Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy.

Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy.

Double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation.

Sternoclavicular joint dislocations account for <5 % of all dislocations of the shoulder girdle. Whereas most cases of anterior dislocation do not experience symptoms, some patients with anterior instability remain symptomatic and require reconstructive surgery to stabilize the sternoclavicular joint. We present the case of a 57-year-old male diagnosed with sternoclavicular joint anterior dislocation and unusual swallowing difficulty while bending the neck forward. The patient was treated using a new and effective surgical technique of sternoclavicular joint reconstruction named "double figure-of-eight" using the ipsilateral gracilis tendon. Surgical outcome was successful, based on the Rockwood SC joint rating scale, and the patient maintained excellent stability even after 2 years. This new surgical technique offers superior stability, without harvest site morbidity, to patients with rare, severe, and chronic sternoclavicular joint dislocation. Level of evidence IV.

Measurement of the tensile forces during bone lengthening.

BACKGROUND: The purpose of this study was to investigate the effects of lengthening frequency on mechanical environment in limb lengthening. METHODS: Tensile forces were continuously monitored using a load sensor attached to a unilateral external fixator. Twenty patients were monitored. Ten patients were with acquired femoral shortening, and five of them underwent quasi-continuous lengthening of 1440 steps per day, and the other five received step lengthening twice a day. The other 10 patients were with achondropalsia. Five of them underwent the same quasi-continuous lengthening, and the other five received the same step lengthening. The circadian change and the daily course of the tensile forces were assessed and compared between quasi-continuous lengthening and step lengthening. FINDINGS: As for circadian change, an acute increase in the force took place simultaneously with each step of lengthening in the step-lengthening group, but very little change of the baseline force level was seen during quasi-continuous lengthening. As for daily course of the tensile force, it increased almost linearly in both lengthening frequency groups in the initial stage of lengthening. No significant difference of the average force increment rate in this phase was recognized between the quasi-continuous and step lengthening groups irrespective of the etiologies. INTERPRETATION: The lengthening frequency greatly affected the circadian change of the tensile force, but did not affect the increment rate of the force in the linear phase.

Treatment of congenital pseudarthrosis of the tibia: a multicenter study in Japan.

Treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge. To clarify the current situation in treatment, a multicenter study was carried out to obtain information on the results of CPT treatment. The objective of this study was to propose appropriate treatment guidelines for CPT. Records of 73 patients with CPT who underwent surgical treatment were collected from 32 hospitals. The modality of the treatment was 26 with Ilizarov technique, 25 with free vascularized fibular graft, 7 with a combination of the two techniques, 6 with intramedullary nailing with free bone grafting, 5 plating with free bone grafting, and 4 with other treatments. Fifty-four procedures resulted in union, 7 resulted in delayed union, 7 were left un-united, 1 underwent amputation, and the results were unknown in 4. According to the results of this study, the most acceptable methods of treatment of CPT are the Ilizarov method and the vascularized fibular graft.

Prediction of the strength and fracture location of the femoral neck by CT-based finite-element method: a preliminary study on patients with hip fracture.

The purpose of this study was to predict fracture load and fracture location of the femora by means of the originally developed CT-based finite-element method (FEM). The femora of ten patients with contralateral hip fracture were analyzed to estimate fracture strength and to investigate whether the predicted fracture locations were similar to those of contralateral hip fractures. FEM has been utilized to determine the stress or strain distribution in bones under a certain load. FEM analyses of the strength of the femora in cadavers and patients have been reported, but those of hip fracture patients have not been analyzed. The femora of ten patients with contralateral hip fracture and those of three volunteers were analyzed based on the axial CT images of the whole femora. Prediction of hip fracture load and failure locations was made using CT-based finite-element analysis software. The predicted strength of the patients was less than half that of volunteers, and the predicted fracture lines existed at the proximal femur in all patients. It can be concluded that the FEM analyses adopted in this study are able to predict the fracture locations and load of the femora in patients with hip fracture.

Correction of tibial deformity in adults.

This report from five hospitals in Japan describes the results of correcting adult tibial deformities using external fixation. There were 49 patients with 59 lower limb deformities, with trauma being the most common cause of the deformity. Varus angulation was the most common deformity, and the most common magnitude was 11 degrees -30 degrees. Twenty-two patients had a leg-length discrepancy. The aim of the correction was to normalize both the mechanical axis and the inclination of the knee and ankle joints. In 63% of the patients corrections were performed gradually during bone lengthening or acutely after bone lengthening. Altogether, 71% of the patients were completely corrected, and no leg-length discrepancies remained after correction in 47%. Complications were encountered in 22 patients, about half of which were pin tract infections, 28% refractures, and the remainder delayed consolidation or fixator failure. There were no neurological or circulatory complications. The average fixation duration was 9 months. The average hospital charges were 3,740,000 yen in bilateral correction patients and 1,940,000 yen in unilateral correction patients. External fixation can correct not only the mechanical axis and joint inclination but also leg-length discrepancy simultaneously.