Patellar instability can significantly influence the locomotor function in children with Down's syndrome. The aim of this study was to evaluate the mid-term results of the operative treatment of patellar instability in children with Down's syndrome. The study included eight children (10 operated knees) with Down's syndrome and associated patellar instability. The children's age ranged from 6 to 11 years (the mean age was 7 years 9 months). The operative treatment involved Green's quadricepsplasty in six cases (eight knees) and Green's quadricepsplasty augmented with a modified Galeazzi procedure - semitendinosus tenodesis - in two cases. The mean follow-up period was 3 years and 3 months. We achieved a stabilization of the patellofemoral joint and a correction of the position of the patella in seven knees (five of these were treated with Green's procedure and in two cases Green quadricepsplasty was combined with the Galeazzi procedure). We did not observe any recurrence of patellar dislocation in this group during the follow-up period. We noted two failures, defined as a recurrence of dislocation, during the mean of 9 months postoperatively. Green's quadricepsplasty provides satisfactory results in younger children with Down's syndrome. In older children, we recommend the modified Galeazzi procedure.
For children with DDH, the abduction brace is a safe and effective method of treatment and, although the infants begin to walk about 3 weeks later compared to healthy children, this practice does not seriously affect the child's locomotor development.
The aim of the study was to evaluate the relation between the activity of collagenase in the subchondral bone of the femoral head and the age of patients with hip osteoarthritis. Thirty-two patients were enrolled into the study. The mean age was 66 (range from 37 to 80 years). Bone samples of the femoral head were harvested during total hip replacement. The activity of collagenase was measured through spectrofluorimetry. We found statistically a significant correlation between collagenase activity in the bone and age. The mean activity of collagenase in younger patients (37-68 years) was 64.17 IU/microg. In older patients (69-80 years), the mean collagenase activity was 52.26 IU/microg. In patients with hip osteoarthritis the activity of collagenase in the subchondral bone of the femoral head tended to decrease with an increase in age.
In the XML version of the online publication the family name of the second author was incorrectly given as Pczek. In fact, the correct family name is Pączek.
<p class="abstract"><strong>Background:</strong> Septic arthritis in paediatric age group poses a significant clinical problem. Common sites are hip and knee joint. There are several orthopaedic literatures available on septic arthritis of the hip and knee joint, however, literature on epidemiology, causative organisms and outcome of septic arthritis of the ankle are very few.</p><p class="abstract"><strong>Methods:</strong> We conducted a retrospective study at a tertiary hospital with an aim to evaluate the incidence, causative pathogen, outcome and to identify differences, if any, between clinical features and laboratory findings of these patients when compared to those with hip and knee joint infection.<strong></strong></p><p class="abstract"><strong>Results:</strong> 47 children were diagnosed with septic arthritis, of which, 14 had septic arthritis of the ankle. Mean age was 5.2 years (8 months - 12 years). 13 children had undergone joint aspiration as a primary procedure. 50% (7) children had positive culture. <em>Streptococcus pyogenes</em> was the commonest causative organism in our cohort (29%) followed by <em>Staphylococcus aureus</em>. Mean follow-up was 36 months (16 - 56 months). 13 children (93%) had good clinical outcome. 1 child developed early arthritis.</p><p class="abstract"><strong>Conclusions:</strong> Septic arthritis of the ankle is a serious condition. Even-though the joint is superficial, diagnosing it clinically can be difficult due to less pronounced symptoms. This can lead to delay in establishing the diagnosis and commencing treatment, hence, it is imperative to have a high index of suspicion. We found early joint aspiration followed by a course of antibiotics to be an effective regimen in management of this devastating condition.</p>
Introduction Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability require surgical treatment. A rarer cause of developing ankle instability is injury to the ligament complex in the presence of os subfibulare, an accessory bone inferior to the lateral malleolus. The aim of this study was to assess the results of operative management of chronic ankle instability in children with os subfibulare. Materials and methods 16 children with os subfibulare and chronic ankle instability who failed non-operative treatment were enrolled prospectively into the study. One child was lost to follow-up and excluded from analysis. The mean age at the time of the surgery was 14 years and 2 months (range 9.5–17 years). The mean follow-up time was 43.2 months (range 28–48 months). Surgical treatment in all cases involved removal of os subfibulare and a modified Broström-Gould lateral complex reconstruction with anchors. Ankle status was assessed before and after surgery with The 100 mm Visual Analogue Scale and Foot and Ankle Outcome Score questionnaire. Results The mean Foot and Ankle Outcome Score improved from 66.8 to 92.3 (p < 0.001). Pain level improved from 67.1 preoperatively to 12.7 (p < 0.001). All children reported improvement in their ankle stability. There was one case of scar hypersensitivity that improved during observation and one superficial wound infection that resolved with oral antibiotics. One child reported intermittent pain without symptoms of instability following another injury. Conclusions Ankle joint sprain with associated injury to os subfibulare complex can lead to chronic instability in children. If conservative management fails, then surgical treatment with modified Broström-Gould technique and excision of accessory bone is a safe and reliable method.
Air travel in a cast with a fracture is associated with an increased risk of leg swelling in a tight compartment. We have hypothesised that there should be an accessible, universal policy for travel recommendations with the cast supported by high-quality literature. We have checked the 20 biggest airlines looking for their guidance on travel recommendation /restrictions in the presence of a broken leg in a cast, particularly in children. We have also carried out a literature review in the last 30 years to ascertain whether there is the best evidence relating to flying safely with a child in a cast. Nine airlines have an accessible policy on flying in a cast. Most airlines recommend to delay the flight 24–48 h after cast application. Four airlines require splitting the cast if applied 48 h before the flight. None of the airlines have specific recommendations related to children. A comprehensive review of the literature revealed 11 relevant articles. None of those studies were experimental studies on flying with a fracture, only one assessed flying in a cast. We did not find a research study focused specifically on children. The recommendation regarding flying restrictions varies among airlines and often there is no coherent policy available. The existing recommendations cannot be fully supported by experimental studies in the existing literature. Flying in a full cast should be delayed until 24–48 h after cast application. If the flight is an emergency, the cast should be bivalved.
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