A Simple Dual-Planar Osteotomy to Correct Cubitus Varus Deformity in Children.

OBJECTIVES: To report the outcomes when performing a dual-planar osteotomy of the distal humerus via a posterior approach for gunstock deformity in children. DESIGN: A retrospective review. SETTING: Penn State Hershey Pediatric Bone and Joint Institute. PATIENTS/PARTICIPANTS: Sixteen patients were reviewed. The average patient age was 8 years (range, 5-13 years). INTERVENTION: A complete dual-planar closing wedge osteotomy was performed with the patient in the prone position via a posterior triceps-splitting approach. Fixation with buried smooth K wires was utilized. MAIN OUTCOME MEASUREMENTS: Valgus correction obtained, final elbow range of motion, radiographic and clinical correction of the deformity, the patient's satisfaction, and elbow function were evaluated. RESULTS: Preoperative radiographs showed the average humeral-ulnar angle (HUA) was 17 degrees of varus (range, 10-26 degrees varus). The average wedge removed wallow-up clinical exam demonstrated that the carrying angle was in valgus in 15 cases and neutral in 1 case. The average carrying angle was 5 degrees of valgus (range, 0-11 degrees valgus). The average hyperextenss 25 degrees (range, 20-40 degrees). Duration of follow-up averaged 51 months (range, 12-126 months). Final foion deformity improved from 9 degrees preoperatively to 1 degree postoperatively. Outcomes were classified by the grading scale described by Oppenheim: 14 cases had excellent results and 2 cases had good results. CONCLUSIONS: This method provides clear visualization and excellent correction of the deformities. The posterior scar is cosmetically acceptable. We recommend this technique for the treatment of gunstock deformity in children. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Case of Acute Compartment Syndrome of the Thigh Associated with Repetitive Athletic Trauma.

We present a case of acute compartment syndrome (ACS) in an athlete who sustained minimal but repetitive trauma to the thigh during a sporting event. During his evaluation, concern was raised regarding the diagnosis of ACS as a cause of his symptoms. This was confirmed by measuring the intra-compartmental pressures and he subsequently underwent successful emergent fasciotomy, eventually making a complete recovery. ACS is a potential complication of muscular-skeletal injuries from various causes, and our case is unusual as the cause was mild but repetitive trauma in an otherwise healthy athlete. It is important to recognize the signs and symptoms of ACS to avoid the potentially significant complications should the diagnosis be missed.

Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions.

BACKGROUND: There is a common belief that surgical reconstruction of an acutely torn anterior cruciate ligament (ACL) should be delayed for at least 3 weeks because of the increased incidence of postoperative motion loss (arthrofibrosis) and suboptimal clinical results. HYPOTHESIS: There is no difference in postoperative range of motion or stability after ACL reconstructions performed either acutely or delayed. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Patients with an acute ACL tear were prospectively randomized to either early (within 21 days) or delayed (beyond 6 weeks) reconstruction using autograft hamstring tendon. Previous knee surgery on the index extremity and a multiligamentous injury were exclusionary criteria. Surgical technique and postoperative rehabilitation were identical for all patients. Postoperative assessments included range of motion and KT-1000 arthrometer measurements compared with the contralateral knee. Standardized outcome measures were used including single assessment numeric evaluation (SANE), Lysholm, and Tegner Activity Score. RESULTS: Seventy consecutive patients were enrolled, and 1 patient was dropped after a postoperative infection. Sixty-nine patients (34 acute, 35 delayed) with an average age of 27 years composed the study cohort. The mean time from injury to surgery was 9 days (range, 2-17 days) for patients in the early group and 85 days (range, 42-192) for those in the delayed group. The average follow-up from surgery was 366 days (range, 185-869). Articular cartilage and meniscal injuries were comparable between the 2 groups. There were no significant differences between the 2 treatment groups in degrees of extension or flexion lost relative to the nonoperative side, operative time, KT-1000 arthrometer differences, or subjective knee evaluations. CONCLUSION: Excellent clinical results can be achieved after ACL reconstructions performed soon after injury using autograft hamstrings. Although the authors do not advocate that all reconstructions should be performed acutely, they found that early ACL reconstructions do not result in loss of motion or suboptimal clinical results as long as a rehabilitation protocol emphasizing extension and early range of motion is employed.