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Ong EJY, Lee NKL, Mishra N, Ng SWL, Chua ZKH, Yet LK, Bin Zainuddin MA, Lim KBL, Mahadev A, Wong KPL. Improved Comfortability and Satisfaction of Hybrid-mesh Casts in the Conservative Management of Pediatric Supracondylar Humeral Fractures: A Randomized Controlled Trial. J Pediatr Orthop 2024; 44:157-163. [PMID: 37994645 DOI: 10.1097/bpo.0000000000002579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cast immobilization is the mainstay of treatment for stable pediatric supracondylar humeral fractures (SCHFs). In recent years, a waterproof and breathable hybrid-mesh (HM) cast has emerged and been marketed to address common complaints such as itch, skin irritation, and malodor. Hence, this randomized controlled trial seeks to assess the overall satisfaction, comfort, and clinical outcomes of using HM casts in the conservative treatment of stable pediatric SCHF. METHODS Seventy-nine patients (age range: 1 to 10 y) with modified Gartland's classification Type I and Type IIa SCHF were recruited and randomized for immobilization with either fiberglass or HM long-arm cast for 3 weeks. During follow-up visits, patients were assessed for any loss of reduction and skin rash. The weight of casts, the presence of cast breakage, the duration of cast application, and removal were recorded. A self-reported patient comfort and satisfaction questionnaire was also administered during the same visit. RESULTS The final analysis included 38 patients immobilized with fiberglass casts and 39 patients with HM casts. Despite the significantly longer duration required for HM cast removal (4.18±1.25 min vs. 2.25±0.55 min, P <0.001), the HM cast was significantly lighter than its fiberglass counterpart (162.82±23.94 g vs. 203.95±36.52 g, P <0.001). The HM casts have better comfort (4.05±0.887 vs. 3.47±0.951, P =0.007) and satisfaction (3.69±1.055 vs. 3.11±0.953, P =0.012) scores as compared to fiberglass casts for immobilizing pediatric SCHF without compromising clinical outcome. CONCLUSIONS HM casts have better comfort and overall satisfaction as compared to conventional fiberglass casts for immobilizing pediatric SCHF without compromising clinical outcomes. LEVEL OF EVIDENCE Level II-therapeutic studies-investigating the results of treatment.
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Aw AAL, Wong KPL, Lee NKL, Mahadev A. The utility of ultrasound and plain radiographs in the management of developmental dysplasia of the hip. J Pediatr Orthop B 2024; 33:9-15. [PMID: 36943691 DOI: 10.1097/bpb.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The purpose of this study is to assess the utility of follow-up radiological imaging in the management of developmental dysplasia of the hip (DDH) in patients successfully treated with the Pavlik harness. A retrospective review was conducted on all children under 6 months diagnosed with DDH at a tertiary pediatric hospital between January 2004 and December 2018. Inclusion criteria included successful Pavlik harness treatment following a standardized protocol with complete radiological documentation at 2 years of age. Ultrasonography was reviewed to measure the α and β angles and Graf classification. Anteroposterior pelvic radiographs were evaluated for the acetabular index and residual acetabular dysplasia. Seventy-eight hips from 57 infants were included in this study. The mean 6-month, 12-month and 2-year acetabular index of Graf I, IIa and IIc hips on ultrasound at 12 weeks were within the normal range according to age. There were no Graf IIb, IId, III and IV hips. All infants had normal radiographs at 2 years follow-up. The 6- and 12-month residual dysplasia rates in patients with DDH normalization at 12 weeks and 6 months range from 2.5 to 8.82%. Regardless of when the acetabular index normalized, all patients eventually had normal hip radiographs at 2 years of age. Following a standardized protocol, patients undergoing Pavlik harness treatment for DDH with Graf I and IIa hips at 12 weeks are likely to have normal plain radiographs at discharge. The incidence of residual dysplasia is very low and hence, radiographic surveillance is probably unnecessary until discharge at 2 years. Level II, retrospective study.
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Affiliation(s)
- Angeline Ai Ling Aw
- Faculty of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Nicole Kim Luan Lee
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
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Olandres RA, Seng DWR, Seneviratna A, Hamouda ESM, Foong BCM, Wong KPL, Mahadev A. C-reactive protein of ≥ 20 mg/L and ultrasound finding of an effusion ≥ 7 mm has a high specificity and sensitivity in diagnosing paediatric hip septic arthritis. Arch Orthop Trauma Surg 2023; 143:7027-7033. [PMID: 37530844 DOI: 10.1007/s00402-023-05005-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Differentiating septic arthritis (SA) from transient synovitis (TS) in children remains a diagnostic challenge. Several algorithms have been developed to diagnose SA including Kocher's criteria and its subsequent modifications, but reports show variable efficacy. This study aims to examine the diagnostic utility of a novel method only using C-reactive protein (CRP) and ultrasound (US) findings of effusion in differentiating SA from TS, determine the optimal values for these predictors and validate this method against existing clinical predictors. METHODS A 5-year retrospective study was performed including all paediatric patients with acute, non-traumatic hip pain with a suspicion of SA. All patients were evaluated using Kocher's criteria, Caird's criteria, and the novel method. Multivariate logistic regression was performed to identify independent clinical predictors of SA. The degree of agreement between the various methods were assessed using Cohen's kappa (k). Receiver operating characteristics (ROC) curves were used to examine the diagnostic accuracy of this novel method as well as to determine optimal cut-offs for US effusion and CRP in diagnosing SA. RESULTS Hundred and one patients were recruited. CRP and effusion on US were found to be independent predictors of SA. Both Kocher's and Caird's method showed good specificity (98.9%) but extremely poor sensitivity for SA (0%). When Kocher's four clinical predictors were present, probability of SA was only 59.16%. The k for both Kocher's and Caird's methods, was -0.017 indicating poor agreement. However the k in the novel method was 0.641, indicating good agreement. CONCLUSION Our study showed that the novel method using CRP (≥ 20 mg/L) and US finding of effusion (≥ 7 mm) has a high specificity (97%) and sensitivity (71%) in diagnosing SA.
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Affiliation(s)
- Richie Arollado Olandres
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Daniel Wei Ren Seng
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore, Singapore
| | - Aruni Seneviratna
- National Public Health and Epidemiology Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ehab Shaban Mahmoud Hamouda
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Bryan Chun Meng Foong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Leow XYJ, Tan JTC, Yeo TH, Wong KPL, Mahadev A, Ang B, Vasanwala RF, Ng ZM. Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition. Singapore Med J 2023; 64:550-556. [PMID: 34600448 PMCID: PMC10564096 DOI: 10.11622/smedj.2021124] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
Abstract
Introduction The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically. Therefore, we aimed to evaluate the risk factors associated with fragility fractures in children with LTNC. Methods In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC on follow-up in the paediatric neurology clinic and patients who presented with fracture to the paediatric orthopaedic clinic. Information on patients' demographics, medical history, intervention, biochemical bone markers and fracture history was collected. Results In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (Gross Motor Function Classification System [GMFCS] V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or were on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% and 33% of the patients had undergone measurements of vitamin D and calcium levels, respectively. Conclusion The local prevalence of fragility fractures in children with LTNC on follow-up at the neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimise bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight children, avoiding vitamin D deficiency and ensuring adequate calcium intake.
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Affiliation(s)
- Xue Yi Jessica Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Tong Hong Yeo
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | | | - Arjandas Mahadev
- Department of Paediatric Orthopaedics, KK Women’s and Children’s Hospital, Singapore
| | - Bixia Ang
- Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore
| | - Rashida Farhad Vasanwala
- Department of Paediatrics, Endocrine and Diabetes Service, KK Women’s and Children’s Hospital, Singapore
| | - Zhi Min Ng
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
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Tan JHI, Mat Jais IS, Wong KPL, Lee NKL, Wong YR, Chia DSY, Chew EM. The right turn around: Penrose tourniquet application in paediatrics. Injury 2023; 54:910-916. [PMID: 36635103 DOI: 10.1016/j.injury.2022.12.032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Commercially available tourniquets are ill-suited for paediatric patients with limb circumferences smaller than the required mechanism, forcing surgeons to improvise. This study aimed to quantify pressures exerted by the Penrose tourniquet when applied on a phantom model and evaluate the intra-/inter-rater reproducibility of the technique previously proposed. METHODS Eight calibrated pressure sensors were distributed evenly along the inner and outer circumference of a silicon-based model. A 30cm-by-3.2 cm ARGYLE Penrose drain, 4-by-4 gauze, marker and ruler were used. The optimal interval for arterial occlusion was determined to be 70% of limb circumference. The tourniquet was secured using two half-knots formed by gauze. RESULTS Two-turns of the tourniquet about the model generated mean pressures (SD) of 209.43 (SD:35.98 mmHg) (95%CI: 195.85-224.00 mmHg) (outer-sensor) and 246.32 (SD:61.92 mmHg) (95%CI: 221.02-273.49 mmHg) (inner-sensor). Three-turns generated mean pressures of 302.07 (SD:23.98 mmHg) (95%CI: 292.29-312.53 mmHg) (outer-sensor) and 314.44 (SD:56.70 mmHg) (95%CI: 291.25-338.25 mmHg) (inner-sensor). CONCLUSION The Penrose tourniquet has clinical utility, particularly for patients where commercially available tourniquets are not suitable. Current application techniques generate inconsistent pressures. Using the existing model, further refinement can be done to improve the consistency and safety of the application. We recommend using intervals of slightly more than 70% of limb circumference and only two turns of the Penrose tourniquet during application. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Joelle Hwee Inn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Nicole Kim Luan Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biomechanics Laboratory, Singapore General Hospital, Singapore; Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore; Division of Surgery, KK Women's and Children's HospitalDivision of Surgery, KK Women's and Children's Hospital
| | - Yoke-Rung Wong
- Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - Dawn Sinn Yii Chia
- Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore
| | - Ee Ming Chew
- Department of Orthopaedics Surgery, KK Women's and Children's Hospital, Singapore
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Tan DJ, Tan TWX, Tay GMLH, Lee NKL, Chew EM, Mahadev A, Wong KPL. Using the radiocoronoid line for diagnosis of elbow dislocation. J Pediatr Orthop B 2022; 31:442-448. [PMID: 35045007 DOI: 10.1097/bpb.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The radiocapitellar line (RCL) has been widely used to diagnose elbow dislocation. However, there are limitations to the RCL, with the cartilaginous portion of bone making interpretation of radiographs difficult. The study aims to show that the radiocoronoid line, which connects two points on the medial aspect of the radius, proximal to the radial tuberosity, is more suited to diagnose elbow dislocations in the anterior-posterior projection. This study also observes factors affecting accuracy of the radiocapitellar line. The radiographs of 50 normal and 17 laterally dislocated elbows were obtained. An unbiased independent reviewer drew the radiocoronoid and radiocapitellar line (RCL). Four other blinded independent reviewers drew the RCL and the radiocoronoid line for 20 radiographs and repeated the process a week later. The accuracy of the RCL was assessed using distance away from bisection point of capitellum, and ratio (distance from the point where line crosses capitellum to lateral aspect of capitellum over the total width of capitellum). The relationship of the radio-coronoid line and the lateral aspect of coronoid fossa was assessed, with dislocation being the line lateral to it and normal being medial to or on it. The radiocoronoid line had a higher accuracy (95.5%) compared to RCL (32.8%), higher specificity (94%) compared to RCL (10%) as well as higher positive predictive value (85%) compared to RCL (27.4%). There was no intra- or inter-observer variability for the radio-coronoid line. Skeletal age statistically predicted the ratio for the male population ( P < 0.05), however, the independent variables did not statistically predict the dependent variables for the female and total population. The radiocoronoid line serves as an additional method to assess radiocapitellar joint lateral dislocation. It is more accurate and reliable than the radiocapitellar line in the anterior-posterior projection. Sex and skeletal age also influence the accuracy of the radiocapitellar line with the radiocapitellar line nearing the bisection point as skeletal age in males increases.
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Tay LHGM, Tan WXT, Lee NKL, Chew EM, Mahadev A, Wong KPL. Retrospective analysis: risk factors predicting failure of closed reduction in pediatric diaphyseal forearm fractures treated with elastic stable intramedullary nails (ESINs). J Pediatr Orthop B 2022; 31:465-470. [PMID: 35045006 DOI: 10.1097/bpb.0000000000000953] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEVEL OF EVIDENCE Level IV.
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Mishra N, Yap ST, Lee NKL, Lua JYC, Tay YH, Saffari SE, Mahadev A, Chew EM, Wong KPL. Dose reduction for minimizing radiation in displaced paediatric supracondylar humerus fractures: single vs. automated pulse mode. J Pediatr Orthop B 2022; 31:296-302. [PMID: 34267167 DOI: 10.1097/bpb.0000000000000898] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conventional C-arm image intensifiers (CCA) are an essential and indispensable aid in modern orthopaedic surgery. CCAs are defaulted to auto-pulse mode which emit multiple pulses (or bursts) of radiation to obtain optimum image quality. The number of pulses per shot can be configured manually. The purpose of this study is to investigate the efficacy of the single pulse mode of CCA in reducing and fixing paediatric supracondylar humeral fractures (SCHF). A retrospective chart review of 99 paediatric patients who underwent closed reduction and percutaneous pinning of displaced SCHF was performed. Fifty-one consecutive cases operated with auto-pulse mode (group A). Another 48 consecutive cases were operated with the single-pulse mode (group B). Baumann's angle, operative duration and average radiation dose rate were recorded for comparison between both groups. Twenty postpinning images were randomly selected (10 from each group) to study intra- and interobserver reliability. Twelve doctors were recruited and tasked to identify if each X-ray was taken with the auto-pulse or single-pulse mode. This was repeated after 2 weeks. The patients in the auto-pulse mode group had a significantly higher mean radiation dose of 40.4 ± 32.51 cGycm2/min compared to that of 14.8 ± 3.24 cGycm2/min for the single-pulse group (P ≤ 0.001). All patients in both groups had Baumann's angle within normal range of 64-81°. No significant difference was noted in average intraoperative timings between both groups (P = 0.869). In the majority of cases, the doctors were unable to visually differentiate between the modes of CCA used. The single-pulse mode is an excellent alternative to the auto-pulse mode in fixing SCHF. It gives significantly lower radiation without compromising the surgical outcome. Level of evidence: Level III retrospective comparative study.
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Affiliation(s)
| | | | - Nicole Kim Luan Lee
- Department of Interventional and Diagnostic Imaging, KK Women's and Children's Hospital
| | | | - Yong Heng Tay
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | | | | | - Ee Ming Chew
- Department of Orthopaedic Surgery
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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Foong B, Wong KPL, Jeyanthi CJ, Li J, Lim KBL, Tan NWH. Osteomyelitis in Immunocompromised children and neonates, a case series. BMC Pediatr 2021; 21:568. [PMID: 34895166 PMCID: PMC8665553 DOI: 10.1186/s12887-021-03031-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteomyelitis in immunocompromised children can present differently from immunocompetent children and can cause devastating sequelae if treated inadequately. We aim to review the aetiology, clinical profile, treatment and outcomes of immunocompromised children with osteomyelitis. METHODS Retrospective review of all immunocompromised children aged < 16 years and neonates admitted with osteomyelitis in our hospital between January 2000 and January 2017, and referred to the Paediatric Infectious Disease Service. RESULTS Fourteen patients were identified. There were 10 boys (71%), and the median age at admission was 70.5 months (inter-quartile range: 12.3-135.0 months). Causal organisms included, two were Staphylococcus aureus, two were Mycobacterium bovis (BCG), and one each was Mycobacterium tuberculosis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia pseudomallei and Rhizopus sp. One patient had both Clostridium tertium and Clostridium difficile isolated. Treatment involved appropriate antimicrobials for a duration ranging from 6 weeks to 1 year, and surgery in 11 patients (79%). Wherever possible, the patients received treatment for their underlying immunodeficiency. For outcomes, only three patients (21%) recovered completely. Five patients (36%) had poor bone growth, one patient had recurrent discharge from the bone and one patient had palliative care for underlying osteosarcoma. CONCLUSIONS Although uncommon, osteomyelitis in immunocompromised children and neonates can be caused by unusual pathogens, and can occur with devastating effects. Treatment involves prolonged administration of antibiotics and surgery. Immune recovery also seems to be an important factor in bone healing.
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Affiliation(s)
- Bryan Foong
- Singapore General Hospital, Singapore, Singapore.
| | - Kenneth Pak Leung Wong
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Carolin Joseph Jeyanthi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jiahui Li
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kevin Boon Leong Lim
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Wong KPL, Mahadev A. Rare right acetabulum aneurysmal bone cyst treated with curettage and local adjuvants in a 4-year-old girl. BMJ Case Rep 2021; 14:e245586. [PMID: 34725063 PMCID: PMC8562523 DOI: 10.1136/bcr-2021-245586] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
Aneurysmal bone cysts are locally aggressive benign bone tumours with a high risk of recurrence. We describe a case in a 4-year-old girl, involving the right acetabulum. A direct posterior approach was used and the lesion ablated with curettage and local adjuvants with bone grafting. The cyst resolved swiftly with an uncomplicated recovery.
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Affiliation(s)
| | - Arjandas Mahadev
- Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore
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Chew EM, Wong KPL, Chan CMS, Teoh LC. Suture osteosynthesis in the bony reconstruction of thumb duplication. J Hand Surg Eur Vol 2021; 46:762-767. [PMID: 33884905 DOI: 10.1177/17531934211010078] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Metacarpal osteotomies are done to correct deviation deformity in thumb duplication. We describe a suture-only technique of metacarpal osteosynthesis, without using K-wires. Thirteen Flatt Type IV thumbs and five Wassel Type VII thumbs were reconstructed with this technique. The median follow-up was 23 months. After osteotomy, the metacarpal bone fragments were sutured together with 5-0 polyglactin or 4-0 polydioxanone sutures. Metacarpal fragment displacement was not observed on postoperative radiographs obtained at 1 and 2 weeks. Bony union was achieved at 6 weeks without loss of alignment. The metacarpophalangeal joint alignment was anatomical (≤5° deviation) in eight cases. The mean pre- and postoperative metacarpophalangeal joint alignments were 27° and 9°, respectively. The 11 patients who were available for grading with the Japanese Society for Surgery of the Hand Score were assessed as good. Complete internalization of the bony fixation eliminates infections associated with exposed K-wires without compromising the overall outcome.Level of evidence: IV.
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Affiliation(s)
- Ee Ming Chew
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore.,Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | | | - Lam Chuan Teoh
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore.,Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Republic of Singapore
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Wong KPL, Wong JLY, Mahadev A. Playground-related Extremity Fractures in an Asian Setting over the Last Decade - Are We Safe? J Epidemiol Glob Health 2020; 9:50-55. [PMID: 30932390 PMCID: PMC7310760 DOI: 10.2991/jegh.k.190225.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/11/2018] [Indexed: 11/01/2022] Open
Abstract
The cost of playground-related injuries remains significant. Measures adopted to prevent such fractures or reduce their severity would translate into appreciable financial savings. Our study looks at the changes in playground-related extremity fracture epidemiology over the past decade after the implementation of latest playground standards. This is a retrospective case series approved by the local ethics board comparing the results of two descriptive studies; one conducted prior to the implementation of the Singapore Productivity and Standards Board Singapore Standards SS 457: 2007 and the other thereafter. The demographics have remained the same. The proportion of public playground injuries has fallen significantly from 89.6% to 76.3% (p < 0.05), whereas school playground injuries have risen from 5.9% to 18.0% (p < 0.05). Fractures related to monkey bars and the flying fox have shown a significant improvement, decreasing to 38.1% from 47.6% (p < 0.05) and 1% from 6.9% (p < 0.05), respectively. There has been a decrease of 33% in playground-related injuries. The total financial cost of sustaining one playground-related extremity fracture has generally increased by 50%. However, considering the 37.4% drop in surgeries, the actual overall costs to the healthcare system have essentially fallen. Safety standards have had a positive effect on playground safety in Singapore. There are now fewer and less severe playground-related extremity fractures.
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Affiliation(s)
- Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - Jeannie Leh Ying Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore 229899, Singapore
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13
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Zhang DZ, Tan TH, Wong KPL, Sundaraghavan S, Choo JTL. Reperfusion Injury with Compartment Syndrome Following Systemic Thrombolysis for Cardiac Catheterization-Related Arterial Thrombosis in an Infant. J Pediatr Intensive Care 2020; 9:74-76. [PMID: 31984163 DOI: 10.1055/s-0039-1700522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022] Open
Abstract
Systemic thrombolysis is increasingly used for management of arterial thrombosis following cardiac catheterization, and complications apart from bleeding manifestations are not well reported. We report the case of an infant with lower limb ischemia secondary to femoral arterial thrombosis, which developed after cardiac catheterization. Systemic thrombolysis resulted in successful reperfusion of the lower limb. However, the infant subsequently developed compartment syndrome, requiring an emergent fasciotomy. This case highlights the importance of surveillance for the development of reperfusion injury-related compartment syndrome postsystemic thrombolysis for arterial thrombosis.
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Affiliation(s)
- Dyan Zhewei Zhang
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Teng Hong Tan
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth Pak Leung Wong
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sreekanthan Sundaraghavan
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jonathan Tze Liang Choo
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
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14
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Li ZX, Wong KPL, Wong JLY, Lim KBL, Mahadev A. The utility of mini C-arm in the fixation of unstable paediatric supracondylar humeral fractures. Injury 2019; 50:1992-1996. [PMID: 31526599 DOI: 10.1016/j.injury.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/28/2019] [Accepted: 09/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pediatric supracondylar humerus fractures have traditionally been reduced and fixed with conventional C-arm (CCA) fluoroscopy guidance. With the increase in popularity of the newer mini C-arm (MCA) system within other fields of surgery due to its ease of use and lower radiation emission, the same adoption should be explored in pediatric orthopedic surgeries. The purpose of this study is to compare the MCA and CCA primarily in reduction and fixation outcomes and secondarily in other perioperative parameters. METHODS Retrospective analysis of 193 patients who underwent surgical fixation for displaced supracondylar humerus fractures. 44 and 149 cases were performed with the MCA and CCA respectively. Baumann's angle and the intersection of anterior humeral line (AHL) were assessed on postoperative anterior posterior and lateral radiographs and adequate reduction was defined by an angle between 64 and 81˚, and AHL intersecting middle third of the capitellum. Surgical time, fluoroscopy duration, number of images and radiation exposure were obtained from the surgical notes. RESULTS Amongst the CCA cases, there were greater satisfactory coronal plane reduction (p < 0.05), while no difference in sagittal plane accuracy (p > 0.05) was seen. In MCA group, longer surgical (p < 0.05) and fluoroscopy times (p < 0.05), and greater number of shots (p < 0.05) was noted. However overall radiation exposure in the MCA group was still lower (p < 0.05). CONCLUSION The MCA system is potentially less accurate in coronal plane reduction and more challenging to use. However, pitfalls can easily be avoided. Usage should be advocated as overall radiation exposure can be reduced. LEVEL OF EVIDENCE Level III retrospective comparative study.
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Affiliation(s)
- Zong Xian Li
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore.
| | | | | | | | - Arjandas Mahadev
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore
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15
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Cheng SDJ, Wong KPL. Distraction osteogenesis of the humerus: a case of 100% humeral lengthening in a short duration without permanent complications. BMJ Case Rep 2019; 12:12/5/e228222. [PMID: 31092483 DOI: 10.1136/bcr-2018-228222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 15-year-old boy with right humeral shortening underwent distraction osteogenesis with 1 mm/day lengthening. Preoperative Sauvegrain method showed skeletal maturity and lengthening did not account for future growth. Functional loading was encouraged 2 months before end of consolidation phase to hasten consolidation and fixator removal was done in the clinic without local anaesthesia at the patient's request 1 month earlier. A Sarmiento brace was made and compliance taught to the patient; however, the patient did not wear the brace and resumed body weight exercise weeks after removal of the fixator. Two months after removal of the external fixator, plain radiographs showed good recanalisation of the humeral shaft with no fracture or distortion. However, the left humerus grew and is now 1 cm longer than the right humerus. Nevertheless, the patient was satisfied with the upper limb length discrepancy.
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16
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Wong KPL, Han AX, Wong JLY, Lee DYH. Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:411-417. [PMID: 27342983 DOI: 10.1007/s00167-016-4211-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/27/2015] [Accepted: 06/14/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study. METHODS The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed. RESULTS In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging. CONCLUSION MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects preoperatively. It is most accurate when evaluating medial meniscus tears. However, MR imaging should be used with discretion especially if there is a high index of suspicion of lateral meniscus tears. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Audrey XinYun Han
- Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore
| | | | - Dave Yee Han Lee
- Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore
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