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The Bone & Joint Journal
Vol. 104-B, Issue 11 | Pages 1273 - 1278
1 Nov 2022
Chowdhury JMY Ahmadi M Prior CP Pease F Messner J Foster PAL

Aims

The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children.

Methods

In this study, there were 59 consecutive tibial lengthening and deformity corrections in 57 children using a circular frame. All were performed or supervised by the senior author between January 2013 and June 2019. A total of 25 who underwent a distal tibial osteotomy were analyzed and compared to a group of 34 who had a standard proximal tibial osteotomy. For each patient, the primary diagnosis, time in frame, complications, and lengthening achieved were recorded. From these data, the frame index was calculated (days/cm) and analyzed.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_7 | Pages 19 - 19
1 May 2015
Pease F Ward A Stevens A Cunningham J Sabri O Acharya M Chesser T
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Stable, anatomical fixation of acetabular fractures gives the best chance of a good outcome. We performed a biomechanical study to compare fracture stability and construct stiffness of three methods of fixation of posterior wall acetabular fractures.

Two-dimensional motion analysis was used to measure fracture fragment displacement and the construct stiffness for each fixation method was calculated from the force / displacement data.

Following 2 cyclic loading protocols of 6000 cycles, to a maximum 1.5kN, the mean fracture displacement was 0.154mm for the rim plate model, 0.326mm for the buttress plate and 0.254mm for the spring plate model. Mean maximum displacement was significantly less for the rim plate fixation than the buttress plate (p=0.015) and spring plate fixation (p=0.02).

The rim plate was the stiffest construct 10962N/mm (SD 3351.8), followed by the spring plate model 5637N/mm (SD 832.6) and the buttress plate model 4882N/mm (SD 387.3).

Where possible a rim plate with inter-fragmentary lag screws should be used for isolated posterior wall fracture fixation as this is the most stable and stiffest construct. However, when this method is not possible, spring plate fixation is a safe and superior alternative to a posterior buttress plate method.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 576 - 577
1 Aug 2008
Pease F Ehrenraich A Skinner J Williams A Bollen S
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Purposes of Study: To establish what happens, over time, to an ACL graft which is implanted in the skeletally immature knee.

Methods/Results: 5 cases of hamstring ACL reconstruction in prepubertal patients were available from the practices of 2 surgeons in which there were X-ray/MRI images taken over a period of an average of approximately 3 years from the operation. The changes in graft dimensions were measured from these images. No case of growth arrest was seen, nor of soft tissue contracture such as fixed flexion. All patients recovered to their same pre-injury level of activity, including elite level sport in 3 cases. Clinical laxity tests were always satisfactory but the senior authors have noticed that they tighten in time.

The growth of the patients was an average 17cm. The graft diameters did not change despite large changes in graft length (average 145%). Most of the length gain was in the femur.

Conclusion: Much has been written regarding potential harm to the growth plate in these patients but we are not aware of literature on the subject of the fate of the graft itself. Considerable length changes in the grafts were evident. The biological phenomena taking place in the graft are unknown. We have clearly shown an increase in the size of graft tissue due to lengthening but no change in girth. Either the graft stretches or tissue neogenesis occurs, or both. If it simply stretched then the graft would be expected to become narrower, at least in places- it did not. Nevertheless the ‘tightening’ phenomenon reported anecdotally could be due to the graft having to stretch but failing to keep up with growth. As the volume of graft increases so much then at least some neogenesis is highly likely.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 4 | Pages 455 - 459
1 Apr 2008
Bollen S Pease F Ehrenraich A Church S Skinner J Williams A

The potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally-immature patients is well documented, but we are not aware of literature on the subject of the fate of the graft itself. We have reviewed five adolescent males who underwent reconstruction of the ligament with four-strand hamstring grafts using MR images taken at a mean of 34.6 months (18 to 58) from the time of operation. The changes in dimension of the graft were measured and compared with those taken at the original operation. No growth arrest was seen on radiological or clinical measurement of leg-length discrepancy, nor was there any soft-tissue contracture. All the patients regained their pre-injury level of activity, including elite-level sport in three. The patients grew by a mean of 17.3 cm (14 to 24). The diameter of the grafts did not change despite large increases in length (mean 42%; 33% to 57%). Most of the gain in length was on the femoral side. Large changes in the length of the grafts were seen.

There is a considerable increase in the size of the graft, so some neogenesis must occur; the graft must grow.