ABSTRACT
Background: Slipped capital femoral epiphysis (SCFE) represents a relatively common hip disorder in adolescents. The present retrospective study analyzes the correlation between age, severity of the slip and physeal stability and the functional outcomes, as well as the ability to return to previous physical activity (PA) of patients surgically treated with either pining in situ (PIS) or the modified Dunn (MD) procedure (anatomical reduction of the slipped epiphysis). Methods:The present research is a retrospective observational study of patients surgically treated for SCFE from 2010 to 2015. The sample was divided into two groups: those treated with PIS and those with the MD procedure. Univariate and multivariate logistic regression analyses were performed to determine the relationship between age, Loder classification (stable/unstable), as well as Southwick slip angle (severity of the slip) to return to previous PA. Furthermore, linear regression was used to investigate the association of the above predictor variables to Oxford and Harris hip scores (HHS). Results:A total of 32 patients were identified (16 treated with PIS and 16 with the MD procedure). None of the examined predictor variables (age, Southwick slip angle, Loder classification) had statistically significant effect on the ability to return to previous PA in either the in situ or Dunn group. Univariate analysis showed that higher patients' age at the time of surgery was related to worse HHS and Oxford scores in both the PIS and MD groups. Unstable hips seem to affect unfavorably the HHS. Conclusion:The present study did not reveal any relationship between the age, degree of the Southwick slip angle, the stability of the physis, and the return to PA. Exploration of additional confounding factors are warranted to better understand the physis-related impact on the functional outcomes in both groups.
ABSTRACT
Objectives: Septic non-union in long-bone fractures represents a challenging clinical entity. Management of lower extremity segmental bone defects, aiming to restore functional anatomy, remains extremely difficult and controversial. Masquelet technique is a reconstruction method for large diaphyseal bone defects, based on the notion of the induced membrane. The principle of the induced membrane is to create a foreign body reaction by placing cement spacer in the bone defect. The purpose of this study was to assess the success rate of induced membrane technique (IMT) in treating lower extremity large bone defects due to septic non-union. Methods:This is a retrospective observational study performed in a single referral center in France, Europe, which is specialized in complex bone and joint infections. All patients operated for septic non-union were identified from a prospectively maintained database. Patients treated with the IMT for septic femoral or tibial non-union between 2013 and 2017 were enrolled in this study. Exclusion criteria were infection of a continuous bone, aseptic non-union, or patients with less than one year of follow-up after antibiotic treatment ending. Results:Twenty-three cases (19 patients) with an average age of 41.3 years were included in the present study. There were 19 tibial and four femoral fractures. The mean bone defect was 65.3 mm. The mean time interval from initial trauma to the first surgical phase was 17 months, while that between the two surgical phases was 77.7 days. After the first surgical phase, samples were positive in 13 cases (68.5%), isolating Staphylococcus (26%) and more than one pathogen in 22% of cases. Bone union was successful in 16 of 23 cases (69.6%, 14 patients). There were seven failures: five amputations due to mechanical and/or infection-related failure and two failed unions. Conclusion:This study found that 69% of cases with septic non-union of tibial or femoral fracture treated with the two-step surgical protocol achieved bone union and infection eradication within about 13.2 months after the second stage of the procedure. The study revealed promising results in patients suffering large-size bone defect; hence, the IMT may prove beneficial in the management of such cases.
