Treatment of early onset spinal deformities with magnetically controlled growing rods: a single centre experience of 30 cases.

PURPOSE: The treatment of early onset scoliosis continues to be a major challenge, even when using motorized growth-sparing implants. We report on 30 cases operated on with magnetically controlled growing rods (MCGRs) at our institution, analyzing radiological parameters and complications, comparing our results with the literature and presenting a special implant fixation technique. A separate focus highlights the challenges of conversion from previous non-motorized implants. METHODS: Consecutive case series. The nature and effects of complications were recorded for all patients. Radiographic evaluations were performed for patients with a minimum follow-up of two years. Separate analyses were carried out for patients who were previously treated with non-motorized growth-sparing implants. RESULTS: There were 12 documented complications in 11/30 (37%) patients leading to 13 unplanned returns to the operating room. In all, 18/30 patients had a minimum follow-up of two years. Major curve and main kyphosis, as well as T1 to T12 and T1 to S1 distances significantly improved with MCGR implantation, however, less in patients converted from previous growth-sparing surgical treatment. While the achieved correction of the major curve was maintained, there was a loss of kyphosis correction with subsequent implant lengthening. Gain in implant length decreased with increasing number of extensions. CONCLUSION: Despite improved patient's comfort, MCGR show a considerable complication rate. Coronal plane deformities can be well controlled, but diminished implant lengthening is already apparent within two years after MCGR implantation. Central databases should help to clarify unresolved aspects and optimize the treatment of these young patients. LEVEL OF EVIDENCE: IV.

Ilizarov tibial lengthening in the skeletally immature patient.

AIMS: We wished to examine the effectiveness of tibial lengthening using a two ring Ilizarov frame in skeletally immature patients. This is a potentially biomechanically unstable construct which risks the loss of axial control. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of 24 boys and 26 girls, with a mean age of 8.6 years (4 to 14), who underwent 52 tibial lengthening procedures with a mean follow-up of 4.3 years (4.0 to 16.9). Tibial alignment was measured before and after treatment using joint orientation lines from the knee and a calculation of the oblique plane axis. RESULTS: The mean percentage length gain was 20% (13 to 31) with a mean bone-healing index (BHI) of 34 days per centimetre (20 to 54). Age at surgery and location of the osteotomy site showed a strong relationship as the location of the osteotomy migrated more proximally with age. However, no significant correlation was found between BHI and the position of the osteotomy. The coronal and sagittal joint orientation of the lengthened tibias were within the normal range in 67% and 92% of cases, respectively. The oblique plane angulation calculation revealed a statistically significant change pre- to post-operatively in both magnitude (p < 0.05) and direction (p < 0.01), but without clinical consequence. The majority of complications were minor (n = 40 in 27 patients; 1.48 complications per segment lengthened) with no residual disability reported. CONCLUSION: Two-ring tibial lengthening is effective in maintaining segmental alignment, efficient in callous production and relatively comfortable for the patient with few significant complications. Cite this article: Bone Joint J 2016;98-B:1276-82.

The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development.

Pelvic obliquity is a common finding in adolescents with cerebral palsy, however, there is little agreement on its measurement or relationship with hip development at different gross motor function classification system (GMFCS) levels. The purpose of this investigation was to study these issues in a large, population-based cohort of adolescents with cerebral palsy at transition into adult services. The cohort were a subset of a three year birth cohort (n = 98, 65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their last radiological review) with the common features of a migration percentage greater than 30% and a history of adductor release surgery. Different radiological methods of measuring pelvic obliquity were investigated in 40 patients and the angle between the acetabular tear drops (ITDL) and the horizontal reference frame of the radiograph was found to be reliable, with good face validity. This was selected for further study in all 98 patients. The median pelvic obliquity was 4° (interquartile range 2° to 8°). There was a strong correlation between hip morphology and the presence of pelvic obliquity (effect of ITDL on Sharpe's angle in the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p < 0.001). This was particularly true in non-ambulant adolescents (GMFCS IV and V) with severe pelvic obliquity, but was also easily detectable and clinically relevant in ambulant adolescents with mild pelvic obliquity. The identification of pelvic obliquity and its management deserves closer scrutiny in children and adolescents with cerebral palsy.

[Brace treatment of adolescent idiopathic scoliosis : a retrospective study and analysis according to the SRS criteria]. / Behandlung der jugendlichen idiopathischen Skoliose mittels Korsett : Eine retrospektive Studie und Analyse nach SRS-Kriterien.

BACKGROUND: The purpose of this study was to analyze patients with adolescent idiopathic scoliosis (AIS) treated with bracing at The Royal Children's Hospital in Melbourne Australia according to the Scoliosis Research Society (SRS) criteria and evaluate the effectiveness of this treatment method. PATIENTS AND METHODS: During the 1 year survey 125 patients with AIS were treated with bracing and 52 (42 %) of those fulfilled the SRS criteria. Measurements were performed according to the follow-up visits at 6 and 12 months. RESULTS: The mean age of the patients was 13.1 years and the mean Cobb angle at the start of therapy was 31.8°. Thirtynine (76 %) patients were treated successfully and an improvement of the Cobb angle was achieved in 26 (51 %) patients. A further 6 patients (12 %) required surgery and 7 (14 %) showed a Cobb angle of more than 45° after reaching skeletal maturity. CONCLUSION: The results show the effectiveness of bracing as a treatment method for patients with AIS. The SRS criteria provide good guidance to classify patients who are likely to benefit from this treatment. A better comparison of the outcome with other studies can be achieved by using these criteria.

A closer look at chemotherapy errors.

Lehigh Valley Hospital and Health Network, a 700-bed tertiary care system, created a reference guide as part of its chemotherapy error prevention initiative.

A collaborative approach to home OKT3 infusion therapy.

Hospitalization of patients who have undergone renal transplantation is often extended because of the need to complete complex antirejection infusion therapy. Because of the costs associated with prolonged hospitalization, medical professionals who provide care to these patients are developing programs that will facilitate attainment of quality care in the outpatient setting. The authors describe the effective implementation of a home Muromonab-CD3 (OKT3) intravenous administration program among renal transplant recipients based on thorough planning and close collaboration between the transplant service and home care staff.