Developing an adolescent and adult Fontan Management Programme.

Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.

Functional outcome in adult patients following Bernese periacetabular osteotomy.

This study evaluated functional outcome following Bernese periacetabular osteotomy. In 24 patients with mean follow-up of 3.5 years, mean dysfunction score was 15.23 on the Short Musculoskeletal Function Assessment. Eighteen patients (75%) scored = or <20, indicating a high functional level. Irrespective of preoperative Shenton line continuity, most patients demonstrated a high functional level. However, a trend toward a poorer outcome was observed in patients with preoperative noncongruent joints and Tonnis osteoarthritis grade 3. These results suggest patients with less than optimal presentation may still benefit from this surgery, delaying or eliminating the need for total hip arthroplasty.

Minimizing osteotomy related complications for abductor sparing periacetabular osteotomy using C-arm image intensification.

The purpose of this study was to determine if C-arm image intensification reliably prevents violations of the posterior column or the hip joint at periacetabular osteotomy sites independent of pelvic flexion and rotation. To assess osteotome placement at the infracotyloid groove, quadrilateral plate, and inner ischial sites, anteroposterior (AP) and false-profile C-arm image intensification views were obtained at each site during both pelvic flexion (0 degrees, 10 degrees, 20 degrees, and 30 degrees) and rotation (0 degrees, 10 degrees, 20 degrees, and 30 degrees). At the infracotyloid groove, AP and false-profile C-arm image intensification confirmed perpendicular orientation of the bifid osteotome in all degrees of pelvic flexion and rotation. On the false-profile view, pelvic flexion and rotation did not impact C-arm image intensification visualization of the posterosuperior and inferior joint spaces at the quadrilateral plate and inner ischial sites, respectively. Optimal step-off of the osteotome from the posterior column was demonstrated on all false-profile views of the quadrilateral plate. Despite varying degrees of pelvic flexion and rotation, C-arm AP and false-profile views confirm accurate osteotome placement, as well as violations of the posterior column or the hip joint at the infracotyloid groove, quadrilateral plate, and inner ischial osteotomy sites. C-arm image intensification is a reliable tool in preventing posterior column violation and an intra-articular osteotomy during an abductor sparing periacetabular osteotomy.

Outcomes analysis after routine removal of implants in healthy pediatric patients.

Routine removal of nonspinal, orthopedic implants from pediatric patients is a debated practice. The purpose of this study was to compare preremoval and postremoval outcome measures in children. Twenty-five patients, mean age 11.6 years, completed a pain scale and the Pediatric Outcomes Data Collection Instrument (PODCI). Many patients scored in the normal range of the PODCI before and after removal. Higher postoperative PODCI scores were found in patients without preoperative pain, and in patients with upper extremity versus lower extremity implants. In summary, routine removal of implants in children was carried out without complications and with some functional benefits.