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https://www.readbyqxmd.com/read/27914027/the-role-of-guided-growth-as-it-relates-to-limb-lengthening
#1
REVIEW
Peter M Stevens
For decades, the classic indication for limb lengthening has been reserved for anisomelia that was expected to reach or exceed 5 cm at maturity. Epiphysiodesis was reserved for discrepancies in the 2-5 cm range. With the increasing sophistication of fixators, including rail, hexapod, and hybrid, complex deformities may be corrected simultaneously while moderate to extreme lengthening is achieved. More recently, iterations of telescoping intramedullary rods have further strengthened our armamentarium. Meanwhile, permanent epiphysiodesis techniques, both open and percutaneous, have yielded to more versatile and reversible tethering of one (angle) or both (length) sides of a physis...
December 2, 2016: Journal of Children's Orthopaedics
https://www.readbyqxmd.com/read/27889923/normal-radiological-unossified-hip-joint-space-and-femoral-head-size-development-during-growth-in-675-children-and-adolescents
#2
Veronika Wegener, Gabriele Jorysz, Andreas Arnoldi, Sandra Utzschneider, Bernd Wegener, Volkmar Jansson, Bernhard Heimkes
Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth...
November 7, 2016: Clinical Anatomy
https://www.readbyqxmd.com/read/27845969/closing-the-growth-plate-a-review-of-indications-and-surgical-options
#3
Joseph J Ruzbarsky, Christine Goodbody, Emily Dodwell
PURPOSE OF REVIEW: The purpose is to review the indications for epiphysiodesis in the treatment of pediatric limb length discrepancies; provide an update on current diagnostic, planning, and surgical techniques; and to introduce possible future alternatives. RECENT FINDINGS: Retrospective comparative studies have failed to demonstrate superiority of one epiphysiodesis technique over the others. EOS low-dose biplanar X-ray and smartphone growth prediction applications are improving our ability to diagnose and plan treatment for leg length discrepancy...
November 14, 2016: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/27798791/anterolateral-ligament-of-the-knee-shows-variable-anatomy-in-pediatric-specimens
#4
Kevin G Shea, Matthew D Milewski, Peter C Cannamela, Theodore J Ganley, Peter D Fabricant, Elizabeth B Terhune, Alexandra C Styhl, Allen F Anderson, John D Polousky
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction failure rates are highest in youth athletes. The role of the anterolateral ligament in rotational knee stability is of increasing interest, and several centers are exploring combined ACL and anterolateral ligament reconstruction for these young patients. Literature on the anterolateral ligament of the knee is sparse in regard to the pediatric population. A single study on specimens younger than age 5 years demonstrated the presence of the anterolateral ligament in only one of eight specimens; therefore, much about the prevalence and anatomy of the anterolateral ligament in pediatric specimens remains unknown...
October 31, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27775895/hierarchical-assembly-of-bioactive-amphiphilic-molecule-pairs-into-supramolecular-nanofibril-self-supportive-scaffolds-for-stem-cell-differentiation
#5
Zhe Wang, Fuwu Zhang, Zhantong Wang, Xiao Fu, Albert Jin, Bryant C Yung, Jing Fan, Xiangyu Yang, Gang Niu, Xiaoyuan Chen
Molecular design of biomaterials with unique features reca-pitulating nature's niche to influence biological activities has been a prolific area of investigation in chemistry and material science. The extracellular matrix (ECM) provides a wealth of bioactive molecules in supporting cell proliferation, migra-tion and differentiation. The well-patterned fibril and inter-twining architecture of the ECM profoundly influences cell behavior and development. Inspired by those features from the ECM, we attempted to integrate essential biological fac-tors from the ECM to design bioactive molecules to construct artificial self-supportive ECM mimics to advance stem cell culture...
October 24, 2016: Journal of the American Chemical Society
https://www.readbyqxmd.com/read/27755266/pediatric-phalanx-fractures
#6
Joshua M Abzug, Karan Dua, Andrea Sesko Bauer, Roger Cornwall, Theresa O Wyrick
Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27748675/physeal-bar-equivalent
#7
Hamlet A Peterson, William J Shaughnessy, Anthony A Stans
Premature partial physeal arrest without the formation of an osseous bar - physeal bar equivalent (PBE) - is uncommon. Four children with a PBE had an infection near the distal femoral physis before the age of 11 months. Some growth was achieved after resection of the PBE in each case. Of two cases diagnosed and treated early, one required only contralateral physeal arrests to achieve limb-length equality at maturity. The other, currently 8 years and 4 months old, has a 1.1-cm limb-length discrepancy 6 years after PBE resection and will require observation until maturity...
September 29, 2016: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/27741108/guided-growth-for-tibia-vara-blount-s-disease
#8
John A Heflin, Scott Ford, Peter Stevens
Blount's disease is commonly attributed to an intrinsic, idiopathic defect in the posteromedial proximal tibial physis resulting in progressive bowing of the leg, intoeing, and lateral knee thrust. Treatment has historically included bracing, physeal stapling, or corrective osteotomy, and was determined primarily by age at presentation. As we feel the pathology is not necessarily age dependent, we have elected to use the technique of guided growth using a lateral tension band plate to correct limb alignment as a first-line treatment in all patients presenting to our clinic as long as they had growth remaining and no evidence of a physeal bar...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27726752/imaging-the-injured-pediatric-athlete-upper-extremity
#9
Jorge Delgado, Diego Jaramillo, Nancy A Chauvin
Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/27717626/functional-outcome-after-transphyseal-anterior-cruciate-ligament-reconstruction-in-young-patients-with-open-growth-plates
#10
C Holwein, S Hinterwimmer, H O Mayr, L Lämmle, P U Brucker, E O Münch, A B Imhoff
BACKGROUND: This study evaluates sports ability, rotational laxity and potential growth changes in children after transphyseal ACL reconstruction with metaphyseal fixation technique, considering physis biology by placing drill holes vertically in the femoral anatomic origin in order to reduce volumetric injury to the physis. METHODS: In this retrospective trial of 42 patients data were collected. Thirty-seven were reviewed measuring rotational laxity and anteroposterior tibial translation using the Laxitester (ORTEMA Sport Protection, Markgroeningen, Germany) and the KT1000...
October 4, 2016: Knee
https://www.readbyqxmd.com/read/27709362/physeal-histological-morphology-after-thermal-epiphysiodesis-using-radiofrequency-ablation
#11
Juan Manuel Shiguetomi-Medina, B Møller-Madsen, O Rahbek
BACKGROUND: Several treatments have been described for leg length discrepancy. Epiphysiodesis is the most commonly used because of its effectiveness. Thermal epiphysiodesis using radiofrequency ablation (RFA) alters the growth plate morphology without damaging the adjacent articular cartilage; it is a minimally invasive method that has shown excellent results in animal models. This study describes the macro and micro morphology after the procedure. MATERIALS AND METHODS: Epiphysiodesis using RFA was performed in vivo for 8 min (92-98 °C) at two ablation sites (medial and lateral) in one randomly-selected tibia in eight growing pigs...
October 5, 2016: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/27703945/arthroscopic-fixation-of-tibial-spine-avulsion-fracture-in-open-physis
#12
Varun Chouhan
INTRODUCTION: Arthroscopic fixation of tibial spine fracture in patients with open physis without damaging the growth plate is very important. We have described a very simple and effective technique for the first time in this article. CASE REPORT: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent results. CONCLUSION: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique providing strong construct, and allowing early mobilization without risk of damage to the growth plate...
April 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/27703943/slipped-distal-femoral-epiphysis-in-congenital-insensitivity-to-pain
#13
M Javed Shaikh, C Rex, R Vignesh, Madhav Chavan
INTRODUCTION: Congenital insensitivity to pain (CIP) is a rare disorder, and often presents to an orthopaedic surgeon as recurrent fractures, dislocations, pseudoarthrosis, osteomyelitis etc. Here, we report a case of congenital insensitivity to pain presenting with distal femoral physeal separation in a child. CASE REPORT: A 12-year-old girl child came with complaints of limp while walking and swelling in the left knee for past 5 weeks. Mother gave a history that the girl is a known case of congenital insensitivity to pain with clear history of no pain on intramuscular injection since birth...
April 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/27703933/coexistence-of-extraskeletal-mesenchymal-chondrosarcoma-and-isolated-hemihyperplasia-a-case-report
#14
Nihat Demirhan Demirkiran, Olcay Akdeniz, Onur Hapa, Hasan Havıtçıoğlu
INTRODUCTION: Arthroscopic fixation of tibial spine fracture without damage to the growth plate is very important in patients with open physis. The present article describes a simple and effective technique being used for the first time to treat this condition. CASE REPORT: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent result. CONCLUSION: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique which provides strong construct, and allows early mobilization without risk of damage to the growth plate...
April 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/27662386/capital-femoral-epiphyseal-extension-may-confer-physeal-stability-in-slipped-capital-femoral-epiphysis
#15
William Z Morris, Joshua K Napora, Keegan T Conry, Raymond W Liu
BACKGROUND: Factors including obesity and morphologic parameters around the hip that increase physeal stress are associated with an increased risk of slipped capital femoral epiphysis (SCFE). Recent evidence suggests that superior epiphyseal extension may confer stability to the physis and help protect against SCFE. The purpose of this study is to investigate the relationship between epiphyseal extension and SCFE using an age-matched and sex-matched cohort study. METHODS: We generated 2 separate cohorts for comparison: 89 patients with unilateral SCFE and 89 healthy subjects with no evidence of hip disease or deformity...
September 22, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27646317/successful-stabilisation-of-a-type-iii-paediatric-tibial-eminence-fracture-using-a-tensioned-wire-technique
#16
Matthew Archer, Tom Parkin, Mark David Latimer
We report the case of an 11-year-old boy presenting with a type III tibial eminence fracture. The fracture fragment was reduced arthroscopically. Two 1.6 mm retrograde K-wires were inserted from the tibial metaphysis across the physis and into the fracture fragment using a standard anterior cruciate ligament tibial tunnel guide. Once the wires were clearly visible within the joint the tips were bent over by ∼120°. The wires were then tensioned around a single small fragment screw inserted into the tibial metaphysis...
2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27630783/giant-cell-tumor-of-bone-documented-progression-over-4-years-from-its-origin-at-the-metaphysis-to-the-articular-surface
#17
Colin Burke, Thomas Link, Richard J O'Donnell, Soo-Jin Cho, Daria Motamedi
The exact location of origin for giant cell tumors of bone (GCTB) remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate...
2016: Case Reports in Radiology
https://www.readbyqxmd.com/read/27612440/advanced-quantitative-imaging-and-biomechanical-analyses-of-periosteal-fibers-in-accelerated-bone-growth
#18
Rajeev Chaudhary, Ming-Song Lee, Kuwabo Mubyana, Sarah Duenwald-Kuehl, Lyndsey Johnson, Jarred Kaiser, Ray Vanderby, Kevin W Eliceiri, David T Corr, Matthew S Chin, Wan-Ju Li, Paul J Campagnola, Matthew A Halanski
PURPOSE: The accepted mechanism explaining the accelerated growth following periosteal resection is that the periosteum serves as a mechanical restraint to restrict physeal growth. To test the veracity of this mechanism we first utilized Second Harmonic Generation (SHG) imaging to measure differences of periosteal fiber alignment at various strains. Additionally, we measured changes in periosteal growth factor transcription. Next we utilized SHG imaging to assess the alignment of the periosteal fibers on the bone both before and after periosteal resection...
November 2016: Bone
https://www.readbyqxmd.com/read/27602916/septic-shoulder-presenting-as-a-shoulder-dislocation-in-the-pediatric-patient-a-case-report
#19
Kathleen J Maguire, Norman Y Otsuka
: Shoulder dislocation is relatively uncommon in the younger pediatric population. Because of the relative strength of the surrounding soft tissue structures of the shoulder compared with the proximal humeral physis, subluxation or dislocation resulting from a traumatic event or application of force is rare and instead a proximal humeral physeal injury occurs. Case presentation - We present a 5-year-old male who presented to the office with post-traumatic left shoulder pain for about 1 week...
September 3, 2016: Journal of Pediatric Orthopedics. Part B
https://www.readbyqxmd.com/read/27574954/clinically-meaningful-improvements-after-hip-arthroscopy-for-femoroacetabular-impingement-in-adolescent-and-young-adult-patients-regardless-of-gender
#20
Gregory L Cvetanovich, Alexander E Weber, Benjamin D Kuhns, Charles P Hannon, Dwayne D'Souza, Joshua Harris, Richard C Mather, Shane J Nho
BACKGROUND: The objective of this study was to determine if adolescent and young adult patients undergoing hip arthroscopy for symptomatic femoroacetabular impingement (FAI) experience clinically meaningful improvements in functional outcome scores. METHODS: A consecutive series of patients under age 18 who underwent primary hip arthroscopy for symptomatic FAI was identified using our institution's hip registry. Demographics, preoperative radiographic measurements, and preoperative and postoperative patient-reported outcome scores [Hip Outcome Score (HOS), Activity of Daily Living (ADL), and Sports-Specific Subscale (SS), and modified Harris Hip Score (MHHS)] were collected...
August 29, 2016: Journal of Pediatric Orthopedics
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