Synthetic Cast Material Versus Plaster of Paris for the Treatment of Idiopathic Clubfoot by the Ponseti Protocol: A Comparative Analysis of 136 Feet.

BACKGROUND: Synthetic casting materials have been used as alternatives to plaster of Paris (POP) in the treatment of clubfoot using the Ponseti method. The aim of this study was to evaluate the clinical outcome of children with idiopathic clubfoot managed by the Ponseti method using POP versus semirigid fiberglass (SRF). METHODS: Medical records were retrospectively reviewed for all newborns with idiopathic clubfoot who underwent manipulation and casting by the Ponseti technique between January 2013 and December 2016 at 2 different institutions. In all, 136 consecutive clubfeet were included, of which 68 underwent casting with POP (Group A), and 68 were casted using SRF (Group B). Statistical analysis was performed using the Fisher exact test for categorical variables, and the unpaired t test for quantitative parameters. RESULTS: Mean age at time of first cast was 10 days (range, 3 to 21 d). Mean Pirani score at start of treatment was 4.6 and 4.5 in Groups A and B, respectively. Mean number of casts for each patient in Group A was 5.2 against 4.2 in patients in Group B. Mean follow-up was 63.8 months (range, 42 to 88 mo). In each group, 4 cases of relapse were reported (2.9%). No complications related to cast phase or brace phase were recorded. Shorter duration of cast treatment was recorded in Group B. CONCLUSIONS: Despite its higher cost and slightly lower moldability, the use of SRF in experienced hands showed comparable results in idiopathic clubfeet treated by the Ponseti technique. LEVEL OF EVIDENCE: Level III.

Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents.

The aim of this work was to evaluate the outcome and efficacy of treatment in a homogeneous group of skeletally immature patients with chronic osteomyelitis of the long bones managed by a combination of radical debridement and insertion of tobramycin-impregnated calcium sulfate pellets to fill the bone defect in a single-stage procedure. Between 2011 and 2016, 12 skeletally immature patients were treated surgically by the reported technique. Single-stage surgery using tobramycin-impregnated calcium sulfate pellets in association with systemic antibiotic therapy yields satisfactory outcomes in skeletally immature children presenting chronic osteomyelitis by reducing the risk of occurrence of comorbidities, hospital stays, and healthcare costs.

Surgical treatment for symptomatic non-ossifying fibromas of the lower extremity with calcium sulfate grafts in skeletally immature patients.

BACKGROUND: Non-ossifying fibromas (NOFs) are common benign bone lesions found in children and adolescents. They usually involve metaphysis of long bones, tend to gradually disappear with age and usually do not require surgery, while they are not associated with pathological fractures. The aim of this study was to evaluate the outcome and efficacy of a single-stage procedure, comprising curettage of the lesion and calcium sulfate pellet (CaSP) grafting, in skeletally immature patients with large, symptomatic NOF of the lower extremity, and the possible limitations of the procedure. METHODS: Nine skeletally immature patients with symptomatic NOF of the lower extremity were treated between 2013 and 2016. Details of age, history of presentation, location and size (in mm) of the lesion, histology and follow-up details were recorded. Lesions were classified in Ritschl radio-morphological stages. CaSP integration was assessed by Irwing's classification. The average size of lesions was 54.6 mm in length (range 31-95). All lesions were symptomatic. The average bone expansion in relation to the bone diameter was 67.4% in the transversal plane (range 31-100) and 77.8% in the sagittal plane (range 55-100). Mean patient age at time of treatment was 9.8 years (range 7-14); mean follow-up was 2 years (range 2-4). All the patients were symptomatic, and 8 out of 9 (89%) NOFs were Ritschl type B. All the patients were treated surgically with a single-step approach, as described. RESULTS: On average, 86 mL of CaSPs was used per case (range 10-250). None of the patients required internal fixation. At last follow-up visit, CaSPs were fully incorporated in all the patients according to Irwing's classification (Stage 3). No serous drainage from wounds was recorded in any of the patients. No cases of pathological fracture, bone deformity, growth arrest or growth disturbance or infection were observed. At last follow-up visit, all the patients had resumed full sport and daily life activities. CONCLUSIONS: CaSPs offer a safe, cheap, convenient alternative to the autograft as an implant substitute that helps regeneration of bone in the defects produced by curettage of large, symptomatic NOFs. Chemical cauterization of bone walls does not interfere with CaSP integration into bone tissue.