Wei-Ning Chang

This retrospective study involves 22 patients with displaced tibial plateau fractures who were treated surgically from July 1993 to April 1996. All the patients were over 60 years old (mean 66.3 years old, range 61-80 years). All of the patients were treated by open reduction and internal fixation with AO/ASIF buttress plates (Synthes, Bochum, Switzerland). Additional small fragment plate or inter-fragmental screws were used in some of them as indicated. Two patients died during follow-up of causes unrelated to the fractures. The average follow-up time was 49.8 months (range 36-68 months). The other 20 patients were interviewed at the outpatient clinic, and radiographs of bilateral standing knees were taken. By comparison with the uninjured side on radiographs, condylar joint space depression was noted in 6 patients. However, joint depression greater than 4 mm was not found. Malalignment with varus or valgus greater than 5 deg was not demonstrated in any case. Their range of motion was restored in all patients, with more than 120 deg of flexion and without extension lag except for the one who suffered a superficial wound infection. No complication required further surgical management. During the period of follow-up, no accelerated degenerative change in the operated knee joint resulted in total knee arthroplasty. Two patients needed occasional medical treatment for residual knee joint pain. Only two patients needed canes for assistance during walking due to old age and minor stroke. The results justify surgical treatment for displaced tibial plateau fractures in elderly patients.

Objective: To evaluate the outcome of spinal fusion with unit rod in pediatric patients with cerebral palsy who were treated by the two senior authors using the same operative technique. Study Design-Methods: This is a retrospective study of 288 patients with mean age at surgery 13.9 years (SD: 3.26), whose medical charts and radiographs were reviewed. A questionnaire including 14 questions assessing patients’ functional improvement was given to the caretakers. Results: Mean radiographic follow up of 3.2 years (range: 1–9.9) was available in 213 patients. In 46 patients anterior-posterior fusion was performed and in 242 only posterior. The preop. Cobb angle was 74°(range: 6–176°) corrected by 68% to 23° (p 60° developed 15.1% technical problems related to pelvic fixation, whereas only 3.4% of those with Conclusions: Spine surgery in patients with cerebral palsy was accompanied by a considerable blood loss and multiple medical complications. A very satisfactory correction of spinal curvatures was achieved and maintained in follow up. Excessive lumbar lordosis was associated with a high incidence of technical problems and an increased morbidity. There were no pseudarthrosis and the overall number of reoperations for technical reasons was very low. The caretakers were extremely pleased with the outcome of this procedure. Unit rod is a very effective instrumentation system, providing excellent results and a low mechanical complication rate in the treatment of cerebral palsy patients with spinal deformities.

Objective: To evaluate the effect of spinal fusion from T1, T2 to the sacrum with pelvic fixation using unit rod instrumentation on the ambulatory potential of pediatric patients with cerebral palsy. Study Design: A retrospective study of 24 ambulatory pediatric patients with spastic cerebral palsy and neuro-muscular scoliosis was performed. Summary of Background Data: Spinal deformities, occurring in patients with cerebral palsy and good ambulatory capacity, are infrequently associated with pelvic obliquity, and so instrumented spinal fusions traditionally do not extend to the pelvis. Methods: The medical charts and radiographs were reviewed, and the patients’ ambulatory ability was assessed clinically, with video tape or complete gait analysis. A questionnaire assessing patients’ functional improvement was given to the caretakers. Results: The study group included 17 female and 7 male patients, 19 quadriplegics and 5 diplegics. Follow-up evaluations for ambulatory function occurred at a mean of 2.86 years after surgery. Mean age at surgery was 15.4 years. Twenty patients underwent posterior spinal fusions and 4 patients combined anterior-posterior procedures. The patients were evaluated clinically pre-operatively, postoperatively and at follow-up with no alteration in their ambulatory status, except one patient who developed bilateral hip heterotopic ossification and gradually lost her ability to ambulate. Thirteen patients had both preoperative and postoperative gait analysis, showing no change in their ambulatory function. The surgical outcome survey demonstrated significant improvement in the child’s physical appearance, head and trunk balance, sitting ability, amount of back pain, respiration, and no change in ambulatory capacity. Conclusions: Spine surgery with fusion extending to the pelvis in ambulatory patients with cerebral palsy provided excellent deformity correction and preserved their ambulatory function.

Object.The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF).Methods.This prospective, case—control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis—induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion—extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups.Conclusions.Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.

Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal. We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant. There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, one patient was classified as type A1, one patient as type A2, two patients as type A3, and three patients as type B3. All patients suffered refracture without high-energy trauma. In group B, the refracture rate was 2.77 %, and all were caused by high-energy trauma. Patients with refracture had a shorter time interval between ORIF and implant removal. The possible risk factors of refracture in this study included a wedge bone defect on plain film, implant removal performed after less than 18 months, and AO/OTA type B fracture. The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.

Spanish Translations of Abstracts From the Journal Radiografı́as de estrés tras fracturas de tobillo: el efecto de la posición de la articulación y del estado del ligamento deltoideo sobre las mediciones del espacio claro interno, Samuel S. Park, Erik N. Kubiak, Kenneth A. Egol, Fred Kummer, Samuel S. Park. NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, NY, USA Objetivos: Los objetivos de este estudio fueron los siguientes: (1) Determinar como la posición del tobillo afecta al espacio claro interno de las radiografı́as de estrés de dicha articulación. (2) Qué medición del espacio claro interno, de la anchura global o del aumento de la misma predice mejor la rotura del ligamento deltoideo profundo en las fracturas distales de peroné tipo B de Weber. (3) Qué valor del espacio claro interno es más predictivo de la rotura del ligamento deltoideo profundo tras las fracturas tipo B de Weber del peroné distal. Diseño: Modelo de fractura en cadáveres. Lugar del Estudio: Laboratorio de biomecánica. Material y Método: Se hicieron radiografı́as en seis tobillos de cadáveres frescos montados en un aparato que permitió colocarlos en flexión neutra, flexión dorsal y flexión plantar, ası́ como aplicar fuerzas rotatorias internas y externas. Tras desestabilizar los tobillos mediante un mecanismo de supinación-rotación externa de Lauge-Hansen, se hicieron radiografı́as repetitivas con la misma combinación de fuerzas de flexión y rotación. Principales Parámetros de Medición: Los principales parámetros medidos fueron la anchura del espacio claro interno y sus cambios. Resultados: Un espacio claro interno $5 mm en las radiografı́as en flexión dorsal bajo fuerzas de rotación externa fue el mejor predictor de rotura profunda del ligamento deltoideo tras fracturas distales de peroné. En flexión dorsal-rotación externa un espacio claro interno $4 mm tuvo poca especificidad y valor predictivo positivo, mientras que un valor $6 mm tuvo poca sensibilidad y valor predictivo negativo. Todas las demás situaciones de estrés y de aumento del espacio claro interno de 2–3 mm fueron aún menos predictivas. Conclusiones: Las radiografı́as de estrés hechas en flexión dorsal-rotación externa fueron las mejores predictoras de rotura del ligamento deltoideo profundo en las fracturas distales de peroné. En dichas condiciones de estrés, un espacio claro interno $5 mm fue el predictor más fiable del estado del ligamento deltoideo profundo. Palabras Clave: Tobillo, fractura de tobillo, ligamento deltoideo, espacio claro interno, radiografı́as de estrés Expresión génica durante la consolidación de las fracturas: estudio comparativo de la fijación intramedular y de la fijación con placa mediante micro-orden (microarray) del ADN en ratas Daniel E. Heiner, Martha H. Meyer, Steven L. Frick, James F. Kellam, James Fiechtl, Ralph A. Meyer, Jr. Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA Objetivo: Comparar la expresión génica del ARNm en la consolidación de las fracturas diafisarias femorales tratadas mediante clavo intramedular o mediante placa y tornillos. Diseño: Se midió la expresión génica en los callos de fracturas diafisarias al dı́a siguiente, a los 3 dı́as y a la primera, cuarta y sexta semanas de la cirugı́a en ratas que habı́an sido distribuidas al azar en tres grupos: enclavado intramedular, fijación rı́gida con placa o ‘‘falsas fracturas’’ (cirugı́a sin que realmente hubiera fractura). Lugar del Estudio: Un laboratorio acreditado por la AAALAC de un centro médico académico independiente. Material: 57 ratas adultas, de sexo femenino, de raza Sprague-Dawley de 16 semanas de edad. Método: Se produjeron fracturas y se trataron mediante enclavado intramedular, placa y tornillos o de forma falsa (‘‘falsas fracturas’’). Principales Parámetros de Medición: Se midió la expresión del ARN de 8.700 genes mediante 19 microarrays Affymetrix U34A. Resultados: El callo de fractura fue significativamente mayor en el grupo del enclavado intramedular que en el de fijación con placa y tornillos. La mayorı́a de los genes respondieron a la fractura con un cambio en la expresión de su ARNm. La mayorı́a de los genes que respondieron siguieron el mismo curso temporal en ambos métodos de fijación. Entre ellos hubo genes relacionados con los factores de crecimiento, con la matriz ósea, con los mastocitos, con la mayorı́a de los factores nerviosos y con la hematopoyesis. El grupo de enclavado intramedular tuvo una mayor regulación de las transcripciones relacionadas con el cartı́lago, la división celular, la inflamación y el receptor acetilcolina. Hubo una mayor regulación en el grupo de las placas y tornillos con respecto a los genes relacionados con la actividad de los macrófagos. Conclusiones: En cada grupo estudiado (clavo frente a placa) hubo distintas expresiones génicas, lo que tal vez puede dar algo de luz al control de la consolidación de las fracturas. Palabras Clave: ratas, fractura, fémur,…

The aim of this study was to clarify the effects of general anesthesia (GA) on joint range of motion (ROM) in children with spastic cerebral palsy (SCP). Eighty-four SCP cases (mean age 8.4 years) admitted for first corrective surgery were retrospectively reviewed. Lower limb ROM were measured 1 day before operation and immediately after GA. Contracture of hip, knee, and ankle joints decreased significantly after GA, with + 11.1° (39.5%) for the hip abduction angle, −3.7° (18.0%) for the Thomas test, −15.0° (19.1%) for the popliteal angle, + 6.6° (39.8%) and 7.0° (109%) for ankle dorsiflexion with knee flexion and extension, respectively (all P < 0.001). These changes were correlated positively to pre-GA contracture and body weight, negatively to age, but independent of preoperative functional level, geographic classification of SCP, or modified Ashworth scale. On the basis of these findings, routine post-GA reassessments of joint ROM before corrective surgeries were recommended for pediatric SCP cases.

Clavicle hook plate is a common implant for treating distal clavicle fracture. Although high bone union rate and good functional outcome have been reported, so have several complications, such as osteolysis and fracture of the acromion, loss reduction, hook impingement, and rotator cuff tear. Peri-implant fracture over the medial side of the hook plate is a rare complication. Sporadic cases have been reported, and most of them have had no history of trauma. Between June 2015 and August 2018, 7 patients treated for distal clavicle fracture with a 3.5-mm locking compression hook plate with no history of trauma experienced peri-implant fracture of the medial clavicle. This complication occurred at a mean of 29 days. The incidence rate was 9.8%. Peri-implant fracture following hook plate fixation for distal clavicle fracture was not rare. Small hook angle, prolonged retention of the implant, an eccentric medial screw, high plate screw density, and small clavicle diameter may be risk factors for peri-implant fracture. Regarding treatment, 2 patients chose fracture revision with a distal clavicle locking plate and 5 patients chose conservative treatment. All patients achieved bone union at fracture sites. Surgical and conservative management of peri-implant fracture can achieve good functional outcome. [Orthopedics. 2020;43(x);xx-xx.].

INTRODUCTION Ankle fractures frequently occur and must be treated with open reduction for long-term stability. The existing anaesthesia methods include general anaesthesia, spinal and epidural anaesthesia, peripheral nerve block and local anaesthesia with IV sedation. However, each method has its inherent risks and potential costs, and the use of a tourniquet is inevitable. Therefore, the wide-awake local anaesthesia no tourniquet (WALANT) technique provides an alternative method for equivalent haemostasis and pain control without the use of a tourniquet. PATIENTS AND METHODS We prospectively enrolled 13 consecutive patients (9 males and 4 females) who presented ankle fractures and required ORIF from January 2017 to December 2017. The fracture types of the 13 patients included lateral malleolar fracture (three patients), bimalleolar fracture (two patients), bimalleolar equivalent fracture (three patients), medial malleolar fracture (two patients) and trimalleolar fracture (three patients; articular surface involvement <25%). We used a solution of 1% lidocaine mixed with 1:40,000 epinephrine for WALANT. RESULTS All patients underwent surgery if they exhibited an initial numerical pain rating scale (NPRS) score of 0 without using a tourniquet. Only two patients required an additional 5 ml of local anaesthesia due to NPRS score elevation during the surgery; no dose exceeded the safe limit of 7 mg/kg. No local complications occurred, and no shifts to other anaesthesia methods were required due to the failure of WALANT. CONCLUSIONS WALANT simplified surgical preparations and provided a safe and reliable method for ankle fracture management. Because the use of a tourniquet was not required, reduced postsurgical pain was observed. Moreover, the use of local anaesthesia resulted in more satisfied patients and facilitated easier recovery.

Spanish Translations of Abstracts From the Journal Radiografı́as de estrés tras fracturas de tobillo: el efecto de la posición de la articulación y del estado del ligamento deltoideo sobre las mediciones del espacio claro interno, Samuel S. Park, Erik N. Kubiak, Kenneth A. Egol, Fred Kummer, Samuel S. Park. NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, NY, USA Objetivos: Los objetivos de este estudio fueron los siguientes: (1) Determinar como la posición del tobillo afecta al espacio claro interno de las radiografı́as de estrés de dicha articulación. (2) Qué medición del espacio claro interno, de la anchura global o del aumento de la misma predice mejor la rotura del ligamento deltoideo profundo en las fracturas distales de peroné tipo B de Weber. (3) Qué valor del espacio claro interno es más predictivo de la rotura del ligamento deltoideo profundo tras las fracturas tipo B de Weber del peroné distal. Diseño: Modelo de fractura en cadáveres. Lugar del Estudio: Laboratorio de biomecánica. Material y Método: Se hicieron radiografı́as en seis tobillos de cadáveres frescos montados en un aparato que permitió colocarlos en flexión neutra, flexión dorsal y flexión plantar, ası́ como aplicar fuerzas rotatorias internas y externas. Tras desestabilizar los tobillos mediante un mecanismo de supinación-rotación externa de Lauge-Hansen, se hicieron radiografı́as repetitivas con la misma combinación de fuerzas de flexión y rotación. Principales Parámetros de Medición: Los principales parámetros medidos fueron la anchura del espacio claro interno y sus cambios. Resultados: Un espacio claro interno $5 mm en las radiografı́as en flexión dorsal bajo fuerzas de rotación externa fue el mejor predictor de rotura profunda del ligamento deltoideo tras fracturas distales de peroné. En flexión dorsal-rotación externa un espacio claro interno $4 mm tuvo poca especificidad y valor predictivo positivo, mientras que un valor $6 mm tuvo poca sensibilidad y valor predictivo negativo. Todas las demás situaciones de estrés y de aumento del espacio claro interno de 2–3 mm fueron aún menos predictivas. Conclusiones: Las radiografı́as de estrés hechas en flexión dorsal-rotación externa fueron las mejores predictoras de rotura del ligamento deltoideo profundo en las fracturas distales de peroné. En dichas condiciones de estrés, un espacio claro interno $5 mm fue el predictor más fiable del estado del ligamento deltoideo profundo. Palabras Clave: Tobillo, fractura de tobillo, ligamento deltoideo, espacio claro interno, radiografı́as de estrés Expresión génica durante la consolidación de las fracturas: estudio comparativo de la fijación intramedular y de la fijación con placa mediante micro-orden (microarray) del ADN en ratas Daniel E. Heiner, Martha H. Meyer, Steven L. Frick, James F. Kellam, James Fiechtl, Ralph A. Meyer, Jr. Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA Objetivo: Comparar la expresión génica del ARNm en la consolidación de las fracturas diafisarias femorales tratadas mediante clavo intramedular o mediante placa y tornillos. Diseño: Se midió la expresión génica en los callos de fracturas diafisarias al dı́a siguiente, a los 3 dı́as y a la primera, cuarta y sexta semanas de la cirugı́a en ratas que habı́an sido distribuidas al azar en tres grupos: enclavado intramedular, fijación rı́gida con placa o ‘‘falsas fracturas’’ (cirugı́a sin que realmente hubiera fractura). Lugar del Estudio: Un laboratorio acreditado por la AAALAC de un centro médico académico independiente. Material: 57 ratas adultas, de sexo femenino, de raza Sprague-Dawley de 16 semanas de edad. Método: Se produjeron fracturas y se trataron mediante enclavado intramedular, placa y tornillos o de forma falsa (‘‘falsas fracturas’’). Principales Parámetros de Medición: Se midió la expresión del ARN de 8.700 genes mediante 19 microarrays Affymetrix U34A. Resultados: El callo de fractura fue significativamente mayor en el grupo del enclavado intramedular que en el de fijación con placa y tornillos. La mayorı́a de los genes respondieron a la fractura con un cambio en la expresión de su ARNm. La mayorı́a de los genes que respondieron siguieron el mismo curso temporal en ambos métodos de fijación. Entre ellos hubo genes relacionados con los factores de crecimiento, con la matriz ósea, con los mastocitos, con la mayorı́a de los factores nerviosos y con la hematopoyesis. El grupo de enclavado intramedular tuvo una mayor regulación de las transcripciones relacionadas con el cartı́lago, la división celular, la inflamación y el receptor acetilcolina. Hubo una mayor regulación en el grupo de las placas y tornillos con respecto a los genes relacionados con la actividad de los macrófagos. Conclusiones: En cada grupo estudiado (clavo frente a placa) hubo distintas expresiones génicas, lo que tal vez puede dar algo de luz al control de la consolidación de las fracturas. Palabras Clave: ratas, fractura, fémur,…

The development of nontraumatic atlantoaxial instability in children with spastic cerebral palsy has not been reported. The authors present three patients with severe spastic quadriplegia who developed C1-C2 instability and cervical myelopathy at mean age 12.6 years. These patients demonstrated a similar clinical picture with symptoms attributed to cervical myelopathy in varied severity including apneic episodes, opisthotonus, alteration in muscle tone, torticollis, respiratory problems, hyperreflexia, and bradycardia. Patient 1 was scheduled for surgery but died due to an apneic episode. Patient 2 refused surgery and has been followed for 3 years while his neurologic condition remains unchanged. Patient 3 underwent occipitocervical decompression and fusion, recovered neurologically, and resumed his previous functional skills. Patients demonstrating considerable functional deterioration or insidious change in their established neurologic status should undergo detailed screening to r...

Background Talipes equinovarus is one of the common congenital disease of foot deformity of newborn. Initial treatment is often with the Ponseti method. Studies have demonstrated that radiographic measurements can be made with clubfoot. The purposes of this study were to document the amount of Achilles tendon lengthening obtained from PAT in Ponseti’s method and to analyze the factors that might impact on the amount of equinus correction. Methods This is a retrospective study carried out from 2002 to 2006. Sixteen feet of twelve children that received percutaneous Achilles tendon tenotomy (PAT) for the treatment of congenital clubfoot were included. Assessments before and after treatment were performed using Dimeglio system. The foot length from toe to heel at the time of PAT, the pre- and post-PAT ankle dorsiflexion and post-casting lateral view of foot were obtained. The Pearson correlation coefficient was used to establish relationships between pre-, post-PATT and post-casting Ti...

Background Diffuse pigmented villonodular synovitis (PVNS) of the knee is a rare benign disease that has a destructive clinical course. Reported treatment options include arthroscopic or open synovectomy with or without adjuvant radiotherapy of various doses. This study compared the long-term functional outcomes and disease control among treatment modalities and discussed 22 years of experience with radiotherapy (RT) as an adjuvant treatment for PVNS of knee.Methods A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) through phone interviews by an independent orthopedist.Results From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open sy...

Osteomyelitis from a retained foreign body should be included in the differential diagnosis of any osteolytic lesion of the foot. We report here a case of a 59-year-old man who presented with swelling over the dorsolateral aspect of the right foot. Plain x-ray showed an osteolytic lesion that mimicked a pseudotumor. Magnetic resonance imaging (MRI) showed multilocular fluid collection over the right cuboid with a hypointense lesion over the plantar fascia. The patient underwent surgery and a rubber fragment (1 cm × 0.8 cm) was removed from his foot that had been present for two years following a stabbing injury. The patient fully recovered without complication or disability.

In acute trauma, posterior cruciate ligament (PCL) injury may occur concomitantly with a bony fracture and be easily overlooked. A popliteal artery injury associated with a tibial plateau fracture and PCL avulsion fracture is rare. Missed or delayed diagnosis of this condition leads to a high amputation rate. Therefore, close attention is required with this type of injury. The limb can be saved though early detection and immediate reconstruction of the injured artery, followed by fasciotomy. We report here a rare case of popliteal artery occlusion proximal to the surgical zone, which was diagnosed after fixation of a medial tibial plateau fracture and posterior cruciate avulsion injury. In dashboard injuries without knee dislocation, the arterial intima may be injured and become vulnerable, even with an initial ankle brachial index greater than 0.9. This can cause concomitant occlusion of the popliteal artery due to iatrogenic retraction during surgery. Therefore, a neurovascular ex...

Management of pediatric septic coxarthritis and osteomyelitis of the femur is challenging, and the sequelae of multiplanar hip joint deformity with instability are difficult to reconstruct. The inadequacy of a suitable device for fixing small bones during pediatric osteotomy is a hindrance to the correction of subluxated hip joints and deformed femurs in children. Two-dimensional axial images and three-dimensional (3D) virtual models representing the patient’s individual anatomy are usually reserved for more complex cases of limb deformity. 3D printing technology can be used for preoperative planning of complex pediatric orthopedic surgery. However, there is a paucity of literature reports regarding the application of 3D-printed bone models for pediatric post-osteomyelitis deformity. We herein present a case of a 4-year-old boy who underwent treatment for post-osteomyelitis deformity. We performed corrective surgery with Pemberton osteotomy of the right hip, multilevel varus derotat...

Wide-awake local anesthesia no tourniquet (WALANT) is used for various hand surgeries, but there are no reports of its use for distal radius fractures. The authors compared perioperative variables and clinical outcomes for volar plating for distal radius fractures with WALANT vs general anesthesia with tourniquet. This retrospective study included 47 patients who presented with distal radius fractures between January 2015 and February 2017. Twenty-one underwent surgical volar plating with WALANT, and 26 underwent surgical volar plating with general anesthesia with tourniquet. Patients were followed for 12 months. The 2 groups were compared regarding perioperative parameters and clinical outcomes, including perioperative field pain evaluated by visual analog scale score on postoperative day 1, range of motion 12 months postoperatively, and Mayo wrist score. The WALANT group had a lower mean visual analog scale score and a shorter mean hospitalization (both P<.001), but greater mean blood loss (P<.001). No significant differences were found regarding operative time (P=.214) or time to union (P=.180). At 12-month follow-up, no significant differences were found regarding wrist extension (P=.721), wrist flexion (P=.119), or Mayo wrist score (P=.223). Although both techniques permitted volar plating for distal radius fractures, WALANT allowed immediate intervention and led to less postoperative pain and shorter hospitalization. Although control of blood loss was worse with WALANT, blood loss was limited to a mean of 22.62 mL and did not interfere with the surgical field. [Orthopedics. 201x; xx(x):xx-xx.].

Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal. We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant. There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, on...

ABSTRACT Crouch gait, one of the most common gait pathologies among cerebral palsy (CP) is characterized by excessive knee flexion during stance phase that worsens over time and decreasing walking efficiency. CP patients in jump-knee gait have similar features to the individuals in crouch gait but exhibit a normal knee moment during midstance. Oxygen cost is the most reliable oxygen expenditure measurement to study the gait efficiency in CP children. The purpose of this study is to compare the energy expenditure between the crouch and the jump-knee groups in CP children. Our analysis showed the average oxygen cost in jump-knee group was greater than those in crouch group, but crouch group demonstrated a higher walking velocity than the jump-knee group. In addition, the crouch group exhibited the highest correlation between oxygen cost and walking speed.

A retrospective study investigated 24 ambulatory pediatric patients with spastic cerebral palsy and neuromuscular scoliosis. To evaluate the effect of spinal fusion from T1-T2 to the sacrum with pelvic fixation using unit rod instrumentation on the ambulatory potential of these patients. Spinal deformities in patients with cerebral palsy and good ambulatory capacity are infrequently associated with pelvic obliquity, so instrumented spinal fusions traditionally do not extend to the pelvis. The medical charts and radiographs were reviewed, and the patients' ambulatory ability was assessed clinically with videotape or complete gait analysis. A questionnaire assessing patients' functional improvement was given to the caretakers. The study group included 17 female and 7 male patients, among whom were 19 quadriplegics and 5 diplegics. The mean age at surgery was 15.4 years. Of the 24 patients, 20 underwent posterior spinal fusion and 4 had combined anteroposterior procedures. The patients were evaluated clinically before surgery and after surgery. Follow-up evaluations of ambulatory function occurred at a mean of 2.86 years after surgery. No alteration in the ambulatory status of the patients was found, except in one patient who experienced bilateral hip heterotopic ossification and gradually lost her ability to ambulate. Preoperative and postoperative gait analysis was performed for 12 patients, showing no change in their ambulatory function. The surgical outcome survey demonstrated significant improvement in the patients' physical appearance, head and trunk balance, sitting ability, and respiration, with no change in ambulatory capacity. Spine surgery with fusion extending to the pelvis in ambulatory patients with cerebral palsy provided excellent deformity correction and preserved their ambulatory function.

Rhabdomyolysis is a potentially life-threatening syndrome if unrecognized. The most common causes are trauma, excessive muscle activity, alcohol abuse, and toxic substances. Rhabdomyolysis as a postoperative complication in children with cerebral palsy who have received multilevel soft-tissue surgery has not been reported in the literature. The purposes of this study are to present the case of a 12-year-old boy with spastic quadriplegic cerebral palsy who developed rhabdomyolysis after soft-tissue release and to review the literature. The patient was treated with adequate sedation and hydration, and discharged in a stable condition 11 days after surgery. His serum creatine kinase level had returned to within the normal range by the 17th postoperative day. At the 6-month follow-up, there were no systemic sequelae. The prompt recognition of rhabdomyolysis depends on a high level of suspicion. Routine checks of urine color after surgery is mandatory. For patients with high muscle tone, monitoring of muscle enzymes is recommended. Adequate sedation, pain control and hydration may prevent the progression of this life-threatening condition.