Objective: The objective of this study is to create an overview of the possible aetiologies of windswept deformity and to emphasize the points of attention when presented with a case. Methods: A systematic search according to the PRISMA statement was conducted using PubMed, African Journals Online, Cochrane, Embase, Google Scholar, and Web of Science. Articles investigating the aetiology of windswept deformity at the knee in children, and articles with windswept deformity as an ancillary finding were included. The bibliographic search was limited to English-language articles only. The level of evidence and methodological appraisal were assessed. Results: Forty-five articles discussing the aetiology of windswept deformity were included. A variety of aetiologies can be brought forward. These can be divided into the following groups: ‘Rickets and other metabolic disorders’, ‘skeletal dysplasias and other genetic disorders’, ‘trauma’ and ‘descriptive articles without specific underlying disorder’. With rickets being the largest group. Interestingly, in the group without a specific underlying disorder, all patients were from African descent, being otherwise healthy and presented with windswept deformity between two and three years of age. Conclusion: We have presented an overview that may help identify the underlying disorder in children with windswept deformity. A step-by-step guide for clinicians who see a child with windswept deformity is provided. Even though, according to the Oxford level of evidence, most articles have a low level of evidence.

Objective The objective of this study is to study familial inheritance for Blount disease to create better understanding of the aetiology of Blount disease. Methods After reviewing patient files and conventional roentgenologic imaging, 139 patients with Blount disease were included in this cross-sectional study, of which 102 patients were interviewed. During the interviews, patient characteristics and family history were collected. Blood samples were taken from five patients and three families and a whole exome sequencing was performed. Results Although patients came from all over the country, 90% of the patients belonged to the Akan tribe. A positive family history was found in 63 families (62%), of which, almost two-third had a positive family history in a first-degree family member. In most of the cases (64%), the varus legs resolved over time. In 9%, severe bowing remained ‘just like the patient’. The results of the whole exome sequencing did not show a genetic predisposition. Conclusion This study describes a large group of Blount patients. Because of the high numbers of positive family history and the centralisation of patients in the Akan region, a familial predisposition is suggested. Further genetic research is essential for better understanding of the possible multifactorial aetiology in Blount disease.

Acute kidney injury is a potentially fatal condition, particularly in low‐resource settings, where access to renal replacement therapy is limited. This creates a problem of accessibility to healthcare for many patients living in low‐resource settings. A 10‐year‐old boy in rural Ghana presented with anuria, edema, hypertension, and seizures, and severely elevated creatinine and urea levels were measured. Local peritoneal dialysis was started on Day 4 of admission, and the patient showed significant improvement. This report shows the effectiveness including subsequent laboratory results of locally made peritoneal dialysis and gives a detailed description on how to locally make dialysis fluids and how to perform peritoneal dialysis in a low‐resource setting.

Background: Blount disease is growth disorder of the proximal tibia, resulting in genu varum, internal rotation, and procurvatum. Three different forms of the condition are described: infantile, or early onset, juvenile onset, and adolescent or late onset. Although several hypotheses exist, the etiology of Blount disease remains unknown. The best-founded hypothesis is the “increased mechanical force hypothesis”. In particular, the relation between obesity and Blount disease. Although, most studies supporting this hypothesis are conducted in high income countries. However, unlike in the Western population that was studied to establish this hypothesis, Blount disease is relatively common in African countries and obesity is not. Methods: This study is a retrospective, case control study in a rural hospital in Ghana (2012-2021). Demographic information, body weight, and age at presentation were collected. The World Health Organization (WHO) weight-for-age growth standard was used. Overweight was defined as a percentile between 85th and 97th. Obese as a percentile between 97th and 99th. Above the 99th percentile was defined as severely obese. Results: In total 96 patients with infantile Blount disease were included, all of black Ghanaian descent. The mean age of onset of Blount disease in our patients was 1.7 (±0.9) years, and the mean age at presentation was 6.3 (±3.4) years. This was not different between boys (n = 27) and girls (n = 69). The mean weight for age percentile in our population was 56.8th (±35.3th), and 68% was of normal weight, 15% overweight, 8% obese, and 9% severely obese. Our study population had a significant (p < 0.05) higher mean weight percentile compared with the local control group (n = 79, 37.0th ± 26.0th). Conclusion: Although our study population of patients with infantile Blount was significantly heavier compared with the control group, the mean weight (56.8th ± 35.3th) was well within normal values. Obesity might have a role in the development of infantile Blount disease, but it is shown to be not as an important factor in the Ghanaian population (18% obese) compared with the more extensively studied US population with much higher obesity rates. Level of Evidence: Level III . See Instructions for Authors for a complete description of levels of evidence.

Introduction: Windswept deformity is a malalignment of the knees characterised by unilateral valgus and contralateral varus. Only a limited number of studies have investigated the aetiology of windswept deformity. Most windswept cases in the literature are ancillary findings in studies or case reports. Typically, the causes of windswept deformity are classified into the following groups: ‘rickets and other metabolic disorders’, ‘skeletal dysplasia and other genetic causes’, ‘trauma’ and ‘idiopathic conditions’. Methods: After retrospectively reviewing patient files and radiographs, 23 patients with windswept deformity seen in a rural hospital in Ghana (between January 2017 and June 2022) were included. Data were collected through medical records, history taking, physical examination, and radiographs. Laboratory tests were carried out in 11 patients. Results: In most of the patients, windswept deformity developed shortly after the onset of walking (70% started within 6 months after walking); it started with unilateral valgus, which was later followed by contralateral varus (65%), and most patients had a normal weight (mean BMI 16.8, 51.7th percentile). A significant difference in mean BMI was observed when arm span was used instead of height (mean BMI: 15.8 ± 3.2 and 16.8 ± 4.0, respectively). The most common underlying condition was rickets (74%). Other causes include dysplastic (multiple epiphyseal dysplasia and unilateral Blount’s disease), post-traumatic (distal femur fracture), and idiopathic factors. Laboratory tests in 8 of the 11 patients showed vitamin D insufficiency. Conclusions: This study suggests that windswept deformity in young children usually develops with an initial valgus position, which is followed by contralateral varus. Rickets was the most frequently identified underlying diagnosis, with vitamin D insufficiency commonly observed among tested patients.

Early recognition of clinically deteriorating patients may improve patient outcomes. Early warning scores (EWS) are widely used in high-income settings, but their effectiveness in low- and middle-income countries (LMICs) remains uncertain. This systematic review evaluates whether the implementation of EWS improves patient outcomes in LMICs and explores factors that may influence their effectiveness. A systematic search was conducted in Pubmed, EMBASE, and the Cochrane Library from database inception to 12 December 2024. Studies comparing patient outcomes before and after EWS implementation in LMICs were included. Outcomes of interest were mortality, length of hospital stay, serious adverse events (SAEs), and intensive care unit (ICU) admissions. Five studies met the inclusion criteria. Overall, EWS implementation was not associated with a consistent reduction in mortality or SAEs. However, two studies reported a shorter length of hospital stays following implementation, and one study demonstrated a reduction in unplanned ICU admissions. The included studies were heterogeneous in design, setting, and patient populations and therefore overall certainty of evidence was low to moderate. Current evidence does not demonstrate an improvement in patient outcomes following the implementation of EWS in LMICs. However, this finding is based on a small number of heterogenous studies with varying methodological quality and should therefore be interpreted with caution. The absence of observed benefits may reflect both limitations of the available evidence and contextual factors, such as limited resources, insufficient training, and restricted escalation capacity. Future research should focus on both clinical effectiveness and implementation factors within LMIC health-care systems.