Is it safe for extended-role radiographers to measure migration percentage in children with cerebral palsy?

INTRODUCTION: In the surveillance of children with cerebral palsy, the measurement of migration percentage is used to identify children at risk of hip dislocation. Early identification of children at risk facilitates early intervention with less invasive surgical procedures to prevent further deterioration. The aim of this study is to evaluate the safety of the measurements of migration percentage for surveillance in cerebral palsy by extended-role radiographers by evaluating the reliability and validity of measurements performed by these professionals. METHODS: A sample of thirty pelvic x-rays were selected from the local cerebral palsy database. A range of hip displacement was selected including some challenging borderline x-rays. All ten extended-role radiographers completed measurements using TraumaCAD which were repeated at a minimum of 4 weeks. Inter-rater and intra-rater reliability was calculated using intraclass correlation coefficients. The accuracy and safety of the system was evaluated by converting measurements into referral categories (red, amber or green) and cohen's kappa was calculated when categories were compared to measurements to orthopaedic surgeon RESULTS: The inter-rater reliability between radiographers was 0.938 (95% CI 0.914-0.991). The intra-rater reliability was 0.941 (95% CI 0.931-0.949). The percentage agreement was 94.8% for green, 93.8% for amber and 98.2% for red hips. The weighted kappa value was 0.923 (95% CI 0.889-0.957). CONCLUSION: The reliability and accuracy of radiographer measurement of migration percentage is excellent. It is safe for radiographers to calculate the migration percentage using semi-automated software for the surveillance of children with cerebral palsy. IMPLICATIONS FOR PRACTICE: We recommend the measurement of migration percentage may be performed by extended-role radiographers to deliver accurate and reliable measurements for use in cerebral palsy surveillance.

Childhood fractures requiring inpatient management.

INTRODUCTION: Fractures account for significant morbidity during childhood. Children requiring inpatient management for their fractures represent the most serious injuries. The aim of this study was to identify injury patterns in childhood fractures requiring inpatient management at a regional trauma centre. METHODS: Three thousand and forty two consecutive injured children were admitted to our orthopaedic centre over a 4-year period. Data was prospectively collected by independent audit clerks and entered onto a database. Data recorded included type of injury, mechanism of injury and place of injury. This was then used to assess injury patterns and trends. RESULTS: Upper limb and lower limb fractures accounted for 51% (n=1,565) and 21% (n=637) of all emergency admissions, respectively. Other causes included soft tissue injury, Infections, Polytrauma and Dislocations. Twice as many males were admitted with upper or lower limb fractures compared to females (67% versus 33%) (P<0.001). Males were more likely to be older (P<0.001) compared to females. Distal radial fractures accounted for 60% of upper limb fractures. Distal and midshaft tibial fractures accounted for 52% of lower limb fractures. Sports injuries were responsible for the majority of lower limb fractures with falls accounting for the majority of upper limb fractures. Fracture incidence peaked during summer months. CONCLUSION: Males are twice as likely to require inpatient management for fractures as females. Male adolescents are particularly at risk. Distal radial fractures following falls and distal tibial fractures following sports injuries are the most common fractures requiring admission. Identifying ways of minimising risk of these injuries would reduce childhood morbidity.

Adduction sign in pediatric hip arthrography.

Various techniques for improving the success of needle placement in hip arthrography have been described. The authors describe a simple consistent sign that occurs in both subluxated and dislocated hips and is present only when the needle is correctly placed within the hip joint. This, in conjunction with other techniques, has improved their quality of hip arthrography.

The orthopaedic presentation of acute leukaemia in childhood.

In children, acute leukaemia can mimic several orthopaedic pathologies and this variable presentation creates difficulties in achieving the correct diagnosis. Four consecutive cases are reported, all of which initially presented via the orthopaedic department, representing 17% of all new cases of leukaemia presenting to our hospital. This series is presented to highlight the need to place acute leukaemia on the list of differential diagnoses of acute joint pathology in children: the associated literature is reviewed.

Transvertebral pedicle fixation in severe grade spondylolisthesis. Report of three cases.

The ideal treatment for spinal stabilization of Myerding Grade III-IV spondylolisthesis remains controversial, with a variety of techniques having been described. The authors report on a consecutive series of three adult patients with high-grade slippage who were treated with transvertebral pedicle fixation and standard spinal instrumentation, as both primary and revision procedures. There were no complications from the procedure, and a good outcome was achieved in all patients. The results at 4- to 8-year follow-up review are presented. This is a relatively simple and safe method of achieving spinal stabilization, which bypasses some of the problems caused by the associated anatomical distortion in high-grade spondylolisthesis and has good results at midterm follow up.

Broomstick plaster with a removable abduction bar: a simple technique that facilitates early postoperative physical therapy and handling.

We present a simple technique utilising a broomstick plaster with a removable abduction bar. This facilitates early postoperative physical therapy and handling after surgery for lower limb problems in patients with cerebral palsy.

Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women.

We studied 58 women of employable age with the carpal tunnel syndrome in order to determine whether the histological appearances of the carpal tunnel, tenosynovium and flexor retinaculum are influenced by work practices. Age, body mass index and the duration of symptoms did not correlate with the extent of oedema or fibrosis within the tenosynovium. The incidence of abnormality on histological examination of the tenosynovium was the same in employed and unemployed patients (p = 1.0), and was not influenced by the level of repetition (p = 0.89) or force (p = 0.29) of work. Myxoid degeneration within the flexor retinaculum was, however, more common in women undertaking 'high-force' work. Apart from this finding, the results suggest that work practices do not affect tenosynovial thickening, fibrosis or oedema in patients with carpal tunnel syndrome.

Migration and failure of the Mecron screw-in acetabular prosthesis.

Early results with the Mecron prosthesis have been variable. We report our experience with this prosthesis at medium- to long-term follow-up. At 5 to 9 years after surgery, 43 patients (49 implants) were reviewed. Radiographic measurements of superior migration, alteration in the opening angle, and thread engagement were made. The failure rate was very high, 33% having been revised or awaiting revision. Of the remainder, 80% had migrated, 86% had changes in the opening angle, and 65% had fewer threads engaged. Many have low-grade symptoms insufficient to merit revision, but the extent of loosening makes eventual revision likely. We feel this represents an example of a new design gaining widespread usage before adequate follow-up studies.

Pollicisation of the index finger. A 27-year follow-up study.

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity. Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side. For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand.