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Moebius syndrome (MS) is a rare disease, with paralysis of the VI and VII cranial nerves, frequently associated with clubfoot (CF). The aim of this study was to evaluate surgical treatment of CF in MS, providing its peculiarities. Between 1990 and 2019, we collected data of 11 MS patients with unilateral (n = 5) or bilateral (n = 6) CF, for a total of 17 feet (9R,8L). Six patients (3M,3F) for a total of 10 feet (6R,4L) were treated elsewhere, performing first surgery at an average age of nine months, and in our hospital for relapse surgery at an average age of 4.5 years (Group 1). Five patients (3M, 2F), for a total of seven feet (3R,4L), were primarily treated in our hospital with a peritalar release according to McKay at an average age of 9.4 months (Group 2). Diméglio score was used to assess CF severity. Three questionnaires were submitted for evaluation of subjective and functional results: American Orthopedics Foot and Ankle Society for Hindfoot (AOFAS), Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Average AOFAS/FAOS/FAMM scores were 82.8, 84.8, and 82.3 for Group 1, and 93.2, 94.7, and 95.1 for Group 2 at an average follow-up of 16.9 and 13.3 years, respectively. The average Diméglio score improved from 15.5 to 4.8 in the long-term follow-up in Group 1 and from 14.6 to 3.8 in Group 2. The comparison between the groups showed better results for AOFAS, FAOS, and FAAM scores for Group 2, particularly for pain, function, and foot alignment and for the post-surgical Diméglio score. CF in MS is more severe and presented a higher relapse rate (58.8%) than idiopathic CF. Peritalar release showed no relapse and better subjective and functional results in the long-term follow-up compared to other surgical techniques
Maurizio De Pellegrin; Lorenzo Marcucci; Lorenzo Brogioni; Giovanni Prati. Surgical Treatment of Clubfoot in Children with Moebius Syndrome. Children 2021, 8, 310 .
AMA StyleMaurizio De Pellegrin, Lorenzo Marcucci, Lorenzo Brogioni, Giovanni Prati. Surgical Treatment of Clubfoot in Children with Moebius Syndrome. Children. 2021; 8 (4):310.
Chicago/Turabian StyleMaurizio De Pellegrin; Lorenzo Marcucci; Lorenzo Brogioni; Giovanni Prati. 2021. "Surgical Treatment of Clubfoot in Children with Moebius Syndrome." Children 8, no. 4: 310.
Hip flexion and abduction is fundamental for developmental dysplasia of the hip (DDH) treatment. At present, double diaper treatment has been inappropriately adopted when DDH is suspected. The aim of this study was to verify whether double diapers influence a newborn’s hip position. Here, we studied 50 children (23 female; 27 male; average age 62.33 ± 20.50 days; average birth weight 3230 ± 447 g) with type I hips according to Graf. At the same time of the ultrasound (US) examination, the following hip positions were measured using a manual protractor: (1) spontaneous position, supine on the outpatient bed without a diaper; (2) spontaneous position, with a double diaper; and (3) squatting position on the caretakers’ side. Statistical analysis was performed with a t-test to compare between (1) the spontaneous position without a diaper and with double diapers; (2) the spontaneous position with double diapers as well as the squatting position on the caretakers’ side with a diaper. The comparison between the hip position without diaper and with double diapers was statistically not significant for all measurements, i.e., right hip flexion (p < 0.33), left hip flexion (p < 0.34), and right and left hip abduction (p < 0.87). The comparison between the hip position with double diapers and on the caretakers’ side was statistically significant for all measurements, i.e., right hip flexion (p < 0.001), left hip flexion (p < 0.001) and right and left hip abduction (p < 0.001). We found that the use of double diapers did not affect hip position, while the position formed on the caretaker’s side shows favorable influence.
Maurizio De Pellegrin; Chiara Damia; Lorenzo Marcucci; Desiree Moharamzadeh. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. Children 2021, 8, 179 .
AMA StyleMaurizio De Pellegrin, Chiara Damia, Lorenzo Marcucci, Desiree Moharamzadeh. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. Children. 2021; 8 (3):179.
Chicago/Turabian StyleMaurizio De Pellegrin; Chiara Damia; Lorenzo Marcucci; Desiree Moharamzadeh. 2021. "Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips." Children 8, no. 3: 179.
The ulnar nerve in children is hypermobile in the cubital tunnel and tends to dislocate anteriorly over the medial epicondyle, especially when the elbow is in hyperflexion. This may be the reason of the increased risk of nerve injury during the insertion of the medial pin in supine position and, instead, an advantage of the prone position. The insertion of both pins from the lateral side could reduce this complication. Larger studies need to be carried out regarding the reported higher duration of anesthesia in prone position.
Maurizio De Pellegrin; Dario Fracassetti; Désirée Moharamzadeh; Carlo Origo; Nunzio Catena. Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review. Injury 2018, 49, S37 -S42.
AMA StyleMaurizio De Pellegrin, Dario Fracassetti, Désirée Moharamzadeh, Carlo Origo, Nunzio Catena. Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review. Injury. 2018; 49 ():S37-S42.
Chicago/Turabian StyleMaurizio De Pellegrin; Dario Fracassetti; Désirée Moharamzadeh; Carlo Origo; Nunzio Catena. 2018. "Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review." Injury 49, no. : S37-S42.
Fractures of the radial neck are rare and account for approximately one percent of all bone fractures in childhood, while severe displaced fractures account for only 1/3 of those. According to the literature, the main complications of surgical treatment include loss of function and avascular necrosis. The aim of the study was to describe our mini-invasive technique and to compare it to eighteen minimally-invasive techniques found after a literature review. Between 1990 and 2017 twelve patients (7 males and 5 females) aged between one and thirteen years (average age 8.3 years) with severe displaced radial neck fractures (6 type III, 4 type IVa and 2 type IVb according to Judet’s classification) were treated with a minimally-invasive technique combining percutaneous Kirschner wire reduction and intramedullary fixation according to Métaizeau. The Metaizeau radiological and functional score evaluation and the functional score of Tibone and Stoltz were considered. The postoperative x-ray evaluation according to Metaizeau showed eleven excellent results and one good result. After an average follow-up of 28 months (range 8–110 months) the scores according to Tibone and Stoltz showed 10 excellent results and two good results; the functional evaluation according to Métaizeau showed 11 excellent results and one good result. Percutaneous reduction of the displaced radial head in radial neck fracture using a Kirschner wire combined with an intramedullary fixation according to Metaizeau has proven to be simple, effective and without complications.
M. De Pellegrin; L. Marcucci; T. Rosenlechner; D. Fracassetti. Le fratture del capitello radiale in età infantile. Lo Scalpello - Otodi Educational 2018, 32, 252 -261.
AMA StyleM. De Pellegrin, L. Marcucci, T. Rosenlechner, D. Fracassetti. Le fratture del capitello radiale in età infantile. Lo Scalpello - Otodi Educational. 2018; 32 (3):252-261.
Chicago/Turabian StyleM. De Pellegrin; L. Marcucci; T. Rosenlechner; D. Fracassetti. 2018. "Le fratture del capitello radiale in età infantile." Lo Scalpello - Otodi Educational 32, no. 3: 252-261.
Purpose The aim of this study was to describe a subtalar extra-articular screw arthroereisis (SESA) technique for the correction of flexible flatfoot (FFF) in children and report the outcome. Methods From 1990 to 2012, data were collected on 485 patients who underwent SESA at the San Raffaele Hospital. The average age of the patient cohort was 11.5 ± 1.81 years (range 5.0–17.9 years; median 11.5 years). Inclusion criteria were FFF and marked flexible hindfoot valgus, and the exclusion criterion was rigid flatfoot. SESA was performed in 732 cases of FFF—bilaterally in 247 patients and monolaterally in 238 patients. Results The values of the pre- and post-SESA weight-bearing X-ray angles were 146° ± 7° and 129° ± 5°, respectively, for the Costa-Bartani angle, 43° ± 8° and 25° ± 6°, respectively, for the talar inclination angle and 11° ± 6° and 14° ± 5°, respectively, for calcaneal pitch (p <0.001). All data were analysed statistically with Student’s t test. Data on 398 patients were ultimately available for analysis. In 93.7 % of cases the results were good in terms of improved clinical aspects and X-ray measurement, absence of complications, normal foot function 3 months post-SESA and no requirement for further surgery. The complication rate was 6.3 % and included ankle joint effusion, painful contracture of peroneal muscles and fourth metatarsal bone stress fractures. A sample of 76 patients (121 feet) were evaluated after screw removal, which occurred on average 2.9 years after SESA. The angle measurements of this sample showed no statistically significant modification. Conclusion Based on our >20 years of experience, we believe that SESA is an optimal technique for the correction of FFF as it is simple and can be performed rapidly, and the corrective effect results from the screw’s mechanical and proprioceptive effect. The indication for surgery must be accurate. We suggest that the patient be at least 10 years of age in order that all of the foot’s growth potential can be utilized and to allow for spontaneous resolution and thereby avoid the possibility of over-treatment.
Maurizio De Pellegrin; Désirée Moharamzadeh; Walter Michael Strobl; Rainer Biedermann; Christian Tschauner; Thomas Wirth. Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children. Journal of Children's Orthopaedics 2014, 8, 479 -487.
AMA StyleMaurizio De Pellegrin, Désirée Moharamzadeh, Walter Michael Strobl, Rainer Biedermann, Christian Tschauner, Thomas Wirth. Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children. Journal of Children's Orthopaedics. 2014; 8 (6):479-487.
Chicago/Turabian StyleMaurizio De Pellegrin; Désirée Moharamzadeh; Walter Michael Strobl; Rainer Biedermann; Christian Tschauner; Thomas Wirth. 2014. "Subtalar extra-articular screw arthroereisis (SESA) for the treatment of flexible flatfoot in children." Journal of Children's Orthopaedics 8, no. 6: 479-487.
Early diagnosis is critical for the prompt implementation of treatment and to ensure the best results in developmental dysplasia of the hip (DDH). Clinical DDH screening with a search for Ortolani's sign does not detect all cases affected by DDH. Universal ultrasound screening is currently the most viable strategy to identify dysplastic hips including subjects with negative results at clinical examination and in the absence of risk factors.
Alberto Chiara; Maurizio De Pellegrin. Developmental dysplasia of the hip: to screen or not to screen with ultrasound. Early Human Development 2013, 89, S102 -S103.
AMA StyleAlberto Chiara, Maurizio De Pellegrin. Developmental dysplasia of the hip: to screen or not to screen with ultrasound. Early Human Development. 2013; 89 ():S102-S103.
Chicago/Turabian StyleAlberto Chiara; Maurizio De Pellegrin. 2013. "Developmental dysplasia of the hip: to screen or not to screen with ultrasound." Early Human Development 89, no. : S102-S103.
During the period from 1985 to 2006, 22 children (44 hips) affected by achondroplasia were ultrasonographically evaluated. The patients' age at examination ranged from 7 days to 29 months. The hip ultrasound (US) examination was performed, according to Graf's method, using a Siemens Sonoline sonogram with linear 5.0- and 7.5-MHz probes. In all the hips, the alpha angle was impossible to be measured because the medial margin of the ilium was not ultrasonographically detectable. The ultrasonographic findings included the following: configuration of the acetabular bony rim, configuration of the acetabular roof, echogenicity of the head and acetabular cartilage, bony coverage percentage of the femoral head according to Morin et al, beta angle according to Graf, dynamic hip instability, and presence of the proximal femoral ossific nucleus. All hips had a sharp acetabular bony rim, a horizontal acetabular roof, thickened acetabular cartilage, and normal echogenicity. The femoral head was well centered and deeply contained in the acetabular fossa. The mean coverage was 86.7% (range: 78%-90%) and showed progressively larger values with increasing age. The mean value of the beta angle was 20 degrees (range: 8 degrees-38 degrees). The value of the beta angle tended to decrease as age increased. No difference was observed between the right and the left hip in both measurements. All hips were stable. The ossific nucleus was present in 5 children. The characteristic findings in hip ultrasonography in children with achondroplasia can aid in its early diagnosis because ultrasound can anatomically detect the altered development of the achondroplastic acetabulum.
Maurizio De Pellegrin; Desiree Moharamzadeh. Ultrasound Hip Evaluation in Achondroplasia. Journal of Pediatric Orthopaedics 2008, 28, 427 -431.
AMA StyleMaurizio De Pellegrin, Desiree Moharamzadeh. Ultrasound Hip Evaluation in Achondroplasia. Journal of Pediatric Orthopaedics. 2008; 28 (4):427-431.
Chicago/Turabian StyleMaurizio De Pellegrin; Desiree Moharamzadeh. 2008. "Ultrasound Hip Evaluation in Achondroplasia." Journal of Pediatric Orthopaedics 28, no. 4: 427-431.
This study reviews the data regarding clinical and ultrasound (US) examinations, collected during an 11-year period, in a DDH dedicated outpatient clinic. The material was analysed in order to verify the importance of US hip examination and Ortolani's test for early DDH diagnosis, to select dysplastic, unstable hips, to identify the role of the labrum in DDH, and to analyse the treatment strategy Of the 21709 newborns (43418 hips) examined with US and Ortolani's manoeuvre for DDH diagnosis, 431 patients (356 F; 75 M; average age 42 ± 33 days) had 574 unstable, dysplastic hips (1.32%). The hips identified according to Grafs classification were: 298 type D, 252 type IIIa, 4 type IIIb, 20 type IV. In 73.09% of the patients, no risk factors were identified; 18.56% had positive family history for DDH, 5.57% had breech presentation, 2.78% had both risk factors. Only 10.63% had a positive Ortolani's test. The diagnosis was made in 21.5% of cases by the 2nd week of life, in 52.9% between the 2nd-8th week, and in 25.5% after the 8th week. Unstable dislocated hips were treated, after reduction with or without sedation, by applying a cast; dysplastic hips were treated using a Gekeler splint. No open reductions or reconstruction surgery were needed. The labrum was always positioned on top of the femoral head, never inverted, and it was not an obstacle to closed reduction. Neither the Ortolani's sign, nor the risk factors are sure signs for the early diagnosis of DDH and its instability. Only US examination permits an early diagnosis of dysplasia and instability of the hip.
M. De Pellegrin; D. Moharamzadeh; G. Fraschini. Early Diagnosis and Treatment of DDH: A Sonographic Approach. HIP International 2007, 17, 15 -21.
AMA StyleM. De Pellegrin, D. Moharamzadeh, G. Fraschini. Early Diagnosis and Treatment of DDH: A Sonographic Approach. HIP International. 2007; 17 (5_suppl):15-21.
Chicago/Turabian StyleM. De Pellegrin; D. Moharamzadeh; G. Fraschini. 2007. "Early Diagnosis and Treatment of DDH: A Sonographic Approach." HIP International 17, no. 5_suppl: 15-21.
M. De Pellegrin; D. Moharamzadeh; G. Fraschini. Early diagnosis and treatment of DDH:a sonographic approach. HIP International 2007, 17, 15 -21.
AMA StyleM. De Pellegrin, D. Moharamzadeh, G. Fraschini. Early diagnosis and treatment of DDH:a sonographic approach. HIP International. 2007; 17 (Suppl. 5):15-21.
Chicago/Turabian StyleM. De Pellegrin; D. Moharamzadeh; G. Fraschini. 2007. "Early diagnosis and treatment of DDH:a sonographic approach." HIP International 17, no. Suppl. 5: 15-21.
Minimally invasive subtalar screw-arthroereisis has gained interest in the correction of flat feet in children. Between 1990 and 2004, this technique was used on 152 children, 74 bilaterally, for a total of 226 feet. There were 82 boys and 70 girls, with an average age of 10.6+/-1.9 years. The results were good in 95.4% of cases, whilst there were complications in 4.6%. For well corrected feet, 55 screws have now been removed, on average 2.9 years after implantation. The indications for such treatment are: talipes calcaneovalgus, which develops into a flat foot (spontaneous correction can be expected to 10-11 years), juvenile flat foot with medial protrusion of the talar head and complete absence of the longitudinal arch, symptomatic talipes calcaneovalgus with pain on the insertion of the tibialis posterior tendon, a minimum age of 6 years if a correction with conservative treatment does not show any improvement; a maximum age of 12-13 years considering that there always has to be a manual reducibility of the deformity. posttraumatic flat foot, congenital flat foot, stiff flat foot, age over 13 years.
M. De Pellegrin. Die subtalare Schrauben-Arthrorise beim kindlichen Plattfuß. Der Orthopäde 2005, 34, 941 -954.
AMA StyleM. De Pellegrin. Die subtalare Schrauben-Arthrorise beim kindlichen Plattfuß. Der Orthopäde. 2005; 34 (9):941-954.
Chicago/Turabian StyleM. De Pellegrin. 2005. "Die subtalare Schrauben-Arthrorise beim kindlichen Plattfuß." Der Orthopäde 34, no. 9: 941-954.
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M. De Pellegrin; D. Fracassetti; P. Ciampi. Coxitis fugax. Der Orthopäde 1997, 26, 858 -67.
AMA StyleM. De Pellegrin, D. Fracassetti, P. Ciampi. Coxitis fugax. Der Orthopäde. 1997; 26 (10):858-67.
Chicago/Turabian StyleM. De Pellegrin; D. Fracassetti; P. Ciampi. 1997. "Coxitis fugax." Der Orthopäde 26, no. 10: 858-67.