Palsy Patients Research Articles

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort.

We characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses. A de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included. Among the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001). In one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months. 4 Laryngoscope, 134:911-918, 2024.

Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis

ObjectivesTo evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. Materials and methodsThis is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. ResultsEleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4–47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5–4 khZ and BC 0,5–3 kHz thresholds was observed between both techniques. ConclusionEven middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

The Relationship Between Speech Delay with Cerebral Palsies in Children at Rs Haji Medan

Speech delay in children is a condition in which the child's expressive language development is inappropriate or below his age. The incidence of speech delay for Indonesian children who are not in school yet reaches 5–10%. There are more male children with speech disorders than females. The causes of speech delay can be hearing loss, cerebral palsy, low thinking ability, or autism. Cerebral palsy patients may experience uncontrollable movements and muscle spasms in the mouth. This will have an impact on the development of children's speech. This research is a descriptive-analytical study with a cross-sectional approach. The subjects of this study are patients with cerebral palsy in RS Haji Medan, with a total sample size of 132 people. Data analysis using the Chi-square tes. There was a significant relationship between speech delay and cerebral palsy among pediatric patients in RS Haji Medan. The result using Fisher’s exact test showed a P value less than 0.05, which validated the hypothesis. There was a significant relationship between speech delay and cerebral palsy among pediatric patients in RS Haji Medan.

Automated Paralysis Patients Healthcare System

Automated Paralysis Patients Healthcare System

Seasonal patterns in the epidemiology of Bell's palsy in Hungary.

Epidemiological data on Bell's palsy are vital for elucidating disease prevalence and enhancing therapeutic options. Our objective was to explore the prevalence and possible risk factors associated with Bell's palsy recurrence in the Clinical Center of the University of Debrecen service area. Secondary data analysis was performed using hospital discharge data, including patient information and comorbidities. Data was obtained from the Clinical Center of the University of Debrecen, on Bell's palsy patients who were treated at the hospital between January 1, 2015 and December 31, 2021. Multiple logistic regression analysis was used to examine the factors associated with Bell's palsy recurrence. Of the 613 patients analyzed, 5.87% had recurrent paralysis, and the median time interval between episodes was 315 days. Hypertension was significantly associated with Bell's palsy recurrence. Moreover, seasonal distribution analysis revealed that the number of Bell's palsy episodes was higher in colder seasons, with spring and winter having a significantly higher number of episodes than summer and autumn. This study provides insights into the prevalence and associated risk factors of Bell's palsy recurrence, which could aid in its management and help reduce the long-term consequences of the disease. Further research is necessary to determine the precise mechanisms underlying these findings.

Novel Baseline Facial Muscle Database Using Statistical Shape Modeling and In Silico Trials toward Decision Support for Facial Rehabilitation.

Backgrounds and Objective: Facial palsy is a complex pathophysiological condition affecting the personal and professional lives of the involved patients. Sudden muscle weakness or paralysis needs to be rehabilitated to recover a symmetric and expressive face. Computer-aided decision support systems for facial rehabilitation have been developed. However, there is a lack of facial muscle baseline data to evaluate the patient states and guide as well as optimize the rehabilitation strategy. In this present study, we aimed to develop a novel baseline facial muscle database (static and dynamic behaviors) using the coupling between statistical shape modeling and in-silico trial approaches. Methods: 10,000 virtual subjects (5000 males and 5000 females) were generated from a statistical shape modeling (SSM) head model. Skull and muscle networks were defined so that they statistically fit with the head shapes. Two standard mimics: smiling and kissing were generated. The muscle strains of the lengths in neutral and mimic positions were computed and recorded thanks to the muscle insertion and attachment points on the animated head and skull meshes. For validation, five head and skull meshes were reconstructed from the five computed tomography (CT) image sets. Skull and muscle networks were then predicted from the reconstructed head meshes. The predicted skull meshes were compared with the reconstructed skull meshes based on the mesh-to-mesh distance metrics. The predicted muscle lengths were also compared with those manually defined on the reconstructed head and skull meshes. Moreover, the computed muscle lengths and strains were compared with those in our previous studies and the literature. Results: The skull prediction's median deviations from the CT-based models were 2.2236 mm, 2.1371 mm, and 2.1277 mm for the skull shape, skull mesh, and muscle attachment point regions, respectively. The median deviation of the muscle lengths was 4.8940 mm. The computed muscle strains were compatible with the reported values in our previous Kinect-based method and the literature. Conclusions: The development of our novel facial muscle database opens new avenues to accurately evaluate the facial muscle states of facial palsy patients. Based on the evaluated results, specific types of facial mimic rehabilitation exercises can also be selected optimally to train the target muscles. In perspective, the database of the computed muscle lengths and strains will be integrated into our available clinical decision support system for automatically detecting malfunctioning muscles and proposing patient-specific rehabilitation serious games.

Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis.

Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors. Two researchers individually searched for relevant studies published till November 2022 in the PubMed, Embase, Web of Science and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran's Q test, and a funnel plot was implemented to evaluate publication bias. The odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type. Eight eligible papers included 915 patients and 1242 exposed nerves. The frequencies of transient, permanent and total recurrent laryngeal nerve (RLN) palsy were 2.64, 0.19 and 2.83%, respectively, in the IONM group and 6.15, 0.75 and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies. The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, the reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.

Etiology of Isolated Third, Fourth, and Sixth Cranial Nerve Palsies with a Cancer History

Purpose: To investigate the causes of isolated ocular motor nerve palsy in patients with a history of cancer.Methods: The charts of 30 patients with cancer diagnosed with isolated acquired third, fourth, and sixth cranial nerve palsies from March 2013 to December 2021 were retrospectively reviewed. Sex, age of onset, underlying disease and causes of cranial nerve palsy were analyzed.Results: Sixth cranial nerve palsy (n = 18, 60.0%) was the most common. Brain metastasis (n = 13, 43.3%) was the most common etiology, followed by microvascular causes (n = 11, 36.7%), radiation-induced neuropathy (n = 2, 6.7%), and undetermined (n = 4, 13.3%). Among the 13 patients with palsies due to brain metastasis, only one (7.7%) had been in complete remission for more than 1 year. Of the remaining 17 patients with other causes, seven (41.2%) had been in complete remission of a previously diagnosed cancer for more than 1 year.Conclusions: In patients with a history of cancer, cranial nerve palsy due to brain metastasis was the most common cause, and it was more likely if the primary cancer had not been in remission for more than 1 year. Brain magnetic resonance imaging should be performed as soon as possible to confirm brain metastasis and a differential diagnosis including various other causes is also important.

Translation and validation of a Finnish version of the Facial Clinimetric Evaluation (FaCE) Scale

Background: The Facial Clinimetric Evaluation (FaCE) scale is a patient-reported health status instrument developed for assessing the health-related quality of life (HRQoL) in patients with facial nerve paralysis. The aim of this study was to translate and validate the FaCE scale for the Finnish-speaking population.Methods: The FaCE scale was translated according to international guidelines. Sixty patients in an outpatient clinic prospectively completed the translated FaCE scale and generic HRQoL instrument (15D). The objective facial paralysis grading was made using the Sunnybrook and House-Brackmann scales. Repeated FaCE and 15D instruments were mailed to patients 2 weeks later. Total scores of the FaCE instrument and subscales were calculated, and floor and ceiling effects were examined. Exploratory factor analysis was made. Internal consistency, reliability, and repeatability were assessed. Convergence with 15D instrument, Sunnybrook, and House-Brackmann scales was examined.Results: The total internal consistency of the FaCE scale was high (Cronbach’s alpha 0.83). There were no statistically significant differences found between mean scores of the subscales in test-retest analysis (p > 0.05). Intra-class correlations coefficients were high, ranging between 0.78 and 0.92, and the correlations were statistically significant (p < 0.001). There were statistically significant correlations observed between the FaCE scale and the 15D, Sunnybrook, and House-Brackmann scores. Conclusion: The FaCE scale was successfully translated and validated in Finnish with good validity and reliability. We also demonstrated statistically significant correlations between the generic HRQoL15D instrument and both the Sunnybrook and House-Brackmann physician-based grading scales. The FaCE scale is now ready for use in Finnish facial paralysis patients.

특발성 안면신경 마비 예후 예측 도구로서 측두골 자기공명영상의 유용성

Background: In facial palsy patients, electroneuronography (ENoG) was used for the diagnosis of the prognosis of facial palsy. This study aimed to determine whether temporal bone magnetic reso-nance imaging (TBMR) was useful for diagnosing and predicting prognosis in facial palsy. Materials and Methods: Among the patients diagnosed with facial palsy, 112 patients who underwent TBMR were included. These patients were divided into three groups according to the enhancement region of the facial nerve in TBMR. Fifty-five patients showed contrast enhancement in the meatal or labyrinthine segment (group 1), 36 patients showed enhancement in the geniculate ganglion (group 2), and 21 patients showed enhancement in the tympanic or mastoid segment (group 3). The initial facial palsy symptoms and prognosis were compared between the three groups. Results: In group 1, 26 patients showed House-Brackmann grade (H-B grade) IV, V initially, and 13 patients and 12 patients showed H-B grade IV, V initially in group 2 and group 3, respectively. Moreover, the initial ENoG results (%) between the three groups did not significantly differ. Patients who took more than 6 months to recover after systemic steroid therapy were 5 patients in group 1, 3 patients in group 2, and 2 patients in group 3. Conclusions: In TBMR of the patients with facial nerve palsy, the most contrast enhancement parts of the facial nerve were the meatal and labyrinthine segments. Enhancement of those segments showed severe initial symptoms clinically. In addition, most of them recovered within 6 months. However, there was no statistical significance, so further studies are needed for more cases and ob-servation periods.

Effect of Whole Body Vibration Therapy on Spasticity, Balance, Fine and Gross Motor Functions in Patients with Spastic Cerebral Palsy: A Systematic Review of RCTs

Context: Cerebral palsy is condition that is caused by neurological damage, which leads to problems in the somatosensory systems. It can cause spasticity in the involved muscles leading to poor function, limitations in range of motion, poor balance and coordination. Therapeutic use of whole-body vibration therapy for the management of the mentioned symptoms have been reported in the literature. This review study examines the effect of whole-body vibration on spasticity, balance and function and summarizes the effective protocols of whole-body vibration therapy for the cerebral palsy patients. Methods: Three following databases were searched comprehensively: Pubmed, PEDro and Cochrane. The selection criteria for the research papers were based on; (1) human studies with Patient-Intervention-Comparison-Outcomes-Study design (PICOS) method, according to which, P = spastic cerebral palsy; I = Whole Body Vibration; C = comparison with conventional/traditional physiotherapy; O = dynamic balance, spasticity, functional balance, fine and gross motor hand function, hand grip strength, Balance Quantification and Range of Motion; and S = Randomized controlled trials, (2) Published in English Language (3) Full Text Available (4) The PEDro scale on which the score is greater than 4 out of 10. Results: Nine RCTs were included based on the inclusion criteria. This systematic review showed that whole body vibration therapy can produce positive therapeutic effects on spasticity, balance, fine and gross motor function, muscle strength and range of motion. This modality can be used independently or in combination with the conventional physical therapy. No harm has been reported in the literature. Conclusion: It can be concluded that whole body vibration therapy is safe, cost effective and fairly simple therapeutic modality that can be used at home or in clinical settings to produce a significant change in spasticity, static and dynamic balance, motor function and range of motion. Keywords: Balance, Cerebral Palsy, Motor Function, Spasticity, Whole body vibration therapy

System identification: a feasible, reliable and valid way to quantify upper limb motor impairments

BackgroundUpper limb impairments in a hemiparetic arm are clinically quantified by well-established clinical scales, known to suffer poor validity, reliability, and sensitivity. Alternatively, robotics can assess motor impairments by characterizing joint dynamics through system identification. In this study, we establish the merits of quantifying abnormal synergy, spasticity, and changes in joint viscoelasticity using system identification, evaluating (1) feasibility and quality of parametric estimates, (2) test–retest reliability, (3) differences between healthy controls and patients with upper limb impairments, and (4) construct validity.MethodsForty-five healthy controls, twenty-nine stroke patients, and twenty cerebral palsy patients participated. Participants were seated with the affected arm immobilized in the Shoulder-Elbow-Perturbator (SEP). The SEP is a one-degree-of-freedom perturbator that enables applying torque perturbations to the elbow while providing varying amounts of weight support to the human arm. Participants performed either a ‘do not intervene’ or a resist task. Elbow joint admittance was quantified and used to extract elbow viscosity and stiffness. Fifty-four of the participants performed two sessions to establish the test–retest reliability of the parameters. Construct validity was assessed by correlating system identification parameters to parameters extracted using a SEP protocol that objectifies current clinical scales (Re-Arm protocol).ResultsFeasibility was confirmed by all participants successfully completing the study protocol within ~ 25 min without reporting pain or burden. The parametric estimates were good with a variance-accounted-for of ~ 80%. A fair to excellent test–retest reliability was found (ICC = 0.46-0.98) for patients, except for elbow stiffness with full weight support (ICC = 0.35). Compared to healthy controls, patients had a higher elbow viscosity and stiffness during the ‘do not intervene’ task and lower viscosity and stiffness during the resist task. Construct validity was confirmed by a significant (all p<0.03) but weak to moderate (r = 0.36-0.50) correlation with parameters from the Re-Arm protocol.ConclusionsThis work demonstrates that system identification is feasible and reliable for quantifying upper limb motor impairments. Validity was confirmed by differences between patients and controls and correlations with other measurements, but further work is required to optimize the experimental protocol and establish clinical value.

Unsupervised machine learning effectively clusters pediatric spastic cerebral palsy patients for determination of optimal responders to selective dorsal rhizotomy

Selective dorsal rhizotomy (SDR) can reduce the spasticity in patients with spastic cerebral palsy (SCP) and thus improve the motor function in these patients, but different levels of improvement in motor function were observed among patients after SDR. The aim of the present study was to subgroup patients and to predict the possible outcome of SDR based on the pre-operational parameters. A hundred and thirty-five pediatric patients diagnosed with SCP who underwent SDR from January 2015 to January 2021 were retrospectively reviewed. Spasticity of lower limbs, the number of target muscles, motor functions, and other clinical parameters were used as input variables for unsupervised machine learning to cluster all included patients. The postoperative motor function change is used to assess the clinical significance of clustering. After the SDR procedure, the spasticity of muscles in all patients was reduced significantly, and the motor function was promoted significantly at the follow-up duration. All patients were categorized into three subgroups by both hierarchical and K-means clustering methods. The three subgroups showed significantly different clinical characteristics except for the age at surgery, and the post-operational motor function change at the last follow-up in these three clusters was different. Three subgroups clustered by two methods could be identified as “best responders”, “good responders” and “moderate responders” based on the increasement of motor function after SDR. Clustering results achieved by hierarchical and K-means algorithms showed high consistency in subgrouping the whole group of patients. These results indicated that SDR could relieve the spasticity and promote the motor function of patients with SCP. Unsupervised machine learning methods can effectively and accurately cluster patients into different subgroups suffering from SCP based on pre-operative characteristics. Machine learning can be used for the determination of optimal responders for SDR surgery.

Ocular motor nerve palsy in patients with diabetes: High-resolution MR imaging of nerve enhancement

To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of inflammatory or microvascular impairment in patients with diabetic ophthalmoplegia. We conducted a retrospective study of 10 patients referred for acute ocular motor nerve palsy in the context of diabetes mellitus from September 15th, 2021 to April 24th, 2022. 3T MRI evaluation included diffusion, 3D TOF, FLAIR, coronal STIR and post-injection 3D T1 SPACE DANTE sequences. Ten patients were included: 9 males and 1 female aged from 46 to 79 years. Five patients presented with cranial nerve (CN) III palsy, and 5 presented with CN VI palsy. Third nerve palsy was pupil-sparing in 4 patients and pupil-involved in 1 patient. Pain was associated in all patients with CN III deficiencies and in 2 patients CN VI deficiencies. In all patients, MRI sequences ruled out mass effect and vascular pathology, such as acute stroke or aneurysm. Eight patients presented with STIR hypersignals, some with enlargement of the involved nerve. The diagnosis was confirmed through a post-injection 3D T1 SPACE DANTE sequence, which showed extended enhancement along the abnormal portion of the nerve. High-resolution MRI evaluation of diplopia in diabetic patients is used to rule out a diagnosis of acute stroke and contributes to the positive diagnosis of ocular motor nerve impairment, possibly combining the influences of inflammatory and microvascular phenomena. Dedicated MR imaging should be included in the initial diagnosis and longitudinal follow-up of patients with diabetic ophthalmoplegia.

Characteristics of Postoperative C5 Palsy Following Anterior Decompression and Fusion Surgery for Cervical Degenerative Disorders: Trends Associated with Advancements in Surgical Technique

To investigate trends in the characteristics of postoperative C5 palsy following anterior decompression and fusion associated with advancements in this surgical procedure to treat cervical degenerative disorders. We included 801 consecutive patients who underwent anterior decompression and fusion for cervical degenerative disorders from 2006 to 2019 and investigated the incidence, onset, and prognosis of C5 palsy. In addition, we compared the incidence of C5 palsy with that found in our previous investigation. The cases of 42 (5.2%) patients were complicated by C5 palsy. For patients with ossification of the longitudinal ligament (OPLL), 22 (12.4%) of 177 were complicated with C5 palsy, and the incidence was significantly higher than that in patients without OPLL (20 [3.2%] of 624, P < 0.01). The incidence of C5 palsy in patients without OPLL was significantly lower than that found in our previous investigation (P < 0.01). The incidence of C5 palsy in patients that required contiguous multilevel corpectomy was significantly higher in patients that required within a single corpectomy (P < 0.01). At 1-year follow-up, muscle strength in 3 (6.1%) of 49 limbs had not improved sufficiently. With advancements in surgical techniques which allowed necessary and sufficient spinal cord decompression and avoided unnecessary corpectomy, the incidence of C5 palsy in patients without OPLL was decreased significantly. By contrast, for patients with OPLL, the incidence of C5 palsy was similar to the incidence found previously, perhaps because a broad and contiguous multilevel corpectomy was usually needed to decompress the spinal cord sufficiently.

Rectal prolapse in a 30-year-old bladder stone male patient: A case report

Rectal prolapse occurs most commonly in children and middle-aged and elderly women and is relatively rare in young men and is occasionally caused by bladder stones. Severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency caused by bladder stones are rare in a 30-year-old man. We report the case of a 30-year-old male patient with cerebral palsy who presented with a large bladder stone that resulted in severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency. Following a definitive diagnosis, the bladder stone was successfully removed, and his kidney function returned to normal. We assessed the patient's nutritional status and stone composition and concluded that the main cause was malnutrition. Rectal prolapse is a rare clinical manifestation of bladder stones, particularly in young adults. Cerebral palsy patients are a vulnerable group in society because of their intellectual disabilities and communicative impairments. Accordingly, besides taking care of their daily diet, abnormal signs in their bodies should receive the doctors' attention in a timely manner.

Caractéristiques cliniques, épidémiologiques et facteurs associés aux fonctions motrices globales chez les enfants atteints de paralysie cérébrale au Nord-ouest du Maroc

The objective is to study the epidemiological and clinical profile and determine the factors associated with gross motor function in cerebral palsy patients. We conducted a descriptive cross-sectional study with prospective collection of patients (between 0–16 years old) who were diagnosed as cerebral palsy and referred for possible treatment at the reception and rehabilitation center for maladjusted children during the period. from July 01, 2021 to 01 June, 2022. Patients with progressive encephalopathy and those with genetic neurological pathology were excluded. A total of 117 children meeting the inclusion criteria were recruited. The male sex was the most represented with a sex ratio of 1.60. The mean age at diagnosis was 26.9 (±12.46) months or 2.24 years. The aetiologies found were mainly perinatal with a frequency of 67%, mainly dominated by prematurity. Spastic cases were the most dominant (71.4%), topographically, (73.2%) of our population was quadriplegic, on the GMFCS, children classified as grade IV and V tend to represent two thirds of our population. population. CT abnormalities were found in 83.8 % of patients who were able to perform a brain scan. In total, 63.6 % of patients presented with seizures as an associated disorder. The main aetiologies of cerebral palsy are perinatal causes mainly dominated by prematurity, neonatal asphyxia and sequelae of kernicterus, health programs should focus on areas aimed at improving prevention, care and education of the various stakeholders.

The Oral Health of Cerebral Palsy Patients in Pakistan: A Neglected Domain

The Oral Health of Cerebral Palsy Patients in Pakistan: A Neglected Domain

Role of POP Boot Traction in Lower Limb Deformities

Background: In India, postpolio residual paralysis (PPRP) patients, present with multiple deformities, which requires surgical intervention, and in rural setting, it poses a big challenge for doctors. Traction is one of the oldest treatments in fracture reduction and deformity correction. The objective of this study was to evaluate the clinical outcome of plaster of Paris (POP) boot traction for the correction of lower limb deformities in PPRP patients. Materials and Methods: This retrospective case series represents 14 cases of PPRP with hip and/or knee deformity treated with POP boot traction for deformity correction, followed by caliper application. Deformities were classified as mild, moderate, and severe and assessed weekly during treatment. Results: There were 8 females and 6 males. The mean age of participants was 22.21 ± 8.107 years, and the mean duration of traction was 5.21 ± 1.76 weeks. There were seven patients with unilateral knee deformity, two patients with bilateral knee deformity, two patients with unilateral hip and knee deformity, and three patients with bilateral hip and knee deformity. The mean baseline deformity angle was 37.41, and the mean postprocedure deformity angle was 15.89. Conclusions: POP boot traction is a low-cost intervention in PPRP patients and can give promising results in the correction of lower limb deformities.

The Reliability of Intraoperative Hip Arthrography in Cerebral Palsy Hip Reconstruction

Background: This study investigates surgeon interpretation of intraoperative hip arthrography after femoral osteotomy to guide decision-making regarding addition of concomitant pelvic osteotomy (PO) for Cerebral Palsy (CP) hip reconstruction.Methods: Ten orthopaedic surgeons reviewed preoperative radiographic images of 21 children with CP, undergoing hip reconstruction. Surgeons recorded if PO was indicated after 1) reviewing the preoperative radiographs. Raters who exhibited poor reliability (kappas <0.60) were excluded from arthrogram analysis. Agreement in decision-making was evaluated by estimating the concordance across six raters with respect to changing their recommendation after reviewing the arthrogram images by estimating Fleiss's kappa coefficient.Results: Intra-rater reliability for the three surgeons who conducted repeat evaluations was substantial to almost perfect (k=0.67, 0.86, 1.00). Pairwise inter-rater reliability for radiographic decision was moderate to almost perfect with kappa values ranging from 0.56 to 0.87. In 20 of 32 hip evaluations, at least 5 of 6 raters recommended PO after reviewing the radiograph, 64% of the cohort (122/192). However, upon reviewing the arthrogram images, only 45% (86/192) of reviewers recommended a PO. Attending surgeons changed their decisions away from PO in 35% of cases overall while fellows changed their decisions in only 7% of cases. Further radiographic characterization of the labrum position demonstrated substantial agreement (kappa=0.73; 95% CI=0.48-0.98) and almost perfect agreement regarding presence of dye pool (kappa=0.85; 95% CI=0.50-1.00).Conclusions: Interpretation of intraoperative hip arthrography to guide addition of PO in CP hip reconstruction is reliable with moderate agreement according to experience level and with substantial retest reliability.Level of Evidence: Level IVKey Concepts•Arthrograms can be helpful to determine hip stability during hip reconstruction in cerebral palsy patients.•The reliability of the interpretation of arthrograms is an important area of study.•Decision-making in neuromuscular hip reconstruction is not standardized across surgeons or institutions.