Optimizing Graft Extraction From the Femoral Condyle for Fresh Osteochondral Allograft Transplantation in Treating Osteochondritis Dissecans of the Capitellum: Best Fit Based on Radius of Curvature.

BACKGROUND: Osteochondritis dissecans (OCD) of the capitellum is a common cause of pain and dysfunction in adolescents that engage in repetitive elbow loading. For large, unstable lesions fresh osteochondral allograft transplantation (FOCAT) from the femoral condyle has been described as an effective treatment. Current practice involves significant guesswork in obtaining an appropriately sized graft, with anatomic variations resulting in poor graft fit. No studies currently exist that analyze and identify the best distal femur FOCAT graft site to repair OCD lesions of the capitellum based on the radius of curvature (ROC) and simulated matching. METHODS: Computed tomography scans of the elbow were used to estimate the subchondral bone ROC of capitella in adolescents aged 11 to 21 years. The capitellar location used corresponds to the most commonly reported site of OCD lesions in the elbow. Computed tomography scans of the lower extremity were used to estimate the subchondral bone ROC of 4 potential donor femoral condyle grafts. ROC from distinct regions at the posterior section of both the medial and lateral femoral condyles were measured: 2 areas representing 10 mm grafts from the center (MC1 and LC1), and 2 areas estimating 10 mm grafts posterior and adjacent to the physeal scar (MC2 and LC2). Intraobserver and interobserver reliability measurements were preformed to corroborate precision and validate the method. RESULTS: The mean ROC of healthy subchondral bone at the region of the capitellum were OCD lesions most commonly occur was 9.79±1.39 mm. The mean ROC of MC1 was 18.61±2.26 mm. The average ROC of the MC2 was 15.23±1.43 mm. The average ROC of LC1 was 16.47±1.34 mm. The average ROC of LC2 was 18.19±3.09 mm. After 15,000 simulated condyle-to-capitellar site matchings based on these measurements, a good fit graft was achieved at a frequency of 15%. DISCUSSION: No site measured from the femoral condyle demonstrated a subchondral ROC that exactly matched the subchondral ROC of the capitellum at the center location where OCD lesions most commonly occur; of the locations measured, a 10 mm section from MC2 demonstrated the closest match. On the basis of this analysis, extracting a graft from MC2 has the potential to further optimize FOCAT fit to the capitellum. LEVEL OF EVIDENCE: Level III.

Is the Iliac Cortical Density Similarly Positioned in the Developing Pediatric Pelvis?

OBJECTIVES: The iliac cortical density (ICD) is a critical fluoroscopic landmark for pelvic percutaneous screw placement. Our purpose was to evaluate the ICD as a landmark in pediatrics and quantify the diameter of osseous pathways for 3 screw trajectories: iliosacral (IS) at S1 and transiliac-transsacral (TSTI) at S1 and S2. METHODS: Two hundred sixty-seven consecutive pelvic CT scans in children 0-16 years of age were analyzed. ICD and S1 vertebral heights were measured at multiple regions along S1. Their height and corresponding ratios, as well as osseous screw corridor dimensions were compared between age groups and by the dysmorphic status. RESULTS: In the nondysmorphic pelvises, S1 height, ICD height, and the ICD to S1 height ratio increased across age groups for all locations (P < 0.001). All 3 screw pathway diameters increased with age (P < 0.001). In the dysmorphic group, there was no increase in ICD to S1 height ratio with age. Except for the age 0-2 group, the ICD to S1 height ratios were significantly larger in the nondysmorphic group. In the dysmorphic group, S1 TSTI pathway remained narrow with age, whereas IS at S1 and TSTI at S2 had a significant increased diameter with age (P < 0.001). CONCLUSION: The ICD is a useful fluoroscopic landmark for percutaneous screw placement in the pediatric pelvis. For nondysmorphic pelvises, the ICD to S1 height ratio, as well as osseous corridors for IS, TSTI at S1, and TSTI at S2 screw trajectories increase significantly with age. The margin for safe screw placement in S1 is smaller for younger and dysmorphic pelvises.

The Effect of Local Intraoperative Steroid Administration on the Rate of Postoperative Dysphagia Following ACDF: A Study of 245,754 Patients.

STUDY DESIGN: A retrospective database analysis. OBJECTIVE: The aim of this study is to compare rates of postoperative dysphagia, length of stay, infection, and wound complications following short and long anterior cervical discectomy and fusion (ACDF) in patients who received local intraoperative steroids and those who did not. SUMMARY OF BACKGROUND DATA: Only one prior small institutional study has investigated the application of local steroids at the time of ACDF to decrease postoperative dysphagia. METHODS: A large administrative database was utilized to compare rates of postoperative dysphagia, length of stay, and infectious complications within 90 days in patients who received local steroid following short (1-2 level) and long (3 or more level) ACDF and control groups who did not. Nonobtainable information within the database included type of steroid, application technique, outcome data, and incidence of miscoding and noncoding by physicians. Odds ratios (ORs), 95% confidence intervals (95% CIs) and P values were then calculated using SPSS. RESULTS: The incidence of dysphagia was significantly lower (9.0% vs. 14.6%, P = 0.005) in patients who received local steroid in the long ACDF group (n = 322) than a control group who did not (n = 45,432). This was not observed (P = 0.198) in the short ACDF group who received steroid (n = 1770) compared with a control group who did not (n = 198,230). The mean difference in length of stay was 1 day less for patients who received local steroid in both the short and long ACDF groups (P < 0.0001). The combined rate of postoperative infection and wound complications was not significantly different between steroid and control groups (P = 0.717). CONCLUSION: This analysis of a large administrative database suggests that local intraoperative steroid is associated with a significantly reduced rate of postoperative dysphagia after long ACDF and reduced average length of stay following both long and short ACDF without any increase in the rate of postoperative infection or wound complication. LEVEL OF EVIDENCE: 3.