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ABSTRACT: This report details the presentation and surgical management of an osteoporotic fracture of the thoracic spine with delayed
onset of paraplegia. The onset of neurological complications was 2weeks after a relatively minor trauma to the patient’s
lower back. Surgical management included posterior decompression of the cord and posterior instrumentation. Delayed onset
of neurological compromise is unusual with osteoporotic fractures and the management of such injuries is controversial. In
this case it was decided to treat this injury by surgical means as it was felt that in the presence of neurological symptoms
the patient had an unstable spinal injury that could be best managed by surgical intervention. This case report demonstrates
the need for close observation of osteoporotic spinal fractures as delayed onset of neurologic compromise can occur. It also
supports the view that surgical intervention in these rare cases is justified.
Cet article rapporte la présentation clinique et le traitement chirurgical d’une fracture ostéoporotique de la colonne thoracique
avec apparition retardée d’une paraplégie. Les signes neurologiques sont apparus 2 semaines après un traumatisme mineur sur
le bas du dos. Le traitement chirurgical a consisté en une décompression postérieure avec instrumentation. L’apparition secondaire
d’un déficit neurologique est inhabituelle dans les fractures sur ostéoporose et le traitement en est controversé. Dans ce
cas le traitement chirurgical a été choisi parce qu’en raison des signes neurologiques, il semblait exister une instabilité
mieux traitée par voie chirurgicale. Ceci démontre qu’il faut suivre les fractures du rachis sur ostéoporose en raison de
la possibilité de troubles neurologiques tardifs, et que le traitement chirurgical est justifié.
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 15(4):313-315. · 0.10 Impact Factor
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ABSTRACT: The purpose of this study was to compare the outcomes of children whose fractures were manipulated with nitrous oxide with those fractures manipulated under a general anesthetic.
We undertook a retrospective analysis of all children who presented to the emergency department with an angulated or displaced nonphyseal forearm fracture requiring manipulation over a 6-month period.
Twenty-eight forearm fractures were manipulated using conscious sedation, whereas 27 were manipulated in the operating theatre under general anesthesia.
The quality of reduction, the Cast Index, Padding Index, and Canterbury Index were similar between the 2 groups.
There was a significant difference between the need for remanipulation in the nitrous oxide group (9) compared with the need for remanipulation in the theatre group (3).
Despite a higher failure, manipulation of fractures in the emergency department using conscious sedation can achieve an adequate reduction and a high quality of cast. Failures were due to inherently more unstable fracture personalities.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Journal of orthopaedic trauma 03/2012; 26(9):550-5; discussion 555-6. · 1.78 Impact Factor
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ABSTRACT: Paediatric pelvic fractures have been infrequently reviewed. The study was performed to highlight the unique features of pelvic fractures in children.
A 14-year retrospective study was undertaken of all patients treated for a pelvic fracture at our institute.
Thirty-nine children were included. The mean Injury Severity Score (ISS) was 17.1 (range 4-75). Simple ring fractures were the most common type (46%), dominated by pedestrian versus motor vehicle trauma (58.9%). A pelvic fracture was evident on the initial plain radiographs of all 39 children. Further radiographic investigations (12 CTs and 1 MRI) were undertaken in 13 (33%) of the children. Additional posterior ring fractures were identified in 9. A total of 32 children (82%) sustained one or more associated injuries. Head injuries accounted for 25% and orthopaedic/skeletal injuries for 33% of all associated injuries. Fourteen children required a total of 24 acute surgical procedures. Mean out-pateint clinical follow-up was for 27 months (range 3-85). There was one mortality in this series. Eight children (20%) suffered long term sequale.
Paediatric pelvic fractures differ from their adult counterpart in aetiology, fracture type, and associated injury pattern. They represent a reliable marker for severe trauma. Prospective studies are required to define optimal treatment guidelines, particularly in older children.
Injury 10/2011; 42(10):1027-30. · 1.98 Impact Factor
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ABSTRACT: Spinal surgery has long been considered to have an elevated risk of perioperative blood loss with significant associated blood transfusion requirements. However, a great variability exists in the blood loss and transfusion requirements of differing patients and differing procedures in the area of spinal surgery. We performed a retrospective study of all patients undergoing spinal surgery who required a transfusion≥1 U of red blood cells (RBC) at the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital over a 10-year period. The purpose of this study was to identify risk factors associated with significant perioperative transfusion allowing the early recognition of patients at greatest risk, and to improve existing transfusion practices allowing safer, more appropriate blood product allocation. 1,596 surgical procedures were performed at the NSIU over a 10-year period. 25.9% (414/1,596) of these cases required a blood transfusion (n=414). Surgical groups with a significant risk of requiring a transfusion>2 U RBC included deformity surgery (RR=3.351, 95% CI 1.123-10.006, p=0.03), tumor surgery (RR=3.298, 95% CI 1.078-10.089, p=0.036), and trauma surgery (RR=2.444, 95% CI 1.183-5.050, p=0.036). Multivariable logistic regression analysis identified multilevel surgery (>3 levels) as a significant risk of requiring a transfusion>2 U RBC (RR=4.682, 95% CI 2.654-8.261, p<0.0001). Several risk factors in the spinal surgery patient were identified as corresponding to significant transfusion requirements. A greater awareness of the risk factors associated with transfusion is required in order to optimize patient management.
European Spine Journal 05/2011; 20(5):753-8. · 1.97 Impact Factor
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ABSTRACT: Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d'Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p < 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p < 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p < 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p < 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p < 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging.
Acta orthopaedica Belgica 02/2011; 77(1):33-40. · 0.40 Impact Factor
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ABSTRACT: A 12-week-old boy with Jeune syndrome (asphyxiating thoracic dystrophy) was referred to the orthopaedic unit with progressive respiratory failure, recurrent respiratory tract infections, and recurrent admissions to the intensive care unit for ventilatory support. His chest x-ray revealed a small and narrow thoracic cage with short broad ribs and abnormal costal cartilages. His chest expansion was impaired by the short, horizontally positioned ribs resulting in alveolar hypoventilation. Without surgical intervention to expand his thoracic cage, he would die of respiratory failure.
Using the technique of distraction osteogenesis, we split his sternum and slowly expanded this split to a total of 3 cm using a Leibinger mid-face distractor allowing adequate wound healing and bone formation between the 2 sternal edges. He returned to the theater 4 weeks after his initial surgery to have the distractor removed and 2 Leibinger plates inserted to hold the sternum out to length. Sternal distraction was repeated and the sternum was then supplemented with a Leibinger mesh. At 8 months, he had successful expansion of his ribs bilaterally using this technique of distraction osteogenesis.
Presently, the patient is 30 months old and is living at home, is not oxygen dependent, and continues to thrive.
Jeune syndrome presenting with respiratory failure in the neonate is fatal without surgical intervention to expand the thoracic cage. No successful surgical techniques have been described in the literature for neonates. This is the first case in which distraction osteogenesis has been used to distract both sternum and ribs in an infant with Jeune syndrome. Hence, distraction osteogenesis in thoracic dystrophy is a novel approach in the neonate.
Case report.
Journal of pediatric orthopedics 09/2010; 30(6):527-30. · 1.23 Impact Factor
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ABSTRACT: Timing of surgery remains a controversial topic in the treatment of the supracondylar humeral fracture. In our institution, patients are not brought to theatre after midnight, except in the 'life or limb' situation. We hypothesised that time to surgery has no significant influence on complication rate with supracondylar fracture of the humerus.
A retrospective review was performed of all patients who required operative intervention for supracondylar fractures of humerus between 2004 and 2006. Patients' charts were assessed for demographic details, fracture type, time to theatre and complications. Statistical comparisons were performed between different fracture grades.
We identified 124 supracondylar fractures of humerus that required operative intervention between 2004 and 2006. Fractures were mainly treated with operative manipulation with medial and lateral crossed K-wire fixation. Gartland III and flexion type fractures had a significantly shorter time to surgery than Gartland II (p<0.05). There was no significant difference in complication rate between fractures operated after midnight or deferred until the morning (p=0.68). Most common complications identified were ulnar nerve palsy and AIN palsy.
We have found no difference in complication rates when treatment of supracondylar fractures is delayed. Supracondylar fractures which are not grossly displaced, have no neurovascular deficit or risk of skin compromise, can be safely deferred without an increased risk of complication. Operative treatment of supracondylar fractures can be delayed until the next morning, except in the 'life or limb' situation.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 04/2010; 8(2):71-3. · 1.41 Impact Factor
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ABSTRACT: In 1961, Salter described the innominate osteotomy for the treatment of dysplastic acetabulum in children presenting late with developmental dysplasia of the hip. He recommended the Gigli saw as the safest instrument for the osteotomy cut and his postoperative immobilization was with a hip spica cast. These have been the standard practice. However, an extensive exposure is required to facilitate passage of the Gigli saw under the sciatic notch while the application of a hip spica can be difficult and prolongs anaesthetic time. We describe a less invasive technique using an oscillating saw for the osteotomy cut. This allows for minimal exposure hence short operation time and quick recovery. We use an abduction brace for our postoperative immobilization thereby significantly reducing anaesthetic time. Fifty innominate osteotomies performed in 49 patients using this technique were reviewed retrospectively. There were 46 female and three male patients. The senior author performed all surgeries. The average age at surgery was 24 months (18-54) and the mean follow-up period was 25 months (12-60). The mean preoperative acetabular index was 35.1 degrees , whereas the acetabular index at final follow-up was 14.9 degrees (P<0.0001). Average duration of surgery was 25 min with minimal blood loss (less than 50 ml). All went home by the second postoperative day. There was no intraoperative complication. Two patients had minor superficial wound infections that resolved uneventfully. There was no loss of correction. We suggest that the oscillating saw is a safe instrument for performing an innominate osteotomy, it allows for less invasive surgery hence less morbidity and quicker recovery without compromising the surgical outcome. The abduction brace can be used for immobilization after innominate osteotomy without loss of correction.
Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 04/2010; 19(4):318-22. · 0.66 Impact Factor
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ABSTRACT: Femoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter's osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter's osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged from 9 to 24 whereas postoperative scores ranged from 25 to 46. Triple osteotomy has been advocated in Legg-Calve-Perthes' disease after the closure of the triradiate cartilage. Using a single incision is a safer alternative to the traditional two-incision approach. We believe that the single incision approach reduces operative time and potential morbidity associated with the steel triple osteotomy with comparable clinical and radiographic outcomes.
Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 04/2010; 19(4):323-6. · 0.66 Impact Factor
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ABSTRACT: Femoroacetabular impingement (FAI) may be common after slipped capital femoral epiphysis though the actual frequency is unknown. The purpose of this study was to determine the frequency of symptomatic FAI in young adults after slipped capital femoral epiphysis and define its relationship with slip severity.
We retrospectively reviewed a consecutive series of 49 patients (65 hips) to determine patient and slip characteristics and treatments. Patients were then recalled for clinical and radiographic review to assess symptoms, particularly impingement, and outcomes after skeletal maturity.
Thirty-six patients (49 hips) were reviewed clinically and radiographically with a mean follow-up of 6.1 years (range: 2.2 to 13.1 y). All patients had reached skeletal maturity. Thirty-one percent (15/49) of patients complained of hip pain or stiffness, whereas 32% (16/49) had clinical signs of impingement. The Southwick slip angle and grade of slip or Loder's classification of physeal stability were not predictive of impingement at follow-up. The anterior head-neck offset angle (alpha angle) correlated most strongly with FAI (r=0.26). No pre-slips or prophylactically pinned hips developed clinical impingement in this review.
In the absence of radiographic indicators to predict FAI, we advocate all but those hips pinned prophylactically or for pre-slip should be followed into adulthood and clinically monitored for impingement. Grade of slip in adolescence cannot be used as a predictive tool for FAI later in life.
Level II, retrospective study.
Journal of pediatric orthopedics 10/2009; 29(6):535-9. · 1.23 Impact Factor
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ABSTRACT: Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries.
We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street-gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury.
Over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1-5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury.
Our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service.
PEDIATRICS 07/2007; 119(6):e1294-8. · 4.47 Impact Factor
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ABSTRACT: Heavy weight lifting using a squat bar is a commonly used athletic training exercise. Previous in vivo motion studies have concentrated on lifting of everyday objects and not on the vastly increased loads that athletes subject themselves to when performing this exercise.
Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights.
Controlled laboratory study.
Forty-eight athletes (28 men, 20 women) performed 6 lifts at 40% maximum, 4 lifts at 60% maximum, and 2 lifts at 80% maximum. The Zebris 3D motion analysis system was used to measure lumbar spine motion. Exercise was performed as a "free" squat and repeated with a weight lifting support belt. Data obtained were analyzed using SAS.
A significant decrease (P < .05) was seen in flexion in all groups studied when lifting at 40% maximum compared with lifting at 60% and 80% of maximum lift. Flexion from calibrated 0 point ranged from 24.7 degrees (40% group) to 6.8 degrees (80% group). A significant increase (P < .05) was seen in extension when lifting at 40% maximum was compared with lifting at 60% and 80% maximum lift. Extension from calibrated 0 point ranged from -1.5 degrees (40% group) to -20.3 degrees (80% group). No statistically significant difference was found between motion seen when exercise was performed as a free squat or when lifting using a support belt in any of the groups studied.
Weight lifting using a squat bar causes athletes to significantly hyperextend their lumbar spines at heavier weights. The use of a weight lifting support belt does not significantly alter spinal motion during lifting.
The American Journal of Sports Medicine 06/2007; 35(6):927-32. · 3.79 Impact Factor
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ABSTRACT: This report describes a case of an eosinophilic granuloma of T7 causing spinal cord compression in an 8-year-old boy who presented with abdominal pain. The purpose of this report was to illustrate both the variable clinical presentation and the rare incidence of cord compression due to an eosinophilic granuloma. Eosinophilic granuloma is a benign tumour-like condition that produces focal bone destruction. It is usually managed conservatively after biopsy, necessary to confirm diagnosis. Vertebral involvement is seen in 7–15% of cases with back pain and stiffness being the presenting features. This case is unique in both the initial presentation with abdominal pain, and the subsequent diagnosis of cord compression due to an extensive eosinophilic granuloma requiring urgent surgical intervention. The child underwent a left sided thoracotomy, T7 vertebrectomy and decompression. The spine was stabilised with a tricortical iliac crest graft. Diagnosis was confirmed by both microscopy and immunocytochemistry. The patient tolerated the procedure with no complications, he was discharged home pain free and will be kept under review. This case highlights both the highly variable presentation and the rare complication of cord compression due to eosinophilic granuloma.Le cas décrit concerne un granulome éosinophile de T7 avec compression médullaire découvert chez un garçon de huit ans se plaignant de douleurs abdominales. Le propos de l’article est d’illustrer à la fois la variabilité du tableau clinique et la faible incidence de la compression médullaire d’un granulome éosinophile. Le granulome éosinophile est une lésion bénigne ressemblant à une tumeur qui produit une destruction osseuse focalisée. Il est habituellement traité de façon conservative après biopsie diagnostique. Un tassement vertébral est constaté dans 7–15% des cas, responsable de rachialgies et de raideur qui constituent les caractéristiques du mode début clinique. Ce cas est unique à la fois en raison du mode de début par des douleurs abdominales et du diagnostic ensuite de compression de la moelle nécessitant un traitement chirurgical en urgence. Le garçon fut opéré par thoracotomie gauche avec vertèbrectomie de T7 et décompression. La colonne vertébrale fut stabilisée par un greffon de crête iliaque tricortical. Le diagnostic fut confirmé à la fois par histologie et par chimie cyto-immunologique. Le patient supporta le traitement sans complications et put retourner au domicile sans douleurs et reste sous contrôle. Ce cas souligne à la fois la grande variabilité du tableau clinique et la rare possibilité de compression de la moelle du granulome éosinophile.
European Journal of Orthopaedic Surgery & Traumatology 11/2006; 16(4):348-350. · 0.10 Impact Factor
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ABSTRACT: We report the use of posterior cervical locking plate fixation after apical vertebral excision for congenital lumbar kyphosis in a 3-year-old male myelomeningocoele patient. At 4-year follow-up the fixation was secure and the correction was well preserved.
Journal of Spinal Disorders & Techniques 07/2006; 19(4):292-4. · 1.50 Impact Factor
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ABSTRACT: Total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip (DDH) is technically difficult due to the abnormal anatomy involved. Surgery may be facilitated by using a modular femoral prosthesis, which allows intra-operative variations in neck length and version to accommodate final acetabular position. The aim of this study was to assess our early results with the S-ROM hip (DePuy), a cementless modular femoral implant, for arthroplasty in patients with DDH. We performed 22 total hip replacements on 20 patients over a three and a half year period. Ten patients had had previous osteotomies performed, including two of whom had Ganz peri-acetabular osteotomies performed in our centre. Follow-up ranged from 6 to 44 (mean 19.6) months. Harris hip scores improved from an average of 42 points pre-operatively to 90 points post-operatively. No radiographic evidence of osteolysis was seen around the femoral implant. Two patients required revision of their acetabular components. Both had satisfactory outcomes. Our early results with the S-ROM femoral prosthesis correlate well with those from other studies involving arthroplasty for DDH. This implant is extremely versatile and easy to use in this complex patient population.Larthroplastie totale de hanche pour coxarthrose secondaire une dysplasie constitue une difficult technique en raison des modifications anatomiques. La chirurgie peut tre facilite en utilisant une prothse fmorale modulaire, qui autorise des variations per-opratoires de longueur, dexcentration et dantversion du col afin de sadapter la position actabulaire finale. Le but de cette tude tait dvaluer nos premiers rsultats avec la hanche S-ROM (DePuy, Johnson et Johnson Company), un implant fmoral modulaire non ciment ddi aux patients porteurs de dysplasie. Nous avons ralis vingt deux remplacements totaux de hanche chez 20 patients, tals sur une priode de trois ans et demi. Dix patients avaient t oprs auparavant par ostotomies, y compris deux par ostotomies peri-actabulaires de Ganz excutes dans notre Centre. Le follow-up sest tendu de six 44 mois (moyenne 19.6 mois). Le score de hanche de Harris a t amlior en passant, en moyenne, de 42 points en pr-opratoire 90 points en post-opratoire. Aucun signe radiographique dostolyse na t constat autour de limplant fmoral. Deux patients ont ncessit une rvision de leurs composants actabulaires. Tous les deux ont eu des rsultats satisfaisants. Nos premiers rsultats avec la prothse S-ROM fmorale se corrlent bien avec ceux dautres tudes darthroplasties pour hanches dysplasiques. Lauteur an trouve cet implant extrmement souple, et facile employer dans cette population patiente complexe.
European Journal of Orthopaedic Surgery & Traumatology 01/2005; 15(2):105-108. · 0.10 Impact Factor
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The Journal of Bone and Joint Surgery 09/2004; 86-A(8):1768-71. · 3.27 Impact Factor
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ABSTRACT: A 3-year-old boy of Romanian origin was admitted with the inability to weight bear and pyrexia. He was investigated to rule out septic arthritis. He subsequently developed an atypical clinical picture of fleeting joint arthritis, spiking temperature with poor response to antibiotics and atypical results of investigations. The peripheral blood smear showed a normal leukocyte count, but evidence of blast cells. Bone marrow aspirate confirmed the diagnosis of acute lymphoblastic leukemia. His skeletal radiographic survey had shown evidence of symmetrical metaphyseal sclerosis in the long bones, which has not been previously described as an isolated feature of acute lymphoblastic leukemia. Following a good response to chemotherapy, partial resolution of the sclerosis occurred. This case illustrates that metaphyseal sclerosis can be one of the manifestations of acute lymphoblastic leukemia and delay in diagnosis can easily occur in the absence of classic features of the disease. An early diagnosis is a good prognostic feature of these childhood malignancies.
Journal of Pediatric Orthopaedics B 08/2003; 12(4):292-4. · 0.47 Impact Factor
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ABSTRACT: Femoral fractures resulting from birth injuries are rare. The authors undertook a study to assess their incidence and outcome. Seven patients from a total of 55,296 live births suffered 8 femoral fractures (incidence 0.13 per 1,000 live births). Twin pregnancies, breech presentations, prematurity, and disuse osteoporosis were associated with the occurrence of a fracture. The typical injury pattern was a spiral fracture of the proximal half of the femur, which was held in an extended position. A variety of treatment modalities were used, including gallows traction, spica cast, and Pavlik harness. All patients in this study, regardless of treatment, had a satisfactory clinical outcome, with no evidence of limb length discrepancy or angular deformity on follow-up.
Journal of Pediatric Orthopaedics 12/2001; 22(1):27-30. · 1.16 Impact Factor
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ABSTRACT: Acetabular dysplasia and hip instability are common in neuromuscular diseases such as spina bifida and cerebral palsy due to deranged muscle function around the hip. Occasionally in developmental dysplasia of the hip, persistent instability may be difficult to manage by standard treatments. It is in these contexts that we wished to investigate whether a dislocatable hip could be stabilized by means of a transarticular suture acting as a reconstructed ligamentum teres. The aim of this study was to investigate and assess the iatrogenic damage caused by such a procedure on the immature proximal femoral physis, epiphysis, and hip joint.
Four- to 6-week-old mixed breed European pigs (n = 18) were used in the study. Six animals with normal hips underwent the stabilization procedure to the right hip joint, the left hips serving as controls. The remaining 12 pigs were subjected to a model of hip dysplasia on the right hip. After 6 weeks, the dysplasia stimulus was removed, and half of the animals underwent the hip stabilization procedure, the remaining 6 animals served as a control for "untreated dysplasia." Animals underwent serial pelvic radiography until euthanasia at 18 weeks of age. Postoperative, morphometric, radiographic, and histological analyses were performed.
The dysplasia model consistently produced an increase in the acetabular index, femoral head subluxation, and growth retardation of the capital epiphysis. We observed no detrimental effect on the capital ossific nucleus, proximal femoral physis, or acetabular development in terms of radiographic, morphometric, or histological findings after the transarticular suture procedure.
The surgical technique of drilling across the immature porcine hip did not result in avascular necrosis of the femoral head, osseous bar formation across the proximal femoral physis, proximal femoral metaphyseal growth disturbance, chondrolysis, or disturbance in normal acetabular development.
The described technique may be a useful augment to the definitive stabilization of the recalcitrant dysplastic or unstable hip where standard operative measures alone are likely to be unsuccessful.
Journal of Pediatric Orthopaedics 28(1):36-42. · 1.16 Impact Factor
