Achilles Tendon Injuries Requiring Surgical Treatment in the Pediatric and Adolescent Population: A Case Series.

ABSTRACT: Pediatric Achilles tendon injuries requiring surgical treatment are considered rare and have not been well described. A retrospective chart review was conducted from 2010 to 2020 to identify cases of acute Achilles tendon rupture or laceration that required surgical repair in individuals 19 years or younger. A total of 24 individuals with acute Achilles tendon ruptures (n = 8) and lacerations (n = 16) were identified. All spontaneous ruptures occurred in skeletally mature individuals during sports. One subject was on minocycline at the time of injury, while two had a body mass index (BMI) ≥ 99% for age. Another had a history of clubfoot surgery on the injured side. Patients with lacerations were younger (9.9 ± 3.3 vs 16.3 ± 1.6 years) and had lower BMI (17.3 ± 3.8 vs. 28.0 ± 9.4) than those with spontaneous ruptures. The majority of cases had good outcomes with no postoperative complications.

Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE).

BACKGROUND: Intramedullary lengthening nails have shown excellent short-term results. The FITBONE and the PRECICE nail are the two most commonly used intramedullary lengthening nails. The manufacturer of each nail recommends the removal of the implant after the completion of the treatment. Despite the need for removal of each nail, the authors are not aware of any prior publications documenting the results of standard intramedullary lengthening nail removal. Therefore, the aim of this study was to examine the intraoperative and postoperative complications of elective intramedullary lengthening nail removals. MATERIALS AND METHODS: We performed a retrospective chart review of patients operated with intramedullary lengthening nails at two limb reconstruction centres (one in the United States, and the second in Denmark). Data retrieved from the patient charts included patient demographics, nail information and any complications occurring at or after nail removal. Only lower limb lengthening with FITBONE and PRECICE or STRYDE nails that had an elective nail removal was included. RESULT: A total of 271 elective nail removals were included in the study. Complications occurred during 3% of the nail removals and in 13% after nail removal. There were 18 reported cases with postoperative knee pain. All these patients had nail removal through the knee joint, representing 8% of the retrograde femur nail removals and 7% of the tibia nail removals. Four postoperative fractures occurred, of which two needed surgery. Eleven percent of femur removals and 26% of tibial removals sustained a complication. CONCLUSION AND CLINICAL SIGNIFICANCE: This study emphasises the importance of adequate follow-up of the bone lengthening patient even after the nail has been removed. It also shows that the recommended removal of the intramedullary nail (IMN) lengthening nails must be included in studies reporting on the overall risks of complications using bone lengthening nails. HOW TO CITE THIS ARTICLE: Frost MW, Kold S, Rahbek O, et al. Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE). Strategies Trauma Limb Reconstr 2021;16(2):110-115.

Radiographs of 366 removed limb-lengthening nails reveal differences in bone abnormalities between different nail types.

AIMS: Limb-lengthening nails have largely replaced external fixation in limb-lengthening and reconstructive surgery. However, the adverse events and high prevalence of radiological changes recently noted with the STRYDE lengthening nail have raised concerns about the use of internal lengthening nails. The aim of this study was to compare the prevalence of radiological bone abnormalities between STRYDE, PRECICE, and FITBONE nails prior to nail removal. METHODS: This was a retrospective case series from three centres. Patients were included if they had either of the three limb-lengthening nails (STYDE, PRECICE, or FITBONE) removed. Standard orthogonal radiographs immediately prior to nail removal were examined for bone abnormalities at the junction of the telescoping nail parts. RESULTS: In total, 306 patients (168 male, 138 female) had 366 limb-lengthening nails removed. The mean time from nail insertion to radiological evaluation was 434 days (36 to 3,015). Overall, 77% of STRYDE nails (20/26) had bone abnormalities at the interface compared with only 2% of FITBONE (4/242) and 1% of PRECICE nails (1/98; p < 0.001). Focal osteolysis in conjunction with periosteal reaction at the telescoping interface was only observed in STRYDE nails. CONCLUSION: Bone abnormalities at the interface of telescoping nail parts were seen in the majority of STRYDE nails, but only very rarely with FITBONE or PRECICE nails. We conclude that the low prevalence of radiological changes at the junctional interface of 242 FITBONE and 98 PRECICE nails at the time of nail removal does not warrant clinical concerns. Cite this article: Bone Joint J 2021;103-B(11):1731-1735.

Evaluating the Utility of the Pixel Value Ratio in the Determination of Time to Full Weight-bearing in Patients Undergoing Intramedullary Limb Lengthening.

INTRODUCTION: Limb lengthening using intramedullary nails is an increasingly popular method of achieving limb length equalisation. Currently, the decision regarding when to commence full weight-bearing (FWB) remains largely subjective. Objective criteria for determining the proper timing of FWB would be helpful to limb lengthening surgeons. This study examines using the pixel value ratio (PVR) as an objective method to determine the time to FWB for patients being lengthened with an intramedullary nail. MATERIALS AND METHODS: A retrospective chart review of 42 patients who underwent unilateral lengthening of the femur was undertaken. The PVR of all four cortices of the regenerate bone was monitored throughout the distraction and consolidation stages to determine the ratio at the time of FWB. RESULTS: Clinically and radiologically determined FWB was achieved at a mean time of 125.7 ± 30.1 days from surgery. The mean PVR at the time of FWB was 0.94. The medial cortex healed fastest with a mean PVR of 0.96, while the posterior cortex healed slowest with a mean PVR of 0.92. CONCLUSION: The PVR is a quick and reliable method to objectively assess the state of healing of the regenerate bone during distraction osteogenesis. We observed that there were no adverse effects when subjects commenced FWB when three out of the four cortices had a PVR of at least 0.93. HOW TO CITE THIS ARTICLE: Bafor A, Duncan ME, Iobst CA. Evaluating the Utility of the Pixel Value Ratio in the Determination of Time to Full Weight-bearing in Patients Undergoing Intramedullary Limb Lengthening. Strategies Trauma Limb Reconstr 2020;15(2):74-78.