International Journal of Surgery Case Reports 111 (2023) 108790

Introduction : Septic arthritis in the neonate is a devastating condition that affects children and causes irreversible limb dysfunction or deformity. Neonatal septic arthritis is harmful and will end with skeletal abnormalities.

Presentation of case : Neonate born with ileal atresia and underwent surgical treatment. Postoperatively, the patient experienced sepsis and was accompanied by septic arthritis. The patient was given triple IV antibiotic treatment without surgical debridement. Ten months later the deformity became prominent with physeal destruction of the affected area at distal femur. At age six the patient came to the orthopaedic outpatient clinic and there was a 3 cm limb-length discrepancy of both legs.

Discussion : Early diagnosis of septic arthritis is critical for successful treatment, since neonates with delayed proper diagnosis have been shown to have poor long-term prognosis. In our case the patient was only managed by IV antibiotics administration and continued with oral antibiotics. The reason for this decision due to general condition was improved after medication although clinically he still has a small amount of knee swelling.

Conclusion : Neonatal septic arthritis is dangerous and may have a devastating long term complication. Surgical management should be considered as treatment of choice if there is a lack or no progression from clinical and laboratory examination after antibiotic adminstration. Growth arrest on the distal femur will result in leg length disparity and angular deformity.

Orthopedic Research and Reviews 2023:15 19–25

Background : Congenital Talipes Equinovarus (CTEV) is a multitude of deformities involving equinus, varus, adductus, and cavus  deformities. Clubfoot affects 1 in every 1000 infants born worldwide, with various incidences according to geographical areas. It has been previously hypothesized that the possible genetic role in Idiopathic CTEV (ICTEV) might have a treatment-resistant phenotype. However, the genetic involvement in recurrent ICTEV cases is yet to be determined.

Aim : To systematically review existing literature regarding the discovery of genetic involvement in recurrent ICTEV to date to further understand the etiology of relapse.

Methods : A comprehensive search was performed on medical databases, and the review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed on several medical databases: PubMed (MEDLINE), Scopus, the Cochrane Library, and European PMC on May 10, 2022. We included studies reporting patients with recurring idiopathic CTEV or CTEV of unknown cause after treatment, reporting whole-genetic sequencing, whole-exome sequencing, Polymerase Chain Reaction, or Western blot analysis as methods of genetic analysis (inter[1]vention) and providing results of idiopathic CTEV genetic involvement. Non-English studies, literature reviews, and irrelevant articles were excluded. Quality and risk of bias assessments were performed using Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies where appropriate. The authors discussed data extracted with the primary outcome of gene(s) frequency being reported of their involvement in recurrent ICTEV cases.

Results : Three pieces of literature were included in this review. Two studies analyzed the genetic involvement in CTEV occurrence, while one analyzed the protein types found.

Discussion : With included studies of less than five, we could not perform other forms of analysis apart from qualitatively.

Conclusion : The rarity of literature exploring the genetic etiology of recurrent ICTEV cases has been reflected in this systematic review, giving opportunities for future research.

International Journal of Surgery Open 47 (2022) 100547

Background: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common but understudied developmental disease of the lower limb. The cause of congenital clubfoot is unclear, and the role of environmental and genetic factors remains unknown. Idiopathic CTEV and syndromic CTEV have rather different clinical features, proposed etiopathogenetic mechanisms, and treatment options. This study aimed to provide an update on the genes involved in idiopathic and syndromic CTEV.

Methods: We conducted this systematic review according to the guideline of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 Statement, only papers that have been published from the year 2019 until the search date was included. Three medical electronic databases (PubMed, Science Direct, and European PMC) were searched by a single author on October 24th, 2021. The titles and abstracts were screened where studies of any level of evidence reporting clinical or preclinical results published from 2019 onwards,
mentioned gene(s) involved in cases presenting with CTEV (idiopathic and syndromic) were included. Data were synthesized with use of the Microsoft Excel (Microsoft, Redmond, WA).

Results: Fifty-three studies were included and analyzed in this paper, which met all inclusion criteria (11 articles that discussed genes involved in the presence of isolated CTEV and 42 articles for syndromes with CTEV phenotypes). The top three individual genes mentioned were PITX1, MTHFR, and ZC4H2 for the idiopathic, also HOX D13, SLC 26A2, and TBX4 for the syndromic. The top three family genes related to CTEV were HOX family, CASP family, and COL family. According to the results, the most often involved in idiopathic CTEV is HOX gene. Including studies of any level of evidence reporting clinical or preclinical results that mentioned gene(s) involved in cases presenting with CTEV carries a greater risk of being due to multiple biases. High heterogeneity and the
paucity of high-profile studies on the etiology of CTEV also sets a major limitation for this study.

Conclusions: Genetic play a significant role in the etiopathogenesis of idiopathic and syndromic CTEV. PITX1 and MTHFR gene are the most frequently mentioned individual gene for idiopathic CTEV, whereas ZC4H2 gene being the most mentioned for syndromic CTEV. The HOX family genes were also found to be associated with both phenotypes.

International Journal of Surgery Case Reports 93 (2022) 106929

Introduction and importance: Distal femoral growth plate fracture is one of the most common growth plate fractures in the pediatric age, and associated with growth disturbance risk. Consequences that may arise are hindered growth, irreversible decrease in range of motion, instability, angular deformity and neurovascular issues. Fractures of the lateral condyle show a higher risk of developing sequelae compared to the medial side.

Case presentation: Corrective osteotomy of the distal femur was performed in patient with history of femoral fracture which undergone an ORIF procedure for the shaft at the previous hospital, while the lateral condyle fracture was treated conservatively. We did close wedge osteotomy medially and transferred the bone fragment to the lateral side as an open wedge to lengthen the lateral cortex. The leg-length discrepancy was reduced from 5 to 2 cm even though subsequent deformities may possibly occur.

Clinical discussion: The management approach for fracture of distal femoral physis can be done conservatively or surgically. Unfavorable outcomes from the conservative approach gave more reasons to opt for a surgical approach. The growth plate location should be considered when deciding which level of osteotomy is best and the fixation points in younger patients. When physeal bars are formed due to the fracture stress on the growth plate, the treatment is based on the patient’s age and the bar’s size.

Conclusion: Fractures of the distal femur involving a growth plate in children should not be considered a trivial case, and a comprehensive treatment plan should be coordinated.  

International Journal of Surgery Open 58 (2023) 100665

Background: In pediatric patients with developmental dysplasia of the hip (DDH), leg discrepancy may occur from Developmental dysplasia of hip treatment complications or from the treatment itself. Surgeons should be mindful that performing osteotomies
Pediatric patient Leg discrepancy Osteotomy Surgery complication with the purpose of providing better pelvic joint fit comes with risks of unequal bone growth. This article aimed to systematically review the reported leg length discrepancy (LLD) as a potential complication from osteotomy procedures in surgical treatment of pediatric patients with DDH.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews. A comprehensive search was performed on PubMed (MEDLINE), Scopus, the Cochrane Library and Europe PubMed Central in March 2022. Studies reporting outcomes of leg length discrepancy after osteotomy was performed were the main inclusion criteria. Quality and risk of bias assessment were performed by individual reviewers.

Results: From existing literatures, a total of eight studies were included in the review. From the data extracted, a total of 94 cases of DDH reported various LLD from 836 published cases with mean incidence of 11.2%. According to the patients’ age when the operation was performed, LLD of 2.20 cm was reported from the youngest patient operated on at 1.6 years old and LLD of 1.50 cm from the oldest patient operated on at 18 years old. The median LLD across the included studies was 1.30 cm. Limitations to this systematic review include study risk of bias, LLD reporting inconsistencies and assumptions when extracting the data which might have caused abnormal data distribution. Since no agreement exists regarding how much discrepancy between limb lengths is considered pathological, reports of cases and management of LLD vary widely. These results underline the importance of creating specific criteria to classify LLD severity and recommend appropriate treatment.

American  Journal of Case Reports, 2023; 24: e940977

Background: Congenital thumb duplication comes under the Wassel type IV classification is the hypoplastic variety, with the extra digit growing from the dominant thumb’s soft tissue alone. Excising the hypoplastic finger while reconstructing for the retained one has been the most adopted approach. Tourniquets are commonly utilized tools in orthopedic surgeries to reduce the amount of blood, thus enhancing the visibility. Unfortunately, tourniquetrelated nerve injury (TNRI) is gaining more attention as a serious complication of tourniquet use in surgery.

Case Report: A 13-year-old Asian boy with preaxial polydactyly Wassel type IV of the right hand underwent reconstruction surgery. A pneumatic tourniquet was applied at 200 mmHg on the right mid-upper arm and maintained for 90 min. After the surgery, the patient had total weakness with numbness, tingling, and burning sensation from his right upper arm to his fingertips. The neurological examination and nerve conduction studies (NCS) results were consistent with axonotmesis lesions. Pharmacological and physical rehabilitation therapy had successfully restored full motoric and sensory function after 6 months.

Conclusions: Nerve injury should be acknowledged as a possible complication from routinely-utilized tourniquets in orthopedic surgeries. Our cases may expand the need for further studies to establish a guideline for tourniquet use and TRNI management.

Annals of Medicine & Surgery (2023) 85:4300–4306

Background: Definitive fracture surgery should be performed as soon as the patient’s condition allows. However, there may be some delays in the treatment during a pandemic.

Objective: This study aimed to investigate and compare the epidemiology and delays in pediatric fracture management during the pandemic and prepandemic periods in terms of how many cases were delayed, how long were the delays, and the causes for the delays of fracture treatment.

Methods: This comparative-retrospective study was conducted in a tertiary referral hospital in Yogyakarta, Indonesia. The authors included all patients who presented to the hospital from 1 December 2019 to 30 November 2021 (pandemic group period) and from 1 December 2017 to 30 November 2019 (prepandemic group period). The collected data included: patients’ age and sex, fractured bone, fracture type, concurrent fracture, hospital stay duration, treatment, need for multidisciplinary treatment, interval from arrival to treatment, and reasons for delayed surgical treatment. The data were obtained from the patients’ medical records. Results: Results showed a decrease in the pediatric fracture cases during the 2 years pandemic period compared to the prepandemic period (75 vs. 135 cases). There was no significant difference in the evaluated parameters of demographic, fractured bone and type, hospital stay duration, treatment, other department involvement, and delayed surgical treatment for the fracture. The most common reason for the definitive surgical management delay was the need for medical condition improvements (n= 63, 79.7%) and it was significantly associated with the need for multidisciplinary treatment approach (22.83 in isolated orthopedic cases vs. 87.5% in multidisciplinary cases; P= 0.000).

Conclusion: There was a decrease in the pediatric fracture cases during the 2-year pandemic period compared to the prepandemic period. The delay in definitive surgical management was mainly due to the need for the medical condition improvements and it was associated with the need for a multidisciplinary treatment approach.

Jurnal Orthopaedi dan Traumatologi Indonesia – The Journal of Indonesian Orthopaedic & Traumatology
Volume 4, Number 3, December 2021

Background: Parenting a child born with a congenital disorder can be very unsettling and stressful for a long period of time. It takes patience, strength, and fortitude as well as a high sense of attention. Parents of children with congenital disorders are expected to collaborate along with healthcare professional and expect to receive support in return. Other than the medical team, parents are hopeful to find acceptance and comfort from the community around them. However, information regarding congenital disorders in society may not be as easily understood which limits their responses.

Main Discussion: This review explores the psychological issues faced by parents of children with congenital disorders of the musculoskeletal system. It is only natural for parents to experience emerging feelings of distress after knowing the unexpected truth. The additional care required for the child’s medical and social aspects adds to the parent’s personal and emotional baggage. Either by stigmatizing or providing support, society’s response to the child with congenital disorders is pivotal to determine the mental health of these parents. Eventually, the coping mechanism opted for by parents might affect their decision making process and eventually, the quality of care they provide for their child.

Conclusion: By recognizing the potential roots of distress one family might endure, healthcare professionals are expected to provide holistic and comprehensive services for parents of children with congenital disorders, including their psychological state.