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Purpose: Postoperative assessment of surgical interventions for correcting femoral rotational deformities necessitates a comparative analysis of femoral rotation pre- and post-surgery. While 2D assessment methods are commonly employed, ongoing debate surrounds their accuracy and reliability. To address the limitations associated with 2D analysis, we introduced and validated a 3D model-based analysis method for quantifying the angular and rotational impact of corrective rotational osteotomy in the growing femur. Methods: The method is based on surface registration of the pre- and post-intervention 3D femoral models. To this end, 3D triangulated surface models were generated using CT images for the right femurs of 11 skeletally immature pigs, each scanned at two distinct time points with a 12-week interval between scans. In our validation procedures, femoral corrective rotational osteotomy of the post-12-week femur was simulated at varying angles of 5, 10, 15 and 20 degrees in three dimensions. Subsequently, a surface 3D/3D registration-based approach was applied to determine the 3D femoral angulation and rotation between the two models to assess the method's detection accuracy of the predefined twist angles as ground truth references. Results: The results document the precision and accuracy of the registration-based method in evaluating rotation angles. Consistently high accuracy was observed across all angles, with an accuracy rate of 92.97% and a coefficient of variance of 8.14%. Conclusion: This study has showcased the potential for improving post-operative assessments with significant implications for experimental studies evaluating the effects of correcting rotational deformities in the growing femur. Level of Evidence: Not applicable.
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Background Rotational deformities in children are currently treated with an osteotomy, acute de-rotation, and surgical fixation. Meanwhile, guided growth is now the gold standard in pediatric coronal deformity correction. This study aimed to evaluate the feasibility of a novel implant intended for rotational guided growth (RotOs Plate) in a large porcine animal model. Methodology A submuscular plate was inserted on the medial and lateral aspect of the distal femoral physis of the left femur in 6 pigs. Each plate was anchored with a screw in the metaphysis and epiphysis respectively. The plates were expected to rotate the femur externally. The right femur acted as a control in a paired design. The animals were housed for 12 weeks after surgery. MRI scanning of both femora was performed before euthanasia after 12 weeks. Rotation was determined as the difference in the femoral version on MRI between the operated and non-operated femur after 12 weeks. Results External rotation in all operated femurs was observed. The mean difference in the femoral version on MRI between operated and non-operated femurs was 12.5° (range 9°-16°). No significant changes in axial growth were detected. Conclusions This study shows encouraging results regarding rotational guided growth, which may replace current invasive surgical treatment options for malrotation in children. However, further studies addressing potential secondary deformities are paramount and should be carried out.
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Purpose: The objective of this scoping review was to describe the extent and type of evidence of using guided growth to correct rotational deformities of long bones in children. Methods: This scoping review was conducted in accordance with the JBI methodology for scoping reviews. All published and unpublished studies investigating surgical methods using guided growth to perform gradual rotation of long bones were included. Results: Fourteen studies were included: one review, three clinical studies, and ten preclinical studies. In the three clinical studies, three different surgical methods were used on 21 children. Some degree of rotation was achieved in all but two children. Adverse effects reported included limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. Of the ten preclinical studies, two were ex vivo and eight were in vivo. Rotation was achieved in all preclinical studies. Adverse effects reported included implant extrusions, LLD, articular deformities, joint stiffness and rebound of rotation after removal of tethers. Two of the studies reported on histological changes. Conclusions: All studies conclude that guided growth is a potential treatment for rotational deformities of long bones. There is great variation in animal models and surgical methods used and in reported adverse effects. More research is needed to shed light on the best surgical guided growth method, its effectiveness as well as the involved risks and complications. Based on current evidence the procedure is still to be considered experimental. Level of evidence: 4.
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We report a case of a seven-year-old girl, who had a scaphoid fracture, which occurred when she fell off her bicycle. She was examined in the emergency room. X-ray did not show any sign of fracture of the scaphoid, but the fracture was later verified with a magnetic resonance imaging scan. She wore a shin cast for eight weeks and recovered completely. Very few cases of children aged under eight years and diagnosed with scaphoid fracture have been reported in the literature. Scaphoid fracture should be suspected and examined for in all children with relevant trauma and symptoms, regardless of age.