Pediatric Orthopaedics Journal Scan

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Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: a case series and meta-analysis.

J Child Orthop. 2012 Aug;6(4):297-306

Authors: Dohin B, Kohler R

Abstract
PURPOSE: A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect.
METHOD: The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated.
RESULTS: In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology.

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Commentary on the article "Alternative technique for open reduction and fixation of displaced pediatric medial epicondyle fractures" by Michael P. Glotzbecker, Benjamin Shore, Travis Matheney, Meryl Gold, Daniel Hedequist. J Child Orthop doi:10.1007/s11832-012-0395-1.

J Child Orthop. 2012 Jul;6(3):255

Authors: Gopinathan NR, Kothari MK

PMID: 23814626 [PubMed]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23814626?dopt=Abstract

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Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws.

J Child Orthop. 2012 Aug;6(4):285-9

Authors: Pretell-Mazzini J, Rodriguez-Vega V, Muñoz-Ledesma J, Andrés-Esteban EM, Marti-Ciruelos R, González-López JL, Curto-De la Mano A

Abstract
PURPOSE: The aim of our study is to report our complication rate and analyze the associated risk factors when removing cannulated stainless steel screws for SCFE fixation.
METHODS: This was a multicenter retrospective study of patients who underwent removal of cannulated stainless steel screws after a mean time of 2.03 years of implantation. Thirty-two patients were included (38 hips) with a mean of 13.7 years of age during screw removal surgery. The mean post-removal follow up time was 1.6 years. In all cases the removal of screws was done systematically. Demographic data, possible risk factors related to removal failure, as well as post-removal complications such as post-removal fractures, infections and scar issues were recorded.

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Spondylolysis is frequently missed by MRI in adolescents with back pain.

J Child Orthop. 2012 Jul;6(3):237-40

Authors: Yamaguchi KT, Skaggs DL, Acevedo DC, Myung KS, Choi P, Andras L

Abstract
PURPOSE: Magnetic resonance imaging (MRI) is often used in the evaluation of lower back pain in adolescents. The purpose of our study is to report on the frequency of MRI missing spondylolysis in adolescents with back pain in a pediatric orthopaedic practice.
METHODS: A retrospective review of all patients with a diagnosis of spondylolysis who presented from January 2000 to March 2010 was performed. All patients were evaluated at a single institution by the senior author. Inclusion criteria were patients with spondylolysis confirmed on computed tomography (CT) or plain film that also received an MRI.
RESULTS: Eleven patients with spondylolysis had an MRI performed. The mean age of the study patients was 14.2 years (range 10-17). The diagnosis of spondylolysis was missed in the MRI radiology reading in 7 out of 11 (64 %) studies.
CONCLUSIONS: MRI missed a spondylolysis in over half of the adolescents in this consecutive series. In patients with a history or physical findings suggestive of spondylolysis, such as localized pain of the lumbar spine with back extension, further radiographic evaluation should be considered, even if an MRI is negative.
LEVEL OF EVIDENCE: III, retrospective review.

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Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study.

J Child Orthop. 2012 Aug;6(4):277-83

Authors: Alves C, Steele M, Narayanan U, Howard A, Alman B, Wright JG

Abstract
PURPOSE: The treatment of unstable slipped capital femoral epiphysis (SCFE) remains controversial. Surgical dislocation and open reduction has the potential to significantly reduce the rate of avascular necrosis (AVN) by allowing direct preservation of the femoral head blood supply. The purpose of this study was to determine if open reduction of the unstable SCFE by means of surgical hip dislocation reduced the risk of AVN compared with closed reduction and percutaneous pinning.
METHODS: We reviewed the medical records and radiographs of patients treated at our institution between the years 2000 and 2008. Sex, age, side of slip, precipitating event, pre- and post-operative anterior physeal separation (APS) and slip angle, slip severity, time between inciting event and surgical treatment, number of screws used, development of AVN, and need for subsequent surgery were evaluated. Statistical analysis was performed to compare risk factors and occurrence of AVN.
RESULTS: From 2004 to 2008, we treated 12 patients with unstable SCFEs: six had closed reduction and percutaneous pinning and six underwent open reduction by means of

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Congenital constriction ring in children: sine plasty combined with removal of fibrous groove and fasciotomy.

J Child Orthop. 2012 Jul;6(3):189-97

Authors: Hung NN

Abstract
OBJECTIVE: To evaluate the clinical and functional results of a technical procedure used in the surgical treatment of congenital constriction ring (CCR) in children.
MATERIALS AND METHODS: This was a retrospective study undertaken to evaluate the results of surgical techniques performed from January 1995 to December 2005 on 95 patients with 134 congenital constriction bands. Due to the drop-out of nine patients during follow-up, data on 86 patients (121 congenital constriction rings; average age at surgery 1 year 2 months) were analyzed. The extent of the constrictions was classified by according to the Patterson criteria. All patients were treated by two-stage sine plasty combined with removal of the fibrous groove and fasciotomy, with one-half of the ring removed during the first stage and the other half removed 1 week later during the second state. The surgical outcomes were assess according to the Moses criteria.

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Surgical treatment of hip dislocation in Kabuki syndrome: use of incomplete periacetabular osteotomy for posterior acetabular wall deficiency.

J Child Orthop. 2012 Aug;6(4):261-7

Authors: Wada A, Nakamura T, Yamaguchi T, Yanagida H, Takamura K, Oketani Y, Kubota H, Fujii T

Abstract
PURPOSE: Kabuki syndrome is characterized by distinctive facial features, skeletal anomalies, persisting fingertip pads with dermatoglyphic abnormalities, postnatal growth deficiency and mental retardation. This report reviews our results in the operative treatment of hip dislocations in patients with Kabuki syndrome.
METHODS: Between 2001 and 2009, seven dislocated hips (three unilateral and two bilateral hips) in five patients (all girls) were operatively treated at our institution. The operative treatment consists of open reduction, femoral derotation varus osteotomy, pelvic osteotomy (Salter in one and incomplete periacetabular osteotomy in six hips) and capsular plication. The age of the patients at the time of surgery ranged from 2.4 to 5.7 years, with an average of 3.6 years.

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Birth-related femoral fracture in newborns: risk factors and management.

J Child Orthop. 2012 Jul;6(3):177-80

Authors: Kancherla R, Sankineani SR, Naranje S, Rijal L, Kumar R, Ansari T, Trikha V

Abstract
PURPOSE: Femoral shaft fracture following birth in newborns is a very rare injury. However, the risk factors for, mechanism of and management of these injuries remain a matter of debate. We describe our observations in a tertiary centre.
METHODS: Ten cases of femoral shaft fracture encountered during a study period from January 2005 to December 2009 were evaluated. The demographic details, risk factors during birth, systemic illness, mode of delivery, type of fracture and management used were documented, and an analysis was performed.
RESULTS: Mean gestational age was 37.2 weeks. Mean time to diagnose was 4 days. Two patients had subtrochanteric fracture, and eight patients had mid-shaft fracture. Most patients had breech presentation and had been born by Caesarean section. All patients showed complete union at the end of 4 weeks. No residual angulation or limb length discrepancy was noted after mean follow-up of 5 years.
CONCLUSIONS: Thorough clinical examination and proper orthopaedic consult in the event of doubtful presentation help in early diagnosis and management. These fractures have good prognosis at long-term follow-up.

PMID: 23814617 [PubMed]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23814617?dopt=Abstract

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The Boyd Amputation in Children: Indications and Outcomes.

J Pediatr Orthop. 2013 Jul 17;

Authors: Westberry DE, Davids JR, Pugh LI

Abstract
BACKGROUND:: The level of amputation in the pediatric population requires appropriate planning to provide an optimal residual limb for prosthetic fitting and must include long-term strategies to accommodate future growth of the extremity.
METHODS:: A retrospective review over a 15-year period was performed of all Boyd procedures (calcaneotibial fusion) in the pediatric limb deficiency population at a single institution. A chart review and radiographic analysis was performed to identify the indications, surgical outcomes, complications, need for additional surgical intervention, and nature of the postoperative prosthetic management. Optimal positioning of the calcaneotibial fusion and the growth-dependent changes in the morphology of the fusion site were determined by radiographic analysis.