Strategies in Trauma and Limb Reconstruction最新文献

{"title":"Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications.","authors":"Justin-Pierre Lorange,&nbsp;Nawaf Alamiri,&nbsp;Yousef Marwan,&nbsp;Abdullah Alshammari,&nbsp;Reggie Charles Hamdy,&nbsp;Mitchell Bernstein","doi":"10.5005/jp-journals-10080-1568","DOIUrl":"10.5005/jp-journals-10080-1568","url":null,"abstract":"<p><strong>Aim: </strong>In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique.</p><p><strong>Materials and methods: </strong>A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the <i>Journal of Limb Lengthening and Reconstruction</i>. The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication.</p><p><strong>Results: </strong>Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13-51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5-7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6-1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50-93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120-228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration.</p><p><strong>Conclusion: </strong>Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques.</p><p><strong>Clinical significance: </strong>Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery.</p><p><strong>How to cite this article: </strong>Lorange JP, Alamiri N, Marwan Y, <i>et al</i>. Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022;17(3):165-171.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 3","pages":"165-171"},"PeriodicalIF":0.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/14/stlr-17-165.PMC9886034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs.","authors":"Tomo Hamada,&nbsp;Hidenori Matsubara,&nbsp;Satoshi Kato,&nbsp;Toshifumi Hikichi,&nbsp;Kanu Shimokawa,&nbsp;Satoru Demura,&nbsp;Hiroyuki Tsuchiya","doi":"10.5005/jp-journals-10080-1566","DOIUrl":"10.5005/jp-journals-10080-1566","url":null,"abstract":"<p><strong>Aim: </strong>When a leg-length discrepancy (LLD) is severe enough, it can result in lumbar scoliosis and other postural defects. To our knowledge, no study has demonstrated associations between LLD and lumbar curvature using full-length standing radiographs of the lower limbs and lumbar spine. This study aimed to examine the correlations between LLD and lateral curvature of the lumbar spine using standing radiographs.</p><p><strong>Materials and methods: </strong>Full-length standing radiographs of the lower limbs and spinal column of 113 participants (age range: 10-65 years) obtained between November 2006 and September 2019 were reviewed. Leg length was measured as the linear distance from the centre of the femoral head to the centre of the tibial plafond and converted to millimetres using a radiographic ruler captured in the images. Leg-length discrepancy was analysed as the absolute difference (mm) between the left and right leg lengths. Inequality was also evaluated as leg-length discrepancy ratio (LLDR), calculated as leg-length discrepancy/length of the unaffected (longer) leg × 100 (%). Lateral lumbar curvature was evaluated with the Cobb angle (°). The association between LLD or LLDR and lumbar Cobb angle was analysed by correlation analysis. Statistical analysis was performed by simple regression in SPSS.</p><p><strong>Results: </strong>Both LLD and LLDR exhibited a robust and positive correlation with lumbar Cobb angle (γ = 0.53, γ = 0.62), as illustrated by the following regression equations: lumbar Cobb angle (°) = 0.316 × leg-length discrepancy (mm) + 2.83 and lumbar Cobb angle (°) = 2.19 × leg-length discrepancy ratio (%) + 3.0.</p><p><strong>Conclusion: </strong>Using objective imaging data, we found that the lumbar Cobb angle tends to be >10° if the difference in leg lengths is >20 mm.</p><p><strong>How to cite this article: </strong>Hamada T, Matsubara H, Kato S, <i>et al.</i> Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs. Strategies Trauma Limb Reconstr 2022;17(3):144-147.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 3","pages":"144-147"},"PeriodicalIF":0.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/55/stlr-17-144.PMC9886032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10684100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Surgeons Agree on Severity and Origin of Complications in Bone-lengthening Nails? An Inter- and Intra-rater Reliability Study.","authors":"Markus Winther Frost,&nbsp;Ole Rahbek,&nbsp;Marie Fridberg,&nbsp;Mindaugas Mikužis,&nbsp;Søren Kold","doi":"10.5005/jp-journals-10080-1571","DOIUrl":"10.5005/jp-journals-10080-1571","url":null,"abstract":"<p><strong>Background: </strong>Bone-lengthening nails result in various complications with different severity and origin. However, no universal reporting system for complications has been agreed upon, making it difficult to compare different nail designs and patient populations. This study aimed to assess the inter- and intra-rater agreement of a classification system of complications according to severity and origin.</p><p><strong>Materials and methods: </strong>Four orthopaedic surgeons assessed 48 complications retrieved from patient charts in a single-centre cohort and 49 literature complications cases. Complications were classified according to severity grading (I, II, IIIA and IIIB) from Black et al. and origin with eight main types and 33 subtypes. A blinded independent assessment was performed twice at least six weeks apart. Cohen/Congers kappa estimated for the inter- and intra-rater agreement was interpreted after Svanholm et al.</p><p><strong>Results: </strong>The surgeons had a good inter-rater agreement for complication severity with a kappa value of 0.68 [95% confidence interval (CI): 0.56-0.79] and complication origin with a kappa value of 0.63 (CI: 0.53-0.73), respectively, on the cohort cases. In literature cases, a good agreement on complication severity and origin grading was shown by kappa values of 0.64 (CI: 0.53-0.75) and 0.74 (CI: 0.65-0.83). The intra-rater assessment of complication severity and origin grading had good to excellent agreement with kappa values ranging from 0.51 to 0.97.</p><p><strong>Conclusion and clinical significance: </strong>The study presents the first structured complication classification on severity and origin in intramedullary bone-lengthening nails. A good reproducibility agreement in both severity and origin was found between four orthopaedic surgeons for both cohort and literature complication cases. For clinical and research purposes, a shared language for communicating complications is essential. We encourage future studies to use a structured and validated complication classification.</p><p><strong>How to cite this article: </strong>Frost MW, Rahbek O, Fridberg M, <i>et al</i>. Do Surgeons Agree on Severity and Origin of Complications in Bone-lengthening Nails? An Inter- and Intra-rater Reliability Study. Strategies Trauma Limb Reconstr 2022;17(3):153-158.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 3","pages":"153-158"},"PeriodicalIF":0.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/0f/stlr-17-153.PMC9886029.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10681664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures.","authors":"Ahmad S Naja,&nbsp;Nour Bouji,&nbsp;Mohamad Nasser Eddine,&nbsp;Humaid Alfarii,&nbsp;Rudolf Reindl,&nbsp;Yehia Tfayli,&nbsp;Mohamad Issa,&nbsp;Said Saghieh","doi":"10.5005/jp-journals-10080-1557","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1557","url":null,"abstract":"<p><strong>Aim: </strong>This article aims to compare the outcomes between open reduction and internal fixation (ORIF) and external fixation (ExFix) in tibial plateau fractures.</p><p><strong>Background: </strong>Open reduction and internal fixation and external fixation are common methods for managing tibial plateau fractures without a consensus of choice.</p><p><strong>Materials and methods: </strong>PubMed, Cochrane Library, Ovid, CINAHL®, Scopus, and Embase were searched. Clinical studies in humans comparing ExFix and ORIF for tibial plateau fractures were included. Case reports, pathological, and biomechanical studies were excluded. Two investigators reviewed the studies independently, and any discrepancies were resolved. The quality and heterogeneity of each study were assessed in addition to calculating the odds ratio (OR) of the surgical outcomes and complications at a 95% confidence interval, with <i>p</i> <0.05 as statistical significance.</p><p><strong>Results: </strong>Of the 14 included studies, one was a randomised trial, one was a prospective study, and 12 were retrospective studies. The 865 fractures identified across the studies constituted 458 (52.9%) in the ExFix group and 407 (47.1%) in the ORIF group. Most studies indicated a better outcome for ORIF as compared to ExFix. Open reduction and internal fixation had a lower incidence of superficial infection and postoperative osteoarthritis, while ExFix revealed a lower proportion with heterotopic ossification (HTO).</p><p><strong>Conclusion: </strong>ExFix has a higher rate of superficial infections and osteoarthritis, whereas ORIF has a higher incidence of HTO. Larger studies are needed to compare outcomes and investigate the findings of this study further.</p><p><strong>Clinical significance: </strong>This up-to-date meta-analysis on tibial plateau management will help surgeons make evidence-based decisions regarding the use of ORIF versus ExFix.</p><p><strong>How to cite this article: </strong>Naja AS, Bouji N, Eddine MN, <i>et al</i>. A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022;17(2):105-116.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"105-116"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/36/stlr-17-105.PMC9357793.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfocal Osteotomy to Treat Shear (Oblique) Non-union of Tibia.","authors":"Om Lahoti,&nbsp;Naveen Abhishetty,&nbsp;Mohannad Al-Mukhtar","doi":"10.5005/jp-journals-10080-1555","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1555","url":null,"abstract":"<p><p>Aseptic non-unions of tibial shaft fractures often need surgical treatment which carry significant socio-economic implications. The causes for non-union include patient co-morbidities, high energy trauma, open fractures and fracture geometry. Oblique fractures are subject to shear forces and, if not adequately neutralised, will fail to unite. Experiments have shown that callus formation is poor in oblique fractures due to local shear stresses. We report a technique of minimally invasive transfocal transverse osteotomy and compression in a hexapod circular fixator, Taylor Spatial Frame (TSF) for 12 patients treated with a shear non-union of tibia between 2010 and 2019. There are four female and eight male patients. The average age is 49 years (range from 26 to 72 years). The fracture pattern was oblique (30-45°) in all cases. Healing of the non-union occurred in 12 cases with one case needed additional treatment with bone marrow aspirate and demineralized bone matrix. The technique of creating a minimally invasive transfocal transverse osteotomy through the oblique non-union of tibia and the use of a hexapod circular fixator to compress the osteotomy is described and adds to the range of treatments available for aseptic non-union of tibia.</p><p><strong>How to cite this article: </strong>Lahoti O, Abhishetty N, Al-Mukhtar M. Transfocal Osteotomy to Treat Shear (Oblique) Non-union of Tibia. Strategies Trauma Limb Reconstr 2022;17(2):117-122.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"117-122"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/95/stlr-17-117.PMC9357796.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment.","authors":"Michelangelo Scaglione,&nbsp;Francesco Casella,&nbsp;Edoardo Ipponi,&nbsp;Federico Agretti,&nbsp;Simone Polloni,&nbsp;Michele Giuntoli,&nbsp;Stefano Marchetti","doi":"10.5005/jp-journals-10080-1559","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1559","url":null,"abstract":"<p><strong>Aim and objective: </strong>Multifocal fractures of the humerus are rare. The aim of our study is to evaluate the effectiveness of surgical treatment and propose a modification to the Maresca-Pascarella classification. A flowchart for surgical treatment is provided.</p><p><strong>Materials and methods: </strong>Thirty-one patients with multifocal humeral fractures were treated and evaluated. The Maresca-Pascarella classification was used. All were treated using with either plates and screws, external fixation or intramedullary nailing. Functional outcomes were evaluated using the QuickDASH test, the University of California - Los Angeles (UCLA) shoulder score and the Mayo elbow performance score (MEPS).</p><p><strong>Results: </strong>There were 12 Type A, 17 Type B, 1 Type C and 1 of combined fractures of the proximal and distal epiphysis. Of the 31 patients, 5 were lost to the follow-up (FU), 1 died of pulmonary embolism (PE) and the remaining 25 had a mean FU of 19.8 (7-35) months. Three patients had radial nerve damage and 1 went to a non-union that required further surgical intervention. The mean QuickDASH score was 15.7, the average UCLA shoulder score was 26.3 and the mean MEPS elbow score resulted to be 83.0.</p><p><strong>Conclusion: </strong>Although multifocal fractures are severe injuries, patients are able to recover good functionality if treated judiciously.</p><p><strong>Clinical significance: </strong>We proposed a standardised surgical approach based on the fracture characteristics, site and a modified Maresca-Pascarella classification.</p><p><strong>How to cite this article: </strong>Scaglione M, Casella F, Ipponi E, <i>et al</i>. Multifocal Humeral Fractures: Clinical Results, Functional Outcomes and Flowchart of Surgical Treatment. Strategies Trauma Limb Reconstr 2022;17(2):81-87.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"81-87"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/30/stlr-17-81.PMC9357792.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pin-site Infection: A Systematic Review of Prevention Strategies.","authors":"David W Shields,&nbsp;Alexis-Dimitris Iliadis,&nbsp;Erin Kelly,&nbsp;Nima Heidari,&nbsp;Bilal Jamal","doi":"10.5005/jp-journals-10080-1562","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1562","url":null,"abstract":"<p><strong>Introduction: </strong>Circular frame fixation remains a key tool in the armamentarium of the limb reconstruction surgeon. One of the key drawbacks is the onset of pin-site infection (PSI). As a result of limited evidence and consensus of PSI prevention, a wide variation in practice remains.</p><p><strong>Aim: </strong>The principal aim of this review is to synthesise primary research concerning all aspects of treatment regarded as relevant to PSI in frame constructs.</p><p><strong>Materials and methods: </strong>Comparative studies until week 26, 2021, were included in the trial. Studies were included that concerned patients undergoing management of a musculoskeletal condition in which pin-site care is necessary for over 4 weeks.</p><p><strong>Results: </strong>Eighteen studies over a 13-year period were captured using the search strategy. Sulphadiazine and hydrogen peroxide cleansing was found to reduce PSI, with the use of low-energy fine wires and hydroxyapatite (HA)-coated pins also associated with lower infection rate. The remainder of studies found no significant improvement across interventions.</p><p><strong>Conclusion: </strong>There is no superiority between weekly and daily care. Low-energy pin-insertion technique had lower rates of infection. Sulphadiazine has positive results as a pin-care solution, but more research is necessary to determine the most effective care regime. Current literature is limited by absence of established definitions and by a lack of studies addressing all aspects of care relevant to PSI.</p><p><strong>How to cite this article: </strong>Shields DW, Iliadis AD, Kelly E, <i>et al</i>. Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies Trauma Limb Reconstr 2022;17(2):93-104.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"93-104"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/70/stlr-17-93.PMC9357789.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study.","authors":"Sabeel Ahmad,&nbsp;Tushar Gupta,&nbsp;Sajid Ansari,&nbsp;Aakriti Jain,&nbsp;Sitanshu Barik,&nbsp;Vivek Singh","doi":"10.5005/jp-journals-10080-1556","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1556","url":null,"abstract":"<p><strong>Background: </strong>Various modalities of treatment have been used for the management of metacarpal and phalangeal fractures which include K-wire fixation, mini plates, lag screws fixation, intramedullary screw fixation and external fixator application. The aim of this study was to analyse complications and patient-related functional outcomes after antegrade or retrograde crossed intramedullary K-wire fixation of metacarpal and proximal phalangeal fractures.</p><p><strong>Methods: </strong>Thirty-one patients (36-fractures, 16-metacarpals, 20-proximal phalanx) meeting the study criteria were included in this prospective study. Fixation of the fractures was done by use of crossed intramedullary K-wire using the principles of 3-point fixation.</p><p><strong>Results: </strong>The mean preoperative angulation of the fractures noted in this study was 35.8° which was significantly reduced at final follow-up. Union was noted at a mean period of 4.2 ± 6.8 weeks. The mean range of motion at the metacarpophalangeal and proximal interphalangeal joint was 96.4% and 86.3%, respectively as compared to the opposite hand. Stiffness (<i>n</i> = 3, 14.2%) and persistent pain (<i>n</i> = 2, 9.5%) at the joints were the most common complications noted in this study.</p><p><strong>Conclusion: </strong>Crossed percutaneous intramedullary fixation of small bone fractures of the hand is a versatile method with advantages such as cost-effectiveness and lesser operative time when compared to other modalities of fixation. Earlier range of motion (ROM) exercises can be started due to preservation of gliding planes, no surgical wound along with good fracture stability and minimal hardware impingement.</p><p><strong>How to cite this article: </strong>Ahmad S, Gupta T, Ansari S, <i>et al</i>. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. Strategies Trauma Limb Reconstr 2022;17(2):74-80.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"74-80"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/a8/stlr-17-74.PMC9357798.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Ankle Reconstruction in a Child with Remote Traumatic Medial Malleolus Loss: Clinical and Radiographic Outcomes.","authors":"Ethan Ponton,&nbsp;Ali Bakkai,&nbsp;Douglas J Courtemanche,&nbsp;Anthony P Cooper","doi":"10.5005/jp-journals-10080-1552","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1552","url":null,"abstract":"<p><strong>Aim: </strong>This article aims to describe a novel surgical technique for medial malleolar reconstruction in a young child.</p><p><strong>Background: </strong>Severe open ankle injuries that result in bone and soft tissue loss carry a high risk for complications, especially in children who are still growing. These injuries can cause abnormal growth patterns, degenerative diseases, and recurrent instability. Cases of medial malleolar reconstruction have been previously described but none in a child this young.</p><p><strong>Case description: </strong>We present a case of an 13-year-old girl who suffered an open injury to the medial distal tibia with traumatic loss of the medial malleolus at the age of 2 and later suffered a Salter-Harris II fracture to the ipsilateral distal fibula. She presented with varus alignment, a leg length discrepancy, premature asymmetrical growth arrest, chronic non-union of the distal fibula physeal fracture, and severe attenuation of the deltoid ligament. Her secondary deformities were managed with distal fibula osteotomy and fixation, distal tibial hemi-plafond corrective osteotomy, and medial malleolus reconstruction with iliac crest autograft. Her leg length discrepancy was corrected by epiphysiodesis of the contralateral distal femur and proximal tibia. At the 2-year follow-up, the alignment was well maintained, the graft was healing well, and the patient reported no pain and being able to walk and play sports without a brace.</p><p><strong>Conclusion: </strong>Surgical reconstruction of the medial malleolus with correction for abnormal angulation and leg length discrepancies is critical to promoting healthy growth patterns and quality of life for paediatric patients. This severe open ankle injury can be successfully managed by distal fibula osteotomy and fixation, distal tibial intra-articular osteotomy, and medial malleolus reconstruction with iliac crest autograft.</p><p><strong>Clinical significance: </strong>This novel technique is an effective method for the surgical management of paediatric traumatic medial malleolar bone loss in children who are skeletally immature and are at risk of complications due to further growth.</p><p><strong>How to cite this article: </strong>Ponton E, Bakkai A, Courtemanche DJ, <i>et al</i>. Late Ankle Reconstruction in a Child with Remote Traumatic Medial Malleolus Loss: Clinical and Radiographic Outcomes. Strategies Trauma Limb Reconstr 2022;17(2):131-135.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"131-135"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/27/stlr-17-131.PMC9357794.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis.","authors":"Ahmed H Elhessy,&nbsp;Jessica C Rivera,&nbsp;Henry T Shu,&nbsp;Taj-Jamal Andrews,&nbsp;John E Herzenberg,&nbsp;Janet D Conway","doi":"10.5005/jp-journals-10080-1554","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1554","url":null,"abstract":"<p><strong>Aim: </strong>In this study, we present a detailed surgical technique for treating chronic osteomyelitis (COM) of the intramedullary canal with injectable tobramycin and vancomycin-loaded calcium sulfate (CS).</p><p><strong>Background: </strong>Chronic osteomyelitis of the long bones has been treated using antibiotic-impregnated polymethyl methacrylate (PMMA), which typically requires a second procedure for removal.</p><p><strong>Technique: </strong>Removal of the infected intramedullary nail (if any), copious irrigation, canal reaming, and intramedullary canal injection of vancomycin- and tobramycin-loaded calcium sulfate as a single-stage procedure for the treatment of COM of long bones.</p><p><strong>Conclusion: </strong>Intramedullary injection of vancomycin- and tobramycin-loaded CS can be used as a single-stage procedure for the treatment of long bone intramedullary COM. Further studies are necessary to compare the long-term outcomes of antibiotic-coated CS vs other antibiotic carriers for infection eradication.</p><p><strong>Clinical significance: </strong>The authors have endeavored to explain the best surgical technique to eradicate long bones COM with injectable tobramycin and vancomycin-loaded CS.</p><p><strong>How to cite this article: </strong>Elhessy AH, Rivera JC, Shu HT, <i>et al</i>. Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis. Strategies Trauma Limb Reconstr 2022;17(2):123-130.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"17 2","pages":"123-130"},"PeriodicalIF":0.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/71/stlr-17-123.PMC9357795.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}