Journal of Pediatric Orthopaedics B最新文献_第6页

Limited internal fixation combined with a joint-spanning external fixator in the treatment of Midfoot injuries in children 有限内固定联合跨关节外固定架治疗儿童中足损伤

Journal of Pediatric Orthopaedics B Pub Date : 2019-09-18 DOI: 10.1097/BPB.0000000000000675

Ming-Chuan Lu, Xuemin Lu, Yi-jing Xu, Gui-sen Yan

{"title":"Limited internal fixation combined with a joint-spanning external fixator in the treatment of Midfoot injuries in children","authors":"Ming-Chuan Lu, Xuemin Lu, Yi-jing Xu, Gui-sen Yan","doi":"10.1097/BPB.0000000000000675","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000675","url":null,"abstract":"The aim of this study was to explore the clinical features and surgical treatment methods of unstable midfoot injuries in children. Eleven children with severe unstable midfoot injuries admitted to Jishuitan Hospital, Beijing, from June 2009 to October 2016 were enrolled, including seven patients with Lisfranc injuries and four patients with Chopart injuries. All Lisfranc injuries had radiographic data from the healthy sides, and radiographs of the affected sides showed that all injured Lisfranc joints separated more than 3 mm compared with the healthy sides. The treatment methods employed a joint-spanning external fixator to distract and maintain the length of the medial and lateral columns, combined with joint-preserving trans-joint locking plate fixation or trans-articular cannulated screw and Kirschner wire fixation that passed through the joint. The patients were followed up for 53.7 months (17–110 months). The average operation time was 95.1 minutes, and the average intraoperative blood loss was 83.3 ml. Nine of the 11 patients were treated with an external fixator to distract and fix the medial or lateral column. Bone healing was achieved in all patients, and none of the patients complained of chronic pain in the midfoot. Flatfoot and valgus deformity were corrected after the surgery in the child with old fracture, and the pain in the calcaneocuboid joint disappeared. The average American Orthopedic Foot and Ankle Society mid-foot score at the last follow-up was 93.4, of which nine cases were greater than 90 and two cases were between 75 and 89. Children’s midfoot injury is characterized by fracture-dislocation. Simple joint capsule tear or ligament rupture is rare and often accompanied by severe cuboid compression fracture. The treatment should be focused on restoring the stability of the bony structure and the length of the medial and lateral columns. The use of a joint-spanning external fixator helps maintain reduction and restore the length of the medial and lateral columns.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"7 1","pages":"458 - 465"},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80411206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Congenital pseudarthrosis of the tibia: the outcome of a pathology-oriented classification system and treatment protocol 先天性胫骨假关节:病理导向的分类系统和治疗方案的结果

Journal of Pediatric Orthopaedics B Pub Date : 2019-09-09 DOI: 10.1097/BPB.0000000000000660

M. El-Rosasy

{"title":"Congenital pseudarthrosis of the tibia: the outcome of a pathology-oriented classification system and treatment protocol","authors":"M. El-Rosasy","doi":"10.1097/BPB.0000000000000660","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000660","url":null,"abstract":"Congenital pseudarthrosis of the tibia is defined as a non-union of a tibial fracture that develops in a dysplastic bone segment of the tibial diaphysis. Pathologically, a fibrous hamartoma surrounds the bone at the congenital pseudarthrosis of the tibia site. The cases of 25 children, who have congenital pseudarthrosis of the tibia, were included in this study. Their ages ranged from 15 months to 15 years at the time of treatment. Neurofibromatosis-1 was present in 24 children. They were managed according to our classification system and treatment protocol. The treatment for mobile pseudarthrosis (types 1 and 2) included complete excision of the pathological periosteum, insertion of autogenous iliac crest bone graft, and combined fixation using intramedullary rod and Ilizarov external fixator. For type 3 pseudarthrosis (stiff pseudarthrosis), a pre-constructed Ilizarov fixator was applied for simultaneous distraction of the pseudarthrosis and deformity correction without open surgery. Evaluation of results was mainly radiological and included achievement of union, leg length equalization, deformity correction and prevention of refracture. Consolidation of the pseudarthrosis and osteotomies was achieved in all cases (100%). Refracture occurred in one case (4%) at the site of previous pseudarthrosis. Residual limb length discrepancy more than 2.5 cm occurred in two cases (8%). Valgus deformity of the ankle was present in 12 cases (48%) and was treated by supramalleolar osteotomy. Follow-up ranged from 24 to 48 months (average 36.9 months) after fixator removal. The results of our treatment protocol, based on our classification system, have been consistently good and predictable in all cases of congenital pseudarthrosis of the tibia. Mobility of the pseudarthrosis is an important factor in choosing the type of interference.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"50 1","pages":"337 - 347"},"PeriodicalIF":0.0,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90557070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip Pavlik托具与t<s:1>宾根髋关节屈曲夹板早期治疗髋关节发育不良的比较

Journal of Pediatric Orthopaedics B Pub Date : 2019-09-09 DOI: 10.1097/BPB.0000000000000667

Lin Ran, Huimin Chen, Yuancheng Pan, Qing-jian Lin, F. Canavese, Shunyou Chen

{"title":"Comparison between the Pavlik harness and the Tübingen hip flexion splint for the early treatment of developmental dysplasia of the hip","authors":"Lin Ran, Huimin Chen, Yuancheng Pan, Qing-jian Lin, F. Canavese, Shunyou Chen","doi":"10.1097/BPB.0000000000000667","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000667","url":null,"abstract":"The Pavlik harness and the Tübingen hip flexion splint (Tübingen hip flexion splint) are two effective options for the early management of patients younger than 6 months of age with developmental dysplasia of the hip (DDH). The main objective of this study was to evaluate the clinical and radiological outcomes of patients younger than 6 months of age with type IIb to IV DDH managed by Pavlik harness or Tübingen hip flexion splint. The Pavlik harness and Tübingen hip flexion splint groups were comparable regarding the affected side (P = 0.09), Graf grade (P = 0.635), and age at initial treatment (P = 0.77). Overall, failure rates were 12 and 33% in Pavlik harness (4/33 hips) and Tübingen hip flexion splint groups (14/43 hips), respectively (P = 0.038). No cases of avascular necrosis (AVN) were found in either group. In the Tübingen hip flexion splint group, the failure rate was significantly higher in bilateral cases (66.6%; P = 0.004), in severe forms (Graf grade IV hips; P ≤ 0.0001), and in patients with lower age at initial treatment (67.7 ± 39.3 days; P = 0.005). The average follow-up time was 30.35 ± 3.58 months (range: 24–36). At the last follow-up visit, no statistically significant differences were found between the Pavlik harness and Tübingen hip flexion splint groups regarding the acetabular index (t = 0.632; P = 0.53) or center-edge angle (Z = −0.303; P = 0.762). Our study showed that both the brace treatments for DDH in children younger than 6 months of age were effective and well tolerated. However, Tübingen hip flexion splint should not be used in patients with severe forms of DDH (Graf grade IV hips).","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"1 1","pages":"424 - 430"},"PeriodicalIF":0.0,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87896800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Unsuspected tarsal coalitions in equinus and varus foot deformities 马蹄形和内翻足畸形中未预料到的跗骨联合

Journal of Pediatric Orthopaedics B Pub Date : 2019-09-09 DOI: 10.1097/BPB.0000000000000668

Noelle L. Van Rysselberghe, Christopher D. Souder, S. Mubarak

{"title":"Unsuspected tarsal coalitions in equinus and varus foot deformities","authors":"Noelle L. Van Rysselberghe, Christopher D. Souder, S. Mubarak","doi":"10.1097/BPB.0000000000000668","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000668","url":null,"abstract":"Tarsal coalitions have been reported in the setting of equinovarus foot deformities, but only as rare isolated findings. Failure to recognize this diagnosis may inhibit successful equinovarus correction. Here, we review a series of tarsal coalitions seen in congenital and neuropathic equinovarus deformity at two institutions, to report the breakdown of types of coalitions encountered, and to suggest methodology to facilitate earlier diagnosis. The records of all patients treated by two of the authors for bilateral equinovarus deformities and found to have either a unilateral or bilateral tarsal coalition between 2006 and 2016 were reviewed. Nine feet with tarsal coalition (calcaneonavicular n = 7 and talocalcaneal n = 2) were reviewed. Five of these cases occurred in patients with idiopathic equinovarus and four cases in patients with equinovarus related to a neurologic disease. All patients were definitively diagnosed by computed tomography scans with 3D reconstruction. In 56% of cases, the patient had previously undergone at least one open procedure before the coalition was recognized. The mean age at diagnosis of the coalition was 11.4 years. Our experience suggests that tarsal coalitions, particularly calcaneonavicular coalitions, may occur more frequently in equinovarus deformities than previously reported. Upon recognition and removal of these coalitions, we were able to achieve improved correction of the equinovarus deformities and improved range of motion. We recommend that surgeons maintain an awareness of this potential concomitant problem in all equinovarus foot deformities and consider advanced imaging in cases which fail to respond to traditional treatment.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"69 1","pages":"370 - 374"},"PeriodicalIF":0.0,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74598606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Anatomic, diagnostic and management challenges in paediatric pelvic injuries: a review. 解剖，诊断和管理挑战在儿科盆腔损伤:回顾。

Journal of Pediatric Orthopaedics B Pub Date : 2019-09-01 DOI: 10.1097/BPB.0000000000000591

R. Wharton, S. Trowbridge, A. Simpson, K. Sarraf, Y. Jabbar

引用次数: 6

Effect of age on radiographic outcomes of patients aged 6–24 months with developmental dysplasia of the hip treated by closed reduction 年龄对6-24月龄髋发育不良闭合复位患者影像学结果的影响

Journal of Pediatric Orthopaedics B Pub Date : 2019-08-28 DOI: 10.1097/BPB.0000000000000672

Yiqiang Li, Xuemei Lin, Yanhan Liu, Jingchun Li, Yuanzhong Liu, B. Pereira, F. Canavese, Hongwen Xu

{"title":"Effect of age on radiographic outcomes of patients aged 6–24 months with developmental dysplasia of the hip treated by closed reduction","authors":"Yiqiang Li, Xuemei Lin, Yanhan Liu, Jingchun Li, Yuanzhong Liu, B. Pereira, F. Canavese, Hongwen Xu","doi":"10.1097/BPB.0000000000000672","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000672","url":null,"abstract":"This study aimed to investigate the effect of age on the rates of redislocation, avascular necrosis (AVN) of the femoral head, and final radiographic outcomes in patients with developmental dysplasia of the hip (DDH) treated with closed reduction. A total of 308 hips (276 patients) with DDH treated with closed reduction were included and divided into three groups according to age (<12, 12–18, 18–24 months). Tönnis grade, rate of redislocation and AVN, Severin radiographic grade, and risk of surgery were evaluated on radiographs. Tönnis grade significantly increased with age (P < 0.001). Redislocation occurred in 17 (5.5%) and AVN occurred in 36 (11.7%) hips. The rate of redislocation and AVN was similar among the three age groups in all Tönnis grades. However, redislocation rate significantly increased with Tönnis grade (P = 0.027). Overall, 246 hips (79.9%) had satisfactory final outcomes, and 62 hips (20.1%) had unsatisfactory outcome; no difference was observed among three age groups. A total of 103 hips (33.4%) were found to be at risk for secondary surgery. The surgical risk (25%) in patients younger than 12 months was lower than that of older patients (12–18 months: 34.4%; 18–24 months: 37.9%). Logistic regression analysis also confirmed that age was not a risk factor for redislocation, AVN, or poor radiographic outcome. In conclusion, age has no significant impact on redislocation and AVN in patients aged 6–24 months with DDH treated by closed reduction. Although older patients have a higher risk developing residual acetabular dysplasia, secondary pelvic surgery provides favorable outcomes in most patients.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"3 1","pages":"431 - 437"},"PeriodicalIF":0.0,"publicationDate":"2019-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80883261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Use of hamstring autograft to reconstruct the patellar tendon after endoprosthetic replacement of the proximal tibia for bone sarcomas. 胫骨近端骨肉瘤内假体置换术后自体腘绳肌腱移植重建髌腱。

Journal of Pediatric Orthopaedics B Pub Date : 2019-07-24 DOI: 10.1097/BPB.0000000000000656

Naji S. Madi, Karim Masrouha, R. Haidar, S. Saghieh

引用次数: 0

Abstracts of the 9th International Clubfoot Congress, Montreal, Canada, 11th October 2018 2018年10月11日，加拿大蒙特利尔，第九届国际畸形足大会摘要

Journal of Pediatric Orthopaedics B Pub Date : 2019-05-01 DOI: 10.1097/bpb.0000000000000585

引用次数: 0

Comparison of plate and screw constructs versus screws only for anterior distal femoral hemiepiphysiodesis in children. 钢板螺钉与螺钉治疗儿童股骨前远端半骺成形术的比较。

Journal of Pediatric Orthopaedics B Pub Date : 2019-01-01 DOI: 10.1097/BPB.0000000000000661

A. Nazareth, M. Gyorfi, S. Rethlefsen, B. Wiseley, K. Noonan, R. Kay

{"title":"Comparison of plate and screw constructs versus screws only for anterior distal femoral hemiepiphysiodesis in children.","authors":"A. Nazareth, M. Gyorfi, S. Rethlefsen, B. Wiseley, K. Noonan, R. Kay","doi":"10.1097/BPB.0000000000000661","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000661","url":null,"abstract":"The study aim was to compare methods of anterior distal femoral hemiepiphysiodesis (ADFH) for treatment of fixed knee flexion deformities in ambulatory children with neuromuscular conditions and flexed knee gait. This is a retrospective review of 47 children (14 female, 33 male, age at surgery: 12.1 ± 2.7 years) who underwent ADFH between 2009 and 2016. Subjects were grouped by ADFH construct: one transphyseal screw (N = 11), two transphyseal screws (N = 28) or plates and screws (P/S group, N = 8). Clinical/radiographic variables were analyzed using paired t tests, χ tests, multiple regression and analysis of covariance. Participants experienced significant reduction in knee flexion contractures (Δ12º, P < 0.006), with no difference among groups (P = 0.43). Postoperative knee pain was significantly more prevalent in the P/S group (5/8, 63%) than the 1-SCR group (0/11, 0%) and the 2-SCR group (2/28, 7%) (P = 0.002). ADFH results in significant reduction of knee flexion deformity and improved knee extension during gait. Plate and screw constructs, the 1 and 2 transphyseal screw techniques are equally effective, but plate and screw constructs may be associated with a higher risk of persistent postoperative knee pain.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"427 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78706549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

Factors associated with unaffected foot deformity in unilateral cerebral palsy. 单侧脑瘫患者未受影响足部畸形的相关因素。

Journal of Pediatric Orthopaedics B Pub Date : 2019-01-01 DOI: 10.1097/BPB.0000000000000665

Jin A Yoon, Da Hwi Jung, Je Sang Lee, Soo-Yeon Kim, Y. Shin

{"title":"Factors associated with unaffected foot deformity in unilateral cerebral palsy.","authors":"Jin A Yoon, Da Hwi Jung, Je Sang Lee, Soo-Yeon Kim, Y. Shin","doi":"10.1097/BPB.0000000000000665","DOIUrl":"https://doi.org/10.1097/BPB.0000000000000665","url":null,"abstract":"The aim of this study was to assess the angular components of the affected foot associated with valgus deformity of the unaffected foot and to redefine the actual leg-length inequality in unilateral cerebral palsy. We retrospectively reviewed the medical records and radiologic images of 76 patients with unilateral cerebral palsy. Weight-bearing plain radiography of both feet of each subject was obtained. Angular measurements focused on the collapse of the longitudinal arch, hind foot valgus and forefoot abduction. Patients were divided into two groups: with and without valgus deformity of the unaffected side. Leg-length discrepancy and pelvic obliquity angle were measured Among 76 patients, 40 (52%) had valgus deformities of the unaffected side. Independent t-test revealed no significant differences in age, affected side, type of deformity on the affected side, or application of bilateral biomechanical foot orthosis between patients with or without valgus deformity of the unaffected side. Patients with valgus deformity had significantly increased voluntary ankle dorsiflexion greater than neutral on the affected side, leg-length discrepancy and lateral talocalcaneal angle (P < 0.05). Laterally measured foot angles of both feet were significantly correlated. The optimal cut-off points for predicting valgus deformity were leg-length discrepancy >10 mm or affected limb/unaffected limb-length index <0.98. Leg-length discrepancy and lateral talocalcaneal angle of the affected foot were significantly increased in patients with valgus deformity of the unaffected side. The optimal cut-off point for predicting valgus deformity of the unaffected foot would be useful in clinical practice.","PeriodicalId":16709,"journal":{"name":"Journal of Pediatric Orthopaedics B","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87124951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0