The effect of hip reconstruction on gross motor function levels in children with cerebral palsy

Objective: The aim of this study was to determine whether the hip reconstruction has an effect on gross motor function classification system (GMFCS) levels in patients with hip instability in cerebral palsy (CP). Methods: A total of 45 hips of 30 patients (mean age: 8.7 (4–17) years) with CP operated due to hip instability with a minimum of 2 years of follow-up were included into the study. Migration index was used for classification of the severity of hip instability. Clinical evaluation included sitting and walking ability, existence of pressure sores, difficulty in perineal care, and hip pain. The functional gains from the surgery were evaluated with changes in GMFCS levels. Wilcoxon T test, chi-square test and Spearman correlation test were used. Results: Mean follow-up time was 57 (24–132) months. The distribution of preoperative GMFCS was level I in 1 patient, level II in 4 patients, level III in 5 patients, level IV in 9 patients and level V in 11 patients. The complaints resolved in 25 patients, and persisted in 5 postoperatively. There was no correlation between the changes in GMFCS levels and the postoperative complaints (p = 0.504). The GMFCS levels did not change in 20 patients, improved in 8, and worsened in 2. There were no significant differences between the preoperative and postoperative GMFCS levels (p = 0.052). Positive correlations were found between the preoperative GMFCS-MI, the type of CP-MI respectively (p = 0.001, p = 0.015). Conclusion: There was an improvement in preoperative complaints. GMFCS levels remained stable after surgery. Relief in symptoms was not consistent with the changes in GMFCS in children with cerebral palsy after hip reconstruction. Level of evidence: Level IV, Therapeutic study. Keywords: Cerebral palsy, Hip reconstruction, Gross motor function, Classification syste

What is the Effect of 90-Degree DoublePlate Fixation with Grafting on Healing of Humeral Shaft Non-unions

WOS: 000406500600007Objective: Our aim was to investigate the clinical and radiological outcomes of double-plate fixation with grafting in the treatment of non-union of humeral shaft fractures. Materials and Methods: We performed a retrospective chart review of patients operated between 2006 and 2012 due to humeral shaft non-union. Patients undergoing surgery with double-plate fixation were included and those treated with external fixator, single plate, intramedullary nails and patients with pathological fractures and infected non-unions were excluded. Surgical intervention via anterolateral or posterior approach included radial nerve identification, decortication and reestablishment of medullary canal followed by compression plating with double-plate fixation and frequent application of autogenous grafts or allografts. Main outcome measures were success rate of non-union repair, rate of re-intervention and complications, range of motion, assessment of pain Visual analogue scale (VAS) and function Disabilities of the arm, shoulder and hand (DASH) and overall outcome Stewart-Hundley classification. Results: Ten patients were treated with double-plate fixation. The study group included six females and four males aged 36 to 70 years. Union was achieved within 4.5 and 8 months in all cases. The mean preoperative VAS score of 6.1 decreased to 2, postoperatively, with an associated decrease in the mean DASH score from 74.1 to 23.4. Excellent or good results were obtained in nine cases. There was no incidence of radial nerve palsy or infection. Conclusion: Our study provides level 4 evidence of the effectiveness of treating non-union fractures of the humeral shaft with double-plate fixation and grafting in providing good-to-excellent functional results and high union rate without any significant complication

Surgical treatment of cervical unilateral locked facet in a 9-year-old boy: A case report

Most of the cervical spine injuries in the pediatric population are typically seen in the upper cervical region. Unilateral cervical facet dislocation (UFD) in subaxial region is a rare injury in pediatric population. In this paper, a rare case of delayed locked UFD in a 9-year-old boy with rare injury mechanism treated surgically is reported. Clinical and radiological findings were described. The patient with C6-7 UFD without neurologic deficit was underwent open reduction and internal fixation via anterior and posterior combined approaches. Significant improvement of pain and free motion in cervical spine was obtained. There was no complication during the follow up. Only three case reports presented about the lower cervical spine injury with UFD under the age of 10 were found in the literature

Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up

The aim of this retrospective study was to evaluate the changes in the vertebral body and spinal canal area in a group of patients who had pedicle screw fixation under age 5 for the treatment of congenital spinal deformity at least 5 year follow-up

Basilar impression in osteogenesis imperfecta treated with staged halo traction and posterior decompression with short-segment fusion

Basilar impression is a cranial base abnormality associated with osteogenesis imperfecta (OI) with serious neurologic implications but controversial treatment options. Combined anterior and posterior decompression with long-segment posterior fusion is often recommended. We report a patient with OI (Sillence type III) with basilar impression treated with halo traction followed by posterior surgery. The patient was a 12-year-old female with a presentation of hiccups and change in upper extremity function. Diagnostic imaging revealed syringomyelia, compensated hydrocephalus, basilar impression, and Chiari type I malformation. The patient was treated with halo traction followed by posterior decompression fusion from the occipital bone to C2. Bone fusion and improved syrinx were evident on images during the 5 years of follow-up. Five years after surgery, syrinx recurred and the fourth ventricular catheter was revised. The treatment with halo traction followed by posterior-only surgery of basilar impression associated with OI resulted in a good postoperative outcome

Rotational deformities of the long bones can be corrected with rotationally guided growth during the growth phase: A study in rabbits

Background and purpose — Coronal and sagittal plane long bone deformities can be corrected with guided growth, whereas transverse plane rotational deformities require osteotomy and internal or external fixation. We investigated whether rotational changes can be introduced with the plating technique. Methods — 45 rabbits (6 weeks old) were divided into 3 groups. The unoperated right tibia was used as control. In groups 1 and 3, two plates were placed obliquely to the long axis and in different directions. In group 2, a sham operation was performed with screws. Animals in groups 1 and 2 were followed for 4 weeks. In group 3 the implants were removed 4 weeks after the operation to observe rebound effect, and the animals were followed for another 4 weeks. The tibial torsion was assessed on computed tomography (CT). External rotation was accepted as a negative value. Results — In group 1, mean torsion was −20° (SD 7.9) in the right tibia and −2.9° (SD 7.2) in the left tibia (p < 0.001). In group 2, mean torsion was −23° (SD 4.9) in the right tibia and −26° (SD 6.5) in the left tibia (p = 0.2). In group 3, mean torsion was −21° (SD 6.3) in the right tibia and −9.5° (SD 5.3) in the left tibia (p < 0.001). Intergroup evaluation for left torsion showed a significant difference between group 2 and the other groups (p < 0.001). When the rebound effect was evaluated, there was no statistically significant difference between groups 1 and 3 (p = 0.08). Interpretation — A rotational change was attained with this technique. Although a rebound effect was seen after implant removal, it did not reach statistical significance. The final rotational change remained constant

Protective effect of the N-methyl-D-aspartate receptor antagonists, MK-801 and CPP on cold-induced brain oedema

Cold injury model in rat was used to determine the effect of treatment with the competitive NMDA antagonists CPP and the noncompetitive NMDA antagonist MK-801 in cerebral oedema. MK-801 was applied in doses of 1 mg/kg and CPP of 10 mg/kg, 15 min. after injury. Control animals received 1 mi saline at the same time interval after injury. Tissue samples from the core and periphery of the lesion of the injured hemisphere and from the symmetrical location of the undamaged contralateral hemisphere were removed 24 hours after injury. Blood brain barrier permeability, brain water content and tissue specific gravity values were determined. MK-801 was found beneficial for reducing the oedema and restore the blood brain barrier permeability at the penumbral zone of the lesion, whereas both MK-801 and CPP were found ineffective for prevention of oedema accumulation at the core of the lesion