Soft Tissue Releases With Simultaneous Guided Growth Decrease Risk of Spastic Hip Displacement Recurrence.

BACKGROUND: Soft tissue release (STR) is an established treatment for spastic hip displacement, but recurrence of hip displacement is not uncommon. This study aims to (1) evaluate the recurrence of hip displacement after STR, (2) define associated factors of recurrence, and (3) elucidate the effects of guided growth on hip displacement recurrence. METHODS: The study subjects included 66 individuals with spastic cerebral palsy treated by STR with or without guided growth for hip displacement. The treatment goal was the maintenance of migration percentage (MP) to <40%. Recurrence was defined by a rebound of the MP by 5% or more after the first postoperative year. Children with recurrence were compared with those without recurrence using the Mann-Whitney U test and the χ 2 test. The risk factors for recurrence were evaluated using multiple logistic regression analysis. RESULTS: Nineteen individuals (29%) had a recurrence of hip displacement after the first postoperative year. They sustained a 2-fold increase in the rate of treatment failure ( P < 0.001) and reoperation ( P = 0.04). Age, sex, motor function, and preoperative radiographic parameters were comparable between individuals with and without recurrence. The use of guided growth was associated with less risk of recurrence than without (5% and 39%, respectively, odds ratio = 0.01 to 0.45, respectively) despite the similar risk of failure (35% and 48%, respectively, odds ratio = 0.15 to 4.82). CONCLUSIONS: Recurrence of the MP >5% after the first postoperative year is an important early indicator for failure to control MP to <40% and reoperation. Guided growth not only decreases coxa valga but also reduces the risk of recurrent hip displacement after STR. LEVEL OF EVIDENCE: Level III; case-control study.

Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta.

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5-11), and the median follow-up period was 55 months (range 33-83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38-80) to 95 (range 71-97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

Pioneering Experience of Uniportal Video-Assisted Thoracoscopic Surgery for Anterior Release of Severe Thoracic Scoliosis.

The optimal way to treat severe thoracic scoliosis remains controversial. Compared with conventional procedures, the uniportal video-assisted thoracoscopic surgery (UniVATS) rises in popularity in thoracic surgery because of less pain and faster recovery. This retrospective study aimed to apply UniVATS to treat severe thoracic scoliosis. Between October 2013 and March 2018, eight scoliotic patients with extremely large Cobb angle and profoundly limited flexibility underwent UniVATS for anterior release, followed by posterior instrumentation and fusion. The mean age at the time of surgery was 14.8 ± 2.4 years and the mean follow-up was 2.2 ± 1.3 years. The average levels of anterior thoracic discectomy and posterior fusion were 3.6 ± 0.7 and 11.5 ± 1.2, respectively. The mean coronal and sagittal correction rates were 70 ± 19% and 71 ± 23%, respectively. UniVATS contributed to minor access trauma (3-cm incision) with minimal blood loss, shorter operation time (75 ± 13 mins), less requirement of stay in the intensive care unit (0.3 ± 0.5 day) or chest tube placement (0.3 ± 0.7 day), speedier and narcotic-free recovery, and earlier ambulation within one day. This is the first study to assess the safety and efficacy of UniVATS in the treatment of severely stiff thoracic scoliosis, providing comparable surgical outcomes, less pain, faster recovery and superior cosmetic results without significant complications.