An original external iliac artery reconstruction with internal iliac artery translocation in a blunt injury of the pelvic vessels in a 4-year-old child: A 12-year follow-up study.

A 4-year-old child presented to the emergency department with an open-book pelvic fracture, blunt trauma to the right external iliac artery and vein, and contaminated abdomen due to jejunal tear. Arterial reconstruction with polytetrafluoroethylene was not considered because of caliber discrepancy of 6 mm compared with 3 mm of the child's external iliac artery and a 40% probability of graft infection. We used the ipsilateral internal iliac artery, which was dissected for 7 cm; the distal artery was translocated and anastomosed to the distal external iliac artery. At 12 years of follow-up, the artery grew with the patient, with no need for replacement.

The Long-Term Outcome After Varus Derotational Osteotomy for Legg-Calvé-Perthes Disease: A Mean Follow-up of 42 Years.

BACKGROUND: Varus derotational osteotomy (VDRO) is one of the most common surgical treatments for Legg-Calvé-Perthes disease, yet its long-term results have not been fully assessed. We aimed to determine the long-term clinical and radiographic outcomes following VDRO. METHODS: Forty patients (43 hips) who underwent VDRO for Legg-Calvé-Perthes disease at our institution from 1959 to 1983, and participated in a follow-up study completed 10 years earlier, were approached for the present study. Clinical examination and radiographs were evaluated. Hip status and well-being were assessed with the Harris hip score and the Short Form-36 (SF-36). RESULTS: Thirty-five patients (37 hips) participated in the study. Information regarding the need for an arthroplasty was gathered on 4 additional hips from the previous study. The mean follow-up was 42.5 years (range, 32.4 to 56.5 years), with a mean patient age of 50.2 years (range, 35.9 to 67.8 years). In total, 7 patients (7 hips; 17% of 41 hips for which information was available, including 1 hip from the original cohort of 40 patients [43 hips]), underwent a total hip arthroplasty for hip pain. Excluding patients who had undergone an arthroplasty, the mean Harris hip and SF-36 scores were 79.8 points (range, 23.1 to 100 points) and 74.8 (range, 15.1 to 100), respectively. Twenty (64.5%) of the 31 hips that had not been replaced achieved a good or excellent Harris hip score (≥80 points). Sixteen (57.1%) of 28 hips with follow-up radiographs had no, or minimal, signs of osteoarthritis. The Stulberg classification was associated with the Harris hip score, the SF-36 score, hip pain, a Trendelenburg sign, coxa magna, and the Tönnis grade. In a multivariate analysis, the Stulberg classification was the only factor associated with fair or poor outcomes (a Harris hip score of <80 points). Patients with a Stulberg class-III or IV hip had significant deterioration with respect to the Harris hip score and Tönnis grade during the 10-year period since the last follow-up. CONCLUSIONS: A long-term follow-up of patients who were operatively treated for Legg-Calvé-Perthes disease revealed that a low proportion underwent total hip arthroplasty and a relatively high proportion maintained good clinical and radiographic outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The effects of femoral derotation osteotomy in children with cerebral palsy: an evaluation using energy cost and functional mobility.

BACKGROUND: The effect of femoral derotation osteotomy (FDO) in children with cerebral palsy (CP) has hitherto been examined using various outcome measures including range of motion of lower extremity joints and gait parameters. However, functional ambulation following this procedure has been scarcely investigated. OBJECTIVE: To evaluate the effect of FDO on energy cost during stair climbing and functional mobility in children with CP. METHOD: A prospective case series study was conducted on 18 children with CP, 11 at Gross Motor Functional Classification System (GMFCS) II and 7 with GMFCS III, aged 8.5 +/- 1.24 years (range, 6.9-11 years) who underwent FDO to correct hip internal rotation. The energy cost was measured using the heart beat cost index (HBCI) during stair climbing test, whereas functional mobility was assessed using the Gillette Functional Assessment Questionnaire (FAQ). Tests were administered before surgery (P0), 6 months (P1), and at approximately a year postoperatively (P2). RESULTS: Compared with P0, significant changes in hip rotation were observed at P1 and P2. There was a significant improvement in HBCI from P0 to P2, whereas FAQ improved significantly from P1 to P2. A moderate correlation was found between HBCI and GMFCS at all times (r = 0.61-0.78). Negative correlations were found between the HBCI and FAQ and between GMFCS and FAQ at all times (r = -0.5). CONCLUSION: This study indicates that children with CP may benefit functionally from FDO as judged by HBCI and functional mobility rating.

Superior mesenteric artery syndrome after scoliosis repair surgery: a case study and reassessment of the syndrome's pathogenesis.

We carried out a retrospective analysis to investigate the prevalence of superior mesentery artery syndrome (SMAS) in children who underwent scoliosis surgical repair at our hospital between 1998 and 2006 and to reassess the syndrome's pathogenesis. Among 133 consecutive pediatric patients, two cases were identified, both 13-year-old girls with idiopathic scoliosis, undergoing surgery using third-generation instrumentation systems. Conservative management achieved resolution of the symptoms without recurrence. SMAS prevalence in our series was 1.6%. SMAS might occur after derotation and translation forces application, and even with nonextreme corrections. Low BMI and significant weight loss at presentation are not mandatory.