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Khan H, Monsell F, Duffy S, Trompeter A, Bridgens A, Gelfer Y. Paediatric tibial shaft fractures: an instructional review for the FRCS exam. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03484-3. [PMID: 36788165 DOI: 10.1007/s00590-023-03484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
This instructional review presents the literature and guidelines relevant to the classification, management and prognosis of paediatric tibial shaft fractures at a level appropriate for the FRCS exit examination in Trauma and Orthopaedic surgery.
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Affiliation(s)
- H Khan
- Trauma and Orthopaedic Department, Kingston Hospital, London, UK.
| | - F Monsell
- Bristol Royal Hospital for Children, Bristol, UK
| | - S Duffy
- Trauma and Orthopaedic Department, Bristol Royal Infirmary, Bristol, UK
| | - A Trompeter
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
| | - A Bridgens
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
| | - Y Gelfer
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
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2
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Khan H, Monsell F, Duffy S, Trompeter A, Bridgens A, Gelfer Y. Paediatric distal radius fractures: an instructional review for the FRCS examination. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03409-6. [PMID: 36201032 DOI: 10.1007/s00590-022-03409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
An instructional review of the literature and guidelines relevant for the classification, management and prognosis of paediatric distal radius fractures. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination.
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Affiliation(s)
- H Khan
- Trauma and Orthopaedic Department, Epsom and St Helier NHS Trust, Carshalton, UK.
| | - F Monsell
- Bristol Royal Hospital for Children, Bristol, UK
| | - S Duffy
- Trauma and Orthopaedic Department, Bristol Royal Infirmary, Bristol, UK
| | - A Trompeter
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
| | - A Bridgens
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
| | - Y Gelfer
- Trauma and Orthopaedic Department, St George's Hospitals NHS Foundation Trust, London, UK
- St George's University, London, UK
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3
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Benning MS, Berwin J, Monsell F, Carpenter C, Kendall J, Crosswell S, Thomas S, Knapper T. 192 An Audit of The Delivery of Paediatric Orthopaedic Services at The Bristol Royal Children’s Hospital in Response to The British Orthopaedic Association Standards for Trauma (BOAST) COVID-19 Guidance. Br J Surg 2021. [PMCID: PMC8135796 DOI: 10.1093/bjs/znab134.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Guidance from the BOAST helped structure our paediatric orthopaedic service n response to COVID-19. We assessed our compliance with 'BOAST COVID-19 standards', whether it is possible to run a safe and effective paediatric orthopaedic service. Method We performed a prospective audit of clinic and theatre data (16th March to 30th April 2020), from the paediatric orthopaedic department at the BRCH against the 'BOAST COVID-19 standards'. We also performed a retrospective audit. Results Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with an increasing trend seen. The number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases dropped by 50% with similar case mix year-on-year. All elective operating was cancelled in 2020. Conclusions By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy, cost, and sustainability of our COVID-19 service.
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Affiliation(s)
- M S Benning
- Bristol Medical School, Bristol, United Kingdom
| | - J Berwin
- Bristol Royal Children' s Hospitals (BRCH), Bristol, United Kingdom
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4
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Goodall R, Claireaux H, Hill J, Wilson E, Monsell F, BOAST 11 Collaborative, Tarassoli P. Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines. Bone Joint J 2018; 100-B:346-351. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0780.r2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective audit of adherence to BOAST 11 standard 1. Data were collected from eight hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 3 supracondylar fractures were eligible for inclusion. A centrally created data collection sheet was used to guide objective analysis of whether BOAST 11 standard 1 was adhered to. Stage 2: We created a quality improvement proforma for use in emergency departments. This was piloted in one of the hospitals used in the primary audit and was re-audited using equivalent methodology. In all, 102 patients presenting between January 2016 and July 2017 were eligible for inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited, adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the motor and sensory function of the individual nerves specified, 318 (73%) for radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102 patient notes audited, adherence to BOAST 11 standard 1 improved to between 72 (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma; when the proforma was used, adherence improved to between 40 (91%) and 43 (98%) throughout. Conclusion Adherence to BOAST 11 standard 1 is poor in hospitals across the country. This is concerning as neurovascular deficit may be an indication for emergent surgery, and missed neurovascular injury can cause long-term, or even permanent, functional impairment. We present a simple proforma that improves adherence to this standard, can easily be implemented into emergency departments, and may improve patient safety. Cite this article: Bone Joint J 2018;100-B:346–51.
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Affiliation(s)
- R. Goodall
- Bristol Medical School, University of
Bristol, Senate House, Tyndall
Avenue, Bristol BS8 1TH, UK
| | - H. Claireaux
- Oxford University Clinical Academic School,
John Radcliffe Hospital, Headley Way, Headington, Oxford
OX3 9DU, UK
| | - J. Hill
- Department of Paediatric Orthopaedics,
Bristol Children’s Hospital, Upper Maudlin Street, Bristol
BS2 8BJ, UK
| | - E. Wilson
- Bristol Medical School, University of
Bristol, Senate House, Tyndall
Avenue, Bristol BS8 1TH, UK
| | - F. Monsell
- Department of Paediatric Orthopaedics,
Bristol Children’s Hospital, Upper Maudlin Street, Bristol
BS2 8BJ, UK
| | | | - P. Tarassoli
- Severn Deanery, Department of Orthopaedics,
Royal United Hospitals Bath, Combe Park, Avon
BA1 3NG, UK
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5
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Abstract
PURPOSE The purpose of this study is to evaluate a surgical technique that aims to address the multi-planar deformities occurring in early onset Blount's disease. METHODS Seven patients (eight lower limbs) with early onset Blount's disease were treated with a surgical technique that used an external fixator to simultaneously address all aspects of deformity. Presenting radiographic parameters including mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and medial plateau angle (MPA) were compared with final follow-up and the unaffected limb. Data was also collected on surgical complications and functional outcomes. RESULTS After a mean interval of 4.6 years (2.2 to 9), the MAD of the affected limb improved from 4.85 cm to 1.88 cm, MPTA from 43.58° to 75.46° and MPA from 43.41° to 20.71°. The mean time in the external fixator was 5.6 months (3.5 to 10.4). Recurrence was noted in three patients; two had evidence of nerve injury and one patient had premature fibular consolidation. CONCLUSION The surgical technique described in this study has attempted to address the complex multiaxial deformity that is encountered in Blount's disease. It identifies difficulties and limitations in developing a comprehensive surgical protocol and highlights complications associated with this approach.
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Affiliation(s)
| | - R. Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - F. Monsell
- Department of Orthopaedics, Royal Hospital for Children, Bristol, UK
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Boyce AM, Turner A, Watts L, Forestier-Zhang L, Underhill A, Pinedo-Villanueva R, Monsell F, Tessaris D, Burren C, Masi L, Hamdy N, Brandi ML, Chapurlat R, Collins MT, Javaid MK. Improving patient outcomes in fibrous dysplasia/McCune-Albright syndrome: an international multidisciplinary workshop to inform an international partnership. Arch Osteoporos 2017; 12:21. [PMID: 28243882 PMCID: PMC5653227 DOI: 10.1007/s11657-016-0271-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED To develop consensus on improving the management of patients, we convened an international workshop involving patients, clinicians, and researchers. Key findings included the diagnostic delay and variability in subsequent management with agreement to develop an international natural history study. We now invite other stakeholders to join the partnership. PURPOSE The aim of this study was develop a consensus on how to improve the management of patients with fibrous dysplasia and prioritize areas for research METHODS: An international workshop was held over 3 days involving patients, clinicians, and researchers. Each day had a combination of formal presentations and facilitated discussions that focused on clinical pathways and research. RESULTS The patient workshop day highlighted the variability of patients' experience in getting a diagnosis, the knowledge of general clinical staff, and understanding long-term outcomes. The research workshop prioritized collaborations that improved understanding of the contemporary natural history of fibrous dysplasia/McCune-Albright syndrome (FD/MAS). The clinical workshop outlined the key issues around diagnostics, assessment of severity, treatment and monitoring of patients. CONCLUSIONS In spite of advances in understanding the genetic and molecular underpinnings of fibrous dysplasia/McCune-Albright syndrome, clinical management remains a challenge. From the workshop, a consensus was reached to create an international, multi-stakeholder partnership to advance research and clinical care in FD/MAS. We invite other stakeholders to join the partnership.
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Affiliation(s)
- A. M. Boyce
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA,Bone Health Program, Division of Orthopedics and Sports Medicine, Children’s National Medical Center, Washington, DC, USA,Division of Endocrinology and Diabetes, Children’s National Medical Center, Washington, DC, USA
| | - A. Turner
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - L. Watts
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - L. Forestier-Zhang
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - A. Underhill
- Chandlers Ford, Eastleigh, Hampshire SO53 1TQ, UK
| | - R. Pinedo-Villanueva
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - F. Monsell
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - D. Tessaris
- Department of Pediatric Endocrinology and Diabetology, Regina Margherita Children Hospital, University of Turin, Piazza Polonia 94, 10126 Turin, Italy
| | - C. Burren
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - L. Masi
- Department of Internal Medicine, University of Florence, Florence, Viale Pieraccini 6, 50134 Florence, Italy
| | - N. Hamdy
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden 2333 ZA, The Netherlands
| | - M. L. Brandi
- Department of Internal Medicine, University of Florence, Florence, Viale Pieraccini 6, 50134 Florence, Italy
| | - R. Chapurlat
- NSERM UMR 1033, Department of Rheumatology, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | - M. T. Collins
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Muhammad Kassim Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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7
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Bruce D, Kocialkowski C, Bintcliffe F, Monsell F, Barnes J, Brown R. Analysis of a paediatric orthopaedic network: a six-year experience in the South West of the United Kingdom. J Child Orthop 2017; 11:404-413. [PMID: 29081857 PMCID: PMC5643936 DOI: 10.1302/1863-2548.11.170076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We report our experience of a paediatric orthopaedic network, based on a 'hub and spoke' model, covering the South West of the United Kingdom. We identify the areas of most clinical concern, the effect of the network on stream-lining patient management and the benefits of the network to the clinician. METHODS Prospective data were collected from the minutes of the bi-annual meetings of the South West Paediatric Network (UK) between November 2006 and May 2012. Data collected included details of the condition, previous treatment, problems, complications and advice given. Cases continue to be followed up in subsequent meetings. RESULTS In total 131 cases were included and hip conditions were discussed most frequently (35.1%). The most common indication for discussion was to support and confirm the local management plan. In total, a mean average of 8.75 cases in total were presented per consultant during the study period, with those within ten to 12 years of starting independent practice presenting the majority. The clinical outcome for patients discussed in this forum was local provision of care in 74%, with transfer to the regional centre in 15.7%. Following advice, 14% of direct referrals were given appropriate advice and avoided a journey to the tertiary centre. CONCLUSION The network has enabled local provision of care, reduced the burden of travel on patients and prevented unnecessary referrals to the tertiary centre. Additionally, it provides a mechanism to reassure and educate clinicians.
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Affiliation(s)
- D. Bruce
- Royal United Hospital, Bath BA1 3NG, UK,Correspondence should be sent to: D. Bruce, Orthopaedic Trauma Department, Southmead hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom. E-mail:
| | | | - F. Bintcliffe
- Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
| | - F. Monsell
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - J. Barnes
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - R. Brown
- Cheltenham General Hospital, Cheltenham GL53 7AN, UK
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8
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Hughes A, Heidari N, Mitchell S, Livingstone J, Jackson M, Atkins R, Monsell F. Computer hexapod-assisted orthopaedic surgery provides a predictable and safe method of femoral deformity correction. Bone Joint J 2017; 99-B:283-288. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0271.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/26/2016] [Indexed: 11/05/2022]
Abstract
Aims Computer hexapod assisted orthopaedic surgery (CHAOS), is a method to achieve the intra-operative correction of long bone deformities using a hexapod external fixator before definitive internal fixation with minimally invasive stabilisation techniques. The aims of this study were to determine the reliability of this method in a consecutive case series of patients undergoing femoral deformity correction, with a minimum six-month follow-up, to assess the complications and to define the ideal group of patients for whom this treatment is appropriate. Patients and Methods The medical records and radiographs of all patients who underwent CHAOS for femoral deformity at our institution between 2005 and 2011 were retrospectively reviewed. Records were available for all 55 consecutive procedures undertaken in 49 patients with a mean age of 35.6 years (10.9 to 75.3) at the time of surgery. Results Patients were assessed at a mean interval of 44 months (6 to 90) following surgery. The indications were broad; the most common were vitamin D resistant rickets (n = 10), growth plate arrest (n = 6) and post-traumatic deformity (n = 20). Multi-planar correction was required in 33 cases. A single level osteotomy was performed in 43 cases. Locking plates were used to stabilise the osteotomy in 33 cases and intramedullary nails in the remainder. Complications included two nonunions, one death, one below-knee deep vein thrombosis, one deep infection and one revision procedure due to initial under-correction. There were no neurovascular injuries or incidence of compartment syndrome. Conclusion This is the largest reported series of femoral deformity corrections using the CHAOS technique. This series demonstrates that precise intra-operative realignment is possible with a hexapod external fixator prior to definitive stabilisation with contemporary internal fixation. This combination allows reproducible correction of complex femoral deformity from a wide variety of diagnoses and age range with a low complication rate. Cite this article: Bone Joint J 2017;99-B:283–8.
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Affiliation(s)
- A. Hughes
- Alfred Hospital, 55
Commercial Road, Melbourne, Australia
| | - N. Heidari
- Royal London Hospital, Whitechapel
Road, London, UK
| | - S. Mitchell
- University Hospitals Bristol NHS Trust, Bristol
Royal Infirmary, Upper Maudlin Street, Bristol
BS2 8HW, UK
| | - J. Livingstone
- University Hospitals Bristol NHS Trust, Bristol
Royal Infirmary, Upper Maudlin Street, Bristol
BS2 8HW, UK
| | - M. Jackson
- University Hospitals Bristol NHS Trust, Bristol
Royal Infirmary, Upper Maudlin Street, Bristol
BS2 8HW, UK
| | - R. Atkins
- University Hospitals Bristol NHS Trust, Bristol
Royal Infirmary, Upper Maudlin Street, Bristol
BS2 8HW, UK
| | - F. Monsell
- University Hospitals Bristol NHS Trust, Bristol
Royal Hospital for Children, Upper Maudlin
Street, Bristol, UK
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10
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Affiliation(s)
- C Meadows
- Bristol Royal Hospital for Children, Bristol, UK
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11
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Abstract
Slipped capital femoral epiphysis is a condition likely to be encountered by all practising orthopaedic surgeons. A sound knowledge of the risk factors, presentation, investigation and management is essential to prevent the potentially significant consequences of missing the diagnosis. We present an overview of the condition, along with a review of the relevant literature to date.
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Affiliation(s)
- S R Mitchell
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK
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12
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Abstract
The results of a functional, clinical and radiological study of 30 children (60 hips) with whole-body cerebral palsy were reviewed at a mean follow-up of 10.2 years (9.5 to 11). Correction of windsweep deformity of the hips was performed by bilateral simultaneous combined soft-tissue and bony surgery at a mean age of 7.7 years (3.1 to 12.2). We were able to recall 22 patients; five had died of unrelated causes and three were lost to follow-up. Evaluation involved interviews with patients/carers and clinical and radiological examination. The gross motor functional classification system was used to assess overall motor function and showed improvement in seven patients. Of the 12 patients thought to have pain pre-operatively, only one had pain post-operatively. Improved handling was reported in 18 of 22 patients (82%). Those with handling problems were attributed by the carers to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, and the mean windsweep index improved from 50 pre-operatively to 36 at follow-up. The migration percentage and centre-edge angle were assessed on plain radiographs. Radiological containment improved, the mean migration percentage improved from 50 pre-operatively to 20 at follow-up and the mean centre-edge angle improved from −5° to 29°. No statistical difference was noted between the three-year and ten-year follow-up results, indicating that the improvements in clinical and radiological outcome had been maintained.
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Affiliation(s)
- M. J. Barakat
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - T. While
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - J. Pyman
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - M. Gargan
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - F. Monsell
- Bristol Royal Hospital for Children, Paul O’Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, UK
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13
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Abstract
Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process. We retrospectively reviewed 16 patients who were diagnosed as having osteofibrous dysplasia initially or on the final histological examination. Their management was diverse, depending on the severity of symptoms and the extent of the lesion. Definitive (extraperiosteal) surgery was localised ‘shark-bite’ excision for small lesions in five patients. Extensive lesions were treated by segmental excision and fibular autograft in six patients, external fixation and bone transport in four and proximal tibial replacement in one. One patient who had a fibular autograft required further excision and bone transport for recurrence. Six initially underwent curettage and all had recurrence. There were no recurrences after localised extraperiosteal excision or bone transport. There were three confirmed cases of adamantinoma. The relevant literature is reviewed. We recommend extraperiosteal excision in all cases of osteofibrous dysplasia, with segmental excision and reconstruction in more extensive lesions.
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Affiliation(s)
- R S Lee
- Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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14
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Barker KT, Foulkes WD, Schwartz CE, Labadie C, Monsell F, Houlston RS, Harper J. Is the E133K allele of VG5Q associated with Klippel-Trenaunay and other overgrowth syndromes? J Med Genet 2006; 43:613-4. [PMID: 16443853 PMCID: PMC2564558 DOI: 10.1136/jmg.2006.040790] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND It has been reported that the activating mutation, E133K, in the angiogenic factor VG5Q (formally named AGGF1) causes Klippel-Trenaunay Syndrome (KTS), a rare vascular disease associated with asymmetric overgrowth. This proposal followed from the observation that five out of 130 KTS patients were constitutionally heterozygous for VG5Q, E133K. OBJECTIVE To explore the possibility that VG5Q, and specifically E133K, is implicated in other mosaic overgrowth syndromes. RESULTS 24 patients were analysed for this sequence change. One patient was constitutionally heterozygous for E133K. Analysis of both parents revealed that the patient's mother, who was healthy, also carried E133K. An analysis of 275 healthy controls showed that 3.3% (9/275) of the population were carriers of E133K. CONCLUSIONS The findings bring into question the assertion that VG5Q, E133K is a mutation and that it causes KTS.
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Abstract
This article attempts to define normal development throughout childhood and provide straightforward advice in the physical assessment of the child in this situation. It also attempts to outline the groups of conditions that lead to walking abnormalities and highlight the salient physical features and special investigations that are required to make these diagnoses with confidence.
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Affiliation(s)
- S Tennant
- Royal National Orthopaedic Hospital, Stanmore
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16
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Halliwell P, Monsell F. Growing pains: a diagnosis of exclusion. Practitioner 2001; 245:620-3. [PMID: 11464551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- P Halliwell
- Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, London
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17
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McNab I, Monsell F. Children's orthopaedics in primary care. Practitioner 1998; 242:785-9, 791-2. [PMID: 10441893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- I McNab
- Great Ormond Street Hospital for Children NHS Trust
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18
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