Congenital pseudarthrosis of the tibia (CPT) has traditionally been a difficult condition to treat, with high complication rates, including nonunion, refractures, malalignment, and leg length discrepancy. Surgical approaches to treatment of CPT include intramedullary rodding, external fixation, combined intramedullary rodding and external fixation, vascularized fibular graft, and most recently cross-union. The current study aims to compare the outcomes and complication rates of cross-union versus other surgical approaches as an index surgery for the management of CPT. Our hypothesis was that a good index surgery for CPT achieves union and minimizes complications such as refractures and limb length discrepancy. A multicentre study was conducted involving two institutions in Singapore and China. All patients with CPT who were surgically managed between January 2009 and December 2021 were included. The patients were divided based on their index surgery. Group 1 included patients who underwent excision of hamartoma, cross-union of the tibia and fibula, autogenic iliac bone grafting, and internal fixation for their index surgery. Group 2 included patients who underwent all other surgical procedures for their index surgery, including excision of hamartoma, intramedullary rodding, and/or external fixation, without cross-union of the tibia and fibula. Comparisons of the rates of union, refracture, limb length discrepancy, reoperations, and other complications were performed between the two groups.Aims
Methods
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs. A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.Aims
Methods
The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively.Aims
Methods
The Masquelet technique, also known as the ‘induced membrane technique’ has been utilised in adult reconstruction with varied success. However, there is limited literature on its use in children and this study aims to share our experience. Materials & Methods. Between 2014 and 2022, 7 children underwent bone defect/infection reconstruction using Masquelet technique, four for complications of Congenital
There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery. Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.Aims
Methods
This is a report of the outcome of management of congenital pseudoarthrosis of the tibia (CPT) at skeletal maturity. Retrospective study. Inclusion criteria:
CPT Crawford IV Skeletally maturity. Availability of radiographs and medical records. Outcome: union rate, healing time, residual deformities, ablation and refracture.Introduction
Materials and Methods
During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients. All patients who underwent a revision surgery after instrumented spinal surgery at our institution between July 2014 and August 2016 with spinal implants submitted for sonication were retrospectively analyzed. Only revisions presumed as aseptic are included in the study. During the study period, 204 spinal revisions were performed for diagnoses other than infection. In 38 cases, sonication cultures were not obtained, leaving a study cohort of 166 cases. The mean age of the cohort was 61.5 years (Aims
Patients and Methods
Several reports showed superior fusion rates, as high as 100%, using rhBMP-2 with ALIF cages. This has led to the widespread off-label use of rhBMP-2 in several other lumbar fusion procedures. There is paucity of reports analysing the clinic-radiological outcome of using rhBMP-2 to promote bone union in cases of symptomatic pseudoarthosis following lumbar spine fusion. 52 consecutive patients who underwent revision spinal surgery for symptomatic pseudoarthosis utilizing rhBMP-2 between 2008 and 2013 were included in the study. Demographic, and surgical data were collected from medical records. Functional outcomes were recorded using the ODI. All patients had preoperative fine-cut CT scan to confirm pseudoarthosis. Postoperative CT-scan at 6 months was routinely done to confirm fusion.Introduction:
Methods:
Proximal humeral fracture occurs most frequently in elderly and usually unite within 12 weeks. Malunion is more common than nonunion. And even if nonunion occurs, we usually treat it by the blade plate. Norris et al. reported hemiarthroplasty is indicated for severe degenerative changes of the articular surface, osteonecrosis of the humeral head, or osteopenia severe enough to jeopardize fixation in order patients. Therefore, it is not common that hemiarthroplasty is used for primary treatment of the proximal humeral pseudoarthrosis. We report a case of proximal humerus pseudoarthrosis which was treated by hemiarthroplasty. A patients is 75 years old male. He was injured by falling from ladder. He was diagnosed proximal humeral fracture Neer type2. After he was followed conservatively for one year, he was referred to our hospital. In X-ray film and CT, the humeral head was scraped by the humeral shaft that was tucked inward to humeral head.(Figure 1) In MRI, rotator cuff muscles were left. The fatty infiltration was stage 1 in the Gourtallier classification. (Figure 2)And osteoarthritis of shoulder was not so severe. Therefore, we decided to do hemiarthroplasty. We used the SMR implant (Lima Corporate, Milano, Italy). Surgical reconstruction was done using a deltpectral approach. Lesser tuberosity was cut from greater tuberosity with subscaplaris muscle. We used the cementless stem. Each fragments and stem was fixed using FiberWire (Arthrex, Florida USA), after autograft which scraped from the reseceted humeral head was stuffed. After the operation, the shoulder was fixed by brace for 4weeks. The passive ROM exercise was started from 21 days later. The Active ROM exercise was started at 28 days later. Three months later, the pseudoarthrosis united successfully. (Figure 3) The active flexion was improved from 20 degrees to 110 degrees. The active abduction was from 20 degrees to 90 degrees. USLA score was improved from 10 to 26.Introduction
Case
Between 2005 and 2012, 50 patients (23 female, 27 male) with
nonunion of the humeral shaft were included in this retrospective
study. The mean age was 51.3 years (14 to 88). The patients had
a mean of 1.5 prior operations ( All patients were assessed according to a specific risk score
in order to devise an optimal and individual therapy plan consistent
with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis
to an angular stable locking compression plate was performed. According
to the individual risk an additional bone graft and/or bone morphogenetic
protein-7 (BMP-7) were applied. A successful consolidation of the nonunion was observed in 37
cases (80.4%) with a median healing time of six months (IQR 6).
Younger patients showed significantly better consolidation. Four
patients were lost to follow-up. Revision was necessary in a total
of eight (16%) cases. In the initial treatment, intramedullary nailing
was most common. Methods
Results
Tibial nonunion represents a spectrum of conditions
which are challenging to treat, and optimal management remains unclear
despite its high rate of incidence. We present 44 consecutive patients
with 46 stiff tibial nonunions, treated with hexapod external fixators
and distraction to achieve union and gradual deformity correction.
There were 31 men and 13 women with a mean age of 35 years (18 to
68) and a mean follow-up of 12 months (6 to 40). No tibial osteotomies
or bone graft procedures were performed. Bony union was achieved
after the initial surgery in 41 (89.1%) tibias. Four persistent
nonunions united after repeat treatment with closed hexapod distraction,
resulting in bony union in 45 (97.8%) patients. The mean time to
union was 23 weeks (11 to 49). Leg-length was restored to within
1 cm of the contralateral side in all tibias. Mechanical alignment
was restored to within 5° of normal in 42 (91.3%) tibias. Closed
distraction of stiff tibial nonunions can predictably lead to union
without further surgery or bone graft. In addition to generating
the required distraction to achieve union, hexapod circular external
fixators can accurately correct concurrent deformities and limb-length
discrepancies. Cite this article:
PURPOSE OF THE STUDY. Occipitocervical fixation and spondylodesis is indicated in various cases of occipitocervical instability. The aim of this retrospective study was to evaluate the results of occipitocervical fixation at our institutions. MATERIAL + METHODS. Between 1997 and 2007, a total of 57 patients underwent occipitocervical fixation (OC) there were 25 men and 32 women, from 4 to 77 years of age. 2 groups, group one - tying wires or cables and group two - screw-rod or screw-plate systems. Indications included trauma in 15, rheumatoid arthritis (RA) in 28, destruction due to psoriasis in one, tumour in eight, and congenital anomalies in five patients. The patients were evaluated at a final follow-up ranging between 12 and 132 months after the primary surgery (average, 42.7 months). Indications for surgery and the method and extent of instrumentation were recorded. The evaluation included pain and neurological deficit assessment, radiographic evidence of the stability of fixation and bone union and intra-operative and early and late post-operative complications. RESULTS. Of the 57 patients, bone fusion was the aim of surgery in 52. Five patients died of associated injuries or serious medical complications shortly after the operation. Of the remaining 47, bone union was achieved in 44 patients (93.6%).
We report the results of vertebral column resection
(VCR) for paediatric patients with spinal deformity. A total of
49 VCRs in paediatric patients from four university hospitals between
2005 and 2009 with a minimum two-year follow-up were retrospectively
identified. After excluding single hemivertebral resections (n =
25) and VCRs performed for patients with myelomeningocele (n = 6),
as well as spondylectomies performed for tumour (n = 4), there were
14 patients who had undergone full VCR at a mean age of 12.3 years
(6.5 to 17.9). The aetiology was congenital scoliosis in five, neuromuscular
scoliosis in three, congenital kyphosis in two, global kyphosis
in two, adolescent idiopathic scoliosis in one and secondary scoliosis
in one. A total of seven anteroposterior and seven posterolateral approaches
were used. The mean major curve deformity was 86° (67° to 120°) pre-operatively
and 37° (17° to 80°) at the two-year follow-up; correction was a
mean of 54% (18% to 86%) in the anteroposterior and 60% (41% to
70%) in the posterolateral group at the two-year follow-up (p =
0.53). The mean Scoliosis Research Society-24 total scores were
100 (92 to 108) for the anteroposterior and 102 (95 to 105) for
the posterolateral group. There was one paraparesis in the anteroposterior
group necessitating urgent re-decompression, with a full recovery. Patients undergoing VCR are highly satisfied after a successful
procedure.
For the treatment of ununited fractures, we developed
a system of delivering magnetic labelled mesenchymal stromal cells
(MSCs) using an extracorporeal magnetic device. In this study, we
transplanted ferucarbotran-labelled and luciferase-positive bone
marrow-derived MSCs into a non-healing femoral fracture rat model
in the presence of a magnetic field. The biological fate of the
transplanted MSCs was observed using luciferase-based bioluminescence
imaging and we found that the number of MSC derived photons increased
from day one to day three and thereafter decreased over time. The
magnetic cell delivery system induced the accumulation of photons at
the fracture site, while also retaining higher photon intensity
from day three to week four. Furthermore, radiological and histological
findings suggested improved callus formation and endochondral ossification.
We therefore believe that this delivery system may be a promising
option for bone regeneration.
Purpose: A retrospective review of 180 consecutive luque unit rod instrumentations for neuromuscular scoliosis revealed a low rate (7%) of reoperation for hardware related issues. The results of this cost effective instrumentation are good, and we question whether moving to more expensive systems (eg pedicle screws) will provide benefit to patients. Method: A retrospective clinical and radiographic review of 180 consecutive patients, treated with the unit rod and sublaminar wires for progressive neuromuscular scoliosis and cerebral palsy, between 1994 and 2004 was done. Preoperative, intraoperative, and outcome data were obtained from hospital and clinic records with 2 to 12 years of followup. Results: Mean age at surgery was 13 years. Of 180 patients, 158 were full time wheelchair users. 112 patients underwent isolated posterior surgery, 68 underwent anterior &
posterior surgeries. Allograft was used in 96%. Mean surgical time was 5 hours 45 minutes, blood loss was 1325 cc. Mean cobb angles improved from 72° to 32°, pelvic obliquity improved from 20° to 9°. Overall postoperative complications were 222, with 36 (20%) of 180 patients experiencing no complication. Only 13 patients of 180 required revision surgery for hardware related problems.
In the case of a complete dislocated hip or a severe deformity of the proximal femur, total hip arthroplasty (THA) can still be combined with a proximal femoral osteotomy for shortening femur or correcting the deformity if needed. Subtrochanteric femoral shortening and a corrective osteotomy are considered to be an integral part of THA for such cases. A precise osteotomy is mandatory to achieve good results. Although, the freehand excision of V-shaped subtrochanteric osteotomy used to be performed frequently, this procedure was also subject to some pitfalls, such as poor coaptation of the osteotomy surface. A new device was thus developed to perform a V-shaped osteotomy in an identical central axis between the distal and proximal femur. The purpose of this study was to evaluate the efficacy of the device by comparing the perioperative results with those of a free-hand subtrochanteric osteotomy. From 1999 to 2002, THA combined with a double-chevron subtrochanteric osteotomy was performed by free hand (free hand group). From 2003 to 2007, THA combined with a double-chevron subtrochanteric osteotomy was performed using a new device (device group). The free hand group included 27 hips in 21 patients. The mean age of the patients (23 females and 3 males) at the time of the operation was 58 years. Fourteen were completely dislocated hips and 13 followed various proximal femoral osteotomies. The device group included 102 hips in 79 patients. The mean age of thepatients (70 females and 9 males) at the time of the operation was 62 years. Seventy two were completely dislocated hips and 26 followed various proximal femoral osteotomies. Four parameters were used to evaluate the efficacy of the device:. operation time,. total blood loss,. C-reactive protein at postoperative 1 day and. early complications at the osteotomy site. The mean operation time, total blood loss, and C-reactive protein in the device group all significantly decreased in comparison to the free hand group. The decreases ranged from; 132 to 96 minutes (p<
0.01), 1346 to 999 g (p<
0.01), 4.9 to 3.0 mg/dl (p<
0.05), respectively. Two types of complications were observed at the osteotomy site.
Introduction: