Late Missed Monteggia Lesions—Reconstruction of the Humeroradial Joint

Objective:: Reconstruction of the humeroradial joint resulting in immediate functional stability. Indications:: Missed traumatic dislocation of the radial head. Congenital dislocation of the radial head. Contraindications:: Secondary dislocation of the radial head in instances of dysplasia or aplasia of the capitellum. Relative: deformation of the radial head in adults. Surgical Technique:: Open reduction of the radial head without reconstruction of the annular ligament. Osteotomy of the shaft of the proximal ulna and installation of an external fixator with open clamps. Three-dimensional correction of the ulna under visual control of the humeroradial joint until the radial head is relocated in its anatomic position. Results:: Between 01/1998 and 05/2001, we performed an osteotomy of the proximal ulna, external fixation, and open reduction of the radial head in 14 patients presenting with a late missed Monteggia lesion (Bado type I). The average age of the seven girls and seven boys at the time of reconstruction was 9 (5-15) years, the mean interval between index trauma and reconstruction amounted to 21 months (2 weeks to 7 years). Removal of the external fixator after an average of 12 (7-16) weeks. In twelve patients the reduction was maintained, and in two patients the radial head redislocated postoperatively. In one of these patients a closed reduction was successful, whereas in the other patient an open reduction was done and the external fixation modified. In both patients the joint position was maintained. Preoperatively seven out of 14 patients showed a decreased range of motion; it improved postoperatively in most. A clinical and radiologic follow-up averaging 14 (3-44) months was possible in 13 patients. No complications were recorde

Early Development of Spinal Deformities in Children Severely Affected with Spinal Muscular Atrophy after Gene Therapy with Onasemnogene Abeparvovec—Preliminary Results

Spinal muscular atrophy (SMA) is a rare genetic disorder, with the most common form being 5q SMA. Survival of children with severe SMA is poor, yet major advances have been made in recent years in pharmaceutical treatment, such as gene-therapy, which has improved patient survival. Therefore, clinical problems, such as the development of spinal deformities in these genetically treated SMA children represent an unknown challenge in clinical work. In a retrospective case series, the development of spinal deformities was analyzed in 16 SMA children (9 male, 7 female) treated with onasemnogene abeparvovec in two institutions during the years 2020 to 2022. Ten out of sixteen patients had a significant kyphosis, and nine out of sixteen patients had significant scoliosis, with the mean curvature angles of 24 ± 27° for scoliosis, and 69 ± 15° for kyphosis. Based on these preliminary data, it can be assumed that early-onset kyphosis presents a clinical challenge in gene-therapy-treated SMA children. Larger datasets with longer follow-up times need to be collected in order to verify these preliminary observations

Continuous Wear of Night and Day Orthosis Is a Key Factor for Improvement of Fixed Equinus Deformity after the Transverse Vulpius Procedure

Background: Equinus foot deformity is secondary to either spasticity or contracture of the gastrocnemius–soleus complex. The plantar flexion is basically treated conservatively; several different surgical methods have been discussed. This paper focuses on the improvement of passive ankle dorsiflexion after a transverse Vulpius procedure in equinus foot deformity. Additionally, the influence of consequent postoperative wear of orthosis on the improvement of ankle range of motion was investigated. Methods: In total, 41 patients with neuromuscular impairment and 59 equinus feet deformities were surgically treated by using a transverse Vulpius procedure. A total of 19 female patients and 22 male patients with a mean age at surgery of 10.18 years (2 to 31) were included. Mean follow-up took place 12.26 ± 7.95 months after surgery. Passive ankle dorsiflexion was measured and subjective patients’ satisfaction was assessed. Results: Range of motion, measured as the maximum of passive ankle joint dorsiflexion, improved significantly from −8° ± 5.9° to 11.1° ± 6.7° directly after surgery to 16.2° ± 10.7° at follow-up. The improvement of passive ankle dorsiflexion was significantly associated with the continuous wearing of night and day orthosis (p = 0.0045). Patient subjective satisfaction was very high. Conclusion: A transverse Vulpius procedure for aponeurotic gastrocnemius and soleus muscle lengthening of equinus foot deformity resulted in a significant improvement of passive ankle dorsiflexion. Positive surgical results correlated to a continuous use of orthotic devices