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Factors associated with the success of the Rigo System Chêneau brace in treating mild to moderate adolescent idiopathic scoliosis.

J Child Orthop. 2012 Aug;6(4):327-31

Authors: Ovadia D, Eylon S, Mashiah A, Wientroub S, Lebel ED

Abstract
BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most prevalent spine deformity within the pediatric population. Orthosis is the mainstay of conservative treatment for mild to moderate AIS. The Rigo System Chêneau (RSC) brace is a custom-made thoracolumbar sacral orthosis (TLSO) based on a three-dimensional correction concept. The purpose of this study was to identify factors that could predict the therapeutic success/failure of the RSC brace.
MATERIALS AND METHODS: A retrospective cohort study was performed on all consecutive patients according to the Scoliosis Research Society (SRS) criteria for the success of conservative treatment. Participants had a 2-year follow-up beyond the termination of brace treatment. All patients were treated with the RSC orthotic device.
RESULTS: Ninety-three patients met the inclusion criteria. At treatment onset, their average age was 12.9 years, average Cobb angle 31.97°, Risser score 1.07, and the mean angle of thoracic rotation (ATR) was 10.2°. The mean brace treatment period was 36 months. Treatment was successful in 83.8 % of these patients (n = 79). The average final Cobb angle was 28.97°, Risser score 4.88, and ATR 8.09°. The

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Loss of a condyle of the femur or tibia following septic arthritis in infancy: problems of management and testing of a hypothesis of pathogenesis.

J Child Orthop. 2012 Aug;6(4):319-25

Authors: Tercier S, Siddesh ND, Shah H, Girisha KM, Joseph B

Abstract
PURPOSE: The study was undertaken to: (1) describe the characteristic radiological features and problems of management of the loss of one condyle of the femur or tibia following septic arthritis of the knee in infancy and (2) test a hypothesis of the cause of the loss of a single condyle.
METHODS: Radiographs of eight children with the loss of one condyle of the femur or the tibia following septic arthritis in infancy were reviewed. The course and outcome in two of these children who underwent reconstructive operations were studied. The knees of 35 stillborn foetuses were dissected to determine if the presence of synovial septae could account for the isolated loss of one condyle following infection.

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Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients.

J Child Orthop. 2012 Aug;6(4):313-8

Authors: Al-Aubaidi Z, Lundgaard B, Pedersen NW

Abstract
AIM: Patients with neuromuscular diseases such as cerebral palsy (CP) and meningomyelocele (MMC) are prone to develop fixed knee flexion contracture. Distal femoral extension osteotomy allows acute correction of the deformity, but it is an extensive surgical procedure, and the complication rate is rather high. Immobilization can prolong the rehabilitation period, and may even result in deteriorated walking ability. The aim of this retrospective study was to evaluate the results of using anterior hemiepiphysiodesis of the distal femur to treat fixed flexion contracture of the knee.
MATERIALS AND METHODS: We studied 21 patients in our department from 2003 to 2009. Mean age was 10 years (5-15). Twelve suffered from MMC, five from CP, two from arthrogryposis, one had an enzyme defect, and one had Down's syndrome. Thirteen patients had a bilateral and eight a unilateral procedure. None of the patients underwent any other procedures. Two staples or 8-plates were inserted using two parapatellar incisions. Nine were operated on with staples and 12 with 8-plates. The plates or staples were removed when the desired effect of full knee extension was achieved or the patient reached skeletal maturity.

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Primary outcomes of the congenital vertical talus correction using the Dobbs method of serial casting and limited surgery.

J Child Orthop. 2012 Aug;6(4):307-11

Authors: Aslani H, Sadigi A, Tabrizi A, Bazavar M, Mousavi M

Abstract
INTRODUCTION: The traditional treatment for congenital vertical talus, which involves serial casting and extensive soft-tissue releases, has been associated with severe stiffness and other complications in adolescents and adults. Our hypothesis is that favorable results will be obtained using the Dobbs method of serial manipulation, casting, and limited surgery for vertical talus correction, even in older children and syndromic cases. Therefore, the present study aimed at evaluating the Dobbs method in such cases.
MATERIALS AND METHODS: We treated 15 feet of 10 patients (aged from 1 month to 9 years) using manipulation and serial casting or the reverse Ponseti method followed by percutaneous Achilles tenotomy and limited open reduction of the talonavicular joint. All patients were evaluated both clinically and radiologically in a mean follow-up period of 2 years.

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Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: a case series and meta-analysis.

J Child Orthop. 2012 Aug;6(4):297-306

Authors: Dohin B, Kohler R

Abstract
PURPOSE: A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect.
METHOD: The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated.
RESULTS: In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology.

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Sprengel's shoulder treated by the Woodward procedure: analysis of factors affecting functional and cosmetic outcome.

J Child Orthop. 2012 Aug;6(4):291-6

Authors: Jindal N, Gupta P

Abstract
PURPOSE: To report the functional and cosmetic results of cases with Sprengel's shoulder who underwent the Woodward procedure.
MATERIALS AND METHODS: Twelve children were operated at a mean age of 5.58 years and reviewed at an average follow up of 31.83 months.
RESULTS: The mean preoperative Cavendish grade for cosmetic evaluation was 3.17, which decreased to 1.25 postoperatively (statistically significant, p < 0.0005, Wilcoxon signed-rank test). Similarly, the range of abduction at the shoulder increased from a mean of 115.83° preoperatively to 153.33° at final review (p < 0.0005). Age had a negative correlation with both functional improvement (r = -0.55, Spearman correlation coefficient) and cosmetic improvement (r = -0.11), although the latter suggested a very weak association, if any. Cavendish grade improvement and increase in abduction had a strong positive association (r = 0.713). However, there was no correlation between the increase in abduction and lowering of the scapula achieved (r = 0.131). The presence of an omovertebral bar did not affect the final functional outcome, nor did the presence of associated congenital anomalies.

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Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws.

J Child Orthop. 2012 Aug;6(4):285-9

Authors: Pretell-Mazzini J, Rodriguez-Vega V, Muñoz-Ledesma J, Andrés-Esteban EM, Marti-Ciruelos R, González-López JL, Curto-De la Mano A

Abstract
PURPOSE: The aim of our study is to report our complication rate and analyze the associated risk factors when removing cannulated stainless steel screws for SCFE fixation.
METHODS: This was a multicenter retrospective study of patients who underwent removal of cannulated stainless steel screws after a mean time of 2.03 years of implantation. Thirty-two patients were included (38 hips) with a mean of 13.7 years of age during screw removal surgery. The mean post-removal follow up time was 1.6 years. In all cases the removal of screws was done systematically. Demographic data, possible risk factors related to removal failure, as well as post-removal complications such as post-removal fractures, infections and scar issues were recorded.

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Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study.

J Child Orthop. 2012 Aug;6(4):277-83

Authors: Alves C, Steele M, Narayanan U, Howard A, Alman B, Wright JG

Abstract
PURPOSE: The treatment of unstable slipped capital femoral epiphysis (SCFE) remains controversial. Surgical dislocation and open reduction has the potential to significantly reduce the rate of avascular necrosis (AVN) by allowing direct preservation of the femoral head blood supply. The purpose of this study was to determine if open reduction of the unstable SCFE by means of surgical hip dislocation reduced the risk of AVN compared with closed reduction and percutaneous pinning.
METHODS: We reviewed the medical records and radiographs of patients treated at our institution between the years 2000 and 2008. Sex, age, side of slip, precipitating event, pre- and post-operative anterior physeal separation (APS) and slip angle, slip severity, time between inciting event and surgical treatment, number of screws used, development of AVN, and need for subsequent surgery were evaluated. Statistical analysis was performed to compare risk factors and occurrence of AVN.
RESULTS: From 2004 to 2008, we treated 12 patients with unstable SCFEs: six had closed reduction and percutaneous pinning and six underwent open reduction by means of

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RETRACTED ARTICLE: Clinical effectiveness of continuous passive motion (CPM) following femoroacetabular impingement surgery in adolescents.

J Child Orthop. 2012 Aug;6(4):269-75

Authors: Hosalkar H, Bomar JD

Abstract
PURPOSE: This study hypothesizes that the use of continuous passive motion (CPM) following open femoroacetabular impingement (FAI) surgery in the adolescent population improves clinical outcomes in terms of the modified Harris hip score (mHHS).
METHODS: Twenty-nine symptomatic adolescent FAI patients were postoperatively divided into one of three groups; no CPM, two days of inpatient CPM, and two weeks of CPM. mHHS was used preoperatively and postoperatively at six weeks, three months, six months, and nine months in all cases. Kruskal-Wallis (KW) analysis was performed to determine statistical differences in mHHS. mHHS was then re-evaluated using the Mann-Whitney test.
RESULTS: There were no statistically significant differences in hip scores between the three groups preoperatively (p = 0.158). There were statistically significant differences (p < 0.001) in mHHS between the three groups at all postoperative time periods. The group that received two weeks of CPM had the best outcome scores.