ABSTRACT
Purpose: This study explored whether surgeons favor unilateral or bilateral reconstructive hip surgery in children with cerebral palsy who have unilateral hip displacement. Methods: An invitation to participate in an anonymous, online survey was sent to 44 pediatric orthopedic surgeons. The case of an 8 year old at Gross Motor Function Classification System level IV with migration percentages of 76% and 22% was described. Surgeons selected their surgical treatment of choice and provided their rationale. Respondents were also asked to list and rank radiographic parameters used for decision-making and multidisciplinary team members involved in decision-making. Results: Twenty-eight orthopedic surgeons from nine countries with a mean 21.3 years (range, 5-40 years) of experience completed the survey. A "bilateral VDROs with a right pelvic osteotomy (PO) was selected by 68% (19/28) of respondents; risk of contralateral subluxation (9/19; 47%) and maintaining symmetry (7/19; 37%) were the most common rationales for bilateral surgery. The remaining 32% (9/28) chose a 'right VDRO with a right PO'" with most of these (8/9; 89%) stating the left hip was sufficiently covered. Of 31 radiographic parameters identified, migration percentage, acetabular angle/index, Shenton line, neck shaft angle, and presence of open/closed triradiate growth plates were the most common. Physical therapists (68%) and physiatrists (43%) were most likely to be involved in pre-operative surgical consultation. Conclusion: There is a lack of agreement on management of the contralateral hip in children with unilateral hip displacement. Further studies comparing patient important outcomes following unilateral and bilateral surgery are required. Level of Evidence: V.
ABSTRACT
INTRODUCTION: Early detection and screening of developmental dysplasia of the hip (DDH) are critical in reducing complications; thus, advocacy and awareness are paramount. Social media, Twitter, in particular, connects users based on their content engagement, allowing global audience to interact with one another, providing an opportunity to spread awareness and support for children and families affected by conditions such as DDH. The objective of this study was to assess the frequency and content of information being published on Twitter pertaining to DDH. METHODS: A search strategy using key terms was developed. An a priori coding guide using search terms was then created to establish a framework to identify themes regarding DDH on Twitter. Data were extracted over one-week periods in June and July of 2019 and 2020. An excel-based coding guide was developed to organize and analyze the extracted data. RESULTS: A total of 142 tweets were extracted for analysis; 41 in 2019 and 101 in 2020. The most frequently used search terms were hip dysplasia, developmental dysplasia of the hip, and dislocated hip. In 2019, the most frequent tweet authors were healthcare organizations (13/41, 31.7%) and healthcare professionals (12/41, 29.3%). In contrast in 2020, 32.7% (33/101) tweets were authored by patients. Prevention, treatment, and general discussions were top categories in 2019, compared to education, awareness, and general discussions in 2020. CONCLUSION: Our data indicate that user engagement with DDH content on Twitter increased by 2.5-fold from 2019 to 2020. We found similar patterns regarding the types of authors and content type in both years. However, focus shifted toward topics of education and awareness in 2020. SIGNIFICANCE: Our analysis identified trends and gaps in the use of Twitter that could be implemented by users to optimize messages, such as connecting directly and conversing with users through replies. Findings also indicate the importance of multi-author engagement to increase the breadth of distribution of information. Social media platforms can efficiently disseminate information to a wide range of individuals; however, they must be leveraged appropriately to accurately inform the public about DDH. Engaging with Twitter users hold great potential to promote advocacy and increase early detection and screening for DDH. LEVEL OF EVIDENCE: 3.
ABSTRACT
BACKGROUND: Despite being a common procedure, there are no standard protocols for postoperative immobilization and rehabilitation following reconstructive hip surgery in children with cerebral palsy (CP). The purpose of this study was to investigate variability in postoperative management and physical therapy (PT) recommendations among orthopaedic surgeons treating hip displacement in children with CP. METHODS: An invitation to participate in an anonymous, online survey was sent to 44 pediatric orthopaedic surgeons. The case of a child undergoing bilateral femoral varus derotation osteotomies and adductor tenotomies was presented. Surgeons were asked to consider their typical practice and the case scenario when answering questions related to immobilization, weight-bearing, and rehabilitation. Recommendations with increasingly complex surgical interventions and different age or level of motor function were also assessed. RESULTS: Twenty-eight orthopaedic surgeons from 9 countries with a mean 21.3 years (range: 5 to 40 y) of experience completed the survey. Postoperative immobilization was recommended by 86% (24/28) of respondents with 7 different methods of immobilization identified. All but 1 (23/24) reported immobilizing full time. Most (20/23) reported using immobilization for 4 to 6 weeks. Return to weight-bearing varied from 0 to 6 weeks for partial weight-bearing and 0 to 12 weeks for full weight-bearing. PT in the first 1 to 2 weeks postoperatively was reported as unnecessary by 29% (8/28) of surgeons. PT for range of motion, strengthening, and return to function was recommended by 96% (27/28) of surgeons, starting at a mean of 2.6 weeks postoperatively (range: 0 to 16 wk). Only 48% (13/27) reported all of their patients would receive PT for these goals in their practice setting. Inpatient rehabilitation was available for 75% (21/28) but most surgeons (17/21) reported this was accessed by 20% or fewer of their patients. CONCLUSIONS: Postoperative immobilization and PT recommendations were highly variable among surgeons. This variability may influence surgical outcomes and complication rates and should be considered when evaluating procedures. Further study into the impact of postoperative immobilization and rehabilitation is warranted.
ABSTRACT
Human disorganization syndrome (HDS) is an extremely rare congenital syndrome characterized by a seemingly random distribution of multiple developmental anomalies involving all three germinal layers. Case Report: We report a rare case of a female child whose congenital anomalies are consistent with HDS. The orthopaedic features of this patient include a popliteus pterygium with an associated flexion contracture secondary to an elongated biceps femoris tendon that attached to the gastrocnemius-soleus muscle complex, two finger-like appendages, a tethered cord, a lipomeningomyelocele at the level of L5, and a leglength discrepancy. The patient was treated with a splinting program, release of the biceps femoris tendon at its erroneous insertion from the gastrocs-soleus, and surgical excision of the finger-like appendages. She underwent three subsequent soft-tissue releases to address recurrence of the knee flexion contracture and an anteromedial and lateral distal femoral eight plate procedure for guided growth and slow correction of the remaining flexion deformity. Conclusion: The treatment of HDS can be quite complex and can present with a variety of anomalies with distinctive orthopaedic features correctable with surgical management, including soft-tissue releases, excision of appendages, and growth modulation.
