Deformity In Children Research Articles

Ear Deformities in Children

Ear deformities occur in 5–50% of newborns [1, 2]. Usually ear deformities minimally affect hearing, however, they can lead to psychological disorders, anxiety, social isolation, and behavioral problems. Ear deformities can spontaneously self-correct without any treatment in about 30% of cases. Surgical or non-surgical correction of ears’ shape is the only alternative for the rest of the patients. Molding is an effective method for non-surgical correction of ear deformations. It is possible to achieve better treatment results if you start the procedure during the first days of life due to sufficient plasticity of ear cartilage in newborns. Otherwise, otoplasty would be necessary at the age of 3–6 years.

Awareness and Attitude of Parents regarding Malocclusion and Early Interception of Oral Habits-associated Dentofacial Deformity in Children

Awareness and Attitude of Parents regarding Malocclusion and Early Interception of Oral Habits-associated Dentofacial Deformity in Children

PREVALENCE OF FLATFOOT VALGUS DEFORMITY IN CHILDREN OF THE VOLGOGRAD REGION

Flatfoot valgus deformity brings about the formation of overloaded kinetic muscular chains, changes in the biomechanics of feet and overlaying locomotor portions of extremities and vertebral column. The purpose of the study was to reveal the presence and investigate flatfoot valgus deformity in children with platypodia aged 7-14. To study the condition of feet we used the following materials and methods: clinical examination and plantoscopy, podometry, and radiography. The analysis of case histories of podiatric patients aged 7-14 including podometry and plantography findings presented as numerical values, digital photographs of feet and diagnostic conclusions about the type and severity of the pathology was performed. The study has demonstrated that flatfoot valgus deformity associated with a combined type of flatfoot prevails both in boys - in 62 (40 %) and girls - in 38 (24,5 %) cases. The obtained findings have also shown that most children have early stages of valgus deformity, which is observed both in boys in 59 (17) cases and girls in 54 (16) cases. The following conclusions have been made: regular monitoring of foot condition must be performed in children, therapeutic correction of foot static deformities shouLd be made. A weLL-directed programme of exercise therapy and surgicaL treatment of pronounced deformities in chiLdren are required.

Anterior Hemi-epiphysiodesis of the Distal Tibia for Residual Equinus Deformity in Children with Clubfeet

Background: Residual equinus deformity in toddlers with a history of clubfoot can be managed with soft tissue release, provided there is no articular incongruity. Distal tibia osteotomy is a reasonable choice in mature patients with a flattened talus provided the growth plate is closed. Anterior distal tibia hemi-epiphysiodesis is an option for children with articular incongruity who have substantial growth remaining. The aim of this study is to evaluate radiographic and clinical outcomes of this method. Methods: Fourteen clubfoot patients (20 ankles) with residual equinus deformity were treated between 2010-2015 with anterior distal tibial hemi-epiphysiodesis utilizing size appropriate modular plate and screw constructs. Patients were evaluated clinically and radiographically. Oxford Ankle Foot Questionnaire for Children (and caregivers) with supplemental questions were requested at most recent follow-up. Results: There were 12 males and 2 females, mean age 10 years at surgery (50-152 months), with the minimum 18 months of radiographic follow-up (Mean 34 months). Pre-surgical mean radiographic anterior distal tibial angle (ADTA) was 87.8 degrees (79-100) and mean maximum dorsiflexion was -5.7 degrees (-40-7). At follow-up, mean improvement of radiologic ADTA was 18 degrees and mean clinical dorsiflexion improvement was 8.4 degrees. On the Oxford Ankle Foot Questionnaire, children reported a mean functional score of 47% in the “Physical” domain, 71% in “School and Play”, 70% in “Emotional”, and 38% in footwear. Parents reported mean scores of 45% in Physical, 69% in School and Play, 56% in Emotional, and 28% in footwear. Sixty percent of parents reported increased foot flexibility, 80% noted improvement in their child’s walking, and 100% would choose this surgery again. Conclusions: Anterior distal tibial hemi-epiphysiodesis is a viable option for treatment of residual equinus in children with a clubfoot history and open growth plates. Radiographic improvement was at least 2x greater than the clinically measured improvements of dorsiflexion; yet each family would undergo the surgery again as they perceived an improvement in function.

Outcomes of Operative Treatment of Forearm Deformity in Children with Osteogenesis Imperfecta: 18 Cases

Osteogenesis imperfecta (OI) often results in recurrent fractures and/or progressive bowing of the long bones, including the arms. Upper extremity deformity has been shown to negatively impact function. The objective of this retrospective case series is to assess the ability to correct deformity, improve function and evaluate the complications and revision rates in our patients with OI who have undergone forearm deformity correction. A retrospective study, approved by The University of Nebraska Medical Center Institutional Review Board, was conducted with OI patients who underwent forearm osteotomy and fixation of one or both forearm bones between December 2011 and August 2018. There were no exclusion criteria. The electronic medical records were reviewed for patient demographics, surgical details, revisions and complications. A total of 48 procedures on 27 forearms in 18 patients were performed during the study. Surgery was performed in children with forearm deformity and recurrent fractures that were interfering with function. Half of the patients had surgery on one forearm and half had surgery on both forearms. The majority of the patients have Type III OI. There were multiple complications, the most common being wire migration which required either replacement or advancement of the wire. In conclusion, forearm deformity in OI is possible, with good healing of osteotomies and fractures, although many patients may require multiple surgical interventions.

Foot Drop after Gastrocsoleus Lengthening for Equinus Deformity in Children with Cerebral Palsy

Foot Drop after Gastrocsoleus Lengthening for Equinus Deformity in Children with Cerebral Palsy

Sagittal Plane Deformities in Children with SMA2 following Posterior Spinal Instrumentation

This is a retrospective radiographic review to assess post-operative sagittal plane deformities in patients with Spinal Muscular Atrophy type 2 that had been treated with posterior spinal instrumentation. Thirty-two patients with a history of either spinal fusion (N = 20) or growing rods (N = 12) were identified with an average of 7.6 (2.1–16.6) years post-operative follow-up. Forty percent (13/32) of the patients were identified as having obvious “tucked chin” (N = 4), “tipped trunk” (N = 9), or both (N = 3). Sacral incidence was the only parameter that was statistically significant change between pre-operative or immediate post-operative measurements (66.9° vs. 55.2° p = 0.03). However, at final follow-up, the post-operative thoracic kyphosis had decreased over time in those that developed a subsequent sagittal deformity (24.2°) whereas it increased in those that did not (44.7°, p = 0.008). This decrease in thoracic kyphosis throughout the instrumented levels, resulted in a greater lordotic imbalance (30.4° vs. 5.6°, p = 0.001) throughout the instrumented levels in the group that developed the subsequent cervical or pelvic sagittal deformities. In conclusion, sagittal plane deformities commonly develop outside the instrumented levels in children with SMA type 2 following posterior spinal instrumentation and may be the result of lordotic imbalance that occurs through continued anterior growth following posterior instrumentation.

Usefulness of Left Ventricular Myocardial Deformation in Children Hospitalized for Acute Myocarditis who Develop Arrhythmias

Cardiac arrhythmias occur in 3-40% of patients with acute myocarditis and cause significant morbidity and mortality. Myocardial injury also results in abnormal myocardial deformation. The relationship between left ventricular (LV) deformation, measured by two-dimensional speckle tracking echocardiography (2D-STE), and arrhythmia in pediatric myocarditis is unknown. We evaluated the association between 2D-STE and arrhythmias in children hospitalized with acute myocarditis. We reviewed patients ≤ 18 years hospitalized for acute myocarditis from 2008 to 2018. Arrhythmias were defined as 1) non-sustained or sustained ventricular tachycardia or ventricular fibrillation, 2) sustained supraventricular tachycardia (SVT), 3) high-grade or complete heart block, and 4) any arrhythmia treated with an antiarrhythmic medication. Systolic LV strain values (including LV global longitudinal strain (GLS), global circumferential strain (GCS), and six segments of LV regional long axis strain) were obtained from initial echocardiograms during hospitalization. Of 66 patients hospitalized, 23 (35%) had arrhythmias. SVT was the predominant arrhythmia (74%). Global and regional strain indices were reduced in the arrhythmia group: LV GLS [-8.9 (IQR -13.6, -6.1) vs. -13.7 (IQR -16.9, -9.7), p=0.038]; basal inferior/septal [-10.7 (IQR -15.5, -7.8) vs. -16.4 (IQR -18, -11.8), p=0.009]; basal anterior/lateral [-7.1 (IQR -12.8, -4.7) vs. -9.4 (IQR -16.7, -7.4), p=0.025]; and mid inferior/septal segments [-9 (IQR -13, -7.7) vs. -14.1 (IQR -22.5, -10.7), p=0.007]. After controlling for age, reductions in GLS and segmental strain in the two basal and two mid-segments were associated with increased arrhythmia occurrence (p <0.05). Our findings suggest that echocardiographic LV deformation by 2D-STE may be useful in identifying pediatric patients with acute myocarditis at risk for arrhythmias.

Surgical Correction of Foot Deformity in Children under 3 Years of Age

Aim. The study aimed to improve the outcomes for surgical correction of talipes equinovarus in children using the Ponseti method, as well as vertical talus correction using the Dobbs method combined with massage, physiotherapy and therapeutic exercise. Material and methods. In the period from 2015 to 2020, 109 children were examined and treated at the Filatov City Children’s Hospital, Moscow. Results. The study has revealed that without timely correction the orthopedic foot pathology in children is often accompanied by pain, functional changes and a high risk of developing disability in a child, which determines a high social significance of this nosology. After a comprehensive assessment and a combination of conservative and surgical correction techniques, the congenital foot deformity in all children was completely eliminated. Conclusion. The Ponseti method is required to be carefully adhered to in order to achieve a complete pes equino-varus correction. Early start of correction of changes is effective.

Treatment of Foot Deformities in Children under 3

Introduction. The choice of treatment options of foot deformity in children is the most acute in the first years of life. In this regard, the need for hospital stay of a child is debatable today. A number of interventions in the treatment of foot pathology can be performed on an outpatient basis.The aim of this study was to improve clinical outcomes of pes equino-varus treatment using the Ponseti procedure, and the Dobbs vertical talus correction combined with massage, physiotherapy and exercise therapy on the outpatient and inpatient basis in pediatric population. Methods. The study included 106 children who were examined and treated at N.F. Filatov Children's City Clinical Hospital in 2015-2020.Results. The study revealed that, if left untreated, the orthopedic pathology of the feet in children is often accompanied by pain, functional changes and a high risk of disability, the fact evidencing high social significance of the studied nosology. In all examined children a congenital deformity of the foot was completely eliminated after a comprehensive assessment and a combination of conservative and surgical correction techniques. Conclusions. Careful adherence to the Ponseti procedure is required to achieve a complete pes equino-varus correction. Early beginning of correction is the most beneficial due to its effectiveness.

Letter to the editor: Management of Chiari I Deformity in Children and Adolescents: A Report from the Consensus Taskforce of the Brazilian Society of Pediatric Neurosurgery

Letter to the editor: Management of Chiari I Deformity in Children and Adolescents: A Report from the Consensus Taskforce of the Brazilian Society of Pediatric Neurosurgery

The Effectiveness of Preoperative Correction Techniques in Improving Nasal Deformity in Children With Unilateral Complete Cleft Lip and Palate.

Unilateral complete cleft lip and palate (UCCLP) is associated with apparent nasal deformities before the cheilorrhaphy. The aim of this study was to determine whether preoperative correction techniques are effective in the treatment of nasal deformities in infant with unilateral UCCLP used by the systematic review and meta-analysis. We searched Medline, Cochrane Library, EMBASE, PubMed, and Chinese BioMedical Literature Database (CBM) until January 31, 2019, to identify studies that compared the effectiveness of preoperative correction techniques in the treatment of nasal deformities in infant with UCCLP. Two authors individually extracted the data and performed the quality assessments. The height of nasal columella, the width of the affected side nasal ala and the inclination of the nasal columella were evaluated. Seven articles were incorporated into the systematic review, and 5 (274 participants) in the meta-analysis according to the inclusion criteria. The preoperative correction could increase the height of nasal columella in children with UCCLP [SMD: 2.64 mm; 95% confidence intervals (CI); (1.35 mm, 3.94 mm); P < 0.0001]. Moreover, the preoperative correction resulted in reduced width of the affected side nasal ala [SMD: -5.14 mm; 95% CI; (-8.96 mm, -1.31 mm); P = 0.008]; However, the evidence was insufficient to determine a significant effect on the inclination of the nasal columella [SMD: -3.48 degrees; 95% CI; (-7.56 degrees, 0.59 degrees); P = 0.09]. Preoperative correction for children with UCCLP can increase the height of nasal columella, reduce the width of the affected side nasal ala, improve the nasal symmetry, and reduce nasal deformity, however, no significant effect could be observed for the inclination of the nasal columella.

Lower Extremity Deformities in Children with Vertebromedullary Anomalies

The article presents the literature data, results of diagnostics and treatment of 219 children with variousmorphologies of spinal herniation and neuroorthopedic disorders. It characterizes in detail motion disordersand deforming arthrosis of the lower extremities in 88.1% and 26% of patients. The authors state that thegenesis of disorders can include the manifestations of spinal cord fixation syndrome in patients with spinalhernias with combined congenital and acquired forms of latent spinal dysraphism. The article confirmsthe feasibility of early preventive and therapeutic measures corresponding to the nature of the combinedpathology, with the participation of specialists.

Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Study on the correlation between OSAS and thoracic deformity in children: A retrospective single-center study in China

ObjectiveTo evaluate the correlation between obstructive sleep apnea syndrome (OSAS) and the development of thoracic deformity in Children. MethodsA retrospective analysis was performed with the medical records of 39 pediatric OSAS patients with thoracic deformity and matching 39 without thoracic deformity as control group between January 2015 and June 2019. The contrast was performed with age, gender, height, weight, body mass index (BMI), apnea/hypopnea index (AHI), the lowest oxyhemoglobin saturation (loSpO2)at night, tonsil and adenoid size, Alkaline phosphatase (ALP)and trace elements and metals between two groups. ResultsBMI, AHI, the lowest SpO2, Phosphorus and Zinc were the risk factors of thoracic deformity. Age, gender, disease history, the size of tonsil and adenoid, ALP and other trace elements were no significant difference occurred between two groups. ConclusionOSAS characterized by apnea and hypoxia which are caused by narrow upper airway may be one cause of thoracic deformity in children. Pediatricians, thoracic and otolaryngologic surgeons should be alert to OSAS when thoracic deformities are diagnosed in children.

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series.

Introduction:The study purpose was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus tertius or brevis in children with static encephalopathy and varus feet.Methods:A retrospective review of short- and long-term complications, change in ankle range of motion, strength, and gait kinematics. Predictors of postoperative varus or valgus were examined.Results:One hundred thirty-three patients were included (average age [SD] 10.3 [3.7]), with an average follow-up of 3.9 (3.4) years. Forefoot/hindfoot eversion range of motion improved (P ≤ 0.05), dorsiflexor strength was maintained or improved in 76.9% of patients, and dorsiflexion in swing phase was maintained. Complications occurred in 6 of 133 patients (4.5%) and included 1 transfer failure, 1 wound dehiscence, and four pressure areas from casts. Successful correction was achieved in 77% of patients. Later onset of recurrent varus (14.4%, 10.6% requiring revision surgery) and pes valgus (8.7%, 4.8% requiring revision surgery) occurred. The length of the follow-up predicted the development of the pes valgus (odds ratio 1.28, 95% CI 1.0 to 1.6).Discussion:SPLATT to the peroneus tertius or brevis is effective, and complications are rare. Subsequent valgus or recurrent varus deformities may occur, possibly requiring repeat surgery.

Management of Chiari I deformity in Children and Adolescents: A report from the Consensus Taskforce of the Brazilian Society of Pediatric Neurosurgery

AbstractMuch controversy remains on the current management of Chiari I deformity (CID) in children, with many clinical, surgical and ethic-legal implications. The Brazilian Society of Pediatric Neurosurgery (SBNPed, in the Portuguese acronym) has put together a panel of experts to analyze updated published data on the medical literature about this matter and come up with several recommendations for pediatric neurosurgeons and allied health professionals when dealing with CID. Their conclusions are reported herein, along with the respective scientific background.

Growth Modulation for Knee Coronal Plane Deformities in Children With Nutritional Rickets: A Prospective Series With Treatment Algorithm.

Purpose:To report prospectively the radioclinical outcome of guided growth surgery for coronal plane deformities around the knee in young children with nutritional rickets on the intermediate term, to assess the responsiveness of torsional deformities of the tibias to guided growth regarding function and objective clinical parameters, and to propose a treatment algorithm.Methods:Fifty children (male:female, 27:23) with knee coronal plane deformities (knees:physes, 86:99), (varum:valgum, 51:35) secondary to nutritional rickets were subjected to femoral and/or tibial temporary hemiepiphysiodesis using a two-hole 8-plate. The mean age at implantation was 3.8 ± 1.5 years (range 2.5 to 5). The mean follow-up was 2.8 years (range 2 to 4). All children received a standing full-length AP radiographs of both lower limbs in neutral rotation to measure the mechanical axis deviation, tibiofemoral angle, and joint orientation angles. Tibial torsion was objectively assessed by measuring the bimalleolar axis.Results:The radiologic measurements, tibiofemoral angle, mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and Hilgenreiner-epiphyseal angle, showed a highly statistically significant improvement (P ≤ 0.001). Radiographic outcomes correlated with their clinical counterparts. The mean duration of correction of the mechanical axis was 10.8 ± 2.4 months (7 to 21). The mean follow-up for rebound of the deformity was 1.5 years (range 1 to 3).Conclusion:The radioclinical outcome is rewarding with a tolerable complication profile. The mechanical complications were mostly related to lengthy implant retainment encountered in severe deformities. Internal tibial torsion seems profoundly responsive to correction of coronal plane deformity. And, derotation osteotomies are rarely justified. Our proposed algorithm may be used as a decision-taking guide for achieving the desired growth modulation in a more efficient manner.

Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.

Guided Growth for Genu Valgum Deformity in Children

Guided Growth for Genu Valgum Deformity in Children