Osteotomías correctoras en secuelas de fracturas supracondíleas de codo en la población pediátrica: revisión bibliográfica sistematizada / Corrective osteotomies in sequelae of supracondylar elbow fractures in the pediatric population: systematized bibliographic review / Osteotomias corretivas em sequelas de fraturas supracondilianas do cotovelo na população pediátrica: revisão bibliográfica sistemática

El cubito varo es la secuela más frecuente en las fracturas supracondíleas de humero en la población pediátrica, objetivo analizar los diferentes tipos de osteotomías y los métodos fijación para el tratamiento de estas lesiones. Materiales y métodos: se realizo una búsqueda bibliográfica utilizando como motor de búsqueda la plataforma Pubmed y OVID, las palabras claves fueron Cubitus AND varus AND osteotomy. Resultados: se seleccionaron 13 artículos, con un N de 237 pacientes, follow-up de 30 meses, edad al momento de la cirugía fue 8,78 años. La técnica de osteotomía más utilizada fue la de cierre lateral. 35.4% se fijaron con placas, 24.8% con fijadores externos y 33.3% fijación con kw/pins. Conclusión: las técnicas de osteotomías utilizadas actualmente logran corrección angular. No se encontraron diferencias significativas entre los resultados de las técnicas analizadas. No existe un implante que sea superior a otro a la hora de realizar la fijación de las osteotomías de humero distal. Cada implante tiene ventajas y desventajas.

Cubitus varus is the most frequent sequelae in supracondylar humeral fractures in the pediatric population, the objective is to analyze the different types of osteotomies and fixation methods for the treatment of these injuries. Materials and methods: a bibliographic search was carried out using the Pubmed and OVID platform as a search engine, the keywords were Cubitus AND varus AND osteotomy. Results: 13 articles were selected, 237 patients, follow-up of 30 months, age at the time of surgery was 8.78 years. The most used osteotomy technique was lateral closure. 35.4% were fixed with plates, 24.8% with external fixators and 33.3% fixation with kw/pins. Conclusion: the osteotomy techniques currently used achieve angular correction. No significant differences were found between the results of the analyzed techniques. There is no implant that is superior to another when fixing distal humerus osteotomies. Each implant has advantages and disadvantages.

A deformidade em varo do cotovelo é uma complicação comum das fraturas supracondilares do úmero na população pediátrica, o objetivo foi analisar os diferentes tipos de osteotomias e métodos de fixação para o tratamento dessas lesões. Materiais e métodos: foi realizada uma pesquisa bibliográfica utilizando as plataformas Pubmed e OVID como mecanismo de busca, as palavras-chave forom Cubitus AND varus AND osteotomy. Resultados: foram selecionados 13 artigos, com N de 237 pacientes, seguimento de 30 meses, idade no momento da cirurgia foi de 8,78 anos. A técnica de osteotomia mais utilizada foi a ressecção de cunha óssea com base laterala. 35,4% foram fixados com placas, 24,8% com fixações externas e 33,3% foram fixados com kw/pins. Conclusão: as técnicas de osteotomia utilizadas atualmente conseguem correção angular. Não forom encontradas diferenças significativas entre os resultados das técnicas analisadas. Não existe implante superior a outro na fixação de osteotomias distais do úmero. Cada implante tem vantagens e desvantagens.

C-arm Free O-arm Navigated Posterior Atlantoaxial Fixation in Down Syndrome: A Technical Note.

The surgical treatment of pediatric atlantoaxial subluxation (AAS) in Down syndrome (DS) remains technically challenging due to radiation exposure and complications such as vertebral artery injury and nonunion. The established treatment is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique). However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation we present here a new C-arm free O-arm navigated surgical procedure for pediatric AAS in DS. A 5-year-old male DS patient had neck pain and unsteady gait. Radiograms showed AAS with an atlantodental interval of 10 mm, and irreducible subluxation on extension. CT scan showed Os odontoideum and AAS. MRI demonstrated spinal cord compression between the C1 posterior arch and odontoid process. We performed a C-arm free O-arm navigated modified Goel procedure with postoperative halo-vest immobilization. At oneyear follow-up, good neurological recovery and solid bone fusion were observed. The patient had no complications such as epidural hematoma, infection, or nerve or vessel injury. This novel procedure is a useful and safe technique that protects surgeons and staff from radiation risk.

Oblique Lateral Interbody Fusion with Anterolateral Screw Fixation Is as Effective as with Posterior Percutaneous Pedicle Screw Fixation in Treating Single-Segment Mild Degenerative Lumbar Diseases.

BACKGROUND Oblique lateral interbody fusion (OLIF) is a new and minimally invasive surgery. This study aimed to compare the clinical efficacy and safety of oblique lateral interbody fusion with anterolateral screw fixation and with posterior percutaneous screw fixation in treating single-segment mild degenerative lumbar diseases. MATERIAL AND METHODS A retrospective analysis was performed on 51 patients with single-segment mild degenerative lumbar diseases who received OLIF from April 2017 to January 2020 in Hong Hui Hospital, Xi'an Jiao Tong University; 24 and 27 patients received OLIF with anterolateral screw fixation (OLIF+AF) and OLIF with posterior percutaneous screw fixation (OLIF+PF), respectively. Anesthesia time, operation time, intraoperative blood loss, intraoperative fluoroscopy number, hospital stay, postoperative complications, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, anterior and posterior disc heights, foraminal height, and fusion rate of the 2 groups were compared to assess clinical and radiological outcomes. RESULTS Anesthesia time, operation time, intraoperative blood loss, number of intraoperative fluoroscopy, and VAS score in the OLIF+AF group were significantly better than those in the OLIF+PF group (P<0.05). There were no significant differences in ODI score, anterior and posterior disc heights, foraminal height, fusion rate, and incidence of complications between the 2 groups (P<0.05). CONCLUSIONS OLIF+AF in treating single-segment mild degenerative lumbar diseases produces a satisfactory clinical effect. Moreover, OLIF+AF does not invade the paraspinal muscle group, thereby reducing trauma, postoperative residual low back pain, operation time, bleeding, and frequency of fluoroscopy. Thus, OLIF+AF is a feasible treatment method for single-segment mild degenerative lumbar diseases.

Facilitating the Approval Process of Anti-Infective Technologies and Advancing Them to the Market: Insights from an FDA Workshop on Orthopaedic Device-Related Infections.

ABSTRACT: Orthopaedic device-related infection is one of the most devastating complications in orthopaedic and trauma surgery. With increasing life expectancies as well as the lifelong risk of bacterial seeding on an implant, the prevention and treatment of device-related infection remains an important area for research and development. To facilitate information exchange and enhance collaboration among various stakeholders in the orthopaedic community, the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) organized an inaugural workshop on orthopaedic device-related infections, exploring the regulatory challenges that are faced when proceeding from the bench level to marketing and clinical implementation of new infection-control devices and products. This article summarizes the perspectives of scientists, clinicians, and industry partners on the current regulatory approval process for orthopaedic anti-infective technologies as well as the proposed strategies to overcome these regulatory challenges.

In vivo deformation of anatomically pre-bent rods in thoracic adolescent idiopathic scoliosis.

Some surgical strategies can maintain or restore thoracic kyphosis (TK); however, next-generation surgical schemes for adolescent idiopathic scoliosis (AIS) should consider anatomical corrections. A four-dimensional correction could be actively achieved by curving the rod. Thus, anatomically designed rods have been developed as notch-free, pre-bent rods for easier anatomical reconstruction. This study aimed to compare the initial curve corrections obtained using notch-free rods and manually bent, notched rods for the anatomical reconstruction of thoracic AIS. Two consecutive series of 60 patients who underwent anatomical posterior correction for main thoracic AIS curves were prospectively followed up. After multilevel facetectomy, except for the lowest instrumented segment, either notch-free or notched rods were used. Patient demographic data, radiographic measurements, and sagittal rod angles were analyzed within 1 week after surgery. Patients with notch-free rods had significantly higher postoperative TK than patients with notched rods (P < .001), but both groups achieved three-dimensional spinal corrections and significantly increased postoperative rates of patients with T6-T8 TK apex (P = .006 for notch-free rods and P = .008 for notched rods). The rod deformation angle at the concave side was significantly lower in the notch-free rods than in the notched rods (P < .001). The notch-free, pre-bent rod can maintain its curvature, leading to better correction or maintenance of TK after anatomical spinal correction surgery than the conventional notched rod. These results suggest the potential benefits of anatomically designed notch-free, pre-bent rods over conventional, manually bent rods.

Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: Application of halo vest before and during surgical management.

Cervical spine fracture-dislocation in patients with ankylosing spondylitis (AS) and severe thoracic kyphosis is extremely unstable. This study was performed to investigate the efficacy and safety of halo vest application before and during surgery for these patients. We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 25 patients with AS and severe thoracic kyphosis who underwent surgical treatment of cervical fracture-dislocation in our department from 2008 to 2019. A halo vest was used to reduce and immobilize the fractured spinal column ends before and during surgery. The neurologic injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score, visual analog scale (VAS) score, and Japanese Orthopaedic Association (JOA) score before and after the operation. Twenty-two patients achieved closed anatomical reduction; two achieved successful reduction and one underwent failed reduction after halo vest application. No fracture site displacement occurred after movement into the prone position. No patients developed secondary neurological deterioration. The mean Cobb angle of thoracic kyphosis was 69.0° ± 12.3°. All patients underwent posterior or combined anterior-posterior surgery. The ASIA grade improved significantly (P < 0.01). The mean VAS and JOA scores also increased significantly after the operation (14.6 ± 3.0 vs. 10.4 ± 4.3 and 0.5 ± 0.6 vs. 4.6 ± 1.9, respectively; P < 0.01). One patient died 3 weeks after the operation. No other severe complications occurred. All patients had reached solid bony fusion by the 12-month follow-up. Use of a halo vest before and during the operation is safe and effective in patients with AS and severe thoracic kyphosis who develop cervical fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration.

Fracturas diafisiarias de tibia tratadas con placa lateral por técnica mínimamente invasiva / Lateral minimally invasive plate osteosynthesis technique for tibial shaft fractures

Las técnicas quirúrgicas mínimamente invasivas ayudan a que el proceso natural de la consolidación ósea ocurra proporcionando estabilidad biomecánica suficiente para obtener los mejores resultados. El objetivo de este trabajo es mostrar los resultados clínicos y radiológicos del tratamiento de las fracturas diafisiarias de tibia con osteosíntesis mínimamente invasiva con placa por cara lateral. Se realizó un estudio clínico observacional, prospectivo, longitudinal y no concurrente. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnósticos de fracturas diafisiarias de tibia 42A, 42B ó 42C, abiertas o cerradas. Se estableció tiempo de seguimiento mínimo de 6 meses. Se incluyeron 23 pacientes, 82,60% de sexo masculino. Promedio de edad de 21±5,63(16­49) años. La fractura más frecuente fue la 42B2 en 26,00% de los casos, y 34,80% fracturas fueron abiertas. A las 12 semanas, 65,10% habían alcanzado consolidación Montoya III; y para la semana 16, 91,30% de los pacientes. De acuerdo a la escala ASAMI, se alcanzaron resultados excelentes en 100,00% pacientes para la semana 16. No se presentaron complicaciones como infección, aflojamiento séptico o aséptico del implante, ni fatiga del mismo. El uso de la técnica MIPO para tratamiento de fracturas diafisiarias de la tibia, por cara lateral es una técnica efectiva y segura, con alta tasas de consolidación, mínimas complicaciones y buenos resultados finales(AU)

Minimally invasive surgical techniques help the natural bone healing process to occur, by providing enough biomechanical stability to obtain the best results. The objective is to show the clinical and radiological results of the treatment of diaphyseal tibial fractures with minimally invasive osteosynthesis with lateral plating. An observational, prospective, longitudinal and non-concurrent clinical study was made. Patients older than 18 years, both sexes, with diagnoses of open or closed tibial shaft fractures 42A, 42B or 42C, were included. A minimum follow-up time of 6 months was established. 23 patients were included, 82,60% male. Average age of 21 years. The most frequent fracture was 42B2 in 26,00% cases, and 34,80% were open fractures. At 12 weeks, 65,10% had reached Montoya III consolidation criterias; and for week 16, 91,30% of the patients. According to the ASAMI scale, excellent results were achieved in 100,00% patients. There were no complications such as infection, septic or aseptic loosening of the implant, or fatigue of the implant. The use of the MIPO technique for the treatment of diaphyseal fractures of the tibia on the lateral aspect is an effective and safe technique, with high rates of union, minimal complications and good final results(AU)

Clinical Results of Unilateral Dynamic Rod Application in the Short-Medium Period.

AIM: To evaluate the clinical results of patients who underwent unilateral dynamic rod stabilization after unilateral facet joint excision during spinal surgery. MATERIAL AND METHODS: Twenty patients who were diagnosed with degenerative spinal disease or spinal tumor, who were operated on using a unilateral approach, who underwent facet joint resection, and who were stabilized with a unilateral dynamic rod were examined. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to clinically evaluate the cases during the preoperative and postoperative periods. Radiological examinations for sagittal alignment, segmental angle, and bone fusion were also conducted. RESULTS: The mean preoperative VAS and ODI scores were 7.6 and 71.7, respectively, and the 12 < sup > th < /sup > postoperative month scores were 1.1 and 12.8, respectively. The mean segmental angle measurements were 22.1° in the preoperative period and 21.6° at the postoperative 12 < sup > th < /sup > month. No deterioration in sagittal alignment and no bone fusion were observed. CONCLUSION: We can protect segmental movements and provide sufficient stability by applying unilateral dynamic rod stabilization after unilateral facetectomy. In addition, applying screws to one side can reduce operation time and cost as well as the possibility of complications.

Bacteriophage therapy for bone and joint infections.

Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics. Cite this article: Bone Joint J 2021;103-B(2):234-244.

The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection.

AIMS: The principle strategies of fracture-related infection (FRI) treatment are debridement, antimicrobial therapy, and implant retention (DAIR) or debridement, antimicrobial therapy, and implant removal/exchange. Increasing the period between fracture fixation and FRI revision surgery is believed to be associated with higher failure rates after DAIR. However, a clear time-related cut-off has never been scientifically defined. This systematic review analyzed the influence of the interval between fracture fixation and FRI revision surgery on success rates after DAIR. METHODS: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed (including MEDLINE), Embase, and Web of Science Core Collection, investigating the outcome after DAIR procedures of long bone FRIs in clinical studies published until January 2020. RESULTS: Six studies, comprising 276 patients, met the inclusion criteria. Data from this review showed that with a short duration of infection (up to three weeks) and under strict preconditions, retention of the implant is associated with high success rates of 86% to 100%. In delayed infections with a fracture fixation-FRI revision surgery interval of three to ten weeks, absence of recurrent infection was reported in 82% to 89%. Data on late FRIs, with a fracture fixation-FRI revision surgery interval of more than ten weeks, are scarce and a success rate of 67% was reported. CONCLUSION: Acute/early FRI, with a short duration of infection, can successfully be treated with DAIR up to ten weeks after osteosynthesis. The limited available data suggest that chronic/late onset FRI treated with DAIR may be associated with a higher rate of recurrence. Successful outcome is dependent on managing all aspects of the infection. Thus, time from fracture fixation is not the only factor that should be considered in treatment planning of FRI. Due to the heterogeneity of the available data, these conclusions have to be interpreted with caution. Cite this article: Bone Joint J 2021;103-B(2):213-221.

Presurgical Short-Term Halo-Pelvic Traction for Severe Rigid Scoliosis (Cobb Angle >120°): A 2-Year Follow-up Review of 62 Patients.

STUDY DESIGN: A 2-year follow-up review of 62 patients with severe rigid scoliosis (>120°). OBJECTIVE: To evaluate the effectiveness and safety of halo-pelvic traction (HPT) for treating severe rigid scoliosis (>120°). SUMMARY OF BACKGROUND DATA: Severe rigid scoliosis (>120°) is still a challenge for spine surgeons. A combination of presurgical HPT traction, osteotomy, and internal fixation could be a safe and effective solution for these cases. METHODS: We reviewed the records of all the patients with severe rigid scoliosis (>120°) treated with presurgical HPT from 2013 through 2017. Radiographic measurements were performed. The period of traction, estimated blood loss, operation time, complications, and bed rest period were recorded. RESULTS: A total of 62 patients who had 2-year radiological follow-up were included in the study. In 30 patients, vertebral column resection (VCR) was performed aiming to achieve a better correction rate. In patients who received a VCR, the average preoperative Cobb angle was 133.6°, and the average correction rate at 2 years after surgery was 65.4%. Compared with the average height before treatment, at 2 years after surgery the average height was 12.5 cm greater. In patients who did NOT received VCR, the average preoperative Cobb angle was 131.5°, and the average correction rate at 2 years after surgery was 64.1%. Compared with the average height before treatment, at 2 years after surgery the average height was 14.0 cm greater. Common complications during HPT included infected pelvic pins, brachial plexus palsy, and weakness of the lower extremities. No patients experienced permanent neurological deficits or death. CONCLUSION: For severe rigid scoliosis with a Cobb angle greater than 120°, a combination of short-term presurgical HPT and posterior surgery is an effective and safe solution. After 4 to 6 weeks of presurgical HPT the Cobb angle can be decreased by approximately 50%, providing a favorable condition for spine corrective surgery.Level of Evidence: 3.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele.

BACKGROUND: The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. METHODS: Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients' pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. RESULTS: The mean patient age was 6.9 (4-10) years. Mean preoperative kyphosis was 115° (87-166°), mean early postoperative kyphosis was 3.9° (20-10°), and final follow-up postoperative kyphosis was 5.1° (22-8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115-35°) preoperative, as 12.9° (32-0°) early postoperative, and 15.7° (34-0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1-T12 and T1-S1, respectively. CONCLUSION: Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. LEVEL OF EVIDENCE: Level 4.

Biomechanical Study of Different Femoral Fixation Devices in the Reconstruction of the Medial Patellofemoral Ligament in Porcine Knees / Estudo biomecânico de diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial em joelhos de suínos

Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.

Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.

Evaluation of complications in patients with open fractures of the upper and lower extremity treated with internal fixation after the external fixation.

BACKGROUND: Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The cost occurring due to both long treatment duration and the delay in returning to work made these conditions more complicated. The present study aims to evaluate of the complications which may occur in cases with an application of internal fixation following external fixator in upper and lower extremity open fractures retrospectively. METHODS: Forty-nine patients, who applied to the emergency service between 2007 and 2013, participated in this study. Thirty-two of these patients consisted of the patients to whom external fixator was first placed, and then internal fixation was performed by us, while 17 patients were treated in another center with the external fixator, and then their treatments were performed by us. All patients' injury mechanism, duration of follow-up with an external fixator, whether debridement was performed after external fixator, the period between external fixation and internal fixation, pin site infection, duration of the union, delayed union, nonunion, whether bone graft was used during internal fixation, internal fixation type, reoperation, development of osteomyelitis and follow-up parameters were recorded. RESULTS: Results were evaluated separately for radius, humerus, tibia and femur fractures. Of the 49 patients, 39 were male, and 10 were female. Mean follow-up time for tibia 28.6 months, for femur 34, for humerus 26.9, for Radius 27 months. Of the 49 patients who participated in this study, 15 applied with upper extremity (11 humeri, 4 Radius) injury and 34 applied with lower extremity (25 tibias, 9 femora) injury. Of the 49 patients, 32 had pin tract infection, 11 had nonunion, 11 had delayed union, two had osteomyelitis. CONCLUSION: Open fractures are always hard to treat. After external fixation to the internal fixation process have some complications, phsycians should be aware of all these problems and plan according to the situation.

Loss of Correction After Removal of Spinal Implants in Congenital Scoliosis.

BACKGROUND: Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. METHODS: We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. RESULTS: Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°-11.58°) and kyphosis of fixed segments (8.50°-9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser's grade with larger scoliosis might be risk factors for correction loss. CONCLUSIONS: Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.

Radiographic Determination of Skeletal Maturity Guides Optimal Timing of Bar Removal After Minimally Invasive Repair of Pectus Excavatum.

BACKGROUND: A small number of patients treated with minimally invasive correction of pectus excavatum recur after bar removal. This risk appears to be greater in younger children who continue to grow following bar removal. METHODS: We propose the use of wrist films to determine skeletal maturity and delay bar removal until it is completed. This is not possible in very young patients (less than 14 years of age) or necessary in patients older than 19. RESULTS: In the 14-year to 18-year age group, we have used wrist films to determine skeletal maturity in 25 patients. Ten patients (age 14-18) demonstrated full maturation, and their bars were removed at 2 years. Five patients had films that demonstrated nearly closed growth plates, and those bars were removed 6 months later (2.5 years post-insertion). Ten patients had 2 sets of films taken, initially at 2 years post-operation demonstrating open growth plates. Films 12 months later showed skeletal maturation. Their bars were removed at 3 years post-operation. There were no recurrences with an average follow-up of 3 years. DISCUSSION: Radiographic determination of skeletal maturity may be used as a guide to the timing of bar removal following the correction of pectus excavatum.

Short-term outcomes and complications of 65 cases of porous TTA with flange: a prospective clinical study in dogs.

BACKGROUND: Cranial cruciate ligament rupture (CrCLR) is the most common orthopaedic cause of lameness in the hind limb in dogs. Many surgical treatments have been described, but tibial tuberosity advancement (TTA) is one of the most commonly used today. Since it was first described, TTA has evolved to reduce major complications and to arrest the progression of osteoarthrosis. The aim of this study was to assess a surgical technique called Porous TTA with flange prospectively. This study was performed in 61 dogs that underwent 65 Porous TTA with flange procedures, to validate it as an alternative CrCLR treatment. Complications and clinical outcomes (pain, lameness, weight bearing, flexion, extension, crepitation and atrophy) were reported over 3 months, i.e. at 3, 6 and 12 weeks postoperatively. RESULTS: The results showed a positive clinical outcome, a minor complication rate of 47.69% at the first review 3 weeks postoperatively, 10.77% at the second one (6 weeks after the surgery) and 4% at the third one (at 12 weeks). Major complications were observed only at the last review, with one case that had an infection requiring implant removal; this represented 1.5% of cases. Variables evaluated for a relationship with complication scores and improvement were body condition score, sex, age, breed, body weight, breed size, side of the affected limb, traumatic anamnesis and time of lameness before surgery. No relationship was detected. CONCLUSIONS: Clinical outcomes and complications show that Porous TTA with flange is an efficient alternative for surgical treatment of CrCLR in dogs.

Spine Fixation Hardware: An Update.

OBJECTIVE. The purpose of this article is to provide a review of the imaging of spine fixation hardware. CONCLUSION. As the prevalence of neck and back pain continues to increase, so does the number of surgical procedures used to treat such pain. Accordingly, new techniques and hardware designs are used, and the hardware will be seen on postoperative imaging. It is critical that radiologists understand the appropriate imaging modalities for the assessment of spine fixation hardware, recognize the normal imaging appearance of such hardware, and be able to detect hardware-related complications.

Anterior Vertebral Body Growth-Modulation Tethering in Idiopathic Scoliosis: Surgical Technique.

The management of idiopathic scoliosis in the skeletally immature patient can be challenging. Posterior spinal fusion and instrumentation is indicated for severe scoliosis deformities. However, the skeletally immature patient undergoing posterior fusion and instrumentation is at risk for developing crankshaft deformities. Moreover, bracing treatment remains an option for patients who are skeletally immature, and although it was found to be effective, it does not completely preclude deformity progression. Recently, fusionless treatment options, such as anterior vertebral body growth modulation, have been developed to treat these patients while avoiding the complications of posterior rigid fusion. Good results have been shown in recent literature with proper indications and planning in the skeletally immature patient.

Use of sublaminar bands for adolescent idiopathic scoliosis - a systematic review / Uso das bandas sublaminares em cirurgia para escoliose idiopática do adolescente - revisão sistemática da literatura / Uso de las bandas sublaminares en cirugía para escoliosis idiopática del adolescente - revisión sistemática de la literatura

ABSTRACT Objective In 2003, Mazda et al. introduced a new device for surgical correction of Adolescent Idiopathic Scoliosis (AIS) called sublaminar bands (SB). The reduction principle that SBs use is posteromedial spinal translation, similar to Luque's wiring, but using polyester bands. Methods We performed a systematic review of the literature on this subject, evaluating the technique in terms of coronal correction, sagittal correction, bleeding, mean surgical time, loss of correction, infection, pseudoarthrosis, and neurological and other complications. The total search resulted in 14 articles published over the last 10 years. We found that the use of SBs in hybrid AIS correction instrumentations provides an average correction of 69% in the frontal plane, a 5° increase in thoracic kyphosis (average increase of 55%), overall complications of 4.5%, and no neurological complications were reported in any of the studies analyzed.. The mean blood loss was 682.5 mL and the mean surgical time was 228.6 minutes. Conclusions We conclude that the literature suggests that this instrumentation is safe, allows good correction in the frontal plane and great correction in the sagittal plane. As for complications, mean surgical time, and blood loss, their averages are lower than those of other constructions used for AIS. Level of evidence IIA; Systematic review.

RESUMO Objetivo Em 2003, Mazda et al. apresentaram um novo dispositivo para correção cirúrgica da Escoliose Idiopática do Adolescente (EIA) denominado Bandas Sublaminares (BS). O princípio de redução que as BS utilizam é a translação posteromedial da coluna vertebral, semelhante àquela dos fios de Luque, através do uso de bandas de poliéster. Métodos Realizou-se uma revisão sistemática da literatura sobre o tema, avaliando a técnica em relação à correção coronal, correção sagital, sangramento, tempo operatório médio, perda de correção, infecção, pseudoartrose, complicações neurológicas e outras complicações. A busca resultou em 14 artigos publicados nos últimos 10 anos. Resultados Observamos que o uso das BS em instrumentações híbridas para correção da EIA proporciona uma redução média de 69% no plano frontal e aumento da cifose torácica de 5º (aumento médio de 55%), 4,5% de complicações em geral e nenhuma complicação neurológica foram apresentadas em todos os estudos analisados. A média de sangramento foi 682,5 mL e o tempo cirúrgico médio de 228,6 minutos. Conclusões Conclui-se que a literatura sugere que essa instrumentação é segura, permite boa correção no plano frontal e grande correção no plano sagital. Em relação às complicações, tempo cirúrgico médio e sangramento, todas essas variáveis em média são inferiores se comparadas as das demais construções utilizadas para EIA. Nível de evidência IIA; Revisão sistemática.

RESUMEN Objetivo En 2003, Mazda et al. presentaron un nuevo dispositivo para corrección quirúrgica de la Escoliosis Idiopática del Adolescente (EIA) denominado Bandas Sublaminares (BS). El principio de reducción que las BS utilizan es la traslación posteromedial de la columna vertebral, similar a aquella de los hilos de Luque, a través del uso de bandas de poliéster. Métodos Se realizó una revisión sistemática de la literatura sobre el tema evaluando la técnica con relación a la corrección coronal, corrección sagital, sangrado, tiempo operatorio promedio, pérdida de corrección, infección, pseudoartrosis, complicaciones neurológicas y otras complicaciones. La búsqueda resultó en 14 artículos publicados en los últimos 10 años. Resultados Observamos que el uso de las BS en instrumentaciones híbridas para la corrección de la EIA proporciona una reducción promedio de 69% en el plano frontal y aumento de la cifosis torácica del 5º (aumento promedio de 55%); 4,5% de complicaciones en general y ninguna complicación neurológica fueron presentadas en todos los estudios analizados. El promedio de sangrado fue 682,5 mL y el tiempo quirúrgico promedio de 228,6 minutos. Conclusiones Se concluye que la literatura sugiere que esta instrumentación es segura, permite buena corrección en el plano frontal y gran corrección en el plano sagital. Con relación a las complicaciones, tiempo quirúrgico promedio y sangrado, todas estas variables en promedio son inferiores si comparadas con las demás construcciones usadas para EIA. Nivel de evidencia IIA; Revisión sistemática.