The Etiologic Risk Factors for Cerebral Palsy at an Orthopedic Surgery Clinic in South Africa.

BACKGROUND: Cerebral palsy (CP) is a group of disorders that affect movement and posture caused by injury to the developing brain. Although prematurity and low birth weight are common causes in developed countries, birth asphyxia, kernicterus, and infections have been identified as predominant etiologies in Africa. There is, however, very little information on the etiology of CP in South Africa. We aimed to determine the etiology, severity, and topographic distribution of CP in children undergoing orthopedic surgery at our tertiary pediatric unit. METHOD: A retrospective folder review was performed for patients with CP who underwent orthopedic surgery from July 2018 to June 2022. Data were collected on perinatal circumstances, etiologic risk factors for developing CP, severity of disability as classified by the Gross Motor Function Classification Scale (GMFCS), and topographic distribution. Descriptive analysis was performed. RESULTS: A total of 202 patients were included in the analysis. Prematurity (gestational age less than 37 weeks) was noted in 41.6% of the cohort and was the most common risk factor. Hypoxic-ischemic encephalopathy (30.7%), postnatal infections (13.4%), congenital brain malformations (10.4%), and cerebral infections were the next most common etiologic risk factors. Forty-eight percent of patients were classified as GMFCS IV or V. There was a predominance of bilateral (69.5%) compared with unilateral (21.3%) subtypes. CONCLUSION: Most patients undergoing orthopedic surgery for musculoskeletal sequelae of CP had GMFCS levels of IV or V and were bilateral subtypes, emphasizing the need for intervention at a primary care level to decrease the incidence of this frequently preventable condition.

Predictors of early recurrence following high tibial osteotomy for infantile tibia vara.

AIMS: Recurrence of deformity following high tibial osteotomy (HTO) for infantile tibia vara (ITV) is common. The purpose of this study was to identify risk factors for recurrent deformity following HTO for ITV and to develop a simple scoring system to quantify the risk of recurrence in each patient. PATIENTS AND METHODS: We identified 69 patients with 102 affected limbs undergoing HTO for ITV from 2005 to 2015. Demographic and radiographic data was collected. On pre-operative radiographs, we measured the mechanical varus angle (MVA), the condyle shaft angle (CSA), the plateau depression angle (PDA), the metaphyseal-diaphyseal angle (MDA), and the mechanical lateral distal femoral angle (LDFA). On the post-operative radiographs, we measured the MVA and MDA only. We classified each limb according to the Langenskiold and LaMont classifications. Statistical analysis was performed to identify variables predictive of recurrent deformity, and these variables were analysed to develop a scoring system to quantify risk of recurrence following HTO. RESULTS: Of the examined variables, age older than 4.5 years, an MVA of more than 23° and a LaMont type C deformity were predictive of recurrent deformity. The incidence of recurrent deformity increased from 14.3% with no risk factors to 91.3% with three risk factors present. CONCLUSION: Advanced deformity and age above 4.5 years at the time of surgery predicts recurrent deformity following HTO for ITV. Surgery should be performed as soon as possible, and caregivers should be counselled appropriately regarding risk of recurrence and the need for future surgery.

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

OBJECTIVES: To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement. METHODS: Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot). SETTING: Single Level 1 University Hospital Trauma Center. MAIN OUTCOME MEASUREMENTS: The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy. RESULTS: Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25-88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40-103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4-16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6-28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 µGy (range, 51-660 µGy; SD, 0.17 µGy) compared with 690.27 µGy (range, 200-2310 µGy; SD, 0.52 µGy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888). CONCLUSIONS: The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique. LEVEL OF EVIDENCE: Therapeutic level II.

Double pathology, sarcoidosis associated with multiple myeloma: A case report.

The association of sarcoidosis with multiple myeloma is not well known. Including this case report, 12 cases of patients with both sarcoidosis and multiple myeloma have been reported in the literature. The skeletal lesions of both conditions have many clinical and radiological similarities, and unless clinicians are aware of the association and the possibility of dual pathologies, the diagnosis of multiple myeloma in patients known with sarcoidosis may be missed. We present a case of a patient known with longstanding sarcoidosis who was found to have multiple lesions on magnetic resonance imaging (MRI) involving the pelvis and both proximal femurs. Histological analysis revealed the presence of both non-necrotising granulomas consistent with sarcoidosis, and sheets of plasma cells consistent with a plasma cell neoplasm.