Outcome of Ilizarov ankle arthrodesis.

BACKGROUND: Many operative techniques have been described for ankle arthrodesis, with varying fusion rates. In revisions, the fusion rate is lower than in primary arthrodesis. Recent reports have described good results after Ilizarov ankle arthrodesis. However, descriptions were qualitative, with none using an accepted score. We describe our experience with this technique and functional outcomes in our patients. METHODS: Seventeen patients (average age 48 years) had primary or revision unilateral ankle arthrodesis using the Ilizarov technique at two centers. Diagnoses included post-traumatic arthritis and Charcot arthropathy. Three patients had talar osteonecrosis. Time in the frame averaged 15 weeks and in a cast 4 weeks. Followup averaged 6 years. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. RESULTS: All ankles achieved solid fusion. The average AOFAS score was 65 out of 86 possible. Based on this, results were defined as excellent in three patients, good in eight, fair in four, and poor in two. Minor complications were common, all resolving with local treatment. No deep infection developed. One fusion malunited in 8 degrees of varus. CONCLUSIONS: The Ilizarov external fixator has numerous advantages applicable to ankle fusion, including: stable fixation, respect for soft tissues, and the possibility of postoperative alignment 'fine-tuning'. Additionally, the ability to direct forces through or around skeletal elements allows varying of the load through the skeletal elements, allowing early weightbearing. The Ilizarov technique, with its high union rate, may be considered for any ankle arthrodesis but is especially useful in complex cases such as revisions, talar osteonecrosis, soft-tissue compromise, and infection. Early weightbearing is an added benefit.

Vascular complications of supracondylar humeral fractures in children.

The purpose of this study was to analyze the vascular complications of 24 children with supracondylar humeral fractures treated in two affiliated hospitals and to propose a management plan. Exploration and repair of the brachial artery were undertaken in 11 of the 24 cases in which the pulse did not resume following reduction of the fracture. The repaired vessels were found to be patent on follow-up. Angiography was performed in six of the 24 cases and resulted in improved management in comparison with cases in which no angiography was performed. We believe that intra-operative angiography and vascular repair are indicated in most cases in which a palpable pulse does not resume after fracture reduction.

Close reduction and intramedullary flexible titanium nails fixation of femoral shaft fractures in children under 5 years of age.

We retrospectively reviewed 13 cases of diaphyseal femoral fractures treated with close reduction and intramedullary flexible titanium nails, in children aged 3-5 years. The mean follow-up time was 11.5 months (range 3-29). No cases of nonunion or malunion were noted. Minor complications were observed in two children. Loss of initially restored femoral lengthening had occurred in one child, with nail protrusion and related focal cellulites. Mild postoperative leg-length discrepancy occurred in another child. The healed fractures usually exhibited abundant callus, which allowed an early ambulation. Although the operative approach to simple diaphyseal fractures of the femur at such a young age is not routinely recommended, it can be a valuable option as an initial treatment, or when a conventional treatment with a spica cast has failed. In our group of patients, the parents chose this type of treatment as an alternative to the conventional spica cast.

[Arrow injury to the elbow causing arthritis].

We describe a severe injury caused by children's games. During a children's game, a 13 years-old girl was injured by an arrow with a metallic head and suffered injury to the elbow joint necessitating surgical drainage of an inflammatory reaction. This article enhances other descriptions in the literature of body injuries caused by dangerous games, and aims to draw attention to this phenomenon.

Removal of flexible titanium nails in children.

Removal of hardware in children after orthopaedic procedures is controversial. The authors retrospectively reviewed hospital charts and radiographs of 143 children who underwent removal of flexible titanium nails from the femur and the forearm. In 16 children the nails were removed because of protrusion, skin irritation, and some discomfort. Most of the patients were asymptomatic and underwent nail removal electively, according to the authors' policy for routine hardware removal in children. Complications included unsuccessful nail removal in three children and refractures after nail removal in two. Although the authors are still inclined to remove flexible titanium nails in most of the patients, the need for routine elective execution of this procedure may be questionable.

Computerized navigation for treatment of slipped femoral capital epiphysis.

In situ pinning with a single screw is the treatment of choice for symptomatic slipped capital femoral epiphysis (SCFE). Some technical features are critical and include proper screw entry point, screw direction in relation to the epiphysis, and the length of screw. These are complicated by the deformity created as a result of the posterior slip of the epiphysis. Fluoroscopic based computerized navigation system can increase precision in screw placement while performing the surgical task, and markedly reduce radiation. By using real fluoroscopy-based navigation, the screw can be placed with only two fluoroscopic images. Entry point, length, and precise direction can all be easily determined through this technique.

Progressive subluxation of the hip joint in a child with hereditary multiple exostosis.

We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis.