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   Table of Contents - Current issue
Coverpage
January-June 2017
Volume 3 | Issue 1
Page Nos. 1-40

Online since Friday, February 17, 2017

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EDITORIAL  

Paediatric orthopaedics and global initiative for children's surgery p. 1
Vrisha Madhuri
DOI:10.4103/pors.pors_1_17  
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REVIEW ARTICLE Top

Paediatric orthopaedics anaesthesia for surgeons p. 3
Serina Ruth Salins
DOI:10.4103/2249-9008.200289  
Paediatric anaesthesia is a well-established subspecialty, which has allowed surgery to be safer, as the science advances in both the specialties. It is imperative for both surgeons and anesthesiologist to be aware of all the implications in children, especially syndromic, coming for surgery. This article gives a comprehensive overview of anaesthesia for orthopaedic surgery.
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ORIGINAL ARTICLES Top

Comparison of two different medial reference points for measurements of the acetabular index p. 7
Sandeep Vijayan, Dhiren Ganjwala, Hitesh Shah
DOI:10.4103/2249-9008.200291  
Introduction: Acetabular index (AI) is a commonly used quantitative measurement of acetabular inclination in plain radiographs. Repeated measurements of this index are used to determine dysplasia in children and for decision making about surgical management. Persistent acetabular dysplasia may be an indication for performing an acetabuloplasty. AI is commonly measured between the Hilgenreiner’s line (line that connects both triradiate cartilages) and the line joining lateral most ossified margin of the acetabulum and triradiate cartilage. Two different methods for measurement of AI with two different medial reference points at the triradiate cartilage have appeared in the literature. Aim: The specific aim of the study was to investigate the difference between AI measurements with two different methods and report on intraobserver and interobserver reliability of both the methods. Materials and Methods: Ninety-eight children with developmental dysplasia of the hip (DDH) (treated and untreated), younger than 9 years, were included in the study. Anteroposterior radiographs of the pelvis having acceptable pelvic rotation and pelvic tilt were included in the study. AI was measured using two different reference points for the affected and normal sides. AI was measured twice at 1-month interval by two investigators. The difference between the two measurement techniques was compared by the paired “t” test. Pearson’s correlation coefficient was calculated to test associations between the two measurement techniques. Results: The reproducibility of measurements of both the techniques was found satisfactory [intraclass correlation (ICC)-0.90 and 0.87]. Statistically significant difference (P value < 0.001) (5.7° for affected and 5.3° for normal side) between the indices measured by two techniques was noted. This difference was noted for all age groups. Significant positive correlations between both the techniques were noted in normal as well as dysplastic hips. Conclusion: Acetabular indices measured with two different medial points gave significantly different values. All subsequent assessment should be consistently carried out by the same method.
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Step-cut translation osteotomy and Y-plate fixation: A novel method for correction of cubitus varus and valgus deformity p. 12
Kumar Shashi Kant, Vikas Gupta
DOI:10.4103/2249-9008.200294  
Introduction: Many types of osteotomy have been proposed for the treatment of cubitus varus and valgus deformity. All these osteotomies have their advantages and disadvantages; however, till date there is no uniform consensus as to which osteotomy is the best suited for correction of these deformities. Materials and Methods: We reviewed the results of step-cut translation osteotomy in the management of cubitus varus and cubitus valgus deformity. This study includes 27 cases of cubitus varus and five cases of cubitus valgus deformity that underwent supracondylar step-cut translation osteotomy with Y-plate fixation for correction of the deformity. Results: The results were evaluated according to the modified criteria of Oppenheim et al. There were 25 excellent, six good, and one poor result. Overall, complication rate in our series was 12.5% (4/32). There was no recurrence of deformity in the available follow-up. Conclusions: Step-cut translation osteotomy is a relatively simple procedure that corrects cubitus varus and valgus deformities without any prominence of the medial or lateral condyle. Moreover, a wide osteotomy surface and rigid fixation allows early mobilization of the joint with good clinical results.
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Isolation, in-vitro expansion, and characterization of human muscle satellite cells from the rectus abdominis muscle p. 16
David Livingstone, Albert A Kota, Sanjay K Chilbule, Karthikeyan Rajagopal, Sukria Nayak, Vrisha Madhuri
DOI:10.4103/2249-9008.200295  
Introduction: Satellite cells are a resident population of stem cells beneath the basal lamina of mature skeletal muscle fibers. Their capacity to regenerate muscle makes them a potentially ideal source for human cell therapy with respect to muscle-related diseases such as urinary and fecal incontinence, and others. In this study, we describe a protocol to isolate, expand in-vitro, and characterize human muscle satellite cells from the rectus abdominis muscle. Materials and Methods: Muscle biopsies from human donors were harvested, digested using collagenase type II, and then plated on extracellular matrix-coated plates. Results: Immunocytochemistry revealed that satellite cells on day 8 were 70–80% Pax7 positive; in contrast, cells expanded until day 12 showed 50–75% positivity for Pax7. The real-time polymerase chain reaction for day 8 culture indicated four-fold increase in Pax3 and Pax7 gene expression, four-fold increase in MyoD gene expression, and five-fold increase in Myf5 gene expression. Conclusion: These findings suggest that satellite cells can be cultured until day 8 for translational purposes. The protocol described here is modest, operational, and reproducible and involves only basic cell culture equipment.
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Treatment of unstable hips in children with Ilizarov hip reconstruction: A retrospective analysis of six cases p. 23
Bipin Ghanghurde, Mandar Agashe, Tarush Rustagi, Chasanal Rathod, Rujuta Mehta, Dominic D'Silva, Alaric Aroojis
DOI:10.4103/2249-9008.200296  
Introduction: Hip instability in older children and adolescents is mainly because of the loss of bone in the proximal femur or conditions that cause loss of the fulcrum. These may be related to infantile septic hip sequelae or neglected developmental dysplasia of the hip. Materials and Methods: We retrospectively analyzed six patients with hip instability treated by Ilizarov hip reconstruction from 2004 to 2007 at our institute. The mean age of the patients was 10 years (range 7–14 years). Results: The etiology was septic hip sequelae (Choi type IV) in four patients and neglected developmental dysplasia of hip in two patients. The fixator was kept for an average of 7 months (range 6–8 months). The average follow-up was 3 years. The visual analog score for pain improved from a preoperative mean of 8 to 2 postoperatively. The gait improved in all the patients and the leg length discrepancy improved from a preoperative mean of 5 to 1 cm postoperatively. All the limbs were aligned to a satisfactory level with the mean mechanical axis deviation of 3 mm (laterally) and pelvic mechanical axis of 90°. The Harris hip score improved from 41 preoperatively to 84 postoperatively (P < 0.0001). Conclusion: Ilizarov Hip Reconstruction is an excellent salvage procedure for adolescent patients with unstable hips, giving good results in the short-term.
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Safety, efficacy, and functional outcome of elastic stable intramedullary nailing in unstable fractures of both bones of forearm in children p. 29
Deeptiman James, Vrisha Madhuri
DOI:10.4103/2249-9008.200293  
Aims: To determine the clinical profile and clinical, functional, and radiological outcomes and complications in children who underwent elastic stable intramedullary nailing (ESIN) for unstable fractures of both bones of forearm. Materials and Methods: A retrospective observational study was conducted in the Paediatric Orthopaedic Unit of the institution. Children with forearm fractures, who underwent ESIN of both the bones with titanium nails from January 2004 to June 2010, were included in the study. Clinical evaluation for deformity, range of motion at wrist and elbow, Daruwalla’s grading for forearm fractures, and radiological evaluation for bony union, malalignment, and radial bow were done. Paediatric Outcomes Data Collection Instrument (PODCI) questionnaire was used to assess functional outcome. Results: Twenty-six patients were followed up for a mean of 2.14 years. These included one primary internal fixation for unstable injury in a 15-year old, 10 open fractures, and 15 with malalignment after closed reduction. Age ranged from 5 to 15 years (mean of 11.39). Average time to bony union was 6 weeks. Twelve children had excellent, 12 good, and two fair outcomes according to Daruwalla’s grade. Average PODCI score was 50.78 (standardized range is minimum of −140 to maximum of 53). There were no major complications related to ESIN. Three patients had paraesthesia over superficial radial nerve distribution, three patients had hypertrophied scars, and one patient had superficial wound infection. One child had distal radial physeal arrest following inadvertent physeal injury during implant removal. Conclusion: ESIN is safe and effective for internal fixation of unstable forearm fractures.
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Grievous injuries in children due to tractor-related accidents p. 34
Kala Ebenezer, Rimi Manners, Sampath Karl, Vrisha Madhuri
DOI:10.4103/2249-9008.200292  
Introduction: Tractor-related accidents are common among the agricultural injuries. Children are prone to such incidents as farmers live in the vicinity of the farmland. Materials and Methods: From the Paediatric Intensive Care unit (PICU) database we extracted the details of children with unintentional injuries and poisonings during the period January 2008 to June 2009. Those with tractor-related injuries were further analyzed using outpatient and inpatient charts, computerized hospital records were accessed to obtain laboratory and radiological investigations details. The clinical characteristics, injuries, and outcome of these children are presented. Results: In the 18 months period, there were 107 children with trauma, envenomations and poisoning constituting 6.5% of all PICU admissions. Of the 31 (29%) with polytrauma, four (12.9%) children, three of them boys had sustained tractor-related injuries. The injuries included three with multiple limb fractures, two each of head, chest, musculoskeletal and perineal injury and one each of abdominal and major vascular injury. All had reached the hospital in life-threatening shock and were resuscitated. Multidisciplinary surgical intervention including craniectomy, liver resection and femoral vessels anastomosis were required along with blood transfusions, ventilatory support and inotropes. Three of them survived the injuries after a mean PICU stay of 34 days. Conclusion: Tractor-related incidents among rural children are associated with major injuries and fatalities in children. The findings call for interventions to prevent such injuries and education of the farming community involved with tractors and other agricultural machineries.
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CASE REPORT Top

Common peroneal nerve entrapment during closed reduction and percutaneous pinning of paediatric distal femur fracture: Surgeons be aware! p. 38
Kiran Sasi, Binu P Thomas
DOI:10.4103/2249-9008.200290  
Distal femoral metaphyseal fracture is a common injury faced by paediatric orthopaedic surgeons. This injury is usually managed with closed reduction and percutaneous Kirschner wire fixation. We present an unusual case wherein the common peroneal nerve was completely severed and entrapped in the fracture site following closed reduction and percutaneous Kirschner wire fixation of a distal femoral metaphyseal fracture.
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