Outcome of Open Hip Reduction, Pelvic Osteotomy, and Varus Derotational Osteotomy in Children With Cerebral Palsy: A Retrospective Study.

Introduction For spastic hip dislocations, a variety of operations are available with open hip reduction and varus derotational osteotomy of the proximal femur combined with pelvic osteotomy ± adductor release being a good option with favourable outcomes. This study aims to assess the outcome and complications of combined open hip reduction with pelvic osteotomy and varus derotational osteotomy. Methods In this study, 70 hips in 52 patients with spastic hip dislocation due to cerebral palsy were included. All included patients were treated surgically in our institute between January 2016 and December 2021. There were 31 males and 21 females. For each patient, information was collected about the age at the time of surgery and different radiological parameters at three different time intervals: pre-operatively, immediately post-operatively, and at the final follow-up. We also collected information about any complications arising from the surgery performed. Results The mean duration of follow-up was 19.58 months. The acetabular index decreased from an average of 35.01° to 17.18° with a mean difference of 17.83° (p<0.001). The central edge angle, which averaged -49.13° in the pre-operative period, increased to 26.34° and then marginally decreased to 25.47° at the final follow-up. The average migration index of 80.51% in the pre-operative period improved to 1.4% post-operatively with a mean difference of -79.11% (p<0.01). The migration index increased to 8.54% at the final follow-up. Similarly, the neck-shaft angle, which averaged 160.89° in the pre-operative period, decreased to 125.23° at the time of final follow-up with a percentage change of -22.16%. Conclusion Single-stage combined surgery in the form of combined open hip reduction and pelvic osteotomy with varus derotational osteotomy successfully treats the condition and shows good outcomes in patients with spastic hip dislocations. This treatment is associated with very few complications.

Severe ocular injuries from pointed door handles in children.

OBJECTIVE: To report severe ocular injuries caused by pointed door handles in children. DESIGN: Noncomparative, interventional, retrospective case series. METHODS: Clinical records of 15 patients who sustained severe ocular injuries from door handles were reviewed for place of trauma, presenting symptoms and signs, surgical procedures performed, and final outcome. MAIN OUTCOME MEASURES: Trauma caused by complications from the door handle injury, such as loss of vision and ocular and adnexal injuries, and treatment rendered. RESULTS: There were 12 boys and 3 girls with an average age of 7.8 years (range, 6-10 years). Place of trauma was at home in 12 children and in school in 3 children. Presenting visual acuity (VA) was 4/200 in 1 patient, light perception (LP) in 5 patients, and no light perception (NLP) in 9 patients. There were 9 eyelid or canalicular lacerations, 4 ruptured globes, and 14 optic nerve avulsions. All ruptured globes were repaired initially and eyelid and canalicular lacerations were repaired primarily within 24 hours of presentation. Average follow-up was 21 months (range, 1 month-8 years). Final VA was 20/30 in 1 patient, LP in 1 patient, and NLP in 13 patients. Eight eyes required enucleation for painful blind eye or to achieve optimal cosmesis. CONCLUSIONS: Pointed door handles installed at current heights may pose a significant risk of ocular and periocular injuries among young children.

Severe ocular and periocular injuries caused by an ostrich.

An adult was attacked by an ostrich and suffered severe ocular and periocular injury, with permanent loss of vision. Fragments of ostrich beak were removed from the right periorbital laceration. Unprovoked severe bird injuries are rare. To the best of our knowledge, ocular injury caused by an ostrich has never been reported in the ophthalmic literature.