X-ref For other Roundups in this issue that cross-reference with Children’s orthopaedics see: Foot & Ankle Roundup 1; Hip Roundup 2, 3, 4, 6; Wrist & Hand Roundup 8; Trauma Roundup 3, 8; Knee Roundup 7.
Sever’s disease under the spotlight X-ref
Sever’s disease (calcaneal apophysitis) is a disabling condition resulting in heel pain and diminished quality of life. Although common, there is as yet little consensus as to which conservative treatment strategy yields the best results. We were delighted here at 360 to read the report of a 3-arm randomised controlled trial of conservative measures from Amsterdam (The Netherlands).1 Their study randomised 101 patients to either expectant management, a heel raise or a calf strengthening programme. Outcomes were primarily assessed with pain scores and a satisfaction scale at six weeks and three months. Surprise, Surprise! At three months of follow-up, all of the patients were improved over baseline and there was no significant difference in pain, patient satisfaction, or scores on the Oxford Ankle and Foot Questionnaire between the groups. However, the heel raise programme offered an earlier satisfaction advantage over the other treatment modalities.
Acetabular remodeling in varus femoral osteotomy X-ref
Controversy continues over the type and timing of hip surgery to maintain concentric reduction in children with cerebral palsy. The ability of the acetabulum to remodel following proximal femoral surgery also remains controversial. The majority of centres worldwide use the varus femoral osteotomy as part of their treatment strategy in at least some dysplastic cerebral palsy hips, either in isolation or combined with a pelvic osteotomy. This retrospective study from Colorado (USA) gives us some useful insights into what the longer-term outcomes might be of remodeling following varus osteotomy.2 In what is essentially a retrospective case series, the medical records including radiographs of a consecutive series of 87 patients (174 hips) with cerebral palsy undergoing varus derotational …