Pronounced femur malunion after pathological bone fracture due to a simple bone cyst in the shaft of the femur, treated using Ilizarov fixation: a case report.

BACKGROUND: Although a simple bone cyst carries the risk of pathological fractures, it rarely causes severe deformity. Here we report a case of severe femoral deformity after multiple pathological fractures due to simple bone cysts, and consider the reason for the progression of malunion despite multiple previous treatments. Finally, we propose a treatment option for malunion correction. CASE PRESENTATION: A 9-year, 7-month-old Japanese girl was referred to our facility with obvious deformity of her right femur, caused by multiple simple bone cyst-related pathological fractures. The deformity included bowing of approximately 90° and an internal rotation of 60° in the middle third of the femoral shaft. To correct this deformity, we excised the lesion, thus shortening the femur, then corrected the alignment and applied an Ilizarov fixator to extend the bone. At present, 3 years after surgery, the deformity has not recurred and our patient is living without any limitations in daily activities or regular exercise. CONCLUSIONS: When a long bone is in a prolonged state of deformation, the deformity not only progresses as the bone grows, but the soft tissues remain unbalanced and treatment becomes increasingly difficult. To prevent increasing bone deformity and fragility, the deformity should be corrected as quickly as possible using intramedullary nailing or other fixation techniques. We believe that our shortening-distraction method is effective for the treatment of severe deformity with unbalanced soft tissues.

Gradual bone transfer for the correction of the pubic diastasis using the Ilizarov technique in closure of bladder and cloacal exstrophy.

BACKGROUND: In the patient of the cloacal exstrophy, cloaca with local abdominal wall is disrupted and exposed inner surface of the bladder needs early closure. Pelvic osteotomies are required for severe cases whose bladder cannot be closed by the suture of soft tissue only. We developed a technique involving the gradual positioning of bone fragments using a light, Ilizarov external fixator. The usefulness of the technique was assessed. METHODS: We enrolled 3 patients with cloacal exstrophy and 1 with bladder exstrophy as a gradual transfer group and 6 patients who were treated by other osteotomies as a control group. The patients aged 6.7-8.4 months at the time of surgery were followed up for 4.0-8.6 years. An external fixator with carbon fiber half-rings was placed to internally rotate and anteriorly move the distal bone fragment over 2 weeks. Then, the bladder was closed. Computed tomography (CT) images were used to assess the pelvis form. Wound dehiscence and number of the surgeries after the osteotomies are also compared between the two groups. RESULTS: CT analysis of correction of the pelvic deformity achieved more and less decreasing its volumetric capacity in the gradual transfer group. No patients had wound dehiscence after the primary closure with pelvic osteotomy in the gradual transfer group but all had them in the control group. The mean number of the surgeries after the osteotomies were 2.25 in the gradual transfer group whereas 5.5 in the control group. CONCLUSIONS: Sufficient closure of the abdominal wall and bladder was achieved in all cases in the gradual transfer group. The correction of pelvic bones were more with less decreasing of their pelvic capacities, no patients had wound dehiscence after the closure and there was an effect to decrease the number of the surgeries after the treatment by this method.

A radiographic method for evaluation of the index-hypoplastic thumb angle.

PURPOSE: Thumb metacarpophalangeal joint radial instability occurs during the pinch motion in patients with hypoplastic thumb because of thumb-index web narrowing. We devised a radiographic technique to measure the thumb-index angle, applied while the patient holds a styrene foam cone, to evaluate the relationship between the thumb and the index finger. We used this technique to compare different types of thumb hypoplasia and the groups before and after surgery. METHODS: Twenty patients with hypoplastic thumbs held the styrene foam cone. The average age of the patients was 6.5 years (range, 1.6 to 12.0 y). We obtained an overhead radiograph while the patient held the cone and evaluated the apparent thumb-index web angle, the thumb to index finger metacarpal angle (1-2MCA), and the first metacarpophalangeal angle (1MPA). RESULTS: In the 9 unilateral cases, no significant difference was detected between the unaffected side and the affected side in terms of thumb-index web angle, but the data showed meaningful differences in terms of 1-2MCA and 1MPA. In addition, the data showed meaningful differences between the groups before surgery and 2 years after surgery in terms of 1-2MCA and 1MPA. CONCLUSIONS: Measuring both 1-2MCA and 1MPA enables evaluation of the severity of the deformity, and these parameters allowed for comparative evaluation of the severity of preoperative and postoperative narrowing of thumb-index web space and the radial instability of the thumb metacarpophalangeal joint. By focusing on these characteristics, we devised a novel approach for imaging of the thumb-index web space.

Osseointegration of a hydroxyapatite-coated multilayered mesh stem.

A new type of porous coating for hip prostheses called "multilayered mesh" was tested under weight-bearing conditions. The surface of the stem is constructed of titanium mesh produced by etching. The hip stems of hydroxyapatite (HA)-coated multilayered mesh and conventional beads were implanted into canine right hips, and animals were killed 3, 6 and 10 weeks and 6 and 12 months after implantation. Shear strength between the implant and the bone was evaluated by the push-out test. Bone ingrowth was calculated from backscattered electron imaging-scanning electron microscopy (BEI-SEM) images of transverse sections. Toluidine blue stained sections and the BEI-SEM images were evaluated histologically. The break sites of the specimens after the push-out test were evaluated on BEI-SEM images of longitudinal sections. The mean push-out strength of the HA-coated multilayered mesh samples was greater than that of the beads-coated samples every time tested, and the HA-coated multilayered mesh implants had significantly stronger push-out strength at 3 and 6 weeks (p<0.05). The strength of the HA-coated multilayered mesh implants was even greater at 6 and 12 months, whereas the strength of the beads-coated samples decreased. The HA-coated multilayered mesh implants showed significantly higher percentages of bone ingrowth than the beads-coated implants every time tested, except at 6 months (p<0.05). At 6 and 12 months, the bone ingrowth data for the HA-coated multilayered mesh implants increased, whereas it decreased for the beads-coated implants. The new bone formation had reached the bottom of the porous area of the HA-coated multilayered mesh surface by 3 weeks, but not had reached the bottom of the conventional beads surface. At 6 and 12 months, the smaller pores of the bead surface stopped the thickening of trabecular bone, and at 12 months, the break sites were at the bone-implant interface of the bead surface, whereas they were on the bone side of the HA-coated multilayered mesh surface. The difference between the break sites was significant at 12 months (p<0.05). The HA-coated multilayered mesh stem provided faster, stronger, and more durable osseointegration than the conventional bead stem.