Henna (Mehndi) as radio-opaque marker for pediatric orthopaedic operations

Abstract

Introduction: Accurate location of the physes is important in many pediatric orthopaedic operative procedures. Pre-operatively the physis can be identified by a simple plain radiograph, while intra-operatively a C-arm Image Intensifier serves as an essential equipment for localizing the physis. The physis is visible as a radiolucent area sandwiched between the epiphysis and the metaphysis. However, due to unavailability of C-arm, per-operative accurate localization of the physis was a challenge. The purpose of this case series was to assess the usage of Henna (Mehndi) as a radio-opaque marker for pediatric orthopaedic operations for localization of the physis. Methods: A preoperative true-size marker film was taken after drying of applied henna paste. Henna is radio-opaque and also stains the skin, the marks of which persist for several days. The marks of henna on the skin were intra-operatively used to correlate with the markings on the radiographic film for accurate localization of the physis in a series of cases of surgical correction of the uniplanar deformity around the knee at a tertiary level pediatric institute between October 2017 and December 2018.Results: There were eleven cases in the study. Mean age at presentation was 9 years (range 7 to 12 years). Three cases had unilateral affection, while eight cases had bilateral affection. Average follow up period was 30 months. All cases had their deformity corrected till the last follow up.Conclusion: Varieties of intra-operative skin markers have been used for past several years, details of which are available in literature. Henna is a near ideal pre-operative skin marker as it is easily available, inexpensive, visible even after vigorous surgical skin preparation and normally has no untoward side effects. Our use of henna in pediatric orthopaedic surgeries for localizing the physis has not been reported in literature as of date.