Supracondylar Fractures of the Humerus in Children: Review of Management and Controversies

Upper extremity fractures account for up to 90% of pediatric fractures. Among these fractures Supracondylar Humerus fractures are one of the commonest requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. The epidemiology, classifications, clinical evaluation and complications of this fracture is hereby comprehensively reviewed along with controversies in management and available guidelines

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

The Effect of Neuromuscular Electrical Stimulation on Children with Congenital Talipes Equinovarus Following Treatment with the Ponseti Method.

Congenital Talipes Equinovarus (CTEV) or clubfoot is the commonest congenital orthopaedic condition with an incidence of 1. 5 per 1000 in the UK. The usual treatment for CTEV is the Ponseti method, consisting of serial manipulation and casting followed by immobilisation in a foot brace. Two main factors have an effect on treatment result: deformity relapse due to muscle imbalance, creating the need for surgery, and smaller ankle range of motion (ROM) and calf circumference (CC). This study investigated the practicality of surface neuromuscular electrical stimulation (NMES) as an ‘active’ intervention in infants with CTEV. The primary outcome measure was the potential to reduce relapse measured by the Pirani score and secondary outcome measures were increase ROM and calf circumference. An A1BA2 approach (A-stimulation, B-non-stimulation), six weeks each phase, was used in a study and a control group each with eight feet. At each session evertor muscle activity, Pirani severity score and static measures were assessed. Usage and parent perception was assessed using a questionnaire. The compliance with the stimulation and the brace were monitored by diary cards. A separate study with normally developing feet (n=26) and clubfeet (n=14) was also undertaken to determine the repeatability of the static measures. The repeatability study provided acceptable limits for ankle dorsiflexion knee flexed (ADKF), ankle dorsiflexion knee extended (ADKE) and CC. The results from the stimulation study demonstrated a positive subjective perspective regarding the experience with stimulation. Statistical analysis demonstrated a significant improvement over the study period in ADKF and ADKE in the study group only. The changes were associated with the stimulation phases. Analysing the differences between consecutive measurements demonstrated a significantly different change only in ADKE during the second stimulation phase. In the rest of the outcome measures no significant difference was found between the study and the control group. The results from this study have been encouraging, with two particular cases appearing to be very appropriate for NMES treatment; the non compliant feet and the feet with poor evertor activity. However, further work, e. g. an extended, longitudinal study, is required to determine the role of NMES in the treatment of CTEV

The Effect of Neuromuscular Electrical Stimulation on Children with Congenital Talipes Equinovarus Following Treatment with the Ponseti Method.

Congenital Talipes Equinovarus (CTEV) or clubfoot is the commonest congenital orthopaedic condition with an incidence of 1. 5 per 1000 in the UK. The usual treatment for CTEV is the Ponseti method, consisting of serial manipulation and casting followed by immobilisation in a foot brace. Two main factors have an effect on treatment result: deformity relapse due to muscle imbalance, creating the need for surgery, and smaller ankle range of motion (ROM) and calf circumference (CC). This study investigated the practicality of surface neuromuscular electrical stimulation (NMES) as an ‘active’ intervention in infants with CTEV. The primary outcome measure was the potential to reduce relapse measured by the Pirani score and secondary outcome measures were increase ROM and calf circumference. An A1BA2 approach (A-stimulation, B-non-stimulation), six weeks each phase, was used in a study and a control group each with eight feet. At each session evertor muscle activity, Pirani severity score and static measures were assessed. Usage and parent perception was assessed using a questionnaire. The compliance with the stimulation and the brace were monitored by diary cards. A separate study with normally developing feet (n=26) and clubfeet (n=14) was also undertaken to determine the repeatability of the static measures. The repeatability study provided acceptable limits for ankle dorsiflexion knee flexed (ADKF), ankle dorsiflexion knee extended (ADKE) and CC. The results from the stimulation study demonstrated a positive subjective perspective regarding the experience with stimulation. Statistical analysis demonstrated a significant improvement over the study period in ADKF and ADKE in the study group only. The changes were associated with the stimulation phases. Analysing the differences between consecutive measurements demonstrated a significantly different change only in ADKE during the second stimulation phase. In the rest of the outcome measures no significant difference was found between the study and the control group. The results from this study have been encouraging, with two particular cases appearing to be very appropriate for NMES treatment; the non compliant feet and the feet with poor evertor activity. However, further work, e. g. an extended, longitudinal study, is required to determine the role of NMES in the treatment of CTEV

Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling.

BACKGROUND: Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear. QUESTIONS/PURPOSES: Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling. METHODS: We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1-19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden. RESULTS: The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°-18°) and 10° for hips without osteonecrosis (95% CI, 7°-13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°-19.7°) for hips with osteonecrosis and 12.4° (10.3°-14.4°) for hips without osteonecrosis. CONCLUSIONS: Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence

The Impact of Living with Clubfoot on Children and Their Families: Perspectives from Two Cultural Environments

Purpose: To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods: A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations—the United Kingdom (UK) and India. Children were divided into age groups of 5–7 and 8–11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an ‘emoji’ system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results: Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents’ responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion: Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes

The outcomes of idiopathic congenital talipes equinovarus : a core outcome set for research and treatment.

AimsTo identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV).MethodsA list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected from patients and families through a questionnaire and interview process. The combined list, as well as the appropriate follow-up timepoint, was rated for importance in a two-round Delphi process that included an international group of orthopaedic surgeons, physiotherapists, nurse practitioners, patients, and families. Outcomes that reached no consensus during the Delphi process were further discussed and scored for inclusion/exclusion in a final consensus meeting involving international stakeholder representatives of practitioners, families, and patient charities.ResultsIn total, 39 OMTs were included from the systematic review. Two additional OMTs were identified from the interviews and questionnaires, and four were added after round one Delphi. Overall, 22 OMTs reached 'consensus in' during the Delphi and two reached 'consensus out'; 21 OMTs reached 'no consensus' and were included in the final consensus meeting. In all, 21 participants attended the consensus meeting, including a wide diversity of clubfoot practitioners, parent/patient representative, and an independent chair. A total of 21 outcomes were discussed and voted upon; six were voted 'in' and 15 were voted 'out'. The final COS document includes nine OMTs and two existing outcome scores with a total of 31 outcome parameters to be collected after a minimum follow-up of five years. It incorporates static and dynamic clinical findings, patient-reported outcome measures, and a definition of CTEV relapse.ConclusionWe have defined a minimum set of outcomes to draw comparisons between centres and studies in the treatment of CTEV. With the use of these outcomes, we hope to allow more meaningful research and a better clinical management of CTEV. Cite this article: Bone Jt Open 2022;3(1):98-106