Evaluating the use of an electronic inclinometer in correcting rotational disorders of the hip in children

Abstract

Study Participants & Setting: Studies comparing two or more treatments for hip subluxation in CP for patients aged <21 and reporting rates of resubluxation or reoperation were included. Materials/Methods: Pubmed, EMBASE, and Cochrane were systematically searched from 1953-January 13th, 2017, inclusive for comparative studies treating hip subluxation/dislocation in children with CP. Studies were screened for inclusion and characteristics including study design, demographics, radiographic parameters (Migration Index and Neck-Shaft Angle), and frequency of resubluxations/reoperations were extracted in duplicate. Studies were graded for quality using the Newcastle Ottawa Scale. Pooled risk estimates (odds ratio for resubluxation/reoperations) were obtained using a fixed effects model due to the low heterogeneity (I2<50). No publication bias was identified. This meta-analysis was performed and reported in accordance with PRISMA guidelines. Results: Ten retrospective cohort studies were included. Two comparison groups were identified: Combined femoral and pelvic osteotomies vs femoral osteotomies, and femoral osteotomies vs soft-tissue surgery. 10.4% of combined osteotomies had hip resubluxation/reoperation compared to 14.5% for femoral osteotomies alone. The odds ratio for resubluxation/ reoperation was not statistically different for combined osteotomies compared to femoral alone, as shown in Figure 1 (OR=0.59 95%CI: 0.31-1.14). 49.3% of femoral osteotomies had resubluxation/reoperation, compared to 64.4% of soft tissue surgeries. The odds ratio for resubluxation/reoperation was decreased for femoral osteotomies compared to soft tissue procedures, shown in Figure 2 (OR=0.38 95%CI: 0.17-0.86). Conclusions/Significance: Resubluxation/reoperation rates were high. Although there may be a role for soft tissue procedures in delaying eventual bony osteotomies, this study supports the use of femoral osteotomies alone or combined femoral and pelvic osteotomies over soft tissue procedures. This is the first systematic review to statistically pool quantitative results from previous studies on this topic. Botox vs soft tissue procedures could not be included due to insufficient comparative studies on this topic. This meta-analysis is limited by the observational nature and small sample sizes of the included studies, with their inherent risk of bias. It is possible that with larger and higher quality studies, the results and conclusions of this analysis may be altered.

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…These findings are in alignment with earlier studies that have underscored the utility of inclinometer technology in enhancing accuracy across diverse surgical applications [8,9,[12][13][14]36]. Our study builds upon these established findings by reaffirming that the integration of portable angle-measuring devices, such as inclinometers, carries substantial significance, particularly in the domain of minimally invasive foot surgery.…”

“…An instrumental aspect of this technological advancement lies in its ability to reduce reliance on the subjective visual perception and experience of the surgeon [22]. By introducing a standardized technique facilitated by the inclinometer, this approach effectively mitigates inter-operator variability [9].…”

“…Nonetheless, it is important to acknowledge that, during these surgical procedures, the variation in the apparent inclination of metatarsal osteotomies can be considerable. Technical errors or intraoperative difficulties [8] can significantly compromise post-operative outcomes [9][10][11]. Since there are no solid evidence-based guidelines to guide the accuracy of these surgical corrections, it has become imperative to minimize the margin of error when performing osteotomies [9,12].…”

“…Technical errors or intraoperative difficulties [8] can significantly compromise post-operative outcomes [9][10][11]. Since there are no solid evidence-based guidelines to guide the accuracy of these surgical corrections, it has become imperative to minimize the margin of error when performing osteotomies [9,12]. Given this scenario, the use of technology has become a means to optimize surgical practice [13], with an increasing focus on the use of portable devices to improve both surgical technique and patient outcomes, as seen in different surgical pathologies [9].…”

Technical note—the use of an inclinometer to accurately guide intra-operative femoral de-rotational osteotomies

“…Furthermore, a sawbone study by Swarup et al. has confirmed the high surgical accuracy of femoral de-rotation when guided by a digital electronic inclinometer [ 9 ]. We have found a bubble inclinometer to be more intuitive and easier to use compared to a digital inclinometer which only lists positive values.…”