Indication for Achilles Tenotomy in Congenital Clubfoot: Effectiveness of Using the Tibio-Plantar Fascia Angle as a Radiographic Parameter.

Congenital clubfoot is one of the most common deformities in children, and currently, the Ponseti method is used worldwide because of its favorable short-term results. With the Ponseti method, the indication for Achilles tenotomy is traditionally based on only physical examination findings; however, some surgeons have also utilized plain radiographs. Because using physical examinations to determine the degree of hindfoot dorsiflexion for the indication of tenotomy can lead to underestimation. We developed and utilized the effectiveness of the tibio-plantar fascia angle (Ti-P angle) in the lateral maximum dorsiflexion view in determining the need for Achilles tenotomy. A retrospective analysis of consecutive 26 patients with congenital idiopathic clubfeet (37 feet) was performed. Whether Achilles tenotomy was indicated was determined based on physical examination for a former period (Group P). For the latter period, whether tenotomy was indicated was determined by referencing radiographs (Group X). No significant differences were found in any of the background factors or severity between Group P and Group X. Cases with larger tibiocalcaneal and Ti-P angles were more likely to require Achilles tenotomy or additional soft tissue release. An angle of more than 72° of the Ti-P angle demonstrated adequate specificity for the indication of Achilles tenotomy. The radiographic lateral tibio-plantar fascia angle is useful for deciding whether a tenotomy needs to be performed.

Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb.

AIM: To describe the novel hybrid fixation technique for paediatric femoral supracondylar fracture during circular external fixation of the lower limb. BACKGROUND: The Ilizarov external fixator is commonly used for various orthopaedic conditions. Difficulties associated with external fixation have previously been described. A fall while using a circular external fixator can cause ipsilateral fracture. Such fractures are ideally treated conservatively, but it is difficult to fix the frame itself. No study has reported the treatment of paediatric femoral supracondylar fracture during circular external fixation. Herein, we describe a novel hybrid fixation technique that was successfully used to treat paediatric femoral supracondylar fracture in three paediatric patients with circular external fixators. TECHNIQUE: The fracture was manually manipulated and reduced by slight hyperextension of the lower extremity under general anaesthesia. After confirmation of good reduction, a stockinette, a cast padding, and a thin core cast were applied to the ipsilateral thigh. The hinge parts were attached to the medial and lateral sides of the proximal ring. The rods were connected to the medial and lateral hinges, and the half ring was connected to the ventral side of the proximal end. Under fluoroscopic confirmation, the thin core cast of the thigh and rods were connected by cast rolled in a figure-of-eight manner. The hinges were locked with the knee joint slightly flexed. CONCLUSION: The minimally invasive hybrid fixation technique enables conservative treatment of paediatric femoral supracondylar fracture during circular external fixation of the lower limb with no complications, and early exercise and recovery. CLINICAL SIGNIFICANCE: This novel hybrid fixation technique will be an effective method for paediatric femoral supracondylar fracture in patients with a circular external fixator. HOW TO CITE THIS ARTICLE: Oka Y, Kim W-C, Yoshida T, et al. Hybrid Fixation for Paediatric Femoral Supracondylar Fracture during Circular External Fixation of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):179-183.

Monitoring of Callus Maturation and Measurement of Resistance Rates Using Bioelectrical Impedance for Patients Treated With an External Fixator.

Evaluation of callus maturation and the decision to remove an external fixator depend on radiographic and clinical findings, which are subjective. Callus fracture or recurrent deformity may occur after premature removal of a fixator. The authors applied a technique to measure bioelectrical impedance to assess callus maturation. This study included 27 limbs that underwent deformity correction or callus distraction using a fixator. Mean patient age at the time of surgery was 17.2 years. Overall impedance during callus maturation was measured from after completion of correction or distraction to removal of the fixator. Temporal changes in impedance values were measured, and maximum and final values were compared with initial values. The resistance rates were compared by age (<15 or ≥15 years), correction site (femur or tibia), and treatment method (noncontact or contact). Mean overall impedance increased gradually. Compared with initial values, maximum and final impedance values were 1.21 times and 1.15 times higher, respectively. Resistance rates by age, correction site, and treatment method were significantly higher in patients 15 years and older, in the tibia, and in the contact group, respectively. Overall impedance tended to increase during callus maturation but varied among patients. Therefore, resistance rates were calculated to classify differences for individual patients. Age and treatment method were important predictors of resistance rates. These data by age, correction site, and treatment method, which assume overall impedance from after completion of correction or distraction, can serve as a useful index to determine when a fixator should be removed. [Orthopedics. 2018; 41(1):54-58.].

Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. A case report.

Multiple epiphyseal dysplasia (MED) may be complicated by osteochondritis dissecans (OCD), most commonly reported in the knee, but involvement of the elbow is very rare. Optimal treatment for MED-associated elbow OCD and treatment outcome have not been established. This report describes the case of an adolescent male patient with elbow OCD treated by arthroscopic drilling at a previous clinic. Progression of osteoarthritis and radial head subluxation were observed. Resection of the osteophytes and modified wedge osteotomy of the lateral condyle were then performed, and a favorable result was obtained by decompression and sufficient congruency of the radiohumeral joint.

Assessment of lateral subluxation in Legg-Calvé-Perthes disease: a time-sequential study of magnetic resonance imaging and plain radiography.

Lateral subluxation of the femoral head is one of the poor prognostic factors of Legg-Calvé-Perthes disease. The aim of this study was to investigate the cause of lateral subluxation of the femoral head on the basis of the changes over time on MRI. Twenty-four patients with unilateral Legg-Calvé-Perthes disease were analyzed retrospectively. Lateral subluxation was measured as the tear drop distance on radiographs. We focused on joint fluid, medial articular cartilage thickening, and abnormal lesion on MRI. Lateral subluxation continued significantly in patients with poor results. Among the MRI findings, the presence of an abnormal lesion was associated significantly with the continuous lateral subluxation.

Detection of early changes after growth plate injury using MRI.

BACKGROUND: To elucidate the association between growth plate injury size and the beginning of physeal growth disturbance by MRI. METHODS: Thirty-two 5-week-old male Japanese white rabbits were used. Injuries were made to the right tibial proximal growth plate central region with a 3.0-mm and a 1.2-mm drill. The left tibia was used as a control. MRI (7.04 Tesla [T], gradient echo: repetition time [TR], 71.68 ms; echo time [TE], 3.60 ms; proton-density weighted imaging: TR, 2000 ms; TE, 12 ms) of the growth plates was performed at 1, 4, 8, 10, and 12 weeks postinjury. Tibia length, histology, radiography, and microcomputed tomography (µCT) were studied. RESULTS: MRI showed that at 10 and 12 weeks postinjury in the 3.0-mm group, the medial and lateral growth plates in the noninjured regions were significantly reduced compared with the controls (P < 0.05). At 12 weeks postinjury in the 1.2-mm group, medial and lateral growth plates in the noninjured regions were significantly reduced (P < 0.05). Tibia length and histological growth plate height of injured side in both groups were significantly shorter than controls at 12 weeks postinjury (P < 0.05). Comparison with the controls showed no significant difference at any of the time periods in either the 3.0- or 1.2-mm group according to the radiographic studies (P > 0.05). Bony bridges developed in all the subjects of the 3.0-mm group and in five of eight subjects of the 1.2-mm group, as shown by µCT images. CONCLUSION: This study suggested that growth plate injury size was associated with the timing of the beginning of physeal growth disturbance.

A new method for the estimation of age at death by using electrical impedance: A preliminary study.

Estimation of age at death is an important part of physical and forensic anthropology. The aim of this study was to investigate whether bioelectrical impedance analysis (BIA) of long bones can be used in the field of forensic medicine as a method to estimate age at death. BIA is easy to use and allows repeat measurements to be taken over time, and the equipment is inexpensive and portable. Impedance values (Z values) in 378 long bones (humeri, radii, femora, tibiae) of 40 male (233 bones) and 26 female (145 bones) autopsy cadavers were measured using two wire electrodes (connected to an alternating current device and a measuring device) inserted into the metaphyses of long bones. Computed tomography of the greater trochanter of the femur was also analyzed to evaluate bone mineral density (BMD). The results showed that Z values could be used to estimate age in males, and with an age cut-off point of 50 years in females. When estimating age at death from femur and tibia in males by using BIA, it is not necessary to consider the length of subjects. And it was thought that Z values reflected BMD. Among the long bones, the tibia is the most suitable and easy to use for Z value measurement. Z value measurement is a useful method for quantitative evaluation of age at death that can be performed quickly with inexpensive, portable equipment.

Use of a rugby helmet brace for postoperative treatment of muscular torticollis.

Prior to 1992, our postoperative management for congenital muscular torticollis consisted of either plaster cast immobilization or no immobilization, depending on the patient's age and the degree of contracture. However, some patients required further surgery and developed complications. In 1992, we produced rugby helmet braces for postoperative management. The purpose of this study was to compare the clinical results of the previous postoperative management with the results achieved using rugby helmet braces. Twenty-five children aged younger than 6 years underwent caudal partial resection of the sternocleidomastoid muscle. Twelve children aged 6 years and older underwent cranial tenotomy. These 37 patients were divided into 2 groups: no immobilization or plaster immobilization (group A; n=19) and rugby helmet braces (group B; n=18). Canale's method was used for evaluation of clinical results. In group A, the results were good in 12 patients, fair in 4, and poor in 3, whereas all 18 patients in group B had good results. Two patients in group A required further surgery, and complications were observed in 5 patients. In group B, alopecia areata was observed in 1 patient.The rugby helmet brace is easy to put on and remove, providing good retention and allowing for physiotherapy. It provides a useful method of postoperative management for congenital muscular torticollis.