Pediatric Orthopaedic Society Of North America Research Articles

Modified Pemberton Acetabuloplasty for the Treatment of Congenital Hip Dysplasia

Modified Pemberton Acetabuloplasty for the Treatment of Congenital Hip Dysplasia

Osseous Manifestations of Tuberculosis in Children

Forty-two children with tuberculous osteomyelitis were seen and treated between 1984 and 1999. The age ranged from 1 to 12 years (average 6); there were 31 boys and 11 girls. There were 50 osseous lesions (excluding spinal and synovial). Five children had multifocal bone involvement. There were four basic types of lesions: cystic (n = 26), infiltrative (n = 10), focal erosions (n = 8), and spina ventosa (n = 6). The majority of the lesions were in the metaphyses (n = 25); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones, and small round bones. The erythrocyte sedimentation rate was normal in seven, and the Mantoux test was negative in four. Bone lesions resembled pyogenic and fungal infections and benign and malignant bone tumors. Histologic confirmation was obtained in all patients. Curettage and antituberculous treatment yielded good results in the majority of patients, with follow-up of 6 months to 9 years. Biopsy is mandatory to confirm the diagnosis.

The Pediatric Orthopaedic Society of North America Pediatric Orthopaedic Functional Health Questionnaire: An Analysis of Normals

Several questionnaires have been developed in an attempt to measure real-life functional levels of pediatric orthopaedic patients. One in particular was developed by the Pediatric Orthopaedic Society of North America (POSNA) in 1994. This POSNA instrument yields four functional assessment scores, a global function score, and a happiness score (each having a possible range from 0 to 100). In this study, the POSNA questionnaire was administered to the parents of 57 normal children and 27 normal adolescents to determine how normal respondents can be expected to score. Means, standard deviations, and other statistics were derived for the functional scores. It was concluded that normal children should respond quite high on all the scores, possibly 100. These results allow us to understand that a child scoring in the low 80s or less is functioning at a different level than the normal child.

Publication of Abstracts Submitted to the Annual Meeting of the Pediatric Orthopaedic Society of North America

A computerized MEDLINE search was performed to determine the publication pattern of the abstracts submitted for podium presentation at the 1991-1994 annual meetings of the Pediatric Orthopaedic Society of North America (POSNA). The publication percentage for all papers submitted to the POSNA meetings from 1991 through 1994 was 45%. Fifty-three percent of papers accepted for podium presentation were ultimately published in comparison with 38% of those not accepted for presentation (p < 0.001). The mean time to publication was 29 months and did not differ significantly for the two groups. The majority of papers (65%) were published in either Journal of Pediatric Orthopaedics (48%) or The Journal of Bone and Joint Surgery (American) (17%). The frequency of ultimate publication of abstracts submitted to the annual POSNA meetings compares favorably with the rates for other medical subspecialties.

The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. Pediatric Outcomes Instrument Development Group. Pediatric Orthopaedic Society of North America.

The goal of orthopaedic interventions is to improve the functional health of patients, particularly physical function. The American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America (POSNA) commissioned a work group to construct functional health outcomes scales for children and adolescents, focusing on musculoskeletal health. The work group developed scales assessing upper extremity function, transfers and mobility, physical function and sports, comfort (pain free), happiness and satisfaction, and expectations for treatment. Parent and adolescent self-report forms were developed and tested on 470 subjects aged 2-18 years. The POSNA scales demonstrated good reliability, construct validity, sensitivity to change over a 9-month period, and ability to outperform a standard instrument, the Child Health Questionnaire physical functioning scale. They were useful for a wide variety of ages and diagnoses. They appear to be ideally suited for orthopaedic surgeons to assess the functional health and efficacy of treatment of their patients at baseline and follow-up.

Posttraumatic Genu Valgum: Operative Versus Nonoperative Treatment

The purpose of this study was to compare the results of operative versus nonoperative treatment for posttraumatic genu valgum. It is a retrospective chart and radiograph review of all patients with the diagnosis of posttraumatic genu valgum from our institution and from data obtained in response to 389 letters sent to the members of the Pediatric Orthopaedic Society of North America (POSNA). The complementary physeal shaft (CPS) angle and the tibial femoral angle (TFA) were measured at the time of injury, at maximal deformity, and at latest follow-up. Fifteen patients were identified, 10 in the nonoperative group and five in the operative group. In both groups, the valgus deformity progressed over a 20-month span. In both groups, the valgus deformity improved at the time of follow-up. There was no significant difference in the CPS angle or TFA, between groups at the time of injury, at maximal deformity, or at follow-up.

V-Y Plasty for Correction of Varus Fifth Toe

V-Y plasty has been used for greater than 35 years for correction of the varus fifth toe. During this time, there has been no study of the results of this operation on children with long-term follow-up. We report the results of 20 operations in 16 children. The short-term results were good in 70%. However, postoperative review at a mean time of 2 years 1 month showed marked deterioration, with only 30% good results. V-Y plasty is not recommended for correction of the varus fifth toe.

Consequences of an osteogenesis imperfecta diagnosis for survival and ambulation.

In osteogenesis imperfecta, time of initial fracture and radiographic appearance of long bones and ribs at time of initial fracture provide good prognostic indicators concerning survival and ambulation. Osteogenesis imperfecta congenita (OIC) comprises those patients with intrauterine and/or birth fractures. Radiographs of newborns with OIC-A show short, broad, and crumpled femurs and ribs, whereas initial radiographs of patients with OIC-B demonstrate bones with normal contours in spite of fractures. Osteogenesis imperfecta tarda (OIT) comprises those patients who fracture initially after birth. Patients with OIT-A fracture initially before walking begins, and patients with OIT-B after walking has begun. In OIC-A, 15 of 16 (94%) died; one survived but was wheelchair bound. In OIC-B, only two of 27 (8%) died, with 59% in wheelchairs and 33% ambulatory. No patients with OIT died. In OIT-A, 33% were in wheelchairs and 67% were ambulatory. In OIT-B, 100% were ambulatory.