China
Africa
Explore chapters and articles related to this topic
Evaluation of Pediatric Limb Deformities
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The frontal plane alignment of the lower limb changes from physiological varus at birth to a neutral position by 18–24 months. Thereafter, the limb is in a valgus alignment, and peak values of 8–10° are attained by 3–4 years of age. Valgus alignment decreases thereafter, and adult values are attained around 7 years of age. Hence, it is important to know these changes in order to differentiate pathological deformities from physiological variation. Varus after 2 years of age, severe varus (>20°) in children below 2 years of age, varus in children with short stature (<3rd percentile), and suspicion of a metabolic or genetic disorder necessitate further workup. Also, an increase in valgus after 7 years of age should be considered pathological and investigated accordingly. The reader must note that physiological varus results from smooth bowing that involves the entire proximal, midshaft, and distal parts of the femur and tibia. Focal angular deformity involving the proximal tibia should raise the suspicion of Blount’s disease.
Paediatric and adolescent foot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
The use of arthroereisis has yet to be accepted widely in the paediatric orthopaedic community, due to poor experiences with the early implants and the lack of criteria for case selection. The basic concept is to reduce heel valgus by blocking excessive eversion at the subtalar joint (73). Those implants, which extend into the tarsal canal, may play a role in reducing plantarflexion of the talus. Some surgeons believe that it may also improve proprioception (74) (Figure 5.9).
Genetics
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Peter Calder, Harish Hosalkar, Aresh Hashemi-Nejad
The hips maintain a persistent flexion contracture. The proximal femoral epiphyses progressively deform and may subluxate. Epiphyseal flattening and hinge abduction develop in many patients. Arthritic changes develop by early to middle adulthood. The knees usually have flexion contractures. Excessive valgus is also common. One-fourth of patients have a dislocated patella. Although patients with diastrophic dysplasia are described as having clubfoot, many foot complications exist in these patients. The great toe may be in additional varus, beyond the degree commonly occurring in idiopathic clubfoot. The great toe in varus is analogous to the Z-shaped deformity of the thumb. These foot complications cause stiffness, bony malformations and contracture, and are as difficult to correct as clubfoot. Approximately 8% of patients die in infancy from respiratory causes or during childhood from cervical myelopathy.
Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Yahui Dai, Ming Ni, Bang Dou, Zhiyuan Wang, Yushan Zhang, Xueliang Cui, Wenqian Ma, Tao Qin, Xiaobin Xu, Jiong Mei
In this study, the main valgus angle was 18° and the average posterior tilt angle was 19°, similar to previous reports (Leonhardt et al. 2017; Hoelsbrekken and Dolatowski 2017; Sjoholm et al. 2019) and close to the limitation of acceptable reduction (Garden 1971). A preoperative posterior tilt ≥20° or anterior tilt >10° increases the risk of fixation failure; (Dolatowski et al. 2016; Sjoholm et al. 2019) therefore, some doctors consider a neck-shaft angle between 130° and 150° and 0–15° of anteversion as acceptable reduction for displaced femoral neck fractures (Weinrobe et al. 1998; Chua et al. 1998). Mild valgus (<15°) is tolerable but varus angulation and posterior tilt are not as they increase the probability of complications (Garden 1971; Weinrobe et al. 1998; Krischak et al. 2003). A more stringent standard for reduction has been proposed as valgus angulation >5° following reduction is thought to significantly affect long-term prognosis, the incidence of severe hip osteoarthritis at the 10-year follow-up was 55.6%, which was 2 times higher than that in cases of valgus angulation <5° (21.2%) (Fuchtmeier et al. 2001). However, it is reported that for Garden I and II femoral neck fractures, good reduction doesn’t reduce the failure rate of surgery, and the reoperation rate is related only to preoperative valgus angulation (Palm et al. 2009). But another study showed that preoperative posterior tilt measurements on lateral radiographs could not be used to detect healing complications in these fractures (Lapidus et al. 2013).
An evaluation of the use of a lateral wedged insole and a valgus knee brace in combination in subjects with medial compartment knee osteoarthritis (OA)
Published in Assistive Technology, 2021
Mobina Khosravi, Mokhtar Arazpour, Arash Sharafat Vaziri
The valgus brace is an orthotic device to provide medial compartment pain relief by reducing the load on the medial compartment through the application of an opposing external valgus moment around the knee joint. Use of this device has reportedly resulted in improvements to function, pain levels and the knee adduction moment (KAM) (Hewett, Noyes, Barber-Westin, & Hedcmann, 1998; Ohnishi et al., 2013; Pagani, Böhle, Potthast, & Brüggemann, 2010; Pollo & Jackson, 2006; Pollo, Otis, Backus, Warren, & Wickiewicz, 2002; Ramsey & Russell, 2009), thereby increasing levels of ambulation in the affected individual (Richards, Sanchez-Ballester, Jones, Darke, & Livingstone, 2005). One study reported that the use of a VB reduced the KAM immediately by 22% and following this, 5 weeks thereafter a further 8 percent reduction in the KAM was reported (Laroche et al., 2014).
Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures
Published in Acta Orthopaedica, 2020
Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen
This is a comparative study of 81 consecutive children prospectively collected who had sustained a > 2 mm displaced medial epicondyle fracture treated by surgeon’s preference either by immobilization or by ORIF with a high follow-up rate, 81/83. Treatment was not randomized, which may cause a bias. Mean age of patients in the nonoperative group was lower than in the ORIF group. We do not have an obvious explanation for this discrepancy, but in general younger children less often require operative treatment in pediatric orthopedic trauma, which may have had an effect on selecting treatment modality. CTs had not been taken routinely and the exact fracture displacement could not therefore be measured. Regardless of treatment some patients remain symptomatic under valgus stress. This raises the question as to whether our treatment decisions are based on the right parameters, e.g., displacement of the fracture fragment vs. medial collateral ligament injury. In light of the shortcomings of this study we have been granted ethical review board permission to start a randomized control trial conducted as a non-inferiority trial.