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Luis A Aponte-Tinao, Jose I Albergo, Miguel A Ayerza, D Luis Muscolo, Federico Milano Ing, German L Farfalli
BACKGROUND: Preservation of limb function after resection of malignant bone tumors in skeletally immature children is challenging. Resection of bone sarcomas and reconstruction with an allograft in patients younger than 10 years old is one reconstructive alternative. However, long-term studies analyzing late complications and limb length discrepancy at skeletal maturity are scarce; this information would be important, because growth potential is altered in these patients owing to the loss of one physis during tumor resection...
March 2018: Clinical Orthopaedics and related Research
Robert G Willson, Regina O Kostyun, Matthew D Milewski, Carl W Nissen
Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique...
February 2018: Orthopaedic Journal of Sports Medicine
B Danino, R Rödl, J E Herzenberg, L Shabtai, F Grill, U Narayanan, E Segev, S Wientroub
Background: Guided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee. Methods: The retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction...
February 1, 2018: Journal of Children's Orthopaedics
William Cody Sessions, Matthew Herring, Walter H Truong
The extensor mechanism of the knee-consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament-is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis...
February 6, 2018: Journal of Knee Surgery
Eric J Cotter, Rachel M Frank, Scott W Trenhaile
Traumatic glenohumeral dislocations often result in significant injury to the anterior-inferior labrum, most commonly leading to recurrent anterior instability. While in skeletally immature patients, shoulder trauma more commonly results in fracture versus a true dislocation, shoulder instability does occur and can be difficult to manage in the setting of open physes. In any event, the goal of treatment is to reduce the risk of recurrence and allow full participation in activities, including sports. Arthroscopic stabilization has been shown to be an effective treatment option for young patients, with good return to sport rates; however, the vast majority of literature on shoulder instability in the youth patient population focuses on anterior instability...
October 2017: Arthroscopy Techniques
Hidehiko Kawabata, Daisuke Tamura
PURPOSE: The purpose of this study was to evaluate long-term outcomes of nonvascularized toe phalanx transfer. METHODS: We retrospectively reviewed 54 nonvascularized toe phalanx transfers in 29 children with symbrachydactyly. Forty-seven transfers in 24 children were evaluated at 5-year follow-up and 27 transfers in 14 children were evaluated at 10-year follow-up. We recorded the incidence of the early physeal closure and the length of the transferred toe phalanx on plain radiographs at 5- and 10-year follow-up...
December 6, 2017: Journal of Hand Surgery
Brady T Evans, Frances A Tepolt, Emily Niu, Dennis E Kramer, Mininder S Kocher
The purpose of this study was to identify the rates of chondral injury, soft tissue impingement, and bony impingement in pediatric patients undergoing the modified Brostrom procedure with ankle arthroscopy for lateral ankle instability. A retrospective review of all patients undergoing a modified Brostrom procedure with ankle arthroscopy performed by two surgeons at a tertiary care children's hospital between October 2002 and April 2014 was performed. Data were collected regarding demographics, history and initial presentation, nonoperative management, surgical procedure and arthroscopic findings, and clinical follow-up...
January 2018: Journal of Pediatric Orthopedics. Part B
B Van Thielen, I Willekens, A Van der Schicht, P Pestieau, F Verhelle, P Goossens, R Decoster, O Jacqmot, P Delperdange, V Busoni, G De Mol, N Buls, S Provyn, M Kichouh, J de Mey, R Murray
This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18...
February 2018: Anatomia, Histologia, Embryologia
Prateek Behera, Nirmal Raj Gopinathan, Avinash Kumar, Balaji Saibaba, Pebam Sudesh, Rakesh John
The physis of a long bone may get 'sandwiched' and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft...
December 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
F Accadbled, J Vial, J Sales de Gauzy
Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging...
February 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
David E Lazarus, Christine L Farnsworth, Megan E Jeffords, Nikolas Marino, Jericho Hallare, Eric W Edmonds
BACKGROUND: There is evidence that oblique tension band plating can affect torsional growth in long bones. This study sought to determine if the torsional growth could be modulated based on the angles of the tension band plating and whether or not oblique plating affected overall longitudinal growth. METHODS: New Zealand White rabbits (10.5 wk old) had one screw placed on the metaphyseal side and one on the epiphyseal side of both medial and lateral sides of the right knee distal femoral physis...
February 2018: Journal of Pediatric Orthopedics
Helen E Gruber, Nomaan Ashraf, Michael D Cox, Jane A Ingram, Megan Templin, John Michael Wattenbarger
BACKGROUND: Although physeal fractures and physeal bars can result in significant clinical consequences to growth and development of the injured physis, little orthopaedic research has focused upon this topic. Our objective was to extend a previously developed rat model to examine the immunohistochemical features following surgical application of techniques disrupting the physis. METHODS: Physes were surgically disrupted using fracture (control), epiphyseal scrape (ES), or epiphyseal drill (ED)...
November 16, 2017: Journal of Pediatric Orthopedics
Sourabh Kumar Sinha, Vineet Kumar, Ajai Singh
BACKGROUND: Fracture shaft of femur is amongst one of the commonest major diaphyseal injuries in school going children presenting to us at emergency rooms of our hospitals. The presence of a growing proximal and distal physes imposes a real challenge in management of these fractures. The use of titanium elastic nails has gained wide acceptance for stabilizing these fractures. MATERIALS AND METHODS: A sample of 53 children of age group 6 to 12 years were included in the study according to the inclusion and exclusion criteria...
October 2017: Journal of Clinical Orthopaedics and Trauma
Shital N Parikh, Charles T Mehlman
Pediatric ankle fractures are common and have unique fracture characteristics because of the presence of distal tibial and fibular physes. When displaced (>3 mm widening of the physis or >2 mm intra-articular gap/step-off), these fractures are typically treated with anatomical reduction and internal fixation. Computed tomography is recommended for preoperative evaluation and surgical planning for intra-articular fractures. These fractures in younger children with substantial growth remaining should be followed closely to monitor for any growth disturbance...
November 2017: Journal of Orthopaedic Trauma
Jie C Nguyen, B Keegan Markhardt, Arnold C Merrow, Jerry R Dwek
The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Emily R Dodwell, Matthew R Garner, Elise Bixby, Eva M Luderowski, Daniel W Green, John S Blanco, Roger F Widmann
BACKGROUND: Percutaneous epiphysiodesis using transphyseal screws (PETS) has been associated with implant failure, implant prominence, angular deformities, and delayed growth inhibition. QUESTIONS/PURPOSES: The aim of this study was to assess the complication rate and efficacy (defined as actual growth inhibition divided by expected growth inhibition) of PETS and to identify factors associated with improved efficacy. METHODS: Patients who underwent distal femoral and/or proximal tibial PETS between January 2007 and June 2014 were identified...
October 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Jonathan A Godin, Mark E Cinque, Jonas Pogorzelski, Gilbert Moatshe, Jorge Chahla, Robert F LaPrade
BACKGROUND: Multiligament knee injuries cause significant functional impairment. Adults undergoing anatomic reconstruction of multiligament knee injuries have excellent outcomes postoperatively. However, less is known about the outcomes in adolescent patients following multiligament reconstruction. PURPOSE/HYPOTHESIS: We aimed to assess patient outcomes and failure rates following unstaged multiligament reconstruction in an adolescent population at a minimum 2-year follow-up...
September 2017: Orthopaedic Journal of Sports Medicine
Michael A Tonkin, Nathan D Trist, Dirk J van der Spuy, Albert Yoon, Harvinder P Singh, Richard D Lawson
PURPOSE: To investigate the radiographic length and width of the new thumb metacarpal in relation to the middle finger proximal phalanx; to assess the incidence of premature physeal closure of the new metacarpal; and to consider whether there is a relationship between growth characteristics and the presence of union or nonunion of the new trapezium to the retained index finger metacarpal base. METHODS: Forty pollicizations were assessed with preoperative or immediate postoperative radiographs and follow-up radiographs to establish the growth characteristics of the new thumb metacarpal...
January 2018: Journal of Hand Surgery
S A Rethlefsen, K K Barrett, T A L Wren, G Blumstein, D Gargiulo, D D Ryan, R M Kay
BACKGROUND: The Koshino (KI) and Caton-Deschamps (CDI) indices are used to measure patellar height in children, with the CDI showing excellent reliability in typically developing (TD) children. Reliability of such measures in children with cerebral palsy (CP) and spina bifida (SB) is unknown. METHODS: Lateral knee radiographs were reviewed retrospectively for children with TD (n = 49), CP (n = 48) and SB (n = 42). Five raters took measurements from radiographs twice, at least two weeks apart...
August 1, 2017: Journal of Children's Orthopaedics
Muayad Kadhim, Luke Gauthier, Karl Logan, Ron El-Hawary, Benjamin Orlik
This retrospective cohort study examined 20 patients (48 physes), 11 boys and nine girls, who were treated with hinge-plate or eight-plate. The mean age of the patients at surgery was 11.9±2.6 years. The mean follow-up duration was 13±2.7 months. The radiographic measurement of both distal femoral and proximal tibial deformity showed significant correction, with no difference between the hinge-plate and the eight-plate. Both screw divergence angle and the hinge angle showed significant changes at the last follow-up...
January 2018: Journal of Pediatric Orthopedics. Part B
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