What's new in pediatric lower limb reconstruction?

The last years brought many advances relevant to lower limb reconstruction. It feels like guided growth has been looked at from every angle, and still there are new emerging concepts like rotational guided growth waiting to be validated. New hexapod external devices are more accurate and easier to use, and new unilateral fixators allow for more versatile and stable fixation and lengthening.

[METATARSUS ADDUCTUS - A COMMON DEFORMITY - WHAT TO DO AND WHEN?].

The most common foot deformity in newborns is the forefoot adduction deformity (FAD), where the hindfoot foot is in a normal position. The diagnosis for this problem is mainly based on a physical examination. The use of imaging methods has been described, but no advantage was shown with their utilization in determining the diagnosis and guiding treatment.

Rebound predictors of varus-valgus deformities around the knee corrected by guided growth.

Purpose: Coronal plane deformities around the knee are rather common condition in children. Guided growth by temporary hemiepiphysiodesis is considered to be the preferred primary treatment in many cases. Despite the popularity of hemiepiphysiodesis, the incidence of recurrence of deformity and predictors for rebound are not well defined.

Correction of Posttraumatic Medial Growth Arrest of the Distal Tibia in Adolescents.

Background: Partial growth arrest of the medial part of the distal tibial physis following fractures that penetrated the epiphysis is relatively common. We present the results of treatment, based on a protocol of supramalleolar tibial and fibular osteotomy for ankle alignment correction, and contralateral epiphysiodesis of distal tibia and fibula to balance leg length discrepancy (LLD).

Methods: This case series study describes the results of 7 patients with a median age of 14 years (range = 10-15 years) who were operated in our institution.

The use of real-time sonography-assisted fracture reduction in children with displaced forearm fractures.

Pediatric forearm and wrist fractures are common; furthermore, some are displaced and require manipulation and reduction. The procedure is commonly performed without real-time image guidance and evaluated radiographically after reduction and casting, leading to multiple reduction attempts and malalignment. Although fluoroscopy can provide real-time assessment of fracture alignment during the procedure, it is not readily available in many emergency departments (EDs) and involves radiation exposure.

Novel device for nonsurgical correction of rigid forefoot adduction in children.

Forefoot adduction deformity (FAD) (commonly called metatarsus adductus) is reported as the most common congenital foot deformity in newborns. Early diagnosis and treatment are important in rigid cases, as better outcomes have been reported if treatment was initiated before 9 months of age. While casting and splinting is the current standard of care for nonsurgical management of rigid FAD (RFAD), several orthoses have demonstrated equal benefit.

Q Fever Osteoarticular Infection in Children.

Q fever osteoarticular infection in children is an underestimated disease. We report 3 cases of Q fever osteomyelitis in children and review all cases reported in the literature through March 2018. A high index of suspicion is encouraged in cases of an unusual manifestation, prolonged course, relapsing symptoms, nonresolving or slowly resolving osteomyelitis, culture-negative osteomyelitis, or bone histopathology demonstrating granulomatous changes.

Treatment and outcomes of arthrogryposis in the lower extremity.

In this multiauthored article, the management of lower limb deformities in children with arthrogryposis (specifically Amyoplasia) is discussed. Separate sections address various hip, knee, foot, and ankle issues as well as orthotic treatment and functional outcomes. The importance of very early and aggressive management of these deformities in the form of intensive physiotherapy (with its various modalities) and bracing is emphasized.

Direct Lateral Approach for Triple Pelvic Osteotomy.

Introduction: Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease.

Methods: This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach.

Intermediate to Long-term Results of Femoral Neck Lengthening (Morscher Osteotomy).

Background: Femoral neck lengthening and transfer of the greater trochanter were introduced by Morscher as treatment for patients with coxa breva and overgrowth of the greater trochanter. In this study we evaluated intermediate and long-term results of this operation.

Methods: We reviewed clinical and radiographic results of 18 patients (20 hips) who were treated by Morscher osteotomy.

Removal of Metaphyseal Screw Only After Hemiepiphysiodesis Correction of Coronal Plane Deformities Around the Knee Joint: Is This a Safe and Advisable Strategy?

Purpose: Correcting lower limb angular deformities in the skeletally immature patient with guided growth is a very common procedure. Using an 8-plate construct to produce reversible hemiepiphysiodesis allows correction of the mechanical axis of the limb. It has become routine strategy to remove only the metaphyseal screw from the 8-plate construct after desired correction is achieved, in order to ease its reinsertion in case of deformity recurrence.

Femur shaft fracture following osteoid osteoma radiofrequency ablation.

Introduction: Radiofrequency ablation is an effective modality in treating osteoid osteoma while avoiding the complications of an open procedure. Its complications are usually self-limited consisting mostly of local skin burns. This report presents a major complication, a femur shaft fracture following an osteoid osteoma radiofrequency ablation.

Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma.

Objective: Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS).

Methods: X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone.

Clinical utility of the Taylor spatial frame for limb deformities.

The Taylor spatial frame (TSF) is a hexapod external fixator that can correct six-axis deformities. The mathematical base of all hexapod systems is projective geometry, which describes complex repositioning of an object in space. The Taylor brothers developed one of the first six-axis correction systems, which is known today as TSF.

Hip stability during lengthening in children with congenital femoral deficiency.

Background: Congenital femoral deficiency (CFD) is one of the most challenging and complex conditions for limb lengthening. We focused on the problem of hip instability during femoral lengthening because subluxation and dislocation are potentially catastrophic for hip function.

Methods: We assessed for hip stability in 69 children (91 femoral lengthenings) who had CFD Paley type 1a (43 children) and 1b (26 children).

Multiplanar Deformities Correction Using Taylor Spatial Frame in Skeletally Immature Patients.

Background: Taylor Spatial Frame (TSF) is a modern circular external fixator that, using a virtual hinge, is able to correct six axis deformities simultaneously. Despite the growing popularity of this method, few reports exist about its use in children and adolescents. To evaluate the effectiveness of TSF in correcting multiplanar deformities in patients with open physis, we reviewed the results of treatment in children who had at least two planes deformities of lower limbs.

Three point fixation of pediatric proximal humerus fractures by prebent wave-shaped wires: technical notes.

Pediatric proximal humerus fractures are uncommon and mostly treated conservatively. However, surgical treatment should be considered in displaced fractures classified as Neer-Horowitz grade III-IV in children older than 11 years. We describe a three-point fixation method of applying two Kirschner wires, prebent into a wave shape, and inserted into the proximal humerus through a single cortical hole.

Current data on acute haematogenous osteomyelitis in children in Southern Israel: epidemiology, microbiology, clinics and therapeutic consequences.

Background: Acute haematogenous osteomyelities (AHO) is the most common form of osteomyelitis, occurring when bone is infected secondary to transient bacteremia. The prevalence, aetiology and outcome of AHO may vary from region to region and period to period. The study objectives were to define the epidemiology, clinical, laboratory and imaging characteristics and treatment consequences of AHO in children in southern Israel.

Treatment of septic hip in a pediatric ED: a retrospective case series analysis.

Background: A pediatric septic hip is a serious condition that must be recognized and treated as early as possible. We describe the clinical course of children with septic hip that were treated with aspiration of the hip joint in the emergency department (AHED).

Methods: This was a retrospective case series analysis.

Developmental dysplasia of the hip: What has changed in the last 20 years?

Developmental dysplasia of the hip (DDH) describes the spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment is critical to provide the best possible functional outcome. Persistence of hip dysplasia into adolescence and adulthood may result in abnormal gait, decreased strength and increased rate of degenerative hip and knee joint disease.

Emergency Department Pain Management in Pediatric Patients With Fracture or Dislocation in a Bi-Ethnic Population.

Study Objective: We determine whether ethnicity in a bi-ethnic population of northern Israel is associated with disparities in pediatric emergency department (ED) opioid analgesia in patients with fracture or dislocation.

Methods: A retrospective cohort study was conducted. All records of patients aged 3 to 15 years and receiving a diagnosis of a limb fracture or dislocation were extracted.