RESUMEN

BACKGROUND: Congenital posteromedial bowing of tibia (CPMBT), a rare anomaly, is characterized by a decreasing deformity and a gradually increasing limb shortening. Lengthening in CPMBT has not been studied extensively. Our series compares the duration and complications of lengthening in younger versus older children to determine early lengthening safety and benefits. METHODS: We studied 28 tibial lengthenings performed by a single surgeon in 23 patients, divided into 2 equal groups of 14 segments: group A 5 years or younger (preschool) and group B above 5 years. All were lengthened with circular external fixators, of which 3 were lengthened over a nail. We measured preoperative (bo) and postoperative (po) sagittal, coronal, and oblique plane deformities, initial limb length discrepancy (LLD), percentage LLD (% LLD), amount of lengthening (AmtL), percentage lengthening (%L), external fixator duration (EFD), and external fixator index (EFI). We graded complications by Lascombes' criteria, results by Association for the Study and Application of the Methods of Ilizarov bone score. RESULTS: The mean age was 8.8±7.1 years; the mean follow-up was 7.9 years. Group A had significantly greater bo-sagittal, coronal, and oblique plane deformities. Mean LLD (3.4 cm in group A vs. 4.1 cm in group B) was similar in both. Expected LLD at maturity (LLDM) using the multiplier method was greater than previously reported (mean, range in group A: 7.2 cm, 4.4 to 9.5 cm; group B: 5 cm, 2.5 to 9.7 cm). Though AmtL (3.5 and 4.1 cm) was similar in both, %L was 24% in group A and 15.7% in group B (P=0.002). EFD (116.6 days) and EFI (33.7 days/cm) were lesser in group A compared with group B (200.3 days, P=0.001; 50.2 days/cm, P=0.01). Lascombes' triple contract was fulfilled in 11/14 lengthenings in group A versus 3/14 in group B. Association for the Study and Application of the Methods of Ilizarov bone score was good and excellent in both groups (P=0.44). CONCLUSIONS: In a large series of lengthenings in CPMBT, we found younger children presenting with large deformities and large projected length discrepancies could be safely lengthened with significantly lesser EFD and complications than in older children. LEVEL OF EVIDENCE: Level IV-therapeutic study.

Asunto(s)

Alargamiento Óseo , Tibia , Adolescente , Niño , Preescolar , Fijadores Externos , Humanos , Lactante , Diferencia de Longitud de las Piernas/etiología , Diferencia de Longitud de las Piernas/cirugía , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/cirugía , Resultado del Tratamiento

RESUMEN

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.

RESUMEN

INTRODUCTION: Flexible flatfoot refers to the loss of the medial longitudinal arch of the foot on weight bearing and is associated with excessive heel eversion or forefoot abduction. Unless symptomatic, flexible flatfeet are best managed non-operatively. The calcaneo-cuboid-cuneiform osteotomy is a procedure that restores the anatomical shape of the foot without arthrodesis of the joints. Our study aims to evaluate the functional and radiological outcomes of patients treated with calcaneo-cuboid-cuneiform osteotomy in patients with planovalgus feet. METHODOLOGY: A retrospective review of records and radiographs of patients with symptomatic flexible planovalgus feet, who were operated with the calcaneo-cuboid-cuneiform osteotomy by a single senior surgeon in a time period between April 2016 and July 2017 was done. The clinical and radiological outcomes were evaluated in 12 feet in 8 children. RESULTS: A total of 12 feet in 8 children were operated (6 males and 2 females). Average age of patients was 11 ± 1.27 years; average follow up was 14.7 months ± 2.7 months. Two patients had planovalgus feet secondary to spastic diplegia and 6 had idiopathic planovalgus feet. There was a statistically significant improvement in the pain score as well as the radiographic parameters in all the operated patients. CONCLUSION: The calcaneo-cuboid-cuneiform osteotomy has potential to give good results for symptomatic planovalgus feet with minimal complications.