Bilateral Congenital Dislocation of the Knee with Ipsilateral Developmental Dysplasia of the Hip – Report of Three Patients

Congenital dislocation of the knee (CDK) is a very rare condition. Here we report our strategy and results in treatment of three children with CDK. All three patients were treated with conservative method, and only one had underwent a surgical procedure on one knee. Of the remaining, we recorded a good outcome with conservative treatment in three knees, while two had poorer outcome as a result of musculoskeletal anomalies. We also present here a unique case of a child born without cruciate ligaments and patellas on both sides. We performed the operative procedure by Z-plasty of the extensor apparatus on one left knee according to Niebauer and King on one child. The clinical result of this procedure was very good. Five years after the operation we decided to perform an MRI examination to assess the postoperative status of the operated knee, especially the position and the shape of left patella. We found the asymmetry and high position of the operated patella resulting in patella alta. Compared to the initial clinical presentation, we consider all patients to have good clinical presentation nowdays

Biomechanics of foetal movement.

© 2015, AO Research Institute. All rights reserved.Foetal movements commence at seven weeks of gestation, with the foetal movement repertoire including twitches, whole body movements, stretches, isolated limb movements, breathing movements, head and neck movements, jaw movements (including yawning, sucking and swallowing) and hiccups by ten weeks of gestational age. There are two key biomechanical aspects to gross foetal movements; the first being that the foetus moves in a dynamically changing constrained physical environment in which the freedom to move becomes increasingly restricted with increasing foetal size and decreasing amniotic fluid. Therefore, the mechanical environment experienced by the foetus affects its ability to move freely. Secondly, the mechanical forces induced by foetal movements are crucial for normal skeletal development, as evidenced by a number of conditions and syndromes for which reduced or abnormal foetal movements are implicated, such as developmental dysplasia of the hip, arthrogryposis and foetal akinesia deformation sequence. This review examines both the biomechanical effects of the physical environment on foetal movements through discussion of intrauterine factors, such as space, foetal positioning and volume of amniotic fluid, and the biomechanical role of gross foetal movements in human skeletal development through investigation of the effects of abnormal movement on the bones and joints. This review also highlights computational simulations of foetal movements that attempt to determine the mechanical forces acting on the foetus as it moves. Finally, avenues for future research into foetal movement biomechanics are highlighted, which have potential impact for a diverse range of fields including foetal medicine, musculoskeletal disorders and tissue engineering

Update on pediatric hip imaging

Hip disorders are common in children. Prompt diagnosis and treatment are important because of the potential complications. Symptoms are frequently nonspecific, and clinical examination can be difficult and unreliable, especially in smaller children. Therefore, imaging can be valuable. Radiography and ultrasound remain the initial imaging modalities of choice. Increasingly, magnetic resonance imaging is obtained for assessing the pediatric hip, although the long imaging time and need for sedation may limit its use in daily practice. Because of the exposure to ionizing radiation, the use of computed tomography and bone scintigraphy in children is limited to selected cases. Pediatric hip pathology varies depending on patient age. This article provides an overview of common hip pathologies in children including congenital and developmental pathologies, trauma, infectious processes, inflammatory disease, and neoplasm. The age of the child, history, and clinical examination are essential to narrow down the differential diagnosis and subsequent selection of the appropriate imaging modality

Not Judging by Appearances: The Role of Genotype in Jewish Law on Intersex Conditions

Jewish communities have always had children with intersex conditions, which involve atypical anatomic, chromosomal, or gonadal sex. In the last several decades, Orthodox rabbis have issued ad hoc rulings to assign sex to children and adults with intersex conditions. However, rabbinic texts reflect disunity over whether to assign gender, for the purposes of Jewish law, according to outward appearance or chromosomal makeup. This rabbinic controversy has been exacerbated by an increasingly complicated medical picture. Endocrinologists have diagnosed more than two dozen intersex conditions, across nine overarching congenital types. Such complexity makes it difficult for rabbis to make across-the-board decisions about gender assignment. This essay examines how rabbinic law may change because gender cannot be assigned consistently by chromosomal sex—despite the prevalence of this formulaic criterion in rabbinic opinions. Consequently, Jewish legal reasoning is poised to shift from a static reliance on chromosomal sex. The essay also considers the implications of this trajectory on Jewish law towards sex change surgery and transsexuals

Hypermobile Ehlers-Danlos Syndrome during Pregnancy, Birth and Beyond: A Review of Midwifery Care Considerations

The Ehlers-Danlos Syndromes (EDS) are an underdiagnosed group of conditions with implications and risks associated with childbearing. Those with EDS suggest that healthcare professionals have a lack of awareness in this area, and consequently describe delays in access to appropriate healthcare services. This paper draws on the existing international evidence available to present evidence-based care considerations for childbearing women with hypermobile Ehlers-Danlos Syndrome (hEDS) throughout the antenatal, intrapartum and postnatal periods. Care considerations are also offered in relation to the care of the newborn infant. The management of hEDS in childbearing women and babies can be complex. Findings point to the need for a multidisciplinary approach to formulating individualised care plans in partnership with women. In understanding the evidence in relation to this issue, midwives will be better able to practice evidence-based and woman-centred care