Showing papers in "Journal of Pediatric Orthopaedics in 2004"
TL;DR: The new Functional Mobility Scale was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.
Abstract: We devised a new Functional Mobility Scale (FMS) to describe functional mobility in children with cerebral palsy, as an aid to communication between orthopaedic surgeons and health professionals. The unique feature of the FMS is the freedom to score functional mobility over three distinct distances, chosen to represent mobility in the home, at school and in the wider community. We examined the construct, content, and concurrent validity of the FMS in a cohort of 310 children with cerebral palsy by comparing the FMS to existing scales and to instrumented measures of physical function. We demonstrated the scale to be both valid and reliable in a consecutive population sample of 310 children with cerebral palsy seen in our tertiary referral center. The FMS was useful for discriminating between large groups of children with varying levels of disabilities and functional mobility and sensitive to detect change after operative intervention.
365 citations
TL;DR: It is demonstrated that ACL injury occurs in skeletally immature soccer players and that females appear to have an increased risk of ACL injury and knee injury compared with males, even in the skeletally mature players.
Abstract: Injury claims from an insurance company specializing in soccer coverage were reviewed for a 5-year period. A total of 8215 injury claims (3340 females, 4875 males) were divided into three categories: (1) all injury, (2) knee injury, and (3) ACL injury. Knee injuries accounted for 22% of all injuries (30% female, 16% male). ACL injury claims represented 31% of total knee injury claims (37% female, 24% males). The youngest ACL injury was age 5. The ratio of knee injury/all injury increased with age. Compared with males, females demonstrated a higher ratio of knee injury/all injury and a higher ratio of ACL injury/all injury. This study demonstrates that ACL injury occurs in skeletally immature soccer players and that females appear to have an increased risk of ACL injury and knee injury compared with males, even in the skeletally immature. Future research related to ACL injury in females will need to consider skeletally immature patients.
299 citations
TL;DR: Surgeons should advance nail ends to lie against the supracondylar flare of the femur to avoid symptoms at the insertion site and should avoid implanting nails of two different diameters.
Abstract: Flexible intramedullary nailing has become a popular method of fixation of pediatric femoral fractures. The authors analyzed their first 5-year experience with titanium elastic stable intra-medullary nailing, specifically to report the complications associated with this technique and to provide recommendations to avoid these complications. Seventy-eight children with 79 femoral fractures were treated by this method. Complications included pain/irritation at the insertion site (41), radiographic malunion (8), refracture (2), transient neurologic deficit (2), and superficial wound infection (2). Ten patients required reoperation prior to union. Malunion and/or loss of reduction requiring reoperation was strongly associated with the use of nails of mismatched diameters (odds ratio = 19.4) and comminution of more than 25% (odd ratio = 5.5). Pain at the insertion site was significantly associated with bent or prominent nail ends. Most complications are minor, and many are preventable. Surgeons should advance nail ends to lie against the supracondylar flare of the femur to avoid symptoms at the insertion site and should avoid implanting nails of two different diameters. Comminuted fractures should be monitored carefully and might benefit from additional immobilization.
227 citations
TL;DR: The study confirms previous retrospective studies finding no significant difference in perioperative complications or rate of open reduction in children undergoing early versus delayed surgical treatment of supracondylar humerus fractures.
Abstract: This retrospective study examined whether a delay of greater than 12 hours is associated with an increased risk of perioperative complications in the operative treatment of supracondylar humerus fractures in children. Of 150 consecutive children with supracondylar fractures, 50 underwent surgery in less than 12 hours and 100 underwent surgery greater than 12 hours after injury. There was no significant difference between groups in rate of open reduction (P = 0.55), pin tract infection (P = 1.0), iatrogenic nerve injury (P = 1.0), vascular complication (P = 0.33), or compartment syndrome (P = 1.0), including when Gartland type III fractures were analyzed independently. There was no iatrogenic nerve injury, no compartment syndrome, and one pin tract infection in 150 patients. The study confirms previous retrospective studies finding no significant difference in perioperative complications or rate of open reduction in children undergoing early versus delayed surgical treatment of supracondylar humerus fractures.
161 citations
TL;DR: Bone marrow transplantation does not appear to alter the natural history of the musculoskeletal disorders in Hurler syndrome, although there may be a beneficial effect on upper extremity joint mobility.
Abstract: Bone marrow transplantation (BMT) is effective in ameliorating many of the clinical manifestations of Hurler syndrome. However, long-term data on the natural history of the musculoskeletal disorders of Hurler syndrome after BMT are limited. The authors report the orthopaedic outcomes in seven patients with Hurler syndrome who were successfully engrafted between 1990 and 1999, and have been followed for a mean of 7.6 years since transplantation. Medical records, clinical examinations, and imaging studies were reviewed to assess the development and management of hip dysplasia, genu valgum, spine abnormalities, hand abnormalities, and joint range of motion. BMT does not appear to alter the natural history of the musculoskeletal disorders in Hurler syndrome, although there may be a beneficial effect on upper extremity joint mobility.
145 citations
TL;DR: Surgical intervention, guided by preoperative gait analysis, is effective and safe for children with cerebral palsy and a significant majority of subjects improved on a predominance of outcome measures.
Abstract: A retrospective study was used to evaluate the outcome of treatment of 135 ambulatory children with cerebral palsy. Diplegic subjects were selected from the existing database at the Gillette Children's Specialty Healthcare Motion Analysis Laboratory. All subjects had undergone gait analysis before and after intervention, which included orthopaedic surgery, selective dorsal rhizotomy, or both treatments. Outcome was based on gait pathology, gait efficiency, functional walking ability, and higher-level functional skills. Gait pathology was assessed using 16 clinically relevant kinematic parameters. Gait efficiency was assessed with steady-state oxygen consumption. Walking ability and higher-level functional skills were based on patient report surveys. Improvements were seen in all outcome measures. A significant majority of subjects (79%) improved on a predominance of outcome measures; only 7% of subjects worsened. Within the restrictions of this study design, the results indicate that surgical intervention, guided by preoperative gait analysis, is effective and safe for children with cerebral palsy.
140 citations
TL;DR: Children with clubfeet who have an initial score of ≥5.0 by the Pirani system or are rated as Grade IV feet by the Dimeglio system are very likely to need a tenotomy.
Abstract: The purpose of this study was to determine how to predict the need for tenotomy at the initiation of the Ponseti treatment. Fifty clubfeet (35 patients) were prospectively rated according to Pirani and Dimeglio scoring systems. Tenotomies were performed in 36 of 50 feet (72%). Those that underwent tenotomy required significantly more casts (P = 0.005). Of 27 feet with initial Pirani scores > or = 5.0, 85.2% required a tenotomy and 14.8% did not; 94.7% of the Dimeglio Grade IV feet required tenotomies. Following removal of the last cast, there was no significant difference between those that did and did not have a tenotomy. Children with clubfeet who have an initial score of > or = 5.0 by the Pirani system or are rated as Grade IV feet by the Dimeglio system are very likely to need a tenotomy. At the end of casting, feet were equally well corrected whether or not they needed a tenotomy.
137 citations
TL;DR: Although the results show that the shoulders and elbows did not do as well as in upper-type lesions, the results at the level of the hand were encouraging, showing 75% useful results after 8 years, even in patients with avulsion injuries of the lower roots.
Abstract: From 1978 to 2002, the authors have operated on 723 babies for obstetric brachial plexus repair. Complete paralyses and associated root ruptures and avulsions are severe, and the results cannot be evaluated before the end of growth. A series of 73 patients operated on from 1978 to 1994 were followed with a mean follow-up of 6.4 years. Secondary operations (mainly on the shoulders) were necessary 123 times. Although the results show that the shoulders and elbows did not do as well as in upper-type lesions, the results at the level of the hand were encouraging, showing 75% useful results after 8 years, even in patients with avulsion injuries of the lower roots. These results demonstrate the usefulness of early exploration and repair of the obstetric plexus.
134 citations
TL;DR: Progressive loss of external rotation beyond neutral correlated with increased angles of retroversion and increased posterior subluxation of the humeral head and should be regarded as in indicator of shoulder malformation.
Abstract: The purpose of this study was to determine whether physical examination findings correlate with glenohumeral joint dysplasia after brachial plexus birth palsy. Thirty-three children with residual palsy underwent magnetic resonance imaging evaluation of both shoulders. Glenoscapular angles and humeral head measurements were calculated. Physical examination findings were recorded about the shoulder. Glenohumeral external rotation was measured during firm stabilization of the scapulothoracic joint. In the uninvolved shoulders, glenoscapular version averaged -8 degrees (range -16 degrees to -2 degrees) and percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) averaged 45% (range 34-54%). In the involved shoulders, glenoscapular version averaged -24 degrees (range -64 degrees to -7 degrees) and PHHA averaged 28% (range 0-51%). Both version and subluxation were significantly different (P < 0.001) between uninvolved and involved shoulders. There was a significant correlation between version and subluxation (r = 0.91, P < 0.001). Humeral head size was significantly less (P < 0.001) on the involved shoulder. Progressive loss of external rotation beyond neutral correlated with increased angles of retroversion and increased posterior subluxation of the humeral head and should be regarded as in indicator of shoulder malformation.
129 citations
TL;DR: Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by application of well-molded long-leg plaster casts and a percutaneous tendoachilles tenotomy to correct residual equinus contracture.
Abstract: Ponseti demonstrated correction of most clubfeet in infants using proper manipulative techniques followed by application of well-molded long-leg plaster casts and a percutaneous tendoachilles tenotomy to correct residual equinus contracture. Medical complications occurring as a result of this technique have not to our knowledge been reported. The authors retrospectively reviewed 134 consecutive infants with 219 idiopathic clubfeet treated with the Ponseti method. A percutaneous tendoachilles tenotomy was performed on 200 clubfeet (91%) at a mean age of 16 weeks (range, 6–77 weeks) when less than 10° of ankle dorsiflexion was present after casting. A total of 4 patients had serious bleeding complications following the percutaneous tendoachillis tenotomy—3 due to presumed injury to the peroneal artery and 1 due to injury to the lesser saphenous vein. The authors detail the technique of performing a percutaneous tendoachilles tenotomy and offer guidelines that may help others avoid this same complication.
119 citations
TL;DR: The frequency of peripheral instability mandates a thorough assessment of meniscal stability at all peripheral attachments during the arthroscopic evaluation and treatment of discoid lateral meniscus, particularly in complete variants and in younger children.
Abstract: The purpose of this study was to determine the prevalence of peripheral rim instability in discoid lateral meniscus. A consecutive series of 112 patients (128 knees) (mean age 10.0 years [range 1 month to 22 years]) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 1993 and 2001 was reviewed. Of those discoid menisci classified intraoperatively (n = 87), 62.1% (n = 54) were complete discoid lateral menisci and 37.9% (n = 33) were incomplete discoid lateral menisci. An associated meniscal tear was present in 69.5% (n = 89) of all knees studied. Overall, 28.1% (n = 36) of discoid lateral menisci had peripheral rim instability: 47.2% (n = 17) were unstable at the anterior-third peripheral attachment, 11.1% (n = 4) at the middle-third peripheral attachment, and 38.9% (n = 14) at the posterior-third peripheral attachment. Thirty-one of the 36 unstable discoid menisci underwent repair of the peripheral meniscal rim attachment. One patient underwent a complete, open meniscectomy. Peripheral rim instability was significantly more common in complete discoid lateral menisci (38.9% vs. 18.2%; P = 0.043) and in younger patients (8.2 vs. 10.7 years; P = 0.002). The frequency of peripheral instability mandates a thorough assessment of meniscal stability at all peripheral attachments during the arthroscopic evaluation and treatment of discoid lateral meniscus, particularly in complete variants and in younger children.
TL;DR: The authors recommend that rotational osteotomies be performed in patients with patellofemoral pain and associated excessive femoral and tibial torsion, otherwise known as miserable malalignment syndrome.
Abstract: Anterior knee pain is one of the more frustrating problems that orthopaedic surgeons treat. This study investigates the results of surgical correction of miserable malalignment syndrome associated with significant patellofemoral pain. The authors identified and retrospectively reviewed 14 consecutive patients with 27 limbs associated with excessive femoral anteversion, excessive tibial outward rotation, and patellofemoral pain. All of the patients were initially reviewed by the senior author and subsequently treated by ipsilateral outward femoral osteotomy and inward tibial osteotomy. All of the patients had failed nonoperative treatment. No persistent complications were seen. Subjectively and clinically, all of the patients were reviewed at an average of 5.2 (range 2.0-12) years after surgery. All of the patients reported full satisfaction with their surgery and outcomes. Most of the current literature discusses alignment in association with patellofemoral pain in the form of the extensor mechanism alignment. When evaluating patients with patellofemoral pain, it is imperative to assess the rotational profiles of the femur and tibia. The authors recommend that rotational osteotomies be performed in patients with patellofemoral pain and associated excessive femoral and tibial torsion, otherwise known as miserable malalignment syndrome.
TL;DR: Backpack weight, measured as a percentage of body weight, was effective in predicting back pain and girls and those who walk to and from school were more likely to report back pain.
Abstract: In a sample of 3,498 students living in two counties in California, each student's weight and backpack load were measured. Demographic information as well as information about backpack use was obtained. Nonspecific mechanical back pain was found to be highly prevalent, and the reported severity and chronicity of pain were high. Controlling for age, socioeconomic status, walking to and from school, and method of wear, results indicated that backpack weight, measured as a percentage of body weight, was effective in predicting back pain (P < 0.01). Girls and those who walk to and from school were more likely to report back pain (P < 0.01). The method of wear, socioeconomic status, and age were not found to be significantly related to the prevalence of back pain. However, with regard to the severity of pain, older age (P < 0.01), walking to and from school (P < 0.01), and method of wear (P < 0.05) were statistically significant.
TL;DR: The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex.
Abstract: The treatment of lateral condyle fractures in children remains controversial. This study investigates whether minimally displaced lateral condyle fractures should be treated surgically and compares different techniques of operative management. The authors retrospectively reviewed medical charts and radiographs of 97 children from two international centers whose therapeutic modalities differed, noting demographic data, fracture features, treatment modalities, complications, and clinical and radiographic results. Long-arm immobilization alone resulted in additional fracture displacement and a higher number of nonunions than did surgical management. The authors conclude that displaced fractures should be fixed surgically with two smooth or threaded Kirschner wires; they can pass through the ossific nucleus of the capitellum if necessary, but they must engage the far cortex. If patients are likely to be noncompliant with treatment, the wires should be buried under the skin to avoid the risk of infection, but this procedure necessitates a second surgery for removal of fixation.
TL;DR: A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures found that participation in athletics, particularly basketball, resulted in 77% of fractures.
Abstract: A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months. A group of four preadolescent patients ages 9 to 12 years at injury was identified. Participation in athletics, particularly basketball, resulted in 77% of fractures. There were one type IA, three type IB, two type IIA, six type IIB, two type IIIA, four type IIIB, and one type IV fractures. Fifteen fractures were treated with open reduction and internal fixation and four by closed reduction and cylinder cast immobilization. Three cases (15.7%) of extensor mechanism disruption were noted, two patellar tendon avulsions and one quadriceps avulsion. Final outcome was good in all patients regardless of fracture type or treatment. There were no complications.
TL;DR: Over a 5-year period, 16 unstable tibia fractures in 14 patients were treated with flexible titanium intramedullary nails and flexible titanium nails are an effective treatment to obtain and maintain alignment and stability.
Abstract: Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the tibia that requires operative stabilization. Over a 5-year period, 16 unstable tibia fractures in 14 patients were treated with flexible titanium intramedullary nails. All charts and radiographs were reviewed. The average age was 10 years 4 months. There were three open fractures. All fractures healed. Closed injuries obtained union by an average of 8 weeks, open fractures by an average of 15 weeks. There were no malunions. The average follow-up was 1 year 5 months. There were no instances of growth arrest, remanipulations, or refracture. In the unstable pediatric tibia fracture, flexible titanium nails are an effective treatment to obtain and maintain alignment and stability.
TL;DR: In a comparison of age- and sex-matched skeletally immature patients, those with midsubstance ACL injuries had a significantly narrower notch index than those with tibial spine fractures, which may account for some of the variation in injury patterns in the skeletally mature knee.
Abstract: Both midsubstance anterior cruciate ligament (ACL) injury and tibial spine avulsion fracture occur in the skeletally immature knee. The purpose of this study was to determine whether there are differences in skeletal maturation or notch parameters between these two groups. A retrospective case-control study of 25 skeletally immature patients with tibial spine fractures compared with 25 age- and sex-matched skeletally immature patients with midsubstance ACL injuries was performed. Bone age and notch width index were determined from preoperative radiographs. There were no significant differences between the tibial spine fracture group and the ACL injury group with respect to skeletal maturation, comparing bone age to chronological age (-0.5 vs. -0.3 years; P = 0.617). The ACL injury group had narrower notch indices than the tibial spine fracture group (0.230 vs. 0.253; P = 0.020). Thus, in a comparison of age- and sex-matched skeletally immature patients, those with midsubstance ACL injuries had a significantly narrower notch index than those with tibial spine fractures. This association may account for some of the variation in injury patterns in the skeletally immature knee.
TL;DR: Within the group of patients who had surgery, patients with longer operative times and more use of intraoperative fluoroscopy were at higher risk of developing CS and patients with intramedullary fixation had an increased incidence of CS.
Abstract: This study was designed to evaluate the incidence of compartment syndrome (CS) resulting from the treatment of both-bone forearm fractures in children. A retrospective analysis of 285 consecutive children who presented with both-bone forearm fractures was performed. Of 235 closed injuries, 205 were treated with closed reduction and casting; none of these patients developed CS. Thirty of the closed injuries were treated with closed reduction and intramedullary fixation; three of these patients (10%) developed CS. Fifty patients sustained open fractures and were treated with debridement and open reduction with intramedullary pinning; CS developed in three of these patients (6%). The eighty patients treated with intramedullary fixation had an increased incidence of CS compared with the 205 patients treated with closed reduction and casting (P < 0.001). Within the group of patients who had surgery, patients with longer operative times and more use of intraoperative fluoroscopy were at higher risk of developing CS.
TL;DR: Repeated aspiration is a safe and efficacious method of treatment for SAHJ and prevents scarring of the skin and the need for general anesthesia and faster return to normal activity was noted in this series.
Abstract: Arthrotomy of the hip joint followed by a variable period of drainage or continuous irrigation and drainage is considered the accepted treatment of septic arthritis of the hip joint (SAHJ). The authors reviewed the results of a cohort of children with SAHJ with repeated aspirations of the hip joint. Thirty-four children diagnosed with SAHJ were treated with repeated aspirations of the hip joint. The aspirations were performed under ultrasound guidance and topical anesthesia or under sedation. After the aspiration the joint was irrigated using the same needle, and the procedure was repeated daily. Six of the patients were operated on and then treated with aspirations because of drain dislodgement or clogging. Twenty-eight of the patients were treated primarily with repeated aspirations. Four of those patients did not improve and underwent arthrotomies, and 24 were treated only by repeated aspirations and healed completely. The mean number of aspirations was 3.6 (range 3-5), and 75% of the patients resumed walking after 24 hours. The mean follow-up time was 7.4 years (range 3-18). No complications were seen. Repeated aspiration is a safe and efficacious method of treatment for SAHJ. This method of treatment is not associated with surgery and its complications and prevents scarring of the skin and the need for general anesthesia. Faster return to normal activity was noted in this series.
TL;DR: MRI studies following treatment with immobilization showed subsidence or disappearance of the metaphyseal but not any apophyseal signal changes commensurate with improvement in symptoms, so Sever’s “apophysitis” may be an overuse injury causing microinjury within the developing metaphYseal “equivalent” trabecular bone that has not completely adapted to the changing biologic requirements of the growing, athletically active child.
Abstract: Magnetic resonance imaging (MRI) in children with a presumptive diagnosis of Sever's apophysitis and with continuing pain after conservative treatment demonstrated bone bruising within the trabecular bone of the metaphyseal region adjacent to the calcaneal apophysis. Limited portions of the apophyseal secondary ossification center showed similar increased signal changes. MRI studies following treatment with immobilization showed subsidence or disappearance of the metaphyseal but not any apophyseal signal changes commensurate with improvement in symptoms. Accordingly, the disorder commonly referred to as Sever's ''apophysitis'' may be a metaphyseal trabecular stress fracture, similar to the toddler's calcaneal stress fracture that has minimal or no involvement of the apophyseal ossification center, and thus should not be referred to as an apophysitis. Rather, it appears to be an overuse injury causing microinjury within the developing metaphyseal "equivalent" trabecular bone that has not completely adapted to the changing biologic (biomechanical) requirements of the growing, athletically active child.
TL;DR: The authors believe that all children under 1 year of age with a femoral shaft fracture are candidates for treatment with a Pavlik harness.
Abstract: This retrospective study compares Pavlik harness application versus spica casting for the treatment of children under 1 year of age with a femoral shaft fracture. The clinical and radiographic outcomes of 24 patients treated in a Pavlik harness were compared with 16 patients treated in a spica cast. The average age and weight of the two groups were significantly different, but there were no differences in radiographic outcomes between the Pavlik and spica cast groups. Approximately one third of all spica patients had a skin complication that added an additional risk to the patient. There were no similar complications in the Pavlik group. There were no differences in the outcome of the fractures in the two groups. The authors believe that all children under 1 year of age with a femoral shaft fracture are candidates for treatment with a Pavlik harness.
TL;DR: In this largest analysis of arthroscopic synovectomy for children with hemophilia, rehabilitation was not problematic and median arc of motion was stable or improved in the year after surgery in ankles, elbows, and shoulders.
Abstract: Children with hemophilia can develop progressive arthropathy. Arthroscopic synovectomy has been used to reduce hemarthroses, but few long-term results have been published. In this article the authors review their first 12 years of experience. Data are reported on 44 pediatric patients (69 joints: 39 ankles, 21 elbows, 7 knees, 2 shoulders). The median age at surgery was 10 years Median follow-up was 79 months. Joints with sufficient follow-up data showed a median bleeding frequency decline of 84% (P < 0.001). Median arc of motion was stable or improved in the year after surgery in ankles, elbows, and shoulders. Complications were rare. Radiographic scores worsened slightly. In this largest analysis of arthroscopic synovectomy for children with hemophilia, rehabilitation was not problematic.
TL;DR: Parents had more appreciation of the benefits in the children's appearance, whereas educators and therapists acknowledged more improvement in gross and oral motor function, and most parents and caretakers would recommend spine surgery.
Abstract: The purpose of this study was to delineate parents' and professional caretakers' satisfaction after spinal fusion in children with spasticity and to determine differences in their perceptions. A questionnaire assessing patients' functional improvement after spinal arthrodesis for correcting scoliosis was addressed to 190 parents. An expanded questionnaire was also addressed to 122 educators and therapists working in the care of children with cerebral palsy. Caretakers did not recognize effects of the scoliotic deformity on patients' head control, hand use, and feeding ability. Most of parents and caregivers reported a very positive impact of the surgery on patients' overall function, quality of life, and ease of care. Parents had more appreciation of the benefits in the children's appearance, whereas educators and therapists acknowledged more improvement in gross and oral motor function. Considering that the benefits from scoliosis correction clearly outweigh the increased risk of surgical complications, most parents (95.8%) and caretakers (84.3%) would recommend spine surgery.
TL;DR: There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.
Abstract: Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.
TL;DR: Gross, histologic, and biomechanical examinations at 36 weeks after the operation showed that the cultured chondrocytes and mesenchymal stem cells had comparable enhancing effects on the repair of chondral defects in advanced osteochondritis dissecans, whereas mosaicplasty did well initially and periosteal graft did less favorably.
Abstract: Management of chondral lesions in osteochondritis dissecans remains a challenge. This study investigated the efficacy of periosteal graft, osteochondroidal autograft, autologous chondrocyte and mesenchymal stem cell transplants in the treatment of chondral lesions in animal models. Full-thickness articular cartilage defects were created in the weight-bearing surface of the medial femoral condyle in 20-week-old NZW rabbits. A total of 56 knees were randomly divided into four groups as follows: group 1, transfer of cultured chondrocytes; group 2, transfer of cultured mesenchymal stem cells; group 3, repair by periosteal graft; and group 4, mosaicplasty. All of the contralateral knees served as control. Gross, histologic, and biomechanical examinations at 36 weeks after the operation showed that the cultured chondrocytes and mesenchymal stem cells had comparable enhancing effects on the repair of chondral defects in advanced osteochondritis dissecans, whereas mosaicplasty did well initially and periosteal graft did less favorably.
TL;DR: It is concluded that percutaneous transphyseal intramedullary K-wire pining for forearm diaphyseal fracture in children is a convenient, effective, and safe operation, without any deleterious effects on subsequent growth of the distal radius.
Abstract: Percutaneous transphyseal intramedullary Kirschner wire (K-wire) fixation was performed for diaphyseal fracture of the forearm in 84 children. In 60 patients (71%) closed reduction was performed, while in the remaining 24 (29%) closed reduction was supplemented with a mini-open reduction The K-wire was inserted transphyseally through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. With an average follow-up of 70 months and a minimum follow-up of 2 years, all the patients reviewed were found to have good functional results; none had nonunion, deep infection, or premature physeal closure. Moreover, initial preoperative translation of the fracture of more than 100% displacement was found to be associated with a significantly higher chance of requiring a mini-open reduction. The authors concluded that percutaneous transphyseal intramedullary K-wire pining for forearm diaphyseal fracture in children is a convenient, effective, and safe operation, without any deleterious effects on subsequent growth of the distal radius.
TL;DR: T titanium intramedullary nails were more stable than stainless steel nails in torsion and axial compression, and both materials stabilized simulated fractures at levels beyond physiologic non-weight-bearing loads without permanent deformation.
Abstract: Flexible intramedullary nails are commonly used to treat femoral fractures in children. This study evaluated the biomechanical differences between stainless steel and titanium nails when securing transverse and comminuted fractures in a synthetic femur model. Retrograde flexible stainless steel and titanium nails placed in a divergent "C" pattern were mechanically tested, and axial rotation and compression stiffness were analyzed with a two-way ANOVA. Rotational stability was significantly greater for titanium nails than stainless steel nails for both fracture patterns. Axial compression stiffness was significantly greater for titanium nails than stainless steel nails for both fracture patterns. There was no statistical difference between materials for axial "failure" load that produced 5 mm of shortening. Titanium intramedullary nails were more stable than stainless steel nails in torsion and axial compression. Both materials stabilized simulated fractures at levels beyond physiologic non-weight-bearing loads without permanent deformation.
TL;DR: In this paper, a biomechanical test was performed to evaluate the stability of simulated transverse and comminuted femoral fractures after retrograde and antegrade flexible titanium intramedullary nail fixation.
Abstract: Biomechanical testing was performed to evaluate the stability of simulated transverse and comminuted femoral fractures after retrograde and antegrade flexible titanium intramedullary nail fixation. Ten synthetic adolescent-sized femoral bone models were used. Five underwent retrograde fixation with two C-shaped nails inserted from medial and lateral entry portals. The other five underwent antegrade fixation using one C- and one S-shaped nail through lateral entry holes just inferior to the greater trochanter. Retrograde nail fixation demonstrated significantly less axial range of motion and greater torsional stiffness than antegrade fixation in both transverse and comminuted fracture patterns. However, there appeared to be a biomechanical trend of greater resistance to shortening for antegrade nails.
TL;DR: This quick, minimally invasive, and potentially reversible procedure has the added benefits of a short hospital stay with low morbidity, making it a suitable alternative to the more traditional methods of epiphysiodesis.
Abstract: Percutaneous epiphysiodesis using transphyseal screws (PETS) is a relatively new procedure being used for the correction of moderate leg length discrepancy and angular deformities in children. Over a mean follow-up of 2.4 years the authors followed prospectively 18 patients who underwent PETS. Nine had correction of angular deformity and nine had leg length inequality. The average reduction in leg length discrepancy was from 3.33 to 1.36 cm. The average improvement in angular deformity was 69%. This quick, minimally invasive, and potentially reversible procedure has the added benefits of a short hospital stay with low morbidity, making it a suitable alternative to the more traditional methods of epiphysiodesis.