Bone Transport with the Taylor Spatial Frame Technique: A Case Series.

Aim: Bone transport is a beneficial reconstructive method for bone defects caused by infected non-unions or bone tumours. The Taylor Spatial Frame (TSF) is a three-dimensional corrective external fixator that can be used to achieve bone transport and correct any residual deformities easily at any time. This study reports the results of bone transport using TSF. Materials and methods: This is a retrospective study of ten patients who underwent bone transport using the TSF. The mean age was 32.3 years; the femur was affected in one case and the lower leg in nine. Bone defects were due to infected non-unions in seven cases and bone tumours in three. The duration of external fixation, bone transport distance, distraction index (DI), alignment at the end of correction, leg length discrepancy, and complications were investigated. Results: The average bone transport distance was 76.0 mm. The external fixation period averaged 367 days with the DI at 20.8 days/cm. Deformity at the docking site was assessed to have an average 2.6° deformity and 2.0 mm translation in the frontal view, as well as 3.3° deformity and 3.7 mm translation in the lateral view. The mean leg length discrepancy was 10.9 mm and the percentage of the mechanical axis (%MA) was 40.6%. Four patients underwent plate conversion after correction and two required additional surgery for non-union at the docking site. Bone union was achieved in all patients and there was no reaggravation of infection or tumour recurrence. Conclusion: The TSF allowed for the correction of deformities and translations that occurred during bone transport giving excellent results. However, as with bone transport using this or other devices, additional procedures are often needed to obtain consolidation or docking site union. How to cite this article: Shimokawa K, Matsubara H, Hikichi T, et al. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):117-122.

Epidemiology of trauma-related paediatric limb fracture using a unique classification: A 10-year retrospective, single-centre study.

INTRODUCTION: Research regarding the epidemiology of paediatric trauma is limited. Using our unique classification, we describe paediatric trauma cases in a 10-year single-centre study to improve paediatric care. MATERIALS AND METHODS: Data regarding all paediatric trauma cases were extracted using a computerised medical record system that detected fracture diagnosis and epiphyseal injury. Registry search identified cases from January 2008 to December 2017. Age, sex, type of fracture, and details of injury mechanism were analysed, and we categorised the 'falls/turnover' mechanism using a new trauma energy classification based on speed and height. RESULTS: A total of 1379 cases (953 boys and 426 girls) were included. The highest number of injuries (553 cases, 40%) was seen in school children (aged 6 to 10 years). Forearm fracture occurred most frequently, followed by humeral fracture. The most frequent injury mechanism in falls/turnover (969 cases, 70%) was sports in 272 cases (28%), playground equipment in 179 cases (18%), furniture in 102 cases (11%), and bicycling in 87 cases (9%). We classified 956 cases of falls/turnover using our trauma energy classification scheme. Most cases (29%) were classified into the L2 category (low height and high speed), followed by the L1 category (low height and low speed) (p < 0.01). Subcategory analysis using the classification revealed that younger children were more likely to be injured by falling from high places because of their physique, whereas older children were more likely to be injured by a turnover from lower places and at higher speed. CONCLUSION: We describe the epidemiology of fractures in detail and present a new classification system, which may aid in understanding the injury mechanism independent of children's height. The fact that paediatric fractures occur at relatively low energy levels and are trended by age, activity, and sex, could be of potential universal use for their prevention and parent education.

Equinus foot deformity and malunion of the medial malleolus caused by tibialis posterior tendon interposition following irreducible fracture dislocation of the ankle: A case report and literature review.

We report a case of equinus foot deformity and malunion of the medial malleolus caused due to tibialis posterior tendon interposition following irreducible fracture-dislocation of the ankle. A 19-year-old female patient was referred to our hospital with the chief complaint of persistent ankle pain and restricted ankle dorsiflexion. Her medical history revealed a fracture-dislocation of the ankle in the left tibia at the age of 18 years. Open reduction and osteosynthesis were performed 3 days after injury. One year after the operation, ankle pain and restricted ankle dorsiflexion persisted. Computed tomography revealed malunion of the medial malleolus and an irregular groove in the interosseous space between the tibia and fibula. Magnetic resonance imaging revealed entrapment of the tibialis posterior tendon within the posterior talocrural joint and syndesmosis, preventing posterior translation of the talus back to its normal position and forcing the fibula to remain anteriorly displaced in the syndesmosis. We performed several procedures, including reduction of the tibialis posterior tendon interposition and dislocation of the talus, augmentation of the tibio-fibular ligament, and recession of the gastrocnemius. Finally, the patient achieved plantigrade stance and improvement in her Japanese Society for Surgery of the foot ankle/hindfoot scale from 42 to 82 points, after a 2-year follow-up. Anterior impingement caused the patient to experience severe osteoarthritis. Early reduction of the tibialis posterior tendon should have been achieved for this case. Age, fracture type, and severely restricted range of motion should raise suspicion of this adverse event. Level of Clinical Evidence: 4.

Comparison of each bundle of the spring ligament complex between the standing and supine positions: A multiposture magnetic resonance imaging study.

BACKGROUND: The spring ligament complex (SLC) supports the medial longitudinal arch of the foot, particularly in standing. We evaluated posture-related changes in the thickness and length of the three SLC bundles and their histology. METHODS: The thickness and length of the supramedial calcaneonavicular ligament (smCNL), medioplantar oblique calcaneonavicular ligament (mpoCNL), and inferoplantar calcaneonavicular ligament (iplCNL) were measured in the supine and standing positions, using a multiposture magnetic resonance imaging system, in 72 healthy adult feet. Histological examination was performed for 10 feet from five cadavers. RESULTS: The smCNL thickness decreased and its length increased from the supine to the standing position (P < 0.001); no other posture-related effects were noted. Histologically, smCNL fibers overlapped along multiple directions while mpoCNL and iplCNL, fibers were oriented horizontally along the longitudinal axis and vertically along the short axis, respectively. CONCLUSION: The complex, multidirectional, orientation of the smCNL allows an adaptive response to changes in loading.

Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs.

Aim: When a leg-length discrepancy (LLD) is severe enough, it can result in lumbar scoliosis and other postural defects. To our knowledge, no study has demonstrated associations between LLD and lumbar curvature using full-length standing radiographs of the lower limbs and lumbar spine. This study aimed to examine the correlations between LLD and lateral curvature of the lumbar spine using standing radiographs. Materials and methods: Full-length standing radiographs of the lower limbs and spinal column of 113 participants (age range: 10-65 years) obtained between November 2006 and September 2019 were reviewed. Leg length was measured as the linear distance from the centre of the femoral head to the centre of the tibial plafond and converted to millimetres using a radiographic ruler captured in the images. Leg-length discrepancy was analysed as the absolute difference (mm) between the left and right leg lengths. Inequality was also evaluated as leg-length discrepancy ratio (LLDR), calculated as leg-length discrepancy/length of the unaffected (longer) leg × 100 (%). Lateral lumbar curvature was evaluated with the Cobb angle (°). The association between LLD or LLDR and lumbar Cobb angle was analysed by correlation analysis. Statistical analysis was performed by simple regression in SPSS. Results: Both LLD and LLDR exhibited a robust and positive correlation with lumbar Cobb angle (γ = 0.53, γ = 0.62), as illustrated by the following regression equations: lumbar Cobb angle (°) = 0.316 × leg-length discrepancy (mm) + 2.83 and lumbar Cobb angle (°) = 2.19 × leg-length discrepancy ratio (%) + 3.0. Conclusion: Using objective imaging data, we found that the lumbar Cobb angle tends to be >10° if the difference in leg lengths is >20 mm. How to cite this article: Hamada T, Matsubara H, Kato S, et al. Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs. Strategies Trauma Limb Reconstr 2022;17(3):144-147.

Rat model of an autologous cancellous bone graft.

Autologous cancellous bone (ACB) grafting is the "gold standard" treatment for delayed bone union. However, small animal models for such grafts are lacking. Here, we developed an ACB graft rat model. Anatomical information regarding the iliac structure was recorded from five rat cadavers (10 ilia). Additionally, 5 and 25 rats were used as controls and ACB graft models, respectively. A defect was created in rat femurs and filled with ACB. Post-graft neo-osteogenic potential was assessed by radiographic evaluation and histological analysis. Iliac bone harvesting yielded the maximum amount of cancellous bone with minimal invasiveness, considering the position of parailiac nerves and vessels. The mean volume of cancellous bone per rat separated from the cortical bone was 73.8 ± 5.5 mm3. Bone union was evident in all ACB graft groups at 8 weeks, and new bone volume significantly increased every 2 weeks (P < 0.001). Histological analysis demonstrated the ability of ACB grafts to act as a scaffold and promote bone union in the defect. In conclusion, we established a stable rat model of ACB grafts by harvesting the iliac bone. This model can aid in investigating ACB grafts and development of novel therapies for bone injury.