Strategies in Trauma and Limb Reconstruction最新文献

{"title":"Tension-band Plating for Leg-length Discrepancy Correction.","authors":"Jaap J Tolk,&nbsp;Rajiv Merchant,&nbsp;Peter R Calder,&nbsp;Aresh Hashemi-Nejad,&nbsp;Deborah M Eastwood","doi":"10.5005/jp-journals-10080-1547","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1547","url":null,"abstract":"<p><strong>Aim: </strong>Dual tension-band plates are used for temporary epiphysiodesis and longitudinal guided growth. The study aim was to assess rate of correction, to identify development of femoral and tibial intra-articular deformity during correction and to document resumption of growth after plate removal.</p><p><strong>Materials and methods: </strong>A retrospective study of 34 consecutive patients treated with dual tension-band plates between 2012 and 2020 was performed. Twenty-four patients had surgery at the distal femur, six at the proximal tibia and four at both. Twenty-five female patients were treated at a mean age of 11.6 (±1.4) years and nine male patients at 13.5 (±1.5) years. Measurements were performed on standardised long-leg radiographs and included leg-length discrepancy (LLD), joint line congruency angle (JLCA), tibial roof angle, femoral floor angle and notch-intercondylar distance. Measurements were taken pre-operatively, at the end of discrepancy correction and at skeletal maturity.</p><p><strong>Results: </strong>The LLD reduced by a mean of 12.9 mm (95% CI 10.2-15.5) with the mean residual difference 8.4 mm (95% CI 5.4-11.4). The mean correction rate for the proximal tibia was 0.40 (SD 0.33) mm/month and 0.68 (SD 0.36) mm/month for the distal femur. A significant mean change in residual LLD [-2.5 mm (95% CI -4.2 to -0.7)] was observed between plate removal and skeletal maturity at the femoral level only. After length discrepancy correction, the tibial roof angle showed a significant difference of 8.4° (95% CI 13.4-3.4) between legs. In femoral epiphysiodesis patients, no important differences were observed.</p><p><strong>Conclusion: </strong>A significant reduction in LLD can be achieved using dual tension-band plating. A change in intra-articular morphology was observed only in the proximal tibia and not in the distal femur. In the authors' opinion, tension-band plating is a useful tool for leg-length equalisation but should be reserved for younger patients or when residual growth is difficult to predict. It is one of the management strategies for limb-length difference prior to skeletal maturity.</p><p><strong>How to cite this article: </strong>Tolk JJ, Merchant R, Calder PR, <i>et al</i>. Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022;17(1):19-25.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":" ","pages":"19-25"},"PeriodicalIF":0.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/ff/stlr-17-19.PMC9166256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40224907","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":"Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease.","authors":"Pieter H Mare,&nbsp;Leonard C Marais","doi":"10.5005/jp-journals-10080-1549","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1549","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the results in terms of correction and complications from gradual correction with a computer-assisted hexapod circular external fixator in a mixed cohort of children with Blount's disease.</p><p><strong>Materials and methods: </strong>A retrospective review was performed of the correction and complications of 19 children (25 limbs) with recurrent infantile (IBD) and late-onset Blount's disease (LOBD) treated by gradual correction with a hexapod external fixator. The correction was measured by the medial proximal tibial angle (MPTA), anatomic posterior proximal tibial angle (aPPTA) and anatomic tibio-femoral angle (TFA). Obesity was present in 76% (19/25) of cases. Fifteen limbs were classified as infantile Blount's disease and 10 limbs as late-onset Blount's disease. The mean age was 12.5 years (range 7-17 years).</p><p><strong>Results: </strong>The mean pre-operative MPTA of 59° (SD 13°, range 33-79°) was corrected to a mean of 86° (SD 5°, range 77-93°). The mean pre-operative aPPTA of 64° (SD 14°, range 33-84°) was corrected to 79° (SD 6°, range 70-90°). The median pre-operative rotation of 15° internal rotation was corrected to normal (0-15° of external rotation). Eight out of 25 limbs had severe deformities with varus or procurvatum greater than 40° or both. The mean pre-operative TFA of 28° varus (SD 13°, range 4-53°) was corrected to 1.8° valgus (SD 6°, range 14° varus to 13° valgus). The median follow-up was 19 months (range 6-67 months). The alignment after correction was \"good\" in 55% (11/20), \"acceptable\" in 35% (7/20) and \"poor\" in 10% (2/20).The median duration for correction was 16 days (IQR 11-31 days, range 7-71 days). The median number of prescribed correction programmes was 1 (IQR 1-2, range 1-5). The mean total time in the frame was 136 days (SD 34 days, range 85-201 days).All patients developed minor pin track infections that resolved with oral antibiotics (Category 1 complications). Four patients developed complications that necessitated modification of the treatment plan (Category 2 complications). In two cases, treatment objectives could not be achieved (Category 3 complications). Two patients treated before skeletal maturity developed recurrent genu varum.</p><p><strong>Conclusion: </strong>Gradual correction with a computer-assisted hexapod external fixator may be a useful technique for correcting recurrent IBD or LOBD even in children with severe deformities. The results of gradual correction were similar in the two groups. While complications occur, most can be mitigated by timely intervention during the correction phase of treatment. Recurrence remains a concern if correction is performed before skeletal maturity.</p><p><strong>Level of evidence: </strong>4.</p><p><strong>How to cite this article: </strong>Mare PH, Marais LC. Gradual Deformity Correction with a Computer-assisted Hexapod External Fixator in Blount's Disease. Strategies Trauma Limb Reconstr 2022;17(1):32-37.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":" ","pages":"32-37"},"PeriodicalIF":0.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/da/stlr-17-32.PMC9166260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40224305","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":"Outcomes and Incidence of Deep Bone Infection in Grade III Diaphyseal Open Tibial Fractures: Circular Fixator vs Intramedullary Nail.","authors":"Ibrahim Natalwala,&nbsp;Cher Bing Chuo,&nbsp;Isla Shariatmadari,&nbsp;Gavin Barlow,&nbsp;Elizabeth Moulder,&nbsp;Joanna Bates,&nbsp;Hemant Sharma","doi":"10.5005/jp-journals-10080-1536","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1536","url":null,"abstract":"<p><strong>Introduction: </strong>High-energy grade III open fractures of tibia are associated with significant complications and generate debate over the ideal fixation method. This study compares the clinical outcomes for circular frame fixation (CFF) vs intramedullary nail fixation (IMF) in grade III open tibial fractures.</p><p><strong>Materials and methods: </strong>Single-centre retrospective study of patients admitted from January 2008 to December 2016. All patients with grade III open diaphyseal tibial fractures (AO 42 A, B, C), treated with either CFF or IMF, were included. The primary outcome was deep bone infection (DBI). Secondary outcomes were delayed or non-union, secondary intervention, and amputation.</p><p><strong>Results: </strong>A total of 48 limbs in 47 patients had CFF, and 25 limbs in 23 patients had IMF. Median time to definitive fixation was significantly longer for CFF at 9 days (IQR 3-13) compared to IMF at 1 day (IQR 0-3.5) (<i>p</i> <0.001). The DBI rate was significantly lower (2 vs 16%) in the CFF group (<i>p</i> = 0.04). There were 14 limbs (29%) with delayed or non-union in the CFF group vs 5 limbs (20%) in the IMF group. In the CFF group, significantly more limbs required bone grafting for delayed or non-union (<i>p</i> = 0.03). However, there was a greater proportion of limbs in the CFF group with segmental fractures or bone loss (46 vs 4%) and these high-energy fracture patterns were associated with secondary bone grafting (<i>p</i> = 0.005), and with delayed or non-union (<i>p</i> = 0.03). A subgroup analysis of patients without segmental fractures or bone loss treated with either CFF or IMF showed no significant difference in secondary bone grafting (<i>p</i> >0.99) and delayed or non-union rates (<i>p</i> = 0.72). Overall, one patient in each group went on to have an amputation.</p><p><strong>Conclusion: </strong>Our study found that CFF had a lower rate of DBI compared to IMF. Injuries with high-energy fracture patterns (segmental fractures or bone loss) were more likely to have delayed or non-union and require secondary bone grafting. These factors should be considered when selecting the appropriate method of definitive fixation.</p><p><strong>How to cite this article: </strong>Natalwala I, Chuo CB, Shariatmadari I, <i>et al</i>. Outcomes and Incidence of Deep Bone Infection in Grade III Diaphyseal Open Tibial Fractures: Circular Fixator vs Intramedullary Nail. Strategies Trauma Limb Reconstr 2021;16(3):161-167.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"161-167"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/0f/stlr-16-161.PMC8778722.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882425","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":"Talar-tarsal Stabilisation: Goals and Initial Outcomes.","authors":"Peter Stevens,&nbsp;Alex Lancaster,&nbsp;Ansab Khwaja","doi":"10.5005/jp-journals-10080-1538","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1538","url":null,"abstract":"Abstract Background While surgical stabilisation of the subtalar joint (arthroeresis) in children remains controversial in the USA, it is widely practised worldwide, with reportedly good outcomes. We are presenting a series of patients who met our criteria for calcaneal lengthening, but whose parents chose the less invasive option of talo-tarsal stabilisation (TTS). The goal of this surgery was to forestall or prevent hindfoot osteotomy. Materials and methods With IRB approval, we conducted this retrospective review of 32 patients (60 ft), who underwent TTS for flexible planovalgus deformity and had a minimum of 1-year follow-up. The aetiology was idiopathic for the majority, with a few being neurogenic or syndromic. The age range was 6–15 years; the younger patients had neuromuscular aetiology or underlying syndromes. Concomitant procedures included percutaneous Achilles lengthening (33 ft), Kidner (9 ft) and guided growth for ankle valgus (2). Results In the early post-immobilisation phase, peroneal spasm occurred in four patients (6 ft). This resolved with Botox injection in the peroneus brevis in three patients and required transfer of the peroneus brevis to the peroneus longus in one patient. At follow-up, ranging from 1 to 4.5 years, 50 implants (83.4%) were retained and the patients reported satisfactory outcomes. Henceforth, those patients will be monitored on a p.r.n. basis. Due to lingering discomfort, implants were repositioned in one and removed in five patients (10 ft = 16.6%). Upon further follow-up, these patients have not manifested recurrent deformity. Therefore, subsequent salvage by osteotomy and/or lengthening of the calcaneus has not been necessary. Conclusion TTS for the symptomatic flatfoot, combined with other procedures as indicated, offers advantages over the currently more accepted methods of medial shift osteotomy or calcaneal lengthening. The outcome at 1 year is a good forecast of whether or not further treatment will be required. This is a simpler and preferred option as compared to other methods of surgical management and, in our experience, has obviated the need for osteotomy or lengthening of the calcaneus. Level of evidence IV retrospective case series. How to cite this article Stevens P, Lancaster A, Khwaja A. Talar-tarsal Stabilisation: Goals and Initial Outcomes. Strategies Trauma Limb Reconstr 2021;16(3):168–171.","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"168-171"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/19/stlr-16-168.PMC8778731.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882856","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":"Distal Forearm Replantation in a Child: A Case Report with a 30-year Follow-up.","authors":"Lee S Hee,&nbsp;Kim Hyung-Sik,&nbsp;Lim Hong-Chul","doi":"10.5005/jp-journals-10080-1532","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1532","url":null,"abstract":"<p><strong>Background: </strong>Amputation in the upper extremities influenced the quality of life a lot adversely. So, replantation was tried in many cases of amputation. Especially, due to good plasticity and healing capacity, replantation in children should be actively attempted. On the contrary, owing to growth potential in children, there are several late complications to happen like shortening and synostosis. There are only a few longterm follow-up reports of paediatric patients after replantation of upper extremities. We report a case of successful distal forearm replantation in a 2-year-old child who sustained a wringer injury by a sawing machine with a follow-up of 30 years.</p><p><strong>Case description: </strong>A 2-year-old female patient was brought to our institution after a wringer injury to the distal forearm by a sawing machine. She sustained a near-total amputation at the distal forearm level with only a skin tag. Replantation was performed 4 hours after the injury. Radius and ulnar fractures were fixed with Kirschner and roll wires. The radial and ulnar arteries were anastomosed and three veins were anastomosed too. The median, ulnar, and radial nerves were managed by epi-perineurorrhaphy. The muscles were readapted, flexor tendons were performed tenorrhaphy each by each, and extensor tendons were performed grouping tenorrhaphy. Ten years after the replantation, a supination motion block was developed but successfully managed.</p><p><strong>Conclusion: </strong>Replantation of upper limbs in children is an eceedingly worthwhile procedure. Though due to growth potential several complications were developed unlikely in adults. But those can be improved with additional procedures. Good plasticity and healing capacity of children make good functional outcomes in long-term follow-up. So, replantation of upper limbs in children should essentially be considered and aggressively performed.</p><p><strong>How to cite this article: </strong>Hee LS, Hyung-Sik K, Hong-Chul L. Distal Forearm Replantation in a Child: A Case Report with a 30-year Followup. Strategies Trauma Limb Reconstr 2021;16(3):179-183.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"179-183"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/d7/stlr-16-179.PMC8778723.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39744480","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":"Surgical Exposure of the Distal Fibula to Protect the Peroneus Brevis Muscle Vascular Pedicle.","authors":"Esmee Irvine,&nbsp;Elliott Cochrane,&nbsp;Paul Harwood,&nbsp;David M Taylor,&nbsp;Waseem Bhat,&nbsp;Chris West","doi":"10.5005/jp-journals-10080-1540","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1540","url":null,"abstract":"<p><p>Ankle fractures are a common presentation to orthopaedic surgeons, with the lateral malleolus involved in 86% of cases. A soft tissue injury can be a concomitant feature of these injuries as a result of the primary injury or following secondary wound breakdown. The peroneus brevis muscle flap provides a reliable and robust option to cover the distal third of the lower limb. With an understanding of the anatomy and cautious dissection during periosteal elevation, the perforating vessels supplying the peroneus brevis can be preserved ensuring that a valuable reconstructive option is available.</p><p><strong>How to cite this article: </strong>Irvine E, Cochrane E, Harwood P, <i>et al.</i> Surgical Exposure of the Distal Fibula to Protect the Peroneus Brevis Muscle Vascular Pedicle. Strategies Trauma Limb Reconstr 2021;16(3):176-178.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"176-178"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/17/stlr-16-176.PMC8778725.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882860","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":"Investigating the Growth of <i>Pseudomonas aeruginosa</i> and Its Influence on Osteolysis in Human Bone: An <i>In Vitro</i> Study.","authors":"Ahmed Al Ghaithi,&nbsp;Atika Al Bimani,&nbsp;Sultan Al Maskari","doi":"10.5005/jp-journals-10080-1534","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1534","url":null,"abstract":"<p><strong>Background: </strong>Isolation of the causal microorganisms in osteomyelitis presents a major challenge for treating clinicians. Several methods have been proposed to rapidly and accurately identify microorganisms. There has been an increasing interest in using Raman spectroscopy in the field of microbial detection and characterisation. This paper explores the use of Raman spectroscopy identification as one of the most difficult-to-isolate microorganisms causing osteomyelitis.</p><p><strong>Methods and results: </strong>Fresh healthy human bone samples were collected from patients undergoing a total knee replacement. These samples were then inoculated with fresh overnight <i>Pseudomonas aeruginosa</i> (PAO) cultures. Bacteria growth and bone ultrastructural changes were monitored over a period of 6 weeks. The experiment demonstrated ultrastructural bony destruction caused by osteolytic PAO secretions. Raman-specific spectral signatures related to the cellular membranes of PAO structures were spotted indicating survival of bacteria on the bone surface.</p><p><strong>Conclusion: </strong>This study showed the promising ability of Raman spectroscopy to identify the presence of bacteria on the surface of inoculated bone samples over time. It was able to detect the osteolytic activity of the bacteria as well as ultrastructure specific to PAO virulence. This method may have a role as an aid to existing diagnostic methods for fast and accurate bacterial identification in bone infection.</p><p><strong>How to cite this article: </strong>Al Ghaithi A, Al Bimani A, Al Maskari S. Investigating the Growth of <i>Pseudomonas aeruginosa</i> and Its Influence on Osteolysis in Human Bone: An <i>In Vitro</i> Study. Strategies Trauma Limb Reconstr 2021;16(3):127-131.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"127-131"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/67/stlr-16-127.PMC8778729.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882420","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":"Measurement of Wire Deflection on Loading may Indicate Union in Ilizarov Constructs: A Pilot Study.","authors":"Beth Lineham,&nbsp;Todd Stewart,&nbsp;John Ward,&nbsp;Paul Harwood","doi":"10.5005/jp-journals-10080-1537","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1537","url":null,"abstract":"<p><strong>Introduction: </strong>No entirely reliable method to assess union during Ilizarov treatment exists. Premature frame removal results in treatment failure, and alternative methods of assessment warrant investigation. Wire deflection might provide an indication of fracture site deformation on weight-bearing, indicating progress towards union. A previous <i>in vitro</i> study from our group demonstrated this approach may be clinically applicable. We investigated translation of this method into clinical practice in an observational pilot study.</p><p><strong>Materials and methods: </strong>Patients with tibial shaft fractures treated with Ilizarov frames were recruited. A prototype depth gauge was used to measure wire deflection on weight-bearing. Investigators undertaking the measurement were blinded to the clinical stage of treatment, and clinicians caring for the patient were blinded to deflection results. Patient records were reviewed at the end of treatment to determine likely fracture stability at each time point. Deflection per kg of weight applied, per mm from the ring was compared between stable and unstable situations.</p><p><strong>Results: </strong>Thirty-one measurements were obtained in 14 patients. The situation was deemed stable at 13 and unstable at 18 measurements. The median deflection in the stable group was 0.030 microns/kg/mm (IQR 0.005-0.104) and 0.165 microns/kg/mm (IQR 0.072-0.328) in the unstable group. This difference was statistically significant (Wilcoxon Mann-Whitney test <i>p</i> = 0.0014). ROC curve analysis revealed that wire deflection was able to predict clinical stability (AUC 0.84, <i>p</i> <0.0001). Various technical problems were encountered when using the device which would potentially limit its clinical utility in its current form.</p><p><strong>Conclusion: </strong>In this set of observations, wire deflection was significantly associated with clinically and radiologically determined stability. Though various practical limitations were encountered in using the prototype measurement device, this proof-of-concept study supports further development of this approach. The research group plan to develop a smaller, more reliable device for further clinical testing in a larger group of patients.</p><p><strong>How to cite this article: </strong>Lineham B, Stewart T, Ward J, <i>et al.</i> Measurement of Wire Deflection on Loading may Indicate Union in Ilizarov Constructs: A Pilot Study. Strategies Trauma Limb Reconstr 2021;16(3):132-137.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"132-137"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/39/stlr-16-132.PMC8778728.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882421","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":"Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results.","authors":"Giuseppe Rollo,&nbsp;Giovanni Vicenti,&nbsp;Roberto Rotini,&nbsp;Ante Prkic,&nbsp;Denise Eygendaal,&nbsp;Luigi Meccariello","doi":"10.5005/jp-journals-10080-1533","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1533","url":null,"abstract":"<p><strong>Aim: </strong>Intra-articular non-union of fractures is an uncommon but complex problem because in general, it is characterised by marked instability, pain, strength loss and significant functional limitation. The aim of this study is to report our prospective medium-term outcomes of the treatment of intra-articular, distal humeral aseptic non-unions using open reduction and internal fixation, augmented with artificial bone.</p><p><strong>Materials and methods: </strong>A retrospective case series of 16 patients with intra-articular, aseptic non-unions of the distal humerus was analysed for range of motion, pain, Mayo Elbow Performance Scores (MEPS) and Oxford Elbow Scores (OES) after 12 months. Mean age was 44 years (range, 18-84 years) and mean total follow-up was 43 months (range, 24-62 months).</p><p><strong>Results: </strong>All subjective and objective scores were significantly higher 12 months after treatment with internal fixation and artificial bone augmentation; the mean improvement on the MEPS was 18 points and 17 points on the OES. All patients returned to work, most without limitations. Autografts had worse outcomes compared to allografts regarding post-operative pain and time to return to work. No adverse events related to the artificial bone augmentation were seen and all fractures consolidated.</p><p><strong>Conclusion: </strong>The use of two locking plates and bone graft augmentation with autografts or allografts with artificial bone grafts is a successful treatment of intra-articular distal humeral non-unions after hardware failure or biological limitations.</p><p><strong>Clinical significance: </strong>The use of artificial bone in the treatment of septic non-unions of the upper limb is safe. When no autograft is possible because of concurrent morbidity, it can be used alone or combined with an allograft to reconstruct the affected bone without leading to extra morbidity or complications.</p><p><strong>How to cite this article: </strong>Rollo G, Vicenti G, Rotini R, <i>et al.</i> Open Reduction and Internal Fixation Using Double Plating with Biological and Artificial Bone Grafting of Aseptic Non-unions of the Distal Humerus: Clinical Results. Strategies Trauma Limb Reconstr 2021;16(3):144-151.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"144-151"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/05/stlr-16-144.PMC8778730.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882423","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":"Guided Growth for Tibial Recurvatum.","authors":"Peter Stevens,&nbsp;Andrew Stephens,&nbsp;David Rothberg","doi":"10.5005/jp-journals-10080-1535","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1535","url":null,"abstract":"<p><strong>Aim and objective: </strong>Sagittal guided growth of the distal anterior femur has been shown to be effective for the correction of fixed knee flexion deformity that is encountered in clinical practice. The opposite deformity, namely genu recurvatum, is comparatively uncommon in children. The most common aetiology is post-traumatic. Acute correction by means of osteotomy has significant associated risks. Our objective was to determine whether a posterior 8-plate would suffice in correcting tibial recurvatum and obviate the need for an osteotomy.</p><p><strong>Materials and methods: </strong>We included a total of five deformities, three boys (one bilateral) and one girl, managed by means of tethering of the posterior proximal tibial physis with a tension band plate. Standard radiographs obtained preoperatively and at follow-up included a standing anteroposterior (AP) of the legs noting limb lengths and the mechanical axis. We also obtained standing lateral views of each knee in maximal extension to measure and compare the posterior proximal tibial angle (PPTA).</p><p><strong>Results: </strong>The same-day surgery was well tolerated and there were no surgical or post-operative complications. The preoperative PPTA ranged from 106° to 117° and averaged 84° at follow-up. Correction occurred in an average of 20 months (range of 18-24 months). The patient with bilateral recurvatum due to Hurler's syndrome developed unilateral recurrent recurvatum culminating in percutaneous reinsertion of the metaphyseal screw. For each patient, knee hyperextension and associated pseudo-laxity resolved and limb lengths remained equal at follow-up.</p><p><strong>Conclusion: </strong>Children with progressive genu recurvatum typically present with an insidious onset of symptoms. Guided growth of the posterior proximal tibia is a safe and effective means of correcting the deformity; osteotomy was avoided in this series.</p><p><strong>Level of evidence: </strong>III - retrospective case series - no controls.</p><p><strong>How to cite this article: </strong>Stevens P, Stephens A, Rothberg D. Guided Growth for Tibial Recurvatum. Strategies Trauma Limb Reconstr 2021;16(3):172-175.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 3","pages":"172-175"},"PeriodicalIF":0.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/95/stlr-16-172.PMC8778727.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882859","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}