Low complication rate associated with raising mature flap for tibial nonunion reconstruction.

BACKGROUND: Tibia fractures may require soft tissue coverage with transposed tissue and can develop nonunions. Tibial defects can be approached with a posterolateral approach or by elevating the previously transposed tissue. No literature has previously reported the efficacy or safety of the latter approach. The purpose of this study was to report the flap survival rate and complications from delayed elevation of transposed soft tissue as part of a protocol for the treatment of tibia nonunions. METHODS: In a retrospective review of patients having local, regional, or free soft tissue transposition for the management of open type III B high-energy tibial fractures and also requiring secondary procedures on the same tibia for treatment of tibial nonunion and/or osteomyelitis that required flap elevation, 23 patients with 24 flaps were identified and studied. The 24 flaps were elevated a total of 72 times as part of a staged protocol for nonunion reconstruction by a single surgeon. Primary end point was flap survival. Mean follow-up after definitive soft tissue coverage was 23.7 months. Mean follow-up after injury was 28.9 months. RESULTS: One flap failed after elevation. On a per elevation surgery basis, the flap survival rate was 98.6% (71 of 72). On a per flap basis, the flap survival rate was 95.8% (23 of 24). CONCLUSIONS: This is the first report of the survival and complication rates for delayed elevation of soft tissue flaps for tibial nonunion reconstruction. A total of 95.8% of flaps survived elevation. Flap elevation seems to be an alternative to posterolateral tibial approaches for treatment of tibial nonunions.

Operative treatment of chest wall injuries: indications, technique, and outcomes.

Most injuries to the chest wall with residual deformity do not result in long-term respiratory dysfunction unless they are associated with pulmonary contusion. Indications for operative fixation include flail chest, reduction of pain and disability, a chest wall deformity or defect, symptomatic nonunion, thoracotomy for other indications, and open fractures. Operative indications for chest wall injuries are rare.

Cobb angle progression in adolescent scoliosis begins at the intervertebral disc.

STUDY DESIGN: Longitudinal radiographic study of patients with progressive idiopathic scoliosis. OBJECTIVE: To determine the relative contributions of vertebral and disc wedging to the increase in Cobb angle during 3 phases of adolescent skeletal growth and maturation. SUMMARY OF BACKGROUND DATA: Both disc wedging and vertebral body wedging are found in progressive scoliosis, but their relative contribution to curve progression over time is unknown. Which occurs first is important for understanding how scoliosis progresses and for developing methods to halt progression. Previous studies have not properly identified maturity, and provide conflicting results. METHODS: Eighteen girls were followed through their adolescent growth spurt with serial spine and hand skeletal age radiographs. Each Cobb angle was divided into disc wedge angles and vertebral wedge angles. The corresponding hand radiographs provided a measure of maturity level, the Digital Skeletal Age (DSA). The disc versus bone contributions to the Cobb angle were then compared during 3 growth phases: before the growth spurt, during the growth spurt and after the growth spurt. Significance of relative changes was assessed with the Wilcoxon 2-sided mean rank test. RESULTS: Before the growth spurt, there was no difference in relative contributions of the disc and the bone (3 degrees vs. 0 degrees, P = 0.38) to curve progression. During the growth spurt, the mean disc component progressed significantly more than that of the vertebrae (15 degrees vs. 0 degrees, P = 0.0002). This reversed following the growth spurt with the vertebral component progressing more than the disc (10 degrees vs. 0 degrees, P = 0.01). CONCLUSION: Adolescent idiopathic scoliosis initially increases through disc wedging during the rapid growth spurt with progressive vertebral wedging occurring later.

Outcome of single incision flexor hallucis longus transfer for chronic achilles tendinopathy.

BACKGROUND: Chronic Achilles tendinopathy may require tendon transfer for treatment. Relatively few studies have reported the clinical outcome for flexor hallucis longus (FHL) transfer for chronic Achilles tendinopathy. Both single and double incision techniques have been reported. We present our series of a single incision technique. MATERIALS AND METHODS: A retrospective study measured the clinical outcomes of 19 patients with chronic Achilles tendinopathy treated with single incision FHL transfer. Patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot instrument, AOFAS hallux instrument as well as pre and postoperative visual analog scales (VAS) for pain. RESULTS: Average AOFAS ankle/hindfoot score was 96.4 +/- 5.7. Average AOFAS hallux score was 92.4 +/- 6.6. Average pre and postoperative VAS was 7.5 +/- 2.7 and 0.6 +/- 1.0, respectively. No tendon reruptures, wound complications or hallux deformities occurred. CONCLUSION: Excellent clinical outcomes with significant decrease in pain are possible with single incision technique for FHL transfer for chronic Achilles tendinopathy.