Journal of pediatric orthopedics. Part B
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Halo-gravity traction has been used preoperatively for patients with severe spinal deformity but there are limited data in the literature on the results and complications. We studied the outcomes of perioperative halo-gravity traction in children with severe spinal deformity. ⋯ Radiographic and pulmonary function parameters showed significant improvement during the course of traction and at the final follow-up. The overall complication rate was 19%, including two patients with pin loosening and two patients with superficial pin-site infections treated with oral antibiotics.
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Surgery for myelomeningocele spinal deformity is accompanied by a high rate of complications. These include infection, pathological skin breakage, instrumentation failure, and neurological deterioration. The four-rib construct associated with the percutaneous technique in immature children with myelomeningocele and spinal deformity is introduced. ⋯ The four-rib construct technique can be considered as a potential surgical option in (powered by Editorial Manager and Preprint Manager; Aries Systems Corporation) treating spinal deformity associated with myelomeningocele, but still more patients with long term follow-up are needed to prove the efficacy of this procedure. The four-rib construct is simple, minimally invasive, and does not exclude alternative treatment. Moreover, the incidence of complications associated with the four-rib construct compares favorably with other growth techniques.
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Several studies recently reported the usefulness of plating methods following limb lengthening with external fixators. This study describes modification at the time of plate insertion, selection of a locking plate, and the direction of plating. From April 2006 to July 2009, 12 consecutive patients, mean age 17.8 years, were enrolled in the study. The mean follow-up period was 36.5 months. All lengthening procedures were performed at the tibia. After proximal tibial osteotomy, a monoaxial external fixator was maintained on the lateral side of the tibia. At the end of distraction, a manually bent locking plate was inserted on the anteromedial side of the tibia, and the external fixator was removed. The mean final lengthening amount was 4.23 cm (range, 3.6-5.0 cm). The mean duration of the external fixator was 54.9 days (range, 47-67 days) and the mean external fixator index was 13.0 days/cm (range, 12.3-14.4 days/cm). The mean time to bony consolidation was 195.7 days (range, 150-264 days) and the mean healing index was 46.1 days/cm (range, 38.4-55 days). There were only minor complications in four patients. This case series showed that, especially with tibia lengthening, our method allows for successful early removal of the external fixator as compared with other methods (plating after lengthening), is associated with fewer complications, and is an effective alternative. ⋯ Therapeutic Level IV.
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Pediatric sacroiliac joint injuries are uncommon lesions, especially when combined with anterior sacroiliac dislocation. Here, we present a rare case of anterior dislocation of the sacroiliac joint associated with ipsilateral acetabulum, subtrochanteric, and pubic rami fractures combined with a contralateral sacral fracture. This appears to be the first such case reported in the literature. At the 6-month follow-up, a favorable clinical outcome was achieved, with radiological healing of the lesion.
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Six consecutive pediatric patients with chronic atlantoaxial rotatory fixation (AARF) underwent posterior fixation. All patients were first treated conservatively such as with a neck collar, traction, Minerva jacket, or halo-vest; however, they failed to achieve successful reduction because of the C2 facet deformity or C1-2 facet fusion. We performed C1-2 fusion using a C1 lateral mass screw and a C2 pedicle screw, a C1-2 transarticular screw, or an occipitocervical fusion using a rod and wiring system. ⋯ One patient had mild torticollis after surgery but no pain. Although we believe that with early diagnosis of AARF and appropriate conservative treatment we can avoid surgery, even with conservative treatment from the onset of symptoms, five patients in our series required surgery because conservative treatment did not lead to successful reduction. When conservative treatment for chronic AARF patients fails, C1-2 transarticular fixation, and C1 lateral mass screw and C2 pedicle screw fixation are reliable methods to treat these patients.