A-Frame free Vascularized Fibular Graft and Femoral Lengthening for Osteosarcoma Pediatric Patients.

Background: Pediatric limb reconstruction after resection of a malignant tumor presents specific challenges. Multiple surgical techniques have been used to treat these patients. This paper describes a staged surgical technique for the reconstruction of large distal femoral defects due to tumor resection in skeletally immature patients.

Single- versus dual-rod anterior instrumentation of thoracolumbar curves in adolescent idiopathic scoliosis.

Purpose: Single or dual-rod instrumentation can be used for the anterior fixation of the spine in adolescent idiopathic scoliosis (AIS). We aim to compare the complications, radiographic and functional outcomes of patients with AIS who have undergone single and dual-rod instrumentation.

Methods: This is a multi-centre study involving the Royal Children's, Royal Melbourne and Epworth hospitals.

Surgical fusion of early onset severe scoliosis increases survival in Rett syndrome: a cohort study.

Aim: Scoliosis is a common comorbidity in Rett syndrome and spinal fusion may be recommended if severe. We investigated the impact of spinal fusion on survival and risk of severe lower respiratory tract infection in Rett syndrome.

Method: Data were ascertained from hospital medical records, the Australian Rett Syndrome Database, a longitudinal and population-based registry, and from the Australian Institute of Health and Welfare National Death Index database.

Caput valgum associated with developmental dysplasia of the hip: management by transphyseal screw fixation.

Purpose: A late finding of some hips treated for developmental dysplasia of the hip (DDH) is a growth disturbance of the lateral proximal femoral physis, which results in caput valgum and possibly osteoarthritis. Current treatment options include complete epiphysiodesis of the proximal femoral physis or a corrective proximal femoral osteotomy. Alternatively, a transphyseal screw through the inferomedial proximal femoral physis that preserves superolateral growth might improve this deformity.

Family satisfaction following spinal fusion in Rett syndrome.

Purpose: We evaluated family satisfaction following spinal fusion in girls with Rett syndrome.

Methods: Families participating in the population-based and longitudinal Australian Rett Syndrome Database whose daughter had undergone spinal fusion provided data on satisfaction overall, care processes and expected changes in health and function. Content analysis of responses to open-ended questions was conducted.

Pediatric pelvic fracture: a modification of a preexisting classification.

Background: The classic pediatric pelvic fracture (PPF) classification was developed by Torode and Zeig in 1985 and is based exclusively on plain radiographs. The purpose of this study was to propose a modification to a previously accepted PPF classification scheme and discuss the significance of this modification with respect to treatment and management of PPF over an 8-year period at a large pediatric hospital.

Methods: PPFs were recorded on a prospectively identified hospital registry of all trauma admissions.

Slipped upper femoral epiphysis in children--delays to diagnosis.

Background: Slipped upper femoral epiphysis (SUFE) is a childhood condition requiring urgent admission for surgery. It is often complicated by delayed diagnosis.

Method: This study investigated incidence and factors contributing to delayed diagnosis of SUFE, by retrospective and prospective review of children (n=120) presenting to a tertiary institution with SUFE from 2003-2007.

Low grade fibromyxoid sarcoma: problems in the diagnosis and management of a malignant tumour with bland histological appearance.

Aims: To review the clinicopathological features and highlight the problems in the diagnosis and management of low grade fibromyxoid sarcomas (LGFMS).

Methods: Three cases of LGFMS were studied with histology and immunohistochemistry, and cytogenetics in one. The features and problems were compared with those in the literature.

SHOX gene is expressed in vertebral body growth plates in idiopathic and congenital scoliosis: implications for the etiology of scoliosis in Turner syndrome.

Reduced SHOX gene expression has been demonstrated to be associated with all skeletal abnormalities in Turner syndrome, other than scoliosis (and kyphosis). There is evidence to suggest that Turner syndrome scoliosis is clinically and radiologically similar to idiopathic scoliosis, although the phenotypes are dissimilar. This pilot gene expression study used relative quantitative real-time PCR (qRT-PCR) of the SHOX (short stature on X) gene to determine whether it is expressed in vertebral body growth plates in idiopathic and congenital scoliosis.

Ligamentum teres tenodesis in medial approach open reduction for developmental dislocation of the hip.

Background: When closed reduction of a developmental dislocation of the hip fails, some form of open reduction is required. In recent years, the many advantages of the medial approach open reduction have been emphasized. However, there have been suggestions that the rate of growth disturbance in the proximal femur and the requirement for secondary surgical procedures may be higher with this route than with others.

Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone.

We wished to determine the relative physical and psychosocial merits of limb-sparing reconstruction, above-knee amputation, and rotationplasty in survivors of childhood and adolescent lower extremity bone sarcoma. In comparing minimum 5-year disease-free survivors, we found that outcome was somewhat dependent on the measuring tool administered. A superior score of statistical significance on the system of evaluation of the Musculoskeletal Tumour Society and a trend toward higher Toronto Extremity Salvage Scores were found among patients with a limb-sparing reconstruction compared with those with an above-knee amputation.

Orthopaedic sequelae of meningococcal septicemia.

The records of 143 patients admitted with a diagnosis of meningococcal septicemia were reviewed to identify vascular, cutaneous, and osseous sequelae. During the acute phase of the disease there were 21 deaths and 17 patients lost tissue. Thirty-six digits were allowed to autoamputate and six surgical amputations were performed.

Medial approach for corrective osteotomy of cubitus varus: a cosmetic incision.

Osteotomies described previously to correct cubitus varus had been associated with unsatisfactory results such as a prominent lateral scar and condyle and injury to the triceps. The authors evaluated the results of a medial approach for the corrective osteotomy of 14 consecutive children (mean age 8.4 years) with cubitus varus.

Changing glenoid version after open reduction of shoulders in children with obstetric brachial plexus palsy.

Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery. All the patients had a preoperative computerized axial tomograph and postoperative computed tomography scan of both shoulders at approximately yearly intervals to assess the degree of congruity of the glenohumeral joint and glenoid version. Surgery was performed between 1988 and 1997.