Metal implants in children.

Background: Metal implants are increasingly used in children for trauma and deformity correction. This review outlines the current knowledge on the types of metals used and explores reasons for removal and the potential for long-term health issues of metal implants.

Methods: The literature pertaining to these aspects was studied and summarised in this review.

Persistently Raised Serum Titanium Levels After Spinal Instrumentation in Children.

Study Design: Prospective study of patients undergoing elective spinal deformity surgery with repeated testing for circulating metal ions including preoperative levels acting as controls.

Objective: The aim was to determine if levels of particular circulating metal ions are maintained to two years postsurgery including different implant systems and rods.

Summary Of Background Data: Adults having hip replacements, especially metal-on-metal bearings, may develop high metal ion levels.

Interobserver and Intraobserver Reliability in the Salter Classification of Avascular Necrosis of the Femoral Head in Developmental Dysplasia of the Hip.

Background: Avascular necrosis (AVN) of the femoral head is a concerning complication that can result from treatments for developmental dysplasia of the hip (DDH). AVN can lead to degenerative osteoarthritis, persistent acetabular dysplasia, reduced function, and continuing hip pain. The incidence of AVN reported in the DDH literature is widely varied (0% to 73%).

Local Bone Grafting Is Sufficient for Instrumented Adolescent Idiopathic Scoliosis Surgery: A Preliminary Study.

Background: Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested.

The coronal aorto-mesenteric orientation theory for post-operative nausea and vomiting following scoliosis surgery in children: a pilot study.

Background: Post-operative nausea and vomiting (PONV) is often encountered following corrective scoliosis surgery in children, frequently attributed to high-dose opiate administration. PONV is a frequent cause of prolonged hospital stay. Mechanisms related to transient partial duodenal compression by narrow angulation of the superior mesenteric artery (SMA) and aorta following scoliosis surgery are poorly understood and might be implicated in PONV.

Chromium Metal Ion Release During Instrumented Spinal Surgery in Children: The Effects of Electrosurgery.

Study Design: Prospective 2-year study with operative sampling and in-vitro analysis of chromium ions following spinal surgery in children.

Objectives: To measure metal ion levels at preoperative, intraoperative, and postoperative times to determine patterns of metal ion release during instrumented spinal surgery.

Summary Of Background Data: Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis.

Clubfoot deformity in the Solomon Islands: Melanesian Polynesian ethnicity, a retrospective cohort study.

Purpose: Congenital talipes equinovarus (CTEV) has a high incidence in the South Pacific, with New Zealand Maori and Polynesian rates of up to seven per 1000 live births, at least five times higher than the Caucasian population. A genetic component is suggested to explain this, however, there is little information regarding the difference of incidence between Polynesian and Melanesian ethnicity in the South Pacific. Our aim was to investigate the effects of ethnicity on the incidence of CTEV in the Solomon Islands, specifically comparing Melanesian and Polynesian ethnicity.

Disruption of paediatric orthopaedic hospital services due to the COVID-19 pandemic in a region with minimal COVID-19 illness.

Purpose: This study was designed to evaluate the impact of the COVID-19 pandemic on paediatric orthopaedic services in a paediatric tertiary hospital in South Australia.

Methods: A retrospective audit was conducted of orthopaedic activity at a major paediatric tertiary hospital with a Level 1 paediatric trauma centre, where no patients were admitted with COVID-19 illness. Orthopaedic Emergency Department (ED) presentations, outpatient clinics and hospital admissions for the period between 16 March 2020 to 26 April 2020 were studied and compared with the same period in 2019 (18 March 2019 to 28 April 2019).

Do Children With Spinal Deformity Who Have Metal Implants and Frequent Exposure to X-Rays Increase Their Risk of Cancer?

Study Design: Spinal surgery cohort.

Objective: The authors assess the risk of cancer in children who have undergone frequent radiographs and have metal implants for the treatment of spinal deformity.

Summary Of Background Data: Concerns have been raised regarding the cancer risk to children exposed to repeated radiological examinations as part of routine surveillance to monitor progression of spinal deformity.

Surgical Management of Thoracolumbar Kyphosis in Patients With Mucopolysaccharidosis: A Systematic Review.

Study Design: Systematic review.

Objective: To determine the indications and outcomes for surgical treatment of thoracolumbar kyphosis in patients with mucopolysaccharidoses (MPS) to define future studies.

Summary Of Background Data: Improvements in the medical treatment of MPS have increased lifespan and improved quality of life for many patients, but with no effect on thoracolumbar kyphosis.

Mini C-arm: faster, cheaper, safer?

Background: Mini C-arm image intensifiers (IIs) are promoted to permit lower radiation dose than traditional IIs with a lower purchase price and without the need for a radiographer, saving time. In real-world usage, radiation dose is not always lower.

Methods: A retrospective review of prospectively collected data for 620 children undergoing forearm fracture reduction in theatre was undertaken.

Fixation methods for acute injuries of the ankle syndesmosis: a systematic review protocol.

The objective of this review is to compare the effectiveness of three fixation methods for acute injuries of the ankle syndesmosis - metal screw fixation, bioabsorbable screw fixation and suture button fixation.The reviewers seek to critically evaluate the available evidence to provide an evidence-based appraisal of the comparative safety and efficacy of the treatment strategies.

Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

Background: The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure.

Methods: All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months.

Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions.

Objectives: To review evidence for the increased incidence of late diagnosed developmental dysplasia of the hip (DDH) in South Australia; to identify perinatal risk factors associated with late DDH in babies born between 2003 and 2009 in SA.

Design: Linkage study of data collected prospectively by the South Australian Birth Defects Register (SABDR) and the Pregnancy Outcome Statistics Unit (SA Department of Health), supplemented by medical records review.

Participants: All children born 2003-2009 in whom DDH was diagnosed between 3 months and 5 years of age and notified to the SABDR (data inclusion range, 2003-2014).

The effectiveness of selective thoracic fusion for treating adolescent idiopathic scoliosis: a systematic review protocol.

Review Question/objective: The objective of this review is to assess the effectiveness of selective thoracic fusion as a form of treatment in adolescent idiopathic scoliosis (AIS). This will be compared with all other forms of operative management for major structural thoracic curves.

Background: Scoliosis is defined as a lateral curvature of the spine of at least 10 degrees, as measured by the Cobb angle.

Review of the Clinical Use of Fluoroscopy in Hand Surgery.

Fluoroscopy is a commonly used tool in hand surgery. There have been recent advances in the technology and its clinical utilisation. Indications include assessment of joint and fracture fixation and stability, particularly when combined with minimally invasive techniques.

Local and systemic metal ion release occurs intraoperatively during correction and instrumented spinal fusion for scoliosis.

Study Design: Prospective pilot study.

Objectives: The aim of this study was to measure titanium, niobium and aluminium levels in various intraoperative and postoperative samples to determine patterns of metal ion release that occur within the first month following instrumented spinal fusion. Raised serum metal ion levels are reported following instrumented spinal fusion in adolescent idiopathic scoliosis.

Serum titanium, niobium and aluminium levels two years following instrumented spinal fusion in children: does implant surface area predict serum metal ion levels?

Purpose: Measurement of serum metal ion levels is used to determine systemic exposure to implant-derived metal debris that may be generated by processes of wear and corrosion. The aim of this study is to investigate predictors of serum metal ion levels in children undergoing instrumented spinal arthrodesis using a titanium alloy, focusing on implant characteristics and instrumentation construct design variables.

Methods: This prospective longitudinal cohort study involved 33 children.

Metachondromatosis: more than just multiple osteochondromas.

Introduction: Metachondromatosis is a rare genetic disease of osteochondroma and enchondroma formation, caused by loss of function of the PTPN11 gene. It is distinct from other similar conditions such as multiple osteochondromas and hereditary multiple exostoses by the distribution and orientation of lesions, and pattern of inheritance. Lesions typically occur in hands, feet, femora, tibiae and the pelvis.

Serum titanium, niobium, and aluminum levels after instrumented spinal arthrodesis in children.

Study Design: A prospective cohort study.

Objective: To determine serum titanium, niobium, and aluminum levels in pediatric patients within the first postoperative year after instrumented spinal arthrodesis.

Summary Of Background Data: Instrumented spinal arthrodesis is a common procedure to correct scoliosis and kyphosis.