The efficacy of hemiepiphysiodesis for idiopathic knee coronal angular deformity by reconstruction plate and screw: A pilot study.

Background: Angular deformities of the lower extremities are among the most common findings in pediatric orthopedics. Alteration of the mechanical axis in the lower extremity affects the cosmetic appearance and may lead to gait disturbances, knee discomfort, patellar maltracking with or without pain, and early joint osteoarthritis. In the current study, we aimed to investigate the efficacy of 3-hole 3.5 mm reconstruction plates in tension-band temporary hemiepiphysiodesis for correcting idiopathic knee coronal angular deformities. Methods: The surgical procedure was performed using an extraperiosteal tension band plate (a 3-hole reconstruction plate) and two 3.5 mm cortical screws to treat idiopathic knee coronal angular deformity in children. The location of the hemiepiphysiodesis was determined based on the type of angular deformity present. Postoperative follow-ups were conducted through x-rays to measure the medial proximal tibial angle and lateral distal femoral angle of the limbs. Statistical analysis was then performed to evaluate the efficacy of the surgical treatment based on the rate of alignment change exhibited. Results: The study included 14 patients (25 limbs) with genu valgum deformity who underwent temporary hemiepiphysiodesis on both the distal femur and proximal tibia, with 16 proximal tibias and 15 distal femurs being corrected. The correction rate for genu valgum was found to be 0.59° per month for both proximal tibial and distal femoral hemiepiphysiodesis. Six patients (12 limbs) were also identified with genu varum deformity, and the correction rates for proximal tibial lateral hemiepiphysiodesis and distal femoral lateral hemiepiphysiodesis were 0.85° and 0.15° per month, respectively. During a mean follow-up duration of 11 ± 5.7 months, only one case of physeal plate closure was observed, and there were no other significant complications. Conclusion: Temporary hemiepiphysiodesis with a 3-hole R-plate and two cortical screws takes advantage of physiological physeal growth to successfully treat idiopathic angular deformities with low complication rates.

Iliac Pedicle Wedge Graft as a New Modification for Iliac Osteotomies in Young Adolescents: A Single-blind Randomized Clinical Trial.

BACKGROUND: Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorption and delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties. METHODS: A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter or triple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a muscle pedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hips were randomized into two groups. The traditional wedge graft was used in group 1, while the new modification was performed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were Center Edge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up. RESULTS: Both groups were similar statistically regarding their age, gender , estimated blood loss and the duration of follow-up. However, significant differences were found in the time to complete union between the two groups (P=0.03). CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decrease was significant only in group 1(P=0.03). The type of surgery (Salter or TPO) had no significant effect on the average time to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period than conventional graft patients. CONCLUSION: With the modification proposed , the healing at the osteotomy site was faster and the loss of correction, owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvic osteotomies in adolescent.

Effectiveness of Minimally Invasive Plate Osteosynthesis (MIPO) on Comminuted Tibial or Femoral Fractures.

BACKGROUND: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site, known as minimally invasive plate osteosynthesis (MIPO), has recently become prevalent. This study has been designed to assess the outcomes of this treatment for tibial and femoral comminuted fractures. METHODS: A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in this cross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequate follow-ups. Patients'data including union time; infection in the fractured site; hip and knee range of motion; and any malunion or deformities like limb length discrepancy were collected after the surgery in every session. RESULTS: Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient with femoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia (17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09). None of the patients suffered from infections or fistula. The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100 internal rotation in 1 patient; and 1cm limb shortening in 2 patients. CONCLUSION: According to the result of this study, MIPO is a simple and effective method of fixation with a high rate of union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion or any deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.

Transfer of Pectoralis Major to Subscapularis in the Management of Brachial Plexus Birth Palsy Sequels.

BACKGROUND: Limitations in abduction and external rotation are the sequel of brachial palsy. The purpose of this study was to evaluate functional outcomes of modified L'Episcopo procedure in children with brachial palsy who do not have gross shoulder joint subluxation. METHODS: From 2002 to 2012, a continuous series of 22 patients with brachial plexus birth palsy underwent a modified L'Episcopo procedure. Through an axillary approach, subscapularis release with latissimus dorsi rerouting and transfer of pectoralis major to subscapularis footprint was performed. RESULTS: The mean age of patients at surgery was 49 months. The mean follow-up time was 51 months (range, 24 to 90 mo). Preoperatively, the mean active abduction and external rotation were 77.5 and 2.5 degrees, respectively. The mean active abduction and external rotation were 135.6 and 32 degrees, respectively, at the final follow-up (P<0.001). CONCLUSIONS: This modified L'Episcopo technique is an effective and reproducible procedure that improves shoulder function significantly. LEVEL OF EVIDENCE: Level III.

Complicated Congenital Dislocation of the Knee: A Case Report.

Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid. Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction.

Changes in electrophysiological parameters after open carpal tunnel release.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly females. Few studies have been performed to assess the electrophysiological parameters before and after carpal tunnel release. The purpose of our study was to evaluate these changes postoperatively and in the course of a 9-month period after operation in comparison with the preoperative values. MATERIALS AND METHODS: A case-series study was carried out and included 17 cases of moderate or severe electrophysiologically confirmed CTS, who underwent open carpal tunnel release (CTR) from December 2010 to May 2011. Severity grade was assigned following American Association of the Electrodiagnostic Medicine criteria of CTS. Distal motor and sensory latencies and sensory nerve conduction velocity of the median nerve across the carpal tunnel were evaluated and compared before, at 6, and 9 months after surgery. RESULTS: From the 17 evaluated hand with moderate, moderate to severe and severe CTS, severity improvement was reported in 82.3% 6 months and in 88.2% 9 months after surgery, but only 47% had satisfied or completely satisfied opinion about the results. Others, though still complaining of serious symptoms, had improved or normal NCS. DISCUSSION: Electrophysiological investigations outlined severity improvement after CTR. In the current study, the electrophysiological studies were not meaningful in determining outcome.