One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator / 中华实用儿科临床杂志

Objective:To investigate the clinical effectiveness of one-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator.Methods:The data of 5 patients (2 males and 3 females) with angulation and shortening deformity in the lower extremity after epiphyseal injury of the distal femur were retrospectively analyzed.The patients underwent monorail external fixator assisted one-stage osteotomy correction of the distal femur and distraction osteogenesis of the middle and upper femur in Zhengzhou Orthopeadics Hospital from May 2017 to December 2019.The mean age was 13.6 years old (range: 10 to 17 years old). The affected limbs were shortened by 5.1 cm on average (range: 3.9 to 6.5 cm). The average angulation deformity of the distal femur was 24.9° (range: 17.0°to 30.5°). The mechanical lateral distal femoral angle (mLDFA), the mechanical posterior distal femoral angle (mPDFA), the mechanical axis deviation (MAD), the range of motion (ROM) of the knee, and the length of the lower limbs before surgery and at the final follow-up were measured and analyzed.Results:All patients were followed up for 22 months on average (range: 15 to 32 months). For all the 5 patients, the mechanical axis was well realigned, mLDFA, mPDFA, and MAD returned to normal range, and the length of the affected limb achieved the goal as planned before the surgery.Besides, the affected limbs were lengthened by 5.6 cm on average (range: 3.9 to 8.0 cm), and the median healing index was 35.6 d/cm (range: 29.0 to 45.0 d/cm). The bone callus in the distraction area and the osteotomy end were well healed at the final follow-up, as indicated by the X-ray results.At the end of the distraction period, the flexion ROM of the knee in all patients reached basically 90°.By the final follow-up, all patients had a normal knee ROM.No vascular or nerve injury, dislocation of hips or knee joints, re-fracture after disassembly, deep infection and other complications were observed in all patients.Conclusions:One-stage biplanar osteotomy correction of angulation and shortening deformity of the lower extremity after epiphyseal injury of the distal femur with a monorail external fixator is safe and feasible.The method requires no multiple operations and improves the tolerance of patients during the treatment period.

Applying the femoral neck-lesser trochanter anteversion to evaluate the proximal femoral deformity of unilateral developmental dislocation of the hip in children / 中华骨科杂志

Objective:A new measurement index, femoral neck-lesser trochanter anteversion (FN-LTA), is proposed. To explore the feasibility and advantage of applying the FN-LTA to evaluate the proximal femoral deformity of unilateral developmental dislocation of the hip in children, so as to solve the current clinical problems.Methods:The imaging data of 90 patients with unilateral DDH admitted to our department from February 2016 to April 2017 were retrospectively analyzed, There were 13 males and 77 females. The age ranged from 0.6 to 11 years, with an average of 2.6±2.3 years. Femoral neck anteversion (FNA) and FN-LTA were measured at the affected and healthy sides. Analyze the correlation between FN-LTA and FNA, analyze the influence of gender, age, side, dislocation degree and other factors on FN-LTA, compare the difference between the affected side and the healthy side of FNA, FN-LTA, and analyze the influence of dislocation degree on this difference, compare the diagnostic efficacy and intra group consistency of FNA and FN-LTA. The possible advantages of FN-LTA in clinical application were preliminarily analyzed.Results:There was a positive correlation between FN-LTA and FNA in both healthy and affected sides (healthy side r=0.217, P=0.040, affected side r=0.298, P=0.004). FNA and FN-LTA in the affected side of DDH children were both larger than the healthy side, FNA affected side 38.86°±11.70°, healthy side 35.44°±11.16°; FN-LTA affected side 72.19°±9.17°, healthy side 61.17°±10.30°. The difference had statistical significance. FN-LTA was not affected by gender, side, degree of dislocation and other factors (gender P=0.060, side P=0.550, degree of dislocation of healthy side P=0.130, affected side P=0.705), but negatively correlated with age (healthy side r=-0.261, P=0.013, affected side r=-0.287, P=0.006). The diagnostic efficiency of FN-LTA is better, AUC FNA=0.561, AUC FN-LTA=0.736 ( P<0.05). FN-LTA and FNA had excellent intra group and inter group consistency. Inter group ICCFNA=0.956, ICCFN-LTA=0.973; intra group ICCFNA1=0.937, ICCFNA2=0.893, ICCFN-LTA1=0.887, ICCFN-LTA2=0.874. With the increase of dislocation degree, the difference between FNA and FN-LTA decreased. This decreasing trend was statistically significant in FNA ( P=0.030) but not in FN-LTA ( P=0.180). Conclusion:FN-LTA is a reliable method with a higher degree of differentiation for the assessment of anteverted deformity in DDH children' proximal end of femur, the measured data are more capable of guiding the rotation of osteotomy.

Effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture / 中华创伤骨科杂志

Objective:To explore the effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture.Methods:Fifty-nine children and adolescents with femoral neck fracture were retrospectively analyzed who had been admitted to Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital Affiliated to Henan University from February, 2015 to September, 2019. They were 39 boys and 20 girls with a mean age of 11.7 (7.1, 13.7) years. By Delbet fracture classification, 7 cases were type Ⅰ, 27 cases type Ⅱ, 20 cases type Ⅲ, and 5 cases type Ⅳ. The patients were divided into 4 groups by the time from injury to operation (TFITO): 17 cases were assigned into group A with TFITO from 24 to 48 hours, 14 cases into group B with TFITO from 49 to 72 hours, 12 cases into group C with TFITO from 73 to 96 hours, and 16 cases into group D with TFITO>96 hours. The effects of TFITO on postoperative complications and operative duration were analyzed.Results:There were no significant differences between the 4 groups in their preoperative general data, showing they were comparable ( P>0.05). This cohort was followed up for 12 to 62 months (average, 20 months). The operation time was not included for this study in 6 cases whose associated injury had to be treated simultaneously. The median operation time for the other 53 patients was 80 (70, 105) min. The correlation coefficient between TFITO and operation time was 0.098 ( P=0.484). Postoperative complications occurred in 37.3% of the patients (22/59), including 14 cases of avascular necrosis of femoral head. For groups A, B, C and D, the incidences of complications were 47.1% (8/17), 50.0% (7/14), 25.0% (3/12) and 25.0% (4/16) while the incidences of avascular necrosis of femoral head 23.5% (4/17), 31.3% (5/16), 16.7% (2/12) and 18.8% (3/16), showing insignificant differences between the 4 groups in all the comparisons ( P>0.05). Conclusion:The time from injury to operation may not increase operative duration or postoperative complications such as avascular necrosis of femoral head in children undergoing non-emergency operation for femoral neck fracture.

Factors associated with refracture after surgery for femoral shaft fracture in children / 中华创伤骨科杂志

Objective To analyze the factors influencing the incidence of refracture after surgery for femoral shaft fracture in children and put forward their countermeasures.Methods A retrospective study was conducted in the children who had been treated at Department I of Pediatric Orthopaedics,Zhengzhou Orthopaedic Hospital from September 2013 to May 2017 for primary femoral shaft fracture or refracture after surgery for femoral shaft fracture.Their clinic data were collected concerning age,gender,height,weight,primary fracture,treatment protocol,time for removal of fixation,time and site of refracture,and violence for refracture.The likely factors associated with refracture were identified by comparing the gender ratios,age distributions and primary fractures between the children with primary fracture and those with refracture,and by comparing the proportions of overweight and obese ones between the children with refracture and their normal counterparts.Results A total of 278 children,with a male to female ratio of 2.43∶ 1,were treated for primary femoral shaft fracture while 22 children,with a male to female ratio of 0.83∶ 1,for refracture contemporarily.In the children with primary fracture and those with refracture,respectively,there were 172 (61.9％) cases and 2 cases (9％) aged from 0 to 4 years,85 cases (30.6％) and 10 cases (45.5％) aged from 5 to 9 years,21 cases (7.5％)and 10 cases (45.5％) aged from 10 to 14 years.There were significant differences between the 2 groups in gender ratio and proportions of age (P ＜ 0.05).Compared to the normal children of the same age,the proportions of overweight and obese ones were significantly higher in those with refracture (P ＜ 0.05).There were no significant differences between the children with refracture and those with primary fracture in the site or type of primary fractures (P ＞ 0.05).Conclusions Refracture after surgery for femoral shaft fracture in children may be closely associated with their gender,age and overweight.Care should be taken to avoid refracture in children with high risks.