Current trends on limb length discrepancy treatment: results of a survey among 11 dedicated Italian centres.

Limb length discrepancies (LLD) are quite frequent, especially in lower limbs. The evolution of the available devices and the refinement of the techniques for correcting the differences in limb length have progressively improved the approach to these deformities. Nevertheless, several points still remain debated. The aim of the study was to investigate the Italian pediatric orthopedic surgeons' choices in approaching and treating LLD in both lower and upper limbs. A survey on the treatment of limb length discrepancy was sent to a group of 11 Italian orthopedic centers, specialising in limb lengthening and belonging to the Italian Society of Pediatric Orthopedics and Trauma and the Italian Society of External Fixation. Despite improvements in knowledge of bone biology and distractional osteogenesis as well as the increase in available hardware for lengthening, many aspects of LLD correction still remain debated. Both the relative rarity of the conditions which lead to significant shortening and the lack of wide groups of patients analysed at adult age, continue to be the main limitations for every surgeon who deals with LLD. Only by overcoming our own convictions and sharing our experiences in multicentric studies, may we reach our goal of developing a shared treatment protocol.

Retrospective, multicenter evaluation of complications in the treatment of diaphyseal femur fractures in pediatric patients.

INTRODUCTION: Femoral shaft fractures are the commonest major pediatric fractures. For generations, traction and casting were the standard method of treatment for children. However, over the past two decades there has been growing recognition of the advantages of fixation and rapid mobilization. METHODS: A prospective multicenter study was conducted at four Italian centers of reference for pediatric fractures (January 2005 to December 2014). The study involved 62 patients of both sexes, between 6 and 14 years of age, with closed femoral shaft fractures. The aim was to find out more about the short-term complications of titanium elastic nailing in diaphyseal femur fractures in children in order to reduce them. RESULTS: The commonest complication observed in our study was pain at the nail entry point (24.19%) due to a local inflammatory reaction. After 1 year, 3.22% had limbs of different lengths. Proximal migration occurred in 1.61% of cases. DISCUSSION: Over the last two decades, the treatment of femoral shaft fractures in pediatric patients has developed to include internal fixation using Titanium Elastic Nails (TEN). We only observed a few complications in our study, most of which were minor and associated with the surgical technique employed, particularly during the initial phase of the surgeon's learning curve. CONCLUSIONS: TEN are an excellent internal fixation system if used by an expert surgeon and have a very low rate of complications. None of them produced permanent damage in the patients. In older children weighing more than 50 kg, alternative techniques such as subtrochanteric nailing, plates, or external fixation are advisable.

[The study of biohumoral parameters during surgical limb lengthening]. / Studio di alcuni parametri bio-umorali in corso di allungamento chirurgico degli arti.

The authors report a series of 7 patients undergoing surgical limb extension with a total of 9 segmentary extensions. The study focuses on the trend of 4 biohumoral parameters (ESR, PCR, leukocytes, neutrophil percentage) during the various stages of surgery. The authors conclude that, in conjunction with clinical assessment, these parameters represent a valid tool for monitoring infections during the course of extension. Of these parameters, PCR was found to be the most sensitive marker. If evaluated using the general trend of these markers, surgical limb lengthening is not dissimilar to the fracture healing process.

[Indications for the use of external fixator in orthopedics and traumatology during the developmental age]. / Le indicazioni al fissatore esterno in ortopedia e traumatologia dell'età evolutiva.

The paper illustrates the characteristics of external fixators (EF) (Wagner, FEA, Ilizarov) regularly used in pediatric surgery. Attention is focused on the indications for their use in orthopedics and traumatology during the developmental age. In conclusion, their use, even though in traumatology this is more restricted than in adults, reduces many complications which may arise from traditional treatment. In addition, it is well tolerated and allows pathologies to be treated which were difficult to cure in the past.

The modified Wagner method for surgical lengthening of the limbs.

The method proposed by Wagner in 1971 for surgical lengthening of the limbs was widely used by the authors for the treatment of dysmetria and (since 1976, for the first time in Italy) for disharmonic hypometria. The limitations of this method were revealed, however, by increasing knowledge in this field and the advent of new biological concepts of bone regeneration. The authors report 51 lengthenings carried out between 1982 and 1987 according to their own modification of the Wagner method. They conclude that the Wagner external fixator associated with corticotomy achieves excellent results, decreasing the number of surgical stages as well as the risk of infection and delay in consolidation.

Experimental studies on peripheral nerve repair following early or delayed suture.

Early suture of the sciatic nerve in rats was compared with delayed suture performed after 2 weeks. The distal tract of the nerve was studied morphologically using semifine sections and computerised measurements of the number and diameters of regenerated fibres, and electrophysiologically by the measurement of nerve velocity conduction. The morphological examination did not reveal any substantial difference, while the velocity conduction tests showed better reinnervation following early suture.