Growth modulation for coronal deformity correction by using Eight Plates-Systematic review.

INTRODUCTION: Coronal deformities are commonly encountered in paediatric orthopaedics and surgical treatment is indicated for severe deformities causing pain, function and cosmetic problems. In a growing bone, major surgical intervention like osteotomy with internal or external fixation can be avoided by growth modulation (hemiepiphysiodesis) using 8-plates. Our aim is to review the published literature on the use of 8-plates for deformity correction. METHODS: We conducted a systematic review on 8-plate growth modulation for coronal deformity correction. We carried out detailed literature search on PubMed, Google Scholar, EMBASE, and Cochrane databases. We analysed selected studies for patient demographics, rate of deformity correction, clinical outcome and complications. RESULTS: We identified seven studies using 8-plate for deformity correction involving 215 patients (350 Limbs). The mean age was 9.5 years (2-16 years M/F Ratio 1.1:1); underlying aetiology was Idiopathic in 33% and Pathological 67% cases. The deformities were successfully corrected in 196/215 patients (91.2%) and partial/no correction in 19/215 patients (8.8%). The mean time to correction was 15.3 Months (10.3-25) and follows up of 18.9 months (12.4-24). The deformity corrected at 1.28 °/month (0.93-1.53), lateral distal femoral angle changed at 0.87°/month (0.65-1.0) and medial proximal tibial angle changed at 0.72 (0.5-1). Complications were reported in 12/215 patients (5.6%) including hardware failure in 5, overcorrection/leg length difference in 5, infection 1 and stiffness 1. The rebound was reported in 8 patients (3.7%). CONCLUSION: Growth modulation with 8-plates has high efficacy and low complications for deformity correction; and has been used widely across all paediatric age groups and aetiology. The literature is mostly retrospective and heterogeneous to develop age and aetiology specific recommendations.

Lateral column lengthening for adolescent idiopathic pes planovalgus deformity - Systematic review.

Pes planovalgus is the commonest foot deformity in children and presents with wide range of severity and symptoms. Surgery is mostly indicated for significant malalignment, resistant to non-surgical management. Lateral column lengthening is considered an appealing option as does not involve arthrodesis and allows for further growth and foot development. METHODS: We conducted a systematic review on lateral column lengthening for pes planovalgus deformity in line with PRISMA-P Checklist. We carried out detailed literature search on PubMed, Cochrane, EMBASE, CINAHL, Google Scholar and Bibliographies. We analysed selected studies for patient demographics, radiological, clinical outcome and complications. RESULTS: We identified seven studies with 103 patients involving 156 feet. The mean age was 13.3 years (Range 5.7-42) and mean follow up was 70.2 Months (Range 24.9-156). There was statistical significant improvement in Calcaneal pitch, Lateral Talo-metatarsal and AP Talo-navicular angles (p-value 0.001). The mean preoperative AOFAS Score (71 Feet) was 58.85 (Range 34-78) and mean postoperative AOFAS Score (91 Feet) was 92.25 (Range 73-100). Two studies (32 Feet) used author specified criteria has reported Good/Excellent result in 72% (23/32 feet) and Fair/Poor result in 18% (9/32) feet. Complications were reported in 17.5% (18/103) included nerve related, pseudo arthrosis, non-union and metal related complications. CONCLUSION: Surgical intervention with lateral column lengthening has good radiological and clinical outcome with high patient satisfaction and acceptable complications. The literature is mostly retrospective and there is need for prospective, multi-centre studies using patient centred validated outcome measure.

Radiographic and functional evaluation of low profile dorsal versus volar plating for distal radius fractures.

INTRODUCTION: Fracture of the distal radius is a common clinical problem. Complex fracture requires open reduction and stabilization with plating to restore anatomy. Dorsal plating has advantages of buttressing the fracture better but often complicated with tendon problems as per literature. The rate of complications however, was not compared between the low-profile dorsal and the volar plates. METHODOLOGY: This was a retrospective study on seventy one patients with dorsally angulated or displaced distal radius fractures, who underwent fixation of fractures with either dorsal or volar locking plate from Jan - Nov 2012. Preoperative radiographs were classified based on Universal and Fernandez classification. Postoperative radiographs were assessed for anatomical restoration of Radial length, radial inclination and volar tilt. Tendon and nerve related complications were assessed and functional evaluation was performed on the basis of PRWE (Patient related wrist evaluation) score. RESULTS: Both groups were matched for their demographic profile and fracture types (p 0.033). Dorsal plating group had 89% excellent/good restoration and fair in 11%. Volar group had 96% excellent/good restoration and fair in 4%. Statistical analysis was performed with unpaired t test for radiographic parameters. Three patients had tendon related complications in dorsal plating group; two patients in volar group had nerve related complications. Functional outcome with PRWE was comparable between two groups. CONCLUSION: Results with low profile dorsal plating were comparable to volar plating. Therefore dorsal plating can be used as an alternative method when dorsal buttressing of comminuted fracture is required, especially with concomitant osteoporosis.

Decreasing the blood transfusion rate in elective hip replacement surgery using an autologous drainage system.

INTRODUCTION: This is a prospective study looking at the effectiveness of autologous postoperative drains in primary uncemented total hip replacement (THR) surgery. PATIENTS AND METHODS: A total of 86 patients were studied, with 43 using standard suction drains (normal drain group) and 43 using autologous drains (autologous drain group). RESULTS: Thirty-seven units of homologous blood were transfused in the normal drain group and 5 units in the autologous drain group. The mean number of units of homologous blood transfused per patient was reduced from 0.86 to 0.12 (P < 0.01) with the use of autologous drains and the transfusion rate was reduced from 23% to 6% (P < 0.02). The mean length of hospital stay was also reduced by two nights (P < 0.05). There were no adverse effects from using the autologous system and it does reduce the need for a homologous blood transfusion. CONCLUSIONS: The system is simple and easy to use and we have also found it to be cost effective. Previously, it has not been reported as being effective in hip arthroplasty surgery, unlike knee arthroplasty surgery. We would recommend using autologous postoperative drains in primary THR surgery.

Neglected volar dislocations of the interphalangeal joint.

Volar dislocations of the proximal interphalangeal joint, if missed, with extensor tendon entrapment will lead to permanent impairment. Prompt diagnosis followed by open reduction and aggressive rehabilitation is necessary.

Dynamic hip screw: does side make a difference? Effects of clockwise torque on right and left DHS.

A study was performed to assess the effect of clockwise rotational torque onto the fracture configuration in unstable intertrochanteric fractures. The premise is that rotational torque in the sagittal plane imparted during screw insertion can lead to a potentially unstable construct in LEFT-sided DHS fixations when compared to the RIGHT-sided ones. This unstable fixation construct manifests as an anterior spike of the proximal fragment in left-sided fixations due to clockwise torque. Eleven out of 30 unstable left-sided fractures showed an anterior spike compared with none in 26 right-sided fractures (p<0.001). The study concludes that appropriate corrective measures of reducing the torque imparted is probably indicated in unstable left-sided fractures treated with a DHS.