RESUMEN
PURPOSE: Arthrogryposis multiplex congenita (AMC) consists of more than 400 conditions involving severe joint contractures of at least two or more body regions. Management of clubfoot in patients with AMC is notoriously challenging, with a higher likelihood of recurrence than idiopathic clubfoot, which can be treated using the Ponseti technique to avoid or delay more invasive procedures. The purpose of this study is to determine the utility of multiple serial casting as a treatment of clubfoot in AMC using Pirani scores as an objective measure of deformity. METHODS: Pirani scores were retrospectively collected from 17 AMC patients with a total of 30 clubfeet and two years follow-up from initiation of treatment. Patients with a minimum of three casting series were included. Pre-treatment and post-treatment deformity scores were examined across casting series using analysis of variance (ANOVA) statistical analysis. RESULTS: The first series pre-treatment Pirani score improved from 4.80±1.54 to 1.68±1.48 (p<0.001). The second series improved from 4.23±1.03 to 2.72±0.916 (p<0.001). The third series had the smallest improvement from 3.87±1.07 to 2.82±1.02 (p<0.001). Change in Pirani scores showed a significant decrease from the first series to the second (p=0.001) and third (p<0.001). In addition, the number of casting days was found to significantly affect the change in scores during the third series (p=0.038). CONCLUSIONS: The Ponseti technique can improve clubfoot in AMC as measured by the Pirani score. Data shows that early intervention yields better results, with a diminished yet effective ability to elicit change over time.
RESUMEN
Objectives: Epidemiology of patellar instability is not fully characterized, as some studies have produced conflicting information or been drawn from limited populations. In this study, we used the Pediatric Health Information System (PHIS) database to examine trends in admissions for patellar instability throughout the United States. We hypothesized that there would be an increasing rate of patellar instability admissions in recent years. Secondarily, we examined how demographic factors and insurance status relate to admissions for patellar instability.Methods: This study queried the Pediatric Health Information System (PHIS). Patients with ICD 9 & 10 codes 8363, 8364, 71,785, M221.0, S83.001, S83.002, S83.003, S83.004, S83.005, and S83.006, were abstracted from PHIS. We included all patients admitted with patellofemoral dislocations that were reported in the PHIS database between 1 January 2004 and 30 April 2017. The rate of patellar instability admissions was examined as well as demographic factors and insurance status.Results: An estimated total of 25,413 admissions for patellar instability were identified by the search of the PHIS database; 15,444 (60.8%) were female patients and 9,966 (39.2%) were male. The adjusted number of admissions per reporting hospital significantly increased over the years studied (r = 0.775, p < 0.001), from 14.5 admissions per reporting hospital in 2004 to 86.0 admissions per reporting hospital in 2016. Of all patellar instability admissions, 55.0% were white, 20.4% were black, 1.7% were Asian, and 22.9% were unknown race. A larger number of admissions occurred in patients with insurance status other than Medicaid in every year data were collected.Conclusions: Based on a PHIS database search, pediatric hospital admissions for patellar instability are steadily increasing. The majority of patients admitted for patellar instability are female, white, and have insurance other than Medicaid. Males admitted for patellar instability tended to be older than females admitted for the same.Level of evidence: II.