Prevention of ankle valgus after vascularized fibular grafts in children.

Ankle valgus after the use of vascularized fibular grafts is a specific complication of the donor site ankle in the growing child. Incidence of this deformity and prevention strategy are documented poorly. The goal of the current study was to evaluate the rate of such deformities and to analyze efficiency of two prevention methods. Charts of 20 children surgically treated for sarcomas of long bones with a mean followup of 4.1 years were studied retrospectively. Ankle valgus was considered if the tibiotalar angle on radiographs with the patient standing was 5 degrees or greater in valgus than that of the opposite ankle, and deformity was considered severe if it required surgical treatment. Prevention was done in some patients with a tibiofibular syndesmotic screw or with reconstruction of the fibula using a tibial autograft. Valgus occurred in nine patients (45%) and was severe in five (25%). Valgus prevention with a syndesmotic screw was efficient and lacking in complications, whereas patients with fibula reconstruction had a high incidence of deformity and relevant complications. The authors recommend using a tibiofibular screw in all patients whose growth plates are open in the lower limbs at the time of surgery

Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases

Background and Objectives: Expandable distal femur prostheses have become more popular over the last decades, but scientific data is limited. Methods: A retrospective study was performed, including cases treated between 1986 and 2019 in 15 European referral centers for bone sarcomas. Results: A total of 299 cases were included. Average follow-up was 80 months (range, 8-287 months). Mean patient age was 10 years. Most (80%) of the implants were noninvasive growers and a fixed hinge knee was used more often (64%) than a rotating hinge. Most prosthetic designs showed good (>80%) implant survival at 10 years, but repeat surgery was required for 63% of the patients. The most frequent reason for revision procedure was the completion of lengthening potential. Noninvasive expandable implants showed less risk of infection compared to invasive growers (11.8% vs 22.9% at 10 years). No difference in aseptic loosening was found between cemented and uncemented stems. Conclusions: This study shows the increasing popularity of expandable distal femur prostheses, with overall good results for function and implant survival. However, repeat surgery is frequently required, especially in patients under the age of 10 years old. Infection is less frequent in noninvasive growers compared to implants that require invasive lengthening procedures

Delayed-iatrogenic injury of the thoracic aorta by an anterior spinal instrumentation

We present a case of a 15-year-old girl who presented to us with an unusual low back pain. About 7 years ago, this patient had corrective surgery for her idiopathic left thoracolumbar scoliosis. Recent surgery revealed a laceration of the posterior wall of the thoracic aorta by an impending screw thread. This injury was repaired by the vascular surgeons and, subsequently, the patient had full recovery without any complications

Bone tumors: MRI pitfalls

[No abstract available