Use of Irradiated Tri-corticocancellous Allograft Bone in the Reconstructive Surgery for Non -Tumorous Bone Lesions in Pediatric Population

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Refractures of Upper Extremity in Children

Purpose: To investigate the etiologic factors related to refractures of the upper extremity in children. Materials and Methods: 18 refractures of the upper extremity were divided into three groups according to the location of initial fractures: Supracondyle fractures of the humerus, lateral condyle fracture of the humerus, and the forearm bone fractures. They were analyzed in terms of the type of refractures(early refracture occurring at the immature callus and late refracture occurring at the remodeled bone), fracture patterns, and the existence of underlying deformity. Results: Nine supracondyle fractures had refractures at the supracondyle (2 cases) and the lateral condyle (7 cases), in which underlying cubitus varus were present in 6 cases. Three lateral condyle fractures had refractures at the supracondyle(1 case) and the lateral condyle (2 cases), in which one case had underlying cubitus varus. All but one cases in the group of humerus fractures were late refractures and treated operatively except one. Of 6 refractures of forearm, 5 were early refractures and occurred within 9 weeks at the original site: 4 at the diaphysis of both bones of forearm and 1 at the diaphysis of ulna. All cases in the group of forearm fractures had volar angulation before the refracture, and treated conservatively except one. Conclusion: In the humerus, underlying cubitus varus was the most important predisposing factor to refractures and the lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis were related to refractures, and complete and circular consolidation of the primary fracture of forearm was thought to be important to prevent refracture.ope

Subsequent Vertebral Compression Fracture after Balloon Kyphoplasty in Osteoporotic Patients

Background: Osteoporosis is very important social health problem and osteoporotic vertebral compression fracture (VCF) is life-threatening disease in the advanced age. Until now it has been treated conservatively. Now conservative treatment were replaced by percutaneous vertebral augmentation procedures, especially balloon kyphoplasty. But many physicians wonder the mechanical adverse effect of cement in vertebral body on the adjacent vertebra. The purpose of this study is to know the fracture pattern and the frequency of adjacent vertebra after balloon kyphoplasty. Methods: We performed the retrospective study about 120 vertebrae in 96 patients. Mean time interval between the onset of symptom and the date of procedure was 29.6 days (range, 1~365 days). Mean follow up period after balloon kyphoplasty was 12 months (range, 6~25 months). Radiographic examination was performed every 2 month after procedure for evaluation of additional vertebral fracture. Results: All of the patients experienced pain relief following the procedure (average improvement in VAS=7, p<0.01). Incidence of new vertebral compression fracture was 10% (10 new VCF in 96 patients). Among them there were only 5 adjacent fractures (5%). When we analyzed the cases, all adjacent fractures except one were located cephalad direction of previous fracture and fractured within 2 month after procedure. Adjacent fractures were occurred in the group which end plates were not completely reduced after kyphoplasty. Conclusion: The additional fracture incidence of adjacent body after kyphoplasty is not higher than the incidence of natural osteoporotic fracture.ope

Effects of Heat Shock and Antioxidant on the Growth Plate of Unloaded Rats

PURPOSE: This study was performed to examine any histopathological changes occurring in the growth plate when the rats were subjected to be deprived of normal weight bearing using the hindlimb suspension model, and to search for any countermeasures for improving and/or recovering the chondrocyte activities within the growth plate. MATERIALS AND METHODS: Sixty male Sprague-Dawley rats, aged 6 weeks, were divided into 10 groups each: Group I-control to unloading; Group II-unloading 3 weeks only; Group III-unloading+application of heat shock; Group IV-unloading+application of antioxidant; Group V-unloading+application of heat shock and antioxidant; Group VI-control to reloading; Group VII-reloading 1 week only; Group VIII-reloading+application of heat shock; Group IX-reloading+application of antioxidant; Group X-reloading+application of heat shock and antioxidant. The animals were double labeled with 5-Bromo-2'-deoxydiuridin (BrdU) and BrdU immunohistochemistry was performed for the cellular kinetic analysis. Transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assay was done for the investigation of apoptotic changes in the growth plate, and the positive cells were counted in each zones of the growth plate in both TUNEL and BrdU immunohistochemistry. Heat shock protein (HSP), indian hedgehog (Ihh), and vascular endothelial growth factor (VEGF) were immunolocalized to assess the chondrocytic activities in terms of production of extracellular matrix protein. RESULTS: Non-weight bearing induced a reduction of height of the growth plate, reduced cellular proliferation of chondrocytes, reduced expression of Ihh and VEGF, and altered expression of heat shock protein. When heat shock and/or antioxidant were applied to the unloaded and reloaded rats, only rats in the group of application of both heat shock and antioxidant showed normal cellular activities in terms of cellular proliferation and the production of extracellular matrix protein. CONCLUSION: The present results suggest that application of heat shock and antioxidant would be a countermeasure for the restoration of chondrocytic activities when the normal weight-bearing is deprived of.ope

The 'four-in-one' procedure for habitual dislocation of the patella in children

We describe our experience with the 'four-in-one' procedure for habitual dislocation of the patella in five children (six knees). All the patients presented with severe generalised ligamentous laxity and aplasia of the trochlear groove. All had a lateral release, proximal 'tube' realignment of the patella, semitendinosus tenodesis and transfer of the patellar tendon. The mean age at the time of the operation was 6.1 years (4.9 to 6.9), and the patients were followed up for a mean of 54.5 months (31 to 66). The clinical results were evaluated using the Kujala score. There has been no recurrence of dislocation. All the patients have returned to full activities and the parents and children were satisfied with the clinical results. The mean Kujala score was 95.3 (88 to 98). Two patients had marginal skin necrosis which healed after debridement and secondary closure. These early results in this small group have shown that the 'four-in-one' procedure is effective in the treatment of obligatory dislocation of the patella in children with severe ligamentous laxity and trochlear aplasia.ope

Use of Allograft in Dega Acetabuloplasty

Purpose: Use of auto-iliac bone in acetabuloplasty in children is the standard method, however this has some problems such as the possibility of injury to the iliac apophysis, potential iliac deformity after operation, and the difficulty in getting enough size of bone. The purpose of this study was to examine the results of use of allobone in Dega osteotomy in children. Materials and Methods: 13 hips in 12 children with acetabular deficiency were included for the study. The mean age at the time of the operation was 7+3 years (range, 4~10+6 years). 7cases were of acetabular dysplasia associated with cerebral palsy and 6 cases were of developmental acetabular dysplasia. Acetabular index (AI) and center-edge angle (CEA) were measured before operation, after immediate operation, postoperative 6 months and postoperative 1 year. Results: There were no postoperative complications, such as deep infection, nonunion, delayed union, graft loss during the follow-up period. The average AI after immediate operation was 2 3 . 1°and CEA was 12.5°. The average AI at postoperative 1 year was 26.6°and CEA was 14.3°. There were no significant differences after immediate operation, postoperative 6 months and postoperative 1 year. Conclusion: Allobone graft in the acetabular reconstruction is thought to be useful for children whose enough bone can not be obtained.ope

Comparison of Treating Tibial Nonunion with Bone & Soft Tissue Defect: Ilizarov Only Versus Free Flap and Ilizarov

Purpose : To statistically analyze the advantages of distraction osteogenesis in combination with free flap in the treatment of tibial open fracture with bone and soft tissue defect. Materials and Methods : Twenty patients with tibial open fracture with bone and soft tissue defect were treated by distraction osteogenesis with or without flap. Patients were followed up for a minimum of 12 months and retrospectively analyzed, for the admission period, the out patient follow-up period, and the intravenous antibiotic period, and distraction consolidation indices were determined. Results : Those treated with free flap showed statistically significance shorter antibiotic period, admission period, and distraction consolidation indices. Conclusion : Free flap and distraction osteogenesis with an Ilizarov external fixator has many advantages for treating tibial open fracture with bone and soft tissue defect.ope

The "Four-in One" Procedure for Habitual Patellar Dislocation in Children with Formation Failure of Femoral Trochlea and Generalized Ligamentous Laxity

Purpose: To evaluate the clinical results of a “Four-in-One” procedure for a habitual dislocation of the patella in children with generalized ligamentous laxity and formation failure of the femoral trochlea. Materials and Methods: Five knees in 4 patients were included in this study. The average age of the patients at the time of surgery was 5.9 years and the subjects were followed up for an average of 41.6 months postoperatively. The clinical results were evaluated using the criteria of the Kujala's scoring system as well as a physical examination and radiological findings. Results: During the follow-up period, there were no recurrent dislocations, knee joint pain, limitations of motion or gait disturbances in any of the cases. The mean Kujala score was 96.8. Two cases had complications related to wound healing but they healed eventually. Conclusion: The "Four-in-One" procedure, which include the lateral retinacular release, medial vector augmentation, semitendinosus tenodesis, and patellar tendon transfer is recommended for a habitual dislocation of the patella in children with generalized ligament laxity and formation failure of the femoral trochlea.ope

In Situ Late Metaphyseal Osteosynthesis for the Fractures of the Lateral Humeral Condyle in Children

Purpose: To evaluate the efficacy of the in situ late osteosynthesis for slightly displaced fractures of the lateral humeral condyle. Materials and Methods: From 2000 to 2004, 12 patients (8 boys and 4 girls) were managed with in situ late osteosynthesis for fractures of the lateral humeral condyle. The average age at the time of operation was 6 years 1 month (1 year 7 months~9 years 1 month), and the mean amount of fragment displacement was 3.3 ㎜(2.0~4.5 ㎜). The operative procedure included curettage and in situ fixation of the fragment. Results: Bony union was achieved in all cases after avg. 48 months (33~73 months) follow-up assessment. According to the score system of Dhillon et al, 7 patients had excellent, 3 had good, 2 had fair results. None of the patients developed avascular necrosis or premature closure of the epiphysis. Conclusion: We suggest that in situ fixation is an effective method for the late treatment of slightly displaced fracture of the lateral humeral condyleope

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