Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

Objective: This study has investigated the amount of bone remodeling in patients with a slipped capital femoral epiphysis (SCFE) treated with in situ fixation until closure of the epiphysis and the factors affecting remodeling. Method: Patients who underwent surgery for SCFE between January 2010 and January 2015 were retrospectively screened: Twenty-four male and 7 female patients (mean age 12.6 +- 1.9 years) were included in the study. Gender, age, history, and laterality of trauma, duration of hip pain (acute, chronic, acute on chronic background), and hip radiographs were evaluated. The Southwick and alpha angles were measured, and the factors affecting remodeling were assessed. The statistical analyses were conducted using SPSS 25.0 (IBM Corp., Armonk, NY); 95% confidence levels were calculated and p < 0.05 was considered to indicate statistical significance. Results: The preoperative displacement angles measured on the anteroposterior and lateral radiographs were 15.03° +- 9.1° and 25.93° +- 14.1° and at the last follow-up they were 11.63° +- 8.7° and 21.6° +- 12.1°, respectively. The alpha angles measured on the lateral radiographs preoperatively and at the end of follow-up were 52.33° +- 11.6° and 47.87° +- 11.8°, respectively. Significant remodeling was reflected in the angles measured on the anteroposterior and lateral X-ray images. Greater preoperative displacement angle was associated with less remodeling. Conclusion: Preoperative displacement affects the degree of postoperative remodeling. In patients with severe epiphyseal displacement, open reduction is an option but in situ pinning should be considered in that it is less invasive and more physiological

Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures. Treatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction, 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction. Lateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR. Medial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation. Level IV, Therapeutic study

Evaluation of Clinical and Radiographic Outcomes of Complete Subtalar Release in Clubfoot Treatment

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results. Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination. Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot. Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. (J Am Podiatr Med Assoc 98(6): 451–456, 2008)</jats:p

Optimum Screw Configuration for the Fixation of Sanders Type IIC Tongue-Type Fractures? A Biomechanical Study

Background: The minimally invasive technique (percutaneous screw fixation) is one of the options for treating tongue-type IIC fractures successfully. The aim of this study was to assess the biomechanics of four different screw configurations used for the fixation of tongue-type IIC calcaneal fractures

Medial percutaneous hemi-epiphysiodesis improves the valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis

BACKGROUND AND PURPOSE: Avascular necrosis (AVN) is a major cause of disability after treatment of developmental dysplasia of the hip (DDH), leading to femoral head deformity, acetabular dysplasia, and osteoarthritis in adult life. Type-II AVN is characterized by retarded growth in the lateral aspect of the physis or by premature lateral fusion, which produces a valgus deformity of the head on the neck of the femur. We investigated the effect of medial percutaneous hemi-epiphysiodesis as a novel technique in the treatment of late-diagnosed type-II AVN. PATIENTS AND METHODS: 9 patients (11 hips) with a diagnosis of type-II AVN who underwent medial percutaneous hemi-epiphysiodesis after the surgical treatment for DDH were included in the study. 10 patients (12 hips) with the same diagnosis but who did not undergo hemi-epiphysodesis were chosen as a control group. Preoperative and postoperative articulotrochanteric distances, head-shaft angles, CE (center-edge) angles, and physeal inclination angles were measured. The treatment group underwent medial hemi-epiphysodesis at a mean age of 8 years. The mean ages of the treatment group and the control group at final follow-up were 14 and 12 years respectively. The mean duration of follow-up was 5.7 years in the treatment group and 8.3 years in the control group. RESULTS: Preoperative articulotrochanteric distance, head-shaft angle, and functional outcome at the final follow-up assessment were similar in the 2 groups. However, preoperative and postoperative CE angles and physeal inclination angles differed significantly in the treatment group (p < 0.05). The final epiphyseal valgus angles were better in the treatment group than in the control group (p = 0.05). The treatment group improved after the operation. INTERPRETATION: Medial percutaneous epiphysiodesis performed through a mini-incision under fluoroscopic control is a worthwhile modality in terms of changing the valgus tilt of the femoral head