Effect of asymmetrical configuration of pins in the TSF external fixator used for tibial lengthening in a pediatric population.

Background: The Taylor Spatial Frame (TSF) is a relatively new circular external fixator linked with a computer program used in limb reconstruction surgery. It is routinely used in our unit (Royal Manchester Children's Hospital) for pediatric tibial lengthening.

Methods: The case notes and radiographs of 17 children who underwent 18 tibial lengthenings were reviewed.

Neuroblastoma: a rare cause of a limping child. How to avoid a delayed diagnosis?

Unlabelled: Neuroblastoma is the most common solid extracranial tumor of childhood. Even though >25% of presentations are orthopaedic in nature, ranging from a limp to lower limb paralysis, neuroblastoma is a rare cause of limping in childhood and can therefore be easily missed by the admitting orthopaedic surgeon. Four cases of metastatic neuroblastoma are reported who all presented with hip pain within the last 3 years at Royal Manchester Children's Hospital.

Hypertension as a complication of circular external fixators.

Hypertension is not a recognized complication of circular external fixation. The aim of this study was to determine the incidence of hypertension following this procedure. A retrospective review of 57 patients was carried out between January 2006 and May 2010.

The use of the taylor spatial frame for the treatment of unstable tibial fractures in children.

Objectives: The aim of this study was to assess the use of the Taylor Spatial Frame (TSF) in the treatment of unstable tibial fractures in skeletally immature patients.

Design: Retrospective review.

Patients/participants: Twelve consecutive skeletally immature patients with unstable tibial fracture treated at our centre with a TSF.

Congenital bowing of the tibia due to infantile lipofibromatosis corrected with a Taylor Spatial Frame.

Congenital lipofibromatosis is a rare slow growing benign fibrofatty neoplasm presenting in childhood. The case of a boy presenting soon after birth with diffuse lower extremity enlargement associated with a significant tibial deformity is presented. Magnetic resonance imaging and soft tissue biopsy confirmed the diagnosis of lipofibromatosis.

Clinical and radiological outcome of combined femoral and Chiari osteotomies for subluxed or dislocated hips secondary to neuromuscular conditions: a minimum of 10-year follow-up.

We evaluated the medium-term results of combined Chiari pelvic and femoral osteotomies performed at the Manchester Children's Hospitals between the years 1985 and 1994. The indications for these osteotomies were either hip dislocation or subluxation in children with neuromuscular disease. We clinically and radiologically evaluated 20 hips in 18 patients treated for hip subluxation and dislocation with Chiari osteotomy.

An aneurysmal bone cyst within the proximal fibula causing common peroneal nerve palsy.

The case of a 15-year-old patient presenting with pain as well as paraesthesia over the lateral aspect of the leg is reported. Clinical and radiological investigations showed an aneurysmal bone cyst arising from the proximal fibula and pressing on the common peroneal nerve. Surgical decompression of the nerve and curettage of the cyst was performed resulting in complete resolution of his symptoms.

Single screw fixation in stable and unstable slipped upper femoral epiphysis.

The aim of this single centre retrospective study was to assess the outcome of patients after the fixation of slipped upper femoral epiphysis (SUFE) using a single cannulated screw. Thirty-eight slips, 28 stable and 10 unstable were treated with single in-situ screw fixation. The minimum follow-up was 1 year.

Osteochondrosis of the proximal phalanx of the hallux in adolescent footballers.

We report two cases with radiographic appearances of osteochondrosis in the proximal phalanx of the big toe in adolescent footballers. The radiological findings were those of initial fragmentation with subsequent healing of the epiphysis. This is the first report of osteochondrosis at this site.

Comparison of bacteriologically proven septic arthritis of the hip and knee in children, a preliminary study.

The hip and knee are the commonest joints affected by septic arthritis in the pediatric age group. Both can present as a limping, unwell child and can be difficult to diagnose. The primary aim of this study is to review and compare characteristics of pediatric patients with culture positive septic arthritis of the hip to those with culture positive septic arthritis of the knee.

Pelvic osteomyelitis in children.

Pelvic osteomyelitis is a rare disease that presents like many other common paediatric orthopaedic conditions. The diagnosis and management of the disease is often delayed and as a consequence this may contribute to increased morbidity in affected individuals. In an attempt to improve our diagnostic accuracy, 23 cases of pelvic osteomyelitis presenting to our tertiary referral centre between 1998 and 2006 were reviewed.

Hypertension as a complication of Taylor spatial frame.

Circular external fixators in children are widely used for limb lengthening, deformity correction and the treatment of fractures. We report a case of successful management of hypertension in a 13-year-old treated with a Taylor spatial frame after a road traffic accident and a tibial fracture. A heightened awareness of the association of hypertension and external fixators is required to improve patient outcomes.

Bisphosphonate-laden acrylic bone cement: mechanical properties, elution performance, and in vivo activity.

Cemented total hip replacements generally fail after 10-20 years, often due to implant loosening from bone resorption. Bisphosphonates such as zoledronic acid (ZA) and pamidronate (PAM) are potent inhibitors of bone resorption. The local delivery of bisphosphonates via acrylic bone cement could decrease osteolysis and prolong implant lifespan.

Posterior sloping angle of the capital femoral physis: interobserver and intraobserver reliability testing and predictor of bilaterality.

The management of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) is controversial. The aims of this study were to assess the interobserver and intraobserver reliability of the posterior sloping angle (PSA) as described by Barrios et al (J Pediatr Orthop. 2005;25:445-449) and whether it can be used as a predictor of need for prophylactic pinning of the contralateral hip.

Intraoperative stability testing of lateral-entry pin fixation of pediatric supracondylar humeral fractures.

The aims of this study were (1) to ascertain prospectively whether rotational instability can be determined intraoperatively and (2) to quantify the incidence of rotational instability after lateral-entry wire fixation in type-3 supracondylar humeral fractures in children according to Wilkins modification of Gartland classification. (Fractures in Children. Vol 3.

Unilateral limb deformity due to fibrous tethers: a report of three cases.

Fibrous tethers are a rare cause of unilateral limb deformity. A review of the literature revealed 9 cases previously described, all located in the distal femur. We report 3 additional cases of fibrous tethers, 2 of which were located in anatomical areas not previously described.

Soft tissue Ilizarov correction of congenital talipes equinovarus--5 to 10 years postsurgery.

The aim of this study was to address concerns regarding maintenance of correction of foot deformity after soft tissue Ilizarov distraction in relapsed clubfeet. We retrospectively reviewed the results of Ilizarov surgery of 19 rigid clubfeet in 14 children. The postoperative follow-up was at least 5 years (range, 5-10 years).