CP) but opinions differ in the literature. The purpose of this study was to re-evaluate the relationship between HSA and hip displacement in a different population of children with CP. Methods The Cerebral Palsy Integrated Pathway Scotland surveillance programme includes 95% of all children with CP in Scotland. The pelvic radiographs from 640 children in GMFCS levels III-V were chosen. The most displaced hip was analysed and the radiographs used were those taken at the child’s first registration in the database to avoid the potential effects of surveillance on subsequent hip centration. A logistic regression model was used with hip displacement (migration percentage [MP] ≥40%) as outcome and HSA, GMFCS, age and sex as covariates. Results The MP was ≥40% in 118 hips with a mean HSA of 164° (range 121–180°) and < 40% in 522 hips with a mean HSA of 160° (range 111–180°). The logistic regression analysis showed no significant influence of age and sex on MP in this population but a high GMFCS level was strongly associated with hip displacement. An increased HSA was also associated with hip displacement, a 10° difference in HSA for children adjusted for age, sex, and GMFCS gave an odds ratio of 1.26 for hip displacement equal or above 40% (p = 0.009) and hips with HSA above 164.5 degrees had an odds ratio of 1.96 compared with hips with HSA below 164.5 degrees (p = 0.002). Conclusion These findings confirm that HSA is associated with hip displacement in children in GMFCS levels III-V.
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Affiliation(s)
- L Finlayson
- University of Edinburgh, Edinburgh, Scotland
| | - T Czuba
- Epidemiology and Register Center South, Lund, Sweden
| | - M S Gaston
- Department of Orthopaedic Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - G Hägglund
- Lund University Department of Clinical Sciences, Orthopedics, Lund, Sweden.
| | - J E Robb
- School of Medicine, University of St Andrews, St. Andrews, Scotland
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Perry DC, Wright JG, Cooke S, Roposch A, Gaston MS, Nicolaou N, Theologis T. A consensus exercise identifying priorities for research into clinical effectiveness among children's orthopaedic surgeons in the United Kingdom. Bone Joint J 2018; 100-B:680-684. [PMID: 29701090 DOI: 10.1302/0301-620x.100b5.bjj-2018-0051] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 11/05/2022]
Abstract
Aims High-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. Methods A modified Delphi technique was used, which involved an initial scoping survey, a two-round Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. Results A total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). Conclusion This consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials. Cite this article: Bone Joint J 2018;100-B:680-4.
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Affiliation(s)
- D C Perry
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK and University of Oxford, Oxford, UK
| | - J G Wright
- University of Oxford, Botnar Research Centre, Oxford, UK
| | - S Cooke
- University Hospital Coventry and Warwick, Coventry, UK
| | - A Roposch
- UCL GOS Institute of Child Health, University College London, London, UK
| | - M S Gaston
- Royal Hospital for Sick Children, Edinburgh, UK
| | - N Nicolaou
- Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - T Theologis
- University of Oxford, Botnar Research Centre, Oxford, UK
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Robinson LW, Clement ND, Herman J, Gaston MS. The Edinburgh visual gait score - The minimal clinically important difference. Gait Posture 2017; 53:25-28. [PMID: 28073083 DOI: 10.1016/j.gaitpost.2016.12.030] [Citation(s) in RCA: 9] [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: 08/04/2016] [Revised: 11/09/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The primary aim was to define the minimal clinically important difference (MCID) of the Edinburgh Visual Gait Score (EVGS) using correlations with the Gross Motor Function Classification System (GMFCS) and the Functional Assessment Questionnaire (FAQ). The secondary aim was to confirm the numerical value of the MCID in the Gait Profile Score (GPS). METHOD The EVGS and GPS scores for 151 patients with diplegic cerebral palsy (GMFCS Levels I-III) were retrospectively identified from a database held at the study centre. One-hundred and forty-one patients had FAQ data available. RESULTS The EVGS and GPS correlated with increasing GMFCS level (p<0.001) and FAQ score (p<0.001). A gradient of 3.8 (2.9-4.7) for the EVGS and 2.9 (2.1-3.7) for the GPS corresponded to a one-level change in GMFCS level. A gradient of 1.9 (1.3-2.4) for EVGS and 1.5 (1.1-2.0) for GPS corresponded to a one-point change in FAQ. CONCLUSIONS The authors propose an MCID value of 2.4 for the EVGS; representing the improvement in gait score after surgery that is likely to reflect a clinical improvement in function. This MCID is closely related to other studies defining post-operative improvements in kinematic data (GPS) and may offer guidance to post-surgical changes that might reasonably be expected to either improve or prevent deteriorating function.
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Affiliation(s)
- L W Robinson
- University of Edinburgh, Edinburgh, United Kingdom.
| | - N D Clement
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - J Herman
- Anderson Gait Analysis Laboratory, Edinburgh, United Kingdom
| | - M S Gaston
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Tsang STJ, McMorran D, Robinson L, Herman J, Robb JE, Gaston MS. A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy. Gait Posture 2016; 50:23-27. [PMID: 27559938 DOI: 10.1016/j.gaitpost.2016.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 04/28/2016] [Revised: 07/21/2016] [Accepted: 08/12/2016] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the outcome of combined tibialis anterior tendon shortening (TATS) and calf muscle-tendon lengthening (CMTL) in spastic equinus. Prospectively collected data was analysed in 26 patients with hemiplegic (n=13) and diplegic (n=13) cerebral palsy (CP) (GMFCS level I or II, 14 males, 12 females, age range 10-35 years; mean 16.8 years). All patients had pre-operative 3D gait analysis and a further analysis at a mean of 17.1 months (±5.6months) after surgery. None was lost to follow-up. Twenty-eight combined TATS and CMTL were undertaken and 19 patients had additional synchronous multilevel surgery. At follow-up 79% of patients had improved foot positioning at initial contact, whilst 68% reported improved fitting or reduced requirement of orthotic support. Statistically significant improvements were seen in the Movement Analysis Profile for ankle dorsi-/plantarflexion (4.15°, p=0.032), maximum ankle dorsiflexion during swing phase (11.68°, p<0.001), and Edinburgh Visual Gait Score (EVGS) (4.85, p=0.014). Diplegic patients had a greater improvement in the EVGS than hemiplegics (6.27 -vs- 2.21, p=0.024). The originators of combined TATS and CMTL showed that it improved foot positioning during gait. The present study has independently confirmed favourable outcomes in a similar patient population and added additional outcome measures, the EVGS, foot positioning at initial contact, and maximum ankle dorsiflexion during swing phase. Study limitations include short term follow-up in a heterogeneous population and that 19 patients had additional surgery. TATS combined with CMTL is a recommended option for spastic equinus in ambulatory patients with CP.
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Affiliation(s)
- S T J Tsang
- Department of Orthopaedics, Royal Hospital for Sick Children Edinburgh, 9 Sciennes Place, Edinburgh EH9 1LF, United Kingdom.
| | - D McMorran
- University of Edinburgh, College of Medicine and Veterinary Medicine, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, United Kingdom
| | - L Robinson
- University of Edinburgh, College of Medicine and Veterinary Medicine, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, United Kingdom
| | - J Herman
- The Anderson Gait Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2, United Kingdom
| | - J E Robb
- The Anderson Gait Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2, United Kingdom
| | - M S Gaston
- Department of Orthopaedics, Royal Hospital for Sick Children Edinburgh, 9 Sciennes Place, Edinburgh EH9 1LF, United Kingdom; The Anderson Gait Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2, United Kingdom
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McMorran D, Robinson LW, Henderson G, Herman J, Robb JE, Gaston MS. Using a goal attainment scale in the evaluation of outcomes in patients with diplegic cerebral palsy. Gait Posture 2016; 44:168-71. [PMID: 27004652 DOI: 10.1016/j.gaitpost.2015.12.003] [Citation(s) in RCA: 8] [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: 06/16/2015] [Revised: 10/11/2015] [Accepted: 12/02/2015] [Indexed: 02/02/2023]
Abstract
A goal attainment scale (GAS) was used to evaluate outcomes of surgical and non-surgical interventions to improve gait in 45 children with diplegic cerebral palsy. Personal goals were recorded during pre-intervention gait analysis in two groups. Twenty children underwent orthopaedic surgery (Group 1) and 25 children received a non-operative intervention (Group 2). Children and/or their carers were contacted post-intervention by telephone to complete a GAS questionnaire, rating the achievement of goals on a 5-point scale. The goals were similar in both groups. The composite GAS was transformed into a standardised measure (T-score) for each patient. Both groups on average achieved their goals (mean T-score for Group 2 was 56.3, versus 47.1 for Group 1). The difference between these two means was significant (p=0.010). Additionally, 16 children had undergone a follow-up gait analysis during the study period, but the relationship between their Gait Profile Score and GAS was not statistically significant. Both surgical and non-surgical interventions enabled children to achieve their goals, although Group 1 reported higher achievements. The GAS reflects patient's/parent's/carer's aspirations and may be as relevant as post-intervention kinematic or kinetic outcomes.
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Affiliation(s)
- D McMorran
- University of Edinburgh, Edinburgh, United Kingdom
| | - L W Robinson
- University of Edinburgh, Edinburgh, United Kingdom
| | - G Henderson
- Anderson Gait Laboratory, Edinburgh, United Kingdom
| | - J Herman
- Anderson Gait Laboratory, Edinburgh, United Kingdom
| | - J E Robb
- Anderson Gait Laboratory, Edinburgh, United Kingdom
| | - M S Gaston
- Anderson Gait Laboratory, Edinburgh, United Kingdom.
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Abstract
Controversy remains whether the contralateral hip should be fixed in patients presenting with unilateral slipped capital femoral epiphysis (SCFE). This retrospective study compares the outcomes and cost of those patients who had prophylactic fixation with those who did not. Between January 2000 and December 2010 a total of 50 patients underwent unilateral fixation and 36 had prophylactic fixation of the contralateral hip. There were 54 males and 32 females with a mean age of 12.3 years (9 to 16). The rate of a subsequent slip without prophylactic fixation was 46%. The risk of complications was greater, the generic health measures (Short Form-12 physical (p < 0.001) and mental (p = 0.004) summary scores) were worse. Radiographic cam lesions in patients presenting with unilateral SCFE were only seen in patients who did not have prophylactic fixation. Furthermore, prophylactic fixation of the contralateral hip was found to be a cost-effective procedure, with a cost per quality adjusted life year gained of £1431 at the time of last follow-up. Prophylactic fixation of the contralateral hip is a cost-effective operation that limits the morbidity from the complications of a further slip, and the diminished functional outcome associated with unilateral fixation. Cite this article: Bone Joint J 2015;97-B:1428–34.
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Affiliation(s)
- N. D. Clement
- Royal Hospital for Sick Children, 9
Sciences Road, Edinburgh, EH9
1LF, UK
| | - A. Vats
- Royal Hospital for Sick Children, 9
Sciences Road, Edinburgh, EH9
1LF, UK
| | - A. D. Duckworth
- Royal Hospital for Sick Children, 9
Sciences Road, Edinburgh, EH9
1LF, UK
| | - M. S. Gaston
- Royal Hospital for Sick Children, 9
Sciences Road, Edinburgh, EH9
1LF, UK
| | - A. W. Murray
- Royal Hospital for Sick Children, 9
Sciences Road, Edinburgh, EH9
1LF, UK
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Abstract
Paediatric fractures are common and can cause significant morbidity. Socioeconomic deprivation is associated with an increased incidence of fractures in both adults and children, but little is known about the epidemiology of paediatric fractures. In this study we investigated the effect of social deprivation on the epidemiology of paediatric fractures. We compiled a prospective database of all fractures in children aged < 16 years presenting to the study centre. Demographics, type of fracture, mode of injury and postcode were recorded. Socioeconomic status quintiles were assigned for each child using the Scottish Index for Multiple Deprivation (SIMD). We found a correlation between increasing deprivation and the incidence of fractures (r = 1.00, p < 0.001). In the most deprived group the incidence was 2420/100 000/yr, which diminished to 1775/100 000/yr in the least deprived group. The most deprived children were more likely to suffer a fracture as a result of a fall (odds ratio (OR) = 1.5, p < 0.0001), blunt trauma (OR = 1.5, p = 0.026) or a road traffic accident (OR = 2.7, p < 0.0001) than the least deprived. These findings have important implications for public health and preventative measures.
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Affiliation(s)
- R Ramaesh
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - N D Clement
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - L Rennie
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - C Court-Brown
- Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - M S Gaston
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
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Robinson LW, Clement N, Fullarton M, Richardson A, Herman J, Henderson G, Robb JE, Gaston MS. The relationship between the Edinburgh Visual Gait Score, the Gait Profile Score and GMFCS levels I-III. Gait Posture 2015; 41:741-3. [PMID: 25684144 DOI: 10.1016/j.gaitpost.2015.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 09/11/2014] [Revised: 12/27/2014] [Accepted: 01/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between the Edinburgh Visual Gait Score (EVGS) and the Gait Profile Score (GPS). METHOD Three dimensional gait data and EVGS scores from 151 diplegic children (Gross Motor Function Classification System (GMFCS) levels I-III) were used for analysis. RESULTS The EVGS correlated strongly with GPS (r=0.816). There was a significant difference in both gait scores between each level of the GMFCS. CONCLUSIONS The strong correlation of GPS with EVGS implies that any advantages of using GPS can also be applied to centres without 3-dimensional gait analysis facilities if the EVGS is used.
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Affiliation(s)
- L W Robinson
- The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - N Clement
- Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, United Kingdom
| | - M Fullarton
- The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - A Richardson
- The Anderson Gait Analysis Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HL, United Kingdom
| | - J Herman
- The Anderson Gait Analysis Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HL, United Kingdom
| | - G Henderson
- The Anderson Gait Analysis Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HL, United Kingdom
| | - J E Robb
- The Anderson Gait Analysis Laboratory, SMART Centre, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HL, United Kingdom
| | - M S Gaston
- Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, United Kingdom.
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Bachmann M, Rutz E, Brunner R, Gaston MS, Hirschmann MT, Camathias C. Temporary hemiepiphysiodesis of the distal medial femur: MPFL in danger. Arch Orthop Trauma Surg 2014; 134:1059-64. [PMID: 24916364 DOI: 10.1007/s00402-014-2032-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Received: 03/04/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Temporary hemiepiphysiodesis (TH) with plate fixation is a well-accepted and common treatment for correcting leg malalignment in skeletally immature patients. The purpose of this study was to investigate any soft tissue damage caused during TH at the distal medial femur with a plate and two screws. We hypothesized that correct plate placement can affect the integrity of the medial stabilizing structures of the knee, especially the medial patellofemoral ligament (MPFL), the medial collateral ligament (MCL) or result in arthrotomy of the knee joint itself. MATERIALS AND METHODS In eight cadaveric knees of five adult humans a TH was performed with a plate and two cancellous screws at the distal medial femur using a standardized surgical technique. Subsequently the medial capsular and ligamentous structures were systematically exposed and assessed. Capsular and synovial tissue was also inspected for impingement by the plate or screws. RESULTS In all knees the MPFL was present. In two specimens the MPFL was intact and the plate was lying over the dorsal part of the MPFL close to the MCL. The MPFL was completely cut in two cases in the central part of the ligament. In four cases the MPFL was partially dissected or perforated by a screw and fixed to the femur by the plate. The MCL was intact and not impinged by the implant in any case. In total four of eight knees the capsule was transected or perforated by a screw or by a part of the plate, resulting in intraarticular implant placement. CONCLUSIONS Standard plate placement during TH on the distal medial femur frequently leads to damage to the MPFL, impingement of the MPFL, the capsular and synovial tissues or exposure of the knee joint.
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Affiliation(s)
- M Bachmann
- Orthopaedics and Sport Traumatology, Sportclinic Villa Linde, 2503, Biel/Bienne, Switzerland,
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12
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Abstract
Fractures of the lateral condyle of the humerus in children are relatively common and can be easily missed on initial plain radiographs especially in the younger age group. We present a case in which diagnosis of this fracture was delayed for five weeks and therefore presented more challenging surgical management. The salient features that were apparent on the initial radiograph at presentation are discussed as is the use of further imaging techniques that may help to clarify the initial diagnosis. This could significantly reduce the risk of serious complications such as chronic pain, deformity and nerve palsy.
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Affiliation(s)
- M S Gaston
- Department of Orthopaedics, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | - G J Irwin
- Orthopaedic Department, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, UK
| | - J S Huntley
- Orthopaedic Department, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, UK
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13
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Gaston MS, Huntley JS. Book Review: Apley's System of Orthopaedics and Fractures. Scott Med J 2011. [DOI: 10.1258/smj.2011.011127] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M S Gaston
- Paediatric Orthopaedic Surgeon, Edinburgh, UK
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14
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Gaston MS, Rutz E, Dreher T, Brunner R. Transverse plane rotation of the foot and transverse hip and pelvic kinematics in diplegic cerebral palsy. Gait Posture 2011; 34:218-21. [PMID: 21616668 DOI: 10.1016/j.gaitpost.2011.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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] [Received: 10/13/2010] [Revised: 04/25/2011] [Accepted: 05/01/2011] [Indexed: 02/02/2023]
Abstract
External rotation of the foot associated with mid-foot break is a commonly observed gait abnormality in diplegic CP patients. Previous studies have shown a correlation between equinus and internal hip rotation in hemiplegic patients. This study aimed to determine if there was a correlation between the amount of transverse plane rotation in diplegic CP patients using kinematic data from standardised gait analysis. Lower limb data of 134 ambulant children with diplegic CP was analysed retrospectively determining the maximum change in foot, hip and pelvis rotation during loading response. Highly significant negative correlations (P=<0.001) were found between foot and hip movements and foot and pelvic movements. Equinus at initial contact diminished the foot:hip correlation while it enhanced the foot:pelvic correlation. There was less external rotation of the foot in equinus patients (P=0.012) and more external rotation of the pelvis in the equinus group (P=<0.001). This data reveal a correlation between transverse plane rotation at foot level to that at the hip and pelvis. The likely biomechanical explanation is relatively excessive transverse external rotation of the foot due to abnormalities such as mid-foot break. When under load, where the foot is fixed to the floor, internal rotation of the entire leg occurs. This is due to lever arm disease as a result of the relatively shortened foot and inefficiency of the plantar-flexion knee-extension couple. Equinus modulates the effect. When treating such patients, lever arm deformities at all levels must be considered to result in the best outcome and prevent recurrences.
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Affiliation(s)
- M S Gaston
- Royal Hospital for Sick Children, Edinburgh, UK
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Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. ACTA ACUST UNITED AC 2010; 92:1568-73. [PMID: 21037354 DOI: 10.1302/0301-620x.92b11.24893] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively evaluated 18 patients with a mean age of 37.3 years (14 to 72) who had undergone pelvic reconstruction stabilised with a non-vascularised fibular graft after resection of a primary bone tumour. The mean follow-up was 10.14 years (2.4 to 15.7). The mean Musculoskeletal Tumor Society Score was 76.5% (50% to 100%). Primary union was achieved in the majority of reconstructions within a mean of 22.9 weeks (7 to 60.6). The three patients with delayed or nonunion all received additional therapy (chemotherapy/radiation) (p = 0.0162). The complication rate was comparable to that of other techniques described in the literature. Non-vascularised fibular transfer to the pelvis is a simpler, cheaper and quicker procedure than other currently described techniques. It is a biological reconstruction with good results and a relatively low donor site complication rate. However, adjuvant therapy can negatively affect the outcome of such grafts.
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Affiliation(s)
- A H Krieg
- Paediatric Orthopaedic Department, University Children's Hospital (UKBB), P. O. Box, Römergasse 8, 4005 Basel, Switzerland.
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Abstract
Compartment syndrome as a result of simvastatin-induced myositis is extremely rare. This case discusses a patient with spontaneous onset compartment syndrome that necessitated four-compartment fasciotomy. A thorough investigation into its cause highlighted statin-induced myositis as the most likely aetiological agent. When investigating a patient with unexplained spontaneous compartment syndrome it is important to consider drug-induced myositis. This case reinforces the difficulty faced in diagnosing spontaneous compartment syndrome.
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Affiliation(s)
- J L Walker
- Department of Orthopaedics, Edinburgh Royal Infirmary, Little France, Dalkeith Road, Edinburgh EH16 4SU, UK
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Abstract
This paper reviews the current literature concerning the main clinical factors which can impair the healing of fractures and makes recommendations on avoiding or minimising these in order to optimise the outcome for patients. The clinical implications are described.
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Affiliation(s)
- M S Gaston
- Department of Orthopaedics University of Edinburgh, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK.
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Gaston MS, Tiemessen CH, Philips JE. Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs. Arch Orthop Trauma Surg 2007; 127:899-903. [PMID: 17541611 DOI: 10.1007/s00402-007-0363-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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] [Received: 07/13/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine the efficacy and safety of viscosupplementation with synthetic hyaluronic acid to the hip joint and to determine if there was any relation to pre-injection radiographic changes of osteoarthritis (OA). METHODS Three Suplasyn injections were performed each to 15 hips with OA. Standing antero-posterior radiographs of the pelvis were performed prior to injection and scored according to Kelgren and Lawrence grades along with recordings of the minimum joint space width. Harris Hip Scores (HHS) which contain a component for pain, function, activities, absence of deformity and range of motion were recorded pre-injection and at 3 and 6 months. RESULTS We established that at 3 months the HHS is significantly higher (P < 0.05). At 6 months, four hips had been excluded as they has went on to total hip arthroplasty (these hips showed a lower HHS at 3 months). For the remaining hips the HHS was highly significantly increased (P < 0.001). No side effects or complications were observed. Analysis of the pre-injection radiographs showed a trend towards a bigger increase in HHS with less radiographic OA changes. CONCLUSIONS Viscosupplementation performed under fluoroscopic guidance is an effective and safe method of treating hip OA and appears to be more efficacious in those with less radiographic changes of OA.
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Affiliation(s)
- M S Gaston
- University Department of Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK.
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Gaston MS, Amin A, Clayton RA, Hannah H, Brenkel I. Single-stage bilateral cemented total hip replacement: is it safe and effective? Eur J Orthop Surg Traumatol 2006. [DOI: 10.1007/s00590-006-0118-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The aim of our study was to survey management of the axilla by specialist breast surgeons in the United Kingdom (UK). The questionnaire was returned by 371 surgeons, 366 (99%) were consultants and 96% treated more than 50 cases of breast cancer every year. 28% treated patients with invasive breast cancer by axillary clearance (AxCl) alone, 5% used sampling alone (AxNS), 40% used both AxCl and AxNS, 10% AxCl and sentinel lymph node (SLN) biopsy and 17% AxCl, AxNS and SLN biopsy. 9% cleared to level I, and sometimes to level II, 42% to level II and 49% to level III. 56% tried to preserve one or multiple intercostal nerves and 44% routinely divided the intercostalbrachial nerves. 52% performed SNB within trials alone and 36% out side of trials only. A range of techniques were described for the SLN biopsy procedure. There is no consistent practice of managing the axilla in the UK and standardisation is required. SLN biopsy is performed both within and outside of trials and a variety of techniques are used.
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Affiliation(s)
- M S Gaston
- Academic Office, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, Scotland, UK
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Gaston MS. [Vascular emergencies in acute disease of the leg]. Phlebologie 1978; 31:141-3. [PMID: 693587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The author essentially studies the urgent surgical nature of embolism and thrombosis. As far as embolism is concerned, he insists on the importance of arteriography. When done during surgery, it makes it possible to determine the existence of unrecognized embolic clots, which would prevent a good distal reflux from being noted. As for thrombosis, the arterial system (common, superficial and deep) is considered as a whole. This system can be made visible only through arteriography, but it must also be explored by techniques which disclose the hemodynamic conditions of the distal sector.
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