The role of Taylor spatial frame in the treatment of Blount disease

BACKGROUND: Alteration of the posteromedial part of the proximal tibia is the main characteristic of Blount's disease and if left untreated, leg alignment and normal development of the lower limbs may be compromised.AIM: To report treatment outcomes in children with Blount's disease using the Taylor Spatial Frame (TSF).MATERIALS AND METHODS: From January 2007 to December 2014, 16 young children (24 tibia) with a mean age of 7.5 years (range of 3-14 yrs) and severe Blount's disease were treated using TSF. Preoperative long standing radiographs were performed and anatomic medial proximal tibial angle (MPTA), diaphyseal-metaphyseal tibial angle (Drennan), femoro-tibial angle and leg length discrepancy (LLD) were measured.RESULTS: Post-operative improvement of all measurements was observed. MPTA increased from a mean of 71.8\ub0 (58\ub0 - 79\ub0) to 92.5\ub0 (90\ub0 - 95\ub0), the Drennan decreased from 16.6\ub0 (14\ub0 - 18\ub0) to 3.6\ub0 (0\ub0 - 6\ub0), the F-T angle changed from 15.4\ub0 (10\ub0 - 25\ub0) of varus to 5.9\ub0 (2\ub0 - 10\ub0) of valgus and the LLD decreased from 208 mm (150-320) to 69 mm (0- +120). Mean follow-up was 45.6 months. According to Paley's criteria pin track infection was present in 6 tibiae, while in 5 patients software changes were necessary. Recurrence was observed in 3 patients (triplets). Complete restoration of the mechanical axis was obtained at the end of the treatment.CONCLUSIONS: In the last decades, different surgical treatments have been proposed for Blount's disease (tension band plate, staples, osteotomies using external or internal fixation). External fixation using the TSF allows gradual safe correction of multiplanar deformities and is a well-tolerated technique by patients with Blount's disease

Total hip arthroplasty in an inveterate femoral neck fracture in a patient with congenital insensitivity to pain with anhidrosis

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protectionmechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to performa total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year

Plasma Protein Carbonylation in Haemodialysed Patients : focus on Diabetes and Gender

Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) experience oxidative/carbonyl stress, which is postulated to increase after the HD session. The influence of diabetes mellitus and sex on oxidation of plasma proteins in ESRD has not yet been clarified despite that diabetic nephropathy is the most common cause of ESRD in developed and developing countries and despite the increasingly emerging differences between males and females in epidemiology, pathophysiology, clinical manifestations, and outcomes for several diseases. Therefore, this study aimed to evaluate the possible effect of type 2 diabetes mellitus, gender, and dialysis filter on plasma level of protein carbonyls (PCO) in ESRD patients at the beginning and at the end of a single HD session. Results show that mean post-HD plasma PCO levels are significantly higher than mean preHD plasma PCO levels and that the type of dialysis filter and dialysis technique are unrelated to plasma PCO levels. The mean level of plasma PCO after a HD session increases slightly but significantly in nondiabetic ESRD patients compared to diabetic ones, whereas it increases more markedly in women than in men. These novel findings suggest that women with ESRD are more susceptible than men to oxidative/carbonyl stress induced by HD

DDH treatment with Pavlik harness: Weekly ultrasound monitoring for stability

Normal development of the infantile hip joint relies upon the congruent and stable relationship of the femoral head and the acetabulum. Treatment with dynamic bracing for instability of the hip joint is accepted, but the duration of treatment required and the timing of follow up is of current debate. The aim of this study was to determine the outcome of Pavlik Harness treatment in children with early presenting ultrasonographically unstable and dislocated hips, independently of morphological appearance of the joint. Children suspected of having or to be high risk for DDH were assessed by clinical and ultrasound examination. Ultrasonographically unstable and dislocated hips were treated in the Pavlik harness and reviewed weekly with ultrasound. Once reduction had been maintained for six consecutive weeks weaning from the harness over the following 5 weeks was started. Thirty three children (37 hips) were treated. The mean follow up time was 2.9 years (6 weeks - 5.3 years). Six hips failed to remain reduced. There was no statistically difference in age at commencement of Pavlik harness treatment between the successful and unsuccessfully treated groups (p>0.1). Evaluation of the duration of splintage required to achieve reduction of the hip compared against the age of the child at the commencement of splintage revealed no statistically significant correlation (p>0.1) to be present. Early treatment of hip instability within the first weeks of life, even with an apparent normal morphology of the acetabular socket, results in normal joint development, decreasing the need for prolonged compliance with treatment. It may also reduce the incidence of late presentation, without increasing the rate of complications (0 in our series)

D.D.S.H.: developmental dysplasia of the spastic hip: strategies of management in cerebral palsy : a new suggestive algorithm

Hip problems in cerebral palsy are relatively frequent (25-75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity. The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%. We consider age and R.I crucial prerequisites for treatment steps. EMMA 1) age 2-4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures). EMMA 2) age 4-6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction). EMMA 3) early bone surgery (growth plates). This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity

Bilateral hip surgery in severe cerebral palsy : a preliminary review

When cerebral palsy involves the entire body pelvic asymmetry indicates that both hips are 'at risk'. We carried out a six-year retrospective clinical, radiological and functional study of 30 children (60 hips) with severe cerebral palsy involving the entire body to evaluate whether bilateral simultaneous combined soft-tissue and bony surgery of the hip could affect the range of movement, achieve hip symmetry as judged by the windsweep index, improve the radiological indices of hip containment, relieve pain, and improve handling and function. The early results at a median follow-up of three years showed improvements in abduction and adduction of the hips in flexion, fixed flexion contracture, radiological containment of the hip using both Reimer's migration percentage and the centre-edge angle of Wiberg, and in relief of pain. Ease of patient handling improved and the satisfaction of the carer with the results was high. There was no difference in outcome between the dystonic and hypertonic groups

Growth of the acetabular lateral cartilage in relation to congenital and developmental dysplasia of the hip. An histological study

There are no clear explanations for the spectrum of hip dysplasia nor for the observation that in normal and dysplastic hips, final development may be unpredictable with or without treatment. Immunohistochemical and histological studies of a three month old child\u2019s acetabulae were performed. Multiple inclusions were found in the lateral ring epiphysis and in the three flanges of the triradiate cartilage. These inclusions may represent cartilage vessel systems pre-destined to form the secondary centres of ossification. Damage to the primary acetabular growth plates may occur congenitally and help to explain the spectrum of acetabular dysplasia. Damage to one or more of these centres, whether due to instability, displacement or iatrogenic injury, may cause failure of late acetabular development. Hips at risk of damage to the acetabular cartilages should be followed up longer