Treatment of congenital pseudarthrosis of the tibia with recombinant human bone morphogenetic protein-7 (rhBMP-7). A report of five cases

Congenital pseudarthrosis of the tibia is one of the most frustrating conditions encountered in pediatric orthopaedics because of the difficulty in achieving healing. Numerous treatment options have been explored with varying degrees of success1-19. Although some reports have demonstrated successful healing7,9,19, it is very difficult to restore the normal structural and functional integrity of the bone such as that which occurs after treatment of other types of fractures in children. Advances in molecular biology have provided a better understanding of the mechanisms of fracture-healing as well as possible new solutions for the problem, including the use of bone morphogenetic protein (BMP)20-24. In a controlled, prospective, randomized study of 124 tibial nonunions (in 122 adult patients) treated with insertion of an intramedullary rod and recombinant human (rh) BMP-7, no significant difference (p = 0.939) was noted between the BMP group and the group that received an intramedullary rod and autogenous iliac crest bone grafts20. In a prospective, randomized, controlled, single-blind study of 450 patients with an open tibial fracture, patients who were treated with rhBMP- 2 (1.50 mg/mL) had significantly (p = 0.005) superior results compared with patients who were treated with intramedullary nail fixation and routine soft-tissue management as dictated by the injury21. These two large clinical series suggest that BMPs may be a good alternative to autogenous iliaccrest bone-grafting. Bone morphogenetic proteins have shown promising results in experimental animal models, and their clinical efficacy has been shown in the treatment of adult tibial nonunions and in spinal fusion20-24. They have not been tested in children because of uncertainty as to the effect on adjacent physes and because of concern about unexpected reactions. The use of BMP to treat congenital pseudarthrosis of the tibia is a logical approach because the results from both animal studies and human trials have suggested that BMP is efficacious in bone-healing. This prospective study was undertaken to determine the clinical efficacy and safety of the use of rhBMP-7 for the treatment of congenital pseudarthrosis of the tibia in skeletally immature patients and to compare the results with those of previously published studies in which autogenous iliac-crest bone grafts have been used in conjunction with various fixation methods

Improvement in a post-stroke pediatric patient with hemiplegia: Use of a hand-arm bimanual intensive therapy with hybrid assistive limb

Background: Pediatric stroke is a rare medical condition that often leads to long-lasting motor and cognitive impairments. Although therapies for adults after a stroke are well described, treatments for motor deficits following a pediatric stroke are yet to be investigated. We report a case of pediatric stroke in the chronic phase, in which a combination of novel treatments resulted in a significant improvement in physical function. Case report: A seven-year-old girl with a left hemispheric cerebral infarction lost almost all right upper extremity motor function. Following onabotulinumtoxinA treatment, she underwent hand-arm bimanual intensive therapy augmented with a hybrid assistive limb for 90 h over 15 days. Evaluation after the training revealed significant improvements in physical function, daily activities, and occupational performance. Conclusions: This report highlights the importance of innovative combinations of techniques in the treatment of pediatric stroke

13Th International Conference On Conservative Management Of Spinal Deformities And First Joint Meeting Of The International Research Society On Spinal Deformities And The Society On Scoliosis Orthopaedic And Rehabilitation Treatment – Sosort-Irssd 2016 Meeting

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