Pronating osteotomy of the forearm for obstetrical brachial plexus palsy with supination deformity: The first cohort to show functional improvement

Introduction: Supination contracture in patients with obstetrical brachial plexus paralysis [OBPP] results in severe functional limitation of daily activities. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not yet been clearly defined

Material and methods: This is a retrospective chart review of children with OBPP who underwent a pronating forearm osteotomy for their supination contracture at our institution between 2007 and 2014. Patients were evaluated for resting forearm position, forearm passive and active pronation and supination, preoperatively and at their last followup. Age correlation to outcomes was also tested. A subjective assessment tool for improvement was also used to evaluate patient-oriented outcomes

Results: Eighteen patients with a mean age of 8.5 years [3.7-17] and a mean follow-up of 55 months [24-100] were included. Preoperatively, patients had a forearm resting position of - 90 degree . Mean passive pronation was -45 degree [-30 degree to - 60 degree]. All patients had no active pronation. At their last follow-up, mean forearm resting position was - 4 degree [- 45 degree to +10 degree ;p < 0.001], mean active pronation was +26 degree [0 degree to +60 degree ; p < 0.001], mean passive pronation reached + 76 degree [+ 50 degree to + 90 degree ; p < 0.001], mean active supination was - 37 degree [- 50 degree to - 25 degree ; [p < 0.001] and mean passive supination was - 80 degree [- 90 degree to - 73 degree ; p < 0.001]. There were no correlation between age at surgery and final outcomes. Subjective self-assessment tool showed a mean partial improvement in all five tested headings

Discussion: Pronation osteotomy in OBPP patients with supination contracture is an effective reliable procedure with reproducible results. It seems to be associated with partially improved functional results in the postoperative period. While recurrence is possible, age at surgical intervention does not seem to affect the final outcome

Monitoring creatine kinase in spine surgery and its relation to acute renal failure

Serum creatine kinase [CK] is the gold standard marker for muscle injury. Any muscle damage, if severe enough, can lead to rhabdomyolysis [RM] and subsequent renal failure if not treated properly. This is usually correlated with high levels of creatine kinase. Spine interventions in orthopaedic surgery are associated with surgical "injury" to the back muscles and abnormal levels of creatine kinase. Rhabdomyolysis associated with spine surgery is in fact multifactorial, and most commonly due to prolonged surgery time and certain operative positions, correlated with high risk of developing compartment syndrome [CS]. However, the final complication of acute renal failure is exceptional in these procedures. This paper reviews all reported cases of rhabdomyolysis and acute renal failure following spinal interventions, and discusses the role of creatine kinase in the evaluation of muscle injury as a predictor of rhabdomyolysis and acute renal failure. Most spine surgeries are in fact not correlated with rhabdomyolysis and acute renal failure as this correlates with very high levels of creatine kinase. As a result, monitoring creatine kinase is only advised to follow in certain circumstances, and will only lead to unnecessary expenses

new approach in the clinical decision-making for cerebral palsy using three-dimensional subject-specific musculoskeletal reconstructions

Cerebral palsy [CP] is a neurological disorder which can cause muscular spasticity. Children with this condition suffer from a combination of gait deviations, skeletal deformities and muscular abnormalities. Precise evaluation of each of these three components is crucial for management planning in children with CP. The aim of this study is to review the latest innovative methods used for three-dimensional [3D] gait analysis and musculoskeletal modeling in children with cerebral palsy. 3D gait analysis is a quantitative objective method based on the use of infrared cameras. It allows the evaluation of dynamic joint angles, forces and moments applied on joints and is usually coupled with dynamic electromyography. Skeletal evaluation is usually based on two-dimensional X-rays and physical examination in clinical practice. However, a novel method based on stereoradiographic 3D reconstruction of biplanar low dose X-rays allows a more thorough evaluation of skeletal deformities, and in particular torsional anomalies. Muscular evaluation of children with CP is most commonly based on magnetic resonance imaging, whereby delimitation of lower limb muscles on axial slices allows 3D reconstruction of these muscles. Novel innovative techniques allow similar reconstructions by extrapolation, thus limiting the necessary quantity of axial slices that need to be manually delimitated

Ganglion cyst arising from the first metacarpophalangeal joint in an adolescent

Pediatric ganglion cyst of the hand is a rare entity. Its incidence is even lower in those arising from the metacarpophalangeal [MP] joint. We herein report the first known case of a ganglion cyst of the first MP joint in a 14-year-old boy. Pathogenesis, diagnosis and treatment are discussed

Vertebral scalloping in neurofibromatosis-1

A 39-year-old male patient known to have neurofibromatosis-1, presented with sciatica and low back pain. At the age of 27, an MRI of the spine revealed widening of the lumbar canal due to posterior scalloping of the last 4 lumbar vertebrae. Repeat MRI and simple lateral lumbosacral plain film at the age of 39, revealed significant progression of the lumbosacral lesion. In view of the progression of the disease during the last 15 years, we opted for insertion of a lumbo-peritoneal [LP] shunt to decrease the CSF pressure, which is the most probable cause of scalloping. We shied away from lumbar fixation as we thought that this would not stop the vertebral erosion. The LP shunt affected good symptomatic and radiologic outcome over a 2-year follow up

Resultats a long terme de la reeducation fonctionnelle dans le traitement du syndrome femoro-patellaire. A propos des 63 patients

Rehabilitation plays a primordial role in the treatment of the patellofemoral syndrome. We wanted to seek in a sample of population suffering from this problem, the factors favoring the occurrence of this syndrome, the rehabilitation result and the continuation of exercises patients and methods: Prospective descriptive study on the rehabilitated patients in a questionnaire form divided in two parts. The first one seeks the information of the patients file demographical, social and professional data, risk factors, clinical assessment and imaging, medical treatment, immediate rehabilitation results. The second part seeks the long-term effect of rehabilitation, the perseverance to exercises and the resumption of professional and sports activities. 78 patients, feminine prevalence 59%; average age: 32.7 years [between 12 and 60 years]. Occurrence favoring factors found: intensive sports 47.4%, profession presenting a risk 14%, traumatism 24.5%, hypermobility 30,7%.Etiology: patellar instability 18/78, dysplasia 2, chondromalacia 14, femoropatellar osteoarthritis 4, non-marked 40. Previous treatment AINS: 45%, efficient in third of cases; previous physical therapy 9/78 [50% failure]. The evaluated results of short-term rehabilitation according to Ficat criteria, regardless of etiology, were satisfying [good or very good] in 77% of cases. Very good: 20.5%; good: 56.5%; acceptable: 19.2%] and bad 3.8%.At long term on 63 patients with an average recession of 18 months [6 months to 3 years] we had very good 22.2%, good: 55.5%, acceptable 20.6% and bad 1.7%. Average duration of carry on of exercises: 4 months. The functional rehabilitation has confirmed its efficiency in the treatment of young patients suffering from patellofemoral syndrome. The education, the life hygiene, the preparation to sports as well as carry on of exercises prevent recurrences

Is MRI effective in detecting interaarticular abnormalities of the injured knee?

Background data Magnetic resonance imaging [MRI] is widely used for the diagnosis of intraarticular anomalies of the knee. Its reliability is controversial mainly in the pediatric population, and its results may vary from one center to the other. The PURPOSE of this study was to assess the validity of MRI in detecting intraarticular abnormalities in patients who sustained an injury of their knee, by comparing its findings to those of arthroscopy. Material and methods: Two hundred and seventeen traumatic knees underwent MRI followed by arthroscopy. Findings of MRI and arthroscopy were statistically compared. Results: Accuracy of MRI was 95.39% and 99.08% for anterior and posterior cruciate ligament ruptures respectively, 85.25% and 90.78% for medial and lateral meniscal tears respectively, and 91.24% for injury of the articular cartilage. There was not a significant difference between the pediatric and the adult populations, except for a greater sensitivity to detect lateral meniscal tears and a better specificity and accuracy to identify chondral lesions in the first group. Variability between centers was significant for the diagnosis of chondral defects. Conclusion The good MRI reliability in detecting intraarticular abnormalities as demonstrated in this report, underlines its importance in the assessment of the injuried knee before arthroscopy

Popliteal cyst in a patient with total knee arthroplasty. A case report and review of the literature

We report a case of total knee arthroplasty [TKA] failure presenting initially as a large popliteal cyst without bony destruction in a 66-year-old woman. A foreign body gigantocellular inflammatory reaction against polyethylene wear particles was found on histology.The size of the cyst and the absence of bony destruction can be due to an exclusive early intramuscular granulomatous reaction. Progressive loosening of the femoral component and narrowing of the joint space heralded the TKA failure