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(1) Background: Respiratory disease is a leading cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP). This study describes the prevalence of CP-related respiratory disease and the non-modifiable risk factors for respiratory-related hospital admissions in the Aotearoa New Zealand population. (2) Methods: New Zealand Cerebral Palsy Register (NZCPR) participant data and de-identified data from the National Minimum Dataset and Pharmaceutical Dispensing Collections were linked to identify all respiratory-related hospital admissions and respiratory illness-related antibiotic exposure over 5 years in individuals with CP (0–26 years). (3) Results: Risk factors for respiratory-related hospital admissions included being classified Gross Motor Function Classification System (GMFCS) IV or V compared to GMFCS I [OR = 4.37 (2.90–6.58), p < 0.0001; OR = 11.8 (7.69–18.10), p < 0.0001, respectively,]; having ≥2 antibiotics dispensed per year [OR = 4.42 (3.01–6.48), p < 0.0001]; and being of Māori ethnicity [OR = 1.47 (1.13–1.93), p < 0.0047]. Māori experienced health inequities compared to non-Māori, with greater functional disability, and also experienced greater antibiotic dispensing than the general population. (4) Conclusion: Māori children and young adults have a higher risk of respiratory-related illness. Priority should be given to the screening for potentially modifiable risk factors for all children with CP from diagnosis onwards in a way that ensures Māori health equity.

Hip subluxation is common in children with cerebral palsy (CP). The aim of this study was to describe the radiological outcome of reconstructive hip surgery in children with CP, gross motor function classification system (GMFCS) level IV and V, and determine whether the GMFCS level plays a predictive role in outcome. This was a retrospective cohort study conducted at a tertiary-level pediatric hospital with a CP hip surveillance program. Of 110 children with GMFCS IV and V CP registered for hip surveillance, 45 underwent reconstructive hip surgery between 1997 and 2009, defined as varus derotational proximal femoral osteotomy with or without additional pelvic osteotomy. Eleven children were excluded because of lack of 12-month follow-up (n=10) or missing clinical records (n=1). Thus, 21 GMFCS IV children (median age 6 years at surgery) and 13 GMFCS V children (median age 5 years at surgery), who underwent 58 index surgeries, were included in the study. Clinical records and radiology were reviewed. The two surgical groups were femoral osteotomy (varus derotational femoral osteotomy with an AO blade plate or femoral locking plate fixation), or femoral ostetotomy with additional pelvic osteotomy. Reimer's migration percentage (MP) was calculated from anteroposterior pelvis radiographs to determine the outcome for each hip independently. Failure was defined as MP of greater than 60% or further operation on the hip. Reconstructive surgeries were performed for 58 hips with a median preoperative MP of 55%. There were 15 failures at a median of 62 months, including nine failures in 35 GMFCS IV hips and six failures in 23 GMFCS V hips. Overall, GMFCS V hips tended to fail earlier, (hazard ratio 2.3) with a median time to failure of 78 and 39 months for GMFCS IV and V hips, respectively. Combined femoral and pelvic osteotomies had the lowest failure rates in both groups of patients. The GMFCS classification may have some predictive value for outcomes following reconstructive hip surgery, with surgery for GMFCS V hips tending to fail earlier.

Background: Unrecognized pin penetration in the treatment of slipped capital femoral epiphysis has serious long-term sequelae. The purpose of this study was to use postoperative computerized tomographic (CT) scans to determine the true position of the screw tip when compared with standard radiograph views. Methods: Twenty-four patients with 33 slipped capital femoral epiphyses were included in the study. Intraoperative or postoperative radiographs [anteroposterior (AP) and frog lateral] were compared with postoperative CT scans (coronal and axial) to determine (1) distance of the screw tip from the subchondral bone of the femoral head, (2) the number of screw threads across the physis, and (3) the 3-dimensional placement of the screw tip in the femoral head. Results: The positions of 38 screws in 33 hips were assessed. Screw position within specific quadrants of the femoral head was more anterior and superior than appreciated on radiographs. AP radiographs overestimated the distance between the screw tip and the subchondral bone, the average distance being 5.5mm on AP radiographs and 3.4mm on coronal CT (P < 0.0001). Bland-Altman analysis confirmed 95% limits of agreement of ― 5.6 to 1.5 mm, indicating that screws could be up to 5.6 mm closer to the subchondral bone than estimated by the AP radiograph. Closer agreement was found between the frog lateral radiograph and the axial CT views, with the distance from the subchondral bone averaging 4.7mm on frog lateral radiographs and 4.1 mm on axial CT (P < 0.01). Bland-Altman analysis showed 95% limits of agreement between the 2 measures of — 3.5 to 2.3 mm, suggesting that some screws were up to 3.5 mm closer to the subchondral bone. Three more anteriorly placed screws seemed to penetrate subchondral bone on CT, findings not shown on standard radiographs. Conclusions: Frog lateral radiographs of the hip provide a more accurate estimation of screw placement than AP radiographs. Screws closer than 4 mm to the subchondral bone on frog lateral radiographs or 6 mm on AP radiographs may penetrate subchondral bone.

High referral volumes to paediatric orthopaedic surgeons create long clinic waiting lists. The use of extended scope roles for doctors and health professionals is one strategy to address these wait times. We completed a 6-month trial of a non-surgical paediatric orthopaedic physician role (NSP) to help manage non-urgent referrals to our service from local general practitioners (GPs).For a 6-month period, the majority of non-urgent GP referrals were assessed by a US-trained NSP. Wait times were compared between this period and the same time period in the previous year. Family and referrer satisfaction was determined through postal surveys.Over the trial period, the NSP saw a total of 155 new patient referrals, which represented 49% of all non-urgent GP referrals for the period. Before the trial, only 75% of non-urgent referrals were seen within 131 days (19 weeks) with 10% waiting more than 215 days (31 weeks). By the end of the trial, 75% of referrals were seen within 55 days (8 weeks) and 90% within 61 days (9 weeks). The most common outcome was discharge with management advice. 12% of patients were referred on to an orthopaedic surgeon but only 1% went on to a surgical wait list. Families and referrers reported high levels of satisfaction and only three patients discharged by the NSP were referred back for orthopaedic surgeon review.The NSP role was effective at reducing clinic wait times for patients with non-urgent paediatric orthopaedic conditions, while maintaining family and referrer satisfaction.

This study determined the intrarater and interrater reliabilities of measurements of paediatric limb length discrepancy on anteroposterior scout computed tomography scanograms. Seven physicians measured 26 films at two measuring sessions, separated by at least 8 weeks. High intraclass correlation coefficients above 0.96 were observed for measures by different raters within one session and also for repeat measures by the same raters across sessions. The intrarater, intersessional 95% limits of agreement were +/-6 mm for tibial length, +/-5 mm for femoral length and +/-7 mm for total limb length. These errors are similar to those seen with the use of orthoroentgenograms.