Antegrade femoral lengthening and simultaneous hemiepiphysiodesis for congenital femoral deficiency.

Purpose: Congenital femoral deficiency is characterized by limb length discrepancy and genu valgum. Lengthening of the femur along its anatomic axis increases valgus alignment by medial knee translation. Pairing limb lengthening with simultaneous medial distal femoral hemiepiphysiodesis can simultaneously correct two limb deformities.

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment.

Genu recurvatum-valgus arises from the proximal tibia and poses challenges in its treatment. The etiology of the combined deformities can include physeal trauma (often unrecognized), iatrogenic injury, infection, tumor, Osgood-Schlatter syndrome, skeletal dysplasia, and ligamentous laxity. Both osseous and ligamentous contributions must be recognized for successful treatment.

Reduction of High Hip Dislocation With a Distraction Nail and Arthroplasty (Preliminary Results of a Novel Technique).

A novel distraction technique is described for total hip arthroplasty in symptomatic high hip dislocation (Crowe IV) combining an intramedullary motorized lengthening nail with a pelvic support plate to gradually stretch hip soft tissues (distalization) and performing total hip arthroplasty with the cup in the primary acetabulum. Twelve patients (15 hips) were identified in a retrospective study via chart review. Medical records and radiographs were reviewed for details of the initial case parameters, surgical details, magnitude of distalization, duration of treatment, outcomes, and complications.

Re-use of Motorised Intramedullary Limb Lengthening Nails.

Aim: This study reviews the re-use of implanted motorised intramedullary lengthening nails previously used for limb lengthening.

Materials And Methods: A retrospective review was performed on the re-use of motorised intramedullary lengthening nails. All patients had a magnetically controlled intramedullary lengthening nail in the femur, tibia, or humerus previously utilised for either lengthening or compression.

Motorized Plate Lengthening of the Femur in Children: A Preliminary Report.

Background: Limb lengthening by distraction osteogenesis can be performed with motorized internal devices, but intramedullary implants risk avascular necrosis of the femoral head in young children. A method of internal limb lengthening using a motorized expandable plate has been developed and preliminary results are presented.

Methods: Seven skeletally immature patients (ages 2.

Segmental Bone Defects and the History of Bone Transport.

This article describes the etiology of segmental bone defects and reviews the options of care, past and present. A brief description of distraction osteogenesis and how the Ilizarov method was used to treat bone defects with circular external fixation leading to the latest method of transport with motorized internal lengthening nails is presented.

Distal Tibial Guided Growth for Anterolateral Bowing of the Tibia: Fracture May Be Prevented.

Background: Congenital pseudarthrosis of the tibia is a rare and challenging pediatric condition. The pre-fracture state, called congenital tibial dysplasia or anterolateral bowing of the tibia, presents a high fracture risk due to underlying bowing and dysplasia. After fracture, there is a substantial risk of nonunion.

Complications of Limb Lengthening With Motorized Intramedullary Nails.

Intramedullary limb lengthening (LL) is now achievable through motorized intramedullary devices. While this technology mitigates some complications of external-fixation-based lengthening, many complications common to all lengthening procedures persist. New challenges and complications exclusive to this newer technology are also presented.

Lengthening of the Humerus Using a Motorized Lengthening Nail: A Retrospective Comparative Series.

Background: Lengthening of the humerus has traditionally been accomplished by the use of external fixation. Intramedullary motorized lengthening nails are now frequently used for lower limb lengthening, and this technology is slowly being adopted for use in the humerus.

Methods: A retrospective, single-surgeon experience of pediatric humeral lengthenings was performed.

Management of a Broken PRECICE Femoral Nail at an Ununited Distraction Osteogenesis Site: A Case Report.

Case: A 20-year-old man with a history of right lower extremity fibular hemimelia previously treated with PRECICE femoral nail lengthening presented with a broken magnetic nail and a displaced fracture through an ununited distraction osteogenesis site. Using a combination of techniques, we removed the broken implant while maintaining the achieved limb length and preserving the native biology without bone grafting.

Conclusion: The unique challenges associated with the removal of a broken PRECICE femoral nail are described, with a technique for implant removal that preserves the achieved length, the innate biology of the distraction osteogenesis site, and promoting union without bone grafting.

What Factors Influence Union and Refracture of Congenital Pseudarthrosis of the Tibia? A Multicenter Long-term Study.

Objective: To identify factors influencing union of congenital pseudarthrosis of the tibia (CPT), refractures, and integrity of the tibia at maturity.

Methods: Data of 119 children operated for Crawford-type IV CPT and followed-up till skeletal maturity were analyzed. Logistic regression and recursive partitioning analyses were used to test associations between several variables and the outcome.

Plate-assisted Lengthening of the Femur and Tibia in Pediatric Patients.

Background: Limb lengthening over a percutaneous plate can be used during pediatric distraction osteogenesis to decrease the time of external fixation.

Methods: A retrospective, consecutive 2-surgeon experience of pediatric femoral and tibial lengthenings with a plate-assisted lengthening (PAL) technique was performed. The plate was placed at the time of index corticotomy.

Eosinophil-dependent skin innervation and itching following contact toxicant exposure in mice.

Background: Contact toxicant reactions are accompanied by localized skin inflammation and concomitant increases in site-specific itch responses. The role(s) of eosinophils in these reactions is poorly understood. However, previous studies have suggested that localized eosinophil-nerve interactions at sites of inflammation significantly alter tissue innervation.

Motorized intramedullary nail for management of limb-length discrepancy and deformity.

Distraction osteogenesis has been used for more than 50 years to address limb-length discrepancy and deformity. Intramedullary fixation has been used in conjunction with external fixation to decrease the time in the external fixator and prevent deformity and refracture. A new generation of motorized intramedullary nails is now available to treat limb-length discrepancy and deformity.

Kerion mimicking erosive pustular dermatosis in elderly patients.

Erosive pustular dermatosis of the scalp typically occurs in elderly patients; a diagnosis of fungal kerion infection in this patient population may seem unlikely. We present 3 elderly patients who developed pustular eruptions on the scalp that were suggestive of erosive pustular dermatosis. Culture and/or biopsy findings initially excluded kerion fungal infections.

Stem cells and the skin.

Stem cells live long lives, renew themselves, and differentiate into more mature, less potent, specialized cells, such as epidermal keratinocytes and dermal fibroblasts. Stem cells can be embryonic, if derived from an embryo, or adult/somatic if derived from postembryonic tissue. By producing new skin cells, stem cell division and differentiation can potentially rejuvenate skin and restore hair.

Nerve involvement in granuloma annulare.

Background: Nerve involvement developed in a patient with granuloma annulare, as evidenced by a perineural infiltrate of histiocytes in the dermis. The histopathologic pattern was suggestive of leprosy. No mycobacteria were observed, and neurologic testing was normal.

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA).