Background

Using flexible tethering techniques, porcine models of scoliosis have been previously described. These scoliotic curves showed vertebral wedging but very limited axial rotation. In some of these techniques, a persistent scoliotic deformity was found after tether release. The possibility to create severe progressive true scoliosis in a big animal model would be very useful for research purposes, including corrective therapies.

Introduction: Children with clubfoot treated by the Ponseti method of clubfoot management require anterior tibialis tendon transfer if there is persistent varus and supination deformity. However the size of bone is a determining factor in whether this transfer can be carried out. We have assesses the difference in the age at which the lateral cuneiform ossifies in normal feet compare with clubfeet

Methods: Foot x-rays of children less than 4 years old (AP view) carried out between 2003 and 2005 were obtained from the Radiology department Booth Hall Children’s Hospital. A total of 341 radiographs were analyzed. Exclusion criteria included: any condition affecting foot anatomy or weight bearing or any previous surgery (including surgery for clubfoot). The lateral cuneiform was measured with 1mm accuracy in the longest diameter.

Results: We analysed the size of the lateral cuneiform in patients with and without clubfoot in relation to age. In children without clubfoot there was a R2 value of 0.517, showing a positive correlation between age and size of the bone. In children with clubfoot, R2 value was 0.207 showing no correlation between age and ossification rate of the lateral cuneiform. In addition, we compare the size of the lateral cuneiform between patients with and without clubfoot at different ages. There was a significance difference in the level of ossification of the lateral cuneiform in all age groups. In addition, a greater number of patients with no ossification of the lateral cuneiform were found amongst the clubfoot group in all age groups up to the age of 36 months.

Conclusions: We have identified a delayed ossification in the lateral cuneiform in children with clubfoot when compared with normal feet. This delayed ossification should be taken into account when considering anterior tibialis tendon transfer for correction of clubfoot

Introduction: There are protocols on the management of polytrauma in obstetric patients. However, there is little information about osteo-articular injuries sustained in these patients. The object of this study is to review the management of these patients and to suggest a guideline.

Material and method: Inclusion criteria: Pregnant patients treated during the last 6 years, treated as inpatients in our center during pregnancy due to osteo-articular injuries.

Variables studied: Gestational age, mechanism of injury, fracture type, management, termination of pregnancy and sequelae.

Results: We treated 13 patients with 21 fractures in our center, with an incidenc of 2,13 fractures/10.000 births. The mechanism of injury was low degree trauma in 6 cases (60% 3rd trimester) and high-degree in 7 (83% 1st and 2nd trimester). There was a predominance of lower extremity fractures, especially tibia and fibula (7 cases) and pelvis (3 cases).

Gestational age was 1st trimester (3 cases), 2nd trimester (5 cases), 3rd trimester (5 cases). 10 women were treated surgically, 8 before finishing gestation. Gestation ended as and induced abortion (3 cases, 1 due to fetal death and 2 due to teratogenic risk), and birth (10 cases, all alive, 50% eutocic). Only 3 babies needed type II or type III neonatal reanimation.

CONCLUSIONS: Pregnant women can get injured by low-energy trauma, especially during the third trimester. Pregnancy does not necessarily compromise surgical management of fractures. We review diagnostic and therapeutic management strategies for these patients.

Aims: To assess the effectiveness of intra-articular facet joint injections in controlling disability in patients with low back pain. Methods: 100 consecutive patients admitted in our day case unit for facet joint injections were included in the study. Fluoroscopically controlled intra-articular facet joint block with injection of a local anaesthetic and corticosteroid suspension was performed after clinical and radiological assessment. Disability due to back pain was assessed by determining a revised Oswestry Low Back Pain Disability Index (Oswestry Score). The patients completed a questionnaire immediately prior to treatment, two weeks following injection and three months following injection. Results: Facet joint injections were performed for intervertebral disc prolapse (66%), spondylolysthesis (13%), spinal stenosis (10%), spondylosis (7%), and sacro-iliac joint pain (4%). The mean Oswestry Score prior to injection was 40.6% (95% conþdence interval 4.4), at two weeks following injection was 26.6% (95% conþdence interval 4.9) and at three months following injection was 21.5% (95% conþdence interval 4.8). 78% of the patients found the facet joint injections useful at 2 weeks following treatment and this þgure was maintained (79%) at 3 months after injection. No complications were reported following treatment. Conclusions: We have found intra-articular facet joint block for the treatment of low back pain a valid therapeutic option, acceptable by the patients and with negligible risks.

Introduction and Objectives: Posterior or posterolateral approaches to the hip joint have classically been associated with higher rates of dislocation. The goal of this study is to investigate the effect of reconstructive procedures of the posterior joint capsule and external rotator muscles in the short term on incidence of luxation and to compare these procedures with anterior or anterolateral approaches in which such procedures were not performed.

Materials and Methods: This is a prospective study of 605 total primary hip arthroplasties based on 2 models that have been widely used in our centre. The cases included 431 biological fixation prostheses coated with hydroxyapatite with 28mm heads and 174 low-friction cemented prostheses with 22.25 mm heads. These surgeries were performed consecutively in our centre, with a minimum follow-up of 6 months. Each patient was assigned to one of two groups based on the individual preference of the surgeon performing the operation: anterior or posterior. Only in the latter group was reconstruction of the capsule and external rotator musculature performed. Cases in which previous surgery had been performed on the hip were not included in this study in order to avoid skewing results, as previous surgery is the factor known to have the greatest impact on dislocation rate.

Results: A procedure involving reconstruction of both the posterior capsule and external rotator musculature significantly reduced the rate of early dislocation in primary total hip arthroplasties done using a posterior approach. Incidence of dislocation in these cases was lower than in cases with anterior approaches where a wider capsulectomy was performed without reconstruction.

Conclusion: The idea that the dislocation rate in total hip arthroplasties is higher with a posterior approach should be reconsidered.