Use of a "kickstand" modification for external fixation of lower extremity fractures in children.

PURPOSE: To evaluate and describe the kickstand modification and its use in children with lower extremity fractures. METHODS: Retrospective review identified eight children in whom the kickstand technique was used during treatment of their lower extremity fractures. The seven boys and one girl had a mean age of 11.8 years. All fractures were caused by high-energy trauma. Five of the eight tibial fractures were open fractures (one type 1, one type 2, and three type 3B), and five of the eight patients had multiple extremity fractures. RESULTS: Additional procedures were required in six of the eight children, four of whom had multiple lower extremity fractures. No additional pressure-relieving modalities were used in any patient. The kickstand did not affect the fracture reduction, prevent patient mobilization, or require operative adjustment in any patient, and none had any skin pressure-related complications on the heel of the affected extremity. CONCLUSION: In pediatric patients with lower extremity trauma, the addition of a kickstand to the external fixator provides a simple, inexpensive, lightweight, adjustable, and adaptable method for encouraging elevation of the injured extremity, which facilitates edema control; it also allows easy neurovascular monitoring and wound care.

Stem cell repair of physeal cartilage.

To evaluate the ability of cultured mesenchymal stem cells (MSC) to repair physeal defects, MSC-matrix constructs with 5% gelatin (group A), 10% gelatin/Gelfoam (Pharmacia, Peapack, NJ) (group B), and MSC grown in the presence of TGF-beta3 with Gelfoam (group C) were implanted in proximal tibial physeal defects created in 20 immature rabbits. Control groups (untreated partial defect and partial defect treated with Gelfoam) showed bony bar formation with varus deformities of 30 degrees and 28 degrees, respectively. Group A had an average 23 degrees varus deformity with bony bridge formation, and group B had mild varus angulation (average 14 degrees) of the proximal tibia. In group C, there was no significant varus deformity (average 9 degrees), and histologic examination showed that some of the columnation areas interspersed with chondrocytes were irregularly arranged in the matrix. These findings suggest that repair of physeal defects can be enhanced by the implantation of MSC cultured with TGF-beta3.