Is the level of vitamin D deficiency correlated with the severity and bilaterality in slipped capital femoral epiphysis? A case series study.

The aim of the study is to find the correlation between vitamin D level and the severity of slippage and bilateral development in slipped capital femoral epiphysis (SCFE) cases if any. Thirty-nine patients with moderate-severe stable SCFE were evaluated regarding their vitamin D level and to which extent the severity of vitamin D deficiency, if present, can be correlated with the severity and bilaterality of the slip. Vitamin D serum level was assessed pre- operatively for all patients. In case of deficiency, the patient underwent in situ pinning unless performed before his/her presentation. Alongside, he/she received a vitamin D course until correction prior to the definitive surgery (Imhäuser osteotomy with osteochondroplasty) 6-12 weeks after. Thereafter, osteotomy healing and physis closure were monitored radiologically. Results show that all patients but one had vitamin D deficiency, with an average of 14.39 ng/mL, necessitating vitamin D therapy before proceeding to the definitive surgery. No correlation existed between vitamin D level and Southwick angle severity with a p-value of 0.85. A negative correlation existed between vitamin D level and bilaterality, but not statistically significant (p-value 0.192). Patients' osteotomy healing was uneventful, and physeal closure was achieved in all the cases that had in situ pinning. We conclude that the severity of Vitamin D deficiency could be linked to the bilateral development of SCFE but not the severity of slippage. Treatment of Vitamin D deficiency facilitates physeal closure.

Ventrally Fused Conjoined Twins (Omphaloischiopagus): A Roadmap to Successful Separation.

Conjoined twining is one of the most fascinating and challenging situations which a pediatric surgeon may face in his career. Only few surgeons may have the opportunity to share in separation of such cases. In this report, we aim to share our experience with the successful separation of ventrally fused male conjoined twins (omphaloischiopagus). The case was thoroughly studied via preoperative cross-sectional imaging modalities (magnetic resonance imaging [MRI] and computed tomography [CT] angiography), complemented by data obtained from reviewing similar cases in the literature. A clear delineation of the complex anatomy was achieved preoperatively which proved to be well consistent with the operative findings. A detailed description of the operative procedure to divide/redistribute the shared abdominal/pelvic organs between both twins is provided. To the best of our knowledge, this is the first report to describe the detailed and unique internal anatomy of a common central phallus associating ischiopagus conjoined twins. The penis was centrally located in the perineum in between both twins with an open urethral plate. This common phallus had a peculiar configuration with four crura anchoring ischial bones of both twins together.

Intertrochanteric Imhäuser osteotomy combined with osteochondroplasty in treatment of moderate-severe stable slipped capital femoral epiphysis: a case series study.

The aim of the study is to assess the safety and efficacy of Imhäuser osteotomy combined with osteochondroplasty in the treatment of moderate-severe stable slipped capital femoral epiphysis (SCFE) on short-term basis. Nineteen patients (20 hips) with moderate-severe stable SCFE were surgically treated by Imhäuser osteotomy combined with osteochondroplasty and followed up for 3-4 years. The cases aged between 12 and 18 years at the time of surgery and complained of a variety of symptoms and signs that included pain, limping, limited range of motion (ROM), and/or abductor weakness. The outcomes were assessed using clinical and radiological parameters as well as functional outcome measures: "Harris hip score" (HHS) and "The Western Ontario and McMaster Universities Osteoarthritis Index" (WOMAC). There were statistically significant improvements in flexion, internal rotation, and abduction ROM. HHS and WOMAC improved significantly with final follow-up scores at 86.76 and 6.4%, respectively. The radiological parameters showed significant improvement regarding Southwick angle (mean 12.8°), alpha angle of Nötzli (mean 29.85°), Hilgenreiner epiphyseal angle (mean 37.65°), neck shaft angle (mean 140.63°), and acetabulo-trochanteric distance (median14.1 mm) at the end of follow-up period. Imhäuser osteotomy combined with osteochondroplasty is a good option in moderate-severe stable SCFE treatment.

Flexion Deformities of the Wrist and Fingers in Spastic Cerebral Palsy: A Protocol of Management.

BACKGROUND: Literature is confusing regarding grading and treatment of flexion deformities of wrist and fingers in spastic cerebral palsy (CP). The most established classification is that described by Zancolli; unfortunately, it has its shortcomings which we experienced in the beginning of our approach to manage this rather difficult deformity. We thus modified Zancolli's classification and developed a classification system and treatment protocol. MATERIALS AND METHODS: Thirty patients with spastic CP were operated upon due to flexion deformity of the wrist and fingers and were included in this study. Age ranged from 4 to 14 years, average 7 years. There were twenty boys and ten girls. RESULTS: The average followup was 18 months (range 9 months - 3 years). The power of wrist dorsiflexion, the "House's classification of upper extremity functional use" and the clinical assessment of hand function were used for evaluation; they improved in all patients and this improvement was statistically significant. In all patients, cosmetic appearance improved without any residual flexion deformity. CONCLUSION: This study introduces a new grading system for flexion deformity of wrist and fingers in spastic CP that correlates with severity of the condition and allows a treatment protocol to be established.