Treatment of proximal tibial buckle fractures: removable knee immobilizer versus long leg cast.

The purpose of this study was to compare outcomes and management of patients with buckle fractures of the proximal tibia treated with either a knee immobilizer or a long leg cast (LLC). A retrospective review was performed of pediatric patients with a buckle fracture of the proximal tibia over a 5-year period. Two cohorts were included, those treated with a LLC versus a removable knee immobilizer. Data collected included immobilization type, fracture laterality, length of immobilization, number of clinic visits, fracture displacement, and complications. Differences in complications and management between the cohorts were evaluated. In total, 224 patients met inclusion criteria (58% female, mean age 3.1 years ± 1.7 years). Of these patients, 187 patients (83.5%) were treated with a LLC. No patients in either group were found to have interval fracture displacement during treatment. Seven patients (3.1%) demonstrated skin complications, all in the LLC cohort. Mean length of immobilization was shorter for those treated in a knee immobilizer at 25.9 days versus 27.9 days for the LLC cohort (P = 0.024). Total number of clinic visits was also less at 2.2 (SD ±â€…0.4 days) for the knee immobilizer and 2.6 (SD ±â€…0.7 days) for the LLC (P = 0.001) cohorts. Pediatric patients with proximal tibial buckle fractures can be safely managed with a knee immobilizer. This treatment method is associated with a shorter duration of immobilization and fewer clinic visits without incidence of fracture displacement. In addition, knee immobilizers can lessen skin issues associated with cast immobilization and cast-related office visits. This is a Level III evidence, retrospective comparative study.

What's New in the Management of Foot Deformities in Children With Cerebral Palsy.

BACKGROUND: Foot deformities have been frequently reported in cerebral palsy (CP), and numerous diagnostic modalities and treatment options have recently been developed to achieve a better level of management for children with CP. METHODS: A thorough search of the English literature, published between January 2013 and March 2016, was performed. A summary of the new findings that had not previously described was reported. The review included recent advances regarding clinical and gait evaluation, orthotic management, botulinum toxin A treatment, and surgical correction. RESULTS: The review summarized new findings reported in 46 articles and abstracts that were published between January 2013 and March 2016. Older articles were included and cited when an original description was mentioned, or when a change or development of some findings was discussed. CONCLUSIONS: Foot deformity forms an essential part of evaluating children with CP. Dramatic advances have been achieved in gait assessment, conservative management, and surgical correction. Promising results have been reported with the goal to reach a higher level of orthopaedic care and optimize the functional potentials for children with CP. LEVEL OF EVIDENCE: Level IV-literature review.

Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation.

STUDY DESIGN: A biomechanical study conducted on cadaveric specimens. OBJECTIVE: (1) To compare the biomechanical strength of the S2 alar-iliac (S2AI) screw to traditional iliac fixation and (2) to examine the effect of length and trajectory on the S2AI screw. SUMMARY OF BACKGROUND DATA: A recent technique to attain spinal fixation distal to S1 pedicle screws is the S2AI screw using either an open or a percutaneous approach with an altered S2 alar screw trajectory to obtain purchase in the ilium. A novel modification of the S2AI screw is placement with bicortical purchase in the ilium (quad-cortical screw). This may allow for a shorter-length screw with equivalent biomechanics. METHODS: Seven human cadaveric spines (L2-Pelvis) were fixed at L2 proximally and the pubis distally. Pedicle screws were placed from L3-S1 with S2AI screw lengths of 65-mm, 80-mm, or 90-mm iliac screws. S2AI screws were tested with and without quad-cortical purchase. Each specimen was tested on the 6 degrees of freedom spine simulator. A load control protocol with an unconstrained pure moment of 10 Nm was used in flexion-extension, lateral bending, and axial rotation for a total of 3 load/unload cycles. The range of motion was normalized to the intact cadaveric spine (100%). RESULTS: All the instrumented constructs significantly reduced range of motion compared with the intact spine. The L3-S1 construct was statistically significantly less stable than all instrumented constructs in flexion-extension. There was statistically no significant difference between the S2AI screws of all lengths and the iliac screw constructs with offset connectors. CONCLUSION: S2AI screws are biomechanically as stable as the test constructs using iliac screws in all loading modes. Sixty-five-millimeter S2AI screws were biomechanically equivalent to 90-mm iliac screws and 80-mm S2AI screws. Quad-cortical purchase did not statistically significantly improve the biomechanical strength of S2AI screws. LEVEL OF EVIDENCE: N/A.