Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis.

Background: This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity.

Methods: Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years.

Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study.

Aim: To investigate the protective behaviours of longer near work distance, discontinuing near work and more time outdoors in recess from parent self-report in the myopia prevalence and progression among myopic children aged 9-11 years.

Methods: Myopia Investigation study in Taipei is a longitudinal population-based study that enrolled elementary school students in Taipei. We provided vision and refraction examination every 6 months.

Guided Growth Improves Coxa Valga and Hip Subluxation in Children with Cerebral Palsy.

Background: Spastic hip subluxation or dislocation that is associated with an excessive coxa valga deformity is a common pathologic condition in children with cerebral palsy (CP) that is often treated with large bone reconstructive procedures. Guided growth techniques (such as stapling, plate, or transphyseal screw) have been widely used to alter the growth axis in patients with a lower-limb deformity but only a few reports have described their use in patients with coxa valga deformities.

Questions/purposes: (1) Does guided growth surgery using a transphyseal screw combined with adductor tenotomy prevent progressive coxa valga deformity and lateral hip subluxation in children with CP? (2) What factors influence the correction of coxa valga deformity and the success of hip stabilization? (3) What complications were associated with this operation and how often did children treated with it undergo reoperation?

Methods: From 2012 to 2016, at our institution, three authors (H-CH, KNK, K-WW) retrospectively studied data on children with CP who underwent guided growth of the hip for progressive bilateral hip subluxation associated with coxa valga deformities.

Comparison of two methods for idiopathic clubfoot treatment: A case-controlled study in Taiwan.

Background/purpose: In last century, two distinctive methods of manipulation and casting were developed, Kite method and Ponseti method. The purpose of this study is to compare the outcomes of parallel series between two methods in one institution.

Methods: From 2003 to 2008, two pediatric orthopedic services in one institution treated 57 patients with 88 idiopathic clubfeet.

The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction.

Introduction: The treatment of neglected radial head dislocation after missed Monteggia fracture dislocation in children is a controversial issue. The purpose of this study is to report our clinical experience in the treatment of the condition without annular ligament reconstruction.

Method: This is a retrospective review of 20 patients between 2008 and 2014.

Loading rates during walking in adolescents with type II osteonecrosis secondary to pelvic osteotomy.

Although Pemberton osteotomy has shown a high success rate even in older children, the occurrence of osteonecrosis (ON) remains one of the most severe complications, leading to premature osteoarthritis. Patients with type II ON are characterized by a valgus deformity of the proximal femur with altered musculoskeletal conditions, affecting the ability to attenuate or sustain the impulsive loading from the ground reaction force. It remains unclear whether these conditions also predispose these patients to harmful impulsive loadings.

Pronator teres transfer for forearm and wrist deformity in cerebral palsy children.

Background: Forearm pronation and wrist flexion contracture can be a disability for daily living care and 2-hand function in cerebral palsy (CP) children. It may be beneficial to improve their posture and hand-grip power for better functional outcome. The purpose of our study was to investigate the outcome of pronator transfer in CP children.

A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip.

Introduction: A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation.

Step 1 Surgical Approach: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage.

Step 2 Explore The Hip Joint: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction.

Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

Background: The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered.

Questions/purposes: The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty.

Outcomes of open reduction for developmental dysplasia of the hip: does bilateral dysplasia have a poorer outcome?

Background: The purpose of this study was to compare the outcomes of surgical treatment in children of walking age with unilateral and bilateral developmental dysplasia of the hip (DDH).

Methods: We examined the records of fifty-six children of walking age with bilateral dysplasia and 156 children of walking age with unilateral dysplasia treated with open reduction and pelvic osteotomy with or without femoral osteotomy from 1990 to 2000. The minimum duration of follow-up was five years.

Medial column stabilization improves the early result of calcaneal lengthening in children with cerebral palsy.

Calcaneal lengthening is a popular surgical treatment for pronated foot deformity. The aim of this study is to assess the effectiveness of medial column stabilization in improving the results of calcaneal lengthening for pronated foot deformity in ambulatory children with cerebral palsy. Twenty-one consecutive (37 feet) children with cerebral palsy with pronated foot deformity who received calcaneal lengthening from 2004 to 2009 were reviewed.

Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures.

Objectives: Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survival of patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis.

Methods: An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years.

Residual gait deviations in adolescents treated during infancy for unilateral developmental dysplasia of the hip using Pemberton's osteotomy.

Early reduction using Pemberton's osteotomy has been suggested for treating DDH but no data on the long-term residual gait changes in such patients are available in the literature. This study aimed to bridge the gap by performing quantitative gait analysis on eleven females (age: 10.6 ± 1.

Modified triple innominate osteotomy for acetabular dysplasia: for better femoral head medialization and coverage.

Unlabelled: Steel's triple innominate osteotomy was created for correcting dysplastic acetabulum in adolescents and young adults. We modified Steel's triple innominate osteotomy with two anterior incisions and ramus cuts close to the acetabulum to improve the mobility of the fragment for better coverage of the hip. The purpose of this study was to compare these two techniques with respect to acetabular morphology, femoral head coverage, and medialization.

Pemberton Osteotomy for Acetabular Dysplasia.

Introduction: We have performed open reduction with Pemberton osteotomy, as our primary treatment method for developmental dysplasia of the hip, in more than 550 patients at our institution since 1993.

Step 1 Exposure: With the patient supine, make an anterior iliofemoral incision that is not directly on the iliac crest, dissect the subcutaneous tissue in the line of the incision, expose the iliac crest, and divide the cartilage at the iliac crest.

Step 2 Perform Iliopsoas Tenotomy: Identify the rectus femoris tendon, release the iliopsoas muscle, and identify the acetabulum-hip capsule junction.

Adolescents after Pemberton's osteotomy for developmental dysplasia of the hip displayed greater joint loading than healthy controls in affected and unaffected limbs during gait.

Patients after reduced developmental dysplasia of the hip (DDH) are at higher than normal risk of developing avascular necrosis (AVN) of the femoral head and degenerative hip osteoarthritis (OA) that are closely related to abnormal loadings. We aimed to determine the lower limb loadings in adolescents after Pemberton's osteotomy for unilateral DDH. Eleven females (age: 10.

Giant ganglionic cyst of the hip as a rare cause of sciatica.

Although ganglionic cysts located at the hip joint are described infrequently, those found in this region are usually small, deep-seated, and asymptomatic. Occasionally, however, a large ganglionic cyst of the hip area is observed that becomes symptomatic following compression of adjacent neurovascular bundles. In this report, the authors describe a 51-year-old man with symptoms of sciatica caused by a giant ganglionic cyst of the posterior hip joint.

Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip: long-term results.

Background: The favorable results of Pemberton acetabuloplasty in children with developmental dysplasia of the hip have been well reported. We reviewed our long-term results related to osteonecrosis of the femoral head after this surgery, especially with regard to the effect of excessive inferior displacement of the femoral head.

Methods: From 1993 to 1997, we performed 167 Pemberton acetabuloplasties in patients with developmental dysplasia of the hip who were eighteen months of age or older.

Outcomes in advanced Legg-Calvé-Perthes disease treated with the Staheli procedure.

Background: Containment and preservation of hip range of motion have been the principles governing the treatment of Legg-Calvé-Perthes disease. The Staheli's slotted acetabular augmentation (SAA) procedure is an alternative approach for older children with Perthes disease with lateral subluxation, incongruent hip, and abduction hinge. It provides effective coverage, restricts lateral displacement of the femoral head, and achieves containment and congruency in short-term follow-up.

The use of bioabsorbable screw in a split anterior tibial tendon transfer: a preliminary result.

The split anterior tibial tendon transfer is a procedure commonly used to correct equinovarus deformity of the foot, primarily in children with spastic cerebral palsy. The procedure has been reported to yield satisfactory results; it can be combined with other soft tissue lengthening. Typically, the transferred tendon can be fixed by either button, staple, metal screw, or anchored into two bony tunnels.

Ultrasound stimulates NF-kappaB activation and iNOS expression via the Ras/Raf/MEK/ERK signaling pathway in cultured preosteoblasts.

It has been shown that ultrasound (US) stimulation accelerates fracture healing in the animal models and non-operatively clinical uses. Nitric oxide (NO) is a crucial early mediator in mechanically induced bone formation. Here we found that US-mediated inducible nitric oxide synthase (iNOS) expression was attenuated by Ras inhibitor (manumycin A), Raf-1 inhibitor (GW5074), MEK inhibitor (PD98059), NF-kappaB inhibitor (PDTC), and IkappaB protease inhibitor (TPCK).

Increasing nail-cortical contact to increase fixation stability and decrease implant strain in antegrade locked nailing of distal femoral fractures: a biomechanical study.

Background: Proximity of the distal locking screw to the fracture site potentially can cause implant failure in locked nailing of distal femoral fractures. In this biomechanical study, we investigated the effects of nail-cortical contact and nail purchase in the distal subchondral bone on fixation stability and implant strain.

Methods: Using fiberglass artificial femurs, we fixed five different distal femoral osteotomies with specially manufactured locked nails representing different conditions of nail-cortical contact.

Reducing limping by tibial lengthening along nails in adult unilateral developmental dysplasia of the hip with high dislocation.

Background/purpose: Treatment of adult neglected developmental dysplasia of the hip (DDH) with high dislocation is still not established. The main concern of young patients is leg-length discrepancy (LLD), which leads to limping gait and impaired body image. Such patients usually ask for a minimally invasive treatment that can improve the LLD.

Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis.

This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance.

Age and height effects on the center of mass and center of pressure inclination angles during obstacle-crossing.

Tripping over obstacles has been reported as one of the most frequent causes of falls in the elderly. Maintenance of the body's balance and precise swing foot control is essential for successful obstacle-crossing. The aim of this study was thus to investigate the height and age effects on the center of mass (COM) and center of pressure (COP) inclination angles and angular velocities during obstacle-crossing.