To evaluate the efficacy of VEPTR in preventing further progression of scoliosis without impeding spinal growth in the treatment of children with progressive early onset scoliosis (EOS) without rib abnormalities.

Prospective, multi-center, observational cohort study on patients with EOS treated with VEPTR with 2-year follow up. Data were analysed based on measurements done pre-implant, immediate post-op and at 2-yr f/u.

Sixty-three patients met inclusion: 35 males and 28 females. Mean age at time of implantation was 6.1±2.4 yrs. Etiologies included congenital (n=6), neuromuscular (n=36), syndromic (n=4), and idiopathic (n=17). Mean follow up was 2.2±0.4 yrs. Scoliosis (72o±18o) decreased after implant surgery (47o±17o) followed by slight increase at 2-yr f/u (57o±18o), p<0.0001.

At 2-yr f/u, VEPTR was effective in treating EOS without rib abnormalities with 86% of patients having an improvement in scoliosis and 94% of patients having an increased spinal height as compared to pre-operatively. VEPTR provided greater than 100% of expected age-matched spine growth and the instrumented spinal segment continued to grow during distraction phase. This large prospective, multicentre study demonstrated the ability of VEPTER to effectively treat EOS without rib abnormalities. Goals of preventing further scoliosis progression and of maintaining normal spine growth were achieved.

Introduction

Appropriate consenting is part of good medical practice and is a medico-legal necessity for invasive procedures. The BOA recently created generic consent forms covering the relevant complications for orthopaedic procedures, thus providing a standard for all orthopaedic consent. This study aims to assess the quality of consent in orthopaedic practice.

Introduction

Children with early-onset scoliosis (EOS) with rib hump chest-wall distortion or fused/absent ribs have thoracic insufficiency syndrome (TIS). Commonly, respiration is adversely affected by loss of lung volume from chest-wall constriction and clinical loss of active rib cage expansion. The dynamic thoracic components of diaphragm or rib cage lung expansion during respiration is poorly characterised by radiograph or CT scan. Pulmonary function tests indicate only hemithorax performance. Dynamic lung MRI, however, can visualise both chest-wall and diaphragm motion, allowing assessment of each individual hemithorax performance, so that a dynamic classification system of the thoracic function can be developed.

Introduction

Many methods are available for distal anchoring of spine-based and rib-based growing rod systems for early-onset scoliosis. One of these methods, pelvic S-hooks, was initially recommended for patients with spina bifida or for those with severe thoracolumbar curves. No study has yet analysed the clinical and radiographic effects of S-hooks on patients with rib-based instrumentation. The purpose of this study is to retrospectively review the results of S-hook pelvic fixation in patients with rib-based instrumentation

Purpose: Since the advent of pinning for supracondylar fractures of the humerus, Volkmann syndrome has been exceptional and most of the posttraumatic compartment syndromes observed in children have been seen in the lower limb. We propose an analysis of the causes, the diagnosis, the treatment and the results of treatment of acute posttraumatic compartment syndrome of the leg in children.

Material and methods: Twenty-eight consecutive cases of acute posttraumatic compartment syndrome in 27 children were reviewed. These children were treated in two American paediatric traumatology units over a ten year period. We evaluated the cause of the trauma, associated lesions, clinical course, diagnostic methods, muscle compartment pressures, time from accident to diagnosis, and time from accident to surgery. Results were analysed at last follow-up.

Results: The study population was 24 boys and three girls, aged 4 months to 15 years. Twenty-four children were pedestrian traffic accident victims. Twenty-two had a tibial fracture, four a femoral fracture, and two no fracture. Twenty-five compartment syndromes were diagnosed on the basis of compartment pressure measurements. Mean time from accident to diagnosis was 19 hours (range 2.5–85 hr). At diagnosis, exacerbated pain was observed in 26 children, paraesthesia in eleven, motor deficit in seven, and diminished pulses in three. Mean time from accident to surgery was 21 hours. Mean follow-up was 15 months. The final outcome was remarkably good. At last follow-up, 24 children were pain free, with no functional or sensorial deficit. Aponeurotomy had been performed very late (43, 83, and 86 hr) in the three patients who developed functional deficit. There were no cases of infection even when surgery was performed late.

Discussion: Most children treated for acute posttraumatic compartment syndrome achieve a good result even when the time from accident to treatment is long, often more than 12 hours. All patients with sequellae at the last follow-up in our series had undergone aponeurotomy more than 36 hours after the accident.

Conclusion: This is the first series devoted exclusively to acute posttraumatic compartment syndrome of the leg in children. The results were generally good despite significant time from accident to treatment.