The aim of this study was to report the restauration of the normal vertebral morphology and the absence of curve progression after removal the instrumentation in AIS patients that underwent posterior correction of the deformity by common all screws construct whitout fusion. A series of 36 AIS immature patients (Risser 3 or less) were include in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). Curve correction was assessed at pre and postoperative, before instrumentation removal, just post removal, and more than two years after instrumentation removal. Epiphyseal vertebral growth modulation was assessed by a coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7°±7.5 to 5.5º±7.5º (89.7%) at the immediate postop. After implants removal (31.0±5.8 months) the MC was 13.1º. T5–T12 kyphosis showed a significant improvement from 19.0º before curve correction to 27.1º after implants removal (p<0.05). Before surgery, WR was 0.71±0.06, and after removal WR was 0.98±0.08 (p<0.001). At the end of follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2±21.0º. SRS-22 scores improved from 3.31±0.25 preoperatively to 3.68±0.25 at final assessment (p<0.001). In conclusion, fusionless posterior approach using a common all pedicle screws construct correct satisfactory scoliotic main curves and permits removal of the instrumentation once the bone maturity is reached. The final correction was highly satisfactory and an acceptable ROM of the previously lower instrumented segments was observed.

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.

Introduction and purpose: We present the results of our surgical method involving nerve decompression, reduction and circumferential spinal fusion via posterior approach for severe spondylolisthesis.

Materials and methods: We studied 14 patients with spondylolisthesis and slippage greater than 50%; mean age 24. Mean slip angle 37° and mean preoperative slip 74%.

Procedure: Via a posterior approach we performed neural decompression and placed pedicle screws in L5-S1 (in one case we instrumented L4 for associated L4-L5 spondylolisthesis) and iliac screws (except in three cases). We removed the annulus fibrosus, the L5-S1 disc and the rounded proximal edge of the sacrum. Following distraction of L5-S1 we inserted bone graft cages (from 3 to 5). We adjusted the bars with spanners to reduce slippage and achieve final curvature of the spine.

The cases were monitored with evoked potentials and epidural catheter.

We studied preoperative, postoperative and final check X-rays. The clinical histories were also reviewed.

Results: One rupture of the dura. Two patients with anterior slippage of a cage. One posterior slippage of L5 screws, without revision surgery. One postoperative infection resolved by surgical cleaning and antibiotic therapy.

After mean follow-up of 32 months the radiographic study showed no pseudoarthrosis. Final mean slippage was 15% and slip angle 5°. Ten patients had no pain or physical limitations. Two presented mild lumbar discomfort and occasional limitation.

Conclusions: The procedure we used was shown to be effective in correcting the deformity with excellent clinical results.

From 1999 to 2002, eight children, ranging in age from 2 to 12 years, were treated for acute septic arthritis of the hip by arthroscopic debridement. The hip was initially aspirated under image control and distended with clear saline and a routine medium, or a small joint arthro-scope was introduced into the joint. The hip was irrigated and a suction drain inserted. All patients who presented early did well; those presenting later had a poor result. The functional recovery rate was faster than with the classical arthrotomy. Arthroscopic drainage may be a valuable tool in the treatment of acute septic arthritis.

We report a postal survey of 59 families of children with osteogenesis imperfecta. From the 51 replies we collected data on developmental milestones and walking ability and related them to the Sillence and the Shapiro classifications of osteogenesis imperfecta. Twenty-four of the patients had been treated by intramedullary rodding.

Both classifications helped to predict eventual walking ability. We found that independent sitting by the age of ten months was a predictor for the use of walking as the main means of mobility with 76% attaining this. Of the patients who did not achieve sitting by ten months, walking became the main means of mobility in only 18%. The developmental pattern of mobility was similar in the rodded and non-rodded patients.

We report two cases of deformity of the ankle caused by physeal damage secondary to extravasation of an intravenous infusion in infancy. The possible mechanisms of injury to the physis are discussed.