Rebound growth after hemiepiphysiodesis may be a normal event, but little is known about its causes, incidence or factors related to its intensity. The aim of this study was to evaluate rebound growth under controlled experimental conditions. A total of 22 six-week-old rabbits underwent a medial proximal tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal growth plate arrest was maintained for three weeks, and animals were killed at intervals ranging between three days and three weeks after removal of the device. The radiological angulation of the proximal tibia was studied at weekly intervals during and after hemiepiphysiodesis. A histological study of the retrieved proximal physis of the tibia was performed. The mean angulation achieved at three weeks was 34.7° (standard deviation (. sd). 3.4), and this remained unchanged for the study period of up to two weeks. By three weeks after removal of the implant the mean angulation had dropped to 28.2° (. sd. 1.8) (p < 0.001). Histologically, widening of the medial side was noted during the first two weeks. By three weeks this widening had substantially disappeared and the normal columnar structure was virtually re-established. In our rabbit model, rebound was an event of variable incidence and intensity and, when present, did not appear immediately after restoration of growth, but took some time to appear. Cite this article: Bone Joint J 2015;97-B:862–8

Aims. Our aim was to investigate the predictive factors for the development of a rebound phenomenon after temporary hemiepiphysiodesis in children with genu valgum. Patients and Methods. We studied 37 limbs with idiopathic genu valgum who were treated with hemiepiphyseal stapling, and with more than six months remaining growth at removal of the staples. All children were followed until skeletal maturity or for more than two years after removal of the staples. Results. On multivariate logistic regression analysis, the rate of correction, body mass index (BMI), age, and initial valgus angle were significantly associated with a rebound phenomenon. With those characteristics, a predictive model for rebound was generated using recursive partitioning analysis. Children with a rapid rate of correction had the most frequent and severe rebound phenomenon (incidence 79%, mean 4°), whereas those with a slow rate of correction had less rebound when they had low BMI (43%, 2°) and none when the BMI was ≥ 21 kg/m. 2. . Conclusion. This is the first study to evaluate a predictive model for a rebound phenomenon after temporary hemiepiphysiodesis in children with idiopathic genu valgum. Cite this article: Bone Joint J 2016;98-B:1270–5

With observed success and increased popularity of growth modulation techniques, there has been a trend towards use in progressively younger patients. Younger age at growth modulation increases the likelihood of complete deformity correction and need for implant removal prior to skeletal maturity introducing the risk of rebound deformity. The purpose of this study was to quantify magnitude and identify risk factors for rebound deformity after growth modulation. We performed a retrospective review of all patients undergoing growth modulation with a tension band plate for coronal plane deformity about the knee with subsequent implant removal. Exclusion criteria included completion epiphysiodesis or osteotomy at implant removal, ongoing growth modulation, and less than one year radiographic follow-up without rebound deformity. Mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), hip-knee-ankle angle (HKA), and mechanical axis station were measured prior to growth modulation, prior to implant removal, and at final follow-up. Sixty-seven limbs in 45 patients met the inclusion criteria. Mean age at growth modulation was 9.8 years (range 3.4–15.4 years) and mean age at implant removal was 11.4 years (range 5.3–16.4 years). Mean change in HKA after implant removal was 6.9O (range 0O–23 O). Fifty-two percent of patients had greater than 5O rebound and 30% had greater than 10O rebound in HKA after implant removal. Females less than ten years and males less than 12 years at time of growth modulation had greater mean change in HKA after implant removal compared to older patients (8.4O vs 4.7O, p=0.012). Patients with initial deformity greater than 20O degrees had an increased frequency of rebound greater than 10O compared to patients with less severe initial deformity (78% vs 22%, p=0.002). Rebound deformity after growth modulation is common. Growth modulation at a young age and large initial deformity increases risk of rebound. However, rebound does not occur in all at risk patients, therefore, we caution against routine overcorrection. Patients and their families should be informed about the risk of rebound deformity after growth modulation and the potential for multiple surgical interventions prior to skeletal maturity

Aim. To investigate the effect of the eight plate position in sagittal plane on tibial slope in temporary epiphysiodesis technique applied to the proximal tibia and whether there is a rebound effect after removing the plate. Method. Forty New Zealand rabbits (6 weeks old) were divided into four groups. In all groups, two 1.3 mm mini plates and cortical screws implantation were placed on both medial and lateral side of the proximal epiphysis of the right tibia. In Group 1 and 3, the plates were placed on anterior of the proximal tibial anatomical axis in the sagittal plane, and placed posteriorly in Group 2 and 4. The left tibia was examined as control in all groups. Group 1 and Group 2 were sacrificed after four week-follow-up. In Group 3 and Group 4, the implants were removed four weeks after index surgery and the rabbits were followed four more weeks to investigate the rebound effect. The tibial slope was measured on lateral X-rays every two weeks. Both medial and lateral plateau slopes were evaluated on photos of the dissected tibia. Results. In Group 1, right MTPA (medial tibial plateau angle) and left MTPA, right LTPA (lateral tibial plateau angle) and left LTPA, and right 4wTPPA (the tibial proximal posterior angle at 4th week) and left 4wTPPA values were compared with each other. There was a significant difference in MTPA, LTPA, and 4wTPPA in Group 1 (p: 0.003, 0.006, 0.004). In Group 1, the medial and lateral slope significantly decreased after 4 weeks. There was no significant difference in MTPA, LTP and 4wTPPA measurements in Group 2 (p= 0.719, 0.306, 0.446, respectively). In Group 2, the slope did not change in four weeks. There was a significant difference in MTPA, LTPA, 4wTPPA, and 8wTPPA (tibial proximal posterior angle at 8th week) in Group 3 (p= 0.005, 0.002, <0.001, <0.001, respectively). In Group 3, the slope decreased at 4th week and remained stabile during the next four week-follow up and no rebound effect was observed. There was no significant difference in MTPA, LTPA, 4wTPPA, and 8wTPPA measurements in Group 4 (p= 0.791, 0.116, 0.232, 0.924), respectively. In group 4, slope did not change at 4th week of index surgery and no rebound effect was observed in the next four week-follow up. Conclusion. If eight plates were placed on anterior of lateral proximal tibia axis on both medial and lateral side, the tibial slope would reduce, and remain stabile after implant removal. Care should be taken to place the plates on the line of proximal tibial axis in sagittal plane in temporary epiphysiodesis technique performed due to angular knee deformities. Changing the slope due to plate placement can be used as a secondary gain for patients who will benefit from slope change, such as adolescent ACL surgery

Aims. The aim of this study was to compare outcomes of guided growth and varus osteotomy in treating Kalamchi type II avascular necrosis (AVN) after open reduction and Pemberton acetabuloplasty for developmental dysplasia of the hip (DDH). Methods. This retrospective study reviewed patients undergoing guided growth or varus osteotomy for Kalamchi type II AVN between September 2009 and January 2019. All children who had undergone open reduction and Pemberton acetabuloplasty for DDH with a minimum two-year follow-up were enrolled in the study. Demographic and radiological data, which included the head-shaft angle (HSA), neck-shaft angle (NSA), articulotrochanteric distance (ATD), Sharp angle (SA), and lateral centre-edge angle (LCEA) at baseline, two years, and at the extended follow-up, were compared. Revision rates were evaluated. Clinical outcomes using the Harris Hip Score were assessed two years postoperatively. Results. A total of 24 patients underwent guided growth and 19 underwent varus osteotomy, over a mean period of 3.3 years (95% confidence interval (CI) 2.8 to 3.8) and 5.2 years (95% CI 4.5 to 6.0), respectively. There were no differences in demographic and preoperative radiological data, except for a younger age at time of acetabuloplasty and larger ATD for the osteotomy group. The HSA did not differ at two years and the extended follow-up because of postoperative rebound in the osteotomy group. The NSA of the osteotomy group remained smaller postoperatively. There were no significant differences in the follow-up ATD, SA, and LCEA, except for a smaller two-year ATD of the osteotomy group. Seven patients (29.2%) in the guided growth group underwent revision surgery and none in the osteotomy group. The Harris Hip Score was similar between groups. Conclusion. Guided growth and varus osteotomy had comparable results in improving caput valgum deformity, given the rebound of lateral tilting of the physis after osteotomy correction. There were no differences in clinical outcomes at two years postoperatively. Cite this article: Bone Joint J 2022;104-B(7):902–908

Guided growth is commonly performed by placing an extra-periosteal two-hole plate across the growth plate with one epiphyseal and one metaphyseal screw. Recent work by Keshet et al. (2019) investigated the efficacy of the removal of the metaphyseal screw only (“sleeper plate”) after correction. They concluded the practice to be unnecessary as only 19% of patient show recurrence of deformity. The aim of this study is to examine the incidence of rebound and undesired bony in-growth of the plate (“tethering”) after metaphyseal screw removal only. In this retrospective case series, patient data on 144 plates inserted around the knee was obtained. Plates still in situ (n=69) at time of study and full hardware removal (n=50) were excluded. The remaining 25 plates had a metaphyseal screw only removed after deformity correction. We analyzed the rate of re-bound, tethering and maintenance of correction in two age groups at latest follow-up for a mean of 3.5 years (1.25 to five). Fisher's exact test with Freeman-Halton extension was used to analyze the two by three contingency table. Twenty-five plates were identified as “sleeper plates” in our series. 13 plates (52%) maintained the achieved correction after a mean of 21 months (four to 39), nine plates (36%) required screw re-insertion due to rebound after a mean of 22 months (12-48) from screw removal, and four plates (16%) showed tethering with undesired continuation of guided growth after a mean of 14 months (seven to 22) from screw removal. Younger patients (years at time of plate insertion) had higher rates of rebound and tethering (p=.0112, Fisher's exact test). All Tethering occurred in titanium plates, none occurred in steel plates. The sleeper plate is an acceptable treatment strategy for coronal deformities around the knee. Rebounding and tethering are potential outcomes that occur in younger patients and should be disclosed to patients; titanium plates may increase the risk of tethering, however further long-term follow-up is needed. We stress the importance of close post-operative follow up to identify tethering early and prevent over correction. The sleeper plate technique is a viable option in younger children with congenital abnormalities, however, continued monitoring of alignment is necessary after screw removal to check for rebound and tethering

The aim of this scoping review is to understand the extent and type of evidence in relation to the use of guided growth for correcting rotational deformities of long bones. Guided growth is routinely used to correct angular deformities in long bones in children. It has also been proven to be a viable method to correct rotational deformities, but the concept is not yet fully examined. Databases searched include Medline, Embase, Cochrane Library, Web of Science and Google Scholar. All identified citations were uploaded into Rayyan.ai and screened by at least two reviewers. The search resulted in 3569 hits. 14 studies were included: 1 review, 3 clinical trials and 10 pre-clinical trials. Clinical trials: a total of 21 children (32 femurs and 5 tibiae) were included. Surgical methods were 2 canulated screws connected by cable, PediPlates obliquely oriented, and separated Hinge Plates connected by FiberTape. Rotation was achieved in all but 1 child. Adverse effects reported include limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. 2 pre-clinical studies were ex-vivo studies, 1 using 8-plates on Sawbones and 1 using a novel z-shaped plates on human cadaver femurs. There were 5 lapine studies (2 using femoral plates, 2 using tibial plates and 1 using an external device on tibia), 1 ovine (external device on tibia), 1 bovine (screws and cable on metacarp) and a case-report on a dog that had an external device spanning from femur to tibia. Rotation was achieved in all studies. Adverse effects reported include implant extrusions, LLD, articular deformities, joint stiffness and rebound. All included studies conclude that guided growth is a viable treatment for rotational deformities of long bones, but there is great variation in models and surgical methods used, and in reported adverse effects

Introduction. The purpose of our study was to retrospectively analyze our patients who were treated for FH and PFFD by means of guided growth temporary Hemiepiphysiodesis. We sought to determine the effectiveness of the procedure, as well as its success rates, complications, and rebound phenomena. Materials and Methods. We retrospectively reviewed the medical records and all routine preoperative and post operative long standing radiograph of all the FH and PFFD patients that were operated in our institute using guided growth hemiepiphysiodesis technique of distal femur or proximal tibia between 2007 to 2017. Results. 42 patients (28/FH, 14/PFFD) with 55 involved physis were included in the study. The mean duration of follow-up was 51.11 ± 27.56 months after the first operation. The average age at first plate insertion was 11.7 years and 50% of patients reached puberty by the time of data collection. 32 physes (21 FH, 11 PFFD) were operated due to pathological mLDFA with a mean angle correction of 6.24° for the FH group and 6° for the PFFD group and time-to-correction of 14.07 months and 11.56 months, respectively. 23 physes (14 FH, 9 PFFD) were operated due to pathological mMPTA with a mean angle correction of 4.43° for the FH group and 6.22° for the PFFD group with time-to-correction of 17.95 months and 20.35 months respectively. 40% (12/30) of patients, whose metalwork was removed, had a recurrence of the deformity, 7/21 [33.3%] in the FH group and 5/9 [55%] in the PFFD group. All required a second hemiepiphysiodesis operation. 2. nd. rebound was recorded in 3/21 (14%) FH patients and 2/9 (22%) PFFD patients. Conclusions. Temporary hemiepiphysiodesis is an effective treatment of angular deformities around the knees of FH and PFFD patients. With low complication rate and high risk of rebound phenomenon

Introduction. Recent advances in algorithms developed with passively collected sensor data from smart phones and watches demonstrate new, objective, metrics with the capacity to show qualitative gait characteristics. The purpose of this feasibility study was to assess the recovery of gait quality following primary total hip and knee arthroplasty collected using a smartphone-based care platform. Methods. A secondary data analysis of an IRB approved multicenter prospective trial evaluating the use of a smartphone-based care platform for primary total knee arthroplasty (TKA, n=88), unicondylar knee arthroplasty (UKA, n=28), and total hip arthroplasty (THA, n=82). Subjects were followed from 6 weeks preoperative to 24 weeks postoperative. The group was comprised of 117 females and 81 males with a mean age of 61.4 and BMI of 30.7. Signals were collected from the participants' smartphones. These signals were used to estimate gait quality according to walking speed, step length, and timing asymmetry. Post-operative measures were compared to preoperative baseline levels using a Signed-Rank test (p<0.05). Results. Mean walking speeds were lowest at postoperative week 2 for all three procedures (p<.001). The TKA population stabilized to preoperative speeds by week 17. For UKA cases, mean walking speeds rebounded to preoperative speed consistently by week 9 (p>.05). THA cases returned to preoperative walking speeds with a stable rebound starting at week 6 (p>.05), and improvement was seen at week 14 (p=.025). The average weekly step length was lowest in postoperative week 2 for both TKA and UKA (p<.001), and at week 3 for THA (p<.001). The TKA population rebounded to preoperative step lengths at week 9 (p=0.109), UKA cases at week 7 (p=.123), and THA cases by week 6 (p=.946). For TKA subjects, the change in average weekly gait asymmetry peaked at week 2 postoperatively (p <0.001), returning to baseline symmetry by week 13 (p=.161). For UKA cases, mean gait asymmetry also reached its maximum at week 2 (p =.006), returning to baseline beginning at week 7 (p=0.057). For THA cases mean asymmetry reached its maximum in week 2 (p <0.001) and was returned to baseline values at week 6 (p=.150). Discussion and Conclusion. Monitoring gait quality in real-world patient care following hip and knee arthroplasty using smart phone technology demonstrated recovery curves similar to previously reported curves captured by traditional gait analysis methods and patient reported outcome scores. Capturing such real-world gait quality metrics passively through the phone may also provide the advantage of removing the Hawthorne effect related to typical gait assessments and in-clinic observations, leading to a more accurate picture of patient function

Introduction. Coronal malalignment and leg length discrepancies (LLD) are frequently associated. Temporary hemiepiphysiodesis (tHED) is commonly employed for the correction of limb malalignment in skeletally immature patients. For treatment of LLD greater than 2 cm, lengthening with intramedullary legnthening nails is a safe and reliable technique. However, the combined application of these approaches in skeletally immature patients has not yet been investigated. Materials & Methods. Retrospective radiological and clinical analysis of 25 patients (14 females, 11 males) who underwent intramedullary femoral lengthening with an antegrade PRECICE® lengthening nail as well as tHED of the distal femur and / or proximal tibia between 2014 and 2019. tHED was conducted by implantation of flexible staples (FlexTack™) either prior (n = 11), simultaneously (n = 10), or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). Results. The median initial LLD was 39.0 mm (35.0–45.0). 21 patients (84%) presented valgus and 4 (16%) showed varus malalignment. Leg length equalization was achieved in 13 patients at skeletal maturity (62%). The median LLD of patients with a residual LLD > 10 mm was 15.5 mm (12.8–21.8). Limb realignment was obtained in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Conclusions. The combination of antegrade femoral lengthening and tHED can efficiently correct LLD and coronal limb malalignment in skeletally immature patients. Nevertheless, achieving limb length equalization and realignment may render difficult in cases of severe LLD and angular deformity. Furthermore, the reported techniques ought to be thoroughly planned and executed and require regular clinical and radiological examinations until skeletal maturity to avoid - or timely detect and manage - adverse events such as overcorrection and rebound of deformity

Introduction. Hindfoot surgery is assumed to be more painful than midfoot/forefoot procedures with the former often requiring an inpatient stay for pain relief. Poorly controlled pain is associated with adverse patient outcomes and consequently, peripheral nerve blocks (PNB) have become popular for their effective pain control. Aim. To investigate whether hindfoot procedures are more painful than forefoot/midfoot procedures by measuring pain scores, assessing effectiveness of PNBs and patient satisfaction in foot and ankle surgery. Method. In total 140 patients were prospectively studied. Inclusion criteria: Adults undergoing elective foot and ankle surgery. Exclusion criteria: Paediatric patients 16 years and under, those with alternate sources of pain, peripheral neuropathy or incomplete pain scores. Pain was measured via the Visual Analog Scale (VAS) at 3 intervals; immediately, 6 hours and at 24 hours post-operatively. A Johnson patient satisfaction assessment was conducted at 2 weeks. Statistical analysis was performed using SPSS v.18.0. Results. Forefoot/midfoot surgery vs. hindfoot surgery pain scores showed that there was no significant difference at any post-operative interval. PNB vs. no PNB pain scores showed that there was no significant difference at the first two intervals, except at 24 hours post-operatively, p = 0.024. Patients' who had a PNB experienced rebound pain at 24 hours. Overall 94% of patients were satisfied with their experience and anaesthetic. Conclusion. Hindfoot surgery is not more painful than forefoot/midfoot surgery when PNBs are used. Additionally, patients who have a PNB experience rebound pain at 24 hours post-operatively, a finding that requires further research

Ankle fractures are common orthopedic injuries, often requiring operative intervention to restore joint stability, improve alignment, and reduce the risk of post-traumatic ankle arthritis. However, ankle fracture surgeries (AFSs) are associated with significant postoperative pain, typically requiring postoperative opioid analgesics. In addition to putting patients at risk of opioid dependence, the adverse effects of opioids include nausea, vomiting, and altered mental status which may delay recovery. Peripheral nerve blocks (PNBs) offer notable benefits to the postoperative pain profile when compared to general or spinal anaesthesia alone and may help improve recovery. The primary objective of this quality improvement (QI) study was to increase PNB administration for AFS at our institution to above 50% by January 2021. A root cause analysis was performed by a multidisciplinary team to identify barriers for PNB administration. Four interventions were chosen & implemented: recruitment and training of expert anesthesiologists in regional anesthesia techniques, procurement of additional ultrasound machines, implementation of a dedicated block room with training to create an enhanced learning environment, and the development of an educational pamphlet for patients outlining strategies to manage rebound pain, instructions around the use of oral multimodal analgesia, and the potential for transient motor block of the leg. The primary outcome was the percentage of patients who received PNB for AFS. Secondary outcome measures included total hospitalization length of stay (LOS), post-anesthesia care unit (PACU) and 24-hour postoperative opioid consumption (mean oral morphine equivalent [OME]), proportion of patients requiring opioid analgesic in PACU, and proportion of patients experiencing post-operative nausea and/or vomiting (PONV) requiring antiemetic in PACU. Thirty-day post-operative emergency department (ED) visits were collected as a balance measure. The groups receiving PNB and not receiving PNB included 78 & 157 patients, respectively, with no significant differences in age, gender, or ASA class between groups. PNB administration increased from less than 10% to 53% following implementation of the improvement bundle. Mean total hospital LOS did not vary significantly across the PNB and no PNB groups (1.04 days vs. 1.42 days, P = 0.410). Both mean PACU and mean 24-hour postoperative opioid analgesic consumption was significantly lower in the PNB group compared to the no PNB group (OME in PACU 38.96mg vs. 55.42mg [P = 0.001]; 24-hour OME 44.74mg vs. 37.71mg [P = .008]). A greater proportion of patients in the PNB group did not require any PACU opioid analgesics compared to those in the no PNB group (62.8% vs. 27.4%, P < 0.001). The proportion of patients experiencing PONV and requiring antiemetic both in the PACU did not vary significantly across groups. Thirty-day postoperative ED visits did not vary significantly across groups. By performing a root cause analysis and implementing a multidisciplinary, patient-centered QI bundle, we achieved significant increases in PNB administration for AFS. As a result, there were significant improvements in the recovery of patients following AFS, specifically reduced use of postoperative opioid analgesia. This multi-faceted approach provides a framework for an individualized QI approach to increase PNB administration and achieve improved patient outcomes following AFS

A total of 25 children (37 legs and 51 segments) with coronal plane deformities around the knee were treated with the extraperiosteal application of a flexible two-hole plate and screws. The mean age was 11.6 years (5.5 to 14.9), the median angle of deformity treated was 8.3° and mean time for correction was 16.1 months (7 to 37.3). There was a mean rate of correction of 0.7° per month in the femur (0.3° to 1.5°), 0.5° per month in the tibia (0.1° to 0.9°) and 1.2° per month (0.1° to 2.2°) if femur and tibia were treated concurrently. Correction was faster if the child was under 10 years of age (p = 0.05). The patients were reviewed between six and 32 months after plate removal. One child had a rebound deformity but no permanent physeal tethers were encountered. The guided growth technique, as performed using a flexible titanium plate, is simple and safe for treating periarticular deformities of the leg

Aims

Temporary hemiepiphysiodesis (HED) is applied to children and adolescents to correct angular deformities (ADs) in long bones through guided growth. Traditional Blount staples or two-hole plates are mainly used for this indication. Despite precise surgical techniques and attentive postoperative follow-up, implant-associated complications are frequently described. To address these pitfalls, a flexible staple was developed to combine the advantages of the established implants. This study provides the first results of guided growth using the new implant and compares these with the established two-hole plates and Blount staples.

Purpose. To evaluate the effectiveness of post-operative pain management using the intra-operative peri-articular injection(PAI) and/or electromyography (EMG)-guided preoperative femoral nerve block (FNB) in total knee arthroplasty(TKA). Materials and Methods. From March 2013 to February 2014, 90 knees which underwent primary TKA by one surgeon were included in our study. The patients were classified into three groups; a single injection FNB with an EMG guide (Group I, 30 knees), intra-operative PAI (Group II, 30 knees) and both FNB and PAI (Group III, 30 knees). Pain at rest and moving was evaluated by Visual Analogue Scale (VAS) at postoperative 0, 4, 8, 24 and 48 hours. Postoperative range of motion, time to walking, total blood loss, amount of opioid consumption and complications were compared in each group. Results. VAS immediately after surgery was 67.9 in group I, 54.6 in group II and 54.7 in group III. VAS was significantly higher in group I than group II and III (p=0.005), but was not significantly different between group II and III (p>0.05). VAS at postoperative 4 and 8hr showed similar results. VAS at postoperative 24 hr was 49.6 in group I, 56.4 in group II and 46.7 in group III, which was significantly higher in group II than group I and III (p=0.043). After postoperative 48hr, there were no differences in group I, II and III. The total amount of opioid consumption in group III was smaller than that in group I and II (p=0.017). There were no differences in postoperative range of motion, time to walking and total blood loss. There was one case with temporary peroneal nerve palsy in group II and no infection in all cases. Conclusion. PAI was more effective than FNB for early (0∼8hr) postoperative period after TKA. However, PAI showed rebound pain at 24hr after TKA. PAI in combination with FNB could enhance the effect of postoperative pain management from immediate postoperative period to 24hr

Diagnosis, treatment and outcome in systemic infection caused by Coccidioides Immitis in a non endemic region. First case in Spain. 71 year old patient. Symptoms: stomach aches, tiredness and weight loss of 14kg. Imaging Investigations: Abdominal pelvic US and Gastroscopy were performed as cancer was suspected. This study showed a bilateral suprarrenal mass. Fearing a pulmonary mass a Thoracic Scan was requested. Results proved mediastinal and axillary nodes. Also found was interstitial illness which lead to a working diagnosis of Granulomatous Lymphangitis. BIOPSIES: An axillary lymph node, suprarrenal gland and pulmonary tissues. ANATOMOPATHOLOGY: Necrotising Granulomatous Lymphadenitis. DIFFERENTIAL DIAGNOSIS: TBC, Sarcoidosis and Autoinmune illnesses. SAMPLE CULTURES were repeatedly negative for funghi, bacteria and Mycobacterium. DIAGNOSIS The patient was subsequently he was commenced on Substitute Hormonal Therapy with improvement of symptoms. MANAGEMENT: Due to a gonarthrosis he required Total Knee Arthroplastia. During surgery a prominent SINOVITIS was noticed, with anatomopathology results of Chronic Necrotising Granulomatous Sinovitis with lymphoid folicules. FOLLOW UP: 7 years after the patient attends A&E with signs of infection on the replaced knee. A bacterial infection is suspected and the patient is admitted into hospital for the replacement extraction, cement substitution with Gentamicin and iv antibiotherapy with LEVOFLOXACIN. His symptoms improved up to a month when he returned to A&E with similar presentation THE PATIENT IS ADMITTED ONCE MORE FOR SURGERY:. Sample Cultures from the prosthesis showed positive growth for Coccidiodes Immitis. Article Reviews provided us with brand new information. A new approach was taken and anamnesis was geared towards finding out a possible contact with the funghi in the endemic region. It appeared that the patient had worked as a Shepherd for four years (1957–1961) in Bakersfield. A Southern Californian region north to LA and under San Francisco. After all, he was admitted for 25 days in a local hospital for pneumonia. DIAGNOSIS WAS REACHED thanks to these findings. The old spacer wasswapped for a Cement Spacer with Amphotericin B 250 mg. Oral treatment with FLUCONAZOL 400 mg/day was associated and after a few days changed to ITRACONAZOL 200 mg/12 hours orally. The patient improved local and systemically. After a few months he evolved as planned and now has a good general and local condition with normal biochemistry results. A final ARTHRODESIS was performed. It's quite likely that he may require long life therapy with Antifungals to avoid reactivations. We highlight the originality of the case, as the first diagnosis of articular Coccidioides diagnosed in Spain, and its successful outcome with prosthetic replacement rebound and chronic antifungal therapy

The December 2022 Children’s orthopaedics Roundup³⁶⁰ looks at: Immobilization of torus fractures of the wrist in children (FORCE): a randomized controlled equivalence trial in the UK; Minimally invasive method in treatment of idiopathic congenital vertical talus: recurrence is uncommon; “You’re O.K. Anaesthesia”: closed reduction of displaced paediatric forearm and wrist fractures in the office without anaesthesia; Trunk range of motion and patient outcomes after anterior vertebral body tethering versus posterior spinal fusion: comparison using computerized 3D motion capture technology; Selective dorsal rhizotomy for individuals with spastic cerebral palsy; Scheuermann’s kyphosis and posterior spinal fusion; All-pedicle-screw constructs in skeletally immature patients with severe idiopathic early-onset scoliosis; Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy.

Aims

Accurate skeletal age and final adult height prediction methods in paediatric orthopaedics are crucial for determining optimal timing of growth-guiding interventions and minimizing complications in treatments of various conditions. This study aimed to evaluate the accuracy of final adult height predictions using the central peak height (CPH) method with long leg X-rays and four different multiplier tables.

Aims

This study investigated vancomycin-microbubbles (Vm-MBs) and meropenem (Mp)-MBs with ultrasound-targeted microbubble destruction (UTMD) to disrupt biofilms and improve bactericidal efficiency, providing a new and promising strategy for the treatment of device-related infections (DRIs).

Purpose. To document the incidence and nature of complications associated with hemiepiphysiodesis using a screw and plate device (8-plate, Orthofix). Methods. We reviewed case notes and radiographs of 71 children (130 segments) with lower limb deformities treated with temporary hemiepiphyseal arrest using the 8-plate. 96% of deformities were in the coronal plane, 4% sagittal. 72% of coronal deformities demonstrated valgus malalignment. We defined three types of complications:. early (perioperative) complications eg infection and/or wound breakdown, bleeding, neurological impairment. implant related complications such as soft tissue irritation, plate breakage or migration,. complications involving the growth plate including rebound deformity, early physeal closure or iatrogenic deformity. Complications were related to variables of patient age, gender, diagnosis, location of deformity and associated surgery. Results. The average age at surgery was 10 years (range 3-16). There were 41 boys, 30 girls. 3/70 patients were treated for an idiopathic deformity: the remainder were affected by a wide range of pathologies (20% skeletal dysplasia, 20% metabolic bone disease). Full correction has occurred in 38% of patients. The remaining 45 children are all showing improvement in their deformity. 10 patients (14%) have had a complication: 3 patients had early complications (wound infection, wound breakdown and intra-operative hypotensive crisis) and 2 patients have had implant related complications (irritation and migration). In a further 5 patients there have been physis related problems: 1 over-correction, 1 recurrence and 3 cases in which the timing of the procedure or the ill-health of the physis did not allow correction to occur. Conclusion. The 8-plate is an effective device in the management of deformity secondary to pathological conditions. 10% of patients had complications: the majority were minor but care should be taken regarding the timing of the procedure related to the growth potential of the pathological physis