Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents.

The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years.

Bony hip reconstruction for displaced hips in patients with cerebral palsy: Is postoperative immobilization indicated?

Purpose: Decisions for postoperative immobilization after bony hip reconstructive surgery in cerebral palsy are controversial in current practice. The aim of this study was to check if choosing not to use any kind of postoperative immobilization is a safe practice.

Methods: A retrospective cohort study was conducted in a pediatric orthopedic tertiary referral center.

Measuring hip migration percentage in cerebral palsy using the HipScreen app.

Aims: Reimers migration percentage (MP) is a key measure to inform decision-making around the management of hip displacement in cerebral palsy (CP). The aim of this study is to assess validity and inter- and intra-rater reliability of a novel method of measuring MP using a smart phone app (HipScreen (HS) app).

Methods: A total of 20 pelvis radiographs (40 hips) were used to measure MP by using the HS app.

Lower limb alignment correction can improve knee stability in congenital absence of anterior cruciate ligament.

We report the 4-year postoperative outcome of a child with Manner Type I aplasia of the anterior cruciate ligament (ACL) in her left knee and severe genu valgum. The child was experiencing pain, reduced mobility, and frequent left knee locking and instability. The patient was successfully treated with hemiepiphysiodesis (guided growth procedure) of the left knee joint to treat genu valgum deformity using 8-plates, resulting in improvement of knee stability.

Surgical management of pes planus in children with cerebral palsy: A systematic review.

Purpose: Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal osteotomies, extra-articular arthrodesis, double calcaneal osteotomy, calcaneo-cuboid-cuneiform osteotomy, intra-articular arthrodesis, and arthroereisis. There is currently no evidence on optimal treatment for flatfoot in children with cerebral palsy.

Surgical management of an isolated symptomatic talonavicular coalition: a paediatric perspective.

Talonavicular (TN) coalition is a rare pathological union of the talus and navicular bones. We report the case of a 7-year-old girl with a symptomatic TN coalition, who underwent operative management with a lateral column lengthening procedure using autologous iliac crest bone grafting. There are no complications to report and the graft was incorporated at an early stage.

Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review.

Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on.Post-operative patient-reported outcome measures recorded marked improvement.

Is the Gothic Arch a reliable radiographic landmark for migration percentage in children with cerebral palsy?

Introduction: Reimers migration percentage (MP) is the gold standard for measuring hip displacement in children with cerebral palsy (CP). Hip surveillance registries proposed using the top of the Gothic arch (GA) as a modification in patients with acetabular dysplasia because the classical method (CM) described by Reimers may underestimate hip migration. The aim of this study is to assess the inter- and intra-observer reliability of the modified method (MM) versus the CM and identify their effect on the MP.

3D ultrasound to quantify lateral hip displacement in children with cerebral palsy: a validation study.

Aim: To assess the validity of a new index, lateral head coverage (LHC), for describing hip dysplasia in a population of children with cerebral palsy (CP).

Method: LHC is derived from 3D ultrasound assessment. Twenty-two children (15 males, seven females; age 4-15y) with CP undergoing routine hip surveillance were recruited prospectively for the study.

C-reactive protein: what to expect after bony hip surgery for nonambulatory children and adolescents with cerebral palsy.

Bony hip reconstruction surgery in children with severe cerebral palsy is associated with high complication rates, usually postoperative chest and urinary tract infections. C-reactive protein (CRP) level is commonly used as an indication of infection; an understanding of its normal postoperative trends is crucial to allow early identification of abnormal levels and possible infection. Our aim was to describe the trends in CRP following bony hip surgery in children who had an uneventful postoperative course, on the basis that the children for whom CRP does not follow this course are likely to have a bacterial infection.

Adolescent hallux valgus: a systematic review of outcomes following surgery.

Purpose: The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery.

Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique.

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System.

The prevalence of bifid iliopsoas tendon on MRI in children.

Objective: The variation in the anatomy of the iliopsoas tendon is important information for orthopaedic surgeons operating around the hip. The aim of this study was to identify the prevalence of bifid iliopsoas tendons in children on magnetic resonance imaging (MRI).

Methods: MRI hip and pelvis images of 50 sequential children aged 7-15 years were retrieved from our radiology database at the Evelina London Children's Hospital from 2007 to 2013.

Initial diagnostic approach of the irritable hip in childhood: is ultrasound really useful?

The acutely painful hip is a common complaint in childhood and has numerous significant causes. This prospective study explored the use of ultrasound as an adjunct to medical history and clinical examination in children with an irritable hip attending a department of orthopaedic emergencies over the course of 8 months. One hundred thirty four children met the inclusion criteria.

Pre-operative patient education reduces length of stay after knee joint arthroplasty.

Introduction: The aim of this study was to evaluate the impact of a pre-operative education programme on length of hospital stay after surgery for primary and revision knee arthroplasty patients. The programme was introduced at our hospital in October 2006 to encourage patients to play an active role in their recovery process after surgery.

Patients And Methods: A multidisciplinary team educated knee arthroplasty patients about their care pathway, knee surgery, pain management, expected discharge goals, in-patient and out-patient arthroplasty rehabilitation.

Preoperative surgical marking: a case of seeing double.

Preoperative marking is an integral part of the care of patients undergoing surgical procedures. It occurs on a daily basis in hospitals and involves all members of the healthcare staff and the patient. Incorrect marking or errors can lead to devastating consequences for the patient and staff involved.

Intraoperative complications using the Bio-Transfix femoral fixation implant in anterior cruciate ligament reconstruction.

The use of biodegradable Transfix femoral fixation technique is a safe and well-accepted method when performing anterior cruciate ligament reconstruction. We report on three cases of deformation and back out of the Bio-Transfix implant over the lateral, distal femoral cortex, with failure of the passing wire when advancing the graft into the femoral tunnel in one of these patients. Two of the patients presented with symptoms of iliotibial band friction syndrome, while the third patient was asymptomatic.

Penetrating injury of the hand with a door handle: a case report.

Introduction: Penetrating injuries of the hand with various sharp objects have previously been reported. In this report we describe an unusual penetrating injury of the hand caused by a door handle.

Case Presentation: A 32-year-old woman presented with a door handle stuck into her hand.

Is MRI useful in the early follow-up after autologous osteochondral transplantation?

The study was carried out to evaluate MRI findings following osteochondral auto-grafting in femoral condyles and talus, and to correlate these with the clinical outcome. Thirty-three patients (20 knees, 13 ankles) were examined 1 to 4 years after operation using MRI, Lysholm Knee Score and Foot and Ankle Osteoarthritis Score. Clinical examination showed pain relief and improved function and MRI images demonstrated graft incorporation.

An unusual presentation of a giant tumour-like lesion of the thigh.

Soft tissue swellings of the thigh, which become painful and are gradually increasing in size, should always raise the suspicion of a soft tissue tumour. We report a case of a clinically silent chronic granuloma formation, which presented 45 years later as a giant tumour-like lesion. A metallic foreign body implanted following an injury was found as the source of the tissue reaction.