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Klein C, Gouron R, Barbier V. Effects of botulinum toxin injections in the upper limbs of children with cerebral palsy: A systematic review of the literature. Orthop Traumatol Surg Res 2024; 110:103578. [PMID: 36754169 DOI: 10.1016/j.otsr.2023.103578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Spasticity is a common motor disorder in children with cerebral palsy (CP). Upper limb CP impairment has a significant negative impact on daily activities. Botulinum toxin (BTX-A) injections are widely used to reduce spasticity, but their effectiveness is not well-defined. We performed a systematic review of literature to answer questions about the effectiveness of BTX-A injections in the upper limb in children with CP. METHODS A systematic review of literature was conducted according to PRISMA guidelines. Eligible studies were randomized controlled trials with a high level of evidence on BTX-A upper limb injections in children. The outcomes analyzed included the study population, spasticity, quality of movement, activity limitations, quality of life, pain, appearance and side effects. RESULTS A total of 24 studies were included. The number of patients included was 1358 with a mean age between 3 and 11years. Improvement after BTX-A injection compared to the control group was observed for spasticity (n=10/19 studies), bimanual activities (Assisting Hand Assessment) (n=3/7), activity limitations (n=6/11), pain (n=2/2) and appearance (n=2/2). No study found an improvement in quality of life. Side effects were described in 16 studies and were moderate in all cases. CONCLUSION This review of literature showed that BTX-A injections can improve spasticity and particularly activity limitations when reasonable objectives are established. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Céline Klein
- Service de chirurgie orthopédique pédiatrique, CHU Amiens-Picardie, Amiens, France; Laboratoire MP3CV, centre de recherche universitaire en santé, CHU Amiens-Picardie, université Picardie Jules-Verne, Amiens, France.
| | - Richard Gouron
- Service de chirurgie orthopédique pédiatrique, CHU Amiens-Picardie, Amiens, France; Laboratoire MP3CV, centre de recherche universitaire en santé, CHU Amiens-Picardie, université Picardie Jules-Verne, Amiens, France
| | - Vincent Barbier
- Laboratoire MP3CV, centre de recherche universitaire en santé, CHU Amiens-Picardie, université Picardie Jules-Verne, Amiens, France; Service de médecine physique et de réadaptation pédiatrique, CHU Amiens-Picardie, Amiens, France
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Abuomira IESA, El-Alfy B, Seddik M, Mohammed Ahmed K, Khashaba AS, Al-Kot A. A modified angled plate for fixation of proximal femoral varus osteotomy in neuromuscular hip dislocation: Mechanical and clinical study. Orthop Traumatol Surg Res 2024; 110:103674. [PMID: 37666326 DOI: 10.1016/j.otsr.2023.103674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Proximal femoral osteotomy is an important step in the management of paralytic hip dislocation. Fixation by the angled plate is demanding and carries the risk of many complications. In this study, we made certain modifications for the angled plate. Does this plate provide a stable fixation for proximal femoral varus osteotomy? The main objective of this study was to assess the results of the modified plate in fixation of proximal femoral varus osteotomy in patients with neuromuscular hip dislocation. HYPOTHESIS This new system would offer significant advantages over the existing systems in terms of easy application and stable fixation. MATERIAL AND METHODS Twenty patients with paralytic hip dislocation were included in this study. The ages ranged from 5 to 15 years with a mean of 8.88±2.92 years. There were 12 boys and 8 girls. Seventeen patients had cerebral palsy and 3 had meningocele disease. Preoperative radiographs were done, and the migration percentage (MP), acetabular index (AI), and neck-shaft angle (NSA) were measured. All patients were treated with open reduction, pelvic osteotomy, and proximal femoral varus osteotomy. The femoral osteotomy was fixed by the modified angled plate in all cases. RESULTS The osteotomy sites united in all patients and the mean time of union was 2.9±0.65 months. The acetabular index, migration percentage, and neck-shaft angle were reduced postoperatively. This reduction was statistically significant. The hips remained stable throughout the period of follow-up in all patients. No cases were complicated by non-union or implant failure. CONCLUSION The modified angled plate (canulated interlocking blade Plate 90°) is a good method for the fixation of proximal femoral varus osteotomy in the management of neuromuscular hip dislocation. It provides a stable fixation. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
| | - Barakat El-Alfy
- Orthopedics and Traumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Seddik
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Khamis Mohammed Ahmed
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
| | - Ahmed Sayed Khashaba
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Amer Al-Kot
- Orthopedics and Traumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Angelliaume A, Harper L, Bouty A, Bouteiller C, Deleplanque B, Ravel M, Le Hanneur M, Narayanan UG, Ferdynus C, Pfirrmann C. Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire. Orthop Traumatol Surg Res 2023:103753. [PMID: 37979675 DOI: 10.1016/j.otsr.2023.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP. OBJECTIVE To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV). MATERIAL AND METHODS The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients. RESULTS The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains. CONCLUSION The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Audrey Angelliaume
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Luke Harper
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Aurore Bouty
- Department of Pediatric Surgery, The Royal Children's Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia
| | - Cécile Bouteiller
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Brigitte Deleplanque
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Magaly Ravel
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopaedics, Trousseau University Hospital, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Unni G Narayanan
- Department of Orthopaedic Surgery and Child Health Evaluative Science, Hospital of Sick Children, Toronto, Canada
| | - Cyril Ferdynus
- Methodological Support Unit, University Hospital, allée des Topazes, 97400 Saint-Denis, Reunion Island, France
| | - Clémence Pfirrmann
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Yu S, Wang C, Lei K, Leng X, Zhang L, Tian F, Chen Z. Case report: genetic analysis of a child with 18q deletion syndrome and developmental dysplasia of the hip. BMC Med Genomics 2022; 15:199. [PMID: 36123715 PMCID: PMC9484224 DOI: 10.1186/s12920-022-01345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze the genotypes and phenotypes of a child with developmental dysplasia of the hip (DDH), developmental delays, recurrent fever, hypothyroidism and cleft palate. METHODS G-banding karyotyping analysis and next-generation sequencing (NGS) were performed for the patient. The genotypes of the parents of the patient were verified by copy number variation analysis and Sanger sequencing to determine the source of variations. RESULTS The karyotype of the patient was 46, XX. A 10.44 Mb deletion (chr18:67562936-78005270del) at 18q22.2q23 was found by NGS. We identified 2 HSPG2 mutations (chr1: 22206699, c.2244C > A, exon 17, p.H748Q; chr1: 22157321-22157321, c.11671 + 154insA, intron). One mutation was inherited from the father, and the other was inherited from the mother. CONCLUSION This is the first 18q deletion syndrome case accompanied by DDH. Most phenotypes of this patient, such as developmental delays and cleft palate, may be related to the 18q22.2q23 deletion, but no variants in genes related to DDH were found in this deletion region. DDH may be related to mutations of HSPG2.
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Affiliation(s)
- Shufeng Yu
- Affiliated Hospital of Qingdao University, Qingdao, China.,Qingdao University, Qingdao, China
| | - Caixia Wang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ke Lei
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuefei Leng
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Tian
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhihong Chen
- Affiliated Hospital of Qingdao University, Qingdao, China.
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Che X, Liu J, Galea GL, Zhang Y, Greene NDE, Zhang L, Jin L, Wang L, Ren A, Li Z. Non-Isolated Neural Tube Defects with Comorbid Malformations Are Responsive to Population-Level Folic Acid Supplementation in Northern China. BIOLOGY 2022; 11:biology11091371. [PMID: 36138850 PMCID: PMC9495576 DOI: 10.3390/biology11091371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Neural tube defects are severe congenital malformations of the central nervous system. Some cases also have comorbid malformations in other organ systems, which cause morbidity and mortality in affected individuals. Although folic acid is effective in preventing neural tube defects, whether folic acid prevents those cases which have comorbid malformations, or only isolated neural tube defects is unknown. In this study, we described the epidemiology of neural tube defects with comorbid malformations and assessed the impact of folic acid supplementation. We found the prevalence of neural tube defects with comorbid malformations decreased after population-level folic acid supplementation in northern China. Malformations of various organ systems are more common in people with neural tube defects, suggesting common etiology. For fetuses with NTDs, clinicians are also suggested to consider screening for possible comorbid congenital malformations. Abstract Objective: Comorbid congenital malformation of multiple organs may indicate a shared genetic/teratogenic causality. Folic acid supplementation reduces the population-level prevalence of isolated neural tube defects (NTDs), but whether complex cases involving independent malformations are also responsive is unknown. We aimed to describe the epidemiology of NTDs with comorbid malformations in a Chinese population and assess the impact of folic acid supplementation. Study Design: Data from five counties in Northern China were obtained between 2002 and 2021 through a population-based birth defects surveillance system. All live births, stillbirths, and terminations because of NTDs at any gestational age were recorded. NTDs were classified as spina bifida, anencephaly, or encephalocele. Isolated NTDs included spina bifida cases with presumed secondary malformations (hydrocephalus, hip dislocation, talipes). Non-isolated NTDs were those with independent concomitant malformations. Results: A total of 296,306 births and 2031 cases of NTDs were recorded from 2002–2021. A total of 4.8% of NTDs (97/2031) had comorbid defects, which primarily affected the abdominal wall (25/97), musculoskeletal system (24/97), central nervous system (22/97), and face (15/97). The relative risk of cleft lip and/or palate, limb reduction defects, hip dislocation, gastroschisis, omphalocele, hydrocephalus, and urogenital system defects was significantly greater in infants with NTDs than in the general population. Population-level folic acid supplementation significantly reduced the prevalence of both isolated and non-isolated NTDs. Conclusion: Epidemiologically, non-isolated NTDs follow similar trends as isolated cases and are responsive to primary prevention by folic acid supplementation. Various clinically-important congenital malformations are over-represented in individuals with NTDs, suggesting a common etiology.
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Affiliation(s)
- Xiaoyu Che
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (J.L.); (Z.L.)
| | - Gabriel L Galea
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1E, UK; (G.L.G.); (N.D.E.G.)
| | - Yali Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Nicholas D. E. Greene
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1E, UK; (G.L.G.); (N.D.E.G.)
| | - Le Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Lei Jin
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Linlin Wang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Zhiwen Li
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing 100191, China; (X.C.); (Y.Z.); (L.Z.); (L.J.); (L.W.); (A.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (J.L.); (Z.L.)
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